Hepatocellular Carcinoma in the Elderly: Clinical Characteristics, Outcomes and Treatment Efficacy, Safety in Older than 75 Years

( Ji Ho Seo ),( Sunmin Kim ),( Eunae Cho ),( Chung Hwan Jun ),( Sun Young Park ),( Sung Bum Cho ),( Chang Hwan Park ),( Hyun Soo Kim ),( Sung Kyu Choi ),( Jong Sun Rew ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: The number of elderly patients diagnosed with hepatocellular carcinoma (HCC) has been increasing because the increase in the longevity of the general population. But there is no proper management based on age stratification in elderly patients. We compared clinical characteristics, outcomes and treatment efficacy, safety between oldest-old (aged more than 85 years), middle-old (aged between 80 and 85 years) and young-old (aged between 75 and 80 years) patients with HCC. Methods: We conducted a retrospective cohort study, from January 2010 to December 2016, at Chonnam National University Hospital. A total of 550 elderly patients whose data included demographics, co-morbidity, etiology of liver disease, presence of cirrhosis, staging of HCC, treatment modality and treatment related adverse event were evaluated retrospectively. Also overall survival was assessed in enrolled patient. Results: Fifty one patients (oldest-old; median 87 years old), 153 patients (middle-old; median 82 years old) and 346 patients (young-old; median 77 years old) were diagnosed with HCC. Both oldest- and middle-old patients, compared to young-old patients had significantly lower rate of alcohol-related disease (13.7% vs 20.9% vs 34.1%, P = 0.001). There were no significant difference in underlying sex, body mass index, presence of co-morbidity, hepatitis C-related disease and stage of HCC. The Child-Pugh class (CPT class A 88.9% vs 84.1% vs 83.6%, CPT class B 11.1% vs 15.9% vs 15.0% and CPT class C 0.0% vs 0.0% vs 1.3%, respectively, P = 0.912) and Model for End Stage Liver Disease score (mean MELD score 7.22±3.34 vs 5.88±3.01 vs 5.77±3.14, P = 0.166) were no significant difference between the patients with active treatment. The modified UICC staging (stage I 5.6% vs 17.1% vs 18.6%, stage II 55.6% vs 46.3% vs 47.3%, Stage III 22.2% vs 24.4% vs 24.8%, Stage IV-A 11.1% vs 6.1% vs 4.9% and Stage IV-B 5.6% vs 6.1% vs 4.4%, respectively, P = 0.826) and Barcelona Clinic Liver Cancer staging (stage 0 5.6% vs 9.8% vs 9.3%, stage A 16.7% vs 17.1% vs 22.1%, stage B 27.8% vs 29.3% vs 24.8%, stage C 50.0% vs 43.9% vs 41.2% and stage D 0.0% vs 0.0% vs 2.7%, respectively, P = 0.878) were no significant difference between the patients with active treatment. Furthermore, there were no difference between the age groups in treatment modality (Surgical resection 0.0% vs 3.3% vs 5.2%, P = 0.166; Radiofrequency ablation 2.0% vs 8.5% vs 11.0%, P=0.113; Transcatheter arterial chemoembolization 21.6% vs 34.6% vs 41.6%, P=0.014; Best supportive care 62.7% vs 40.5% vs 29.2%, P < 0.001), adverse event related treatment (P = 0.731) and disease-free survival days (329 .3±309.1 days vs 271.7 ± 414.2 days vs 357.2 ± 511.6 days, P = 0.336). Multivariate analysis showed that age, performance status, CTP class, MELD score, modified UICC staging, presence of portal vein thrombosis and ruptured HCC are risk factors for mortality. Conclusions: Clinician should make an active treatment in elderly patients with HCC not a age but performance status, liver function and disease status of cancer.

敎育評價制度에 對한 考察

최용범 충남대학교 행정대학원 1984 行政硏究 Vol.3 No.-

蓄熱用 TMA 包接化合物의 熱物性에 關한 實驗 硏究(Ⅰ)

최영범,한영옥,하옥남,김병철,김진흥 조선대학교 동력자원연구소 1996 動力資源硏究所誌 Vol.18 No.2

This paper presents the test-tube experimental results of thermal properties of TMA clathrate compounds for latent heat storage applications. The results are : ⅰ) subcooling in TMA clathrate compound is the lower than water, ⅱ) Phase change temperature in TMA clathrate compound is the higher than water. ⅲ) Latent heat of 25wt% TMA clathrate compounds of 220.4kJ/㎏K appear to be maximum. ⅳ) Comparing with water, volume of TMA clathrate compounds decreased as the phase change. ⅴ) TMA clathrate compounds precipitated because of increase of density as phase change. Thus, TMA clathrate compounds are found to be the promising compounds for the heat storage from the viewpoint of thermal property.

혈관 조영술을 이용한 관동맥,말초혈관,경동맥의 동맥경화성 협착병변의 빈도

최동훈,편욱범,윤영섭,장양수,심원흠 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.9

아동의 성과 운동참가가 신체적 자기개념에 미치는 영향

최범규,노영호 한국학교체육학회 2004 한국학교 체육학회지 Vol.14 No.2

본 연구에서는 신체적 성장과 발달적 변화 뿐 아니라 심리·정서적 변화를 나타내고 있는 아동의 성과 규칙적인 운동참가가 신체적 자기개념에 미치는 영향을 살퍼보았다. 본 연구의 대상은 서울에 소재한 B, C와 Y초등학교 6학년 355명(남 172명, 여 183명)이었고, 1주일에 3일 이상, 매일 1시간 정도의 신체활동에 참여한 아동을 운동참가 집단으로 설정하였으며, 김병준(2001)이 계발한 한국판 신체적 자기개념 측정도구를 사용하여 설문조사를 실시하였다. 신체적 자기개념 측정도구는 스포츠유능감, 체지방/날씬함, 외모, 건강, 신체활동, 자기존중감, 유연성, 지구력, 근력과 신체전반의 10개 하위요인으로 구성되어 있으며, 각 하위요인별 4개 문항씩 총 40문항으로 구성되어 있다. 연구결과를 살피보면, 먼저 성과 운동참가 여부에 따라 신체적 자기개념간의 상관을 살펴본 결과 스포츠유능감 요인이 다른 하위요인과 높은 상관이 있는 것을 알 수 있었다. 성별에 따른 신체적 자기개념의 차이를 규명하기 위해 다변량분석(MANOVA)을 실시한 결과, 스포츠유능감, 외모, 신체활동과 지구력 요인에서 남자가 여자보다 신체적 자기개념이 높은 것으로 나타났으며, 신채활동 요인의 차이가 신체적 자기개념의 성차에 가장 큰 역할을 하는 것을 알 수 있었다. 또한, 운동참가 여부에 따라 신체적 자기개념의 차이를 살펴본 결과 스포츠유능감, 외모, 신체활동, 지구력, 유연성, 근력과 신체전반 요인에서 운동참가 집단이 운동비참가 집단보다 신체적 자기개념이 높은 것으로 나타났으며, 스포츠유능감 요인이 운동참가와 운동비참가 집단간의 다변인적 차이에 가장 큰 역할을 하는 것을 알 수 있었다. The purpose of this study was to examine the effects of gender and involving physical activity on the physical self-description. The subjects were 355 students(male:172, female:183) in 6th grade in elementary schools in Seoul. The data for this study was collected through the survey questionnaires. The questionnaires of this study was Korean version of the PSDQ (Physical Self-Description Questionnaire; Kim, 2001). The statistics used for data analysis were Cronbach a, descriptive factor analysis, correlation, one-way ANOVA, MANOVA analysis in SPSS 11.0. From the analysis of the data, the conclusions of this study were obtained as follows; Physical self-description was higher in the male than in the female. Especially, physical activity factor was important role in the gender difference of the physical self-description. Also, Involving physical activity group was higher physical self-description than non-involving physical activity group. Sports competance factor was important role in the group difference of the physical self-description.

체육수업중 교사의 상호작용 행동이 수업평가에 미치는 영향

최경범,최영인,염건영,류기성 한국스포츠리서치 2004 한국 스포츠 리서치 Vol.15 No.5

The purpose of this study was to re-examine the effectiveness of teacher interaction behaviors on student learning products using two different kinds of experimental teaching units(E,T.U.). In one E.T.U., two teachers instructed respectively "vault activity units" to 5th grade classes of elementary schools with the same objectives, contents, methods and similar Environments. In such controlled conditions, we intervened with teacher A to perform active interaction behaviors(especially feedback behaviors to individual motor learning). On the other hand, teacher B was not intervened concerning interaction behaviors. In these practices, teacher A performed interaction behaviors 2 times more than teacher B. As a result, the average scores of student formative Evaluation to physical Education were significantly higher in teacher A's class than teacher B's class. In the other E.T.U., the same teacher instructed "volleyball activity units" to 2 different classes of the 9th grade in a junior high school, Instructional conditions with 2 classes were Equally controlled without teacher interaction behaviors. In the model C class, we intervened with the teacher to perform active interaction behaviors especially with individual student motor learning. In the model D class, the teacher was not intervened with performance of interaction in their motor learning, but to give advices about learning how to learn, in order to facilitate their spontaneous learning. As a result, the teacher in model C class performed interaction behaviors 3 times more than in the model D class. The average scores of student formative evaluation were also significantly higher in the model C class than the model D class. Thus, it seemed that the effectiveness of teacher interaction behaviors for student motor learning in physical education class suggested by previous research was confirm through these results of these E.T.U. studies.

두개외 경동맥 협착증에 대한 스텐트 삽입술의 추적 결과

윤영섭,홍범기,최동훈,김선호,김동익,김승민,장양수,심원흠 대한순환기학회 1998 Korean Circulation Journal Vol.28 No.11

제주도 북부연안역의 생물생태학적 기초연구 : Phytoplankton Dynamics and Primary Productivity at the Hamduk Area 함덕해역의 식물플랑크톤 동태와 일차생산력

고형범,고유봉,최영찬,이준백 濟州大學校海洋硏究所 1995 해양과환경연구소 연구논문집 Vol.19 No.-

제주도 북부 함덕해역의 연안역과 외양역에 있어 식물플랑크톤 동태와 일차생산력을 파악하기위해 1989년 7월부터 1990년 7월까지 조사하였다. 조사기간중 출현한 식물플랑크톤은 총 132종으로 규조류가 96종(72.7%), 와편모조류가 28종(21.2%), 기타 식물성 편모조류가 8종(6.1%)을 차지하였다. 출현종중 Chaetoceros socialis, Fragilaria oceanica 그리고 Lauderia annulata가 연안역에서 현존량의 70% 이상의 높은 우점율을 보였으며 대체적으로 Chaetoceros속이 높은 우점을 나타내었다. 평균현존량의 분포는 연안역(정점1,2)이 7.1×10³∼7.3×10⁴cells/ℓ, 외양역(정점3,4,5)이 5.8×10³∼3.0×10⁴cell/ℓ의 범위로써 규조류가 97%를 차지하였다. 수주의 평균일일 일차생산력은 연안역(정점 2)에서 631.06(156.74∼1,055.26)㎎C/㎡/day,외양역(정점 4)에서 367.12(111.83∼734.44)㎎C/㎡/day로 년간 평균 약 182gC/㎡/yr로 추정된다. 식물플랑크톤의 동화계수는 표층에서0.93-13.16㎎C/㎎Chla/hr의 범위로써 하계에 높았다. 개체수의 수직분포와 일차생산력의 계절변화로 볼때 함덕해역의 식물플랑크톤 동태는 수괴의 수직혼합 및 성층과 밀접한 상관을 보이고 있다고 판단된다. This study has been carried out to understand the dynamics and primary productivity of phytoplankton at nearshore and offshore in the Hamduk area, northern Cheju Island from July 1989 to July 1990. A total of 132species were identified, comprising mainly 96 spp. of diatoms(72.2%) as majority, and also 28 spp. of dinoflagellates(21.2%) and 8 spp. of other phytoflagellates(6.1%) as minority. Of these, Chaetoceros socilis, Fragilaria oceanisa, Lauderia annulata predominated more than 70% of standing crops at nearshore and the genus Chaetoceros was most abundant in all stations. The cell number of surface layer ranged from 7.1×10³to 7.3×10⁴cells/ℓat nearshore and from 5.8×10³to 3.0×10⁴cell/ℓat offshore, showing the composition ratio of 97% by diatoms. The means of daily depth-integrated primary productivity in the water-column were 631.06(156.74∼1,055.26)㎎C/㎡/day at nearshore(st.2) and 367.12(111.83∼734.44)㎎C/㎡/day at offshore(st.4), estimating about 182gC/㎡/yr in the yearly primary productivity. Assimilation number of phytoplankton at the surface ranged from 0.93 to 13.16㎎C/㎎Chla/hr, showing higher values in summer. It is speculated that the dynamics of phytoplankton show the close relation with the vertical mixing and stratification of the water mass in terms of the vertical distribution of cell number and the seasonal variation of primary productivity.

일차성 식도이완불능증의 풍선확장술후 치료효과의 객관적 평가지표

손영해,나호영,조성범,주영은,김현수,최성규,유종선,김세종 全南大醫大 2001 전남의대학술지 Vol.37 No.2

유방암에서 PCR을 이용한 p53 유전자의 Codon 175에서의 점돌연변이에 관한 연구

김영철,김종석,김선한,목영재,최상용,문홍영,구범환 고려대학교 의과대학 1993 고려대 의대 잡지 Vol.30 No.2

The p53 gene, which is located in the short arm of chromosome 17, has been a constant source of fascination since its discovery at 1979. Allelic deletion coupled with mutation of the remaining allele is a theoretical hallmark of functional inactivation of tumor suppressor gene, and mutation and/or deletion of p53 gene is to be the most frequently observed genetic changes in breast cancer related to a single gene. In the present report, we have attempted to determine a point mutation at codon 175 which is known as one of four hot spots within highly conserved regions of the p53 gene where almost all of the reported mutations cluster A 304-bp fragment of exon 5 of p53 gene in fresh tissue of breast carcinoma was amplified by polymerase chain reaction (PCR), digested with Hha I restriction endonuclease, and electrophoresed. A point mutation was studied by observation of polymorphism with ethidium bromide staining under ultraviolet transillumination. The result revealed all of 14 carcinomas had wild-type p53 gene.