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Object : The purpose of this study was to determine the prevalence of fungal infection and ulcer on the feet of diabetic patients and the existence of correlation between ulcer and fungal infection. Methods : A total 21,693 outpatients diagnosed as diabetes mellitus at the department of endocrinology of 32 hospitals were examined. The diabetic patients with foot problems were consulted to the department of dermatology. Physical examination and KOH preparation were performed. Results : 13,271 patients had certain kinds of foot problem, accounting for 61.2% of 21,693 diabetics examined. Of these, fungal foot disease were found in 10,403 that constituted 78.4% (48.0% of the entire diabetic population). Tinea pedis was the diagnosis in 6,496 (29.9%), onychomycosis in 7,783 (35.9%), and coexistence was in 3,883 (17.9%). Foot deformity was in 1,346 (6.2% of diabetics; 10.1% of foot disease), non-palpable pulse in 1,051 (4.8% ; 7.9%), and foot ulcer was in 425 (2.0% ; 3.2%), following in a descending order of frequency. Odds ratios for diabetic foot ulcer were 2.5 in patients with the foot deformity, 1.6 with fungal foot disease and 2.2 with non-palpable pulse. Conversely, Odds ratios for fungal foot disease were 2.5 with foot deformity, and 1.6 with foot ulcer. A total of 5,486 patients paid a visit to the department of dermatology. Of these, 4,519 patients were diagnosed with fungal infection through physical examination and KOH smear by dermatologists. The population comprised of 2,272 males and 2,247 females, showing similar prevalence between sexes. However, age did have positive correlation regarding prevalence of fungal foot disease. The number of diabetic patients with toenail problems was 3,847 patients (70%) and onychomycosis was proven mycologically in 3,276. Onychomycosis of distal subungal type was the most common clinical finding, most frequently involving the great toenails. Abnormal skin findings of the foot were seen in 3,885(70.8%) and tinea pedis was found in 3,209 (58.5%), most commonly involving the soles. Conclusion : This study showed that fungal infection might be regarded as a risk factor of foot ulcer. Treatment of fungal infection in diabetic patients might prevent diabetic foot disease such as ulcer and reduce the disability, morbidity and mortality in diabetic patients. (Korean J Dermatol 2003;41(7) : 908~915)
Background : The relative frequency and clinicopathologic characteristics of lymphomas vary according to geography and race. Data on the features of cutaneous lymphoma in Korea we limited. Objective : The aim of this study was to document the relative occurrence, the clinical and histopathological features of cutaneous lymphomas in Korea. Methods : The Korean Dermatopathology Research Group conducted a review of nationwide collection of 80 cutaneous lymphomas, diagnosed at 23 institutes over recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. Results and Conclusion : 1. Korea has a higher rate of T-cell lymphoma and NK/T cell lymphoma and a much lower rate of cutaneous B cell lymphoma. 2. The relative frequency of the major diagnostic group according to WHO classification was as follows mycosis fungoides/Sezary syndrome, 42.5%; anaplastic large cell lymphoma, 19%; nasal and nasal type NK/T cell lymphoma, 15%; subcutaneous panniculitis-like T cell lymphoma, 11%; peripheral T cell lymphoma, unspecified, 7.5%; follicular lymphoma, 3%; marginal zone Iymphorna, 1%; angioimmunoblastic lymphadenopathy, 1%. 3. Compared with Western countries, the rate of nasal and nasal-type NK/T cell lymphoma and subcutaneous panniculitis-like T cell lymphoma were much higher. Therefore, The EORTC classification is not effective in dealing with Korean cases of cutaneous lymphoma. We consider the principles of the WHO classification are applicable to the Korean cases of cutaneous lymphoma. (Korean J Dermatol 2003;41(1) : 48∼57)
목적 : H. influenzae는 성인에서 흔히 호흡기 감염을 일으키는 균주로, 최근 ampicillin 내성 β-lactamase 생성 균주들이 지속적인 증가를 보이고 있어, 이에 국내 성인에서 H. influenzae에 의한 감염의 임상양상과 분리된 균주들의 미생물학적 특성을 조사하고자 하였다. 방법 : 1998년 3월부터 1999년 9월까지 고려대 구로병원에 내원한 환자중에서 H. influenzae가 분리된 68명을 대상으로 임상양상을 조사하고 항균제 감수성 검사를 시행하였다. 분리된 33주에 대해서 혈청형, 생물형, 세포외막 단백분석을 시행하였고, β-lactamase 생성여부에 따른 감염 환자군간 임상상 및 예후의 차이를 비교하였다. 결과 : 환자의 평균연령은 68세였고, 지역사회 획득감염이 전체의 85%를 차지하였다. 폐렴과 기관지염과 같은 하기도 감염이 전체환자의 75%를 차지하였고 분리 검체 역시 객담이 84%로 가장 많았다. 환자의 71%가 기저질환을 가지고 있었으며, 그 중에 만성 폐쇄성 폐질환, 심혈관 질환, 악성종양, 당뇨병이 대부분이었다. 혈청형으로는 nontypeable 형이 68%로 가장 많았고 b형은 한 예도 없었다. β-lactamase 생성율은 63.2%였고, β-lactamase 양성균주의 항균제 내성율이 음성균주에 비하여 높았으나 β-lactamase 생성 여부에 관계없이 cefotaxime, azithromycin, ciprofloxacin에 대하여 100%의 감수성을 나타내었고 cefaclor, cefuroxime에 대해서는 10% 이하의 낮은 내성율을 보여 이들 항균제들이 치료에 효과적일 것으로 사료된다. 세포외막 단백분석에서는 C형과 D형이 전체의 64%로 가장 많았으며, 혈청형과의 유의한 연관성은 보이지 않았다. 결론 : 성인에서 H. influenzae는 주로 만성 기저질환자에서 급성 호흡기감염 또는 만성 폐쇄성 폐질환의 급성 악화를 유발한다. 기존의 보고에 비해 β-lactamase 양성율이 증가하였고, 이에 따른 항균제 내성율도 증가하여 항균제의 선택에 유의하여야 할 것으로 생각된다. 세포외막 단백분석상 특정한 유형의 균주에 의해 감염이 집중적으로 발생하고 있어 향후 역학 조사의 도구로 이용할 수 있겠다. Purpose : H. influenzae is one of the common causative microorganisms of respiratory tract infections in adults. Recently. β-lactamase producing, ampicillin-resistant H. infiuenzae has become worldwide problem as well as in Korea. We studied to investigate the clinical features and microbiologic characteristics of H. infiuenzae infections in adults. Materials & Methods : From March 1998 to September 1999, 68 patients were enrolled in this study. Clinical features of H. infiuenzae infections were investigated, 68 isolates were subjected to the β-lactamase test, and 33 isolates were used for serotyping. biotyping, antibiotic susceptibility and outer membrane protein (OMP) analysis. Results : Mean age of study patients was 68 years-old and the acquisition rate in community was 85%. Pneumonia and bronchitis were the most common type of infection such as 80%, sputum was the most common clinical specimen for H. mQuenzae isolation. 70% of patients had chronic underlying diseases. Non-typeable strains were 68% and β-lactamase producing rate was 63%. There was no difference in the clinical features and prognosis of H. influenzae infection between the β-lactamase positivie and -negative groups. The susceptibility of cefotaxime, azithromycin, and ciprofloxacin was 100% and that of cefaclor, cefuroxime was under 10% in spite of β-lactamase positivity. In OMP analysis, C and D types were dominant (64%). Conclusion : H. influenzae caused acute respiratory infections in adults with chronic underlying disorders. This study shows higher β-lactamase producing rate and antibiotic-resistance rate than that were reported previously. OMP analysis shows that two major types of strains cause clinical infections intensively.
Lee, Jong-Hee. 1998. The Defects of Schema Theory: Pedagogic Priorities for EFI,/ESL Reading. Linguistics, 6-1, 371-388. Schema theory has been viewed as a notable foundation for current EFL/ESL reading strategies. The main purpose of this paper is, however, to subject the schema-theoretical approach to critical examination from the viewpoints of its intrinsic and extrinsic defeats. The former is connected with the question of verifiability to be approved as a well-documented theory; and the latter is involved in the problem of generality to be recognized as a well-integrated approach to L1/L2 reading pedagogy. So in the light of such theoretical investigations, and more significantly, based on my standpoint that the prime requirement for both intensive and complete reading is the reader's macrolinguistic cognition capacity, I have established the framework of component skill-oriented priorities designed for successful EFL/ESL reading instruction. This methodology is anticipated to guide the reader to realize the essential deficiencies of schema theory and, eventually, to shed light on a possible way of constructing a more reliable approach to reading in a foreign/second language than such a controversial theory. (Kongju National University)
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연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.
Background : Malignant melanoma in Korea has been increasing as in other countries, but there is no nationwide survey of malignant melanoma in Korea. Objective : The aim of this study was to document the clinical and histopathological features of cutaneous melanoma in Korea. Methods : The Dermatopathology Research Group conducted a review of nationwide collection of109 primary cutaneous melanomas, diagnosed at 23 institutes over a recent 3-year period. Clinical records and pathology slides of the patients were reviewed retrospectively. Results and Conclusion : 1. The peak age was the 7th decade with the mean age of 58.1 years. Korea has a higher rate of acral melanoma and much lower rate of lentigo maligna melanoma. 2. Major component tumor cell was spindle cell type. 3. Clark level of tumor was Ⅲ or more and Breslow depth was 2 ㎜ or more at the time of the first diagnosis in many cases (62%). 4. Pre-existing melanocytic nevus was present in a few cases (3 cases). 5. All these features suggest that the racial difference between the Korean and the Caucasian is evident. We also suggest that an early detection program is very important to cure this malignant tumor. (Korean J Dermatol 2003;41(1) 43∼47)
그 동안 한국 교회는 교회 성장에 최우선적인 목표를 두어 왔기에, 교회학교의 중요성을 인식하면서도 교육방법이나 교육환경에 전문적인 노력과 투자를 하지 못했다. 따라서 교육시설의 절대적 부족과 부적절한 교육환경 속에서 기독교 교육은 정체될 수 밖에 없었다. 최근 교회 성장의 정체 현상과 함께 교회학교의 여러 가지 문제점을 인식한 교회들이 교회학교 시설에 관심을 두기 시작하였고 점차 예배 공간보다는 교회학교의 교육 공간에 더 중점을 두는 교회들이 많아지게 되었다. 이에 본 논문은 교회학교의 각 부서 중 유치부실을 중심으로 교육 환경의 실태를 조사, 분석하여 문제점과 지향점을 제시함으로써 향후 효과적인 교회 교육 공간의 실내 환경을 개선하는데 도움을 주고자 한다. 기존 교회 유치부실 교육 공간의 사례 및 설문조사 도구로 머사 앤 리(Murtha & Lee)의 사용자 이득기준(Dimensions of User Benefit)을 사용하였으며 결과는 다음과 같다. 첫째, 예배 및 교육 공간, 관리 공간, 서비스 공간은 유치부실 계획 시 반드시 확보되어야 하는 공간이다. 둘째, 아동 수 대비 필요 공간에 대한 면적 확보가 적극적으로 지원되어야 한다. 셋째, 동적인 활동이 가장 활발한 성장기 아동들을 위해 안전성을 배려한 환경이 조성되어야 한다. 넷째, 교사와 아동의 시각적 접근이 용이한 시각적 환경과 공간간의 소음을 단절시킬 수는 청각적 환경의 배려가 필요하다. 다섯째, 내구성과 안전성 및 환경친화를 고려한 마감재의 사용과 교육환경에 적합한 조도의 유지 및 채광을 위한 외부창이 설치되어야 한다. Giving priority to expansion, Korean churches have failed to make professional efforts and investment in educational methods or environment, though they are aware of its importance. As a result, Christian education could not help but be stagnant under lack of appropriate facilities and unsuitable educational environment. Recent stagnant growth of churches make more and more churches look at problems with christian schools and their underdeveloped facilities and thus start to see the schools not so much places for worship as educational institutions. This paper intends to identify and analyze the educational environment of kindergartens run by christian churches among other institutions and present problems and possible remedies, ultimately contributing to future organization of effective church education system. As a tool for case collection and survey about the education spaces for church kindergartens, Murtha & Lee`s Dimensions of User Benefit was used. The results are as follows. First, the spaces required for a kindergarten include those for worship, education and service, all of which are indispensable from the planning stage. Second, necessary support must be given to securing minimum space per kid. Third, finishing materials must be environmentally friendly ones for safety, robustness and maintenance easiness for the active and growing-fast kids. Dedicated rooms including those for faculty, parents and feeding as well as spaces for kids` playing must be secured.
사용하지 않은 새 금속 압력용기에 대하여, 사용 전 음향방출시험을 수행할 때 장비점검, 탐촉자 간 거리, 탐촉자 위치, 전 측정 시스템 점검, 가압방법, 잡음 제거법 및 시험 결과의 평가 등에 대한 절차를 수립하고 현장 응용시험이 수행되었다. 일반적으로 음향방출 시험은 많은 잡음을 포함하는데 시험동안 관찰결과를 기록하여 평가 시 시간 필터링함으로서 잡음을 제거할 수 있었다. The field application of acoustic emission(AE) testing for brand-new metal pressure vessel were performed. We will introduce the test procedure for acoustic emission test such as instrument check, distance between sensors, sensor location, whole system calibration, pressurization sequence, noise reduction and evaluation. The data of acoustic emission test contain many noise signal, these noise can be reduced by time filtering which based on the description of observation during AE test.
( Hee Yeon Kim ),( Jong Young Choi ),( Dong Goo Kim ),( Myoung Soo Kim ),( Soon Il Kim ),( Shin Hwang ),( Sung Gyu Lee ),( Kwang Woong Lee ),( Kyung Suk Suh ),( Young Seok Han ),( Dong Lak Choi ),( Se 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-
Background: The outcome of hepatitis B virus (HBV) infection after liver transplantation (LT) was improved by hepatitis B immunoglobulin (HBIG) and nucles(t)ide analogue (NUA). However, HBV recurrence after LT is critical because the recurrence is occasionally accompanied by a progressive destruction of graft and poor survival. The aims of this study were to investigate the significance HBV recurrence and identity factors associated with HBV recurrence. Methods: From October 1999 to February 2011, a total of 2684 consecutive LT recipients who underwent HBV-associated LT were retrospectively enrolled from 7 transplantation centers in Korea. Results: Prophylaxis regimens were HBIG monotherapy (67.7%) or a combination of HBIG with NUA (22.3%). The recurrence rate of HBV was 6.1% (164 recipients) during mean follow-up duration of 10.9 years. The median time from transplantation to recurrence was 2.1 years (0.1-7.9 years). Of the 1,071 patients with hepatocellular carcinoma (HCC) prior to LT, 155 patients (14.5%) had HCC recurrence after transplantation, and 48 patients (31.0%) had HBV recurrence. Of the 48 patients with recurrence of both HBV and HCC, 25 patients (52.1%) experienced HBV recurrence after HCC recurrence. In the multivariate analysis, pretransplant HCC, pretransplant HBV DNA above 5.5 log copies/mL was independent clinical factors influencing HBV recurrence after LT. The mortality rate among the recipients with HBV recurrence was 34.1% (56 recipients). Mean overall survival was 6.4 years in the HBV-recurrence group and 9.9 years in the HBV-nonrecurrence group (p<0.001). HBV recurrence was not an independent prognostic factor for overall survival. HCC recurrence was the most important factor for overall survival. Conclusions: The overall outcome of LT in HBV-related liver disease was excellent with the current prophylaxis regimen Choon Hyuck David Kwon,8 Suk-Koo Lee8 Pretransplant HBV DNA and HCC were important factors for HBV recurrence. HBV recurrence after LT did not significantly influence on the overall survival without combining of HCC recurrence.
The cytotoxic T lymphocyte (CTL) are an important component in host defense mechanism against viral infection. They can recongnize virus-derived peptides presented by the Class I MHC molecule at the cell surface of the infected cells. On searching for effective CTL epitopes of hepatitis B virus(HBV), we synthesized a distinct set of 9-10 mer peptide containing amino acid sequence of hepatitis B virus surface protein that are selected on the basis of a computer modeling and the previously described HLA-A2 specific motifs.Binding assay of the synthetic peptides to HLA-A2 molecules using human antigen processing defectant T2 cells showed that 3 out of 4 synthetic peptides enhanced the expression of HLA-A2 molecule on T2 cell surface.Two anchor positions, namely P2 and P9(or P10) appeared to play a decisive role for binding.Structural. characteristics of the peptides addressed by molecular dynamics simulation was analysed and compared.These peptides also partially triggered CTL isolated from human peripheral blood mononuclear cells of HBV positive patients, and the response was peptide-spcific.These results showed that negatively-charged amino acid residue at P2 hampered binding affinity of the peptides to HLA-A2 molecules, and that binding affinity of the peptides are not always reflected by their immunogenicity among natural T cell repertoire.