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Toll-Like Receptor의 발암, 그리고 항암 효과
곽금연 ( Geum Youn Gwak ) 대한간암학회 2011 대한간암학회지 Vol.11 No.2
Toll-like receptors are a family of pattern recognition receptors that allow the immune system to sense molecules that are present in most classes of pathogens such as bacteria and viruses, but not the host, and to coordinate defense mechanisms against these pathogens. Emerging evidence also suggests that TLRs have an important role in maintaining tissue homeostasis by regulating the inflammatory and tissue repair responses to injury. Due to the important role in inflammation, tissue regeneration and fibrogenesis, TLRs are potential candidates to mediate effects of the innate immune system on carcinogenesis. Although the role of TLRs in carcinogenesis is far from being completely understood, current data suggest a dual role of TLRs in carcinogenesis: anti-tumor effects versus tumor-promoting effects. Here we discuss how TLRs function in the context of carcinogenesis.
특 집 -C형 간염의 치료 : 특수한 경우의 C형 간염 치료: 간경변증
곽금연 ( Geum Youn Gwak ) 대한내과학회 2015 대한내과학회지 Vol.88 No.6
Acquiring a sustained virological response (SVR) in patients with cirrhosis or advanced hepatic fibrosis reduces liver disease- related mortality and the incidence of hepatocellular carcinoma. However, the SVR rate of the current standard of care, which is combination therapy with peg-interferon-alpha and ribavirin, is significantly lower, and treatment-related complications occur more frequently in patients with cirrhosis. Thus, antiviral treatment should be individualized in this population. This review highlights the issues associated with anti-hepatitis C virus treatment in patients with compensated and decompensated cirrhosis. (Korean J Med 2015;88:643-646)
곽금연 ( Geum-youn Gwak ) 대한간학회 2018 간질환 연수강좌 Vol.2018 No.1
In Korea, the guideline on the ‘management of hepatitis C’ was first developed in 2004 by the Korea Association for the Study of the Liver (KASL) and revised in 2013 and 2015, respectively. Recently, with the introduction of direct acting antivirals (DAAs), paradigms for the treatment of hepatitis C has been remarkably changed. DAAs have an advantage of higher sustained virologic response (SVR) rate, lower adverse events, and convenience of medication over IFN-based therapy. However, the choice of DAAs is sometimes complicated because treatment regimens and durations are variable according to genotypes/subtypes, resistance-associated substitutions (RAS), the presence/absence of previous treatment experience, and the presence/absence of cirrhosis. Therefore, the revised guideline on the ‘management of hepatitis C’ was newly released in 2017.
기획2015년 대한간학회 C형간염 진료 가이드라인 개정, 무엇이 달라졌는가? - 비대상성 간경변증 환자의 치료
곽금연 ( Geum Youn Gwak ) 대한소화기학회 2016 대한소화기학회지 Vol.67 No.3
HCV-related decompensated liver cirrhosis is a life-threatening illness with an average 5-year survival rate of 50%. Because these patients have higher risk of morbidity and mortality including development of hepatocellular carcinoma, the benefits of eradicating the virus may be greater than in those with less-advanced disease. Recently, direct-acting antiviral agents (DAAs) are replacing interferon-based regimens that have serious adverse events and low tolerability in the treatment of HCV infection. Many clinical trials using combination of several DAAs with or without ribavirin are now actively on-going in HCV-related decompensated cirrhosis, and encouraging data are beginning to appear. In this review, recent advances in the treatment of HCV-related decompensated cirrhosis are introduced with special focus on new DAAs. (Korean J Gastroenterol 2016;67:137-141)
PARALLEL SYMPOSIUM 3 : Acute on Chronic Liver Failure-Definition and Pathogenesis
곽금연 ( Geum Youn Gwak ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1
Recently, the concept of acute-on-chronic liver failure (ACLF) was introduced to describe a specific clinical form of liver failure associated with cirrhosis. The syndrome refers to an acute deterioration of liver function and a rapidly evolving multi-organ failure following a precipitating event in a patient with previously well-compensated cirrhosis. The precipitating events include an indirect (e.g., variceal bleeding, sepsis) and a direct (e.g., drug) hepatotoxin. ACLF is frequently accompanied by the development of severe inflammatory response syndrome and has a high mortality. At present, considerable efforts are ongoing to better characterize this disease entity and to gain further insight into its pathophysiology.