크론병으로 인한 십이지장-대장 누공의 Endoloop과 Hemoclip을 이용한 수술 전 내시경적 결찰: 증례보고

Duodeno-colonic fistula is an enterocolonic fistula that occurs as a complication of Crohn's disease. Symptoms of duodeno-colonic fistula are similar to those of Crohn's disease, such as weight loss and diarrhea. The treatment of choice is surgery, although medical treatment may also be considered. However, surgery is recommended when all available medical therapies have been ineffective. In this case, we report a secondary duodeno-colonic fistula due to Crohn's disease that was temporarily managed by an endoscopic procedure with a detached endoloop and hemoclips as a bridging therapy to final surgical repair.ope

Duodenal adenocarcinoma following a neuroendocrine tumor in the duodenum

Primary duodenal adenocarcinoma is a rare malignant neoplasm accounting for 0.3% of all gastrointestinal tract carcinomas. We herein present one case of duodenal adenocarcinoma after duodenal neuroendocrine carcinoma. Poorly differentiated duodenal neuroendocrine carcinoma with liver metastasis (TxNxM1) was confirmed, and eight cycles of palliative chemotherapy (5-fluorouracil/etoposide/cisplatin) were administered. The patient was then in a clinically complete response status. About 1 year later, newly developed adenocarcinoma was detected at the same site. It was completely surgically resected, and the patient was cured.ope

A Case of Intractable Bisphosphonate-Related Osteonecrosis of the Jaw Treated with Teriparatide

Bisphosphonates are the most widely used medications for treating high bone turnover osteoporosis, Paget's disease of bone, multiple myeloma and metastatic carcinomas, etc. However, a destructive complication of bisphosphonate-related osteonecrosis of the jaw (BRONJ) can occur. The treatments of BRONJ are challenging and the currently recommended managements for BRONJ are still controversial. Our case demonstrated that teriparatide can be a treatment of choice for intractable BRONJ, which had not been cured for 2 years even with the proper surgical treatment and withdrawal of bisphosphonates.ope

The Relationship between BMI and Glycated Albumin to Glycated Hemoglobin (GA/A1c) Ratio According to Glucose Tolerance Status

Glycated albumin to glycated hemoglobin (GA/A1c) ratio is known to be inversely related with body mass index (BMI) and insulin secretory capacity. However, the reasons for this association remain unknown. We aimed to investigate whether BMI directly or indirectly influences GA/A1c by exerting effects on insulin secretion or resistance and to confirm whether these associations differ according to glucose tolerance status. We analyzed a total of 807 subjects [242 drug-naïve type 2 diabetes (T2D), 378 prediabetes, and 187 normal glucose tolerance (NGT)]. To assess the direct and indirect effects of BMI on GA/A1c ratio, structural equation modeling (SEM) was performed. GA/A1c ratio was set as a dependent variable, BMI was used as the independent variable, and homeostasis model assessment-pancreatic beta-cell function (HOMA-β), homeostasis model assessment-insulin resistance (HOMA-IR), glucose level were used as mediator variables. The estimates of a direct effect of BMI on GA/A1c to be the strongest in NGT and weakest in T2D (−0.375 in NGT, −0.244 in prediabetes, and −0.189 in T2D). Conversely, the indirect effect of BMI on GA/A1c exerted through HOMA-β and HOMA-IR was not statistically significant in NGT group, but significant in prediabetes and T2D groups (0.089 in prediabetes, −0.003 in T2D). It was found that HOMA-β or HOMA-IR indirectly influences GA/A1c in T2D and prediabetes group through affecting fasting and postprandial glucose level. The relationship between GA/A1c and BMI is due to the direct effect of BMI on GA/A1c in NGT group, while in T2D and prediabetes groups, this association is mostly a result of BMI influencing blood glucose through insulin resistance or secretion.ope

성장호르몬 분비 뇌하수체 종양의 수술적 완치 후 발견된 지연형 자가면역 당뇨병 1예

Acromegaly is generally caused by a benign growth hormone (GH)-secreting pituitary adenoma. It is characterized by a wide range of complications; cardiovascular, respiratory, bone and joint, and metabolic complications. Among them, impaired glucose tolerance and diabetes mellitus, due to GH-induced insulin resistance, has been reported in approximately 16-46% and 19-56%. They are usually improved following the treatment of acromegaly, surgical or medical therapy. We report a first case of 36-year-old man who was paradoxically diagnosed with GAD antibody positive latent autoimmune diabetes in adults (LADA) after the surgical cure of acromegaly.ope

A 47,X,+t(X;X)(p22.3;p22.3)del(X)(p11.23q11.2),Y Klinefelter Variant with Morbid Obesity

Klinefelter syndrome is the most common type of genetic cause of hypogonadism. This syndrome is characterized by the presence of 1 or more extra X chromosomes. Phenotype manifestations of this syndrome are small testes, fibrosis of the seminiferous tubules, inability to produce sperm, gynecomastia, tall stature, decrease of serum testosterone and increases of luteinizing hormone and follicle stimulating hormone. Most patients with Klinefelter syndrome are tall, with slender body compositions, and reports of obesity are rare. We report the case of a 35-yr-old man with hypogonadism and morbid obesity and diabetes mellitus. He had gynecomastia, small testes and penis, very sparse body hair and his body mass index was 44.85. He did not report experiencing broken voice and was able to have erections. We conducted a chromosome study. His genotype was 47,X,+t(X;X)(p22.3;p22.3)del(X)(p11.23q11.2). In this case, the patient was diagnosed as Klinefelter syndrome. He showed rare phenotypes like morbid obesity and average height and the phenotype may be caused by the karyotype and the excess number of X chromosome. Further studies of the relationship between chromosomes and phenotype are warranted.ope

A Case of Pheochromocytoma Associated with Diabetic Ketoacidosis and Infective Endocarditis

Pheochromocytoma is a rare neuroendocrine tumor that is usually derived from adrenal medulla or chromaffin cells along with sympathetic ganglia. In Western countries, the prevalence of pheochromocytoma is estimated to be between 1:6,500 and 1:2,500, compared with an incidence in the United States of 500 to 1,100 cases per year. Despite this low incidence, pheochromocytoma should always be considered for differential diagnoses because previous studies have shown that this condition can be cured in approximately 90% of cases. However, an untreated tumor is likely to be fatal due to catecholamine-induced malignant hypertension, heart failure, myocardial infarction, stroke, ventricular arrhythmias or metastatic disease. Symptoms that result primarily from excess circulating catecholamines and hypertension include severe headaches, generalized inappropriate sweating and palpitations (with tachycardia or occasionally bradycardia). Pheochromocytoma, however, has highly variable and heterogeneous clinical manifestations, including fever, general weakness and dyspepsia, and can be observed in patients who are suffering from infectious diseases. Several of such case reports have been presented, but most of these included infectious patients with high blood pressure and severe fluctuations. In this study, we presented the case of a 53-year-old male who showed normal blood pressure, but had a sustained fever. He was diagnosed with diabetic ketoacidosis, infective endocarditis and asymptomatic adrenal incidentaloma. Despite treatment with antibiotics and valve replacement, the fever persisted. After the patient underwent evaluation for the fever, adrenal incidentaloma was identified as pheochromocytoma. After removal of the abdominal mass, his fever improved.ope

A Study on Anton Webern's 'String Trio, Op.20'

Webern (3 December 1883 ~ 15 September 1945) is called 'The Second Viennese School' together with Schoenberg (1874~1951) and Berg (1885~1935). Webern's works are classified into three periods according to the style of the works. The first is the period of tonality (1899-1908), the second is that of the atonality (1908-1924) and the third is that of twelve-tone music (1924-1945). In this study we analyzed 'String Trio, op.20' out of the works in the 3rd period, the period of twelve-tone music . The purpose of this study is to examine how the part of Webern's tone-row technique and the traditional music factors in the process of composition are connected to the modern music by analyzing the tone-row structure, division, melody and rhythm structure through the tone-row. The first movement of 'String Trio, op.20' consisting of two movements is presented in the Rondo Form classified as Introduction-A-B-A-C-Introduction-A-B-A-Coda. The R4 - P4 tone-row forming the symmetrical structure used in the introduction appears reversely as P4 - R4 in Coda which induces the symmetrical structure of the whole tune. When we consider that the starting tone-row of A Part is I4, I2 and RI8, the last two tone-row of A Part have the same two tetrachord as I4 and R3, the last tone-row of C Part forms the combinatoriality with I4, it may be fairly said that T4 plays a role of Tonic in this tune. The repeated parts give the uniformity to the tune by using the same tone-row. Tetrachord and hexachord manifest themselves in the tone-row division which can be seen in the Introduction and Coda. The second movement is constructed as Sonata Form which is distinguished for Introduction - Exposition - Development - Recapitulation - Coda. As in the first movement the second movement starts with P0 of Introduction and ends R0 with Coda. In this tune the traditional proceeding of Ⅰ-Ⅴ-Ⅰ is embodied through the modulation of the tone-row. And the exposition and the recapitulation give the tune the uniformity through almost the same length, the use of the tone-row of the same number-excluding two tone-row with 5 bars with extended closing- and the conformity of the content of Introduction and Coda. And it is a conspicuous feature that the tone-row is arrayed in polyphony to make the tune proceed. In the rhythm the first theme features the ratio 2:3 rhythm division, and the second theme does the dot tone-value rhythm respectively. In this respect we can see this tune keeps the principle of the technique of twelve-tone music composed of the modern musical art but in the structure of the tone-row the structure of the formative music, the uniformity of the content of each part and the embodiment of clear tonic etc. reflects the features of the traditional music. That is to day, we can see Webern attempted to combine the reformative twelve-tone music's technique based on the traditional music.;베베른은 쇤베르크, 베르크와 더불어 제 2 빈 악파(The Second Viennese School)로 불린다. 그의 작품은 작품양식에 따라 3기로 나뉘는데 제 1기는 조성 음악의 시기(1899-1908)이고, 제 2기는 무조 음악의 시기(1908-1924)이며, 제 3기는 12음 기법의 시기(1924-1945)이다. 본 연구에서는 12음 음악의 시기인 제 3기의 작품 중 'String Trio, op.20'을 분석하였다. 연구목적은 이 곡에 나타난 음열, 선율과 리듬의 구조적인 특징을 통해서 베베른 음열 기법의 일부와 작곡과정에 있어서의 전통음악적 요소가 현대음악에 어떻게 접목되어 나타나는가를 음열구조와 분할 그리고 선율과 리듬구조에 대해 살펴보는 형식을 사용하였다. 두 악장으로 구성된 'String Trio, op.20' 의 제 1 악장은 론도 형식으로 Introduction-A-B-A-C-Introduction-A-B-A-Coda로 구분된다. Introduction에 사용되어 대칭구조를 이루는 R4 - P4 음열은 Coda에서 P4 - R4 로 역행되어 나타나 곡 전체의 대칭구조를 유도한다. A부분의 시작음열이 I4 인 점과 A부분의 마지막 2음열인 I2와 RI8이 I4와 동일한 2개의 tetrachord를 가진다는 점 그리고 C부분의 마지막 음열인 R3이 I4와 조합(combinatoriality)을 이룬단 점등을 감안할 때 이 곡에서 T4는 Tonic의 역할을 담당한다고 볼 수 있다. 반복되는 부분들은 동일한 음열을 사용함으로 곡에 통일성을 부여한다. 음열분할에 있어서는 tetrachord와 hexachord가 나타나는데 Introduction과 Coda에서 찾아 볼 수 있다. 제 2 악장은 소나타 형식으로 Introduction - Exposition - Development - Recapitulation - Coda로 구분된다. 2악장도 1악장과 마찬가지로 Introduction의 P0로 시작하여 Coda의 R0로 곡을 마친다. 이 곡에서는 전통적인 Ⅰ-Ⅴ-Ⅰ진행을 음열의 전조(modulation)를 통해 구현한다. 또한 exposition과 recapitulation의 거의 정확하게 같은 길이, 동일한 수-closing의 확장된 5마디의 두 음열 제외한-의 음열 사용 그리고 Introduction과 Coda의 내용의 일치를 통해 곡에 통일성을 부여한다. 그리고 음열을 다성부(polyphony)적으로 배열하여 곡을 진행시킨 점이 눈에 띄는 특징이다. 리듬에 있어서 제 1 주제는 2:3 리듬 분할을, 제 2 주제는 점(dot) 음가 리듬을 각각 그 특징으로 한다. 이와 같은 내용을 통해서 이 곡이 12음 기법의 원칙을 지키며 현대 음악기법으로 구성되긴 하였으나 음열의 구조에 있어서의 조성음악적 구조, 각 부분들의 내용에 있어서의 통일성 그리고 명확한 tonic의 구현 등은 전통음악의 특징이 반영된 것이라 볼 수 있다. 즉, Webern은 전통음악을 기반으로 혁신적인 12음 음악기법을 융합시키려 했음을 알 수 있다.목차 논문 개요 = ⅷ Ⅰ. 서론 = 1 Ⅱ. 본론 = 3 A. Webern의 작품 = 3 B. Webern의 String Trio, Op.20의 분석 = 8 a. 제 1악장 = 14 b. 제 2악장 = 27 Ⅲ. 결론 = 51 참고문헌 = 53 부록 = 57 ABSTRACT = 7

An Analysis of Music Education for Elderly People in Social Education Programs of Senior Welfare Center

This study has the purpose to search and analyze the current situation of music education for older adults in the social education programs of senior welfare center and to investigate the future direction of music education for older adults based on the result from above. For this, the importance of education for the elderly in the aging society, the definition of educational gerontology along with the impact of music education on the elderly learners were surveyed first through the documentary study. Presently, Korea has 211 senior welfare centers, 44 of which are located in Gyeonggi-do. In this paper, a questionnaire survey was carried out for the social educational program directors and the music education instructors of 33 senior welfare centers in Gyeonggi-do to comprehend the situation of music education for elderly people. As a result, it was found that all senior welfare centers were carrying out the music education programs. The retaining rate of social worker license was as high as 96.4%, the rates of lifelong educator and educational gerontology specialist were fairly low. The highest rate of the music educators was the teaching certificate/teacher's license. The age range of music educators in the senior welfare centers was 40% of 40s, 27.1% of 50s, 14.3% of 30s, 14.3% of 60s and 4.3% of 20s. Through this, it was found that the education in the senior welfare centers were made not only for older adults but also by older adults. Present music education programs in the senior welfare centers were surveyed as pop song class, classical song class, traditional song, choir activity, folk play or samulnori(traditional performance), nanta(beating performance), janggu(traditional drum), harmonica, ocarina, accordion and other symphony activities. Meanwhile, it was found that the social education programers and the music lecturers were feeling the necessity of education about older adults and aging for themselves. Presently, the institutions which actually supplies the opportunity of training or education to the persons in charge of social education are 17. But the institution which provided the training or education to both of person in charge and lecturer was only one. In the item questioning which effect of the music education for the elderly learners was greatest, 67.3% of persons in charge of social education program answered that it could give the mental stability and energy, while the music lectures answered uniformed for 3 items of the mental stability and energy, the improvement of memory and concentration and the enhancement of life quality through the creative activities by 31.4%. In the question about the operation level of current music education programs in the senior welfare centers, 41.8% of the persons in charge of social education program answered that the programs were diverse enough to meet the desires of learners. In the same question, 61.4% of the music lecturers answered that the satisfaction was increasing and the quality of program was improving thanks to their efforts. In the senior education program, it is not sufficient to faithfully follow the request of elderly learners. To maintain the present elderly participants and to induce the new elderly participants, it is necessary to continuously develop the new programs including the interesting and challenging activities. Otherwise, it will never induce the new participants, because it becomes a self-satisfied program or gives an exclusive impression. In the future, it seems necessary to survey and analyze the situation of music education for elderly people in the senior education institutions including the senior welfare centers in the whole nation as well as Gyeonggi-do. In addition, the studies by the government should be carried out to systemize the elderly education.;본 연구는 노인복지관 사회교육프로그램을 중심으로 한 노인음악교육의 실태를 조사하여 분석을 통해 얻어진 결과를 토대로 향후 노인음악교육이 나아가야 할 방향을 모색하는데 목적이 있다. 이를 위해 문헌연구를 통해 고령화의 특징과 고령화 사회에서의 노인교육의 중요성, 노인교육의 정의, 그리고 음악교육이 노인학습자에게 미치는 영향에 대해 알아보았고 한국 노인교육의 역사와 현황 그리고 노인교육기관에서의 음악교육을 살펴보았다. 우리나라에는 현재 211개의 노인복지관이 설립되어 있으며, 이 중 44개 기관이 경기도에 위치하고 있다. 이 논문은 경기도 소재 44개 노인복지관 중 설문조사에 응한 33개 기관을 대상으로 기관별 사회교육프로그램 담당자와 음악교육 강사에게 설문조사를 실시하여 결과를 분석함으로써 노인음악교육 실태를 파악하였다. 연구 결과 모든 노인복지관에서 음악교육프로그램을 실시하고 있었다. 사회교육프로그램 담당자들의 보유자격증 비율은 사회복지사 자격증 보유율에 비해 평생교육사와 노인교육전문가 자격증의 보유율은 상당히 낮은 것으로 조사됐다. 음악교육강사들에 있어 가장 높은 소지 비율을 나타낸 건 정교사 2급 자격증이었다. 노인복지관 음악교육강사의 연령분포는 40대가 가장 많았고 다음으로 50대, 60대와 30대 그리고 20대의 순으로 나타났다. 현재 노인복지관에서 실시 중인 음악교육프로그램은 가요교실, 가곡교실, 민요교실, 합창단 또는 합창반, 풍물놀이나 사물놀이, 난타, 장구, 하모니카, 오카리나, 아코디언, 기타합주인 것으로 조사됐다. 한편, 노인복지관의 사회교육프로그램 담당자와 음악교육강사는 자신들에게 노인교육(노화와 노인에 관한 교육)이 필요하다고 생각하는 것으로 나타났다. 실제로 현재 사회교육 담당자에게 연수나 교육의 기회를 제공하는 기관은 17개였으나 담당자와 강사 모두에게 연수나 교육의 기회를 제공하는 곳은 한 곳뿐인 것으로 조사됐다. 앞으로는 경기도뿐 아니라 전국의 노인복지관을 비롯한 노인교육기관들을 대상으로 한 음악교육현황 조사 분석이 필요하다고 본다. 또한 노인교육의 체계화를 위한 국가차원에서의 연구들이 이뤄져야 할 것이다.Ⅰ. 서론 = 1 A. 연구의 필요성 및 목적 = 1 B. 연구의 내용 및 방법 = 2 C. 연구의 제한점 = 3 D. 용어의 정의 = 3 Ⅱ. 이론적 배경 = 7 A. 고령화와 노인교육 = 7 1. 고령화 = 7 2. 노인교육의 중요성 = 9 3. 노인교육의 정의 = 13 B. 한국 노인교육의 역사와 노인음악교육 = 16 1. 한국 노인교육의 역사와 현황 = 16 2. 한국의 노인음악교육 = 17 C. 노인음악교육의 효과 = 20 Ⅲ. 노인복지관 음악교육프로그램 운영실태 = 23 A. 조사개요 = 23 1. 조사범위 = 23 B. 연구도구 = 25 1. 노인복지관 사회교육프로그램 담당자용 설문지 = 25 2. 노인복지관 음악교육프로그램 강사용 설문지 = 26 C. 설문조사결과 분석 = 27 1. 사회교육프로그램 담당자의 일반적 특성 = 29 2. 음악교육프로그램 강사의 일반적 특성 = 34 3. 기관관련 사항 분석 = 43 4. 사회교육프로그램 담당자 설문 분석 = 49 5. 음악교육프로그램 강사 설문 분석 = 54 Ⅳ. 결론 및 제언 = 64 참고문헌 = 70 부록1. 사회교육프로그램 담당자 설문지 = 77 부록2. 음악교육프로그램 강사 설문지 = 82 ABSTRACT = 8

케모카인수용체 2/5 동시 저해제가 대식세포의 집합과 M1/M2 상태를 조절함으로써비만에 의한 인슐린 저항성을 개선시킨다

Department of Medicine/박사케모카인수용체 2와 케모카인수용체 5를 통한 대식세포의 집합에 의해 유도되는 지방조직내 만성 염증은 비만 관련 만성 질환과 인슐린 저항성에 있어 중요한 병인으로 작용한다. 하지만, 아직까지 이 두가지 수용체를 타깃으로 비만에서의 효과를 보고자 했던 연구는 없었다. 따라서, 본 연구에서는 케모카인수용체 2와 5를 동시에 억제시킬 수 있는 PF4178903을 이용하여 케모카인수용체 2와 5를 동시 억제가 비만과 인슐린 저항성에 미치는 영향을 보고자 하였다. 본 연구에서는 40마리 8주령의 수컷 C57BL/6J mice를 다음과 같이 식이와 약물 처리에 따라 4가지 그룹으로 나누었다. 있다: (1) 정상 식이 군, (2) 정상식이를 하면서 PF4178903을 경구로 주입한 군 (3) 고지방식이군 (4) 고지방식이를 하면서 PF4178903을 경구로 주입한 군. 이들은 총 12주간 해당 식이와 약제 투여를 유지하고, 이후, 부검하였다. 그 결과, PF4178903을 투여한 군에서는 고지방식이를 하더라도 체중증가가 적고, 지방조직을 구성하는 비만세포의 크기도 작으면서 지방조직 내에 대식세포의 숫자가 감소하는 것을 확인할 수 있었다. 또한 PF4178903로 인해 혈중에서 염증성 시토카인과 혈당, 그리고 중성지방 및 콜레스테롤 수치가 감소하며, 인슐린 저항성이 개선되는 효과를 보였다. 그리고, 지방 조직 내 면역세포의 구성 변화를 확인하기 위해 FACS 분석을 하였는데, PF4178903을 투여함으로써 대식세포의 유형이 M1에서 M2로 변화하고, CD8 T 세포의 숫자가 감소하는 것을 확인할 수 있었다. 따라서, 케모카인수용체 2/5를 동시억제는 지방 조직 내에 면역세포의 구성의 변화를 통해 비만에서 이루어지는 염증과정이 완화시킨다. 이러한 결과를 바탕으로 케모카인수용체 2/5 동시저해제의 비만 관련 만성질환의 예방 또는 치료적 목적의 활용에 대해 기대해볼 수 있겠다.open박