Evaluation of the Performance of the MicroScan Pos Breakpoint Combo Panel Type 28 for Susceptibility Testing of Staphylococcus aureus: Low-range Minimum Inhibitory Concentration of Vancomycin, Cefoxitin Screening, and Inducible Clindamycin Resistance Det

지미숙,이미영,노신애,김미나 대한진단검사의학회 2010 Annals of Laboratory Medicine Vol.30 No.6

Background : Susceptibility testing of Staphylococcus aureus often requires cumbersome supplementary tests. MicroScan Pos Breakpoint Combo Panel Type 28 (PBC28) (Siemens, USA) includes cefoxitin screening to detect methicillin-resistant Staphylococcus aureus (MRSA), inducible clindamycin resistance detection (ICD), and determination of low-range minimum inhibitory concentration of vancomycin (0.5-16 mg/mL). The purpose of this study was to evaluate the performance of PBC28 in comparison with that of Pos Combo Type 1A (PC1A) (Siemens). Methods : From December 2009 to March 2010, 500 non-duplicate clinical isolates of S. aureus were tested with PC1A and PBC28. Categorical agreements (CA) between the interpretations of the 2 panels were estimated. The presence of the mecA gene was determined by PCR, and double-disk diffusion test (D-test) was performed on the isolates resistant to erythromycin but susceptible or intermediately resistant to clindamycin. Ninety-six isolates representing various vancomycin minimum inhibitory concentrations (MICs) were tested in parallel with repeat PBC28, broth macrodilution, and epsilometer test (E test). Results : The CA was 99.3% with a very major error (VME) of 0.2%, major error (ME) of 0.1%, and minor error (mE) of 0.4% in total. PBC28 showed 100% CA for 1 isolate with vancomycin MIC of 4 mg/mL and 35 isolates (7.0%) with MIC of 2 mg/mL. However, only 15, 27, and 35 isolates with vancomycin MIC of 2 mg/mL showed 100% CA in repeat PBC28, broth macrodilution, and E test, respectively. PC1A and PBC28 detected all 314 mecA-positive isolates. Among the 63 isolates tested with the D-test, 58 (92.1%) were positive, and the results were 100% concordant with those of ICD. Conclusions : PBC28 can be appropriate susceptibility testing of S. aureus, including MRSA detection and ICD. However, the lower-range vancomycin MIC test was not reproducible enough to reliably differentiate MIC of 2 mg/mL from MIC≤1 mg/mL. (Korean J Lab Med 2010; 30:637-46)

Genetic Polymorphism of CYP2D6 and Clomiphene Concentrations in Infertile Patients with Ovulatory Dysfunction Treated with Clomiphene Citrate

지미숙,김광래,이우창,최원호,전사일,민원기 대한의학회 2016 Journal of Korean medical science Vol.31 No.2

CYP2D6 is primarily responsible for the metabolism of clomiphene citrate (CC). The purpose of the present study was to investigate the relationship between CYP2D6 genotypes, concentrations of CC and its major metabolites and drug response in infertility patients. We studied 42 patients with ovulatory dysfunction treated with only CC. Patients received a dose of 100 mg/day CC on days 3-7 of the menstrual cycle. CYP2D6 genotyping and measurement of CC and the major metabolite concentrations were performed. Patients were categorized into CC responders or non-responders according to one cycle response for the ovulation. Thirty-two patients were CC responders and 10 patients were nonresponders with 1 cycle treatment. The CC concentrations were highly variable within the same group, but non-responders revealed significantly lower (E)-clomiphene concentration and a trend of decreased concentrations of active metabolites compared to the responders. Nine patients with intermediate metabolizer phenotype were all responders. We confirmed that the CC and the metabolite concentrations were different according to the ovulation status. However, our results do not provide evidence for the contribution of CYP2D6 polymorphism to either drug response or CC concentrations.

신포괄수가제 참여 유무에 따른 신포괄수가제와 그 영향에 대한 인식 비교

지미숙,최용준,김솔잎,윤여민,엄태현,허재혁,이건세,권계철,김형수 대한진단검사의학회 2021 Laboratory Medicine Online Vol.11 No.1

Background: The medical insurance payment system can have a considerable effect on quality of care, medical expenses, and laboratory test utilization. The new diagnosis-related group (NDRG) is a mixed payment system implemented throughout many hospitals. To date, physicians’ level of understanding of the NDRG system has received minimal research attention. We have conducted a survey targeting doctors affiliated with various hospitals. Methods: Forty-two NDRG participating public hospitals (participant group), and 84 non-participating hospitals (non-participant group) were included in this study. Three physicians per hospital (clinical pathologist, internist, and surgical specialist) were asked to complete a questionnaire about the influence of the NDRG system. A total of 116 doctors (32.5%) responded. Results: Recognition of the NDRG was significantly higher among the participant group than among non-participants (87.9% vs. 45.8%, P =0.001). About half of the respondents expected introduction of the NDRG to help reduce medical overuse and length of stay, while about 80% expected a negative impact on overall quality of care and quality control for laboratory tests, irrespective of group. In terms of patient satisfaction and inpatient laboratory test utilization, the participant group responded more positively. About half of the respondents had some knowledge of quality incentives, and about 90% agreed with the need for additional rates or application of quality incentives under the NDRG system. Conclusions: In this study, the physicians’ degree of understanding of the NDRG system was quantitatively assessed, and some areas in need of reform were addressed. 배경: 진료비 지불보상제도란 진료의 대가로 의료공급자에게 지불되는 보상 방식을 의미하며 의료의 질, 의료비, 검체검사량 등에 많은 영향을 준다. 신포괄수가제는 포괄수가제 기반에 고가 의료서비스 등을 행위별수가로 보상하는 혼합형 신규 지불제도이며, 공공의료기관 중심으로 시범운영 중에 있다. 그러나 신포괄수가제에 대한 의료인의 인식 수준에 대한 연구는 별로 없다. 이에 의료기관 전문의를 대상으로 신포괄수가제의 영향에 대한 인식 정도를 파악하기 위하여 설문조사를 시행하였다. 방법: 신포괄수가제에 대한 이해도, 정책 목표달성도, 제도 도입 시 의료행위와 환자에 미칠 영향, 입원환자 진단검사 처방량 변화, 검체검사 질 가산료 관련 설문지 문항을 개발하여 2019년 5-6월 설문조사를 시행하였다. 2018년 9월 이전부터 신포괄수가제 시범 사업에 참여해 온 42개 공공기관 및 신포괄수가제 미적용 84개 민 간기관을 선정하였고 기관별 진단검사의학과, 내과계열, 외과계열 전문의 각 1인에게 설문조사를 요청하였다. 총 116부의 설문지가 회수되어 전체 연구대상자 대비 설문조사 응답률은 32.5%였다. 결과: 신포괄수가제에 대한 인지율은 참여기관에서 유의하게 높 았다(참여 87.9%, 비참여 45.8%; P =0.001). 소속기관에 상관없이 약 50%의 응답자에서 신포괄수가제 도입이 과잉의료 감소 및 재원 기간 단축 등에 도움이 될 것으로 예상하였고, 약 80%에서는 전반 적인 의료의 질과 진단검사 질 관리에 부정적인 영향을 미칠 것으 로 예상하였다. 환자 만족도에 미칠 영향 및 입원 검체검사 처방량 변화에 대해서는 비참여기관에 비하여 참여기관의 긍정적 평가 비율이 유의하게 더 높았다. 검체검사 질 가산료에 대한 인지율은 46.6%로, 소속기관에 따른 차이는 없었으나 진단검사의학 97.7%, 내외과계열 15.3%로 전공과목에 따라 차이를 보였다. 약 90%의 응 답자들은 신포괄수가제 하에서 검체검사 질 관리를 위한 가산율 적용이나 별도 수가의 필요성에 대해 찬성하였다. 결론: 이 연구를 통하여 의료기관 의사들의 새로운 지불보상제도 에 대한 인지 정도를 파악하고 보완이 필요한 사항을 제시하였다.

마크로라이드 치료에 반응하지 않는 마이코플라즈마 폐렴 증례에 대한 고찰

지미숙,성흥섭,심태선,장우리,김미나 대한진단검사의학회 2012 Laboratory Medicine Online Vol.2 No.4

We present a case of community-acquired pneumonia (CAP) that developed in a previously healthy young woman. She was diagnosed with Mycoplasma pneumoniae pneumonia, but did not respond to macrolide treatment. The pathogens of CAP was examined using chest radiographs, computed tomography, and various laboratory tests including Mycoplasma IgG and IgM antibodies, blood and sputum cultures, and PCR for M. pneumoniae, Legionella pneumophila, and Chlamydophila pneumoniae. In this study, differential diagnosis of the pathogens and analysis of the mechanisms underlying their resistance to macrolide treatment were performed, and the results were discussed. After changing the antimicrobial to quinolone, the patients’ clinical symptoms and radiographic findings improved, and she was discharged after 8 days. 저자들은 평소 건강하던 젊은 여성에서 발생한 Mycoplasma pneumoniae 폐렴에서 마크로라이드 초치료에 실패한 증례를 보고한다. 환자의 객담 검체로 시행한 M. pneumoniae 23S rRNA 유전자 염기서열분석에서 마크로라이드 고도내성과 연관되어 있는돌연변이가 발견되었으며, 이 돌연변이가 치료 실패의 원인이 되었을 것으로 생각되었다. 환자는 quinolone 제제로 항균제를 변경한후 임상적인 증상과 흉부 X선에서 호전 소견을 보였으며 입원 8일째 퇴원하였다.

Acute Promyelocytic Leukemia Presenting with Central Nervous System Involvement: A Report of 2 Cases

지미숙,지현숙,박찬정,이정희,서종진,장성수 대한진단검사의학회 2011 Annals of Laboratory Medicine Vol.31 No.1

Central nervous system (CNS) involvement in acute promyelocytic leukemia (APL) is rare, and the presence of CNS symptoms at the time of diagnosis of APL is even rarer. We report 2 cases of APL presenting with CNS involvement. A 43-yr-old woman presented with easy bruising and stuporous mentality. Her complete blood count (CBC) revealed leukocytosis with increased blasts. Bone marrow (BM) analysis was carried out, and the diagnosis of APL was confirmed. This was done by cytogenetic analysis and demonstration of PML-RARα rearrangement by reverse transcriptase PCR in the BM cells. A lumbar puncture was performed to investigate the cause of her stuporous mentality, and her cerebrospinal fluid (CSF) analysis revealed 97% leukemic promyelocytes. Despite systemic and CNS therapy, she died due to septic shock by infection and rapid disease progression only 3 days after her admission. Another patient, a 3-yr-old girl, presented with easy bruising and epistaxis, and her CBC showed pancytopenia with increased blasts. BM studies confirmed APL. Quantitative PCR for PML-RARα in the BM cells revealed a PML-RARα/ABL ratio of 0.33 and CSF analysis revealed 9.5% leukemic promyelocytes (2 of 21 cells). She received induction chemotherapy and intrathecal therapy and achieved complete remission (CR) in the BM and CNS. She has been maintained in the CR status for the past 31 months. Thus, patients with APL must be evaluated for CNS involvement if any neurological symptoms are present at the time of diagnosis.

통합예술치료 프로그램이 남성 독거노인의 자아통합감, 자아존중감 및 우울에 미치는 효과

지미숙(Ji, Mi Suk) 협성대학교 교양학연구소 2017 교양학연구 Vol.4 No.1

본 연구는 통합예술치료가 남성 독거노인의 자아통합감 및 자아존중감의 증가, 우울감소에 미치는 효과를 알아보고자 하는데 목적이 있다. 연구대상은 S시 J구 D복지시설을 이용하며 프로그램에 참여 의사를 밝힌 남성 독거노인 15명이며 2016년 7월부터 2016년 12월까지 총 15회에 걸쳐 주 1회 60분간 통합예술치료 프로그램을 진행했다. 통합예술치료 프로그램의 효과검증을 위해 자아통합감, 자아존중감 및 우울 척도를 사전, 사후에 걸쳐 실시하였다. 프로그램의 효과성을 검정하기 위해 대응표본 t-검정을 실시하여 분석하였다. 연구결과를 요약하면, 첫째, 자아통합감 사전-사후 검사결과를 보면 사전에 비해 사후의 평균이 증가한 것으로 나타났다. 둘째, 자아존중감 검사결과를 살펴보면 사전에 비해 사후의 평균이 증가한 것으로 나타났다. 셋째, 우울 검사 결과를 살펴보면, 사전에 비해 사후의 평균이 감소한 것으로 나타났다. 따라서 통합예술치료 프로그램은 독거노인의 자아통합감과 자아존중감 및 우울에 긍정적인 효과가 있음을 알 수 있다. The purpose of this study is to investigate the effects of integrated art therapy on the self-integration, self-esteem, and depression of the elderly living alone. The subjects of this study were 15 the elderly men living alone who used the welfare center in S city and announced their intention to participate in the program. From July 2016 to December 2016, a total of 15 times a week 60-minute integrated art therapy program was conducted. Self-integration, self-esteem and depression scale were tested before and after the program to verify the effectiveness of the integrated art therapy program. In order to test the effectiveness of the program, a corresponding sample t-test was conducted and analyzed. The results of this study are summarized as follows: First, Self-integration pre-post test results showed that the post-test average was increased compared to the pre-test. Second, the results of the self-esteem test showed that the post-averages increased. Third, the results of the depression test showed that the post-averages decreased compared to the pre-test. Therefore, it can be seen that the integrated art therapy program has a positive effect on self-integration, self-esteem and depression of the elderly living alone.

一部 서울地域의 영아영양에 關한 調査硏究

池美淑,姜吉遠 서울大學校 保健大學院 1974 公衆保健雜誌 Vol.11 No.1

For the purpose of studying the infant nutrition a study was conducted by the Author on 1,034 women, who have experienced live-birth before April, 1972, residing in Kumho Dong, Sungdong-gu, Seoul City during the period from October to December of 1972. The results and findings obtained from the study are summarized as follows: 1) General characteristics of the women: The largest age group among those interviewed was 30∼34 (31%), and the average age of the sample was 33 years, 57% of the women interviewed had a primary school education or less, while 43% had attended middle school or beyond. In terms of standard of living, the great majority was lower class, accounting for 72% of the sample. The average age at marriage was 22 years, the average age at first childbirth was 23.8 years, and the average duration or marriage was 11 years. The average number of pregnancies was 4.0 and the average number of births per woman was 2.9. Fetal wastage amounted to 27.5% and the rate of induced abortion was 0.9 per woman. The average number of children was 2.9, the number of surviving sons averaged 1.5 and the average number of additional children desired was 0.3. 2) Period of observation: Those whose last pregnacy terminated at least 13 months prior to the interview accounted for 94% of the sample. The average amount of time elapsed since the end of the last pregnancy was 37 months. Ninety-six percent gave birth to their last child at least 13 months prior to the interview. The average period since was 49 months. 3) Duration of lactation:About 6 percent of the sample did not breast feed their children at all. Of these, the greatest proportion (64%) gave "insufficient breast milk" as their reason. Nineteen percent of the sample were currently nursing children at the time of the survey, while 75% had completed lactation. The lactation period for the greatest number (35.1%) fell in the range of 13∼18 months, and averaged 18 months. 4) Staple food during infancy: During the first six months after birth, the major source of nutrition was breast milk in 88.2% of the cases, artificial milk in 11.3% of the cases, and other foods for the remaining 1%. For the period from the 7th to the 12th month, the major food was breast milk for 81% of the sample, artificial milk for 9.1% and other foods for 10.3%. The number relying on breast milk through early and late infancy is thus quite high. 5) Ideal duration of lactation: About 4 percent of the sample felt that the ideal lactation period was six months or less, 8.1% felt that 7∼9 months was ideal, 43.0% felt that 10∼12 months was ideal while 45.0% felt that 13 months or more was necessary. The average ideal lactation period was 12.3 months. 6) Actual lactation period and ideal lactation period: The actual lactation period varied with ideas regarding ideal lactation period. Of those who felt that the ideal lactation period was 0∼3 mouths, 21% weaned their children within 6 months, while only 1.5% of those who felt that the ideal lactation period was 10∼12 months weaned their children within the same period. Of the latter, 26% continued lactation for 25 months or more. The average lactation period was 18 months, 5.7 months, longer than the ideal lactation period of 12.3 months. 7) Cow's milk:Twenty two percent of the women interviewed fed, their children with both breast milk and cow's milk, 17.5% starting the use of cow's milk within the first six months and the remaining 4.3% starting thereafter. 8) Supplementary foods: Fourty six percent of the sample (450 persons) used supplementary foods and 54% did not. Of the 46% who used supplementary foods, 15.1% started within the first 6 months and the remaining 31.1% did so thereafter. The average time at which use of supplementary foods began was 7.0 months.

一部 서울地域의 嬰兒營養에 關한 調査硏究

池美淑(Mee Sook Chi),姜吉遠(Kil Won Kang) 서울대학교 보건환경연구소 1974 보건학논집 Vol.11 No.1

요 알부민 측정에서 DiaSys Albumin in Urine/CSF FS 시약의 JEOL BioMajesty JCA-BM6010/C 기기에서 분석능 평가

김현정,지미숙,문희원,허미나,윤여민 대한진단검사의학회 2016 Laboratory Medicine Online Vol.6 No.2

Background: High albuminuria is defined as albumin excretion of >30 mg/24 hr or an albumin-to-creatinine ratio of 30 mg/g in a random urine sample. We assessed the analytical performance of the Albumin in Urine/CSF FS kit (DiaSys Inc., UK) using a BioMajesty JCA-6010/C analyzer (JEOL Inc., Japan). Methods: Urine albumin concentrations were measured by the Albumin in Urine/CSF FS kit using a BioMajesty JCA-BM6010/C analyzer. Imprecision, linearity, and carry-over were measured according to the Clinical Laboratory and Standards Institute documents EP10 and EP9. The assay was compared with the ALB-T TQ Gen.2 (Roche, Germany) assay on a Cobas8000 C702 (Roche, Germany), the Tina-Quant Albumin (Roche, Switzerland) assay on a Hitachi7600-210 (Hitachi, Japan), and an Abbott urine albumin assay (Abbott Laboratories, USA) on a TBA 200FR (Toshiba, Japan) using 50 random urine samples. Results: Within-run and total imprecision were 0.551-1.023% and 0.551-1.214%, respectively. Linearity ranged from 6.31 to 30.60 mg/dL, and functional sensitivity was 0.5 mg/dL. Results from the Albumin in Urine/CSF FS kit showed good correlation with the ALB-T TQ Gen.2 (r=0.987) and the Tina-Quant Albumin assays (r=0.991). However, the four assays categorized 18 of 50 urine samples into different albuminuria groups. Conclusions: Albumin in Urine/CSF FS testing on a BioMajesty JCA-BM6010/C analyzer showed good linearity, functional sensitivity, precision, and correlation with the ALB-T TQ Gen.2 and Tina-Quant Albumin assays. However, because some samples were categorized into different albuminuria groups by the different assays, further studies on the standardization of albuminuria assays are needed. 배경: 고알부민뇨증은 24시간 요에서 알부민의 배설이 30 mg 이상 또는 임의뇨에서 크레아티닌에 대한 알부민의 농도가 30 mg/g 이상인 경우로 정의된다. 저자들은 Albumin in Urine/CSF FS (DiaSys Inc., UK) 시약의 BioMajesty JCA-6010/C analyzer (JEOL Inc., Japan) 장비에서의 분석능을 평가하였다. 방법: 요 알부민 농도는 BioMajesty JCA-BM6010/C 장비에서 Albumin in Urine/CSF FS 시약으로 측정되었다. 평가는 정도관리물질을 사용하여 CLSI EP10과 EP9에 따라 비정밀도, 직선성, 잔효를 포함하였다. 이 검사방법은 50개의 임의뇨 검체를 이용하여 Cobas8000 C702 (Roche, Germany) 장비에서 ALB-T TQ Gen.2(Roche, Germany) 시약, Hitachi7600-210 (Hitachi, Japan) 장비에서 Tina-Quant Albumin (Roche, Switzerland) 시약, 그리고 TBA 200FR (Toshiba, Japan) 장비에서 Abbott urine albumin assay (Abbott Laboratories, USA) 시약을 이용한 검사방법과 비교하였다. 결과: 3개의 정도관리물질을 이용한 검사차례 내 그리고 총 비정밀도는 각각 0.551-1.023%와 0.551-1.214%였다. 직선성은 6.31부터 30.60 mg/dL까지 관찰되었고, 기능적 민감도는 0.5 mg/dL였다. BioMajesty JCA-BM6010/C에서 Albumin in Urine/CSF FS 시약의 검사방법은 Cobas8000 C702에서 ALB-T TQ Gen.2 시약의 검사법 및 Hitachi7600-210에서 Tina-Quant Albumin 시약의 검사법과 우수한 상관관계를 보였다. 그러나 네 개 검사법은 50개의 요검체 중 18검체를 서로 다른 알부민뇨 그룹으로 분류하였다. 결론: BioMajesty JCA-BM6010/C 장비에서 Albumin in Urine/CSF FS 시약의 검사방법은 우수한 직선성, 기능적 민감도, 비정밀도를 보였고, Cobas8000 C702에서 ALB-T TQ Gen.2를 사용하는 경우와 Hitachi 7600-210에서 Tina-Quant Albumin을 사용하는 검사법과 우수한 상관관계를 보여주었다. 그러나, 각각의 검사방법에 의해 50개의 검체 중 상당수가 다른 알부민뇨 그룹으로 분류되었기 때문에, 알부민뇨에 대한 앞으로의 연구와 검사 제품 간의 표준화에 대한 연구가 더 필요할 것으로 생각하였다.

Clinical Utility of Measurement of Vitamin D-Binding Protein and Calculation of Bioavailable Vitamin D in Assessment of Vitamin D Status

김현정,지미숙,송정한,문희원,허미나,윤여민 대한진단검사의학회 2017 Annals of Laboratory Medicine Vol.37 No.1

Background: The associations of vitamin D deficiency with various clinical conditions highlighted the importance of vitamin D testing. Currently, clinicians measure only the total 25-hydroxyvitamin D [25(OH)D] concentration, regardless of its bioavailability. We aimed to determine the effect of vitamin D-binding protein (VDBP) on 25(OH)D bioavailability. Methods: Serum samples were collected from 60 healthy controls, 50 pregnant women, and 50 patients in intensive care units (ICUs). Total 25(OH)D was quantified by liquid chromatography with tandem mass spectrometry, and VDBP levels were determined by using an ELISA kit (R&D Systems, USA). The bioavailable 25(OH)D levels were calculated by using total 25(OH)D, VDBP, and albumin concentrations. Results: In comparison with healthy controls, the total 25(OH)D concentration was significantly lower in ICU patients (median, 11.65 vs 18.25 ng/mL; P<0.00001), but no significant difference was noted between pregnant women (18.25 ng/mL) and healthy controls. The VDBP level was significantly lower in ICU patients (95.58 vs 167.18 μg/mL, P=0.0002) and higher in pregnant women (225.01 vs 167.18 μg/mL, P=0.008) compared with healthy controls. Nonetheless, the calculated bioavailable 25(OH)D levels of ICU patients and pregnant women were significantly lower than those of healthy controls (1.97 and 1.93 ng/mL vs 2.56 ng/mL; P=0.0073 and 0.0027). Conclusions: A single marker of the total 25(OH)D level is not sufficient to accurately evaluate vitamin D status, especially in pregnant women. In cases where VDBP concentrations may be altered, VDBP measurements and bioavailable 25(OH)D calculations may help to determine vitamin D status accurately.