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.

서울시 영상산업의 입지 특성 분석

김의준,박승규 동의대학교 경제경영전략연구소 2004 經濟經營硏究 Vol.2 No.2

This research analyzes the reasons of movement from Chnug-mu district to Kang-nam district of motion picture industry. As motion picture industry moved to Kang-nam district from Chung-mu district, this research assumes that relating industry of motion picture industry also moved to same location. So, this research reveals the reasons in order to find out determinants of movement. Also, this reason deals propriety of geographical location through Weber’s Theorem, which means, it finds out optimal location point between user and location of facilities. This research was taken by buffering analysis, spatial analysis, and network analysis of Arcview, according to number of chair in theater as a reference pole. Also it uses a density and contour analysis to find out spatial affected region by agglomerated motion picture industry. Lastly, it shows extent of effect by motion picture industry to self-government district through number of labor forces. In results, it shows that agglomeration and movement of motion picture industry happened by the extent of agglomeration of relative motion picture industry. And agglomeration of relative motion picture industry draw and affect to movement and growth of motion picture industry.

고속 광무선 LAN 시스템 개발 연구

김준환,김영권,홍권의 건국대학교 산업기술연구원 1997 건국기술연구논문지 Vol.22 No.-

Optical communications through the atmosphere offer the potential of relatively inexpensive high speed line-of-sight communications. Furthermore, the performance of any gound-to-ground or satellite-to-ground optical link will be affected by the atmosphere. The atmosphere is an imperfect medium for transmission of optical communications signals. It is not homogeneous and further, it is dynamic in its behavior. The atmosphere can be considered as producing some effects on transmission of light. These effects are turbulence, absorption, and scattering. All three can reudce the amount of light energy that is collected at the receiver and corrupt the data being sent. Although the effect of attenuation due to absorption/scattering can be overpowering in a link design, and can be compensated with judicious choice of wavelength of light signal, the fluctuations in amplitude and phase due to turbulence give rise to a number of important effects.

진행암 환자에서 Cisplatin 병용화학요법 시 Ondansetron의 오심 구토 조절 효과

조문준,윤환중,전의건,길준영,조덕연,김삼용 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

Ondansetron is a novel agent that selectively binds to the 5-hydroxytryptamine_3 receptor, and has been reported to have a prominent effect in the prevention of anti-neoplastic agent induced nausea and vomiting. Twenty solid tumor patients who were scheduled to receive cisplatin containing combination chemotherapy participated in a prospectively open-labeled study to evaluate the antiernetic efficacy and safety of ondansetron. The male to female ratio was 11 : 9 and median age was 49(16-70). The sites of primary neoplasms and number of patients were as following : head and neck 4, metastatic carcinoma of unknown primary site 3, stomach 3, osteosarcoma 2, ovary 2, esophagus 1, melanoma 1, penile 1, bladder 1, cervix 1, and extragonadal germ cell 1. Ondansetron was given as an 8mg loading dose IV before chemotherapy followed by 8mg IV every 8 hours until 24 hours after chemotherapy completion. Complete or major control(0 to 2 emetic episodes) of emesis was achieved in 17 of 20 patients(85%;complete 50%, major 35%) receiving ondansetron during the first 24hrs of chemotherapy. During the period of day 2 through clay 5 of chemotherapy, 14 of 20(75%) patients had complete or major control of emesis(complete 35%, major 35%). No severe side reactions were recorded in ondansetron treated patients, while mild to moderate headache was noted in 20% of patients. These results show that ondansetron is effective in the control of cisplatin induced nausea and emesis, and can be administered safely with minimal side effects.

Regulation of morphogenesis and neural differentiation of human mesenchymal stem cells using carbon nanotube sheets

Kim, Jeong Ah,Jang, Eui Yun,Kang, Tae June,Yoon, Sungjun,Ovalle-Robles, Raquel,Rhee, Won Jong,Kim, Taewoo,Baughman, Ray H.,Kim, Yong Hyup,Park, Tai Hyun Oxford University Press 2012 Integrative biology Vol.4 No.6

Pyruvate Protects against Cellular Senescence through the Control of Mitochondrial and Lysosomal Function in Dermal Fibroblasts

Kim, Jeong Yeon,Lee, Sung Hoon,Bae, Il-Hong,Shin, Dong Wook,Min, Daejin,Ham, Mira,Kim, Kyu-Han,Lee, Tae Ryong,Kim, Hyoung-June,Son, Eui Dong,Lee, Ai-Yong,Song, Yeong Wook,Kil, In Sup Springer Nature 2018 The Journal of investigative dermatology Vol.138 No.12

<i>In situ</i> fabrication of freestanding single‐walled carbon nanotube rope interconnection

Kim, Taewoo,Kang, Tae June,Seo, Dong Kyun,Jang, Eui Yun,Jin, Kyoung Cheol,Choi, Ajeong,Kim, Dae‐,Weon,Park, Yung Woo,Jeong, Dae Hong,Kim, Yong Hyup WILEY‐VCH Verlag 2012 Physica status solidi. PSS. A, Applications and ma Vol.209 No.11

<P><B>Abstract</B></P><P>A single‐walled carbon nanotube rope interconnect is fabricated by utilizing dielectrophoresis and capillary condensation. The rope connects a pair of prefabricated cantilevers with good alignment and outstanding packing density. The diameter and resistance of the rope are readily controlled by adjusting the dielectrophoresis parameters such as applied voltage and frequency. The properties of the rope, including packing density, electron transport, and maximum current density, are investigated. The maximum current density of the rope is measured to be as high as 1 × 10<SUP>7</SUP> A/cm<SUP>2</SUP> in vacuum. </P>

Highly Efficient Cold Sputtered Iridium Oxide Films for Polyimide based Neural Stimulation Electrodes

Kim, Shin-Ae,Kim, Eui-Tae,Kim, Sung-June The Korean Society of Medical and Biological Engin 2009 의공학회지 Vol.30 No.3

Iridium oxide films (IROFs) have been extensively studied as a material for electrical stimulation of neurons, as iridium oxide has higher charge storage capacity than other metal films. More recently, sputtered iridium oxide film (SIROF) has been studied, because it can be made more conveniently than activated iridium oxide film (AIROF). Typically, the SIROFs are grown at temperatures from 400 to 600 $^{\circ}C$. However, such high temperatures cannot be used when the iridium oxide (IrOx) film is to be deposited on a flexible polymer material, such as polyimide. In this paper, we show that we can still obtain excellent characteristics in SIROFs grown without heating (cold SIROF), by optimizing the growth conditions. We show that the oxygen flow rate is a critical parameter for controlling the surface properties of a cold SIROF. At an oxygen flow rate of 12 seem, the cold SIROF exhibited a charge storage capacity (CSC) of 60 mC/cm$^2$, which is comparable to or better than other published values for iridium oxide films including heated SIROFs. The film produced under these conditions also had the minimum impedance value of all cold SIROFs deposited for this study. A stability test and biocompatibility test also demonstrated the superiority of the optimized cold SIROF.

CD24 expression predicts distant metastasis in extrahepatic bile duct cancer.

Kim, Kyubo,Min, Hye Sook,Chie, Eui Kyu,Jang, Jin-Young,Kim, Sun Whe,Han, Sae-Won,Oh, Do-Youn,Im, Seock-Ah,Kim, Tae-You,Bang, Yung-Jue,Jang, Ja-June,Ha, Sung W WJG Press 2013 World journal of gastroenterology Vol.19 No.9

<P>To evaluate the prognostic significance of CD24 expression in patients undergoing adjuvant chemoradiotherapy for extrahepatic bile duct (EHBD) cancer.</P>

지역재생사업 파급효과의 결정요인

김의준 ( Eui June Kim ),박주형 ( Joo Hyung Park ),정다운 ( Da Woon Jeong ) 한국농촌계획학회 2010 농촌계획 Vol.16 No.4

The purpose of this paper is to identify the determinants of spillover effects of regional regeneration projects. This finds that the effects are positively determined by population sizes of regions and degree of industrial specialization of regeneration related industries. In particular, the improvement of accessibility through the development of transportation infrastructure facilities can contribute to increases of economic impacts of regeneration projects of high-income regions on the lagged regions. Microeconomic approaches and dynamic modelling need to be integrated for this impact analysis as further research fields.