Outcomes and clinical relevance of stool multiplex bacterial polymerase chain reaction in patients with acute diarrhea: single center experience

Won Gun Kwack,Yun Jeong Lim,Ki Hwan Kwon,Jae Woo Chung,Jin Young Oh 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.2

Background/Aims: Diagnostic stool multiplex polymerase chain reaction (PCR) testing has attracted considerable interest, because of its high sensitivity, short turnaround time, and ability to detect multiple organisms simultaneously. This study investigates the clinical usefulness of a stool multiplex bacterial PCR in patients with acute diarrhea. Methods: We retrospectively evaluated the stool multiplex bacterial PCR results, clinical parameters, and clinical courses of patients hospitalized because of acute diarrhea between August 2014 and November 2016. Results: A total of 725 patients (male, 372; mean age, 30.9 ± 29.3 years) underwent stool multiplex bacterial PCR. A total of 243 pathogens were detected in 226 patients. The detection rate of multiplex PCR testing was higher than that of stool culture (32.7% vs. 3.3%, p < 0.01). Severe symptoms of acute diarrhea (bloody diarrhea, frequent diarrhea) and prescribed empirical antibiotics were significantly more common in the positive multiplex PCR group (p = 0.02, p < 0.01, p < 0.01, respectively). However, mean durations of hospital stay were similar in the 2 groups according to the multiplex PCR results (p = 0.32). In addition, Campylobacter spp., which was the most commonly detected pathogen (97/243, 39.9%), was significantly associated with frequent diarrhea and prescribed empirical antibiotics (p < 0.01), but not with duration of hospital stay (p = 0.09). Conclusions: We concluded that stool multiplex bacterial PCR might be a useful tool for identifying bacterial etiology in patients with acute diarrhea, especially in those with Campylobacter spp. infection.

Current Status and Research into Overcoming Limitations of Capsule Endoscopy

Won Gun Kwack,Yun Jeong Lim 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.1

Endoscopic investigation has a critical role in the diagnosis and treatment of gastrointestinal (GI) diseases. Since 2001, capsule endoscopy (CE) has been available for small-bowel exploration and is under continuous development. During the past decade, CE has achieved impressive improvements in areas such as miniaturization, resolution, and battery life. As a result, CE is currently a first-line tool for the investigation of the small bowel in obscure gastrointestinal bleeding and is a useful alternative to wired enteroscopy. Nevertheless, CE still has several limitations, such as incomplete examination and limited diagnostic and therapeutic capabilities. To resolve these problems, many groups have suggested several models (e.g., controlled CO2 insufflation system, magnetic navigation system, mobile robotic platform, tagging and biopsy equipment, and targeted drug-delivery system), which are in development. In the near future, new technological advances will improve the capabilities of CE and broaden its spectrum of applications not only for the small bowel but also for the colon, stomach, and esophagus. The purpose of this review is to introduce the current status of CE and to review the ongoing development of solutions to address its limitations.

임상신질환 : 경기북서부 지역에서 발생한 급성신우신염의 Ciprofloxacin 항생제 내성 및 결과 분석

곽원건 ( Won Gun Kwack ),신성준 ( Sung Joon Shin ),김경수 ( Kyung Soo Kim ),이정상 ( Jung Sang Lee ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

코카콜라 경구 투여 및 내시경을 통한 코카콜라주입법으로 치료한 활동성 위궤양을 동반한 다발성 거대위석 1예

곽원건,박보라,강지훈,강현우,김재학,임윤정,이준규,고문수,이진호 동국대학교 의학연구소 2009 東國醫學 Vol.16 No.1

위석은 섭취된 이물질이 위내에서 응결된 덩어리로 일반적으로 내시경적 분쇄법 및 화학적 용해법이 치료방법으로 알려져 있다. 최근 코카콜라를 경구 또는 비위관을 통하여 주입하여 치료한 사례들이 보고되고 있으며 경구 투여 및 내시경을 이용하여 위석내 콜라를 주입하는 것이 치료기간 및 위석치료 성공률을 향상시킨다는 보고가 있다. 최근 저자들은 급성 위궤양이 확인된 환자의 거대위석을 코카콜라 경구 및 내시경 직접 주입법을 통하여 치료한 1예를 경험하였기에 보고하는 바이다. Gastric bezoars are concretions of foreign bodies found in the stomach, common method for the treatment was endoscopic fragmentation or chemical dissolution therapy, recently, there were reports on the treatment of bezoars by cola drinking or Coca-Cola gastric lavage, combination therapy with Coca.Cola drinking and endoscopic injection decreases duration of therapeutic time and increases dissolution rate, we report one case of active gastric ulcer with huge gastric Bezoars completely treated by drinking Coca.Cola with endoscopic injection

Framed Steel Plate Wall Behavior under Cyclic Lateral Loading

Park, Hong-Gun,Kwack, Jae-Hyuk,Jeon, Sang-Woo,Kim, Won-Ki,Choi, In-Rak American Society of Civil Engineers 2007 Journal of structural engineering Vol.133 No.3

후복막 육종으로 인해 발생한 급성신부전

박보라 ( Bo Rha Park ),곽원건 ( Won Gun Kwack ),이종호 ( Jong Ho Lee ),최종순 ( Jong Sun Choi ),신성준 ( Sung Joon Shin ),김경수 ( Kyung Soo Kim ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.5

Retroperitoneal sarcoma is a rare tumor accounting for 1-2% of all solid malignancies. These tumors are usually large when diagnosed because of their typically silent nature and should be distinguished from other retroperitoneal masses for adequate management. In spite of an apparent complete resection which is the only potential curative treatment, the high rate of local recurrence is the major problem of retroperitoneal sarcoma; therefore, patients with high-grade tumors should undergo regular and continuous follow-ups. Postrenal acute kidney injury (AKI) results from a urinary outflow tract compression due to the mass effect of retroperitoneal sarcoma, which is one of less common causes of postrenal AKI and has not been reported in Korea. We report a case that an 81-year-old-woman with undifferentiated retroperitoneal sarcoma presented with post-renal AKI and improved after complete resection.

주기하중을 받는 골조강판벽의 실험연구

박홍근,곽재혁,전상우,김원기,Park, Hong Gun,Kwack, Jae Hyuk,Jeon, Sang Woo,Kim, Won Ki 한국강구조학회 2004 韓國鋼構造學會 論文集 Vol.16 No.6

스티프너가 없는 얇은 강판을 사용한 골조강판벽 시스템에 대한 실험연구를 실시하였다. 1경간 3층의 골조강판벽에 주기횡하중을 재하하였으며, 주요한 실험 변수는 강판의 두께, 기둥의 강도이다. 실험결과를 이용하여 강판벽의 강도, 변형능력, 에너지 소산능력을 연구하였으며, 이를 토대로 골조강판벽의 파괴메카니즘을 분석하였다. 실험결과, 얇은 강판을 사용하는 골조강판벽은, 높은 강도, 낮은 연성능력, 캔틸레버거동특성을 나타내는 일반적인 가새골조나 스티프너 보강된 강판벽과는 여러 면에서 다른 거동특성을 나타낸다. 골조강판벽에서는 강판의 조기국부좌굴과 인장응력장 작용이 발생하면서, 전 층에 고르게 항복변형이 분포된다. 이로 인하여 변형형태는 휨변형과 전단변형의 복합형태를 나타내며, 우수한 강도 및 에너지 소산능력과 연성모멘트 골조에 버금가는 변형능력을 나타내었다. 그러나 일반적인 가새골조와는 달리 보, 기둥 등의 골조부재는 강판의 인장응력장을 지지할 수 있도록 설계되어야 하며, 따라서 기둥의 강도가 작고 콤팩트 단면을 사용하지 않은 경우에는 약층현상이 발생하며 강도가 급격히 저하되었다. 얇은 강판을 사용하는 골조강판벽은 일반적인 가새골조나 스티프너 보강 강판벽과는 차별되는 우수한 변형능력을 갖고 있으므로 연성내진구조시스템으로 활용할 수 있다. Experiments were performed to study the cyclic behavior of framed steel walls with thin web plates. Five specimens of single-bay and three-story steel plate walls were tested for cyclic lateral load. The parameters for the test specimens included the plate thickness and the column strength. Based on the test results, the strength, deformability, and energy dissipation capacity of the framed steel walls were studied. The test results showed that the behavioral characteristics of the framed steel walls with thin web plates were different in many aspects from those of the conventional braced frame, and the steel wall with a stiffened web plate exhibited cantilever action, high strength, and low ductility. With the framed steel plate walls, local plate buckling and tension-field action developed in the thin web plates, and plastic deformation was uniformly distributed along the wall's height. As a result, the framed steel plate walls exhibited combined flexural and shear deformation, but they also showed high strength and energy dissipation capacity. Moreover, such walls have high deformability, which was equivalent to that of the conventional moment frame. Frame members such as columns and beams, however, must be designed to resist the tension-field action of the thin web plates. If the column does not have sufficient strength, and if its sections are not compact enough, the overall strength of the framed steel wall might be significantly decreased by the development of the soft-story mechanism. The framed steel walls with thin web plates have advantages, such as high deformability and high strength. Therefore, they can be used as ductile elements in earthquake-resistant systems.

In-depth proteomic analysis of human bronchoalveolar lavage fluid towards the biomarker discovery for lung cancers

( Jun-hyung Lee ),( Jin-young Kim ),( Min-sik Kim ),( Seung Hyeun Lee ),( Jung Mi Lee ),( Myung Jae Park ),( Won Gun Kwack ),( Kyoung-hee Sohn ),( Hye Sook Choi ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: Since BALF were directly collected from the tumor environment than plasma, we expected that biomarkers for the lung cancer may exist in higher concentration in BALF than in blood. Here, we developed a novel method for in-depth proteomic analysis of BALF by combining antibody-based depletion of high abundant proteins from BALF with high pH pep tide fractionation. Material and Methods; BALF samples were collected from segmental bronchus from 14 patients with lung cancers, which were centrifuged at 500 g for 5 minutes at 4°C to remove debris. Two milliliters from each of 14 patients were pooled and concentrated using Amicon filters at 5,000 g for 60 min at 4°C. Depletion was performed to remove 14 high abundant proteins Then, high pH reversed phase liquid chromatography fractionation was carried out using UltiMate 3000 HPLC. Peptides were analyzed on a high resolution Orbitrap Fusion mass spectrometer. Results: MaxQuant search resulted in the identification of 4,615 protein groups, from which 3,786 proteins were in common between lung tumors and BALF from lung cancer patients. Interestingly, 748 were specifically enriched in BALF as compared to lung tumors. We found that 28 potential biomarker proteins make up ~26% of protein concentration in BALF while ~14% in human plasma. Conclusion: We developed a novel proteomic approach that combined antibody-based depletion with high pH RPLC fractionation to maximize the BALF protein identification from lung cancer patients. Our result implied that BALF contains concentrated lung cancer biomarkers and suggests a possibility that BALF is a better source than plasma for the diagnosis of the lung cancer. We believe that this method help find novel biomarkers for the early diagnosis of the lung cancer and would facilitate the lung cancer research.

Normal body temperature in patients with sepsis who present to emergency department is associated with low compliance rate for hour-1 sepsis bundle and increased hospital mortality

( Sunghoon Park ),( Dong-kyu Oh ),( Kyeongman Jeon ),( Sang Bum Hong ),( Eun Young Choi ),( Seok Chan Kim ),( Gil Myeong Seong ),( Jeongwon Heo ),( Youjin Chang ),( Kwack Won Gun ),( Byung Ju Kang ),( 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: Although several studies showed that hypothermia was associated with poor outcomes in patients with sepsis, data on the implications of normothermia are very limited. Methods: This was a multicenter retrospective cohort study on patients who presented to emergency department for sepsis, conducted during one-month period (January 2018), by the Korean Sepsis Alliance. Nineteen tertiary or university-affiliated hospitals participated in the study. Results: A total of 862 patients with sepsis for whom initial lactate level was available were enrolled for this study (age, 71.8 ± 13.1 years; female, n = 370). Body temperature groups were categorized as three groups (hypothermia, n = 113 [13.1%]; normothermia, n = 521 [60.4%]; and hyperthermia, n = 228 [26.5%]). Regarding hour-1 sepsis bundles, completion rate with lactate measurement was lower in patients with normothermia, compared with the other two groups (63.9% vs. 75.2% in hypothermia vs. 74.6% in hyperthermia, P = 0.004). The completion rate with total bundle components was also lower in normothermia patients, compared with the other two groups (2.3% vs. 7.1% vs. 9.8%, respectively; P <0.001). Hospital mortality rates were 42.5%, 30.7%, and 17.1% in hypothermia, normothermia, and hyperthermia patients (P < 0.001), respectively, and particularly, the difference in hospital mortality rate between normothermia and hyperthermia patients was significant among patients whose lactate levels were > 2 mmol/L (Figure 1). Finally, the multivariable analysis showed that, as well as hypothermia, normothermia was a significant risk factor for hospital mortality (odds ratio, 2.187; 95% confidence interval, 1.286 - 3.691). Conclusion: Among the hour-1 sepsis bundles, compliance with lactate measurement and total bundle was lower in normothermia patients compare to hypothermia or hyperthermia patients, and normothermia was significantly associated with increased hospital mortality in patients with sepsis.