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직장-구불 결장부 거대 표재성 종양의 내시경 점막하 박리술 치료 성적
고진성,박종재,정원호,이준영,임상아,권민정,노혜진,주문경,이범재,김지훈,연종은,김재선,변관수,박영태 대한소화기내시경학회 2011 Clinical Endoscopy Vol.42 No.4
Background/Aims: Endoscopic submucosal dissection (ESD) of a colorectal tumor is technically difficult. This study aimed to analyze the clinical outcomes of superficial large rectosigmoid tumors after ESD. Methods: Medical records of 15 patients with large rectosigmoid tumors (more than 30 mm), in which ESD performed, were reviewed retrospectively. Results: The mean tumor size was 42.5±14.3 mm (range, 30∼78 mm). A histological examination revealed a well-differentiated adenocarcinoma in five cases (33.3%), adenoma with high-grade dysplasia in six cases (40%), and low-grade dysplasia in four cases (26.7%). The mean procedural time was 90.5±60.7 min (range, 22∼246 min). The en bloc resection rate was 86.7%, and the complete resection rate 100%. The lateral resection margin was positive in four cases (26.6%), but no cases with a positive vertical margin were observed. Bleeding occurred in three cases (20%), and all were treated successfully using endoscopic measures. Perforations occurred in three cases (20%); two cases were treated by clipping and the other by a laparotomy. Conclusions: ESD is a treatment option for superficial large rectosigmoid tumors. Further studies with larger cases and a longer term follow-up are needed to establish the efficacy and safety of ESD for colorectal tumors. 목적: 대장의 거대 종양의 경우 기술적인 어려움으로 인해 내시경 점막하 박리술이 보편적으로 이루어지고 있지 않다. 이번 연구에서는 직장-구불 결장부의 표재성 거대 종양에서 시행한 내시경 점막하 박리술 성적을 알아보고자 하였다. 대상 및 방법: 고려대학교 구로병원에서 크기가 30 mm 이상인 직장-구불 결장부 종양에 대하여 내시경 점막하 박리술을 시행한 15명을 대상으로 병리결과, 시술성적, 합병증에 대하여 후향적으로 의무기록을 조사하였다. 결과: 병변의 평균 크기는 42.5±14.3 mm(30∼78)이었다. 조직병리 검사에서 고분화 선암 1명(6.6%), 고도 이형성을 동반한 선종 4명(26.7%), 그리고 저도 이형성을 동반한 선종 10명(66.7%)이었다. 평균 시술시간은 90.5±60.7분(22∼246)이었다. 일괄절제율은 86.7%이었고 완전절제율은 100%이었다. 측방 절제연 양성은 4명(26.6%), 수직 절제연 양성은 없었다. 합병증으로 조기출혈이 3예(20%)에서 발생하였으나 내시경으로 모두 치료하였다. 천공은 3명(20%)에서 발생하였고 이중 2명은 내시경 클립술, 1명은 개복수술을 시행하였다. 결론: 직장-구불 결장의 표재성 거대 종양에서 내시경 점막하 박리술은 높은 일괄절제율을 기대할 수 있는 치료법 중 하나이다. 향후 많은 증례와 장기 추적 관찰에 의한 내시경 점막하 박리술의 안전성과 유용성에 대한 연구가 필요하다.
Design Optimization of Hybrid-Integrated 20-Gb/s Optical Receivers
정현용,연진성,최우영 대한전자공학회 2014 Journal of semiconductor technology and science Vol.14 No.4
This paper presents a 20-Gb/s optical receiver circuit fabricated with standard 65-nm CMOS technology. Our receiver circuits are designed with consideration for parasitic inductance and capacitance due to bonding wires connecting the photodetector and the circuit realized separately. Such parasitic inductance and capacitance usually disturb the high-speed performance but, with careful circuit design, we achieve optimized wide and flat response. The receiver circuit is composed of a transimpedance amplifier (TIA) with a DC-balancing buffer, a post amplifier (PA), and an output buffer. The TIA is designed in the shunt-feedback configuration with inductive peaking. The PA is composed of a 6-stage differential amplifier having interleaved active feedback. The receiver circuit is mounted on a FR4 PCB and wire-bonded to an equivalent circuit that emulates a photodetector. The measured transimpedance gain and 3-dB bandwidth of our optical receiver circuit is 84 dBΩ and 12 GHz, respectively. 20-Gb/s 231−1 electrical pseudo-random bit sequence data are successfully received with the bit-error rate less than 10−12. The receiver circuit has chip area of 0.5 mm × 0.44 mm and it consumes excluding the output buffer 84 mW with 1.2-V supply voltage.
MiroCam® 캡슐내시경 검사의 완전 소장 검사 및 양성 진단에 영향을 미치는 요인
정원호 ( Wonho Jung ),고진성 ( Jin Sung Koh ),김성호 ( Sung Ho Kim ),임상아 ( Sang Ah Lim ),임은혜 ( Eun Hye Lim ),이준영 ( Joon Young Lee ),주문경 ( Moon Kyung Joo ),이범재 ( Beom Jae Lee ),김지훈 ( Ji Hoon Kim ),연종은 ( Jong Eu 대한장연구학회 2011 Intestinal Research Vol.9 No.1
Background/Aims: Mirocam® capsule endoscopy has been widely used in Korea; however, data with respect to Mirocam® capsule endoscopy is lacking. We have assessed the factors affecting complete small bowel studies and diagnostic yield in Mirocam® capsule endoscopic studies. Methods: We retrospectively analyzed 103 cases that were assessed with Mirocam® capsule endoscopy between June 2007 and February 2010 at Guro Korea University Hospital. Results: The mean age of the 103 cases was 55.47 years (range, 16-99 years) and 67 cases (65%) were male. The indications for capsule endoscopy were hematochezia/melena (77 cases, 74.8%), anemia (8 cases, 7.8%), abdominal pain (12 cases, 11.7%), and miscellaneous (weight loss and chronic diarrhea; 6 cases, 5.8%). The mean stomach transit time was 59.9±88.3 minutes (range, 1-630 minutes) and the mean small bowel transit time was 396.0±131.7 minutes (range, 117-708 minutes). The rate of successfully performing a complete small bowel study was 82.5% (85 cases), and the stomach transit time was a significant factor for a complete small bowel study (OR=0.991, 95% CI= 0.984-0.998, P=0.012). The diagnostic yield was 51.5% (53 cases); visual quality was a significant factor in determining the diagnostic yield (OR=6.776, 95% CI=1.32-34.70, P=0.022). Conclusions: In a Mirocam® capsule endoscopic study, short stomach transit time was a significant factor affecting completion of the small bowel study. Achieving excellent visual quality by good bowel preparation was a significant factor for improving the diagnostic yield. (Intest Res 2011;9:0-34)
소화기 ; 판토프라졸이 난소 적출한 ICR 생쥐의 골교체에 미치는 영향
임은혜 ( Eun Hye Lim ),김기현 ( Key Hyeon Kim ),이범재 ( Beom Jae Lee ),주문경 ( Moon Kyung Joo ),고진성 ( Jin Sung Koh ),이준영 ( Joon Young Lee ),임상아 ( Sang Ah Lim ),김지훈 ( Ji Hoon Kim ),연종은 ( Jong Eun Yeon ),박종재 ( Jo 대한내과학회 2011 대한내과학회지 Vol.80 No.1
목적: 장기간의 양성자 펌프 억제제 투여는 골다공증과 연관된 병적 골절과 연관이 있다고 알려져 있다. 그러나 양성자 펌프 억제제의 장기간 사용이 어떤 기전으로 골절의 위험을 높이는지에 대해서는 알려지지 않았다. 이 연구는 난소 적출한 ICR 생쥐의 골교체에 양성자 펌프 억제제인 판토프라졸이 미치는 영향을 알아보고자 하였다. 방법: 실험동물로 난소를 적출한 암컷 ICR 생쥐를 사용하였다. 이들은 무작위로 판토프라졸군(n=10) 및 대조군(n=10)으로 나누었다. 판토프라졸군은 매일 20 mg/kg의 판토프라졸을 복강 내로 두 차례씩 주입했다. 4주간의 실험이 끝난 뒤 이들을 희생시켜 골밀도 및 경골의 건중량을 측정하였고 채취한 혈액으로 ELISA를 이용하여 골교체 표지자인 osteocalcin 및 CTX-1을 측정하였다. 또한, 비장을 추출하여 균질화한 후 RT-PCR을 통해 파골세포의 분화를 촉진하는 사이토카인의 발현을 측정하였다. 골대사와 연관이 있는 혈청 calcium, phosphorus, ALP (alkaline phosphatase) 등도 측정하였다. 결과: 혈청 osteocalcin 농도는 판토프라졸군에서 의미있게 낮게 측정되었으나(p=0.023) 골밀도, 경골의 건중량, 그리고 혈청 ALP, calcium, phosphorus, CTX-1 농도는 양 군 간에 유의한 차이를 보이지 않았다. RT-PCR을 통해 측정한 IL-1β의 발현은 판토프라졸군에서 감소하는 경향을 보였으나(p=0.058), TNF-α, IL-1β, IL-6의 발현은 양 군 간에 유의한 차이를 보이지 않았다. 결론: 이번 실험에서 판토프라졸은 난소를 적출한 ICR 생쥐의 혈청 osteocalcin 농도 및 비장 세포에서의 Il-1β 활성도를 감소시켜 판토프라졸이 골형성 및 골흡수에 영향을 미칠 수 있음을 보여주었다. 그러나 추후 보다 많은 개체수를 이용한 추가적인 연구가 더 필요할 것으로 생각한다. Background/Aims: Long-term exposure to proton pump inhibitors is associated with osteoporosis-related fractures; however, the mechanism is unknown. The purpose of this study was to evaluate the effect of pantoprazole on osteoporosis and bone turnover in ovariectomized ICR mice fed a calcium-free diet. Methods: Ovariectomized female ICR mice were divided into a pantoprazole group (n=10) and a control group (n=10). The mice in the pantoprazole group were given an intraperitoneal injection of pantoprazole at 20 mg/kg twice daily. After 4 weeks, the mice were humanely euthanized, and bone mineral density (BMD) and dry tibia weight were measured. Serum osteocalcin and CTX-1 levels were measured by enzyme-linked immunosorbent assay. The mRNA expression levels of cytokines that stimulate osteoclast differentiation were determined using RT-PCR. Serum calcium, phosphorus, and alkaline phosphatase (ALP) levels were also analyzed. Results: Serum osteocalcin concentration was significantly lower in the pantoprazole group compared with the control group (p=0.023). There was no difference in BMD, dry tibia weight, or serum ALP, calcium, phosphorus, or CTX-1 between the two groups. The expression of interleukin (IL)-1β was lower in the pantoprazole group compared with the control group, but not significantly lower (p=0.058). The levels of tumor necrosis factor-α and IL-6 did not differ between the two groups. Conclusions: Pantoprazole, a proton pump inhibitor, decreased serum osteocalcin and suppressed IL-1β expression, suggesting that pantoprazole affects bone formation and resorption in ovariectomized ICR mice. Further studies using larger sample sizes are needed. (Korean J Med 2011;80:56-62)