Clostridium difficile에 의한 설사의 예후인자

김준형,김희정,구남수,김영근,최준용,신소연,박윤선,김연아,김명수,정수진,최희경,송영구,이경원,김준명 대한감염학회 2007 감염과 화학요법 Vol.39 No.2

배경 : Clostridium difficile에 의한 설사(Clostridium difficile associated diarrhea; CDAD)는 임상 경과가 다양하다. 최근에 유럽과 북미에서 C. difficile 감염의 발생률이 증가하고 고전적 치료에 잘 반응하지 않으며 이환률이 증가하였고, 이러한 원인이 새로운 균주의 탄생에 기인한다고 보고되었다. CDAD의 예후에 영향을 미치는 세균성 요인과 숙주 요인을 확인하기 위해 본 연구를 진행하였다. 재료 및 방법 : 2002년 8월부터 2003년 12월까지 CDAD가 진단된 20세 이상인 환자들을 대상으로 후향적 Cohort 연구를 하였다. 세균성 요인을 확인하기 위해 cdt A, cdtB, tcd A, tcd A rep 그리고 tcd B 유전자(binary toxin)를 확인하였다. 설사가 치료 시작 후 11일 이상 지속되거나, 2달 이내에 재발하거나, 수술 혹은 다른 시술이 필요한 경우, 사망한 경우 예후가 좋지 않은 것으로 정의하였다. 결과 : 총 115예에서 toxin을 생성하는 C. difficile가 동정되었으며, Toxin A와 toxin B 모두 양성인 균이 91예, toxin B만 양성인 균이 24예였다. Toxin A 생성 여부가 예후에 영향을 미치지 않았지만, 제산제를 사용한 환자에서 그렇지 않은 환자에 비해 toxin B만 양성인 균이 많이 동정되었다(P<0.05). 예후가 좋지 않은 경우는 39예(33.9%)였고 76예(66.1%)에서 예후는 양호하였다. 단변량 분석에서 70세 이상의 고령, 남성, 증상 발현 후 사용한 항생제의 개수 사용, 증상 발현 후 carbapenem, aminoglycoside, glycopeptide 사용, 당뇨 및 뇌졸중 병력이 있는 경우, 그리고 높은 Charlson index가 불량한 예후 인자로 확인되었다. 그러나 독립적인 예후 인자를 조사했을 때에는70세 이상의 고령(odds ratio=3.378, P=0.009), 증상 발현후 carbapenem 사용(odds ratio 7.210, P<0.001)이 예후에 중요한 영향을 미치는 요소로 확인되었다. 결론 : 70세 이상의 고령과 증상 발현 후 carbapenem 사용이 CDAD 독립적인 불량한 예후인자이다. Background : Clostridium difficile associated diarrhea (CDAD) has a wide range of clinical manifestations. The prognostic factors of CDAD are not fully understood. Materialsand Methods : A retrospective cohort study of 115 patients with CDAD from Aug. 2002 to Dec. 2003 was conducted to evaluate prognostic factors of CDAD. Bacteriologic factors were determined by detecting the binary toxin gene, tcd A, tcd A rep and tcd B gene. Poor prognosis was defined as diarrhea more than 10 days even with classic treatment, recurrence, death, and moribund discharge. Results : Approximately 79% of isolated strains were toxin A+/B+ strains and 21% were toxin A-/B+ strains. There was no difference in prognosis between toxin A+ and toxin A- strains. 39 (33.9%) cases showed poor prognosis and 76 (66.1%) cases showed good prognosis. Univariate analyses revealed that the poor prognostic factors were old age over 70 years old, male, the number of antibiotics used after onset of symptom, the administration of carbapenems, aminoglycosides, glycopeptides after onset of symptom, history of DM and stroke, and high Charlson comorbidity index. Multiple logistic regression analysis identified old age over 70 years old (odds ratio=3.378, P=0.009) and the administration of carbapenems after onset of symptom (odds ratio 7.210, P<0.001) as the independent poor prognostic factors. Conclusion : Old age over 70 and the administration of carbapenems after onset of symptom were the poor prognostic factors for CDAD caused by none-binary toxin producing strains.

자궁 내 감염 관련 유전자 및 산화 스트레스 관련 유전자와 조기분만의 연관성

유시연 ( Si Yeon You ),김정명 ( Jung Myung Kim ),이경아 ( Kyung A Lee ),박미혜 ( Mi Hye Park ),김영주 ( Young Ju Kim ),전선희 ( Sun Hee Chun ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.7

목적: 조기 분만과 자궁 내 감염 관련 유전자 (IFN-γ, interleukin [IL]-10) 및 산화 스트레스 관련 유전자 (CYP1A1)와의 연관성을 알아보고자 한다. 연구 방법: 2007년 1월부터 2008년 12월까지 이대 목동병원 산부인과에서 산전 검사 및 분만을 시행한 산모 중 37주 이전에 분만한 조산군 164명과 37주 이후에 분만한 대조군 305명을 대상으로 하였으며, 임신 주수 24주 미만, 태아의 선천성 기형, 다태아 분만, 사산의 경우를 제외하였다. 참여자는 입원 시 키, 몸무게 측정 및 혈액 채취를 시행하였고 임신 주수는 최종 월경일 또는 초음파 측정을 통해 계산 되었다. 산모의 혈액에서 IFN-γ, IL-10, CYP1A1 유전자형을 PCR과 SNaPShot method를 사용하여 검사하였으며 카이제곱 검정과 다중 로지스틱 회귀분석을 사용하여 통계분석 하였다. 결과: 조기 분만군과 만삭 분만군 사이에 임신 주수, 태아 체중에 통계적으로 유의한 차이가 있었다(P<0.0001). IFN-γ, IL-10, CYP1A1 유전자형의 빈도와 조기 분만 사이에는 유의한 상관성이 없었다(P>0.05). 결론: 본 연구에서 IFN-γ (874A/T) 및 IL-10 (1082A/G), IL-10 (819C/T), IL-10 (592A/C)와 CYP1A1 (T6235C), CYP1A1 (Ile462val [A/G]) 유전자형의 빈도는 조산과 관련이 없었다. Objective: To investigate the association between preterm birth and cytokine genes (IFN-γ, interleukin (IL)-10) in intrauterine infection and enzyme gene (CYP1A1) in oxidative stress response. Methods: This study involved a case-control study conducted at Ewha Womans University Hospital in Seoul, Korea. Subjects with preterm deliveries (<37 weeks of gestation) and normal controls with term deliveries (≥37 weeks of gestation) were selected from gravidas who had undergone prenatal examinations in the hospital and were followed until infant delivery. The weight, height, and blood samples of each participants were obtained according to standard protocols. We included subjects who gave birth to a singleton infant and had a gestational age between 24 and 42 weeks. Mutiple births, stillbirths, and congenital anomalies were excluded. Finally, 164 gravidas with preterm births and 305 normal controls with term deliveries were enrolled in the present study. Results: Preterm delivery group and term delivery group had significant difference in gestational age and neonatal body weight (P<0.0001). There were no statistically significant association between preterm birth and IFN-γ, IL-10, CYP1A1 genes (P>0.05). Conclusion: In this study, IFN-γ (874A/T), IL-10 (1082A/G), IL-10 (819C/T), IL-10 (592A/C) and CYP1A1 (T6235C), CYP1A1 (Ile462val [A/G]) genes had no significant association with preterm birth.

흉부 방사선 치료후 완전방실차단증과 양측 관동맥구 협착증을 보인 1예

고경환,김정경,이수금,윤재형,조성제,이상훈,홍석근,현민수,황흥곤,김명아,박성훈 대한내과학회 1997 대한내과학회지 Vol.53 No.3S

We have experienced a case of radiation-induced coronary biostial stenosis presented with recurrent syncopal attack, which was confirmed by coronary angiography and pathologic findings. A 60 year-old woman was admitted with the symptoms of recurrent syncopal attack. She had a history of radiation therapy of the chest for lung neoplasm 15 years ago. Initial electrocardiogram showed transient high-degree A-V block followed by third-degree atrioventricular block which was associated with syncope. Echocardiography revealed mild aortic regurgitation without left ventricular dysfunction. The coronary angiogram revealed biostial stenosis of coronary arteries. Initial cardiac symptom subsided after temporary pacemaker implantation. She had a coronary bypass graft surgery on both coronary arteries using saphenous vein. Biopsy findings showed mild fibrosis with intimal thickening of coronary artery.

Guanylate cyclase activator YC-1 potentiates apoptotic effect of licochalcone A on human epithelial ovarian carcinoma cells via activation of death receptor and mitochondrial pathways

Lee, C.S.,Kwak, S.W.,Kim, Y.J.,Lee, S.A.,Park, E.S.,Myung, S.C.,Kim, W.,Lee, M.S.,Lee, J.J. North-Holland ; Elsevier Science Ltd 2012 european journal of pharmacology Vol.683 No.1

Natural phenol licorice compounds have been shown to induce apoptosis in cancer cells. 3-(5'-Hydroxymethyl-2'-furyl)-1-benzyl indazole (YC-1) may enhance the sensitivity of cancer cells to anticancer drugs. However, the combined effect of licochalcone A and YC-1 on cell death in ovarian cancer cells has not been studied. We assessed the combined effect of licochalcone A and YC-1 on apoptosis in human epithelial ovarian carcinoma cell lines in relation to the cell death process. In the OVCAR-3 and SK-OV-3 cell lines, licochalocone A induced a decrease in Bid, Bcl-2, Bcl-xL and survivin protein levels; an increase in Bax levels; loss of the mitochondrial transmembrane potential; cytochrome c release; activation of caspases (-8, -9 and -3); cleavage of PARP-1; and an increase in the tumor suppressor p53 levels. YC-1 enhanced licochalcone A-induced apoptosis-related protein activation, nuclear damage and cell death. These results suggest that YC-1 may potentiate the apoptotic effect of licochalcone A on ovarian carcinoma cell lines by increasing the activation of the caspase-8- and Bid-dependent pathway and the mitochondria-mediated apoptotic pathway, leading to caspase activation. The combination of licochalcone A and YC-1 may confer a benefit in the treatment of human epithelial ovarian adenocarcinoma.

한국인 직무 스트레스 측정도구의 개발 및 표준화

장세진,고상백,강동묵,김성아,강명근,이철갑,정진주,조정진,손미아,채창호,김정원,김정일,김형수,노상철,박재범,우종민,김수영,김정연,하미나,박정선,이경용,김형렬,공정옥,김인아,김정수,박준호,현숙정,손동국 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.4

Background and Purposes: Over the past three decades, numerous studies performed in Korea have reported that job stress is a determinant risk factor for chronic diseases and work disability. Every society has its own culture and occupational climate particular to their organizations, and hence experiences different occupational stress. An occupational stress measurement tool therefore needs to be developed to estimate it objectively. The purpose of this study is to develop and standardize the Korean Occupational Stress Scale (KOSS) which is considered to be unique and specific occupational stressors in Korean employees. Subjects and Methods: Data were obtained from the National Study for Development and Standardization of Occupational Stress (NSDSOS Project: 2002-2004). A total of 12,631 employees from a nationwide sample proportional to the Korean Standard Industrial Classification and the Korean Standard Occupational Classification were administered. The KOSS was developed for 2 years (2002-2004). In the first year, we collected 255 items from the most popular job stress measurement tools such as JCQ, ERI, NIOSH and OSI, and 44 items derived from the a qualitative study (depth interview). Forty-three items of KOSS, in the second year, were retained for use in the final version of the KOSS by using Delphi and factor analysis. Items were scored using conventional 1-2-3-4 Likert scores for the response categories. Results: We developed eight subscales by using factor analysis and validation process: physical environment (3 items), job demand (8 items), insufficient job control (5 items), interpersonal conflict (4 items), job insecurity (6 items), organizational system (7 items), lack of reward (6 items), and occupational climate (4 items). Together they explained 50.0% of total variance. Internal consistency alpha scores were ranged from 0.51 to 0.82. Twenty-four items of the short form of the KOSS (KOSS-SF) were also developed to estimate job stress in the work setting. Because the levels of the subscales of occupational stress were gender dependent, gender-specific standard norms for both the 43-item full version and the 24-item short form using a quartile for the subscales of KOSS were presented. Conclusion: The results of this study suggest that KOSS might be an appropriate measurement scale to estimate occupational stress of Korean employees. Further and more detailed study needs to be conducted to improve the validity of this scale.

건강가정지원센터 가정생활교육 프로그램 운영 및 성과 : 용산구·숙명여자대학교 시범사업을 중심으로

김명자,계선자,박미석,장진경,김연화,한은주,류진아 한국가족관계학회 2005 한국가족관계학회지 Vol.10 No.1

The purpose of this study is to propose a model for service programs and management strategies for the division of family education in Healthy Families Center. For the purpose, the researchers find out demands for the family education programs of people in Yong-San Gu, Seoul, exam the effect of each family education program of Yong-San Gu & Sookmyung Women's University Healthy Families Center from June to December, 2004. According to the results, people in Yong-San Gu need economic education service mostly, and they want to study at Saturday afternoon. The programs show positive effect on the improvement of family health.

Control of Morphology and Subsequent Toxicity of AβAmyloid Fibrils through the Dequalinium-induced Seed Modification

Kim, Jin-A,Myung, Eun-Kyung,Lee, In-Hwan,Paik, Seung-R. Korean Chemical Society 2007 Bulletin of the Korean Chemical Society Vol.28 No.12

Amyloid fibril formation of amyloid β/A4 protein (Aβ) is critical to understand the pathological mechanism of Alzheimer's disease and develop controlling strategy toward the neurodegenerative disease. For this purpose, dequalinium (DQ) has been employed as a specific modifier for Aβ aggregation and its subsequent cytotoxicity. In the presence of DQ, the final thioflavin-T binding fluorescence of Aβ aggregates decreased significantly. It was the altered morphology of Aβ aggregates in a form of the bundles of the fibrils, distinctive from normal single-stranded amyloid fibrils, and the resulting reduced β-sheet content that were responsible for the decreased fluorescence. The morphological transition of Aβ aggregates assessed with atomic force microscope indicated that the bundle structure observed with DQ appeared to be resulted from the initial multimeric seed structure rather than lateral association of preformed single-stranded fibrils. Investigation of the seeding effect of the DQ-induced Aβ aggregates clearly demonstrated that the seed structure has determined the final morphology of Aβ aggregates as well as the aggregative kinetics by shortening the lag phase. In addition, the cytotoxicity was also varied depending on the final morphology of the aggregates. Taken together, DQ has been considered to be a useful chemical probe to control the cytotoxicity of the amyloid fibrils by influencing the seed structures which turned out to be central to develop therapeutic strategy by inducing the amyloid fibrils in different shapes with varied toxicities.

만성 승모판 패쇄부전증 환자에서의 안지오텐신 전환효소 억제제의 장기 투여 효과

김대희,이명묵,이해영,조현재,박승정,서재빈,서정원,양한모,윤창환,조상호,이준희,김용진,김명아,손대원,오병희,박영배 대한순환기학회 2004 Korean Circulation Journal Vol.34 No.2

Functional Characterization of Pharmcogenetic Variants of Human Cytochrome P450 2C9 in Korean Populations

( Myung-a Cho ),( Jihoon G Yoon ),( Vitchan Kim ),( Harim Kim ),( Rowoon Lee ),( Min Goo Lee ),( Donghak Kim ) 한국응용약물학회 2019 Biomolecules & Therapeutics(구 응용약물학회지) Vol.27 No.6

Human cytochrome P450 2C9 is a highly polymorphic enzyme that is required for drug and xenobiotic metabolism. Here, we studied eleven P450 2C9 genetic variants―including three novel variants F69S, L310V, and Q324X―that were clinically identified in Korean patients. P450 2C9 variant enzymes were expressed in Escherichia coli and their bicistronic membrane fractions were prepared The CO-binding spectra were obtained for nine enzyme variants, indicating P450 holoenzymes, but not for the M02 (L90P) variant. The M11 (Q324X) variant could not be expressed due to an early nonsense mutation. LC-MS/MS analysis was performed to measure the catalytic activities of the P450 2C9 variants, using diclofenac as a substrate. Steady-state kinetic analysis revealed that the catalytic efficiency of all nine P450 2C9 variants was lower than that of the wild type P450 2C9 enzyme. The M05 (R150L) and M06 (P279T) variants showed high k_cat values; however, their K_m values were also high. As the M01 (F69S), M03 (R124Q), M04 (R125H), M08 (I359L), M09 (I359T), and M10 (A477T) variants exhibited higher K_m and lower k_cat values than that of the wild type enzyme, their catalytic efficiency decreased by approximately 50-fold compared to the wild type enzyme. Furthermore, the novel variant M07 (L310V) showed lower k_cat and K_m values than the wild type enzyme, which resulted in its decreased (80%) catalytic efficiency. The X-ray crystal structure of P450 2C9 revealed the presence of mutations in the residues surrounding the substrate-binding cavity. Functional characterization of these genetic variants can help understand the pharmacogenetic outcomes.

신경망을 이용한 협력적 추천 시스템의 성능 향상

김종수,도영아,류정우,김명원 한국뇌학회 2001 한국뇌학회지 Vol.1 No.2

개인화 기술은 과다한 정보를 줄이기 위한 여과 기술로서 최근 인터넷 사용자들과 정보 제공자들로부터 관심의 대상이 되고 있다. 그 중 가장 많이 사용되고 있는 개인화 기술은 협력적 추천으로서, 이 방법은 사용자에게 어떤 항목(상품)을 추천해주는 데 있어서 그 사용자의 다른 항목들에 대한 선호도나 추천 항목에 대한 다른 사용자들의 선호도를 이용하여 추천해준다. 협력적 추천 방법 중 보편적으로 많이 사용되는 최근접 이웃 방법은 유사한 사용자들의 행위에 기반하여 항목들을 추천해 준다. 그러나 이 방법은 사용자들간의 단순한 유사도를 계산함으로써 성능이 떨어지는 문제점이 있다. 데이터마이닝 기법을 적용하여 사용자 선호도 데이터로부터 추천 규칙을 생성하여 추천을 해주는 연관규칙 방법 또한 사용자나 항목간의 내용적, 분류적인 공통성 또는 개념에 의한 연관성을 고려하지 못하고, 단지 단순하고 표면적인 연관성만을 고려하는 문제점을 가지고 있다. 본 논문에서는 추천의 정확도를 향상시키기 위한 신경망 추천 모델을 제안한다. 신경망으로는 다층 퍼셉트론을 사용하여 우선 학습변수들과 입력차원의 변화에 따른 신경망에 기반한 협력적 추천의 성능에 대해 조사하고, 순수한 협력적 추천에서의 문제점인 희소성(sparsity)문제를 해결하기 위해 내용기반 추천과 협력적 추천을 병합한 모델을 신경망에서 보인다. 마지막으로 다른 협력적 추천 방법과의 비교를 통하여 본 신경망 추천 방법의 장점과 성능의 우수함을 보인다. Personalization is a filtering technique to reduce information overload and it recently draws attention upon internet users and information providers. The collaborative recommendation is one of the widely used personalization methods. It recommends a user an article based on other users preferences for the target article or the preferences for other articles of the target user. The nearest neighbor method is one of the common collaborative recommendation methods, which recommends articles based on the behavior of the similar users. However, it suffers from poor performance mainly because it fails in properly computing similarity between users. The rule method extracts recommendation rules from the users preference data using data mining technique. It also suffers from simple and superficial association between users or articles without utilizing conceptual level of association such as commonality in contents and category. In this paper we propose neural networks model to improve the accuracy of recommendations. We investigate various aspects of collaborative recommendation based on multi-layer perceptrons by varying parameters and the dimension of input data. We also combine the collaborative recommendation and the content-based recommendation within a neural network model to solve sparsity problem in pure collaborative recommendation. We finally demonstrate through experiments that the neural network based collaborative recommendation outperforms the existing methods.