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Clement Chun Ho Wu,Samuel Jun Ming Lim,Christopher Jen Lock Khor 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.4
Endoscopic retrograde cholangiopancreatography (ERCP) plays a crucial role in the management of pancreaticobiliary disorders. Although the ERCP technique has been refined over the past five decades, it remains one of the endoscopic procedures with the highest rate of complications. Risk factors for ERCP-related complications are broadly classified into patient-, procedure-, and operator-related risk factors. Although non-modifiable, patient-related risk factors allow for the closer monitoring and instatement of preventive measures. Post-ERCP pancreatitis is the most common complication of ERCP. Risk reduction strategies include intravenous hydration, rectal nonsteroidal anti-inflammatory drugs, and pancreatic stent placement in selected patients. Perforation is associated with significant morbidity and mortality, and prompt recognition and treatment of ERCP-related perforations are key to ensuring good clinical outcomes. Endoscopy plays an expanding role in the treatment of perforations. Specific management strategies depend on the location of the perforation and the patient’s clinical status. The risk of post-ERCP bleeding can be attenuated by preprocedural optimization and adoption of intra-procedural techniques. Endoscopic measures are the mainstay of management for post-ERCP bleeding. Escalation to angioembolization or surgery may be required for refractory bleeding. Post-ERCP cholangitis can be reduced with antibiotic prophylaxis in high risk patients. Bile culture-directed therapy plays an important role in antimicrobial treatment.
The Role of Endoscopic Management in Afferent Loop Syndrome
Wu Clement Chun Ho,Brindise Elizabeth,Abiad Rami El,Khashab Mouen A. 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.3
Afferent loop syndrome (ALS) is a morbid complication that may occur after gastrectomy and gastrojejunostomy reconstruction. The aim of this article is to review the different endoscopic treatment options of ALS. We describe the evolution of the endoscopic treatment of ALS and its limitations despite the overall propitious profile. We analyze the advantages of endoscopic ultrasound-guided entero-enterostomy (EUS EE) over enteroscopy-guided intervention, and the clinical outcomes of EUS EE. We expound on pre-procedural considerations, intra-procedural techniques and post-procedural care following EUS EE. We conclude that given the simplification of the technique and the ability to place a stent away from the tumor, EUS EE is a promising technique that will likely be established as the treatment of choice for ALS.
Research Articles : Does PEAD Increase with Event-Specific Information Uncertainty?
( Joon Ho Lee ),( Michael Clement ),( Robert Freeman ) 한국회계학회 2015 회계학연구 Vol.40 No.2
We examine the empirical relation between event-specific information uncertainty and post-earnings-announcement-drift (PEAD). Since PEAD is largely attributed to delayed price reactions to the implications of announced earnings for future earnings, our primary thesis is that PEAD is associated with the uncertainty facing investors when they interpret earnings announcements. Accordingly, we examine the relation between PEAD and three proxies for event-specific uncertainty: pre-announcement to post-announcement change in dispersion of future earnings forecasts, the interval between earnings announcement and post-announcement forecast revisions, and the number of post-announcement forecast revisions. We argue that these three characteristics of analysts`` forecasts capture the uncertainty analysts face as they consider the implications of announced earnings for future earnings. For each proxy, we find that PEAD increases with signal uncertainty. In sum, our results indicate that drift in post-signal prices is less prevalent when analysts quickly agree on the implications of the signal for future earnings.
Yung Ka Chin,Clement Chun Ho Wu,Damien Meng Yew Tan 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.1
The prevalence of pancreatic cystic lesions (PCLs) has increased recently due to the increased use of cross-sectional abdominalimaging and the ageing global population. Current diagnostic techniques are inadequate to distinguish between PCLs thatrequire surgery, close surveillance, or expectant management. This has resulted in increased morbidity from both inappropriatelyaggressive and conservative management strategies. Needle-based confocal laser endomicroscopy (nCLE) has allowed microscopicexamination and visual delineation of the surface epithelium of PCLs. Landmark studies in this decade have correlated nCLE andhistological findings and identified characteristics differentiating various types of PCLs. Subsequent studies have confirmed thehigh diagnostic yield of nCLE and its diagnostic utility in PCLs with an equivocal diagnosis. Moreover, nCLE has been shown toimprove the diagnostic yield of PCLs. This will help avoid unnecessary pancreatic surgery, which carries significant morbidity andmortality risks. The early detection of high-grade dysplasia in PCLs will provide early surgical treatment and improve outcomes forpancreatic cancer. Despite the high upfront cost of nCLE, the improved diagnostic accuracy and resultant appropriate managementhave resulted in improved cost effectiveness. Refining the procedure technique and limiting the procedure length have significantlyimproved the safety of nCLE. A structured training program and device improvements to allow more complete mapping of thepancreatic cyst epithelium will be crucial for the widespread adoption of this promising technology.
Bacterial Logic Devices Reveal Unexpected Behavior of Frameshift Suppressor tRNAs
Sawyer, Eric M.,Barta, Cody,Clemente, Romina,Conn, Michel,Davis, Clif,Doyle, Catherine,Gearing, Mary,Ho-Shing, Olivia,Mooney, Alyndria,Morton, Jerrad,Punjabi, Shamita,Schnoor, Ashley,Sun, Siya,Suresh, Korean Society for Bioinformatics 2012 Interdisciplinary Bio Central (IBC) Vol.4 No.3
Introduction: We investigated frameshift suppressor tRNAs previously reported to use five-base anticodon-codon interactions in order to provide a collection of frameshift suppressor tRNAs to the synthetic biology community and to develop modular frameshift suppressor logic devices for use in synthetic biology applications. Results and Discussion: We adapted eleven previously described frameshift suppressor tRNAs to the BioBrick cloning format, and built three genetic logic circuits to detect frameshift suppression. The three circuits employed three different mechanisms: direct frameshift suppression of reporter gene mutations, frameshift suppression leading to positive feedback via quorum sensing, and enzymatic amplification of frameshift suppression signals. In the course of testing frameshift suppressor logic, we uncovered unexpected behavior in the frameshift suppressor tRNAs. The results led us to posit a four-base binding hypothesis for the frameshift suppressor tRNA interactions with mRNA as an alternative to the published five-base binding model. Conclusion and Prospects: The published five-base anticodon/codon rule explained only 17 of the 58 frameshift suppression experiments we conducted. Our deduced four-base binding rule successfully explained 56 out of our 58 frameshift suppression results. In the process of applying biological knowledge about frameshift suppressor tRNAs to the engineering application of frameshift suppressor logic, we discovered new biological knowledge. This knowledge leads to a redesign of the original engineering application and encourages new ones. Our study reinforces the concept that synthetic biology is often a winding path from science to engineering and back again; scientific investigations spark engineering applications, the implementation of which suggests new scientific investigations.
Yue Yan Katherine Fan,Ka Lam Wong,Ka Lai Cally Ho,Tai Leung Daniel Chan,Oswald Joseph Lee,Chi Yui Yung,Kin Shing Lun,Mo Chee Elaine Chau,Shui Wah Clement Chiu,Lik Cheung Cheng,Wing Kuk Timmy Au 대한이식학회 2022 Korean Journal of Transplantation Vol.36 No.4
Background: The year 2022 marks the 30th anniversary of heart transplant service in Hong Kong (HK). In this study, we describe prevailing trends and outcomes of advanced heart failure (AHF), including heart transplantations (HTx), in HK over the past 30 years. Methods: Trends in heart failure prevalence in HK from 1993 to 2021 were analyzed based on data from the Hospital Authority Clinical Data and Reporting System. All AHF patients referred for HTx consideration between 1992 and 2021 were reviewed. The bridge-to-transplant (BTT) utilization of short-term mechanical circulatory support (ST-MCS) devices, including venoarterial extracorporeal membrane oxygenation (VA-ECMO) and durable left ventricular assist devices (LVADs), from 2010 to 2021 was reviewed. Results: Overall, 237 heart transplants were performed in HK, with 10-year posttransplant and median survival of 68.1% and 18.7 years, respectively. An increase in AHF clinic referrals was correlated with increasing heart failure prevalence (R2=0.635, P<0.001). In total, 146 referrals were made for ST-MCS, and an observed increase in ST-MCS referrals was correlated with increasing VA-ECMO utilization (R2=0.849, P<0.001). Among 62 patients accepted for AHF therapy, those with durable LVAD implementation had better 1-year survival (71.5%) than those receiving an extracorporeal CentriMag (Levitronix) device as BTT (40%, P=0.008). In total, 143 LVADs were implanted, with 130 as BTT or bridge-to-candidacy (BTC) methods. The survival rate among the 130 BTT/BTC LVAD patients resembled that of HTx recipients (73.8% vs. 69.8% at 9 years, P=0.296). Conclusions: The burden of AHF management has increased and gained complexity over the past 30 years in Hong Kong.
Song, Seul Ji,Park, Taehyung,Yoon, Kyung Jean,Yoon, Jung Ho,Kwon, Dae Eun,Noh, Wontae,Lansalot-Matras, Clement,Gatineau, Satoko,Lee, Han-Koo,Gautam, Sanjeev,Cho, Deok-Yong,Lee, Sang Woon,Hwang, Cheol American Chemical Society 2017 ACS APPLIED MATERIALS & INTERFACES Vol.9 No.1
<P>The growth characteristics of Ta2O5 thin films by atomic layer deposition (ALD) were examined using Ta((NBu)-Bu-t)(NEt2)3 (TBTDET) and Ta((NBu)-Bu-t)(NEt2)(2)Cp (TBDETCp) as Ta-precursors, where tBu, Et, and Cp represent tert-butyl, ethyl, and cyclopentadienyl groups, respectively, along with water vapor as oxygen source. The grown Ta2O5 films were amorphous with very smooth surface morphology for both the Ta-precursors. The saturated ALD growth rates of Ta2O5 films were 0.77 angstrom cycle(-1) at 250 degrees C and 0.67 angstrom cycle(-1) at 300 degrees C using TBTDET and TBDETCp precursors, respectively. The thermal decomposition of the amido ligand (NEt2) limited the ALD process temperature below 275 degrees C for TBTDET precursor. However, the ALD temperature window could be extended up to 325 degrees C due to a strong Ta-Cp bond for the TBDETCp precursor. Because of the improved thermal stability of TBDETCp precursor, excellent nonuniformity of similar to 2% in 200 mm wafer could be achieved with a step coverage of similar to 90% in a deep hole structure (aspect ratio 5:1) which is promising for 3-dimensional architecture to form high density memories. Nonetheless, a rather high concentration (similar to 7 at. %) of carbon impurities was incorporated into the Ta2O5 film using TBDETCp, which was possibly due to readsorption of dissociated ligands as small organic molecules in the growth of Ta2O5 film by ALD. Despite the presence of high carbon concentration which might be an origin of large leakage current under electric fields, the Ta2O5 film using TBDETCp showed a promising resistive switching performance with an endurance cycle as high as similar to 17?500 for resistance switching random access memory application. The optical refractive index of the deposited Ta2O5 films was 2.1-2.2 at 632.8 nm using both the Ta-precursors, and indirect optical band gap was estimated to be similar to 4.1 eV for both the cases.</P>