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Gilbert 증후군에서 열량 제한 시험과 Phenobarbital 자극 시험의 의의(14예)
이헌영,채경훈,정재훈,강윤세,김연수,문희석,박기오,이엄석,김선문,김석현,성재규,이병석,이강욱 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2
Gilbert 증후군은 인구의 7%에서까지 나타날 수 있는 매우 흔한 증후군으로서 비진행성인 양성의 만성적 경과를 치하며, 간질환의 증상과 징후가 없는 경한 비포합형 고빌리루빈혈증이 특징인 일종의 체질적인 증상으로서 혈장 빌리루빈 농도에 대한 사춘기의 영향 때문에 10대와 20대에 자주 진단이 된다. 따라서 임상적인 중요성은 미약하지만 높은 빈도가 예상되는 점에 그 중요성이 부여되어야 할 것이다. 따라서 적정한 임상적 진단법으로 기왕에 소개된 열량제한 시험과 phenobarbital 유도 시험을 시행하고 이들의 진단적 가치를 알아보기 위하여 본 연구를 시행하였다. 1990년 7월부터 1999년 4월까지 충남대학교병원에 내원하여 HBsAg, IgG anti-HBc 및 anti-HCV가 음성이고, 간 초음파 스캔에서 이상이 없으며, 혈청 AST, ALT 및 AP가 정상인 비음주자에서 경한 비포합형 고빌리루빈혈증이 있는 14예의 환자들을 대상으로 ^(99m)Tc-DISID 스캔을 시행하였으며, 기저 치 총빌리루빈 및 포합형 빌리루빈 치를 측정한 다음에 하루에 400Kcal로 48시간동안 제한한 열량 제한 시험을 시행하였고, phenobarbital을 하루 60mg씩 5일간 투여한 후에도 각각 총빌리루빈과 포합형 빌리루빈 치를 검사하여 비포합형을 구하였다. 대상 환자들은 모두 14예로서 남자가 11예(78.6%)였고 여자가 3예(21.4%)여서 3.7:1로 남자에서 많았으며, 20대가 6예(42.9%), 30대가 역시 6예(42.9%) 및 40대가 2예(14.2%)로서 2,30대가 대부분(85.8%)이었다. 열량 제한 시험 후의 총빌리루빈 치, 비포합형 및 포합형 빌리루빈 치들은 평균 각각 5.5±2.7, 4.2±2.3 및 1.3±10mg/dL 로서, 시험 전 치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg/dL 보다 유의하게(p=0.001, p=0.001, p=0.023) 상승하였다. 포합형 빌리루빈 치도 유의하게 상승하였으나 비포합형의 상승보다는 훨씬 낮아서 주로 비포합형이 증가하였다. phenobarbital 투여 중 설사가 발생하여 중단한 1예를 제외한 13예에서 열량 제한 시험 후에 상승하였던 총, 비포합형 및 포합형 빌리루빈 치가 phenobarbital 유도 시험후에는 2.0±1.1, 1.5±0.8 및 0.5±0.4mg/dL로서 열량 제한 시험 결과보다 유의하게 낮아졌고(p=0.00, p=0.000, p=0.001), 열량 제한 시험 전의 기초치들인 3.0±0.8, 2.2±0.8 및 0.7±0.4mg.dL 보다도 더욱 낮아졌으며 유의한 차이(p=0.001, p=0.02, p=0.005)를 나타내었다. 14예에서 시행한 ^(99m)-Tc DISIDA 스캔에서 9예(64.3%)가 정상이었고, 5예(35.7%)에서는 심장 및 신장으로의 간외 섭취가 3예였고, 60분까지 소장 배출이 없는 배설 지연 예와 담낭 수축 불량 예가 각각 1예 씩 발견되었다. Phenobarbital 투여시험에서 민감도가 열량제한시험에 비해 더 높았다(92.3%와 50.0%). Gilbert 증후군에서 1일 400 Kcal로 48시간의 열량제한 시험과 1일 60mg의 phenobarbital을 5일간 투여하는 유도 시험은 편리하고 유용한 임상적인 진단법으로 이용할 수 있다고 생각된다. 그러나 열량 제한 시험에서는 증가 기준의 통일이 필요하다고 유추되며 phenobarbital 유도 시험이 민감도가 더 높은 것으로 생각된다. Gilbert's syndrome is very frequent and benign chronic process characterized by mild, intermittent, unconjugated hyperbilirubinemia without any symptom and sign of liver disease. Previously intoduced caloric restriction test and phenobarbital stimulation test as two appropriate clinical tests had been examined and their diagnostic values were reevaluated. Fourteen patients with mild, persistent, unconjugated hyperbilirubinemia were included. Subsequently caloric restriction has been applicated by 400 Kcal/day for 48 hours and phenobarbital has been prescribed by 60 mg/day for 5 days. Therafter serum levels of total and direct bilirubin were measured. Most of the patients were third and fourth decade(85.8%) and male predominant. Each basal serum levels of total, indirect and direct bilirubin were 3.0±0.8, 2.2±0.8 and 0.7±0.4 mg/dL. After caloric restriction test, each levels were increased significantly to 5.5±2.7, 4.2±2.3 and 1.3±1.0 mg/dL(p=0.001, p=0.001, p=0.023). After phenobarbital stimulation test for 13 patients had been practiced, increased levels of each bilirubin after caloric restriction test were decreased significantly to 2.0±1.0, 1.5±0.8 and 0.5±0.4 mg/dL(p=0.000, p=0.000, p=0.001) and these levels were significantly lower than basal levels(p=0.001, p=0.02, p=0.005). The sensitivities of caloric restriction test were 85.7%, 50.0%, and 71.4%, 35.7%(1.0, 1.5 mg increase of total bilirubin and 1.0, 1.5 mg/dL increase of indirect bilirubin). The sensitivities of phenobarbital stimulation test were 93.2% and 92.3% at criteria of 1.5 mg/dL increase of total bilirubin and indirect bilirubin. On the diagnosis of Gilbert syndrome, caloric restriction test and phenobarbital stimulation test are convenient and useful diagnostic tools in clinical face. And also phenobarbital stimulation test has higher sensitivity than caloric restriction test. Furthermore, standardization of bilirubin increment would be necessary in caloric restriction test.
Lee, Sun-Sook,Lee, Eun-Seok,Kim, Seok-Hwan,Lee, Byung-Kook,Jeong, Seok-Jong,Hwang, Jin-Ha,Kim, Chang-Gyoun,Chung, Taek-Mo,An, Ki-Seok Korean Chemical Society 2012 Bulletin of the Korean Chemical Society Vol.33 No.7
Dimethylaluminum isopropoxide (DMAI, $(CH_3)_2AlO^iPr$) as a single precursor, which contains one aluminum and one oxygen atom, has been adopted to deposit non-stoichiometric aluminum oxide ($AlO_x$) films by low pressure metal organic chemical vapor deposition without an additional oxygen source. The atomic concentration of Al and O in the deposited $AlO_x$ film was measured to be Al:O = ~1:1.1 and any serious interfacial oxide layer between the film and Si substrate was not observed. Gaseous by-products monitored by quadruple mass spectrometry show that ${\beta}$-hydrogen elimination mechanism is mainly contributed to the $AlO_x$ CVD process of DMAI precursor. The current-voltage characteristics of the $AlO_x$ film in Au/$AlO_x$/Ir metalinsulator-metal (MIM) capacitor structure show high ON/OFF ratio larger than ${\sim}10^6$ with SET and RESET voltages of 2.7 and 0.8 V, respectively. Impedance spectra indicate that the switching and memory phenomena are based on the bulk-based origins, presumably the formation and rupture of filaments.
Lee Dong Ho,Lee Eun Sun,Lee Jae Young,Bae Jae Seok,Kim Haeryoung,Lee Kyung Bun,Yu Su Jong,Cho Eun Ju,Lee Jeong-Hoon,Cho Young Youn,Han Joon Koo,Choi Byung Ihn 대한영상의학회 2020 Korean Journal of Radiology Vol.21 No.12
Objective: The aim of this study was to prospectively evaluate whether liver stiffness (LS) assessments, obtained by twodimensional (2D)-shear wave elastography (SWE) with a propagation map, can evaluate liver fibrosis stage using histopathology as the reference standard. Materials and Methods: We prospectively enrolled 123 patients who had undergone percutaneous liver biopsy from two tertiary referral hospitals. All patients underwent 2D-SWE examination prior to biopsy, and LS values (kilopascal [kPa]) were obtained. On histopathologic examination, fibrosis stage (F0–F4) and necroinflammatory activity grade (A0–A4) were assessed. Multivariate linear regression analysis was performed to determine the significant factors affecting the LS value. The diagnostic performance of the LS value for staging fibrosis was assessed using receiver operating characteristic (ROC) analysis, and the optimal cut-off value was determined by the Youden index. Results: Reliable measurements of LS values were obtained in 114 patients (92.7%, 114/123). LS values obtained from 2D-SWE with the propagation map positively correlated with the progression of liver fibrosis reported from histopathology (p < 0.001). According to the multivariate linear regression analysis, fibrosis stage was the only factor significantly associated with LS (p < 0.001). The area under the ROC curve of LS from 2D-SWE with the propagation map was 0.773, 0.865, 0.946, and 0.950 for detecting F ≥ 1, F ≥ 2, F ≥ 3, and F = 4, respectively. The optimal cut-off LS values were 5.4, 7.8, 9.4, and 12.2 kPa for F ≥ 1, F ≥ 2, F ≥ 3, and F = 4, respectively. The corresponding sensitivity and specificity of the LS value for detecting cirrhosis were 90.9% and 88.4%, respectively. Conclusion: The LS value obtained from 2D-SWE with a propagation map provides excellent diagnostic performance in evaluating liver fibrosis stage, determined by histopathology.
Hyponatraemia and its prognosis in acute heart failure is related to right ventricular dysfunction
Lee, Heesun,Lee, Sang Eun,Park, Chan Soon,Park, Jin Joo,Lee, Ga Yeon,Kim, Min-Seok,Choi, Jin-Oh,Cho, Hyun-jai,Lee, Hae-Young,Choi, Dong-Ju,Jeon, Eun-Seok,Kim, Jae-Joong,Oh, Byung-Hee BMJ Publishing Group Ltd 2018 Heart Vol.104 No.20
<P>Trial registration number Korean Acute Heart Failure registry NCT01389843; Results.</P>
Lee, Byung Il,Lee, Seongsoo,Suh, Yoon Seok,Lee, Joon Seok,Kim, Ae‐,kyeong,Kwon, O‐,Yu,Yu, Kweon,Park, Chan Beum WILEY‐VCH Verlag 2015 Angewandte Chemie Vol.127 No.39
<P><I><B>Photoangeregte Porphyrinmoleküle</B></I> hemmen die β‐Amyloid‐Aggregation und bewahren vor postsynaptischer Toxizität und Verhaltensdefekten im <I>Drosophila</I>‐Alzheimermodell unter blauem Licht. In ihrer Zuschrift auf Seite 11634 ff. schildern C. B. Park, K. Yu et al. eine chemische Strategie für die photodynamische Unterdrückung der β‐Amyloid‐Aggregation mithilfe photosensibilisierender Moleküle.</P>
Lee, Jinsup,Baek, Jinwook,Ryu, Gyeong Hee,Lee, Mi Jin,Oh, Seran,Hong, Seul Ki,Kim, Bo-Hyun,Lee, Seok-Hee,Cho, Byung Jin,Lee, Zonghoon,Jeon, Seokwoo American Chemical Society 2014 NANO LETTERS Vol.14 No.8
<P>Crystallization of materials has attracted research interest for a long time, and its mechanisms in three-dimensional materials have been well studied. However, crystallization of two-dimensional (2D) materials is yet to be challenged. Clarifying the dynamics underlying growth of 2D materials will provide the insight for the potential route to synthesize large and highly crystallized 2D domains with low defects. Here, we present the growth dynamics and recrystallization of 2D material graphene under a mobile hot-wire assisted chemical vapor deposition (MHW-CVD) system. Under local but sequential heating by MHW-CVD system, the initial nucleation of nanocrystalline graphenes, which was not extended into the growth stage due to the insufficient thermal energy, took a recrystallization and converted into a grand single crystal domain. During this process, the stitching-like healing of graphene was also observed. The local but sequential endowing thermal energy to nanocrystalline graphenes enabled us to simultaneously reveal the recrystallization and healing dynamics in graphene growth, which suggests an alternative route to synthesize a highly crystalline and large domain size graphene. Also, this recrystallization and healing of 2D nanocrystalline graphenes offers an interesting insight on the growth mechanism of 2D materials.</P><P><B>Graphic Abstract</B> <IMG SRC='http://pubs.acs.org/appl/literatum/publisher/achs/journals/content/nalefd/2014/nalefd.2014.14.issue-8/nl5012323/production/images/medium/nl-2014-012323_0007.gif'></P><P><A href='http://pubs.acs.org/doi/suppl/10.1021/nl5012323'>ACS Electronic Supporting Info</A></P>
Rectal Neuroendocrine and L-cell Tumors: Diagnostic Dilemma and Therapeutic Strategy
Lee, Suk Hee,Kim, Byung Chang,Chang, Hee Jin,Sohn, Dae Kyung,Han, Kyung Su,Hong, Chang Won,Lee, Eun-Jung,Lee, Jae-Bum,Lee, Doo-Seok,Lee, In Taek,Youk, Eui-Gon Lippincott Williams Wilkins, Inc. 2013 The American journal of surgical pathology Vol.37 No.7
Rectal neuroendocrine tumors (NETs) are currently divided into L-cell and non–L-cell types. In the World Health Organization 2010 classification, L-cell tumors are defined as borderline, whereas non–L-cell tumors are considered to represent malignancies. To establish differential diagnostic criteria and therapeutic strategy, we investigated the pathologic features of rectal NETs associated with lymph node metastasis and the clinicopathologic significance of the L-cell phenotype. We analyzed 284 patients with rectal NETs. Factors, including T stage, mitosis, histologic pattern, lymphatic invasion, tumor border, and lymph node metastasis, were retrospectively evaluated. We also evaluated tumor immunoreactivity for L-cell markers, including glucagon-like peptide 1, pancreatic peptide, and peptide YY, in 240 cases. L-cell immunoreactivity was detected in 189 of 240 NETs (79%). Of the factors evaluated, only age and the frequency of lymphatic invasion were significantly different between patients with L-cell and non–L-cell tumors. Of the 284 patients, 18 (6.3%) had lymph node metastases. Lymphatic invasion and T stage were independent risk factors for lymph node metastasis. Subgroup analysis based on tumor size showed lymph node metastasis in 0%, 4%, 24%, and 100% of patients with NETs with a size of <5, 5 to 9, 10 to 14, and ≥15 mm, respectively. Depth of tumor invasion, lymphatic invasion, and mitosis were correlated with tumor size (P<0.0001). In conclusion, L-cell phenotype alone does not guarantee favorable biological characteristics. The clinical management of rectal NETs should depend on tumor size. Careful pathologic examination of lymphatic invasion is necessary.
Sentinel Node Mapping and Skip Metastases in Patients with Early Gastric Cancer
Lee, Sang Eok,Lee, Jun Ho,Ryu, Keun Won,Cho, Soo Jeong,Lee, Jong Yeul,Kim, Chan Gyoo,Choi, Il Ju,Kook, Myung Cherl,Nam, Byung-Ho,Park, Sook Ryun,Lee, Jong Seok,Kim, Young-Woo Springer - Society of Surgical Oncology 2009 Annals of surgical oncology Vol.16 No.3