한국에서 분리된 콕사키 바이러스 B3 cDNA의 클로닝 및 전체 염기서열 분석

정윤석(Yoon Suk Jung),김기순(Gee Sun Kim),박정구(Jung Goo Park),이윤성(Yoon Sung Lee),신수연(Soo Yeon Shin),천두성(Doo Sung Chun),지영미(Young Mi Jee),김문보(Mun Bo Kim),나병국(Byung Gook Na),윤재득(Jae Deuk Yoon),이광호(Gwang Ho Lee 대한바이러스학회 2000 Journal of Bacteriology and Virology Vol.30 No.1

We have determined and analyzed the full-length cDNA sequence of a coxsackievirus B3 (CVB3) Korean isolate (CVB3-Korea/97) which has been known as a general human pathogen. The whole genome contains 7,400 nucleotides and has a single large open reading frame with 6,555 nucleotides that encodes a potential polyprotein precursor of 2,185 amino acids. The genome also contains a 5 non-coding region (NCR) of 741 bases and a 3' NCR of 104 bases followed by poly(A) tail. Sequence homologies of nucleotides and deduced amino acids between the CVB3-Korea/97 strain and the prototype (Nancy strain) were 81.7% and 91.5%, respectively. The genes encoding the functional proteins including viral protease and RNA dependent RNA polymerase showed higher homology than those encoding the structural proteins. We have further analyzed the sequences of 5' NCR, VP1 and VP2 of CVB3-Korea/97, which are known as cardiovirulent determining factors at the nucleotide and amino acid levels. Although the CVB 3-Korea/97 strain was isolated from an aseptic meningitis patient without cardiomyopathy, its 234th nucleotide and 165th amino acid were uracil and Asn as same as those of other cardiovirulent strains one. However, the 155th amino acid of VP1, which closely associated with cardiovirulence, was replaced with Arg by single nucleotide substitution from A2916 to T2916. Moreover, additional amino acid substitutions were observed in the flanking region of Asp155. Taken together, amino acid(s) substitution in VP1 may play a critical role in determining cardiovirulence of the CVB3- Korea/97 strain rather than individual nucleotide replacements in the 5' NCR and/or an amino acid substitution in VP2.

흑자 및 적자병원의 경영성과요인 - 지방공사의료원을 중심으로 -

정윤석(Yoon Suk Jung),정기선(Key Sun Jung),최성우(Sung Woo Choi),정수경(Soo Kyung Jung),이창은(Chang Eun Lee) 한국병원경영학회 2001 병원경영학회지 Vol.6 No.2

This study was designed to find out the factors which influence on the financial performance of the hospital. Out of 32 provincial hospitals witch were established by the government, 10 hospitals were selected as sample hospitals. Ten hospitals were divided into two groups (5 hospitals each), one of which was profit-making and the other loss-making. The criteria in selecting profit or loss-making hospitals was net profit to total revenue. The major finding of the study was as follows ; 1. Whether or not a hospital had specialized in certain departments was proved to be the major factor influencing on the financial performance. Three out of five profit-making hospitals could harvest following results by operating specific departments. ① Man powers needed for the operation of specific departments were 14.6 persons per 100 bed, which was only 1/7 of the general hospital. ② The number of doctors has not increased in proportion to the increase of the number of beds. ③ Ratio of total revenue to M.D.`s payroll expenses of the profit-making hospitals was 75.0% higher than the loss-making hospitals. ④ The average length of stay of specific department was very long (388.1 days). However, the specific departments were found to have contributed much to the financial performance because the occupancy rate of such departments was very high (94.5%). 2. The headcount per 100 bed of the profit-making hospitals was 23.9 persons (24.0%) less than the loss-making hospitals and the ratio of payroll expenses to total revenue 15.1% less. 3. Averagel revenue per specialist of the profit-making hospitals was 108 million (25.1%) more than loss-making hospitals and the ratio of total revenue to M.D`s payroll expenses of profit-making hospital was 75.0% higher. 4. Profit-making hospitals have introduced new systems or renovation in 36 fields, such as incentive payment system, utilization of contracted man powers, change of the payroll structure of the nurses, specialization in certain departments, etc; however, loss-making hospitals introduced only 25 new systems or renovations. These kind of renovation could not be achieved without the cooperation of the labor union and the strong will of the top management. Therefore, it could be said that the labor union of the profit-making hospitals seems to have been very cooperative compared with that of loss-making hospitals.

포스너-슐로스만 증후군 환자에서 녹내장 발생의 임상 요인

박원호,정윤석,한계숙,손용호.Won-Ho Park. M.D.. Yoon-Suk Jung. M.D.. Kye-Sook Han. M.D.. Yong-Ho Sohn. M.D. 대한안과학회 2005 대한안과학회지 Vol.46 No.4

Purpose: To determine the factors that affect glaucomatous change and the clinical course of patients with Posner-Schlossman syndrome. Methods: A retrospective analysis of 52 eyes of 51 patients who had been diagnosed with Posner-Schossman syndrome between January 1995 and June 2003 was performed. We analysed the factors by the age of onset, the duration of disease, the number of attacks, the highest intraocular pressure, the cup/disc ratio of affected eye and unaffected fellow eye during attacks, and visual field change. Results: Twelve (23.1%) of 52 eyes revealed significant glaucomatous change. The number of attacks showed statistically significant difference between the two groups who had developed glaucoma and who had not (P=0.021). But the age of onset, the duration of disease, and the highest intraocular pressure during attack did not show statistically significant difference (P>0.1). Conclusions: From this study, we observed that the only factor influencing glaucomatous change in patients with Posner-Schlossman syndrome was the number of attacks. So in case of recurrent attacks, close observation and aggressive treatment is mandatory.

두꺼비독 중독 2례

권정훈,전우찬,정윤석,안정환,Kwon Cheong-Hoon,Jun Woo-Chan,Jung Yoon-Suk,Ahn Jung-Hwan 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.1

The venom gland of Toad contains large quantities of cardiac glycosides, and toad venom poisoning is similar to digitalis toxicity and carries a high mortality. Sometimes after ingestion of aphrodisiac pills which contain dried toad, a patient develops gastrointestinal symptoms and bradycardia, psychoneurologic symptoms. We have experienced 2 cases of toad venom intoxication, who ingested asian toads. Patients were presented to our ED with nausea, vomiting, and abdominal pain. The patients were peformed monitoring and conservative treatment and were fully recovered. Toad venom intoxication should be considered in patients with clinical manifestation of gastrointestinal irritation, cardiac arrhythmias, hyperkalemia, and detectable serum digoxin level without current medication of digoxin.

공정 변화에 따른 침지식 막반응조의 처리특성과 중수도 적용성 평가에 관한 연구

강용태(Kang Yong Tae),정윤석(Jung Yoon Suk),조용현(Cho Yong Hyun),장성부(Chang Sung Pu) 대한토목학회 2003 대한토목학회 학술대회 Vol.2003 No.10

원주지역 설사 환자에서 분리한 Small Round Structured Viruses ( SRSV ) 염기서열 분석

지영미(Young Mi Jee),김기순(Gee Sun Kim),천두성(Doo Sung Chun),박정구(Jung Goo Park),강영화(Young Hwa Kang),정윤석(Yoon Suk Jung),고운영(Woon Young Ko),신영학(Young Hak Shin),윤재득(Jae Deuk Yoon) 대한바이러스학회 1999 Journal of Bacteriology and Virology Vol.29 No.4

Small round structured viruses (SRSV) are the major ethological agents which can cause outbreaks of non-bacterial gastroenteritis or food poisoning both in children and adults. The classification of family Caliciviridae to which SRSV belong, is based on the genome encoding three open reading frames. The rotavirus is another major pathogen which causes diarrhea in young children. We examined stool specimens obtained from diarrheal patients in Wonju from which bacterial pathogens were not found. To detect causative viruses from stool specimens of patients, reverse transcription (RT)-polymerase chain reaction (PCR) or nested PCR using rotavirus or SRSV specific primers was performed. In this study, RT-nested PCR procedure which can amplify a 330 bp fragment derived from RNA dependent RNA polymerase (RDRP) region within ORF1 was applied for the detection of SRSV. For the detection of rotaviruses, a 877 bp fragment from the VP4 region of rotavirus genome was amplified. As a result, rotavirus was not detected while SRSV sequences were detected from one out of five specimens. The nucleotide and amino acid sequences of the Wonju isolate were compared with other 6 Korean isolates which have been isolated and sequenced in our laboratory. Sequence analysis revealed that the Wonju isolate was rather distinct from other Korean isolates: the Wonju isolate was closer to genogroup I of SRSV while other 6 Korean isolates belonged to genogroup II.

골형성부전증 10예의 임상적 특징

이형숙,김현주,조재현,이승원,김현아,최준혁,송영준,김대중,이관우,정윤석 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.5

연구배경 및 방법: 골형성부전증은 비교적 희귀한 유전병으로 교원질 대사 장애로 인한 골의 취약성과 다발성 골절 및 척추측만증 등을 특징으로 한다. 유전방식과 표현형의 발현 정도에 따라 다양한 임상 양상을 보이며, 임상적 중증도에 따라 4가지 형태로 분류된다. 지금까지 국내 보고는 분만과정이나 태아 진찰시 골격이상으로 발견된 증례보고가 주였다. 저자들은 비교적 경미한 임상 양상을 보이는 예를 포함한 다수의 골형성부전증 환자들의 전반적인 임상적 특징에 대해 보고하는 바이다. 결과: 2001년 6월부터 2003년 2월까지 골형성부전증으로 진단받은 6 가계, 10예를 대상으로 하였다. 평균 나이는 27.3(5∼56)세였고 소아가 2예였다. 모두 상염색체 우성으로 유전되었으며, 제 I형이 4예, 제 III형이 4예, 그리고 제 IV형이 2예였다. 전 예에서 다수의 골절 경험이 있었고, 골밀도 저하와 골피질 두께 감소 소견이 관찰되었다. 전신의 평균 골밀도는 0.690(0.421∼1.039) g/cm²였다. 골형성지표로 측정된 sAlk는 소아의 경우만 증가되어 있었고, 골흡수지표로 측정된 uDPD의 평균치는 12.9(4.4∼36.3) nM/mM Cr으로 증가된 소견을 보였다. mobility score는 대부분 3,4단계에 속해 있었다. 중증형일수록 진단 시의 mobility score가 낮은 경향을 보였다. 결론: 한국인 골형성부전증 환자의 임상적 특징을 살펴본 결과 기존의 보고된 II형 외에도 I, III, IV형이 다양하게 존재함을 알 수 있었으며, 모든 예에서 상염색체 우성으로 유전됨을 확인할 수 있었다. 또한 모든 예에서 증가된 골흡수로 인한 골밀도 저하와 골절을 확인할 수 있었다. Osteogenesis Imperfecta (OI) is a relatively rare hereditary disease, which is characterized by multiple bone fractures and spine scoliosis, due to the fragility of bone, and is often associated with blue sclerae, deafness and dentinogenesis imperfecta. Four types of OI can be distinguished, according to the clinical findings. Although mutations affecting type I collagen are responsible for the disease in most patients, the mechanism by which the genetic defects cause abnormal bone development remains to be fully understood. Here, the clinical characteristics of 10 OI patient cases are reported, with a review of the literature. All the cases, including 4 type I, 4 type III and 2 type IV, inherited OI as an autosomal dominant trait. All the subjects had multiple old fractures and decreased bone densities. In this study, the biochemical marker of bone formation, serum alkaline phosphatase, was found to be increased only in the pediatric OI patients, while the biochemical marker of bone resorption, urinary deoxypyridinoline, was increased in all cases. The mobility score was found to correlate with the severity of the type on diagnosis (J Kor Soc Endocrinol 18:496∼503, 2003).

한국인에게서 그레이브스병 약물치료의 적정기간

이형숙,이동훈,정희선,이종우,김정은,신승수,정윤석,이관우,김현만 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.1

연구배경: 그레이브스병의 치료에는 항갑상선제, 수술 및 방사성 요오드법이 선택되어 사용되고 있다. 이중 항갑상선제는 가장 많이 선호되고 있으나 낮은 관해율과 높은 재발율로 장기간 치료기간이 요구된다. 저자들은 그레이브스병 환자에게서, 선택되는 치료법의 선호도와 각 치료법의 관해율을 조사하고자 본 연구를 시행하였다. 또한 본 연구에서는 항갑선제 치료의 적정기간을 평가하고자 하였다. 방법: 아주대학교병원에 내원한 환자 중 1년 이상 추적관찰이 가능한 205명의 그레이브스병 환자를 대상으로 조사하였다. 항갑상제군, 수술군 및 방사성 요오드군은 각각 170명, 29명 그리고 6명이었다. ROC curve를 이용하여 약물치료의 예후예측인자를 분석하였다. 결과: 1) 그레이브스병 환자의 치료 방법의 선택은 항갑상선제군, 수술군 및 방사성 요오드군 각각 170명(83.0%), 29명(14.1%) 그리고 6명(2.9%)으로 항갑상선제 치료가 가장 선호되었다. 2) 그레이브스병의 관해율은 항갑상선제군, 수술군 및 방사성 요오드군에서 각각 60.0%(102/170명), 96.5%(28/29명) 그리고 83.0%(5/6명)으로 수술군이 가장 높았다. 3) ROC curve의 AUC는 치료기간과 진단시 TBII가 각각 0.709 및 0.648이었고 적절한 약물투여 추적 관찰기간은 26개월이었다. 결론: 그레이브스병의 일차 치료법으로는 항갑상선제가 선호되고 있으나 수술 및 방사성 요오드 치료군에 비해 상대적으로 낮은 관해율을 보였다. 따라서 항갑상선제 치료로 26개월 이상 관해가 되지 않을 경우에는 치료 방법의 변경을 고려하는 것이 관해율을 높이는데 도움이 될 것으로 생각된다. Background: Graves' disease in an organ specific autoimmune disease. Three kinds of therapeutic modalities (antithyroid drugs, ablation with radioactive iodine and subtotal thyroidectomy) are frequently performed for the management of this disease. The most popular therapeutic policy for the disease in Korea is antithyroid treatment. We analysed and compared the remission rates of all three modalities for Graves' disease, and evaluated the antithyroid modality to determine the correct duration of treatment. Subjects & Methods : The medical records of 205 patients with Graves' disease were reviewed. For the evaluation of the antithyroid modality medical treatment, antithyroid drugs were administered for more than 1 year. The prognostic factors associated with remission were analysed by means of an ROC curve. Results: 1) Of the 205 patients, proportions that received medical therapy, subtotal thyroidectomy and radioiodine therapy were 83.0, 14.1 and 2.9%, respectively. 2) The remission rates of the medical therapy, surgery and radioiodine therapy were 60.0, 96.5 and 83.0%, respectively. 3) The remission rate of the medical therapy was associated with the duration of medication and TBII activity. The determined proper duration for the antithyroid treatment was 26 months from the ROC curve analysis. Conclusion: The above results suggest that the proper duration of antithyroid treatment for Graves' disease is 26 months, after which time the subtotal thyroidectomy or radioiodine therapy should be considered if the disease has not remitted (J Kor Soc Endocrinol 18:24∼31, 2003).

신생아 이송에서의 저체온증

김향숙,정윤석,조준필,박문성,배기수 대한응급의학회 1999 대한응급의학회지 Vol.10 No.4

Back Ground : Hypothermia is a condition that can lead to serious complications and even to death in newborn. Although the temperature control is essential in neonatal care, it is often neglected during urgent transfer from local private hospitals. The purpose of this study is to evaluate the incidence and clinical outcomes of transfer induced neonatal hypothermia. Subjects and Method : In this retrospective study, subject is limited to transferred outborn babies with age less than 27 hours from June 1996 to May 1999. A total of 3,086 patients were admitted in NICU during the study period and inborn and outborn babies were 1,743(56%) and 1,343(44%) respectively. Among the 1,343 outborn babies, 212 babies were transferred from the private hospital within 24 hours of birth and were eligible for the study. Rectal temperature on arrival, transfer time, birth weight, gestational age, initial arterial gas study, and clinical outcome were compared. Statistical analysis has been done with chi-sqaure test and multiple logistic regression analysis. Results : There were 84 cases(39.6%) hypothermia(<36℃) among the 212 babies and the rate of hypothermia in transfered babies have not decreased over the study period. There were significantly more hypothermia in lower gestational age (less than 28 weeks) and lower birth weight (less than 2,000gm) caused hypothermia significantly more than normal gestational age or normal range of birth weight. And time interval (less than 12 hour) from birth to arrival at emergency department was also significant factor in hypothermia. The mortality rate was three fold higher in hypothermia than normothermic or hyperthermic babies. Conclusion: This study shows that hypothermia during neonate transportation is a major cause of neonatal mortality and morbidity in prehopital care. Body temperature control during transport of neonates under 24 hours of age should be emphasized for the better outcome of treatment.

한국 청소년에서 혈청 Adiponectin 농도와 비만도와의 상관관계

김현아,이형숙,김철식,안철우,정윤석,이관우,허갑범,김대중 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.5

연구배경: Adiponectin은 지방세포에서 특이적으로 발현되고 분비되는 adipocytokine이다. 아직 adiponectin 과 소아 비만과의 관련성을 연구한 보고는 많지 않다. 본 연구에서는 한국 청소년을 대상으로 혈청 adiponectin농도와 비만도 및 심혈관계 질환의 위험인자들과의 상관관계를 보고자 하였다. 방법: 2003년 4월 서울특별시 서대문구 소재의 한 중학교에서 12∼15세의 무작위 선발된 164명을 연구 대상으로 하여 신장, 체중, 허리둘레, 체지방을 측정하고 체질량지수를 계산하였다. 또한 공복채혈을 통하여 콜레스테롤, HDL-콜레스테롤, 중성지방, 혈당 및 인슐린 농도를 측정하고 혈청 adiponectin 농도는 ELISA 방법을 이용하여 측정하였다. 결과: 혈청 adiponectin 농도에 따라 삼등분하여 저 adiponectin군, 중간 adiponectin군, 고 adiponectin군으로 나누고 각 군간에 신체계측치 및 임상적 특성을 비교 분석하였다. 저 adiponectin군에서 다른 군에 비해 체질량지수와 허리둘레가 의미있게 크게 나타났다. 또한 저 adiponectin군에서 공복혈당 및 공복혈청 인슐린 농도가 높게 나타났으며, HOMA-IR 값도 높게 나타났다. 저 adiponectin군에서 총콜레스테롤과 중성지방치는 높게, 그리고 HDL 콜레스테롤치는 낮게 나타났다. 다변량회귀분석을 시행한 결과 혈청 adiponectin농도와 가장 상관관계가 높은 변수는 허리둘레와 성별로 나타났다. 결론: 소아에서도 성인과 마찬가지로 혈청 adiponectin농도와 복부비만 및 심혈관계 질환의 위험인자들과의 강한 음의 상관관계를 보임을 알 수 있었다. 향후 사춘기 성호르몬의 변화가 adiponectin에 미치는 영향 및 소아비만의 치료에 따른 adiponectin의 변화 등에 대한 연구가 필요하리라 사료된다. Background: Adiponectin is an adipocytokine that is highly specific to adipose tissue. In contrast to other adipocytokine, the adiponectin levels are decreased in obesity and/or type 2 diabetes. There are few studies regarding the correlation between the adiponectin concentration and obesity in children. Thus, whether the serum adiponectin concentrations are associated with adiposity in children was investigated. Methods: One hundred and sixty four subjects were selected from the participants in an ongoing study on the relationship between birth weight and insulin resistance in children. The current weights, heights, body fat percentages, waist circumferences, blood pressures, lipid profiles and insulin resistance, by the HOMA method, were measured in all the subjects. The serum adiponectin concentrations were determined by a validated sandwich ELISA, using a human adiponectin-specific antibody. Results: The serum adiponectin concentration was negatively correlated with the body mass index, waist circumference, systolic blood pressure, insulin resistance by HOMA and serum triglycerides, and positively correlated with the serum HDL cholesterol level. The serum adiponectin concentrations in the boys were significantly lower than in the girls. In a multiple regression analysis, the serum adiponectin concentration was strongly associated with waist circumference and gender. Conclusion: It is concluded that there was an inverse relationship between the serum adiponectin concentration and abdominal adiposity in children. However, further studies on independent gender differences on adiponectin are needed (J Kor Soc Endocrinol 18:473∼480, 2003).