문제중심 학습방법을 적용한 임상실습교육의 만족도, 자율성, 성취종기와의 관계 -모아임상실습을 중심으로-

백경선 ( Kyoung Seon Baek ),송애리 ( Ae Ri Song ),김영희 ( Yeong Hie Kim ),김태경 ( Yae Kyung Kim ) 경희대학교 동서의학연구소 2007 동서간호학연구지 Vol.13 No.2

본 연구는 학생들이 실제 임상 상황의 맥락 안에서 문제를 해결해 나가면서 기존의 지식과 경험을 반영 하고 이로 인해 사고력과 학습에 대한 흥미와 동기를 증가시키는 문제중심학습법을 적용한 간호학생들의 성취동기,자율성과 임상실습만족도 간의 관계를 파악하여 보다 효과적이고 질적인 임상실습 교육의 전략 마련을 위한 기초자료를 제시하고자 시도하였다. 문제중심학습은 실제적인 문제에서 학습이 시작하게 되며,효과적인 학습이 이루어지기 위해서 학습자에게 제시되는 문제는 자신이 실제 임상세계에서 경험하는 문제이어야 한대 따라서, 모아임상실습을 하면서 경험하게 되는 실제 임상사례에 바탕을 둔 시나리오를 개발하여 간호과 2학년 학생의 모아임상실습시에 적용하였다. 본 연구의 대상자는 임상실습을 시행하기전에 사전에 교과목을 통하여 문제중심학습 에 대한 학습방법의 지식을 습득하였으며,이 방법을 통하여 이론 수업을 진행한 경험이 있는 학생들이다. 이러한 사전경험으로 학생들은 새로운 학습법으로 인한 시간소요나 혼란을 줄일 수 있었으며, 임상실습을 통하여 시나리오의 사례를 실제로 경험하면서 보다 역동적으로 실습에 임하고, 지식 습득 및 문제해결에 대한 높은 흥미를 보였다. 본 연구에서 문제중심학습법을 적용한 간호학생들의 임상실습만족도는 3.34으로 나타났다. 이는 문제중심학습법을 적용하지 않은 일반적인 간호학생들의 임상실습반족도를 연구한 Kim과 Oh(2000) 의 연구결과 인 2.96점과 Park과 Lee (2002)의 2.86점 보다 높은 점수이다. 또한, 임상실습만족도의 하부영역 중 ``임상실습내용``에 대한 만족도 (3.49)가 타 하부영역에 비해 높게 나타났으며, 이는 Park과 Lee(2002)의 연구에서 임상실습 환경영역의 점수(3.11)가 가장 높게 나타난 것과 다소 상반되는 결과이다. 실제 본 연구대상자들은 임상실습지도 (3.46), 환경(3.31) 평가(3.23) 및 시간 (3.16) 등과 같은 임상실습의 외부적인 부분이 다소 열악한 상황에서도 실습의 내용적인 면에서는 만족하고 있었으며, 이는 현재 우리나라 간호대학 임상실습의 환경이 주로 수동적인 환경임에도 불구하고, 문제 중심학습법이 학생들의 능동적인 학습태도와 학습 동기 유발 및 흥미를 상승시킨 효과로 볼 수 있다. 자율성(Autonomy)이란 의미는 자기- 규율, 자기·결정, 자기·통치 및 독립성이란 용어로 오늘날 전문직 자율성의 개념은 간호 전문직 내에서 관심과 중요성이 증가되고 있다. 현 시대의 간호사는 신속하고 정확한 판단과 종합적인 결정 능력이 요구되는 복잡한 간호현장에서 중요시되는 자율성을 높이기 위해서는 간호교육에서부터 자율성을 신장시켜 주는 교육이 필요하다고 하겠다. (Shin, 1996). 본 연구 대상자의 자율성은 평균 3.83점으로 Kim (1998)의 4년제 간호대학생을 대상으로 한 연구의 3·53점 보다 높게 나타났다. 이는 문제중심학습을 적용한 본 연구가 간호학생들로 하여금 스스로 문제를 찾아내고 해결해가는 자율적 이고 자기주도적인 학습능력을 향상시킨 결과로 이해 되어진다. 간호사는 대상차의 건강과 관련된 요구에 적절히 반응할 수 있는 지식의 소유자이며, 대상자를 위한 이타적인 가치관을 소유한 전문가로써 간호사 자신 뿐만 아니라 대상자에 대한 존중을 기본적인 소양으로 가지고 있어야만 한다. 이에 간호사의 진정한 자율성은 대상자에 대한 존중에서부터 나온다고 할 수 있다. 본 연구의 지율성 하부영역에서 ``타인에 대한 존중`` 이 4.15점으로 상당히 높게 나타났으며, 이는 간호학생들의 임상실습교육이 단순히 이론적인 지식의 실제 적용을 넘어 대상자를 존중하고 대상자의 요구를 사정하여 적합한 간호중재를 제공하는 기회로 간호전문가로써의 기본 자질을 함양할 수 기회를 제공 한것으로 보인다. 성취동기는 어떤 훌륭한 일을 이루어보겠다는 내적 의욕으로 과업을 성취해나가는 과정에서 만족하는 성취의욕이며 후천적으로 학습되고 습득되며 육성된다. 간호학생들의 성취동기는 학업수행과 밀접한 연관성이 있으며, 성취동기는 학습의 효율성을 높이기 위한 기본 요소로서 본 연구에서는 간호과 학생들의 성취 동기는 3.83점으로 높게 나타났으며, 이는 Park과 Lee (2002) 의 연구보다 높게 나타났다. 성취동기는 이론학습과는 높은 상관관계가 있는 것으로 많은 연구에서 나타났지만, 실제 임상실습시에도 높은 성취동기는 임상실습 만족에 영향을 주는 것으로 나타났다. 문제 중심학습법은 학습의 동기유발을 통하여 성취동기를 향상시키며,이를 통하며 적극적인 학습태도를 유발 한다. 일반적 특성에 따른 성취동기, 자율성과 임상실습 만족도를 살펴보며 성취동기,자. 성이 학과만족도에 따라 차이를 보여주고 있는데, 이는 학과에 대한 만족도가 높을수록 성취동기와 자율성이 높은 것으로 결국 학과에 대한 만족도는 학업성취에 많은 영향을 미치며 (Park, 1992), 본 연구에서도 학과전공에 대한 만족도가 높을수록 성취동기가 높게 조사되어 유의한 차이가 있었다. 또한 실습시기에서 임상실습만족도 중 ``임상실습내용`` (t=2.219, P<0.35)과 자율성 중 ``타인에 대한 존중``(t=3.133, P<.005)이 차이를 보였다. 이는 ``학교수업을 한후 실습`` 을 하는 실습이 ``실습 후 학교수업``을 하는 경우보다 임상실습에서 이론적 지식을 습득한 후 실습을 할 경우 실습에 조금 더 자신 감을 가지고 수행할 수 있는 것으로 보여진다. 따라서 임상실습의 시기는 이론 강의가 이루이진 후 시행 되는 현재의 간호교육이 타당하다고 하겠다. 본 연구에서는 성취동기, 자율성과 임상실습만족도가 유의한 상관성이 있는 것으로 나타났다. 문제중심 학습법을 임상실습에 적용한 본 연구대상자들의 성취 동기와 임상실습만족도간의 상관관계는 r=.476으로 유의하게 나타났는데 이는 Jang(2000)의 연구에서 성취동기와 임상실습만족도와의 관계가 순 상관관계를 나타낸 것 같다. 이러한 결과를 통하여 성취동기가 높을수록 임상실습만족도가 높아지는 것을 알 수 있으며, 어떠한 일을 잘 이루어 내겠다는 욕구가 내재 화되어 있는 사람은 임상교육에서도 그 욕구가 작용하여 성공적으로 그 일을 끝마치려는 행동을 보이고 그 결과 좋은 교육효과를 거두는 것으로 추론할 수 있다. 또한 자율성과 임상실습만족도와의 관계에서도 Park(2003)의 연구와 유사하게 본 연구에서도 자율성 과 임상실습만족도가 유의한 상관성이 있는 것으로 나타났으며 (r=.328), 자율성과 성취동기도 유의한 상관 관계 (r=.468)를 보였다. 성취동기는 후천적 학습에 의해 더욱 강화되므로 단시간의 훈련으로 높일 수 있으며 지능과 관계없이 육성될 수 있는 좋은학습 신장도구이므로, 현장실습 과정에서 학생들의 임상실습만족도를 높이기 위하여 성취동기를 높일 수 있는 교육학습법이 요구되어진다. 문제중심학습법은 임상의 실제 사례를 통하여 학습에 대한 동기유발을 통한 자율성 증대와 문제해결능력을 향상시킴으로써 다양하고 급변해 가는 임상현장 에 적합한 간호 인력을 양성하기 위한 교수학습법이다. 이론 강의시 사용되는 문제중심학습법은 실무와 떨어진 교육환경에서의 적용이라는 한계점을 여전히 수반하고 있으며, 학생들에게 이론적인 지식의 습득에 대한 접근을 달리하는 방법으로만 적용되어 오고 있다. 이에 본 연구에서는 임상현장에서 실습을 하고 있는 학생들에게 문제중심학습법을 적용해 봄으로써 이론 강의의 적용에서 오는 한계점을 극복할 수 있었다. 학생들은 주어진 사례를 직접 임상실습을 통하여 확인할 수 있었으며, 이러한 학습과정이 학생들의 임상실습에 대한 성취동기와 자율성을 증가시켰고, 이는 임상실습에 대한 만족도를 높여 실습교육을 긍정적이고 능동적으로 수행하도록 유도하였다. 이상의 논의를 종합해 볼 때 간호학생들의 임상실습학습의 질적인 향상을 위하여서는 학생들의 성취동기 및 자율성을 향상시킬 수 있는 교육학습법으로 문제중심 학습법이 기존의 이론강의뿐만 아니라 임상실 습교육에서도 학생들의 성취동기를 향상시키며 자율성을 강화시킨다는 점에서 간호학생을 위한 임상실습 의 학습법으로 적합하다고 생각된다. The purpose of this study was to examine nursing students`` satisfaction level with PBL-based clinical practice, their autonomy, achievement motivation and what affected them in those regards in an attempt to lay the groundwork for providing more systematic and efficient clinical practice. Method: The subjects in this study were 138 nursing sophomores at J college who participated in PBL-based clinical practice. Results: They got a mean of 3.34, 3.83 and 3.83 in satisfaction level with the clinical practice, autonomy and achievement motivation respectively. In regard to the relationship of the satisfaction level to general characteristics including motivation of choosing the major and time for undergoing the clinical practice, the students who decided to major in nursing at their own option(3.6l) were most contented with practice teaching(F=6.356, p<.0l), and those who underwent the clinical practice after taking lessons(3.82) were most pleased with the content of the clinical practice (t=2.129, p<.05). Concerning connections between autonomy and general characteristics involving age, satisfaction with the major and time for the clinical practice, the students who were at the age of 22(3.92) valued themselves the most(F=3.003, P<.05). And those who found their major satisfactory (4.28) and undergo the clinical practice after taking lessons(4.37) respected others the most(F=3.l33, p<.0l). As to relations between achievement motivation and general characteristics, the students who were contented with their major(4.00) excelled the others who weren``t in that aspect(F6.038, p<.0l). The satisfaction level with the clinical practice was positively correlated to autonomy (r=.328, p<.0l) and achievement motivation(r.476, p<.01). Conclusions: The findings illustrated that the nursing students expressed the satisfaction with the PBL-based clinical practice education. The older students who were 22 years old were more autonomous, and those who took part in the clinical practice after receiving theoretical instruction were more autonomous and more pleased with the practice. The students who found their major more satisfactory surpassed the others in autonomy and achievement motivation. There was positive correlation among the clinical- practice satisfaction level, autonomy and achievement motivation. There are some suggestions: Intensive research efforts should be directed into getting a profound grasp of PBL-based clinical practice education geared toward nursing students. The development of modules for PBL-based nursing clinical practice education was required. How to provide PBL-based theoretical education to nursing students should be studied.

SATEEC ArcView GIS를 이용한 홍천군 자운리 유역임의 경작지의 산림 환원에 따른 토양유실 및 유사저감 분석

장원석 ( Won Seok Jang ),박윤식 ( Youn Shik Park ),김종건 ( Jong Gun Kim ),김익재 ( Ik Jae Kim ),문유리 ( Yu Ri Mun ),전만식 ( Man Sig Jun ),임경재 ( Kyoung Jae Lim ) 한국환경정책평가연구원 2009 환경정책연구 Vol.8 No.1

댐 유역내 경작지나 산림에서의 가속화된 토양유실은 하류지역의 탁수문제를 야기시킨다. 토양유실은 탁수의 증가와 생태계 파괴의 원인으로서 사회적으로나 환경적으로 해결되어야만 하는 문제로 나타나고 있다. 또한 토양유실은 강우로 인하여 유출이 일어날 때 대부분의 경작지에서 발생하는데, 이는 수리 구조물을 불안정하게 만들고, 생태계를 파괴하며 취수를 악화 시키는 등 환경적·경제적 문제를 일으킨다. 이로 인해 수자원의 지속가능한 이용뿐만 아니라 하천생태계에도 많은 피해를 주고 있으나, 그동안 탁수문제는 저수지를 포함한 유역 물관리 운영에 적극적으로 고려되지는 않았다. 소양강댐 유역내 탁수의 주원인이 되는 탁수우선관리지역(우심지역) 세 개의 소유역 중 하나가 홍천에 위치한 자운리 지역이다. 특히 이 지역에서는 산림을 무허가로 밭으로 개간하여 소득작물을 재배하는 무허가 경작이 행해지고 있다. 본 연구의 목적은 Sediment Assessment Tool for Erosion Control (SATEEC) ArcView GIS를 기반으로 고해상도 위성사진과 지적도를 이용하여 현 상황을 보여주는 토지이용을 새롭게 구축하여 무허가 경작지를 산림으로 환원하였을 경우 토양유실저감을 평가하고자 함에 있다. 본 연구 결과에서 같이 무허가 경작지를 산림으로 환원한다면 17.42%의 토양유실 저감이 기대된다. 자운리 지역의 무허가 경작지는 경사도가 30%이상인 지역에서 47.48ha(30.83%), 경사도가 15%이상인 지역에서는 103.64ha(67.29%)를 차지하고 있다. 만약 모든 무허가 경작지를 산림으로 환원한다면 17.41%의 토양유실 및 유사량 감소가 기대되고, 경사도가 30%이상인 지역에서는 10.86%, 경사도가 15%이상인 지역에서는 16.15%의 감소가 기대된다. 따라서 자운리 유역에서 야기되는 토양유실과 이에 따른 탁수발생을 저감시키기 위해서는 경사지에 위치한 무허가 경작지를 우선적으로 환원시켜야만 한다. The fact that soil loss causing to increase muddy water and devastate an ecosystem has been appearing upon a hot social and environmental issues which should be solved. Soil losses are occurring in most agricultural areas with rainfall-induced runoff. It makes hydraulic structure unstable, causing environmental and economical problems because muddy water destroys ecosystem and causes intake water deterioration. One of three severe muddy water source areas in Soyanggang-dam watershed is Jawoon-ri region, located in Hongcheon county. In this area, many cash-crops are planted at illegally cultivated agricultural fields, which were virgin forest areas. The purpose of this study is to estimate soil loss with current land uses (including illegal cash-crop cultivation) and soil loss reduction with land use conversion from illegal cultivation back to forest. In this study, the Sediment Assessment Tool for Effective Erosion Control (SATEEC) ArcView GIS was utilized to assess soil erosion. If the illegally cultivated agricultural areas are converted back to forest, it would be expected to 17.42% reduction in soil loss. At the Jawoon-ri region, illegally cultivated agricultural areas located at over 30% and 15% slopes take 47.48 ha (30.83%) and 103.64 ha (67.29%) of illegally cultivated agricultural fields respectively. If all illegally cultivated agricultural fields are converted back to forest, it would be expected that 17.41% of soil erosion and sediment reduction, 10.86% reduction with forest conversion from 30% sloping illegally agricultural fields, and 16.15% reduction with forest conversion from 15% sloping illegally agricultural fields. Therefore, illegally cultivated agricultural fields located at these sloping areas need to be first converted back to forest to maximize reductions in soil loss reduction and muddy water outflow from the Jawoon-ri regions.

Effect of toluene on RANTES and eotaxin expression through the p38 and JNK pathways in human lung epithelial cells

Kim, Yu-Ri,Kim, In-Kyoung,Seo, Sang-Hui,Lee, Seung-Ho,Lee, Hee-Ra,Pie, Jae-Eun,Kim, Meyoung-Kon The Korean Society of Toxicogenomics and Toxicopro 2010 Molecular & cellular toxicology Vol.6 No.4

The increasing prevalence and severity of environmental diseases have been attributed the rise in environmental pollutants occurring as a consequence of industrial development. In this study, we examined that underlying mechanisms of toluene in human lung epithelial cells. We selected two genes known to be involved in environmental disease such as RANTES and eotaxin for the present study based on published reports and prior observation. We observed that toluene increased the mRNA and protein levels of RANTES and eotaxin in a dose-dependent manner, together with the activation of p38 MAPK and JNK. Moreover, the inhibition of p38 MAPK and JNK activation prevented the release of RANTES and eotaxin induced by toluene. The present study is the first to show that toluene exposure induces the expression of RANTES and eotaxin in human bronchial epithelial cells through two distinct MAPKs such as p38 and JNK. Our observations suggest that modulation of the expression of immunerelated chemokines and cytokines may be important factors in development of environmental diseases induced by air pollutants.

The Efficiency of Zinc-Aspartate Complex on Zinc Uptake in Plasma and Different Organs in Normal SD Rats

Kim, Yu-Ri,Kim, Ki-Nam,Shim, Boo-Im,Lee, Seung-Min,Kim, In-Kyoung,Sohn, Sung-Hwa,Park, Myung-Gyu,Park, Hong-Suk,Kim, Meyoung-Kon The Korean Society of Toxicogenomics and Toxicopro 2007 Molecular & cellular toxicology Vol.3 No.2

Zinc is essential metal and plays a role in a wide variety of physiological and biochemical processes. Prostate gland contains high level of zinc, generally 3-10 folds higher than other organs. Prostatic zinc uptake is resulted from the existence of zinc transporter (ZnT) protein families in membrane. In this study, we investigated the difference of zinc uptake efficiency of zinc-aspartate complex (Zn-Asp) into various organs compared with $ZnSO_4$. We observed that Plasma zinc concentration in both $ZnSO_4$ and Zn-Asp administrated group was increased progressively following administration, and reached a peak level at 2 hr. The increasing pattern of zinc concentration was similar to each groups, however the zinc concentration of Zn-Asp administrated group was higher than that of $ZnSO_4$ administrated group. We found that prostatic zinc level of Zn-Asp administrated group was higher than $ZnSO_4$ administrated group, and was increased approximately $\sim$2.7 fold and $\sim$4.2 fold at 4 and 8 hr after administration. From these observations, we suggest than Zn-Asp has high uptake efficiency of zinc into the prostate gland. Therefore, Zn-Asp is potentially useful treatment of many prostatic diseases.

Transfusion Related Acute Lung Injury after Cesarean Section in a Patient with HELLP Syndrome

Kyoung Min Moon,Min Soo Han,Ch`ang Bum Rim,So Ri Kim,Sang Ho Shin,Min Seok Kang,Jun Ho Lee,Jihye Kim,Sang Il Kim 대한가정의학회 2016 Korean Journal of Family Medicine Vol.37 No.1

Transfusion-related acute lung injury (TRALI) is a serious adverse reaction of transfusion, and presents as hypoxemia and non-cardiogenic pulmonary edema within 6 hours of transfusion. A 14-year-old primigravida woman at 34 weeks of gestation presented with upper abdominal pain without dyspnea. Because she showed the syndrome of HELLP (hemolysis, elevated liver enzymes, and low platelet count), an emergency cesarean section delivery was performed, and blood was transfused. In the case of such patients, clinicians should closely observe the patient’s condition at least during the 6 hours while the patient receives blood transfusion, and should suspect TRALI if the patient complains of respiratory symptoms such as dyspnea. Furthermore, echocardiography should be performed to distinguish between the different types of transfusion-related adverse reactions.

Mutational analysis of <i>CASP1</i>, <i>2</i>, <i>3</i>, <i>4</i>, <i>5</i>, <i>6</i>, <i>7</i>, <i>8</i>, <i>9</i>, <i>10</i>, and <i>14</i> genes in gastrointestinal stromal tumors

Kim, Yoo Ri,Kim, Kyoung Mee,Yoo, Nam Jin,Lee, Sug Hyung Elsevier 2009 Human pathology Vol.40 No.6

<P><B>Summary</B></P><P>Deregulation of apoptosis is one of the hallmarks of cancer, and inactivation of cancer cell apoptosis has been reported in many cancers. Caspases, the main executioners during apoptosis and inflammation, have been reported to harbor inactivating mutations in several cancers. The aim of this study was to explore whether <I>CASP1</I> to <I>10</I> and <I>14</I> genes that encode caspase 1 to 10 and 14 are somatically mutated in gastrointestinal stromal tumor. We analyzed the entire coding region and all splice sites of all 11 human <I>CASP</I> genes for the detection of somatic mutations in 22 gastrointestinal stromal tumors by a single strand conformation polymorphism assay. We found a recurrent <I>CASP4</I> mutation (c.1093C>G [p.L365V]) in 4 gastrointestinal stromal tumors, but there were no mutations in the other 10 <I>CASP</I>s. The <I>CASP4</I> mutation was a missense mutation and was predicted to substitute amino acids in the small protease subunit of caspase 4. Overall, the gastrointestinal stromal tumor tissues harbored a <I>CASP</I> mutation in 18.2% (4/22). Our data indicate that somatic mutation of the <I>CASP4</I> gene is common in gastrointestinal stromal tumor and suggest a possibility that <I>CASP4</I> mutation might lead to alteration of apoptotic or inflammatory function and contribute to the pathogenesis of some gastrointestinal stromal tumors.</P>

Profiling of Gene Expression in Human Keratinocyte Cell Line Exposed to Quantum Dot Nanoparticles

Kim, In-Kyoung,Lee, Seung-Ho,Kim, Yu-Ri,Seo, Sang-Hui,Jeong, Sang-Hoon,Son, Sang-Wook,Kim, Meyoung-Kon The Korean Society of Toxicogenomics and Toxicopro 2009 Molecular & cellular toxicology Vol.5 No.1

Quantum Dot (QD) nanoparticles are used in various industrial applications, such as diagnostic, drug delivery, and imaging agents of biomedicine. Although QDs are extensively used in many medical science, several studies have been demonstrated the potential toxicity of nanoparticles. The first objective of this study was to investigate the nanotoxicity of QDs in the HaCaT human keratinocyte cell line by focusing on gene expression pattern. In order to evaluate the effect of QDs on gene expression profile in HaCaT cells, we analyzed the differential genes which related to oxidative stress and antioxidant defense mechanisms by using human cDNA microarray and PCR array. A human cDNA microarray was clone set, which was sorted for a list of genes correlated with cell mechanisms. We tried to confirm results of cDNA microarray by using PCR array, which is pathway-focused gene expression profiling technology using Real-Time PCR. Although we could not find the exactly same genes in both methods, we have screened the effects of QDs on global gene expression profiles in human skin cells. In addition, our results show that QD treatment somehow regulates cellular pathways of oxidative stress and antioxidant defense mechanisms. Therefore, we suggest that this study can enlarge our knowledge of the transcriptional profile and identify new candidate biomarker genes to evaluate the toxicity of nanotoxicology.

Antidepressant Effects of Aripiprazole Augmentation for Cilostazol-Treated Mice Exposed to Chronic Mild Stress after Ischemic Stroke

Kim, Yu Ri,Kim, Ha Neui,Hong, Ki Whan,Shin, Hwa Kyoung,Choi, Byung Tae MDPI 2017 INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES Vol.18 No.2

<P>The aim of this study was to determine the effects and underlying mechanism of aripiprazole (APZ) augmentation for cilostazol (CLS)-treated post-ischemic stroke mice that were exposed to chronic mild stress (CMS). Compared to treatment with either APZ or CLS alone, the combined treatment resulted in a greater reduction in depressive behaviors, including anhedonia, despair-like behaviors, and memory impairments. This treatment also significantly reduced atrophic changes in the striatum, cortex, and midbrain of CMS-treated ischemic mice, and inhibited neuronal cell apoptosis, particularly in the striatum and the dentate gyrus of the hippocampus. Greater proliferation of neuronal progenitor cells was also observed in the ipsilateral striatum of the mice receiving combined treatment compared to mice receiving either drug alone. Phosphorylation of the cyclic adenosine monophosphate response element binding protein (CREB) was increased in the striatum, hippocampus, and midbrain of mice receiving combined treatment compared to treatment with either drug alone, particularly in the neurons of the striatum and hippocampus, and dopaminergic neurons of the midbrain. Our results suggest that APZ may augment the antidepressant effects of CLS via co-regulation of the CREB signaling pathway, resulting in the synergistic enhancement of their neuroprotective effects.</P>

Artifacts in slab average-intensity-projection images reformatted from JPEG 2000 compressed thin-section abdominal CT data sets.

Kim, Bohyoung,Lee, Kyoung Ho,Kim, Kil Joong,Mantiuk, Rafal,Kim, Hye-ri,Kim, Young Hoon American Roentgen Ray Society, etc.] 2008 American Journal of Roentgenology Vol.190 No.6

<P>OBJECTIVE: The objective of our study was to assess the effects of compressing source thin-section abdominal CT images on final transverse average-intensity-projection (AIP) images. MATERIALS AND METHODS: At reversible, 4:1, 6:1, 8:1, 10:1, and 15:1 Joint Photographic Experts Group (JPEG) 2000 compressions, we compared the artifacts in 20 matching compressed thin sections (0.67 mm), compressed thick sections (5 mm), and AIP images (5 mm) reformatted from the compressed thin sections. The artifacts were quantitatively measured with peak signal-to-noise ratio (PSNR) and a perceptual quality metric (High Dynamic Range Visual Difference Predictor [HDR-VDP]). By comparing the compressed and original images, three radiologists independently graded the artifacts as 0 (none, indistinguishable), 1 (barely perceptible), 2 (subtle), or 3 (significant). Friedman tests and exact tests for paired proportions were used. RESULTS: At irreversible compressions, the artifacts tended to increase in the order of AIP, thick-section, and thin-section images in terms of PSNR (p < 0.0001), HDR-VDP (p < 0.0001), and the readers' grading (p < 0.01 at 6:1 or higher compressions). At 6:1 and 8:1, distinguishable pairs (grades 1-3) tended to increase in the order of AIP, thick-section, and thin-section images. Visually lossless threshold for the compression varied between images but decreased in the order of AIP, thick-section, and thin-section images (p < 0.0001). CONCLUSION: Compression artifacts in thin sections are significantly attenuated in AIP images. On the premise that thin sections are typically reviewed using an AIP technique, it is justifiable to compress them to a compression level currently accepted for thick sections.</P>

Survival outcome and prognostic factors of neoadjuvant treatment followed by resection for borderline resectable pancreatic cancer

Kim, Hyeong Seok,Jang, Jin-Young,Han, Youngmin,Lee, Kyoung Bun,Joo, Ijin,Lee, Doo-Ho,Kim, Jae Ri,Kim, Hongbeom,Kwon, Wooil,Kim, Sun-Whe The Korean Surgical Society 2017 Annals of Surgical Treatment and Research(ASRT) Vol.93 No.4

<P><B>Purpose</B></P><P>Neoadjuvant treatment may provide improved survival outcomes for patients with borderline resectable pancreatic cancer (BRPC). The purpose of this study is to evaluate the clinical outcomes of neoadjuvant treatment and to identify prognostic factors.</P><P><B>Methods</B></P><P>Forty patients who met the National Comprehensive Cancer Network definition of BRPC and received neoadjuvant treatment followed by surgery between 2007 and 2015 were evaluated. Prospectively collected clinicopathological outcomes were analyzed retrospectively.</P><P><B>Results</B></P><P>The mean age was 61.7 years and the male-to-female ratio was 1.8:1. Twenty-six, 3, and 11 patients received gemcitabine-based chemotherapy, 5-fluorouracil, and FOLFIRINOX, respectively. The 2-year survival rate (2YSR) was 36.6% and the median overall survival (OS) was 20 months. Of the 40 patients, 34 patients underwent resection and the 2YSR was 41.2% while the 2YSR of patients who did not undergo resection was 16.7% (P = 0.011). The 2YSR was significantly higher in patients who had partial response compared to stable disease (60.6% <I>vs</I>. 24.3%, P = 0.038), in patients who did than did not show a CA 19-9 response after neoadjuvant treatment (40.5% <I>vs</I>. 0%, P = 0.039) and in patients who did than did not receive radiotherapy (50.8% <I>vs</I>. 25.3%, P = 0.036). Five patients had local recurrence and 17 patients had systemic recurrence with a median disease specific survival of 15 months.</P><P><B>Conclusion</B></P><P>Neoadjuvant treatment followed by resection is effective for BRPC. Pancreatectomy and neoadjuvant treatment response may affect survival. Effective systemic therapy is needed to improve long-term survival since systemic metastasis accounts for a high proportion of recurrence.</P>