병원과 지역사회에서 메티실린 내성 황색 포도상구균(methicillin-resistant Staphylococcus aureus) 감염의 임상 분자역학 연구

박정원,이종섭,송준영,김철현,엄중식,정희진,김우주,박승철 대한화학요법학회 2002 대한화학요법학회지 Vol.20 No.2

목적 : 국내에서 1990년대 이후 중요한 병원균으로 대두되고 있는 methicillin-resistant S. ureus(MRSA)는 주로 입원환자에서만 분리되는 것으로 알려져 있으나, 최근들어 지역사회에서도 퍼져있는 것으로 알려지기 시작하였다. 이에 병원획득 및 지역사회획득 MRSA의 임상역학 및 분자역학적 연구를 통하여 획득요인, 병원과 지역사회 획득 균주간의 교류 양상등을 규명하고자 하였다. 방법 : 1998년 1월부터 12월까지 고려대 부속 구로병원에서 임상검체로부터 분리된 S. aureus 균주중에서 MRSA 균주의 빈도를 구하였고, 이중 1998년 10월 1개월 동안 분리되었던 42균주에 대하여 지역사회획득 균주와 병원획득 균주로 나누고, 임상역학적 조사를 하였다. 지역사회 획득 18주와 병원획득 22주에 대하여 PCR 방법으로 mecA 유전자를 확인하였고, PFGE를 시행하여 균주의 클론형(clonal type)을 결정하고 이 결과에 준하여 덴드로그램 분석을 시행하여 분자적 친밀도를 결정하였다. 결과 : 1998년 1년간 분리된 총 1,587주의 S. aeureus 균주중 73.8%(1,163주)가 MRSA 였다. 1998년 10월 1개월 동안 임상자료의 고찰이 가능하였던 MRSA 감염환자 42명 중 20명이 지역사회획득 환자였고, 병원획득 환자가 지역사회획득 환자보다 항생제사용 과거력(17 vs 5, p=0.001), 기저질환의 존재(18 vs 8, p=0.002) 등이 통계적으로 의미있게 높았다. 지역사회획득환자가 이루(7/20[35.0%] vs 2/22[9.1%] ; p=0.041)와 밀접한 관계가 있음도 확인하였다. 분자생물학적연구가 진행된 40주의 MRSA 균주는 모두 mecA 유전자 양성이었고, 18주의 지역사회획득 균주에서 총 8가지의 PFGE 클론형이 존재하였으며 A형이 가장 많았다(7/18, 38.8%). 22주의 병원획득균주에서는 6가지의 클론형이 존재하고 A형이 가장 많았으며(15/22, 68%), 15주의 지역사회획득 균주(83.3%)가 21주의 병원획득균주와 공통적인 클론형을 공유하고 있었다. 결론 : 지역사회 획득 MRSA는 주로 이루나 창상부위에서 많이 분리되는 반면 병원획득 MRSA는 객담에서 많이 분리되고 또한 당뇨병을 가진 환자에서 감염을 잘 일으키는 것으로 밝혀졌다. PFGE 분석 결과 원내감염은 단일균주에 의한 유행양상을 보였고, 지역사회에서도 같은 형의 균주에 의한 감염빈도가 가장 높음을 보여 MRSA 균주가 지역사회로 유입되어 지역사회내 MRSA 감염의 발생에 기여했을 것으로 사료된다. Background : Until recently, methicillin-resistant Staphylococcus aureus (MRSA) infection has been acquired primarily in hospital settings. During the late 1990s, the incidence of community-acquired MRSA infections has been increased in this university hospital. This retrospective study evaluated the clinical features and risk factors for community-acquired MRSA infection compared with hospital-acquired MRSA infection; and molecular relatedness of MRSA strains determined by pulsed-field gel electrophoresis(PFGE). Method: MRSA isolates collected from patients during October of 1998 were classified as community-acquired("community') or hospital-acquired("hospital") cases. MRSA infections were defined as hospital-acquired if organisms were isolated > 48 hours after admission to the hospital or isolated from patients with a history of admission to a hospital within the last 3 months. A comparative analysis of risk factors for community MRSA compared with hospital MRSA was performed. mecA gene PCR and PFGE of MRSA isolated was used as a tool of strain identification and molecular typing. Result : During one month, there were 42 patients with MRSA infection or colonization. Of 42 patients with MRSA isolates, 22(52%) were hospital cases and 20(48%) were community cases. Previous exposure to antibiotics(17 vs 5, p = 0.001) and presence of underlying diseases (18 vs 8, p = 0.002) were more common in hospital cases than in community cases. MRSA were more frequently isolated in otorrhea specimens from patients with otitis media in community cases compared with hospital cases. Of the 40 MRSA isolates subjected for PFGE typing, 18 were community isolates and 22 were hospital isolates. There were 8 distinct PFGE types among the 18 community isolates and type A was the most common clonal type (7/18, 38.8%). 22 hospital isolates were of 6 distinct PFGE types, and type A was dominant clonal type (15/22, 68%). PGFE subtyping indicated that 15(83.3%) of 18 community MRSA strains were clonally related with that of 21 hospital MRSA strains. Conclusion : Our results suggest that hospital MRSA strains may have disseminated in the community setting. PFGE subtyping support the finding that MRSA is circulating beyond nosocomial settings in the regional community.

Putti-platt 씨 법에 의한 습관성 견갑관절 탈구 2예 치험보고 : Two Cases Report

박준식,전경호 최신의학사 1971 最新醫學 Vol.14 No.3

Two cases of recurrent dislocation of the shoulder were treated by Putti-platt operation at Capital Army Hospital in 1970. Patients are young men whose age are 24 and 26 years old. At addmission their physical contour were normal and noted that history of 11th and 5th times of recurrent. In x-ray view there. were no specific abnormalities. There are many procedures for recurrent dislocation of the shoulder but many advantages and disadvantages are present at same time in each procedure. Nowadays Bankart and Putti-platt operation are widely accepted due to its excellent result to many surgeons. After putti-platt operation the range of motion were 150° in abduction and 30° in external rotation in primary case and 170° abduction and 35° external rotation in next case. Afte operation there ware no recurrent, pain and other complications.

진단적 복강 세척법

박상문,박준석,류명곤,김갑득,송화식,김종완 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Diagnostic peritoneal lavage is a accurate and safe method confirming the intraabdominal injury with head trauma, unstable multiple injuried patients. But the development of imaging technique and the trend in noninvasive diagnostic value is decreasing now. In the emergency room, the emergency physicians are required the rapidity and accuracy in intial assessment and the decisions for the operation or not. So emergency physicians have been investigating the diagnostic method for intraabdomial injury that is more rapid, safe and accurate. Many diagnostic tools are developed and now accepted and used widely, among them the diagnostic peritoneal lavage is still the best method for unsatble or head injuried patients. But the positive diagnostic criterias are variable by many authors and still remain imperfectly. So our study was reviewed by medical record of patients who were undertaken the diagnostic peritoneal lavage for the diagnosis intraabdominal injury and statistical analysis was done compared with many criteria of red blood cell and white blood cell for the more accurate way. A retrospective study of diagnostic peritoneal lavage was done of 90 patients with blunt abdominal trauma during 2 years from January, 1996 to December, 1997 and summerized our experience. The results were as follows; 1) There are 73 males and 17 females in sex. The most common type of injury was the traffic accident. 2) With many variable criteria of RBC and WBC, the accuracy and the false positive and false negative were not different in statistical results. The average accurracy was 80.1%. 3) The operations were done in 30(33.3%) cases, and the most frequent injuried organ was the small bowel, 20 cases(66.7%).

화학 용액 증착 공정으로 제조된 후막 Pb(Zr_(0.52), Ti_(0.48))O₃의 e_(31,f) 특성

박준식,양성준,강성군,나경환 대한금속재료학회 2003 대한금속·재료학회지 Vol.41 No.9

Thick Pb(Zr_(0.52), Ti_(0.48))O₃(briefly, PZT) films are required for the cases of micro actuators and sensors with high driving force, high breakdown voltage and high sensitivity, and so on. In this work, thick PZT films were fabricated by chemical solution deposition process. Total 16 types of samples using thick PZT films with thicknesses, about 1 ㎛ and 2 ㎛, and Pt top electrodes shapes for measuring effective transverse piezoelectric coefficients (e_(31,f)) were prepared using MEMS processes. All samples were characterized by fabricated e_(31,f) measurement system before and after poling process at 125 kV/cm and 150℃ for 10 min. |e_(31,f)| values of samples after poling were higher than samples before poling. Those of 2 ㎛ thick PZT films were also higher than 1 ㎛ thick PZT films. We found that |e_(31,f)| was directly related with {111} to {h00} crystal structures of thick PZT films. And those with narrow electrodes (x₁- x_(0)) as top Pt electrodes were also higher than cases with wide top Pt electrodes in agreement with given equation.

Cutter-Sanborn저자기호에 관한 분석적 고찰

박준식 韓國文獻情報學會 1992 圖書館學 Vol.23 No.1

The purpose of this is to evaluate the contents through the analysis of the merits and demerits, and its special quality of the Cutter-Sanborn Three-figure Author Table. table. The abstract of this study is as follows : With the results of the analysis of Cutter-Sanborn's Table, several advantages were found in the area of enumerative-ordinal numbering system, mixed notation, and information retrieval. A defect is that each corporate author and serials and reference book's titles are difficult to be numbered, and there is serious diviation in percentages of the numbers assigned to each letter because each letter apportion rate was applied without any criteria. Such phenomenon decrease the effectiveness as author notation in several letters. The separation of headings are seriously unbalanced because the separation of heading is not consistent with actual publishing trends. This phenomenon made difficult individualization of materials in several letters

TiN 코팅이 전기도금한 교정용 스테인레스스틸 선재의 세포독성에 미치는 영향

최준규,조진형,황현식,박병주 전남대학교 치의학연구소 2003 구강과학 Vol.15 No.4

This study was performed to investigate whether TiN coating could reduce the cytotoxicity of electroplated orthodontic stainless steel wire which had been known to be cytotoxic. Nickel plating was done on stainless steel wire using a electroplating technique. Some of the electroplated wires were coated by TiN film and 4 groups of specimen were prepared (Non-coated electroplated wire, TiN coated electroplated wire, Titanium which was known to have no cytotoxicity, Copper which was known to have high cytotoxicity). Each wire was incubated for 72 hours on the medium. The release of the metal ion was measured by ICP-AES. The incubated medium was diluted 75 %, 50%, 25 % and added on each microplate with Balb/c 3T3 mouse fibroblast for MTT analysis and compared with medium only. Through the measuring of the change in absorbency value of each wire group and the difference of absorbency value according to change of dilution, following results were obtained. 1. The results of ICP-AES analysis showed that lots of nickel ions were isolated from non-coated wires but not isolated from TiN coated wires. 2. The inverted microscope showed that there was a decrease in cell count in non-coated wires but no significant change in TiN coated wires. 3. The results of MTT analysis showed that there was no difference in the absorbency value between TiN coated wires and medium and between titanium and medium but the absorbency value of non-coated wires and copper were lower than that of medium only at all dilution and showed statistically significant differences(p<0.001). 4. Assessment as per ISO 10993, part 5, non-coated wires and copper investigated corresponded to "moderately cytotoxic" and "highly cytotoxic" ; whereas titanium and TiN coated wires were alloted to "non-cytotoxic". The results of the present study indicate that the cytotoxicity of the electroplated orthodontic wire can be changed from "moderately cytotoxic" to "nontoxic" by TiN coating and electroplated wire can be used clinically without the concern of cytotoxicity.

마이크로 압전 엑츄에이터용 Sol-Gel PZT 박막의 두께 변화에 따른 특성

장연태,박준식,김대식,박효덕,최승철 호서대학교 반도체제조장비국산화연구센터 2001 반도체장비학술심포지움 Vol.2001 No.-

Pb가 10% 과잉되고 Zr : Ti = 52 : 48 조성을 갖는 PZT sol이Pt(3500A˚)/Ti(400A˚)/SiO2(3000A˚)/Si(525㎛)기판 위에 스핀 코팅법으로 반복 코팅된 후, 450℃에서 10분, 650℃에서 2분간 반복 열처리되었다.이와 같이 다양한 두께로 적층된 박막은 각 시편에 대해 최종적으로 650℃ 30분 동안 어닐링 처리되었다.제조된 PZT 박막의 두께는 4100A*에서 1.75㎛사이의 4종이었다.이어서 스퍼터링법으로 Pt전극이 PZT 막 위에 증착되었다.제조된 PZT 박막의 결정 구조 조사를 위해 XRD, 그리고 미세 구조 및 전기적 특성을 알아보기 위해 FESEM과 P-E 이력 곡선이 각각 관찰되었다.4100A˚에서 1.75㎛까지 두께 중가에 따른 장비상의 포화 이력 한계로 잔류 분극(Pr)값이 25A˚u C/㎠에서 다소 감소되었다.측정된 X선 회절 결과에서 최초 4회 코팅시 perovskite 결정 구조로 성장한 결정립은 (111)배향이 우세하였으나, 두께가 증가됨에 따라 (111)/(110)값이 감소되었으며, 이를 통해 두께 증가에 따른 (111)배향성이 다소 감소됨을 알 수 있었다.이상의 결과로부터 제조된 PZT 박막은 큰 힘과 높은 내전압 특성을 갖는 마이크로 압전 액츄에이터에 적용될 수 있을 것으로 생각되었다.

복부외상 환자에 관한 임상적 고찰

현석천,박준석,김갑득,송화식 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

This report is a retrospective clinical study of 60 patients with abdominal trauma admitted and treated at the department of emergency medicine of DanKuk University hospital during the period from January 1995 to December 1995. we obtained following results. 1) The sex distribution was 45 males(75%) and 15(25%) females with significant predominence in male(3:1), and the age distribution revealed high incidence in second to fourth decades(50%). 2) The cases of the abdominal trauma were traffic accident(80%) in most common, violence, fall down in order frequency. All were blunt trauma. 3) The clinical manifestations and physical examination were abdominal pain(92%), abdominal tenderness, rigidity, decreased bowel sound, rebound tenderness in order frequency. 4) The shock status on admission(below 80 mmHg in systolic) were 10 cases with high mortality(30%). 5) The hematocrit changes in serial check after admission were 36 cases(60%). 6) The diagnostic methods were abdominal paracentesis, simple X-ray, abdominal sonography, abdominal CT, and DPL(Diagnostic Peritoneal Lavage). The abdominal paracentesis showed positive 36 cases(63%) among 48 cases. Abdominal paracentesis was one of the valuable diagnostic method in abdominal trauma. The Abdominal CT was the best diagnostic method in solitary organ injury, but the diagnostic rate was very low(25%) in small bowel injury. 7) The injured intraabdominal organs were small bowel(41%), liver(30%), spleen(20%), and kidney(17%). 8) The commonly associated extraabdominal injury were chest trauma(30%), upper and lower extremity injuries(20%), head trauma(15%). 9) The overall mortality rate was 5%, in abdominal trauma with multiple injury.

전국 10개 종합병원 중환자실 환자의 직장내 Vancomycin-resistant Enterococci(VRE) 보균율, 보균의 위험요인 및 유전적 다양성 조사

정희진,송준영,엄중식,김우주,최선주,최정현,이혁,정문현,이광미,신동현,손보라,최종성,우흥정,권정아,이경원,최강원,박승철 대한감염학회 2002 감염 Vol.34 No.5

WORK AND QUALITY OF WORKING LIFE IN THE PERCEPTION OF THE KOREAN PEOPLE

JOON-SHIK PARK(박춘식) 서울대학교 사회발전연구소 1998 Journal of Asian Sociology Vol.27 No.2