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In this study, changes in bioavailable concentrations of Pb, Zn, Cu and As in former smelter site soils (J1 and J2) were investigated before and after lime amendment. The immobilization efficiencies of metal(loid)s were evaluated by Toxicity Characteristic Leaching Procedure (TCLP). Their bioavailable concentrations in the soils were evaluated by the acid-extractable and -reducible fractions in Standard Measurement and Testing Program (i.e., SM&T(I+II)), in vitro physiologically based extraction test (PBET) and diffusive gradients in thin-films (DGT). The results showed that the bioavailable concentrations remarkably decreased after lime amendment in both J1 and J2 soils. DGT uptake and resupply (R) of Zn, Cu and As from soil to soil solution increased but that of Pb decreased. This pattern was consistent with SM&T(I+II)- and PBET-extractable concentrations after lime amendment. This indicates that lime amendment is highly effective for the immobilization of Zn, Cu and As, but not for Pb. Our results implicate that DGT can be used to estimate bioavailability of metal(loid)s in soils and further extended to estimate risk reduction after soil remediation.
Backgrounds/Aims: The challenging dilemma of Mirizzi syndrome for operating surgeons arises from the difficulty to diagnose it preoperatively, and approximately 50% of cases are diagnosed intraoperatively. In this study, we analysed the effectiveness of diagnostic modalities and treatment options in our series of Mirizzi syndrome. Methods: Patients had a preoperative or intraoperative diagnosis of Mirizzi syndrome, and were classified into three groups: Group 1: Incidental finding of Mirizzi syndrome intraoperatively (n=34). Group 2: Patients presented with jaundice, diagnosed by endoscopic retrograde cholangiopancreatography (n=17). Group 3: Patients diagnosed initially by ultrasound (n=13). Laparoscopic cholecystectomy was conducted in all 49 patients with Cendes type I disease. Partial cholecystectomy, common bile duct exploration, repair of fistula and t-tube placement was conducted on eight patients with Cendes type II and five patients with Cendes type III. Partial cholecystectomy with Roux-en-Y hepaticojejunostomy was conducted in two patients with Cendes type IV disease. Results: Sixty-four patients were diagnosed with Mirizzi syndrome. Morbidity rate was 3.1%. Mortality rate was 0%. Group 3 (patients diagnosed initially by ultrasound) had the best treatment outcome, the least morbidity, and the shortest hospital stay. Conclusions: Suspected cases of Mirizzi syndrome should not be underestimated. Difficulty in establishing preoperative diagnosis is the major dilemma. As it is mostly encountered intraoperatively, the approach should be careful and logical to identify the correct type of Mirizzi by a thorough diagnostic laparoscopy and thus, provide optimum treatment for the subtype to achieve the best outcome.
Bader, Andreas Matthaeus,Brodarac, Andreja,Klose, Kristin,Bieback, Karen,Choi, Yeong-Hoon,Kurtz, Andreas,Stamm, Christof Springer International 2014 European journal of cardio-thoracic surgery Vol.45 No.6
<P>Among the mechanisms by which somatic stem cells may improve left ventricular function in ischaemic heart disease are pro-survival stimuli mediated by secreted factors. This phenomenon is frequently referred to, but remains poorly understood. We therefore investigated the non-regenerative cardioprotective effects of cord blood mesenchymal stromal cells (CBMSCs) in vitro and sought to identify relevant intracellular signalling pathways.</P>
Bader Hamza Shirah,Hamza Asaad Shirah,Muhammad Adnan Saleem,Mohammad Azam Chughtai,Mohamed Ali Elraghi,Mohamed Elsayed Shams Korean Association of Hepato-Biliary-Pancreatic Su 2019 Annals of hepato-biliary-pancreatic surgery Vol.23 No.3
Backgrounds/Aims: Gallbladder gangrene is a grave complication of acute calculous cholecystitis that is difficult to detect preoperatively. Ultrasound could show a gallbladder wall that is more thickened. In addition, other clinical measures were reported to be possible predictive factors. Therefore, we aim in this study to evaluate the gallbladder wall thickness measured by ultrasound and other clinical measures as predictive factors for gangrene complication in acute calculous cholecystitis. Methods: A prospective cohort database analysis of the results of 674 patients diagnosed and treated for acute calculous cholecystitis between January 2010 and December 2014 was done. Patient’s inclusion criteria were acute calculous cholecystitis in adults who were operated within three days of onset of symptoms. Results: 117 (17.4%) patients had gangrene. Gallbladder sonographic wall thickness 5.1-6 mm, more than 6 mm, male gender, diabetes mellitus, leukocytosis ˃15,000 cells/ml, and age ≥40 years were found to be factors predisposing to gangrene complicated acute calculous cholecystitis that represented a statistically significant difference (p≤0.01). Conclusions: We conclude that gallbladder sonographic wall thickness 5.1-6 mm, more than 6 mm, male gender, diabetes mellitus, leukocytosis ˃15,000 cells/ml, and age ≥40 years were found to be factors predisposing to gangrene complicated acute calculous cholecystitis that represented a statistically significant difference. By implementing these risk factors, patients urgency for surgery can be decided in the emergency department. Other risk factors such as high alanine aminotransferase, elevated aspartate aminotransferase, and high alkaline phosphatase could be of help in the decision for early operation.
Purpose: A cutting seton is used after a partial distal fistulotomy to treat patients with a high exrasphincteric fistula in ano to avoid fecal incontinence and recurrence. In Saudi Arabia, religious practices necessitate complete cleanness, which makes conditions affecting anal continence a major concern to patients affected by an anal fistula. Therefore, we aimed to evaluate the efficiency of the cutting seton in treating a high anal fistula among Saudi Arabians. Methods: Between January 2005 and December 2014, a prospective study was done for 372 Saudi Arabian patients diagnosed as having a high anal fistula and treated with a cutting seton at Al-Ansar General Hospital, Medina, Saudi Arabia. 0-silk sutures were used. All patients underwent the same preoperative assessment, operative technique, and postoperative follow-up. Weekly, the seton was tightened in outpatient clinics. Results: Two hundred ninety-eight patients (80.1%) were males and 74 (19.9%) females. The duration of symptoms varied from 3–21 months. The fistula healed completely in 363 patients (97.6%); 58 patients (15.6%) reported some degree of incontinence to flatus, but none to feces. In 9 patients (2.4%) the fistula recurred. Conclusion: The utilization of the cutting seton method in the treatment of patients with a high anal fistula is highly efficient as it simultaneously drains the abscess, cuts the fistulous tract, and causes fibrosis along the tract. Treatment of a high anal fistula by using a staged fistulotomy with a cutting seton was very rewarding to Saudi Arabian patients who feared anal incontinence for religious reasons and was associated with low postoperative complication and recurrence rates.
Backgrounds/Aims: Postcholecystectomy syndrome represents a heterogeneous group of symptoms and findings in patients who have previously undergone cholecystectomy. It is rare and under-reported in Saudi Arabia. It can be attributed to many complications such as bile duct injury, biliary leak, retained common bile duct stones, recurrent bile duct stones, and bile duct strictures. In this study, we aimed to analyze the causes and evaluate the approach to postcholecystectomy syndrome in our local Saudi Arabian community because of the vast number of cases encountered in our hospital for gallbladder clinical conditions and its related complications. Methods: A prospective cohort database analysis of 272 patients who were diagnosed and treated for postcholecystectomy syndrome between January 2000 and December 2013 were reviewed. Results: The incidence rate of postcholecystectomy syndrome was 19.8%. The male to female ratio was 1:1.45. The mean age was 37.41±7.12 years. The most common causes were as follows: No obvious cause in 50 (18.4%) patients, Helicobacter pylori infection in 43 (15.8%), pancreatitis in 42 (15.4%), peptic ulcer disease in 41 (15.1%), recurrent common bile duct (CBD) stone in 26 (9.6%), retained CBD stone in 22 (8.1%), bile leakage in 19 (7%), stenosis of the sphincter of Oddi in 12 (4.4%), cystic duct stump syndrome in 11 (4%), and CBD Stricture in 5 (1.8%). The mortality rate was 0%. Conclusions: Any clinical presentation of postcholecystectomy should not be underestimated and be thoroughly investigated. Multidisciplinary collaboration is crucial for the best outcome and a safe approach for all the patients.
Customer experience has become an important concept in explaining consumer behaviour with hedonic products in the online game industry. However, few studies have examined the differences in game experience internationally between players from different nationalities. Game producers who market their wares to a global audience need to take into account that individuals from different national backgrounds have different experiences according to nationally specific cultural and societal norms and restrictions. These experiences determine how players perceive, interact and enjoy products. The current study attempts to examine differences in game experiences between India and the US. Around 600 respondents were collected from Amazon Mechanical Turk (Mturk), an online data panel. Analysis of results using a series of multivariate analysis of covariate, showed that players from India and the US are different in most aspects of game experience except for their analytical experience. Theoretical and practical implications of the study are discussed and recommendations are made with consideration to the ramifications of the investigation.
The large majority of elections in the post-Soviet area, by some accounts the most authoritarian region in the world, are marred by large-scale electoral malpractice. Since the late 1990s, the final reports from OSCE election observation missions include numerical data on the quality of election-day procedures as judged by election observers. With these data it is possible to study trends and patterns in the prevalence of electoral malpractice in the post-Soviet area. This study accordingly explores the relationship between electoral malpractice and three variables: the type of elections (presidential or parliamentary), the presence of electoral competition (present in competitive elections, absent in hegemonic elections), and the advance of time. The findings suggest that electoral malpractice does not significantly decrease over time, is as widespread in parliamentary as in presidential elections, but, in line with expectations, is more severe in hegemonic elections than in competitive elections. These findings contribute to insights about the nature of authoritarian elections and are important for considerations about the future of election observation in the region.
The necessity for greener and more efficient equipment has led OEMs and manufacturers to bring intelligence into fluid power systems. The integration of electronic controls in key components allow for better power management and safer work environment, which are two major concerns in the fluid power industry. One of the challenges of these new integrated solutions resides in the complexity of the design which involves many different expertise. Fluid Power, Electrical and Control Specialists need a communication platform to develop more efficient systems combining all technologies. Traditional control modeling methods are used to develop performant controllers with the help of equation-based or model-based software. However, more hybrid modeling methods – such as Machine Knowledge Management – are favored to design fluid power systems using integrated mechatronics software. By combining both methods to allow integration or co-simulation, control specialists will be properly integrated in the design and analysis process to build more intelligent machines.