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( Yeonjung Ha ),( Mohamed A. Mohamed Ali ),( Molly M. Petersen ),( William S. Harmsen ),( Terry M. Therneau ),( Han Chu Lee ),( Baek-yeol Ryoo ),( Sally Bampoh ),( Kenneth A. Valles ),( Mohamad Mady ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: The ability of the pretreatment lymphocyte to monocyte ratio (LMR) to predict outcomes of patients with hepatocellular carcinoma (HCC) receiving sorafenib is not conclusively determined. Methods: We retrospectively studied patients treated with sorafenib for HCC in two tertiary referral centres in Asia and North America. Primary endpoints were overall survival (OS) and progression-free survival (PFS). Predictive factors for the outcomes were determined by Cox proportional hazards models. A risk-assessment tool was developed. Results: Compared to the North America cohort, the Asia cohort was more heavily pretreated (72.1% vs. 35.2%; P<0.001), had higher hepatitis B virus infection (87.6% vs. 5.6%; P<0.001), and more distant metastases (83.2% vs. 25.4%; P<0.001). Lower monocyte count in the Asia cohort (median, 462.7 vs. 600.0/μL; P=0.023) resulted in a higher LMR (median, 2.6 vs. 1.8; P<0.001). High LMR was associated with a significantly higher OS (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.81-0.97; P=0.007). This was confirmed in a sensitivity analysis including patients treated in Asia only (HR, 0.89; 95% CI, 0.81-0.97; P=0.010). An OS nomogram was constructed with following variables selected in the multivariate Cox model: LMR, treatment location, previous treatment, performance status, AFP, lymph node metastasis, and Child-Pugh score. The concordance score was 0.71 (95% CI, 0.69-0.73). LMR did not predict PFS. Conclusions: Pretreatment LMR predicts OS in HCC patients treated with sorafenib. Our OS nomogram, incorporating LMR, can be offered to clinicians to improve their ability to assess prognosis, strengthen the prognosis-based decision making, and inform patients in the clinic.
( Yeonjung Ha ),( Young Eun Chon ),( Yun Bin Lee ),( Mi Na Kim ),( Joo Ho Lee ),( Hana Park ),( Seong Gyu Hwang ),( Kyu Sung Rim ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Terlipressin is the most commonly used agent in patients with type 1 hepatorenal syndrome (HRS-1). The effect of early administration of terlipressin on short- and long-term survival was evaluated. Methods: Cirrhotic patients treated with terlipressin due to renal impairment (N = 60) between Jan 2006 and Jun 2016 were identified. The patients were divided into: 1) early administration (EA, n=23) and 2) conventional administration (CA, n=37) groups. EA consisted of patients who received terlipressin before HRS-1 diagnosis, whereas CA included patients treated with terlipressin after HRS-1 diagnosis. The 2-week and 3-month survival differences were evaluated. Factors associated with survival were assessed using Cox-proportional hazards model. Results: Creatinine levels (4.3 ± 2.7 vs. 2.0 ± 0.4; P <0.001) and Child-Pugh scores were higher in the CA group (11.2 ± 2.0 vs. 10.0 ± 1.9; P=0.038). The 2-week survival time was not significantly different between the two groups (78% for EA vs. 54% for CA; P=0.06). Baseline creatinine levels (hazards ratio [HR] = 1.17), Child-Pugh score (HR=1.45), and decrease in creatinine levels at day 3 (HR=0.29) were significantly associated with 2-week survival (all Ps <0.05). For 3-month, the EA group was not associated with higher survival (43.5% for EA vs. 34.0% for CA; P=0.33). Child-Pugh score (HR=1.39) and decrease in creatinine levels at day 3 (HR=0.30) predicted 3-month survival (all Ps <0.05). Conclusions: Although terlipressin is widely used in clinical practice, even in less severe kidney injury, the early administration of terlipressin did not exhibit any survival benefits.
( Yeonjung Ha ),( Young Eun Chon ),( Yun Bin Lee ),( Mi Na Kim ),( Joo Ho Lee ),( Hana Park ),( Seong Gyu Hwang ),( Kyu Sung Rim ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1
Aims: Previous studies have shown inconsistent results regarding the association between vitamin D insufficiency and nonalcoholic fatty liver disease. Methods: We attempted to demonstrate this relationship using population-based data. Data of the Sixth Korea National Health and Nutrition Examination Survey were reviewed. Vitamin D insufficiency was defined as a 25(OH)D level ≤20 ng/mL. Hepatic steatosis index was calculated to define NAFLD. Significant fibrosis was assessed using Body mass index, AST/ALT Ratio, Diabetes (BARD) score. Logistic regression analyses were performed to determine the relationship between vitamin D insufficiency and nonalcoholic fatty liver disease. Results: Among 1,812 participants, 409 (22.6%) had nonalcoholic fatty liver disease. Patients with nonalcoholic fatty liver disease were more likely to be male (56.7%), had higher body mass index (28.1 kg/m2), and had more metabolic syndrome (57.2%). The proportion of vitamin D insufficiency did not differ between nonalcoholic fatty liver disease and non- nonalcoholic fatty liver disease (77.5% vs. 77.4%). Logistic regression analyses showed that BMI, diabetes, and triglyceride level were significantly associated with nonalcoholic fatty liver disease, whereas vitamin D insufficiency was not related. Subgroup analyses involving nonobese participants, male participants, and participants without metabolic syndrome showed similar results. The BARD score and the proportion of significant fibrosis by BARD score did not differ according to vitamin D status. Conclusions: Vitamin D insufficiency was not associated with the presence of nonalcoholic fatty liver disease.
( Yeonjung Ha ),( Young Eun Chon ),( Yun Bin Lee ),( Mi Na Kim ),( Joo Ho Lee ),( Hana Park ),( Seong Gyu Hwang ),( Kyu Sung Rim ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: The prognostic impact of sarcopenia has not been clearly demonstrated in patients newly diagnosed with hepatocellular carcinoma (HCC), especially those without symptoms. Methods: Area of skeletal muscle and abdominal fat were measured at L3 level of computed tomography scan in 132 patients newly diagnosed with HCC between Jan 2007 to Jun 2011. Sarcopenia was defined as L3 skeletal muscle index of ≤ 52.4 cm/m2 for male and ≤ 38.5 cm/m2 for female. Baseline data were analyzed to determine the effect of sarcopenia on overall survival (OS) using the univariate and Cox multivariate analyses in overall and propensity- score matched cohorts. The impact of sarcopenia in asymptomatic vs. symptomatic patients was subsequently evaluated. Results: Sarcopenic patients (32 out of 132) were older (65.3 vs. 57.0 years old) and had lower body mass index (21.0 vs. 24.0 kg/m2), total fat (55.7 vs. 68.0 cm2/m2), and subcutaneous fat (21.9 vs. 29.2 cm2/m2) area. The presence of sarcopenia dichotomized patients with regard to OS (median 41.2 vs. 13.8 months, P=0.001). Multivariate analysis found that sarcopenia (hazard ratio [HR], 2.15, P=0.008), alpha-fetoprotein (HR, 2.79, P=0.004), Child-Pugh stage (HR, 2.38, P=0.017), infiltrative tumor (HR, 2.29, P=0.021), and BCLC stage (P<0.001) were predictive of OS. In a propensity score-matched cohort, sarcopenia (HR, 5.50, P=0.027) was the only predictive factor. In particular, asymptomatic patients with sarcopenia had a poor OS than patients without sarcopenia (median 69.6 vs. 22.2 months, P<0.001), while no significant difference in symptomatic patients (median 17.2 vs. 9.7 months, P=0.26). Subdividing asymptomatic patients of BCLC A and B stages according to sarcopenia status improved the predictive ability of staging system (c-index, 0.87 vs. 0.67, P<0.001). Conclusions: Sarcopenia is an independent prognostic factor in patients newly diagnosed with HCC, especially those without symptoms. Subdividing BCLC A and B stages according to sarcopenia status showed a better stratification.
의학강좌 : 급성 간부전의 이해 -기본 개념과 치료를 중심으로
하연정 ( Yeonjung Ha ),임영석 ( Young Suk Lim ) 대한내과학회 2015 대한내과학회지 Vol.89 No.6
Acute liver failure is a rare but fatal condition characterized by rapid deterioration of liver function resulting in coagulopathy and altered mentation in patients without known liver disease. The three most common causes of liver failure in Korea are hepatitis B virus, exposure to certain herbs, and hepatitis A virus. Because the cause of liver failure is the most important prognostic factor, the etiology of liver failure should be evaluated as the initial step in the assessment of affected patients. Patients with acute liver failure should be intensively monitored and treated for various secondary conditions that may occur or have already developed, including cerebral edema, seizures, hemodynamic instability, renal failure, infection, bleeding, and metabolic disturbances. Although treatment with N-acetylcysteine has shown a survival benefit in patients with mild hepatic encephalopathy, the overall mortality rate associated with acute liver failure is high unless patients undergo liver transplantation, prompting patients and physicians to be prepared for transplantation. Therefore, patients who are suspected to have, or who have been diagnosed with, acute liver failure should be transferred to a transplant facility and be prepared for liver transplantation while they undergo intensive monitoring and medical treatment. (Korean J Med 2015;89:672-674)
The Unseen Threat: Microplastic Emissions from Face Masks and Limited Public Awareness
Park Yeonjung,Bae Heekyung,Park Ha-neul,Park Jeonggue,홍재환,Kim Younghun 한국화학공학회 2024 Korean Journal of Chemical Engineering Vol.41 No.1
Masks are typically made of plastic materials, which can contribute to plastic pollution if not properly disposed. A survey should be conducted to assess the public awareness of microplastics (MP) emissions and mask disposal, which could inform targeted educational campaigns to promote sustainable practices. This study used an online survey to gather data from a sample of the general public aged 20 years or older who had used masks. The survey included questions on mask usage, disposal, and awareness of the presence of MP in masks. The survey found that, although awareness of the risks of MP was high, the respondents’ understanding of them was low, particularly among younger individuals. The survey also revealed that more than half of the respondents did not know whether their masks contained plastic materials and that there was a lack of awareness regarding the potential environmental and health impacts of improper mask disposal. These results revealed that it is crucial to raise public awareness of the environmental and health impacts of improper mask disposal and the presence of MP in masks.