Reduction of Bacillus cereus Contamination in Biofilms on Stainless Steel Surfaces by Application of Sanitizers and Commercial Detergent

Lee, Min-Jeong,Ha, Ji-Hyoung,Kim, Yong-Su,Ryu, Jee-Hoon,Ha, Sang-Do The Korean Society for Applied Biological Chemistr 2010 Applied Biological Chemistry (Appl Biol Chem) Vol.53 No.1

We established the effectiveness of a washing, detergent and sanitizer treatments for reducing Bacillus cereus (B. cereus) contamination in biofilms on stainless steel surfaces. A water treatment did not affect biofilms and chlorine treatments at 200 ppm for 10 min and 300 ppm for 5 min, iodophor at 200 ppm for 10 min, and QAC at 400 ppm for 10 min were used to eliminate all B. cereus cells. B. cereus cells after detergent treatment were eliminated by chlorine at 100 ppm for 10 min, 200 ppm for 5 min, and 300 ppm for 3 min, and with iodophor at 100 ppm for 10 min and 200 ppm for 10 min, and QAC at 400 ppm for 10 min.

Bi-factor MIRT True-Score Equating for Testlet-Based Tests

이규민(Gue min Lee),Won Chan Lee,Michael J Kolen,박인용(In Yong Park),Dong In Kim,Ji Seung Yang 한국교육평가학회 2015 교육평가연구 Vol.28 No.2

Lee and Lee (2014) proposed bi-factor multidimensional item response theory model (BFM) "observed-score" equating procedures. The main purposes of this study were to develop BFM "true-score" equating procedures, and to investigate applicability of the proposed procedures with actual data. Eight equating methods (including both true- and observed-score) based on dichotomous IRT (2-parameter logistic model: 2PL), polytomous IRT (graded response model: GRM), testlet response model (TRM), and BFM were compared with target equipercentile equating. Data for this study were from the Reading Comprehension test for a large-scale state assessment program, which consisted of several passages and corresponding groups of items. True- and observed-score equating methods based upon 2PL and BFM produced similar equating results. The GRM true- and observed-score equating methods provided equating results somewhat different from others, and more similar to the target equipercentile equating. Lee와 Lee(2014) 연구는 혼합형 검사에서의 bi-factor 다차원 문항반응모형을 적용한 IRT "관찰점수" 동등화 절차를 제안하였다. 이 연구는 Lee와 Lee(2014) 연구의 추수연구로 단위검사를 대상으로 bi-factor 다차원 문항반응모형을 적용한 IRT "진점수" 동등화 절차를 제안하고, 그 적용 가능성을 실제 자료를 이용하여 탐색하고자 하였다. 이를 위해 단위검사로 구성된 대규모 독해 검사 자료를 이용하여, 2모수 로지스틱 모형(2-parameter logistic model: 2PL), 등급반응모형(graded response model: GRM), 단위검사모형(testlet response model: TRM), bi-factor 모형(bi-factor model: BFM)을 적용하였으며, 관찰점수 및 진점수 동등화를 시행하여 총 8개의 동등화 방법을 적용하고, 산출된 결과를 동백분위 동등화 결과와 비교하였다. 연구 결과, 2PL과 BFM을 적용한 관찰점수 및 진점수 동등화는 유사한 결과를 산출하였으며, GRM을 적용한 관찰점수 및 진점수 동등화 방법은 다른 방법들과 다소 차이를 보이는 결과를 산출하였고, 비교 기준이 된 동백분위 동등화 결과와 보다 유사한 결과를 보였다.

쿠싱증후군 환자에서 당 대사 이상 정도에 따른 인슐린 감수성과 인슐린 저항성의 변화

정인경,김성훈,정재훈,민용기,이명식,이문규,유형준,안규정,노정현,김동준,김광원 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.4

연구배경 당질 코르티코이드는 당 대사에 매우 중요한 호르몬으로 내인성 당질 코르티코이드 과다상태인 쿠싱증후군에서는 말초조직에서 인슐린 저항이 증가하고 이를 보상하고자 인슐린 분비의 증가로 고인슐린혈증이 동반된다고 보고되고 있다. 하지만 생체 내에서와 달리 시험관내에서는 췌도세포에 당질 코르티코이드를 장시간 처리하면, 인슐린 분비 및 생합성이직접적으로 억제됨이 확인된 바 있어 쿠싱증후군 환자에서 당뇨병의 원인으로는 아마도 말초조직에서 증가된 인슐린 저항성 뿐 아니라 이를 충분히 보상하지 못하는 췌장에서의 인슐린 분비 저하가 같이 동반되어있지 않을까 하는 가설을 세우게 되었고, 아직까지 당질코르티코이드가 당대사 이상을 일으키는 기전에 대해 쿠싱증후군을 당대사 정도에 따라 인슐린 감수성과 분비능을 분석한 연구는 없었기에 이를 알아보고자 하였다. 방법: 삼성서울병원에서 쿠싱증후군으로 진단 받은 환자 15명을 대상으로 하였다. 이에 대한 대조군으로는 쿠싱증후군 환자와 같은 성별 그리고 체질량지수를 갖은 15명의 건강한 성인을 대상으로 비교 하였다 쿠싱증후군 환자를 대상으로 경구당부하 검사를 통해 당대사 정도를 정상군, 내당능장애군, 그리고 당뇨병군으로 나눈 후 정맥 당부하 검사를 시행하여 각군의 인슐린 저항성과 인슐린 분비능의 지표를 비교하고, 수술 후 쿠싱증후군이 완치된 상태에서 수술 전후의 당대사 지표의 변화를 조사하였다. 결과: 1) 쿠싱증후군 환자 중 정상인은 20%, 내당능 장애는 27%, 그리고 당뇨병은 53%였다. 체질량지수, 나이, 그리고 발병 기간은 세 군간에 의미 있는 차이가 없었으나, 24시간 소변검사의 코르티솔 농도는 당뇨병군에서 의미있게 높았다. 2) 정맥당부하 검사 결과, 인슐린 감수성 지표인 Sl는쿠싱증추린」서 1.58±0.10[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 대조군의 3.37±0.49[×10^(-4)(min^(-1)(μU/mL)^(-1)]에 비해 의미있게 낮았으나(P=0.024), 쿠싱증후군 환자 중 NGT, IGT, DM 군간에 서로 통계적인 차이는 없었다. 3) SG는 정상 대조군과 쿠싱증후군 환자간에는 의미있는 차이가 없었고, 쿠싱 증후군에 있어서 당대사가 악화될수록 감소하는 경향을 보였으나 의미있는 차이는 없었다. 4) 인슐린 분비능의 지표인 AIRg는 정상인에 비해 전체 쿠싱증후군 환자의 경우 증가하는 경향을 보였으나 의미있는 차이는 없었다. 하지만 쿠싱증후군 환자중에서 당대사 상태에 따라 NGT군은 1299 (1297∼1310)(mu/g/min ×10^(-2))로 정상 대조군(368.9±98.6[mu/g/min ×10^(-2)]) 보다도 의미있게 높았고, DM군{202.2 (91.1~371.4) [mu/g/min ×10^(-2)}은 NGT군에 비해 의미있게 낮았다(P=0.0031). 5) 15명중 현재 완치 상태에 있는 6명에 대해 수술전과 후로 비교하였다. 수술 전 당대사 상태가 1명은정상, 1명은 내당능 장애, 그리고 4명은 당뇨병이었으나 수술 후 시행한 경구 당부하 검사상 모두 정상 당대사 상태를 보였다. 6) 수술 후 완치된 환자 6명에 있어 인슐린 감수성지표인 Sl는 수술전에 중앙값이 1.22[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 대조군에 비해 의미있게 감고』어 있었으나(p.0.05), 수술후 10.95 [×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 수준으로 회복되었고(P=0.0022), 인슐린 분비능을 나타내는 AIRg [mu/g/min ×10^(-2)] 값도 정상수준으로 회복되었다. 특히 인슐린 분비능의 회복양상은 혈당농도에 따라 판이하게 나타나서, 정상과 내당능장애 상태에 있던 2명은 수술전에 1201 [mu/g/min ×10^(-2)]로 증가되어 있던 AIRg 값이 수술 후 정상 수준으로 감소하였고, 수술 전에 당뇨병 상태에 있던 4명의 경우 245.9 [mu/g/min ×10^(-2)]로 인슐린 분비능이 감고il어 있었는데 이들은 수술 후 모두 정상 수준으로 증가되었다 (P=0.0286). 결론: 쿠싱증후군 환자에서 당대사 이상은 80%로 높은 유병률을 보였다. 모든 쿠싱증후군환자에서 인슐린 감수성은 정상인에 비해 저하되어 있어 말초조직의 인슐린 저항이 선행됨을 시사하며, 인슐린 분비능은 당대사의 정도에 따라 다르게 나타났는데, 정상 당대사군에서는 인슐린의 저항성을 극복할 만큼 정상 대조군보다 더 많은 양의 인슐린 분비를 하다가 고코르티솔혈증이 심할수록 인슐린 분비능의 감소로 당뇨병으로 진행됨을 확인할 수 있었고, 이런 인슐린 저항성과 인슐린 분비장애는 수술 후 다시 회복되는 가역적인변화를 보였다. Background: Glucocorticoid plays an important role in the control of carbohydrate metabolism. Patients with Cushing's syndrome have been reported to have an increased incidence of carbohydrate intolerance due to peripheral insulin resistance and hyperinsulinemia, although the exact incidence and nature of this disorder have remained unclear. Few results have been published about insulin resistance and insulin secretion according to the level of glucose concentration, or about the reversibility of such defects in patients with Cushing's syndrome. Methods: To assess the effect of glucocorticoid on the insulin sensitivity and insulin secretion in Cushing's syndrome, 15 patients with Cushing's syndrome were classified into 3 groups (normal glucose tolerance: NGT, impaired glucose tolerance: IGT, diabetes: DM) according to the degree of glucose tolerance based on the oral glucose tolerance test (OGTT). Insulin modified, frequently sampled, intravenous glucose tolerance test (FSIGT) was performed before and after curative surgery on these patients and on 15 healthy control subjects. Data were evaluated by non-parametric statistical analysis. Results: 1) Among the 15 patients with Cushing's syndrome, 3 (20%) were NGT, 4 (27%) IGT, and 8 (53%) DM, based on OGTT. Twenty-four hour urinary free cortisol (UFC) was significantly higher in the DM group. 2) Insulin sensitivity index (SI) of Cushing's syndrome was significantly lower than that of the control group p=0.0024), but was not significantly different among the three Cushing's syndrome groups of NGT, IGT and DM. 3) Glucose mediated glucose disposal (SG) (Ed- confirm this abbreviation; it does not seem to match the definition) of Cushing's syndrome was not significantly different from that of the control group. 4) Insulin secretion (AIRg) of Cushing's syndrome tended to be high, but it was not significantly different from that of control. However, according to the level of glucose concentration there was significant difference in AlRg among the three Cushing's syndrome groups p=0.0031); AIRg of DM was significantly lower than that of NGT. 5) After surgical treatment, parameters of insulin sensitivity and insulin secretion were normalized in 6 cured patients; 1 with NGT, 1 with IGT, and 4 with DM, preoperatively. Median SI of all 6 patients was significantly improved up to the normal range postoperatively p=0.0022). Median AIRg of these 6 patients was balanced around that of normal control postoperatively p=0.0286). Conclusion: Eighty percent of patients with Cushing's syndrome had abnormality of carbohydrate metabolism. Insulin sensitivity was significantly decreased in Cushing's syndrome. Insulin secretion was significantly higher only in the NGT and IGT groups of Cushing's syndrome. As the hypercortisolemia is exacerbated, insulin secretion is significantly decreased and causes DM, suggesting that glucocorticoid has a direct or indirect toxic effect on the pancreatic beta cell (J Kor SOC Endocrinol 18:392-403, 2003).

대장내시경검사의 전처치로서 항콜린제 사용에 관한 연구 : 전향적, 이중맹검법으로

박경남,한동수,이민호,최호순,박준용,손주현,이오영,함준수,전용철,송승찬,기춘석,윤병철,이종희 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.3

Background: Use of antispasmodic medication prior to colonoscopy is controversial but someone believes antispasmodic may improve visualization of colonic mucosa and ease colonoscope insertion. So, we designed a study to assess the effect of premedication with the antispasmodic, hyoscine-N-butyl bromide(Buscopan') on the performance of colonoscopy. Methods: This study was prospective, double blinded, randomized, controlled study, One hundred three consecutive patients were randomized to receive intravenous buscopan lml(n=52) or placebo(n=51) combined with our standard initial medication(me- peridine 50 mg and midazolam 2 mg). Insertion of colonoscopy was timed, and 100 mm visual analogue scales (VAS) were used for asscssing difficulty of procedure, colonic motility, frequency of positional change, frequency of external compression, difficulty of assistance and degree of discomfort experienced by the patients. Results: There were no significant differences of intubation time between buscopan group(mean time, 7.23 min., range 2~15) and placebo group(7.07 min., range 3-25), (p=0.83) and withdrawal time between buscopan group (6.46 min., range 2-22) and placebo group(6.76 min., range 2 25), (p=0.69). Also, there was no significant differences in intubation time between males and females(buscopan; males 7.00 min., females 7.60 min., p=0.34, placebo; males 7.0~5 min., females 7.08 min., p 0.44). The VAS scores checked by endoscopist(p=0.29), assistant(p=0.32) and patient (p=0.15) were not significantly different in both groups. There were no significant differences in intubation time, VAS scores nf endoscopist, assistant, and patients. Conclusion: Premedication with intravenous bu.opan has no advantage on colonoscopy procedure. Use of antispasmodic medication prior to colonoscopy was not considered as recommendable agent.

Ultrasonic Degradation of Endocrine Disrupting Compounds in Seawater and Brackish Water

So Young Park,Jong Sung Park,Ha Yoon Lee,Ji Yong Heo,Yeo Min Yoon,Kyung Ho Choi,Nam Guk Her 대한환경공학회 2011 Environmental Engineering Research Vol.16 No.3

In this study, a series of experiments was conducted on the relative degradation of commonly known endocrine-disrupting compounds such as bisphenol A (BPA) and 17α-ethinyl estradiol (Ee₂) in a single-component aqueous solution using 28 and 580 kHz ultrasonic reactors. The experiments were conducted with three different types of model water: deionized water (DI), synthetic brackish water (SBW), and synthetic seawater (SSW) at pH 4, 7.5, and 11 in the presence of inert glass beads and humic acids. Significantly higher sonochemical degradation (93-97% for BPA) occurred at 580 kHz than at 28 kHz (43-61% for BPA), regardless of water type. A slightly higher degradation was observed for Ee₂ compared to that of BPA. The degradation rate of BPA and Ee₂ in DI water, SBW, and SSW after 30 min of ultrasound irradiation at 580 kHz increased slightly with the increase in pH from 4 (0.073-0.091 min-1 for BPA and 0.081-0.094 min-1 for Ee₂) to 7.5 (0.087-0.114 min-1 for BPA and 0.092?0.124 min-1 for Ee₂). In contrast, significant degradation was observed at pH 11 (0.149-0.221 min-1 for BPA and 0.147-0.228 min-1 for Ee₂). For the given frequencies of 28 and 580 kHz, the degradation rate increased in the presence of glass beads (0.1 mm and 25 g) for both BPA and Ee₂: 0.018-0.107 min-1 without beads and 0.052-0.142 min-1 with beads for BPA; 0.021-0.111 min-1 without beads and 0.054-0.136 min-1 with beads for Ee₂. A slight increase in degradation of both BPA and Ee₂ was found as the concentration of dissolved organic carbon (DOC, humic acids) increased in both SBW and SSW: 0.107-0.115 min-1 in SBW and 0.087-0.101 min-1 in SSW for BPA; 0.111-0.111 min-1 in SWB and 0.092-0.105 min-1 in SSW for Ee₂. After 30 min of sonicating the humic acid solution, DOC removal varied depending on the water type: 27% (3 mg L-1) and 7% (10 mg L-1) in SBW and 7% (3 mg L-1) and 4% (10 mg L-1) in SSW.

모과내 기능성 유용성분 용매추출공정의 최적화

전주영 ( Ju Yeong Jeon ),조인희 ( In Hee Jo ),경현규 ( Hyun Kyu Kyung ),김현아 ( Hyun A Kim ),이창민 ( Chang Min Lee ),최용희 ( Yong Hee Choi ) 한국산업식품공학회 2010 산업 식품공학 Vol.14 No.2

본 연구에서는 모과내의 여러 가지 기능성 유용성분을 효과적으로 추출하기 위해서, 모과나무의 익은 열매로 만든 약재인 모과를 사용 하였다. 모과의 기능성 유용성분용매 추출 공정의 최적 조건을 확립하고자 하였다. 모과를 에탄올에 추출하여 반응표면 분석법으로 모니터링하여 최적 용매 조건을 설정하였다. 중심합성계획법에 따라 시료에 대한 용매비(X1)와 추출온도(X2), 추출시간(X3)을 요인변수로 하고 추출수율(Y1), 총페놀 함량(Y2), 전자공여능(Y3), 갈색도(Y4), 환원당(Y5)을 종속변수로 하여 시행하였다. 실험 결과 추출수율은 추출 온도와 추출 시간에 유의하게 영향을 받음을 알 수 있었다. 안장점에서 추출조건은 시료에 대한 용매비는 26.38mL/g, 추출온도는 72.82oC, 추출시간은 74.86 min에서 최대값을 나타내었다. 총페놀 함량은 용매비와 시간에 영향을 거의 받지 않았고 추출시간에는 영향을 받았으며, 최대값은 20.70mg/mL 로 나타났다. 이때의 추출조건은 시료에 대한 용매비는 22.61mL/g, 추출온도는 84.49oC, 추출시간은 77.25 min으로 나타났다. 전자공여능은 추출온도에 따라 유의하게 영향을 받은 것으로 나타났다. 안장점에서의 추출조건인 시료에 대한 용매비 10.65mL/g, 추출온도 67.78oC, 추출시간 96.75 min에서 추출수율은 94.12%로 예측되었다. 갈색도에 대한 추출조건은 시료에 대한 용매비 23.77mL/g, 추출온도 87.27oC, 추출시간 96.68 min 일 때 안장점이 나타났다. 환원당은 시료에 대한 용매비 26.83mL/g, 추출온도 82.167oC, 추출시간 81.94 min에서 10.55mg/mL로 최대값을 나타내었고 추출시간에 영향을 받았다. In this study, various active functional components in Chinese Quince were extracted by solvent extraction method. A central composit design for optimization was applied to investigate the effects of independent variables such as solvent to sample ratio (X1), extraction temperature (X2), and extraction time (X3) on the soluble solid contents (Y1), total phenols (Y2), electron donating ability (Y3), browning color (Y4) and reducing sugar contents (Y5). It was found that extraction temperature and extraction time were the main effective factors in this extraction process. The maximum soluble solid contents of 35.77% was obtained at 26.38mL/g (X1), 72.82oC (X2) and 74.86 min (X3) in saddle point. Total phenols were rarely affected by solvent ratio and extraction time, but it was affected by extraction temperature. The maximum total phenols of 20.70% was obtained at 22.61mL/g (X1), 84.49oC (X2), 77.25 min (X3) in saddle point. The electron donating ability was affected by extraction time. The maximum electron donating ability of 94.12% was obtained at 10.65mL/g (X1), 67.78oC (X2), 96.75 min (X3) in saddle point. The maximum browning color of 0.32% was obtained at 23.77mL/g (X1), 87.27oC (X2), 96.68 min (X3) in saddle point. The maximum value of reducing sugar content of 10.55% was obtained at 26.83mL/g (X1), 82.167oC (X2), 81.94 min (X3). Reducing sugar content was affected by extraction time.

개의 췌도분리에서 췌장의 팽창과 콜라겐 분해요소

이상훈,김성주,박정환,김종성,오승훈,한진수,정인경,양태영,김동준,김광원,이문규,민용기,이명식,정재훈,함종렬 대한당뇨병학회 2000 Diabetes and Metabolism Journal Vol.24 No.2

Backgrounds: One of the main problems conditioning the outcome of islet transplantation is the ability to separate a sufficient number of viable islets with preserved function. Islet purification is critically affected by all of the isolation stages. Thus, it is necessary to set up the standard isolation method that islets are separate well from acinar without compromising islet yield and viability. Methods: Twenty three adult mongrel dogs were used for the experiment of total pancreatectomy with islet isolation. The islets were properly isolated by a modified Recordi method. The obtained islets were further purified by centrifugation on discontinuous gradients using cell separation system (Model 2991, Cobe, Lakewood Colo). We evaluated islet number (islet equivalent number, 150 um equivalents/kg of recipient body weight, IEq/kg), purity, cell volume, viabilty, recovery rate, and comparison of outcome according to the isolation conditions. Results: 1) The mean of islet numbers before purification were 13543±9431Eq/kg, digestion times were 13.8±2.6 min., digestion temperature was 37.4±0.2℃, purity was 59.7?.0%, viability was 90.0±2.1%, cell volume was 4.7±1.1 mL, islet number after purification were 4064±361 IEq/kg, and recovery rate was 29±2.9%. 2) Isolated islet numbers were different according to the degree of pancreas distension with collagenase, digestion temperature, and digestion time. 3) The best conditions for islet isolation were above 37.5℃ in temperature at recirculation of collagenase, within 12 min in digestion time and well distended pancreas with collagenase. 4) According to multiple regression adjusted by variable factors, the degree of pancreas distension with collagenase and digestion time were independently associated factors for successful islet isolation. Conclusions: In this study, we concluded that the degree of pancreas distension with collagenase and digestion time were independent factors for successful islet isolation and the best conditions for islet isolation were above 37.5℃ in temperature at recirculation of collagenase, within 12 min in digestion time and well distended pancreas with collagenase.

치면열구전색제의 조건에 따른 법랑질 결합강도에 관한 연구

이용근,이흥수,이성재,방기숙,최정민,류승호,강민석 대한치과기재학회 1997 대한치과재료학회지 Vol.24 No.1

In this study, the shear bond strengths and accompanying elastic modulus ratio, displacement at bond failure and work up to fracture of pit and fissure sealants to toothe enamel were analyzed by the following variables, those were acid etching, moisture content of the surface of enamel, dentin bonding agent(species and method), thermocycling, saliva contamination. One kind of chemically cured resin based pit and fissure sealant, two kinds of light cured resin based pit and fissure sealants and one kind of glass ionomer based pit and fissure sealant, and two kinds of dentin bonding agents were studied. The buccal surface of extracted premolars were ground flat with # 600 silicone carbide papers, and the ground surface was treated depending on the experimental conditions. After each treatment, each pit and fissure sealant was filled into plastic tube of 3mm diameter, which were laid on the surface of ground enamel surface, and were cured. Sealant bonded teeth specimens were immersed in 37℃ distilled water form 24 hours. The shear bond strength of sealant to enamel surface was measured with Universal testing machine with the cross head speed of 1mm/min. From the obtained load-deflection curves, modulus ratio, bond strength, displacement at bond failure and work up to fracture were analyzed. From this experiment, the following results were obtained : 1. Comparing the results of standard condition(i. e. acid etching, dry surface, no dentin bonding agent and 300 thermocyling), the elastic modulus ratio of chemically cured resinbased pit and fissure sealant was significantly higher than those of other materials(P<0.05), and the bond strength, displacement at bond failure and work up to fracture of glass ionomer based pit and fissure sealant were significantly lower than those of other materials(P<0.05). 2. The results of ANOVA with the variables of type of material, acid etching, moisture condition of the enamel surface, dentin bonding agents were as follows ; 1) variables showed significant main effect on the shear bond strength of pit and fissure sealant to enamel(P<0.01), 2) type of material, acid etching and moisture condition of enamel influenced the bond strength significantly(P<0.01), 3) type and application methods of dentin bonding agents influenced on the bond strength significantly(P<0.05). 3. There were statistically significant correlation between the work up to fracture and the bond strength, and between the work up to fracture and the displacement at bond failure(P<0.01), and in these cases the correlation coefficient was 0.87.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

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.