병원획득 Klebsiella pneumoniae 균혈증 분석을 통해 본 Ciprofloxacin 내성과 Extended-Spectrum β-Lactamase생성 간의 연관성

김미영,추은주,곽이경,송문희,나성수,송태준,김성혜,전재범,최상호,정진용,김남중,김양수,우준희,류지소 대한감염학회 2004 감염과 화학요법 Vol.36 No.5

목적 : K. pneumoniae는 ciprofloxacin내성 증가가 전세계적으로 문제가 되고있는 extended-spectrum beta-lactamase (ESBL)를 생성하는 대표적인 세균으로 최근 외국에서 ciprofloxacin 내성과 ESBL 생성사이에 관련이 있다는 2-3편의 보고들이 있었다. 본 연구에서는 병원획득 K. pneumoniae 패혈증이 있었던 환자들을 대상으로 ciprofloxacin 내성과 관련된 인자를 알아보고자 하였다. 재료 및 방법 : 2001년 1월 부터 2002년 12월 사이에 2200병상의 3차 의료기관인 한 대학병원에서 입원 후 72시간 이후에 나간 혈액배양에서 K. pneumoniae가 배양된 입원환자를 대상으로 의무기록과 전산기록을 분석하여 환자의 성별, 나이, 병동, 기저질환, 이전의 항생제 사용력, 패혈증 발생당시까지의 재원기간, 이전 입원력, 원인균의ESBL 생성유무 등을 파악하였고 이들 변수가 ciprofloxacin 내성과 관련이 있는지를 분석하였다. 재발성 패혈증의 경우는 첫 번째 경우만을 분석에 포함하였다. 결과 : 연구대상 환자는 총154명이었고 K. pneumoniae의 ciprofloxacin에 대한 내성률은 28.6% (44/154)였다. Ciprofloxacin 내성균주 중 ESBL 생성균주의 비율은 95.5% (42/44)였고 ciprofloxacin 감수성균주에서 ESBL 생성균주의 비율은 24.5% (27/110)였다(P<0.001). ESBL생성외에 단변량 분석에서 유의한 관련을 보인 변수로는 남자, 나이가 많은 경우, 패혈증 당시 중환자실 재원, 기저질환이 고형암, 혈액암, 담도계 질환인 경우, 패혈증 발생이전 1달 이내의 항생제 사용력, 3세대 cephalosporin, metronidazole, fluroquinolone, carbapenem 투여력이 있었다. 다변량 로지스틱 분석을 시행 하였을 때는 나이가 많은 경우(Adjusted odds ratio[A0R]; 1.04, 95%confidence interval[CI]; 1.01-1.06)와 ESBL 생성(AOR; 81.35, 95% CI; 17.76-372.53)이 유의하게 ciprofloxacin 내성과 관련이 있었다. 결론 : 패혈증을 일으킨 병원획득 K. pneumonias에서의 ciprofloxacin 내성은 ESBL 생성과 유의한 관련을 보였고 향후 이에 관련된 원인이나 기전을 분석하기위한 분자역학적·분자생물학적 연구가 필요하겠다. Background : Strains of ciprofloxacin-resistant Klebsiella pneumoniae have emerged worldwide. We investigated the epidemiology of ciprofloxacin resistance and its relationship to ESBL production in nosocomial K. pneumoniae bacteremia. Materials and Methods : Using the computerized database of clinical microbiology, we identified all patients whose blood culture had yielded K. pneumoniae between January 2001 and December 2002 at a 2200-bed university-affiliated tertiary-care hospital. During the study period, total of 392 episodes of K. pneumoniae bacteremia were documented of which 163 episodes were acquired nosocomially. 9 cases of recurrent episodes were excluded. Results : The resistance rates to ciprofloxacin was 28.6% (44/154). ESBL-production was significantly more common in ciprofloxacin-resistant isolates than in ciprofloxacin-susceptible isolates (95.9% [42/44] vs. 24.5% [27/110], P<0.001). In univariate analysis, following factors were significantly associated with resistance to ciprofloxacin: older age, male sex, ICU admission at the time of bacteremia, prior use of antibiotics within 1 month before bacteremia, solid tumor, hematological malignancy, or biliary disease as underlying disease, and ESBL-production. The prior use of 3^(rd)-generation cephalosprins, metronidazole, fluroquinolone, or carbapenem were also risk factors. Independent risk factors for ciprofloxacin resistance were older age (adjusted odds ratio [AOR]; 1.04, 95% confidence interval [CI]; 1.01-1.06) and ESBL production (AOR; 81.35, 95% CI; 17.76-372.53). Conclusion : The close relationship between ciprofloxacin resistance and ESBL production was documented in nosocomial K. pneumoniae bacteremia. Further epidemiological and molecular studies to determine factors and mechanisms involved in the relationship are needed.

말초성 동맥 질환에 있어서 201TI을 이용한 말초혈관 관류스캔의 유용성

김진우(Jin Woo Kim),김영설(Young Seol Kim),김광원(Kwang Won Kim),최영길(Young Kil Choi),고은미(Eun Mi Koh),김덕윤(Deog Yoon Kim),우인숙(In Sook Woo),나정일(Jung Il Nah) 대한핵의학회 1991 핵의학 분자영상 Vol.25 No.2

N/A Peripheral arterial disease, because of its significant and prolonged morbidity and related mortality is a major medical and surgical problem. Contrast angiograrn remains the essential standard for the anatomic demonstration of disease. It does not, however, provide data suitable for quantification or any evaluation of the microcirculation. For these reasons, radionuclide studies are playing an increasingly important role by not only confirming the diagnosis and offering objective data on the physiologic significance of anatomic lesions, but by offering prognosis of healing and prediction of therapeutic results. In addition, radionuclide procedures offer means t.o safely and repeatedly monitor response to therapy and long term follow up. 1'he object of this study was to evaluate the clinical availability of 'Tl perfusion scan in patients with peripheral arteriai diseases. We performed 'Tl perfusion scans in patients with five Buerger s disease (10 legs), six DM gangrenes (12 legs) and classified three perfusion pattern groups. Finally we compared treatment modalities among each groups and compaired Tl-201 perfusion scan findings with angiographic findings in six patients with Buergers disease. The results were as follows: 1) Seven legs showed increased perfusion in stress image and normal or increased perfusion in resting image (type 1). Six legs showed decreased perfusion in stress image and irnproved in resting image (type II). Of total 13 legs, only 1 leg needed to amputation. 2) Three legs showed decreased perfusion in stress and resting irnage (type III), and subsequently all cases were received surgical amputation. 3) In six Buergers disease patients, there were disagreernents in two patients (2 legs) between 'Tl scan and angiography, in which angiograms were normal but 'Tl scans shawed type II perfusion patterns.

갑상선 질환의 병태생리를 이해하는 데 있어서 갑상선 스캔의 재평가

김진우(Jin Woo Kim),김영설(Young Seol Kim),김광원(Kwang Won Kim),최영길(Young Kil Choi),고은미(Eun Mi Koh),김덕윤(Deog Yoon Kim),우인숙(In Sook Woo),나정일(Jung Il Nah),김성운(Sung Woon Kim),양인명(In Myung Yang) 대한핵의학회 1991 핵의학 분자영상 Vol.25 No.1

N/A To diagnosis and understand the pathophysiologic status of thyroid disease, not only hormonal measurments but also thyroid scan is believed to have a unique role. Especially in the cases of the change of the thyroid function by thyroiditis, it is emphasized that thyroid scan can be helpful in differentia! diagnosis, Discordant results of thyroid hormone levels and thyroid scan are found in transient hyperthyroidism, or in transient hypothyroidism. We analysed and reevaluated thyroid scan to look at the importance of thyroid scan. The results are summerised as follows: 1) 80%. of hyperthyroid patients had hyperthyroidism increased RAIU with even density, they are compatible with Graves' disease. 2) 2.1% of hyperthyroid patients had normal or decreased RAIU, which are classfied as high iodine turn over genuine hyperthyroidism. 3) 8.5% of hyperthyroid patients had markedly decreased RAIU at both 2 hour and 24 hour, whose patholgic processes are suggested to be heterogenous namely subacute thyroiditis, postpartum thyroiditis, Hashimotos thyroiditis, and pamless thyroiditis. 4) 45% of hypothyroid patients had increased 24hr RAIU, 30% of hypothyroid patients were normal, 25%, decreased In conclusion. thyroid scan should be reevaluated its useful role to asses the pathophysiologic status of thyroid disease. Especially in cases of transient thyrotoxicosis, thyroid scan is essential to diagnose and follow up the disease process.

Safety and efficacy of dietary supplement (gintonin-enriched fraction from ginseng) in subjective memory impairment: A randomized placebo-controlled trial

Lee Woo-Jin,Shin Yong-Won,Chang Hyeyeon,Shin Hye-Rim,Kim Won-Woo,Jung Seok-Won,Kim Manho,Nah Seung-Yeol 한국한의학연구원 2022 Integrative Medicine Research Vol.11 No.1

Background: Gintonin inhibits β-amyloid production, increases acetylcholine level in the brain, and promotes neurogenesis. We evaluated the efficacy of gintonin-enriched fraction (GEF) in improving the cognitive performance in subjective memory impairment. Methods: In this 8-week, randomized, assessor and participant blinded, placebo–controlled study, participants with subjective memory impairment but preserved cognitive function (Korean Mini-Mental State Examination [K-MMSE] score ≥23) were assigned to GEF 300mg/day or placebo. K-MMSE, Korean versions of the Alzheimer's disease assessment scale, color-word stroop test (K-CWST), clinical dementia rating, and Beck depression inventory-II were evaluated along with the safety profiles. The primary outcome was set as the change in the K-MMSE. Results: Seventy-six participants complete the study protocol. After 8 weeks, there was no inter-group difference in the primary or secondary outcome score changes. However, GEF group showed an improvement in the K-MMSE scores (P= 0.026), and in the number of correct answers in both word reading (P= 0.008) and color reading (P= 0.005) of K-CWST, although only the improvement in the K-CWST scores were higher than the minimum clinically important difference. The frequency of adverse events was comparable between the groups and all were of mild severity. Conclusion: GEF is safe but might not be effective in treating subjective memory impairment within the current study setting. However, GEF showed a trend of improving the global cognition and the frontal executive function. Further large-sized studies with longer follow-up period are warranted. Clinical trial registration: This clinical trial was registered at Clinical Research Information Service of Korea Centers for Disease Control and Prevention: KCT0004636. Background: Gintonin inhibits β-amyloid production, increases acetylcholine level in the brain, and promotes neurogenesis. We evaluated the efficacy of gintonin-enriched fraction (GEF) in improving the cognitive performance in subjective memory impairment. Methods: In this 8-week, randomized, assessor and participant blinded, placebo–controlled study, participants with subjective memory impairment but preserved cognitive function (Korean Mini-Mental State Examination [K-MMSE] score ≥23) were assigned to GEF 300mg/day or placebo. K-MMSE, Korean versions of the Alzheimer's disease assessment scale, color-word stroop test (K-CWST), clinical dementia rating, and Beck depression inventory-II were evaluated along with the safety profiles. The primary outcome was set as the change in the K-MMSE. Results: Seventy-six participants complete the study protocol. After 8 weeks, there was no inter-group difference in the primary or secondary outcome score changes. However, GEF group showed an improvement in the K-MMSE scores (P= 0.026), and in the number of correct answers in both word reading (P= 0.008) and color reading (P= 0.005) of K-CWST, although only the improvement in the K-CWST scores were higher than the minimum clinically important difference. The frequency of adverse events was comparable between the groups and all were of mild severity. Conclusion: GEF is safe but might not be effective in treating subjective memory impairment within the current study setting. However, GEF showed a trend of improving the global cognition and the frontal executive function. Further large-sized studies with longer follow-up period are warranted. Clinical trial registration: This clinical trial was registered at Clinical Research Information Service of Korea Centers for Disease Control and Prevention: KCT0004636.

은닉마르코프 모델 및 구조학습법을 통한 수소충전소 설비의 베이지안 네트워크 모델 추론

이진우(Jin-woo Lee),최진혁(Jin-Hyuk Choi),조원정(Won-Jeong Choi),나광호(Gwang-Ho Nah) 한국가스학회 2021 한국가스학회 학술대회논문집 Vol.2021 No.5

HBV : Predictors of the Complete Virologic Response in Na?ve Chronic Hepatitis B Patients Treated with Entecavir

( Jin Nyoung Kim ),( Jae Young Jang ),( Woong Cheul Lee ),( Soung Won Jeong ),( Eui Ju Park ),( Byoung Moo Lee ),( Yun Nah Lee ),( Sae Hwan Lee ),( Sang Gyune Kim ),( Sang Woo Cha ),( Young Seok Kim ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background: We assessed baseline and on-treatment variables to determine factors predictive of the complete virologic response in naive chronic hepatitis B patients treated with entecavir. Methods: A total of 261 naive chronic hepatitis B (CHB) patients treated with entecavir (0.5 mg daily) for at least 12 weeks were enrolled. The complete virologic response was defined as the absence of serum HBV-DNA by PCR assay (<20 IU/mL) on 2 consecutive measurement during entecavir treatment. Compliance with therapy was assessed when patients visited the outpatient clinic and phone calls. The medication adherence was more than 80% of all patients. Results: The mean follow-up duration was 20±16.5 months, and 55 patients (56.1%) showed HBeAg positivity. Finally, 98 patients were treated with entecavir for 96 weeks. The median pretreatment levels of serum ALT and HBV DNA were 206±20.53 U/L and 1.50 × 8 log10 IU/mL, respectively. The cumulative rates of the complete virologic response at 12, 24, 48, and 96 weeks were 17.2%, 46.0%, 67.6%, and 71.4%, respectively. An absence of HBeAg and DNA level at baseline were significant predictors of the complete virologic response at 96 weeks in a univariate analysis (P<0.001, P=0.02). An absence of HBeAg at baseline was significant predictor of the complete virologic response at 12 weeks, 24 weeks, 48 weeks, and 96 weeks in a multivariate analysis (P<0.001). Aminotransferase level was significant predictor of the complete virologic response at 12 weeks, 24 weeks, 48 weeks and 96 weeks in HBeAg positive patients (P<0.05). Conclusions: Our data showed a good complete virologic response (71.4%) in naive CHB patients treated with entecavir. Regardless of any period, the predictor of the complete virologic response was an absence of HBeAg. Additionally, aminotransferase level can be used for predictor of the complete virologic response in HBeAg positive patients.

Evaluating relaxation of high-strength bolts by parameters on slip faying surfaces of bolted connections

Nah, Hwan-Seon,Lee, Hyeon-Ju,Kim, Kang-Seok,Kim, Jin-Ho,Kim, Woo-Bum Springer-Verlag 2010 International Journal of Steel Structures Vol.10 No.3

Analysis of 18F-fluorodeoxyglucose positron emission tomography findings in patients with pituitary Lesions

( Han Nah Seok ),( Eun Young Lee ),( Eun Yeong Choe ),( Woo In Yang ),( Joo Young Kim ),( Dong Yeob Shin ),( Ho Jin Cho ),( Tae Sung Kim ),( Mi Jin Yun ),( Jong Doo Lee ),( Eun Jig Lee ),( Sung Kil Li 대한내과학회 2013 The Korean Journal of Internal Medicine Vol.28 No.1

Background/Aims: Although magnetic resonance imaging (MRI) is a good visual modality for the evaluation of pituitary lesions, it has limited value in the diagnosis of mixed nodules and some cystic lesions. We evaluated the usefulness of 18F-fluorodeoxyglucose positron emission tomography (FDG PET) for patients with pituitary lesions. Methods: 18F-FDG PET and MRI were performed simultaneously in 32 consecutive patients with pituitary lesions. The relationships between FDG uptake patterns in PET and MRI findings were analyzed. Results: Of 24 patients with piuitary adenomas, 19 (79.2%) showed increased uptake of 18F-FDG in the pituitary gland on PET scans. All patients with pituitary macroadenomas showed increased 18F-FDG uptake on PET scans. Meanwhile, only five (50%) of the 10 patients with pituitary microadenomas showed positive PET scans. Interestingly, of two patients with no abnormal MRI findings, one showed increased 18F-FDG uptake on PET. For positive 18F-FDG uptake, maximum standardized uptake values (SUVmax) > 2.4 had 94.7% sensitivity and 100% specificity. In addition, SUVmax increased in proportion to the size of pituitary adenomas. Most cystic lesions did not show 18F-FDG uptake on PET scans. Consclusions: About 80% of pituitary adenomas showed positivity on PET scans, and SUVmax was related to the size of the adenomas. PET may be used as an ancillary tool for detection and differentiation of pituitary lesions.

Toward a better fluid solver: developing and verifying the YUMMy (Yonsei Unstructured Moving-Mesh Hydrodynamics) code

Ji-Woo Kim,Kiyun Yun,Jun-Sung Moon,Jongsam Nah,Sung-Ho An,Suk-Jin Yoon,Juhan Kim,Sungsoo Kim 한국천문학회 2022 天文學會報 Vol.47 No.2

Kappa Opiate Receptor Agonist Inhibit Pertussis Toxin Catalyzed ADP-ribosylation

Bae, Jin-Woo,Nah, Seung-Yeol 건국대학교 의과학연구소 1993 건국의과학학술지 Vol.3 No.-

아편수용체와 GPT-결합단백질(G-Protein)과의 상호작용과 아편수용체의 탈감작(Desensitization)시에 일어나는 변화들에 대하여 아직 모르는 사항이 많다. 지금까지의 연구에서 척수와 후근신경절(Spinal coar-dorsal root ganglion, SC-DRG)의 복합배양세포에 카파-수용체 효현제를 장기간 첨가하였을 경우 백일해독소에 의해 민감한 G-protein에 의한 Adenyl cyclase와 칼슘체널의 활성을 억제하는 아편의 기능을 현저히 저하시켰으며 세포배양시 카파-수용체 효현제의 첨가로 백일해독소에 의해 촉진되는 Gi, Go의 알파-Subunit의 ADP-ribosylation이 50±8% 감소된 반면 Cholera toxin에 의한 촉진되는 Gas의 알파-Subunit의 ADP-ribosylation을 35±5% 증가시켰다. 더군다나 백일해독소에 의해 촉진되는 ADP-ribosylation은 카파-수용체의 효현제인 U50488, Dysnorphin(1~13)을 전처리하였을 때도 비슷한 감소를 초래하였으며 흥미롭게도 U50488 전처리하였을 경우 Cholera Tocin에 의해 촉진되는 Gas의 ADP-ribosylation이 증가되었다. 아편의 길항제인 Naloxone은 백일해독소에 의해 촉진되는 ADP-ribosylation을 억제하는 카파수용체의 효현제의 작용을 감소시켰으며 Naloxone 단독으로는 ADP-ribosylation에 아무 영향이 없고 또한 아편의 뮤-, 델타-수용체의 효현제는 ADP-ribosylation에 아무런 영향을 주지 않았다. G-protein과 아편수용체의 분리를 촉진시키는 물질인 NaCl, GTP등에 의해 U50488의 Ribosylation 억제작용이 크게 저하되었고 정제된 βγ dimer와 Lubol-PX의 첨가에 의해서도 비슷한 억제작용이 저하되는 효과를 보였다. 이러한 결과는 카파-수용체가 G-protein과 단단히 결합되어 있고 카파-수용체의 효현제에 의한 Giα, Goα의 ADP-ribosylation의 감소는 아편 수용체와 결합하는 G-protein의 변화가 수용체의 탈감작을 유발하는 것으로 보여진다. Little is known about the interaction of the GTP-binding proteins(G-Proteins) with the opiate receptors and the changes that accompany opiate receptor desensitization. Our previous studies demonstrated that prolonged exposure of spinal cord-dorsal root ganglion(SC-DRG) cocultures to k opiates agonist lead to marked decrease in the capacity of the opiate to inhibit the adenylate cyclase and the ?? channel activities which are mediated through pertussis toxin sensitive G-proteins. Here we show that incubation of the cultured cells with k opiate agonists leads 50% reduction in the pertusis toxin catalyzed ADP-ribosylation of the α subunits of Gi and Go, whereas k opiate agonist increased cholera toxin catalyzed ADP-ribosylation of the α subunit of 45 Kd Gsα by 35%. Moreover, similar attenuation in pertussis toxin catayzed AD-ribosylation was observed in vitro following preincubation of the cell homognates with k opiate agonists, such as the ligands U50488 and dynorphin ??. Interestingly, preincubation with U50499 increased the cholera catalyzed ADP-ribosylation of GSα. The effects of the k opiate agonists on the pertussis catalyzed ADP-ribosylations were reserved by the opiate antagonist naloxone. Naloxone itself had no effect on the ADP-ribosylation. μ and δ opiate agonist did not affect the pertussis toxin catalyzed ADP-ribosylation. Materials, which activate G-protein-receptor dissociation such as GTP and NaCl greatly attenuated the inhibitory effect of U50499. A similar effect was observed by the addition of purified βγ dimers and Lubrol PX, which increased the ADP-ribosylation of both Giα and Goα. These results suggest that the opiate receptors are tightly linked to the G-proteins and the reduction in the level of the ADP-ribosylation of Giα and Goα may reflect a change in the G-protein coupling to the opiate receptor leading to opiate receptor desensitization.