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Acrylonitrile is most commonly used aliphatic nitrile compounds characterized by the structural formula R-C=N and used mostly to make acrylic fibers, plastics, synthetic rubber, and wall coverings In recent, because of its extensive usage and the rapid expansion of the chemical industry, many poisonings have been reported and many studies on its health effects have been performed Acute toxicity resembles cyanide poisoning and results mainly in effects on the nervous system High exposure also can cause temporary damage to red blood cells and the liver and can cause lead to death Because long-term occupational exposure to the acrylonitrile has been with cancer in humans, the U.S EPA dassifies acrylonitrile as probable carcinogen For this reason, The federal govemment has developed regulations and advisories to protect individuals from the potential health effects of aaylonitrile in the enviroment, but there are few studies, case reports and regulations of the govemment in our country We experienced acute poisoning caused by acrylonitrile inhalation that occurred in an industrial accident. So, we report this case with literature reveiw
추진기에서 캐비테이션이 발생되면 효율이 저하되고 진동과 소음이 발생한다. 소음은 캐비테이션이 처음으로 발생되는 시점부터 크게 증가되므로 캐비테이션 초생속도(CIS)를 가능한 높이는 것이 중요하다. 본 논문에서는 가변추진기의 캐비테이션 초기발생 현상을 확인하기 위하여 처음으로 캐비테이션 실선관측을 수행하였다. 관측 결과 가변추진에서 캐비테이션 초기발생은 볼트 캐비테이션으로 확인되어 볼트부위를 개선한 새로운 형상의 가변추진기를 제안하였다. 개선된 가변추진기에서는 볼트 캐비테이션이 전혀 발생되지 않았으며, CIS는 개선 전 가변추진기 보다 약 4.5 노트 향상된 것을 확인하였다. 본 연구 결과는 향후 저소음 가변추진기 개발과 CIS 성능 향상에 매우 유용한 자료로 활용될 것이다. If cavitation occurs in propeller, it generates vibration and noise accordingly which results in low efficiency of propeller. It"s important to increase cavitation inception speed(CIS) since the noise of cavitation increases significantly from the beginning of cavitation. This paper describes the result of actual observation and measurement onboard ship with controllable pitch propeller(CPP), so as to verify the first occurrence phenomenon of cavitation. The research suggests new type of controllable pitch propeller with improved CIS at the bolt as it started with bolt cavitation as result of observation. It"s not found bolt cavitation on the CPP proposed in this paper, furthermore its CIS is increased approximately by 4.5 knots than the existing CPP. The result of the research can be used for development of low-noise CPP and improving performance of CIS.
Purpose: A traumatic lung cyst (TLC) is a rare complication and is usually detected with a pulmonary contusion. This study attempted to identify the prognostic factors and the clinical characteristics for pulmonary contusion with TLCs. Methods: We retrospectively reviewed the medical records and chest CT findings of 71 TLC patients who visited our hospital from January 2006 to December 2007. Patients were assessed for any clinical characteristics. We evaluated significant differences between the survival and the death groups for patients with a traumatic lung cyst. Results: The male-to-female ratio of patients with TLCs was 54:17, and the mean age of the patients was 37.70±19.78 years with 36.6% of the patients being under 30 years forage. The cause of blunt thoracic trauma was mainly pedestrian traffic accidents (26.8%) and falls (25.4%). Associated conditions included pulmonary contusion in 68 patients (95.7%), hemopneumothorax in 63 patients (88.7%), and rib fracture in 52 patitents (73.2%). There was no consistent relationship between the number of TLCs and the pulmonary contusion score. The overall mortality rate of TLC patients was 26.8%. Death correlated with a need for ventilatory assistance, mean arterial pressure, worst mean arterial pressure in 24 hours, initial pH and base excess, worst pH and base excess in 24 hours, refractory shock, initial GCS score, and pulmonary contusion score. Conclusion: The presence of the aforementioned predictors indicate serious injury, which is the main determinant of the outcome for thoracic injuries with TLCs. (J Korean Soc Traumatol 2008;21:100-107)
김용인 ( Yong In Kim ), 노기철 ( Ki Cheul Noh ), 강영준 ( Young Joon Kang ), 임용수 ( Yong Su Lim ), 양혁준 ( Hyuk Jun Yang ), 이근 ( Gun Lee ), 진욱 ( Wook Jin ), 황성연 ( Seong Youn Hwang ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2
Background: Simple cervical X-rays often miss cervical spine injuries. Magnetic resonance imaging is valuable in these cases. The aims of this study is to determine high-risk factors of the cervical injuries, and to contribute to make indications of cervical MRI in evaluation of blunt trauma patients. Methods: We retrospectively reviewed the patients who visited our ED due to nuchal pain and examed by simple cervical X-ray and cervical MRI after blunt trauma. We analyzed the incidence of abnormal MRI findings in various patients groups. We also compared the incidence of missed cervical spine injury by level of injured spine. We thought cervical MRI to be goldstandard of this analysis. Results: The incidence of abnormality on cervical MRI is higher in male patients than female patients (p<0.01). Old (age≥40) patients frequently shows abnormal cervical MRI findings than young patients (p<0.001). In patients who had neurologic abnormality, the incidence of abnormality on cervical MRI is higher than neurologically normal patients (p<0.001). But, mechanisms of injuries and associated injuries are not related to the incidence of abnormality on cervical MRI. Injuries of lower cervical spine (C7) are frequently missed than those of other cervical spines (p<0.01). Conclusion: When evaluate cervical injuries in male, old, and neurologically abnormal patients, we must consider cervical MRI although the simple cervical X-ray is normal. We must pay more attention to lower cervical spine injuries than other cervical spine injuries.
장지용 ( Jee Yong Jang ), 임용수 ( Yong Su Lim ), 양혁준 ( Hyuk Jun Yang ), 박원빈 ( Won Bin Park ), 현성열 ( Sung Youl Hyun ), 조진성 ( Jin Sung Cho ), 김진주 ( Jin Joo Kim ), 이미진 ( Mi Jin Lee ) 대한응급의학회 2011 大韓應急醫學會誌 Vol.22 No.2
Purpose: In patients resuscitated from out-of-hospital cardiac arrest (OHCA), the influences of serial serum glucose and variability on neurological outcome are not well understood. We investigated the influence of serum glucose and variability on neurological outcome in OHCA survivors. Methods: Records of 105 OHCA survivors who received therapeutic hypothermia (TH) between April, 2007 and January, 2010 were retrospectively reviewed. By neurological prognosis at 6 months after restoration of spontaneous circulation, patients were divided to two groups based on cerebral performance category (CPC) score; 1-2 (good) and 3-5 (poor). The serial measured glucose level and glucose variability during 72 hours were compared between the groups. Results: The poor CPC group had statistically higher mean, median and maximum glucose level, but not minimal glucose, compared to the good CPC group. The poor CPC group also comparatively displayed higher standard deviation and time-glucose variability index (TGVI) of glucose level during 72 hours. Multiple logistic regression demonstrated that increased TGVI was significantly associated with poor neurological outcome (odds ratio 1.304, 95% confidence interval 1.078-1.578) Conclusion: Serial glucose level and variability are strongly related with neurological outcome in post-resuscitated patients who received TH after OHCA. Further randomized controlled studies are needed.
Snake bite during pregnancy is rare condition, and when it occurs there are two patients, mother and fetus. Timing is particularly important for pregnant women bitten by a snake. The earlier in the pregnancy the bite occurs, the more hazard to the fetus there is, and there are case reports of snake-bite-induced abortion and malformation of the fetus. The usefulness of antivenin during pregnancy is debatable. We report a case of snake bite during third-trimester pregnancy in a patient with general symptoms of envenomation and progressing edema in the bitten leg who was successfully treated with an emergency Caesarian section following the administration of antivenin.
우재혁 ( Jae Hyug Woo ), 임용수 ( Yong Su Lim ), 김재광 ( Jae Kwang Kim ), 김진주 ( Jin Joo Kim ), 현성열 ( Sung Youl Hyun ), 양혁준 ( Hyuk Jun Yang ), 이근 ( Gun Lee ), 이미진 ( Mi Jin Lee ) 대한응급의학회 2009 大韓應急醫學會誌 Vol.20 No.6
Purpose: This study evaluated the efficacy and positive influences of a critical event monitoring system (CEMS), which is an automatic alerting system for patients with critical laboratory results. Methods: We compared various patient data variables with hyperkalemia during the 1 year before and after CEMS, which was initiated in July 2007 (Before group: July 2006~June 2007, After group: July 2007~June 2008). Results: A total of 2,417 patients had severe hyperkalemia (K+≥6.5 mmol/L) during the period. Of the 2,417, 1680 were excluded, Leaving 389 patients to be enrolled in the `before group` and 348 in the `after group`. Baseline characteristics were similar between the two groups. Although the load of work for the medical staff increased during the period when CEMS was begun, the time interval from critical laboratory results to appropriate treatment decreased (72.68±94.03 vs. 70.07±92.28 minutes) as did the length of hospital stays (20.27±27.01 vs. 17.03±26.89 days). These decreases were not statistically significant. Decreases in time interval and hospital stay were more prominent for patients treated in the ICU and by emergency physicians during the day time. Mortality within 48 hours (19.5 vs. 19.5%) did not change after beginning CEMS. Mortality in the ICU (2.04 vs. 1.94%, p=0.046) decreased after beginning CEMS. Conclusion: Information technology strategies such as using CEMS may be an effective tool for improving the quality of medical care. But we must also consider other factors such as work load of the medical staff which also influence the quality of medical care.
정건영 ( Geon Yeong Jeong ), 임용수 ( Yong Su Lim ), 김진주 ( Jin Joo Kim ), 김재광 ( Jae Kwang Kim ), 김정권 ( Chung Kwon Kim ), 양혁준 ( Hyuk Jun Yang ), 이형석 ( Hyung Seok Lee ), 이미진 ( Mi Jin Lee ) 대한응급의학회 2009 大韓應急醫學會誌 Vol.20 No.1
Purpose: We wanted to investigate the serial changes of the serum interleukin-6 (IL-6) and interleukin-10 (IL-10) concentrations, according to the neurological outcome, in patients who received therapeutic hypothermia after successful cardiopulmonary resuscitation. We also wanted to evaluate the usefulness of serum IL-6 and IL-10 as biochemical markers to predict the neurological outcome. Methods: We prospectively evaluated 23 patients who received therapeutic hypothermia after successful cardiopulmonary resuscitation. Blood samples were taken at 0, 4, 12, 24 and 48 hours after the return of spontaneous circulation. We compared the IL-6 and IL-10 levels between the good (CPC 1 to 2) and poor (CPC 3 to 5) neurological outcome (NO) groups. Results: The serum IL-6 level at 0 hr was significantly higher in the good NO group than that in the poor NO group. The periods of time that showed the greatest pattern of change between the good and poor NO groups were 4-12 hr for the IL-6 level and 0-4 hr for the IL-10 level. On the analysis of the ROC curve, the cut-off value for delta IL-10 (0-4 hr) was -5.4 pg/ml (AUC=0.827, sensitivity 80.0%, specificity 93.3%, p=0.032) and the cut-off value for delta IL-6 (4-12 hr) was 62.8 ng/ml (AUC=0.527, sensitivity 80.0%, specificity 34.0%, p=0.861, respectively). Conclusion: Our study suggests that the early delta IL-10 can be used as a neurological prognostic marker for patients who are undergoing therapeutic hypothermia after successful cardiopulmonary resuscitation.