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161.
Seung Eun Lee Kyung Sik Kim Wan Bae Kim In-Gyu Kim Yang Won Nah Dong Hee Ryu Joon Seong Park Myung Hee Yoon Jai Young Cho Tae Ho Hong Dae Wook Hwang Dong Wook Choi Korean Association of Hepato-Biliary Pancreas Surgery 《Journal of Korean medical science》2014,29(10):1333-1340
At present, surgical treatment is the only curative option for gallbladder (GB) cancer. Many efforts therefore have been made to improve resectability and the survival rate. However, GB cancer has a low incidence, and no randomized, controlled trials have been conducted to establish the optimal treatment modalities. The present guidelines include recent recommendations based on current understanding and highlight controversial issues that require further research. For T1a GB cancer, the optimal treatment modality is simple cholecystectomy, which can be carried out as either a laparotomy or a laparoscopic surgery. For T1b GB cancer, either simple or an extended cholecystectomy is appropriate. An extended cholecystectomy is generally recommended for patients with GB cancer at stage T2 or above. In extended cholecystectomy, a wedge resection of the GB bed or a segmentectomy IVb/V can be performed and the optimal extent of lymph node dissection should include the cystic duct lymph node, the common bile duct lymph node, the lymph nodes around the hepatoduodenal ligament (the hepatic artery and portal vein lymph nodes), and the posterior superior pancreaticoduodenal lymph node. Depending on patient status and disease severity, surgeons may decide to perform palliative surgeries.
Graphical Abstract
相似文献162.
Kyoung Lok Min Jae Yeoul Ryu Min Jung Chang 《Basic & clinical pharmacology & toxicology》2019,125(3):215-236
Anti‐epileptic drugs (AEDs) have various pharmacokinetic profiles, inter‐individual variabilities, high possibilities of drug‐drug interactions and narrow therapeutic indices. To provide optimal treatment for patients, therapeutic drug monitoring (TDM) is necessary. However, TDM requires sufficient quantities of blood samples to measure drug concentrations. Therefore, TDM could be a burden, particularly in paediatric cases. A good alternative that overcomes these disadvantages is the dried blood spot (DBS) method, which is simple, convenient to use and less invasive, requiring a lower quantity of blood than traditional blood sampling methods. However, the DBS method is affected by haematocrit (Hct) levels to varying extents depending on the drug properties. In addition, different papers with varying characteristics are available for use when applying the DBS method. Therefore, it has not yet been applied to TDM in clinical practice. To achieve this, several steps are required, including method development, method validation and clinical validation. Currently, the development status of the DBS method is different for each AED and unclear. Therefore, we assessed the development status of the following 19 AEDs in 26 studies: lamotrigine, valproic acid, levetiracetam, phenytoin, topiramate, carbamazepine, carbamazepine epoxide, gabapentin, phenobarbital, pregabalin, clobazam, clonazepam, ethosuximide, felbamate, monohydroxycarbamazepine, nitrazepam, rufinamide, vigabatrin and zonisamide. Among them, carbamazepine, lamotrigine, topiramate and valproic acid have been developed such that they are nearly available for TDM. In addition, Whatman 903 Protein Saver Cards and concentration analysis by liquid chromatography with triple quadrupole mass spectrometer were used most often. 相似文献
163.
In Woong Han Kyeongwon Cho Youngju Ryu Sang Hyun Shin Jin Seok Heo Dong Wook Choi Myung Jin Chung Oh Chul Kwon Baek Hwan Cho 《World journal of gastroenterology : WJG》2020,26(30):4453-4464
BACKGROUND Despite advancements in operative technique and improvements in postoperative managements,postoperative pancreatic fistula(POPF) is a life-threatening complication following pancreatoduodenectomy(PD).There are some reports to predict POPF preoperatively or intraoperatively,but the accuracy of those is questionable.Artificial intelligence(AI) technology is being actively used in the medical field,but few studies have reported applying it to outcomes after PD.AIM To develop a risk prediction platform for POPF using an AI model.METHODS Medical records were reviewed from 1769 patients at Samsung Medical Center who underwent PD from 2007 to 2016.A total of 38 variables were inserted into AI-driven algorithms.The algorithms tested to make the risk prediction platform were random forest(RF) and a neural network(NN) with or without recursive feature elimination(RFE).The median imputation method was used for missing values.The area under the curve(AUC) was calculated to examine the discriminative power of algorithm for POPF prediction.RESULTS The number of POPFs was 221(12.5%) according to the International Study Group of Pancreatic Fistula definition 2016.After median imputation,AUCs using 38 variables were 0.68 ± 0.02 with RF and 0.71 ± 0.02 with NN.The maximal AUC using NN with RFE was 0.74.Sixteen risk factors for POPF were identified by AI algorithm:Pancreatic duct diameter,body mass index,preoperative serum albumin,lipase level,amount of intraoperative fluid infusion,age,platelet count,extrapancreatic location of tumor,combined venous resection,co-existing pancreatitis,neoadjuvant radiotherapy,American Society of Anesthesiologists' score,sex,soft texture of the pancreas,underlying heart disease,and preoperative endoscopic biliary decompression.We developed a web-based POPF prediction platform,and this application is freely available at http://popfrisk.smchbp.org.CONCLUSION This study is the first to predict POPF with multiple risk factors using AI.This platform is reliable(AUC 0.74),so it could be used to select patients who need especially intense therapy and to preoperatively establish an effective treatment strategy. 相似文献
164.
Sung Woo Ryu Gene Hyun Bok Jae Young Jang Soung Won Jeong Nam Seok Ham Ji Hye Kim Eui Ju Park Jin Nyoung Kim Woong Cheul Lee Kwang Yeun Shim Sae Hwan Lee Sang Gyune Kim Sang-Woo Cha Young Seok Kim Young Deok Cho Hong Soo Kim Boo Sung Kim 《Gut and liver》2014,8(3):292-297
Background/Aims
To evaluate the diagnostic value of contrast (SonoVue®) enhancement ultrasonography (CEUS) and to compare this method with computed tomography (CT) and magnetic resonance imaging (MRI) in evaluating liver masses.Methods
CEUS (n=50), CT (n=47), and MRI (n=43) were performed on 50 liver masses in 48 patients for baseline mass characterization. The most likely impression for each modality and the final diagnosis, based on the combined biopsy results (n=14), angiography findings (n=36), and clinical course, were determined. The diagnostic value of CEUS was compared to those of CT and MRI.Results
The final diagnosis of the masses was hepatocellular carcinoma (n=43), hemangioma (n=3), benign adenoma (n=2), eosinophilic abscess (n=1), and liver metastasis (n=1). The overall diagnostic agreement with the final diagnosis was substantial for CEUS, CT, and MRI, with κ values of 0.621, 0.763, and 0.784, respectively. The sensitivity, specificity, and accuracy were 83.3%, 87.5%, and 84.0%, respectively, for CEUS; 95.0%, 87.5%, and 93.8%, respectively, for CT; and 94.6%, 83.3%, and 93.0%, respectively for MRI. After excluding the lesions with poor acoustic sonographic windows, the sensitivity, specificity, and accuracy for CEUS were 94.6%, 87.5%, and 93.3%, respectively, with a κ value of 0.765.Conclusions
If an appropriate acoustic window is available, CEUS is comparable to CT and MRI for the diagnosis of liver masses. 相似文献165.
Je-Hwang Ryu Gi-Ja Lee Wan-Sun Kim Han-Eol Lim Mallory Mativenga Kyu-Chang Park Hun-Kuk Park 《Materials》2014,7(3):1975-1983
We demonstrate the fabrication of an all-carbon electrode by plasma-enhanced chemical vapor deposition for use in flexible electrochemical applications. The electrode is composed of vertically aligned carbon nanotubes that are grown directly on a flexible graphite foil. Being all-carbon, the simple fabrication process and the excellent electrochemical characteristics present an approach through which high-performance, highly-stable and cost-effective electrochemical applications can be achieved. 相似文献
166.
167.
Woo Jung Kim Ra Yeon Ha Ja Yeun Sun Vin Ryu Su Jin Lee Kyooseob Ha Hyun-Sang Cho 《Comprehensive psychiatry》2014
Objective
The aim of this study was to investigate the overgeneralization of autobiographical memory (AM) in bipolar disorder (BD) and assess its association with multiple cognitive domains.Method
Twenty-eight clinically stable bipolar I patients and an equal number of age- and gender-matched healthy controls (HC) were included. All participants were examined using the autobiographical memory test (AMT) and the neuropsychological battery including the general intelligence, attention, verbal memory, verbal fluency, visual memory, and executive functions domain. Demographic, clinical, and test variables were compared between BD and HC groups. Correlation analyses of AMT scores with cognitive functions were performed within each group, controlling for demographic and clinical variables.Results
Total and negative scores of AMT were significantly lower in BD patients compared to HC individuals. AMT scores were significantly correlated with WAIS similarities, WCST perseverative errors, and WCST categories completed in BD, whereas AMT scores were correlated with verbal memory and verbal fluency in HC.Conclusion
Our findings suggest that overgeneral AM is a characteristic of BD and is related to executive function. Future studies should investigate the benefit of additional treatment focusing on overgeneral AM in BD. 相似文献168.
169.
170.
Oxidative stress and inflammation are key promoters of atherosclerosis and myocardial damage. When orally administered, the novel astaxanthin prodrug CDX-085 delivers high levels of the xanthophyll antioxidant astaxanthin that protects LDL from oxidation and reduces primary thrombosis. In this study, we analyzed whether delivery of astaxanthin from administration of the CDX-085 prodrug reduces plasma lipoprotein levels and the progression of atherosclerosis in low-density lipoprotein receptor negative (LDLR?/?) and apolipoprotein E deficient (ApoE?/?) mice.MethodsRelative circulating levels of astaxanthin derived from CDX-085 administration compared to administration of pure astaxanthin was initially evaluated in a canine model. In mouse Study #1, 16 wild-type and 16 LDLR?/? mice on 0.5% cholesterol diet supplemented with either 0.0%, 0.08%, 0.2% and 0.4% CDX-085 were used to assess plasma levels and lipoprotein biodistribution measured by FPLC after 4 weeks treatment. In Study #2, 36 male LDLR?/? mice were randomized to a 0.5% cholesterol chow diet (CHOW group, n = 12) or 0.5% cholesterol chow fortified with 0.08% CDX-085 (n = 12) or 0.5% cholesterol chow with 0.4% CDX-085 (n = 12) for 12 weeks. In Study #3, 34 male ApoE?/? mice were randomized in the same fashion as the Study #2 and fed similar diets for 9 weeks.ResultsCDX-085 administration was shown to result in significantly higher levels of circulating astaxanthin (p < 0.001 ANOVA) over a 72 h period compared to pure, non-esterified astaxanthin in a single-dose pharmacokinetic study in beagles. In Study #1, plasma astaxanthin levels were 5–9-fold higher in LDLR?/? mice compared to wild-type mice. Astaxanthin was highly distributed among all lipoprotein fractions, generally reflecting cholesterol content of lipoproteins. In Study #2, administration of CDX-085 resulted in significantly lower total cholesterol levels (528 ± 68 mg/dL vs. 550 ± 67 mg/dL vs. 602 ± 80 mg/dL, p = 0.047) and aortic arch atherosclerosis (9.0 ± 4.2% vs. 9.8 ± 3.5% vs. 13.2 ± 3.6%, p = 0.023) in the 0.4% CDX-085 group compared to the 0.08% CDX-085 and CHOW groups, respectively. In ApoE?/? mice, a 72% reduction in triglycerides in the 0.4% CDX-085 group and 50% reduction in the 0.08% CDX-085 groups was noted compared to CHOW group (final levels 17 ± 11 mg/dL vs. 30 ± 15 mg/dL vs. 60 ± 32 mg/dL, respectively, p = 0.001).ConclusionOral administration of the novel astaxanthin prodrug CDX-085 shows that it distributes among lipoproteins. CDX-085 lowers total cholesterol and aortic arch atherosclerosis in LDLR?/? mice and triglyceride levels in ApoE?/? mice and shows promise for further evaluation in human studies. 相似文献