• 대한임상검사과학회지
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• 제54권4호
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• pp.265-272
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• 2022

Carbapenemase 생성 장내 세균(carbapenemase-producing Enterobacteriaceae, CPE) 중 특히 KPC-2 생성 Klebsiella pneumoniae의 출현과 확산은 전 세계적으로 급격히 증가하고 있으며, 심각한 공중 보건 위협이 되고 있다. 이러한 KPC-2 생성 K. pneumoniae의 역학과 특징은 지역 및 기간에 따라 다르기 때문에, 본 연구에서는 2017년 3월부터 2020년 12월까지 대전지역의 3차 병원에서 분리된 carbapenem 내성 K. pneumoniae (carbapenem-resistant K. pneumoniae, CRKP) 78 균주를 대상으로 carbapenemase 유전자를 분석하고, 이에 대한 역학 관계를 조사하였다. 항균제 감수성 양상은 디스크 확산법으로 확인하였고, carbapenemase 유전자의 분석을 위해 PCR과 DNA 염기서열분석을 수행하였다. 또한, 역학관계는 MLST (multilocus sequence typing)를 통해 조사하였다. 78 균주의 CRKP 중 35 균주(44.9%)가 carbapenemase 생성 K. pneumoniae였으며, 주요 carbapenemase 유형은 KPC-2 (30주, 85.7%)로 확인되었다. NDM-1과 NDM-5는 각각 4 균주(11.4%)와 1 균주(2.9%)에서 확인되었다. MLST 분석에서 10개의 sequence type (ST)이 확인되었고, 가장 흔한 ST는 ST307 (51.4%, 18/35)이었다. ST307 균주는 모두 KPC-2 생성 K. pneumonia였고, 다제내성으로 확인되었다. 또한, ST307은 4년 동안 지속적으로 출현하였다. 이러한 결과는 KPC-2 생성 K. pneumoniae ST307의 확산을 방지하기 위해 지속적인 모니터링과 적절한 감염 관리가 필요할 것으로 사료된다.

• Journal of Korean Neurosurgical Society
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• 제66권3호
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• pp.332-339
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• 2023

Objective : The present study aimed to investigate the clinical characteristics of electrolyte imbalance in patients with moderate to severe traumatic brain injury (TBI) who underwent craniotomy and its influence on prognosis. Methods : A total of 156 patients with moderate to severe TBI were prospectively collected from June 2019 to June 2021. All patients underwent craniotomy and intracranial pressure (ICP) monitoring. We aimed to explore the clinical characteristics of electrolyte disturbance and to analyze the influence of electrolyte disturbance on prognosis. Results : A total of 156 patients with moderate and severe TBI were included. There were 57 cases of hypernatremia, accounting for 36.538%, with the average level of 155.788±7.686 mmol/L, which occurred 2.2±0.3 days after injury. There were 25 cases of hyponatremia, accounting for 16.026%, with the average level of 131.204±3.708 mmol/L, which occurred 10.2±3.3 days after injury. There were three cases of hyperkalemia, accounting for 1.923%, with the average level of 7.140±1.297 mmol/L, which occurred 5.3±0.2 days after injury. There were 75 cases of hypokalemia, accounting for 48.077%, with the average level of 3.071±0.302 mmol/L, which occurred 1.8±0.6 days after injury. There were 105 cases of hypocalcemia, accounting for 67.308%, with the average level of 1.846±0.104 mmol/L, which occurred 1.6±0.2 days after injury. There were 17 cases of hypermagnesemia, accounting for 10.897%, with the average level of 1.213±0.426 mmol/L, which occurred 1.8±0.5 days after injury. There were 99 cases of hypomagnesemia, accounting for 63.462%, with the average level of 0.652±0.061 mmol/L, which occurred 1.3±0.4 days after injury. Univariate regression analysis revealed that age, Glasgow coma scale (GCS) score at admission, pupil changes, ICP, hypernatremia, hypocalcemia, hypernatremia combined with hypocalcemia, epilepsy, cerebral infarction, severe hypoproteinemia were statistically abnormal (p<0.05), while gender, hyponatremia, potassium, magnesium, intracranial infection, pneumonia, allogeneic blood transfusion, hypertension, diabetes, abnormal liver function, and abnormal renal function were not statistically significant (p>0.05). After adjusting gender, age, GCS, pupil changes, ICP, epilepsy, cerebral infarction, severe hypoproteinemia, multivariate logistic regression analysis revealed that hypernatremia or hypocalcemia was not statistically significant, while hypernatremia combined with hypocalcemia was statistically significant (p<0.05). Conclusion : The incidence of hypocalcemia was the highest, followed by hypomagnesemia, hypokalemia, hypernatremia, hyponatremia and hypermagnesemia. Hypocalcemia, hypomagnesemia, and hypokalemia generally occurred in the early post-TBI period, hypernatremia occurred in the peak period of ICP, and hyponatremia mostly occurred in the late period after decreased ICP. Hypernatremia combined with hypocalcemia was associated with prognosis.

• Journal of Korean Neurosurgical Society
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• 제66권5호
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• pp.582-590
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• 2023

Objective : Trauma is a leading causes of death and disability in all ages. The aim of this study was to describe the demography and characteristics of paediatric head trauma in our institution and examine the predictors of outcome and incidence of injury related mortality. Methods : We examined our institutional Trauma Registry over a 2 year period. Results : A total of 1100 trauma patients were seen over the study period. Of the 579 patients who had head injury 99 were in the paediatric age group. Of the paediatric head trauma patients 79 had documented Glasgow coma score (GCS), 38 (48.1%), 17 (21.5%) and 24 (30.4%) had mild, moderate and severe head injury respectively. The percentage mortality of head injury in the paediatric age group was 6.06% (6/99). There is an association between mortality and GCS (p=0.008), necessity for intensive care unit (ICU) admission (p=0.0001), associated burns (p=0.0001) and complications such as aspiration pneumonia (p=0.0001). The significant predictors of outcome are aspiration (p=0.004), the need for ICU admission (p=0.0001) and associated burns (p=0.005) using logistic binary regression. During the study period 46 children underwent surgical intervention with extradural haematoma 16 (34.8%), depressed skull fracture 14 (30.4%) and chronic subdural haematoma five (10.9%) being the commonest indication for surgeries. Conclusion : Paediatric head injury accounted for 9.0% (99/1100) of all trauma admissions. Majority of patients had mild or moderate injuries. Burns, aspiration pneumonitis and the need for ICU admission were important predictors of outcome in children with traumatic brain injury.

• 한국응용곤충학회지
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• 제62권2호
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• pp.95-102
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• 2023

최근 들어 반려동물을 키우는 가구 수가 증가하고 있다. 그로인해 진드기와 냄새에 대한 관심 또한 증가하고 있다. 본 연구는 제충국 추출물(Tanacetum cinerariifolium), 수용성 피톤치드(water-soluble phytoncide)가 진드기 퇴치제로서 효과와 탈취 및 항균 효과가 있는지 알아보기 위하여 연구를 진행하였다. 틱 클라이밍 테스트(Tick climbing test)에서 제충국 추출물(Tanacetum cinerariifolium) 23.33점, 수용성 피톤치드 22.00점으로 높은 기피효과를 보였다. 복합추출물로서의 진드기 기피 효과를 확인하기 위해 위 실험에서 기피 효과가 확인된 제충국 추출물, 수용성 피톤치드를 포함한 복합추출물(Sample이라 함.), 타사 제품(Control이라 함.)로 틱 클라이밍 테스트(Tick climbing test)를 진행하였다. 결과 Sample 13.00점, Control 26.67점으로 Sample이 높은 기피 효과를 나타내었다. 참진드기 실내 기피제 효력 시험법에서도 Sample이 88%, Control이 12%로 우수한 진드기 기피효과를 보인다는 것을 확인하였다. Sample을 가지고 탈취 시험을 진행한 결과 암모니아에서 98.3%, 트리메틸아민에서 99.5%의 탈취 효과를 보여주었으며, 항균시험에서 대장균, 황색포도상구균, 폐렴균 모두 99.9%의 항균 효과를 보여주었다. 본 연구결과를 종합해 볼 때 위 소재를 포함한 복합추출물은 추후 진드기 기피제와 탈취 및 항균에도 효과가 있는 소재로서의 활용 가치가 높다고 판단된다.

• Journal of Applied Biological Chemistry
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• 제65권1호
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• pp.43-48
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• 2022

많은 약리학적 효과가 입증되고 안전하다고 인정되는 생약제를 포함한 천연물은 오랫동안 사용되어 왔다. 다만 생약제로 사용되는 천연물의 안전성 등 부작용은 명확하게 확인되지 않았다. 이번 연구의 목적은 통증, 비염, 폐렴 치료에 사용되는 신이의 안정성 평가를 확인하기 위하여 SD 랫드 동물모델을 이용하여 4주 반복 용량 결정 독성시험으로 신이의 독성평가를 수행하였다. 수컷과 암컷 SD 랫드에 신이추출물을 28일 동안 1,500, 3,000 mg/kg의 농도로 하루 1회 경구 투여하였다. 신이추출물의 안정성 평가는 일반증상관찰, 체중 및 사료섭취량 측정, 혈구 및 혈액생화학 분석, 부검소견 관찰 및 상대적 장기무게 측정으로 판단하였으며 실험기간동안 신이추출물의 투여로 독성 관련 유의미한 변화는 나타나지 않았다. 따라서 이러한 연구결과는 4주 반복 용량 결정 독성시험에서 신이추출물이 독성 등 부작용은 나타나지 않았으며, 신이추출물의 독성이 나타나지 않는 최대무독성량은 3,000 mg/kg 이상으로 추정되었다.

• 한국방사선학회논문지
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• 제17권3호
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• pp.343-350
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• 2023

본 연구에서는 2016년 11월부터 폐암 검진 판독 시 판독의 표준화를 위하여 사용되고 있는 Lung-RADS (Lung CT Screening Reporting and Data System)에 기반하여 폐암 이외에 부수적으로 발견되는 "S" modifier 소견들의 종류와 빈도를 분석하고자 하며 이를 통하여 저선량 CT를 통해 얻을 수 있는 폐암 외의 중요 소견들에 대해 살펴보고 저선량 CT의 폐암 외 질환에 대한 유용성을 파악하고자 하였다. 본 연구 결과 전체 1023명의 대상자에서 360건(35.19%)의 "S" modifier 소견이 나타났으며 가장 발생빈도가 높은 질환은 관상동맥 석회화와 폐기종으로 관상동맥 석회화는 145건(14.17%), 폐기종은 138건(13.49%)으로 나타나 다른 소견들에 비해 발견 비율이 매우 높음을 알 수 있다. 또한 흡연 기간과 연관성이 매우 높은 것으로 확인되었는데 관상동맥 석회화의 경우 비흡연자인 A 그룹에서는 발견 비율이 9건(5.73%), 흡연 10년 이내의 B그룹은 23건(11.44%), 흡연 20년 이내의 C 그룹은 39건(13.68%), 흡연 30년 이내의 D그룹은 43건(18.53%), 흡연 30년 이상의 E그룹은 31건(20.94%)로 나타나 흡연력이 증가할수록 관상동맥 석회화의 발생 확률이 증가함을 알 수 있다. 관상동맥 석회화와 폐기종 이외에도 폐렴 및 폐 간질의 이상소견, 종격동 질환도 흡연 기간과의 연관성 분석결과 p<0.05로 나타나 흡연 기간에 영향을 받음을 알 수 있다.

• Tuberculosis and Respiratory Diseases
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• 제86권2호
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• pp.133-141
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• 2023

Background: The present study evaluated the association between participation in a rehabilitation program during a hospital stay and 1-year survival of patients requiring at least 21 days of mechanical ventilation (prolonged mechanical ventilation [PMV]) with various respiratory diseases as their main diagnoses that led to mechanical ventilation. Methods: Retrospective data of 105 patients (71.4% male, mean age 70.1±11.3 years) who received PMV in the past 5 years were analyzed. Rehabilitation included physiotherapy, physical rehabilitation, and dysphagia treatment program that was individually provided by physiatrists. Results: The main diagnosis leading to mechanical ventilation was pneumonia (n=101, 96.2%) and the 1-year survival rate was 33.3% (n=35). One-year survivors had lower Acute Physiology and Chronic Health Evaluation (APACHE) II score (20.2±5.8 vs. 24.2±7.5, p=0.006) and Sequential Organ Failure Assessment score (6.7±5.6 vs. 8.5±2.7, p=0.001) on the day of intubation than non-survivors. More survivors participated in a rehabilitation program during their hospital stays (88.6% vs. 57.1%, p=0.001). The rehabilitation program was an independent factor for 1-year survival based on the Cox proportional hazard model (hazard ratio, 3.513; 95% confidence interval, 1.785 to 6.930; p<0.001) in patients with APACHE II scores ≤23 (a cutoff value based on Youden's index). Conclusion: Our study showed that participation in a rehabilitation program during hospital stay was associated with an improvement of 1-year survival of PMV patients who had less severe illness on the day of intubation.

• 한국위험물학회지
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• 제2권1호
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• pp.18-26
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• 2014

We analyzed the demand of competent authorities requiring adequate technical information for initial investigation of chemical accidents. Reflecting technical reports on chemical accident response by environmental agencies in the U.S. and Canada, we presented information on environmental diffusion and toxic effects available for the first chemical accident response. Hydrogen fluoride may have the risk potential to corrode metals and cause serious burns and eye damages. In case of inhalation or intake, it could have severe health effects. The substance itself is inflammable, but once heated, it decomposes producing corrosive and toxic fume. In case of contact with water, it can produce toxic, corrosive, flammable or explosive gases and its solution, a strong acid, may react fiercely with a base. In case of hydrogen fluoride leak, the preventive measures are to decrease steam generation in exposed sites, prevent the transfer of vapor cloud and promptly respond using inflammable substances including calcium carbonate, sodium bicarbonate, ground limestone, dried soil, dry sand, vermiculite, fly ash and powder cement. The method for fire fighting is to suppress fire with manless hose stanchions or monitor nozzles by wearing the whole body protective clothing equipped with over-pressure self-contained breathing apparatus from distance. In case of transport accident accompanied with fire, evacuation distance is 1,600m radius. In cae of fire, fire suppression needs to be performed using dry chemicals, CO₂, water spray, water fog, and alcohol-resistance foam, etc. The major symptoms by exposure route are dyspnoea, bronchitis, chemical pneumonia and pulmonary edema for respiration, skin laceration, dermatitis, burn, frostbite and erythema for eyes, and nausea, diarrhea, stomachache, and tissue destruction for digestive organs. In atmosphere, its persistency is low, and its bioaccumulation in aquatic organism is also low.

• Journal of Digestive Cancer Research
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• 제2권1호
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• pp.28-31
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• 2014

췌장암은 예후가 매우 불량한 암으로 gemcitabine을 근간으로 하는 항암화학요법이 진행성 췌장암에 대한 표준치료이지만, 이러한 일차 항암화학요법에 반응이 없을 경우의 이차 항암화학요법에 대해서는 아직까지 정립된 것이 없는 상태이다. FOLFIRINOX 병합용법은 최근 여러 연구에서 일차 항암화학요법으로서의 치료 효과가 보고되고 있고, gemcitabine 항암화학요법에 반응이 없는 진행성 췌장암에 대한 이차 항암화학요법으로도 시도되어 양호한 치료 효과가 보고되고 있다. 저자들은 gemcitabine을 근간으로 하는 병합요법에 대해 반응이 없는 진행성 췌장암 환자에 대한 이차 항암화학요법으로 FOLFIRINOX 병합요법을 시행하여 완전 관해를 획득한 증례를 문헌고찰과 함께 보고하는 바이다.

• Korean Journal of Radiology
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• 제22권3호
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• pp.476-488
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• 2021

Objective: We aimed to develop a deep neural network for segmenting lung parenchyma with extensive pathological conditions on non-contrast chest computed tomography (CT) images. Materials and Methods: Thin-section non-contrast chest CT images from 203 patients (115 males, 88 females; age range, 31-89 years) between January 2017 and May 2017 were included in the study, of which 150 cases had extensive lung parenchymal disease involving more than 40% of the parenchymal area. Parenchymal diseases included interstitial lung disease (ILD), emphysema, nontuberculous mycobacterial lung disease, tuberculous destroyed lung, pneumonia, lung cancer, and other diseases. Five experienced radiologists manually drew the margin of the lungs, slice by slice, on CT images. The dataset used to develop the network consisted of 157 cases for training, 20 cases for development, and 26 cases for internal validation. Two-dimensional (2D) U-Net and three-dimensional (3D) U-Net models were used for the task. The network was trained to segment the lung parenchyma as a whole and segment the right and left lung separately. The University Hospitals of Geneva ILD dataset, which contained high-resolution CT images of ILD, was used for external validation. Results: The Dice similarity coefficients for internal validation were 99.6 ± 0.3% (2D U-Net whole lung model), 99.5 ± 0.3% (2D U-Net separate lung model), 99.4 ± 0.5% (3D U-Net whole lung model), and 99.4 ± 0.5% (3D U-Net separate lung model). The Dice similarity coefficients for the external validation dataset were 98.4 ± 1.0% (2D U-Net whole lung model) and 98.4 ± 1.0% (2D U-Net separate lung model). In 31 cases, where the extent of ILD was larger than 75% of the lung parenchymal area, the Dice similarity coefficients were 97.9 ± 1.3% (2D U-Net whole lung model) and 98.0 ± 1.2% (2D U-Net separate lung model). Conclusion: The deep neural network achieved excellent performance in automatically delineating the boundaries of lung parenchyma with extensive pathological conditions on non-contrast chest CT images.