72 research outputs found

    A Study on the Optimization of Miller Cycle for Naval Vessel Diesel Engine

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    Since May 2005, all ocean-going vessels built after January 2000 have had to comply with the emission control regulations according to Annex โ…ฅ of the MARPOL 73/78 convention. Thesse regulations set limits on exhaust gas emissions for nitrogen oxides(NOx), sulphur oxides(SOx) and particulate matter(PM) from ships. The air pollutants as NOx, SOx, PM etc are harmful things for human health. They can be obsorbed onto the lung and cause lung disease like a lung cancer. And they are blamed as one of the major causes of photochemical smog and acid rains. The NOx emission is related with engine combustion process as like high peak pressure, high compression ratio, high rate of fuel delivery. In other words, the higher combustion temperature, the grater amount of NOx formation. Much of NOx emission can be decreased by the technology today. For example the fuel injection control by CR(Common Rail) and electronic control, EGR(Exhaust Gas Recirculation), SCR(Selective Catalytic Reduction) which using ammonia or urea, Miller Cycle and 2-stage turbocharging, etc. Miller Cycle is one of the few measures that can be applied in an internal combustion engine to simultaneously reduce NOx emission and fuel consumption. Since all engine builders strive to meet engine emission limits without any loss of efficiency, practically every modern engine is operated today with at least moderate Miller timing. In this study, a performance simulation about naval vessel diesel engine carried out through a mathematical modeling techniques for flow analysis of the working gas. And the simulation results were compared with measured data to evaluate reliability of simulation. Finally we obtained reliable simulation results. The purpose of this study is to predict effect of miller cycle for naval vessel diesel engine. By changing the intake valve closing timing and boost pressure, the engine performance is simulated. And we found the best valve timing and proper boost pressure.List of Tables โ…ฒ List of Figures โ…ด Abstract โ…ต Nomenclature โ…ท ์ œ1์žฅ ์„œ ๋ก  1 1.1 ์—ฐ๊ตฌ ๋ฐฐ๊ฒฝ 1 1.2 ์—ฐ๊ตฌ ๋‚ด์šฉ 3 ์ œ2์žฅ ์นœํ™˜๊ฒฝ ์—”์ง„์˜ ์š”๊ตฌ์™€ ๋Œ€์ฑ… 4 2.1 ์œ ํ•ด ๋ฐฐ๊ธฐ๊ฐ€์Šค ๋ฐฐ์ถœ๊ทœ์ œ ๊ทœ์ • 4 2.2 ์œ ํ•ด ๋ฐฐ๊ธฐ๊ฐ€์Šค ๊ฐ์ถ• ๋Œ€์ฑ… 9 2.2.1 ๋ฐฐ๊ธฐ๊ฐ€์Šค ์žฌ์ˆœํ™˜(EGR) ์žฅ์น˜ 10 2.2.2 ์„ ํƒ์  ์ด‰๋งค ํ™˜์›(SCR) ์žฅ์น˜ 11 2.2.3 EGR ๋ฐ SCR ์žฅ์น˜ ํ•จ์ • ์„ค์น˜ ๊ฐ€๋Šฅ์„ฑ ๊ณ ์ฐฐ 12 ์ œ3์žฅ ๋ฐ€๋Ÿฌ ์‚ฌ์ดํด(Miller Cycle) ํšจ๊ณผ 15 3.1 ๋ฐ€๋Ÿฌ ์‚ฌ์ดํด์˜ ์›๋ฆฌ 15 3.2 ๋ฐ€๋Ÿฌ ์‚ฌ์ดํด์˜ ์—ดํšจ์œจ 17 3.3 ์—”์ง„์˜ ๋ฐ€๋Ÿฌ ์‚ฌ์ดํดํ™” ์—ฐ๊ตฌ ๋ฐ ์ ์šฉ์‚ฌ๋ก€ 21 ์ œ4์žฅ ๋””์ ค๊ธฐ๊ด€์˜ ์„ฑ๋Šฅ ์‹œ๋ฎฌ๋ ˆ์ด์…˜ ํ”„๋กœ๊ทธ๋žจ 23 4.1 ์ด๋ก  ํ•ด์„์— ์ด์šฉ๋œ ์ฃผ๋œ ๊ฐ€์ • 23 4.2 ์‹ค๋ฆฐ๋” ๋ฐ ์šฉ๊ธฐ๋‚ด์˜ ์ƒํƒœ ๋ณ€ํ™” 25 4.2.1 ๊ฐ€์Šค ๊ตํ™˜ ๊ณผ์ • 25 4.2.2 ์••์ถ• ํŒฝ์ฐฝ ๊ณผ์ • 27 4.3 NO ์ƒ์„ฑ๋Ÿ‰ ๊ณ„์‚ฐ๋ฐฉ๋ฒ• 29 4.4 ๊ณผ๊ธ‰๊ธฐ ํšจ์œจ ๊ณ„์‚ฐ๋ฐฉ๋ฒ• 30 4.4.1 ์ž…๋ ฅ๋ฐ์ดํ„ฐ ๋ฐ ๊ฐ€์ • 30 4.4.2 ๊ณผ๊ธ‰๊ธฐ ํšจ์œจ ๊ณ„์‚ฐ๊ณผ์ • 31 4.5 ์‹œ๋ฎฌ๋ ˆ์ด์…˜ ๋Œ€์ƒ์—”์ง„ ๋ฐ ๊ณ„์‚ฐ ๋ชจ๋ธ 32 4.5.1 ์‹œ๋ฎฌ๋ ˆ์ด์…˜ ๋Œ€์ƒ์—”์ง„ 32 4.5.2 ๊ณ„์‚ฐ๋ชจ๋ธ ๋ฐ ์กฐ๊ฑด 32 4.6 ์‹œ๋ฎฌ๋ ˆ์ด์…˜ ๊ฒฐ๊ณผ ๊ณ ์ฐฐ 34 ์ œ5์žฅ ๋ฐ€๋Ÿฌ ์‚ฌ์ดํด ์ ์šฉ์‹œ ์„ฑ๋Šฅ์˜ˆ์ธก 36 5.1 ๋ฐ€๋Ÿฌ ์‚ฌ์ดํด ์ ์šฉ 36 5.1.1 EIVC ์ ์šฉ 36 5.1.2 LIVC ์ ์šฉ 39 5.2 ๋ฐ€๋Ÿฌ ์‚ฌ์ดํด ์ ์šฉ ๊ฒฐ๊ณผ ๊ณ ์ฐฐ 39 5.2.1 25% ๋ถ€ํ•˜์กฐ๊ฑด 40 5.2.2 50% ๋ถ€ํ•˜์กฐ๊ฑด 44 5.2.3 75% ๋ถ€ํ•˜์กฐ๊ฑด 48 5.2.4 100% ๋ถ€ํ•˜์กฐ๊ฑด 52 ์ œ6์žฅ ๊ฒฐ๋ก  56 ์ฐธ๊ณ ๋ฌธํ—Œ 57Maste

    Epidemiology of HIV/AIDS in East Asia

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    Background:Recent predictions of catastrophic epidemic surge of HIV infection in East Asia concern experts and governmental organizations. As in many other areas, countries in East Asia show diversities in their HIV epidemics, both geographically and temporally. However, they have similar regional, cultural and racial characteristics which allow them to have certain common factors. Having a clear picture of the current extent and feature of HIV/AIDS in this region is a very difficult task largely due to the fast pacing of expending epidemic and difficulty in data-sharing among countries in the region. Hence, we decided to study the epidemiologic feature of HIV/AIDS in East Asia through East Asia Network on HIV (EAN-HIV). Materials and Methods:The epidemiological patterns of HIV/AIDS in East Asian countries were investigated by collecting data through EAN-HIV. Results:The HIV/AIDS epidemic in East Asia started relatively late at mid 1980s. Since then, the number of newly infected HIV/AIDS cases has been steadily increasing with stiffer escalation in recent years. In China and Taiwan, IDU plays an important part in the swiftly growing HIV epidemics; however, in other regions like Korea, Japan, and Hong Kong, MSM (men who have sex with men) seems to be more of a problem. The major subtypes of HIV in East Asia are subtype B, C, and CRF01_AE, and rapidly evolving circulating recombinant forms (CRF) between subtypes such as CRF07_BC give dynamic change to the current status. Conclusion:The incidence of HIV/AIDS is rapidly increasing in East Asia. The epidemic pattern has undergone dynamic changes over time. China seems to be the leading source of HIV/AIDS epidemic in East Asia due to its large population and rapidly growing epidemics.ope

    A Case of Brucellar Spondylitis with Multiple Spine Involvement

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    Brucellosis, a zoonosis with world wide distribution, is a systemic infection that affects several organs and has protean presentation. Although spondylitis is universally the most common complication of brucellosis and difficult to treat, there is no consensus on the preferred combination of antibiotics use. The authors report a case of a 58-year-old male patient with brucellar spondylitis involving several vertebrae. Diagnosis was made by positive blood culture and magnetic resonance imaging. The authors use a combination method of doxycycline, ciprofloxacin and streptomycin for a period of 3 months. The systemic symptoms were improved after treatment.ope

    Prognosis Factors of Clostridium difficile Associated Diarrhea

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    Background:Clostridium difficile associated diarrhea (CDAD) has a wide range of clinical manifestations. The prognostic factors of CDAD are not fully understood. Materialsand Methods:A retrospective cohort study of 115 patients with CDAD from Aug. 2002 to Dec. 2003 was conducted to evaluate prognostic factors of CDAD. Bacteriologic factors were determined by detecting the binary toxin gene, tcd A, tcd A rep and tcd B gene. Poor prognosis was defined as diarrhea more than 10 days even with classic treatment, recurrence, death, and moribund discharge. Results:Approximately 79% of isolated strains were toxin A+/B+ strains and 21% were toxin A-/B+ strains. There was no difference in prognosis between toxin A+ and toxin A- strains. 39 (33.9%) cases showed poor prognosis and 76 (66.1%) cases showed good prognosis. Univariate analyses revealed that the poor prognostic factors were old age over 70 years old, male, the number of antibiotics used after onset of symptom, the administration of carbapenems, aminoglycosides, glycopeptides after onset of symptom, history of DM and stroke, and high Charlson comorbidity index. Multiple logistic regression analysis identified old age over 70 years old (odds ratio=3.378, P=0.009) and the administration of carbapenems after onset of symptom (odds ratio 7.210, P<0.001) as the independent poor prognostic factors. Conclusion:Old age over 70 and the administration of carbapenems after onset of symptom were the poor prognostic factors for CDAD caused by none-binary toxin producing strains.ope

    ํ‘์ƒ‰๋งˆ์šฐ์Šค์—์„œ ์ž์™ธ์„ ์„ ์กฐ์‚ฌํ•œ ํ‘œํ”ผ์ƒ‰์†Œ์„ธํฌ์— ํƒˆ์ƒ‰์†Œ์ œ์ œ๊ฐ€ ๋ฏธ์น˜๋Š” ์˜ํ–ฅ

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    ์˜ํ•™๊ณผ/๋ฐ•์‚ฌ[์˜๋ฌธ] [ํ•œ๊ธ€] ์ธ์ฒด์˜ ์ •์ƒ ํ”ผ๋ถ€์ƒ‰์€ ์ฃผ๋กœ ํ‘œํ”ผ์— ์นจ์ฐฉ๋œ ๋ฉœ๋ผ๋‹Œ์ƒ‰์†Œ์™€ ์นด๋กœํ‹ฐ๋…ธ์ด๋“œ์ƒ‰์†Œ ๊ทธ๋ฆฌ๊ณ  ์ง„ํ”ผ ํ˜ˆ๊ด€๋‚ด์˜ ํ˜ˆ์ƒ‰์†Œ๋“ฑ์— ์˜ํ•ด ์˜ํ–ฅ์„ ๋ฐ›์œผ๋‚˜ ์ด์ค‘ ํ”ผ๋ถ€์ƒ‰์— ๊ฐ€์žฅ ์ค‘์š”ํ•œ ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ๊ฒƒ ์€ ๋ฉœ๋ผ๋‹Œ์ƒ‰์†Œ์ด๋‹ค. ํ”ผ๋ถ€์˜ ๋ฉœ๋ผ๋‹Œ์ƒ‰์†Œ ์นจ์ฐฉ์„ ๋‘๊ฐ€์ง€ ๋ฒ”์ฃผ๋กœ ๊ตฌ๋ถ„ํ•  ๋•Œ ์ฒซ์งธ๋Š”, ์ž์™ธ์„  ์ด๋‚˜ ๋˜๋Š” ํ™˜๊ฒฝ์š”์ธ์˜ ์˜ํ–ฅ์—†์ด ์œ ์ „์ ์œผ๋กœ ๊ฒฐ์ •๋œ ์ƒ‰์†Œ์„ธํฌ์˜ ๊ธฐ๋Šฅ์— ์˜ํ•ด์„œ๋งŒ ๋ฉœ๋ผ๋‹Œ์ƒ‰ ์†Œ ์นจ์ฐฉ์ด ํ˜•์„ฑ๋˜๋Š” ๊ณ ์œ ์˜ ํ”ผ๋ถ€์ƒ‰ (constitutive skin color)๊ณผ ๋‘˜์งธ๋Š”, ๊ณ ์œ  ํ”ผ๋ถ€์ƒ‰์— ๋”ํ•˜์—ฌ ์ž์™ธ์„ ์ด๋‚˜ ๊ทธ์™ธ ๋‹ค๋ฅธ ํ™˜๊ฒฝ์š”์ธ์— ์˜ํ•ด ์œ ๋ฐœ๋˜๋Š” ์ž„์˜์˜ ํ”ผ๋ถ€์ƒ‰ (facultative ski n color)์œผ๋กœ ๊ตฌ๋ณ„๋  ์ˆ˜ ์žˆ๋‹ค. ์ž์™ธ์„  ์กฐ์‚ฌํ›„ ์œ ๋ฐœ๋˜๋Š” ๋ฉœ๋ผ๋‹Œ์ƒ‰์†Œ์˜ ์ฆ๊ฐ€๋Š” tyrosinaseํ™œ์„ฑํ™” ๋ฐ ํ™œ๋™์„ฑ ์ƒ‰์†Œ์„ธํฌ ์ˆ˜ ์˜ ์ฆ๊ฐ€์™€ ์—ฐ๊ด€์ด ์žˆ๋Š” ๊ฒƒ์œผ๋กœ ๋ฐŸํ˜€์กŒ์œผ๋ฉฐ, Rosdahl(1979)์€ ์ž์™ธ์„ ์ด ์กฐ์‚ฌ๋˜์ง€ ์•Š์€ ์‹ค ํ—˜๋™๋ฌผ์— ์ž์™ธ์„ ์„ ์ผ์ •์–‘ ๋ฐ˜๋ณต์กฐ์‚ฌํ•  ๊ฒฝ์šฐ DOPA์–‘์„ฑ ์ƒ‰์†Œ์„ธํฌ์˜ ์ˆ˜์  ์ฆ๊ฐ€๋Š” ์ž์™ธ์„ ์กฐ์‚ฌ ์ค‘๋‹จํ›„ ์žฅ๊ธฐ๊ฐ„ ํ™œ์„ฑํ™”๋˜์–ด ์ง€์†๋˜๋Š” ํ˜„์ƒ์„ ๋ณด๊ณ ํ•˜์˜€๋‹ค. ๋ณธ ์‹คํ—˜์—์„œ ์ €์ž๋Š” ์‹คํ—˜๋™๋ฌผ์— ์ž์™ธ์„ ์„ ๋ฐ˜๋ณต์กฐ์‚ฌํ•˜์—ฌ ์ƒ‰์†Œ์„ธํฌ ์ˆ˜์˜ ์ฆ๊ฐ€์™€ ๋ฉœ๋ผ๋‹Œ ์ƒ์„ฑ์„ ์œ ๋ฐœ์‹œํ‚จ ํ›„ ์„ฑ๋ถ„์ด ๋‹ค๋ฅธ ํƒˆ์ƒ‰์†Œ์ œ์ œ๋“ค์„ ๋„ํฌํ•˜์—ฌ ์ƒ๊ธฐ ์ œ์ œ๋“ค์ด ํ‘œ์ง€์˜ ์ƒ‰์†Œ์„ธ ํฌ์— ๋ฏธ์น˜๋Š” ์˜ํ–ฅ์„ ๊ด€์ฐฐํ•˜์˜€๋‹ค. ์‹คํ—˜๋™๋ฌผ๋กœ ์„ฑ์ˆ™๋œ C57Bl ์›…์„ฑ๋งˆ์šฐ์Šค 72๋งˆ๋ฆฌ๋ฅผ ์‚ฌ์šฉํ•˜์˜€์œผ๋ฉฐ ์ „์ฒด ๋งˆ์šฐ์Šค์˜ ์–‘์ชฝ ๊ท€์— UV-B๋ฅผ 10์ผ๊ฐ„ ์กฐ์‚ฌํ•˜์˜€๋‹ค. UV-B์˜ ๊ด‘์›์œผ๋กœ YS UVB-400์„ ์‚ฌ์šฉํ•˜์˜€์œผ๋ฉฐ ํŒŒ์žฅ์€ 290โˆผ325 nm(์ฃผํŒŒ์žฅ, 301nm) ์ผ์ผ ์กฐ์‚ฌ๋Ÿ‰์€ 100mJ/ใŽ ์˜€๋‹ค. ์ž์™ธ์„  ์กฐ์‚ฌ์™„๋ฃŒํ›„ 72๋งˆ๋ฆฌ์˜ ๋งˆ์šฐ์Šค๋ฅผ ๋ฌด์ž‘์œ„๋กœ 3๊ตฐ์œผ๋กœ ๋‚˜๋ˆ„์–ด ๋‹ค์Œ๊ณผ ๊ฐ™์ด ์‹คํ—˜ํ•˜์˜€ ๋‹ค. ์ œ โ… ๊ตฐ: ์—ฐ๊ณ ๊ธฐ์ œ ๋„ํฌ๊ตฐ(๋Œ€์กฐ๊ตฐ)โ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆ 24๋งˆ๋ฆฌ ์ œ โ…ก๊ตฐ: 20% monobenzylether of hydroquinone (MBEHQ) ๋„ํฌ๊ตฐโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆ24๋งˆ๋ฆฌ ์ œ โ…ข๊ตฐ: 20% azelaic acid(AZA) ๋„ํฌ๊ตฐโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆ24๋งˆ๋ฆฌ ์ƒ๊ธฐ ํƒˆ์ƒ‰์†Œ์ œ์ œ๋ฅผ ๋งˆ์šฐ์Šค์˜ ์–‘์ชฝ ๊ท€์— ๋งค์ผ ์˜ค์ „ ์˜คํ›„ 2ํšŒ์”ฉ 6์ฃผ๊ฐ„ ๋„ํฌํ•˜์˜€์œผ๋ฉฐ, DOP A์—ผ์ƒ‰๊ณผ ๊ด‘ํ•™ํ˜„๋ฏธ๊ฒฝ ๋ฐ ์ „์žํ˜„๋ฏธ๊ฒฝ ๊ด€์ฐฐ์„ ์œ„ํ•ด ์‹คํ—˜ 6์ฃผ๋™์•ˆ ๋งค์ฃผ ๊ฐ๊ตฐ๋‹น 4๋งˆ๋ฆฌ์˜ ๋งˆ์šฐ ์Šค ์–‘์ฆ‰ ๊ท€ ๋ฐฐ๋ถ€์—์„œ ์ƒ๊ฒ€ํ•˜์˜€๋‹ค. ์‹คํ—˜๊ฒฐ๊ณผ๋ฅผ ์š”์•ฝํ•˜๋ฉด ๋‹ค์Œ๊ณผ ๊ฐ™๋‹ค. 1. 20% MBEHQ์™€ 20% AZA๋„ํฌ๊ตฐ์€ ๋Œ€์กฐ๊ตฐ์— ๋น„ํ•ด DOPA์–‘์„ฑ ์ƒ‰์†Œ์„ธํฌ์˜ ์ˆ˜์™€ ํฌ๊ธฐ, ๋‘˜๋ ˆ ๊ธธ์ด ๋ฐ ๋ฉœ๋ผ๋‹Œ์ƒ‰์†Œ ํ˜•์„ฑ์— ์œ ์˜ํ•œ ๊ฐ์†Œ๋ฅผ ๋ณด์—ฌ ํƒˆ์ƒ‰์†Œ์ œ์ œ๋กœ์„œ ์˜์˜์žˆ๋Š” ํšจ๊ณผ๋ฅผ ๋‚˜ํƒ€๋‚ด ์—ˆ๋‹ค. 2. ๋‘ ์‹คํ—˜๊ตฐ๊ฐ„์˜ ๋น„๊ต์—์„œ AZA๋„ํฌ๊ตฐ์˜ DOPA์–‘์„ฑ ์ƒ‰์†Œ์„ธํฌ์ˆ˜๋Š” ๋„ํฌ 6์ฃผ ํ›„์— MBEHQ ๋„ํฌ๊ตฐ๋ณด๋‹ค ์˜์˜์žˆ๊ฒŒ ๊ฐ์†Œ๋˜์—ˆ์œผ๋ฉฐ, hematoxylin-eosin ์—ผ์ƒ‰์ƒ MBEHQ๋„ํฌ๊ตฐ์€ AZA๋„ํฌ๊ตฐ ์— ๋น„ํ•ด ๋„ํฌ 4์ฃผ ์ดํ›„๋ถ€ํ„ฐ ํ‘œํ”ผ์˜ ํ˜„์ €ํ•œ ๋น„ํ›„๋ฅผ ๋‚˜ํƒ€๋‚ด์—ˆ๋‹ค. 3. ์‹คํ—˜์•ฝ๋ฌผ์ด DOPA์–‘์„ฑ ์ƒ‰์†Œ์„ธํฌ์˜ ํ˜•ํƒœ์— ๋ฏธ์น˜๋Š” ์˜ํ–ฅ ์ค‘ ํŠน์ดํ•œ ํ˜„์ƒ์€ MBEHQ๋„ํฌ๊ตฐ ์—์„œ ๋„ํฌ 3์ฃผ ํ›„์— ์ˆ˜์ƒ๋Œ๊ธฐ๋งŒ ๊ฐ์†Œ๋˜๊ฑฐ๋‚˜ ์†Œ์‹ค๋œ ๊ตฌํ˜•์˜ ๋น„์ •ํ˜• ์ƒ‰์†Œ์„ธํฌ๊ฐ€ ๋ฐœ๊ฒฌ๋œ ๊ฒƒ ์ด๋ฉฐ, AZA๋„ํฌ๊ตฐ์—์„œ๋Š” ์ƒ‰์†Œ์„ธํฌ์˜ ์„ธํฌ์ฒด์™€ ์ˆ˜์ƒ๋Œ๊ธฐ๊ฐ€ ๋ชจ๋‘ ๋„ํฌ๊ธฐ๊ฐ„์— ๋น„๋ก€ํ•˜์—ฌ ๊ฐ์†Œ ๋˜๋Š” ์†Œ๊ฒฌ์„ ๋ณด์˜€๋‹ค. 4. ์ „์žํ˜„๋ฏธ๊ฒฝ ์†Œ๊ฒฌ์ƒ, ๋Œ€์กฐ๊ตฐ์—์„œ ์‹คํ—˜ ์ „๊ธฐ๊ฐ„์— ๊ฑธ์ณ ๊ฐ์งˆํ˜•์„ฑ์„ธํฌ ๋‚ด์™€ ์ƒ‰์†Œ์„ธํฌ ๋‚ด ์— stage โ…ฃ์˜ ๋ฉœ๋ผ๋‹Œ์†Œ์ฒด๋“ค์ด ๋‹ค์ˆ˜ ๊ด€์ฐฐ๋˜์—ˆ์œผ๋ฉฐ ์‹คํ—˜๊ตฐ์—์„œ๋Š” ๋„ํฌ 3์ฃผ ํ›„๋ถ€ํ„ฐ ๊ฐ์งˆํ˜• ์„ฑ์„ธํฌ ๋‚ด์—์„œ ๊ณตํฌ(vacuole)์— ๋“ค์–ด์žˆ๋Š” ์ „์ž๋ฐ€๋„๊ฐ€ ๋‚ฎ์€ ์†Œ๋Ÿ‰์˜ ๋ฉœ๋ผ๋‹Œ์†Œ์ฒด๋“ค์ด ๊ด€์ฐฐ๋˜ ์—ˆ๋‹ค. ์ด๋Ÿฌํ•œ ํ˜„์ƒ์€ MBEHQ๋„ํฌ๊ตฐ์—์„œ ๋” ํ˜„์ €ํ•˜์˜€๋‹ค. ๋„ํฌ 5์ฃผ์™€ 6์ฃผ ํ›„์—๋Š” ์‹คํ—˜๊ตฐ์˜ ๊ฐ์งˆํ˜•์„ฑ์„ธํฌ ๋ฐ ์ƒ‰์†Œ์„ธํฌ ๋‚ด์—์„œ ๋ฉœ๋ผ๋‹Œ์†Œ์ฒด๊ฐ€ ์†Œ์‹ค๋˜์—ˆ๊ฑฐ๋‚˜ ๋“œ๋ฌผ๊ฒŒ ๊ด€์ฐฐ๋˜์—ˆ๋‹ค. ์ด์ƒ์˜ ๊ฒฐ๊ณผ๋ฅผ ์ข…ํ•ฉํ•˜๋ฉด, MBEHQ์™€ AZA๊ฐ€ ํƒˆ์ƒ‰์†Œ์ œ์ œ๋กœ์„œ ์ž‘์šฉํ•˜๋Š” ๊ธฐ์ „์€ ์ƒ๊ธฐ ์•ฝ์ œ ๋ชจ ๋‘ ํ‘œํ”ผ์ƒ‰์†Œ์„ธํฌ์— ์ž‘์šฉํ•˜์—ฌ ํƒˆ์ƒ‰์†Œ ํšจ๊ณผ๋ฅผ ๋‚˜ํƒ€๋‚ด๋Š” ๊ฒƒ์œผ๋กœ ์‚ฌ๋ฃŒ๋˜๋ฉฐ MBEHQ๋Š” ์žฅ๊ธฐ๊ฐ„ ๋„ ํฌ์‹œ ๋งˆ์šฐ์Šค ํ”ผ๋ถ€์— ์ž๊ทนํ˜„์ƒ์„ ์œ ๋ฐœํ•˜๋Š” ๊ฒƒ์œผ๋กœ ๊ด€์ฐฐ๋˜์—ˆ๋‹ค. The Effect of Depigmenting Agents on Epidermal Melanocytes in UV-irradiated Mice Young Keun Kim Department of Medical Science The Graduate School, Yonsei University (Directed by Professor Yoon-Kee Park, M.D.) Normal human skin colors are produced by four skin pigments: in the epidermis, carotenoids and melanin; and in the dermis, oxygenated and reduced hemoglobin. Of these pigments, the major color determinant is melanin. Melanin pigmentation of the skin can be divided into two categories. The first, constitutive skin color designates the amount of cutaneous melanin pigmentation generated in accordance with cellular genetic programs in the absence of direct influences by radiations. The second, facultative (inducible) skin color characterizes the increase in melanin pigmentation above the constitutive level and arises from the complex interplay of solar radiation and other environmental factors upon the genetically endowed melanogenesis of the individual. Published reports regarding the increased melanin pigmentation following ultraviolet radiation suggest that an increase in tyrosinase activitr and a numerical increase of functioning melanocytes are responsib1e for enhanced pigment production. In this experiment, we induced activation of melanocytes and melanin pigmentation in the epidermis of C 57 B1 mice by UV-B irradiation. Aftar UV-B irradiation we observed the effect of the two different kinds of depigmenting agents on the epidermal melanocytes in UV-irradiated mice. A total of 72 mice had both their ears irradiated by UV-B daily for 10 days. The light source was YS UVB-400 with a wave length spectrum of 290โˆผ325nm(peak out-put at 301). The lamp to target distance was 30ใŽ and daily dose was 100 mJ/ใŽ . After irradiation, 72 mice were divided into 3 groups in random sampling and the application of depigmenting agents on each group is as follows. Group โ… : cream base(control)โ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆ24 Group โ…ก: 20% monobenzylether of hydroquinone (MBEHQ)โ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆ24 Group โ…ข: 20% azelaic acid(AZA)โ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆโ€ฆ24 The application of the depigmenting agents was done twice a day on both ears of mice for 6 weeks and four mice in each group were sacrificed by the end of the 1st, 2nd, 3rd, 4th, 5th, and 6th week of the application. Both ears of the mouse were cut at the base for split-dopa preparation and for light microscopic and electron microscopic preparation. The results are summarized as follows: 1. Both of MBEHQ and AZA showed significant diminution in the size, circumference, and number of dopa-positive melanocytes in C 57 Bl mouse skin. 2. As compared with the two experimental groups, the number of dopa-positive melanocytes tended to be of smaller quantity in AZA treated group by the end of the 6th week of the application. In areas treated with MBEHQ, the vertical sections stained with hematoxylin-eosin showed marked epidermal thickening after the 4 weeks' application. 3. In areas treated with MBEHQ, many of the remaining melanocytes were abnormal in shape having lost their dendrites so that they appeared as round bodies after the 3 weeks' application. In areas treated with AZA, there were no abnormal morphologic changes such as round bodies throughout the period of experiment. 4. On electron microscopic findings, there were many melanosomes of stage โ…ฃ in the keartinocytes and melanocytes during the experimental period in the control group. In the experimental groups, a small amount of melanosomes surrounded by vacuoles in the cytoplasm of keratinocytes was a prominent feature after the 3 weeks' application especially in MBEHQ treated group. By the end of the 5th and 6th week of the application in the experimental groups, there was a small amount or no melanosomes in the epidermis. In summary, the present study suggests that both of MBEHQ and AZA inhibit melanin pigmentation by the action on epidermal melanocytes either by destroying or inactivating melanocytes and the skin treated with MBEHQ skewed marked epidermal thickening comparing to the skin treated with AZA.restrictio

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    Chloroquine resistance and analysis of single-nucleotide polymorphisms of pvmdr1 gene in Korean vivax malaria

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    ์˜ํ•™๊ณผ/๋ฐ•์‚ฌ[ํ•œ๊ธ€] ๋ฐฐ๊ฒฝ: 1997๋…„ ์ดํ›„ ๋น„๋ฌด์žฅ์ง€๋Œ€ ๊ทผ์ฒ˜ ๋ง๋ผ๋ฆฌ์•„ ์œ„ํ—˜์ง€์—ญ์„ ์ค‘์‹ฌ์œผ๋กœ ์‹œ์ž‘ํ•œ ํ•œ๊ตญ๊ตฐ์˜ ๋ง๋ผ๋ฆฌ์•„์— ๋Œ€ํ•œ hydroxychloroquine/primaquine ์˜ˆ๋ฐฉ์š”๋ฒ•์€ ๋ง๋ผ๋ฆฌ์•„ ๋ฐœ์ƒ์œจ ๊ฐ์†Œ์— ๊ธฐ์—ฌํ•˜๊ณ  ์žˆ์œผ๋‚˜, chloroquine ๋‚ด์„ฑ ๋ง๋ผ๋ฆฌ์•„ ์ถœํ˜„์˜ ์œ„ํ—˜์„ฑ์ด ์žˆ๋‹ค. ์ด์— ์—ฐ๊ตฌ์ž๋Š” ์˜ˆ๋ฐฉ์•ฝ์„ ์ ์ ˆํžˆ ๋ณต์šฉํ•˜์˜€์Œ์—๋„ ๋ถˆ๊ตฌํ•˜๊ณ  ๋ฐœ์ƒํ•œ ๋ง๋ผ๋ฆฌ์•„์˜ ๋นˆ๋„ ๋ฐ chloroquine ๋‚ด์„ฑ๊ฐ์‹œ๋ฅผ ์‹œํ–‰ํ•˜์˜€๊ณ , pvmdr1 ์œ ์ „์ž ๋‹จ์—ผ๊ธฐ๋ณ€์ด์™€ chloroquine ๋‚ด์„ฑ๊ณผ์˜ ์—ฐ๊ด€์„ฑ์„ ์กฐ์‚ฌํ•˜์˜€๋‹ค.๋ฐฉ๋ฒ•: ๋ง๋ผ๋ฆฌ์•„ ๋ฐœ์ƒ ์œ„ํ—˜์ง€์—ญ์˜ ํ•œ๊ตญ๊ตฐ์„ ๋Œ€์ƒ์œผ๋กœ ์˜ˆ๋ฐฉ์„ ์œ„ํ•˜์—ฌ 2006๋…„ 5์›”๋ถ€ํ„ฐ hydroxychloroquine sulfate 400 mg์ด ๋ง๋ผ๋ฆฌ์•„ ์œ ํ–‰๊ธฐ์— 1์ฃผ๋งˆ๋‹ค ํˆฌ์—ฌ๋˜์—ˆ๋‹ค. 2006๋…„ 6์›”๋ถ€ํ„ฐ 9์›”๊นŒ์ง€ ๋น„๋ฌด์žฅ์ง€๋Œ€ ๊ทผ์ฒ˜์˜ ๊ฒฝ๊ธฐ๋„์— ์ฃผ๋‘”ํ•œ ํ•œ๊ตญ๊ตฐ์—์„œ ๋ฐœ์ƒํ•œ 102๋ช…์˜ ํ™˜์ž๋ฅผ ๋Œ€์ƒ์œผ๋กœ ๋ง๋ผ๋ฆฌ์•„ ๋ฐœ์ƒ ์ด์ „์˜ ์˜ˆ๋ฐฉ์š”๋ฒ•์˜ ์ ์ ˆ์„ฑ์„ ์กฐ์‚ฌํ•˜์˜€๋‹ค. ์ด ์ค‘ 85๋ช…์˜ ํ™˜์ž๋ฅผ ๋Œ€์ƒ์œผ๋กœ 28์ผ๊ฐ„ chloroquine ์น˜๋ฃŒ ๋‚ด์„ฑ ๊ฐ์‹œ๋ฅผ ์‹œํ–‰ํ•˜์˜€์œผ๋ฉฐ ์ด๋“ค ํ™˜์ž๋กœ๋ถ€ํ„ฐ ๋ถ„๋ฆฌ๋œ Plasmodium vivax๋กœ๋ถ€ํ„ฐ pvmdr1 ์œ ์ „์ž์˜ ๋‹จ์—ผ๊ธฐ๋ณ€์ด๋ฅผ ๋ถ„์„ํ•˜์˜€๋‹ค.๊ฒฐ๊ณผ: 102๋ช…์˜ ํ™˜์ž ์ค‘ ์˜ˆ๋ฐฉ์š”๋ฒ•์ด ์ ์ ˆํ•˜์˜€๋˜ ํ™˜์ž๋Š” 66๋ช…(64.7%) ์ด์—ˆ๊ณ , ๋ถˆ๊ทœ์น™ํ•œ ๋ณต์šฉ 11๋ช…(10.8%), ์˜ˆ๋ฐฉ์•ฝ์„ ์ „ํ˜€ ๋ณต์šฉํ•˜์ง€ ์•Š์•˜๋˜ ํ™˜์ž๋Š” 25๋ช…(24.5%)์ด์—ˆ๋‹ค. Chloroquine ์น˜๋ฃŒ ๋‚ด์„ฑ ๊ฐ์‹œ๋ฅผ ์‹œํ–‰ํ•œ ๋ชจ๋“  ํ™˜์ž์—์„œ chloroquine ํ‘œ์ค€์น˜๋ฃŒ 3์ผ ์ดํ›„์˜ ๋ง์ดˆํ˜ˆ์•ก๋„๋ง๊ฒ€์‚ฌ์—์„œ ๋ง๋ผ๋ฆฌ์•„ ์›์ถฉ์€ ๊ด€์ฐฐ๋˜์ง€ ์•Š์•˜๋‹ค. pvmdr1 ์œ ์ „์ž ๋ถ„์„์„ ์‹œํ–‰ํ•œ 78์˜ˆ ๋ชจ๋‘์—์„œ F1076L ๋ณ€์ด๊ฐ€ ๊ด€์ฐฐ๋˜์—ˆ๋‹ค.๊ฒฐ๋ก : ์—ฐ๊ตฌ ๋Œ€์ƒ ๋ง๋ผ๋ฆฌ์•„ ๋ฐœ์ƒ ํ™˜์ž ์ค‘ 2/3๊ฐ€ ์ ์ ˆํžˆ ์˜ˆ๋ฐฉ์•ฝ์„ ๋ณต์šฉํ•˜๊ณ  ์žˆ์—ˆ๋‹ค. Chloroquine์˜ ์น˜๋ฃŒ์‹คํŒจ๋Š” ์—†์—ˆ์œผ๋‚˜, pvmdr1 ์œ ์ „์ž์˜ F1076L ๋ณ€์ด๊ฐ€ chloroquine ์˜ˆ๋ฐฉ์‹คํŒจ์™€ ๊ด€๋ จ ์žˆ์„ ๊ฒƒ์œผ๋กœ ์ƒ๊ฐ๋œ๋‹ค. [์˜๋ฌธ] Background: Chemoprophylaxis with chloroquine (CQ) and primaquine has been used in the Republic of Korea (ROK) Army since 1997 to reduce the number of the malaria cases. It has contributed, in part, to the decrease in the number of malaria cases among military personnel. However, chemoprophylaxis may facilitate the development of CQ-resistant strains of Plasmodium vivax. We investigated the breakthrough malaria infection and the therapeutic efficacy of CQ in P. vivax in ROK. And the pvmdr1 gene polymorphisms and its relevance to CQ-resistance in P. vivax were evaluated.Methods: Chemoprophylaxis with hydroxychloroquine sulfate (400 mg, once per week) was started in May and continued throughout the transmission season. From June to September 2006, 102 soldiers with vivax malaria near the demilitarized zone in Gyeonggi-do, ROK, were enrolled. Breakthrough malaria was defined when a patient had taken all prophylactic doses every week prior to infection. The status of chemoprophylaxis was determined by the interview. In 85 patients, therapeutic efficacy was monitored during 28 days after standard CQ treatment. The single nucleotide polymorphisms of pvmdr1 in the isolates from these patients were analyzed.Results: Among 102 malaria cases occurring during study period, breakthrough malaria was observed in 66 patients (64.7%) who had complete compliance. Incomplete compliance was 11 cases (10.8%) and no compliance was 25 cases (24.5%). In all patients enrolled in therapeutic efficacy monitoring, parasitemia had not been observed since 3 days after standard CQ treatment. Nucleotide polymorphism at 1 codon (F1076L) was found in all analyzed isolates.Conclusion: Breakthrough malaria was observed in about two thirds of malaria cases occurring in the area on chemoprophylaxis. Although there was no treatment failure, it was likely that the F1076L mutation of the pvmdr1 gene might contribute to CQ-prophylaxis failure in P. vivax.ope

    Effect of tuberculosis on the course of HIV infection

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    ์˜ํ•™๊ณผ/์„์‚ฌ[ํ•œ๊ธ€] ์‚ฌ๋žŒ๋ฉด์—ญ๊ฒฐํ•๋ฐ”์ด๋Ÿฌ์Šค(human immunodeficiency virus; HIV) ๊ฐ์—ผ์ž์—์„œ ๋ฐœ์ƒํ•˜๋Š” ๊ธฐํšŒ๊ฐ์—ผ ์ค‘ ๊ฒฐํ•ต์€ ๊ตญ๋‚ด๋ฟ๋งŒ ์•„๋‹ˆ๋ผ ์„ธ๊ณ„์ ์œผ๋กœ ๊ฐ€์žฅ ํ”ํ•œ ํ›„์ฒœ์„ฑ ๋ฉด์—ญ๊ฒฐํ•์ฆ(acquired immunodeficiency syndrome; AIDS) ์ •์˜ ์งˆํ™˜์ด๋ฉด์„œ HIV ๊ฐ์—ผ์ž์˜ ์ฃผ์š” ์‚ฌ๋ง ์›์ธ์ด๋‹ค. ๊ฒฐํ•ต์ด HIV์˜ ๋ณต์ œ๋ฅผ ์ฆ๊ฐ€์‹œํ‚จ๋‹ค๊ณ  ์•Œ๋ ค์ ธ ์žˆ์ง€๋งŒ ์ž„์ƒ์ ์œผ๋กœ HIV ๊ฐ์—ผ์˜ ์งˆ๋ณ‘๊ฒฝ๊ณผ๋ฅผ ์•…ํ™”์‹œํ‚ฌ ์ˆ˜ ์žˆ๋Š”์ง€์— ๋Œ€ํ•˜์—ฌ๋Š” ๋…ผ๋ž€์ด ๋งŽ์•„ ๊ตญ๋‚ด์—์„œ์˜ ๊ฒฐํ•ต์ด HIV ๊ฐ์—ผ์˜ ์งˆ๋ณ‘๊ฒฝ๊ณผ์— ๋ฏธ์น˜๋Š” ์˜ํ–ฅ์„ ์กฐ์‚ฌํ•˜์˜€๋‹ค.์—ฐ์„ธ๋Œ€ํ•™๊ต ์˜๊ณผ๋Œ€ํ•™ ์„ธ๋ธŒ๋ž€์Šค๋ณ‘์›์—์„œ 1992๋…„๋ถ€ํ„ฐ 2004๋…„๊นŒ์ง€ HIV ๊ฐ์—ผ์ž์ค‘ ๊ฒฐํ•ต์œผ๋กœ ์ง„๋‹จ ๋ฐ›์€ 44์˜ˆ์˜ ํ™˜์ž๊ตฐ๊ณผ ํ™˜์ž๊ตฐ๊ณผ ๋น„์Šทํ•œ CD4+ T์„ธํฌ์ˆ˜ (ยฑ25/ใŽ•)์— ๋Œ€์‘ํ•˜๋Š” ๊ฒฐํ•ต ๋ฐœ๋ณ‘์ด ์—†์—ˆ๋˜ HIV ๊ฐ์—ผ์ž 44์˜ˆ์˜ ๋Œ€์กฐ๊ตฐ์„ ํ›„ํ–ฅ์  ์ฝ”ํ˜ธํŠธ ์—ฐ๊ตฌ๋ฐฉ๋ฒ•์œผ๋กœ viral load, ๊ด€์ฐฐ ์‹œ์ž‘ ํ›„ AIDS ์ •์˜ ์งˆํ™˜์˜ ๋ฐœ์ƒ ๋นˆ๋„, ์ƒ์กด์œจ์„ ๋น„๊ตํ•˜์—ฌ ๊ฒฐํ•ต์ด HIV ๊ฐ์—ผ์˜ ์งˆ๋ณ‘๊ฒฝ๊ณผ์— ๋ฏธ์น˜๋Š” ์˜ํ–ฅ์„ ์กฐ์‚ฌํ•˜์˜€๋‹ค.ํ™˜์ž๊ตฐ๊ณผ ๋Œ€์กฐ๊ตฐ ๊ฐ„์˜ ์—ฐ๋ น, ์„ฑ๋ณ„, ๊ฐ•๋ ฅํ•œ ํ•ญ๋ ˆํŠธ๋กœ๋ฐ”์ด๋Ÿฌ์Šค ์น˜๋ฃŒ(highly active anti-retroviral therapy; HAART) ์œ ๋ฌด์˜ ์ฐจ์ด๋Š” ์—†์—ˆ๋‹ค. ํ‰๊ท  CD4+ T์„ธํฌ์ˆ˜๋„ ํ™˜์ž๊ตฐ 84.5๊ฐœ/ใŽ•, ๋Œ€์กฐ๊ตฐ 84.0๊ฐœ/ใŽ•๋กœ ์ฐจ์ด๊ฐ€ ์—†์—ˆ๋‹ค. ํ‰๊ท  viral load๋Š” ํ™˜์ž๊ตฐ 6.2ร—105 copies/ใŽ•, ๋Œ€์กฐ๊ตฐ 2.9ร—105 copies/ใŽ•๋กœ ํ™˜์ž๊ตฐ์—์„œ ๋†’๊ฒŒ ๋‚˜ํƒ€๋‚ฌ์œผ๋ฉฐ(p=0.001), ๊ด€์ฐฐ ์‹œ์ž‘ ํ›„ AIDS ์ •์˜ ์งˆํ™˜์˜ ๋ฐœ์ƒ ๋นˆ๋„๋„ ํ™˜์ž๊ตฐ 2.9/100 person-months, ๋Œ€์กฐ๊ตฐ 1.2/100 person-months๋กœ ๋Œ€์กฐ๊ตฐ์— ๋น„ํ•˜์—ฌ ํ™˜์ž๊ตฐ์ด 2.43(95% CI: 1.02-5.14)๋ฐฐ ๋†’์•˜๋‹ค. ํ™˜์ž๊ตฐ์˜ ์‚ฌ๋ง๋ฅ  ๋˜ํ•œ ๋Œ€์กฐ๊ตฐ๋ณด๋‹ค ๋†’์•˜์œผ๋ฉฐ(p=0.025, log rank), ๊ฒฐํ•ต์ด HIV ๊ฐ์—ผ์ž์˜ ์‚ฌ๋ง์— ๋ฏธ์น˜๋Š” ๊ธฐ์—ฌ ์œ„ํ—˜๋„๋Š” 2.09(95% CI: 1.07-4.08)์˜€๋‹ค.์ƒ๊ธฐ์˜ ๊ฒฐ๊ณผ๋ฅผ ํ†ตํ•˜์—ฌ HIV ๊ฐ์—ผ์ž์—๊ฒŒ ๊ฒฐํ•ต์ด ๋ฐœ์ƒํ•˜๋ฉด viral load๊ฐ€ ์ฆ๊ฐ€ํ•˜์—ฌ ๋ฉด์—ญ ์ €ํ•˜๋ฅผ ์ฆ๊ฐ€์‹œํ‚ด์œผ๋กœ ๊ธฐํšŒ ๊ฐ์—ผ์˜ ๋นˆ๋„๋ฅผ ๋†’์ด๊ณ  ๊ฒฐ๊ตญ ์‚ฌ๋ง์— ์˜ํ–ฅ์„ ์ค„ ์ˆ˜ ์žˆ์–ด ๊ฒฐํ•ต์ด HIV ๊ฐ์—ผ์ž์˜ ์งˆ๋ณ‘ ๊ฒฝ๊ณผ๋ฅผ ์•…ํ™”์‹œํ‚จ๋‹ค๋Š” ๊ฒƒ์„ ์•Œ ์ˆ˜ ์žˆ์—ˆ๋‹ค. [์˜๋ฌธ]Background: In Korea, endemic area of Mycobacterium tuberculosis (TB) infection, the incidence of new HIV infection has been persistently increasing each year and HIV/TB coinfected patients are common. Several studies suggested that TB enhanced the replication of HIV and could accelerate the course of HIV infection. So, we investigated the effect of tuberculosis on the course of HIV infection in Korea.Methods: In an observational study of retrospective cohorts at Severance Hospital, Yonsei University College of Medicine, Seoul, Korea from 1992 to 2004, the evolution of 44 HIV-infected patients with TB (cases) was compared with that of the absolute CD4+ T cell count matched(ยฑ25 cells/ใŽ•) 44 HIV-infected patients without TB (control subjects). To determine the effect of tuberculosis on the course of HIV infection, the incidence rate of opportunistic diseases and the mortality were evaluated.Results: There were no significant differences between the cohorts for age, sex and antiretroviral therapy including highly active antiretroviral therapy. The mean CD4+ T cell counts were similar between cases and control subjects (84.5 cells/ใŽ• versus 84.0 cells/ใŽ•, respectively). The mean viral load was much higher in cases than that of control subjects (6.2ร—105 copies/ใŽ• versus 2.9ร—105 copies/ใŽ•, respectively, p=0.001). The incidence rate of new subsequent AIDS-defining opportunistic diseases in cases was 2.9 infections per 100 person-months compared with 1.2 infections per 100 person-months in control subjects for an incidence rate density ratio of 2.43 (95% CI: 1.02-5.14). Cases also had a shorter overall survival than did control subjects (p = 0.025, log rank test). Tuberculosis in HIV-infected patients was associated with an increased risk for death (hazard ratio = 2.09, 95% CI: 1.07-4.08).Conclusion: Tuberculosis in HIV-infected patients was related to more frequent AIDS-defining opportunistic diseases and shorter survival.ope
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