아미노글리코사이드 사용제한에 따른 병원성 균혈증 유발 그람음성간균의 내성변화 및 임상적 의의

오종택,김신우,손종원,도병훈,한승우,신병철,박지현,이종명,김능수 대한감염학회 2003 감염과 화학요법 Vol.35 No.4

목적 : 항균제 오남용으로 인한 내성균의 출현, 약물부작용의 발생 및 약제 비용의 증가는 환자 개인뿐만 아니라 사회적으로 문제가 되고 있다. 본 연구는 항생제의 오남용을 막기 위한 제도의 일환으로 시행한 아미노글리코사이드 사용 제한정책의 비용 효과적인 측면을 조사하고 그람음성간균에 의해 병원성 균혈증이 발생한 환자들을 대상으로 이 정책이 항생제 내성률과 환자 사망률에 미치는 영향을 연구하였다. 방법 : 930병상 규모의 3차 병원인 일개 대학병원에서 아미노글리코사이드 사용제한정책이 시행된 직후인 2002년 3월에서 9월 사이에 그람음성간균(Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, Enterobacter aerogenes, Serratia marcescens, Stenotrophomonas maltophilia, Burkholderia cepacia)에 의해 발생한 병원성 균혈증 환자 60명(실험군)과, 이 정책이 시행되기 전에 입원한 환자들 중 균주별로 같은 수만큼 선별한 병원성 균혈증 환자 60명(대조군)의 의무기록을 후향적으로 조사하였다. 결과 : 아미노글리코사이드 사용제한정책이 시행된 시기인 2002년 3월에서 9월 사이에 처방된 아미노글리코사이드 사용량 및 비용을 이 정책이 시행되기 전인 2001년 3월에서 9월 사이와 비교한 결과, 아미노글리코사이드의 사용량(antimicrobial utilization density)은 사용제한 후 225.2에서 130.3으로 42% 감소하였고 약제 비용은 44% 감소하였다. 아미노글리코사이드 사용제한 후 병원성 균혈증을 유발한 그람 음성간균의 이 항생제에 대한 내성률은 유의한 변화를 보이지 않았으며 균혈증과 직접 연관된 사망률도 환자의 나이, 성별, 기저질환 및 원발병소 등을 보정할 경우 유의한 차이를 보이지 않았다(40.4% vs. 24.1%, P=0.11). 결론 : 아미노글리코사이드를 5일을 초과한 사용 시 감염전문가의 사전 승인을 필요로 하는 사용제한정책은 아미노글리코사이드의 사용량과 비용을 유의하게 감소시켰다. 또한 이 정책 시행 후 그람음성간균에 의한 균혈증 환자에서 균혈증으로 인한 사망률과 아미노글리코사이드에 대한 내성률은 유의한 차이가 없었다. Objective : To evaluate the effects of an aminoglycoside restriction policy on expenditures for aminoglycosides, antimicrobial resistance rates and clinical outcome of nosocomial bacteremia caused by Gram-negative bacilli (GNB). Methods : Starting in February, 2002, a prior consultation with an infectious disease specialist for using aminoglycoside antibiotics over 5 days was required in a 930-bed university hospital. In retrospective analysis of medical records 7 months after initiation of the aminoglycoside restriction policy, sixty cases of clinically relevant nosocomial bacteremia caused by GNB were found. These bacteremic patients were compared with sixty, species-matched, control patients with nosocomial Gramnegative bacteremia before the policy for total expenditures for aminoglycosides, susceptibility to antibiotics and clinical outcomes of bacteremia. Results : During the same period of 7 months before and after the restriction policy, total expenditures for aminoglycosides decreased by 44% in cost (from 465,030,841 Won to 259,618,337 Won) and the antimicrobial utilization density of aminoglycosides decreased by 42% (from 225,2 to 130.3). On the other hand, the patterns of antibiotic susceptibility and bacteremia-related in-hospital mortality rates after the policy did not show a significant change, compared with those before the policy. Conclusion : Antibiotic restrictions are among the most popular methods to diminish the practice of antibiotic overuse in hospitals. In this study, requirement for prior approval of aminoglycoside use over 5 days led to a significant decrease in the amount and cost of total aminoglycosides without a significant change in susceptibility patterns and bacteremia-related mortality rates.

전신성 홍반성 낭창의 임상적 고찰

신영태,김종학,장윤경,양종오,구영선,강민규,황평주,나기량,이강욱,서광선 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

The epidemiology, diagnostic criteria, clinical features, symptoms and signs laboratory findings, kidney pathology, and clinicopathologic correlation of systemic lupus erythematosus(SLE) were analyzed. The 63 patients studied were managed at the Department of Internal medicine, CNUH, from January 1983 to December 1997. Kidney biopsy was performed in 53 patients out of 63 patients with SLE. The results were as follows: 1. The ratio of male to female was 1:26. They were 12 to 71 years old and mean age was 32.1 years old. The peak age incidence was 4th decades(30%). 2. The most frequent chief complaint on admission was generalized edema. Most patients complain two or more symptoms. 3. Immunologic and renal disorders were the most frequently observed in the ARA criteria of SLE. And the positive ANA, hematologic disorder, malar rash, and arthritis, were observed in order of frequency. 4. Among the 53 patients with renal biopsy, 30 patients revealed class Ⅳ lupus nephritis(56%), class II in 12 patients(23%), class V in 8 patients(15%) and class III in 2 patients(6%). 5. The cases of lupus nephritis represented as nephrotic syndrome were high in the class IV with 68% and class V with 86%. 6. Of 30 patients who can be followed up, 5 patients resulted in death(17 % of mortality). They "were 14 to 57 years old and mean age was 28 years old. Follow up duration were from 1 month to 6 years and 3 months, and mean duration was 1 year and 1 month, but 3 cases 7. The causes of death were as follows: Two cases were due to seizure and coma resulted from CNS involvement. One was sepsis due to miliary the & pneumonia. One was dilated cardiomyopathy and heart failure due to cardiac ac involvement. And the other one was sepsis and acute renal failure resulted from cellulitis. 8. Prednisolone was used in all patients basically, and methyl-prednisolone pulse therapy, antimalarials and alkylating agents were used in some cases. In the cases of combined therapy, the activity of SLE was well controlled.

Serratia marcescens Purine Nucleoside Phosphorylase의 생합성에 대한 글리옥실산의 대사적 역할

신종란,방선권,최병범 한국식품영양학회 1999 韓國食品營養學會誌 Vol.12 No.1

최소 배지에 여러 퓨린 분해 대사 산물을 첨가하여 배양시킨 Serratia marcescens ATTC 25419 세포 추출물에서 purine nucleoside phosphorylase(PNP)의 활성을 조사한 결과, 구아노신은 대조군에 비해 효소의 활성을 5∼15mM에서 60% 이상 감소시켰고, 이노신은 7∼15mM에서 30% 정도 감소시켰으나 0.1∼1mM에서 효소의 활성을 원래대로 회복시켰다. 아데노신, 히포크산틴 및 크산틴도 5∼15mM에서 효소의 활성을 40∼50%정도 감소시켰으나 0.1∼0.5mM에서는 원래대로 회복시켰다. 한편, 요산은 효소의 활성을 0.5mM에서 20% 증가시킨 반면 15mM에서 80% 감소시켰다. 요산의 최종 분해 산물인 글리옥실산도 효소의 활성을 0.5mM에서 20% 증가시킨 반면 3∼15mM에서 30∼50% 정도 감소시켰다. 5mM 농도의 이노신, 히포크산틴 및 요산을 동시에 첨가했을 경우 효소의 활성을 20% 정도 감소된 반면, 이노신과 요산, 세 퓨린 분해 대사 산물은 각각 0.5mM씩 동시 첨가했을 경우는 각각 22, 33%씩 증가시켰다. 이 결과는 낮은 농도 (0.5mM)의 글리옥실산이 S. marcescens purine nucleoside phosphorylase (PNP)의 활성을 증가시키고 고 농도의 글리옥실산은 감소시키는 것을 나타내기 때문에 퓨린 분해 대사 과정에서 글리옥실산이 PNP 생합성의 조절 역할을 하는 것으로 분석된다. The effects of purine catabolites in growth media on the Serratia marcescens purine nucleoside phosphorylase activity were examined. The enzyme activity was decreased above 60% by guanosine (5 to 15mM). The enzyme activity was decreased approximately by 30% in the presence of high concentrations of inosine (7∼15mM), but was not affected at low concentration of inosine (0.1∼1mM). The enzyme activity was decreased approximately by 40∼50% in the presence of high concentrations of adenosine, hypoxanthine, and xanthine (5∼15mM), but was not affected at low concentration of adenosine, hypoxanthine, and xanthine (0.1∼0.5mM). However, the enzyme activity was increased by 20% with low concentrations of uric acid (0.5mM), but was decreased by 80% with high concentrations of same purine catabolite (15mM). Also, the enzyme activity was increased by 20% with low concentration of glyoxylate (0.5mM), final degradative product of uric acid , but was decreased by 30∼50% with high concentrations of glyoxylate (3∼15mM). The enzyme activity was decreased approximately by 20% by the simultaneous addition of inosine, hypoxanthine and uric acid at 5mM each, whereas it was increased by 22 and 33% by the combination of inosine and uric acid, three purine catabolites at 0.5 mM, respectively. These data suggest that S. marcescens purine nucleoside phosphorylase is positively regulated by a glyoxylate concentration, and then may play a regulatory role in a purine catabolism.

요부 외측구역 협착증에서 단순감압술과 기구고정술을 병행한 요추체간 골유합술과의 임상적 비교

손병길,최은석,정을수,신종현,김명진,지용철 대한척추신경외과학회 2004 Neurospine Vol.1 No.1

Objective: The lumbar spinal canal can be devided into the central zone and the lateral zone. The divisions of the lateral zone are the subarticular, the foraminal, and the extraforaminal zone. A common causes of the operation for the spinal stenosis are related to the association with the spondylolisthesis and the central stenosis. There is a paucity of data, however, regarding the operative intervention in the lateral zone stenosis(LZS). Our aim was to analyze the surgical result by the anatomical type and the operative method. Methods: 72 patients of LZS excepting the association with the spondyolisthesis have been operated by six neurosurgeons of our hospital from 30th April, 1994 through 30th September, 2002. The patients had been interviewed about surgical result through telephone by third party persons. The surgical results were analyzed by the four score rating system: ① medication, ② ADL(Ability of daily living), ③ the degree of improvement, ④ the degree of satisfaction. Results: Among 72 patients, there were 25 males and 47 females. The age group of the patients were in their thirties(1), forties(9), fifties(21), sixties(36) and seventies(5). Surgical methods were used on decompression(22), posterior lumbar interbody fusion(PLIF) with cage(1) and PLIF with transpedicular screw fixation system(49). The types of stenosis were subarticular(24), foraminal(16) and extraforaminal(30) and double crush(2). The overall surgical results were Excellent(18), Good(34), Fair(19), and Poor(1). The Non-success rate according to the methods of surgery were decompression(34.8%), PLIF with transpedicular fixation system(24.4%). The overall success rate was(53/72: 73.6%). The success rate according to the types were subarticular(17/24: 70.8%), extraforaminal(21/30: 70%), and foraminal(12/16: 75%). Conclusion: It is suggested that the result was more favorable on the cases of lateral zone stenosis operated with PLIF and transpedicular fixation system. According to the method used, the success rate of decompression was worse than PLIF with transpedicular fixation system.

가열처리에 의한 단감의 이화학적 특성

손규목,김광호,성태수,김종현,신동주,정지영,배영일 한국식품영양학회 2002 韓國食品營養學會誌 Vol.15 No.2

단감의 기능성 소재 및 기호성이 우수한 부원료로서의 이용 가능성을 확인하기 위하여 단감새옥를 전처리별 즉, 열처리 온도 (25℃, 75℃ 및 95℃) 에서 NaCl (0, 1, 3%) 농도별로 침적 (1, 5분) 하여 동결건조한 시료구를 대상으로 탄닌, 비타민 C, 색도 및 조직감 등을 분석한 결과는 다음과 같다. 탄닌 성분은 열처리 온도, NaCl 농도 및 침적시간이 증가할수록 탄닌함량이 감소하는 경향을 나타내었으며, 특히, 대조구 (420 mg%) 에 비해 95℃에서 1% 및 3% NaCl 농도에 5분간 침적시 각각 228 및 198 mg%로 감소하였다. 비타민 C 함량은 대조구 (122.4 mg%)에 비해 95℃에서 3% NaCl 농도에 5분간 침적시 75.8 mg% 로 감소하였고, 색도는 열처리 온도, NaCl 농도 및 침적시간이 증가할수록 L(명도) 및 b(황색)값이 뚜렷하게 증가한 반면, a(적색도) 값은 감소하였고, ??E 값은 증가하여 처리조건이 가중될수록 색의 변화가 진행됨을 알 수 있었다. 단감껍질과 전처리한 시료 (95℃, 1% NaCl, 5 분)의 flavonol 함량은 껍질에 myricetin(2.0 ㎍/g), quercetin (34. 5 ㎍/g) 및 kaemferol (1.1 ㎍/g) 성분이 검출되었고, 전처리한 시료는 myricetin (9.5 ㎍/g), quercetin (5.5 ㎍/g)이 검출되었다. 조직감은 대조구에 비해 전처리 (95℃, 1% NaCl, 5분) 한 시료에서 부서짐성, 응집성, 점성 및 씹힘성이 우수하였다. 관능검사는 95℃에서 1% NaCl에 5분 및 3% NaCl 농도에 1부간 침지한 시료가 좋은 평가를 받았다. Sweet persimmon were tested in order to identify their use as secondary material which is excellent in function and taste as food. Samples were soaked for 1 and 5 min with NaCl concentration (0, 1 and 3%) at a certain heating temperature (25, 75 and 9r℃), and then tannin, vitamin C, flavonol, color intensity, sensory test and textural properties were analyzed. The results of the analyses were as follows. Tannins were decreased as heating temperature, NaCl concentration and soaking time were increased, especially, that the control was 420 mg% but decreased 228 and 198 mg% at 95℃ (1 and 3% NaCl concentration) for 5 min, soaked in each. Vitamin C content also decreased more in higher temperature and NaCl concentration than control (122.4 mg%). Color intensity showed higher value in L and b than in heating temperature, NaCl concentration and soaked time longer remarkably, but a value decreased. The peel of sweet persimmons was analyzed myricetin (2.0 ㎍/g), quercetin (34.5 ㎍/g) and kaemperaol (1.1 ㎍/g), but in pre-treatment sample ( 95℃, 1% NaCl concentration and 5 min, soaked ) was showed higher myricetin (9.5 ㎍/g) and quercetin (5.5 ㎍/g). Textural properties were good in pre-treatment sample ( 95℃, 1% NaCl concentration and 5 min, soaked) such as brittleness, cohesiveness, gumminess and chewiness. In sensory analysis, the pre-treatment samples (95℃, 1% NaCl concentration and 5 min, soaked and 95℃, 3% NaCl concentration and 1 min, soaked) were showed higher point than others.

지속성 외래 복막투석 환자의 복막염

신영태,황평주,김종학,강민규,구영선,양종오,장윤경,이강욱 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

CAPD has established itself as an effective method maintaining the patients with end stage renal disease. CAPD peritonitis is one of the most important complication of peritoneal dialysis. We analyzed the incidence, pathogens, and outcome of the peritonitis, of the 95 patients who underwent CAPD at CNUH from January 1993 to July 1998. The result were as follows : 1) A total of 72 episodes of peritonitis occurred during this periods. The incidence of peritonitis were 0.64/patient/year. 2) The first episode of peritonitis was occurred within a year in 75%, within two year in 95.8%. 3) The rate of positive and negative culture were 27.8% and 72.2% respectively. Gram positive organisms were cultured in 60%, Gram negative organisms in 40%. S. aureus were most prevalent organisms(30%). 4) The cure rate were 83.3% in Gram positive organisms and 62.5% in negative organisms. 5) Peritoneal catheter were removed in 18 cases. Among them, 7 cases are due to peritonitis. In conclusion, improved technology and increasing patients' effort to careful management of catheter will reduce the incidence of peritonitis.

국내 실내 라돈농도와 연간 피폭선량 예측에 관한 연구

이종대,김윤신,손부순,김대선 한국환경과학회 2006 한국환경과학회지 Vol.15 No.4

법랑모세포 분화와 법랑질 형성과정에서 OD314, Apin protein의 발현 및 기능

박종태,최용석,김흥중,정문진,오현주,신인철,박주철,손호현 대한치과보존학회 2006 Restorative Dentistry & Endodontics Vol.31 No.6

본 연구에서는 법랑모세포 분화와 법랑질 형성에 연관이 있는 OD314 일명 Apin protein의 기능을 밝힐 목적으로, in-situ hybridization에 의한 OD314 mRNA 발현과 법랑모세포 세포주에서 OD314 enamel matrix protein의 발현, 그리고 OD314 유전자를 과발현/억제시킬 수 있는 construct를 제작한 후 법랑질 형성 중에 OD314의 기능을 알아보고자 RT-PCR를 시행하여 다음과 같은 결과를 얻었다. 1. OD314 mRNA는 발생중인 상아모세포보다 법랑모세포에서 강하게 발현되었다. 2. Tuftelin은 석회화 결정이 형성되는 14일까지 발현이 지속되고, 그 이후부터 점차 감소하였다. Amelogenin과enamelin은 7일부터 그 발현이 점점 감소하였다. 3. U6-OD314 siRNA construct를 이용하여 transfection한 법랑모세포 세포주는 OD314와 tuftelin,MMP2 mRNA 발현이 감소하였으며, CM-OD314를 transfection하여 OD314의 과발현을 유도한 경우에는 OD314와 MMP20 mRNA의 발현이 뚜렷이 증대되었다. 이 결과는 OD314가 법랑모세포의 분화와 법랑질의 형성 그리고 석회화 과정에 중요한 역할을 하는 새로운 인자임을 시사한다. This study was aimed to elucidate the biological function of OD314 (Apin protein), which is related to ameloblast differentiation and amelogenesis. Apin protein, calcifying epithelial odontogenic (pindborg) tumors (CEOTs)-associated amyloid, were isolated from CEOTs, and has similar nucleotide sequences to OD314. We examined expression of the OD314 mRNA using in-situ hybridization during tooth development in mice. Expression of OD314 and several enamel matrix proteins were examined in the cultured ameloblast cell line up to 28 days by reverse transcription-polymerase chain reaction (RT-PCR) amplification. After inactivation and over-expression of the OD314 gene in ameloblast cell lines using U6 vector-driven RNA interference and CMV-OD314 construct, RT-PCR were performed to evaluate the effect of the OD314 during amelogenesis. The results were as follows: 1. In in-situ hybridization, OD314 mRNAs were more strongly expressed in ameloblast than odontoblast. 2. When ameloblast cells were cultured in the differentiation and mineralization medium for 28 days, the tuftelin mRNA expression was maintained from the beginning to day 14, and then gradually decreased to day 28. The expressions of amelogenin and enamelin were gradually decreased according to the ameloblast differentiation. 3. Inactivation of OD314 by U6-OD314 siRNA construct down-regulated the expression of OD314, MMP-20, and tuftelin, whereas over-expression of OD314 by CMV-OD314 construct up-regulated the expression of OD314 and MMP-20 without change in tuftelin. These results suggest that OD314 is considered as an ameloblast-enriched gene and may play the important roles in ameloblast differentiation and mineralization.

수종 식물추출물의 항히스타민작용

이신웅,이윤주,손종근 영남대학교 약품개발연구소 1996 영남대학교 약품개발연구소 연구업적집 Vol.6 No.-

The antihistaminic action of eighteen herbal medicines was investigated by the radioligand binding and functional assays. The hexane fractions of Trichosanthis radix, Mori cortex radicis and Evodiac fructus dose-dependently inhibited [³H]mepyramine binding to H, receptor in guinea-pig brain homogenates and histamine-induced contraction of isolated guinea-pig ileum. Antihistaminic action of the hexane and ethyl acetate fractions of Mori cortex radicis and the hexane fraction of Evodiae fructus was more potent than their antimuscarinic action evaluated from the inhibition of [³H]QNB binding and carbachol response. The ethyl acetate and chloroform fractions from Scutcllariae radix also inhibited histamine-induced contraction, but antihistaminic potencies of these fractions were almost identical with their antimuscarinic potencies. The hexane fractions of Mori cortex radicis and Evodiae fructus inhibited selectively the increase of histamine-induced cutaneous vascular permeability in the rat dorsal skins. However, the ethyl acetate fraction from Scutellariae radix inhibited eqipotently the effects of histamine and serotonin on the vascular permeability. These results demonstrate that the hexane and ethyl acetate fractions of Mori cortex radicis and the hexane fraction of Evodiae fructus have the selective histamine H₁ receptor blocking activity.

하계 실내 및 실외환경의 공기 중 휘발성 유기화합물 농도 및 개인노출

양원호,손부순,박종안,장봉기,박완모,김윤신,어수미,윤중섭,류인철 한국환경과학회 2003 한국환경과학회지 Vol.12 No.9

Volatile organic compounds (VOCs) are present in essentially all natural and synthetic materials from petrol to flowers. In this study, indoor and outdoor VOCs concentrations of houses, offices and internet-cafes were measured and compared simultaneously with personal exposures of each 50 participants in Asan and Seoul, respectively. Also, factors that influence personal VOCs exposure were statistically analyzed using questionnaires in relation to house characteristics, time activities, and health effects. All VOCs concentrations were measured by OVM passive samplers (3M) and analyzed with GC/MS. Target pollutants among VOCs were Toluene, o-Xylene, m/p-Xylene, Ethylbenzene, MIBK, n-Octane, Styrene, Trichloroethylene, and 1,2-Dichlorobenzene. Indoor and outdoor VOCs concentrations measured in Seoul were significantly higher than those in Asan except Ethylbenzene. Residential indoor/outdoor (I/O) ratios for all target compounds ranged from 0.94 to 1.51 and I/O ratios of Asan were a little higher than those of Seoul. Relationship between personal VOCs exposure, and indoor and outdoor VOCs concentrations suggested that time-activity pattern could affect the high exposure to air pollutant. Factors that influence indoor VOCs level and personal exposure with regard to house characteristics in houses were building age, inside smoking and house type. In addition insecticide and cosmetics interestingly affected the VOCs personal exposure. Higher exposure to VOCs might be caused to be exciting increase and memory reduction, considering the relationship between measured VOCs concentrations and questionnaire (p<0.05).