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Atsushi Goto,Takeshi Okamoto,Ryo Ogawa,Kouichi Hamabe,Shinichi Hashimoto,Jun Nishikawa,Taro Takami 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.4
Background/Aims: Intralesional steroid injections have been administered as prophylaxis for stenosis after esophageal endoscopicsubmucosal dissection. However, this method carries a risk of potential complications such as perforation because a fine needle is usedto directly puncture the postoperative ulcer. We devised a new method of steroid intralesional infusion using a spray tube and evaluatedits efficacy and safety. Methods: Intralesional steroid infusion using a spray tube was performed on 27 patients who underwent endoscopic submucosal dissectionfor superficial esophageal cancer with three-quarters or more of the lumen circumference resected. The presence or absence ofstenosis, complications, and the number of endoscopic balloon dilations (EBDs) performed were evaluated after treatment. Results: Although stenosis was not observed in 22 of the 27 patients, five patients had stenosis and dysphagia requiring EBD. The stenosisin these five patients was relieved after four EBDs. No complications related to intralesional steroid infusion using the spray tubewere observed. Conclusions: Intralesional steroid infusion using a spray tube is a simple and safe technique that is adequately effective in preventingstenosis (clinical trial number, UMIN000037567).
기업소유권은 정말 중요한가? 일본 기업지배구조에서 외국인 투자가의 역할
미야지마 히데아키,Takaaki Hoda,Ryo Ogawa 서울대학교 아시아연구소 2016 아시아리뷰 Vol.5 No.2
After the banking crisis of 1997, corporate ownership in Japan shiftedfrom an insider-dominated to an outsider-dominated structure. This paperanalyzes the impact of dramatic changes in the ownership structure oncorporate governance and firm value, focusing on the role of foreigninstitutional investors. There are two competing views on the role ofincreased foreign ownership. The positive view is that foreign investorshave had high monitoring capabilities and have encouraged improvementsin the governance arrangement of firms resulting in higher performance. Conversely, the negative view is that they have had strong bias in theirinvestment strategies, and were less committed to a particular firm. Eventhough a correlation between foreign ownership and high performance hasbeen observed, it may be a superficial relationship. Higher stock returnscan be induced by demands for stocks, while performance can simplyreflect a foreign investor’s preference for a high quality firm. To determinewhich view is more compelling, we constructed a unique long-term dataset, and examined the determinants of foreign ownership and its impacton stock returns as well as performance. We found that the investmentbehavior of foreign investors has been characterized by a particular bias,and takes into account governance arrangements. Second, their investmentsubstantially affected the stock returns of firms. Third, even after controlling for reverse causality, their growing presence positively affectedfirm performance, suggesting that foreign institutional investors played adisciplinary role after their shareholding increased. 1997년의 금융위기 이후, 일본 기업의 소유구조는 내부자 지배에서 외부자 지배 구조로 변화했다. 이 글은 외국인 기관투자가의 역할에 초점을 맞추면서 기업소유구조의 극적인 변화가 기업지배구조와 기업가치에 끼친 영향에 대해 분석한다. 증가한 외국인 소유의 역할을 두고 서로 대립하는 두 가지 견해가 존재한다. 긍정적인 견해는 외국인 투자가가 감시 능력이 매우 높고 기업지배구조를 개선하며, 그 결과 기업의 실적을 향상시킨다는 것이다. 반대로 부정적인 견해는 외국인 투자가의 투자 전략이 매우 편향되어 있고 특정 기업에 대한 헌신도가 낮다는 것이다. 비록 외국인 소유와 높은 기업 실적 간에 상관관계가 관측되기는 하나, 이것은 피상적인 것일 수 있다. 높은 주식 수익률은 주식 수요에 의해 유인될 수 있는 것이고 기업 실적은 단순히 양질의 기업에 대한 외국인 투자가의 선호를 반영하는 것일 수 있다. 두 견해 중 어느 쪽이 더 설득력 있는지 결정하기 위해 우리는 독특한 장기적 데이터 세트를 구축했다. 그리고 외국인 소유의 결정 요소를 검토하고외국인 소유가 주식 수익과 기업 실적에 미치는 영향을 조사했다. 먼저 외국인 투자가의 투자 행위는 어떤 특정한 편향(bias)이 특징이고, 기업지배구조의 성격을 고려해서 이루어진다는 점을 발견했다. 두 번째 발견 사항은 외국인 투자가 기업의 주식 수익에 상당한 영향을 미쳤다는 점이다. 세 번째는 역의 인과관계(reverse causality)를 통제한 후에도 증가하는외국인 투자는 기업 실적에 양의 효과를 미쳤다는 점이다. 이는 일단 외국인 기관 투자가들의 주식 보유량이 증가하고 나면 이들이 기업에 대해 규율자 역할을 했음을 보여준다.
Hiroki Sato,Yusuke Fujiyoshi,Hirofumi Abe,Hironari Shiwaku,Junya Shiota,Chiaki Sato,Hiroyuki Sakae,Masaki Ominami,Yoshitaka Hata,Hisashi Fukuda,Ryo Ogawa,Jun Nakamura,Tetsuya Tatsuta,Yuichiro Ikebuchi 대한소화기 기능성질환∙운동학회 2022 Journal of Neurogastroenterology and Motility (JNM Vol.28 No.2
Background/AimsPatients with achalasia-related esophageal motility disorders (AEMDs) frequently present with dilated and sigmoid esophagus, and develop esophageal diverticulum (ED), although the prevalence and patients characteristics require further elucidation. MethodsWe conducted a multicenter cohort study of 3707 patients with AEMDs from 14 facilities in Japan. Esophagography on 3682 patients were analyzed. ResultsStraight (n = 2798), sigmoid (n = 684), and advanced sigmoid esophagus (n = 200) were diagnosed. Multivariate analysis revealed that long disease duration, advanced age, obesity, and type I achalasia correlate positively, whereas severe symptoms and integrated relaxation pressure correlate negatively with development of sigmoid esophagus. In contrast, Grade II dilation (3.5-6.0 cm) was the most common (52.9%), while grade III dilation (≥ 6 cm) was rare (5.0%). We found early onset, male, obesity, and type I achalasia correlated positively, while advanced age correlated negatively with esophageal dilation. Dilated and sigmoid esophagus were found mostly in types I and II achalasia, but typically not found in spastic disorders. The prevalence of ED was low (n = 63, 1.7%), and non-dilated esophagus and advanced age correlated with ED development. Patients with right-sided ED (n = 35) had a long disease duration (P = 0.005) with low integrated relaxation pressure values (P = 0.008) compared with patients with left-sided ED (n = 22). Patients with multiple EDs (n = 6) had lower symptom severity than patients with a single ED (P = 0.022). ConclusionsThe etiologies of dilated esophagus, sigmoid esophagus, and ED are considered multifactorial and different. Early diagnosis and optimal treatment of AEMDs are necessary to prevent these conditions.
Tetsuya Tatsuta,Hiroki Sato,Yusuke Fujiyoshi,Hirofumi Abe,Akio Shiwaku,Junya Shiota,Chiaki Sato,Masaki Ominami,Yoshitaka Hata,Hisashi Fukuda,Ryo Ogawa,Jun Nakamura,Yuichiro Ikebuchi,Hiroshi Yokomichi 대한소화기 기능성질환∙운동학회 2022 Journal of Neurogastroenterology and Motility (JNM Vol.28 No.4
Background/Aims ManoScan and Sandhill high-resolution manometry (HRM) systems are used worldwide; however, the diagnosis of achalasia on the Starlet HRM system is not fully characterized. Furthermore, the impact of calcium channel blockers and nitrites in treating achalasia has not been investigated using HRM. Management of recurrent cases is a priority issue, although few studies have examined patient characteristics. Methods We conducted a multicenter, large-scale database analysis. First, the diagnosis of treatment-naive achalasia in each HRM system was investigated. Next, patient characteristics were compared between type I-III achalasia, and the impact of patient characteristics, including calcium channel blocker and nitrite use for integrated relaxation pressure (IRP) values, were analyzed. Finally, patient characteristics with recurrent achalasia were elucidated. Results The frequency of type I achalasia with Starlet was significantly higher than that with ManoScan and Sandhill HRM systems. In achalasia, multivariate analysis identified male sex, advanced age, long disease duration, obesity, type I achalasia, and sigmoid type as risk factors related to normal IRP values (< 26 mmHg). Calcium channel blockers and nitrites use had no significant impact on the IRP values, although achalasia symptoms were indicated to be alleviated. In recurrent cases, the IRP value was significantly lower, and advanced age, long disease duration, and sigmoid type were more common than in treatment-naive patients. Conclusions We should cautiously interpret the type of achalasia and IRP values in the Starlet HRM system. Symptoms of recurrent cases are related to disease progression rather than IRP values, which should be considered in decision making.