병원획득 Klebsiella pneumoniae 균혈증 분석을 통해 본 Ciprofloxacin 내성과 Extended-Spectrum β-Lactamase생성 간의 연관성

김미영,추은주,곽이경,송문희,나성수,송태준,김성혜,전재범,최상호,정진용,김남중,김양수,우준희,류지소 대한감염학회 2004 감염과 화학요법 Vol.36 No.5

목적 : K. pneumoniae는 ciprofloxacin내성 증가가 전세계적으로 문제가 되고있는 extended-spectrum beta-lactamase (ESBL)를 생성하는 대표적인 세균으로 최근 외국에서 ciprofloxacin 내성과 ESBL 생성사이에 관련이 있다는 2-3편의 보고들이 있었다. 본 연구에서는 병원획득 K. pneumoniae 패혈증이 있었던 환자들을 대상으로 ciprofloxacin 내성과 관련된 인자를 알아보고자 하였다. 재료 및 방법 : 2001년 1월 부터 2002년 12월 사이에 2200병상의 3차 의료기관인 한 대학병원에서 입원 후 72시간 이후에 나간 혈액배양에서 K. pneumoniae가 배양된 입원환자를 대상으로 의무기록과 전산기록을 분석하여 환자의 성별, 나이, 병동, 기저질환, 이전의 항생제 사용력, 패혈증 발생당시까지의 재원기간, 이전 입원력, 원인균의ESBL 생성유무 등을 파악하였고 이들 변수가 ciprofloxacin 내성과 관련이 있는지를 분석하였다. 재발성 패혈증의 경우는 첫 번째 경우만을 분석에 포함하였다. 결과 : 연구대상 환자는 총154명이었고 K. pneumoniae의 ciprofloxacin에 대한 내성률은 28.6% (44/154)였다. Ciprofloxacin 내성균주 중 ESBL 생성균주의 비율은 95.5% (42/44)였고 ciprofloxacin 감수성균주에서 ESBL 생성균주의 비율은 24.5% (27/110)였다(P<0.001). ESBL생성외에 단변량 분석에서 유의한 관련을 보인 변수로는 남자, 나이가 많은 경우, 패혈증 당시 중환자실 재원, 기저질환이 고형암, 혈액암, 담도계 질환인 경우, 패혈증 발생이전 1달 이내의 항생제 사용력, 3세대 cephalosporin, metronidazole, fluroquinolone, carbapenem 투여력이 있었다. 다변량 로지스틱 분석을 시행 하였을 때는 나이가 많은 경우(Adjusted odds ratio[A0R]; 1.04, 95%confidence interval[CI]; 1.01-1.06)와 ESBL 생성(AOR; 81.35, 95% CI; 17.76-372.53)이 유의하게 ciprofloxacin 내성과 관련이 있었다. 결론 : 패혈증을 일으킨 병원획득 K. pneumonias에서의 ciprofloxacin 내성은 ESBL 생성과 유의한 관련을 보였고 향후 이에 관련된 원인이나 기전을 분석하기위한 분자역학적·분자생물학적 연구가 필요하겠다. Background : Strains of ciprofloxacin-resistant Klebsiella pneumoniae have emerged worldwide. We investigated the epidemiology of ciprofloxacin resistance and its relationship to ESBL production in nosocomial K. pneumoniae bacteremia. Materials and Methods : Using the computerized database of clinical microbiology, we identified all patients whose blood culture had yielded K. pneumoniae between January 2001 and December 2002 at a 2200-bed university-affiliated tertiary-care hospital. During the study period, total of 392 episodes of K. pneumoniae bacteremia were documented of which 163 episodes were acquired nosocomially. 9 cases of recurrent episodes were excluded. Results : The resistance rates to ciprofloxacin was 28.6% (44/154). ESBL-production was significantly more common in ciprofloxacin-resistant isolates than in ciprofloxacin-susceptible isolates (95.9% [42/44] vs. 24.5% [27/110], P<0.001). In univariate analysis, following factors were significantly associated with resistance to ciprofloxacin: older age, male sex, ICU admission at the time of bacteremia, prior use of antibiotics within 1 month before bacteremia, solid tumor, hematological malignancy, or biliary disease as underlying disease, and ESBL-production. The prior use of 3^(rd)-generation cephalosprins, metronidazole, fluroquinolone, or carbapenem were also risk factors. Independent risk factors for ciprofloxacin resistance were older age (adjusted odds ratio [AOR]; 1.04, 95% confidence interval [CI]; 1.01-1.06) and ESBL production (AOR; 81.35, 95% CI; 17.76-372.53). Conclusion : The close relationship between ciprofloxacin resistance and ESBL production was documented in nosocomial K. pneumoniae bacteremia. Further epidemiological and molecular studies to determine factors and mechanisms involved in the relationship are needed.

한의진단명과 진단요건의 표준화 연구 III : 3차년도 연구결과 보고

최선미,양기상,최승훈,박경모,박종현,심범상,김성우,노석선,이인선,정진홍,이진용,김달래,임형호,김윤범,박성식,송태원,김종우,이승기,최윤정,신순식 한국한의학연구원 1997 한국한의학연구원논문집 Vol.3 No.1

The diagnostic requirements were suggested and explained regarding the systems of differentiation of symptoms and signs in the third year study of standardization and unification of the terms and conditions used for diagnosis in oriental medicine. The systems were as follows : - analyzing and differentiating of epidemic febrile disease - analyzing and differentiating in accordance with the Sasang constitution medicine based on four-type recognition - differentiation of disease according to pathological changes of Chong and Ren channels - standards for diagnosis of women's disease - standards for diagnosis of children's disease - standards for diagnosis of motor and sensor disturbance (-muscle. born, joint, etc.) - standards for diagnosis of neuropsychiatric disease - standards for diagnosis of five sense organ disease - standards for diagnosis of external disease The indivisual diagnosis pattern was arranged by the diagnostic requirements in the following order : another name, notion of diagnosis pattern, index of differentiation of symptoms and signs, the main point of diagnosis, analysis of diagnosis pattern, discrimination of diagnosis pattern, prognosis, a way of curing a disease, prescription, herbs in common use, disease appearing the diagnosis pattern, documents. The standards for diagnosis of each disease was arranged by the diagnostic requirements in the following order : another name, notion of disease, the main point of diagnosis, analyzing and differentiating of disease, analysis of disease, discrimination of disease, prognosis, a way of curing and prescription of disease, disease in western medicine appearing the disease in oriental medicine, documents.

직류 서보 전동기를 대상으로한 적응퍼지속도제어기의 설계

김호찬,조성범,문동춘,고봉운 제주대학교 공과대학 첨단기술연구소 2001 尖端技術硏究所論文集 Vol.12 No.2

This paper presents a study of the performance of a DC servo motor with a model reference adaptive fuzzy speed controller (MRAFSC) in the presences of load disturbances. MRAFSC comprised inner feedback loop consisting of the fuzzy logic controller (FLC) and plant, and outer loop consisting of an adaptation mechanism which is designed for tuning a control rule of the FLC. Experimental results show the good performance in the DC servo motor system with the proposed adaptive fuzzy controller.

UV-TiO₂광촉매 반응기를 이용한 미생물의 살균효과

김시욱,이정섭,정해광,박열,윤성명,유진철,이범규,이인화,박진열 조선대학교 환경공해연구소 1998 環境公害硏究 Vol.14 No.-

UV-TiO_(2) 반응기를 이용하여 Escherichia coli와 Aspergillus oryzae var. oryzae의 살균효과를 측정하였다. 254 ㎚에서 최대 14 watt의 자외선 방출량을 내는 램프를 원형 Pyrex유리관 중앙에 설치하였고 TiO_(2)는 석영관에 박막증착(Thin Film Coating)된 형태와 슬러리 형태로 나누어 회분식으로 살균정도를 측정하였다. E. coli에 대한 살균력은 1.7× 10^(7) cells/㎖에 대해 5분간 자외선 조사를 하였을 경우 2.0× 10^(2) cells/㎖으로 감소하였고, 자외선 조사와 함께 슬러리 형태의 TiO_(2)를 첨가하였을 경우에는 3.4× 10 cells/㎖으로, 자외선 조사와 함께 TiO_(2)가 석영관에 박막증착된 경우에는 7.6× 10^(2) cells/㎖으로 감소하였다. 한편 위와 같은 조건에 유리관 하부에서 기포를 주입후 11분 동안 자외선을 조사시킨 경우에는 1.3× 10^(2) cells/㎖으로, 자외선 조사와 함께 슬러리 형태의 TiO_(2)를 첨가하였을 경우에는 1× 100 cells/㎖으로, 자외선 조사와 함께 TiO_(2)가 박막증착된 경우에는 7.9× 10 cells/㎖을 나타내었다. 결국 UV-TiO_(2) 반응기에 사용되는 TiO_(2)가 슬러리 형태일 때 최대 살균효과를 나타내었으나 기포가 첨가되었을때는 오히려 살균에 장애를 받는 것으로 나타난 반면 석영관에 박막증착된 경우에는 기포가 첨가되는 것이 살균에 효과적인 것으로 관찰되었다. The killing effect of UV-TiO_(2) photocatalytic system on the Escherichia coli DH5-慣 and Aspergillus oryzae var. oryzae (KCTC 6095) was studied. The UV lamp which emits maximum 14 watts at 254 nm was set on the center of pyrex round glass tube. Two types of TiO_(2), one of which is slurry and another which is thin film coated form, were used to determine the killing effect. When UV was irradiated to 1.7 * 10^(5) cells/??of E. coli for 11 min, the living cell number decreased to 4.0 * 1.0^(0) cells/?? The effect of UV system together with slurried TiO_(2) was less than 1 cells/?? whereas that of UV-coated TiO_(2) system decreased to 7.1 * 10^(3) cells/?? To study the effect of bubble on the killing of microorganisms, air was bubbled to the bottom of glass tube. When 1.7 * 10^(5) cells/??were exposed to UV for 11 min in combination with air bubble, the living cell number decreased to 1.3 x 10^(2) cells/?? In the same condition except the addition of slurried TiO_(2), the living cells were 1 * 10^(2) cells/?? However, more cells could be killed by the system which consists of UV, coated TiO_(2), and air bubble (7.9 * 10^(1) cells/??. From these results, it was found that UV-slurried system is the most effective one, but its killing effect is not stimulated by air bubble. However, bubbling was very effective in the UV-coated TiO_(2) system.

고속도로 휴게소 오수의 특성(I)

김종오,서성규,김상채,이우범 木浦大學校 沿岸環境硏究所 1999 沿岸環境硏究 Vol.16 No.1

The sewage characteristics in the highway service area were investigated according to an interval of 2hrs for 24hrs. and seasonal variation to use them as the basic data for operating and maintaining those sewage treatment units. The range of temperature, pH and DO as physical characteristics were 15.1 ∼ 23.6℃, 6.6 ∼7.4 and 1.1 ∼ 2.2 mg/L, respectively, and found to be appropriate to the biological treatment. The sewage concentrations were larger than those of the general domestic sewage but analogous to those of shopping center and office. Specially, BOD and SS concentraions among them were analogous to those of Japan. The variation of sewage characteristics for 24hrs were insignificant except at high-demand time. It was observed that those concentrations were insignificantly changed with seasonal variation(spring, summer, autumn, winter) except temperature.

림프관 확장증형 모기질종 1예

김도현,김재욱,이지범,김성진,원영호,이승철 대한피부과학회 2003 大韓皮膚科學會誌 Vol.41 No.2

Pilomatricoma is a benign adnexal tumor differentiating toward elements of the hair matrix and shaft. It typically presents as a solitary, deep, dermal nodule, but other variants, such as anetodermic form and pseudo-bullous form have rarely been reported. A 22-year-old man presented with erythematous 4×5㎝ sized bulla-like nodule of about 1 month history on the upper back. Histopathologic examination of the lesion showed a well-circumscribed dermal nodule composed of basophilic cells, shadow cells, and transitional cells. There were also marked lymphangiectatic dilatations above the tumor in the upper dermis. We diagnosed this case as a lymphangiectatic pilomatricoma with pseudo-bullous appearance. (Korean J Dermatol 2003;41(2) : 258∼260)

잠재적 간성혼수 환자의 인지기능과 양성자 자기공명분광 소견과의 상관관계

김성윤,정범석,서동완,이정희,이 철 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.6

연구목적 : 잠재성 간성혼수 환자들의 신경인지기능 장애 정도와 기저 핵이나 두정엽 백질부에서의 자기공명분광 (proton MRS)으로 측정한 양성자 함유 화합물의 변화와의 상관관계를 조사하고자 하였다. 방법: 한국판 웩슬러 지능 검사(KWIS) 중 토막짜기나 기호 바꾸기, 그리고 번호잇기 검사를 적용하여 잠재성 간성혼수로 정의된 18명의 간경변 환자를 대상군으로 하고 20명의 정상인을 대조군으로 하였다. 복합주의력과 시각 정보 분석능력 측정을 위해 Vienna 전산화 신경인지기능 검사 중, Cognitrone 검사. 미세 협응 운동능력을 위해 Grooved pegboard 검사를 적용하였단 1.5 Tesla 임상용 자기공명 촬영기를 이용해 자기공련명 분광을 얻었으며 두정엽 백질부와 기저핵의 각각 2×2×2cm3 vocel에서의 myoinositol(ml), N-acetyl-L-aspartate(NAA). creative(Cr), choline(Cho) 등의 농도를 측정하고 Cr 농도에 대한 상대적 농도비율을 구하여 분석하였다. 결과: 1) 잠재성 간성혼수 환자들의 기저핵과 두정엽 백질부에서 Cho/cr 및 ml/Cr 비가 감소하였다. 2) 미세 협응 운동능력을 반영하는 Grooved pegboard 검사의 수행능력이 기저핵의 ml 및 두정엽 백질부의 Cho농도와 유의미한 역상관관계를 보였다(r= -0.59. p<.05). 3) Cognitrone 검사 중 정반응하는데 걸리는 평균시간은 두정엽 백질부의 NAA와 역 상관관계를 보였다(r= -0.55, p<.05) . 결론 : 잠재성 간성혼수 환자들의 특정 신경인지기능의 장애는 양성자 자기공명분광법으로 측정한 기저핵 및 두정엽 백질부의 신경화학적 변화와 상관관계를 보인다. 하지만 이러한 신경화학적 변화가 잠재성 간성 혼수의 근본적 병리 생리인지 2차적 변화인지를 규명하기 위해서는 질병의 경과에 따른 신경인지기능 및 양성자 자기공명분광 소견의 추적연구가 필요하며 비슷한 인지기능의 장애를 보이는 다른 신경퇴행성 질환과의 비교 연구가 필요하다. 0bjectives To investigate the relationship of neurochemical changes of brain in SCHE patients and the level of cognitive function, the authors measured hydrogen containing neurochemicals in two brain regions using 1H MRS, and compared those changes with the level of cognitive performances such as attention, visual analysis, or fine motor function. Methods ; A total of patients with liver cirrohosis were defined as SCHE, for they performed poorly(out of 1 SD of normative data) in more than one neuropsychological tests conventionally used(digit symbol and block design tests in KWIS, trail making test A and B). They were further evaluated in attentional ability and efficacy of visual analysis using Cognitrone subtest in Vienna Neurocognitive Test battery. Fine motor coordination were also measured by Grooved Pegboard test. Patients and 20 nodal controls underwent proton MRS study. Proton containg neurochemirals , such as myoinositol(mI) , N-acetrl-L-aspartate(NAA) , creating (Cr) , choline(Cho) were measured from 2*2*2cm3 voxel of basal ganglia and parietal white matter using 1.5 tesla dinical MRI/MRS system. The ratios of above metabolites to Cr were analyzed. Results : 1) Patients with SCHE showed reductions in Cho/Cr and ml/Cr in both basal ganglia and parietal white matter compared to normal subjects. 2) Performance of Grooved Pegboard test were negatively correlated with ml level of basal gang1ia and with Cho level of parietal white matter(r= -0.59, p<.05). 3) Mean time of correct responses in Cognitrone test skewed negative correlation with NAA level of parietal white matter(r= -0.55, p<.05). Conclusion : Certain neurocognitive disturbances in SCHE patients seemed to be related with neurochemical changes in basal ganglia or parietal white matter. To further elucidate the relationship of focal biochemical changes and neurocognitive deficits in SCHE patients, however, fo11ow-up study according to the illness stage must be performed. Studies on other disorders showing similar cognitive deficit patterns would be helpful.

심초음파로 결정된 응급 심낭천자술의 천자부위

김성환,황성오,이강현,조준휘,강구현,문중범,이승환,윤정한,최경훈,김영식 대한응급의학회 2000 대한응급의학회지 Vol.11 No.3

Background: The aim of this study was to determine whether the conventional subcostal approach is suitable for emergency pericardiocentesis in patients with cardiac tamponade or impending cardiac tamponade. Methods: This study was a prospective, observational study conducted at the emergency department of a tertiary hospital, Patients who had symptomatic pericardial effusion and who needed emergency pericardiocentesis in the emergency department were included in this study. We measured the epicardium-to-pericardium distance at the subcostal, parasternal, and apical area with two-dimensional echocardiography to determine the appropriate puncture site for pericardiocentesis. An epicardium-to-pericardium distance of more than 1.0 cm was considered as the primary safety factor in determining the Puncture site for pericardiocentesis. The skin-to-pericardium distance was considered as secondary safety factor. Results: Ninety-five consecutive patients(55 males and 40 females; total mean age: 53 year old) with cardiac tamponade or impending cardiac tamponade were enrolled in this study. The puncture site for pericardiocentesis, as determined by echocardiography, was the subcostal area in 43 patients(45%), the apical area in 40 patients(42%), the left parasternal area In 11 patients(12%), and the right parastemal area in one patient(1%). Pericardiocentesis failed in 2 patients(2%) with the subcostal approach and in one patient(1%) with the apical approach. The average epicardium-to-pericardium distance was 31 ±21 mm in patients with the subcostal approach and 21±8 mm in patients with other approaches. There were no differences in the amount of pericardial fluid and in the intraperical pressure among patient groups according to puncture site. There were two procedure related complications: a puncture of the right ventricle with the subcostal approach and a ventricular tachycardia with the apical approach.

여드름 환자에서의 경구 레티노이드(Roaccutane^(�))의 치료 효과

김종율,김성진,이지범,이승철,원영호 全南大醫大 2000 전남의대학술지 Vol.36 No.2

장기간 요가운동이 알코올의존자의 면역글로블린에 미치는 영향

민범일,김홍식,김성곤 한국스포츠리서치 2004 한국 스포츠 리서치 Vol.15 No.1

The purpose of this study was to investigate the effect of Yoga exercise on Immunoglobulin(IgE, IgM, IgD, IgG, IgA) in the alcoholism. The subjects involved in this study consists of 14 people who were confirmed to have alcohol-related problems by DSM-Ⅳ(1994) of American Psychiatric Association and were diagnosed as alcoholism in hospital. The subjects were classified into yoga exercise group(7 people) and control group(7 people). The yoga exercise group participated in the exercise programs named Hatayoga and Asana. This treatment was performed an hour per day, three days a week for 16 weeks while the control group watched TV for the same time. A paired t-test was used to examine differences between pre, post 8weeks and post 16weeks test scores. The results are as follows. After 16 week yoga exercise, there was a significant increase(p<.01) of Immunoglobulin (IgM, IgA(p<.05) & IgG) in the experiment group, compared with the control group. In terms of periodic change, the experiment group showed a significant higher result(p<.01) than the control group after 16 weeks, rather than after the 8 weeks. The result of this study above indicates that the long-term low intensity exercise can activate Immunoglobulint in alcoholism.