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.

척수 손상 환자의 우울에 대한 정신과적 고찰

김문두,신태균,심기범,신지남 최신의학사 2003 最新醫學 Vol.46 No.9-10

이소성 타액선에 의한 경부 누공 1예

김병균,김문범,이재봉,오창근,장호선,권경술 대한피부과학회 2003 대한피부과학회지 Vol.41 No.3

Ectopic salivary tissue is an uncommon etiology of a neck mass in an infant. It is due to anomalous embryologic development of salivary tissue. We have experienced a case of cervical fistula due to ectopic salivary gland in 3-year-old male. The discharge is saliva-like and related to meals. Histopathologically, mucinous acini are located in lower dermis and subcutaneous fat. When a cystic neck mass or fistula is present on cervical area especially in children, an ectopic salivary gland should be considered as one of the causes. (Korean J Dermatol 2003;41(3) : 394∼396)

경구용 Fluconazole 투여로 치유된 스포로트리쿰증 1예

김문범,오창근,장호선,권경술 대한의진균학회 1999 대한의진균학회지 Vol.4 No.2

We report a case of lymphocutaneous sporotrichosis in a 76-year-old female successfully treated with oral fluconazole. This case had showed almost complete clinical resolution by 200mg daily administration of oral fluconazole for 7 weeks and has got no relapse until 18 weeks after the completion of the treatment. We would emphasize good therapeutic effects of fluconazole such as more rapid therapeutic response than the previous reports and no observable side effects. [Kor J Med Mycol 4(2): 148-152]

유방암에서 PCR을 이용한 p53 유전자의 Codon 175에서의 점돌연변이에 관한 연구

김영철,김종석,김선한,목영재,최상용,문홍영,구범환 고려대학교 의과대학 1993 고려대 의대 잡지 Vol.30 No.2

The p53 gene, which is located in the short arm of chromosome 17, has been a constant source of fascination since its discovery at 1979. Allelic deletion coupled with mutation of the remaining allele is a theoretical hallmark of functional inactivation of tumor suppressor gene, and mutation and/or deletion of p53 gene is to be the most frequently observed genetic changes in breast cancer related to a single gene. In the present report, we have attempted to determine a point mutation at codon 175 which is known as one of four hot spots within highly conserved regions of the p53 gene where almost all of the reported mutations cluster A 304-bp fragment of exon 5 of p53 gene in fresh tissue of breast carcinoma was amplified by polymerase chain reaction (PCR), digested with Hha I restriction endonuclease, and electrophoresed. A point mutation was studied by observation of polymorphism with ethidium bromide staining under ultraviolet transillumination. The result revealed all of 14 carcinomas had wild-type p53 gene.

시계열 매칭 기반의 윤곽선 이미지 매칭 시스템 설계 및 구현

김범수,문양세,김진호 강원대학교 정보통신연구소 2008 정보통신논문지 Vol.12 No.-

In this paper we exploit time-series matching for boundary image matching. The motivation is based on that images can be converted to time-series. Thus, we implement a boundary image matching system using time-series matching techniques. We use an index-based matching method that efficiently performs boundary image matching. We implement our boundary matching system as a client-server model. Experimental results show that our index-based method outperforms the sequential scan by one to three orders of magnitude. Our system is practically implemented for image matching through the appropriate techniques in the time-series domain, and we thus believe that our approach can be widely used in image matching areas.

수종 유기산 용액에서 글라스 아이오노머 시멘트의 표면조도 및 색 변화에 관한 연구

김용대,문현정,임범순,김철위 대한치과기재학회 1997 대한치과재료학회지 Vol.24 No.2

The chemical bonding ability of glass ionomer cement to tooth structure and sustained fluoried release render glass ionomer cements advantageous over other restorative materials, such a amalgam and composite resins. Poor polishability and high solubility in organic solvents, however, are still a significant disadvantage of the existing glass ionomer cements. The purpose of this study was to estimate the aging effect of glass ionomer cements in organic acid solutions on surface change and color change. Using metal molds, disk type speciments, 100mm×1mm were prepared from three chemical-curing and three light-curing glass ionomer cements. Specimens were prepared from each material following the manufacturer's intructions, and setted against a mylay matrix strip supported by a glass slab. Three specimens were prepared for each experimental groups. Profilometric analyses were carried out using the surface roughness tester(Surtronic 3P, Rank Taylor Hobson Ltd. England). R?? valuse, which were the mathematical mean values of the departure of the roughness profile from the mean line calculated by the machine, recorded. Color measurements(CIE coefficients ; L, a, b) were peformed using the spectrophotometer(CM-3500d, Minolta, Japan). Before aging treatment and after 1, 7, 14, 21, and 28 days aged at 37℃ in a various organic and solutions(such as acetic acid, lactic acid and citric acid) and deionized water, surface roughness and color coefficients measuements were carried out. Then, surface roughness changes(ΔRa) and (ΔE) of specimens were calcuiated. From the experiment, the following results were obtained : 1. Chemical-cured glass ionomer cements showed statistically surface roughness changes after aged in the deionized water(P<0.10), and light-cured glass ionomer cements showed statistically significant color changes after aged in the deionized water(P<0.10). 2. Chemical-cured glass ionomer cements showed statistically color changes after aged in acetic acid solutions (P<0.10), and light-cured glass ionomer cements did not showed statistically significant surface roughness changes, but showed statisticall significant color changes after aged in acetic acid solutions (P<0.10). 3. Chemical-cured glass ionomer cements did not showed statistically significant color changes as a function of concentration of lactic acid solutions (p>0.10), and light-cured glass ionomer cements showed statistically significant color changes after aged in acetic acid solutions. 4. Chemical-cured glass ionomer cements did not showed statistically significant surface roughness changes as a function of concentration iof lactic acid solutions (p>0.10), but showed significantly less solubility in lactic acid solutions than chemical-cured glass ionomer cements.

불소이온에 따른 치과용 티타늄의 물성변화에 관한 연구 : 1. 티타늄 합금의 변색 및 표면 변화 1. TARNISH AND SURFACE CHANGE OF TITANIUM ALLOYS

김철위,임범순,문현정 대한치과기재학회 1998 대한치과재료학회지 Vol.25 No.3

The prophylactic application, at regular time intervals, of gels and solutions containing high concentrations of fluorides had indeed become more frequent, reaching a noticeable impact on the dental caries prevention. In the particular case of dental titanium alloys, however, use of prophylactic products with a high concentration of fluorides could cause tarnish and corrosion of titanium alloys. The aim of this study was to investigate the effect of fluoride concentration and pH value on the tarnish and surface change of titanium alloys, and provide a profitable information whether titanium alloys was affected or not in the concerned environment. Six titanium and titanium alloys and one cobalt-chromiun alloy were investigated by the spectrophotometer and the stereo zoom microscope. Various concentration of fluoride gel and NaF solutions with four different pH values were used as electrolytes for test. From the experiments, the following results were obtained. As the titanium oxide passivated layers were severely damaged by fluoride solution, the degree of discoloration did not show a monotonical increase as function of fluoride concentration and period of treatments. TZN and TZSN showed a significantly high discoloration in the high concentration of fluoride solution. Specimens showed a high discoloration in solution with pH 4 for 1000 ppm NaF solution, and pH 3 for 100 ppm NaF solution. On the contrary, pH values of NaF solution did not affect the discoloration of titanium specimens for fluoride concentration below 10 ppm. NITI showed a less surface damage by fluoride solution than the other titanium alloys. Fluoride solution did not affect the color stability and surface properties of cobalt-chromium alloy (VTL).

구강조건과 유사용액에서 치과용 소와열구 전색제의 잔류 단량체 용출

문현정,이용근,임범순,김철위 대한치과기재학회 2000 대한치과재료학회지 Vol.27 No.1

The estrogenic effect of Bisphenol A (BPA) was targeted because BPA can be present as an impurity in resins (Bis-GMA), or as a degradation product from other resins. 75% ethanol was used as a food-simulating liquids, similar liquid as oral environment, and solubility parameter of which matches that of resin. The purpose of this study was to identify and quantify BPA, TEGDMA, UDMA, Bis-GMA, and degradation product of Bis-GMA that might be released from seven resin-based pit and fissure sealants (CON ; Concise, PFS ; Pit & Fissure Sealant, ELT ; Elite, FSF ; Fissurit F, TMF ; Teethmate F1, UXF ; Ultraseal XT Plus, and HEL ; Helioseal). Specimens were embeded in 1 mm (T) x 5 mm (D) molds then cured and were immersed in 75% ethanol (EH) and artificial saliva (AS) for 1, 7, 14, 21, and 28 days. The extracts were analyzed by HPLC. All the components except BPA were leached highly at the initial stage, so the amount of component leached was not linear with the immersion time. In AS, only TEGDMA was leached. There were significant differences in the amount of eluted TEGDMA depending on the solution (p<0.05) in CON, PFS and ELI group (p<0.05). The amount of eluted BPA was various depending in the sealant (0.023∼2.790 ㎍/㎎). TEGDMA was leached highly from ELI, CON, and HEL in both EH and AS. Bis-GMA was leached from all the sealants, whereas UDMA was leached only from PFS, ELI, FSF, and UXP. The detected amount of BPA and the content of Bis-GMA was not correlated (p>0.05). Bis-GMA did not seem to be decomposed to BPA during the 28 days immersion period. EH penetrates the matrix of pit & fissure sealant, which has been shown to maximize the elution of resin components.

콤포짓트 레진의 중합체계에 따른 중합률 및 잔류단량체 유출

문현정,임범순,이용근,송재경,김철위 대한치과기재학회 2001 대한치과재료학회지 Vol.28 No.2

Newly developed curing units for the dental composite resins are claimed to result in optimum properties and short curing time. The purpose of this study was to detemine the curing effectiveness of the curing units, and to evaluate the relationship between the degree of polymerization and leachability of residual monomer. Three composite resins were tested (Z100; z100, Herculite XRV; HX, Heliomolar; HM). Disk specimens of 2 mm in thickness and 6 mm in diameter were cured with a plasma arc [Apollo 95E; at 1370 mW/㎠, for 5 sec.(A5), 10 sec.(A10), 15sec(A15)], halogen lamp [VIP; at 500 mW/㎠, for 13 sec.(V13), 26 sec.(V26), 40 sec.(V40)] and custom made light emitting diode [LED; at 500 mW/㎠, for 13 sec.(L13), 26 sec.(L26), 40 sec.(L40)]. Specimens were immersed in 75% ethanol for 7 days. Eluates of the composites were analyzed by a high-performance liquid chromatography, and the degree of polymerization of composites were determined by a Fourier transform infrared spectroscopy. To obtain the sufficient curing by a plasma arc, the curing time should be longer than 10 sec. When the same light energy was irradiated, LED showed similar curing performance to halogen lamp. The light energy and the degree of polymerization was not correlated (p>0.05), but the light energy and the leachability of residual monomer was correlated (p<0.05). The leachability of residual monomer (TEGDMA+BisGMA) depended on the degree of polymerization.