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Obesity is an important determinant of severity in newly defined metabolic dysfunction-associated fatty liver disease

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Hepatobiliary & Pancreatic Diseases International 2022年第3期21卷 241-247页

作者： Ji hye Huh Kwang Joon kim Seung Up kim Bong-Soo Cha Byung-Wan Lee Division of Endocrinology and Metabolism Department of Internal MedicineHallym University Sacred Heart HospitalAnyang 14068Korea Division of Geriatrics Department of Internal MedicineYonsei University College of MedicineSeoul 03722Korea Division of Endocrinology and Metabolism Department of Internal MedicineYonsei University College of MedicineSeoul 03722Korea Institute of Gastroenterology Department of Internal MedicineYonsei University College of MedicineSeoul 03722Korea

Background: The recently proposed definition of metabolic dysfunction-associated fatty liver disease(MAFLD) is based on the co-existence of hepatic steatosis with other metabolic disorders, including obesity and metabolic risk abnormalities such as hyperglycemia, high blood pressure and dyslipidemia. This study aimed to assess MAFLD severity according to the presence of metabolic abnormalities and obesity. Methods: Using transient elastography, hepatic steatosis and fibrosis severity were assessed by measuring the controlled attenuation parameter and liver stiffness measurement. A total of 1163 patients with MAFLD were categorized into the following four groups according to metabolic risk abnormalities and obesity presence: non-obese without metabolic risk abnormality group(Group 1;reference group);nonobese with metabolic risk abnormality group(Group 2);obese without metabolic risk abnormality group(Group 3);and obese with metabolic risk abnormality group(Group 4). A multiple logistic regression analysis was performed to determine severe hepatic steatosis and fibrosis risk in each group in both unadjusted and adjusted models. Results: In the adjusted model, the odds ratios(ORs) [95% confidence interval(CI)] for severe hepatic steatosis in Groups 2, 3, and 4 were 1.07(0.61-1.88), 2.43(1.44-4.08), and 4.07(2.56-6.48), respectively( P trend < 0.001). For liver fibrosis, compared with Group 1, Group 2 showed no significant increases in OR, whereas Groups 3 and 4(obese groups) showed significant increases(OR = 4.70, 95% CI: 1.24-17.82 and OR = 6.43, 95% CI: 1.88-22.02, respectively). Conclusions: Obesity, rather than metabolic abnormality, is the principal determinant of severe hepatic steatosis and fibrosis in patients with MAFLD.

关键词： Metabolic dysfunction-associated fatty liver disease Metabolically-healthy obesity Liver fibrosis

Coexisting cytomegalovirus colitis in an immunocompetent patient with Clostridioides difficile colitis:A case report

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World Journal of Clinical Cases 2023年第10期11卷 2343-2348页

作者： Jun Hyoung kim Hee-Sung kim hye Won Jeong Department of Internal Medicine Chungbuk National University HospitalCheongju 28644ChungbukSouth Korea Department of Internal Medicine Chungbuk National University College of MedicineCheongju 28644ChungbukSouth Korea

BACKGROUND Clostridioides difficile(***)colitis is one of the most common infections in hospitalized patients,characterized by fever and *** usually improves after appropriate antibiotic treatment;if not,comorbidities should be ***(CMV)colitis is a possible co-existing diagnosis in patients with *** infection with poor treatment ***,compared with immunocompromised patients,CMV colitis in immunocompetent patients is not well *** SUMMARY We present an unusual case of co-existing CMV colitis in an immunocompetent patient with *** *** 80-year-old female patient was referred to the infectious disease department due to diarrhea,abdominal discomfort,and fever for 1 wk during her hospitalization for *** toxin B polymerase chain reaction on stool samples was *** *** infection was diagnosed,oral vancomycin treatment was *** symptoms including diarrhea,fever and abdominal discomfort improved for ten ***,the symptoms worsened again with bloody diarrhea and ***,a sigmoidoscopy was performed for evaluation,showing a longitudinal ulcer on the sigmoid *** biopsy confirmed CMV colitis,and the clinical symptoms improved after using *** Co-existing CMV colitis should be considered in patients with aggravated *** infection on appropriate treatment,even in immunocompetent hosts.

关键词： Cytomegalovirus Clostridioides difficile Coinfection Colitis Immunocompetent Case report

The effectiveness of emotion-focused art therapy on the resilience and self-image of emergency physicians

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World Journal of Emergency Medicine 2022年第6期13卷 479-484页

作者： Soo Kyung Eo Chanwoong kim Kyung hye Park Eun Kyung Eo Graduate School of Art Therapy at CHA University Pocheon 11160Republic of Korea Department of Emergency Medicine Chung-Ang University College of MedicineSeoul 06974Republic of Korea Department of Medical Education Yonsei University Wonju College of MedicineWonju 26426Republic of Korea Department of Emergency Medicine Wonju Severance Christian HospitalWonju 26426Republic of Korea Department of Emergency Medicine Soonchunhyang University Bucheon HospitalBucheon 14584Republic of Korea

INTRODUCTION Resilience refers to the quality of being able to overcome adversity.[1]Studies conducted in the United States[2]and China[3]following the 2019 coronavirus disease(COVID-19)pandemic reported reduced resilience levels among medical *** resilience levels are associated with low burnout levels among residents.[4]Physician burnout affects patients’safety and quality of care.[5]In particular,emergency physicians(EPs)are more prone to exhaustion or poor resilience,as their turnover intention tends to be higher.[6]Therefore,improving EPs’resilience is imperative.

关键词： image physician overcome

Prognostic implication of isolated tumor cells and micrometastases in regional lymph nodes of gastric cancer

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World Journal of Gastroenterology 2005年第38期11卷 5920-5925页

作者： hye Seung Lee Min A kim Han-Kwang Yang Byung Lan Lee Woo Ho kim Department of Pathology Department of Pathology and Cancer Research Institute Department of Surgery and Cancer Research Institute Department of Anatomy

AIM： To determine the prognostic significance of isolated tumor cells （ITCs） and lymph node micrometastases in gastric cancer. METHODS： Hematoxylin and eosin-stained slides of lymph node dissections of 632 consecutive gastric cancers were reviewed. Cytokeratin immunostaining was performed in 280 node-negative cases and 5 cases indefinite for lymph node metastases. Lymph node metastases were divided into ITCs, micrometastases, or macrometastases, according to the sizes of tumor deposits in largest dimension. ITCs were further classified into four groups according to metastasis pattern. RESULTS： Lymph node metastases were identified by immunostaining in 58 of 280 node-negative cases （20.7%） and were not significantly associated with patient survival （P = 0.3460）. After cytokeratin immunostaining, 196 cases were classified as pN1, which consisted of 20 cases with micrometastases detected by immunostaining （pNlmi（i＋））, 34 cases with only micrometastases （pNlmi）, and 142 cases with pN1 with one or more macrometastases （pN1）. Cases with pNlmi and pNlmi（i＋） had a significantly better prognosis than the cases with pN1 （P = 0.0037）. ITCs were found in 38 of these 58 cases, and could be divided into four groups： 12 cases with only a single cell pattern, 7 cases with multiple individual cells, 5 cases with single small cluster, and 14 cases with multiple small clusters. Among these four groups, cases with ITCs of multiple individual cell pattern showed the worst survival （median survival： 28 mo, P〈0.0001）.CONCLUSION： Both size and pattern of lymph node metastases can give prognostic information on the survival of gastric cancer patients.

关键词： Immunohistochemistry Cytokeratin Patientsurvival Lymph node metastasis

Recent aspects of ketogenic diet in neurological disorders

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Acta Epileptologica 2021年第1期3卷 134-140页

作者： hye Eun Kwon Heung Dong kim Department of Pediatrics International St.Mary’s HospitalCatholic Kwandong UniversityCollege of MedicineIncheonSouth Korea Division of Pediatric Neurology Severance Children’s HospitalYonsei University College of Medicine50 Yonsei-roSinchon-dongSeodaemun-guSeoulSouth Korea

The ketogenic diet(KD)is a high-fat,low-carbohydrate diet,in which fat is used as the primary energy source through the production of ketone bodies(KBs)in place of *** KD was formally introduced in 1921 to mimic the biochemical changes associated with fasting and gained recognition as a potent treatment for pediatric epilepsy in the *** clinical and basic scientific knowledge that supports the anti-seizure efficacy,safety,and feasibility of using the KD in patients with epilepsy is ***,the International Ketogenic Diet Study Group’s consensus guidelines provide practical information in 2009 and *** KD is a broad-spectrum therapy for drug resistant epilepsy and is gaining attention as a potential therapy for other neurological *** article will review recent aspects on the use of the KD,including its mechanisms of action,KD alternatives,expanding its use across different age groups and regions,its use as a treatment for other neurologic disorders,and future research subjects.

关键词： epilepsy disorders neurological

Clinical feasibility of modified extended left hemihepatectomy in advanced perihilar cholangiocarcinoma

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Hepatobiliary Surgery and Nutrition 2024年第1期13卷 165-167页

作者： hye-Sung Jo Dong-Sik kim Division of HBP Surgery and Liver Transplantation Department of SurgeryKorea University College of MedicineSeoulRepublic of Korea

Curative resection is undoubtedly the most important prognostic factor in perihilar cholangiocarcinoma(1).The current consensus of surgical resection of perihilar cholangiocarcinoma consists of hemihepatectomy,including caudate lobectomy and aggressive lymphadenectomy,depending on the extent of bile duct *** decisions on whether to resect the right or left liver and whether to perform an extended hepatectomy or trisectionectomy are all aimed at obtaining negative radial and longitudinal margins(2,3).

关键词： Treatment outcome hepatectomy perihilar cholangiocarcinoma

A simple,sensitive and non-destructive technique for characterizing bovine dental enamel erosion:attenuated total reflection Fourier transform infrared spectroscopy

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International Journal of Oral Science 2016年第1期8卷 54-60页

作者： In-hye kim Jun Sik Son Bong Ki Min Young Kyoung kim Kyo-Han kim Tae-Yub Kwon Department of Dental Science Graduate SchoolKyungpook National UniversityDaeguKorea Korea Textile Development Institute DaeguKorea Center for Research Facilities Yeungnam UniversityGyeongsanKorea Department of Conservative Dentistry School of DentistryKyungpook National UniversityDaeguKorea Department of Dental Biomaterials School of DentistryKyungpook National UniversityDaeguKorea

Although many techniques are available to assess enamel erosion in vitro, a simple, non-destructive method with sufficient sensitivity for quantifying dental erosion is required. This study characterized the bovine dental enamel erosion induced by various acidic beverages in vitro using attenuated total reflection Fourier transform infrared （ATR-FTIR） spectroscopy. Deionized water （control） and 10 acidic beverages were selected to study erosion, and the pH and neutralizable acidity were measured. Bovine anterior teeth （110） were polished with up to 1 200-grit silicon carbide paper to produce flat enamel surfaces, which were then immersed in 20 mL of the beverages for 30 min at 37 ℃. The degree of erosion was evaluated using ATR-FTIR spectroscopy and Vickers＇ microhardness measurements. The spectra obtained were interpreted in two ways that focused on the ~1, ~3 phosphate contour： the ratio of the height amplitude of ~3 P04 to that of/11 P04 （Method 1） and the shift of the v3 P04 peak to a higher wavenumber （Method 2）. The percentage changes in microhardness after the erosion treatments were primarily affected by the pH of the immersion media. Regression analyses revealed highly significant correlations between the surface hardness change and the degree of erosion, as detected by ATR-FTIR spectroscopy （P〈0.001）. Method 1 was the most sensitive to these changes, followed by surface hardness change measurements and Method 2. This study suggests that ATR- FTIR spectroscopy is potentially advantageous over the microhardness test as a simple, non-destructive, sensitive technique for the quantification of enamel erosion.

关键词： acidic beverage enamel erosion Fourier transform infrared spectroscopy microhardness sensitivity

Second-look endoscopy with prophylactic hemostasis is still effective after endoscopic submucosal dissection for gastric neoplasm

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World Journal of Gastroenterology 2015年第48期21卷 13518-13523页

作者： Ji hye Jung Beom Jin kim Chang Hwan Choi Jae G kim Department of Internal Medicine Chung-Ang University College of Medicine

AIM: The clinical value of second-look endoscopy(SLE) after endoscopic submucosal dissection(ESD) has been doubted continuously. The aim of this study was to assess the effectiveness of SLE based on the risk of delayed bleeding after ESD. METHODS: A total of 310 lesions of gastric epithelial neoplasms treated by ESD were reviewed. The lesions were divided into two groups based on the risk of postprocedural bleeding estimated by Forrest classification. The high risk of rebleeding group(Forrest?Ⅰa,?Ⅰb and Ⅱa) required endoscopic treatment, while the low risk of rebleeding group(Forrest Ⅱb, Ⅱc and Ⅲ) did not. Delayed bleeding after ESD was investigated. RESULTS: Sixty-six lesions were included in the high risk of rebleeding group and 244 lesions in the low risk of rebleeding group. There were no significant differences in delayed bleeding between the high risk group(1/66) and the low risk group(1/244)(P = 0.38). The high risk of rebleeding group tended to be located more often in the mid-third and had higher appearance of flat or depressed shape than the low risk group(P = 0.004 and P = 0.006, respectively). CONCLUSION: SLE with pre-emptive prophylactic endoscopic treatment is still effective in preventing delayed bleeding after ESD.

关键词： Second-look endoscopy Forrest classification Endoscopic submucosal dissection Delayed bleeding

Optimal Cyber Attack Strategy Using Reinforcement Learning Based onCommon Vulnerability Scoring System

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Computer Modeling in Engineering & Sciences 2024年第11期141卷 1551-1574页

作者： Bum-Sok kim hye-Won Suk Yong-Hoon Choi Dae-Sung Moon Min-Suk kim Department of Electronic Information System Engineering Sangmyung UniversityCheonan31066Republic of Korea Department of Human Intelligence&Robot Engineering Sangmyung UniversityCheonan31066Republic of Korea Intelligent Convergence Research Laboratory Electronics and Telecommunications Research InstituteDaejeon34129Republic of Korea

Currently,cybersecurity threats such as data breaches and phishing have been on the rise due to the many differentattack strategies of cyber attackers,significantly increasing risks to individuals and *** technologies such as intrusion detection have been developed to respond to these cyber ***,advanced integrated cybersecurity that incorporates Artificial Intelligence has been the *** this paper,wepropose a response strategy using a reinforcement-learning-based cyber-attack-defense simulation tool to addresscontinuously evolving cyber ***,we have implemented an effective reinforcement-learning-basedcyber-attack scenario using Cyber Battle Simulation,which is a cyber-attack-defense *** scenarioinvolves important security components such as node value,cost,firewalls,and ***,we applieda new vulnerability assessment method based on the Common Vulnerability Scoring *** approach candesign an optimal attack strategy by considering the importance of attack goals,which helps in developing moreeffective response *** attack strategies are evaluated by comparing their performance using a variety ofReinforcement Learning *** experimental results show that RL models demonstrate improved learningperformance with the proposed attack strategy compared to the original *** particular,the success rateof the Advantage Actor-Critic-based attack strategy improved by 5.04 percentage points,reaching 10.17%,whichrepresents an impressive 98.24%increase over the original ***,the proposed method canenhance security and risk management capabilities in cyber environments,improving the efficiency of securitymanagement and significantly contributing to the development of security systems.

关键词： Reinforcement learning common vulnerability scoring system cyber attack cyber battle simulation