리네졸리드와 반코마이신을 교대로 투여하여 치료한 지속성 메티실린 내성 황색포도알균 균혈증 1예

김낙현,김문석,장은선,강유민,김가연,장희창,박완범,김의종,김남중,오명돈 대한감염학회 2009 감염과 화학요법 Vol.41 No.6

Persistent Staphylococcus aureus bacteremia is frequently defined as bacteremia persisting for ≥7 days despite proper antibiotic therapy. Its treatment includes removal of all infection foci and proper antibiotic therapy. Vancomycin remains the antibiotic of choice in MRSA bacteremia. Alternative agents, linezolid or daptomycin, are available, but a consensus regarding management of persistent MRSA bacteremia on vancomycin failure is still lacking. We report a case of a 60-year-old male who received thoracoabdominal aorta replacement operation due to dissecting aneurysm of the ascending and descending aorta. Surgical site infection and bacteremia caused by MRSA occured, and wound debridement operations were performed. The patient was treated with vancomycin in therapeutic doses but MRSA bacteremia persisted for 168 days in a row. Although the inserted aortic graft was the most probable source of persistent bacteremia, surgical removal was impossible. Linezolid was administered as an alternative antibiotic but had to be discontinued from time to time due to thrombocytopenia induced by this agent. In the end, MRSA bacteremia was successfully managed by alternating vancomycin-linezolid therapy.

만성 승모판 패쇄부전증 환자에서의 안지오텐신 전환효소 억제제의 장기 투여 효과

김대희,이명묵,이해영,조현재,박승정,서재빈,서정원,양한모,윤창환,조상호,이준희,김용진,김명아,손대원,오병희,박영배 대한순환기학회 2004 Korean Circulation Journal Vol.34 No.2

경연 대회를 통한 초ㆍ중고생의 창의력 신장 효과에 관한 연구

이희복,육근철,류해일,김현섭,김희수,박달원,유병환,김선효,김여상,서광수,변두원,서명석,배성효,박종석,심규철,이성희 공주대학교 과학교육연구소 2001 과학교육연구 Vol.32 No.1

미래 사회를 대비하기 위한 개인의 개성을 존중과 창의적인 능력을 지닌 인간을 양성을 목적으로 충청남도 지역의 초 ㆍ 중고등학생들을 대상으로 한 창의력 경연대회가 공주대학교 과학교육연구소에서 개최되었다. 충청남도 초 ㆍ중 ㆍ 고등학생들을 대상으로 실시한 창의력 경연대회는 창조적 아이디어를 내어 스스로 문제를 해결해 나갈 수 있는 교육 프로그램을 제공하는 좋은 기회였음이 확인되었으나, 일부의 팀에서만 참신하고 재미있는 아이디어들이 제안되었다. 여학생의 참가자 수가 상당히 증가하였으며, 대체적으로 입상권의 학생들의 상당 부분이 여학생이라는 것이 특이할만하다. 학년이 올라감에 따라서 창의적인 아이디어를 내는 양이나 질에 있어서 뒤떨어지는 것으로 분석되었으며, 토론 학습의 적응력이 미흡하고 발표력 및 청취력에 있어서도 떨어지는 것으로 나타났다. 따라서 중 ㆍ고등학교의 학교교육에서도 학생들에게 프로젝트형 탐구학습 프로그램의 적용은 물론 토론식 수습을 통한 학생들의 사고의 전환의 기회를 제공해야 할 것으로 사료된다. The creativity competition was held to foster the creativity of elementary and secondary school students in the Institute of Science Education, Kongju national University. It was found that the creativity competition effected on the improvement of inventing creative ideas and problem solving activities. But, only some competitors participated in semifinal and final contests, presented original and interesting ideas. More female students participated in competition than last year. More female participants were awarded a prize than males. Totally, participants were defective in discussion and communication, and presentation and listening ideas. Increasing grades correlated inversely with creativity and originality. There is need of inquiry project teaming programs and presenting opportunities of conversion of thinking by discussing instructions in school

국내 다기관에서 조사한 지역사회획득 메티실린내성 황색포도알균의 빈도와 임상적 특성

송진수,최평균,송경호,조재현,김성한,방지환,이창섭,박경화,박경운,신수,최희정,김의석,김동민,이미숙,박완범,김남중,오명돈,김의종,김홍빈,최강원 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

목적 : 최근 전세계적으로 지역사회획득 메티실린내성 황색포도알균(community-associated methicillin-resistant Staphylococcus aureus, CA-MRSA)의 보고가 증가하고 있다. 하지만, 우리나라에서는 CA-MRSA 감염증에 대한 증례보고만 있을 뿐 아직까지 체계적인 연구결과가 없는 실정이다. 저자들은 국내에서 CA-MRSA의 빈도, 감염증의 임상적 양상, 분리된 균주의 항균제내성 양상을 조사하였다. 재료 및 방법 : 2005년 1월부터 2005년 6월까지 7개 병원에서 MRSA가 분리된 환자의 명단을 파악한 후 의무기록지와 건강보험심사평가원의 자료를 검토하였다. 외래나 응급실에서 혹은 입원 후 72시간 이내에 균주가 분리되고 MRSA 획득과 관련된 위험인자가 없는 경우 CA-MRSA로 정의하였으며, 분리된 균주의 임상적 의미에 따라 원인병원체(pathogen), 집락화(colonizer), 미결정(undetermined)으로 분류하였다. Penicillin과 oxacillin을 제외하고 3개 이상의 다른 계열 항균제에 내성이면 다제내성으로 정의하였다. 결과 : 연구기간동안 총 3,251주의 황색포도알균이 분리되었으며, 이 중 MRSA는 1,900주(58.4%)였다. MRSA 가운데 CA-MRSA는 114주(6.0%) 였으며, 이들이 분리된 부위는 귀(62주), 비뇨기계(14주), 피부 및 연부조직(11주), 호흡기계(10주), 혈액(3주) 등이었다. CA-MRSA 균주 가운데 집락균은 22주, 원인병원체는 22주였으며, 나머지 균주에 대해서는 그 임상적 의미를 결정할 수 없었다. 항균제 감수성 검사를 시행한 73균주 중 47주(64.4%)는 다제내성이었다. CA-MRSA 감염증 22예 중 피부 및 연부조직 감염(9예)과 중이염/외이도염(9예)이 가장 흔하였다. 침습적 감염증(invasive infection)은 4명(원발성 균혈증 3예, 감염성 관절염 1예)에서 확인되었지만, CA-MRSA 감염증으로 사망한 환자는 없었다. 결론 : 병원내 감염증에서는 MRSA가 심각한 문제이지만, 아직까지 지역사회 감염증에서 CA-MRSA는 흔하지 않았다. Background : Methicillin-resistant Staphylococcus aureus (MRSA) infection has emerged in patients who do not have the established risk factors. In Korea, little is known about the epidemiology and clinical features of community-associated MRSA (CA-MRSA). Material and Methods : Clinical microbiology laboratory databases of 7 hospitals were reviewed to identify the patients from whom MRSA was isolated during the period of January to July 2005. Only one isolate per patient was enrolled. In order to identify the risk factors of MRSA acquisition, the medical records and the Health Insurance Review Agency databases were reviewed. CA-MRSA was defined as MRSA isolated from patient without established risk factors. We analyzed patient demographics, underlying medical conditions, characteristics of infection, and antimicrobial susceptibility profiles. Results : Of total 3,251 S. aureus isolates, 1900 (58.4%) were MRSAs. Of the MRSA isolates, 114 (6.0%) were CA-MRSA. Of 114 CA-MRSA isolates, 22 (19.3%) were colonizers, 22 (19.3%) were pathogens, and the clinical significance of remaining 70 (61.4%) could not be determined. Median age of the 22 patients with CA-MRSA disease was 47 years. Nine patients had skin and soft tissue infections, 9 ear infections, 3 bacteremia, 1 septic arthritis. Seven patients had underlying medical disease. None died of the CA-MRSA infections. Of the 73 isolates of CA-MRSA, 47 (64.4%) were resistant to more than 3 classes of antibiotics besides β-lactams. Conclusion : Although MRSA is highly prevalent among hospital-associated S. aureus infection, CA-MRSA infections are not common.

시대와 문학 -게오르크 뷔히너의 경우-

김명희 한국독일언어문학회 2003 독일언어문학 Vol.0 No.21

In dieser Arht wird versucht, die Beziehung von Literatur und Zeit bei Georg Biichner aufzuzeigen. Buchner hat sich trotz seiner Tatigkeit in verschiedenen Bereichen bis zu seinem Tod mit der sozio-historischen Real& seiner Zeit auseinandergesetzt. In seiner Zeit, dem Vorm&z, gab es scharfe Konflikte zwischen dem Feudaladel und dem liberalen Biirgertum. Biichner ist sowohl gegen den Feudahsmus als auch gegen die biirgerliche Klasse aufgetreten. Er ist fur das Interesse des Volkes gewesen. Er war uberzeugt, da8 die wichtigsten Widerspriiche seiner Zeit auf wirtschaftliche Ungleichheit zuriickzufiihren waren. Mit dieser Ansicht ist Buchner als Revolution& und Dichter Mtig gewesen. Die literarische Arbeit Biichners geht aus seiner politisch-revolutioniiren Praxis hervor. In den literarischen Texten Biichners spiegelt sich sein Zeitbedtsein wider. Seine zentralen Themen sind folgende: F roblematik von Reichtum und hut, veralkte moderne Gesellschaft , Kritik am falschen Bedtsein der herrschenden Klassen, Machtlosigkeit der Menschen in der Geschichte, Nihilismus, Langeweile, Entfremdung und Schizophrenie. Biichner hat festgestellt, dal3 die rein materiel1 orientierte Zeit mit den Mitteln und den Prinzipien der klassisch-romantischen Kunst nicht mehr beschreiben werden kann. Das heifit, man braucht neue Formen, urn die Wirklichkeit der veriinderten Zeit darzustellen. Die wichtigsten strukturellen Merkmale von Biichners Texten sind Diskontinuitlit und Parataktik in Szenenreihen, Handlungsablauf, Personencharakter und Sprachstil. Bese liickenhafte Stmktur fiihrt zur Differenziang von Personen und Situationen, was dem Publikum und dem Leser die Moglichkeit verschiedener Interpretationen bietet. Es ist gerade dieses Merkmal, dal3 Biichners Dichtung lebendig erhalten hat. Biichners Literatur geht nicht von der Idee oder dern Begriff seiner Zeit aus, sondern von der Realitlit und von den Menschen, so wie sie waren. Die ein bestimmtes Zeitalter beherrschende Idee verwdmt sich mit der &it. Aber das Wesen der Menschen und ihrer GesellschaftJichkeit iindert sich nur wenig. Biichner setzt sich in seiner Dichtung mit seiner historischen Lebenswelt auseinander. Trotz dieser Gebundenheit an die Zeit fihren sein Interesse fiir das Leben der Menschen und die neue poetische Struktur seiner Dichtung mit ihrer realistischen Darstellungsweise dazu, da13 seine Dichtung ncch heute lebendig ist und ihre Wirkung entfaltet.

항생제 사용과 관련된 Clostridium difficile 감염증

김홍빈,김남중,최희정,오명돈,김의종,최강원 대한화학요법학회 1997 대한화학요법학회지 Vol.15 No.1

목적 : Clostridium difficile 감염증은 중요한 원내 감염중의 하나로 최근 들어 항균제 사용의 증가와 함께 그 빈도가 늘어나고 있어 Clostridium difficile 감염의 빈도 및 임상양상을 알기 위해 본 연구를 시행하였다. 방법 : 102명의 정상 성인으로부터 대변에서 Clostridium difficile 배양을 시행하였으며, 92년 3월부터 93년 9월까지 서울대학교 병원에 입원한 환자중 대변배양 검사에서 Clostridium difficile이 배양된 61명의 환자를 대상으로 병록지를 토대로 조사하였다. 결과 : 정상 성인 중 3%에서 Clostridium difficile이 분리되었다. 대상환자의 기저 질환은 악성고형종양(29%), 혈액종양(6.5%), 뇌혈관 질환(6.5%), 간경변(4.9%) 등의 순이었으며, 대상 환자의 75%에서 균이 분리되기 6주 이내에 항균제가 사용되었다. 사용된 항균제는 aminoglycoside(60.8%), 1세대 cephalosporin(56.5%), 3 세대 cephalosporin(43.4%), ampicillin(15.2%), metronidazole(15.2%), clindamycin(8.6%)의 순이었다. 흔한 증상은 설사(77%), 복통(53.8%), 오심(37%), 빈맥(25%) 등이었며, 혈액 검사상 백혈구증가증은 21.6%, 저알부민혈증은 3.03%에서 관찰되었다. 44명의 환자중 24명의 환자가 대증적 치료 후 호전되었고, vancomycin이나 metronidazole을 투여받은 17명의 환자중 15명의 환자가 증상의 호전을 보였다. 4예가 사망하였으며, 3예(4.9%)는 재발하였다. 결론 : Clostridium difficile 장염은 항균제 사용시 흔히 발생하는 질환이다. 정상 성인의 3%에서 Clostridium difficile이 분리되었다. Objective : Clostridium difficile gastrointestinal disease is an important nosocomial infection and is associated with antibiotic use. This study evaluated the incidence and clinical characteristics of Clostridium difficile infections. Methods : Stool specimens from 102 normal adults were cultured for Clostridium difficile. Sixty-one patients with Clostridium difficile isolated from stool specimens were reviewed retrospectively. The patients were seen at the Seoul National University Hospital during the period from Mar., 1592 to Sep., 1993. Results : Clostridium difficile was isolated in 3% (3/102) of normal adult Population. Underlying diseases of the patients included solid tumor(29%), hematologic malignancy(6.5%), corebrovascular disease(6.5%), and liver cirrhosis(4.9%). Antibiotics associated with Clostridium difficile infections included aminoglycosides (60.8%), first generation cephalosporin(56.5%), third generation cephalosporin(43.4%), ampicillin(15.2%), metronidazole(15.2%), and clindamycin(8.6%). In 3/4 of the cases, these antibiotics had beer) administered within 6 weeks before Clostridium difficile isolated. Associated symptoms included diarrhea(77%), abdominal pain(53.8%), nausea(37%), fever(37.7%), and tachycardia(25%). Leukocytosis and hypealbuminemia were observed in 21.6% and 30.3%. Out of 44 cases received symptomatic treatment, 54% (24/44) improved. Of 17 cases treated with metronidazole or vancomycin, 88% (15/17) improved. Four cases expired and 3 cases(4.9%)were relapsed. Conclusion : Clostridium difficile gastroenteritis is frequently associated with antibiotic treatment. Three percent of normal adult population had Clostridium difficile.

唐·太宗과 貞觀의 治

김명희 전남사학회 2002 역사학연구 Vol.19 No.-

Tang Tai-zong(太宗:r. 629-649) was known as one of the most successful monarch throughout Chinese imperial history. On the first day of 627, Tai-zong took 'True vision'(Zhen-guan 貞觀) as the title of his reign and his era has been referred as the 'good government of the Zhen-guan period'(Zhen-guan zhi zhi 貞觀之治). In various historical writings he was described as a person with a keen rational intelligence. He seemed to be deeply and extraordinarily concerned over his self-image as an emperor or, even further, as a person. He was often described as a man who wanted to be a scholastic emperor: the conversations with his ministers were almost always focused on 'how to be a good emperor' as well revealed in the Zhen-guan Zheng-yao(貞觀定要). He had somehow established close relations with his advisers, accepting their open and blunt critical remonstrance. Under Tai-zong's order, the remonstrating officials(jian-guan 諫官) did participated in formal discussions of affairs together with great ministers of the Chancellery and Secretariat. Among many excellent scholar-officials at the Tai-zong's imperial court, Fang Xuan-ling(房玄齡: 578∼648), Du Ru-hui(杜如晦: 585∼630) and Wei Zheng(衛徵: 580∼643) were counted as the most prominent ministers. Fang Xuan-ling was an extremely practical and straight forward adviser, yet he was willing to give in when necessary. He played a role as a vital source of stability and moderation at court, particularly when Tai-zong became increasingly arrogant in his later reign. Du Ru-hui and Fang were joint heads of the Department of State Affairs from 629 to 630, They worked harmoniously together and quite a lot of occasions they played complementary role for each other. Tai-zong had complete confidence in Du Ru-hui's shrewdness of judgement and decision. Whenever he had to make important decision, and even when Fang was there with him, the emperor always waited for Du's arrival. In sharp contrast to these decisive, effective and practical statesmen, the dry and formal Wei Zheng represented the Confucian moralist: incorruptible, unrelenting conscience of man. Wei Zheng has always been known as fearless remonstrator, and he was a symbol of the deep mutual trust between ruler and minister in Tai-zong's court. Or probably Tai-zong had wanted Wei Zheng to play those roles in order to show emperor's generosity. Whichever is true, today we only could accept the image they had created for us to know. In other words, we only could understand what they wanted us to understand. Anyway each of these three high-officials was symbol and representative of their different way of political approaches and characterized Tai-zong's court with the frank exchange of blunt political advice. Tai-zong, however, became the same as the other imperious emperors in the later period: after 630 he became more and more confident in his achievement and his own administrative skill, increasingly arrogant and extravagant, neglecting state affairs for long and costly hunting trips. Despite his shortcomings, on the whole, he accomplished some political ideals Confucius had suggested, and in some ways he succeeded In his life-time endeavor. The most important aspect for the estimation of Tai-zong's reign would be that he genuinely wanted to be a true humanistic monarch. Therefore it would probably unnecessary to question that whether his sincerity was genuine or not: as 1 mentioned above, he really wanted others to believe what he himself wanted believe to be, perhaps including us today. All throughout his reign, from beginning to the end, he had acknowledged the importance of his ministers-their support and their quality not only as a politician but as a person.

唐代의 良賤制와 北魏의 良奴制에 관한 硏究

金明姬 湖南大學校 1990 호남대학교 학술논문집 Vol.11 No.1

Throughout the period of Ch'in-Han, Nan-Pei Chao and T'ang dynasty, the system of servility had seen some changes in its contents, the form of institutions and the term in its expression of the system. During Han dynasty, the term slavery became a settled institution. From then on slaves were seen as a group having a distinct customary in society. In Pei-Wei dynasty the institution had changed the purpose of it. Shaowen ti(孝文帝) institutionalized Liang-nu(良奴) System. The Liang-nu system, compared to slavery, focused on increasing commoners' number and also counted them as more important factor for the foundation of imperial power. Some scholars opinioned that the system came out from an intention of unification of China under the Northern tribes' power and also emphasized the energy of Pei-Wei dynasty and the T'ang system had been the result of these sino-synthetic rule. It is not yet fully varified, however, whether the T’ang servile system were developed from the Slavery system or inherited the commoner-slavery system. In this article, an assumption that T’ang servile system derived directly from commoner-slavery system and strongly inter- connected together. In the beginning of T’ang dynasty, it was not easy task for the government to divide all the people into two definite categories, such as Liang or Nu, for instances, a group of pu-ch’u, Kwan-hu and cha-hu who were gradually becoming to play an important role in society during six dynasties, could neither be categorised intc slave class nor as commoner class. For the T’ang government, an establishment of a new system in society was needed and subsequently a system of law & statutes were legalized. Accordance with such condition the common-servile system also came into being by the law. The common-servile system, as in commoner and slave system, it aimed to increasing the number of commoner within the status-order of government. In this respect, the two systems have close connections to each other not only by the periodic space but also by their characteristics.

고등학교 생물 '생명의 연속성' 단원 분석 : 탐구 활동을 중심으로

김명란,김윤희,조은희 조선대학교 사범대학 부설 교과교육연구소 2000 敎科敎育硏究 Vol.3 No.1

Recent advances in biotechnology has centered around the field of genetics. Although the likely benefits of biotechnology is obvious, it is assuring that the potential risks has to be carefully weighed. It also rasied new social and ethical issues in everyday life experiences. Thus, biology education especially in the units on biotechnology and genetics should emphasize social implications of the technology. In this study, the "Continuity of Life" unit in high school biology Ⅱ curriculum was analyzed in the context of Science, Technology and society(STS). The unit, "Continuity of Life", describes basic genetic phenomena and evolution of life. five different high school biologyⅡ textbooks were chosen and inquirty content dimension, and the inquiry process dimension. Analyses of the inquiry content dimension showed that 40.6% of inquiry activities in the unit were devoted to the evolution part and those for cell division, reproduction and development, and Mendelian genetics were at most 8.7%, 13.0%, and 16.0%, respectively. In the inquiry process dimension. ´interpreting data and formulating generalization´ and ´observation and measuring´categories consist of 81.1%. The other categories, ´seeing a problem and seeking ways to solve it´and ´building, testing, and revising the theoretical model´were under represented. In the context dimension, the scientific context consists of 73.0% and the proportion of the other three categories, individual context, the social context, and the technical context was only 26.1% in total. In conclusion, the analysis of inquiry activities on the "Continuity of Life" unit in five textbooks composed based upon the Sixth Curriculum of High School Education failed to show intimate relationship between science and society and simply concentrated on description and explanation of scientific facts. Provided the fact that the Biology Ⅱ is used in the highchool class for students who want to be future natural science majors of who show special interests in natural science, it is important for students to understand the ethical and social issues that recent biotechnology rasied and to become scientifically literate and responsible persons.

쌍발 복합재 항공기의 세로 안정 미계수 추정

김칠영,이정모,은희봉,신충화,황명신 한국 항공대학교 항공산업기술연구소 1997 航空宇宙産業技術硏究所 硏究誌 Vol.7 No.-

본 연구의 목적은 비행시험으로부터 항공기의 동적 세로 안정 미계수를 결정하는 것이다. 일반적으로 미계수를 결정하는 방법은 풍동시험 방법, 분석적 방법 그리고 비행시험 방법등으로 나누어진다. 앞의 두가지 방법은 미계수 추정에 있어 많은 제한을 갖고 있으며 추정된 미계수의 유효성에도 문제가 있다. 따라서 비행 시험은 가장 정확한 미계수를 얻을 수 있는 방법이며 반드시 필요한 절차이다. 쌍발 복합재 항공기의 비행시험을 통해 자료를 획득하였고 최대공산법을 이용하여 세로 조종/안정 미계수를 추정하였다. 추정된 미계수를 이용하여 항공기의 운동을 시뮬레이션하여 실제 시험자료와 비교하여 좋은 결과를 나타냄을 알 수 있었다. The purpose of this paper is to find how to determine the longitudinal controllability and stability derivatives from flight test and to display the longitudinal stability of the Twinbee aircraft. There are various methods developed to find the derivatives : wind tunnel testing, predicted result from empirical data, flight test and so on. Among those methods, the estimation from flight test of real aircraft is the most reliable. We performed the flight test of Twinbee and recorded the states of aircraft. Using those states and parameter estimation algorithem based on the Maximum Likelihood (MMLE) criterion, we can estimate the controllability and stability derivatives. In this paper, we will show the process from designing the proper flight test input to estimation of derivatives.