Parathyroid Glands Preservation Using Indocyanine Green Fluorescence in Bilateral Axillo-Breast Approach Robotic Thyroidectomy

학위논문 (석사)-- 서울대학교 대학원 : 의학과 외과학 전공, 2016. 2. 김수진.Background: Bilateral Axillo-Breast Approach (BABA) robotic thyroidectomy (RoT) has shown favorable cosmetic and surgical outcomes since its introduction in 2008. With increasing use of BABA RoT, many trials have been made for effective identification and preservation of parathyroid glands and recurrent laryngeal nerves (RLNs). The aim of this study was to identify and preserve parathyroid glands using indocyanine green (ICG) fluorescence under near-infrared (NIR) light in BABA RoT. Methods: A pilot study of 14 patients was designed to determine an optimal ICG dose. Seven different ICG doses (1 mg, 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg) were assessed for fluorescence patterns and optimal identification time of inferior parathyroid glands. Simultaneous intraoperative tissue parathyroid hormone (PTH) assays were done in 9 patients for biochemical confirmation of assumed parathyroid glands identified by ICG fluorescence. From September 2014 to August 2015, among patients who had undergone BABA RoT due to thyroid cancers, 22 patients were enrolled with informed consents. The patients were given 10 mg ICG intravenously after strap muscle dissection. By Firefly system (NIR illuminator: 805 nm / filter: 825 nm) integrated to da Vinci Si robot system, ICG was excited and emitted green fluorescence. ICG fluorescence duration with optimal identification time of inferior parathyroid glands was estimated from time of its appearance and disappearance in parathyroid and thyroid respectively, with an attempt to find RLN at the same time. Using propensity score matching, control group was set to compare surgical complications between two groups. Patient demographics and clinico-pathologic characteristics were analyzed together. Results: In the pilot study, inferior parathyroid glands were effectively identified with 10 mg ICG at 3 minutes after injection. The results of intraoperative tissue PTH assays suggested successful parathyroid glands identification had been achieved in 9 patients. The mean time taken to visualize parathyroid and thyroid by ICG fluorescence was 203 ± 89 sec (range: 125-331 sec) and 207 ± 112 sec (range: 130-356 sec) with mean fluorescence duration of 20.8 ± 6.0 min (range: 16.6-35.8 min) and 20.1 ± 7.3 min (range: 15.5-33.8 min) respectively. All 32 parathyroid glands of 22 patients were distinguished from thyroid by earlier enhancement, more focal and intense fluorescence pattern. RLNs didn't show ICG fluorescence in contrast to thyroid and parathyroid glands. In postoperative period mild transient hypoparathyroidism was reported in one patient, otherwise no RLN palsy occurred. ICG group showed significantly lower rates of transient hypoparathyroidism (4.5 % vs 50 %, P < 0.001) and incidental parathyroidectomy (0 % vs 38.6 %, P < 0.001) compared to control group. Conclusions: The results of the present study suggest that parathyroid glands preservation using ICG fluorescence under NIR light may be feasible and safe in BABA RoT. RLNs were also easily detected and saved by means of its non-fluorescent property.Introduction 1 Patients and Methods 4 Results 11 Discussion 20 Conclusions 24 References 25 Abstract in Korean 28Maste

무른 물질 시스템에 외부장이 미치는 영향: 타원형 제한공간에서의 액정을 중심으로

학위논문(박사) - 한국과학기술원 : 물리학과, 2012.8, [ vii, 50 p. ]Soft matter has large response functions to external fields such as shear forces, electric/magnetic fields, and confinements. The studies of these response functions have contributed to the fundamental understanding of soft matter and the development of various applications such as electro-optic displays and sensors. In this point of view, we discuss the following problems. 1) We report the first study on the confinement-induced transition of the topological defects of liquid crystals (LCs) using smectic-A LCs confined in prolate spheroids with homeotropic anchoring. Upon increasing the aspect ratio of a LC droplet, dispersed in a stretched elastomer film, the topological defect undergoes a transition from a point to a line of which the length is a function of the aspect ratio. Additionally, when the size of a droplet is larger than a certain value, the defect has a pearl-necklace-like texture. We propose a simple model to understand the formation of these defects in terms of the misorientation and undulation instability of the smectic layers. 2) We present the first observation of liquid crystals confined in elliptic cylinders. To fabricate the elliptic cylinder, poly(dimethlysiloxane) (PDMS) micro-channels of circular cross sections are stretched uniaxially along the direction of the diameter. Upon increasing the aspect ratio of the elliptic cross section, confined nematic liquid crystals maintain the escaped-radial configuration with homeotropic anchoring. In smectic-A liquid crystals, defect regions of focal conic domains appear as a function of the aspect ratio. We propose a model to understand the formation of these defects in terms of the confinement-induced misorientation, and thereby the tilt grain boundaries. 3) We introduce a new one-step method to prepare magnetic Janus particles and observe their supra-structures under external magnetic field. We utilize the phase separation of polymers inside microfluidics-generated emulsion droplets dur...한국과학기술원 : 물리학과

Surgical Treatment of Hernias in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

Purpose: The incidence of hernia is estimated to be 3 similar to 5% in the general population. In patients on continuous ambulatory peritoneal dialysis (CAPD), the incidence of hernia is 6 similar to 25% and immediate surgical treatment is critical to maintain CAPD. This study was performed to identify clinical characteristics of hernias in CAPD patients and evaluate the surgical results. Methods: We retrospectively analyzed 13 prospectively registered patients (male : female=12 : 1) on CAPD treated with hernia between March 1998 and June 2008 at the Seoul National University Hospital by one surgeon. Perioperatively, patients underwent intermittent hemodialysis via-internal jugular catheter indwelled just before the operation. Peritoneal dialysis was resumed between 2 weeks and 2 months after operation. Results: Mean age-was 46.6 years (range: 19 similar to 71 years). Fifteen hernias developed in 13 patients of which, 10 (67%) were inguinal and 5 (33%), umbilical. Mean duration from CAPD start to onset of hernia was 31.4 months (range: 0 similar to 129 months). All inguinal hernia patients received standard McVay operation, 3 patients with umbilical hernia were repaired with primary herniorrhaphy and 1 patient with-large fascial defect needed mesh implant. During mean follow-up periods of 31 months, recurrence was detected in 1. patient in umbilical hernia group. The only complication related to operation was wound hematoma in. one patient. Two patients were converted to hemodialysis after operation because of low compliance to peritoneal dialysis in one patient and suspected catheter-related infection in the other. Conclusion: Our results indicate that hernia repair can be safely performed with acceptable outcomes in patients on CAPD. (J Korean Surg Soc 2009;77:333-337)Mislowsky A, 2008, HERNIA, V12, P627, DOI 10.1007/s10029-008-0396-7Jaenigen BM, 2008, ZBL CHIR, V133, P440, DOI 10.1055/s-2008-1076955LEE JH, 2008, KOREAN J NEPHROL, V27, P487Shah H, 2006, PERITON DIALYSIS INT, V26, P684Garcia-Urena MA, 2006, PERITON DIALYSIS INT, V26, P198MALANGONI MA, 2004, SABISTON TXB SURG, P1199GIANETTA E, 2004, HERNIA, V8, P354Lau H, 2003, SURG ENDOSC, V17, P2016, DOI 10.1007/s00464-003-9027-7Del Peso G, 2003, PERITON DIALYSIS INT, V23, P249HAIDER MH, 2003, J PAK MED ASS, V53, P36Basaran O, 2002, TRANSPLANT P, V34, P2039TSANG LY, 2002, ACTA NEPHROL, V16, P57METTANG T, 2001, ADV PERIT DIAL, V17, P84Aranda RA, 2000, PEDIATR NEPHROL, V14, P22Morris-Stiff GJ, 1998, POSTGRAD MED J, V74, P669Afthentopoulos IE, 1998, CLIN NEPHROL, V49, P251MorrisStiff G, 1997, BRIT J SURG, V84, P615WINCHESTER JF, 1994, PERITON DIAL INT S3, V14, pS43SUH H, 1994, ADV PERIT DIAL, V10, P85RUTKOW IM, 1993, SURGERY, V114, P3BARGMAN J, 1993, KIDNEY INT S, V40, pS75DURAND PY, 1992, ADV PERITONEAL DIALY, V8, P108MODI KB, 1989, ADV PERIT DIAL, V5, P84APOSTOLIDIS NS, 1988, AM SURGEON, V54, P318VONLILIEN T, 1987, AM J KIDNEY DIS, V10, P356LICHTENSTEIN IL, 1986, HERNIA REPAIR DISABIROCCO MV, 1985, PERITON DIALYSIS B, V5, P171RUBIN J, 1982, ARCH INTERN MED, V142, P1453

Information System for Metabolic Flux Analysis UsingeXtensible Markup Language and Operating Method Thereof

본 발명은 XML(eXtensible Markup Language)을 이용한 대사흐름분석(MFA: Metabolic Flux Analysis) 정보 시스템 및 그 운용방법에 관한 것으로, 보다 구체적으로는 XML을 이용하여 MFA 모델 피쳐(feature) 및 MFA 객체를 생성, 편집, 저장 및 가시화하고, 그 객체를 바탕으로 MFA를 수행하여 수득되는 결과를 편집, 저장 및 가시화할 수 있는 MFA 정보 시스템(Information System) 및 그 운용방법에 관한 것이다. 본 발명은 XML을 이용하여 MFA 정보 시스템(MFA Information System)의 MFA 모델 피쳐 및 MFA 객체를 생성, 편집, 저장 및 가시화할 수 방법을 제공함으로써, XML이 지니는 이식성, 재사용성, 해독성, 확장성, 유동성, 효율적인 데이터 교환 등의 이점을 활용하여 MFA 수행시 용이성과 편리함을 제공하므로 대사공학을 이용한 균주 개량에 응용될 수 있다