Predictors of Outcome in Patients with Unresectable Hepatocellular Carcinoma and Impaired Hepatic Function Treated with Transarterial Chemoembolization

( A Reum Choe ),( Tae Hun Kim ),( Kwon Yoo ),( Minuk Kim ),( Sun Young Choi ),( Hye Ah Lee ),( Hwi Young Kim ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Transarterial chemoembolization is frequently implemented in patients with unresectable hepatocellular carcinoma (HCC). Child-Pugh (C-P) classification is widely used for risk stratification in those patients. However, C-P system includes subjective and/or interrelated variables with arbitrarily defined scores and predetermined cutoff points. The aim was to investigate prognostic factors in HCC patients treated with TACE, and to combine those factors into a prediction model to distinguish patients who are more suitable for TACE. Methods: Between January 2011 and December 2015, a total of 155 consecutive patients with their Child-Pugh score ≤8 were enrolled who underwent TACE at least once for their unresectable HCC. A risk prediction model was developed for overall survival based on prognostic factors using the Cox model. Results: Median age was 67.8 years, and 121 patients were male (78.1%). Etiologies of underlying liver diseases were mostly viral (55.5%) or alcoholic (16.1%). Tumor multiplicity was observed in 68 patients (43.9%), and macrovascular invasion was present in 35 patients (18.4%). C-P classes were A in 118 patients (76.1%) and B in 37 (23.9%), respectively. Relevant prognostic factors for overall survival in all patients included ALBI grade (1,2 vs. 3; hazards ratio [HR], (2.564 (95% confidence interval [CI], 1.312-5.012 ); P= 0.006), aspartate aminotransferase (AST; HR, 1.009 (95% CI, 1.006-1.012); P< 0.001), and alphafetoprotein (AFP; HR, 1.982 (95% CI, 1.211-3.246); P= 0.007). A scoring system was developed using these variables, differentiating all patients into three groups (score 0 (n=69) vs. score 1 (n=56 ) vs. score 2-3 (n=30)); median OS was 45 months for patients with score 0 vs. 24 months for those with score 1 vs. 5 months for those with score 2-3, respectively (P= 0.000). In the subanalysis for C-P class B patients, same significant prognostic factors were identified: ALBI (HR, 54.79 (95% CI, 5.36-560.21); P=0.001), AST ((HR, 1.028 (95% CI, 1.01-1.05 ); P= 0.002), and AFP (HR, 14.56 (95% CI, 2.91-72.78); P=0.001). Same scoring system discriminated patients with score 0-1 (n= 17) vs. those with score 2-3 points (n= 13), with median OS of 29 months vs. 4 months, respectively (P= 0.015). Conclusions: Our scoring system using ALBI grade, AST and AFP distinguished patients with favorable outcome who receive TACE across C-P class A and B.

Risk Assessment and Suitability of Transarterial Chemoembolization in Patients with Unresectable Hepatocellular Carcinoma with or without Impaired Hepatic Function

( A Reum Choe ),( Joon Yeul Nam ),( Jeong-hoon Lee ),( Su Jong Yu ),( Yoon Jun Kim ),( Jung-hwan Yoon ),( Hyo-cheol Kim ),( Jin Wook Chung ),( Hye Ah Lee ),( Tae Hun Kim ),( Kwon Yoo ),( Hwi Young Kim 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: The decision of initiation or repetition of transarterial chemoembolization (TACE) for unresectable hepatocellular carcinoma (HCC) still remains challenging, especially in patients with impaired hepatic function. The aims: were (i) to identify prognosticators in patients undergoing TACE, (ii) to develop a risk prediction model, and (iii) to investigate the outcomes according to the scores in patients undergoing TACE with or without impaired hepatic functional reserve. Methods: A total of 597 consecutive patients were enrolled who underwent TACE as their initial treatment for unresectable HCC without macrovascular invasion or extrahepatic spread from two university hospitals in Korea. The entire cohort was randomly divided into two groups with 7:3 ratio to derive and validate a risk prediction model. Tumor- and liver function-related risk factors for overall survival were explored using Cox proportional-hazards model. Results: Median age was 64.0 years, and 474 patients were male (79.4%). Etiologies of underlying liver diseases were mostly viral (HBV, 386 [64.7%]; HCV, n=82 [13.7%]) or alcoholic (n=60, 10.1%). Multiple tumors were found in 379 patients (63.6%), and median maximal tumor diameter was 3.2 cm (interquartile range [IQR], 2.2-5.2). Median alpha-fetoprotein (AFP) was 16.0 ng/mL (IQR, 6.0-153.0). Child-Pugh classes were A in 479 patients (80.2%) and B in 118 (19.8%), respectively. Hepatoma arterial-embolisation prognostic (HAP) score D and modified HAP score D were in 95 patients (15.9%) and in 43 (7.2%), respectively. Albumin-bilirubin (ALBI) grades were 1 in 204 patients (34.2%), 2 in 363 (60.8%) and 3 in 30 (5.0%), respectively. Multivariable Cox model with stepwise selection identified the following four relevant prognostic factors: ALBI grade (hazards ratio [HR], 2.299; 95% confidence interval[CI], 1.694-3.119; P<0.001); AFP (HR, 1.583; 95% CI, 1.164-2.154; P=0.003); maximal tumor diameter (HR, 1.704; 95% CI, 1.424- 2.038; P<0.001); tumor response (HR, 1.915; 95% CI, 1.431- 2.563; P<0.001). A scoring system (ASAR) based on these risk factors was developed by assigning points as shown in Table 1. C-index for the prediction of overall survival (OS) was 0.73 (95% CI, 0.70-0.77). The 1-year and 3-year survival rates were 92.1% and 69.7% in patients with ASAR<4, and 52.4% and 23.7% in those with ASAR≥4, respectively (P<0.001). The 1-year and 3-year survival rates in subgroups according to the hepatic function and ASAR scores were as follows (all P<0.001): i) 93.6% and 73.3% in Child-Pugh class A and ASAR <4; ii) 54.4% and 29.0% in Child-Pugh A and ASAR≥4,; iii) 85.2% and 53.4% in Child-Pugh B and ASAR <4; iv) 46.3% and 6.6% in Child-Pugh B and ASAR ≥4. However, no significant differences were observed in Child-Pugh class B patients using HAP score (P=0.523) or modified HAP score (P=0.298). Conclusions: A novel scoring system (ASAR) may be helpful in patient selection undergoing TACE for unresectable HCC, especially those with impaired hepatic function.

미성년자인 환자에 대한 의사의 설명의무에 관한 소고(小考) - 대법원 2023. 3. 9. 선고 2020다218925 판결에 대한 평석을 중심으로 -

최아름(Choe, A-Reum),김성은(Kim, Sung-Eun),백경희(Baek, Kyoung-Hee) 서강대학교 법학연구소 2023 서강법률논총 Vol.12 No.2

Outcome of Localized Granulomatosis with Polyangiitis: A Case Study

( A Reum Choe ),( In Je Kim ),( Jisoo Lee ),( Sun Hee Sung ) 대한류마티스학회 2016 대한류마티스학회지 Vol.23 No.3

Objective. A substantial portion of granulomatosis with polyangiitis (GPA) patients present with localized disease limited to the upper respiratory tract, however; disease spectrum and prognosis of these patients are unclear. The aim of this study is to describe the clinical characteristics and outcome of patients with localized GPA. Methods. This was a retrospective descriptive case series of patients with a biopsy proven localized GPA presenting to a single tertiary rheumatology service between January 1995 and September 2015. Results. A total of 5 patients, median age 56 years (range 48 to 59 years) at diagnosis and 80% female, were identified. The median follow-up period was 42 months (range 15 to 62 months). Diagnosis was delayed with median time to diagnosis of 12 months (range 3 to 36 months), and patients underwent 1-3 ear, nose, and throat surgeries during the period of diagnostic delay. Sinusitis was the most frequent symptom in all patients, followed by otomastoiditis with cranial nerve palsies (n=2) and orbital mass (n=1). Antineutrophil cytoplasmic antibody (ANCA) was positive initially in 2/5 patients (40%). Two patients with otomastoiditis and cranial nerve palsies progressed to systemic disease with ANCA positive conversion. These two cases along with a case with orbital mass were refractory to standard treatment of cyclophosphamide with glucocorticoids requiring rituximab treatment. Conclusion. Patients with localized GPA may progress to systemic disease over the disease course, and may have aggressive disease refractory to standard treatment. Close monitoring for systemic symptoms and repeated ANCA testing is required in patients with localized GPA. (J Rheum Dis 2016;23:174-178)

식도이완불능증의 치료에 관한 임상 진료지침 소개

최아름 ( A Reum Choe ),정혜경 ( Hye-kyung Jung ) 대한소화기학회 2019 대한소화기학회지 Vol.73 No.5

Achalasia is a motility disorder of the esophagus characterized by absence of peristalsis and failure of relaxation of lower esophagus sphincter. The introduction of high resolution manometry (HRM) and per-oral endoscopic myotomy (POEM) has made a new chapter in diagnosis and treatment of achalasia. HRM allows classify according to the subtype of achalasia, and help predict prognosis and therapeutic response. POEM is a minimally invasive, effective option for treating achalasia. The management of achalasia required tailored application of various therapies such as botox injection, pneumatic balloon dilatation, POEM, or Heller’s myotomy. In this review, we state the important aspects of diagnosis as well as management of achalasia. (Korean J Gastroenterol 2019;73:294-298)

유해인자별 노출실태 및 분석방법 25 - GC/NPD를 이용한 공기 중 포름아미드 분석

최아름,Choe, A-Reum 대한산업보건협회 2013 산업보건 Vol.305 No.-

Child-friendly Spaces in Disaster Shelters for Child Disaster Victims

Bo Reum Kim,Seol Mi Oh,Deok Hui Choe 위기관리 이론과 실천 2020 Crisisonomy Vol.16 No.2

본 연구는 재난상황에서 신체적, 심리사회적, 발달적 특성으로 인해 스스로를 보호하기 힘들고 회복력이 부족하여 재난취약계층에 속하는 재난피해아동에게 아동맞춤형 서비스를 제공하는 아동친화 공간의 개념과 역할을 소개하고 도입사례를 살펴보았다. 진도 7.0 이상의 대형지진이 발생한 네팔, 일본, 중국 사례에서는 국제 NGO와 정부가 협력하여 재난대피소 내 아동친화공간에서 전문가를 통한 신체·심리사회·발달영역의 통합서비스를 제공하였다. 아동친화공간은 아동 맞춤형 식료품과 구호물품, 의료·위생서비스를 지원함과 동시에 아동이 안전한 공간에서 보호받으면서 심리치료와 상담, 놀이와 교육을 통해 재난으로 인한 피해를 최소화하고 조기에 회복할 수 있도록 하였다. 반면 아동친화공간을 도입하지 않은 한국의 포항지진 사례에서는 재난대피소에서 아동을 위한 물품과 공간, 서비스의 부족이 문제점으로 나타났다. 따라서 아동의 특성을 고려한 재난대피소 세부규정을 수립하고 대피소에 아동돌봄공간을 마련할 것을 제언하였다. 또한 아동심리지원의 문제점을 보완하는 매뉴얼 마련과 재난의 특수상황을 이해하고 대응할 수 있는 아동보호전문인력의 양성과 배치가 필요하다. This study introduced the concept, role, and cases of child-friendly spaces providing customized services to child disaster victims who have difficulty in protecting themselves and insufficient resilience due to their physical, psychological, and developmental characteristics. In Nepal, Japan and China experiencing earthquakes with a magnitude of 7.0 or higher, international NGOs and the government worked together to provide integrated services with experts in child-friendly spaces in disaster shelters. Child-friendly spaces were designed to help children minimize damage from disasters and recover early through psychological treatment, counseling, play and education as well as child-tailored services such as food, relief goods, medical and sanitation services. The 2017 Pohang earthquake in South Korea without child-friendly spaces lacked goods, spaces and services specifically for children in disaster shelters. This study suggested that the detailed regulations for disaster shelters should be established considering the characteristics of children and the child care areas should be provided in shelters. In addition, it is necessary to prepare a manual to resolve problems with child psychological support and to train professional experts who can protect and educate children in disaster situations.

생강(Zingiber officinale Roscoe) 뿌리, 줄기, 잎의 라디칼 소거 활성을 통한 산화스트레스 억제 효과

임푸름(Pu Reum Im),황혜정(Hye-Jeong Hwang),임정연(Jeong Yeon Im),황유진(Yu-Jin Hwang),남동건(Dong-Geon Nam),최정숙(Jeong-Sook Choe),황경아(Kyung-A Hwang) 한국식품영양과학회 2021 한국식품영양과학회지 Vol.50 No.2

본 연구에서는 신규 식품 원료로 등록된 생강 잎과 생강 줄기의 항산화 효과를 생강 뿌리와 비교 분석하였다. DPPH와 ABTS 라디칼 소거능에 의한 항산화력을 측정한 결과 모든 시료 추출물에서 농도 의존적으로 항산화력이 증가하는 경향이 나타났으며, 특히 100 μg/mL 농도에서 생강 뿌리(58%)와 생강 잎(35%)에서 우수한 항산화 효능을 확인하였다. NO 생성 억제 효과는 모든 시료에서 나타났으며, 특히 생강잎은 25~31%의 저해율을 보여 생강 뿌리(22~37%)와 유사하게 NO 생성 억제 효과가 나타나 우수한 효능을 확인하였다. 생강 줄기는 24~26%의 저해율을 보였으나 농도 의존성은 없었다. 세포 내 활성산소종 생성은 생강 뿌리(21~46%), 생강 잎(15~30%), 생강 줄기(2~11%) 순서로 억제 효과가 높게 나타났다. 항산화 기전을 확인하기 위해 항산화효소의 유전자 발현을 평가한 결과 생강 잎은 Cu/Zn-SOD와 Mn-SOD 유전자 발현을 높은 수준으로 증가시켰으며, GPx와 catalase는 생강 뿌리, 생강 잎, 생강 줄기 순서로 발현을 증가시키는 것으로 나타났다. 본 연구 결과를 통해 그동안 버려지던 생강 잎과 생강 줄기의 항산화 효과를 확인하였고 생강 잎에서 우수한 항산화 활성을 확인하여 향후 건강기능식품 소재로서 개발이 가능할 것으로 판단된다. 그러나 생강 잎에 관한 연구는 미비한 실정으로 향후 생강 잎추출물의 체내 생리활성 메커니즘 구명을 위한 동물실험 등의 추가적인 연구가 필요할 것으로 판단된다. In this study, the antioxidant effects of Zingiber officinale Roscoe leaves and stems which have been registered as new food ingredients were comparatively analyzed with Z. officinale Rosc. roots. The increase in antioxidant activity was concentration-dependent in all extracts, and excellent antioxidant activity was confirmed in the roots (58%) and leaves (35%) at 100 μg/mL. The inhibitory effect of nitric oxide production was found in all samples. In particular, the leaves showed an inhibitory rate of 25∼31%, an effect similar to that of the roots (22∼37%), confirming their excellent efficacy. The stems showed a 24∼26% inhibition rate, but the inhibition was not concentration- dependent. The inhibitory effect of the roots, stems and leaves of Z. officinale Rosc. on the reactive oxygen species production was highest in the roots (21∼46%), followed by leaves (15∼30%) and stems (2∼11%). Cu/Zn-superoxide dismutase (SOD) and Mn-SOD mRNA expressions were increased to high levels by the leaves. Glutathione peroxidase and catalase levels were in the increased in the roots, leaves, and stems, in that order. Through the results of this study, the antioxidant effects of Z. officinale Rosc. leaves and stems were confirmed, and excellent antioxidant activity was confirmed in the leaves. Z. officinale Rosc. leaves can therefore be considered for use as an antioxidant functional health food material in the future. However, since studies on the leaves are insufficient, additional studies in animals are needed to investigate the mechanism of the physiological activity of Z. officinale Rosc. leaves in the body.

Anti-inflammatory Activity of Agrimonia pilosa Ledeb. Extract in LPS-stimulated RAW264.7 Macrophages

Jeong-Sook Choe,Hee Sun Yang,Mi Jin Kim,Mina Kim,Pu Reum Im 한국식품영양과학회 2020 한국식품영양과학회 학술대회발표집 Vol.2020 No.10

허용기준 대상물질 13종 노출 실태 조사 연구 - 톨루엔-2,4-디이소시아네이트

최아름,임성국,이귀영,Choe, A-Reum,Im, Seong-Guk,Lee, Gwi-Yeong 대한산업보건협회 2014 산업보건 Vol.313 No.-