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Background: Although deleterious effects of sunlight have been increased recently, the surveillance of the attitudes toward sun-exposure and the behavioral aspect of using sunscreens in Koreans has hot been carried out. Objective: Our purpose was to evaluate the attitude toward the harmfulness of sun-exposure and behaviors of using sunscreens in Korea. Method: Five hundred and fifty-two subjects were surveyed to assess the attitude toward sun-exposure, as well as the subjects knowledge about, and the use of sunscreens. Underlying data including demographic data, skin colors, skin types, occupation, and sun-exposure, were obtained. Results: Fifty-four percent of subjects believed that sun-exposure is bad for their skins, but, on the contrary, 12.5% believed it to be beneficial. Fifty-two percent of subjects used sunscreens. Almost all subjects(93.8%) knew why to use sunscreens but 62.7% of subjects did not know the meaning of sun protective factors(SPF). Women, indoor workers, subjects less than 40 years old, with less sun-exposed, fair colored skin, or with skin type I, II, III tended to know the deleterious effects of sunlight and the meaning of SPF and used more sunscreen. Conclusion: High risk population-men, outdoor workers, subjects oider than 40 years old, with more sun-exposed, dark colored skin, or skin type VI, V could be targeted with campaigns that promote attitudinal and behavioral changes.
Background: The recognition of prevention and early detection of skin cancer has been increased more than before. Although skin cancer is not rare, most patients are little known about general awareness of skin cancer. Objectives: In this study, we survey the awareness and knowledge of skin cancer and sun protection behavior among South-Gyeongnam province. Methods: We reviewed a written questionnaire and patients' self-checked records including patients' basic medical information and knowledge of skin cancer protective modalities. Results: In total 284 subjects (94.7%(284/300), 67%(190/284) females, mean age 57.4 years) completed the survey. Most people (77.5%, 220/284) knew that the sun was most dangerous for their skin but relatively large portion of them (42.7%, 94/220) had no action to protective attitude like sun screen, large hat and gloves. Conclusion: The results show that many participants had known necessity of skin cancer prevention and importance of early detection, but didn't have had any protective action. Therefore, a more effective skin cancer education and prevention program is needed. We suggest that the measurement of effects of a multimodal educational intervention on knowledge of sun protection practices and engagement in self sun-protection behaviors also need to be check.
( Tae Hyung Kim ), ( Yeon Seok Seo ), ( Yoo Ra Lee ), ( Han Ah Lee ), ( Sun Young Yim ), ( Young Sun Lee ), ( Sang Jun Suh ), ( Young Kul Jung ), ( Ji Hoon Kim ), ( Hyunggin An ), ( Hyung Joon Yim ), ( Jong Eun ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: Acute kidney injury (AKI) is a common complication in cirrhotic patients, and also associated with increased mortality and development of complications including variceal bleeding, spontaneous bacterial peritonitis and encephalopathy. Currently, there are limitations to use serum creatinine to distinguish patients at high risk for AKI in patients with cirrhosis. We tried to elicit the association between levels of renal biomarkers including serum cystatin C and urine N-acetyl-β-D-glucosaminidase (NAG) and the prognosis of patients with decompensated cirrhosis. Methods: In 84 hospitalized patients with decompensated cirrhosis and without AKI at baseline, we identified serum creatinine, cystatin C, urine NAG levels and outcomes including AKI development and mortality. Results: During a median follow-up of 6.1 months, 17 patients experienced AKI and 21 patients died. In the AUC analysis for predicting the development of AKI within 6 months, those of serum Cr and cystatin C levels and urine NAG level were 0.562, 0.802, and 0.833, respectively. On multivariate Cox-regression analysis, AKI significantly occurred more frequently with higher serum cystatin C (HR, 21.168; P=0.010) and urine NAG levels (HR, 1.023; P<0.001). Patients significantly survived longer with lower serum cystatin C (HR, 0.273; P=0.003), urine NAG levels (HR, 0.983; P=0.001), and Child-Pugh scores (HR, 0.627; P=0.001). Patients with the serum cystatin C ³ 1.0 mg/L and urine NAG ³ 31 U/g urinary Cr (n=12) showed more AKI development (P<0.001) and higher mortality (P<0.001) than other patients on Kaplan-Meier plots. Conclusions: Serum cystatin C and urine NAG levels are strong predictors for AKI development and mortality in patients with decompensated cirrhosis. In addition, the use of urine NAG in conjunction with cystatin C may provide a more accurate prediction.
( Tae Hyung Kim ), ( Hyung Joon Yim ), ( Young-sun Lee ), ( Young Kul Jung ), ( Han Ah Lee ), ( Sun Young Yim ), ( Ji Hoon Kim ), ( Yeon Seok Seo ), ( Jong Eun Yeon ), ( Kwan Soo Byun ), ( Soon Ho Um ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: In chronic hepatitis B (CHB), nucleos(t)ide analogues (NAs) cannot exterminate the virus, and only suppress its proliferation. Thus, even though NAs improve the liver function, the risk of hepatocellular carcinoma (HCC) persists over time. Since a large cohort study which suggested the superiority of tenofovir over entecavir in reducing HCC risk, there is a great deal of controversy in choosing NAs. In this study, we aimed to meta-analyze the published data from Korea to date together with the unpublished data of our institution to derive the robust conclusion. Methods: We searched on-line database and derived 6 publications from Korea. In addition, we investigated 535 treatment- naïve patients with CHB who were first treated with entecavir (n=298) and tenofovir (n=237) between 2008 and 2016 at Korea University Medical Center (Ansan and Guro Hospitals). We used Kaplan-Meier method, Cox regression model, propensity score matching and meta-analysis. Results: From the 6 publications, 9,844 patients were included, 556 developed HCC. From our institutions, HCC was developed in 59 patients during a median follow-up of 21.6 months. After 1:1 propensity score matching, the kind of antiviral agent did not affect the development of HCC (HR, 0.72; 95% CI 0.31-1.71; P=0.46). Combined with the results of six domestic studies, the tenofovir group did not show significant suppression of HCC development compared to the entecavir group (HR, 0.96; 95% CI 0.74-1.25). Conclusions: In a meta-analysis of seven studies of HBV-endemic area including our own institutional data, HCC occurrence was not significantly different between patients with treated with entecavir or tenofovir.
Top of the basilar (TOB) syndrome occurs with occlusion of the rostral portion of the basilar artery that supplies blood to the midbrain, thalamus, and temporal and occipital lobes. Symptoms associated with TOB include decreased alertness, abnormal eye movement, dysarthria, and disorders of cerebellar function. A 47-year-old man was transferred to our hospital to manage C2 vertebral fracture sustained in a traffic accident. He was alert on arrival; however, he lapsed into semicoma. He was diagnosed with TOB. Thrombolytic agents could not be administered due to a contraindication in cervical spine fracture. Brain magnetic resonance imaging showed acute infarction of the pons, cerebellum, and posterior cerebral artery territory. This rare case demonstrates that C2 vertebral fracture can result in TOB.
Plasma amino acid concentrations and urinary excretion of free amino acids were measured in healthy female vegetarians (n=20, 19.9±0.43 years old) and age-matched omnivores (n=20, 21.9±0.38 years old) in Korea. Differences in fasting plasma amino acid concentrations and plasma aminogram pattern were not spectacular between the vegetarian and omnivore controls. Compared to the omnivores, vegetarians showed significantly lower plasma levels of methionine, phenylalanine, α-aminobutyrate, citrulline, phosphoserine and taurine, and significantly higher plasma concentrations of arginine, α-aminoadipate, asparagine, aspartate, glutamate and ornithine. Although these differences were statistically significant, they were all within the normal range (21~70% differences) for human adults. Most of the urinary amino acids (n㏖/㎎ creatinine or μ㏖24 hr urine) were excreted to significantly lesser degrees in vegetarians than was the case in omnivore controls. For almost every individual free amino acid, plasma concentration did not significantly correlate with urinary excretion level. These results indicate that vegetarians excreted less amino acids in their urine than did omnivores, most probably in an effort to maintain amino acid homeostasis to an altered dietary protein intake level and/or amino acid composition of their diets.
( Sun Young Yim ), ( Chung Gyo Seo ), ( Yoo Jin Lee ), ( Jihwan Lim ), ( Tae Hyung Kim ), ( Young Sun Lee ), ( Na Yeon Han ), ( Yeon Seok Seo ), ( Ji Hoon Kim ), ( Hyung Joon Yim ), ( Young Dong Yu ), ( Dong Sik) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: The American Joint Committee on Cancer (AJCC) 8th edition staging manual introduced several significant changes to the staging system for hepatocellular carcinoma (HCC). However, the revised staging system still does not consider tumor gross morphology when staging, which is considered to be an important predictive factor of survival in HCC patients as previously reported. Firstly, we aimed to compare the diagnostic efficacy of 8th edition of AJCC staging system to 7th edition. Secondly we evaluated the impact of infiltrative type HCC and propose new staging system to improve the diagnostic efficacy of current staging system. Methods: We retrospectively reviewed database of 992 patients with pathologically confirmed HCC between year 2004 and 2016 from three institutes. The infiltrative type HCC was defined as a mass with foci varying in size which fuse to form a larger foci without a distinct margin or a mass with a permeative appearance which blends into the background of the cirrhotic liver with an indistinct margin. Overall survival analysis (OS) were performed using Kaplan-Meier method and compared using log-rank tests. The Harrell concordance index (c index) and Akaike information criterion (AIC) were calculated to compare prognostic powers. Results: A total of 774 patients who had undergone hepatic resection were available for the analysis. The cohort was comprised of T1 (55.6%), T2 (32.8%), T3a (5%), T3b (4.7%) and T4 (1.9%) stages according to AJCC 7<sup>th</sup> staging system while T1a (21.4%), T1b (37%), T2 (30%), T3 (5%) T4 (6.6%) stages according to AJCC 8<sup>th</sup> staging system (Fig. 1). The OS did not differ between the advanced stages (T3a vs T3b; T3b vs T4 in AJCC 7<sup>th</sup> edition similarly between T2 vs T3; T3 vs T4 in 8<sup>th</sup> edition). Among all patients, 56 patients had infiltrative type HCC and OS analysis was performed after reclassifying the infiltrative type HCC separately. The OS of the patients with infiltrative type HCC was similar to OS of T4. After excluding infiltrative type HCC, sub-analysis was performed according to tumor sizes (≤2cm, >2-4cm, >4cm) for single and multiple tumors respectively as survival rate did not differ between the stages as shown above. Since the OS rate differed significantly among tumors with different sizes, we modified the T-stages as shown in Table 1. The modified AJCC T-staging system efficiently stratified patients according to survival as shown in Fig.1. Furthermore, modified staging system showed highest diagnostic performance followed by AJCC 8<sup>th</sup> edition and AJCC 7<sup>th</sup> edition (AIC 3074.4 vs 3087.8 vs 3103.4 and C-index 0.701 vs 0.67 vs 0.65, all P<0.01). Conclusions: The AJCC 8<sup>th</sup> T-staging system showed improved prognostic efficacy compared to 7<sup>th</sup> edition. However, modified AJCC staging system presented finer stratification of patients compared to previous staging systems by reclassifying sizes within single or multiple tumors and reassigning infiltrative type HCC to T4. The AJCC staging system requires surgical specimen for analysis and this study includes a large number of patients who undergone hepatectomy which is believed to have clinical impact with further validation in other cohorts.
Proteinuric conditions demonstrate structural and compositional changes of the foot processes and slit diaphragms between podocytes. β-Catenin in podocytes serves as an adapter protein anchoring P-cadherin of slit diaphragms to actin filaments of the podocyte cytoskeleton. To investigate the effect of ginseng total saponin (GTS) on pathologic changes of podocyte P-cadherin/β-catenin unit induced by diabetic conditions, we cultured mouse podocytes under: 1) normal glucose (5 mM, = control); 2) high glucose (HG, 30 mM); 3) advanced glycosylation end products (AGE)-added; or 4) HG plus AGE-added conditions and treated with GTS. In confocal imaging, β-catenin colocalized with P-cadherin predominantly at intercellular junction area. However, diabetic conditions relocalized and concentrated both molecules at perinuclear cytoplasmic area. In Western blotting, diabetic conditions, especially HG plus AGE-added condition, also decreased cellular β-catenin protein levels at 6, 24, and 48 hours. GTS improved such quantitative and qualitative changes of β-catenin. These findings imply that HG plus AGE have an influence on the redistribution and amount of P-cadherin/ β-catenin unit of podocytes, which can be reversed by GTS.