조혈모세포이식 환자에서 침습성 진균 감염에 대한 Micafungin의 예방 효과 및 안전성

김시현,이동건,최수미,권재철,박선희,최정현,유진홍,이성은,조병식,김유진,이석,김희제,민창기,조석구,김동욱,이종욱,민우성,박종원 대한감염학회 2010 감염과 화학요법 Vol.42 No.3

Background: Micafungin, a potent inhibitor of 1,3-β-D-glucan synthase, is a novel antifungal agent of the echinocandin class. In vitro study showed that micafungin was effective against Aspergillus species as well as Candida species, but clinical data on the prophylactic efficacy against invasive fungal infections (IFIs) other than candidiasis are still lacking. Materials and Methods: We identified 60 consecutive adult hematopoietic stem cell transplantation (HSCT) recipients who received at least 3 doses of micafungin during neutropenic period. Micafungin was started as an alternative in patients who were intolerant or had adverse events (AEs) to primary prophylactic antifungal agents. We retrospectively reviewed the medical records and analyzed the efficacy and safety of micafungin for prophylaxis against IFIs. Results: The patients either had autologous (n=9) or allogeneic (n=51: 1 syngeneic, 24 sibling, 26 unrelated donor) HSCT. Itraconazole oral solution (n=58) was the most frequently used first line antifungal agent for prophylaxis and was administered for median 11 days. The most frequent cause of switch to micafungin was vomiting (n=42). The duration of neutropenia and micafungin administration was median 13 and 12 days, respectively. A successful outcome was achieved in 45 (75%) patients. Empirical antifungal therapy was initiated in 13 (22%) patients. There were 2 cases (3.3%) of breakthrough fungal infections which comprised a probable invasive pulmonary aspergillosis and a possible invasive fungal sinusitis. There was no case of invasive candidiasis. A total of 53 (88%) patients experienced at least one AE regardless of causality during micafungin administration. The most frequent AEs were hypokalemia, vomiting, diarrhea, and elevated serum aspartate aminotransferase or alanine aminotransferase. Among the aforementioned AEs, only 1 case of diarrhea could be classified as a probable relation with micafungin when causality was assessed. There was no AEs that caused discontinuation of micafungin. Conclusions: Micafungin seems to be a safe and effective agent for prophylaxis of IFIs including aspergillosis as well as candidiasis in HSCT recipients. However, further large, prospective, and randomized comparative studies are warranted for aspergillosis.

선인장 양심실 보조장치의 설계 및 임상적용을 위한 평가

민병구,박찬영,최재순,이혁수,황창모,김삼성,윤걸중,김종원,선경,이경갑,정종태,김원곤 제주대학교 인공심장이식연구소 2001 인공심장 연구 Vol.2 No.1

현재 개발되고 있는 맥동형 이식형 인공심장은 완전이식형 인공심장과 좌심실보조장치 뿐이다. 좌심실보조장치를 장착한 환자의 10~15%가 우심실의 보조를 필요로하고 완전이식형 인공심장의 장착을 위해서는 자연심장을 제거해야하는 상황에서 이식형 양심실보조장치에 대한 필요성이 대두되고 있다. 본 연구진은 완전이식형 인공심장으로 개발된 한국형 인공심장을 개선하여 양심 실 보조장치를 개발하였다. 양심실보조장치는 이동형 작동기식 미케니즘을 이용하고 있으며 에너지 변환장치와 감속기로 구성된 작동기와 혈액주머니, 그리고 내장형 제어기로 구성되어 있다. 선인장 펌프로 명명된 KAH350은 캐뉼라의 연결을 위한 커넥터를 포함하여 길이 177mm, 폭 164mm, 높이 67 이고 무게 780g이며 최대 심박출량은 5L/min 이다. 양심실보조장치로 개발된 선인장펌프는 좌심실보조장치로도 응용이 가능하다. 이식적합성과 생체적합성을 평가하기 위하여 좌심실보조장치로 5회, 양싱실보조장치로 6회의 동물실험을 수행하였다. 각각 최장 28일간 생존하였으며 11회의 동물실험중 장치의 결함에 의한 것이 3회 있었는데 이들은 모두 전자장치의 결함과 방수처리문제였다. 현재 이식적합성과 일박출량을 향상시킨 KAH400모델이 개발중이다. The types of pulsatile implantable artificial hearts that are on the way of development and have been developed are totally implantable artificial heart and implantable left ventricular assist device (LVAD). Approximately 10% to 15% of all patients Implanted with wearable VADs have required right heart support with another device. And it is reluctant to patient who should remove his or her own heart to be implanted with total artificial heart. These situations drive the development of implantable bi-ventricular assist device (BVAD). The Korean BVAD was develophed by modifying the moving actuator type Korean artificial heart. This electro-mechanical BVAD comprises actuator including energy converter and reduction gear train, blood sacs, and internal motor and energy controllers. The KAH350 which is named as 'Cactus Pump' is 177mm in length, 164mm in width, and 67mm in thickness including connectors and nuts. The weight and maximum cardiac output of Cactus Pump is 780g and 5L/min, respectively. The Cactus Pump that was developed as BVAD could be used as LVAD by attaching compliance caps on the 2 ports of one ventricle. The animal experiments were undergone 5 times for LVAD, and 6 times for BVAD. The best records were 28 days survival in both applications. There were 3 times of device failure and they were all associated with electrical connection and hermetic sealing. The KAH400 that has improved anatomical fitting characterisitcs and stroke volume is on development.

황사 이동 경로에 따른 대기 부유 곰팡이 포자의 변화

김종호,여환구 한국대기환경학회 2004 한국대기환경학회지 Vol.20 No.1

Asian Dust samples were collected in the ambient air of Seosan, Western Korea, in spring of 2000~2002. PM (Particulate Matter) concentrations were 199.8 ㎍/㎥ in the first Asian Dust period (March, 23~24) and 249.4 ㎍/㎥ in the second period (April, 7~9) of 2000. Compared with the concentrations in 2000, relatively low PM concentrations, 157.3 ㎍/㎥ were measured in the periods of 2001 (April, 24~26). Especially high PM concentration 953.1 ㎍/㎥ were measured in the periods of 2002 (March, 21~22). The variation in the PM concentration was observed according to the time for the formation of Asian dust. Considering the particle size distributions of Asian dust, a high concentration was also observed in coarse particle region. The results of backward trajectory model showed the route of the dust storms from northern area of Mongol and Gobi desert. Various mycelia grown from fungal spores were observed on the PM samples and identified at the genus level. All the genera from the three years (2000~2002), Fusarium, Aspergillus, Penicillium, Basipetospora, Epicoccum and Monotospora are hyphomycetes in the division Fungi imperfecti (Deuteromycota). Fungal composition on the dust sample in March, 2000 was similar to the result of March, 2002. However, the result of April, 2001 was obviously different from the other dust periods. The variations of fungal compositions between the dust periods could be caused by the trajectories of the dust storms.

심동적 영역의 평가에서 문항반응이론의 활용

김종택,고병구,김주학 師範大學 體育硏究所 1998 서울大學校 體育硏究所論集 Vol.19 No.2

The purpose of this study was to introduce item response theory(IRT) and to explore the possible applications to the measurement of psychomotor behavior. The primary assumption of IRT is an individual will respond to an item on a test can be described in terms of a probabilistic function that describes the probability of an examinee responding correctly to an item. By contrast with the classical test theory, the advantage of IRT is to be able to estimate examinee's true ability and the estimate does not depend on the other examinees or on the particular test administered. When the item response of an examinee is dichotomous, if the probability of an examinee responding correctly to an item would be dependent of the ability of the examinee and the difficulty of the item, Rasch Model or 1-parameter IRT model could be used for estimating the item parameters. But if the discriminant or guess factor would be considered, then 2-parameter of 3-parameter model could be used. However, when the item response is polytomous, polytomous response model such as Partial Credit Model, Rating Scale Model, Nominal Response Model can be used. Especially, Binomial Trial Model, Poisson Counts Model, and Inverse Binomial Model can be used for analyzing multiple-attempt, single-item skill tests of psychomotor domain. Through reviewing the literatures of IRT, item bank, computer adaptive testing, mastery test measurement of change, repeating skill test, and sequential test has been proposed as the possible applications for psychomotor domain. In conclusion, for more valid and reliable assessment in the pychomotor domain, IRT and the possible applications of IRT should be seriously considered in measurement research in physical education.

桂枝茯笭丸 및 그 構成藥物의 血小板凝集抑制에 關한 硏究

金宗求,朴宣東,朴元煥 동국대학교 한의학연구소 2000 東國韓醫學硏究所論文集 Vol.8 No.2

動物性 脂肪攝取量의 增加, 運動不足, 肥滿, 스트레스의 加重, 高齡化의 增加 等의 原因으로 循環器系疾患의 發病率이 增加하고 있으며, 이러한 循環器系疾患의 危險因子로서 血栓症이 重要하게 대두되고 있다. 특히 최근 문제시되고 있는 狹心症이나 心筋梗塞등의 虛血性 心疾患은 血小板凝集에 의해 일어나는 血栓形成에 起因하고 있다. 韓醫學에서 血栓症은 瘀血의 範疇에 屬하며, 瘀血은 각종 病理的 原因에 의해 발생한 全身性 또는 局所性의 血液循環 障碍 또는 血流停滯와 그에 수반되는 일련의 病症을 나타내며, 驚悸정충, 鼓脹, 積聚, 미하, 癲狂, 中風等의 發病原因이 된다. 또한 瘀血에 의한 각종 症候에는 活血祛瘀劑 또는 驅瘀血劑등이 사용되고 있다. 本 硏究에서는 韓醫學에서 瘀血症으로 惹起되는 여러 가지 症狀의 개선에 사용되는 驅瘀血劑들의 血小板凝集에 미치는 영향을 검색하기 위하여 桂枝茯笭丸(Geijibokryunghwan; GBH) 및 그 構成藥物을 使用하였다. 桂枝茯笭丸은 『금궤요략』에 있는 方으로써 祛邪不傷正하고 調氣寒熱하여 예로부터 驅瘀血劑로 사용되어 왔다. 이에 桂枝茯笭丸 및 그 構成藥劑의 ADP, AA 또는 collagen으로 유도되는 血小板凝集에 대하여 抑制效果를 探索한 結果, 桂枝茯笭丸 및 個別 構成藥物의 血小板凝集抑制作用을 확인하였고, 血小板凝集으로 惹起되는 血栓症등에 桂枝茯笭丸 및 個別 構成藥物은 매우 臨床實驗的 應用價値가 있는 것으로 생각되었다. The cause that the increase of animality fat intakes, under exercise, fatness, adding the stress, advanced age etc., the occurrence rate of the circulation system &sea= has been increased. And the thrombosis importantly came to the front as the risk factor of these circulation system's disease. Nowadays, the ischemic disease has especially discussed, for example the angina or myocardial infarction, originated in thrombosis that came from the platelet aggregation. In the western medicine, as the cure and prevention, using the aspirin or ticlopidine for platelet aggregation suppressant. But in the <Synopsis of the golden chamber : On Pulse, Syndrome Complex and Treatment of Chest Obstruction, Heart Pain and Shortness of Breath>, the curing method must be used properly according to the pectoralgia or heartache's lund, state, grade. The platelet do not attache to the normal hemangioendothelial cell. But when It stimulated by endothelium peronia and so on, it attache to the injury endothelium or rise aggregation between the platelet. On this time, it secrete the platelet aggregation inducer as like ADP, thromboxane A2 from the inside of platelet. So it has first defensive function through the aggregation augment that prevent the celerity consumption of blood. But the activation of abnormal platelet occur the platelet grume and thrombogenesis. So it bring up the occlusive angiosis. so to speak, cardiovascular disease, cerebrovascular disease, arterial sclerosis. In oriental medicine, the thrombosis in the category of blood stasis and this blood stasis present the generalise or local blood circulation disturbance that generated by all kinds of pathological fact or blood stream retention accompanying with a series of syndrome. As the syndrome, stabbing pain fixed at certain region, squamous and dry skin, fullness and pain of the chest and hypochondrium, firmness and fullness of the lower abdomen, black stool, dark purple tongue or with ecchymoses and petechiae etc.. has been created. And it becomes the pathopoiesis cause that the convulsion and palpitation, severe palpitation. tympanites, the symtom complex with a mass or swelling in the abdomen, insanity, stricken by wind etc.. Moreover, it used the drugs for invigorating blood circulation and eliminating blood stasis or drugs for removing blood stasis for all kinds of syndrome through the blood stasis. And the drugs for activating the blood circulation, such as Salviae Radix, Angelicae Sinensis Radix, Persicae Semen, Achyranthis Radx, Cnidii Rhizoma, Carthami Flos are used for that. And it is used to the herbs of insects that has strong effect about the disintergrating blood stasis such as Hirudo, Scolopendrae Corpus, Buthus, Lumbricus etc.. On this study, It used Geijibokryunghwan(GBH) and the consisting herbs to investigate the influence of platelet aggregation about drugs that used to improvement various symptoms created by the thrombosis in oriental medicine. GBH formula has as formula recorded in the <Synopsis of the golden chamber>, action of 'eleminating the evil and not impairment of healthy energy' and 'promoting the flow of QI and cold and heat, so used for the expel blood stasis herbs from the ancient. Therefore we investigated the restraint effect of GBH and the consisting herbs about the platelet agregation induced to the ADP, AA or collagen. The conclusion is following. 1. When it added the aggregation inducer after that it added GBH and individual consisting herbs in the PRP, GBH showed the (+) inhibition effect on the platelet aggregation and it showed the (+) inhibition effect in the individual consisting herbs as like Paeoniae Radix and Moutan Cortex Radicis. 2. It showed the (+), (+,++) inhibition effect on the platelet aggregation in Paeoniae Radix·Hoelen, Paeoniae Radix· Moutan Cortex Radicis, Hoelen· Moutan Cortex Radicis etc. 3. In the aggregation inhibition activating on the difference of density, GBH showed strong ihbition effect to the aggregation state induced to collagen, and it showed the inhibition effect in the individual consisting herbs as like Paeoniae Radix and Moutan Cortex Radicis about the aggregation induced by the collagen. 4. It showed the strong inhibition effect about the aggregation induced by the collagen in Paeoniae Radix·Hoelen, Paeoniae Radix· Moutan Cortex Radicis, Hoelen·Moutan Cortex Radicis etc Like this, as confirm GBH and the individual consisting herb's inhibition effect of platelet aggregation, We considerated that GBH and the individual consisting herbs have practical applicational value of clinical trial in the thrombosis caused by platelet aggregation.

식도암의 임상적 고찰

김만중,김만우,채종구,정춘해,홍순표,조건국 朝鮮大學校 附設 醫學硏究所 1987 The Medical Journal of Chosun University Vol.12 No.1

A Clinical observation was made in 52 cases of patients with esophageal cancer at Chosun University Hospital during about 5years from january 1981 until may 1986. The following results were obtained: 1. The peak age of patients was fifth decade. The average age of patients is 55.7 years old. The sex ratio is 7.6 : 1 with a greater prevalence male. 2. Duration of the disease before admission was relatively long, about 4~6 months is 48% of all case. 3. The most common initial symptoms were swallowing difficulty, weight loss, substernal pain. 4. On the majority of patients, Heavy s.noking was manifested. 5. In blood type, A type was predominent. 6. In location of tumor, 69.2% of total cases were located in mid esophagus. 7. In histopathologic finding, 73% of total cases was squamous cell ca.

DC/DC 승압 컨버터의 출력 특성 개선을 위한 스너버 회로 설계

김성종,김인혁,정구종,손영익,한병문 明知大學校 産業技術硏究所 2009 産業技術硏究所論文集 Vol.28 No.-

Applications of DC!DC boost converters are increasing recently in many industrial areas including renewable energy sources. High switching frequency of the power semiconductor devices including MOSFET, IGBT causes the EMI noise owing to the large values of dv/dt and di/dt. Since the EMI noises degrade power efficiency and reliability of the system many researches have been made to reduce the noise. This paper presents a passive snubber circuit to improve the tum-on and turn-off transients of the pulsewidth modulated (PWM) DC/DC boost converters. The noises in the output voltage of the DC!DC converter are reduced by adding a resistor and an inductor to the circuit. Experimental results show the effectiveness of the proposed snubber circuit to improve the output characteristics of the boost converter.

CBCT 영상에서 무치악부 임프란트 매식체 주위골 골밀도(HU)의 정량적 평가

구종국,김진수,김재덕 대한구강악안면방사선학회 2008 Imaging Science in Dentistry Vol.38 No.1

Purpose : The primary aims of this retrospective study were to compare subjective bone quality and bone quality based on the Hounsfield scale in different segments of the edentulous jaw, and to establish quantitative and objective assessment of the bone quality. Materials and Methods : Twenty eight randomly selected cone-beam computed tomographic (CBCT) scans were analyzed. For evaluation one hundred and twelve edentulous areas were selected. Implant recipient sites were evaluated visually for Lekholm and Zarb classification. The same sites were subsequently evaluated digitally using the Hounsfield scale with Vimplant2.0, and the results were correlated with visual classification. Data was subject for statistical analysis in order to determine correlation between recorded HU and the regions of the mouth with the Kruskal-Wallis test. Results : The highest unit/mean density value (311 HU) was found in the anterior mandible, followed by 259 HU for the posterior mandible, 216 HU for the anterior maxilla, and 127 HU for the posterior maxilla. These results demonstrate a strong correlation for HU depending on the region of the mouth (p<0.001). The relationship between HU and type 4 bone was found to be significant (r=0.74). Conclusion : Knowledge of the Hounsfield value as a quantitative measurement of bone density can be helpful as a diagnostic tool by using CBMercuRay with Vimplant software.

고요산혈증의 위험인자 : 아산시 지역 주민을 대상으로

김용배,장원기,황보영,김화성,안규동,이병국,이용진,이종은,이준숙,이찬구,이한정,이성수 순천향대학교 2006 Journal of Soonchunhyang Medical Science Vol.12 No.1

Objective : Serum uric acid has now been identified as a marker for a number of metabolic and hemodynamic abnormalities. The aim of this study is to evaluate risk factors which influence hyperuricemia in the citizens of Asan. Method : The study design was cross-sectional and research subjects were 1086 citizens of Asan. General characteristics, cigarette smoking, alcohol consumption, and past history were obtained by interview using a structural questionnaire. Also, we measured height, weight and blood pressure, and serum uric acid of the subjects. Results : The mean serum uric acid level was 5.27 ㎎/㎗ in men and 4.01 ㎎/㎗, in women, In the multiple logistic regression analysis, statically significant risk factors of hyperuhcemia were gender, body mass index, blood lead concentration, and serum creatinine. Conclusion : Our results suggest that gender, body mass index, blood lead concentration, and serum creatinine might be the most important risk factors of hyperurcemia. Education program as well as routine check-up for serum uric acid was highly recommended for the effective prevention of hyperuricemia.

오차 보정에 의한 피드포워드 증폭기의 고조파 왜곡 특성에 관한 연구

김남호,류지구,정종혁 釜慶大學校 1997 釜慶大學校 論文集 Vol.2 No.2

In this paper, a feedforward amplifier with error correction is designed and implemented. So as to ecaluate its performance of the characteristics of the haminic distortion that proposed inverting and moninverting feedforward amplifier is compared with that of the referemce amplifier without error correction. This result of the secondary harmonics level is improved about 10[㏈]. Thus, it should be noted that the proposed feedforward amplifier network is also acceptable for wide-band amplifiers.