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The three northeast Asian nations, South Korea, China and Japan which are depending on the seaborne trade which is the majority of the trade, need active measures to respond to the international marine environmental changes and implement it. This thesis is to look into the maritime security plans which is made by the United States and adopted by each nation and the three nations' policy of new maritime security threats causes like cyber terrorism and to assess the appropriateness. This is also in order to suggest some assignments for the successful adaptation of the maritime security plans. Maritime security has been a national agenda by terrorist attacks of pirates, maritime terrorism and shipping ports' threats since the Cold War. South Korea, China and Japan, the three nations in northeast Asia, are paying closer attention to maritime traffic security because of a high level of dependence on maritime trade as most exportations and importations are being made through marine transportation. Especially nowadays there are new security threat factors using cyber terrorism and drones, so costal states need changes in security policy besides traditional maritime security. The purpose of this thesis is to criticize the three northeast nations' policy about new threats and the maritime security plan which is initiative to be drawn up and applied by the United States and also to present countermeasure. Safety secure of sea lanes has become a national assignment which is directly connected to global survival to the three northeast Asian nations, South Korea, China and Japan which are dependent on trade through the sea. This thesis shows that each nation has put in a great deal of effort in order to keep the maritime order from the threats like pirates interfering ships' free passages and disconcerting marine trade orders and there have been considerable achievements. However, there are limits of united countermeasures because three northeast Asian nations have different stances in cultural, social and political situations. It will be an important matter how to deal with security issues and unite continuous efforts against new threats liked cyber terrorism and drones with typical maritime security threats. I hope that stable environments of maritime security in eastern Asia come true through careful consideration about a few countermeasures shown on this thesis and reflection of the policy.
Objectives: The purpose of this study is to evaluate the preliminary effects of the Peer Relationship Enhancement Program in adolescents deemed to be in an at-risk group for Internet and smartphone addiction. Methods: The study group consisted of 33 adolescent participants (24 boys and 9 girls) at risk of Internet and smartphone addiction in small and medium-sized cities. The subjects participated in 8 consecutive sessions of the Peer Relationship Enhancement Program. The Korean Internet Addiction Proneness Scale, the Korean Smartphone Addiction Proneness Scale, the Real-Ideal Self Discrepancy Scale, the UCLA Loneliness Scale, the Peer Intimacy Scale, and the Escaping from the Self Scale were evaluated before the initial and after the final session. A paired t-test was performed to statistically analyze the data. Results: The Peer Relationship Enhancement Program led to a significant decrease (p<0.05) in self-reported measures of The Korean Internet Addiction Proneness Scale, the Korean Smartphone Addiction Proneness Scale, and the Real-Ideal Self Discrepancy Scale. Conclusion: The Peer Relationship Enhancement Program reduces the risk of Internet and smartphone addiction and effectively prevents the associated problems.
LC : A Randomized, Multi-center, Phase IV Open-label Study to Evaluate the Long-term Effect of Carvedilol versus Propranolol on Reduction in Portal Pressure in Patients with Cirrhosis: An Interim Analysis
( Tae Yeob Kim ), ( Joo Hyun Sohn ), ( Soon Ho Um ), ( Yeon Seok Seo ), ( Soon Koo Baik ), ( Moon Young Kim ), ( Jae Young Jang ), ( Soung Won Jeong ), ( Young Seok Kim ), ( Sang Gyune Kim ), ( Dong Joon Kim ), ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1
Background: Carvedilol, a potent non-cardioselective beta blocker with vasodilating properties due to alpha-1 blockade, is more effective in reducing portal pressure than propranolol in randomized controlled hemodynamic studies. Recently, longterm low dose of carvedilol may be suggested an option for primary prophylaxis in patients with high-risk esophageal varices. The aim of this study is to evaluate long-term effect of carvediolol versus propranolol on reduction in portal pressure in patients with cirrhosis. Methods: We conducted this ongoing prospective randomized multicenter study (target sample size: 130 patients) between July 2011 and February 2013 and analyzed clinical and hemodynamic measurement data of 99 cirrhotic patients with severe portal hypertension (HVPG > 12 mmHg). During that period, these patients were randomized to either carvedilol (mean dose 11.6±2.2 mg/day in 50 patients) or propranolol group (mean dose 153.5±100.2 mg/day in 49 patients). After randomization, 8 patients and 11 patients were dropped out in carvedilol and propranolol group, respectively. The responders were defined to achieve a fall in HVPG to < 12 mmHg or a 20% reduction from baseline values 6weeks after treatment. Results: There were no significant differences between carvedilol and propranolol group in age, sex, etiology, Child-Turcott- Pugh score, MELD score, severity of HVPG, presence of ascites and baseline serum parameters. In per-protocol analysis, the rate of responder of patients with receiving carvedilol was 54.8% (23/42) as compared with 45.2% (16/38) of those with receiving propranolol (P=0.258). In intent-to-treat analysis, the rate of responder between carvedilol and propranolol group were 46.0% and 32.7%, respectively (P=0.174). The mean decrease of HVPG was 15.6±18.1% and 8.1±30.1%, respectively (P=0.188). Finally, there was no significant difference in adverse events between two groups. Conclusions: In this interim analysis, low dose of carvedilol showed similar effi cacy in reducing portal pressure compared to propranolol in cirrhotic patients with severe portal hypertension.
( Tae Suk Kim ), ( Dae Hee Choi ), ( Min Jong Lee ), ( Eun-hee Cho ), ( Young Don Kim ), ( Gab Jin Cheon ), ( Moon Young Kim ), ( Soon Koo Baik ), ( Ki-tae Suk ), ( Dong Joon Kim ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: Although osteoporosis in alcoholic liver cirrhosis (ALC) is clinically important because of resulting a significant morbidity such as spinal fractures, its real prevalence in Korea remains unknown. The aim of this prospective study is to describe the prevalence of osteopenia and osteoporosis assessed by the reference method. In addition, another aim of this study is to identify affecting factors on osteoporosis in ALC patients. Methods: We present the prospective multicenter study. During July 2013 to March 2015, one hundred eight ALC patients who admitted at four centers in Gangwon province were consecutively recruited. The diagnosis of osteoporosis and osteopenia in ALC is made after a bone densitometry by WHO criteria. Alcohol consumption habits, known risk factors of osteoporosis development through lifestyle questionnaires, laboratory findings, and hormone levels were also conducted. Results: The crude prevalence of osteoporosis in ALC patient (29-82 years old) was 20.0% for men (N=95) and 15.4% for women (N=13). Our data compared with that of 2008-10 Korean National Health and Nutrition Examination Survey data, the prevalence of osteoporosis in ALC patient(male, >50 years) was high (20.0% vs. 7.8%). The free testosterone level (1.93±1.80 pg/mL vs. 4.24±2.81 pg/mL; P=0.007) and trabecular bone score; an index of bone microarchitecture (1.08±0.13 vs. 1.25±0.15; P=0.001) were significantly lower in osteoporosis in ALC patients. The intact PTH (45.07±28.10 pg/mL vs. 29.50±17.53 pg/mL; P=0.014) and PT(INR) (1.44±0.37 vs. 1.26±0.20; P=0.018) were higher in patients with osteoporosis. Conclusions: Our data shows high prevalence of osteoporosis in alcoholic cirrhosis patients than healthy Koreans, as we expected. This finding highlights the need for prophylactic measures to optimize bone health in patient with alcoholic liver cirrhosis.
( Tae Hyung Kim ), ( Soon Ho Um ), ( Han Ah Lee ), ( Jung Mi Chang ), ( Dae Hoe Gu ), ( Jem Ma Ahn ), ( Yeon Seok Seo ), ( Hyung Joon Yim ), ( Yoon Tae Jeen ), ( Hong Sik Lee ), ( Hoon Jai Chun ), ( Chang Duck K) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: As hepatocellular carcinoma (HCC) progresses, it is accompanied by deterioration of liver function, which makes treatment difficult. In particular, advanced HCC involves not only impairment in liver function and general condition but also vascular invasion and other organ metastasis. It is very heterogeneous stage and needs to be further subdivided. In the present study, we investigated treatment outcomes and the factors associated with prognosis in HCC patients with distant metastasis. Methods: We analyzed data of 103 patients with advanced HCC with distant metastasis at initial diagnosis from June 2004 to June 2015. The patients received the first treatment for HCC in our hospital. Results: Mean age of patients was 57.3 ± 11.6 years and men were predominant (80.6%). The median observation period was 3.2 (0.3-39.1) months, and 99 (96.1%) of these patients died. There were no significant association with survival in sex, age, etiology and the number of liver tumors (p = 0.274, 0.094, 0.854 and 0.280, respectively). In univariate analysis, bilobar tumor distribution, invasion of main portal vein or IVC, Child-Pugh class, and treatment modality showed significant association with shorter survival. (p = 0.033, <0.001, 0.015, <0.001, and <0.001, respectively). In multivariate analysis, Child-Pugh class (p<0.001) and initial treatment modality (p=0.001) were significantly independent factors for survival. In Kaplan-Meier curve, systemic chemotherapy-alone or combination of locoregional treatment (LRT) and cytotoxic chemotherapy has no significant difference on survival compared with best supportive care as initial treatment. (median survival time, MST, 2.3 vs. 1.6 months) However, LRT alone (MST) or combination of sorafenib and LRT (MST 4.8, 4.3 months) showed significant survival benefit. (p = 0.001, 0.002). Conclusions: The Child-Pugh score and treatment modality in HCC patients with metastasis showed significant prognostic relevance. We also found that locoregional control for primary liver mass therapy is important in the treatment of sorafenib.
Background: Alcohol is traditionally known to have a relaxing effect. However, persons who consume alcohol in excessive amounts suffer from poor sleep quality and patients with alcohol use disorders commonly report insomnia. In this study, we aimed to evaluate the effects of alcohol use on sleep quality. Methods: A questionnaire-based cross-sectional survey was conducted with 234 men and 159 women who had visited a general hospital. We used structured questionnaires, including Alcohol Use Disorder Identification Test- Korean revised version (AUDIT-KR) and the Pittsburgh Sleep Quality Index-Korean version (PSQI-K). We analyzed the association between scores for all subcategories of the PSQI-K and the AUDIT-KR and then analyzed the correlation between AUDIT-KR and global PSQI-K scores. Results: The global PSQI-K score for men was positively correlated with the AUDIT-KR score (P=0.008) after adjusting for age, chronic disease, tobacco use, exercise, depression, and anxiety. The AUDIT-KR score was significantly associated with subjective sleep quality (P=0.005), sleep duration (P=0.047), and sleep disturbance (P=0.048); it was not associated with sleep latency, sleep efficiency, or daytime dysfunction. Sleep disturbances due to snoring were significantly associated with total AUDIT-KR score (P=0.008). There was no correlation between the global PSQI-K and AUDIT-KR scores for women (P=0.333). However, daytime dysfunction showed a significant association with total AUDIT-KR score (P=0.048). Conclusion: Men with higher AUDIT-KR scores tended to suffer from poor sleep quality. AUDIT-KR scores showed significant correlations with subjective sleep quality, sleep duration, and sleep disturbances in men.
showed cognitive improvement in normal population. To investigate the efficacy of ginseng in patients with Alzheimer'sdisease, patients, who met NINDS-ADRDA criteria for AD were studied Subjects were randomly asigned to ginsenggroup and control group, and ginseng group was treated with Korean white ginseng powder (4.5 g/day) for 12 weks. Effi-cacy variables included changes in mini-mental status exam (MMSE) and cognitive subscales of Alzheimer's diseasebetwen the two groups. Results showed that ginseng improved ADAS-cog compared to the control group at 12 weeks(p<0.05). MMSE was also increased by ginseng treatment compared to the control at 12 weeks (p<0.01). This study sug-gests the symptomatic efficacy of ginseng in patients with Alzheimer's disease.