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목 적 : 저자들은 양전하를 띤 N, N-diethyl-aminoethyl group이 부착되어 있는 Hemophan 투석기에 음전하를 떤 헤파린을 결합시키는 Gretz 등의 방법을 수정하여 출혈 위험성이 있는 말기신부전 환자에서 헤파린 결합 Hemophan을 이용한 혈액투석법 (hemodialysis using heparin bound Hemophan, HBH-HD)을 보고한 바 있다. 저자들은 지난 7년 동안 출혈 위험성이 있는 말기신부전증 환자들에서 HBH-HD를 시행하였으며 이에 그간의 결과를 종합하여 HBH-HD의 안전성과 효율성을 보고하고자 한다. 방 법 : 저자들은 1995년 4월부터 2002년 4월까지 출혈 위험성이 있는 만성혈액투석환자 159명에서, 헤파린을 결합시킨 Hemophan 투석기 (GFS plus 11, Gambro)를 사용하여 총 1,057회의 HBH-HD를 시행하였다. 투석기나 혈액관 교체가 필요할 정도의 심한 혈액응고 없이 4시간 동안 혈액투석이 가능하였던 40회 투석에서 혈액투석 전, 투석 시작 후 15분, 60분, 120분과 투석 종료 직전 (240분)에 혈중 헤파린 농도와 activated partial thromboplastin time (aPTT)을 측정하였다. 투석의 효율성을 평가하기 위하여 동일 환자에서 시행한 HBH-HD와 이후 헤파린을 전신적으로 사용한 혈액투석 (routine hemodialysis, R-HD) 간의 혈액구획용적(total blood compartment volume, TBCV) 손실과 투석기요소청소율 (K), Kt/V를 비교하였다 (n=20). 결 과 : 1,057회 투석 중 11회 (1.0%)에서는 투석 후 150분 이내에 투석기와 혈액관에 혈액 응고가 발생하어 투석을 증단하였고, 64회 (6.1%)에서는 투석 후 150분부터 230분 사이에 혈액관에 혈액응고가 발생하여 혈액관 교체가 필요하였다. 투석기나 혈액관의 교체가 필요할 정도의 심한 혈액응고 없이 4시간 동안 혈액투석이 가능하였던 982회 증 40회의 투석에서 측정된 헤파린 농도는 투석전 값 (0.11±0.06 U/mL, 평균±표준편차)에 비하여 투석 후 15분 (0.14±0.06 U/mL)에 경미한 증가를 보인 후 (p<0.05), 60분에 0.11±0.05 U/mL, 120분에 0.08±0.04 U/mL, 투석 종료 후 0.08±0.04 U/mL로 감소하였다. 투석 중 aPTT는 투석 전 (44.3±12.9초)에 비하여 투석 후 15분 (49.8±10.5초)에 증가한 후 (p<0.05), 60분에 40.8十7.1초, 120분에 36.1±5.5초, 투석 종료 후 32.1±5.3초로 감소하였다. 두 투석간의 TBCV 손실은 HBH-HD시 17.2±9.6%, R-HD시 2.8±1.2%로 유의한 차이를 보였다 (p<0.0001). 그러나, HBH-HD시 측정한 K값은 136.9±14.6 mL/min, Kt/V는 1.27±0.21로 R-HD의 137.6±18.4 mL/min와 1.20±0.22와 각각 비교하여 볼 때 유의한 차이가 없었다 (p>0.05). 결 론 : 헤파린을 결합시킨 투석막을 사용한 혈액투석법은 출혈 위험성이 있는 말기신부전증 환자들에서 시행할 수 있는 안전하고 효과적인 투석법이다. 그러나 체외 회로에 심한 혈액응고를 완전히 방지하지는 못하므로 투석 중 투석기와 혈액관에서 혈액응고 발생 여부를 감시해야 한다. Objective : Positively charged N,N-diethyl-aminoehtyl groups on Hemophan enable negative charged heparin to be bound with the dialyzer membrane and hemodialysis using heparin bound Hemophan (HBH-HD) could be a hemodialysis modality in patients at risk of bleeding. We designed simplified heparin binding technique and evaluated the bleeding risk and effciency of HBH-HD in chronic renal failure patients at risk of bleeding. Methods : During the period from April 1995 through April 2002, 159 patients at high bleeding risk received 1057 HBH-HD (dialyzer : GFS plus 11, Gambro). The duration of each HBH-HD was standardized to 4 hours at blood-flow rate of 200-250mL/min. To evaluate of HBH-HD, we measured serum heparin concentration (HC) and activated partial thromboplastin time (aPTT) at baseline, 15, 60, 120 minutes and endpoint (240 minutes) (n=40). To evaluate the dialysis effciency, HBH-HD and routine hemodialysis with systemic heparinization (R-HD) were compared for total blood compartment volume (TBCV) loss, dialyzer urea clearance (K) and Kt/V in same study group patients (n=20). Results : Clotting of dialyzer necessitating termination of dialysis occurred in 11 (1.0%) out of 1,057 dialyses at 150 minutes, and clotting requiring change of blood line occurred in 64 dialyses (6.1%) between 150 and 230 minutes. There was a slight increase in the aPTT (mean±SD, 49.8±10.5 sec) and HC (0.14±0.06 U/㎖) at 15 min, compared to predialysis levels of 44.3±12.9 sec and 0.11±0.06 U/㎖, respectively (p>0.05). But no increase in aPTT, HC was observed in measurements at 60 min, 120 min, and at the endpoint. TBCV loss was significantly higher in HBH-HD (mean±SD, 17.2±9.6%), compared to R-HD (2.8±1.2%) (p<0.0001). However, K and Kt/V value (mean±SD) were 136.9±14.6 ㎖/min and 1.27±0.21 in HBH-HD and 137.6±18.4 ㎖/min and 1.20±0.22 in R-HD, showing no significant difference (p>0.05). Conclusion : HBH-HD could be a safe and efficient HD technique in patients at high risk of bleeding. Extracorporeal clotting, however, should be observed cardfully during HBH-HD. (Korean J Nephrol 2003;22(4):389-396)
Yoon-Keun Chun¹,Joohun Ha□Hong-Jung Woo□, Soo Myung Oh□,Sung Soo Kim□ ¹Department of Molecular Biology, College of Medicine,²Department of Surgery, college of Medicine,³Department of Internal Medicine, College of Oriental Medicine,and ⁴East-Weat Medical Reserch Institute,Kyung Hee University, Seoul, Korea. The HBV DNA Amounts in Serum Have No relationship with ALT level and Hetergeneous Population Coexits in Chronic Hepatitis B Virus Infection. Proceedings of International Symposium on East-West Medicine, Seoul. 212-230, 1999. -Hepatitis B is caused by hepadnavirus. Hepatitis B virus replicates through 3.5kb pregenomic RNA intermediate which is regulated by core promoter. Pathogenesis of hepatitis B virus has been bilieved the result of host immune response. But recently many studies have reported that high level of viral replication caused by mutation in core promoter might result in severs hepatitis. But these studies were performed in vitro, not in vivo. So there is yet debate about which factor, viral of host factor, is more important in pathogenesis of hepatitis B virus. So we measured real viral replication level in 204 chronic hepatitis B patients by quantifying HBV DNA from sera by our novel PCR-based more sensitive method, and compared these results with ALT level measured from same sera, which indicates liver cell damage. Surprisingly there are no significant correlation between HBV DNA quantity and ALT level. Then we cloned core promoter region. In SSCP, we found that many viral mutants coexist in one patient. Base on SSCP result, we chose main viral core promoter type in each patients, which is thought to determine overall viral replication level in this patient. Main type of core promoter region of each 41 patients were directly sequenced. And with these we measured promoter activity by luciferase assay system and compared promoter activity with on another. We found tha there were some differences in promoter activity according to core promoter sequences. And we constructed replication-competent viral constructs with core promoter from 41 patients and Transfected these into HepG2 cell and measured HBV DNA by southern blot. There were also differences in HBV DNA quantity according to core promoter sequences. On these all results we investigated correlation between the effect of HBV core promoter on viral replication in vitro and HBN DNA quantity, ALT level from sera of each patients. We found there is no significant correlation among them. As a result, we concluded that in determining severity chronic hepatitis B patients, host factors of each patient is more important rather than replicative activity of virus itself.
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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.
연구목적: 많은 의치 환자들은 의치의 유지력, 안정성 그리고 저작기능을 향상시키기 위해 의치접착제를 사용하고 있다. 이상적인 의치접착제는 독성이나 자극이 없고, 구강점막에 편안함을 제공하고, 나쁜 냄새나 맛이 없어야 한다. 의치접착 크림의 세포독성 여부를 확인하고, 의치접착제의 효과와 시간에 따른 유지력의 변화를 알아보고자 하였다. 연구재료 및 방법: 의치접착크림의 세포독성 여부를 알아보기 위해 mouse 섬유아세포를 이용한 MTT시험을 통해 의치접착크림의 농도와 1일에서 4일까지의 시간에 따른 세포독성 여부를 평가하였다. 의치 접착제가 유지력 향상에 미치는 효과와 시간에 따른 유지력의 변화를 알아보기 위해 무치악 덴티폼과 이에 맞는 의치상을 제작하여 의치 접착제 적용 후 3일까지의 인장결합강도를 측정하였다. 결과: 1. 의치접착크림은 농도와 시간에 따라 세포독성이 관찰되는 것은 없었다. 2. 의치접착크림과 인공타액을 동시에 사용한 경우 통계학적으로 가장 높은 인장 결합강도를 나타내었고, 의치접착크림을 단독으로 사용한 경우보다 인장결합강도가 통계학적으로 유의성 있게 높았다. 이는 인공타액과 의치접착크림의 인장결합강도의 단순 합계보다 높았다. 3. 의치접착크림과 인공타액을 동시에 사용한 군에서 도포 후부터 1시간 후까지 인장 결합강도는 최대치를 기록하였고 3시간부터 인장 결합강도는 점차 감소하기 시작하여 12시간 후는 최대 인장 결합강도의 70%, 1일 후에 50%까지 감소하였다. 이상의 결과를 토대로 의치접착크림은 1일에서 4일까지 세포독성이 없었고 의치의 유지력을 향상시키는데 효과적이며, 타액과 같이 작용하여 효과를 더 발휘할 수 있었다. 향후 장기적인 사용에 따른 다양한 세포독성 실험과 접착력의 감소에 대한 연구가 필요하리라 사료된다. Statements of the problem: Many denture wearers occasionally use denture adhesives to improve denture retention, stability and chewing of efficiency. An ideal denture adhesive is nontoxic, non-irritating, and provides comfort to the oral mucosa. Purpose: The purpose of this study was to evaluate the cytotoxicity and adhesive properties of a selected denture adhesive. Material and methods: To test cytotoxicity of the selected denture adhesive, mouse fibroblast cells were used in MTT testing. Cytotoxicity was examined according to the concentration of the denture adhesive and incubated for 1 to 4 days. To examine adhesive property, a denture base was fabricated on an edentulous dentiform. The adhesive was applied to the denture base, then tensile bond strength was measured, to evaluate the change in retention during 3 days. Results and Conclusion: 1. 1% and 2% concentration denture adhesive cream had no cytotoxicity. 2. The tensile bond strength of the group with both denture adhesive and artificial saliva was significantly higher than that of group with only denture adhesive (P<.05). The tensile bond strength of the group with denture adhesive was significantly higher than that of with only artificial saliva(P<.05). 3. The tensile bond strength had no significant change during 1 hour, and then gradually decreased. After 1 day, it decrease to half. Within the limitation of this study, the tested denture adhesive had no cytotoxicilty and was effective in improving denture retention. The adhesive strength began to continuously decrease after 1 hour and it decreased to half at 1 day after application.
These days the supply of national medical market has been continue to exceed since the 2000s, as a response to this situation, investment for medical facility is overgrowing up, but it makes insolvency of medical institutions and the healthcare consumer's complain has been growing up. Accordingly, this study will point out the ineffective response to the changes to the external environment of medical institution as a cause for this situation, through the literature research method to access medical consumer's complain in terms of marketing approach, propose an offering the customer-centric medical service not the doctor-centric focus on technology as a solution, and as an innovative marketing strategy of medical guidelines for the effective service of customer-centric medical service, firstly derive the quality evaluation criteria for medical service with 7P as a central figure, secondly present the design direction of the medical institution's internal organization for offering customer-centric medical service Medical examination is described as physical support(like medical facilities and equipment) and customer contact factor, so the notion of medical service is defined as a composite process of service delivery system conveyed to the customer through the interaction of customer contact factor and the physical support for medical examination, and propose the human rights and social responsibility of medical service by classifying the feature of medical service as general characteristics and unique characteristics. In the processing of deriving medical service's quality evaluation criteria, devide the quality of medical service into technical quality and functional quality based on the definition of user-centered concepts of the views of various scholars, approach the evaluation factors of medical service quality a level of truth, exploring and experience, and customer's final quality recognition is analyzed as being formed through the comparison the expected service with recognized service. For achieving the marketing goal of medical institution, we insist on the need of 7P's marketing mix of medical service adding person, physical evidence and process on the original 4P's marketing mix which means products, price, place and promotion, and presented by total 48 evaluation factors for every 7P, propose the range of improving medical institution's quality and the reason for reasonable judgement for the medical customer about future quality of medical service. In the traditional internal organization focus on manufacturing, marketing departments is composed as marketing-oriented, that marketing department takes responsibility of marketing and accomplishes of it, but the medical institution's internal organization should be designed customer-centric because it's marketing function and marketing departments are related with the customer, so it's marketing is evolved mutually. Medical institution's customer-centric internal organization design is proposed into three categories of marketing, production and management, and we present the role and the perform functions, of each part of design. Finally, marketing strategies of medical institution for overcoming today's excess supply and customer's complain of medical market, are involving the 7P's marketing mix related to medical service for offering to the customer-centric medical service and designing&developing customer-centric internal organization effectively for product the high quality medical service and delivering it to the medical customer effectively.
A ten months old, female Yorkshire terrier weighing 2.88 kg referred to veterinary teaching hospital of college of veterinary medicine, Konkuk University because of syncope, cough and dyspnea. First hematological and serum chemical test revealed thrombocytopenia, mild anemia, and increase of concentration of ALP (195 U/L). On 57 days later, second hematological and serum chemical test revealed polycythemia, increase of concentration of ALP (211 U/L), and Tchol (387 mg/dl). Right atrium enlargement, main pulmonary artery bulge and cardiomegaly (VHS = 11.5) were observed in radiographic findings. Ultrasonographic images showed both right and left ventricular dilation and turbulent flow between the descending aorta and the main pulmonary artery in color Doppler imaging. ECG showed left ventricular enlargement, SA block, and electrical alternant. Thoracotomy was performed through left fourth intercostal incision under isoflurane anesthesia. Patent ductus arteriosus was double ligated with 1-0 silk. Cough and dyspnea disappeared on 5 days after operation. Turbulent flow was not found in color doppler imaging of ultrasonography on 10 days after operation. Ten months later after the operation, syncope could not exist any more.
We investigated characteristics of bacterial infection and antimicrobial suscerptibility patterns of clinical specimens in Dong Guk University Kyong Ju Hospital from october 1991 to december 1992. The types of clinical specimens requested for culture were as follows ; pus(34.2%), urine(29.6%), sputum(25.2%), blood(9.2%), etc. The most frequently isolated organisms were E. coli(17.6%), Pseudomonas(12.7%), S. aureus(12.2%), and CNS(11.2%), orderly. Predominant organisms from pus, urine and sputum were S.aureus, E. coli and Pseudomonas. Blood culture was requested 1,244 samples from 614 patients, 91 pathogeni organisms were isolated(14.8% from patient and 7.3% from requested clinical samples). E. coli was most frequently isolated(29.7%) and Salmonella typhi was noted 8.8% from the requested samples. The patterns of isolated organisms according to departments were as follows ; E.coli and Klebsiella were frequently isolated in internal medicine and general surgery, E.coli and Pseudomas in Neurosurgery, S. aureus and Pseudomonas in orthopedic surgery. In ICU, Pseudomonas was predominatly isolated and the rate of mixed infection was also high(16.4%). Most of gram-negative bacilli revealed relatively high susceptibility to Chlorampenicol, Amikacin, Tobramycin and Carbenicillin, but Acinetobacter were only susceptible to Carbenicillin and Tetrecyclin, and Serratia were to Carbenicillin and Amikacin while Salmonella were susceptible to all tested first drugs. The proportions of multi-drug resistant bacteria were 34.9% of Acinetobacter, 21.1% of Serratia, 20.0% of Pseudomonas and 15.4% of Citrobacter but Aztreonam was highly susceptible(84∼100%) except Acinetobacter. S. aureus and CNS were susceptible to Chlorampenicol, Oxacillin, Cephalothin and Vancomycin, especially, 100% susceptible to Vancomycin. But Methicillin reistant Staphylococcus aureus were very high(49%) inspite of new constructed hospital. Pneumococcus and Streptococcus species were relatively high susceptible to all tested drugs.
현재 컴퓨터 그래픽스 기술을 이용하여 물체를 표현하기 위한 작업들은 물체의 복잡도에 따라 많은 시간을 요구한다. 따라서, 실시간 렌더링을 요구하는 응용분야에서는 다른 기술을 요구한다. 이러한 요구에 따라 본 연구에서는 실시간 렌더링을 지원하기 위해서 물체의 원형을 유지하면서 단순화시키는 다각형 감소 기술을 다루고 있다. 다각형 감소를 위해서 물체의 지형정보 분석, 면합성, 재삼각형화 같은 기술들이 필요하다. 본 연구를 통하여 기대되는 효과는 현재 많이 연구되고 있는 가상현실 공간에서나 지형저보시스템등에서 더욱 빠른 시간내에 현실감있는 영상을 만들 수 있을 것으로 기대된다. In present, the jobs which express objects with computer graphics need execution time as much as object complexity. So, real-time application needs other techniques. In this research, we studied the polygon reduction technique which maintain the object frame and reduce the object. This technique require the geometric analysis of object, face merge and re-triangulation. In this research, the applied region which we hope are VR(Virtual Reality) and GIS(Geographical Information System).
Methanol extract of G. elata inhibited the binding of [³H]Ro15-1788, a selective benzodiazepine receptor antagonist, to benzodiazepine receptor of rat cortices. Saturation experiments followed by Scatchard analysis of the results showed that the inhibition of [³H]Ro15-1788 binding by G. elata. appeared to be competitive. These competitive inhibiton of the butanol fraction was observed to be higher than the methanol extract. Methanol extract of G. elata inhibited a [³H]flunitrazepam, a selective benzodiazepine receptor agonist, binding to benzodiazepine receptor. GABA significantly enhanced the inhibition of [³H]flunitrazepam binding by G. elata, and these "positive GABA shift" supported the strong possibility of agonistic activity to benzodiazepine receptor. Butanol fraction was observed to be higher than crude extract by methanol in an agonistic activity to benzodiazepine receptor, furthermore enhanced the binding of [³H]SR95531 to GABA_(A) receptor. Butanol fraction of G. elata significantly diminished the pentylenetetrazole-induced lethality of mice. From these results, it can be concluded that substance or substances with neurochemical properties characteristic of a benzodiazepine receptor agonist may be important components, and contribute to the anticonvulsant property of G. elata.