Marked Decreases of Foxp3 and CTLA-4 Are Associated with Strong Antiviral Effects of Tenofovir in Patients with Chronic Hepatitis B

( Ji Young Kim ),( Chang Wook Kim ),( Yun Hui Kim ),( Seok Cheon Yeom ),( Su Gyeong Lee ),( Hee Yeon Kim ),( Si Hyun Bae ),( Jong Young Choi ),( Seung Kew Yoon ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Immune regulatory molecules such as forkhead box P3 (Foxp3) on CD4+ T cell and cytotoxic T lymphocyte-associated antigen 4 CTLA-4) on CD8+ T cell are associated with antiviral effector T cell dysfunction, which influences on T cell exhaustion and persistent viral infection in patients with chronic hepatitis B. These Foxp3 and CTLA-4 are up-regulated in chronic hepatitis B. During antiviral therapy with tenofovir, the expressions of Foxp3 and CTLA-4 could be changed. We investigated the relationship between antiviral effects of tenofovir and the expression of Foxp3 and CTLA-4 during tenofovir treatment in chronic hepatitis B. Methods: Eight patients with chronic hepatitis B under tenofovir treatment were enrolled for detection of Foxp3 on CD4+ T cell and CTLA-4 on CD8+ T cell. Peripheral blood mononuclear cells were isolated from these subjects before tenofovir treatment (T0), 3 month (T3) and 6 month (T6) during tenofovir treatment. For antiviral effect analysis, serum HBV DNA levels were checked at same time. The expressions of Foxp3 and CTLA-4 on T cells were monitored by flow cytometry. Results: Three patients (3 of 8) showed marked decreases of Foxp3 and CTLA-4 during tenofovir therapy (group 1). Five patients (5 of 8) showed minimal changes of Foxp3 or CTLA-4 during tenofovir therapy (group 2). Group 1 showed complete virologic response within 6 month therapy regardless of baseline HBV DNA level but, group 2 showed complete virologic response within 6 month therapy only in patients with low baseline HBV DNA level (< 7log HBV DNA). Conclusions: Among the patients with chronic hepatitis B, the patients who showed marked decrease of Foxp3 and CTLA-4 during tenofovir therapy are associated with strong antiviral effects of tenofovir regardless of baseline HBV DNA level. This finding suggests that restoration of HBV-specific T cell strengthens the antiviral effects of tenofovir.

LiF:Mg,Cu,Na,Si TL 소자의 선량계적 특성

남영미,김장렬,장시영 대한방사선 방어학회 2001 방사선방어학회지 Vol.26 No.1

최근 개발된 방사선량 측정용 LiF:Mg,Cu,Na,Si TL 소자의 글로우 곡선, 방출스펙트럼, 광자에 대한 선량의존성, 에너지의존성 및 페이딩 등과 같은 물리적 및 선량계적 특성들을 연구하였다. LiF:Mg,Cu,Na,Si TL 소자는 LiF:Mg,Cu,Na,Si TL 분말에 압력을 가한 후 소결하는 방법으로 제조되었다. 방사선에 대한 특성을 알아보기 위하여 광자선 조사는 한국원자력연구소의 X선 발생 장치 및 137Cs γ선 원격조사장치를 이용하였으며, 사용된 광자선 에너지 범위는 20-662keV, 선량 범위는 10-6-102 Gy이었다. 글로우 곡선은 수동형의 TLD 판독장치 (System 310, Teledyne)로 질소를 흘리면서 선형적인 가열률로 측정하였으며, TL 강도는 글로우 곡선을 전체 적분한 면적으로 평가하였다. 5℃·s-1의 선형적인 가열률로 측정한 글로우 곡선은 5개의 피그들로 분리되었으며, 234℃에 나타나는 주피크의 활성화에너지는 2.34 eV, 진동수인자는 1.00×1023이고, 방출스펙트럼은 410nm를 중심으로한 단일한 분포로 나타났다. 선량의존성은 100Gy 이상까지 선형성을 나타내었으며, 137Cs에 대한 저에너지 광자의 상대적인 에너지 반응값은 20% 범위 이내였다. 또한 실온에서 1년간 보관하였을 때, 시간경과에 따른 TL 감도의 감소가 거의 없는 좋은 페이딩 특성을 보였다. Sintered LiF:Mg,Cu,Na,Si thermoluminescence (TL) pellets were developed for application in radiation dosimetry. In the present study, the TL dosimetric properties of LiF:Mg,Cu,Na,Si TL pellets have been investigated for emission spectrum, dose response, energy response, and fading characteristics. LiF:Mg,Cu,Na,Si TL pellets were made by using a sintering process, that is, pressing and heat treatment from TL powders. Photon irradiations for the experiments were carried out using X-ray beams and a 137Cs gamma source at the Korea Atomic Energy Research Institute(KAERI). The average energies and the dose were in the range of 20-662 keV and 10-6- 102 Gy, respectively. The glow curves were measured with a manual type TLD reader(System 310, Teledyne) at a constant nitrogen flux and a linear heating rate. For a constant heating rate of 5℃·s-1, the main dosimetric peak of glow curve appeared at 234℃, the activation energy was 2.34eV and frequency factor was 1.00×1023. TL emission spectrum is appeared at the blue region centered at 410 nm. A linearity of photon dose response was maintained up to 100 Gy. The photon energy responses relative to 137Cs response were within ±20% at overall photon energy region. The fading of TL sensitivity of the pellets stored at the room temperature was not found for one year.

신축학교 실내공기질이 초등학생들의 인지기능에 미치는 영향

김태섭,김선주,박시영,전만중,김규태,김창윤,정종학,백성옥,사공준 대한산업의학회 2007 대한직업환경의학회지 Vol.19 No.1

목적: 신축초등학교와 대조학교를 선정하여 교실 내 포름알데히드와 TVOCs를 측정하고 컴퓨터 신경행동검사를 이용하여 실내공기 오염물질이 학생들의 인지기능에 미치는 영향을 평가하였다. 방법: 신축초등학교 5학년 71명을 실내공기 오염물질 노출군으로 하고, 개교한지 12년째인 대구시의 일개 초등학교 5학년 2학급 63명을 대조군으로 하여 실내공기 오염물질농도 측정 및 컴퓨터 신경행동검사를 실시하였다. 결과: 신축학교에서 의도적으로 창문을 개방한 학급에서 1교시 포름알데히드 농도는 34.6 ㎍/㎥, 4교시에는 27.3 ㎍/㎥, 창문을 개방하지 않은 학급에서 1교시 80.2 ㎍/㎥, 4교시 127.1 ㎍/㎥, 대조학교에서는 2학급 각각 1교시에 12.6 ㎍/㎥, 7.5 ㎍/㎥, 4교시에 19.8 ㎍/㎥, 25.2 ㎍/㎥였다. TVOCs의 경우 신축학교의 의도적으로 창문을 개방한 학급에서 1교시에 농도는 487.2 ㎍/㎥, 4교시에 428.2 ㎍/㎥, 창문을 개방하지 않은 학급에서 1 교시에 농도는 1,283.5 ㎍/㎥, 4교시에 1,715.4 ㎍/㎥, 대조학교의 경우 2학급에서 각각 1교시에 농도는 240.9 ㎍/㎥, 150.8 ㎍/㎥, 4교시에 농도는 371.9 ㎍/㎥, 448.0 ㎍/㎥였다. 부호숫자 짝짓기의 평균반응시간은 대조학급이 1교시에 2,585 msec에서 4교시에 2,459 msec으로 감소한 반면 신축학교의 창문을 의도적으로 개방한 학급은 2,343 msec에서 2,510 msec으로, 평소대로 수업한 학급은 2,340 msec에서 2,563 msec으로 반응시간이 각각 167 msec, 223 msec 증가하였다. 1교시의 부호숫자 짝짓기 의 반응시간을 100%로 했을 때 창문을 의도적으로 개방 한 학급은 4교시에 5.9% 증가하였고(p<0.01), 평소대로 수업한 학급은8.3% 증가하였다(p<0.01). 반면에 대조학급은 4교시에 5.0% 감소하였다(p<0.01). 결론: 향후 학교의 실내공기질의 안전성 평가는 샘플링 된 공기의 오염수준의 측정뿐만 아니라 학생들의 건강영향도 함께 고려되는 것이 바람직할 것이다. Objectives: Most studies on the indoor air quality of newly built schools have focused only on the number of schools exceeding a standard or on subjective symptoms, such as sneezing, irritated eyes and an irritated nose. However, there has been no report on how poor indoor air quality affects children's academic performance. This study evaluated the effects of indoor air quality on the neurobehavioral performance of elementary school children. Methods: This study measured the indoor air pollutants and compared children's performance, using a computerized neurobehavioral test, between a newly built and a 12-year-old school. In addition, a questionnaire was administered regarding the indoor air quality related symptoms of children in a newly built and a 12-year-old school. Results: In the newly built school, the formaldehyde levels in the 1^(st) and 4^(th) classes with an open window were 34.6 and 27.3 μg/㎥, respectively. The levels in the 1^(st) and 4^(th) classes with the window closed were 80.2 and 127.1 μg/㎥, respectively. In the 12-year-old school, the formaldehyde levels in 1^(st) and 4^(th) class with open and closed window were 12.6 and 7.5 μg/㎥, and 19.8 and 25.2 μg/㎥, respectively. With respect to total volatile organic compounds, the levels in the 1^(st) and 4^(th) classes with the window open in the newly built school were 87.2 and 428.2 μg/㎥, respectively. In the 1^(st) and 4^(th) classes with the window closed, the total volatile organic compounds were 1,283.5 and 1,715.4 μg/㎥, respectively. In the 12-year-old school, the total volatile organic compounds were 240.9 and 150.8 μg/㎥, and 371.9 and 448.0 μg/㎥ in the 1^(st) and 4^(th) classes, respectively. In the case of a newly built school, the performance of the students in the neurobehavioral test in the 4^(th) class with the window closed was 8.3% lower than for those in the 1^(st) class with the window closed, but was only 5.9% lower when the windows were open. There was a statistical significant difference in the total numbers of symptoms between the two schools. Conclusions: These results suggest a proper evaluation of the indoor air quality within schools is required into both the level of contamination and the health effects of these contaminants toward children.

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.

냉기치료후 슬관절강내의 온도변화

백승석,최기섭,박시복,이상건,김영호,양길태,장윤희 大韓再活醫學會 1998 Annals of Rehabilitation Medicine Vol.22 No.2

냉기 치료에 따른 둔근에서의 피부 및 근육내 온도 변화

정우성,김미정,박시복,이상건,김영호,양길태,장윤희 大韓再活醫學會 1998 Annals of Rehabilitation Medicine Vol.22 No.2

광양만에서 춘계와 하계 영양염류 첨가가 식물플랑크톤군집의 성장에 미치는 영향

배시우,김동선,최현우,김영옥,문창호,백승호,Bae, Si Woo,Kim, Dongseon,choi, Hyun-Woo,Kim, Young Ok,Moon, Chang Ho,Baek, Seung Ho 한국해양학회 2014 바다 Vol.19 No.1

춘계와 하계 광양만에서 식물플랑크톤 군집구조와 그들의 성장에 영향을 미치는 영양염제한 특성을 파악하기 위해서 만내외측의 20개 정점에서 생물학적 요인과 무생물학적 요인을 조사했다. 또한 식물플랑크톤 군집에 대한 영양염 첨가 효과를 알아보기 위해서 실험실에서 현장 20개 정점의 표층수를 이용하여 생물검정실험을 수행하였다. 전체 식물플랑크톤 군집의 90%이상을 규조류가 차지하였다. 이들 규조류중 Eucampia zodiacus와 Skeletonema costatum-like 종이 춘계와 하계에 각각 우점하였다. E. zodiacus와 S. costatum-like 규조류의 개체군 밀도가 춘계와 하계에 높은 밀도를 유지하게 된 이유를 간단히 설명하면, E. zodiacus 의 성장은 춘계 투명도가 높게 나타나 유광층내 광량의 증가가 원인으로 생각된다. 즉 유광층내 광량의 증가는 E. zodiacus의 개체수를 폭발적으로 증가시킬 수 있는 방아쇠 역할을 한 것으로 판단된다. 하계에 S. costatum-like이 전해역에서 우점한 이유는, 섬진강 담수 유입에 의한 낮은 염분과 함께 공급된 다량의 영양염은 그들 생물의 증식에 중요한 bottom-up 효과를 보였다고 판단된다. 실험실의 생물검정실험에서는 비록 내만(정점 8)과 외해(정점 20)에서 식물플랑크톤 군집의 최대 성장율은 유사하였지만, 인산염에 대한 반포화계수($K_s$)는 내만정점보다 약간 낮았다. 상대적으로 낮은 영양염농도에 적응한 세포는 낮은 인산염농도에서 충분히 성장할 수 있고, 다른 미세조류에 비하여 낮은 영양염농도의 조건에서 경쟁의 우위를 차지 할 것이다. 특히, 하계의 N영양염 첨가군의 효율은 대조군과 P영양염 첨가군에 비해서 높았다. 이는 광양만에서 하계에 N영양염의 공급이 섬진강을 통하여 계속적으로 유입되지만, 빠른 식물플랑크톤의 증식으로 인하여 N영양염 제한이 일어날 수 있다는 것을 시사할 수 있다. 반면, 규산염은 식물플랑크톤의 성장에 영향을 미치는 제한인자로 나타나지 않았고, 규조류의 분해로 인하여 Si의 재순환과 담수로부터 공급된 높은 규산염농도는 광양만에서 규조류 생태계를 유지할수 있는 유리한 조건이라 생각된다. In order to estimate the effect of nutrients addition for phytoplankton growth and community compositons in spring and summer season, we investigated the abiotic and biotic factors of surface and bottom waters at 20 stations of inner and offshore areas in Gwangyang Bay, Korea. Nutrient additional experiments were also conducted to identify any additional nutrient effects on phytoplankton assemblage using the surface water for the assay. Bacillariophyceae occupied more than 90% of total phytoplankton assembleges. Of these, diatom Eucampia zodiacus and Skeletonema costatum-like species was mainly dominated in spring and summer, respectively. Here, we can offer the season why the two diatom population densities were maintained at high levels in both seasons. First, light transparency of spring season in the euphotic zone was greatly improved in the bay. This improvement is one of important factor as tigger of increase in E. zodiacus population. Second, low salinity and high nutrient sources supplied by Seomjin River discharge are a main cue for strong bottom-up effects on S. costatum-like species during the summer rainy season. Based on the algal bio-assays, although maximum growth rate of phytoplankton communities at inner bay (St.8) were similar to those of outer bay (St.20), half-saturation constant ($K_s$) for phosphate at outer bay was slightly lower than those of inner bay. This implied that adapted cells in low nutrient condition of outer bay may have enough grown even the low phosphate and they also have a competitive advantage against other algal species under low nutrient condition. In particular, efficiency of N (+) addition in summer season was higher compared to control and P added experiments. In the bay, silicon was not a major limiting factor for phytoplankton growth, whereas nitrogen (N) was considered as a limiting factor during spring and summer. Therefore, a sufficient silicate supply form water mixing Si recycled from diatom decomposition and river water is favorable form maintaining diatom ecosystems in Gwangyang Bay.

조혈모세포이식 환자에서 발생한 Cytomegalovirus 질환의 특징 : 일개 대학변원에서 최근 10년간의 경험

최수미,이동건,박선희,김시현,김유진,민창기,김희제,이석,최정현,유진홍,김동욱,이종욱,민우성,신완식,김춘추 대한감염학회 2009 감염과 화학요법 Vol.41 No.1

Background : Studies on cytomegalovirus (CMV) diseases in Korean hematopoietic stem cell transplant (HSCT) recipients are lacking and do not reflect the recent trends of advances and changes. Therefore, we tried to analyze the clinical features of CMV diseases in HSCT recipients over the past 10 years at a tertiary university hospital in Korea. Methods : Retrospective review of medical records was done for all adult HSCT patients who received transplant at the Catholic HSCT Center from January 1998 to January 2008. Results : Forty-four cases (2.2%) of CMV diseases were identified. CMV pneumonia was diagnosed in 17 patients, retinitis in 16 patients, enterocolitis in 7 patients, esophagitis 1 patient, gastritis in 1 patient, duodenitis in 1 patient, and hepatitis in 1 patient. The median onset of symptom was 90 days after transplantation. Late CMV diseases accounted for 47.7%. CMV related death varied from 0 to 58.8% according to the involved organ. CMV retinitis was diagnosed relatively later in the course of transplantation mostly in patients who had chronic graft versus host disease (GVHD). On the contrary, CMV enterocolitis mainly occurred in patients who suffered from acute GVHD. The overall concurrent CMV reactivation was documented to be 63.6%: the concurrent CMV reactivation was observed only in 37.5% of patients with retinitis. Conclusions : We observed some differences in the pattern of CMV disease manifestation according to the involved organ and reconfirmed the fact that CMV pneumonia is the most common and fatal disease in HSCT recipients. Additionally, CMV retinitis was not uncommon in HSCT recipients. Since specific marker does not exist in predicting retinitis, regular ocular examination should be done thoroughly, especially in patients with chronic GVHD.

중증 고혈압증의 임상적 관찰

육동민(Dong Min Yook),곽시영(Si Young Kwak),김성식(Seong Sik Kim),이성숙(Seong Sook Lee),홍관표(Kwan Pyo Hong),최창필(Chang Pil Choi),이재우(Jae Woo Lee),이시래(Si Rhae Lee) 대한내과학회 1987 대한내과학회지 Vol.33 No.2

N/A Clinical studies were carried out in the 110 cases of severe hypertension who had been admitted from January 1979 to August 1985 and the following results were obtained: 1) Underlying diseases of severe hypertension were essential hypertension in 67 cases, renal parenchymal hypertension in 36 cases, and renovascular hypertension in 7 cases. 2) Plasma renin activity was the highest in the group of renovascular hypertension which was 22.07±9.20 ng/ ml/hr, and as a whole, the higher diastolic blood pressure, the higher plasma renin activity was. Plasma renin activity in the group of K-W grade IV retinopathy was higher than those of the other groups. 3) The incidence of ventricular hypertrophy fullfilling voltage criteria and with accompanying ST-T changes on electrocardiolgram was 81.5% in the group of essential hypertension and there was no difference in relation to the level of pressure or fundoscopic changes. 4) The serum creatinine level was the highest in the group of renal parenchymal hypertension (7.93±2.98 mg/dl), and in the group of K-W grade IV retinopathy (6.86±3.50mg/dl), but there was no significant difference in relation to the level of diastolic blood pressure, 5) There were no significant difference in cardiothoracic ratio on chest X-ray in relation to underlying diseases, diastolic blood pressure or fundoscopic changes. 6) The major complications were congestive heart failure (49.1%), hypertensive encephalopathy (17.3%), and cerebrovascular accident (8.2%). 7) In the group of essential hypertension blood pressure was controlled by conservative treatment in 81.0% but in 35.7% in the group of renal hypertension. The patients of chronic renal failure who were treated with dialysis blood pressure was controlled in 87.0%. In all 6 cases with renal transplantation, nephrectomy or renal angioplasty blood pressure was well controlled. 8) In cases refractory to triple antihypertensive regimen blood pressure was controlled by minoxidil in 66.7% and by captopril in 75.0%. 9) In 45 cases who were followed up for more than 6 months diastolic blood pressure was controlled under 100mmHg in 77.8% and there were improvement of renal function, fundoscopic findings and electrocardiographic findings in 20.0%, 33.3% and 16.7%, respectively.

미술치료 석사과정생의 정신과 임상실습 체험연구

김시내,장연집 서울여자대학교 2010 심리치료: 다학제적 접근 Vol.10 No.2

미술치료 전공의 석사과정생이 정신과에서 임상실습을 통해 어떠한 체험을 하는지를 탐색해 보기위한 목적을 가지고 수행된 본 연구는 인간의 체험에 관심을 갖고 그들이 경험하는 것에 대해 심층적으로 이해 할 수 있도록 도와주는 Max van Manen의 해석학적 현상학적 질적 연구 방법론을 적용하고 있다. 정신과 병동에서 1년 이상 임상실습 경험이 있는 총 11명의 연구 참여자를 대상으로 2010년 4월부터 6월까지 심층면접을 실시한 결과, 연구문제에 따른 10개의 본질적 주제와 30개의 하위 주제들을 산출하였다. 연구결과와 글쓰기 등을 토대로 본 연구에서는 정신과 임상실습을 체험한 미술치료 석사과정생인 연구 참여자들이 다음과 같은 4가지의 체험을 하였다는 결론을 내리고 있다. 첫째, 병원의 치료진을 포함하여 정신과 환자까지도 미술치료에 대한 인식부족으로, 미슬 치료 전공 실습생들은 정체감에 큰 혼란을 겪는 기회를 직면한다. 둘째, 병원의 치료진들이 전해준 미술치료로 정신과 환자의 상태 개선이란 소식을 접하면서, 미술치료만이 해낼 수 있는 특수성을 재인식하게 되며, 고된 실습의 보상과 함께 고양된 경험을 갖게 되고, 임상미술치료의 실습이 중요함을 재인식하게 된다. 셋째, 미술작업과 미술언어를 매개로 하여 미술치료전공 실습생은 정신과에서의 미술치료실습이 매우 중요한 기회임을 실감하며, 치료진과 정신과 환자들 사이의 관계를 연결 짓는 중간자 역할을 하는 자신을 발견한다. 넷째, 임상미술치료를 자신 있게 다루고 싶어져 전공 지식의 심화를 스스로 요구하게 되며, 내적인 자기성장의 욕구를 경험한다. In this research, Max van Manen's hermeneutical phenomenology providing assistance to understanding in depth how human beings are interested in the experiment and what it is they experience, is used for the progress. As for the research participants, total of 11 subjects the students enrolled in art therapy master's program and having more than a year experience in clinical practice were selected from the psychiatry department of a combined hospital and the psychiatry department of a single hospital containing the hospitalization ward. As a result of performing in-depth screening on these subjects, 10 essential and 30 subordinate topics were categorized. This research is making following 4 conclusion through research participants that is the students of the art therapy master's program experience at the psychiatry clinical training. First, the students of the art therapy master's program experience frustration and identity confusion during the course of clinical practice due to lack of awareness of art therapy from clinical staff and patients. Second, the students of the art therapy master's program from clinical staff of hospital receive the news about psychiatry patient's state improvement, so they recognizing peculiarity that work process of only art therapy can have. In addition, they have compensation of hard practice with enhanced experience, and they recognized practice of clinical art therapy is being important. Third, the students of the art therapy master's program perform the role of middleman in between the clinical staff and the patients and thus learn about exclusive particularities held by the art therapy. Fourth, the students of the art therapy master's program require deepening of major knowledge to oneself because they want self-assured handle at clinical art therapy. In addition, they experience desire of inner own growth.