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.

Caffeine이 지구성 운동 수행능력에 미치는 영향과 억제성 아미노산에 의하여 활성화되는 이온통로의 조절작용

김은경,김영표,천병옥,이계영,김연정,임백빈,조영욱,김창주,김성수 대한스포츠의학회 1999 대한스포츠의학회지 Vol.17 No.1

To investigate the effect and mechanism of caffeine on endurance exercise, two experiments were performed. First, to test caffeine effect on aerobic exercise, 200-300g Sprague-Dawley rats were used and three groups, control group, low caffeine injection group and high caffeine injection group, were divided. Blood smpling by heart puncture were done at rest, after 30 min treadmill exercise, and after maximal exercise. Blood glucose, free fatty acid concentration were detected and following results were obtained. Glucose concentration showed significant difference between groups(p=0.0305) and also significant changes were exhibited between time(p=0.0004). Free fatty acid concentration had no difference between groups. but had significance between times(p=0.00065). Exercise endurance performance time showed significant difference(p=0.02350 in high caffeine injection group compared to control group. In this experiments, endurance exercise capacity was increased by caffeine injection. Therefore, second experiment was performed to investigate the effect of caffeine on ion current induced inhibitory amino acid neurotransmitter. GABA and glycine. Single periaqueductal gray neuron was acutely dissociated and nystatin perforated patch clamp was performed under voltage clamping condition. Caffeine evoked outward current in PAG neuron dose dependent manner. 1mM of caffeine application had no response. but 3mM caffeine evoked about 32.5±8.539pA outward ion current and 10mM caffeine evoked about 215.46±19.4pA outward current. 10^-2mM GABA activated Cl￣current and recorded by inward current. Caffeine inhibited GABA activated Cl￣ current concentration dependent manner. 10^-2mM of caffeine had no effect on 1-^-2mM of GABA response. but 10^-1mM caffeine inhibited GABA activated Cl￣ current about 5.74±2.13%, 1mM caffeine inhibited about 17.25±2.70%, 10mM caffeine inhibited GABA response about 45.31±7.71%. 10^-1mM of glycine activated Cl￣ current and also recorded by inward current. Caffeine inhibited glycine activated Cl￣ current concentration dependent manner. 10^-2mM caffeine decreased glycine activated Cl￣ current about 4.61±1.650%, 10^-1mM caffeine decreased about 6.49±2.24%, 1mM caffeine decreased about 26.82±4.27%, and 10mM caffeine decreased glycine response about 94.47±1.39%. These results suggest that caffeine inhibite inhibitory amino acid, GABA and glycine, this response causes excitation of CNS and this seems to be the basic mechanism of increasing effect to aerobic exercise performance by caffeine.

간 세포암에서 VEGF, TGF-β1, b-FGF 발현의 의의

김성용,남충현,주종우,채만규,백무준,이문수,김형철,안현철,김홍수,김창진,김창호 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Purpose: Angiogenesis is important for the proliferation and the metastasis of solid tumors. The growth of a solid tumor is widely recognized to depend on the process of neovascularrozation. Without angiogenesis, tumors cease to grow beyond even a few milimeters in diameter. It has been shown that tumor vascular density is an independent prognostic marker in several types of human tumors and is known to correlate with poor prognosis. To date, many angiogenic factors have been identified, such as transforming growth factor-α(TGF-α), transforming growth factor-β(TGF-β), fibroblast growth factor family(FGF), vascular endothelial growth factor(VEGF), platelet derived endothelial cell growth factor(PD-ECGF), tumor necrosis factor-α(TNF-α), and angiogenin. Hepatocellular carcinoma(HCC) is the second most common tumor in Korean males and is known as a typical hypervascular tumor with frequent portal vein invastion. The authors identified the expreesion of VEGF, TGF-β1, and b-FGF in HCC specimens and evaluated the relationship between these growth factors and the clinicopathologic characteristics of HCC. Method: We reviewed the medical records of 30 patients who were diagnosed as hepatocellular carinoma treated with hepatic resection between January 1994 and December 1998 in Soonchunhyang University Chunan Hospital. The selection of the cases was decided according to the condition of paraffin block fixation. The prognostic factors such as age, sex, tumor size, concentration of serum α-fetoprotein, presence of liver cirrhosis, presence of tumor emboli in portal vein, TMN stage, amount of transfusion during the operation, hepatitis B virus(HBV) infection, and Edmonson-Steiner(E-S) grade were investigated. Relationship between the prognostic factors and the immunopathologic expression of the TGF-β1, b-FGF, and VEGF was examined. Result: Thirty patients (24 males, 6 females) were included in the current study. The patient's mean age was 50.6 years and the age ranged from 36 to 65 years. The mean size of the tumor was found to be 5.2cm. All the patients were follewed up for 7 to 63 months. Child's classification A patients were 23(76.7%)cases, B patients were 7(23.3%)cases, and C was none. Immunohistochemical staining of HCC tumor mass in VEGF expression patients were 17(56.7%), b-FGF expression patients were 10(33.3%), and TGF-β1 expression patients were 10(33.3%). VEGF expression or more than one positive expression among the three factors correlated with tumor size and the stage of HCC but did not correlated with other clinicopathological characteristics. TGF-β1 and b-FGF did not correlate with any clinicopathological characteristics. Conclusion: The results suggest that the expression of VEGF or more than one positive expression among the three factors in HCC cells may be a significant prognostic factor of HCC.

메티실린 내성 황색 포도상구균에서 vancomycin과 gentamicin병용의 항균력 상승효과 : Gentamicin 감수성에 따른 영향

김양수,김은옥,이상오,김백남,류지소,배직현,우준희,김미나,정두련,박수진 대한감염학회 1998 감염 Vol.30 No.2

배 경 : Vancomycin은 메티실린 내성 황색 포도상구균(methicillin-resistant Staphylococcus aureus, MRSA) 감염치료 시 선택 약제이다. 그러나, MRSA에 의한 심내막염과 같은 심부감염에서는 vancomycin 단독치료로 실패하는 경우가 흔히 보고되고 있다. MRSA에서 vancomycin과 aminoglycoside 병용의 상승효과에 대하여는 기존의 연구가 많지 않았다. 따라서 본 연구에서는 MRSA에서 vancomycin과 gentamicin 병합 시 상승효과가존재하는지를 알아보고, 만일 상승효과가 있다면 이를 예측할 수 있는 gentamicin의 최소억제농도를 밝히고자 하였다. 방 법 : 임상검체로부터 분리된 MRSA균주 중 무작위로 51균주를 선택하여 한천 희석법으로 gentamicin에 대한 최소 억제농도를 측정하였다. 이들 중 다양한 최소억제농도를 가지는 25균주에 대하여 vancomicin에 대한 최소억제농도와 최소살균농도를 측정하여 vancomycin에 대한 내약성(tolerance)여부를 조사하였고, vancomicin과 gentamicin 단독 및 병합에 대한 "time-kill 연구"를 시행하였다. 결 과 : MRSA 51균주에 대한 gentamicin의 최소억제농도는 4μg/mL 이하에서 512μg/mL 이상의 범위였으며, 7균주(13.7%)에서 감수성을 보였고 나머지 44균주(86.3%)는 내성이었다. 선택된 25균주의 MRSA 모두가 vancomycin에 감수성을 보였으나 16균주(64.0%)는 vancomycin에 tolerance를 보였다. Time kill 측정에서 약물 상호 작용의 분석이 가능하였던 18균주 중 5균주(27.8%)에서 상승효과가 관찰되었으며 나머지 13균주(72.2%)는 상호 무관한 작용을 보였다. 상승효과를 보인 5균주 모두가 gentamicin 최소억제농도 32μg/mL 이하이었으며, gentamicin 최소억제농도가 64μg/mL 이상인 균주 중 상승 작용을 보인 균주는 없었다. 결 론 : 메티실린 내성 황색 포도상구균의 대부분은 gentamicin에 내성을 보이지만, gentamicin에 내성이 있는 경우라도 gentamicin 최소억제농도가 32μg/mL 이하라면 vancomicin과 gentamicin을 병합 치료하여 상승효과를 기대할 수 있을 것으로 생각된다. Background : Vancomycin is the drug of choice for the treatment of infections caused by methicillin-resistant Staphylococcus aureus(MRSA). However, vancomycin monotherapy of deep-seated staphylococcal infection may be associated with poor bacteriological response. Limited data suggest that vancomycin-gentamicin combination therapy is effective against MRSA. In this study, we evaluated the vancomycin-gentamicin synergism against MRSA and also investigated whether gentamicin susceptibility may affect the synergism. Materials and Methods : The 51 strains of MRSA were obtained from patients at the Asan Medical Center from 1995 to 1996. The minimal inhibitory concentrations(MICs) of gentamicin were determined by the agar dilution method. The 25 strains with various levels of gentamicin MICs were chosen for time-kill studies. The MICs and minimal bactericidal concentrations(MBCs) of vancomycin were defined to determine vancomycin tolerance. Time-kill curves were established with vancomycin, gentamicin, and a combination of both. Results : Gentamicin MICs ranged from 4 to 512 μg/mL. Only 7 of the 51 strains were gentamicin-susceptible and 44 were resistant. All of the 25 strains chosen were susceptible to vancomycin, but 16 of them showed tolerance. Vancomycin-gentamicin synergism was demonstrated in 5 of the 18 strains, in which the analysis of drug interaction was possible. In the remaining 13 strains, vancomycin and gentamicin interacted in a nonsynergistic manner. In all strains that showed synergism, the MICs of gentamicin were below 32 μg/mL. No synergism was demonstrated in strains with gentamicin MICs above 64 μg/mL. Conclusions : Although most of MRSA strains are resistant to gentamicin, synergistic interaction between vancomycin and gentamicin may be expected when the MIC of gentamicin is below 32 μg/mL.

뼈에 발생한 악성 림프종 환자의 치료 효과 판정에서 ^(18)F-FDG Positron Emission Tomography의 유용성

김남돈,박연희,기승석,박용진,김형준,류백렬,김흥태,김성은,천기정,최창운,임상무 대한핵의학회 2003 핵의학 분자영상 Vol.37 No.5

원발성골림프종은 매우 드문 질환이기는 하나, 복합항암요법이나 방사선 치료등에 높은 반응율을 보이며, 좋은 예후를 가지는 림프절의 비호지킨 림프종의 일종이다. 그러나, 치료 효과 판정에 있어 골병변의 특이성에 의한 모호한 방사선학적 특징으로 어려움이 있어 왔다. 본 증례는 위와 같은 원발성골림프종 환자에서 PET 스캔을 사용하여 민감하게 완전 반응을 평가할 수 있었던 예로, 앞으로 다른 고식적인 방법과 함께 이 질환의 진단과 치료 평가 있어 유용하게 사용 될 수 있을 것으로 전망할 수 있었다. Purpose: Accurate assessment of the lesion after treatment of patients with bone lymphoma is difficult. In this patient who demonstrated complete remission after chemotherapy, the regions of fluorine-18 fluorodeoxyglucose (^(18)FFDG)PET uptake diminished more rapidly following therapy, indicating a complete response at much earlier stage than did Magnetic Resonance Imaging (MRI) or CT based findings. With the conventional methods, such as MRI and CT. It was difficult to assess whether the residual tumor tissue was viable or not. Decision to complete response is very important in patients with ymphoma to plan the further treatment. We experienced a patient with primary lymphoma of bone who revealed complete response to chemotherapy on ^(18)FFDGPET while CT showed persistent destructive bone lesion. Thus, ^(18)FFDGPET study after therapy may be superior to CT in the evaluation of response to treatment in primary lymphoma of bone.

Negative Regulation of Hypoxic Responses via Induced Reptin Methylation

Jason S. Lee,김윤호,김익수,김보규,최희준,이지민,신희재,김정화,김지영,서상범,이호,Olivier Binda,Or Gozani,Gregg L. Semenza,김민형,김근일,황대희,백성희 Sookmyung Women's University Research Institute of 2010 여성과 건강 Vol.6 No.1

마우스에서 조합시험법에 의한 고려홍삼의 생식발생독성 평가

김미라, 박동선, 장자영, 신선희, 이예은, 백인정, 연정민, 이세라 , 남상섭, 황방연, 노재섭, 김순선, 조대현, 남상윤, 이범준, 김윤배, 윤영원 충북대학교 동물의학연구소 2006 Journal of Biomedical and Translational Research Vol.7 No.1

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Negative Regulation of Hypoxic Responses via Induced Reptin Methylation

Jason S. Lee,김윤호,김익수,김보규,최희준,이지민,신희재,김정화,김지영,서상범,이호,Olivier Binda,Or Gozani,Gregg L. Semenza,김민형,김근일,황대희,백성희 Sookmyung Women's University Research Institute of 2010 여성과 건강 Vol.6 No.1

2003년 국내 중증급성호흡기증후군 진료 현황 및 문제점 분석

이진수,김은실,정문현,백제중,정선화,안주희,최영화,이선희,고철우,김성범,김민자,박승철,기현균,송재훈,최상호,김양수,이상오,조용균,박영훈,정숙인,김연숙,이흥범,손창희,장성희,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

목적 : 2002년 말 중국에서 SARS가 발생한 이후 국내에서도 2003년 10월까지 총 3명의 추정환자, 17명의 의심환자가 보고되었다. 향후 추가적인 SARS의 유행이 우려되는 상황에서, 그간의 SARS 환자 진료에 있어서의 실질적인 준비사항, 진료 현황 등에 대한 조사를 통해 문제점을 파악하여, 향후 더 나은 대비가 될 수 있도록 개선점을 제시하고자 하였다. 재료 및 방법 : SARS로 의심되는 환자를 진료 경험이 있는 병원의료진을 대상으로 2003년 10월에 설문조사를 실시하였다. 설문에는 SARS 환자 진료 시의 실질적인 조치, 진료 현황, 병실, 응급실 및 외래에서의 격리 시설과 준비사항, 보건당국의 관리와 지원에 관한 사항을 포함하였다. 결과 : 대상이 되는 22개 병원 중 17개(17/22, 77.2%) 병원이 설문에 응하였다. SARS 환자를 위한 격리실은 응급실, 외래, 일반병실 및 중환자실에서 각각 9개(9/17, 52.9%), 5개(5/17, 29.4%), 15개(15/16, 93.7%), 4개(4/16, 25%) 병원에서 음압처리가 되어있지 않은 일인실 혹은 다인실이 사용되었고, 1개(1/16, 6.3%) 병원에서만 일반병실에서 음압격리실이 운영되었다. 입원환자의 진찰 시 개인보호구의 착용은 거의 모든 의료기관에서 이루어졌다. 보건당국에서 SARS지정병원의 시설 등을 사전에 확인한 곳은 1곳(1/12, 8.3%)이였고, 14개 병원(14/15, 93.3%)에서는 보건당국에 의뢰한 검사결과를 통하 받지 못하였다. 결론 : 의료기관에서 SARS 환자용 격리실뿐만 아니라 기존의 격리실 설비 등이 미흡하였으며, 특히 중환자실 및 외래의 준비가 더욱 부족하였다. 보건당국의 의료기관에 대한 종합적인 지원이 부족하였고, 병원과의 원활한 연계가 잘 이루어지지 않았다. SARS 만이 아닌 격리를 필요로 하는 질환의 적절한 진료를 위해 향후 병원 시설의 정비와 정부차원에서의 보다 구체적이고 실질적인 대책마련이 필요하다. Background : There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. Materials & Methods : Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. Results : The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. Conclusions : The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

반코마이신 내성 장구균 감염에 대한 quinupristin-dalfopristin 치료 경험

추은주,최상호,조영환,정선미,김백남,김남중,김미나,김양수,우준희,류지소 대한화학요법학회 2002 대한화학요법학회지 Vol.20 No.1

VRE 감염이 중환자에서 급속히 증가하고 있으나 이에 대한 확실한 치료제가 없어 새로운 항생제에 대한 활발한 연구가 있는데 그 중 하나가 quinupristin/dalfopristin이고, 저자들은 중증 환자들의 VRE 감염에 대해 quinupristin/dalfopristin를 투여하여 치료한 임상적 경험을 하였기에 문헌고찰과 함께 보고하는 바이다. Vancomycin-resistant enterococci (VRE) was first recognized in 1992 in Korea. VRE infection have been increasingly reported in immunosuppressed patients over the past decade and have become one of major nosocomial pathogens. Clinicians carings for patients with VRE infections face severe constraints in the selection of treatment. Quinupristin/dalfopristin is active in vitro againt vancomycin-resistant E. faecium (VREF), with a MIC_(90) of 1.0㎍/mL. We studied the clinical efficacy and safety of this agent in the treatment of VREF infection. Patients were included if they had signs and symptoms of active infection including bacteremia, intra-abdominal infection, and wound infection. A total of 13 patients with VREF infection were enrolled. A favorable clinical response (cure or improvement) occured in 10 of 11 evaluable patients. The only adverse events related to quinupristin/dalfopristin were arthralgia and myalgia, which occurred in 2 of 13 patients. These results suggest that quinupristin/dalfopristin is effective and safe as treatment for VREF infections in critically ill patients with serious underlying conditions.