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National Survey of Mycobacterial Diseases Other Than Tuberculosis in Korea (비결핵항산균증 전국 실태조사)

  • 대한결핵 및 호흡기학회 학술위원회
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.3
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    • pp.277-294
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    • 1995
  • Background: The prevalence of tuberculosis in Korea decreased remarkably for the past 30 years, while the incidence of disease caused by mycobacteria other than tuberculosis is unknown. Korean Academy of Tuberculosis and Respiratory Diseases performed national survey to estimate the incidence of mycobacterial diseases other than tuberculosis in Korea. We analyzed the clinical data of confirmed cases for the practice of primary care physicians and pulmonary specialists. Methods: The period of study was from January 1981 to October 1994. We collected the data retrospectively by correspondence with physicians in the hospitals that referred the specimens to Korean Institute of Tuberculosis, The Korean National Tuberculosis Association for the detection of mycobacteria other than tuberculosis. In confirmed cases, we obtained the records for clinical, laboratory and radiological findings in detail using protocols. Results: 1) Mycobacterial diseases other than tuberculosis were confirmed that 1 case was in 1981, 2 cases in 1982, 4 cases in 1983, 2 cases in 1984, 5 cases in 1985, 1 case in 1986, 3 cases in 1987, 1 case in 1988, 6 cases in 1989, 9 cases in 1990, 14 cases in 1990, 10 cases in 1992, 4 cases in 1993, and 96 cases in 1994. Cases since 1990 were 133 cases(84.2%) of a total. 2) Fifty seven percent of patients were in the age group of over 60 years. The ratio of male to female patients was 2.6:1. 3) The distribution of hospitals in Korea showed that 61 cases(38.6%) were referred from Double Cross Clinic, 42 cases(26.6%) from health centers, 21 cases(13.3%) from tertiary referral hospitals, 15 cases(9.5%) from secondary referral hospitals, and 10 cases(6.3%) from primary care hospitals. The area distribution in Korea revealed that 98 cases(62%) were in Seoul, 17 cases(10.8%) in Gyeongsangbuk-do, 12 cases(7.6%) in Kyongki-do, 8 cases(5.1%) in Chungchongnam-do, each 5 cases(3.2%) in Gyeongsangnam-do and Chungchongbuk-do, 6 cases(3.8%) in other areas. 4) In the species of isolated mycobacteria other than tuberculosis, M. avium-intracellulare was found in 104 cases(65.2%), M. fortuitum in 20 cases(12.7%), M. chelonae in 15 cases(9.5%), M. gordonae in 7 cases(4.4%), M. terrae in 5 cases(3.2%), M. scrofulaceum in 3 cases(1.9%), M. kansasii and M. szulgai in each 2 cases(1.3%), and M. avium-intracellulare coexisting with M. terrae in 1 case(0.6%). 5) In pre-existing pulmonary diseases, pulmonary tuberculosis was 113 cases(71.5%), bronchiectasis 6 cases(3.8%), chronic bronchitis 10 cases(6.3%), and pulmonary fibrosis 6 cases(3.8%). The timing of diagnosis as having pulmonary tuberculosis was within 1 year in 7 cases(6.2%), 2~5 years ago in 32 cases(28.3%), 6~10 years ago in 29 cases(25.7%), 11~15 years ago in 16 cases(14.2%), 16~20 years ago in 15 cases (13.3%), and 20 years ago in 14 cases(12.4%). Duration of anti-tuberculous treatment was within 3 months in 6 cases(5.3%), 4~6 months in 17 cases(15%), 7~9 months in 16 cases(14.2%), 10~12 months in 11 cases(9.7%), 1~2 years in 21 cases(18.6%), and over 2 years in 8 cases(7.1%). The results of treatment were cure in 44 cases(27.9%) and failure in 25 cases(15.8%). 6) Associated extra-pulmonary diseases were chronic liver disease coexisting with chronic renal failure in 1 case(0.6%), diabetes mellitus in 9 cases(5.7%), cardiovascular diseases in 2 cases(1.3%), long-term therapy with steroid in 2 cases(1.3%) and chronic liver disease, chronic renal failure, colitis and pneumoconiosis in each 1 case(0.6%). 7) The clinical presentations of mycobacterial diseases other than tuberculosis were 86 cases (54.4%) of chronic pulmonary infections, 1 case(0.6%) of cervical or other site lymphadenitis, 3 cases(1.9%) of endobronchial tuberculosis, and 1 case(0.6%) of intestinal tuberculosis. 8) The symptoms of patients were cough(62%), sputum(61.4%), dyspnea(30.4%), hemoptysis or blood-tinged sputum(20.9%), weight loss(13.3%), fever(6.3%), and others(4.4%). 9) Smear negative with culture negative cases were 24 cases(15.2%) in first examination, 27 cases(17.1%) in second one, 22 cases(13.9%) in third one, and 17 cases(10.8%) in fourth one. Smear negative with culture positive cases were 59 cases(37.3%) in first examination, 36 cases (22.8%) in second one, 24 cases(15.2%) in third one, and 23 cases(14.6%) in fourth one. Smear positive with culture negative cases were 1 case(0.6%) in first examination, 4 cases(2.5%) in second one, 1 case (0.6%) in third one, and 2 cases(1.3%) in fourth one. Smear positive with culture positive cases were 48 cases(30.4%) in first examination, 34 cases(21.5%) in second one, 34 cases(21.5%) in third one, and 22 cases(13.9%) in fourth one. 10) The specimens isolated mycobacteria other than tuberculosis were sputum in 143 cases (90.5%), sputum and bronchial washing in 4 cases(2.5%), bronchial washing in 1 case(0.6%). 11) Drug resistance against all species of mycobacteria other than tuberculosis were that INH was 62%, EMB 55.7%, RMP 52.5%, PZA 34.8%, OFX 29.1%, SM 36.7%, KM 27.2%, TUM 24.1%, CS 23.4%, TH 34.2%, and PAS 44.9%. Drug resistance against M. avium-intracellulare were that INH was 62.5%, EMB 59.6%, RMP 51.9%, PZA 29.8%, OFX 33.7%, SM 30.8%, KM 20.2%, TUM 17.3%, CS 14.4%, TH 31.7%, and PAS 38.5%. Drug resistance against M. chelonae were that INH was 66.7%, EMB 66.7%, RMP 66.7%, PZA 40%, OFX 26.7%, SM 66.7%, KM 53.3%, TUM 53.3%, CS 60%, TH 53.3%, and PAS 66.7%. Drug resistance against M. fortuitum were that INH was 65%, EMB 55%, RMP 65%, PZA 50%, OFX 25%, SM 55%, KM 45%, TUM 55%, CS 65%, TH 45%, and PAS 60%. 12) The activities of disease on chest roentgenogram showed that no active disease was 7 cases(4.4%), mild 20 cases(12.7%), moderate 67 cases(42.4%), and severe 47 cases(29.8%). Cavities were found in 43 cases(27.2%) and pleurisy in 18 cases(11.4%). 13) Treatment of mycobacterial diseases other than tuberculosis was done in 129 cases(81.7%). In cases treated with the first line anti-tuberculous drugs, combination chemotherapy including INH and RMP was done in 86 cases(66.7%), INH or RMP in 30 cases(23.3%), and not including INH and RMP in 9 cases(7%). In 65 cases treated with the second line anti-tuberculous drugs, combination chemotherapy including below 2 drugs were in 2 cases(3.1%), 3 drugs in 15 cases(23.1%), 4 drugs in 20 cases(30.8%), 5 drugs in 9 cases(13.8%), and over 6 drugs in 19 cases (29.2%). The results of treatment were improvement in 36 cases(27.9%), no interval changes in 65 cases(50.4%), aggravation in 4 cases(3.1%), and death in 4 cases(3.1%). In improved 36 cases, 34 cases(94.4%) attained negative conversion of mycobacteria other than tuberculosis on cultures. The timing in attaining negative conversion on cultures was within 1 month in 2 cases(1.3%), within 3 months in 11 cases(7%), within 6 months in 14 eases(8.9%), within 1 year in 2 cases(1.3%) and over 1 year in 1 case(0.6%). Conclusion: Clinical, laboratory and radiological findings of mycobacterial diseases other than tuberculosis were summarized. This collected datas will assist in the more detection of mycobacterial diseases other than tuberculosis in Korea in near future.

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A Study on the Economical Nutrition Supplement of Cereal Food for Improvement in our National Eating Habits (국민식생활(國民食生活) 향상(向上)을 위(爲)한 곡류제품(穀類製品)의 경제적( 經濟的) 영향강화(營養强化)에 관(關)한 연구(硏究))

  • Ju, Jin-Soon;Yu, Jong-Yull;Kim, Sook-He;Lee, Ki-Yull;Han, In-Kyu
    • Journal of Nutrition and Health
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    • v.6 no.1
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    • pp.1-9
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    • 1973
  • I. Subject of the Study: Studies on the economical nutrition supplement of cereal foods for the improvement in our notional eating habits. II. Purpose and Importance of the Study: 1. Our nation is confronted with the situation that the rice, a principal food, short of some essential amino acids, lysine and threonine, leads to imbalanced meals insufficient in the nutrient of protein, to bring many difficulties in the elevation of our national physique. 2. The shortage of even the rice imperfect in the nutrient of protein makes the import of lots of foreign rice inevitable. It is considered that the protein supplement and decrease in the consumption amount, of rice, is a serious key to the solution of our food difficulty, and then a way of the proetin supplement of rice through the addition of essential amino acid is to be rarely applied in the view of the our present finance and situation. 3. In the present experiment, therefore, it aims to the suggestion of an aspect of the improvement in our national eating habits guiding in the nutrition elevation which our nation can afford economically through the development of first, a way of the protein supplement by the mixture of cereals producted plentifully in our country, and second, a way of the decrease in the consumption amount and the improvement in the nutrition of rice through the substitution of the other cereals for rice. III. Contents of Scope of the Study: 1. Objects of the study: Objects of the study are the following three items; a) The nutrition supplement of rice through the mixture of cereals. Our nation makes mainly rice as a principal food, but practically many kinds of cereal are produced in our country. They contain different levels and qualities of each nutrient and they are different from one another in the kinds of essential amino acid consisting protein. For that reason, the mutual complement efficeincy of insufficient nutrients is observed through the mixture of cereals. b) The nutrition supplement of rice through the addition of superior protein sources to rice, a principal food. The development of rice as superior foods in the sense of nutrition is conducted through the risement in protein quality by the addition of protein sources in good quality, for example, fish flour (anchovy flour), egg powder, milk powder, and so on, and through the supplement of vitamins and minerals. c) The decrease in the consumption amount of rice through the substitution of the other cereals for rice, as a principal food. The compensation for the short amount of rice is made by the reduction in the consumption of rice through the discovery of a way of substitution of the other cereals for rice, as a principal food and of the settlement of problems in nutrition and finance subsequent to this. 2. Contents of the study: a) An ideal mixture-ratio of cereals is established for rats by feeding mixed foods(rice-barely or rice-wheat) containing 5%, 15%, 25%, 35% and 45% level of either barely or wheat. b) The nutritive value is determined in the whole subsititution of other foods for rice, and then, a way of the complement of over and under nutrients is devised. c) The ideal combination is investigated for rats through feeding mixed foods of main food, rice and supplement foods of protein sources, soy bean, fish flour, egg powder and milk Powder. d) According to results from the above three experiments, the concise functional test for men and the examination of economical property are made. 3. Scope of the study: a) The observation of the effect of each diet on the growth rate for rats. The growth rate of rats was observed for 15 groups of mixed foods of a main food, rice, and wheat flour, barley powder or soy bean powder, respectively, and 12 groups of wheat flour diets supplemented with $1{\sim}3%$ milk powder, and rice or wheat flour diets supplemented with 5% of milk powder, egg powder, fish flour or soy bean powder, respectively. b) The determination of food consumption. The food consumption was determined at weekly intervals for 27 kinds of diet described in a) item. c) The determination of food efficiency rate. The food efficiency rate for each diet was determined by calculation from the gained body weight and the food consumption amount at the same intervals described in b) item. d) The determination of protein efficiency rate. The protein efficiency rate for each diet was determined by calculation form gained body weight and the protein amount of the food consumption amount at the same intervals described c) item. e) The determination of the body component. The hematocrite and hemoglobin levels in the blood, total nitrogen in the serum, blood sugar, and lipids and glycogen in the liver were determined. f) The observation of nitrogen balance. As a means of the observation of nitrogen balance, the total nitrogen in the urine was determined. g) The analysis of economical property. The economical property was analyzed as the gained body weight to the amount equivalent to one won through the conversion of the food consumption amount into money. h) The functional test for men. The concise functional test for men was made in order to establish if the best diet for experimental animals can be applied to men. IV. Results of the Study: The national food product plan, nationwide nutritive enlightment and the improvement activities in our country eating habits, especially, mixed and powder food problems are to be significantly referred, and the following results must be applied. a) In the mixed foods of cereals, the mixed food of the rice-barley containing $5{\sim}15%$ level of barley is best in terms of nutrition. b) The addition of superior protein sources, egg, Bilk, soy bean, or fish, respectively to either rice or wheat flour makes a great risement in the nutritive value. c) The animal protein is more effective in the elevation of nutritive value of cereals. d) Rice takes the most nutritive operation and has the highest preference, among rice, wheat flour and barley. e) Wheat flour is more economical than rice in evaluation of the gained body weight to the regular money, and the addition of fish or soy bean is more economical than that of any other supplement food. But the above results are true of the range of nutrition and economical property. f) The study on the nutrition composition and barley will lead to the improvement in our national eating habits as mixed food of the rice-barley containing $5{\sim}15%$ level of barley is more nutritive. g) This study on the nutrition only for the growing animal can not be considered as a perfect and entire evaluation. Consequently, the perfect data for our national nutrition can be obtained from the experiment similar to this for the much longer period examining, in details, the growth rate, change of physical strength, mental and bodily change, average life span, and resistance ability to infectious diseases.

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Evaluation of Korean Native Ducks on Production Efficiency Factor, Carcass Yield, Partial Meat Ratio and Meat Quality with Weeks (토종오리 대형종의 주령별 생산지수, 도체 수율, 부분육 비율 및 육질 평가)

  • Heo, Kang-Nyeong;Kim, Hak-Kyu;Kim, Chong-Dae;Kim, Sang-Ho;Lee, Myeong-Ji;Choo, Hyo-Jun;Son, Bo-Ram;Choi, Hee-Cheol;Lee, Sang-Bae;Hong, Eui-Chul
    • Korean Journal of Poultry Science
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    • v.40 no.2
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    • pp.121-127
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    • 2013
  • This work was carried to evaluate production efficiency factor, carcass yield and meat quality with weeks of Large-type Korean native ducks. Korean native ducks (n = 90) from National Institute of Animal Science (RDA, Korea) were used in this work. Ninety ducks were divided into 6 groups (15 birds/group) and were fed with meat-type duck diets for 8 wk old. When ducks grew at specific wk (6, 7 and 8 weeks), 2 ducks per group were slaughtered at 6, 7 and 8 wk old. Production efficiency factor, carcass yield, partial meat and meat quality were researched in this work. There was no significant difference on livability with weeks, but body weight at 7 and 8 wk old was higher than that at 6 wk old (P<0.05). Feed conversion ratio at 6, 7 and 8 wk old were 2.25, 2.69 and 3.21, respectively, so there was significant difference with weeks (P<0.05). Production efficiency factor at 6, 7 and 8 wk old were 256.6, 199.8 and 153.0, respectively, so there was significant difference with weeks (P<0.05). Carcass yield at 8 wk old was higher than that at 6 and 7 wk old as 73.5% (P<0.05). Lightness at 6, 7 and 8 wk were 41.8, 39.0 and 38.1, respectively, and that at 6 wk old was the higher than other weeks (P<0.05). There was no significant difference on redness at 6, 7, and 8 wk old (P>0.05) and yellowness at 8 wk old was higher compared to other weeks (P<0.05). Cooking loss was the highest at 6 wk old as 31.6%, but water holding capacity was the highest at 8 wk old (P<0.05). There was no significant difference on shear force among weeks. pH at 6 wk old was the lower than that of other weeks as 5.84. Moisture content significantly decreased with weeks (P<0.05) and fat content at 8 wk was the highest as 1.88% (P<0.05). Protein content significantly increased with weeks until 20.9% at the age of 8 wk (P<0.05). Ash content at 7 and 8 wk old was the higher than that at 6 wk old (P<0.05). There was no significant difference on juiciness, tenderness, and flavor with weeks. Finally, these results may provide that shipping time at 7 wk old preferred to that at 6 and 7 wk old, but further research was needed because of deficiency of data.

Difference in Chemical Composition of PM2.5 and Investigation of its Causing Factors between 2013 and 2015 in Air Pollution Intensive Monitoring Stations (대기오염집중측정소별 2013~2015년 사이의 PM2.5 화학적 특성 차이 및 유발인자 조사)

  • Yu, Geun Hye;Park, Seung Shik;Ghim, Young Sung;Shin, Hye Jung;Lim, Cheol Soo;Ban, Soo Jin;Yu, Jeong Ah;Kang, Hyun Jung;Seo, Young Kyo;Kang, Kyeong Sik;Jo, Mi Ra;Jung, Sun A;Lee, Min Hee;Hwang, Tae Kyung;Kang, Byung Chul;Kim, Hyo Sun
    • Journal of Korean Society for Atmospheric Environment
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    • v.34 no.1
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    • pp.16-37
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    • 2018
  • In this study, difference in chemical composition of $PM_{2.5}$ observed between the year 2013 and 2015 at six air quality intensive monitoring stations (Bangryenogdo (BR), Seoul (SL), Daejeon (DJ), Gwangju (GJ), Ulsan (US), and Jeju (JJ)) was investigated and the possible factors causing their difference were also discussed. $PM_{2.5}$, organic and elemental carbon (OC and EC), and water-soluble ionic species concentrations were observed on a hourly basis in the six stations. The difference in chemical composition by regions was examined based on emissions of gaseous criteria pollutants (CO, $SO_2$, and $NO_2$), meteorological parameters (wind speed, temperature, and relative humidity), and origins and transport pathways of air masses. For the years 2013 and 2014, annual average $PM_{2.5}$ was in the order of SL ($${\sim_=}DJ$$)>GJ>BR>US>JJ, but the highest concentration in 2015 was found at DJ, following by GJ ($${\sim_=}SJ$$)>BR>US>JJ. Similar patterns were found in $SO{_4}^{2-}$, $NO_3{^-}$, and $NH_4{^+}$. Lower $PM_{2.5}$ at SL than at DJ and GJ was resulted from low concentrations of secondary ionic species. Annual average concentrations of OC and EC by regions had no big difference among the years, but their patterns were distinct from the $PM_{2.5}$, $SO{_4}^{2-}$, $NO_3{^-}$, and $NH_4{^+}$ concentrations by regions. 4-day air mass backward trajectory calculations indicated that in the event of daily average $PM_{2.5}$ exceeding the monthly average values, >70% of the air masses reaching the all stations were coming from northeastern Chinese polluted regions, indicating the long-range transportation (LTP) was an important contributor to $PM_{2.5}$ and its chemical composition at the stations. Lower concentrations of secondary ionic species and $PM_{2.5}$ at SL in 2015 than those at DJ and GJ sites were due to the decrease in impact by LTP from polluted Chinese regions, rather than the difference in local emissions of criteria gas pollutants ($SO_2$, $NO_2$, and $NH_3$) among the SL, DJ, and GJ sites. The difference in annual average $SO{_4}^{2-}$ by regions was resulted from combination of the difference in local $SO_2$ emissions and chemical conversion of $SO_2$ to $SO{_4}^{2-}$, and LTP from China. However, the $SO{_4}^{2-}$ at the sites were more influenced by LTP than the formation by chemical transformation of locally emitted $SO_2$. The $NO_3{^-}$ increase was closely associated with the increase in local emissions of nitrogen oxides at four urban sites except for the BR and JJ, as well as the LTP with a small contribution. Among the meterological parameters (wind speed, temperature, and relative humidity), the ambient temperature was most important factor to control the variation of $PM_{2.5}$ and its major chemical components concentrations. In other words, as the average temperature increases, the $PM_{2.5}$, OC, EC, and $NO_3{^-}$ concentrations showed a decreasing tendency, especially with a prominent feature in $NO_3{^-}$. Results from a case study that examined the $PM_{2.5}$ and its major chemical data observed between February 19 and March 2, 2014 at the all stations suggest that ambient $SO{_4}^{2-}$ and $NO_3{^-}$ concentrations are not necessarily proportional to the concentrations of their precursor emissions because the rates at which they form and their gas/particle partitioning may be controlled by factors (e.g., long range transportation) other than the concentration of the precursor gases.

An Analysis of the Psychiatric Characteristics of the Alopecia Areata in Female (여성 탈모증의 정신의학적 특성 분석)

  • Lee, Kil-Hong;Na, Chul;Lee, Young-Sik;Lee, Chang-Hoon;No, Byung-In;Hong, Chang-Kwon
    • Korean Journal of Psychosomatic Medicine
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    • v.8 no.1
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    • pp.31-45
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    • 2000
  • Objectives : The present study was performed to reveal differences between female and male cases of alopecia in their alopecia related variables such as patterns of hair loss, psychiatric characteristics, associate illnesses, and methods of treatment, and to use them as basic materials for proper management and early prevention of the alopecia prone cases. Methods : In order to analysis the gender difference in hair losses, the subjects were divided into two subgroups as the 51 cases of female alopecia and the 42 cases of male alopecia, who had visited to the department of psychiatry consulted from the department of dermatology, Yongsan hopital, ChungAng University, Seoul, Korea, from January 1998 to December 1998. In data analysis, the subjects were statistically assesed by chi-squre test and analysis of varaiance, through SPSS-$PC^+$ 9.0V. Results : 1) Female subjects were more likely showed lower socio-economical level including lower eonomical level, lower educational level, or lower occupational level in their parent's job, were more likely to have larger number of siblings and to have many sisters comparison to the male cases. 2) Female subjects were more likely visited to the department of dermatology, more history of alopecia in their female family members, lesser history of alopecia in their male family members, more loss of hairs in vertex or frontal region of scalp, lesser loss of hairs in occipital region, and lesser nail changes in comparison to the male cases. 3) Female subjects were more suffered from intra-familial conflicts and economical changes, or their introverted personality makeup, lesser likely suffered from changes of business and health changes, and showed lesser conflicts related with poorer adaptaion in their job life. 4) Female subjects were more likely diagnosed as depression or conversion disorders, more frequently complaint anxiety symptoms or depressive symptoms, higher level of anxiety index, lesser complaint somatization or obsessive compulsive symptoms, and lesser diagnosed as anxiety disorder in comparison to the male cases. 5) Female subjects were more likely tended to show personality makeup such as the introverted, the lie, the repressed, or the feminine trends than the male cases. 6) Female subjects were more significantly treated by antianxiety drug such as etizolam and dermatological therapies include tretinoin, and lesser treated by clotiazepam and prednicarbonate in comparison to the male cases. Conclusion : From the facts that The most important factors in developing hair loss in the female subjects in comparison to the male cases seems to be closely correlated with the serious psychopathology such as the presence of mental disorders including depression, the presence of complaining anxiety or depressive symptomatology, the presence of stressful life events such as intrafamilial life changes, and the presence of personality makeup such as the introverted, the lie, the repressed, or the feminine trends, the authors confirmed that dermatologists act as the primary care physician are in a unique position to recognize psychiatric comorbidity and execute meaningful intervention for female patients with the alopecia with psychiatrists.

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Sesquiterpenoids Bioconversion Analysis by Wood Rot Fungi

  • Lee, Su-Yeon;Ryu, Sun-Hwa;Choi, In-Gyu;Kim, Myungkil
    • 한국균학회소식:학술대회논문집
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    • 2016.05a
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    • pp.19-20
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    • 2016
  • Sesquiterpenoids are defined as $C_{15}$ compounds derived from farnesyl pyrophosphate (FPP), and their complex structures are found in the tissue of many diverse plants (Degenhardt et al. 2009). FPP's long chain length and additional double bond enables its conversion to a huge range of mono-, di-, and tri-cyclic structures. A number of cyclic sesquiterpenes with alcohol, aldehyde, and ketone derivatives have key biological and medicinal properties (Fraga 1999). Fungi, such as the wood-rotting Polyporus brumalis, are excellent sources of pharmaceutically interesting natural products such as sesquiterpenoids. In this study, we investigated the biosynthesis of P. brumalis sesquiterpenoids on modified medium. Fungal suspensions of 11 white rot species were inoculated in modified medium containing $C_6H_{12}O_6$, $C_4H_{12}N_2O_6$, $KH_2PO_4$, $MgSO_4$, and $CaCl_2$ for 20 days. Cultivation was stopped by solvent extraction via separation of the mycelium. The metabolites were identified as follows: propionic acid (1), mevalonic acid lactone (2), ${\beta}$-eudesmane (3), and ${\beta}$-eudesmol (4), respectively (Figure 1). The main peaks of ${\beta}$-eudesmane and ${\beta}$-eudesmol, which were indicative of sesquiterpene structures, were consistently detected for 5, 7, 12, and 15 days These results demonstrated the existence of terpene metabolism in the mycelium of P. brumalis. Polyporus spp. are known to generate flavor components such as methyl 2,4-dihydroxy-3,6-dimethyl benzoate; 2-hydroxy-4-methoxy-6-methyl benzoic acid; 3-hydroxy-5-methyl phenol; and 3-methoxy-2,5-dimethyl phenol in submerged cultures (Hoffmann and Esser 1978). Drimanes of sesquiterpenes were reported as metabolites from P. arcularius and shown to exhibit antimicrobial activity against Gram-positive bacteria such as Staphylococcus aureus (Fleck et al. 1996). The main metabolites of P. brumalis, ${\beta}$-Eudesmol and ${\beta}$-eudesmane, were categorized as eudesmane-type sesquiterpene structures. The eudesmane skeleton could be biosynthesized from FPP-derived IPP, and approximately 1,000 structures have been identified in plants as essential oils. The biosynthesis of eudesmol from P. brumalis may thus be an important tool for the production of useful natural compounds as presumed from its identified potent bioactivity in plants. Essential oils comprising eudesmane-type sesquiterpenoids have been previously and extensively researched (Wu et al. 2006). ${\beta}$-Eudesmol is a well-known and important eudesmane alcohol with an anticholinergic effect in the vascular endothelium (Tsuneki et al. 2005). Additionally, recent studies demonstrated that ${\beta}$-eudesmol acts as a channel blocker for nicotinic acetylcholine receptors at the neuromuscular junction, and it can inhibit angiogenesis in vitro and in vivo by blocking the mitogen-activated protein kinase (MAPK) signaling pathway (Seo et al. 2011). Variation of nutrients was conducted to determine an optimum condition for the biosynthesis of sesquiterpenes by P. brumalis. Genes encoding terpene synthases, which are crucial to the terpene synthesis pathway, generally respond to environmental factors such as pH, temperature, and available nutrients (Hoffmeister and Keller 2007, Yu and Keller 2005). Calvo et al. described the effect of major nutrients, carbon and nitrogen, on the synthesis of secondary metabolites (Calvo et al. 2002). P. brumalis did not prefer to synthesize sesquiterpenes under all growth conditions. Results of differences in metabolites observed in P. brumalis grown in PDB and modified medium highlighted the potential effect inorganic sources such as $C_4H_{12}N_2O_6$, $KH_2PO_4$, $MgSO_4$, and $CaCl_2$ on sesquiterpene synthesis. ${\beta}$-eudesmol was apparent during cultivation except for when P. brumalis was grown on $MgSO_4$-free medium. These results demonstrated that $MgSO_4$ can specifically control the biosynthesis of ${\beta}$-eudesmol. Magnesium has been reported as a cofactor that binds to sesquiterpene synthase (Agger et al. 2008). Specifically, the $Mg^{2+}$ ions bind to two conserved metal-binding motifs. These metal ions complex to the substrate pyrophosphate, thereby promoting the ionization of the leaving groups of FPP and resulting in the generation of a highly reactive allylic cation. Effect of magnesium source on the sesquiterpene biosynthesis was also identified via analysis of the concentration of total carbohydrates. Our current study offered further insight that fungal sesquiterpene biosynthesis can be controlled by nutrients. To profile the metabolites of P. brumalis, the cultures were extracted based on the growth curve. Despite metabolites produced during mycelia growth, there was difficulty in detecting significant changes in metabolite production, especially those at low concentrations. These compounds may be of interest in understanding their synthetic mechanisms in P. brumalis. The synthesis of terpene compounds began during the growth phase at day 9. Sesquiterpene synthesis occurred after growth was complete. At day 9, drimenol, farnesol, and mevalonic lactone (or mevalonic acid lactone) were identified. Mevalonic acid lactone is the precursor of the mevalonic pathway, and particularly, it is a precursor for a number of biologically important lipids, including cholesterol hormones (Buckley et al. 2002). Farnesol is the precursor of sesquiterpenoids. Drimenol compounds, bi-cyclic-sesquiterpene alcohols, can be synthesized from trans-trans farnesol via cyclization and rearrangement (Polovinka et al. 1994). They have also been identified in the basidiomycota Lentinus lepideus as secondary metabolites. After 12 days in the growth phase, ${\beta}$-elemene caryophyllene, ${\delta}$-cadiene, and eudesmane were detected with ${\beta}$-eudesmol. The data showed the synthesis of sesquiterpene hydrocarbons with bi-cyclic structures. These compounds can be synthesized from FPP by cyclization. Cyclic terpenoids are synthesized through the formation of a carbon skeleton from linear precursors by terpene cyclase, which is followed by chemical modification by oxidation, reduction, methylation, etc. Sesquiterpene cyclase is a key branch-point enzyme that catalyzes the complex intermolecular cyclization of the linear prenyl diphosphate into cyclic hydrocarbons (Toyomasu et al. 2007). After 20 days in stationary phase, the oxygenated structures eudesmol, elemol, and caryophyllene oxide were detected. Thus, after growth, sesquiterpenes were identified. Per these results, we showed that terpene metabolism in wood-rotting fungi occurs in the stationary phase. We also showed that such metabolism can be controlled by magnesium supplementation in the growth medium. In conclusion, we identified P. brumalis as a wood-rotting fungus that can produce sesquiterpenes. To mechanistically understand eudesmane-type sesquiterpene biosynthesis in P. brumalis, further research into the genes regulating the dynamics of such biosynthesis is warranted.

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Mid-term results of IntracardiacLateral Tunnel Fontan Procedure in the Treatment of Patients with a Functional Single Ventricle (기능적 단심실 환자에 대한 심장내 외측통로 폰탄술식의 중기 수술성적)

  • 이정렬;김용진;노준량
    • Journal of Chest Surgery
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    • v.31 no.5
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    • pp.472-480
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    • 1998
  • We reviewed the surgical results of intracardiac lateral tunnel Fontan procedure for the repair of functional single ventricles. Between 1990 and 1996, 104 patients underwent total cavopulmonary anastomosis. Patients' age and body weight averaged 35.9(range 10 to 173) months and 12.8(range 6.5 to 37.8) kg. Preoperative diagnoses included 18 tricuspid atresias and 53 double inlet ventricles with univentricular atrioventricular connection and 33 other complex lesions. Previous palliative operations were performed in 50 of these patients, including 37 systemic to pulmonary artery shunts, 13 pulmonary artery bandings, 15 surgical atrial septectomies, 2 arterial switch procedures, 2 resections of subaortic conus, 2 repairs of total anomalous pulmonary venous connection and 1 Damus-Stansel-Kaye procedure. In 19 patients bidirectional cavopulmonary shunt operation was performed before the Fontan procedure and in 1 patient a Kawashima procedure was required. Preoperative hemodynamics revealed a mean pulmonary artery pressure of 14.6(range 5 to 28) mmHg, a mean pulmonary vascular resistance of 2.2(range 0.4 to 6.9) wood-unit, a mean pulmonary to systemic flow ratio of 0.9(range 0.3 to 3.0), a mean ventricular end-diastolic pressure of 9.0 (range 3.0 to 21.0) mmHg, and a mean arterial oxygen saturation of 76.0(range 45.6 to 88.0)%. The operative procedure consisted of a longitudinal right atriotomy 2cm lateral to the terminal crest up to the right atrial auricle, followed by the creation of a lateral tunnel connecting the orifices of either the superior caval vein or the right atrial auricle to the inferior caval vein, using a Gore-Tex vascular graft with or without a fenestration. Concomitant procedures at the time of Fontan procedure included 22 pulmonary artery angioplasties, 21 atrial septectomies, 4 atrioventricular valve replacements or repairs, 4 corrections of anomalous pulmonary venous connection, and 3 permanent pacemaker implantations. In 31, a fenestration was created, and in 1 an adjustable communication was made in the lateral tunnel pathway. One lateral tunnel conversion was performed in a patient with recurrent intractable tachyarrhythmia 4 years after the initial atriopulmonary connection. Post-extubation hemodynamic data revealed a mean pulmonary artery pressure of 12.7(range 8 to 21) mmHg, a mean ventricular end-diastolic pressure of 7.6(range 4 to 12) mmHg, and a mean room-air arterial oxygen saturation of 89.9(range 68 to 100) %. The follow-up duration was, on average, 27(range 1 to 85) months. Post-Fontan complications included 11 prolonged pleural effusions, 8 arrhythmias, 9 chylothoraces, 5 of damage to the central nervous system, 5 infectious complications, and 4 of acute renal failure. Seven early(6.7%) and 5 late(4.8%) deaths occured. These results proved that the lateral tunnel Fontan procedure provided excellent hemodynamic improvements with acceptable mortality and morbidity for hearts with various types of functional single ventricle.

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