구강 전암병소의 악성변환에서 CK13과 CK19 발현의 예후적 의미

Oral cancer is one of the top 10 cancers that occur around the world. Although many treatment methods have been developed over the past decades, it has a poor prognosis and 5-year survival rate is less than 50%. In particular, compared to cancers that occur in the other organs, it reduces significantly the quality of life. Therefore, the importance of early diagnosis and prevention is being emphasized as the best method in the treatment of oral cancer. At present, it is the most effective method that surgical intervention through early detection of oral precancerous lesions with a high malignant transformation potential. Many biomarkers have been proposed to predict malignant transformation of oral precancerous lesions experimentally, but clinical significance of these markers needs to be verified. In this study, the clinical usefulness of cytokeratin markers discovered through previous studies was verified, and the results of this study are as follows. 1. In the malignant transformation of oral precancerous lesions, age and extent of epithelial dysplasia are important clinicopathological risk factors. 2. CK13 and CK19 keratin subtypes are associated with the malignant transformation of oral precancerous lesions. 3. Two cytokeratin markers and clinicopathological factors were combined to measure the risk of the malignant transformation of oral precancerous lesions, which showed the highest accuracy (c-index: 0.871) 4. It was revealed that CK13 and CK19 play a role in attenuating invasion and proliferation abilities of YD-10B OSCC cells and p53 mutation promotes proliferation and invasion abilities of keratinocyte. These results support the fact that the initial atypical change from oral precancerous lesions, represented by oral leukoplakia, to oral squamous cell carcinoma begins with the changes in the skeletal differentiation patterns of oral squamous cells, such as loss of CK13 and CK19 expression. In addition, CK13 and CK19 can be used as useful markers for predicting the risk of the malignant transformation in oral precancerous lesions. 구강암은 전 세계에서 발생하는 10 대 암중의 하나로 지난 수십년 동안 많은 치료방법들이 발전되어 왔지만, 5 년 생존률이 50%에 미치지 못하는 예후가 불량한 암 중에 하나이다. 특히 타 장기에 발생하는 암에 비해서, 구강암은 완치가 되더라도, 환자의 삶의 질을 현저하게 감소시키는 특징을 가지고 있다. 따라서 구강암의 치료에 있어서 가장 좋은 방법으로 암의 조기 진단 및 예방의 중요성이 강조되고 있으며, 현재로서는 암이 발생할 가능성이 높은 구강 전암병소의 조기 탐지를 통한 외과적 수술방법이 가장 효과적인 암 예방법으로 알려져 있다. 따라서, 악성변환의 가능성이 높은 병소를 초기에 발견하고 동정하는 것이 임상적으로 매우 중요하다고 할 수 있다. 현재 실험적으로 악성변환을 예측하기 위한 많은 바이오 마커가 제시되고 있으나, 이에 대한 임상적인 유의성에 대한 검증이 필요하다. 본 연구에서는 선행연구들을 통하여 발굴해 낸 사이토케라틴 마커들의 임상적 유용성에 대해서 검증하였으며, 연구결과는 다음과 같다. 1. 구강 전암병소의 악성변환에 있어서 연령과 상피이형성의 정도가 중요한 임상-병리학적 위험 요소이다. 2. 구강 전암병소의 악성변화에 있어서 CK 13 과 CK19 가 연관되어 있다. 3. 구강 전암병소의 악성 변환의 위험도를 계측화하기 위하여 두가지 사이토케라틴 마커와 임상병리학적 요소들을 결합하였고, 이것은 높은 예측 정확도를 보여주었다. 4. CK13 과 CK19 가 YD10B OSCC cell 의 침윤 및 증식능력을 억제하는 역할을 한다는 사실을 밝혔으며, P53 mutation 이 keratinocyte 의 증식 및 침윤능력을 촉진한다는 사실을 확인하였다. 이러한 연구결과들은 구강 백반증으로 대표되는 구강 전암병소에서 구강편평상피세포 암종으로의 초기 비정형적인 변화가 CK13 및 CK19 발현소실과 같은 구강 편평상피세포의 골격분화 패턴의 변화에서 시작된다는 사실을 뒷받침한다. 또한 CK13 및 CK19 는 구강 전암병소의 암 진행 위험도를 예측하는 유용한 마커로써 활용될 수 있다.open박

Design and behavior of partially steel embedded composite beam with variable depth

학위논문(석사) --서울대학교 대학원 :건축학과,2007.Maste

CycleGAN denoising of extreme low-dose cardiac CT using wavelet-assisted noise disentanglement

Abstract In electrocardiography (ECG) gated cardiac CT angiography (CCTA), multiple images covering the entire cardiac cycle are taken continuously, so reduction of the accumulated radiation dose could be an important issue for patient safety. Although ECG-gated dose modulation (so-called ECG pulsing) is used to acquire many phases of CT images at a low dose, the reduction of the radiation dose introduces noise into the image reconstruction. To address this, we developed a high performance unsupervised deep learning method using noise disentanglement that can effectively learn the noise patterns even from extreme low dose CT images. For noise disentanglement, we use a wavelet transform to extract the high-frequency signals that contain the most noise. Since matched low-dose and high-dose cardiac CT data are impossible to obtain in practice, our neural network was trained in an unsupervised manner using cycleGAN for the extracted high frequency signals from the low-dose and unpaired high-dose CT images. Once the network is trained, denoised images are obtained by subtracting the estimated noise components from the input images. Image quality evaluation of the denoised images from only 4% dose CT images was performed by experienced radiologists for several anatomical structures. Visual grading analysis was conducted according to the sharpness level, noise level, and structural visibility. Also, the signal-to-noise ratio was calculated. The evaluation results showed that the quality of the images produced by the proposed method is much improved compared to low-dose CT images and to the baseline cycleGAN results. The proposed noise-disentangled cycleGAN with wavelet transform effectively removed noise from extreme low-dose CT images compared to the existing baseline algorithms. It can be an important denoising platform for low-dose CT

Beyond Coronary CT Angiography: CT Fractional Flow Reserve and Perfusion

© 2022 Korean Radiological Society. All right reserved.Cardiac CT has been proven to provide diagnostic and prognostic evaluation of coronary artery disease for cardiovascular risk stratification and treatment decision-making based on rapid technological development and various research evidence. Coronary CT angiography has emerged as a gateway test for coronary artery disease that can reduce invasive angiography due to its high negative predictive value, but the diagnostic specificity is relatively low. However, coronary CT angiography is likely to overcome its limitations through functional evaluation to identify the hemodynamic significance of coronary artery disease by analyzing myocardial perfusion and fractional flow reserve through cardiac CT. Recently, studies have been actively conducted to incorporate artificial intelligence to make this more objective and reproducible. In this review, functional imaging techniques of cardiac computerized tomography are explored.N

기계식 인공 판막 앞 판누스 형성에 따른 밸브 후류의 3차원 유동특성 분석

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Late Gadolinium Enhancement of Left Ventricular Papillary Muscles in Patients with Mitral Regurgitation

Objective: Arrhythmogenic mitral valve prolapse (MVP) is an important cause of sudden cardiac death characterized by fibrosis of the papillary muscles or left ventricle (LV) wall, and an association between late gadolinium enhancement (LGE) of the LV papillary muscles and ventricular arrhythmia in MVP has been reported. However, LGE of the papillary muscles may be observed in other causes of mitral regurgitation, and it is not limited to patients with MVP. This study was to evaluate the association of LGE of the LV papillary muscles or ventricular wall on cardiac magnetic resonance imaging (CMR) and ventricular arrhythmia in patients with mitral regurgitation. Materials and Methods: This study included 88 patients (mean age +/- standard deviation, 58.3 +/- 12.0 years; male, 42%) with mitral regurgitation who underwent CMR. They were allocated to the MVP (n = 43) and non-MVP (n = 45) groups, and their LGE images on CMR, clinical characteristics, echocardiographic findings, and presence of arrhythmia were compared. Results: LV myocardial wall enhancement was more frequent in the MVP group than in the non-MVP group (28% vs. 11%, p = 0.046). Papillary muscle enhancement was observed in 7 (7.9%) patients. Of the 43 patients with MVP, 15 (34.8%) showed LGE in the papillary muscles or LV myocardium, including 12 (27.9%) with LV myocardial wall enhancement and 4 (9.3%) with papillary muscle enhancement. One patient with bilateral diffuse papillary muscle enhancement experienced sudden cardiac arrest due to ventricular fibrillation. Univariable logistic regression analysis showed that high systolic blood pressure (BP; odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01-1.09; p = 0.027) and ventricular arrhythmia (OR, 6.84; 95% CI, 1.29-36.19; p = 0.024) were significantly associated with LGE of the papillary muscles. Conclusion: LGE of the papillary muscles was present not only in patients with MVP, but also in patients with other etiologies of mitral regurgitation, and it was associated with high systolic BP and ventricular arrhythmia. Papillary muscle enhancement on CMR should not be overlooked