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The feasibility of single-port laparoscopic appendectomy using a solo approach
Say-June Kim,Byung-Jo Choi,Wonjun Jeong,Sang Chul Lee 대한외과학회 2016 Annals of Surgical Treatment and Research(ASRT) Vol.90 No.3
Purpose: To investigate the feasibility and safety of solo surgery with single-port laparoscopic appendectomy, which is termed herein solo-SPLA (solo-single-port laparoscopic appendectomy). Methods: This study prospectively collected and retrospectively analyzed data from patients who had undergone either non-solo-SPLA (n = 150) or solo-SPLA (n = 150). Several devices were utilized for complete, skin-to-skin solo-SPSA, including a Lone Star Retractor System and an adjustable mechanical camera holder. Results: Operating times were not significantly different between solo- and non-solo-SPLA (45.0 ± 21.0 minutes vs. 46.7 ± 26.1 minutes, P = 0.646). Most postoperative variables were also comparable between groups, including the necessity for intravenous analgesics (0.7 ± 1.2 ampules [solo-SPLA] vs. 0.9 ± 1.5 ampules [non-solo-SPLA], P = 0.092), time interval to gas passing (1.3 ± 1.0 days vs. 1.4 ± 1.0 days, P = 0.182), and the incidence of postoperative complications (4.0% vs. 8.7%, P = 0.153). Moreover, solo-SPLA effectively lowered the operating cost by reducing surgical personnel expenses. Conclusion: Solo-SPLA economized staff numbers and thus lowered hospital costs without lengthening of operating time. Therefore, solo-SPLA could be considered a safe and feasible alternative to non-solo-SPLA.
( Say-june Kim ),( Jung Hyun Park ),( Kee-hwan Kim ),( Ho Joong Choi ),( Dong Do You ),( Kwang Yeol Paik ),( Jae Hyun Han ),( Tae Ho Hong ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Peroxisome proliferator activated receptor λ coactivator 1a (PGC-1a) is a potent regulator of mitochondrial biogenesis and energy metabolism. In this study, we investigated the therapeutic potential of the secretome released from the adipose-derived stem cells (ASCs) transfected with PGC-1a (PGC-secretome). Methods: We first generated PGC-1a-overexpressing ASCs by transfecting ASCs with the plasmids harboring the gene encoding PGC-1a. Secretory materials released from PGC-1a-overex-pressing ASCs were collected and their therapeutic potential was determined using in vitro (thioacetamide [TAA]-treated AML12 cells) and in vivo (70% partial hepatectomized mice) models of liver injury. Results: In the TAA-treated AML12 cells, the PGC-secretome significantly increased cell viability, promoted expression of proliferation-related markers, such as PCNA and p-STAT, and significantly reduced the levels of ROS. In the mice, PGC-secretome injections significantly increased both liver tissue expression of proliferation-related markers than did normal secretome injections (P<0.05). We demonstrated that the PGC-secretome does not only have higher antioxidant and anti-inflammatory properties, but also has a potential of significantly enhancing liver regeneration in both in vivo and in vitro models of liver injury. Conclusions: Reinforcing the mitochondrial antioxidant potential by transfecting ASCs with PGC-1a could be one of the effective strategies to enhance the therapeutic potential of ASCs.
Double Intrahepatic and Extrahepatic Cholangiocarcinomas Arising from Biliary Papillomatosis
Say June Kim,Jung Uee Lee 한국간담췌외과학회 2010 한국간담췌외과학회지 Vol.14 No.1
Biliary papillomatosis is a rare disease entity characterized by multiple papillary adenomas along the bile duct mucosa. It is widely accepted that the adenoma-carcinoma sequence represents the process by which most, if not all, cholangiocarcinomas of an intraductal-growing type arise. Interestingly, friable papillary projections easily detached from the primary site can be implanted into the other sites in the bile duct in suitable animal models, resulting in multiple tumors. A 76-year-old male was referred to our hospital due to intermittent abdominal discomfort. Imaging workups revealed two lesions: wall thickening in the proximal portion of the left interhepatic duct and abrupt narrowing of the distal common bile duct. A hepatopancreaticoduodenectomy was carried out and pathological analysis demonstrated a well-differentiated adenocarcinoma of the left hepatic duct and carcinoma in situ of the distal common bile duct on a background of biliary papillomatosis. Six days after the operation, the patient received a re-exploration due to ruptured mesenteric vessels. Unfortunately, 3 months after the initial operation, the patient died of aspiration pneumonia. Biliary papillomatosis can present with a broad spectrum of disease characteristics ranging from adenoma to, usually, low-grade adenocarcinoma. If there is a complete excision, and a favorable postoperative course is secured, excellent survival can be expected after surgery.
( Say-june Kim ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Cholestatic liver injury is one of the major causative factors for the development of liver fibrosis and cirrhosis in patients with chronic liver disease. Based on the fact that these diseases produce imponderable health care costs, it is comprehensible that many researchers are trying to understand the pathogenic mechanisms of ongoing hepatic fibrosis. Therefore, experimental models have been generated that mimic various aspects of the complex mechanisms that lead to hepatic inflammation, fibrosis and cirrhosis. We herein have described some of the elements that can be involved in the progression into hepatic failure following cholestasis induced by bile duct ligation in experimental mice, which recruits immunocompetent cells, possibly by the increased levels of inflammatory cytokines, a decrease of regulatory T cells, and failure of bile duct epithelial cell homeostasis. Surgical bile duct ligation (BDL) is one of the most widespread experimental models that is used to induce obstructive cholestatic injury in mice and rats. In most of the protocols, animals are anesthetized and a midsection laparotomy is performed. Subsequently, the bile duct is uncovered from the abdominal cavity and ligated twice using surgical twine. As a consequence, the mice and rats that received this surgery develop a strong fibrotic reaction that at first originate from the periportal fields. During the establishment of this model, we demonstrated that it reproducibly causes cholestasis with only minimal histological tissue injury and does not proceed to chronic cholestasis. We also found the correlation between the serum levels of hyperbilirubinemia and the degree of hepatic failure. In conclusion, it is critically important to attempt to lessen the progression of hyperbilirubinemia before reaching irreversible hepatic dysfunction.
Say-June Kim,Dong-Goo Kim,Tai-Gyu Kim,Hee-Baeg Choi,Eun-Sun Jung 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.6
Purpose: The design of this study was to determine the most influential factor(s) on post-transplant immunological consequences, particularly with regard to the role of killer cell immunoglobulin-like receptors (KIRs) and their ligands (type Ⅰ human leukocyte antigen (HLA)) in unstable liver function. Methods: Retrospectively collected data from 319 recipients undergoing adult living donor liver transplantation (LDLT) using a right lobe graft between January 2002 and August 2008 were analyzed. Patients were categorized according to the serum alanine transaminase (ALT) pattern; stable ALT pattern was defined as ALT pattern during 3 months post-transplantation, except for initial 2 weeks post-transplantation, in which 2 times or less additional elevation(s) of serum alanine transaminase (ALT) (≥80 IU/L) were observed. When a serum ALT pattern showed fluctuating and/or unpredictable nature, it was defined as an unstable pattern. In addition, genetic information of KIRs and HLA-C allotypes received from 68 recipients and 59 donors was analyzed by way of polymerase chain reaction using sequence-specific primers (PCR-SSP) to determine the factor(s) influencing a serum ALT pattern. Results: Among 319 LDLT recipients included in this study, the actual incidences of AR and unstable ALT pattern were 13.4% (43/319) and 42.3% (135/319), respectively. Unstable ALT pattern correlated with poorer survival following LDLT than stable pattern (P<0.000). Genetically, unstable ALT pattern was related to recipients carrying KIR2DL2(+)/KIR2DS2(+) combined with the heterogeneous HLA-C allotype (HLA-C1/C2), (relative risks 45.0, 95% confidence interval 2.160∼937.321; P=0.013). Conclusion: This study indicates that, when performing LDLT, pretransplant determination of recipient’s KIRs and HLA-C allotypes may be beneficial in coping with post-transplant immunological circumstances.
( Say-june Kim ),( Kee-hwan Kim ),( Sang Chul Lee ),( Ok-hee Kim ),( Sang Kuon Lee ),( Byung Jo Choi ),( Wonjun Jeong ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: The critical role of the mammalian target of rapamycin (mTOR) pathway has raised the possibility of applying specific mTOR inhibitors to halt cancer progression. While everolimus only inhibits mTORC1, Ku0063794 inhibits both mTORC1 and mTORC2. Methods: Thus, we examined the ability of everolimus and Ku0063794, individually or in combination, to inhibit the growth of hepatocellular carcinoma (HCC) cells (HepG2 and Hep3B) both in an in vitro experiment and in vivo mouse xenograft model. Results: HCC cells treated with both agents showed significantly lower rates of cell proliferation and higher apoptosis than HCC cells treated with the respective monotherapies ( P<0.05). Unlike the monotherapies, combination therapy significantly decreased the percentage of HCC cells containing GFP-LC3 puncta, indicating reduced autophagosome formation ( P<0.05). A reduction in autophagy induced by bafilomycin A1 promoted the pro-apoptotic effects of combination therapy, as demonstrated by higher expression of an apoptotic protein (Bim) and by lower expression of anti-apoptotic proteins (Mcl-1 and Bcl-xl). In addition, western blot analysis showed that combination therapy decreased the expression of SIRT1, which is known to promote autophagy. Overexpressing SIRT1 directly abrogated the pro-apoptotic effects of combination therapy, as evidenced by lower expression of an apoptotic protein (Bim) and higher expression of an anti-apoptotic protein (Mcl-1). In a nude mouse xenograft model, the shrinkage of tumors was more prominent in mice treated with combination therapy than in mice treated with the respective monotherapies, while equivalent total body weights were maintained in all groups ( P<0.05). Conclusions: Thus, our study suggests that combining everolimus and Ku0063794 potentiates the anticancer effects against HCC cells by inducing SIRT1 downregulation, resulting in decreased autophagy.