A prospective study

학위논문(석사) -- 서울대학교대학원 : 의과대학 의학과, 2023. 2. 이정렬.Background: Endometriosis (EMS) is a benign gynecologic disease defined as ectopic proliferation of endometrial gland and stroma. Although the strong relationship between EMS and infertility is well known, its mechanism is still a conundrum. Recently, metabolomics has been spotlighted as a tool to elucidate the etiology, pathophysiology and mechanism of various diseases. Despite follicular fluid (FF) provides the microenvironment for follicular development and affects the quality of oocytes, there are only a limited number of metabolomic studies analyzing FF in EMS. The aim of this study is comparing the metabolomic and microbiome composition of FF of unilateral ovarian EMS with non-EMS patients. Method: Ten women receiving oocyte retrieval were enrolled prospectively from July 2021 to July 2022 at Seoul National University Bundang Hospital. Five patients were diagnosed with unilateral EMS and the other five patients were non-EMS control group. In EMS group, FF from EMS-affected ovary was collected. Targeted quantitative metabolomics kit, which can detect 188 metabolites, and twenty bile acid (BA) quantification kit are used for metabolomic analysis. Multivariate analysis (principal component analysis) was performed to identify discriminative the differences of composition. Result: There were six metabolites with statistical differences. In EMS group, acylcarnitine propenoylcarnitine (C3:1) was significantly increased, whereas amino acid valine, alanine, acylcarnitine butyrylcarnitine (C4), butenylcarnitine (C4:1), and phosphatidylcholine diacyl C 38:3 (PC aa C38:3) were significantly elevated in non-EMS control group. Since antimullerian hormone level and the presence of DOR showed significant difference between EMS group and non-EMS group, the correlation with these factors and the six metabolites were performed. Valine was showed statistically significant positive correlation with AMH and C3:1 and valine had negative and positive correlation with DOR, respectively. Also, the BA kit analysis did not show any statistical difference between EMS and non-EMS patients. Conclusion: The different levels of acylcarnitines, amino acids, and glycerophospholipids suggest that endometriosis has altered mitochondria energy metabolism in cellular level. The gut microbiome may not affect the pathophysiology of follicular development in EMS since BA kit did not show significantly different patterns.자궁내막증은 자궁 내막의 분비선 및 기질이 자궁 외의 장소에서 증식하는 양성 부인과 질환이다. 자궁내막증과 난임의 높은 연관성은 많은 연구에서 입증되었으나, 자궁내막증이 난임에 작용하는 기전은 아직도 완전히 밝혀지지 않았다. 최근, 대사체학이 다양한 질환의 병인, 병태생리, 기전을 밝히는 도구로 각광받고 있다. 난포액은 난포의 발달에 필요한 미세 환경을 제공하고 난자의 질에 영향을 주는 물질이다. 그러나 자궁내막증 환자에서 그 난포액을 분석한 대사체학 연구는 제한적이다. 본 연구의 목적은 단측성 난소 자궁내막증에서 난포액의 대사체 구성과 마이크로바이옴 조성을 비자궁내막증 군과 비교하는 것이다. 단측성 난소 자궁내막증 환자의 검체는 모두 자궁내막증에 이환된 쪽의 난소에서 채취한 난포액을 이용하여 분석하였다. 2021년 7월부터 2022년 07월에 걸쳐 분당서울대학교병원에서 10명의 난자 채취 예정 환자가 전향적으로 연구에 참여하였다. 5명은 단측성 난소 자궁내막증으로 진단된 환자였고, 나머지 5명은 비자궁내막증 대조군이었다. 이후 키트를 사용한 표적 대사체 분석이 진행되었다. 188개의 대사체를 분석할 수 있는 키트와 20개의 담즙산을 분석할 수 있는 정량 키트가 사용되었다. 다변량 분석과 주 성분 분석을 통해 난포액 구성 성분의 유의한 차이를 확인하였다. 6개의 대사체에서 통계적 유의성이 확인되었다. 자궁내막증 군에서는 아실카르티닌 C3:1 (propenoylcarnitine)이 통계적으로 유의하게 증가하였고, 비 자궁내막증 군에서는 발린, 알라닌, 아실카르티닌 C4:1 (butenylcarnitine), C4, PC aa C38:3이 유의하게 증가하였다. 한편, 자궁내막증 군과 비자궁내막증 군의 임상적 지표에서 유의한 차이를 보인 항뮬러관호르몬 수치와 난소기능저하 여부에 대해 6개의 대사체와의 연관성 분석을 시행하였고, 발린과 항뮬러관호르몬 사이에서 양의 상관 관계를 보였다. 또한 C3:1과 발린은 난소기능저하와 각각 음의 상관 관계와 양의 상관 관계를 보였다. 또한 담즙산 분석 키트에서는 유의한 차이가 확인되지 않았다. 자궁내막증 환자에서 아실카르니틴, 아미노산, 글리세로인지질의 수치 차이는 이 질병으로 인한 세포 수준에서의 미토콘드리아의 에너지 대사 변화를 암시한다. 담즙산 분석 키트에서 유의한 패턴의 차이가 없었기 때문에, 자궁내막증 환자에서 장 마이크로바이옴이 난포 발달에 미치는 영향은 없을 것으로 생각된다.1. Introduction 01 2. Methods 03 3. Results 07 4. Discussion 09 Bibliography 13 Abstract in Korean 15 Tables [Table 1] 16 [Table 2] 17 [Table 3] 18 Figures [Figure 1] 19 [Figure 2] 20 [Figure 3] 21 [Figure 4] 22 [Figure 5] 23석

지리산에서 볼로냐까지 : 김남두 선생님과 함께 걷는 길

산을 과연 탈 없이 넘을 수 있을까? 대학원 정규수업과 병행해 선생님의 연구실에서 꾸준히 모였던 고전강독이 일정한 궤도에 오르고 토론 주제도 제법 모였으니 공부 점검을 위한 작은 발표회를 겸해 다른 산도 아닌 지리산을 제대로 경험해보자 하셨다. 걱정이 왜 없었겠는가? 공부보다도 체력단련을 먼 저 했어야 했다는 선배의 농이 무겁게 느껴질 무렵 산행계획은 구체적으로 잡혔다. 밀든 끌든 끝까지 함께 오르자는 서로를 향한 응원에 힘입어 각자에게 그리고 모두에게 파란만장했던 80년대를 마감하는 그 가을, 우리들은 선생님과 지리산을 향했다

Missed Ipsilateral Adrenal Adenoma With Recurrent Hypercortisolism After Prior Left Adrenalectomy

ope

Comparison of Parenting Stress between Married Migrants and Korean Women

Purpose: The purpose of this study was to compare parenting stress between married migrant women and Korean women. Methods: Subjects were 68 married migrant women and 70 Korean women raising children aged seven years or younger, living in three different cities in Gangwon Do. To measure parenting stress, we used Kims (1997) questionnaire that had been modified from Richard & Abidins (1990) Parenting Stress Index (PSI). Results: There were significant differences between the two groups in age, academic credentials, job, monthly income, and achievement of maternal role. No statistically significant differences were found for parenting stress scores (p<.355), but there was a significant difference in the child characteristics of parenting stress (p<.007) between the two groups. There were no differences in the demographic variables influencing parenting stress between the two groups. Conclusion: The development of multi-cultural parenting and family support programs should consider the nationality and marital satisfaction of the family

Effects of Music Therapy and Phone Counseling on Postpartum Depression and Maternal Identity in High Risk Women

Purpose: This study examine the effects of music therapy and phone counseling on ostpartum depression and maternal identity in high risk women. Methods: A nonequivalent control group time series research design was employed. Eighteen women comprised the experimental group and seventeen women, the control group. Experimental group received 4 weeks of music therapy and phone counseling. Postpartum depression and maternal identity were measured prior to intervention and on the 1st, 2nd, and 4th weeks after its introduction. Results: The first hypothesis (i.e.,the degree of postpartum depression would be lower in the experimental group than in the control group in a months time) was not supported (z=-0.47, p=.641). The second hypothesis (i.e.,the degree of maternal identity would be lower in the experimental group than in the control group in a month) was not supported as well (z=1.08, p=.285). Conclusion: There is the need to monitor long-term effects of music therapy and phone counseling on high risk postpartum women, beyond 4 weeks observed in this study. Additionally, the development of music therapy tailored to high risk individuals and systematic phone counseling protocols for postpartum depression is required

Impact of metabolic syndrome-related factors on the development of benign prostatic hyperplasia and lower urinary tract symptoms in Asian population

This study aimed to investigate the metabolic syndrome-related risk factors for the development of benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS) in healthy men.A total of 4880 healthy men who underwent transrectal ultrasonography at our hospital during routine health examinations were included in this study. Those who had undergone a prior biopsy or surgery for prostate disease, were suspected of having urinary tract infection, or were taking BPH/LUTS or metabolic syndrome medications were excluded. BPH/LUTS was defined as an International Prostate Symptom Score (IPSS) of ≥8 and a prostate volume (PV) of ≥30 cm.The subjects had a mean age of 54.1 years, PV of 29.2 cm, prostate-specific antigen (PSA) level of 1.20 ng/mL, and IPSS of 9.2. The annual PV growth rate was 0.48 cm/year. Age, body mass index (BMI), PSA, basal metabolic rate, apolipoprotein A-1, fasting blood glucose, high-density lipoprotein (HDL) cholesterol levels were significant predictive factors for PV. Age, PSA, apolipoprotein B, fasting blood glucose, cholesterol, HDL, and low-density lipoprotein (LDL) levels were predictors of BPH/LUTS at the initial health examination. A decreased fat mass and LDL level were a significant risk factor for the development of BPH/LUTS within 5 years in men without a BPH/LUTS diagnosis at the initial examination.Metabolic syndrome-related variables were strongly associated with BPH/LUTS and by decreasing fat mass and LDL levels, development of BPH/LUTS could be prevented within 5 years in healthy Korean men.ope

Uric Acid Variability as a Predictive Marker of Newly Developed Cardiovascular Events in Type 2 Diabetes

Background: Cardiovascular disease (CVD) is associated with morbidity and mortality in patients with type 2 diabetes mellitus (T2D). However, the role of serum uric acid as a risk factor for developing cardiovascular disease is controversial. This study investigated whether uric acid variability was associated with new-onset symptomatic CVD in patients with T2D, requiring percutaneous coronary intervention. Methods: A total of 1,071 patients were enrolled in this retrospective cross-sectional study after propensity score matching. Patients with T2D and new-onset symptomatic CVD who received percutaneous coronary intervention for the first time, and with at least three consecutive 6-monthly measurements of serum uric acid were recruited from Severance Hospital between January 2015 and December 2019. Uric acid variability was measured by average successive variability (ASV) and analyzed to evaluate a possible correlation with the risk of developing CVD. Results: The patients were divided into quartiles based on the uric acid variability. Patients in the highest quartile were older and presented lower renal function and a higher mortality from CVD. There was a linear association between a high uric acid variability and the development of CVD. Compared to the lowest quartile, patients in the higher quartiles had a higher risk of CVD [quartile 3: adjusted odds ratio (aOR) = 1.76; 95% confidence interval (CI), 1.20-2.82; P = 0.019; quartile 4 aOR = 2.89; 95% CI, 1.74-4.80; P < 0.001]. Conclusion: High uric acid variability is independently associated with an increased risk of new-onset symptomatic CVD requiring percutaneous coronary intervention in patients with T2D. Thus, maintaining serum uric acid in a narrow range by prescribing effective medications is essential to prevent new-onset CVD in patients with T2D. Nonetheless, the potential use of uric acid variability as a predictive marker of CVD in patients with T2D needs further validation.ope

Renal Tubular Damage Marker, Urinary N-acetyl-β-D-Glucosaminidase, as a Predictive Marker of Hepatic Fibrosis in Type 2 Diabetes Mellitus

Background: Non-alcoholic steatohepatitis is closely associated with the progression of diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM). We investigated whether urinary N-acetyl-β-D-glucosaminidase (u-NAG), an early renal tubular damage biomarker in DKD, could be related to the degree of hepatic fibrosis in patients with T2DM. Methods: A total of 300 patients with T2DM were enrolled in this study. Hepatic steatosis and fibrosis were determined using transient elastography. The levels of urinary biomarkers, including u-NAG, albumin, protein, and creatinine, and glucometabolic parameters were measured. Results: Based on the median value of the u-NAG to creatinine ratio (u-NCR), subjects were divided into low and high u-NCR groups. The high u-NCR group showed a significantly longer duration of diabetes, worsened hyperglycemia, and a more enhanced hepatic fibrosis index. A higher u-NCR was associated with a greater odds ratio for the risk of higher hepatic fibrosis stage (F2: odds ratio, 1.99; 95% confidence interval [CI], 1.04 to 3.82). Also, u-NCR was an independent predictive marker for more advanced hepatic fibrosis, even after adjusting for several confounding factors (β=1.58, P<0.01). Conclusion: The elevation of u-NAG was independently associated with a higher degree of hepatic fibrosis in patients with T2DM. Considering the common metabolic milieu of renal and hepatic fibrosis in T2DM, the potential use of u-NAG as an effective urinary biomarker reflecting hepatic fibrosis in T2DM needs to be validated in the future.ope

Stage du professeur de francais en Core´e : provle｀me et ame´lioration

Pour bien enseigner, plusieurs facteurs entrent en jeu. Mais ce qui le plus important, c&amp;apos;est le professeur. Un bon manuel ou une bonne me´thode n&amp;apos;ont pas de valeur si le professeur ne sait pas s&amp;apos;en servir efficacement dans la classe. Nous pouvons dire que le succe｀s ou I&amp;apos;e´chec de l&amp;apos;enseignement de´pend absolument du professeur. Par conse´quent il a besoin de faire des stages de recyclage au cours de sa carrie｀re. Au moment ou il n&amp;apos;y a pas beaucoup de recherches sur les stages des professeurs, nous allons d&amp;apos;abord essayer d&amp;apos;analyser les proble｀mes qui sont ressortis des enque＾tes qui ont e´te´ effectue´es aupre｀s des professeurs d e lyce´e et ensuite d&amp;apos;e´mettre quelques propositions pour l&amp;apos;ame´lioration de ces stages. Voici le resultat des enque＾tes: 1. Le public 1.1 La plupart des professeurs sont faibles en langue orale (26%), en linguistique (19%) et en me´thodologie (16%). 1.2 Ils ont appris le franc¸ais par la me´thode traditionnelle, c&amp;apos;est-a｀-dire par la me´thode dite grarnmaire-traduction quand ils e´taient e´tudiants, mais ils pratiquent la me´thode e´clectique dans la classe. 1.3 La plus faible des 4 aptitudes (skills) de la langue, c&amp;apos;est l&amp;apos;oral, et ils mettent l&amp;apos;accent sur la compre´hension e´crite quand ils enseignent le franc¸ais. 1.4 72% des professeurs ont suivi le stage. Parmi eux, 59% l&amp;apos;ont suivi deux fois. 2. Stage 2.1 Les professeurs regrettent de ne pas avoir de manuel syste´matique du stage et ils pensent que le stage ne les aident pas a｀ pre´parer le test de fin d&amp;apos;e´tudes. (le Hakryukgosa). 2.2 I1 y a des classes de conversation at des travaux pratiques en petits groupes. 2.3 Les professeurs e´trangers charge´s des cours ne comprennent pas bien l&amp;apos;enseignernent du franc¸ais en Core´e. 2.4 21% des professeurs ont suivi le stage en France et ils pensent qulil a e´te´ trop court. 2.5 78% des professeurs trouvent que le stage a e´te´ tre｀s utile en ge´ne´ral. 3. Demandes des professeurs 3.1 Les professeurs voudraient principalement un cours de conversation ou de me´thodologie. Ils pre´fe｀rent avoir des Franc¸ais et des professeurs de lyce´e comme enseignants pour le stage. 3.2 Ils aimeraient que le stage ait un rapport avec le Hakryukgosa et que le franc¸ais en soit une des matie｀res obligatoires. 3.3 Le stage qui a lieu en France devrait e＾tre non pas une visite touristique mais un vrai stage linguistique. 3.4 Ils sentent qu&amp;apos;ils ont besoin d&amp;apos;une publication re´gulie｀re et d&amp;apos;une re´union entre eux. 4. En analysant les enque＾tes, nous pouvons faire quelques propositions pour l&amp;apos;ame´lioration du stage. 4.1 Il serait ne´cessaire d&amp;apos;e´laborer un manuel syste´matique pour le stage 4.2 Les professeurs charge´s des cours doivent e＾tre des Franc¸ais et des professeurs de lyce´e qui peuvent te´moigner de leur expe´rience 4.3 Il faudrait que le stage en France soit plus e´largi afin d&amp;apos;aider les professeurs a｀ mieux comprendre le franc¸ais et a｀ s&amp;apos;exprimer plus aise´ment dans cette langue 4.4 Il faudrait qu&amp;apos;il y ait un rapport direct entre le stage et le Makryukgosa 4.5 Il serait ne´cessaire de publier un bulletin re´gulier pour les professeurs et d&amp;apos;organiser une re´union par laquelle ils pourraient e´largir leur expe´rience et s&amp;apos;entre-aider.;천연자원이 풍부하지 못하나 인적자원이 풍부한 한국이 선진대국을 향해 나가기 위해서는 영어권 나라뿐 아니라 다른 여러나라와의 교역이 필요하다. 그 중 불어를 사용하는 나라는 수십개국에 달한다. 그러므로 불어를 배운다는 것은 우리에게 보다 많은 가능성을 제시해 주며, 국제사회에 능동적으로 대처해 나갈 수 있는 능력을 키워준다고 말할 수 있을 것이다. 이런 점에서 불어교육이 차지하는 위치는 상당히 크다고 할 수 있다. 불어교육을 잘하기 위해서는 여러가지 여건이 요구된다. 그러나 아무리 좋은 교재와 교수법이 존재한다 해도, 이를 실천할 교사가 적절히 훈련되어 있지 못하다면 아무런 효과가 없을 것이다. 따라서 효과적인 불어교육은 곧 적절한 교사양성과 직결된다고 할 것이다. 본 연구의 목적은 보다나은 불어교육을 하기 위하여 불어교사의 재교육이 어떻게 이루어져야하는지 그 이론적 배경을 살펴보고, 재교육의 현실을 설문지를 통해 조사하여 그 문제점을 검토하고, 이에 대한 대책을 강구해 보려고 한다. 연구결과는 다음과 같다. 1. 연수대상자 1) 대부분의 교사들이 부족한 분야는 회화, 언어학, 교수법이다. 2) 문법번역식으로 대학에서 불어를 배운 데 비해, 대부분의 교사들은 고등학교에서 절충식교수법을 사용하고 있다. 3) 언어의 4기능 중 말하기가 가장 약하고, 학생을 가르칠때 읽기를 강조한다. 4) 72%의 교사가 연수를 받았으며 그 중 59%의 교사가 두번 이상 연수를 받았다. 2. 연수 1) 체계화된 연수교재가 없고 연수내용이 현장문제 해결에 도움이 되지 않는다. 2) 연수는 회화식과 그룹식수업으로 이루어지고 있다. 3) 외국인강사의 현장이해도는 낮으며, 전문지식수준은 보통이다. 4) 21%의 교사가 해외연수를 받았으며, 연수기간은 짧은 편이다. 5) 78%의 교사가 연수가 유익하다고 하여 연수성과에 대해 매우 긍정적이다. 3. 교사들의 요구 1) 연수에서 교사들이 원하는 내용은 회화와 교수법이며 회화식 수업과 그룹별 수업을 원하며, 담당강사로는 본국인과 일선교사를 원하고 있다. 2) 연수내용에 대입학력고사 내용이 첨가되고 불어가 대입학력고사에서 필수선택이 되기를 원한다. 3) 해외연수가 보다 체계적이 되어 현지시찰과 여행을 벗어난 진정한 연수가 되기를 원한다. 4) 정기간행물 보급과 교사모임이 결성되기를 바란다. 이상의 연구결과를 토대로 불어교사 재교육을 효과있게 하기 위한 개선책을 생각할 수 있다. 1) 현장문제해결에 도움을 줄 수 있는 체계화된 연수교재 개발이 필요하다. 2) 연수담당강사로 현장이해도가 높은 본국인과 일선교사가 기용되어야 한다. 3) 구술청취능력을 배양하는 데 가장 효과적인 해외연수기회 확대와 내실화가 요구된다. 4) 입시정책의 불어교육정책과 교사교육정책은 일치되어야 하며 이를 위한 정책적인 배려가 요구된다. 5) 불어교사를 위한 정기간행물 보급과 상호 의견교환을 위하여 불어교사모임이 결성되어져야 한다.목차 = ⅰ 논문개요 = ⅵ Ⅰ. 서론 = 1 A. 연구의 필요성 및 목적 = 1 B. 연구의 내용 및 방법 = 2 Ⅱ. 이론적 배경 = 4 A. 불어교사 재교육의 필요성 및 목적 = 4 B. 불어교사의 재교육의 유형 = 10 C. 불어교사 재교육의 진행과정 = 15 Ⅲ. 불어교사 재교육의 실태와 분석 = 20 A. 불어교사 재교육의 실태 = 20 B. 불어교사 재교육의 분석 = 23 Ⅳ. 결론 = 40 참고문헌 = 42 불어교사 현직연수에 관한 설문지 = 44 RESUME´ = 5