성인 지역사회 폐렴의 원인 미생물에 대한 전향적 다기관 연구 : Legionella, Leptospira, Hantaan virus and Orientia tsutsugamushi

김민자,정희진,손장욱,심희선,박대원,박승철,우준희,강재명,김유겸,신완식,김양리,이환종,김지희 대한감염학회 2001 감염 Vol.33 No.1

Background : Despite rigorous investigations, the etiology of community-acquired pneumonia remains unknown in about 50% of hospitalized patients. The diagnosis of the etiological agent is becoming more challenging and more critical as number of newer pathogens have been recognized in recent years. In the 3-year period prospective study we investigated adult patients with community-acquired pneumonia for Legionella, Leptospira, Hantaan virus and Orientia tsutsugamushi as potential etiologic agents. Methods : A prospective multicenter study was performed from May 1997 to April 2000. A total of 431 patients with community-acquired pneumonia under the inclusion criteria were examined for specific microbial diagnosis; sputum culture and PCR, and serologic teats including indirect immunofluorescence antibody (IFA) test for Legionella, and hemagglutination tests for Leptosoira, Hantaan virus and O. tsutsugamushi. Etiologic diagnosis was determined on the basis of the review of case record forms and specific laboratory diagnostic criteria. Results : During the study period a total of 385 sputum and 283 serum samples were examined. Legionella pneumonia was diagnosed in 2.3% (10/431) of the cases examined : 1.4% cases with PCR-positive (5/367) and 2.1% with positive IFA test (6/283). Leptospirosis and scrub typhus were diagnosed in 0.4% (1/252) and 2.0% (5/252), respectively. All 5 cases with scrub typhus occurred in late fall, and rash or eschar was not found. None of cases was Hantaan virus infection. Conclusion : The results suggest that Legionella, Leptospira, and O. tsutsugamushi should be considered in the etiologic diagnosis and empirical antibiotic therapy of community-acquired pneumonia. (Korean J Infect Dis 32:24∼31, 2001)

불응성 자가면역질환에서의 자가조혈모세포이식

민도준,양동원,민창기,김완욱,이상헌,박성환,김동욱,이종욱,조철수,민우성,김범생,김호연,김춘추 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.1

배경: 기존의 치료에 불응하고 예후가 불량한 자가면역질환 환자들에게 최근 고용량 면역억제 및 조혈모 세포이식이 새로운 치료방법으로 대두되고 있다. 저자들은 다발성 경화증(multiple sclerosis, MS) 및 류마티스 관절염(rheumatoid arthritis, RA) 등 2명의 자가면역질환 환자들에서 자가조혈모세포 이식을 시행하였다. 방법: 말초혈액 조혈모세포 가동화를 위하여 cyclophosphamide (4 g/㎡) 및 granulocyte colony stimulating factor (10 g/kg/day)를 투여하였고, CD34+ 세포를 분리·채집 하였다, 이식 전처치로 MS 환자에서 BEAM 및 antihymocyte globulin (ATG) (3.75 mg/kg), RA 환자에서 fludarabine (180 mg/㎡), ATG (10 mg/kg)와 busulfan (8 mg/kg)을 투여하였다. 결과: 호중구 수가 500/㎕ 이상으로 회복되는 기간은 MS 환자에서 9일, RA 환자에서 15일이었다. 혈소판이 20.000/㎕ 이상으로 회복되는 가간은 RA 환자에서 9일 이었고, MS 환자에서는 혈소판 감소증이 발생하지 않았다. 비혈액학적 독성으로 MS 환자에서 WHO 1도의 오심 및 점막염이 관찰되었다. MS 환자는 이식 6개월 후까지 시력감소가 남아있었으나, 이식전에 관찰되던 감각이상 및 운동장애 등의 신경학적 이상 소견은 더 이상 관찰되지 않았다. RA 환자는 이식 1개월 후 관절 증상 및 검사소견의 호전을 보였다. 결론: 불응성 자가면역질환 환자에서 고용량 면역억제 및 조혈모세포이식은 적은 독성으로 높은 치료효과를 기대할수 있으며, 향후 이 시술의 임상적 의의를 규명하기 위하여 전향적이고 장기적인 연구가 필요할 것으로 사료된다. Background: High-dose immunosuppressive therapy followed by autologous hemathpoietic stem cell transplantation (HSCT) has been proposed as a new approach to treat severe, refractory autoimmune diseases. We describe two patients with refractory autoimmune diseases (one multiple sclerosis 〔MS〕and one rheumatoid arthritis〔RA〕) who underwent T-cell-depleted autologous peripheral bleed stem cell transplantation for the first time in Korea. Methods: We mobilized autologous stem cells with cyclophisphamide (4 g/㎡) and granulocyte colony-stimulating factor (10 ㎍/kg/day). Stem cells were enriched ex vivo using CD34-positive immunoselection and reinfused after high-dose chemotherapy with BEAM and antithymocyte globulin (ATG) (3.75 mg/kg) in MS, or fludarabine (180 mg/㎡), ATG (10 mg/kg) and busulfan (8 mg/kg) in RA. Results: The engraftment with an absolute nerutrophil count greater than 500㎕ occurred on day 9 in MS and 15 in RA, respectively. The time to nontransfused platelet count greater than 2.000/㎕ was 9 day in RA. MS patient did not show ant episode of thrombocytopenia. Regimen-related non-hematopoietic toxicity was minimal. For 6 months since HSCT, them patient with MS had been free from previously existed sensory and motor abnormalities except decreased visual acuity. Then patient with RA and only one tender joint and two mildly swollen joints with improvement in laboratory parameters at one month after HSCT. Conclusion: These results underscore the feasibility and potential efficacy of intensive immunosuppression followed by autologous HSCT for treatment of intractable autoimmune diseases. The durability of remission, however, remains to be clarified.

Ca 첨가한 AZ31합금의 열간압연 특성

金完哲 弘益大學校 産業技術硏究所 2004 産業技術 Vol.14 No.-

The effects of homogenization on hot rolling properties of gravity cast AZ31-xCa (x=0~2.0wt.%) alloys were evaluated by examination of surface and microstructures of sheets. The side cracking during hot rolling was decreased by homogenization by the elimination of local inhomogeneity and dissolution of brittle precipitate into matrix. The coarse grains in raw materials were changed to fine grains with the average particle size of 5~10μm by the dynamic recrystallization during repeated hot rolling . A deformation twinning was more favorably formed in the hot-rolled sheets after homogenization. It is considered that the grains grow and the precipitates are solved into the matrix during homogenization heat treatment, which results in increasing the possibility of formation of deformation twinning during hot rolling.

냉연한 Cu-10Zn 황동의 재결정립 핵생성에 관한 연구

金容圭,金完哲 홍익대학교 산업기술연구소 1993 産業技術 Vol.2 No.-

The effect of heating on the microstructure of cold rolled Cu-10Zn brass is described. Almost all of the inhomogeneities of deformation that occur in the microstructure of heavily deformed fcc metals and alloys can be observed in cold rolled Cu-10Zn brass and potentially each of these is a site for the nucleation of recrystallized grains. In 90% cold rolled brass the first nuclei developed in brass type shear bands and this nucleation process was associated sometimes with the lateral growth of recovery twins but also with subgrain coalescence and boundary migration processes. Nucleation also occured at interfaces between different types of inhomogeneity. The results are discussed with reference to the currently accepted view.

기계적 합금화에 의한 급속냉각된 Al 분말의 조직과 기계적성질의 개선

金完哲 홍익대학교 산업기술연구소 1996 産業技術 Vol.6 No.-

Severe working of splats produced a very fine grain size and substructural strengthening. The dispersed particles were spherical and much finer then those obtained by conventional SAP. MA-AI splats extruded bars had the recrystallized grains when isothermally aged for 100 hours at 450℃. At higher temperature, hower, only the Al_2O_3 patricles pinned the grain boundaries. Accordingly grain size become smaller and grain boundary sliding was retarded, providing a superior high temperature hardness as the amount of Al_2O_3 increased.

g-2Ca-0.3X계 합금의 첨가원소에 따른 용탕산화 거동

金完哲,김문회 홍익대학교 산업기술연구소 2001 産業技術 Vol.11 No.-

This study has examined the ignition characteristics and oxidation resistant of the non-combustible Mg- 2Ca-0.3 weight % X(Al, La, Nd, Y) alloys in an attempt to develop new alloy systems that can subject to melting in the atmosphere and also prevent natural ignition of chips produced in mechanical working. Both the ignition property and oxidation resistant were found to improve significantly in any case where one of the third elements was added to the binary MG-2Ca alloy. The new alloy systems also improved the solidification characteristics, and their ingots were found to be relatively free from impurities and thermal crack whose presence is hard to avoid in the production of pure Mg ingots. The oxidation experiments with molten metals at 700℃ and 750℃ for 1 and 5 hours showed that the addition of Al or Y causes fine and dense oxide layers to develop. The oxide layers appear to suppress the grower of MgO products and thereby enhance the resistance of the alloys to ignition and burning. In alloys with the Y addition, the thickness of oxide layers did not show any significant change with the increase in temperature and time, indicating that the Y is relatively stable compared with that of Mg-2Ca. The ignition temperature of Mg-2Ca alloys, which is 100℃ higher than of pure Mg, increased by 100℃ with the addition of 0.3 weight % Al. There was a substantial increase in the ignition temperature as much as 800℃ in Mg-2Ca alloys containing both Al and Y by 0.3 weight %.

肺癌에 있어서 職業과의 關聯性 硏究

김두희,박완섭,손지연,이종영,홍성철 大韓産業醫學會 1995 대한직업환경의학회지 Vol.7 No.2

폐암에 대한 직업의 관련성을 밝히기 위하여 1993년 11월에서 1994년 8월까지 대구 시내 2개 종합병원에 입원하여 병리 조직학적으로 진단된 168명의 폐암 환자와 같은 병동에 있는 내과 환자를 연령군과 성별로 빈도 짝짓기하여 168명의 대조군으로 선정하였다. 직업력과 유해 물질의 폭로력, 거주 환경, 흡연에 관한 정보는 설문지를 통하여 얻었다. 흡연 상태를 보정하고 연령군과 성별에 대한 짝지은 자료에 대하여 직업과 산업 분류에 대한 폐암 발생의 상대 위험은 농업 종사자에서 유의하게 높았고(OR=1.84 ; 95% 신뢰구간 1.16-2.94) 생산직, 가내 수공업, 운수창고통신업, 숙박음식업, 건설업에서도 높게 나타났으나 유의하지 않았다. 그러나 가사(OR=0.31 ; 95% 신뢰구간 0.11-0.89), 관리직(OR=0.22 ; 95% 신뢰구간 0.08-0.61), 공공 행정업(OR=0.23, 95% 신뢰구간 0.08-0.66), 공공 사회및 개인 서비스직(OR=13 ; 95% 신뢰구간 0.03-0.56)에서는 폐암 발생의 상대 위험이 유의하게 낮았으며, 전문직, 도소매업에서도 낮게 나타났으나 유의하지 않았다. 거주 환경에 따른 폐암 발생의 상대 위험은 연탄난로 사용자(OR=3.00 ; 95% 신뢰구간 1.06-8.52)와 농약 사용시(OR=2.14 ; 95% 신뢰구간 1.36-3.37)에 통계학적으로 유의하게 높았고, 공장지대 거주자에서도 높게 나타났다(OR=1.97 ; 95% 신뢰구간 0.92-4.27) 그러나, 중앙집중식난방사용자(OR=0.5 ; 95% 신뢰구간 0.28-0.89)에서는 낮게 나타났으며 통계학적으로 유의하였다. 유해 물질 폭로에 따른 폐암 발생의 상대 위험은 농약(OR=2.07 ; 95% 신뢰구간 1.31-3.26)과 용접 및 흄(OR=10.56 ; 95% 신뢰구간 1.07-103.90)에 폭로시 유의하게 높게 나타났다. 흡연에 의한 폐암 발생의 상대 위험은 비흡연자에 비하여 흡연자(OR=3.98 ; 95% 신뢰구간 1.88-8.45)와, 과거흡연자(OR=4.50 ; 95% 신뢰구간 1.99-10.16)에서 높게 나타났다. 이상의 결과로 비록 흡연이 폐암의 중요한 원인이지만 흡연의 영향을 보정한 후에도 대기오염 및 직업과 폐암과 관련성이 있음을 보여주고 있으며, 앞으로 이러한 직업에서 어떠한 위험 요인이 있는지에 대한 추구가 필요하여 그에 대한 예방 대책을 밝히는 연구가 필요하다. The relationship between occupation and risk of lung cancer was analyzed in hospitalbased case-control study conducted in Taegu on 168 patients with histologically confirmed lung cancer and age group(30-39, 40-49,etc) and sex frequency-matched 168 controls admitted into hospitals for other internal medicine problems. A self adminstered questionnaire was used to obtain occupation, resident environment, smoking histories and specific agent exposure history. The conditional logistic regression was used to estimate oddsratio for age group and sex frequency matched, after controlling for smoking status(non smoker, exsmoker, current smoker) Significant association was observed for farmer[odds ratio(OR), 1.84 ; 95% confidence interval(CI), 1.16-2.94], briquette stove users[OR, 3.0 ; 95% CI, 1.06-8.25], agricultural chemicals users[OR, 2.14 ; 95% CI, 1.35-3.37], and welding/fume exposures[OR, 10.56 ; 95% CI, 1.07-103.90]. Although there were elevated risks associated with production, home industry, transportation/storage/communication, lodgement/food worker and construction, none were statistically significant. The effect of smoking was showed significantly increased risk for exsmoker [OR, 4.50 ; 95% CI, 1.99-10.16] and current smoker [OR, 3.98 ; 95% CI, 1.88-8.45]. As results, although smoking is important risk of lung cancer, occupation and resident environment are showing association of lung cancer. So further evaluation is necessary for occupation risk and take preventive measures.

납(Pb)이 흰쥐 신장의 미세구조와 metallothionein 양상에 미치는 영향

김완종,한상철,길영천 순천향대학교 기초과학연구소 1997 순천향자연과학연구 논문집 Vol.3 No.2

The present study was carried out to investigate the effects of lead on ultrastructure and metallothionein (MT) in the kidney of rat given lead acetate. Rats were intraperitoneally injected with 10mg, 30mg or 50mg of lead acetate per kg body weight everyday for three days, and the kidney tissues were removed at 24 hours after repeated injections. The tissues were prepared for light and electron microscopy and immunohistochemistry of metallothionein(MT). By light microscopy, the shrinkage of glomerulus and the presence of blood cells in tubular lumen were observed in the kidney of rat given lead acetate. The reaction products for MT by immunohistochemical analysis appeared strongly in the cells consisting tubular walls in experimental groups. By electron microscopy, there were numerous cytoplasmic vacuoles and bundles of collagen fibrils, indicating the interstitial fibrosis. These results suggest that lead causes the degenerative changes of ultrastructure and increases MT content in rat kidney.

급냉응고된 Mg-9Al-xCa 합금의 시효특성에 관한 연구

金完哲,朴祉河 홍익대학교 산업기술연구소 1999 産業技術 Vol.9 No.-

Mg-Al-Si-Ca alloys were fabricated into the ribbons by rapid solidification using a single-roll melt spinner. The time and temperature effect on age-hardening was investigated for the ribbons with varying Ca contents of 1, 3, 6 and 10 wt%. The behavior of precipitates, phase transitions, and mechanical properties were examined by measurements of micro-hardness, XRD analysis, and transmission electron microscopy. For the case of 1 hour's isochronal heat treatment, the temperature of 200℃ gave the most significant age hardening effect and the increase in Ca content caused enhanced hardening. In the aging treatment at 200℃, the hardness decreased with the increase in aging time from 1 up to 81 hour. The microstructural analysis for Ca-added sample showed uniformly distributed compounds of Al_4Ca and Al_2Ca, forming coherent precipitates with matrix. When the alloy contains more Ca than the solubility limit, the excess Ca precipitates as Mg_2Ca and an increased hardness is observed.

납(Pb)에 의한 흰쥐 간조직의 미세구조와 Metallothionein의 분포 변화

김완종,한상철 순천향대학교 기초과학연구소 1997 순천향자연과학연구 논문집 Vol.3 No.1

This study was conducted to investigated the alterations of ultrastructure and metallothionein(MT) in liver of rats given lead acetate. Rats were injected with 10㎎, 30㎎ or 50㎎ of lead acetate per ㎏ body weight everyday for three days, and the lever tissues were removed at 24 hours after repeated injections. The tissues were prepared for electron microscopy and immunohistochemistry of metallothiomein(MT). On electron microscopy, alterations of ultrastructure in liver of rat injected with lead acetate were characterized by the increase of heterochromatin, the irregularity of nuclear envelope, the swelling of rough endoplasmic reticulum, the increases of lipid droplets and glycogen particles. And also, higher dosaged groups showed large vacuoles in the cytoplasm and damaged connective tissue outside the cell. On immunohistochemistry, the reaction products for MT appeared in both cytoplasm and nucleus. The reactivity was more prominent in liver of rat injected with lead citrate than that of control rat. This findings suggest that lead caused the detrimental changes of liver structure and induced MT synthesis.