The emerging echogenic tract sign of pyriform sinus fistula: an early indicator in the recovery stage of acute suppurative thyroiditis

AST is commonly associated with pyriform sinus-thyroid fistula in children. Radiologic findings of AST are documented in a few reports. We report a new sign we term the "emerging echogenic tract sign," which reflects a patent air-containing pyriform sinus-thyroid fistula on follow-up US. Recognition of this sign is an important finding suggesting an associated pyriform sinus-thyroid fistula in a patient with AST and also suggesting the adequate timing of barium esophagography to confirm the fistula.ope

남북조 수당시기의 사회적현실과의 연관을 중심으로

학위논문(박사) -- 서울대학교대학원 : 인문대학 철학과(동양철학전공), 2023. 8. 조은수.本論文は、東アジア大乗菩薩戒を代表する『梵網経』(T1484）が450年から480年までの間に成立したという歴史性に着目し、当時中国の国家制度と律令、儒学思想、道教、医学、農学などの総体的背景の中で、『梵網経』の戒律に含まれた倫理的意味を多面的に論じたものである。とりわけ「酒」と「孝順」に対し、インド仏教の既存概念が中国ではどのように変容されたかについて究明したものである。 本論は四章で構成した。 第I章では先行研究の成果を分析し、倫理規範の生成と受容に対するこれまでの多様な研究アプローチを検討した。その上、『梵網経』の成立時期に於ての社会文化的流れ及び当時の主要思想と比較することにより、『梵網経』に関する新たな研究方法論の提案を試みた。『梵網経』の戒律を国家の律令及び道教の戒律と比較・対照し、国家と宗教、すなわち、「国家(法律化された倫理)と宗教(仏教・道教の倫理)」の共通点及び相違点について考察し、更に、東アジア仏教というマクロ視点を維持しながらも、梵網経と梵網経の注釈伝統をかけ離し、時代的・地理的な違いも考慮した上での戒律解釈を試みた。 第Ⅱ章では本格的に450年から480年頃まで中国大陸にて一般的に広まっていた幾つかの「共通観念」と「相違点」を述べ、『梵網経』の戒律に含まれた倫理観を考察した。とりわけ中国の律令では「原心定罪」、つまり罪科に対し犯罪動機を中心とした理解をしてきた、という点を考慮したとき、本稿は果たして仏教倫理が単純に「動機」のみによって解釈されてもよいであろうかを問題視したのである。合わせて晋代以降の法律文献では全般的に罪科が血縁的親疎関係である五服によって決まり、不孝者には死刑を下すという価値判断が中国で働いていたという点を確認した。それを踏まえた上、本研究は身分秩序の中で、主人・部曲・奴隷に要求する行為責任の程度、連座制、贖罪という三つの基準に基づき、『梵網経』が成立する前までの社会文化的背景を明かにした。『梵網経』の場合、平等に奴隷の受戒まで許容し、また平等に彼らに道徳的責任を自ら負わせ、そして財物で罪を相殺させないという点は、既存の律令や道教の戒律観とは異なるのである。 一方、死刑制度の運用に関しては、中国大陸と朝鮮半島が互いに異なっていたため、『梵網経』の戒律に対する感受性についても地域的差異が見られると考えられる。また、道教の戒律はその特徴として「種民思想」を強調し、新しい太平の御代に生き残るためには、「孝」のような世俗倫理を重視したという点を述べた。『梵網経』成立前の446年、北魏で法難を起した主人公である道士の寇謙之の『老君音誦誡経』もやはり種民思想と孝を強調し、440年に北魏の太武帝は太平の御代を導くべく年号を「太平真君」に改元した。民衆は種民に選ばれるために、孝行と忠誠を人生のモットーとして内面化させねばならなかったのである。他にも道教の戒律と仏教の戒律では酒と医薬に注目した点、また『梵網経』の戒律に見える教唆行為と呪文の特徴を、律令や道教の理解と合わせて考察した。以上の分析は、たとえ「地域的区別及び感受性の違い」、「常識として広まっていた概念の成層(stratification)に関する分析」、そして「人物」などの要素に対する総合的な考慮も欠かせないと思われるが、最低でも本章の分析結果は、ある特定の文献に対する多面的な意味把握が可能であることをよく示したのであろう。 第Ⅲ章では『梵網経』が第五の重戒として「酤酒戒」、すなわち「酒の販売」を重罪として提示したという点に基き、『梵網経』の戒律が有する社会倫理的特徴を究明した。インド仏教ではすべての出家者の徳目として「酒を飲まないこと」が強調されてきた。また、在家信者が守るべき基本戒律である五戒に於ても、インド仏教を受け継ぎ不飮酒が力説されてきた。仏教におけるこのような戒律史の流れから見ると、『梵網経』の酤酒戒は非常に特色のあるものであると考えられる。本章は酤酒戒の意味をより多くの側面から分析すべく、『梵網経』の成立時期と推定された450─480年の直前である446年に起きた北魏の太武帝の法難に注目した。その理由としては、『魏書』「釈老志」に収録された446年法難の記事では、大規模な醸造器具が寺院で発覚されたことが、太武帝が法難を引き起こした原因の一つであると指摘されたためである。 これに対し、本章は法難の記事を具体的に理解するために、酒が持つ社会経済的意味を示した。秦代の簡牘資料の中に表れた田律をはじめ、漢代の大酺と禁酒令、酒の専売制度である榷酒酤、国家財政、それに北魏の食糧事情と北魏の農業書である『斉民要術』など諸々の情報にしたがい、「経済倫理的」側面から醸造が禁止されてきた社会の様相を遡って検討した。一方、本章は僧侶が医療行為の主な主体であった点に着目し、古代中国の医学について探究した。道教を基盤とした中国の伝統医学では、酒が主な医薬品として使われていたため、患者に治療を行うためには酒が必要不可欠となり、そこで当時の人々が直面した数々の医療倫理にまつわる葛藤を明らかにした。ここで初期道教の戒律における節酒に対する強調も、『梵網経』の酤酒戒と対照になる。以上の考察を通し、『梵網経』の酤酒戒は専ら在家信者だけに当てはまるような戒律であるというよりも、実に僧伽の存立に於て大変重要な項目である可能性が新たに見出された。 第Ⅳ章では『梵網経』をめぐる中国成立説の重要根拠である「孝順」について述べた。本章は『梵網経』よりも成立時期が早いと言われた律令及び道教関係の文献の中で、孝順と不孝五逆などに含まれた意味を考察した。その中でも特に『梵網経』の場合、孝順が「父」・「母」・「師」・「僧」・「三宝」、そして「至道之法」という六つの目的語に対する述語であることに注目し、「孝順」に真理の意味まで含まれるに至った文献の起源を検討した。これにより、『孝経』や『周礼』などの文献に登場した孝順の概念が、直ちに『梵網経』へ反映されたものであるとは判断され難いという点も明かにした。 本研究の意義は、中国で広まっていた「孝順」という概念が「孝の律令化」という社会的な制度運用という側面から、そして世俗倫理である孝を最高の神仙になるための徳目として受け入れた道教という枠組みから取り上げられたことである。『梵網経』が成立する前までは、当時の法律制度と儒教的秩序に則り、不孝者を死刑にするという規律が厳しく適用されていた。他方、初期道教の文献である『太平経』·『抱朴子』に孝と孝順の概念が登場していた。それに「孝順」という概念は道教の「種民思想」の中、すなわち、孝行こそ救いという宗教観の中でも現れていた。本研究はその代表的な文献として3世紀の『女青鬼律』に登場した「孝順」及び「不孝五逆」の概念を論じ、「孝」と「順」にはある種の連語関係(collocational relation)が形成されていることを示した。また、『女青鬼律』の「順」を通し、天地と師匠に服従せよという道教的思惟を確認することができた。北魏に起きた法難の主人公である道士の寇謙之の『老君音誦誡経』には、道教の律令に対する「順従」について力説され、「不孝者は悪人ゆえに死す」と戒めた。北魏の太平真君元年である440年は、このような道教的思想体系が国家体制と結びついた基点となった。国家の律令と道教の戒律という二つの側面から考えた時、450─480年頃に成立した『梵網経』の十重戒の中に「孝順」が入ったことは、もしかすると自然な流れかもしれないとも言えるであろう。 以上、本論文は『梵網経』の成立時期に於ての社会文化的背景の中で、『梵網経』の戒律が持つ意味を多面的に検討してきた。その上で、本論文の成果を踏まえて、『梵網経』の成立及びその注釈家を取り巻く時代的・社会的背景を考慮しながら、その戒律の意味範疇に対する理解をより一層深めることができた。中国で成立したと言われてきた『梵網経』という文献が、東アジア全般にわたり、如何なる倫理的意味として受け入れられたかについての研究を行なう際、本論文の問題意識及び方法論が一助になるよう期待される。Drawing on the historical fact that Brahmā's Net Sutra (梵網經, T1484), which represents the great vehicle bodhisattva precepts in East Asia, was compiled between 450 and 480, this paper takes a multifaceted approach to explore the ethical implications in the precepts of Brahmā's Net Sutra against the backdrop of Chinas state system, legal codes (律令, luling), Confucianism, Taoism, medicine, and agriculture. In particular, this paper examines how the existing Indian Buddhist concepts of liquor, and filial piety and obedience were transformed in China. Chapter I of this paper evaluates existing studies and discusses various approaches in creating and accepting ethical norms. This chapter establishes a new methodology through the research on Brahmā's Net Sutra by examining the overall sociocultural context and comparing the major ideas of the era that the scripture was compiled in. In other words, this paper compares the precepts of Brahmā's Net Sutra with the states legal codes and Taoist precepts and examines the similarities and differences between the state (legalized ethics) and religions (Buddhist and Taoist ethics). Moreover, this study attempts to analyze the precepts by separating Brahmā's Net Sutra from its exegetical tradition, taking into consideration time and geographical differences while maintaining a macroscopic perspective of East Asian Buddhism. Chapter II examines the ethics in the precepts of Brahmā's Net Sutra by presenting a few common concepts and differences existing in the Chinese continent from 450 to 480. This paper questions the focus on "motive" alone in interpreting Buddhist ethics because the Chinese legal codes focused on the offenders motive to determine the severity of a crime. In addition, this study explores how crimes were determined by wufu (五服, the five service system), which shows a degree of kinship, as seen in legal documents dating from the Jin (晉) dynasty onward, and that it was also accepted in China to sentence undutiful humans to death. This study then examines the sociocultural background of the period leading up to the compilation of Brahmā's Net Sutra based on three criteria: the degree of responsibility of masters, the buqu (部曲), and slaves within the class hierarchy; the guilt by association principle; and atonement. Brahmā's Net Sutra differed from existing legal codes or Taoist precepts as it allowed slaves to be ordained, held people to be morally accountable for their behaviors, and did not allow people to redeem their sins with worldly goods. Because the death penalty system was executed differently in the Chinese continent and the Korean peninsula, this paper posits that the reception of the precepts of Brahmā's Net Sutra would have differed by region. This paper also introduces how the Taoist precepts emphasized eschatology (thought of zhongmin, 種民) as its key feature and how secular ethics such as filial piety were valued in order to survive in a new era of peace. Eschatology and filial piety were also emphasized in Laojun yinsong jiejing (老君音誦誡經, Hymnal Rules of Lord Lao) by Kou Qianzhi (寇謙之), the Taoist master who led the persecution of Buddhists in 446 before the establishment of Brahmā's Net Sutra. Emperor Taiwu (太武帝) of the Northern Wei (北魏) dynasty also changed the name of the era to taipingzhenjun (太平眞君) in 440 to herald the new time of peace. In order for people to be selected as the people of the seed, they had to internalize filial piety and fidelity as life principles. In addition, the Taoist and Buddhist precepts attention to liquor and medicine as well as the characteristics of instigation and incantation in the precepts of Brahmā's Net Sutra are examined alongside the understanding of law codes and Taoist ideas. The analysis conducted in Chapter II suggests that the multilayered meanings of a specific book can only be understood with a comprehensive consideration of regional distinctions and sentimental differences, a stratified analysis of what would have been considered as conventional concepts, and the people. Chapter III studies the socio-ethical characteristics of the precepts of Brahmā's Net Sutra based on the fact that the fifth precept (酤酒戒) out of the ten grave precept (十重戒) in the Brahmā's Net Sutra forbids dealing in alcohol. Buddhism in India banned those who entered the Buddhist priesthood from drinking. Furthermore, the Five Precepts, the basic precepts followed by the Buddhist laity, also continuously prescribed people not to drink liquor, starting from Buddhism in India. In the context of Buddhist precept history, the precept forbidding any dealing with alcohol is quite distinctive. To analyze the significance of this precept, this paper focuses on the Buddhist persecution, which took place in 446 during the reign of Emperor Taiwu of the Northern Wei dynasty, just before the Brahmā's Net Sutra is said to have been compiled from 450 to 480. According to an article on the persecution found in Weishu Shilaozhi (魏書 釋老志), one of the reasons Emperor Taiwu began persecuting Buddhists was the discovery of a large-scale brewing pot in a temple. Accordingly, this paper presents the socio-economic meaning of liquor to examine an article on Buddhist persecution in detail. It traces the societies that prohibited brewing for economic and ethical reasons based on the tianlu (田律) among records written on excavated bamboo and wooden slips from the Qin (秦) dynasty; the dapu (大酺, carnival), prohibition law, quejiugu (榷酒酤, monopoly on liquor sales), and state finance of the Han (漢) dynasty; and the food situation in Northern Wei and Qiminyaoshu (齊民要術) — the book on agriculture written during the Northern Wei dynasty. Drawing from the fact that monks were the main practitioners of medicine, this paper also turns to ancient Chinese medicine. Liquor was used as a key medicinal ingredient in Chinese traditional medicine, which was based on Taoist beliefs, so this study sheds light on the medical and ethical dilemma of requiring alcohol to treat patients. The emphasis on abstinence in early Taoist precepts is also compared with the precept forbidding any dealing with alcohol in Brahmā's Net Sutra. Through such discussions, this study newly demonstrates that the Brahmā's Net Sutra precept of forbidding dealing in alcohol is not limited to laities but may have also been an important precept necessary for the existence of the community of monks and nuns (saṃgha, 僧伽). Chapter IV examines the notion of filial piety and obedience(孝順), which form the key rationale of the foundation of China in Brahmā's Net Sutra. This paper traces the implications of filial piety and obedience and the unfilial conduct and the five heinous crimes(不孝五逆) in legal codes and Taoist texts that date back to earlier than Brahmā's Net Sutra. Focusing on the fact that filial piety and obedience in Brahmā's Net Sutra are used to predicate the following six types of objects — father, mother, mentor, monk, the three treasures (the Buddha, the Dharma, and the Saṃgha), and the Dharma as the ultimate truth — this paper analyzes historical documents to identify how filial piety and obedience came to incorporate the ultimate truth. The analysis in this chapter concludes that it would be incorrect to assume that the concepts of filial piety and obedience found in Brahmā's Net Sutra were directly derived from books such as Xiaojing(孝經) or Zhouli (周禮). This study is significant in that it analyzes filial piety and obedience, common concepts in China, with regards to the social system that codified filial piety. It also sheds light on the Taoist framework that accepted the secular ethics of filial piety as the highest virtue required to become a Taoist hermit with miraculous powers. Within the legal system and Confucian order that existed before the Brahmā's Net Sutra was compiled, a strong law that sentenced undutiful children to death was in place. The notion of filial piety and obedience can also be found in early Taoist texts such as Taipingjing (太平經) and Paopuzi (抱朴子). Furthermore, this notion can also be spotted in Taoist eschatology, which states that one should be loyal to ones parents for salvation. By analyzing the concepts of filial piety and obedience and unfilial conduct and the five heinous crimes found in Nuqingguilu(女靑鬼律) written in the third century, this paper thereby reveals that filial piety and obedience formed a type of collocational relation. In addition, the concept of obedience in Nüqingguilü also displayed the Taoist idea of obeying heaven and earth and ones master. Laojun yinsong jiejing by Kou Qianzhi, the Taoist master who led the Buddhist persecution during the Northern Wei dynasty, also asserted the importance of obeying Taoist precepts and warned that unfilial people would meet death as they are evil. 440, which was the first year of taipingzhenjun during the Northern Wei dynasty, was the starting point for such Taoist ideas to be integrated with the state system. Considering state legal codes and Taoist precepts, it was, in a way, quite natural that the concepts of filial piety and obedience were interpolated in Brahmā's Net Sutra, which is estimated to have been compiled from 450 to 480. Also taking into account the history of the concepts of filial piety and obedience, it was natural for these two concepts in Brahmā's Net Sutra to include the notions of the master and the ultimate truth. In conclusion, this paper examines from a multilateral perspective the significance of the precepts of Brahmā's Net Sutra within its sociocultural background at the time of its compilation. The semantic categories of the precepts should now be studied in consideration of the historical and social contexts surrounding the compilation of the Brahmā's Net Sutra and its commentators. The questions raised and methods presented in this study will contribute to analyzing how the ethical implications of the Brahmā's Net Sutra, which was established in China, had been perceived across East Asia.본 논문에서는 동아시아 대승보살계를 대표하는 『범망경(梵網經)』(T1484)이 450년에서 480년 사이에 성립되었다는 역사성에 착목하여, 중국의 국가 제도와 율령, 유학 사상, 도교, 의학, 농학 등의 총체적인 배경 속에서 『범망경』 계율의 윤리적 함의를 다면적으로 탐색한다. 특히 술[酒]과 효순(孝順)에 대해서 기존 인도불교의 개념이 중국에서 어떻게 변용되었는지를 규명한다. 제Ⅰ장에서는 기존 연구를 분석하며 윤리 규범의 생성과 수용에 대한 다양한 접근 방법을 논구한다. 본장에서는 해당 경전의 성립 시기 전반의 사회문화적 맥락 및 주요 사상 간의 비교를 통한 새로운 『범망경』 연구방법론을 정립한다. 『범망경』의 계율을 국가의 율령 및 도교의 계율과 비교·대조하며 국가와 종교, 즉 국가(법률화된 윤리)와 종교(불교 및 도교의 윤리)의 공통점과 차이점을 고찰하는 것이다. 또한 동아시아 불교라는 거시적 관점은 유지하면서도 『범망경』과 『범망경』의 주석 전통을 분리하고 시대적·지리적 차이 역시도 고려하며 계율을 해석하고자 한다. 제Ⅱ장에서는 본격적으로 450-480년경까지 중국대륙에 유통되던 몇 가지 공통관념 및 차이점을 제시하여 『범망경』 계율의 윤리관을 고찰한다. 특히 중국의 율령에서는 원심정죄(原心定罪), 즉 범죄자의 동기를 중심으로 죄과를 이해해왔다는 점에서, 본고는 불교 윤리를 단순히 동기만으로 해석하는 것에 문제를 제기한다. 또한 진대(晉代) 이후 법률 문헌 전반에서 혈연적 친소 관계인 오복(五服)에 의해 죄과가 정해졌으며, 불효(不孝)한 경우 사형을 내리는 가치판단이 중국에서 작동되었음을 살펴보았다. 이후 본 연구는 신분 질서 속에서 주인·부곡(部曲)·노예에 대한 행위 책임의 요구 정도, 연좌제, 속죄(贖罪)라는 세 가지 기준을 바탕으로 『범망경』 성립 이전까지의 사회문화적 배경을 연구한다. 『범망경』은 노예까지도 평등하게 수계(受戒)를 허용하고, 도덕적 책임을 자기가 지도록 하며, 재물로 죄값을 상쇄시킬 수 없게 한다는 점에서 기존 율령이나 도교의 계율관과는 상이한 지점이 있다. 한편 중국대륙과 한반도의 사형제도의 운용이 달랐기에, 『범망경』 계율에 대한 감수성 역시 지역적으로 차이가 있었을 것으로 본고는 추정한다. 또한 도교 계율이 지니는 특성으로 종민사상[種民]을 강조하고, 새로운 태평성대에 생존하기 위해서는 효(孝)와 같은 세속윤리가 중시되었음을 소개하였다. 『범망경』 성립 이전의 446년 법난의 주역인 도사 구겸지의 『노군음송계경』에서도 종민사상과 효는 강조되고 있었으며, 북위의 태무제는 440년 태평성대를 이끄는 태평진군(太平眞君)으로 연호를 개칭한다. 백성들은 종민(種民)으로 선발되기 위해서 효도와 충성을 삶의 원리로 내재화해야 했다. 이외에도 도교계율과 불교계율이 술[酒]과 의약에 관해 주목했던 점, 『범망경』 계율에서의 교사(敎唆) 행위와 주문의 특성을 율령이나 도교의 이해와 함께 살펴보았다. 이러한 제Ⅱ장의 분석은, 지역적 구분 및 감수성의 차이, 상식으로 유통되었을 개념들의 성층(成層, stratification) 분석, 그리고 인물 등을 종합적으로 고려해야지만, 특정 문헌의 다면적인 의미를 파악할 수 있음을 잘 보여준다. 제Ⅲ장에서는 『범망경』이 제5번째 중계로 고주계(酤酒戒) 즉, 술의 판매를 중죄로 제시하고 있다는 점에 바탕을 두고 『범망경』 계율의 사회윤리적 특성을 연구한다. 인도불교에서는 모두 출가자의 덕목으로 술을 마시지 말 것[不飮酒]을 강조해왔다. 또한 재가 신도가 지키는 기본 계율인 오계(五戒) 역시도 원래 인도불교에서부터 계속 불음주를 역설해왔다. 이러한 불교계율사의 맥락에서 보았을 때, 『범망경』의 고주계는 매우 특색있는 것이다. 본고는 고주계의 의미를 다면적으로 분석하기 위하여 『범망경』 성립 시기로 추정되는 450-480년의 직전인 446년 북위(北魏) 태무제의 법난(法難)에 주목한다. 『위서(魏書)』「석로지(釋老志)」의 법난(法難) 기사에서는, 사찰에서 대규모 양조(釀造) 기구의 발각이 태무제가 법난을 일으키는 원인 중 하나로 지목되었기 때문이다. 이에 본장에서는 법난 기사를 구체적으로 조망하기 위하여 술의 사회경제적 의미를 제시한다. 진대(秦代)의 간독(簡牘) 자료 중 전율(田律)을 비롯하여, 한대(漢代)의 대포(大酺)와 금주령, 술 전매제도[榷酒酤], 국가재정, 그리고 북위(北魏)의 식량 사정 및 북위 농업서인 『제민요술(齊民要術)』 등을 바탕으로, 경제 윤리적 측면에서 양조를 금지해온 사회양상을 추적하였다. 한편 승려가 의료행위의 주요 주체였던 점에 착목하여 본고는 고대 중국의 의학을 살핀다. 도교를 바탕으로 하는 중국 전통의학에서 술이 주요 의약품으로 사용되었기에, 환자 치유를 위해서는 술이 필요하던 의료윤리적 갈등을 밝힌다. 초기 도교 계율에서의 절주(節酒) 강조도 『범망경』의 고주계와 대조한다. 이상의 논의를 통해 『범망경』 고주계를 재가신도만을 위한 계율 조목으로 볼 수 없으며, 승가(僧伽)의 존립에도 중요한 조항일 가능성을 새롭게 규명하였다. 제Ⅳ장에서는 『범망경』의 중국성립설의 핵심 근거인 효순에 대해 살폈다. 본고는 『범망경』보다도 그 성립 시기가 이른 율령 및 도교 문헌들 속에서 효순과 불효오역(不孝五逆) 등의 함의를 추적하였다. 본 논문은 『범망경』의 효순이 부(父)·모(母)·사(師)·승(僧)·삼보(三寶) 그리고 지극한 도인 법[至道之法]이라는 여섯 가지 목적어에 대한 서술어임에 주목하며, 효순이 진리까지 포함하게 된 문헌적 연원을 검토한다. 본장의 내용을 통해 이제는 『효경』이나 『주례』라는 문헌으로부터 효순 개념이 곧바로 『범망경』에 반영된 것이라 간주할 수 없다는 점도 규명하였다. 본 연구의 의의는 중국에서 유통되던 효순 개념이 사실 효의 율령화라는 사회적 제도 운용 속에서, 그리고 세속윤리인 효를 최고의 신선이 되는 덕목으로 수용한 도교라는 틀 속에서 조망하였다는 점에서 찾을 수 있다. 『범망경』 성립 이전까지의 법률제도와 유교적 질서 속에서는, 불효자를 사형시키는 강력한 규율이 작동하고 있었다. 또한 초기 도교의 문헌들인 『태평경』·『포박자』에서 효와 효순 개념이 등장한다. 더 나아가 효순 개념은 도교의 종민(種民) 사상 속에서 효도를 해야만 구원받을 수 있다는 종교관 속에서도 드러난다. 이에 대표적으로 본고는 3세기의 『여청귀율(女靑鬼律)』에 나오는 효순 및 불효오역(不孝五逆) 개념을 논구하여, 효와 순(順)이 일종의 연어 관계(collocational relation)를 형성함을 드러내었다. 또한 『여청귀율』의 순(順) 개념을 통해 천지와 스승에 순종하라는 도교의 사유를 확보할 수 있다. 그리고 북위 법난의 주역인 도사 구겸지의 『노군음송계경(老君音誦誡經)』에서 역시, 도교의 율령에 순종[順]할 것을 역설하며, 효성스럽지 않은[不孝] 사람은 악인(惡人)이기에 죽을 것이라 경고한다. 북위 태평진군 원년인 440년은 이와 같은 도교적인 사상체계가 국가 체제와 접목되었던 기점이었다. 국가의 율령과 도교 계율이라는 두 가지 측면에서 조망할 때, 450-480년경에 성립되었을 『범망경』의 십중계(十重戒) 속에 효순이 내삽된 것은 어쩌면 너무도 자연스러운 일이었던 것이다. 이상을 통해 본고는 『범망경』 성립 시기의 사회문화적 배경 속에서 『범망경』 계율의 의미를 다면적으로 검토할 수 있었다. 이제는 『범망경』의 성립과 주석가들을 둘러싼 시대적·사회적 배경을 고려하며 계율 규범의 의미 범주를 다층적으로 파악해야만 한다. 본고의 문제의식과 방법론은, 『범망경』이라고 하는 중국 성립 문헌이 동아시아 전반에서 어떠한 윤리적 의미로 수용되었을지를 분석하는 데에 일조할 수 있을 것이다.Ⅰ. 서론: 『범망경』 계율의 구조와 그 의미 1 1. 동아시아에서 전개된 『범망경』 및 그 주석 문헌의 특징 1 1) 『범망경』과 그 주석 문헌의 역사적 고찰 12 2) 『범망경』 계율 연구의 재검토 18 2. 규범의 생성과 수용에 대한 다양한 접근 방법 23 Ⅱ. 『범망경』 성립 당시의 사회문화적 배경 31 1. 『범망경』의 동기주의적 해석에 대한 비판 33 2. 『범망경』의 평등하면서도 엄격한 윤리관 37 1) 율령에서 노정되는 인간관 39 2) 계급·속죄·연좌에 관한 『범망경』 계율과 도교의 윤리관 47 3) 사형제도로 접근한 『범망경』 계율의 수용 기반 54 3. 『범망경』 성립 당시 존재한 도교 계율의 특징 57 1) 도교 계율의 개념에 대하여 57 2) 도교 경전에서의 종말사상: 효 윤리의 강조를 중심으로 58 3) 불교와 도교계율에서의 술과 의약에 관한 조항 66 4. 『범망경』 계율에서의 교사(敎唆)와 주문(呪文)의 성격 69 5. 소결 75 Ⅲ. 『범망경』 고주계(酤酒戒)의 새로운 이해 79 1. 『범망경』 성립 이전의 금주(禁酒) 관련 규범 91 2. 술의 사회경제 문화적 의미 93 1) 강력한 통치수단이자 경제수단이었던 술 93 2) 의약품의 일종이었던 술 105 3. 도교 계율에서의 절주[不醉, 減酒] 115 4. 『범망경』 경문에서의 고주계와 음주계의 차이: 전도심(顚倒心) 122 5. 주석가들의 사회적 배경(6C 후반-8C 중반)에서 살펴본 고주계 127 1) 중국 대륙 주석가들의 경우 127 (1) 중국 대륙의 주세 제도의 폐지(583-761년) 127 (2) 『당육전』 상식료(常食料)의 술(739년 이후) 129 2) 신라의 경우 130 (1) 신라의 최초 대포령(大酺令, 615년) 130 (2) 나당연합군 이후 당 군진의학의 전래(7C 중반 이후) 133 6. 북위 농업기술서 『제민요술(齊民要術)』과의 비교 분석 135 7. 소결: 『범망경』 고주계에 대한 재해석 139 Ⅳ. 『범망경』 효순(孝順) 개념의 재검토 143 1. 효순에 관한 선행 연구 143 2. 『범망경』 성립 당시의 법률제도와 유교적 질서 153 3. 『범망경』 성립 이전 도교(道敎) 문헌의 효순 159 1) 『태평경(太平經)』·『포박자(抱朴子)』의 경우 159 2) 『여청귀율(女靑鬼律)』의 경우 166 (1) 『여청귀율』에서의 효순 개념 166 (2) 『여청귀율』에서의 오역(五逆)과 불효오역(不孝五逆) 171 (3) 『여청귀율』과 『범망경』에서의 귀신 개념의 차이 176 3) 『노군음송계경(老君音誦誡經)』의 율령대로 행하라[行如律令] 178 4) 가족에서 종교 공동체, 그리고 진리에 대한 효순으로 181 4. 효순과 관련해서 착목할 지점들: 『범망경』의 주석가들 183 5. 소결 186 Ⅵ. 결론 191 참고문헌 196 Abstract 218 和文抄錄 224박

J. S. Bach, Prelude and Fugue in a minor, BWV 889, J. S. Bach - E. Petri, "Sheep May Safely Graze", BWV 208, R. Schumann, Fantasiestücke, Op. 12, J. Brahms, Klavierstücke, Op. 117, R. Muczynski, Masks, Op. 40의 연주 및 연구

학위논문(석사)--서울대학교 대학원 :음악대학 음악과,2019. 8. 문익주.본 논문은 본인의 석사과정 졸업연주 프로그램인 J. S. Bach, , J. S. Bach - E. Petri, , R. Schumann, , J. Brahms, 그리고 R. Muczynski, 에 대한 연구이다. 필자는 이 논문을 통해 총 다섯 곡의 작곡 배경을 탐구하고 각 곡의 구조와 특징을 분석함으로써 이 곡들을 올바로 이해하고자 한다. 첫째로 바흐(Johann Sebastian Bach, 1685-1750)의 은 평균율에 근거하여 24개의 조성으로 작곡된 것이며, 그 중 논문에서 논의될 의 전주곡은 반음계적인 동기를 가지고 대위적으로 엄격하게 작곡된 2성 곡이다. 한편 이 곡의 푸가에서는 동기의 단편들을 탄탄하게 짜나가며 극적인 전개를 이루어내는 바흐의 작곡기법이 여실히 나타난다. 둘째로 은 바흐가 작곡한 칸타타 의 소프라노 아리아이며, 페트리(Egon Petri, 1881-1962)에 의해 피아노곡으로 편곡되었다. 페트리는 부조니(Ferruccio Busoni, 1866-1924)에게 큰 영향을 받아 바흐의 작품들에 크게 관심을 가지게 된 작곡가이다. 이 곡은 페트리에 의해 편곡되기는 했지만 원곡의 구조와 화성 진행 등이 아주 잘 보존되어 있다. 셋째로 슈만(Robert Schumann, 1810-1856)의 는 그의 성격소품이며, 이것은 그를 대표하는 음악 장르중 하나이다. 이 곡은 총 8개의 소품으로 구성되어있고, 그의 문학에 대한 관심과 음악적인 상상력이 매우 잘 나타난다. 각 소품들은 연결되지 않는 개별적인 곡이면서도 서로 음악적 재료들을 공유하는 하나의 유기적인 작품이기도 하다. 넷째로 브람스(Johannes Brahms, 1833-1897)는 고전주의적인 성향을 나타내는 작곡가이며, 그의 견고한 작곡기법은 그의 성격소품에서도 잘 나타난다. 이 논문에서 논의될 은 3개의 간주곡으로 구성되어 있고, 각 곡은 곡의 성격을 나타내는 표제가 없으며, 섬세한 작곡기법을 통해 음악 자체가 이 곡의 특정한 감정들을 전달한다. 마지막으로 무진스키(Robert Muczynski, 1929-2010)는 를 통해 그의 다양한 음악적 기법을 보여준다. 그는 리듬의 변화와 그들의 조합을 통해 다양한 리듬감을 만들어내고, 다양한 음정의 구성을 통해 현대적인 음색을 만들어내어 괴기스럽고 전위적인 분위기를 만들어냈다.This study is about researchers graduation performance programs: J. S. Bach, , J. S. Bach - E. Petri, , , , . This study reviews the background of composition of these four pieces and analyzes their structures and characteristics to help them understood correctly. Bach's is a piece composed of 24 keys based on the equal temperament, and the prelude among his is a contrapuntally and strictly composed piece with a chromatic motif. On the other hand, the fugue shows his compositional techniques that make diverse and dramatic developments only with the fragments of the short motifs. Bachs was a soprano Aria of his cantata, , and it would be arranged by Petri for a piano music. Due to Ferruccio Busonis influence, Petri was much interested in Bachs works. Although this work is an arranged version, the original piece has been well preserved in terms of structure and harmonic progression. Schumanns is one of his character pieces, and it is his representative music genre. This work consists of 8 pieces in total, and it shows composers interest in literature and his musical imagination well. The 8 pieces are individual works, and at the same time, they are parts of a whole work since they have common materials among them. Brahms is a composer, showing some classical tendency. His solid compositional techniques are well shown in his character pieces, although their scales are comparatively smaller than other works. His is a short piece consisting of 3 Intermezzis, and the three pieces don't have titles that represent characters of them. The specific emotions are delivered by the music itself through his delicate compositional techniques. R. Muczynski shows his diverse musical techniques through his . He made diverse rhythms through changes and combinations of them, and he created an avant garde and bizarre atmosphere with modern tones through diverse organizations of notes.Ⅰ. 서론-----------------------------------------------------01 Ⅱ. 본론-----------------------------------------------------02 1. J. S. Bach, Prelude and Fugue No. 20 in a minor, BWV 889 1.1 작품배경------------------------------------------------02 1.2 작품연구------------------------------------------------03 2. J. S. Bach - E. Petri, "Sheep May Safely Graze", BWV 208 2.1 작품배경------------------------------------------------08 2.2 작품연구------------------------------------------------09 3. R. Schumann, Fantasiestücke, Op. 12 3.1 작품배경------------------------------------------------11 3.2 작품연구------------------------------------------------12 4. J. Brahms, Klavierstücke, Op. 117 4.1 작품배경------------------------------------------------35 4.2 작품연구------------------------------------------------36 5. R. Muczynski, Masks, Op. 40 5.1 작품배경------------------------------------------------46 5.2 작품연구------------------------------------------------47 Ⅲ. 결론-----------------------------------------------------53 참고문헌-----------------------------------------------------54 Abstract-----------------------------------------------------56Maste

Hybrid surgery versus percutaneous mechanical thrombectomy for the thrombosed hemodialysis autogenous arteriovenous fistulas

PURPOSE : For the successful treatment of thrombosed autogenous arteriovenous fistula (AVF), we designed and performed a hybrid surgery. Its clinical outcomes were compared with those of percutaneous mechanical thrombectomy, retrospectively. METHODS : Forty cases of thrombosed autogenous AVFs underwent hybrid surgery, whereas 19 cases received percutaneous mechanical thrombectomy. Hybrid surgery consisted of surgical thrombectomy, balloon angioplasty and/or additional surgical angioplasty. Percutaneous mechanical thrombectomy included catheter-introduced thrombus aspiration, balloon angioplasty and/or stenting. Procedure related outcomes such as technical success rates and primary patency rates were analyzed, retrospectively. RESULTS : There were no statistically significant differences between the two groups in terms of demographic data of the patients including age, gender, diabetes status, and frequency of antiplatelet use, as well as the characteristics of thrombosed autogenous AVFs such as access age, site, type, and length of time between thrombosis and AVF creation (P > 0.05). Technical success rates (92.5% vs. 68.4%, P = 0.005, respectively) and primary patency rates (85.9% vs. 36.8% at 6 months, 81.1% vs. 26.3% at 12 months, 81.1% vs.21.1% at 18 and 24 months respectively, log-rank test, (P < 0.001) were significantly higher in the hybrid surgery group. In terms of cost analysis, supply cost was not different (P = 0.065), but total cost was statistically lower in the hybrid surgery group (P = 0.019). CONCLUSION : Hybrid surgery showed better technical success rates and patency rates in the salvaging of thrombosed autogenous AVFs than in percutaneous mechanical thrombectomy.ope

Cardiac Dysfunction in Association with Increased Inflammatory Markers in Primary Aldosteronism

Background : Oxidative stress in primary aldosteronism (PA) is thought to worsen aldosterone-induced damage by activating proinflammatory processes. Therefore, we investigated whether inflammatory markers associated with oxidative stress is increased with negative impacts on heart function as evaluated by echocardiography in patients with PA. Methods : Thirty-two subjects (mean age, 50.3±11.0 years; 14 males, 18 females) whose aldosterone-renin ratio was more than 30 among patients who visited Severance Hospital since 2010 were enrolled. Interleukin-1β (IL-1β), IL-6, IL-8, monocyte chemoattractant protein 1, tumor necrosis factor α (TNF-α), and matrix metalloproteinase 2 (MMP-2), and MMP-9 were measured. All patients underwent adrenal venous sampling with complete access to both adrenal veins. Results : Only MMP-2 level was significantly higher in the aldosterone-producing adenoma (APA) group than in the bilateral adrenal hyperplasia (BAH). Patients with APA had significantly higher left ventricular (LV) mass and A velocity, compared to those with BAH. IL-1β was positively correlated with left atrial volume index. Both TNF-α and MMP-2 also had positive linear correlation with A velocity. Furthermore, MMP-9 showed a positive correlation with LV mass, whereas it was negatively correlated with LV end-systolic diameter. Conclusion : These results suggest the possibility that some of inflammatory markers related to oxidative stress may be involved in developing diastolic dysfunction accompanied by LV hypertrophy in PA. Further investigations are needed to clarify the role of oxidative stress in the course of cardiac remodeling.ope

Incidence and risk factors of recurrence after endovascular treatment of intracranial vertebrobasilar dissecting aneurysms.

BACKGROUND AND PURPOSE: The incidence and risk factors for recurrence after endovascular treatment of intracranial vertebrobasilar dissecting aneurysms (VBDAs) have not been studied. We aimed to evaluate the incidence and risk factors for recurrence after endovascular treatment of VBDAs. METHODS: A total of 111 patients (mean age, 45±10 years) underwent endovascular treatment for 119 VBDAs (ruptured/unruptured=73:46). Incidence and risk factors for recurrence were retrospectively evaluated. RESULTS: Sixty-two VBDAs were treated by a reconstructive technique by using 1 to 3 overlapping stents with or without coiling, and 57 VBDAs were treated by a deconstructive technique by using proximal occlusion or internal trapping at the dissected segment of the parent artery. Follow-up angiography was available for 97 VBDAs (81.5%) in 89 patients at 3 days to 48 months (median, 13 months) after treatment. There were 13 recurrences: 6 had rebleeding but 7 had no rebleeding. All 6 hemorrhagic recurrences had initially presented with a ruptured form. Ten recurrences were confirmed by angiography, but 3 recurrences with rebleeding did not receive follow-up angiography. The rate of post-treatment recurrence did not differ between reconstructive and deconstructive treatments. Involvement of the posterior inferior cerebellar artery origin (odds ratio=8.026; 95% confidence interval, 1.561 to 41.259; P=0.013) was the only independent risk factor for recurrence. CONCLUSIONS: There was a 13% recurrence after endovascular treatment of VBDAs. Posterior inferior cerebellar artery origin involvement was the only independent risk factor for recurrence after endovascular treatment of VBDAs.ope

Sonographically guided core needle biopsy of cervical lymphadenopathy in patients without known malignancy

OBJECTIVE: The purpose of this study was to retrospectively evaluate the efficacy of sonographically guided core needle biopsy (core biopsy) for diagnosing the causes of cervical lymphadenopathy in patients without known malignancy. METHODS: One hundred fifty-five sonographically guided core biopsies performed in 155 patients with cervical lymphadenopathy were retrospectively evaluated. None of the 155 patients had any known primary malignancy. Final diagnoses were determined by the histologic examination from excision biopsy when performed or by the clinical and sonographic follow-up for more than 12 months. When a lymph node diagnosed as benign by sonographically guided core biopsy regressed spontaneously or by subsequent management, the diagnosis made by the sonographically guided core biopsy was considered correct. When a lymph node diagnosed as benign by sonographically guided core biopsy was unchanged or increased in size with subsequent management, excision biopsy was performed. Diagnostic yield, sensitivity, specificity, accuracy, and complications of core biopsy were evaluated. RESULTS: Histologic diagnosis could be made by sonographically guided core biopsy in 146 (94%) of the 155 patients. The histologic diagnoses were reactive hyperplasia in 44 patients, tuberculosis in 37, Kikuchi disease in 25, metastasis in 16, lymphoma in 16, normal in 7, and toxoplasmosis in 1. Sensitivity, specificity, and accuracy of sonographically guided core biopsy were 97.9%, 99.1%, and 97.9%, respectively. There were no procedure-related complications. CONCLUSIONS: Sonographically guided core biopsy is a safe and efficient tool for diagnosing the cause of cervical lymphadenopathy in patients without known malignancy and may obviate unnecessary excisional biopsy.ope

Endovascular coil embolization of aneurysms with a branch incorporated into the sac

BACKGROUND AND PURPOSE: Because of the concern for occlusion of the incorporated branch artery, an aneurysm with a branch incorporated into the sac has been regarded as a contraindication for coiling. The aim of this study is to evaluate the feasibility, techniques, and clinical and angiographic outcomes of coiling for aneurysms with a branch incorporated into the sac. MATERIALS AND METHODS: The medical records and radiologic studies of 69 patients with 79 aneurysms having a branch incorporated into the sac (26 ruptured, 53 unruptured) were retrospectively reviewed and evaluated. RESULTS: Coiling was accomplished in 78 aneurysms in 68 patients but was suspended in 1 due to incorporated branch occlusion. The aneurysms were treated by using the following techniques: single-catheter (n = 37), multicatheter (n = 22), balloon-remodeling (n = 7), stent-assisted coiling (n = 6), and combined (n = 7). Postembolization angiography revealed the following: near-complete occlusion in 71 (89.8%), remnant neck in 4 (5.1%), and incomplete occlusion in 4 (5.1%) aneurysms. Procedure-related permanent morbidity and mortality rates were 5.8% (4/69) and 0%, respectively. All patients with unruptured aneurysms had a modified Rankin Scale (mRS) score of 0, except for 1 patient who had an mRS score of 3. Of the 26 patients with ruptured aneurysms, 18 had favorable outcome (mRS 0-2) but 8 had poor outcome (mRS 3-6). Follow-up angiography was available at least once at 6-50 months (mean, 15 months) in 55 aneurysms (69.6%), of which 45 showed stable or improved occlusion; 4, minor recurrences; and 6, major recurrences. All 6 major recurrent aneurysms were retreated without complication by using a single-catheter (n = 1), multicatheter (n = 2), or balloon-assisted technique (n = 3). CONCLUSIONS: With appropriate techniques, most aneurysms with a branch incorporated into the sac could be safely treated by coiling, with acceptable outcomes.ope

Emergent self-expanding stent placement for acute intracranial or extracranial internal carotid artery dissection with significant hemodynamic insufficiency.

BACKGROUND AND PURPOSE: ICAD with hemodynamic insufficiency may present with either fulminant infarct or with progressive neurologic deterioration. The purpose of this study was to evaluate the safety and efficacy of emergent self-expanding stent placement for acute intracranial or extracranial ICAD with significant hemodynamic insufficiency. MATERIALS AND METHODS: Eight patients (7 men and 1 woman; age range, 20-55 years; NIHSS score, 5-21) underwent emergent self-expanding stent placement for treatment of significant hemodynamic insufficiency due to acute ICAD. The safety and efficacy of emergent self-expanding stent placement were retrospectively evaluated. RESULTS: All patients presented with progressive (n = 6) or fluctuating (n = 2) neurologic deficits and revealed markedly decreased perfusion on CT or MR perfusion studies. Conventional angiography revealed acute occlusion (n = 2) or critical stenosis (n = 6) in intracranial (n = 3) or extracranial (n = 5) carotid arteries with a lack of sufficient collaterals. Stent placement was successful in all patients without any procedure-related complications. In all patients, hemodynamic insufficiency was corrected immediately after stent placement, and neurologic symptoms were completely resolved during several days. Mean improvement of the NIHSS score between baseline and discharge was 11.6 (range, 5-21). All patients remained neurologically intact (mRS, 0) during clinical follow-up for a mean of 21 months (range, 8-50 months). Angiographic follow-up was available for 6 patients at 3-12 months. None of the 6 patients revealed residual or in-stent restenosis. CONCLUSIONS: Self-expanding stent placement is a safe and effective option for selected patients with significant hemodynamic insufficiency due to acute intracranial or extracranial ICAD.ope

Early Detection of Hemodialysis Arteriovenous Fistula Dysfunction with Intra-access Static and Total Pressure Measurement

Purpose: To detect the dysfunction of arteriovenous fistula (AVF) early, we have developed a new method to calculate the intra-vascular conduit flow rate based on the Bernoulli`s theory. However, this method has limitation on detection of inflow stenosis. For detection of both in- and out-flow stenosis, we tried to measure intra-access static (pS) and total pressure (pT), and compared with angiographic findings. Methods: From a total of 46 cases of native AVFs, of at least 3 months of construction, intra-access pS and pT were measured, before starting hemodialysis. Δp (pT-pS) and pT/mean arterial pressure (MAP) ratio were calculated, and compared with angiographic findings. Results: Among 37 patients without outflow stenosis (Vs) in fistulogram, 10 patients with inflow stenosis (As) had significantly lower pT/MAP ratio and Δp than those without As patients (p<0.005). Among 34 patients without As, Δp was significantly lower in 7 patients with Vs than those 27 patients without Vs (p=0.001). Conclusion: pT/MAP ratio was correlated with As, and Δp reflects Vs in angiography. The measurement of pS and pT might be useful to predict inflow and outflow stenosis of AVFs.ope