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.

강화학습을 이용한 클라이밍 모션 합성

강경원(Kyungwon Kang),권태수(Taesoo Kwon) 한국컴퓨터그래픽스학회 2024 컴퓨터그래픽스학회논문지 Vol.30 No.2

최근 자연스러운 모션 데이터에 대한 수요가 늘고 있지만, 클라이밍 모션을 정확하게 캡처하는 것은 가려진 부분이 많은 클라이밍 동작의 특성상 쉽지 않다. 또한 벽 구조물의 스캔이나 다양한 암벽 코스 준비 등 필요한 데이터를 수집하는 과정이 쉽지 않다. 본 논문에서는 강화학습을 이용한 클라이밍 모션 합성 방법론을 제안한다. 학습 과정은 두 단계의 난이도로 구성되어 있다. 첫 번째 단계는 매달리기 정책을 학습하는 것이다. 매달리기 정책은 자연스러운 자세로 홀드를 잡는 방법을 학습한다. 이후 추론 단계를 통해 위치, 자세, 잡기 상태를 다양하게 추출한 초기 상태 데이터세트를 만든다. 두 번째 단계에서는 이 초기 상태 데이터세트를 사용해서 실제 클라이밍을 수행하는 태스크를 학습한다. 클라이밍 정책은 자연스러운 자세로 타겟 위치로 이동하는 방법을 학습한다. 실험을 통해 제안하는 방법이 클라이밍 하기 위한 좋은 자세를 효과적으로 탐색할 수 있는 것을 보였다. Although there is an increasing demand for capturing various natural motions, collecting climbing motion data is difficult due to technical complexities, related to obscured markers. Additionally, scanning climbing structures and preparing diverse routes further complicate the collection of necessary data. To tackle this challenge, this paper proposes a climbing motion synthesis using reinforcement learning. The method comprises two learning stages. Firstly, the hanging policy is trained to grasp holds in a natural posture. Once the policy is obtained, it is used to extract the positions of the holds, postures, and gripping states, thus forming a dataset of favorable initial poses. Subsequently, the climbing policy is trained to execute actual climbing maneuvers using this initial state dataset. The climbing policy allows the character to move to the target location using limbs more evenly in a natural posture. Experiments have shown that the proposed method can effectively explore the space of good postures for climbing and use limbs more evenly. Experimental results demonstrate the effectiveness of the proposed method in exploring optimal climbing postures and promoting balanced limb utilization.

한국한의학연구원 논문집에 사용된 통계기법의 평가

강경원(Kang Kyungwon),강병갑(Kang Byunggab),고미미(Go Mimi),신선화(Shin Sunhwa),최선미(Choi Sunmi) 한국한의학연구원 2007 한국한의학연구원논문집 Vol.13 No.2

Background and Purpose : The purpose of this study was done to investigate what kinds of statistical techniques have been used to analyze data from oriental medicine research. Methods : 135 original articles which used statistical techniques in their data analysis were selected from the articles published in The Journal of Korea Institute of Oriental Medicine(JKIOM) between 1995 to 2007. Results : Among 135 articles, 59 articles used descriptive statistics while 76 articles used inferential statistics for data analysis. For that 76 articles. two-sample t-test(33 articles), analysis of variance(29 articles), regression(9 articles), chi-square test(5 articles), nonparametic test(4 articles), Fisher's exact test(3 articles), and other test(9 articles) were chosen to analyze the data. SAS and SPSS statistical softwares(82.50%) were mostly used to analyze the data. Nonparametic tests were used to 4 articles(6.97%) of 67 articles and parametic tests were used to 63 articles(93.03%) of 67 articles. Among 29 articles used analysis of variance, duncan(8 articles), dunnet(4 articles), bonferroni(4 articles), turkey(3 articles), scheff(1 article) were used to do multiple comparison. 9 articles did not carry out the multiple comparison. Conclusions : It was found that the frequencies of statistical package used and statistical analysis used were not much by now. High level statistical analyses were not used most for oriental medicine research.

비만의 변증 진단을 위한 판별모형

강경원(Kang Kyungwon),문진석(Moon Jinseok),강병갑(Kang Byunggab),김보영(Kim Boyoung),김노수(Kim Nosoo),유종향(Yoo Jonghyang),신미숙(Shin Misook),최선미(Choi Sunmi) 한국한의학연구원 2008 한국한의학연구원논문집 Vol.14 No.2

The study was to investigate the agreement rate between the statistical diagnosis of pattern identification by discriminant analysis and the clinical diagnosis of pattern identification by medical specialist in obese patients with BMI ≥ 23. The agreement rate of deficiency of the spleen, phlegm-retention, deficiency of Yang, retention of undigested food, stagnation of liver Gi, and blood stagnation are 0.40, 0.33, 0.52, 0.76, 0.71, and 0.66, respectively and accuracy rate and prediction rate using linear discriminant function are 0.59 and 0.61, respectively. Therefore, the complementary management in CRF questionnaires and/or consultation from experts will improve the accuracy and prediction rate, which will be helpful for pattern identification of obesity by clinical experts.

동적 바이어스 조절 고효율 전력증폭기 설계

강종필(Kang Jongpil),이세현(Lee Sehyun),이경우(Lee Kyungwoo),민이규(Min Yikyu),강경원(Kang Kyungwon),김동현,이상설(Lee Sangseol),안광은(Ahn Kwangeun) 대한전자공학회 2000 대한전자공학회 학술대회 Vol.2000 No.11

중풍 발생 위험인자에 대한 환자-대조군 연구

강경원(Kang Kyungwon),강병갑(Kang Byunggab),차민호(Cga Minho),고미미(Go Mimi),박세욱(Park Saewook),방옥선(Bang Oaksun),조기호(Cho Kiho),김윤식(Kim Yoonsik),최선미(Sunmi Choi) 한국한의학연구원 2007 한국한의학연구원논문집 Vol.13 No.2

Background and Purpose : The purpose of this case-control study was to show the relationship between risk factors(past medical history, BMI, WHR, smoking, drinking), warning signs(dyscinesia, sightless, dysarthria, sensory disorder, numbness, blephalospasm, facial spasm, tension) and the incidence of stroke in korean adults. Methods : 455 stroke patients were enrolled as the case group and 180 non-stroke patients as control group from Oct. 2005 to Feb. 2006. Patients were hospitalized within 2 weeks after the onset of stroke. Obesity were defined as BMI≥25㎏/m2, WHR≥0.9 in male and WHR≥0.8 in female. Risk factors and warning signs were obtained from personal interview. The analysis of the data was done by chi-square test, Fisher's exact test and two-sample t-test. Results : The percentage of current smokers(or current drinkers) of case group is higher significantly than that of control group. The past medical history of risk factors were found to be transient ischemic attack(p=0.0698), facial palsy(p=0.406l), hypertension(p<0.0001), hyperlipidemia(p=0.l484), DM(p<0.0001), ischemic heart disease(p=0.0093). migraine(p=0.0014) and hypochondria(p=0.2370). WHR≥0.9 in male had a 6.696 (3.711-12.082) odds ratio, WHR≥0.8 in female had a 1.567 (0.659-3.726) odds ratio. BMI≥25㎏/m2 had a 2.017(1.263-3.222). The dyscinesia and sensory disorder of warning signs were found to be statistical difference between case and control group. Conclusions : According to the above results, it was found that smoking, drinking, BMI, WHR, hypertension, DM, ischemic heart disease, migraine affected to the incidence of stroke.

한국한의학연구원 논문의 통계적 오류에 관한 연구

강경원(Kang Kyungwon),김노수(kim Nosoo),유종향(Yoo jonghyang),강병갑(Kang Byunggab),고미미(Ko Mimi),최선미(Choi Sunmi) 한국한의학연구원 2008 한국한의학연구원논문집 Vol.14 No.2

Background and Purpose: The purpose of this study was investigate statistical validities of previously reported articles that used various statistical techniques such as t r test and analysis of variance. Methods: To analyze the statistical procedures. 66 original articles using those statistical methods were selected from 『Korean Journal of Oriental Medicine(KJOM)』 published from 1995 to 2007. Results: Twenty-one articles(32%) did not report correct p-values, 33 articles(50%) used mean ± standard error(mean ± SE) and 11 articles(l7%) used mean ± standard deviation(mean ± SD). Fifty-two articles(95%) of 55 ones which were tested for normal distribution made an error in describing normal distribution. Seventeen articles misused t-test and 12 articles did not carry out the multiple comparison. Conclusions: The training of researchers with clinical statistics or the participation of statisticians in research design will reduce the significant errors in statistical interpretation of the results.

중풍환자의 습담변증 진단지표에 관한 연구

강병갑(Byeongkab Kang),고호연(Hoyeon Go),강경원(Kyungwon Kang),박세욱(Saewook Park),김정철(Jeongchul Kim),고미미(Mimi Go),김보영(Boyoung Kim),설인찬(Inchan Seol),이인(In Lee),조현경(Hyunkyung Jo),최선미(Sunmi Choi) 한국한의학연구원 2007 한국한의학연구원논문집 Vol.13 No.2

Background and Purpose : The purpose of this study was to investigate that which symptoms are adequate indicator of the Dampness-Phlegm pattern in the stroke patients. Methods : In the time period Jul. 2005 to Sep. 2006, 136 patients with a first-ever stroke admitted in the department of Internal Medicine of Daejeon University Oriental Medical Hospital in Daejeon city, Wonkwang Oriental Medical Hospital in Iksan, JeonJu city were included. Patients were hospitalized within 3 months after the onset of stroke. Stroke patients had been interviewed by resident who studied standard operation procedures in Fundamental Study for Standardization and Objectification of Differentiation and Pattern Identification of Syndrome of Oriental Medicine for Stroke. Gi-deficiency patients was confirmed by medical specialist diagnosis, resident diagnosis, case report form analysis without a dissenting voice. Results : Dampness-Phlegm group included 37 case, Non Dampness-Phlegm group 45 case out of 136 patients. white tongue coating, slippery purse, yellowish complexion, enlarged tongue, swollen tongue were higher among Dampness-Phlegm group. Dampness-Phlegm and Non Dampness-Phlegm patients do not significantly differ in heavy sensation in the head, voice with sputum, teeth printed tongue, borborygmus, dizziness with nausea. Conclusions : This study was insufficiency because sample size is very small. More data from prospective cohort studies will help to Korean Standard Differentiation of the Symptoms and Signs for the Stroke.

중풍의 변증 진단을 위한 판별모형

강병갑(Byeongkab Kang),강경원(Kyungwon Kang),박세욱(Saewook Park),김보영(Boyoung Kim),김정철(Jeongchul Kim),고미미(Mimi go),설인찬(Inchan Seol),조현경(Hyunkyung Jo),이인(In Lee),최선미(Sunmi Choi) 한국한의학연구원 2007 한국한의학연구원논문집 Vol.13 No.2

The purpose of this study was to diagnosis that what patterns identification using the statistical method. Discriminant analysis using the medical specialist and resident pattern identification agree case in stroke patients within 1 month of onset. The agreement rate of dificiency of Gi(75%), heat-transformation(74%), dampphlegm syndrome(69%), deficiency of Eum(51 %) and syndrome of blood stagnation(43%) are respectively 0.75, 0.74, 0.69, 0.51 and 0.43 in medical specialist and using linear discriminant function pattern identification are same. The study of inspection, pulse feeling and palpitation will be continued to evaluate concordance rate. Discrimination model will be make to get higher Accuracy and prediction, it means becomes the help in pattern identification diagnosis objectivity and scientific.

Feasibility of Peripherally Inserted Central Catheter Placement in COVID-19 Patients Isolated in the Intensive Care Unit of a Small Volume Center (291-Bed Hospital)

Kyungwon Lee,Min Chang Kang 대한외상중환자외과학회 2022 Journal of Acute Care Surgery Vol.12 No.3

Purpose Patients with coronavirus disease 2019 (COVID-19) should be isolated from others to prevent widespread infection. The purpose of this study was to evaluate the feasibility of performing peripherally inserted central catheter (PICC) placement in patients with COVID-19 isolated in the intensive care unit (ICU) of a small volume center hospital. Methods This retrospective study included 79 patients who underwent PICC in 2 ICUs. There were 41 patients with COVID-19 who were isolated in an ICU (isolated ICU) and there were 38 patients who required ICU care who did not have COVID-19 (non-isolated ICU). Their medical records including PICC-related complications and clinical variables were compared. Results PICC placement was performed to maintain long-term intravenous access for 78% of the COVID-19 group and 52.6% of the non-COVID-19 group (p = 0.017). The mean procedure time (minutes) was 15.2 ± 7.58 in the COVID-19 group and 12.6 ± 6.65 in the non-COVID-19 group (p = 0.109). When PICC tip locations were divided into three groups (optimal, suboptimal, and malpositioned), there was no significant difference between the two groups of patients. PICC-related complications in COVID-19 and non-COVID-19 groups included non-functioning catheter (0% vs. 5.3%, p = 0.137), occurrence of swelling or hematoma around PICC inserted site (2.4% vs. 0%, p = 0.333), and PICC-related infection. Conclusion PICC placement for patients with COVID-19 isolated in the ICU of a small volume center hospital was feasible and safe.