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.

흰쥐에서 반복적 스트레스가 신경활성 스테로이드의 GABAA 수용체 조절작용에 미치는 영향

장봉석,이종범,박형배,하정희,송창진 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.3

연 구 : 신경활성 스테로이드는 대뇌피질 세포막의 GABAA 수용체 복합체에서 GABAA 수용체 효현제 양상으로 작용하여 [³H]flunitrazepam이 GABAA 수용체에 결합하는 항진 작용이 관찰되었으나, 반복적으로 신경활성 스테로이드를 처치한 세포에서는 이러한 신경활성 스테로이드의 [³H]flunitrazepam 결합 항진효과가 소실되었다는 보고가 있었다. 이에 본 연구에서는 반복적인 스트레스에 부하된 흰쥐를 사용하여 신경활성 스테로이드의 GABAA 수용체에 대한 배위자(ligand)의 결합반응 양상을 정상 실험동물과 비교, 관찰하여 보고자 하였다. 방 법 : 본 연구에서, 벤조다이아제핀 수용체 결합반응(receptor binding assay)을 위한 [3H]flunitrazepam 결합반응을 위해서는 GF/B 여과지(Whatman) 상에서 Brandel M-24R을 사용하여 측정했고, GABAA 수용체 결합반응 (receptor binding assay)을 위한 [3H]muscimol 결합반응에서는 각 시험관 당 100㎕의 대뇌피질 조직(약 0.32mg 단백에 해당)을 사용하였으며, 상기 벤조다이아제핀 수용체 결합반응과 동일한 실험방법을 실시하였다. 결 과 : 신경활성 스테로이드인 pregnanolone은 대뇌피질 세포막의GABAA수용체 복합체에 대한 [³H]flunitrazepam 결합반응을 항진시켜 GABAA 수용체 효현제 양상으로 작용하는 것으로 관찰되었다. 또 pregnanolone이 GABAA 수용체 복합체상의 GABA 결합부위에 대한 결합력을 알아보기 위하여 GABAA 수용체 효현제인 [³H]muscimol 결합반응을 실시하였을 때 pregnanolone은 50%정도의 억제율을 보여주는 GABA와는 그 결과가 다르게 [³H]muscimol 결합반응을 억제하지 않음으로써. muscimol과 경쟁적으로 같은 결합부위에 작용하지 않는다는 것을 보여주었다. 또 반복적인 부동화 스트레스에 부하된 흰쥐의 대뇌 피질조직을 사용하여 pregnanolone의 [³H]flunitrazepam 결합반응을 관찰하였을 때, 대조군에 비하여 pregnanolone의 [³H]flunitrazepam 결합 항진작용이 감약되는 것을 관찰하였다. 결 론 : 이상의 결과로부터 반복적인 스트레스에 부하된 흰쥐의 대뇌피질조직에서는 정상 흰쥐에 비하여, pregnanolone이 GABA성 신경전달에 미치는 항진작용이 감약되었으며, 이는 반복적인 스트레스와 연관된 불안장애의 정신생리 규명에 중요한 정보라고 사료된다. Objectives : Pregnanolone is a potent positive modulator of the γ-aminobutyric acid(GABA) response that enhances the binding of [³H]flunitrazepam to the GABAA receptor. Recently, it was reported that chronic treatment with pregnanolone uncouples allosteric interactions between steroid and benzodiazepine recognition sites. The present study was designed to assess the effect of repeated stress on the modulation of neuroactive steroids on the GABAA receptor. Methods : The effect of steroids on the ligands binding to GABAA receptor was investigated using cerebral cortices of unstressed and repeatedly immobilized rats. Male Sprague-Dawley rats, weighing 200-250g were forced to suffer an immobilization stress for 2 hours. Results : Pregnanolone enhanced the binding of [³H]flunitrazepam to GABAA receptor in both of unstressed and repeatedly stressed rats. However, repeatedly stressed rats showed significantly higher values in EC50 and lower values in Emax of enhancement binding of [³H]flunitrazepam than those of unstressed rats. Conclusions : From these findings, it can be concluded that repeated stress reduced the positive modulation of neuroactive steroid no the GABAA-receptor complex.

정중과잉치로 인해 회전된 상악 중절치의 치험례

이범의,김영재,김정욱,장기택,이상훈,김종철,한세현 大韓小兒齒科學會 2004 大韓小兒齒科學會誌 Vol.31 No.4

정중과잉치의 원인은 잘 알려지지는 않았지만 dental lamina의 hyperactivity에 의해 발생한다는 가설이 가장 많이 받아들여지고 있다. 이러한 정중과잉치의 병발증으로는 주변 영구절치의 맹출 장애, 만곡 치근, 치근흡수, primordial 혹은 follicular cyst의 형성, 회전, 이환된 부위의 총생 및 비정상적인 정중이개를 일으킬 수 있다. 이러한 이유로 영구전치의 회전이 야기되면 보통 공간의 부족은 적거나 없으며 재발이 흔하므로 과개선이 요구된다. 재발의 방지를 위해서는 조기치료, 과개선, 긴 보정기간, 적절한 접촉면의 형성, 짝힘의 사용, 그리고 수술적인 방법 등이 제안되어왔다. 이에 저자는 정중과잉치로 인하여 심하게 회전된 상악중절치를 주소로 내원한 환아에서 교정적, 외과적 술식을 이용하여 양호한 결과를 얻은 두 증례를 보고하는 바이다. The etiology of mesiodens is unknown but the most widely accepted theory is the hyperactivity of the dental lamina. Complications of mesiodens are delayed or prevented eruption of maxillary central incisors, displacement or rotation of permanent teeth, crowding of affected region, abnormal diastema or permanent space closure, dilaceration or abnormal root development of permanent teeth, primordial or follicular cyst formation, root resorption of adjacent teeth, eruption into nasal cavity. If mesiodens rotate the maxillary central incisors, space deficiency is not common and relapse is very common. So overcorrection is needed. To prevert the rotational relapse, early treatment, overcorrection, long retention period, properly formed proximal surface, use of coupled force, and surgical techniques have been suggested. The authors present two cases, whose chief complain were severely rotated maxillary incisors by mesiodens, treated by orthodontic and surgical technique and showed good results.

공동주택의 에너지 절약 및 공기환경개선을 위한 열교환기의 성능평가

김범석,정용호,박병윤,손장열 대한건축학회 2003 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.23 No.1

This study was aimed to suggest the appropriate residential heat and moisture recovery ventilation systems(HRVs) in order to maintain an acceptable indoor air quality for the climatic conditions of Korea. This study was developed from experimental data on HRV Performance specifications and HVAC system. Results show that total heat exchangers of rotary type is applied on HVAC system that is possible to conserve energy and improve indoor air quality.

Lidocaine에 의한 경련이 뇌조직에서 c-fos 발현에 미치는 영향

조성범,채한정,강장숙,김형룡 원광대학교 생체재료·매식연구소 1998 원광생체재료·매식 Vol.7 No.1

Recently, a variety of stimuli including convulsion, ischemia and noxious stimuli have been shown to induce the expression of c-fos mRNA in central nervous system (CNS). In this study, c-fos expression in both mRNA and protein (Fos) levels is examined up to 72 hr in brain regions, including hippocampus, piriform cortex, neostriatum, amygdala, dentate gyrus, cerebral cortex, and thalamus during lidocaine-inducced convulsion. Intraperitoneal administration of lidocaine (120 mg/kg) induces generalized convulsion of rats within 10 min and subsequent increase of c-fos expression in both mRNA and Fos protein levels in dentate gyrus, piriform cortex, amygdala, neostriatum, cerebral cortex, hippocampus, and thalamus. A prominent induction of c-fos mRNA and Fos protein in dentate gyrus suggests that dentate gyrus plays an important role in the process of lidocaine-induced convulsion. These results suggest that c-fos may participate in plastic changes of central nervous system associated with stimuli such as seizure activity.

순수 Ti 용접재의 기계적 특성 및 피로크랙 성장특성에 관한 연구

최병희,이종범,정장만,장경천,최병기 朝鮮大學校 機械技術硏究所 2007 機械技術硏究 Vol.10 No.2

In this study, fatigue fracture often occurs due to the fatigue crack in the machine and welding structure and this is the result of severe operational environment, operational condition, and design condition caused by the large scaled and light weighted machine and structure in recent days. Therefore, safety and reliability should be secured to prevent the fatigue fracture of machine and structure, and the use of titanium has been increased in the metal material for the safety and reliability. The purpose of this thesis was to investigate the welding characteristics and fatigue crack growth characteristics of titanium, commonly using power station, aircraft and ship. The experimented material was TIG welded in order to look over the characteristics according to the notch position and compare with other material. The results, at the same welding condition, 4 pass specimen which had the smallest number of welding pass had the highest tensile strength with 51kgf/㎟ and the tensile strength of 4 pass specimen was 10% higher than the one of 7 pass specimen, and its elongation reduced about 30%. The initial fatigue crack growth characteristic is slower in this order, boundary zone < welding zone < HAZ < base metal. Especially boundary zone's growth speed is slower about 30 times than base metals.

잔류응력을 고려한 SS400재의 피로특성에 관한 연구

최병희,이종범,정장만,장경천,최병기 朝鮮大學校 機械技術硏究所 2007 機械技術硏究 Vol.10 No.2

In this study is about the fatigue characteristics which appears in the welding residual stress field. The welding residual stress takes place mostly at the portion where SS400 materials are automatical welded. The effects of the welding residual stress in the growth and propagation of fatigue crack, so as to study the fatigue behavior in the welding residual stress field. The results, in case of the load range is constant, as the stress ratio is changing to 0.1, 0.33. 0.5 the propagation life is constant but the growth life decreases. And than, when maximum load or minimum load is constant, as the stress ratio increases the growth life and propagation life increase. The fatigue crack propagations rate da/dN appears to accelerate when the stress intensity factor range △K is less than 15MPa-m^(1/2). The growing and propagation fatigue crack in the welding residual stress field is similar to original specimen after being passed the original residual stress field.

다제내성 그람양성균에 대한 Linezolid(Zyvox^(�))의 시험관내 항균력 비교

박대원,정희진,엄중식,황병연,김성범,이재갑,이연주,정혜원,정성주,박재형,이진수,손장욱,김우주,김민자,박승철 대한감염학회 2003 감염과 화학요법 Vol.35 No.5

배경 : MRSA, VRE, VRSA같은 다제 내성 그람 양성균의 등장에 따라 glycopeptide를 대체할 새로운 항생제의 개발이 필요하게 되었고 결과적으로 새로운 항생제인 linezolid라는 항생제가 개발되었다. Linezolid는 이전의 항생제와는 다른 새로운 계열의 oxazolidinone으로 경구 이용률이 우수하다. 원내 및 원외감염의 중요한 원인균이 되고 있는 MRSA, VRE에 대한 적절한 경구용 항균제가 없는 국내에서 폐렴 및 피부 연조직 감염에서 경구용으로 사용해 볼 수 있는 약제이다. 본 연구에서는 고대 구로 병원에서 분리된 MRSA, VRE 등을 대상으로 다른 여러 항균제와 비교한 linezolid의 시험관내 항균력을 조사하고자 하였다. 재료 및 방법 : 연구대상은 1998년 1월부터 2000년 12월까지 본원에서 입원 및 외래를 통하여 피부 연조직 감염증 및 호흡기 감염증, 요로감염증으로 진단된 환자들의 가검물로부터 분리된 MRSA 60균주, VRE 43균주, PRSP 25균주를 액체배지 또는 한천배지 희석법을 통하여 linezolid 및 기타 항균제에 대한 최소발육억제농도를 구하였다. 결과 : 실험에 사용한 S. aureus는 모두 MRSA였고 이들은 linezolid에 대해 MIC_(90) 2㎍/㎖(MIC 범위 1-2㎍/㎖), Enterococcus spp는 모두 VRE로 linezolid의 MIC_(90)은 2㎍/㎖로 MIC 범위는 1-4㎍/㎖였다. 한 개의 균주에서 MIC 4㎍/㎖로 중등도 감수성을 보였으나 MIC breakpoint가 (8㎍/㎖인 내성균주는 없고 모두 감수성을 보였다. S. pneumoniae의 경우 penicillin 내성이었고, linezolid MIC_(90) 1㎍/㎖ (MIC 범위 0.5-1㎍/㎖)로 전부 감수성을 보였다. 결론 : Linezolid는 MRSA를 위시한 VRE, PRSP 등의 다제 내성 그람 양성균에 대하여 우수한 시험관내 항균력을 보임을 알 수 있었다. Background : The emergence of multi-drug resistant Gram-positive cocci, such as MRSA, VRE, and VRSA, necessitated to develop new antibiotics, which could replace the glycopeptide. As a result, a new antibiotics named linezolid was developed. Linezolid is different line of oxazolidinones with a good oral bioavailability, compared to other antibiotics. Since appropriate oral antibiotics are not presently available for MRSA, which is a major cause of nosocomial and community acquired infections, the introduction of linezolid will have favorable effect on treatment of infections such as pneumonia or skin infections. In this study, we investigated the antibiotic effect of linezolid on MRSA and VRE isolated from patients who were treated in Korea University Guro Hospital. Material and Methods : By using broth microdilution and agar dilution method we measured minimum inhibitory concentration (MIC) with sixty S. aureus, forty three Enterococcus spp., and twenty five S. pneumoniae isolates from patients who were diagnosed as skin, soft tissue, respiratory, and urinary infections in Korea University Guro Hospital from January, 1998 to December, 2002. Results : All of S. aureus used in this study were MRSA, and MIG_(90) of linezolid was below 2 ㎍/㎖ (MIC ranged between 1-2 ㎍/㎖). All of Enterococcus spp. were VRE, and had MIG_(90) of 2 ㎍/㎖ (MIC ranged between 1 to 4 ㎍/㎖). One of the VRE showed intermediate susceptibility with MIC of 4 ㎍/㎖. However, none was resistant with MIC breakpoint above 8 ㎍/㎖. All of S. pneumoniae were resistant to penicillin, but they were susceptible to linezolid with MICao of 1 ㎍/㎖(MIC range 0.5-1㎍/㎖). Conclusion : In conclusions, linezolid has an excellent in vitro antibiotic effect on multi-drug resistant Gram-positive cocci, such as MRSA, PRSP, and VRE.

A SENSITIVITY ANALYSIS OF THE KEY PARAMETERS FOR THE PREDICTION OF THE PRESTRESS FORCE ON BONDED TENDONS

Jang, Jung-Bum,Lee, Hong-Pyo,Hwang, Kyeong-Min,Song, Young-Chul Korean Nuclear Society 2010 Nuclear Engineering and Technology Vol.42 No.3

Bonded tendons have been used in reactor buildings at some operating nuclear power plants in Korea. Assessing prestress force on these bonded tendons has become an important pending problem in efforts to assure continued operation beyond their design life. The System Identification (SI) technique was thus developed to improve upon the existing indirect assessment technique for bonded tendons. As a first step, this study analyzed the sensitivity of the key parameters to prestress force, and then determined the optimal parameters for the SI technique. A total of six scaled post-tensioned concrete beams with bonded tendons were manufactured. In order to investigate the correlation of the natural frequency and the displacement to prestress force, an impact test, a Single Input Multiple Output (SIMO) sine sweep test, and a bending test using an optical fiber sensor and compact displacement transducer were carried out. These tests found that both the natural frequency and the displacement show a good correlation with prestress force and that both parameters are available for the SI technique to predict prestress force. However, displacements by the optical fiber sensor and compact displacement transducer were shown to be more sensitive than the natural frequency to prestress force. Such displacements are more useful than the natural frequency as an input parameter for the SI technique.

A SENSITIVITY ANALYSIS OF THE KEY PARAMETERS FOR THE PREDICTION OF THE PRESTRESS FORCE ON BONDED TENDONS

JUNG BUM JANG,HONG PYO LEE,KYEONG MIN HWANG,YOUNG CHUL SONG 한국원자력학회 2010 Nuclear Engineering and Technology Vol.42 No.3

Bonded tendons have been used in reactor buildings at some operating nuclear power plants in Korea. Assessing prestress force on these bonded tendons has become an important pending problem in efforts to assure continued operation beyond their design life. The System Identification (SI) technique was thus developed to improve upon the existing indirect assessment technique for bonded tendons. As a first step, this study analyzed the sensitivity of the key parameters to prestress force, and then determined the optimal parameters for the SI technique. A total of six scaled post-tensioned concrete beams with bonded tendons were manufactured. In order to investigate the correlation of the natural frequency and the displacement to prestress force, an impact test, a Single Input Multiple Output (SIMO) sine sweep test, and a bending test using an optical fiber sensor and compact displacement transducer were carried out. These tests found that both the natural frequency and the displacement show a good correlation with prestress force and that both parameters are available for the SI technique to predict prestress force. However, displacements by the optical fiber sensor and compact displacement transducer were shown to be more sensitive than the natural frequency to prestress force. Such displacements are more useful than the natural frequency as an input parameter for the SI technique.