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Risk-Scoring System for Prediction of Non-Curative Endoscopic Submucosal Dissection Requiring Additional Gastrectomy in Patients with Early Gastric Cancer

  • Kim, Tae-Se;Min, Byung-Hoon;Kim, Kyoung-Mee;Yoo, Heejin;Kim, Kyunga;Min, Yang Won;Lee, Hyuk;Rhee, Poong-Lyul;Kim, Jae J.;Lee, Jun Haeng
    • Journal of Gastric Cancer
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    • v.21 no.4
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    • pp.368-378
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    • 2021
  • Purpose: When patients with early gastric cancer (EGC) undergo non-curative endoscopic submucosal dissection requiring gastrectomy (NC-ESD-RG), additional medical resources and expenses are required for surgery. To reduce this burden, predictive model for NC-ESD-RG is required. Materials and Methods: Data from 2,997 patients undergoing ESD for 3,127 forceps biopsy-proven differentiated-type EGCs (2,345 and 782 in training and validation sets, respectively) were reviewed. Using the training set, the logistic stepwise regression analysis determined the independent predictors of NC-ESD-RG (NC-ESD other than cases with lateral resection margin involvement or piecemeal resection as the only non-curative factor). Using these predictors, a risk-scoring system for predicting NC-ESD-RG was developed. Performance of the predictive model was examined internally with the validation set. Results: Rate of NC-ESD-RG was 17.3%. Independent pre-ESD predictors for NC-ESD-RG included moderately differentiated or papillary EGC, large tumor size, proximal tumor location, lesion at greater curvature, elevated or depressed morphology, and presence of ulcers. A risk-score was assigned to each predictor of NC-ESD-RG. The area under the receiver operating characteristic curve for predicting NC-ESD-RG was 0.672 in both training and validation sets. A risk-score of 5 points was the optimal cut-off value for predicting NC-ESD-RG, and the overall accuracy was 72.7%. As the total risk score increased, the predicted risk for NC-ESD-RG increased from 3.8% to 72.6%. Conclusions: We developed and validated a risk-scoring system for predicting NC-ESD-RG based on pre-ESD variables. Our risk-scoring system can facilitate informed consent and decision-making for preoperative treatment selection between ESD and surgery in patients with EGC.

Sputtering Yield and Secondary Electron Emission Coefficient(${\gamma}$) of the MgO, $MgAl_2O_4$ and $MgAl_2O_4/MgO$ Thin Film Grown on the Cu Substrate by Using the Focused Ion Beam (Cu 기판위에 성장한 MgO, $MgAl_2O_4$$MgAl_2O_4/MgO$ 박막의 집속이온빔을 이용한 스퍼터링수율 측정과 이차전자방출계수 측정)

  • Jung K.W.;Lee H.J.;Jung W.H.;Oh H.J.;Park C.W.;Choi E.H.;Seo Y.H.;Kang S.O.
    • Journal of the Korean Vacuum Society
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    • v.15 no.4
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    • pp.395-403
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    • 2006
  • It is known that $MgAl_2O_4$ has higher resistance to moisture than MgO, in humid ambient MgO is chemically unstable. It reacts very easily with moisture in the air. In this study, the characteristic of $MgAl_2O_4$ and $MgAl_2O_4/MgO$ layers as dielectric protection layers for AC- PDP (Plasma Display Panel) have been investigated and analysed in comparison for conventional MgO layers. MgO and $MgAl_2O_4$ films both with a thickness of $1000\AA$ and $MgAl_2O_4/MgO$ film with a thickness of $200/800\AA$ were grown on the Cu substrates using the electron beam evaporation. $1000\AA$ thick aluminium layers were deposited on the protective layers in order to avoid the charging effect of $Ga^+$ ion beam while the focused ion beam(FIB) is being used. We obtained sputtering yieds for the MgO, $MgAl_2O_4$ and $MgAl_2O_4/MgO$ films using the FIB system. $MgAl_2O_4/MgO$ protective layers have been found th show $24{\sim}30%$ lower sputtering yield values from 0.244 up to 0.357 than MgO layers with the values from 0.364 up to 0.449 for irradiated $Ga^+$ ion beam with energies ranged from 10 kV to 14 kV. And $MgAl_2O_4$ layers have been found to show lowest sputtering yield values from 0.88 up to 0.109. Secondary electron emission coefficient(g) using the ${\gamma}$- FIB. $MgAl_2O_4/MgO$ and MgO have been found to have similar g values from 0.09 up to 0.12 for indicated $Ne^+$ ion with energies ranged from 50 V to 200 V. Observed images for the surfaces of MgO and $MgAl_2O_4/MgO$ protective layers, after discharge degradation process for 72 hours by SEM and AFM. It is found that $MgAl_2O_4/MgO$ protective layer has superior hardness and degradation resistance properties to MgO protective layer.

Origin of limestone conglomerates in the Choson Supergroup(Cambro-Ordovician), mid-east Korea

  • Kwon Y.K.;Chough S.K.;Choi D.K.;Lee D.J.
    • 한국석유지질학회:학술대회논문집
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    • autumn
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    • pp.63-65
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    • 2001
  • The Chosen Supergroup (Cambro-Ordovician), mid-east Korea consists mainly of shallow marine carbonates and contains a variety of limestone conglomerates. These conglomerates largely comprise oligomictic, rounded lime-mudstone clasts of various size and shape (equant, oval, discoidal, tabular, and irregular) and dolomitic shale matrices. Most clasts are characterized by jigsaw-fit (mosaic), disorganized, or edgewise fabric and autoclastic lithology. Each conglomerate layer is commonly interbedded with limestone-dolomitic shale couplets and occasionally underlain by fractured limestone layer, capped by calcareous shale. According to composition, characteristic sedimentary structures, and fabric, limestone conglomerates in the Hwajol, Tumugol, Makkol, and Mungok formations of Chosen Supergroup can be classified into 4 types: (1) disorganized polymictic conglomerate (Cd), (2) horizontally stratified polymictic conglomerate (Cs), (3) mosaic conglomerate (Cm), and (4) disorganized/edgewise oligomictic conglomerate (Cd/e). These conglomerates are either depositional (Cd and Cs) or diagenetic (Cm and Cd/e) in origin. Depositional conglomerates are interpreted as storm deposits, tidal channel fills, or transgressive lag deposits. On the other hand, diagenetic conglomerates are not deposited by normal sedimentary processes, but formed by post-depositional diagenetic processes. Diagenetic conglomerates in the Chosen Supergroup are characterized by autoclastic and oligomictic lithology of lime-mudstone clasts, jigsaw-fit (mosaic) fabric, edgewise fabric, and a gradual transition from the underlying bed (Table 1). Autoclastic and oligomictic lithologies may be indicative of subsurface brecciation (fragmentation). Consolidation of lime-mudstone clasts pre-requisite for brecciation may result from dissolution and reprecipitation of CaCO3 by degradation of organic matter during burial. Jigsaw-fit fabric has been considered as evidence for in situ fragmentation. The edgewise fabric is most likely formed by expulsion of pore fluid during compaction. The lower boundary of intraformational conglomerates of depositional origin is commonly sharp and erosional. In contrast, diagenetic conglomerate layers mostly show a gradual transition from the underlying unit, which is indicative of progressive fragmentation upward (Fig. 1). The underlying fractured limestone layer also shows evidence for in situ fragmentation such as jigsaw-fit fabric and the same lithology as the overlying conglomerate layer (Fig, 1). Evidence from the conglomerate beds in the Chosen Supergroup suggests that diagenetic conglomerates are formed by in situ subsurface fragmentation of limestone layers and rounding of the fragments. In situ subsurface fragmentation may be primarily due to compaction, dewatering (upward-moving pore fluids), and dissolution, accompanying volume reduction. This process commonly occurs under the conditions of (1) alternating layers of carbonate-rich and carbonate-poor sediments and (B) early differential cementation of carbonate-rich layers. Differential cementation commonly takes place between alternating beds of carbonate-rich and clay-rich layers, because high carbonate content promotes cementation, whereas clay inhibits cementation. After deposition of alternating beds and differential cementation, with progressive burial, upward-moving pore fluid may raise pore-pressure in the upper part of limestone layers, due to commonly overlying impermeable shale layers (or beds). The high pore-pressure may reinforce propagation of fragmentation and cause upward-expulsion of pore fluid which probably produces edgewise fabric of tabular clasts. The fluidized flow then extends laterally, causing reorientation and further rounding of clasts. This process is analogous to that of autobrecciation, which can be analogously termed autoconglomeration. This is a fragmentation and rounding process whereby earlier semiconsolidated portions of limestone are incorporated into still fluid portions. The rounding may be due mainly to immiscibility and surface tension of lime-mud. The progressive rounding of the fragmented clasts probably results from grain attrition by fluidized flow. A synthetic study of limestone conglomerate beds in the Chosen Supergroup suggests that very small percent of the conglomerate layers are of depositional origin, whereas the rest, more than $80\%$, are of diagenetic origin. The common occurrence of diagenetic conglomerates warrants further study on limestone conglomerates elsewhere in the world.

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A Morphological Study on the Granulosa Cell Apoptosis and Macrophages during Follicular Atresia in Pig Ovary (돼지난소에서 난포폐쇄시 과립층세포의 아포토시스와 대식세포에 관한 형태학적 연구)

  • Park, C.S.;Han, S.R.;Kim, S.I.;Cho, K.J.;Kim, W.S.;,
    • Journal of Animal Science and Technology
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    • v.46 no.4
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    • pp.571-584
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    • 2004
  • It is known widely that granulosa cell apoptosis leads follicular atresia and macrophages exert their effects directly and/or indirectly from the initiation to the completion of follicular atresia by phagocytosis of apoptotic bodies and secretion of various cytokines. However, the site of initiation, propagation routes and the elimination methods of apoptotic bodies, and the time and methods of penetration of macrophages into the follicles are not known completely. Using pig(Yorkshire-breed) ovary, immunohistochemical studies with TUNEL for apoptotic bodies and pig macrophage monoclonal antibody 4E9 for macrophages, and light and transmission electron microscopic observations were performed. In the pig, follicular atresia began with the granulosa cell apoptosis, and the apoptosis of theca intema cells occured at the same time. The apoptosis of granulosa cells initiated randomly within the granulosa cell layer and propagated rapidly into the whole layer. Ultrastructura1ly, apoptotic granulosa cells showed characteristic pyknotic and deformed nucleus and intracytoplasmic vesicles. Apoptotic bodies were eliminated by intact granulosa cells and macrophages. Intact granulosa cells ingested apoptotic bodies transiently, soon after they fell into the apoptosis. Finally, apoptotic bodies and degenerated oocyte were phagocytosed by macrophages. Macrophages entered the ovarian follicle at the time of initiation of granulosa cell apoptosis, and migrated with the progression of apoptosis. By elimination of theca cells, macrophages contributed the completion of follicular atresia These results will provide valuable informations on the study of the interrelation between macrophage and ovarian follicular atresia.

Weed Occurrence and Competitive Characteristic under Different Cultivation Types of Rice(Oyriza sativa L.) - 2. Competition for Community Space of Rice and Weed (수도(水稻) 재배유형별(栽培類型別) 잡초발생양상(雜草發生樣相)과 경합특성(競合特性) - 제(第) 2 보(報). 군락공간(群落空間)에 대한 벼와 잡초(雜草)의 경합(競合))

  • Im, I.B.;Guh, J.O.;Lee, S.Y.
    • Korean Journal of Weed Science
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    • v.13 no.1
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    • pp.36-43
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    • 1993
  • Differences in community space of weed and rice were investigated among five types of rice (Oryza sativa L.) cultivation. The five types employed were three transplanting cultivations such as conventional hand transplanting, machine transplanting with 30-day-old seedling, and machine transplanting with 10-day-old seedling and two direct-seedlings such as flood direct-seeded rice by pregerminated seed and dry direct-seeded rice by dry seed. The greatest competition between rice and weeds as determined by growth rate of rice was found in between 10 and 11 weeks after transplanting (WAT) and/or seeding, irrespective of cultivation types. Competition injury due to weeds was greater in transplanting with 10-day-old seedling than with 30-day-old seedling. The greatest injury in growth of rice was found in direct-seeded cultivation. In transplanting cultivations space occupation by rice in lower than 80 cm height level was low as compared with that by weeds. Plant heights of dominant weeds such as E. crus-galli and E. kuroguwai were shorter by heading date, but taller after the heading date than those of rice. In direct-seeding community space was mainly occupied by the weeds. The pattern of community structure and competition injury caused by weeds showed a similar tendency obtained on the basis of species distribution, number, and dry weight of the occurred weeds.

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The Statistical Identification of Airmass Characteristics during the Manna Loa Observatory Photochemistry Experiment (Mauna Loa (Hawaii)에서 관측된 대기질 특성의 통계적 분석)

  • Lee, Gang-Woong;Barry J. Huebert
    • Journal of Korean Society for Atmospheric Environment
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    • v.10 no.E
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    • pp.332-342
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    • 1994
  • Hierarchical cluster and factor analyses were used to identify various influences on free tropospheric air samples at Mauna Loa Observatory in Hawaii during MLOPEX. The cluster analysis separated thirteen chemical and meteorological variables into three characteristic groups (1)clean air, (2)anthropogenically influenced air, (3)marine and volcanic influenced air. The cluster analysis results compared well with those of factor analysis. Six independent components were identified in factor analysis. We have related these components to (1)volcano influenced air, (2)stratosphere-like air, (3)boundary-layer air with recent anthropogenic influence, (4)photochemical haze, (5)marine boundary- layer air, and (6)modified marine tropospheric air. Excluding local influence, we could calculate the nighttime free tropospheric values for $O_3$(41$\pm$10 ppbv), HN $O_3$(94$\pm$45 pptv), N $O_3$$^{[-10]}$ (16$\pm$10 ppbv), S $O_4$$^{[-10]}$ (60$\pm$0 pptv), N $H_4$$^{+}$(71$\pm$6 pptv), N $a^{+}$(5$\pm$1 pptv), PAN(13$\pm$9 pptv), MeN $O_3$(3.5$\pm$1.5 pptv), 2-butyl N $O_3$(0.6$\pm$0.1 pptv), $H_2O$$_2$(1015$\pm$44 pptv), $C_2$C $l_4$(3.3$\pm$0.1 pptv), condensation nuclei(249$\pm$13c $m^{-3}$), and dew point(-8.5$\pm$5.3$^{\circ}C$) during this experiment..

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The Effect of Au Addition on the Hardening Mechanism in Ag-20wt% Pd-20wt% Cu (Ag-20wt% Pd-20wt% Cu 3원합금(元合金) 및 Au첨가합금(添加合金)의 시효경화특성(時效硬化特性))

  • Park, M.H.;Bae, B.J.;Lee, H.S.;Lee, K.D.
    • Journal of Technologic Dentistry
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    • v.19 no.1
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    • pp.21-35
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    • 1997
  • The Ag-Pd-Cu alloys containing a small amount of Au is commonly used for dental purposes, because this alloy is cheaper than Au-base alloys for clinical use. However, the most important characteristic of this alloy is age-hardenability, which is not exhibited by other Ag-base dental alloys. The specimens used were Ag-20Pd-20Cu ternary alloy and Au addition alloy. These alloys were melted and casted by induction electic furace and centrifugal casting machine in Ar atmoshpere. These specimens were solution treated for 2hr at $800^{\circ}C$ and were then quenched into iced water, and aged at $350{\sim}550^{\circ}C$ Age-hardening characteristics of the small Au-containing Ag-pPd-Cu dental alloys were investigated by means of hardness testing, X-ray diffraction and electron microscope observations, electrical resistance, differential scanning calorimetric, emergy dispersed spectra and electron probe microanalysis. Principal results are as follows : Hardening occured in two stages, I. e., stage I in low temperature and stage II in high temperature regions, during continuous aging. The case of hardening in stage I was due to the formation of the Llo type face centered tetragonal PdCu-ordered phase in the grain interior and hardening in stage I was affedted by the Cu concentration. In stage II, decomposition of the $\alpha$ solid solution to a PdCu ordered phase(L1o type) and an Agrich ${\alpha}2$ phase occurred and a discontiunous precipitation occurred at the grain boundary. Form the electron microscope study, it was concluded that the cause of age-hardening in this alloy is the precipitation of the PdCu ordered phase, which has AuCu I type face-centered tetragonal structure. Precipitation procedure was ${\alpha}\to{\alpha}+{\alpha}2+PdCu\to{\alpha}1+{\alpha}2+PdCu$ at Pd/Cu = 1 Ag-Pd-Cu alloy is more effective dental alloy as ageing treatment and is suitable to isothermal ageing at $450^{\circ}C$.

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