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( Byung Heon Kang ),( Soon Young Hwang ),( Jeong Yeop Kim ),( Yu Ah Hong ),( Mi Yeon Jung ),( Eun Ah Lee ),( Ji Eun Lee3 ),( Jae Bok Lee ),( Gang Jee Ko ),( Heui Jung Pyo ),( Young Joo Kwon ) 대한내과학회 2015 The Korean Journal of Internal Medicine Vol.30 No.6
Background/Aims: To prevent hypocalcemia after parathyroidectomy (PTX), parenteral calcium is required in addition to oral calcitriol and calcium. After switching to oral calcium, patients can be discharged from the hospital. The aim of this study was to analyze the clinical characteristics and outcomes of PTX performed at a single Korean center and to investigate the associated laboratory factors used to analyze the total amount of postoperative calcium required. Methods: We enrolled 91 hemodialysis patients undergoing PTX from November 2003 to December 2011. We collected clinical and laboratory data preoperatively, 12 and 48 hours postoperatively, at discharge, and 3 and 6 months postoperatively. Results: In total, 59 patients underwent PTX with autotransplantation (AT), 6 underwent total PTX without AT, 11 underwent subtotal PTX, and 15 underwent limited PTX. Total PTX without AT showed the lowest recurrence rate. At all postoperative time points, the mean levels of serum calcium, phosphorus, and intact parathyroid hormone (iPTH) decreased significantly, compared with preoperative levels; however, alkaline phosphatase (ALP) increased significantly from 48 hours postoperatively to discharge (p < 0.001). On multiple linear regression analysis, the total amount of injected calcium during hospitalization showed a significant correlation with preoperative ALP (p < 0.001), preoperative iPTH (p = 0.037), and Δphosphorus at 48 hours (p < 0.001). We developed an equation for estimating the total calcium requirement after PTX. Conclusions: Preoperative ALP, preoperative iPTH, and Δphosphorus at 48 hours may be significant factors in estimating the postoperative calcium requirement. The formula for postoperative calcium requirement after PTX may help to predict the duration of postoperative hospitalization.
Background: Micafungin, a potent inhibitor of 1,3-β-D-glucan synthase, is a novel antifungal agent of the echinocandin class. In vitro study showed that micafungin was effective against Aspergillus species as well as Candida species, but clinical data on the prophylactic efficacy against invasive fungal infections (IFIs) other than candidiasis are still lacking. Materials and Methods: We identified 60 consecutive adult hematopoietic stem cell transplantation (HSCT) recipients who received at least 3 doses of micafungin during neutropenic period. Micafungin was started as an alternative in patients who were intolerant or had adverse events (AEs) to primary prophylactic antifungal agents. We retrospectively reviewed the medical records and analyzed the efficacy and safety of micafungin for prophylaxis against IFIs. Results: The patients either had autologous (n=9) or allogeneic (n=51: 1 syngeneic, 24 sibling, 26 unrelated donor) HSCT. Itraconazole oral solution (n=58) was the most frequently used first line antifungal agent for prophylaxis and was administered for median 11 days. The most frequent cause of switch to micafungin was vomiting (n=42). The duration of neutropenia and micafungin administration was median 13 and 12 days, respectively. A successful outcome was achieved in 45 (75%) patients. Empirical antifungal therapy was initiated in 13 (22%) patients. There were 2 cases (3.3%) of breakthrough fungal infections which comprised a probable invasive pulmonary aspergillosis and a possible invasive fungal sinusitis. There was no case of invasive candidiasis. A total of 53 (88%) patients experienced at least one AE regardless of causality during micafungin administration. The most frequent AEs were hypokalemia, vomiting, diarrhea, and elevated serum aspartate aminotransferase or alanine aminotransferase. Among the aforementioned AEs, only 1 case of diarrhea could be classified as a probable relation with micafungin when causality was assessed. There was no AEs that caused discontinuation of micafungin. Conclusions: Micafungin seems to be a safe and effective agent for prophylaxis of IFIs including aspergillosis as well as candidiasis in HSCT recipients. However, further large, prospective, and randomized comparative studies are warranted for aspergillosis.
Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.
다양한 향미를 가진 막걸리의 개발을 위해 전통누룩으로부터 분리한 곰팡이로 입국을 제조한 후 품질특성을 분석하여 입국의 규격에 적합하며 이취가 없고 관능이 우수한 9균주를 입국 제조용 우수균주로 최종 선발하였다. 선발된 균주는 Aspergillus oryzae(C1-5-2-2, C20-7-3, CN1.3.1-4, CN16.19.1-1, N152-1, N220-1), Mycocladus corymbiferus (N162-2), Rhizopus oryzae(N20), Lichtheimia corymbifera (N21)로 동정되었으며, 제조한 입국의 산도는 5.0~6.8, 당화력은 128~241sp이었다. Various koji were prepared by fungi isolated from traditional nuruk and their quality characteristics were investigated. Acidity and saccharification power of their koji were ranged in 5.0~6.8 and 128sp~241sp. Nine fungi which were showed good quality and sensory evaluation were identified by analysis of their nucleotide sequences with PCR-amplified 18S rDNA internal transcribed spacer-1(ITS-1) and ITS-4 genes. Among them, six strains were identified as Aspergillus oryzae and the other strains were identified as Mycocladus corymbiferus, Rhizopus oryzae, Lichtheimia corymbifera.
Background : In recent years, gonorrhea has been panedemic and remains one of the most commom STDs in the world, especially in developing countries. Objective & Methods: For the detection of a more effective therapeutic regimen and assessing the prevalence of PPNG, we have been trying to study the patients who have visited the VD Clinic of Choong-Ku Public Health Center in Seoul since 1980 by means of the chromogenic cephalosporin method. Results: In 1996, 139 strains of N. gonorrhoeae were isolated, among which 53(39.0%) were PPNG. Conclusion: Our results suggests that after a peak of 74.3% in 1993, the prevalence of PPNG in Seoul is gradually declining.
미생물 살충제로 사용되고 있는 B. thuringiensis를 모기유충방제에 적용하기 위한 시도는 B. thuringiensis가 수서생태계에서 부유하지 못하고 가라앉으며, 생활환을 이루지 못한다는 문제점으로 인해 적용에 어려움이 있다. 따라서 본 연구는 모기유충에 강한 독성을 갖는 B. thuringiensis subsp. morrisoni PG-14의 cryIVD 유전자를 모기유충의 먹이인 cyanobactrium에 도입하기 위하여 발현벡터 pCYASK 5-1을 제작하고, cyanobacterium Synechocystis PCC6803에 형질전환시켜, 세포내에서 cryIVD 유전자의 발현과 뇌염모기에 대한 독성을 조사하였다. 그 결과 형질전환체 내에서 cryIVD 발현은 immunoblot 분석을 통해 B. thuringiensis subsp. morrisoni PG-14에서 발현된 단백질과 같은 분자량으로 발현되는 것을 확인하였으며, 모기유충에 대한 형질전환체의 독성은 1.40×10^6 cells/ml 농도에서 약 80%의 치사율을 나타내었다. Bacillus thuringiensis subsp. morrisoni PG-14 is a gram-positive soil bacterium producing mosquitocidal parasporal inclusions composed of several crystal proteins. Among these crystal protein genes, cryIVD gene is one of major component which has 72 kDa in size. However, these parasporal inclusions sink quickly from the surface of water where mosquito larval feeding occurred. To develope mosquitocidal cyanobacterium, therefore, we constructed the expression vector, pCYASK 5-1 harboring cryIVD gene. The expression vector, pCYASk5-1 was transformed into the cyanobacterium Synechocystis PCC6803 reported as a natural mosquito larval food source and the transformants were selected with kanamycin. Expression of cryIVD gene in transformant was characterized by SDS-polyacrylamide gel electrophoresis (PAGE) and immunoblot analysis. The mosquitocidal activity of a transformant was determined electrophoresis (PAGE) and immunoblot analysis. The mosquitocidal activity of a transformant was determined with Culex tritaeniorhynchus. The results showed that the transformed cyanobacterium is toxic to mosquito larvae and will be expected as a potential agent that is used for mosquito control.
이 연구에서는 사회적 상호작용을 강조한 과학 탐구실험을 실시하여 학생-학생 상호작용의 유형을 분류하고, 인지수준에 따른 모둠별 상호작용 양상을 분석하였다. 이를 위해 인지수준이 이질적인 모둠과 동질적인 모둠을 각각 2모둠씩 선정하여 활동지를 해결하는 과정을 녹음, 녹화하였다. 학생들의 상호작용 유형을 크게 인지적 측면과 정의적 측면으로 나누어 인지적 측면은 「질문」, 「응답」, 「의견제시」, 「의견 받기」로 구분하여 각 범주를 상호작용의 질적 수준에 따라 세분하였다. 정의적인 측면은 「활동참여도」, 「분위기 관련」, 「의견에 대한 반응」으로 나누었다. 동질, 이질 모둠의 인지적, 정의적 상호작용의 빈도를 비교하여 상호작용 양상을 분석한 결과 인지적 측면에서는 동질 모둠이 이질 모둠에 비해 상호작용의 빈도가 더 높았고 상호작용의 질적 수준도 더 높은 것으로 나타났다. 정의적 측면에서는 교사 의존도나 모둠에 대한 불만 등 동질 모둠에서 부정적인 태도를 더 많이 보였으나, 동료의 의견에 ‘수용’과 ‘반대’를 표현하는 빈도는 동질 모둠이 더 많아 자신의 의견을 말할 수 있는 토론분위기가 이루어졌음을 알 수 있었다. The purposes of this study were to categorize the type of student-student interaction and analyze the pattern of group interaction by cognitive level in interactive science inquiry experiments. For this study, two homogeneous and two heterogeneous groups by cognitive level were selected. Social interactions during group discussions were audio/video taped. The types of student's interaction were classified as intellectual and emotional aspects. Intellectual aspects were consisted of asking question, response, making suggestion, receiving opinion and then further coded by interaction level. Emotional aspects were consisted of relevance to behavioral participation, relevance to students' feeling, reaction to opinion. Interaction frequency in the intellectual and emotional aspect between homogeneous and heterogeneous group were compared to analyze interaction pattern. The results of this study showed that in intellectual aspect the frequency and quality of interaction in homogeneous group was higher than that in heterogeneous group. In emotional aspect, homogeneous group more showed such negative attitude as lack of confidence and dissatisfaction than heterogeneous group, on the other hand showed acceptable mood to be able to accept or object to peer's opinion. Some educational implications were drawn.