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        대사성 산증을 동반한 알코올성 간질환 환자의 단기 예후

        배기선,유권,조유경,심기남,정성애,문일환 대한간학회 2004 Clinical and Molecular Hepatology(대한간학회지) Vol.10 No.2

        목적: 알코올성 간질환에서의 대사성 산증은 지속적인 과량의 알코올 섭취로 인한 당 신생 합성의 억제와 BOHB/AcAc 비율의 증가, 단기간의 금식으로 인한 저혈당, 인슐린 분비 저하, 유리 지방산과 케톤체 형성의 증가, 구토와 수분 섭취 부족에 의한 심한 탈수에 의해 발생하는 것으로 알려져 있다. 알코올성 케톤산증과 감별할 질환으로는 당뇨병성 케톤산증, 젖산증, 살리실레이트, 메탄올, 에틸렌글리콜 중독 등이 있다. 본 연구는 대사성 산증을 동반한 알코올성 간질환으로 내원하여 입원한 환자들을 대상으로 생존군과 사망군에서 임상적 양상 및 검사 소견들의 차이를 비교하여 단기 예후와 연관 있는 인자들을 알아보고자 하였다. 대상과 방법: 만성 알코올 남용자이면서 대사성 산증을 동반하여 입원한 알코올성 간질환 환자 29명을 생존군(18명)과 사망군(11명)으로 나누어 임상 소견과 검사실 소견을 비교하였다. 결과: 1) 대상 환자군은 연령은 36-65세였으며, 성별은 남자가 26명이었고 여자가 3명이었다. 2) 임상 증상은 의식저하, 복통, 구토, 호흡 곤란, 토혈, 흉통 등 다양하게 나타났으며, 신체검사 소견은 탈수, 황달, 빈혈, 간비대, 복수, 부종 등이었고 두 집단을 비교했을 때 사망군에서 복수가 유의하게 더 많은 빈도로 관찰되었다. 일일 평균 음주량은 사망군에서 유의하게 더 많았고(198 vs. 123, P=0.034) 음주 기간과 총 음주량은 두 군 간에 유의한 차이를 보이지 않았다. 4) 내원시 혈액검사 소견을 비교하였을 때 사망군에서 동맥혈 산염기 차이가 유의하게 낮았고 헤모글로빈, 혈소판도 유의하게 낮았다. 사망군에서 총 비리루빈, 크레아티닌, 무기인, 암모니아가 유의하게 높았고 알부민, 클로라이드가 유의하게 낮았다. 사망군에서 프로트롬빈 시간이 유의하게 연장되었으며 섬유소원은 유의하게 낮았고 D dimer는 유의하게 높았다. 결론: 대사성 산증을 동반한 알코올성 간질환 환자에서 일일 알코올 섭취량을 파악하고 복수의 유무, 동맥혈 산염기 차이, 헤모글로빈, 혈소판, 총 빌리루빈, 알부민, 크레아티닌, 무기인, 클로라이드, 암모니아, 프로트롬빈 시간, 섬유소원, D dimer 등을 검사하는 것이 단기 예후를 예측하는 데 도움이 될 것으로 사료된다. 향후 많은 환자들을 대상으로 하여 예후 관련 인자들에 대한 전향적이고 체계적인 연구가 요망된다. Background/Aims: Alcoholic liver disease with metabolic acidosis may have possible causes such as alcoholic ketoacidosis, diabetic ketoacidosis, lactic acidosis. Salicylate, methanol, and ethylene glycol intoxication should also be considered. The aim of this study was to investigate the short-term prognostic factors in patients with alcoholic liver disease with metabolic acidosis. Methods: Clinical data related to twenty-nine patients with alcoholic liver disease and metabolic acidosis was analysed retrospectively. Patients were divided into two groups according to the outcome (survival or death). Past medical history, and physical, laboratory and radiologic data at admission were compared. Results: The amount of daily alcohol intake differed significantly between the two groups (P=0.034), but duration and total amount of alcohol intake did not differ significantly between the two groups (P=0.128; P=0.360). The presence of ascites differed significantly between two the groups (P=0.019). On laboratory testing, the following differed significantly: base excess (P=0.038), hemoglobin (P=0.019), platelet (P=0.040), total bilirubin (P=0.007), albumin (P=0.012), creatinine (P=0.014), phosphorus (P=0.021), chloride (P=0.010), ammonia (P=0.003), prothrombin time (P=0.033), fibrinogen (P=0.011) and D-dimer (P=0.024). Review of the medical history of the patients showed diabetes (10/29), cirrhosis (10/29), and hepatocellular carcinoma (1/29). Combined conditions at admission were sepsis (8/29), pneumonia (7/29), acute renal failure (6/29), rhabdomyolysis (5/29), gastrointestinal hemorrhage (4/29), acute pancreatitis (3/29), acute respiratory distress syndrome (2/29), and acute myocardial infarction (1/29). Conclusions: The amount of daily alcohol intake, base excess, hemoglobin, platelet, total bilirubin, albumin, creatinine, phosphorus, chloride, ammonia, prothrombin time, fibrinogen and D-dimer seemed to be useful parameters in predicting short-term prognosis of patients with alcoholic liver disease with metabolic acidosis. Further study is needed to define the significance of these factors. (Korean J Hepatol 2004;10:117-124)

      • 당뇨병과 동반된 화농성 간농양의 임상상 및 예후인자

        오은숙,강무일,이원영,오기원,임동준,이소영,이정민,고승현,김성래,안유배,손현식,윤건호,차봉연,이광우,손호영,강성구 대한당뇨병학회 2000 임상당뇨병 Vol.1 No.1

        연구배경: 감염질환은 혈관질환과 함께 당뇨병의 중요한 사망원인의 하나이며, 혈당조절이 불량할수록 감염 빈도가 증가됨은 잘 알려져 있다. 간농양의 발생이 있어서도 당뇨병은 중요한 기저질환 중의 하나이다. 일반적으로 간농양의 가장 흔한 원인균은 Escherichi coli라고 알려져 있으나, 최근 당뇨병을 가진 간농양 환자에서 Klesiella pneumoniae의 검출이 증가되고 있다. 또 최근 연구에 의하면 K.pneumonie가 간농양의 가장 흔한 원인균이며, K. pneumoniae에 의한 간농양은 K.pneumoniae 이외의 균주에 의한 간농양보다 당뇨병과 밀접히 관련되어 있다고 보고된 바 있다. 이에 저자들은 간농양 환자를 대상으로 당뇨병환자의 빈도를 알아보고, 그 원인균 및 특징을 비당뇨병 환자들의 경우와 비교해 보고자 하였다. 방법: 1992년 1월부터 1999년 6월까지 방사선학적 검사 혹은 수술에 의해 간농양이 확인되거나, 경피적 천자나 수술을 통한 배농액 배양, 혹은 혈액 검사에서 원인균이 증명된 182명의 환자를 대상으로 후향적 임상고찰을 실시하였다. 결과: 화농성 농양을 가진 167명의 환자(남:94명, 여:73명)중 당뇨병을 가진 환자는 54명 (남:30명, 여:24명)으로 32.3%를 차지하였다. 환자의 평균나이는 당뇨군에서 62.1 ± 13.4세, 비당뇨군에서는 55.1 ±15.5세로 당뇨군에서 높았으며(p=0.0021), 남녀간의 평균나이 비교 시 두 군 모두 여성의 나이가 의미있게 높았다. 비당뇨군에 비하여 당뇨군의 경우 저알부민혈증의 빈도와 aspartate transaminase가 증가되어있었다. 원인균주는 K. pneumoniae (당뇨군54%, 비당뇨군 39.1%), E. coli(당뇨군 17.5%, 비당뇨군 18.8%), Pseudomonas aeruginosa, Streptococcus viridans, Enterococcus 순이었으며 두 군간의 의미는 차이는 없었으나 K. pneumoniae의 경우 다른 균종에 비해 단독감염의 빈도가 높았다(82.8%). 사망률은 당뇨군에서 16.7%, 비당뇨군에서 7.1%로 당뇨군에서 의미있게 높았으며(p=0.019), 당뇨군에서의 사망환자는 모두 패혈증이 동반되어 있었다. 당뇨환자의 사망군은 생존군에 비해 당뇨병 이환기간이 길고 혼합감염의 빈도가 높았다(p=0.046). 검사실 소견에서는 총 빌리루빈 및 알카리성 포스파타제의 증가가 관찰되어 있었다. 결론: E. coli가 간농양의 주된 원인균이라는 기존 보고와는 달리 당뇨군과 비당뇨군 모두 K. pneumoniae가 간농양의 주된 원인균이었다. 또한 당뇨 유병기간이 길고 당뇨조절이 불량한 환자에서 혼합감염이며 총 빌리루빈 및 알카리성 포스파타제의 증가등과 같은 위험인자가 존재할 경우 사망률이 증가될 수 있으므로 이들 군에서는 적극적인 치료가 필요할 것으로 사료된다. Background: Liver abscesses are commonly associated with underlying disease, particularly diabete mellitus. The number of the liver abscesses caused by Klebslella pneumoniae in diabetic patient has been increased in Korea nowadays. This study was conducted to clarify the clinical presentation and prognostic factors of pyogenic liver abscesses, especially in diabetic patients and to determine the proportion of K. pneunomiae as a pathogen in liver abscess in Korea. Methods: Medical records of 167 patients treated for pyogenic liver abscess from January, 1992 through June, 1999 were reviewed retrospectively in detail. Major Pathogenic organism, clinical manifestations, prognostic factors, the importance of diabetes mellilus as an underlying disease and its effect on clinical features and prognosis were analyzed. Results: Among 167 cases of pyogenic liver abscess, underlying diabetes mellitus was present in 32.3%. The mean age of patients was 62.7 13.4 years in diabetic liver abscess group and 55.1 15.5 years in non-diabetic liver abscess group. Most liver abscesses were cryptogenic in origin or secondary to the billary tree diseases. The clinical presentations among the two groups were not significantly different. When compared to patients without diabetes, patients with diabetes had significantly higher proportions of hypoalbuminemia and elevated aspartate transaminase level. The most common organism of the pyogenic abscess was K. pneumoniae in both groups. Percutaneous drainage of the abscess with appropriate antibiotics was the most commonly used therapeutic modality in liver abscess. The mortality rate of diabetic liver abscess is 16.1 % and 7.1% in nondiabetic liver abscess. Complications, especially septicemla, were found more frequently in patients with diabetes than in patients without diabetes (64.8% vs 28.3%, septicemia : 31.5% vs 9.7%). The factors influencing mortality in the diabetic liver abscess were disease duration, mixed infection, presence of septicemia, elevated bilirubin and alkaline phosphatase. Conclusions: In contrast to prior report that the E. coli was the most common pathogen in liver abscess, we found that K. pneumoniae was the most common organism cultured in liver abscess. Diabetic patients have more complications and higher mortality than patients without diabetes. Early detection and proper treatment are needed to improve the outcome for diabetic patient with liver abscess.

      • 간세포암환자에서 간동맥 화학 색전술 후 발생한 리피오돌에 의한 폐렴 1예

        김소이,김유리,허현미,배서은,이명원,최윤정,김고흔,김태헌,유 권,문일환 이화여자대학교 의과대학 2009 EMJ (Ewha medical journal) Vol.32 No.2

        Hepatocellular carcinoma(HCC)is one of common causes of cancer-related death in Korea where the majority of HCC patients were Hepaitc B virus(HBV)carriers and have cirrhosis. Transarterial chemoembolization(TACE)is commonly applied to the treatment of multinodular HCC in Korea and careful selection of candidate is important for the risk of various side effects. Besides common side effects as fever, nausea, abdominal pain and elevation of liver enzyme, TACE may predispose to hepatic failure, ischemic cholecystitis, pulmonary embolism, cerebral embolism and pneumonitis. In previous studies, some cases of pulmonary and cerebral embolism cases were reported but lipiodol pneumonitis after TACE was rarely reported. A 65-year-old woman with a multinodular HCC associated with HBV infection, was treated with TACE. Seven days after the procedure, nonspecific respiratory symptoms such as dyspnea and dry cough developed. Chest X-ray and chest computed tomography showed diffuse ground glass opacities in whole lung fields, suggestive of lipiodol pneumonitis. After several days of supportive care with steroid administration, radiologic abnormalities and subjective symptoms were much improved, considered that the disease was compatible with lipiodol pneumonitis.

      • Therapeutic effect of a novel histone deacetylase 6 inhibitor, CKD-L, on collagen-induced arthritis in vivo and regulatory T cells in rheumatoid arthritis in vitro

        Oh, Bo Ram,Suh, Dong-hyeon,Bae, Daekwon,Ha, Nina,Choi, Young Il,Yoo, Hyun Jung,Park, Jin Kyun,Lee, Eun Young,Lee, Eun Bong,Song, Yeong Wook BioMed Central 2017 Arthritis research & therapy Vol.19 No.-

        <P><B>Background</B></P><P>Histone deacetylase (HDAC) inhibitor has recently been reported to have a therapeutic effect as an anti-inflammatory agent in collagen-induced arthritis (CIA). We investigated the therapeutic effect of a new selective HDAC6 inhibitor, CKD-L, compared to ITF 2357 or Tubastatin A on CIA and regulatory T (Treg) cells in patients with rheumatoid arthritis (RA).</P><P><B>Methods</B></P><P>CIA was induced by bovine type II collagen (CII) in DBA/1 J mice. Mice were treated with HDAC inhibitor for 18 days. Arthritis score was assessed and histological analysis was performed by hematoxylin and eosin (H&E) stain. Cytotoxic T-lymphocyte associated protein (CTLA)-4 expression in induced Treg cells was analyzed and suppression assay was analyzed using Treg cells and effector T (Teff) cells isolated from naive C57BL/6 mice by flow cytometry. Cytokines were analyzed in peripheral blood mononuclear cells (PBMC) of five patients with RA by enzyme-linked immunosorbent assay (ELISA) and real-time polymerase chain reaction (PCR). Tumor necrosis factor (TNF) was analyzed using PMA- activated THP-1 cells by ELISA. Suppression assay was analyzed using Treg cells and Teff cells isolated from RA patients by flow cytometry.</P><P><B>Results</B></P><P>In the CIA model, CKD-L and Tubastatin A significantly decreased the arthritis score. CKD-L increased CTLA-4 expression in Foxp3<SUP>+</SUP> T cells and inhibited the proliferation of Teff cells in the suppression assay. In RA PBMC, CKD-L significantly inhibited TNF and interleukin (IL)-1β, and increased IL-10. CKD-L and Tubastatin A inhibited TNF secretion from PMA-activated THP-1 cells. CKD-L and ITF 2357 inhibited the proliferation of Teff cells in RA patients in the suppression assay. Tubastatin A had no effect on inhibition of proliferation.</P><P><B>Conclusion</B></P><P>CKD-L decreased the arthritis score in CIA, reduced the expression of TNF and IL-1β, and increased the expression of IL-10 in PBMC from RA patients. CKD-L increased CTLA-4 expression and the suppressive function of Treg cells. These results suggest that CKD-L may have a beneficial effect in the treatment of RA.</P>

      • 교내 커피전문점 소비에 대한 중요도·실행도 분석: - 충북대학교 사례를 중심으로 -

        배재원, 장동건, 유도일 忠北大學校 農業科學硏究所 2017 農業科學硏究 Vol.33 No.1

        This study investigates students’ use conditions in- and out-of- school coffee shops, and analyzes the importance and the performance for students’ consumption behaviors for those coffee shops. For this study, we apply Importance-Performance Analysis (IPA) by carrying out a survey targeting students at the Chungbuk National University. IPA results categorize various factors with respect to levels of the importance and the performance, respectively.

      • Nanostructures of diblock copolymer micelles for controlled fluorescence resonance energy transfer

        Yoo, Seong Il,Bae, Su Hak,Kim, Ki-Se,Sohn, Byeong-Hyeok Royal Society of Chemistry 2009 Soft matter Vol.5 No.16

        <P>Since fluorescence resonance energy transfer (FRET) between fluorophores strongly depends on the distance between and position of donors and acceptors at the nanometer scale, the accurate organization of multiple fluorophores in a specific arrangement plays a critical role in controlling their energy-transferring processes. Herein, we highlight our recent development on the utilization of nanostructures of diblock copolymer micelles for nanoscale arrangement of multiple fluorophores including quantum dots (QDs) to adjust FRET for tuning emissions from a single emitting layer.</P> <P>Graphic Abstract</P><P>In this Highlight, we summarize our recent development on the utilization of nanostructures of diblock copolymer micelles for the arrangement of multiple fluorophores including quantum dots (QDs) to adjust FRET for tuning emissions from a single emitting layer. <IMG SRC='http://pubs.rsc.org/services/images/RSCpubs.ePlatform.Service.FreeContent.ImageService.svc/ImageService/image/GA?id=b903956b'> </P>

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