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    The study on transcription๏ผreplication conflicts induced by perturbation of replication timing control

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    ํ•™์œ„๋…ผ๋ฌธ(์„์‚ฌ) -- ์„œ์šธ๋Œ€ํ•™๊ต๋Œ€ํ•™์› : ์‚ฌ๋ฒ”๋Œ€ํ•™ ๊ณผํ•™๊ต์œก๊ณผ(์ƒ๋ฌผ์ „๊ณต), 2022. 8. ์ด์ค€๊ทœ.์ „์‚ฌ-๋ณต์ œ ์ถฉ๋Œ(TRCs)์€ ๋ณต์ œ๊ธฐ๊ตฌ์™€ RNA ์ค‘ํ•ฉํšจ์†Œ๊ฐ€ S๊ธฐ์— ์ถฉ๋Œํ•  ๋•Œ ๋ฐœ์ƒํ•œ๋‹ค. ๋น„๋ก ์ „์‚ฌ์™€ ๋ณต์ œ๊ฐ€ TRCs์˜ ๋ฐœ์ƒ์„ ์ตœ์†Œํ™”ํ•˜๊ธฐ ์œ„ํ•ด ์กฐ์ ˆ๋˜์ง€๋งŒ, TRCs๋Š” ์ •์ƒ์„ธํฌ์—์„œ ํ•„์—ฐ์ ์œผ๋กœ ๋ฐœ์ƒํ•˜๋ฉฐ ํŠนํžˆ ์•”์„ธํฌ์—์„œ๋Š” ๋”์šฑ ๋งŽ์ด ์ฆ๊ฐ€ํ•œ๋‹ค. ๊ทธ๋Ÿฌ๋ฏ€๋กœ S๊ธฐ์— TRCs๋ฅผ ์ ์ ˆํ•˜๊ฒŒ ํ•ด์†Œํ•˜๋Š” ๊ฒƒ์€ ์œ ์ „์ฒด์˜ ์•ˆ์ •์„ฑ์„ ์œ ์ง€ํ•˜๋Š” ๋ฐ ๋งค์šฐ ์ค‘์š”ํ•˜๋‹ค. ๋ณธ ์—ฐ๊ตฌ์‹ค์˜ ์„ ํ–‰์—ฐ๊ตฌ์—๋Š” RecQL4-Orc4 ์œตํ•ฉ๋‹จ๋ฐฑ์งˆ์ด ๋ฐœํ˜„๋˜๋Š” ์ฆ‰, pre-RC์— RecQL4 ๋‹จ๋ฐฑ์งˆ์„ ๊ฒฐํ•ฉ์‹œํ‚จ ์ธ๊ฐ„ ๊ณจ์œก์ข… ์„ธํฌ์—์„œ ํ›„๊ธฐ ๋ณต์ œ ์›์ ์˜ ๋ณต์ œ๊ฐ€ S๊ธฐ ์ดˆ๊ธฐ์— ํ™œ์„ฑํ™”๋˜์–ด TRCs์ผ ๊ฐ€๋Šฅ์„ฑ์ด ํฐ ๋ณต์ œ ์ŠคํŠธ๋ ˆ์Šค๊ฐ€ ์œ ๋ฐœ๋˜๋ฉฐ, ์ด ๋ณต์ œ ์ŠคํŠธ๋ ˆ์Šค์— ๋Œ€ํ•œ ์„ธํฌ ๋ฐ˜์‘์— TOPBP1์ด ํ•„์š”ํ•จ์„ ํ™•์ธํ•˜์˜€๋‹ค. ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ๋ณต์ œ ์‹œ๊ธฐ ์กฐ์ ˆ ๋ณ€ํ™”์— ์˜ํ•ด ๋ฐœ์ƒํ•˜๋Š” ๋ณต์ œ ์ŠคํŠธ๋ ˆ์Šค๊ฐ€ TRCs์ธ์ง€ ํ™•์ธํ•˜๊ธฐ ์œ„ํ•ด์„œ, ์ „์‚ฌ ์–ต์ œ์ œ ์ฒ˜๋ฆฌ์‹œ ๋ณต์ œ ์ŠคํŠธ๋ ˆ์Šค๊ฐ€ ๊ฐ์†Œํ•˜๋Š”์ง€ ์—ฌ๋ถ€์™€ ์ „์‚ฌ๊ธฐ๊ตฌ์™€ ๋ณต์ œ๊ธฐ๊ตฌ์˜ ์ถฉ๋Œ์ด ์‹ค์ œ๋กœ ๋ฐœ์ƒํ•˜๋Š”์ง€๋ฅผ ์กฐ์‚ฌํ•˜์˜€๋‹ค. ๊ทธ ๊ฒฐ๊ณผ ๋ฉด์—ญ ํ˜•๊ด‘ ์—ผ์ƒ‰๋ฒ•์„ ํ†ตํ•ด R-loop์™€ FANCD2์˜ foci๊ฐ€ ์ „์‚ฌ ์–ต์ œ์ œ ์ฒ˜๋ฆฌ์— ์˜ํ•ด ๊ฐ์†Œํ•˜๋Š” ๊ฒƒ์„ ํ™•์ธํ•˜์˜€๋‹ค. DNA:RNA hybrid ๊ตฌ์กฐ๋ฅผ ๊ฐ€์ง€๊ณ  ์žˆ๋Š” R-loop๋Š” RNA ์ค‘ํ•ฉํšจ์†Œ๊ฐ€ ๋ฉˆ์ถ˜ ๊ณณ์— ํ˜•์„ฑ๋˜๋ฉฐ FANCD2๋Š” ์ •์ง€๋œ ๋ณต์ œ๋ถ„๊ธฐ์ ์— ๊ฒฐํ•ฉํ•œ๋‹ค. ๋˜ํ•œ, ๋ณต์ œ๊ธฐ๊ตฌ์˜ ํ•ต์‹ฌ ์ธ์ž์ธ PCNA ํ•ญ์ฒด์™€ RNA ์ค‘ํ•ฉํšจ์†Œโ…ก์˜ C-๋ง๋‹จ ์ธ์‚ฐํ™” ๋ถ€์œ„ ํŠน์ด์  ํ•ญ์ฒด๋ฅผ ์‚ฌ์šฉํ•˜์—ฌ ๊ทผ์ ‘ ๊ฒฐํ•ฉ ๋ถ„์„์„ ์ง„ํ–‰ํ•œ ๊ฒฐ๊ณผ, ๋ณต์ œ ์‹œ๊ธฐ ์กฐ์ ˆ ๋ณ€ํ™”์— ์˜ํ•ด PLA foci๊ฐ€ ์ฆ๊ฐ€ํ•˜๋Š” ๊ฒƒ์„ ํ™•์ธํ•˜์˜€๋‹ค. ํ•œํŽธ ์ด ๋•Œ ๋ฐœ์ƒํ•˜๋Š” ์ „์‚ฌ-๋ณต์ œ ์ถฉ๋Œ ๋ฐ˜์‘์—์„œ TOPBP1์˜ ์—ญํ• ๊ณผ ์ž‘์šฉ ๊ธฐ์ „์„ ๊ทœ๋ช…ํ•˜๊ธฐ ์œ„ํ•ด์„œ TOPBP1 BRCT ๋„๋ฉ”์ธ์˜ ์ผ๋ถ€๊ฐ€ ๊ฒฐ์‹ค๋œ ๋‹ค์–‘ํ•œ TOPBP1 ๋‹จ๋ฐฑ์งˆ๋“ค์„ ๋ฐœํ˜„์‹œํ‚จ ๋‹ค์Œ ์ „์‚ฌ-๋ณต์ œ ์ถฉ๋Œ ๋ฐ˜์‘์„ ๋ถ„์„ํ•˜์˜€๋‹ค. ๊ทธ ๊ฒฐ๊ณผ, FANCD2 foci๋ฅผ ํ˜•์„ฑํ•˜๋Š” ๋ฐ์—๋Š” ATR ํ™œ์„ฑํ™” ๋„๋ฉ”์ธ๊ณผ BRCT7-8 ๋„๋ฉ”์ธ์„ ํฌํ•จํ•˜๋Š” TOPBP1์˜ C๋ง๋‹จ๋งŒ ์žˆ์–ด๋„ ์ถฉ๋ถ„ํ•˜์ง€๋งŒ, ์ „์‚ฌ-๋ณต์ œ ์ถฉ๋Œ์— ์˜ํ•ด ์œ ๋ฐœ๋˜๋Š” DNA ์ด์ค‘ ๊ฐ€๋‹ฅ ์ ˆ๋‹จ์„ ์–ต์ œํ•˜๊ธฐ ์œ„ํ•ด์„œ๋Š” C๋ง๋‹จ๊ณผ ๋”๋ถˆ์–ด BRCT3, 6 ๋„๋ฉ”์ธ์ด ํ•„์š”ํ•จ์„ ํ™•์ธํ•˜์˜€๋‹ค. TOPBP1๊ณผ FANCD2์˜ ์ƒํ˜ธ์ž‘์šฉ์ด TRCs๊ฐ€ ๋ฐœ์ƒํ–ˆ์„ ๋•Œ ๋”์šฑ ์ฆ๊ฐ€ํ•˜๋Š” ๊ฒƒ์„ ํ™•์ธํ–ˆ๋‹ค. ์ด๋Ÿฌํ•œ ๊ฒฐ๊ณผ๋กœ๋ถ€ํ„ฐ RecQL4-Orc4 ์œตํ•ฉ๋‹จ๋ฐฑ์งˆ์„ ๋ฐœํ˜„ํ•˜์—ฌ ํ›„๊ธฐ ๋ณต์ œ ์›์ ์˜ ์กฐ๊ธฐ ํ™œ์„ฑํ™”๋ฅผ ์œ ๋„ํ•œ ์„ธํฌ์—์„œ ์‹ค์ œ๋กœ ์ „์‚ฌ-๋ณต์ œ ์ถฉ๋Œ์ด ์ผ์–ด๋‚˜๋ฉฐ, ATR ํ™œ์„ฑํ™” ์ด์™ธ์—๋„ TOPBP1์ด ์ง์ ‘์ ์œผ๋กœ ๊ด€์—ฌํ•˜๋Š” ์ „์‚ฌ-๋ณต์ œ ์ถฉ๋Œ์— ๋Œ€ํ•œ ์„ธํฌ ๋ฐ˜์‘ ๊ฒฝ๋กœ๊ฐ€ ์กด์žฌํ•จ์„ ์•Œ ์ˆ˜ ์žˆ๋‹ค. ๋˜ํ•œ, ๋ณธ ์—ฐ๊ตฌ์—์„œ Doxycycline ์ฒ˜๋ฆฌ๋กœ ์†์‰ฝ๊ฒŒ ์ „์‚ฌ-๋ณต์ œ ์ถฉ๋Œ์ด ์œ ๋„๋˜๋Š” ์•ˆ์ •์ ์ธ ์ธ๊ฐ„ ์„ธํฌ์ฃผ๋Š” ํ–ฅํ›„ ์ธ๊ฐ„์„ธํฌ์—์„œ ์ผ์–ด๋‚˜๋Š” TRCs ๋ฐ˜์‘์„ ์—ฐ๊ตฌํ•˜๋Š” ๋ชจ๋ธ ์‹œ์Šคํ…œ์œผ๋กœ์„œ ์œ ์šฉํ•˜๊ฒŒ ํ™œ์šฉ๋  ์ˆ˜ ์žˆ์„ ๊ฒƒ์œผ๋กœ ๊ธฐ๋Œ€๋œ๋‹ค.Transcription-Replication conflicts (TRCs) occur when replication machinery collides with RNA polymerase in S phase. Although transcription and replication are coordinated to minimizes TRCs, TRCs inevitably occur in normal cells and increase significantly in cancer cells. Therefore, proper resolution of TRCs in S phase is critical for the maintenance of genome integrity. In previous studies in this lab, it was confirmed that the late replication origin was activated in early S-phase in human osteosarcoma cancer cells that tethered RecQL4 on the pre-RC by expressing RecQL4-Orc4 fusion protein, leading to replication stress which is likely to TRCs and TOPBP1 was needed in the cell response to this replication stress. In this study, to confirm that the replication stress induced by perturbation of the replication timing control is TRCs, we investigated whether the replication stress is reduced when transcription inhibitor is treated and whether a collision between transcription machinery and replication machinery actually occurs. Immunofluorescence staining analysis showed that foci of R-loop, a loop containing DNA-RNA hybrids produced by stalling of RNA polymerases, and FANCD2, a protein binding to stalled replication fork, were decreased by transcription inhibition. In addition, as a result of using the PLA using an antibody specific to the C-terminal phosphorylation site of RNA polymeraseโ…ก and PCNA antibody, which is a key factor in the replication machinery, it was confirmed that PLA foci were increased by perturbation of the replication timing control. Meanwhile, in order to identify the role and mechanism of TOPBP1 in the transcription-replication conflicts response, various TOPBP1 proteins in which some BRCT domains are deleted were expressed and then the TRCs response was analyzed. It was confirmed that only the C-terminus of TOPBP1 containing the ATR activation domain and the BRCT7-8 domain is sufficient to rescue FANCD2 foci, but the BRCT3 and BRCT6 domains as well as the C-terminus are required to reduce DNA double-strand breaks(DSBs) which is induced by TRCs. The interaction of TOPBP1 and FANCD2 was also increased when TRCs occurred. From these results, it was confirmed that TRCs actually occurs in cells in which early activation of late replication origin was induced by expressing RecQL4-Orc4 fusion protein and in addition to ATR activation, there is a cellular response pathway to the transcription-replication conflicts in which TOPBP1 is directly involved. In addition, it is expected that the stable human cell line, in which transcription-replication conflict is easily induced by treatment with Doxycycline in this study, will be usefully utilized as a model system to study the TRCs response in human cells in the future.์ œ 1 ์žฅ ์„œ ๋ก  1 ์ œ 1 ์ ˆ ์ด๋ก ์  ๋ฐฐ๊ฒฝ 1 ์ œ 2 ์ ˆ ์—ฐ๊ตฌ์˜ ํ•„์š”์„ฑ ๋ฐ ์—ฐ๊ตฌ ๋ชฉํ‘œ 17 ์ œ 2 ์žฅ ์—ฐ๊ตฌ ๋ฐฉ๋ฒ• ๋ฐ ์žฌ๋ฃŒ 23 ์ œ 1 ์ ˆ ์„ธํฌ ๋ฐฐ์–‘ 23 ์ œ 2 ์ ˆ ํ”Œ๋ผ์Šค๋ฏธ๋“œ 24 ์ œ 3 ์ ˆ ํ”„๋ผ์ด๋จธ 27 ์ œ 4 ์ ˆ siRNA ํ˜•์งˆ์ฃผ์ž… 27 ์ œ 5 ์ ˆ ํ”Œ๋ผ์Šค๋ฏธ๋“œ ํ˜•์งˆ์ฃผ์ž… 29 ์ œ 6 ์ ˆ ์›จ์Šคํ„ด ๋ธ”๋กฏ 30 ์ œ 7 ์ ˆ ๊ณต๋™ ๋ฉด์—ญ์นจ๊ฐ• 31 ์ œ 8 ์ ˆ ๋ฉด์—ญ ํ˜•๊ด‘ ์—ผ์ƒ‰๋ฒ• 33 ์ œ 9 ์ ˆ ๊ทผ์ ‘ ๊ฒฐํ•ฉ ๋ถ„์„ 35 ์ œ 10 ์ ˆ ํ•ญ์ฒด 38 ์ œ 3 ์žฅ ์—ฐ๊ตฌ ๊ฒฐ๊ณผ 39 ์ œ 1 ์ ˆ ๋ณต์ œ ์‹œ๊ธฐ ์กฐ์ ˆ ๋ณ€ํ™”์— ์˜ํ•ด ๋ฐœ์ƒํ•˜๋Š” ์ „์‚ฌ๏ผ๋ณต์ œ ์ถฉ๋Œ(TRCs)์˜ ํ™•์ธ 39 ์ œ 2 ์ ˆ ์„ธํฌ ๋‚ด TRCs ๋ฐ˜์‘์— ๊ด€์—ฌํ•˜๋Š” ATR ๋น„์˜์กด์  TOPBP1 ๋„๋ฉ”์ธ ํƒ์ƒ‰ 47 ์ œ 3 ์ ˆ TOPBP1๊ณผ FANCD2์˜ ์ƒํ˜ธ์ž‘์šฉ ํƒ์ƒ‰ 52 ์ œ 4 ์žฅ ๋…ผ์˜ 56 ์ฐธ๊ณ ๋ฌธํ—Œ 60 Abstract 80์„

    ํšจ์œจ์ ์ธ ์ •์ˆ˜ ๊ธฐ๋ฐ˜ ๋™ํ˜• ์•”ํ˜ธ

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    ํ•™์œ„๋…ผ๋ฌธ (๋ฐ•์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ์ˆ˜๋ฆฌ๊ณผํ•™๋ถ€, 2015. 2. ์ฒœ์ •ํฌ.Fully homomorphic encryption allows a worker to perform additions and multiplications on encrypted plaintext values without decryption. The first construction of a fully homomorphic scheme (FHE) based on ideal lattices was described by Gentry in 2009. Since Gentry's breakthrough result, many improvements have been made, introducing new variants, improving efficiency, and providing new features. The most FHE schemes still have very large ciphertexts (millions of bits for a single ciphertext). This presents a considerable bottleneck in practical deployments. To improve the efficiency of FHE schemes, especially ciphertext size, we can consider the following two observations. One is to improve the ratio of plaintext and ciphertext by packing many messages in one ciphertext and the other is to reduce the size of FHE-ciphertext by combining FHE with existing public-key encryption. In the dissertation, we study on construction of efficient FHE over the integers. First, we propose a new variant DGHV fully homomorphic encryption to extend message space. Using Chinese remainder theorem, our scheme reduces the overheads (ratio of ciphertext computation and plaintext computation) from O~(ฮป4)\tilde{O}(\lambda^4) to O~(ฮป)\tilde{O}(\lambda). We reduce the security of our Somewhat Homomorphic Encryption scheme to a decisional version of Approximate GCD problem (DACD). To reduce the ciphertext size, we propose a hybrid scheme that combines public key encryption (PKE) and somewhat homomorphic encryption (SHE). In this model, messages are encrypted with a PKE and computations on encrypted data are carried out using SHE or FHE after homomorphic decryption. Our approach is suitable for cloud computing environments since it has small bandwidth, low storage requirement, and supports efficient computing on encrypted data. We also give alternative approach to reduce the FHE ciphertext size. Some of recent SHE schemes possess two properties, the public key compression and the key switching. By combining them, we propose a hybrid encryption scheme in which a block of messages is encrypted by symmetric version of the SHE and its secret key is encrypted by the (asymmetric) SHE. The ciphertext under the symmetric key encryption is compressed by using the public key compression technique and we convert the ciphertext into asymmetric encryption to enable homomorphic computations using key switching technique.Contents Abstract 1 Introduction 1 1.1 A Brief Overview of this Thesis 3 2 CRT-based FHE over the Integers 8 2.1 Preliminaries 12 2.2 Our Somewhat Homomorphic Encryption Scheme 14 2.2.1 Parameters 14 2.2.2 The Construction 15 2.2.3 Correctness 17 2.3 Security 19 2.4 FullyHomomorphicEncryption 27 2.4.1 BitMessageSpace 28 2.4.2 LargeMessageSpace 29 2.5 Discussion 35 2.5.1 SecureLargeIntegerArithmetic 35 2.5.2 Public key compression 35 3 A Hybrid Scheme of PKE and SHE 37 3.1 Preliminaries 39 3.1.1 HardProblems 40 3.1.2 Homomorphic Encryption Schemes 41 3.2 Encrypt with PKE and Compute with SHE 43 3.2.1 A Hybrid Scheme of PKE and SHE 44 3.2.2 Additive Homomorphic Encryptions for PKE in the HybridScheme 48 3.2.3 Multiplicative Homomorphic Encryptions for PKE in theHybridScheme 51 3.3 Homomorphic Evaluation of Exponentiation 56 3.3.1 Improved Exponentiation using Vector Decomposition 56 3.3.2 Improve the Bootstrapping without Squashing 59 3.4 Discussions 62 3.4.1 ApplicationModel 62 3.4.2 Advantages 63 3.5 Generic Conversion of SHE from Private-Key to Public-Key 68 4 A Hybrid Asymmetric Homomorphic Encryption 70 4.1 Preliminaries 72 4.2 A Hybrid Approach to Asymmetric FHE with Compressed Ciphertext 73 4.2.1 MainTools 73 4.2.2 Hybrid Encryption with Compressed Ciphertexts 76 4.3 ConcreteHybridConstructions 77 4.3.1 Hybrid Encryptions based on DGHV and Its Variants 77 4.3.2 Hybrid Encryptions based on LWE 87 4.4 Discussion 93 4.4.1 Comparison to Other Approaches 93 4.4.2 Other Fully Homomorphic Encryptions 94 5 Conclusion 95 Abstract (in Korean) 105 Acknowledgement (in Korean) 106Docto

    LWE ๋ฌธ์ œ ๊ธฐ๋ฐ˜ ๊ณต๊ฐœํ‚ค ์•”ํ˜ธ ๋ฐ commitment ์Šคํ‚ด์˜ ํšจ์œจ์ ์ธ ์ธ์Šคํ„ด์Šคํ™”

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    ํ•™์œ„๋…ผ๋ฌธ (๋ฐ•์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ์ž์—ฐ๊ณผํ•™๋Œ€ํ•™ ์ˆ˜๋ฆฌ๊ณผํ•™๋ถ€, 2018. 2. ์ฒœ์ •ํฌ.The Learning with Errors (LWE) problem has been used as a underlying problem of a variety of cryptographic schemes. It makes possible constructing advanced solutions like fully homomorphic encryption, multi linear map as well as basic primitives like key-exchange, public-key encryption, signature. Recently, developments in quantum computing have triggered interest in constructing practical cryptographic schemes. In this thesis, we propose efficient post-quantum public-key encryption and commitment schemes based on a variant LWE, named as spLWE. We also suggest related zero-knowledge proofs and LWE-based threshold cryptosystems as an application of the proposed schemes. In order to achieve these results, it is essential investigating the hardness about the variant LWE problem, spLWE. We describe its theoretical, and concrete hardness from a careful analysis.1.Introduction 1 2.Preliminaries 5 2.1 Notations 5 2.2 Cryptographic notions 5 2.2.1 Key Encapsulation Mechanism 5 2.2.2 Commitment Scheme 6 2.2.3 Zero-Knowledge Proofs and Sigma-Protocols 7 2.3 Lattices 9 2.4 Discrete Gaussian Distribution 11 2.5 Computational Problems 12 2.5.1 SVP 12 2.5.2 LWE and Its Variants 12 2.6 Known Attacks for LWE 13 2.6.1 The Distinguishing Attack 14 2.6.2 The Decoding Attack 15 3.LWE with Sparse Secret, spLWE 16 3.1 History 16 3.2 Theoratical Hardness 17 3.2.1 A Reduction from LWE to spLWE 18 3.3 Concrete Hardness 21 3.3.1 Dual Attack (distinguish version) 21 3.3.2 Dual Attack (search version) 23 3.3.3 Modifed Embedding Attack 25 3.3.4 Improving Lattice Attacks for spLWE 26 4.LWE-based Public-Key Encryptions 29 4.1 History 29 4.2 spLWE-based Instantiations 31 4.2.1 Our Key Encapsulation Mechanism 31 4.2.2 Our KEM-Based Encryption Scheme 33 4.2.3 Security 35 4.2.4 Correctness 36 4.3 Implementation 37 4.3.1 Parameter Selection 38 4.3.2 Implementation Result 39 5.LWE-based Commitments and Zero-Knowledge Proofs 41 5.1 History 42 5.2 spLWE-based Instantiations 43 5.2.1 Our spLWE-based Commitments 44 5.2.2 Proof for Opening Information 47 5.3 Application to LWE-based Threshold Crytosystems 50 5.3.1 Zero-Knowledge Proofs of Knowledge for Threshold Decryption 50 5.3.2 Actively Secure Threshold Cryptosystems 58 6.Conclusions 63Docto

    Unilateral standing leg tremor as the initial manifestation of Parkinson disease

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    Background: The aim of this study was to analyze the different forms of leg tremors exhibited while standing in patients with Parkinson disease (PD), and to determine if the type of leg tremor exhibited is indicative of prognosis or treatment response in PD patients. Methods: We studied the clinical characteristics of five PD patients (all women; mean age, 59 years, range, 53-64 years) with unilateral standing leg tremor as the initial manifestation of PD, including their electrophysiological findings and the results of long-term followup. Results: For each patient, parkinsonism either existed at the time of onset of the initial symptoms or developed later. Patient responses to drugs were generally good, but one patient showed a poor response to drugs, even though she had only a low frequency leg tremor. For two patients whom we could observe during the 10-year follow-up period, neither the leg tremor nor parkinsonism was aggravated. Conclusions: There are two forms of unilateral standing leg tremor in PD. One form is high frequency, similar to the primary orthostatic tremor. The other is low frequency and similar to the parkinsonian resting tremor. Based on these observations, it appears that progression might be slow if PD patients have standing leg tremor as the initial manifestationope

    Clinicopathologic Analysis of Gastrointestinal Stromal Tumors of the Colon and Rectum

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    Purpose: This studyโ€™s aim is to investigate the clinicopathologic characteristics of colorectal gastrointestinal stromal tumors (GISTs) and to evaluate the result of those tumors. Methods: We retrospectively reviewed 22 patients who had been diagnosed with primary colorectal GISTs and who had undergone a surgical resection between October 1996 and July 2008. Results: Colorectal GISTs accounted for 0.28% of all colorectal malignancies and 7.7% of all GISTs. Rectal GISTs (19, 86.4%) were more common than colonic GISTs (3, 13.6%). According to the National Institute of Healthโ€™s (NIH) grading system, there were 1 (4.5%) very low, 5 (22.7%) low, 4 (18.2%) intermediate, and 12 (54.6%) high-risk tumors. The disease recurred in 7 patients (1 with intermediate risk and 6 with high risk). Recurrence sites were the liver (42.9%), the peritoneum (71.5%), and the lymph nodes (14.3%). Adjuvant imatinib therapy and/or radiation therapy were done for patients with microscopically positive margins of resection and high risk, of which one experienced a recurrence at 95 months after surgery. The five-year recurrence rates were 0% in the very-low-grade and low-grade groups, 33.3% in the intermediate-grade group, and 37.5% in the high-grade group. The five-year overall survival rates were 100% in the very-low-grade and low-grade groups, 66.7% in the intermediate-grade group, and 62.5% in the high-grade group. Conclusion: Poor prognosis of colorectal GISTs was closely related to the tumorโ€™s histologic grade and size. Integrating surgery, molecular therapy, and radiation therapy might improve outcomes, but further study with more cases is needed.ope

    Duplicated Inferior Vena Cava Recognized during Laparotomy

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    Duplicated inferior vena cava (IVC) is a congenital anomaly seen rarely in the general population. Patients with IVC variants usually do not present any symptoms and are found incidentally in many cases. However, physicians are urged to recognize the presence of such anomalies during diagnostic or invasive procedures as these variants of blood vessel systems can impose substantial implications in certain clinical situations. Subsequently, information about IVC variants may become critical if surgical injuries or predisposing conditions act as life-threatening risks to patients during medical procedures. We present a case of duplicated IVC in a 68ห—yearห—old female patient with rectal cancer where an IVC anomaly was found during surgical resection of her tumor. From our experience, we emphasize the importance of having the knowledge of IVC variations in patients undergoing invasive surgical procedures which may involve large vessels.ope

    Robotic Anterior Resection for Sigmoid Colon Cancer: Short-term Outcome of a Pilot Study

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    Purpose: The DaVinci system is new emerging device for performing colorectal surgery. However, in the era of laparoscopic sigmoid colon cancer surgery, there are few previous reports on using the DaVinci system for sigmoid colon cancer. Therefore, the aim of this study is to evaluate the safety and feasibility of using the DaVici system for anterior resection in patients with sigmoid colon cancer, as compared with conventional laparoscopic anterior resection. Methods: Between March 2007 and Jun 2007, 7 sigmoid colon cancer patients underwent robotic anterior resection using the da Vinci Surgical system, and 9 patients underwent conventional laparoscopic anterior resection. The patientsโ€™ characteristics, the perioperative clinical results and the pathologic details were prospectively collected and compared between the two groups. Results: The patient characteristics were not significantly different between the two groups. The mean operation time were 205.9ยฑ17.6 in the robotic group and 102.4ยฑ25.0 in the laparoscopic group (p=0.001). The change of the hemoglobin level, the number of days until peristalsis and the average length of stay were not different between the groups. Also, the pathologic details were not different between the groups. There were no complications or conversion in the both groups. Conclusion: Our data demonstrates that robotic anterior resection is feasible and effective for sigmoid colon cancer patients. However, we could not find better outcomes for robotic anterior resection as compared with conventional laparoscopic anterior resectionope

    Comparison between the Initial 25 Cases and the Last 25 Cases of Laparoscopic Colorectal Resection during a Learning Period and According to the Clinicopathologic Outcomes

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    Purpose: The present study was designed to investigate the clinicopathologic results of performing laparoscopic colorectal resection during a learning curve period. Methods: A prospective analysis of 50 consecutive patients who underwent elective laparoscopic colorectal surgery was conducted between April 2006 and September 2006. We monitored the learning curve of one surgeon. The perioperative clinical results, complications and pathologic details were evaluated prospectively. The 50 patients were divided into two chronological groups (the 25 early cases and the 25 late cases). Statistical analysis between the two groups was performed to evaluate the different outcomes and with taking into account the progressively increasing experience. Results: A total of 45 cases had colorectal cancer. The operative procedure was executed by the standard laparoscopic technique and according to the tumor location, with proper lymph node dissection. Curative resection was performed for the all malignant cases. The remaining 5 cases all involved benign disease. The overall complication and conversion rates were 12% and 6%, respectively. All the complications were treated conservatively. The pathologic outcomes for the malignant cases were acceptable, with no differences being manifested between the two groups. The complication rate and the length of stay were decreased in the late group. Conclusion: Laparoscopic colorectal resection can be performed safely and effectively. The clinicopathologic outcomes were acceptable even though the cases of the present study were done during the learning curve period of a surgeon.ope

    Intersphincteric Resection and Coloanal Anstomosis for Very Low Lying Rectal Cancer

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    Purpose: Ultralow anterior resection and coloanal anastomosis (hand-sewn) has commonly been used for preserving the anal sphincter in patients with low-lying distal rectal cancer. Preoperative chemoradiation therapy is a contributing factor to preserve the anal sphincter. Intersphincteric resection has been introduced and has begun to be applied to distal rectal cancer for anal sphincter preservation. The aim of this study was to report on patients who underwent intersphincteric resection and coloanal anastomosis for very low-lying rectal cancer. Methods: Intersphincteric resection was performed in 21 patients with very low-lying rectal cancer (within 4 cm from the anal verge) between December 2004 and May 2008. All patients received colonic J pouch anal anastomosis and loop ileostomy. The patients were selected prospectively and followed up for the function of bowel movement and recurrence. Results: Mean tumor distance from anal verge was 2.8 cm (range 2โˆผ4 cm). No postoperative mortality was encountered. One patient developed ischemic colitis of colonic J-pouch after high doses of tomotherapy. Subsequently he received abdominoperineal resection and permanent colostomy. One patient underwent diverting colostomy for severe incontinence after ileostomy takedown. The other cases reported good anorectal function such as frequency of bowel movement and fecal incontinence. There were two local recurrences during a mean follow-up period of 11.6 months. Conclusion: Based on a single surgeonโ€™s experiences, postoperative morbidity and anorectal function after intersphincteric resection with coloanal anastomosis seems acceptable.ope

    Intestinal endometriosis mimicking carcinoma of rectum and sigmoid colon: a report of five cases

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    Among women with intestinal endometriosis, the sigmoid colon and rectum are the most commonly involved areas. Sometimes, the differential diagnosis of colorectal endometriosis from carcinoma of the colon and rectum is difficult due to similar colonoscopic and radiologic findings. From October 2002 to September 2007, we performed five operations with curative intent for rectal and sigmoid colon cancer that revealed intestinal endometriosis. Colonoscopic and radiologic findings were suggestive of carcinoma of rectum and sigmoid colon, such as rectal cancer, sigmoid colon cancer and gastrointestinal stromal tumor (GIST). Anterior resection was performed in two patients, low anterior resection was performed in one patient and laparoscopic low anterior resection was done in two patients. We suggest to consider also intestinal endometriosis in reproductive women presenting with gastrointestinal symptoms and an intestinal mass of unknown origin.ope
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