CT소견 및 임상 지표와의 비교연구

The purpose of this study is to evaluate CT findings of febrile urinary tract infection(UTI) in children and to assess the correlation between CT findings and clinical parameters. Thirty children who had been diagnosed as febrile UTI were studied with enhanced CT(N=30) and follow-up CT(N=12). CT finding were classified into three groups(groupⅠ: no renal parenchymal lesion, group Ⅱ: multiple renal parenchymal lesions, and group Ⅲ: multiple renal parenchymal lesions with abscess formation) and six subgroup(subgroup A: 5 lesion, subgroup B: 6-10 lesion, subgroup: C 11lesions). CT findings were retrospectively compared with the five clinical parameters and development of the renal scar on follow-up CT. The results were as follows: 1. CT demonstrated linear and wedge shaped hypoenhancing renal parenchymal lesions in 35 kidneys of 25 patients and normal finding in five patients. Group Ⅰ(N=5), groupⅡ(N=18) and group Ⅲ(N=7). And subgruop ⅡA(N=8), ⅡB(N=7), ⅡC(N=3), ⅢA(N=4), ⅢB(N=3). 2. The group Ⅰ,Ⅱ and Ⅲ correlated with part of clinical parameters(maximal body temperature, post-antibiotic fever duration, admission period), while, the subgroups(ⅡA-ⅢB) demonstrated no significant correlation with any clinical parameter. 3. Renal cortical scars detected on follow-up CT scan were more prevalent in group ⅢA and ⅢB rather ⅡA, ⅡB and ⅡC. In conclusion, clinical parameters correlate wite the presence of renal parenchymal hypoenhancing lesions and abscess formation on CT scan rather than the number of the renal parenchymal lesions. Renal cortical scars were more prevalent in the patients who had abscess formation. So, enhanced CT is useful in diagnosing and predicting the clinical course of febrile UTI in children.;본 연구에서는 소아의 발열성 요로감염에 대한 CT(Computed Tomography) 소견을 평가하고 임상 지표와의 연관성을 분석하고자 하였다. 발열성 요로감염으로 진단된 소아중 CT를 시행하였던 30명을 대상으로 하였고, 이 중 12명에서는 추적 CT를 시행하였다. 조영증강 CT에서 신실질내 병변의 유무 및 특성(농양형성 여부)에 따라 세 군(Ⅰ군; 신실내에 병변이 없는 경우, Ⅱ군; 신실질내에 조영증강이 저하된 병변이 있는 경우, Ⅲ군; 신실질내의 조영증강이 저하된 병변내에 저음영의 노양형성이 동반된 경우)으로 분류하고, 병변의 파급정도(신실질내의 병변의 개수)에 따라 아군(A아군; 5개이하, B아군; 6-10개, C아군; 11개이상의 신실질내의 병변이 있는 경우)으로 세분하였다. CT분류와 임상 지표(최고 체온, 치료 반응 기간, 백혈구 증가증, 농뇨 및 입원 기간) 및 추후 신반흔 형성을 후향적으로 비교하여 다음과 같은 결과를 얻었다. 1. 발열성 요로감염으로 진단된 30명중 25명의 35신장의 신실질내에서 조영증강이 저하된 부위가 발견되었으며, Ⅰ군은 5예, Ⅱ군은 18예, Ⅲ군은 7예였고, ⅡA는 8예, ⅡB는 7예, ⅡC는 3예, ⅢA는 4예, ⅢB는 3예였다. 2. CT와 임상지표간의 연관성 분석시, Ⅰ,Ⅱ 및 Ⅲ군과 임상 지표중 최고 체온, 치료 반응기간 및 입원 기간은 유의한 상관관계를 보였으나, 아군(ⅡA-ⅢB)과 임상 지표간에는 유의한 상관관계가 없었다. 3. 추적 CT상 신반흔의 형성은 농양 형성군에서 많았고, 같은 군에서는 병변의 파급정도가 심한경우에 많았으며, 이는 통계적으로 유의하였다. 소아의 발열성 요로감염시 CT에서 관찰되는 신실질 병변의 존재유무 및 농양형성이 임상 지표와 상관관계가 있었다. 또한, 농양 형성군과 같은 군에서는 병변의 파급정도가 심한 경우에 추후 신반흔 형성이 많았다. 따라서, CT는 소아의 발열성 요로감염에 대한 진단 및 임상경과의 예측에 유용하다고 생각된다.I. 서론 1 II. 대상 및 방법 3 III. 연구성적 6 IV. 고찰 8 V. 결론 13 참고문헌 15 표 17 사진부도 및 설명 19 ABSTRACT 2

The Study on Alternative Education for Geography applied to Multiple Intelligences Theory

☞ 이 논문은 저자가 원문공개에 동의하지 않은 논문으로, 도서관 내에서만 열람이 가능하며, 인쇄 및 저장은 불가합니다.본 연구는 대안학교의 교육과정과 다중지능이론의 교육적 적용을 통한 교육 개선의 방향에 대해 논의하고자 하였다. 즉 다중지능이론의 교육적 적용으로서 대안학교 교육과정과 지리 관련 대안학교 교수학습활동에 대하여 연구하였다. 또한 기존의 제도권 교육의 문제점에 대한 대안으로서 대안학교와 다중지능이론이 제시하는 교육적인 적용과 교육개선을 위한 실천적 방법을 찾아 보았다. 연구 방법은 대안교육과 대안학교 그리고 다중지능이론에 대한 문헌조사와 대안학교에서의 지리과 교사와 대안학교 관계자와의 면담 및 수업관찰 또는 수업참관 등을 통해 교수학습방법을 조사 분석하였다. 대안학교의 지리관련 교육과정은 지리학의 5대 기본주제를 기준으로 분류하였고 대안학교 지리 교육과정 및 교육활동을 다중지능이론에 적용하여 구체적인 교육 실천방안을 도출하였다. 연구결과 대안학교 지리관련 교육활동은 대체로 특성화교육과정에서의 다양한 체험학습 및 생태·환경 교육과정에서 찾아볼 수 있었고 이러한 지리관련 교육과정은 다중지능이론의 공간적 지능과 신체-운동 지능과 밀접한 관련을 가지고 있었다. 즉 다중지능이론의 교육적 적용과 대안학교 특성화 교과는 학습자들의 다양한 능력과 지능을 존중하고 있으며, 다양한 삶의 양식을 체험하게 함으로써 학습자의 잠재력 개발과 학습자 중심의 열린교육을 실천하고 있다는 점에서 기본적인 취지가 같다. 또한 환경·생태에 관한 교육과정은 인간과 자연의 환경으로서의 장소와 지역, 공간에 대한 연구를 중시하는 지리학의 연구전통과 일치하며 지리교육과 매우 밀접한 관련을 가지고 있다. 한편 대안학교와 다중지능이론에서 추구하는 교육적 방향이 제도권 교육에 시사하는 바는 다음과 같았다. 첫째, 개인 중심의 작은 학교를 들 수 있다. 다중지능이론의 교육적 적용과 대부분의 대안학교에서는 작은 학교를 지향하고 있으며, 이러한 작은 학교 지향은 학생 개개인의 특성과 능력, 개인의 의견을 존중하는 교육과정을 실천하게 한다. 둘째, 학습의 ‘이해(understanding)’를 중시, 기존의 전통적 교육이 객관적 지식, 명제적 지식, 선언적 지식 위주의 실증주의적인 입장에서의 지식의 이해를 중시하였다면, 대안학교와 다중지능이론에서 강조하는 지식의 ‘이해’는 학습자의 적극적인 인지 활동을 통한 방법적, 과정적 지식의 습득을 진정한 ‘이해’로 보고 있다. 셋째, 통합교육과정을 지향한다. 다중지능이론에 의한 교수학습과 대안학교의 교육과정은 통합수업을 지향하는 경향이 있으며, 다중지능이론에서는 주제중심의 통합교육과정을 교육적 개선으로서 제안한다. 본 연구는 제도권 교육의 위기에 대한 교육 개선방향 도출을 위해 대안학교와 다중지능이론의 교육 내용을 살펴보았으며, 연구결과 대안학교의 교육과정은 다중지능이론을 적용한 교수학습과 매우 유사하였다. 따라서 교육개선의 방향으로 일반학교에서 대안학교의 교육과정을 도입하고자 할 경우 다중지능이론을 이용한 교수학습을 적용한다면 교육적 효과가 클 것으로 예상된다. 즉 제도권 교육의 위기에 대한 교육적 개선의 방향으로 대안학교와 다중지능이론의 교육적 적용에서의 일치점이 열린 교육의 실천과 관련된 교육개선을 도모할 수 있을 것이다.;This study paid attention to the aspects of intelligence of traditional education for crisis in institutional education. That is, traditional education regarded human ability(intelligence) simply, and carried out narrow-minded and examination-oriented education, requiring specific ability only. In this regard, this study aims to find practical education improvement for crisis in institutional education and examined educational application of Multiple Intelligences Theory and alternative school curriculum for this purpose. In particular, it examined geography related education of alternative school. As a result, it found out that alternative school(specialize school) can organize diverse curriculum through specialize subject and most specialize subjects put emphasis on know how·procedural knowledge, rather than objective·declarative knowledge, the knowledge of subject matter which has been emphasized in existing institutional education. Such knowledge prospect of alternative school takes a serious view of understanding that can apply and generalize knowledge in new situation, rather than satisfying with simple understanding of knowledge. Accordingly, it is closely related to 'Teaching for Understanding' of multiple intelligence. Multiple Intelligences Theory emphasizes diverse educational application of intelligences rather than logical and language-oriented education contents and methods that have been emphasized at existing education. As a result of examining curriculum related to geography of alternative school, geography related education of alternative school is carried out in terms of experience learning of specialize subject, ecological and environmental curriculum. In addition, geography related curriculum of alternative school is very similar to the application of Multiple Intelligences Theory to teaching and is very actively carried out in spatial Intelligence and Bodily-Kinesthetic Intelligence in particular. Spatial intelligence plays an important role in learning of space and understanding of space in geography subject, and bodily·kinesthetic intelligence is an important intelligence in field work of geography subject. That is, spatial intelligence and bodily·kinesthetic intelligence are the most important intelligence for 'understanding of space' and 'doing geography'. Musical intelligence can expect teaching of cultural geography through tradition music and folk music, and Logical- Mathematical Intelligence and Intrapersonal Intelligence are regarded as the important intelligence in forming personal geography and decision making by geographical decision. Linguistic intelligence and interpersonal intelligence are closely related to communication and self expression between teachers and students, students and students, and can be applied in cooperation learning and group learning in geography subject. Educational application of Multiple Intelligences Theory and alternative school curriculum values various abilities and intelligences of learners, and puts into practices open education focusing on learner and potentiality development of learner by having them experience various types of life. Coincidence of educational application in alternative school and multiple intelligences theory is as shown below. First is the individual-oriented small school. Such small school practices curriculum valuing opinion, features and ability of each students. That is, small school is individual-centered school based on multiple intelligences theory. Second is values understanding of learning. While existing classical education values understanding of knowledge from the aspect of positivism focusing on objective knowledge, propositional knowledge and declarative knowledge, 'understanding' of knowledge that is emphasized in alternative school and Multiple Intelligences Theory regards acquisition of procedural knowledge and know how through active perception activity of learner as the true 'understanding'. Third, it pursues integrated curriculum. In terms of teaching-learning, curriculum of alternative school is very similar to that of Multiple Intelligences Theory. Accordingly, if institutional system introduces curriculum of alternative school, planning of curriculum by Multiple Intelligences Theory is likely to obtain educational effects of alternative school. Given that current alternative school cannot remain as alternative school in the future, and that new alternative of education may emerge and change, educational application of Multiple Intelligences Theory can be the alternative for existing education. Accordingly, Multiple Intelligences Theory suggests much in alternative school as well as existing institutional education.목차 논문개요 Ⅰ. 서론 = 1 A. 연구목적 = 1 B. 연구방법 = 3 Ⅱ. 이론적 배경 = 6 A. 신자유주의와 제도권 교육 = 6 B. 제도권 교육의 위기와 7차 교육과정 = 10 Ⅲ. 다중지능이론의 기본 개념 = 15 A. 지능의 일반적 정의 = 16 B. 다중지능이론의 특성 = 17 C. 다중지능이론의 영역 = 19 Ⅳ. 대안학교에서의 교육과정 = 25 A. 대안학교에서의 일반 교육과정 = 25 B. 대안학교에서의 특성화교육과정 = 29 Ⅴ. 다중지능 측면에서 대안학교 지리관련 교육 과정 = 38 A. 공간지능과 대안학교 특성화 교육과정 = 38 B. 대안학교별 지리관련 교수학습 방법 = 53 Ⅵ. 요약 및 결론 = 71 참고문헌 = 75 ABSTRACT = 7

토끼를 이용한 실험적 연구

With the recent introduction of a 16 Multidetector-row helical CT (MDCT), there has been increasing expectations for the progress of cardiac imaging. Although there has been a few case reports about MDCT findings of acute myocardial infarction, the study assessing the accuracy of MDCT in the diagnosis of acute myocardial infarction has not been reported. The purpose of this study is to evaluate the MDCT findings and the diagnostic accuracy of MDCT in the rabbit with acute myocardial infarction. Myocardial infarction was induced in 14 rabbits by ligation of left coronary arteries. CT scans were obtained in contiguous transverse planes with retrograde ECG gating. Early and delay phase scans were obtained at 1 minute and 6 minutes after intravenous contrast injection each other. The rabbits were sacrificed after the CT scans and the sliced cardiac specimens were stained for the gross inspection and microscopic examination. For the scoring of transmural extent of myocardial infarction, the left ventricle was divided into 12 circumferential segments on middle six transverse slices of the CT scans and triphenyltetrazolium chloride(TTC)-stained specimens. The transmural extent of myocardial infarction was scored according to the ratio of infracted myocardium over the wall thickness. The agreement of transmural extent between CT scans and TTC-stained specimens were analyzed by kappa values. Acute myocardial infarction was demonstrated in the ligated left coronary artery-dependent myocardium in nine of 14 rabbits on the TTC-stain and CT scans. The infracted myocardium was demonstrated as a low-attenuation area on early phase CT scan and a low-attenuation area with rim-like enhancement along the endocardial and pericardial sides of the myocardial wall on delay phase CT scan. There was excellent agreement in the scores of transmural extent of myocardial infarction between TTC-stained specimens and CT scans in early phase (kappa value = 0.882, p = 0.000) and fair to good agreement between TTC-stained specimens and CT scans in delay phase (kappa value = 0.439, p = 0.000). Microscopic examination of cardiac specimens revealed necrosis of myocardial cells with infiltration of inflammatory cells and granulation tissue along the endocardial and pericardial sides of the necrotic myocardium. In the correlation between microscopic examinations and CT scans, the low-attenuation area on early phase CT scan corresponded to the infracted myocardium. On delay phase CT scan, the low-attenuation area corresponded to the area of myocardial necrosis and the area of rim-like enhancement along the endocardial and pericardial sides of the myocardium corresponded to the area of inflammation and granulation tissue in infracted myocardium. In conclusion, 16 slice MDCT scan was useful in the diagnosis of acute myocardial infarction and early phase scan was more accurate than delay phase scan in the evaluation of transmural extent of myocardial infarction. In histopathologic examination, infracted myocardium consisted of myocardial necrosis with inflammation and granulation tissue along the endocardial and pericardial sides of infracted myocardium, which corresponded to low-attenuation area and rim-like enhancement each other on delay phase CT scan. ;급성 심근 경색의 영상 소견에 대하여 1980년대에 고식적 CT (conventional computed tomography)를 이용한 보고가 있었으나, 심박동에 의한 운동 인공물 (motion artifact)로 인하여 해상도 및 정확도가 다른 검사법에 비하여 떨어지는 단점이 있었고, 이후 자기공명영상 (MR)의 발달로 심장영상은 주로 MR에 의하여 이루어지고 있다. 그러나, 최근 16 다중 검출 나선형 전산화 단층 촬영 (16 Multidetector-row helical computed tomography; MDCT)이 개발된 이래로 단층 촬영을 이용한 심장 영상의 발전이 기대되고 있다. 현재까지 급성 심근 경색의 MDCT 소견에 대한 증례 보고가 일부 있었으나, MDCT의 급성 심근 경색 진단의 정확도에 대한 체계적인 연구는 보고된 바가 없다. 따라서, 폐쇄성 급성 심근 경색을 유발한 토끼에서 심근 경색의 MDCT 소견과 진단의 정확도에 대한 실험적 연구를 시행하였다. 14마리의 토끼에서 좌전하행 또는 좌회선동맥을 결찰하여, 페쇄성 심근 경색을 유발하였다. 정맥으로 조영제를 주입하여 MDCT를 촬영하였으며, 후향적 심전도 동조화를 시행하여 심장이완 중기에 영상을 얻었다. 조영제 주입으로부터 1분과 6분의 초기와 지연기에 심장의 단축에 가까운 횡단면 영상을 얻었다. 단층 촬영 후 토끼를 희생시켜 심장 표본을 만들고, 염색을 시행하여 육안 및 병리조직소견을 관찰하였다. 심장의 횡단면 중 심장의 중심으로부터 상하로 6개의 단면을 선택하고, 각 단면을 12개의 원주형 분절로 나누어 각 분절에서 전체 심근 두께에 대하여 경색 심근이 차지하는 비율을 등급화하여 기록하였으며, MDCT 소견과 triphenyltetrazolium chloride (TTC)를 이용한 염색표본의 육안 소견간의 심근 경색의 전층 침범 여부에 대한 일치도를 구하여 통계적 유의성을 검증하였다. 14마리의 토끼 중 9마리에서 결찰한 동맥 분포에 해당하는 부위에 경색이 발생하였다. 경색 심근은 MDCT 초기 영상에서 저음영으로 보였으며, 지연기 영상에서는 중앙의 저음영과 심막측 및 심내막측의 변연부에 선상의 조영증강으로 보였다. 조영증강 정도는 좌심실 음영 또는 정상 심근과 비슷하여, 잘 구분되지 않아, 초기 영상의 저음영의 범위가 작아진 것으로 보이는 경우가 많았다. MDCT 소견과 TTC염색 표본의 육안 소견을 비교하였을 때, 초기 영상에서는 kappa 값 0.882로 최우수 (excellent)의 일치도를 보였고, p 값은 0.05이하로 통계적으로 유의하였으며, 지연기 영상에서는 kappa 값 0.439로 양호에서 우수 (fair to good)의 일치도를 보였고, p 값은 0.05이하로 통계적으로 유의하였다. 심근 경색의 병리 소견에서, TTC 염색에서 염색되지 않는 부위에는, 괴사된 심근이 중앙부에 위치하고, 염증세포와 섬유모세포의 침윤, 모세혈관의 증식을 동반한 육아조직이 심막측 및 심내막측의 변연부에 분포하였다. MDCT 소견과 연관해 보면, 초기 영상의 저음영 부위는 TTC 염색에서 염색되지 않는 부위와 통계적으로 유의하게 일치되었으며, 따라서 괴사 심근과 육아조직으로 구성된 것으로 추정된다. 또한, 지연기 영상의 저음영 부위는, 변연부의 조영증강으로 인하여, TTC 염색에서 염색되지 않는 부위보다 작게 보였으며, 괴사된 심근만이 있는 부위는 저음영 부위와, 심막측 및 심내막측의 육아조직은 변연부의 조영증강과 연관되어 있을 가능성이 높다. 결론적으로, MDCT 영상은 폐쇄성 급성 심근 경색의 진단에 유용하며, 초기 영상이 지연기 영상보다 경색의 범위 및 전층 침범 여부의 진단에 있어 정확하다. 병리 소견을 MDCT 영상과 연관시켜 보면, 지연기의 저음영부위는 괴사 심근과, 심막측 및 심내막측의 조영증강은 육아조직과 연관되어 있을 것으로 추정된다.논문개요 = vi I. 서론 = 1 II. 연구재료 및 방법 = 3 III. 연구결과 = 8 IV. 고찰 = 12 V. 결론 = 21 표 = 23 사진부도 및 설명 = 25 참고문헌 = 30 영문 초록 = 3

Method for the creation of carbon dioxide reducing low-carbon ecological residential complex

학위논문(석사) --서울대학교 대학원 :생태조경·지역시스템공학부(생태조경학전공),2010.2.Maste

Arterioportal shunt: Prevalence in small hemangiomas versus that in hepatocellular carcinomas 3 cm or smaller at two-phase helical CT

PURPOSE: To compare the prevalence of arterioportal (AP) shunting associated with (a) small (≤3 cm) hemangiomas and (b) hepatocellular carcinomas (HCCs) (≤3 cm) at two-phase helical computed tomography (CT). MATERIALS AND METHODS: Two-phase helical liver CT was performed in 107 patients (61 men, 46 women; age range, 25-73 years; mean, 48.6 years) with 169 small hemangiomas and in 384 patients (292 men, 92 women; age range, 18-82 years; mean, 58.3 years) with 598 HCCs 3 cm or smaller. Diagnosis of HCC was verified with histologic findings (n = 30) or typical imaging and clinical findings (n = 568); that of all hemangiomas was verified with typical imaging and clinical findings. Three radiologists retrospectively reviewed all CT images in consensus. Contrast material-enhanced CT scans were obtained during the hepatic arterial and portal venous phases. AP shunt was considered to be present when wedge-shaped or irregularly shaped homogeneous enhancement peripheral to tumor appeared at hepatic arterial phase CT and isoattenuation or slight hyperattenuation in that area appeared at portal phase CT. The prevalence of AP shunting associated with hemangiomas and that associated with HCCs were compared with multivariate model testing. Speed of lesion enhancement (rapid enhancement, when extent of intratumoral enhancement at hepatic arterial phase CT was >50%; slow enhancement, when extent of intratumoral enhancement was ≤50%) and presence of AP shunt were correlated with χ2 or Fisher exact testing. RESULTS: AP shunts were more frequently found in hemangiomas (36 lesions [21.3%]) than in HCCs (25 lesions [4.2%]) (P <.001). Twenty-four (38%) of the 64 hemangiomas with rapid enhancement had AP shunts, whereas only 12 (11.4%) of the 105 hemangiomas with slow enhancement had AP shunts (P <.001). There was no significant difference between prevalence of AP shunt in the 573 HCCs with rapid enhancement (24 lesions, 4.2%) and that in the 25 HCCs with slow enhancement (one lesion, 4.0%). CONCLUSION: AP shunts were more frequently seen at two-phase helical CT in small hepatic hemangiomas than in HCCs and thus represent a suggestive but not specific finding of hemangioma. Small hemangiomas with AP shunts tend to show rapid rather than slow enhancement. © RSNA, 2004

Diagnosis of intrahepatic and common duct stones: Combined unenhanced and contrast-enhanced helical CT in 1090 patients

Background: We determined the accuracy of combined unenhanced and contrast-enhanced helical computed tomography (CT) for diagnosis of bile duct stones. Methods: During a 12-month period, 1090 patients who underwent combined CT and endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangioscopy (PTC) were enrolled in this study. The results of prospective CT interpretation regarding the presence of bile duct stones were compared with results of endoscopic stone removal, PTC and with surgical results. In 70 patients, detectability of stones on CT was evaluated depending on stone types. Results: Of 1090 study patients, 175 and 299 patients were confirmed to have intrahepatic and common duct stones, respectively. The sensitivity and specificity of combined CT were 73% and 98% for diagnosis of intrahepatic stones and 71% and 97% for common duct stones. Of 70 patients 24, 25, and 21 patients had cholesterol, black pigment, and brown pigment stones, respectively. Eleven of 24 cholesterol stones, 21 of 25 black pigment stones, and 15 of 21 brown pigment stones were detected on combined CT. Conclusion: Combined CT is of limited sensitivity for detection of bile duct stones, especially in Western countries where cholesterol stones predominate. It may be of greater value in populations with a higher incidence of pigment stones. Other complementary imaging modalities are needed for patients with negative CT findings who are highly suspected to have biliary stones. © 2006 Springer Science+Business Media, Inc

Microwave ablation of liver tumors: degree of tissue contraction as compared to RF ablation

Purpose: To compare the amount of tissue contraction after microwave (MW) versus radiofrequency (RF) ablation of liver tumors. Materials and methods: Seventy-five hepatic tumors in 65 patients who underwent percutaneous MW or RF ablations were included in this retrospective study. All patients underwent MRI within 6 months before the ablation and 24 h after the procedure. Two blinded radiologists, by consensus, performed measurements on the corresponding series of pre and post-ablation MRI. Absolute and relative contraction of liver, tumor, and control were calculated and compared. Results: Thirty-one patients underwent MW ablations, and 44 patients underwent RF ablations. The absolute and relative contraction of the ablation zone were significantly greater with MW than RF ablation (p = 0.003 to <0.001). Thirty-two lesions were visible on both pre- and post-ablation MRI. MW ablation had significantly more tumor contraction as compared to RF ablation (p = 0.003 to 0.009). The control measurements demonstrated no significant difference in normal tissue variation between MW and RF groups. Conclusions: MW ablation of hepatic tumors produced significantly more contraction of tumor and ablated hepatic tissue compared to RF ablation. Tissue contraction should be taken into account during pre-procedural planning and assessing treatment response by comparing pre- and post-ablation images

MRI detection of intratumoral fat in hepatocellular carcinoma: Potential biomarker for a more favorable prognosis

OBJECTIVE: The purpose of this study was to determine whether the presence of intratumoral fat in hepatocellular carcinoma (HCC) could serve as an imaging biomarker to predict a favorable prognosis. MATERIALS AND METHODS: After a search of the radiology and pathology databases from January 2002 to December 2010, a cohort of patients with fat-containing HCC imaged by chemical-shift MRI techniques was matched with a cohort of patients with non-fat-containing HCC for TNM stage and type of subsequent treatment. The number and type of tumor progression, time to tumor progression (TTP), and overall survival (OS) were determined for each cohort. RESULTS: There were 46 patients included in each cohort. Tumor progression was more prevalent in the non-fat-containing HCC cohort (30 patients, 65.2%) compared with the fat-containing HCC cohort (16 patients, 34.7%; p = 0.001). Distant metastasis occurred more commonly in the non-fat-containing HCC cohort (10 patient, 21.7%) compared with the fat-containing HCC cohort (two patients, 4.3%; p = 0.039). The median TTP was significantly longer in the fat-containing HCC group (52 months) compared with the non-fat-containing HCC group (27 months; p = 0.037). The significantly longer TTP was primarily observed in the locoregional treatment subgroup (p = 0.028). No statistical significance in OS and subanalysis by treatment was observed (p = 0.63-0.81). CONCLUSION: Fat-containing HCC, imaged on an MRI unit, may predict a more favorable prognosis compared with nonfat-containing HCC. © American Roentgen Ray Society

US characteristics for the prediction of neoplasm in gallbladder polyps 10 mm or larger

PurposeTo evaluate the characteristics of gallbladder polyps 10 mm or larger to predict a neoplasm in US examinations. Materials and methodsFifty-three patients with gallbladder polyps a parts per thousand yen 10 mm with follow-up images or pathologic diagnosis were included in the retrospective study. All images and reports were reviewed to determine the imaging characteristics of gallbladder polyps. Univariate and multivariate analyses were used to evaluate predictors for a neoplastic polyp. ResultsA neoplastic polyp was verified in 12 of 53 patients and the mean size was 13.9 mm. The univariate analysis revealed that adjacent gallbladder wall thickening, larger size (a parts per thousand yen15 mm), older age (a parts per thousand yen57 years), absence of hyperechoic foci in a polyp, CT visibility, sessile shape, a solitary polyp, and an irregular surface were significant predictors for a neoplastic polyp. In the multivariate analysis, larger size (a parts per thousand yen15 mm) was a significant predictor for a neoplastic polyp. ConclusionA polyp size a parts per thousand yen15 mm was the strongest predictor for a neoplastic polyp with US. The hyperechoic foci in a polyp and CT visibility would be useful indicators for the differentiation of a neoplastic polyp, in addition to the established predictors

A Study on the Forecasting of Demand and Supply and the Diagnosis and Countermeasure of Manpower Shortage of Korean Merchant Marine Officer

The role of marine officer who manages and controls vessels to ensure safe navigation and generate transportation profits is a critical factor in determining the competitiveness of shipping companies. In response to the changes in the maritime industry, such as the advent of innovative ships (smart ships), stricter regulation and policy, and fierce cost competition due to high volume of shipments, retaining talented officer has been considered as a core factor. However, due to the peculiarity of shipping labor that is isolated from land for a certain period, the number of marine officers is gradually decreasing. This study explored the current state of the marine officers so as to cope with the issues of workforce caused by the decrease in the labor of merchant ships, predicted future demand and supply of labors in various ways, and the results were compared and analyzed. According to the result, the study analyzed how the countermeasures to improve the manpower shortage will affect the demand and supply of manpower in the future. The demand for manpower of marine officer is forecasted using various methods such as the simple average method using geometric mean, linear and polynomial models of trend analysis, and Auto-Regression(AR), Moving Average(MA), AR+MA(ARMA), and Auto Regression Integrated Moving Average(ARIMA) models of time series analysis based on data between year 2003 and year 2020. In order to increase the objectivity of the forecasting, the results from each method were compared. As a result of forecasting the demand for marine officer in overseas service ships, the result of the simple average method using trend analysis and the linear regression model showed the increase from 6,241 in year 2020 to 11,856 and 9,853 in year 2040 in respectively. The polynomial regression model is considered to be inappropriate because it represents an unrealistic figure in long-term prediction. The predicted figures of the four models of the time series analysis presented the slight increase at a similar level and then stagnation. The demand of marine officer in coastwise ships slightly increases from 6,241 in year 2020, to 7,887 and 7,786 in year 2040 in the simple average method and linear model of trend analysis respectively while the prediction of polynomial models showed inadequate figure. The predicted figure of all time series models showed slight increase until year 2023 and then stagnation as well. Demand for overseas employed marine office will continue to decrease from 2,062 in year 2020 to 809 in year 2040 in the case of the simple average method. On the other hand, the predicted figure of linear model and polynomial models of trend analysis showed dramatic fluctuation, which was not adequate to be applied. In the MA model of time series analysis, the figures slightly decreased and then stagnated while those of the other three models all increased slightly to a similar level and then remained stagnant. The comparative analysis was conducted between the result of demand forecasting for marine office and the actual performance figure from year 2015 to year 2020, to identify the degree to which the forecast results coincide with the actual scale of manpower. As a result of the analysis, the simple average method of trend analysis showed little difference with the actuality, and the AR, ARMA, and ARIMA models of time series analysis showed similar level of differences whereas the difference of the MA model was slightly higher. In the forecasts of the demand for merchant marine officers, when there is a change as well as a large increase or decrease in the actual manpower, the error is large and such error would be delayed and later on reflected on the forecast. Therefore, for the short-term forecast of marine officer manpower, it is appropriate to apply the demand forecast. While for the long-term forecast, various forecasting methods should be applied. The results should be then comparatively evaluated and applied within appropriate categories. On the other hand, it was found that supply or marine officer of overseas merchant ships will decrease to 5,085 in year 2040 and those of coastwise ships will decrease to 973 according to forecasting analysis based on the manpower scale considering number of retirees and promotions, and new entrants by position and age, the turnover rate in year 2020. As a result of comparing the forecasts of manpower demand and supply of merchant ship marine officers, it was predicted that the problem of manpower shortage in overseas and coastwise ships will be seriously raised in the future. As a measure to respond to the problem of manpower shortage according to the forecast of demand and supply for merchant mariner officers, we analyzed the extent to which the shortage of manpower was reduced due to the introduction of autonomous ships on the demand side and the implementation of the plan to expand the supply of marine officers (Preferential wages for long-term sailors, income tax exemption, employment incentives, and improvement of seafarer occupational awareness, training of new employee, and improvement of boarding rate) on the supply side. The results of time series model analysis of changes in the demand and supply of manpower for merchant marine officers due to the introduction of autonomous ships and the expansion of supply, and consequent shortage of manpower showed that the shortage issue of marine officers could not be completely addressed. In particular, it was predicted that the problem of shortage of manpower for domestic merchant ships would not be resolved and worse still, expected to deteriorate at very concerning level. Since it is essential to secure and maintain Korean marine officers for the stable transport volume of coastal freight and secure mobilized fleets during wartime, innovative measures to expand the supply of marine officers should be implemented urgently to prevent the collapse of the coastwise shipping industry by shortage of manpower. This study comprehensively analyzed and predicted the demand for manpower of marine officers by applying simple average method using geometric mean, linear and polynomial models of trend analysis, and AR, MA, ARMA, and ARIMA models of time series analysis. The purpose of this study is to improve the objectivity and reliability of prediction by comparing and evaluating the prediction results of different methods. In addition, the forecast accuracy of demand forecasting methods was evaluated by comparing the forecasted demand and actually measured figure. The study presents the problems in the application of the demand forecasting method and proposes appropriate utilization methods. Furthermore, a scientific and systematic forecasting method considering the factors affecting marine officer supply was suggested by presenting changes in supply of marine office according to the changes in workforce composition (number of retirees and promotions, and new entrants by position and age, the turnover rate) for each year by using Markov analysis. Lastly, this study examined the feasibility and effect of plan for supply and demand of marine officer in quantitative way by analyzing the impact of the introduction of autonomous vessel and the realistic supply expansion plan on the reduction of the manpower shortage. Based on the result, it was suggested that proactive measures should be urgently prepared to solve the problem of seaman manpower shortage as the problem will become more serious in the future. This is study is likely to be assessed as very timely research emphasizing the necessity of maintaining Korean marine officer in a situation where the number of marine officers in merchant ships is decreasing.Abstract ⅹ 제 1 장 서 론 1 제 1 절 연구 배경 및 목적 1 제 2 절 연구의 방법 및 구성 4 제 2 장 이론적 배경 6 제 1 절 인력 수요 및 공급 예측 6 1. 인력 예측의 필요성 6 2. 인력 수요 예측 방법 7 3. 인력 공급 예측 방법 17 제 2 절 해기인력의 수급 예측 20 1. 해기인력 수급 예측의 중요성 20 2. 해기인력 수급 예측의 향후 영향요인 22 제 3 절 해기사 인력 수급 예측 선행연구 33 제 3 장 해기사 인력 현황 분석 39 제 1 절 선원 인력 동향 39 1. 세계 선원 수급 동향 39 2. 우리나라 선원 수급 동향 45 제 2 절 해기사 인력 수급 53 1. 해기사 인력 현황 53 2. 해기사 인력 공급 60 제 4 장 해기사 인력 수요 및 공급 예측 70 제 1 절 해기사 인력 수요 예측 70 1. 추세분석에 의한 해기사 인력 수요 예측 70 2. 시계열분석에 의한 해기사 인력 수요 예측 80 제 2 절 상선 해기사 인력 수요 및 예측결과 비교 평가 96 1. 상선 해기사 인력 수요 예측결과 비교 96 3. 상선 해기사 인력 수요 예측 결과와 실적치의 비교 평가 104 제 3 절 해기사 인력 공급 예측 117 1. 외항상선 해기사 인력 공급 예측 117 2. 내항상선 해기사 인력 공급 예측 124 3. 내·외항 상선 해기사 인력 공급 예측 129 제 5 장 해기사 수급 예측에 따른 인력부족 진단 및 대응 분석 131 제 1 절 해기사 수급 예측에 따른 인력부족 진단 131 제 2 절 해기사 인력부족 대웅방안의 향후 수급에 미치는 영향 137 1. 자율운항선 도입에 따른 상선 해기사 수요 변화 137 2. 상선 해기사 공급 확대 방안에 따른 공급 변화 162 제 6 장 결 론 173 제 1 절 연구결과의 요약 173 제 2 절 연구의 한계점과 향후 연구방향 178 참고문헌 180Docto