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.

Dehydrocoupling of Bis(1-sila-3-butyl)benzene and 2-Phenyl-1,3-disilapropane to Polymers Using Zirconocene Combination Catalysts

Jun Lee, Jong-Hyun Kim, Soo-Yong Mo, Hee-Gweon Woo1, Do-Heyoung Kim, Jin Jun 조선대학교 기초과학연구원 2011 조선자연과학논문집 Vol.4 No.3

The catalytic dehydrocoupling of bis(1-sila-3-butyl)benzene 1 and 2-phenyl-1,3-disilapropane 2 by Cp2ZrCl2/Red-Al and Cp2ZrCl2/n-BuLi was reported to compare their catalytic efficiency. The dehydrocoupling of monomeric silanes 1 with the Cp2ZrC12/Red-Al and Cp2ZrCl2/n-BuLi combination catalysts produced two phases of polymers: one is a highly crosslinked insoluble solid, and the other is noncross-linked or slightly cross-linked soluble oil and could be a precursor for the solid polymer. The dehydrocoupling of 2 with the Cp2ZrCl2/n-BuLi combination catalyst similarly produced two phases of polymers. By contrast, the catalytic reaction of 2 with the Cp2ZrCl2/Red-Al combination catalyst produced a soluble polymer via redistribution/dehydrocoupling process.

老齡者의 建康을 위한 生活習慣 實態調査

申東敏,長鳳愚,李揆文,金賢俊,金昌範,崔宗洙,崔鍾晥,李鍾珏,金圭碩,趙庚旭,金鍾聲,朴鍾振 平生體育硏究所 論文集 1987 平生體育硏究所 論文集 Vol.2 No.-

With a view to examining the habit and method in which old people maintain and improve their health, we consulted 551 men and 444 women who were over 65 years old, and concluded as follows: 1. Habit of eating It's been revealed that most of the old people keep a regular eating hour, control the quantity of meal or eat a little food, and prefer vegetables to meat. 2. Mental health Old people feel the necessity for mental health and most of them (about 80%) keep good mental health without becoming pessimistic. Their chief concenrs have turned out to be about their sons and daughters and their own health and finance. 3. Managing Good Health It has been revelaed that old people do not possess any special kind of secret to keep good health but taking plenty of rest, regular meal, and proper exercise, and many of them (about 60%) have been shown to eat invigorant food that they can easily get around their living area. 4. Physical Functions It has been revealed that many old people are conscious of some symptoms about their parts of body and about to percent of them suffers from neuralgia. Some measures like medical aid especially for old people need to be taken as soon as possible. As we have found that the health-keeping method of old people consists plenty of rest, proper exercise, and appropriate nutrition, we can conclude that the recreatonal and culture facilities and programs for keeping old people in good health should be developed. It is also necessary to study food that contribute to their health and develop ways to get rid of the stresses to which they are exposed in their daily life. Presides, it is natural that government found an administrative department to deal with these matters effectively.

뇌실외 배액술 시행과 관련된 뇌실염 : 원인균주와 경험적 치료약제의 적절성

도병훈,김신우,오종택,손종원,하상우,이응갑,장현하,이종명,김능수 대한감염학회 2005 감염과 화학요법 Vol.37 No.2

목적 : 본 연구는 뇌실외 배액술을 시행한 신경외과 환자들에서 뇌실염 발생 빈도, 원인균주와 감수성 추이 및 경험적 치료로 사용되는 항생제인 ceftazidime과 vancomycin의 적절성 여부에 대하여 조사하였다. 재료 및 방법 : 2000년 12월부터 2003년 10월까지 EVD를 시행한 경북대학교병원 신경외과 입원환자 340명 중 뇌실염이 발생한 39명을 대상으로 후향적으로 조사하였다. 결과 : 340명 중 39예 (11.5%)에서 뇌실염이 발생하였고 이들 가운데 4명이 뇌실염과 연관하여 사망하였다(10.3%). EVD 시행일로부터 뇌실염 발생까지는 평균 8.4일이었다. 원인균은 33예(87.1%)에서 확인되었으며 Aci-netobacter (19예, 45%), methicillin-resistant coagulase negative Staphylococcus (9예, 22%), methicillin-resistant Staphylococcus aureus (9예, 22%) 등의 순이었다. 가장 많이 동정된 Acinetobacter 19예 중에서 8예(42.1%)가 ceftriaxone에 내성을 보였으며 현재 경험적으로 널리 사용되는 ceftazidime에 대해서는 11예중 3예(27%)가 내성을 보였다. 결론 : 최근 EVD 시행과 관련된 뇌실염 뇌실염 최근 그람음성 non-fermenter 특히 Acinetobacter에 의한 경우가 증가하고 있으며, 이들 그람음성 non-fermenter는 현재까지 경험적으로 사용되는 ceftazidime에 점차 내성을 보이고 있다. 경험적 치료제에 대한 성공률을 높이기 위해서는 각 병원별 내실염의 원인균주의 감수성에 대한 검사가 필요하겠다. Purpose : To investigate the etiologic microorganisms of external ventricular drain (EVD)-related ventriculitis and the appropriateness of using ceftazidime and vancomycin as an empiric therapy in neurosurgical patients with EVD-related ventriculitis. Materials and Methods : Retrospective analysis of 39 patients with EVD-related ventriculitis among 340 neurosurgical patients to whom EVD had been placed during December 2000 and October 2003 at Kyungpook National University Hospital. Results : Thirty-nine EVD-related infections (39/340, 11.5%) occurred and the attributable mortality rate was 10.3% (4/39). The average duration from the ventricular catheter placement to the development of ventriculitis was 8.4 days. All patients with EVD infection had fever and 89.7% (35/39) of the patients showed nuchal rigidity. The positive culture rate in CSF was 87.1% (34/39) and the frequency of individual organism is as follows : Acinetobacter 45% (19 cases), methicillin-resistant coagulase negative Staphylococcus 22% (9 cases), methicillin-resistant Staphylococcus aureus 22% (9 cases), Enterococcus 5% (2 cases), Streptococcus pneumoniae 3% (1 case), non-fermenting gram-negative bacilli 3% (1 case). The polymicrobial infection rate was 15.4% (6/39). Among 19 cases of Acinetobacter infection, 42.1% (8/19) of the strains showed resistance to ceftriaxone and 15.7% (3/11) to ceftazidime. However, all cases were sensitive to meropenem. Conclusion : These findings show that the major etiologic organisms causing EVD-related ventriculitis have recently changed to Gram-negative non-fermenters, especially Acinetobacter. Because Gram-negative non-fermenting rods resistant to ceftazidime are increasing, an immediate change from ceftazidime plus vancomycin, the widely accepted empiric antibiotic therapy, to meropenem plus vancomycin should be considered when clinical symptoms and signs show no improvement or even deterioration.

Tardive Dyskinesia 에 대한 Sodium Valproate 의 치료효과에 관한 연구

禹種仁,權俊壽,洪澤裕 大韓神經精神醫學會 1987 신경정신의학 Vol.26 No.4

We performed the double-blind placebo-controlled study to investigate the therapeutic effect of sodium valproate known as GABA-ergic agent on tardive dyskinesia. 15 out of 31 patients were treated with sodium valproate (maintenance dose: 1500-2700㎎) and the rest of them were treated with placabo over 8 weeks. We checked the severity of tardive dyskinesia by TDRS (Tardive Dyskinesia Rating Scale, Simpson et al, 1979) just before treatment, the 4th week, the 8th week and the 12th week following beginning of treatment. We checked the serum level of sodium valproate at the 4th weeks and the 8th weeks since the beginning of treatment. The results were as follows: 1) Both TDRS scores of 4th week and 8th week were significantly low compared with those of pretreatment in the group treated with sodium valproate (P<0.001), but TDRS scores returned to the pretreatment score at 12th week (4 weeks after withdrawal of medication). There was no significant relationship between serum level of sodium valproate and TDRS total scores. 2) All of the TDRS scores of 4th week, 8th week, and 12th week were significantly low compared with those of pretreatment in the group treated with placebo.(P<0.01) 3) TDRS scores of the group treated with sodium valproate were not significantly different from those of the group treated with placebo at the time prior to treatment, 4th week, 8th week and 12th week.

사지 체벽 복합기형 1례

우종진,조석재,박소정,박재복,김용진,조경일,이헌수 啓明大學校 醫科大學 1993 계명의대학술지 Vol.12 No.3

Limb body wall complex(LBWC) has been included in the spectrum of defects seen in early amnion rupture sequence. LBWC is a complicated fetal malformation with essential features of exencephaly or encephaloceles associated with facial clefts, lateral body wall defects with evisceration of organs, and limb defects. Our case is characterized by the absence of craniofacial anomalies and normal development of urogenital system comparing with other repoerted cases. We present a case of LBWC with a brief review of the literatures.

관해된 정신분열병과 양극성장애 환자의 언어성 기억 및 학습 기능 비교

우종민,정성심,정인원,김이영,이동수,홍경수 大韓神經精神醫學會 2001 신경정신의학 Vol.40 No.4

연구목적 : 본 연구는 관해 상태에 있는 정신분열병과 양극성장애 환자의 언어성 기억 및 학습 기능을 평가하고 이를 정상대조군과 비교하여 기억 요소의 질환별 특성을 분석하고자 실시하였다. 방 법 : 관해상태의 정신분열병 환자 30명과 양극성장애 환자 28명 및 정상대조군 72명을 대상으로 성, 연령, 교육연한, 발병연령, 잔여증상, 추체외로증상, 단순주의력 수준을 통제한 후 한글언어청각학습검사를 실시하여, 초과용량 즉각기억, 기억의 등록, 유지, 인출, 재인, 학습전략, 간섭효과를 분석하였다. 결 과 : 한글언어청각학습검사 결과를 세 집단간 비교한 결과, 정신분열병은 전행성 간섭효과를 제외한 모든 항목에서 대조군보다 유의하게 저하된 기억 수행을 보였으며, 양극성장애에 비해서도 대부분의 회상 시도에서 유의한 저하를 보였다. 특징적으로 학습 전략 활용 능력이 저조하였다. 양극성장애는 대조군에비해 즉각기억, 재인,학습전략에서 유의한 차이를 보이지 않았으나, 반복에 따른 회상과 학습은 대조군에 비해 유의하게 저하되었다. 정신분열병에 비해서는 전반적으로 비슷하거나 우월했지만, 간접자극 제시에 의한 회상 저하는 세 집단 중 가장 크게 나타났다. 환자군에서 검사성적에 대한 임상적 특성의 설명력을 분석한 결과, 정신분열병에서는 BPRS의 무력증 소척도, 유병기간, 입원횟수 등이 유의한 설명력을 갖는 것으로 나타났고, 양극성장애에서는 우울삽화 횟수가 유의한 설명력을 갖는 것으로 나타났다. 결 론 : 관해상태의 양극성장애와 정신분열병 모두에서 대조군과 구별되는 언어성 기억 및 학습 기능 저하가 관찰되었다. 이러한 기억 및 학습 기능의 결함은 이들 두 장애의 고유한 질병 특성 표지자일 가능성이 높으며, 향후 이들 질환의 병태생리를 이해하고 치료적 접근 방법을 모색하는 데에 단초가 될 수 있을 것이다. Objectives : This study was to investigate the verbal memory and learning ability in remitted schizophrenic patients and euthymic bipolar patients in order to explore trait-dependent cognitive deficits of each disorder. Methods : Verbal memory was assessed with KAVLT(the Korean version of Rey Auditory Verbal Learning Test) in outpatients with remitted schizophrenia(N=30), euthmic bipolar disorder(N=28), and normal control(N=72), KAVLT is made for assessment of immediate supraspan memory, registration, retention, retrieval, recognition, learning strategy, and interference effect. Several confounding factors including age, sex, educational level, attention span, residual psychopathology, and extrapyramidal symptoms were controlled among 3 groups. Patient groups were matched according to the age of onset, duration of illness, and frequency of hospitalization. Results : 1) The performance of bipolar group generally fall between the performance of schizophrenia and normal controls, while being most impaired in retroactive interference. Schizophrenic group showed significant impairment on most variables of KAVLT in comparison with the groups of bipolar disorder and normal control. 2) Within group analysis revealed that residual negative symptoms, duration of illness, and number of admission were highly correlated with the impairment of verbal memory and learning in schizophrenics. Number of depressive episodes and age were negatively correlated with verbal memory and learning among bipolar disorder patients. Conclusions : Both remitted schizophrenia and euthymic bipolar patients showed distinctive impairment in verbal memory and learning compared with controls. These results suggest that apecific impairment of verbal memory and learning in remitted state can be trait-dependent marker in both diseases. These deficits can give clues to the understanding of the pathophysiology and searching for more appropriate therapeutic interventions of mental disorders to improve cognitive deficits in remitted patients.

문서화상의 신뢰성 향상을 위한 효율적 합성알고리즘

우종원,김호걸,최길성,유재수,조기형 충북대학교 컴퓨터 정보통신 연구소 1998 컴퓨터정보통신연구 Vol.6 No.2

본 논문은 Distance 합성알고리즘과 Runlength-Distance 합성알고리즘을 이용하여 효율적으로 문서화상을 합성하기 위한 방법을 제안한다. 데이터 또는 문서의 화소정보를 비밀리에 화상에 혼합하는 합성 알고리즘에는 임 Runlength 합성알고리즘(RM), Distance 합성알고리즘(DM), Runlength-Distance 합성알고리즘(RDM)등이 제안되었다. 그러나 이러한 합성알고리즘들을 적용한 기존의 방법은 암호화 시간이 길어지고 신뢰도가 떨어지는 문제점을 갖는다. 본 논문에서는 DM과 RDM 알고리즘을 보다 효율적으로 적용하여 암호화 시간을 단축시켰다. 또한, 기존 합성알고리즘에서의 합성방법을 변형한 형태로서 모듈별로 디지털 서명을 합성하는 방법을 제안한다. 이렇게 모듈별로 디지털 서명을 가함으로써 보안 전송에 있어서 가장 중요한 요소인 신뢰도를 증가시키도록 하였다. Runlength Mixing(RM), Distance Mixing(DM) and Runlength-Distance Mixing(RDM) algorithms have been proposed for mixing of bits of document-images security. However the existing mixing algorithms have some problems that increase cryptographic time and reduce confidence. In this paper, we propose an algorithm for mixing document images efficiently by using DM and RDM. When we mix digital signatures and secure documents, by using DM the proposed algorithm reduces the encryption time of document images. In addition the proposed algorithm mixes digital signatures by each module in order to increase confidence. It is shown through the experiments that our algorithm outperforms the existing mixing algorithms in terms of encryption time and confidence.

효과적인 문헌 정보 관리를 위한 데이타언어와 질의처리기

우종원,윤승현,유재수 충북대학교 컴퓨터 정보통신 연구소 1998 컴퓨터정보통신연구 Vol.6 No.1

데이터관리시스템은 문헌 정보들에 대한 정보 검색 및 관리를 효율적으로 지원하기 위한 시스템이다. 이러한 데이터 관리시스템은 하나의 테이블만으로 정보들을 관리하기 때문에 기존 데이터베이스 관리시스템에서 사용되는 조인 연산과 뷰 연산 등 많은 비용이 소요되는 연산을 제공할 필요가 없다. 본 논문은 데이터관리시스템에서 자료의 주고 정의, 처리 등을표현할 수 있는 효과적인 데이터 언어를 정의하고, 정의된 데이터 언어로 작성된 질의를 효율적으로 처리하기 위한 질의 처리기를 설계하고 구현한다. 구현된 데이터관리시스템을 위한 질의처리기는 기존 관계형 데이터 베이스 관리시스템의 질의처리기를 데이터관리시스템의 질의처리기로 사용할 때 나타나는 성능저하 문제점을 해결한다. Data management System(DMS) is a system that retrieves and manages documents efficiently. Since DMS manages the information using only one table, it does not need to provide join and view operations on DBMS that spend high cost. In this paper we define a data language that represents the structure definition and process of data in the DMS. We also design and implement a query processor to process the query processors of relational DBMS are used as a query processor of DMS, they degrade the whole system performance. The proposed query processor overcomes such a problem.

근로자 당면문제가 스트레스와 업무 수행도에 미치는 영향

우종민,최수찬,김대성 大韓神經精神醫學會 2008 신경정신의학 Vol.47 No.4

Objective : This study was conducted to determine the effects of workers' current problems to the perceived stress and work performance among manufacturing industry workers in Korea. Methods : Responses to structured survey questionnaires were received from 556 workers at 7 medium-sized manufacturing factories in Gyeongsang Province. Results : Among the 556 responders, health problems, job stress, and life stress showed significant effect on their perceived stress. Job stress showed significant effect on workers' lateness and early leaving, and culture & leisure problems on absenteeism. Health problems and job stress took negative effects on their job concentration difficulty. The severity of these problems were related with the desired length of retention. Conclusion : We proved the effect of workers' current problems to their performance. The study results will be helpful to clarify what EAP services should be considered to solve these problems at a certain organization.