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Thyroid nodules are a common clinical problem. Routine use of neck ultrasonography increase in the frequency of nodular thyroid disease, however, only a small percentage of the nodules currently being detected will prove to be malignant. The clinical importance of thyroid nodules rests with the need to exclude thyroid cancer, which occurs in 5∼10% of cases. Most thyroid nodules are cytologically benign and can be managed nonsurgically. Fine-needle aspiration cytology has a central role in identification of malignant nodules, which are generally treated with surgery. Benign nodules that are completely asymptomatic require follow-up without treatment. Cosmetic problems with or without compressive symptoms may be indications for surgery. When surgery is contraindicated or refused, several nonsurgical approaches are available. These include TSH suppressive therapy, radioactive iodine treatment, ethanol ablations, laser ablation, and radiofrequency ablation. TSH suppressive therapy is the most widely used, however, its clinical efficacy and safety are controversial. When surgery is not available, radioactive iodine therapy is the therapy of choice for treatment of toxic nodules or symptomatic nodular goiters. Ethanol ablation can be used as the first-line therapy for treatment of symptomatic cystic nodules. Radiofrequency ablation is another safe and effective treatment for benign nodules and may also have an effective complementary role in management of recurrent thyroid cancers. Laser photocoagulation should be reserved for selected patients undergoing treatment in experienced centers. Through higher understanding of thyroid and neck anatomy, surgeons should actively participate in various non-surgical managements.
Purpose: We evaluated the influence of time-related input,throughput, and output factors on ambulance diversions in an urban emergency department (ED). Methods: Data was prospectively collected in an urban ED for one year. We measured daily input factors (daily number of visit, etc), throughput factors (ED length of stay), and output factors (occupancy rate of adult ward, etc). The duty emergency physician had the authority to declare an ambulance diversion. There was no written protocol for ambulance diversion, and each diversion lasted 4 hours if not extended. We estimated the effect of the potential factors of the same day and the previous day on ambulance diversion with a multivariates logistic regression analysis excluding variables with collinearity Results: The total annual number of visits was 40,863. The number of patients delivered by ambulance was 4,059(9.9%). Ambulance diversion occurred 29 times during 365twenty-four hour observation intervals (7.9%). The multivariates logistic regression analyses revealed three significant independent factors of ambulance diversion: the ward occupancy rate of the previous day (odds ratio [OR], 1.278; 95%confidence interval [CI], 1.039-1.573), the elderly proportion for the day (OR, 1.106; 95% CI, 1.005-1.217), the total number of visits of the day (OR, 1.079; 95% CI, 1.039-1.120). Conclusion: Daily number of visits, proportion of elderly, and ward occupancy rate of the previous day were found to be factors related with ambulance diversion, with the hospital occupancy rate of the previous day showing the highest OR.
In order to study genetic engineering in trees, the characterization of genes and promoters from trees is necessary. We isolated the promoter region (867 bp) of Pagns-LTP from poplar (P. alba × P. glandulosa) and characterized its activity in transgenic poplar plants using a β-glucuronidase (GUS) reporter gene. High-level expression of the Pagns-LTP transcript was found in poplar roots, while comparatively low-level expression was found in the young leaves. Pagns-LTP mRNA was not detected in other poplar tissues. Additionally, transgenic poplar plants that contained a Pagns-LTP promoter fused to a GUS reporter gene, displayed tissue-specific GUS enzyme activity localized in root tissue. In silico analysis of the Pagns-LTP promoter sequence reveals the presence of several cis-regulatory elements responsive to phytohormones, biotic and abiotic stresses, as well as those regulating tissue-specific expression. These results demonstrate that the Pagns-LTP promoter has tissue-specific expression activity in poplar roots and leaves that may be involved in organ development and plant resistance to various stresses. Therefore, we anticipate that the Pagns-LTP promoter would be a useful tool to genetically optimize woody plants for functional genomics.