Original Articles : Clinical significance of occult hepatitis B virus infection in chronic hepatitis C patients

( Jae Young Jang ),( Soung Won Jeong ),( Sung Ran Cheon1 ),( Sae Hwan Lee1 ),( Sang Gyune Kim ),( Young Koog Cheon ),( Young Seok Kim1 ),( Young Deok Cho1 ),( Hong Soo Kim ),( So Young Jin ),( Yun Soo 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.3

Background/Aims: We investigated the frequency of occult hepatitis B virus (HBV) infection in anti-hepatitis C virus (HCV)-positive individuals and the effects of occult HBV infection on the severity of liver disease. Methods: Seventy-one hepatitis B virus surface-antigen (HBsAg)-negative patients were divided according to their HBV serological status into groups A (anti-HBc positive, anti-HBs negative; n=18), B (anti-HBc positive, anti-HBs positive; n=34), and C (anti-HBc negative, anti-HBs positive/negative; n=19), and by anti-HCV positivity (anti-HCV positive; n=32 vs. anti-HCV negative; n=39). Liver biopsy samples were taken, and HBV DNA was quantified by real-time PCR. Results: Intrahepatic HBV DNA was detected in 32.4% (23/71) of the entire cohort, and HBV DNA levels were invariably low in the different groups. Occult HBV infection was detected more frequently in the anti-HBc-positive patients. Intrahepatic HBV DNA was detected in 28.1% (9/32) of the anti-HCV-positive and 35.9% (14/39) of the anti-HCV-negative subjects. The HCV genotype did not affect the detection rate of intrahepatic HBV DNA. In anti-HCV-positive cases, occult HBV infection did not affect liver disease severity. Conclusions: Low levels of intrahepatic HBV DNA were detected frequently in both HBsAg-negative and anti-HCV-positive cases. However, the frequency of occult HBV infection was not affected by the presence of hepatitis C, and occult HBV infection did not have a significant effect on the disease severity of hepatitis C. (Korean J Hepatol 2011;17:206-212)

실과 교실원예 프로그램이 학업 성취에 미치는 효과

김장수,조선행,김형균 韓國實科敎育硏究學會 2002 實科敎育硏究 Vol.8 No.1

The purpose of this study was to examine educational effectiveness for the classroom horticulture program that can be utilized in the culture domain of practical arts in elementary school. The subjects in this study were students in two sixth grade class of elementary school. The statistical technique used for the academic achievement were percentage and t-test. The findings of this study were as follows: (1) when the two class were compared with each other after experiment, the experiment class were significantly better in cognitive achievement than the control class; (2) the culture skill achievement of the experiment class students was higher than that of control class students; (3) most students of the experiment class responded that the classroom horticulture program was very enjoyable and attractive. A summarized above, It was found that the classroom horticulture program for the academic achievement by the elementary school students in practical arts was more effective than the conventional one.

방사선조사와 Paclitaxel의 병합요법에 의한 신내막 과증식억제

장기육,승기배,강동헌,임상현,정해억,임효영,김태균,김연실,채장성,김재형,홍순조,윤세철,최규보 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.6

Efficacy and Safety of Fexuprazan in Patients with Acute or Chronic Gastritis

Kim Gwang Ha,Choi Myung-Gyu,Kim Jin Il,Lee Soo Teik,Chun Hoon Jai,Lee Kook Lae,Choi Suk Chei,Jang Jae-Young,Lee Yong Chan,Kim Jae Gyu,Kim Ki Bae,Shim Ki-Nam,Sohn Chong Il,Kim Sung Kook,Kim Sang Gyun,J 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.6

Background/Aims: Fexuprazan is a novel potassium-competitive acid blocker that could be of benefit to patients with gastric mucosal injury. The aim of this study was to assess the 2-week efficacy and safety of fexuprazan in patients with acute or chronic gastritis. Methods: In this study, 327 patients with acute or chronic gastritis who had one or more gastric erosions on endoscopy and subjective symptoms were randomized into three groups receiving fexuprazan 20 mg once a day (q.d.), fexuprazan 10 mg twice a day (b.i.d.), or placebo for 2 weeks. The posttreatment assessments were the primary endpoint (erosion improvement rate), secondary endpoints (cure rates of erosion and edema and improvement rates of redness, hemorrhage, and subjective symptoms), and drug-related adverse events. Results: Among the patients, 57.8% (59/102), 65.7% (67/102), and 40.6% (39/96) showed erosion improvement 2 weeks after receiving fexuprazan 20 mg q.d., fexuprazan 10 mg b.i.d., and placebo, respectively. Both fexuprazan 20 mg q.d. and 10 mg b.i.d. showed superior efficacy to the placebo (p=0.017 and p<0.001, respectively). Likewise, both fexuprazan 20 mg q.d. and 10 mg b.i.d. also showed higher erosion healing rates than the placebo (p=0.033 and p=0.010, respectively). No difference was noted in the edema healing rate and the improvement rates for redness, hemorrhage, and subjective symptoms between the fexuprazan and placebo groups. No significant difference was noted in the incidence of adverse drug reactions. Conclusions: Fexuprazan 20 mg q.d. and 10 mg b.i.d. for 2 weeks showed therapeutic efficacy superior to that of placebo in patients with acute or chronic gastritis

Overestimation and Underestimation of Liver Fibrosis Stage Classification Assessed by Transient Elastography and Two-Dimensional Shear Wave Ultrasound

( Sang Gyune Kim ),( Jeong Joo Yoo ),( Young Seok Kim ),( Bora Lee ),( Soung Won Jeong ),( Jae Young Jang ),( Sae Hwan Lee ),( Hong Soo Kim ),( Young Don Kim ),( Gab Jin Cheon ),( Boo Sung Kim ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: The accuracy of detailed fibrosis stage classification assessed with transient elastography (fibroscan) was only 65% and, what is more, significant discrepancy rate (≥ 2 fibrosis stage) reached up to 13%. Several causative factors such as age, elevated liver enzyme, body mass index (BMI), skin to liver distance (SLD) are considered to contribute to this discrepancy, but there are few authentic evidences of what really works. In this study, we compared the discordance of fibrosis stage classification between fibroscan and two-dimensional shear wave ultrasound (2D-SWE) and looked for which variables are related with it. Methods: Patients who had a valid measurement and an adequate liver biopsy specimen were 291. The fibrosis stage classifications derived from the cumulated cut-offs calculated for different fibrosis stage by fibroscan as well as 2D-SWE. The discrepancy score took into account the size of error between fibrosis stage (Metavir) and fibrosis stage classification (fibroscan, 2D-SWE). This score was defined as follows: 0 for correct classification, then 1, 2, or 3 as per the misclassification in fibrosis stages. Results: Patients were male predominant (54.0%), their mean age was 48.9±13.5 years old. Liver fibrosis stage consisted of F0 (13.4%), F1 (22.0%), F2 (24.1%), F3 (16.8%) and F4 (23.7%). The optimal cut-off for each fibrosis stage observed by fibroscan was 6.9 (≥F2), 7.9 (≥F3), 10.4 (F4) and 6.7 (≥F2), 7.1 (≥F3), 10.0 (F4) by 2D-SWE. Accurate assessment of fibrosis stage classification by discrepancy score showed that the proportion of underestimation and overestimation was 19.6%, 22.0% in fibroscan, and 21.0%, 17.9% in 2D-SWE. The descrepancy score of fibroscan was higher than that of 2D-SWE (p=0.032). In multivariate analysis, viral liver disease, shorter SLD, lower prothrombin time were associated with underestimation in both fibroscan and 2D-SWE. Longer SLD and higher AST level significantly increased overestimation in fibroscan and, in 2D-SWE along with age. When a skin to liver distance is over 2.5cm, 80.0% (12/15) of fibroscan and 46.7% (7/15) of 2D-SWE were overestimated. Conclusions: Liver fibrosis stage in fairly large number of patients is misclassified by either fibroscan or 2D-SWE. Skin to liver distance rather than BMI was most important factor to affect the over and underestimation of liver fibrosis classification.

Comparison of serum cystatin C based and Creatinine based GFR equations for estimation of kidney function in patients with Liver cirrhosis

Sang Gyune Kim,Young Seok Kim,Hyung Ki Kim,Seung Won Jung,Jae Young Jang,Hong Soo Kim,Moon Sung Lee,Boo Sung Kim 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.3(S)

The Comparison of Long-term Survival in Cirrhotic Patients with Significant Ascites and Esophageal Varices According to the Treatment Modality between Endoscopic Variceal Ligation and Non-selective Beta-blockers

( Sang Gyune Kim ),( Jeong-ju Yoo ),( Young Seok Kim ),( Bora Lee ),( Soung Won Jeong ),( Jae Young Jang ),( Sae Hwan Lee ),( Hong Soo Kim ),( Young Don Kim ),( Gab Jin Cheon ),( Boo Sung Kim ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Non-selective beta-blocker (NSBB) use has been established in the primary and secondary prevention of esophageal variceal hemorrhage. However, the use of beta-blockers in cirrhotic patients with ascites is still under debate. In this study, we compared overall survival (OS) in cirrhotic patients with ascites (≥grade 2) and esophageal varices according to their treatment strategies between endoscopic band ligation (EBL) and NSBB. Methods: This retrospective study included consecutive 269 patients who were diagnosed as liver cirrhosis complicated with esophageal varices and ascites (≥grade 2) in a tertiary single center in Korea. Patients were divided into 3 groups which were EBL only, NSBB, non-treatment group. A Cox-proportional hazard analysis was performed to compare overall survival between the groups. Results: The mean age was 53.8±10.9 years, and median follow-up duration was 37.7 months (IQR, 12.4-65.2). Overall survival was significantly shorter in the NSBB group followed by non-treatment group and EBL only group (median, 47.5 vs. 61.1 vs. 77.0 months; P=0.003). A multivariate analysis showed that the use of NSBB were an independent poor prognostic factor for shorter overall survival (adjusted hazard ratio, 1.98; 95% confidence interval, 1.31-2.98; P<0.001) after adjusted by Child-Pugh class. Conclusions: The use of NSBB worsens the prognosis of cirrhotic patients patients with significant ascites. These results suggest that EBL is a more appropriate treatment option of esophageal varices when complicated with ascites (≥grade 2).

The Validity of Two-dimensional Shear Wave Ultrasound (GE Elastography) for Assessing Fibrosis Stage in Patients with Chronic Liver Disease

( Sang Gyune Kim ),( Jeong Joo Yoo ),( Young Seok Kim ),( Bora Lee ),( Soung Won Jeong ),( Jae Young Jang ),( Sae Hwan Lee ),( Hong Soo Kim ),( Young Don Kim ),( Gab Jin Cheon ),( Boo Sung Kim ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Several real-time two-dimensional shear wave elastography (2D-SWE) have been developed to assess liver fibrosis with readily use of combining elastography and traditional ultrasound imaging. However, compared with transient elastography (fibroscan), the diagnostic accuracy and clinical usefulness of these methods were not fully validated. In this study, newly developed 2D-SWE (LOGIQ E9, GE healthcare, UK) was evaluated for predicting liver fibrosis stage and compared with fibroscan. Methods: Out of 1,395 patients who received 2D-SWE during May 2015 to Apr 2016, seventy (5.0%) who failed to get available value of 2D-SWE due to obesity and 131 (9.4%) with high value of AST or ALT were excluded in the analysis. Liver biopsy was performed in 177 patients. 2D-SWE measurement was considered valid when homogenous color pattern in a region of interest of at least 10 mm was shown at 10 different sites. Diagnostic performance was calculated using area under the receiver operating characteristics curve (AUROC). Results: Patients were male predominant (60.8%), their mean age was 50.4±12.4 years old and most common etiology of liver disease was hepatitis B (40.3%) followed by alcohol (26.1%). Liver fibrosis stage consisted of F0 (14.1%), F1 (12.4%), F2 (28.8%), F3 (18.1%) and F4 (26.6%). Overall, 2D-SWE was well correlated with transient elastography (r=0.788, P<0.001). 2D-SWE median values (kPa) increased with increasing stage of liver fibrosis [ F0 (5.0±1.5), F1 (6.4±2.3), F2 (6.5±2.0), F3 (9.0±2.7), F4 (12.7±2.9)] (p for trend <0.001). For the diagnosis of liver cirrhosis, AUROCs and optimal cutoff of 2D-SWE were 0.928 (95% confidence interval [CI], 0.890-0.967) and 10.1 kPa. The sensitivity, specificity, positive predictive value and negative predictive value for predicting cirrhosis were 82.2%, 92.2%, 78.7% and 93.7% respectively. For diagnosing significant liver fibrosis (≥F2), AUROCs and optimal cutoff of 2D-SWE were 0.913 (95% CI, 0.870-0.956) and 7.99 kPa. Conclusions: With effective comparability to fibroscan and availability of a conventional ultrasound examination, 2D-SWE is an useful tool for stratifying liver fibrosis stage and diagnosing liver cirrhosis.

How to Define Splenomegaly in the Diagnosis of Liver Cirrhosis? : Significance of Splenic Volume MeasurementUsing Ultrasonography

( Sang Gyune Kim ),( Jeong-ju Yoo ),( Young Seok Kim ),( Bora Lee ),( Soung Won Jeong ),( Jae Young Jang ),( Sae Hwan Lee ),( Hong Soo Kim ),( Young Don Kim ),( Gab Jin Cheon ),( Boo Sung Kim ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: To date, there is no acceptable criteria of spleen size for the clinical diagnosis of liver cirrhosis even though the recent Baveno consensus states splenomegaly is an adjunctive finding to define liver cirrhosis. We evaluated how relevant spleen volume (SV) measured by ultrasonography is to liver fibrosis stage and investigated the optimal cut-off of SV for liver cirrhosis. Methods: Total 431 patients whose SV was measured by ultrasonography (length x height x width x π/6) and got a liver biopsy for various reasons were included in this study. Spleen volume/body surface area (SV/BSA) in each patient was used for sensitivity analysis. Fibroscan score (kPa) was compared to SV for the relation with liver fibrosis stage. Clinical and laboratory findings were also collected. Results: The baseline characteristics of the patients were as follows: mean age (49.1±12.2), slightly male predominance (223/431, 51.7%), mean BSA (1.7±0.2 m2), most common etiology of liver disease is hepatitis B (190, 44.1%), mean MELD score (9.7±4.1), Child-Pugh class [(A/B/C, 339(78.7%)/75(17.4%)/17(3.9%)], fibrosis stage [F0/F1/F2/F3/F4, 35(8.1%)/40(9.3%)/69(16.0%)/56(12.99%)/231(53.6%)]. SV was significantly larger in young age (<40), male sex, viral hepatitis, high BSA, high MELD and Child-Pugh score. SV was also well correlated with fibroscan score (r=0.509, p<0.001). Mean SV (ml) according to fibrosis stage was F0 (169±59), F1 (189±99), F2 (198±82), F3 (236±79), F4 (457±283). AUROCs of SV and SV/SBA for predicting cirrhosis were 0.891 (95% confidence interval, 0.862-0.921), 0.905 (95% CI, 0.878-0.932). Optimal cut-off of SV and SV/SBA for the diagnosis of cirrhosis were 268ml, 161ml respectively. Conclusions: SV measured by ultrasonography was closely associated with severity of liver disease and fibrosis stage. SV measurement using ultrasonography is useful as a supplementary method for the diagnosis of liver cirrhosis.

Effect of Helicobacter pylori Treatment on Long-term Mortality in Patients with Hypertension

Young-Il Kim,Young Ae Kim,Jang Won Lee,Hak Jin Kim,Su-Hyun Kim,Sang Gyun Kim,Jin Il Kim,Jae J. Kim,Il Ju Choi 거트앤리버 소화기연관학회협의회 2020 Gut and Liver Vol.14 No.1

Background/Aims: A meta-analysis of randomized trials performed in healthy asymptomatic individuals suggested that overall mortality may increase after Helicobacter pylori eradication despite a significant decrease in the gastric cancer incidence and mortality rates. This retrospective population-based cohort study investigated if H. pylori treatment is associated with an increase in overall mortality in patients with hypertension. Methods: From the database of the Korean National Health Insurance Sample Cohort, we selected 198,487 patients treated for hypertension between 2002 and 2010. Those who received H. pylori treatment (H. pylori treatment cohort, 5,541 patients) were matched to those who did not (nontreatment cohort, 11,082 patients) at the ratio of 1 to 2. The primary outcome was the risk of overall mortality. The secondary outcomes were the risks of mortality due to cardiovascular disease, cerebrovascular disease, and cancer. The outcomes were evaluated from 6 months after H. pylori treatment to December 2013. A Cox proportional hazard model was used to estimate the hazard ratios (HRs). Results: During a median follow-up period of 4.8 years, death from any cause was reported in 4.1% of the patients in the H. pylori treatment cohort and 5.5% of the patients in the nontreatment cohort. The adjusted HR (aHR) for overall mortality in the H. pylori treatment cohort was 0.70 (95% confidence interval [CI], 0.60 to 0.82; p<0.001). With regard to cause-specific mortality, compared with the nontreatment cohort, the H. pylori treatment cohort had a lower risk of mortality due to cerebrovascular disease (aHR, 0.46; 95% CI, 0.26 to 0.81; p=0.007). The risks of mortality due to cancer and cardiovascular disease were not different between the cohorts. Conclusions: H. pylori treatment is not associated with an increase in overall mortality in patients treated for hypertension.