Efficacy of Long-Term Tenofovir-Based Therapy in Chronic Hepatitis B Patients with Previous Nucleos(t)ide Analogues Treatment Experience

( Na Eun Lee ),( Hong Seon Son ),( Sung Hoon Choi ),( Chang Hun Lee ),( Seung Young Seo ),( Seong Hun Kim ),( Sang Wook Kim ),( Seung Ok Lee ),( Soo Teik Lee ),( Dae Ghon Kim ),( In Hee Kim ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Tenofovir disoproxil fumarate (TDF) is considered as the preferred treatment option for chronic hepatitis B (CHB) patients with treatment failure or resistance to prior nucleos(t)ide analogues (NAs) treatment. We investigated the efficacy of long-term TDF-based therapy in CHB patients with previous NAs-experience. Methods: This study included total 251 patients who had previous history of NAs therapy and were treated with TDF mono (n=173) or TDF combined with other NA (n=78) from August 2012 to March 2017. Virologic response (VR) was defined as undetectable serum HBV DNA by PCR (<20 IU/mL). Results: Mean age of patients was 49.3 years, median duration of TDF therapy was 27.2 months, 75.7% were HBeAg-positive, and median HBV DNA was 3.7 log10IU/mL. The cumulative rates of VR were 188/244 (77.0%), 180/211 (85.3%), and 146/161 (90.7%) at 12, 24, and 36 months, respectively. Multivariate analysis showed that body mass index (OR 0.77, 95% CI 0.61-0.95, p=0.0189) and duration of TDF therapy (OR 1.09, 95% CI 1.02-1.18, p=0.0221) was significantly associated with VR. TDF monotherapy, HBeAg-positivity, platelet count, serum albumin was associated with VR in the univariate analysis, but not significant in the multivariate analysis. In relation to renal safety, patients showed renal impairment (7, 3.0%), mild hypophosphatemia (15, 7.2%), severe hypophosphatemia (1, 0.4%). Conclusions: Long-term TDF-based therapy demonstrated highly effective in viral suppression and relatively favorable renal safety in CHB patients with previous NA-experience. The body mass index and duration of TDF therapy was independent factors associated with VR.

Comparison of Virologic Response and Renal Safety of Long-Term Antiviral Therapy with Tenofovir and Entecavir in Naive Patient with Chronic Hepatitis B

( Hong Seon Son ),( Sung Hoon Choi ),( Na Eun Lee ),( Chang Hun Lee ),( Seung Young Seo ),( Seong Hun Kim ),( Sang Wook Kim ),( Seung Ok Lee ),( Soo Teik Lee ),( Dae Ghon Kim ),( In Hee Kim ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Tenofovir (TDF) entecavir (ETV) are considered as the preferred treatment options for treatment-naïve chronic hepatitis B (CHB) patients. We compared the virologic response and renal safety of long-term TDF versus ETV therapy in naïve CHB patients. Methods: This retrospective study included total 432 patients who were treated with TDF (n=205) or ETV (n=227) from August 2012 to March 2017. Virologic response (VR) was defined as undetectable serum HBV DNA by PCR (<20 IU/mL). Results: Mean age of patients, sex, baseline serum levels of AST, ALT, creatinine, and HBV DNA were not significantly different between TDF and ETV groups. The cumulative rates of VR between TDF and ETV groups were 71.6% vs. 61.8% (p=0.477), 88.1% vs. 79.6% (p=0.058), and 84.8% vs. 83.7% (p=0.966) at 1, 2, and 3 years, respectively. The cumulative rates of genotypic resistance between TDF and ETV groups were 0% vs. 0%, 0% vs. 1.5% (p=0.404), and 0% vs. 2.2% (p=0.447) at 1, 2, and 3 years, respectively. Incidences of renal impairment and hypophosphatemia during treatment up to 3 years were not significantly different between two groups. Multivariate analysis showed that HBeAg-positivity (OR 0.27, 95% CI 0.12-0.58, p=0.0012) and serum HBV DNA at 1 year 2000 IU/mL (OR 0.09, 95% CI 0.03-0.25, p<0.0001) were significantly associated with VR. Conclusions: Long-term TDF and ETV treatments appear to have similar virologic response and renal safety in naïve CHB patient. However, long-term ETV therapy might to be associated with genotypic resistance in 2.2% up to 3 years, while none of patients on TDF therapy did.

무선통신채널에서 QAM신호의 전송과 채널 특성에 따른 신호점 배치에 관한 연구

柳尙進,崔在翼,羅哲勳 木浦大學校 工業技術硏究所 1998 工業技術硏究誌 Vol.8 No.-

최근 들어 새롭고 복잡해져가는 정보의 대량 전송과 정보 체계의 다양화에 따라 여러 방식의 전송 기법이 개발되고 있다. 그리고 보다 편리한 무선통신의 가입자 수요는 급증하고 있는데, 아날로그 방식보다는 다지틀 방식이 요구되고 스펙트럼 활용효율이 좋은 변조 기법이 또한 바람직하다. 본 연구에서는 활용가능성이 큰 16-ary QAM신호를 선정하여 신호점배치에 따라 여러 QAM신호의 전송신호생성에 관해 고찰하였으며, 가산성 백색 가우시안 잡음(Additive White Gaussian Noise : AWGN)이 더해진 전송채널과 직접파 성분이 없고 반사파들로만 수신신호가 이루어져 있다고 가정할 수 있는 레일리 페이딩(Ratleigh fading)이나 도플러 효과(Doppler effect)가 가미된 이동통신채널을 모델링하고, 이들 채널에서 신호의 왜곡을 보상하는 변.복조 방법을 살펴보았다. 결론적으로 이러한 페이딩 환경하에서 나타나는 시스템의 성능 열화를 최소화하여 좋은 성능을 발휘할 뿐만 아니라 복조단에서 야기되는 위상 모호성(Phase ambiguity)문제를 근본적으로 해결할 수 있는 Differential 방식의 QAM 변.복조 방식을 소개하고, 이동통신과 위성통신 채널에 적용가능한 16-ary QAM 신호의 최적 신호점 배치와 송.수신 방법을 제시하였다.

가스크로마토그래피를 이용한 요중 마뇨산 측정시 새로운 시료 전처리 방법의 검증

조수현,임용현,김선민,권호장,하미나,한상환 大韓産業醫學會 1995 대한직업환경의학회지 Vol.7 No.1

Urinary hippuric acid was analyzed by gas chromatography/mass spectrometry method. A simple and economical derivatization procedure using excessive methanol in acidic condition was adopted to esterify hippuric acid. Quantitative analysis was performed with two internal standards, heptadecanoic acid and hydrocinnamic acid, to evaluate the derivatization procedure as an analytical method. Using the standard addition method, linear and reproducible calibration curves were obtained for both internal standards. Calibration experiment showed that good quantitative result could also be obtained with the calibration curve obtained without urine matrix. Recovery rates for the urine samples were in the range of 95.6∼111.4%. Using hydrocinnamic acid as internal standard, analysis time could be reduced.

유기용제 사용 소규모사업장의 체계적 건강관리 프로그램 개발에 관한 연구1) : 신경행동학적 검사법의 적용 가능성 Application of Neurobehavioral Core Test Battery(NCTB)

한상환,하미나,권호장,윤덕로,조수헌 大韓産業醫學會 1995 대한직업환경의학회지 Vol.7 No.2

It is known that there appear some nonspecific and delicate changes in neuropsychiatric aspect on the workers when they are exposed for a long period to low concentrated organic solvents in the work places. Therefore, it gives rise to the necessity of developing a program for the health supervisor stationed in the work place to supervise these neurobehavioral health affection. In addition to the questionnaire posed to the workers exposed to organic solvents, the study team conducted NCTB(Neurobehavioral Core Test Battery) respectively on an exposed group and a non-exposed group to organic solvents. The study team compared the results and decided whether or not to apply the results to the evaluation program of health affection. The study team divided 132 workers in 6 car repairing factories and 2 textile printing factories into exposed group and non-exposed group, pairing them off into 66 research objects according to their age, sex, and job. Neurobehavioral test was conducted on 6 items, except the POMS test, of NCTB developed by the World Health Organization(WHO). The study team conducted examinations of working environment on the exposed and non-exposed groups of each work place. The analysis of the collected materials for examinations were conducted with GC-MS. The concentration of the mixture in the air, relative to their respective threshold limit values(TLV) was calculated according to the formula of the ACGIH and the Korean threshold limits. The results indicated that for two of eight factories samples the recommended concentration limits for mixtures was exceeded. Of the six tests, the 'digit span forward', 'digit span backward' and 'digit symbol' produced conspicuous statistical differences between the two groups(p<0.1) as a result of compairing the test values by means of paired t-test. The results of respective analysis of the car repairing factories and textile printing factories revealed that the textile printing factories had greater differences between the exposed and the non-exposed than in the car repairing factories. It is presumably because the textile printing workers are continuously exposed to the organic solvents during working hours, whereas the car repairing workers are exposed only when they are doing painting works, The NCTB is assessed very useful in examining the neurobehavioral health affection under the exposure to organic solvents, and, therefore, the study team expects that the NCTB will play an important part in the course of developing a health program for the workers exposed to organic solvents.

슬개골 골절에서 관절경을 이용한 정복 및 내 고정술

고상훈,조성도,나화엽,김우석,정유영,곽창렬,김범수 대한골절학회 2003 대한골절학회지 Vol.16 No.4

사업장 소음 폭로에 의한 일과성 역치 상승과 회복

조수헌,하미나,한상환,주영수,성주헌,강종원,윤덕로,송동빈,이명학,김선태 大韓産業醫學會 1996 대한직업환경의학회지 Vol.8 No.2

To determine the recovery time from noise-induced temporary threshold shift(TTS), a prospective field study was conducted at three worksites where workers are known to be exposed high level of noise. Subjects were selected according to answers on a questionnaire which inquired about otological history and previous noise exposure, including avocational, military and occupational exposures. After excluding employee with past otologic problems, recent exposure to high level noise, and under medications, total 92 employees participated in the study. Among 92 participants, complete consecutive audiometric examinations were carried out at 0∼2 hours, 5∼7 hours, 14∼16 hours after worktime noise exposure on 26 participants wearing hearing protectors and 22 participants wearing no protective devices. The difference between the hearing level 0∼2 hours after noise exposure and 5∼7 hours is statistically significant by paired t-test(p<0.01). The median recovery times calculated from the data of 22 participants wearing no protective hearing devices are 15.6 hours at 4000Hz, and 7.7 hours, 10.3 hours, 8.4 hours at 1000Hz, 2000Hz and 8000Hz respectively. These data suggest that when measuring the pure tone audiometry for noise exposed workers, at least 16 hours noise-free interval is required.

쪽파[Allium ascalonicum L.] 재배기간 중 Diazinon, Iprodione 및 Chlorfenapyr의 잔류랑 변화

고광용,나은식,김성헌,김상준,장영희,이규승 충남대학교 농업과학연구소 2005 농업과학연구 Vol.32 No.2

In order to know the residual pattern of pesticides and predict to the degradation period until below MRL, we experimented diazinon, iprodinon and chlorfenapyr for shallot. They were the most detected pesticide in shallot by NAQS (National Agricultural product Quality management Service) survey. In this experiment, we sprayed those pesticides 15days before harvest and analyzed 0, 1, 2, 3, 5, 7, 10, 14 day sample to establish logical equation and to calculate DT_(50). During the cultivating period, the residue amount of diazinon was changed from 1.02 mg/kg (0 day) to 0.01 mg/kg (14 day), DT_(50) was 2.19 days, and iprodione was changed from 1.45 mg/kg (0 day) to 0.14 mg/kg (14 day), DT_(50) was 4.15 days, and chlorfenapyr was changed from 1.5 mg/kg (0 day) to 0.01 mg/kg (14 day), DT_(50) was 1.97 days. The DT_(50) of double amount in those pesticides, diazinon was 2.24 days, iprodione was 4.82 days, and chlorfenapyr was 2.24 days, respectively.

복막투석복막염 환자에서 발생한 창자벽공기증 1예

정선영,나지훈,최윤정,고성애,조규향,박종원,도준영,윤경우 영남대학교 의과대학 2009 Yeungnam University Journal of Medicine Vol.26 No.1

Peritonitis is a serious problem in patients undergoing peritoneal dialysis. Rarely pneumatosis intestinalis can occur as a complication of this infectious process. Pneumatosis intestinalis is a potential life threatening condition with a challenging management. The mortality of peritoneal dialysis patients with pneumatosis intestinalis secondary to mesenteric ischemia is almost 100%. We describe a rare case of pneumatosis intestinalis in a peritoneal dialysis patient who developed Staphylococcus aureus peritonitis which was initially treated with appropriate antibiotics. Since initial response to therapy was not achieved, an abdominal computerized tomography was done which revealed a pneumatosis intestinalis. A laparotomy was performed and small bowel necrosis was seen. A segmented resection with ileostomy, jejunostomy was done. Though surgical treatment was performed, the patient died in 2 weeks after admission. Pneumocystitis intestinalis in peritoneal dialysis peritonitis is a uncommon complication which requires prompt evaluation to rule out mesenteric ischemia as it carries a high mortality and its management will be surgical.

우리 나라 보건관리대행서비스 평가 연구

하은희,조수헌,김선민,주영수,한상환,하미나,권호장,홍윤철,김창엽 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.1

Group occupational health service programme started in 1990 is one of the measures to cope with limited human and financial resources in occupational health. The programme has expanded rapidly to include 52 institutions, private as well as public, all over the country. In spite of its potential impact on health of employees and practice of occupational health in small and medium sized industries, comprehensive evaluation in terms of quality has not been tried. This study has aims to develop the criteria to assess the quality of newly developed group occupational health service programme, and to investigate the quality of institutions, and finally to develop policies for the quality improvement. 1) Criteria development : By defining occupational health services, in particular for small and medium sized industries, as one of the primary health care, followings are included as core elements of qualitative occupational health programme; accessibility, continuity, comprehensiveness, technical quality, intersectoral collaboration, emphasis on preventive services, community participation, and adequacy. Again each element is divided into five major components of national health system infrastructure developed by the World Health Organization; development of health resources, organized arrangement of resources, delivery of health care, economic support, and management. In turn, each component is categorized into three aspects of quality assessment, structure, process and outcome. Expert panel selected several criteria for each category to evaluate the programme. Criteria were modified according to each group of interviewees, to produce two sets of questionnaire, one for chief operating officer and another for nurses in the institutions, and the chief operating officer and workers in the workplace. 2) Subject : Of all 52 institutions, 25 voluntarily participated in the survey. At individual institution, chief operating officer and practicing nurses were interviewed in depth. After intensive education for interviewees, every interviewees, every interview was performed with standardized guideline and questionnaire. The quality of the 'Group occupational health service programme' was found to be lower than expected. Especially in continuity, comprehensiveness, technical quality, community participation and adequacy, lower quality in structural aspect was commonly identified throughout all the institutions,. Quality in terms of accessibility and continuity highly varied among institutions., To improve quality of the programme, more comprehensive and systematic programme such as accreditation has to be introduced. In addition, human resources, governmental fund and information systems for individual workers are to be developed. As a long range plan, integration of occupational health services into the national health systems and pooling of financial resources and planned allocation should be considered.