노인외상환자의 예후 인자

문철규,전정민,최성혁,문준동,이성우,홍윤식 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: It has been documented that certain prognostic factors may affect the outcomes of the old aged victims by trauma. Considering that trauma is the sixth most common cause of death in people over the age of 65 years and there is a rapid growth of elderly population, it is paramount to understand the prognostic factors when dealing with geriatric trauma patients. Hypothesis and Goals: It can be hypothesized that the prognostic factors should be determined independently between populations being consisted of different races, countries, socio-economic states, cultures, or so on. Thus, the study was designed to evaluate the factors affecting the outcomes of elderly Korean trauma patients. Methods: One hundred forty six patients aged over 65 years were retrospectively reviewed, who visited the Emergency Center of Korea University from January, 1997 to June, 1998. Of 146 patients, 7 were excluded due to discharge against advice or transfer to the other hospitals. Parameters analyzed were age, sex, mechanism of injuries, body region injured, Injury Severity Score (ISS), previous medical illness, hospital morbidity, duration of hospital stay, and cost. Each patient was classified into improved or not-improved group depending on the outcomes, and young-old or old-old group depending on the age. The factors affecting the hospital stay in improved patients were analyzed in the parameters of previous medical illness, hospital morbidity, multiple injuries, ISS, and age. All statistical tests were conducted with two-tailed levels of 0.05. Results: Of 139 patients, the mean age was 74±7.1 years, mean ISS 9.3±7.26, mean hospital stay 27±27.1 days. Most commonly injured body region was the extremities due to fall from a level surface. Rate of previous illness showed 0.94 medical diseases per person and were aggravated after trauma in 39 patients (60.9%). Hospital morbidity rate was 0.46 incidents per person. There were no differences in age and duration of hospital stay between the improved and the not-improved group. Substantial differences were noted in affected body region, incidence of previous illness, and hospital morbidity between the groups (p=NS). Not-improved group had higher ISS(p<0.05). ISS, previous illness and hospital morbidity affected the duration of hospital stay in the improved group. Hospital stay was 40±25.1 days in patients with ISS over 6 while 6±8.6 days in those with ISS 5(p<0.05). Hospital stay in the improved was 26±26.9 days while 31±24.8 days in the improved old-old group (p=NS). Hospital stay in the young-old minor trauma (ISS5) patients with previous illness and hospital morbidity was 26±10.1 days while 4±7.3 days in those without previous illness and hospital morbidity (p<0.05). Conclusion: Previous medical illness and hospital morbidity, not age, are predictive of outcomes of geriatric trauma patients with respect to hospital stay. As most of the hospital morbidity was a trauma-induced aggravation of previous medical illness and hospital morbidity contributing poor outcomes can be potentially avoidable, routine aggressive care for the geriatric trauma patients with previous medical illnesses is needed.

차세대 통신망 환경에서의 멀티미디어 트래픽 중심 품질 보증 체계 구축방법

정지문,노시춘,최성,문송철,김정길 남서울대학교 2012 남서울대학교 논문집 Vol.18 No.2

This paper is presented to prepare NGN quality assurance management process under the quality system test methodology. The process should be drawn for NGN quality measurement framework of multimedia traffic. NGN test bed management process model are QoS measurement metrics, measurement interval meter above, and measuring tools, measuring equipment, measurement methods and measurement results from a series of processes for the analysis and methodology. This model, NGN quality assurance activities should be utilized in the future. Quality target level only when themselves constantly measured and managed, does not guarantee the communication quality of service. It is sensitive to the importance of NGN network technology paradigm for research on quality management in the NGN. Key Words : Quality Assurance, Test Bed, Design,Next-generation Network

7개 대학 병원에서 조사한 지역사회 폐렴의 원인균

정문현,김성민,강문원,최희정,정희진,이경원,한성우,송재훈,신형식,김의종,최강원,김민자,박승철,배현주,정윤섭,김준명,백경란,신완식,이규만,김양리 대한감염학회 1997 감염 Vol.29 No.5

목 적 : 폐렴은 많이 발생하면서 사망률이 크게 줄지 않는 질환이며, 이를 적절히 치료하기 위해서는 원인균의 상대적 빈도, 기저 질환에 따른 변화, 항균제 내성률, 사망에 관련된 인자들을 알아야 한다. 원인균의 빈도는 지역마다 차이가 있고 국내에서는 항균제 내성률이 높아 지역사회에서 발생한 폐렴을 치료하기 위한 경험적 항균제 선택에 도움이 되기 위해 서울 소재 6개 대학 병원과 천안의 1개 대학 병원이 참여하여 위의 사항들에 대해 조사를 하였다. 방 법 : 1995년에 내과에 입원했던 16세 이상 환자를 대상으로 했다. 퇴원 진단명이 폐렴 또는 폐결핵인 병록지을 찾았고, 이중에서 병원 감염을 제외하였다. 특이도를 높이기 위해, 이들 중에서 호흡기 증상이 있고 발열이나 저체온이 있으면서 흉부 X-선에서 이상 음영이 있는 환자만을 대상으로 했다. 폐결핵은 위의 기준에 입원 초기에 항균제 치료를 하고 입원 7일 이후에야 항결핵제가 투여된 경우만을 폐렴의 원인균으로 하였다. 혈액 배양에서 양성, 객담에서 항상균이나 M. tuberculosis가 증명된 경우, 혈청학적으로 항체가가 4배 이상 증가된 경우, 조직에서 원인균이 진단된 경우는 확정(definitive) 원인균으로 하였고, 객담에서 배양된 균이 그람 도말과 일치할때, 항결액제에 대한 반응으로 진단한 폐결핵, 단일 항체가 양성이고 이에 대해 항균제를 사용했을 때는 가능(probable) 원인균으로 정의하였다. 다세균 감염균은 각각 다 른 원인균으로 처리하였다. 임상 조사와 함께 임상병리과에서 S. pneumoniae, H. influenzae, M. catarrhalis, mycoplasma, 항상균에 대해 검사 의뢰 건수, 배양 양성수, 항균제 감수성 결과를 조사하였다. 결 과 : 폐렴의 증례 정의에 부합하지 않은 135명과 폐결핵의 정의에 해당하지 않는 230명을 제외하고 남은 246명의 평균 나이는 58.2세이고 남성이 142명(58.2%) 이었고, 71%의 환자에서 기저 질환이 있었다. 진단 방법의 시행 횟수는 혈액 배양 77.6%, 혈청 검사 18.3%, 기관지경 검사는 4.1%였고, 세균의 항원 검사를 한 예는 없었다. 원인균이 밝혀진 예는 77명(31.3%)이었다. 다세균 감염이 4명에서 있었고, 원인균의 상대적 빈도는 결핵 20명(확정 17, 가능 3: 6개 병원 자료), 폐렴구균 18(확정8 가능 10)명과 폐렴구균이 아닌 Streptococcus 3명 (모두 확정), H. influenzae 11명(모두 가능), 그람음성간균 11명(확정 7, 가능 4) (K. pneumoniae 8건), Mycoplasma 5명(확정 1, 가능 4), S. aureus 4명(확정 2, 가능 2), mucormycosis 1명(확정)이었다. 평균 입원 기간은 19일이고, 중환자실 입원률과 인공 호흡기 사용율은 각각 18%와 9.3%였다. 사망률은 13.8%였고 사망까지 평균 기간은 14.6일 이었다. 다변량 분석에서 사망을 예측할 수 있는 인자는 저체온과 빈호흡이었다. 임상병리과에서 배양되었던 모든 폐렴구균의 Penicillin 내성률은 서울 3개 병원에서 82-88%, 천안에서 72%였다. 폐렴 환자의 혈액에서 배양된 7주는 모두 Penicillin에 감수성이 있었다. K. pneumoniae 8주 모두 cefotaxime과 gentamicin에 감수성을 보였다. 결 론 : 후향적 조사이고 병원마다 원인균 진단에 차이가 있지만, 원인이 밝혀진 경우에는 결핵과 폐렴균이 흔하였고, 무균 부위에서 배양된 폐렴구균의 항균제 내성률은 낮았다. 원인이 밝혀지지 않은 경우가 많고, 혈청검사로 진단되는 원인균이 드물며, 분리균주가 적어 항균제 내성 정도를 추정하기 어려워, 이를 밝히기 위한 전향적 조사가 필요하다. Background : Community-acquired pneumonia (CAP) is one of the leading causes of mortality and morbidity, but its management is still challenging. The limitation of diagnostic methods to identify etiologic agents rapidly make it necessary to use empiric antibiotics in almost all patients, and furthermore the discovery of new respiratory pathogens and the emergence of antibiotic-resistant organisms pose difficulties to the selection of an empiric regimen. To clarify the factors necessary for the optimal choice of empirical antibiotics, such as the frequency of etiologic agents, the attributable rates to death and antimicrobial resistance rates in the community, six university hospitals in Seoul and one university hospital in Cheonan were participating in this study. Methods : medical records of adults (>15 years of age) hospitalized for CAP or pulmonary tuberculosis between April 1995 and March 1996, were reviewed. Patients who satisfied all of the following criteria were included in the study: (1) fever or hypothermia; (2) respiratory symptoms; and (3) pulmonary infiltrates on chest roentgenogram. To exclude cases of pulmonary tuberculosis whose roentgenographic features were so typical that it could be easily differentiated from conventional pneumonia, two additional criteria were required for inclusion: antibiotic treatment during the first week of hospital admission and initiation of anti-tuberculosis medications thereafter. Organisms isolated from sterile body sites, acid-fast bacilli or Mycobacterium tuberculosis isolated from sputum, pathogens diagnosed by a 4-fold rising titer of antibodies to “atypical”pathogens, or pathogens revealed by histopathology were defined as definitive cause of pneumonia; isolates from sputum withcompatible Gram stain, pathogens diagnosed by a single diagnostic titer plus use of a specific antimicrobial agent, or tuberculosis diagnosed by clinucal response to anti- tuberculosis medications were considered probable cause of pneumonia. The records of the clinical microbiology were reviewed for isolates of S. pneumoniae, H. influenzae, M. catarrhalis, Mycobacterium or acid-fast bacilli, and Mycoplasma. Then the frequency of these agents, antimicrobial resistance rates of resiratory pathogens from all body sites, and their clinical significance were evaluated. Results: After excluding 365 patients (230 with pulmonary tuberculosis and 135 with CAP) who were screened for inclusion but did not meet the inclusion criteria,246 persons were enrolled in this study. Their mean age was 58.2 years old with slight male predominance (58.2%), and 171(71%) patients had underlying illnesses. Blood cultures were performed on 191 (77.6%) patients and serologic tests on 44(18.3%) patients. The etiologic agents were identified in 31.3%, and the list of individual agents, in decreasing order, was pulmonary tuberculosis (17 definite and 3 probable: data of six hospitals), S. pneumoniae (8 definite and 10 probable), non-pneumococci (3 definite), aerobic gram-negative bacilli (7 definite and 4 probable), Haemophilus spp. (11 probable), mycoplasma (1 definite and 4 probable), polymicrobial infections (2 definite and 2 probable: E. coli and S. agalactiae, M. tuberculosis and S. aureus, S. pneumoniae and H. influenzae and A. baumannii and K. pneumonias), S. aureus (2 definite and 2 probable) , and mucormycosis (1 definite). Among gram-negative bacilli, K. pneumoniae was the most common agent (8isolates). therates of admission to the intensive care unitand of using assisted ventilation were 18% and 9.3%, respectively. The mortality was 13.8% and logistic regression analysis showed that hypothermia and tachypnea were associated with death. Hospital stay averaged 19 days. Susceptible rates of S. pneumoniae isolated from all body sites to penicillin ranged from 8% to 28% but seven isolated from blood of patients with pneumonia were susceptible to penicillin. Also all 8 isolated of k> pneumoniae from patients with pneumonia were susceptible to cefotaxime and gentamicin. Conclusion: In Korea, in addition to S. pneumoniae, M. tuberculosis is an important agent causing community-acquired pneumonia. The low incidence of etiologic diagnosis is probably related to infrequent requesting of test "atypical" pathogens and does not represent the true incidence of infections by "atypical" pathogens, which well be answered by a prospective study. The antimicrobial resistance rates of major respiratory pathogens from sterile body sites are low, however, because of a small number of the isolates this result needs confirmation by a nationwide surveillance of antimicrobial resistance.

HBsAg 양성혈청에서의 HBeAg 및 anti-HBe 양성율과 ALT와의 관계 고찰

문희주,윤기은,박정오,배형준,최범열 서울보건대학 1996 서울보건대학 부설 한국보건과학연구소 논문집 Vol.3 No.1

The authors investigated HBeAg and anti-HBe in 1,000 cases(male 941, female 59) of HBsAg positive among the 225,512 blood donors in Seoul Nambu Blood Center in 1994. HBeAg and anti-HBe was detected by the method Enzyme Immunoassy. The results obtained were as follows ; 1. HBeAg and anti-HBe positive rates were detected 498 cases(49.8%) and 445 cases(44.5%) respectively among 1,000 cases HBsAg positive blood donors. 2. In HBsAg positive carriers, HBeAg positive rates were not significantly different between anti-HBe positive rates, but in sex were significantly different between HBeAg positive rates and anti-HBe positive rates. 3. HBeAg positive 498 cases were analyzed with age and it was found percentages of positive rates were 63.6% in 1st decade, 53.7% in 2nd decade, 20.6% in 3rd decade, 19.6% in 4th decade and 8.3% in over 5th decade, but anti-HBe positive 447 cases were 32.4% in 1st decade, 40.5% in 2nd decade, 69.2% in 3rd decade, 78.3% in 4th decade and 91. 7% in above 5th decade. 4. HBeAg positive rate decreased stepwise with age, while anti-HBe positive rate increased stepwise with age. 5. ALT abnormal cases in the HBeAg positive donors were higher than normal cases, but ALT normal cases in the anit-HBe positive donors were higher than abnormal cases.

Computer Simulation에 의한 FMS의 生産日程 計劃 硏究

최효돈,남현우,문기주,하정진 동아대학교 공과대학 부설 한국자원개발연구소 1992 硏究報告 Vol.16 No.1

An FMS(Flexible Manufacturing System) consists of a group of computer numerically controlled machines linked by and automated material handling system, and which operates under computer control. FMS's are designed for production of small and medium-sized batchs comprising several different part types with the efficiency of automated mass production and the flexiblity of the job shop. In this research, job scheduling for minimizing APT(average processing time) was studied in FMS with 3 machining centers which are served by a cyclic-unidirectional conveyor while the conveyor speed is set to 1, 2, or 3, respectively. The results of this research could be useful to reduce APT in part manufacturing systems in practice.

가교화 쌀 전분의 이화학적 특성

최현욱,정구민,김정호,문태화,박천석,백무열 경희대학교식량자원개발연구소 2007 硏究論文集 Vol.26 No.1

라오스의 벼 생산 현황과 문제점

이문희,최경진,이정일,정남진,양원하,김제규 한국국제농업개발학회 2001 韓國國際農業開發學會誌 Vol.13 No.4

Rice is the single most important crop in Lao PDR. In the 2000 rice production year, total rice production in the Laos reached 2.2 million tons. This is regarded as sufficient to provide national self-sufficiency. The rice harvested area in 2000 was approximately 719,500ha and represented 80% of cropped land area. Approximately 82% of production was from wet season cropped and 18% was from the irrigated dry season. Grain yield per unit area vary from 1.68 to 4.39 ton/ha in the wet season environment. However, the highest grain yield (4.39 ton/ha) obtained from the dry season irrigated crop. Higher yields and reduced year variation in production can be expected with the further intensification of production systems in the low land environments. However, further imporvements in production will be dependent on higher levels of inputs and further alleviation of some the production constraints.

退溪의《禮安鄕約》에서 표현된 '孝'와 현대교육

김충실,최문식 단국대학교 퇴계학연구소 1990 退溪學硏究 Vol.4 No.-

열안정형 카테콜-O-메틸전이효소 유전자의 클로닝

홍경만,최용복,정갑용,지은정,장현신,박현,백문기 圓光大學校 醫科學硏究所 1998 圓光醫科學 Vol.14 No.2

Catechol-O-methyltransferase (COMT; EC 2.1.1.6) is the enzyme which catalyzes the transfer of methyl group to the catecholamine neurotransmitters from its methyl donor S-adenosyl-L-methionine. Partially purified COMT from rat liver has been used to measure the concentration of catecholamines in the blood through solvent extraction and thin layer chromatography after converting ^3H-methyl derivatives of catecholamines. To improve this inconvenient and fluctuating method, an attempt was made to use COMT gene for the measurement of catecholamines. Specific primers, COMT5P (5'-TGC TCA GAG GTG CTT TGA AG-3') and COMT3P (5'-GGA GCC GCA GAA GGT CA G-3'), were used to amplify COMT gene from human placenta cDNA library. The amplified COMT gene through 35 cycles of polymerase chain reaction was cloned into T-vector and the nucleotide sequences are determined by automatic sequencer. Human COMT has two common variants, a thermostable high activity form which has valine at amino acid 158 and a thermolabile low activity form which Has methionine at the same position. The cloned COMT gene in this study has both variants. Clone 4 and 5 have valine at amino acid 158 (guanine at nucleotide 472) and clone 1-3 have methionine at this site (adenine at nucleotide 472). In addition to this, there are other DNA polymorphisms in COMT gene at nucleotide 101, 102 (amino acid 34, a structural mutation cysteine/serine) and nucleotide 186 (a silent mutation). All of the clones have cysteine at amino acid 34 (guanine and adenine at nucleotides 101 and 102) and cytosine at nucleotide 186 except clone 3 which has thymine at this nucleotide. Clone 4 and 5 are thermostable high activity variants, suggesting being more useful for the measurement of catecholamines after expressing the gene.

지역(군수준)모자보건인력에 대한 교육과정 및 교육자료 개발에 대한 연구

방숙,최정심,안문영 순천향대학교 1988 논문집 Vol.11 No.3