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Diagnostic Usefulness of the Spot Urine Sodium/Potassium Ratio in Cirrhotic Patients with Ascites
( Jin Wook Lee ),( Jae Seok Hwang ),( Woo Jin Chung ),( Heon Ju Lee ),( Jung Gil Park ),( Chang Hyeong Lee ),( Byung Seok Kim ),( Jeong Eun Song ),( Young Oh Kweon ),( Won Young Tak ),( Soo Young Park 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: A low-salt diet is considered important for the control of ascites in cirrhotic patients. The 24-hour (24-h) urine sodium (Na) excretion test is a standard method performed to determine low-salt diet compliance. Considering that measuring 24-h urine Na excretion is a time-consuming method, the spot urine Na/potassium (K) ratio can be alternatively measured. However, whether 24-h urine Na excretion can be alternatively replaced with the spot urine Na/K ratio has not been fully validated yet. Hence, this study aimed to validate whether the spot urine Na/K ratio could replace 24-h urine Na excretion in assessing low-salt diet compliance. Methods: A total of 192 patients with liver cirrhosis and ascites were screened. We prospectively studied 175 patients who met the inclusion criteria. Furthermore, 24-h urine collection was performed, and 5-mL spot urine was collected in the morning. Subsequently, 24-h urine Na, creatinine (Cr) level, and spot urine Na and K were assessed. A complete urine collection was confirmed based on 24-h Cr excretion levels of 15 mg/kg/day for men and 10 mg/kg/day for women. The area under the receiver operating characteristic (AUROC) curve analysis was performed to evaluate the feasibility of the spot urine Na/K ratio in predicting 24-h urine Na greater than 78 mmol/day. Results: Out of the 175 patients, 24-h urine samples were completely collected in 57 patients only. Moreover, urine samples were not completely collected in 118 patients because their 24-h urine Cr excretion level was less than the established criteria. There was no significant difference in age, sex, etiology of liver cirrhosis, Child-Pugh class, and Model for End-Stage Liver Disease score between the two groups. In the complete urine collection group, the AUROC curve for the spot urine Na/K ratio in predicting 24-h urine Na greater than 78 mmol/day was 0.874 ± 0.051 (P<0.001). In the incomplete urine collection group, the AUROC was 0.832 ± 0.039 (P<0.001). Both groups showed similar AUROC values. In the complete urine collection group, the classical cutoff value greater than 1.0 of the spot urine Na/K ratio showed 90.9% sensitivity, 56.0% specificity, 73.2% positive predictive value (PPV), and 82.4% negative predictive value (NPV). The best cutoff value for the spot urine Na/ K ratio was 1.5, with 87.9% sensitivity and 80.0% specificity. In all patients, the AUROC was 0.841 ± 0.031 (P<0.001), with 94.1% sensitivity, 47.9% specificity, 71.6% PPV, and 85.4% NPV when the cutoff value of the spot urine Na/K ratio was 1.0. Among the studied patients, 131 collected their urine during hospitalization. Complete urine collection did not differ between the inpatient group (34.4%) and the outpatient group (29.5%) (P=0.348). Conclusions: The spot urine Na/K ratio reflects 24-h urine Na, but the AUROC value obtained in this study is lower than that of a previous study. However, drawing conclusions based on the results of the study is difficult considering the large number of patients with incomplete urine collection. Even in hospitalized patients, several incomplete urine collections are observed, making it difficult to accurately check 24-h urine Na. Therefore, a method that more easily identifies low-salt diet compliance in cirrhotic patients with ascites is required in the future.
( Heon Ju Lee ),( Jeong Min Kim ),( Young Oh Kweon ),( Soo Young Park ),( Jeong Heo ),( Hyun Young Woo ),( Jae Seok Hwang ),( Woo Jin Chung ),( Chang Hyeong Lee ),( Byung Seok Kim ),( Jeong Ill Suh ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
Aims: Tenofovir (TDF) monotherapy is a standard treatment for patientswho have lamivudine (LAM)-resistant chronic hepatitis B (CHB).However, the efficacy of switching to TDF monotherapy for LAMresistant CHB patient with undetectable HBV DNA while on LAMplus adefovir (ADV) combination therapy (stable switching) is notclear.Methods: In this non-inferiority trial, LAM-resistant CHB patients whohad undetectable serum HBV DNA (<20 IU/mL) for more than 6months after initiating LAM plus ADV combination therapy wererandomized (in a 1:2 ratio) to continue LAM plus ADV combinationtherapy (LAM/ADV group, n=58) or TDF monotherapy (TDF group,n=111) and followed-up with serum biochemistry and HBV DNA in12 week intervals for 96 weeks. The primary endpoint of this studywas the proportion of patients with viral reactivation at week 96.Viral reactivation was defined as HBV DNA >40 IU/mL at two consecutivetimepoints, or persistent HBV DNA levels of 20-40 IU/mL atthree consecutive timepoints.Results: A total of 169 CHB patients were enrolled in this study including74 with compensated cirrhosis. There were no significant differencesbetween two groups in age, gender, biochemistry findingsand duration of LAM and ADV combination therapy at baseline.Twelve (20.7%) patients in the LAM/ADV group and 18 (16.2%)patients in TDF group were HBeAg-positive. Nine patients (4 in theLAM/ADV group and 5 in the TDF group) discontinued the study.After a mean follow up period of 96 weeks, there was no subjectin either group experienced viral reactivation in both groups. Onepatient achieved HBsAg seroconversion in TDF group (1/106, 0.94%).The number of patients with HBeAg loss at week 96 was 5/12(41.7%)and 3/17(17.6%) in the LAM/ADV and TDF groups, respectively. Twopatients (2/17, 11.8%) achieved HBeAg seroconversion in TDF group.Transient virological rebound occurred in 14 patients (6 patients inLAM/ADF group and 8 patients in TDF group) through 96 weeks,but all patients achieved HBV DNA undetectable at the next visit.There were no patients experienced an increase of serum creatininelevels of ≥0.5 mg/dL above baseline.Conclusions: Stable switching to TDF monotherapy for 96 weekshowed a comparable virological response to continuous LAM plusADV combination therapy in LAM resistant CHB patients with undetectableHBV DNA. (Trial registration number Clinicaltrial.gov IDNCT01732367)
Minoxidil 외용액에 의한 알레르기성 접촉피부염 1예
강권수,이보현,한희진,박천욱,이철헌 대한피부과학회 2004 大韓皮膚科學會誌 Vol.42 No.4
Minoxidil (2, 6-diamino-4-piperidinopyrimidine 1-oxide) is a systemic antigypertensive agent, the topical application of which has been shown to produce hair growth. Topical minoxidil solution (5% minoxidil, propylene glycol, alcohol, water) has generally been well-tolerated, but allergic contact dermatitis has been reported. When allergic contact dermatitis to minoxidil solution is suspected, evaluation of ingredients of minoxidil solution should be performed because allergic contact dermatitis due to propylene glycol in minoxidil solution has been frequently reported. A 34-year-old male presents with a diffuse erythematous patch on the scalp. He has applied minoxidil solution for 7 days due to androgenic alopecia. A Patch test with Korean standard series and the ingredients of used topical agents showed positive reactions to 1%, 2% and 5% minoxidil solution. (Korean J Dermatol 2004;42(4):500~502)
강권수,전진곤,한희진,박천욱,이철헌 대한피부과학회 2003 大韓皮膚科學會誌 Vol.41 No.7
Shiitake (Lentinus edodes) is nowadays the second most commonly produced edible mushroom in the world. Two patients complained of severe itching and showed widespread disseminated very small erythematous papule and characteristic linear grouped erythematous papules after scratching (Ko¨bner phenomenon). Here we report two cases of mushroom intolerance which developed after ingestion of boiled or cooked shiitake mushrooms. (Korean J Dermatol 2003;41(7) : 974~976)
권진경 ( Jin Kyung Kwon ),김형권 ( Hyung Kweon Kim ),윤성욱 ( Sung Wook Yun ),김성헌 ( Sung Heon Kim ),장세훈 ( Se Hun Jang ) 한국농업기계학회 2023 한국농업기계학회 학술발표논문집 Vol.28 No.2
최근 온실의 연동화와 규모화가 진행됨에 따라 고측고의 온실이 국내에도 많이 보급되고 있다. 이러한 온실은 열부력에 의해 상하부의 환경 불균일이 발생하며, 주로 토마토, 파프리카 등의 유인성 작물을 재배하므로 일반적인 순환팬으로는 작물군락에 공기유동을 조성하기가 어렵다. 환경 불균일에 의해 발생하는 에너지소비, 생육 불균일, 과습 등의 피해를 저감하고 작물 군락에 적정 풍속을 조성하여 엽면경계층을 감소키기 위해 온실 상부에 설치하여 수직방향으로 순환하는 확산기류를 생성할 수 있는 확산형 순환팬을 설계하고 성능평가를 수행하였다. 순환팬은 하측방으로 기류를 생성하여 직하부에 음압을 형성함으로 전체적 상승-하강 순환기류를 생성한다. 운전 모드는 난방모드, 환경균일화모드, 군락기류조성모드, 고온기 환기모드 등으로 구성하였으며 9엽/각도고정형/원형암의 시작기를 이용하여 연기유선 시험을 수행한 결과 중앙상승기류 및 역회전시 상부로의 환기기류가 발생하는 것을 확인하였다. 동고 8.3m의 벤로형 비닐온실 테스트베드(972m2)에 6대의 확산형 순환팬을 설치한 후 기존의 관행 수평형 순환팬과 비교시험을 수행하였다. 동절기 난방 시 온실 상하부의 온도차이는 관행 온실은 4°C 였으나 확산형 순환팬 온실은 0.5°C로 균일도가 매우 높게 나타났다. CO2 시용시 온실 상하부의 농도차이는 확산형 순환팬이 상대적으로 작았으나 가스 확산에 의해 그 차이는 크지 않았다. 상하부의 온도편차 감소로 인해 난방기의 가동횟수가 감소하여 난방열량은 약 17%가 감소하는 것으로 나타났다. 하절기의 경우 온실 상하부의 온도차이는 주간에는 확산형 순환팬이, 야간에는 관행 순환팬이 크게 나타났으며, 이는 확산형 순환팬이 온실 하부덕트의 냉기가 상승하는 것을 막는 역할을 했기 때문으로 판단되었다. 기류분석을 통해 확산현 순환팬의 온실 설치기준을 검토하였다. 그 결과 확산형 순환팬은 설치간격은 12m, 바닥에서 최대6m, 상부구조물에서 0.5m, 기둥 등에서 2m의 이격을 두는 것이 적절한 것으로 나타났다.