아미노글리코사이드 사용제한에 따른 병원성 균혈증 유발 그람음성간균의 내성변화 및 임상적 의의

오종택,김신우,손종원,도병훈,한승우,신병철,박지현,이종명,김능수 대한감염학회 2003 감염과 화학요법 Vol.35 No.4

목적 : 항균제 오남용으로 인한 내성균의 출현, 약물부작용의 발생 및 약제 비용의 증가는 환자 개인뿐만 아니라 사회적으로 문제가 되고 있다. 본 연구는 항생제의 오남용을 막기 위한 제도의 일환으로 시행한 아미노글리코사이드 사용 제한정책의 비용 효과적인 측면을 조사하고 그람음성간균에 의해 병원성 균혈증이 발생한 환자들을 대상으로 이 정책이 항생제 내성률과 환자 사망률에 미치는 영향을 연구하였다. 방법 : 930병상 규모의 3차 병원인 일개 대학병원에서 아미노글리코사이드 사용제한정책이 시행된 직후인 2002년 3월에서 9월 사이에 그람음성간균(Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Serratia marcescens, Stenotrophomonas maltophilia, Burkholderia cepacia)에 의해 발생한 병원성 균혈증 환자 60명(실험군)과, 이 정책이 시행되기 전에 입원한 환자들 중 균주별로 같은 수만큼 선별한 병원성 균혈증 환자 60명(대조군)의 의무기록을 후향적으로 조사하였다. 결과 : 아미노글리코사이드 사용제한정책이 시행된 시기인 2002년 3월에서 9월 사이에 처방된 아미노글리코사이드 사용량 및 비용을 이 정책이 시행되기 전인 2001년 3월에서 9월 사이와 비교한 결과, 아미노글리코사이드의 사용량(antimicrobial utilization density)은 사용제한 후 225.2에서 130.3으로 42% 감소하였고 약제 비용은 44% 감소하였다. 아미노글리코사이드 사용제한 후 병원성 균혈증을 유발한 그람 음성간균의 이 항생제에 대한 내성률은 유의한 변화를 보이지 않았으며 균혈증과 직접 연관된 사망률도 환자의 나이, 성별, 기저질환 및 원발병소 등을 보정할 경우 유의한 차이를 보이지 않았다(40.4% vs. 24.1%, P=0.11). 결론 : 아미노글리코사이드를 5일을 초과한 사용 시 감염전문가의 사전 승인을 필요로 하는 사용제한정책은 아미노글리코사이드의 사용량과 비용을 유의하게 감소시켰다. 또한 이 정책 시행 후 그람음성간균에 의한 균혈증 환자에서 균혈증으로 인한 사망률과 아미노글리코사이드에 대한 내성률은 유의한 차이가 없었다. Objective : To evaluate the effects of an aminoglycoside restriction policy on expenditures for aminoglycosides, antimicrobial resistance rates and clinical outcome of nosocomial bacteremia caused by Gram-negative bacilli (GNB). Methods : Starting in February, 2002, a prior consultation with an infectious disease specialist for using aminoglycoside antibiotics over 5 days was required in a 930-bed university hospital. In retrospective analysis of medical records 7 months after initiation of the aminoglycoside restriction policy, sixty cases of clinically relevant nosocomial bacteremia caused by GNB were found. These bacteremic patients were compared with sixty, species-matched, control patients with nosocomial Gramnegative bacteremia before the policy for total expenditures for aminoglycosides, susceptibility to antibiotics and clinical outcomes of bacteremia. Results : During the same period of 7 months before and after the restriction policy, total expenditures for aminoglycosides decreased by 44% in cost (from 465,030,841 Won to 259,618,337 Won) and the antimicrobial utilization density of aminoglycosides decreased by 42% (from 225,2 to 130.3). On the other hand, the patterns of antibiotic susceptibility and bacteremia-related in-hospital mortality rates after the policy did not show a significant change, compared with those before the policy. Conclusion : Antibiotic restrictions are among the most popular methods to diminish the practice of antibiotic overuse in hospitals. In this study, requirement for prior approval of aminoglycoside use over 5 days led to a significant decrease in the amount and cost of total aminoglycosides without a significant change in susceptibility patterns and bacteremia-related mortality rates.

혈중 감마지티피 상승의 임상적 의의

신주연,김용규,박신구,이지나,김환철,임종한,홍윤철 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.1

목적: 혈중 감마지티피는 주로 알코올 섭취와 간세포 손상의 지표로서 이용되어져 왔으나 최근에는 혈중 감마지티피가 체내의 산소성 스트레스를 민감하게 반영하는 지표이며, 혈중 감미지티피를 이용하여 만성질환의 발생을 조기에 예측할 수 있다는 주장들이 있다. 이에 본 연구에서는 일반 인구 집단을 대상으로 한 건강검진 자료를 분석하여 혈중 감마지티피의 상승에 영향을 미치는 요인들을 분석하고 혈중 감마지티피와 산소성 스트레스와의 관련성 및 임상적인 이용 가능성을 알아보고자 한다. 방법: 2001년부터 2003년까지 한 대학병원 산업의학과에서 건강검진을 실시한 15,546명을 대상으로 하였고 신체계측, 혈액검사 그리고 설문지의 정보를 분석하였다. 총 15,546명 중 남성은 9,660명 이었고 여성은 5,886명 이었다. 연령, 성별, 체질량지수, 흡연, 음주, 운동량 비타민 복용 여부에 따른 혈중 감마지티피의 평균을 분석하였고, 성별에 따른 다변량 분석을 실시하였다. 다변량 분석에는 연령, 체질량지수, 음주빈도, 흡연량, 혈색소, 이완기혈압, 공복시혈당, 총콜레스테롤, ALT를 포함하였다. 결과: 연구 대상자들의 혈중 감마지티피의 평균은 남성에서 평균(±2SD)이 47.51(±111.62)이었고, 여성에서는 19.09(±42.02) 으로서, 대체적으로 정상 범위에 있다고 보여 지나 개인차가 상당히 크다는 사실을 알 수 있었다. 다변량 분석의 결과에서는 혈중 감마지티피의 상승에 영향을 미치는 요인이 성별에 따라 다소 달랐으나 남녀 모두에게 연령, 음주빈도, 흡연량, 이완기혈압, 공복시혈당, 총콜레스테롤, ALT가 유의한 영향이 있음을 확인할 수 있었다. 그리고 다변량 로지스틱회귀분석의 결과에서 '임상적 비정상'을 예측함에 있어 혈중 감마지티피가 진단적 유용성이 있음을 확인하였다. 결론: 긴존에 일반적으로 알려져 있는 것처럼 혈중 감마지티피를 단순히 알코올 섭취와 간세포 손상의 지표로서만 볼 수 없으며, 성별, 연령, 흡연, 고지혈증, 당뇨, 고혈압 등 많은 다른 요인들에 의해서 영향을 받으며, 혈중 감마지티피를 산소성 스트레스를 반영하는 생물학적 지표로 해석할 수도 있다. 따라서 혈중 감마지티피의 상승을 임상적으로 해석할 때는 (비록 정상인 범위에 있다하더라도), 알코올 섭취나 간세포 손상 뿐 아니라 다른 여러 요인들을 함께 고려해야 한다. 더욱이 혈중 감미지티피의 상승을 만성질환 즉, 고혈압, 당뇨, 고지혈증 등의 발생을 조기에 발견할 수 있는 지표로서 임상영역이나 건강검진시 유용하게 활용할 수 있을 것이다. Objectives: Incresed gamma-glutamyltransferase (GGT) concentration has mainly been used as a biologic marker of alcohol drinking and liver diseases. However, some recent reports have suggested that serum GGT concentration may be an early biomarker of oxidative stress and associated with chronic diseases like hypertension, DM, hyperlipidemia, CHD, stroke etc. In this study, we analysed the factors associated with increased serum GGT level and evaluated the clinical application of serum GGT in predicting the risk of chronic diseases. Methods: The data were collected from 15,546 periodic health examinations, 9,660 males and 5,886 females, done at one university hospital from 2001 to 2003. We analysed self-questionnaire, physical examination and laboratory data. Statistical analyses(t-test, ANOVA, Pearson's correlation analysis, multiple regression analysis and logistic regression analysis) were done by SPSS for windows 10.0. Results: Mean serum GGT levels were quite different according to age, sex, BMI, smoking and alcohol drinking (all P-value <0.001), but were not different by regular vitamin intake or not (P-value = 0.117). There was significant correlation between serum GGT level and the variables (of age, BMI, blood pressure, Hb, fasting blood sugar, total cholesterol, AST and ALT) (all P-value <0.001). In sex-specific multiple regression analysis, increased serum GGT level was significantly associated with age, alcohol drinking, smoking, blood pressure, fasting blood sugar and ALT in males (all P-value <0.001), and with age, alcohol drinking, smoking, Hb, blood pressure, total cholesterol and ALT in females (all P-value <0.05). In sex-specific logistic regression analysis, increased serum GGT level was significantly associated with risk of 'clinical abnormalities'. This risk increased about 13-fold in males and 4.6-fold in females for serum GGT level over the third quatile, compared with under the first quartile. Conclusions: Serum GGT level is increased not only by alcohol drinking or liver diseases, but also by many other factors associated with chronic diseases and behavioral factors. Thus many factors should be considered in evaluating an increase in GGT level, even when within the upper normal range. Serum GGT level may be a predictor for the early development of chronic diseases.

요부수핵탈출증에서 Thermography의 진단적 가치

신현택,신승우,송재철,정석희,이종수,김성수,신현대 경희대학교 동서의학연구소 2001 東西醫學硏究所 論文集 Vol.2000 No.-

Objectives : Lumbar radiculopathy is a common disease in oriental rehabilitation medicine. It can be diagnosed by physical examination, plain X-ray, Myelography, CT, MRI, EMG etc. But those methods are not useful in observing the clinical procedure. Objectvie evaluating the clinical procedure is very important in treatment of lumbar radiculopathy. Mehthods : We studied the clinical efficacy of thermography in lumbar radiculopathy during conservative managements. We studied 36 patients with lumbar radiculopathy convinced by MRI. The had low back pain and radiating pain on one side. Thermography had taken before an after 4 weeks treatments, and compared with clinical procedure Results and conclusions : Thermography is not pertinent as a primary diagnostic method in lumbar radiculopathy, but useful in observing the clinical procedure. And it can be recommended as a objective evaluation for lumbar radiculopathy.

인체측정변인에 의한 펜싱 종목의 경기력 판별분석

신범철,유종만,최태석,박재현,김혜진 한국스포츠리서치 2003 한국 스포츠 리서치 Vol.14 No.4

The purpose of this study was to analyze on the morphological characteristics of elite fencing players. In this study, 32 male fencing players completed the measurement of 39 anthropometric variables. To assess of the differences between elite fencing player and non-elite fencing players' morphological characteristics, discriminant test and morphological analysis were used. The results of this study were follows. There were no statistical differences in all the morphological characteristics between elite player and non-elite players in length variables except length variables. In conclusion, elite and non-elite players of fencing become most discriminant by length variables.

震顫痲痺에 對한 文獻的 考察

申鉉喆,金鍾?,鄭智天 동국대학교 한의학연구소 1995 東國韓醫學硏究所論文集 Vol.4 No.-

This study is that examine ana readjust cause - pathology, symptom, treatment, clinical reports recorded in western medicine, successive literature of oriental medicine and recent literatures and journals of chinese medicine about Paralysis agitans. The results was followed ; 1. Paralysis agitans is similar with symptoms of Jinjeon, Qi, Gyeong, Gyejong, Lyeon and Pyengo, Tantan, Jungbu, Jungpung. 2. There are runs, Hwa, Dam, Eo in the causes of disease, Gansinyinheo, Qihyeolyangheo, Jeokyeoldamhwa, Qichehyeoleo, Ganpungnaedong etc in clinical types, to be concerned with liver, kidney, heart and spleen in Jangbu. Gansinyinheo and Qihyeolyangheo are concerned wiyh idopathic paralysis agitans, Jeokyeoldamhwa and Qichehyeoloe successive it, Ganpungnaedong both idiopathic and successive. 3. Treatments are Jayinjamyang, Pyeonggansikpung, Ikqiyanghyeol, Sikpunghwallak, Seoganhaewool, Hwalhyeoltonglak etc, and prescriptions are Yukmi, Chunmagudeongum, Paljintang, Tonggyuhwalhyeoltang, Hyeoltbuchukeotang etc. 4, In caring, it is necessary to live pleasantly, to be temperate sexual intercourse, to control diet, to do suitable exercises, for example Qigong, Physical exercises, Walking etc. 5. In clinical reports, this disease frequently occurs more than 50 years, male is more than female, and there are many complications as hypertension and arteriosclerosis etc. The majority of causes are Gansinyinheo, Qichehyeoleo, and the others are Qihyeolyangheo, Damhwa, Ganpungnaedong, Qigiulche, Yeolyoesimsin etc, the majority of care Jabogansin, Yukyinsikpung, Hwalhyeolhwaeo, and the others Ikqiyanghyeol, Haldamtonglak, Seoganhaewool. Curing period is generally from 2 to 3 months. In effectiveness rate, successive Qichehyeoleo type is the highest, and idiopathic Qihyeolyangheo type is the lowest. Effectiveness of rigidity is higher than tremor.

정신병적 증상을 동반한 기면병 1례

신일선,양종철,윤진상 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.4

저자들은 정신병적 증상이 동반된 기면병 환자를 경험하였다. 본 증례에서 정신병적 증상은 methyl-phenidate에 의해 유발 및 악화되었지만, 또한 기면병과는 별개로 서서히 진행되어온 정신분열병의 증상이기도 하였다. 진단 및 치료 특히 약물치료와 관련된 어려움을 외국문헌의 고찰과 함께 보고한다. The case of a 19-year-old man with coexistent narcolepsy and psychotic symptoms was presented. The psychotic symptoms were induced and / or exacerbated by methylphenidate. In addition, they were considered as symptoms of schizophrenia which had been developed regardless of the use of methylphenidate. The case illustrates the difficulties in diagnosing and treating, in particular, pharmacotherapy.

Computer Graphics에 의한 3성분계 Wilson, NRTL 및 UNIQUAC 방식을 이용한 VLE 추정방식의 비교

신형섭,박종철 慶熙大學校 1988 論文集 Vol.17 No.-

The purpose of this study is to estimate VLE by means of the Wilson, NRTL, UNIQUAC equations and to compare with these three methods for two ternary systems: ethanol-benzene-cyclohexane, cyclohexanone-cyclohexanol-phenol, by the computer graphic technology. The temperatures and compositions of two systems were estimated by means of three TPTT equations. Isothermal lines of these two ternary systems were graphically illustrated from these estimated values and the reported experimental values. As a result of the analysis of the parameters and computer graphics, these parameter pairs changing with respect to the temperature and composition of the solutions. From the result of plotting the parameter pairs, A_12, vs, A_21, a locus contour between two parameters is observed, therefore numerous number of roots to satisfy these TPTT equations are found. These phenomena is nearly identical with the previously reported results that there are some correlation between these parameter pairs.

敗醬草가 癌細胞柱에 미치는 影響

申大澈,權貞南,金瑩均,韓宗鉉,김재석,김재섭 동의대학교 한의학연구소 1997 동의한의연구 Vol.1 No.-

The purpose of this study was to investigate effect of water extract of Patriniae Herba on the poliferation of human cancer cell-lines. The effects of Patriniae Herba on the poliferation of A43l, HeLa, MOLT-4, K562 cells, Balb/c 3T3 cells, mouse thymocytes, splenocytes and human lymphocytes were estimated by MTT colorimetric assay, The results were as follows; 1. Patriniae Herbs did not effect A43l, HeLa, MOLT-4, K562 cells. 2. The cytotoxicity of mitomycin C on MOLT-4 cells was increased by the combination of Patriniae Herba. 3. Patriniae Herba inhibited the proliferation of Balb/c 3T3 cells. 4. Patriniae Herba stimulated the proliferation of thymocytes. 5. Patriniae Herba stimulated the proliferation of splenocytes. 6. Patriniae Herba stimulated the proliferation of human lymphocytes.

全蝎 抽出物의 抗癲癎效果에 關한 硏究

신현철,윤철호,김종대,정지천,신억섭,허근 한국한의학연구원 1997 한국한의학연구원논문집 Vol.3 No.1

In convulsion state by PTZ in rat, anticonvulsive effect and some γ-aminobutyric acid (GABA)-related mechanisms of Bythus extract in brain was experimented. It was ingibited GABA-T activity, lipid peroxide generation and xanthine oxidase activity as scheduled administration in vitro and vivo. And the content of brain gutathione was increased as scheduled administration in rat. In convulsion state by PTZ of previously managed rat by Buthus extract, onset eime and duration were non-specific changes but recovery time and severity was remarkably reduced. In conclusion speculated that Buthus extract inhibits convulsion by control of GABA content in brain.

쇼트피닝 가공 최적조건 탐색을 위한 실험적 연구

신용승,김태형,윤종학,노승남,이철구 서울産業大學校 2002 논문집 Vol.53 No.1

The shot peening process is most often used to improve fatigue properties of metal parts. In order to achieve optimum, repeatable and reliable fatigue enhancement from the shot peening process, the important shot peening parameters must be controlled. In this paper, the optimum shot peening condition is investigated. Rotary bending fatigue test was accomplished to investigate the effects of shot peening on the fatigue strength. Experimental results show that the fatigue strength was tremendously increased by optimum peening.