의학 - HIV 치료의 최신지견

방지환,Bang, Ji-Hwan 대한에이즈예방협회 2009 레드리본 Vol.82 No.-

강력한 항레트로바이러스 치로(highly active antiretroviral therapy, HAART)의 도입으로 HIV 감영인의 기대여명(life expectancy)이 비감염인과 큰 차이가 나지 않을 정도로 향상된 것은 널리 알려진 사실이다. 하지만 평생 동안 약물을 복용해야 하며, 이에 따른 약물 부작용, 약제 내성, 경제적 손실, 불편함 등이 문제가 되고 있으며, 이를 극복하기 위한 다양한 치료법에 대한 연구가 진행 중이다. 이 글에서는 최근 발표되거나 진행 중인 새로운 치료 방법에 대해 간단히 알아보고자 한다.

HIV 감염 치료의 최신 지견

방지환 ( Ji Hwan Bang ) 대한내과학회 2016 대한내과학회지 Vol.90 No.6

The treatment of human immunodeficiency virus is under constant development. This report reviews recent advances in antiretroviral agents. (Korean J Med 2016;90:481-486)

페이지랭크 알고리즘 적용을 위한 구현 기술

김성진,이상호,방지환,Kim, Sung-Jin,Lee, Sang-Ho,Bang, Ji-Hwan 한국정보처리학회 2002 정보처리학회논문지D Vol.9 No.5

1998년에 등장한 구글 검색 사이트(http://www.google.com)에 처음 소개된 페이지랭크 알고리즘은 웹 문서들의 연결 구조에 기반하여 문서들간의 순위를 부여하는 방법이다. 페이지랭크 알고리즘은 상용 검색 엔진에서 구현되어 사용되고 있으나, 상업상의 이유들로 인하여 구현 기법에 관한 연구 결과는 거의 발표되지 않고 있다. [4,8]에서 소개된 페이지랭크 알고리즘의 구현 기법은 웹 문서들의 페이지랭크 값을 산출하기에 충분하지 않다. 본 논문은 페이지랭크 알고리즘의 구현 기법[4,8]을 설명하고, 이를 적용하는데 필요한 입/출력 자료 구조 및 4가지 주요 구현 기술을 제시한다. 본 논문은 실제 웹 문서의 페이지랭크 값을 산출하는 시스템을 예로 들어 페이지랭크 알고리즘을 적용하는 방법에 대한 이해를 돕도록 하였다. The Google search site (http://www.google.com), which was introduced in 1998, implemented the PageRank algorithm for the first time. PageRank is a ranking method based on the link structure of the Web pages. Even though PageRank has been implemented and being used in various commercial search engines, implementation details did not get documented well, primarily due to business reasons. Implementation techniques introduced in [4,8] are not sufficient to produce PageRank values of Web pages. This paper explains the techniques[4,8], and suggests major data structure and four implementation techniques in order to apply the PageRank algorithm. The paper helps understand the methods of applying PageRank algorithm by means of showing a real system that produces PageRank values of Web pages.

드론을 이용한 Multi-hop 음성통신 시스템 구현

구윤표(Koo Yoon Pyo),방지환(Bang Ji Hwan),손경환(Son Kyeong Hwan),신수호(Shin Su Ho),안수명(Ahn Su Myeong),이융(Yi Yun),유정훈(Yu Jeong Hun),김재신(Kim Jae Sin) 한국통신학회 2017 한국통신학회 학술대회논문집 Vol.2017 No.1

청각 장애인을 위한 센서 네트워크 기반 지능형 웨어러블 디바이스

김건엽(Geon Yeop Kim),곽윤기(Yun-gi Kwak),방지환(Ji Hwan Bang),이봉주(Bong Ju Lee),양우열(Woo Yeol Yang),김성찬(Sungchan Kim) 한국통신학회 2020 한국통신학회 학술대회논문집 Vol.2020 No.11

증예(症例) : 복막 투석 및 HIV 감염 환자에서 Stenotrophomonas maltophilia peritonitis: Colistin 치료와 결과 1예

곽동명 ( Dong Myoung Kwak ),전용덕 ( Yong Deok Jeon ),방지환 ( Ji Hwan Bang ),최광준 ( Gwang Jun Choi ),정현일 ( Hyun Il Cheong ),양성욱 ( Seong Wook Yang ),박상민 ( Sang Min Park ) 전북대학교 의과학연구소 2009 全北醫大論文集 Vol.33 No.2

Stenotrophomonas maltophilia is increasingly being recognized as an important cause of infection on immunodeficient patients. But S. maltophilia peritonitis in continuous ambulatory peritoneal dialysis (CAPD) are not common. Here, we report the case of a 40-year-old male with HIV infection and end-stage renal disease treated with CAPD. The patient had frequent previous history of peritonitis and known HIV infection. He presented with chilling, abdominal pain, and cloudy peritoneal effluent. White blood cell and neutrophil count were elevated at the initial peritoneal fluid analysis, so we diagnosed him as having CAPD-associated peritonitis. On the seventh hospital day, the organism isolated from the effluent was S. maltophilia. We changed the antibiotics to trimethoprim-sulfamethoxazole (TMP-SMX). But it was happened severe nausea, vomiting due to TMP-SMX complication. Thus, TMP-SMX was changed to colistin. after 8 days, He recovered completely, with no need for catheter removal. No recurrence was observed.

국내 공수병의 발생현황 및 예방대책

이중복(Joong-Bok Lee),이훈재(Hun-Jae Lee),현방훈(Bang-Hun Hyun),방지환(Ji-Hwan Bang),남경옥(Kyung-Ok Nam),정영의(Young-Eui Jeong),신영학(Young-Hack Shin) 한국역학회 2005 Epidemiology and Health Vol.27 No.1

Rabies is a uniformly fatal encephalitis and cannot be treated, therefore efforts must be focused on preventing the disease. The incidence of rabies in humans and animals has decreased with the introduction of rabies vaccination for animals since the early 1950s in Korea. There was no rabies occurrence either in human or animal for 8 years from 1985 to 1992. However, a case of animal rabies recurred in 1993. Since then, rabies endemic areas were expanded into 17 counties near the demilitarized zone, and 6 human cases were reported from the endemic areas of animal rabies. According to epidemic studies, wild raccoon dogs were suspected to be the transmission source of rabies in dogs, domestic animals, and other wild animals, which resulted in human rabies. Rabies prevention strategies were aimed at the animals capable of transmitting rabies or vaccination for the high risk group and postexposure prophylaxis for the bitten patients. Unfortunately, these activities were not conducted appropriately and substantially. All rabies victims were either not treated or did not receive timely and appropriate postexposure treatment. Prevention of rabies can only be achieved by securing political and financial support for an effective rabies program. Key activities for rabies prevention should include changing current public perception regarding rabies, strengthening surveillance for the exposed person to suspected rabid animals, and laboratory-based rabies surveillance.

증례 : 감염 ; 후천성 면역 결핍증 환자에서 발생한 진행성 다발성 백질뇌병증 7예

곽동명 ( Dong Myoung Kwak ),정현일 ( Hyun Il Jeong ),박상민 ( Sang Min Park ),차혁환 ( Hyuck Hwan Cha ),정자영 ( Ja Yong Jung ),방지환 ( Ji Hwan Bang ),신형식 ( Hyoung Shik Shin ) 대한내과학회 2010 대한내과학회지 Vol.78 No.6

AIDS 환자에서 2차적인 중추신경계 기회감염은 전체 기회감염의 1/3 정도를 차지한다. 고효능 항바이러스 치료(highly active antiretroviral therapy, HAART)가 본격적으로 사용된 이후에 이러한 기회감염은 현저히 줄어들고 있으나, JC바이러스(JCV)에 의한 진행성 다발성 백질뇌병증(progressive multifocal leukoencephalopathy, PML)의 발생률은 줄어들지 않고 있다. 저자들은 국립의료원 감염병센터에서 경험하였던 7예의 진행성 다발성 백질뇌병증의 임상상을 조사하였다. HAART 후 PML 진단된 1예를 제외하고는 6예에서 PML진단 당시 HAART를 시행하지 않은 상태였다. 조사대상자의 중간 연령은 39세였다. 남자 6예, 여자 1예였다. 7예의 CD4림프구 개수는 각각 58, 6, 18, 73, 90, 252, 94 cells/μL이었고, 중간 CD4 림프구 개수는 84 cells/μL이었다. 가장 흔한 임상증상은 편측마비였으며, 호발부위는 측두엽이었다. 2예에서 진단 후 25일, 52일에 사망하였다. 3예에서 질환의 진행없이 1년 이상 생존하였다. HIV 감염자에게서 신경학적 증상이 있는 경우 이에 대한 적극적인 병력청취와 신경학적 검사, 뇌 자기공명영상 촬영이 필요하다. Secondary opportunistic central nervous system infections occur in approximately one-third of patients with acquired immune deficiency syndrome. With the introduction of highly active antiretroviral therapy, the number of opportunistic infection cases has significantly decreased. However, the number of progressive multifocal leukoencephalopathy (PML) cases caused by opportunistic human JC polyomavirus has not decreased at a noticeable rate. In this report, seven patients with PML were evaluated at the infectious disease unit of the National Medical Center. Six of the 7 patients were not on antiretroviral therapy at the time of diagnosis. The mean patient age of the 6 men and 1 woman was 39 years. The individual CD4 cell counts were 58, 6, 18, 73, 90, 252, and 94 cells/μL. The mean CD4 cell count was 84 cells/μL. The most common clinical manifestation was focal weakness and the temporal lobe was mainly involved. Two of the patients died 52 days after the diagnosis was made. Three patients survived for more than 1 year without disease progression. We conclude that one must take a careful patient history, perform a neurological examination, and examine brain magnetic resonance images in patients with human immunodeficiency virus who show neurological symptoms. (Korean J Med 78:771-775, 2010)

그람양성균으로 인한 감염 척추염에서 Linezolid의 효과와 안전성

정종탁 ( Jongtak Jung ),이은영 ( Eunyoung Lee ),송경호 ( Kyoung-ho Song ),최평균 ( Pyoeng Gyun Choe ),박완범 ( Wan Beom Park ),방지환 ( Ji Hwan Bang ),김의석 ( Eu Suk Kim ),김홍빈 ( Hong Bin Kim ),박상원 ( Sang Won Park ),김남중 ( 대한내과학회 2018 대한내과학회지 Vol.93 No.5

목적: 감염 척추염은 장기간의 항생제 치료를 필요로 하며, 이 기간 동안의 정주 항생제의 사용은 입원으로 인한 사회적 손실과 비용을 유발한다. Linezolid는 경구 생체 이용률이 100%이며 신기능과 간기능에 따라 linezolid의 약동학이 영향받지 않는 장점이 있다. Beta-lactam 항생제에 내성을 보이는 그람양성균에 의한 감염 척추염에서 linezolid의 임상적, 미생물학적 치료 효과를 분석하였다. 방법: 2006년부터 2016년까지 서울대병원, 분당서울대병원, 보라매병원에서 감염 척추염으로 진단된 환자 중 linezolid가 4주 이상 투약된 사례에서 임상정보를 후향적으로 수집하여 분석하였다. 결과: Linezolid가 4주 이상 투약된 환자는 총 20명이었다. 가장 흔한 원인균은 methicillin-resistant Staphylococcus aureus 였으며(n = 15), 다음으로 methicillin-resistant coagulase-negative Staphylococcus가 많았다(n = 3). 20명의 환자 중 14명을 성공적으로 치료하였고 4명에서는 치료에 실패하였다. 2명의 환자는 감염 척추염이 아닌 다른 원인으로 사망하였다. Vancomycin 치료 실패 환자 13명 중 10명에서 linezolid로 치료에 성공하였다. 지속적인 균혈증을 보인 10명의 환자 중 8명에서 linezolid 투약 이후 균음전이 확인되었다. Linezolid 사용 기간의 중앙값은 40.5일(28-90)이었다. 약물 이상 반응 평가에서 항생제 중단을 고려할 만한 심한 혈구감소증은 호중구감소증 11.11%, 빈혈 12.96%, 혈소판감소증이 20.37%였다. 결론: Linezolid는 감염 척추염에서 치료제로 효과적으로 사용할 수 있으며 특히 1차 치료제의 치료 실패가 예상되는 경우 구제 치료로 사용할 경우 높은 치료 성공률을 기대할 수 있다. Background/Aims: Infectious spondylitis requires long-term antibiotic treatment; however, the use of intravenous antibiotics during this period has high social and monetary costs due to hospitalization. Linezolid has high oral bioavailability and is not affected by changes in renal or hepatic function. We investigated the clinical and microbiological effects of linezolid in infectious spondylitis caused by beta-lactam resistant gram-positive bacteria. Methods: Clinical data from patients who were treated with linezolid for at least four weeks were collected retrospectively from electronic medical records at the Seoul National University Hospital, Seoul National University Bundang Hospital, and Boramae Medical Center from 2006 to 2016. Results: Twenty Korean patients were treated with linezolid for at least four weeks during the study period. Of these, 14 patients were cured, four failed, and two cases of mortality occurred due to other causes than infectious spondylitis. Ten of 13 patients who had previously been assessed as vancomycin treatment failure were cured by linezolid. Bacteremia occurred in 14 patients, and 10 of these showed persistent bacteremia at the time of linezolid administration. Eight of these cases of persistent bacteremia were cured by linezolid. Median duration of linezolid treatment was 40.5 days (28-90 days). Severe cytopenia (grade II or more of National Cancer Institute criteria) was the most common adverse event, with incidences of 11.11% for neutropenia, 12.96% for anemia, and 20.37% for thrombocytopenia. Conclusions: Linezolid can be used as an effective antibiotic agent in patients with infectious spondylitis, especially when treatment failure of the first-line treatment is expected. (Korean J Med 2018;93:464-472)

자발성 세균성 복막염을 일으킨 그람음성간균의 3세대 세팔로스포린 내성률 변화

방지환,송경호,박주경,박완범,김성한,김홍빈,김남중,오명돈,김의종,이효석,최강원 대한감염학회 2007 감염과 화학요법 Vol.39 No.3

The third generation cephalosporin is widely used in treatment of spontaneous bacterial peritonitis (SBP). Resistance to the third generation cephalosporin was associated with poor outcome in patients with SBP. Thus it is necessary to know the changes in resistance rate. We planned to investigate retrospectively on resistance rate of the third generation cephalosporin of gram negative bacteria isolated in patients with SBP, who visited Seoul National University Hospital between 1998 and 2006. The Clinical and Laboratory Standards Institute guidelines were applied for antibiotic susceptibility test. A total of 269 consecutive episodes of clinically and microbiologically proven SBP was identified during the study period and 209 cases were caused by gram negative organisms. Among 209 isolates, 22 (10.5%) showed resistance to the third generation cephalosporin. The prevalence of resistance was decreasing during the study period (P=0.014).