그람양성균 감염에 대한 Teicoplanin의 임상적 효과

최강현,송재훈,조구영,유빈,김형호,서철원,배직현 대한감염학회 1993 감염 Vol.25 No.1

Backgrounds: Gram-positive cocci have been an increasing cause of nosocomial infections in recent years. Treatment of these infections is often difficult, particularly infections by methicillin-resistant Staphylococcus aureus (MRSA). Teicoplanin, a new glycopeptide antibiotic, has been reported to have an excellent in vitro and in vivo effect against various gram-positive infections. To evaluate the clinical efficacy of teicoplanin in the treatment of patients with gram-positive bacterial infection and to compare the in vitro susceptibility of teicoplanin with other antimicrobials, we performed a prospective open trial of teicoplanin. Methods: Twenty patients with infections by gram-positive organism were enrolled. The patients were received 400mg of teicoplanin followed by 200 mg from next day as maintenance dose. During the follow-up period, clinical features and laboratory parameters were ckecked to evaluate clinical efficacy and appropriate cultures were followed to determine the microbiologic efficacy. The adverse effects of teicoplanin were also observed. Results: The enrolled patients were 16 males and 4 females, whose mean age was 51±13 years. The categories of infections were bacteremia (5), skin and soft tissue infection (4), empyema (3), UTI (2), pneumonia (1), catheter associated infection (1) and infective endocarditis (1). The etiologic organisms isolated were MRSA (9), coagulase-negative Staphlycoccus (5), S. viridans (2), group D streptococcus (2), S. pneumoniae (1), and E. faecalis (1). All 20 patients treated with teicoplanin showed clinical cure (13/20) or clinical improvement (7/20), whereas 90% of isolated organisms were eradicated after teicoplanin therapy. The adverse effect of teicoplanin was minimal. Conclusion: Teicoplanin is safe and effective in the therapy of many different infections caused by gram-positive oragnisms.

국내 3개병원에서 분리된 메티실린 내성 황색포도상구균 균주간의 유전학적 연관성

백경란,김성민,송재훈,이혁,양지원,진정화,최강원,오명돈,배현주 대한감염학회 1997 감염 Vol.29 No.6

목적:본 연구는 병원감염의 주된 원인균인 MRSA의 병원 내 및 병원간의 전파양상을 파악하고, MRSA 균주 중 pathogen과 colonizer 간에 유전자형의 차이가 있는지 알아보고자 시행되었다. 방법:삼성의료원 중환자실에 1996년 1월에서 7월까지 입원한 26명의 환자로부터 분리되었던 MRSA 30균주와 서울대학교병원에서 1995년 9월에서 10월까지 37명의 환자로부터 분리되었던 MRSA 37균주, 그리고 단국대학교병원 신생아 중환자실에서 MRSA 감염증의 돌발적 발생에 연관되어 분리된 MRSA 균주 40주를 대상으로 하였다. 균주간의 상관성을 평가하기 위한 세균형별법으로 Pulsed field gel electrophoresis(PFGE, CHEF DR-II)를 이용하였고, 제한효소로 Smal I을 사용하였다. 결과:삼성의료원의 균주 30주 중 A 패턴이 10주(33.3%), B 패턴이 7주(23.3%)로 나타나, 주된 유행 균주가 있음을 확인하였다. 내과 중환자실에서 분리된 5 균주 중 4 주가 A패턴인 반면, 신생아 중환자실에서 분리된 9균주 중 4주가 B패턴에 속하여, 한병원내에서도 구역에 따라 유행균주가 다름을 알 수 있었다. 서울대학교병원 균주 중 23주(62.2%)가 동일한 A패턴으로 나타났고 단국대학교 병원 균쥬 중 27 균주(67.5%)가 B 패턴에 속하여, 세 병원의 MRSA 유행 균주 사이에 유전적 연관성이 있음을 시사하였다. Pahtogen과 colonizer간에 PFGE 패턴의 차이는, pathogen이 colonizer에 비해 유행균주에 많이 속하였으나 통계학적으로 유의한 차이가 없었다. 결론:PFGE를 이용한 세균형별법으로 분류한 MRSA 균주의 양상으로 볼 때, 한 병원 내에서 유행하는 MRSA 균주에는 소수의 주된 클론이 있었으며, 한 병원 내에서도 구역에 따라 유행균주는 서로 달랐다. 지역적으로 떨어져 있는 서울대학교병원과 단국대학교병원의 MRSA 유행균주는 삼성의료원의 유행균주 중 한 클론과 각각 일치하였다. 이 결과는 유행 MRSA 균주가 공동의 오염원에서 파급되어 지역적으로 다른 병원간에도 전파되고 있거나, 균주가 숙주의 요인에 의해 특정 MRSA 균주가 선택 분리되고 있을 가능성을 시사하였다. Background: Methicillin-resistant Staphylococcus aureus(MRSA) has become a major pathogen of nosocomial infection. In Korea, incidence of MRSA is alarmingly high up to 70-80% of total S. aureus strains isolated from teriary care hospitals. To investigate the mechanism of inra- and interhospital spread of MRSA, we evaluated the genetic relatedness of MRSA isolates recovered from 3 different hospitals in Korea. Methods:30 MRSA isolates obtained from Samsung Medical Center(SMC), 37 MRSA isolates from Seoul National University Hospital(SNUH) and 40 MRSA isolates from Dankook University Hospital(DUH) were classified into clonal types on the basis of pulsed field gel electrophoresis(PFGE). Results: Several PFGE patterns were predominant among the isolates from SMC(A-7/30[23.3%], B-6/30[20.0%], C-4/30[13.3%], G-3/30[10.0%]). The prevalent PFGE patterns were different between medical ICU(A-3/5[60.0%]) and newborn ICU(B-4/9[44.4%]0. The major clone of SMC. The major clone at DUH was PFGE type B, which was identical with another dominant clone of SMC. Although MRSA strains from SMC which caused clinical diseases belonged to major PFGE patterns more often than colonized strains, the association was not significant statistically. Conclusion: The presence of epidemic strains of MRSA suggests that epidemic MRSA clones may be originated from common sources and spread between different hospitals. Also, there may be virulence factors of stains or host factors, which could select specific strains.

7개 대학 병원에서 조사한 지역사회 폐렴의 원인균

정문현,김성민,강문원,최희정,정희진,이경원,한성우,송재훈,신형식,김의종,최강원,김민자,박승철,배현주,정윤섭,김준명,백경란,신완식,이규만,김양리 대한감염학회 1997 감염 Vol.29 No.5

목 적 : 폐렴은 많이 발생하면서 사망률이 크게 줄지 않는 질환이며, 이를 적절히 치료하기 위해서는 원인균의 상대적 빈도, 기저 질환에 따른 변화, 항균제 내성률, 사망에 관련된 인자들을 알아야 한다. 원인균의 빈도는 지역마다 차이가 있고 국내에서는 항균제 내성률이 높아 지역사회에서 발생한 폐렴을 치료하기 위한 경험적 항균제 선택에 도움이 되기 위해 서울 소재 6개 대학 병원과 천안의 1개 대학 병원이 참여하여 위의 사항들에 대해 조사를 하였다. 방 법 : 1995년에 내과에 입원했던 16세 이상 환자를 대상으로 했다. 퇴원 진단명이 폐렴 또는 폐결핵인 병록지을 찾았고, 이중에서 병원 감염을 제외하였다. 특이도를 높이기 위해, 이들 중에서 호흡기 증상이 있고 발열이나 저체온이 있으면서 흉부 X-선에서 이상 음영이 있는 환자만을 대상으로 했다. 폐결핵은 위의 기준에 입원 초기에 항균제 치료를 하고 입원 7일 이후에야 항결핵제가 투여된 경우만을 폐렴의 원인균으로 하였다. 혈액 배양에서 양성, 객담에서 항상균이나 M. tuberculosis가 증명된 경우, 혈청학적으로 항체가가 4배 이상 증가된 경우, 조직에서 원인균이 진단된 경우는 확정(definitive) 원인균으로 하였고, 객담에서 배양된 균이 그람 도말과 일치할때, 항결액제에 대한 반응으로 진단한 폐결핵, 단일 항체가 양성이고 이에 대해 항균제를 사용했을 때는 가능(probable) 원인균으로 정의하였다. 다세균 감염균은 각각 다 른 원인균으로 처리하였다. 임상 조사와 함께 임상병리과에서 S. pneumoniae, H. influenzae, M. catarrhalis, mycoplasma, 항상균에 대해 검사 의뢰 건수, 배양 양성수, 항균제 감수성 결과를 조사하였다. 결 과 : 폐렴의 증례 정의에 부합하지 않은 135명과 폐결핵의 정의에 해당하지 않는 230명을 제외하고 남은 246명의 평균 나이는 58.2세이고 남성이 142명(58.2%) 이었고, 71%의 환자에서 기저 질환이 있었다. 진단 방법의 시행 횟수는 혈액 배양 77.6%, 혈청 검사 18.3%, 기관지경 검사는 4.1%였고, 세균의 항원 검사를 한 예는 없었다. 원인균이 밝혀진 예는 77명(31.3%)이었다. 다세균 감염이 4명에서 있었고, 원인균의 상대적 빈도는 결핵 20명(확정 17, 가능 3: 6개 병원 자료), 폐렴구균 18(확정8 가능 10)명과 폐렴구균이 아닌 Streptococcus 3명 (모두 확정), H. influenzae 11명(모두 가능), 그람음성간균 11명(확정 7, 가능 4) (K. pneumoniae 8건), Mycoplasma 5명(확정 1, 가능 4), S. aureus 4명(확정 2, 가능 2), mucormycosis 1명(확정)이었다. 평균 입원 기간은 19일이고, 중환자실 입원률과 인공 호흡기 사용율은 각각 18%와 9.3%였다. 사망률은 13.8%였고 사망까지 평균 기간은 14.6일 이었다. 다변량 분석에서 사망을 예측할 수 있는 인자는 저체온과 빈호흡이었다. 임상병리과에서 배양되었던 모든 폐렴구균의 Penicillin 내성률은 서울 3개 병원에서 82-88%, 천안에서 72%였다. 폐렴 환자의 혈액에서 배양된 7주는 모두 Penicillin에 감수성이 있었다. K. pneumoniae 8주 모두 cefotaxime과 gentamicin에 감수성을 보였다. 결 론 : 후향적 조사이고 병원마다 원인균 진단에 차이가 있지만, 원인이 밝혀진 경우에는 결핵과 폐렴균이 흔하였고, 무균 부위에서 배양된 폐렴구균의 항균제 내성률은 낮았다. 원인이 밝혀지지 않은 경우가 많고, 혈청검사로 진단되는 원인균이 드물며, 분리균주가 적어 항균제 내성 정도를 추정하기 어려워, 이를 밝히기 위한 전향적 조사가 필요하다. Background : Community-acquired pneumonia (CAP) is one of the leading causes of mortality and morbidity, but its management is still challenging. The limitation of diagnostic methods to identify etiologic agents rapidly make it necessary to use empiric antibiotics in almost all patients, and furthermore the discovery of new respiratory pathogens and the emergence of antibiotic-resistant organisms pose difficulties to the selection of an empiric regimen. To clarify the factors necessary for the optimal choice of empirical antibiotics, such as the frequency of etiologic agents, the attributable rates to death and antimicrobial resistance rates in the community, six university hospitals in Seoul and one university hospital in Cheonan were participating in this study. Methods : medical records of adults (>15 years of age) hospitalized for CAP or pulmonary tuberculosis between April 1995 and March 1996, were reviewed. Patients who satisfied all of the following criteria were included in the study: (1) fever or hypothermia; (2) respiratory symptoms; and (3) pulmonary infiltrates on chest roentgenogram. To exclude cases of pulmonary tuberculosis whose roentgenographic features were so typical that it could be easily differentiated from conventional pneumonia, two additional criteria were required for inclusion: antibiotic treatment during the first week of hospital admission and initiation of anti-tuberculosis medications thereafter. Organisms isolated from sterile body sites, acid-fast bacilli or Mycobacterium tuberculosis isolated from sputum, pathogens diagnosed by a 4-fold rising titer of antibodies to “atypical”pathogens, or pathogens revealed by histopathology were defined as definitive cause of pneumonia; isolates from sputum withcompatible Gram stain, pathogens diagnosed by a single diagnostic titer plus use of a specific antimicrobial agent, or tuberculosis diagnosed by clinucal response to anti- tuberculosis medications were considered probable cause of pneumonia. The records of the clinical microbiology were reviewed for isolates of S. pneumoniae, H. influenzae, M. catarrhalis, Mycobacterium or acid-fast bacilli, and Mycoplasma. Then the frequency of these agents, antimicrobial resistance rates of resiratory pathogens from all body sites, and their clinical significance were evaluated. Results: After excluding 365 patients (230 with pulmonary tuberculosis and 135 with CAP) who were screened for inclusion but did not meet the inclusion criteria,246 persons were enrolled in this study. Their mean age was 58.2 years old with slight male predominance (58.2%), and 171(71%) patients had underlying illnesses. Blood cultures were performed on 191 (77.6%) patients and serologic tests on 44(18.3%) patients. The etiologic agents were identified in 31.3%, and the list of individual agents, in decreasing order, was pulmonary tuberculosis (17 definite and 3 probable: data of six hospitals), S. pneumoniae (8 definite and 10 probable), non-pneumococci (3 definite), aerobic gram-negative bacilli (7 definite and 4 probable), Haemophilus spp. (11 probable), mycoplasma (1 definite and 4 probable), polymicrobial infections (2 definite and 2 probable: E. coli and S. agalactiae, M. tuberculosis and S. aureus, S. pneumoniae and H. influenzae and A. baumannii and K. pneumonias), S. aureus (2 definite and 2 probable) , and mucormycosis (1 definite). Among gram-negative bacilli, K. pneumoniae was the most common agent (8isolates). therates of admission to the intensive care unitand of using assisted ventilation were 18% and 9.3%, respectively. The mortality was 13.8% and logistic regression analysis showed that hypothermia and tachypnea were associated with death. Hospital stay averaged 19 days. Susceptible rates of S. pneumoniae isolated from all body sites to penicillin ranged from 8% to 28% but seven isolated from blood of patients with pneumonia were susceptible to penicillin. Also all 8 isolated of k> pneumoniae from patients with pneumonia were susceptible to cefotaxime and gentamicin. Conclusion: In Korea, in addition to S. pneumoniae, M. tuberculosis is an important agent causing community-acquired pneumonia. The low incidence of etiologic diagnosis is probably related to infrequent requesting of test "atypical" pathogens and does not represent the true incidence of infections by "atypical" pathogens, which well be answered by a prospective study. The antimicrobial resistance rates of major respiratory pathogens from sterile body sites are low, however, because of a small number of the isolates this result needs confirmation by a nationwide surveillance of antimicrobial resistance.

Flow Synthesis of Cyanine Dyes for Absorbing Orange Light from the Neon Gas Discharge

Choe, Jae-Hoon,Seo, Jung-Hyun,Song, KwangHo Korean Chemical Society 2009 Bulletin of the Korean Chemical Society Vol.30 No.8

Analysis of Partial cDNA Sequence from Human Fetal Liver

Jae Wha Kim,Jae Chan Song,In Ae Lee,Younghee Lee,Myoung Soo Nam,Yoonsoo Hahn,Jae Hoon Chung,In Seong Choe 생화학분자생물학회 1995 BMB Reports Vol.28 No.5

Single-run Partial cDNA sequencing was conducted on 1,592 randomly selected human fetal liver cDNA clones of Korean origin to isolate novel genes related to liver functions. Each partial cDNA sequence determined was analyzed by comparing it with the databases, GenBank, Protein Information Resource (PIR) and SWISS-PROT Protein Sequence Data Bank. From a set of 1,592 cDNA clones reported here, 1,433 (90.0% of the total) were informative cDNA sequences. The other 159 clones were identified as DNA sequences which had originated from the cloning vector. Among 1,433 informative partial cDNA sequences, 851 (59.3%) clones were revealed to be identical to known human genes. These known genes have been classified into 225 different kinds of genes. In addition, 340 clones (23.7%) showed various degrees of homology to previously known human genes. Ninety four (6.6%) clones contained various repeated sequences. Twenty four (1.7%) partial cDNA sequences were found to have considerable homology to known genes from evolutionarily distant organism such as yeast, rice, Arabidopsis, mouse and rat, based on database matches, whereas 124 (8.7%) had no significant matches. Human homologues to functionally characterized genes from different organisms could be classified as candidates for novel human genes of similar functions. Information from the partial cDNA sequences in this study may facilitate the analysis of genes expressed in human fetal liver.

Analysis of Partial cDNA Sequence from Human Fetal Liver

Kim, Jae-Wha,Song, Jae-Chan,Lee, In-Ae,Lee, Young-Hee,Nam, Myoung-Soo,Hahn, Yoon-Soo,Chung, Jae-Hoon,Choe, In-Seong Korean Society for Biochemistry and Molecular Biol 1995 Journal of biochemistry and molecular biology Vol.28 No.5

Single-run Partial cDNA sequencing was conducted on 1,592 randomly selected human fetal liver cDNA clones of Korean origin to isolate novel genes related to liver functions. Each partial cDNA sequence determined was analyzed by comparing it with the databases. GenBank, Protein Information Resource (PIR) and SWISS-PROT Protein Sequence Data Bank. From a set of 1.592 cDNA clones reported here, 1,433 (90.0% of the total) were informative cDNA sequences. The other 159 clones were identified as DNA sequences which had originated from the cloning vector. Among 1,433 informative partial cDNA sequences, 851 (59.3%) clones were revealed to be identical to known human genes. These known genes have been classified into 225 different kinds of genes. In addition, 340 clones (23.7%) showed various degrees of homology to previously known human genes. Ninety four (6.6%) clones contained various repeated sequences. Twenty four (1.7%) partial cDNA sequences were found to have considerable homology to known genes from evolutionarily distant organism such as yeast, rice, Arabidopsis, mouse and rat, based on database matches, whereas 124 (8.7%) had no Significant matches. Human homologues to functionally characterized genes from different organisms could be classified as candidates for novel human genes of similar functions. Information from the partial cDNA sequences in this study may facilitate the analysis of genes expressed in human fetal liver.

Cloning and Characterization of Yeast Ribosomal RNA Promoter Binding Protein cDNA

Joo, Jae Hoon,Rho, Jae Kyun,Kim, Chul Geun,Choe, Soo Young,Park, Sang Dai Korean Society of Molecular Biology 1996 Molecules and cells Vol.6 No.4

Analysis for Regulatory Elements in Yeast MGMT Gene Transcription

Joo, Jae-Hoon,Kim, Woo-Jae,Rho, Jae-Kyun,Choe, Jae-Hyun,Choe, Soo-Young,Sang-Dai The Korean Society for Integrative Biology 1998 Korean journal of biological sciences Vol.2 No.2

The Saccharomyces cerevisiae MGMT gene encodes a O6-methylguanine DNA methyltransferase that protects cells from mutation or death by DNA alkylating agents. Using an in vitro transcription system, we analyzed its promoter region to find regulatory elements for transcription initiation. DNase I footprinting and a transcription assay showed that a functional TATA box, 5'-TGATATAGCA-3', is located in the region spanning from -25 to -34. We also found one upstream repressing sequence (URS), -333 to -213, by promoter deletion and competition analysis. Gel mobility shift assays and Southwestern blot analysis using URS region indicate specific complex formations. These results indicate that several cis-acting and trans-acting elements might be involved in the transcriptional regulation of the S. cerevisiae MGMT gene.

The Korean Society of Gastroenterology& SLDDS 2037 : Slide Session ; K-BP-27 : Pancreatobiliary ; Early Check Up CA 19-9 for Pancreatic Cancer Screening in New Onset Diabetic Patient

( Jung Wan Choe ),( Jae Seon Kim ),( Soon Young Hwang ),( Hyo Jung Kim ),( Moon Kyung Joo ),( Beom Jae Lee ),( Ji Hoon Kim ),( Jong Eun Yeon ),( Jong Jae Park ),( Kwan Soo Byun ),( Young Tae Bak ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: Patients with diabetes have higher risk for pancreatic cancer and the risk is reported to be high in early period after diagnosis. We had reported the usefulness of CA 19-9 with the new onset (< 2yrs) diabetes as a screening test for pancreatic cancer. (KJS, abstract 251) This study was to evaluate the validity of CA 19-9 check soon after diagnosis of diabetes as a pancreatic cancer screening tool. Methods: We reviewed medical records of diabetes patients who were diagnosed fi rst time at our hospital from Jan.2004 to Jan.2013. Among them, 2385 patients who checked CA 19-9 were enrolled. We classifi ed groups according to the timing of CA 19-9 measurement; first group, checked CA 19-9 within 1 year after diagnosis of diabetes and second group checked within 1~2 year after diabetes diagnosis. Results: Of 2385 diabetes patients, 91 (3.8%) were diagnosed with pancreatic cancer. In fi rst group, 72 (4.1%) of 1739 diabetes patients developed pancreatic cancer and odd ratio of pancreatic cancer according to abnormal CA 19-9 was 13.7 (p<0.001). 10 of pancreatic cancer (4.4%) were detected in second group of 226 patients and odd ratio was 8.02 (p=0.002). But after 2 years, the odd ratio for pancreatic cancer had no statistically signifi cance. The incidences of pancreatic cancer in 1965 patients with new onset diabetes followed by checking CA 19-9 within 2 years and in 420 patients with diabetes established for more than 2 years were 82 (4.1%) and 9 (2.1%), respectively. The odd ratio of pancreatic cancer for abnormal CA 19-9 within 2 year following diabetes diagnosis was 12.5 (P<0.001) Conclusion: Early check up of CA 19-9 following new onset diabetes diagnosis is meaningful as a screening test for pancreatic cancer.

Foods Inducing Typical Gastroesophageal Reflux Disease Symptoms in Korea

( Jung Wan Choe ),( Moon Kyung Joo ),( Hyo Jung Kim ),( Beom Jae Lee ),( Ji Hoon Kim ),( Jong Eun Yeon ),( Jong-jae Park ),( Jae Seon Kim ),( Kwan Soo Byun ),( Young-tae Bak ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2017 Journal of Neurogastroenterology and Motility (JNM Vol.23 No.3

Background/Aims Several specific foods are known to precipitate gastroesophageal reflux disease (GERD) symptoms and GERD patients are usually advised to avoid such foods. However, foods consumed daily are quite variable according to regions, cultures, etc. This study was done to elucidate the food items which induce typical GERD symptoms in Korean patients. Methods One hundred and twenty-six Korean patients with weekly typical GERD symptoms were asked to mark all food items that induced typical GERD symptoms from a list containing 152 typical foods consumed daily in Korea. All patients underwent upper gastrointestinal endoscopy followed by 24-hour ambulatory esophageal pH monitoring. The definition of “GERD” was if either of the 2 studies revealed evidence of GERD, and “possible GERD” if both studies were negative. Results One hundred and twenty-six cases (51 GERD and 75 possible GERD) were enrolled. In 19 (37.3%) of 51 GERD cases and in 17 (22.7%) of 75 possible GERD cases, foods inducing typical GERD symptoms were identified. In the GERD group (n = 19), frequent symptom-inducers were hot spicy stews, rice cakes, ramen noodles, fried foods, and topokki. In the possible GERD group (n = 17), frequent symptom-inducers were hot spicy stews, fried foods, doughnuts, breads, ramen noodles, coffee, pizza, topokki, rice cakes, champon noodles, and hotdogs. Conclusions In one-third of GERD patients, foods inducing typical symptoms were identified. Hot spicy stews, rice cakes, ramen noodles, fried foods, and topokki were the foods frequently inducing typical symptoms in Korea. The list of foods frequently inducing typical GERD symptoms needs to be modified based on their own local experiences. (J Neurogastroenterol Motil 2017;23:363-369)