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Background: Hepatocellular carcinoma (HCC) is the most common form of primary hepatic carcinoma and is a pressing sociomedical problem in Korea. Of the various solid cancers, HCC is perhaps the most diffcult to treat because of the frequently associated cirrhosis and advanced stage of tumor. In recent years, diagnostic procedures, surgical techniques and various therapeutic modalities other than surgery have been developed and improved. So, the prognosis of these patients may have changed from what it was in the past and it is necessary to establish the criteria for selection of therapeutic modality in indivisual patient with HCC. The purpose of this study was to elucidate the natural history of HCC and the survival rate of patients with HCC in relation to various therapeutic modalities in different stage of chronic liver disease. Method: A total of 1149 patients with HCC seen during the last 20 years were analyzed retropectively. The effects of treatment on survival were analyzed with regard to Child's grading and UICC stage of HCC. Results: In the 265 patients who received no specific treatment, the cumulative survival rates of 6 month and 1 year were 37.5%, 16.6% and the median survival time was 4 months. Survival rates of the surgically treated patients were better than that of other patients groups in comparable Child's grade and UICC stage, Especially, among patients with Child's A or B the actuarial survival rate for surgery was significantly better than that for transarterial chemoembolization. Transarterial chemoembolization gave a significantly better survival rate compared with systemic chemotherapy and no specific treatment in all child's grade and UICC stage. Systemic chemotherapy improved survival as compared with no specific treatment in Child's A or B patients and with UICC stage IV and Child's C with stage IV, patients. The major causes of death were hepatic failure and gastrointestinal bleeding irrespective of treatment modality. Conclusion: Adequate therapeutic modalities according to the severity of liver cirrhosis and tumor stage could improve the prognosis of HCC patients.
Intestinal lactase activity is very high at birth and declines to low levels after weaning. Because of the association of the decline with weaning, lack of lactose in the diet has been implicated. The purposes of t,his study were to determine the effect of the continued supplementa tion of the diet on the lactase specific activity and to evaluate the dietary control of the lactase mRNA expression in the rat intestine. Adult rats were fed a diet with 10% sucrose, lactose or glucose solution supplementation for 6 weeks and then lactase and sucrase specific activities were measured and lactase mRNA levels were determined by northern and slot blot hybridization. Although sucrase specific activity rose with sucrose, lactose or glucose solution supplementation, there was no increase of lactase specific activity. However, lactase mRNA levels increased after a diet with physiologic concentration of sucrose, lactose or glucose solution supplementation and t.hese changes in mRNA levels did not correlated with the corresponding lactase specific activity. In conclusion, diet plays no significant role in the regulation of lactase activity and lactase expression may be regulated at the post transcriptional level in the rat.
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This study aims to review the concept and indicators of the Quality of Life(QoL) in general, to introduce the measuring method of the Quality of Life of Vancouver, Canada and to analyze the city planning and development of Vancouver and Gwangju from the viewpoint of the Quality of Life. There are a lot of various definition of the Quality of Life according to the difference of the countries and their cultural background. Even though, the “Quality of Life could be defined as everything related to the alleviation and management of stress from living and working in a busy world city through the guaranteed life of the health and the gratification resulted from the realization of potential .According to the results of analyzing the important city planning and development of Vancouver and Gwangju, the contents and democratization of city planning may be very vital to the Quality of Life. The interrelationship between the general measuring domain of the Quality of Life and the city planning sectors should be researched in more detail in the future.
The development of new products is crucial for a business to maintain its competitive advantages, but the introduction of new products is risky. To avoid huge losses from launching unsuccessful products, marketers try to test the market potential of a new product in the early stages of the development process. It is not uncommon for a multi-store retail chain to test the potential profitability of a new product in a few selected stores before it introduces the product to the entire chain. Since test marketing would involve huge costs, marketers need to find a better way to select markets for accurate testing while keeping the number of test markets as low as possible. This study proposes a model to develop an optimal sampling network with which one can identify the optimal combination of markets for test marketing. Based on a simple demand model, an approach to find an optimal sampling network that would lead to an efficient estimate of the market size of a new product is developed. It is also demonstrated that the samples based on the proposed procedure produces a much more accurate estimate of the market size for a new product than randomly chosen samples do.
Objectives: The spectrum of clinical features of chronic liver disease has wide range from asymptomatic cases to hepatic failure. The natural course and longterm prognosis of chroni liver disease also varies greatly, and this diversity makes it difficult to predict the clinical course of indivisual patient. To evaluate the natural history, survival rates and prognostic factors of chronic liver disease in Korea, the authors analyzed prospectively the clinical courses of large number of chronic hepatitis and liver cirrhosis patients. Methods: 2691 patients who were registered at the Liver Research Institute, SNUH, from 1972 to 1989 were included in this study and followed up to 1992. The initial diagnosis was chronic hepatitis in 1455patients (including 465patients with biopsy proven chronic active hepatitis) and liver cirrhosis in 1236patients. The subjects who were related to alcohol and drugs were excluded. Clinical and laboratory data of each patient were obtained from medical record and from the database stored in the computer of Liver Research Institute. Deaths were identified from medical records and mortality referral to the national computer network. Result: Liver cirrhosis was developed in 9%, 23%, 36%, and 48% of chronic hepatitis patients in 50, 10, 15, and 20 years, respectively. The 5-, 10-, 15-and 20-year survival rate of chronic hepatitis patients was 97%, 90%, 79% and 77%, and the 5-, 10-and 15-year survival rate of liver cirrhosis patients was 689, 57% and 43%, respectively. The survival rates of liver cirrhosis patients after development of major complications, ie., ascites, UGI bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis were 32%, 40%, 21%, and 30% in 5years, 8% 22%, 23%, 8%, and 20% in 10years, respectively. Multivariate analysis showed that older age, HBsAg positivity, low albumin level and high bilirubin level were associated with unfavorable prognosis in chronic hepatitis and liver cirrhosis patients. Primary liver cancer was developed in 2.7%, 11%, 25%, and 35% of chronic hepatitis patients in 5, 10, 15, and 20years, and 13%, 27%, and 42% of liver cirrhosis patients in 5, 10, and 15years, respectively, Among longterm survivors, HBsAg was cleared in the serum of 26chronic hepatitis patients and 10cirrhosis patients after normalization of LFT. Among the patients followed up, the development of liver cirrhosis and/or primary liver cancer was not different between HBsAg-positive and anti-HCV positive groups. The development of liver cirrhosis and/or primary liver cancer, on the other hand, was significantly lower in both negative group. Conclusion: The results of this study explored the natural history and survival rates of chronic hepatitis and liver cirrhosis in Korea and reconfirmed the poor outcome of HBV associated chronic liver disease.
In this article, the Regional Development has been re-difined as $quot;an Innovation Diffusion Process into a certain region,$quot; and the relations between regional development and innovation, and between innovation and telephone network system have been analyzed. According to this analysis, the telephone network system can be recognized as an important media for the innovation diffusion in a region. In addition, the diffusion process of the telephone system in Chonnam Province has been studied and the concrete regional development effects of the telephone network system has been analyzed with the case study of Shinji-Myun, Wando-county and Haije-Myun Muan-county of Chonnam Province. There is very close, positive correlations between regional development and innovation diffusion. In general, the innovation in Chonnam Province has been diffused according to the urban hierarchy from Seoul over Kwangju and each county seat to $quot;Myun,$quot; but the necessary information for the residents has been mainly acquired from $quot;Mynn,$quot; Kwangju, Seoul and other regions in order. The ruling power of Seoul and Kwangju is much larger than it might be thought. Accordingly, the adequate urban hierarchy and their functioning have been recognized as a very important strategy for Chonnam development. Concludingly, in order to solve the regional problems, which Chonnam Province is now confronted with the residents' accessibility to the telephone service system and its usability should be actively improved from the viewpoint of the telephone tax, telephone fee and the regional differences of telephone fee and its facility establishment charge.
Gastric submucosal tumors are occasionally symptomatic (bleeding) but usually found incidentally at endoscopy. To evaluate comparisons of gastric endoscopy and upper gastrointestinal series in the submucosal tumor, we studied 50 patients which were diagnosed as submucosal tumor at SNUH from 1985 to 1988. The results were as follow: 1) Gastric submucosal tumors occupied 2.2% of the stomach cancer. (continue...)
Primary biliary cirrhosis is a rare disease in Asia. A few case have been reported in Japan and only one case has been reported in Korea so far. The authors have experienced a case of primary biliary cirrhosis with Sjogren's syndrome in 49 year-old female who has suffered from eyeball pain and dry mouth since 4 years ago, and generalized pruritus since 1 month ago. She was treated with D-penicillamine and ursodeoxycholic acid with biochemical improvement. We report the second case of primary biliary cirrhosis in Korea and it is the first case of primary biiiary cirrhosis with Sjogren's syndrome in this country.
The purpose of this study is to find out the bile reflux index score in patients with bile reflux during the gastroscopic examination and to compare the difference of the bile reflux index according to symptoms, gastroscopic findings and medication of cisapride which is known as a new prokinetic agent in a gastrointestinal tract. We studied in Seoul National University Hospital from October 1990 to February 1991. The bile reflux indecies calculated from bile reflux scan results in 18 patients, who showed bile reflux grossly on the gastroscopic examination, were analysed in terms of age, sex, histories of smoking and alcohol ingestion, nature and duration of symptoms and the effect of cisapride. 1) The mean bile reflux index was 0.137 (SD = 0. 082), and there showed no statistical difference by age, sex, duration of symptoms and histories of smoking or alcohol ingestion. 2) The gastroscopic findings showed normal (16.7%), erosive gastritis (16.7%), chronic superficial gastritis (61.1%) and benign gastric ulcer (5.6%), but there was no statistical difference of bile reflux index according to the presence of gross gastric mucosal lesion. 3) Symptoms complained by the patients were nausea (88.9%), epigastric fullness (72.2%), epigastric soreness (66.7%), abdominal pain (44.4%), belching (66.7%) and bile vomiting (33.3%), and only in cases with epigastric fullness showed stastically higher bile reflux idex score (t-test). 4) After administration of cisapride for ane week, the bile reflux index score was significantly decreased from 0.137 (SD=0.082) to 0.090 (SD=0.049) (paired t-test, p$lt;0.05).