Impact of Interferon-Based Treatment on Quality of Life and Work Related Productivity from the Korean Cohort in the MOSAIC Study

( Sang Hoon Ahn ),( Won Hyeok Choe ),( Yoon Jun Kim ),( Jeong Heo ),( Dorota Latarska-smuga ),( Jiho Kang ),( Seung Woon Paik ) 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Chronic Hepatitis C Virus (HCV) infection increases the risk for progressive liver disease, hepatocellular carcinoma and negatively impacts the patient’s quality of life. HCV treatment is evolving with direct acting antivirals but IFN based therapy has been the standard of care for many years and remains available in some countries. The MOSAIC study aims to characterize patients with chronic HCV infection and assess the impact of IFN-containing treatment on health-related quality of life, work related productivity and health care utilization. Methods: MOSAIC is an international prospective multicenter observational study that has been conducted in 20 countries. Consecutive patients with chronic HCV infection were enrolled and those who initiated an IFN based regimen were prospectively followed for 48 weeks. We report results from the Korean cohort Results: 100 patients were enrolled: 86 were treatment naïve and 14 were treatment experienced. 33 patients initiated an IFN based regimen: 6 patients started IFN + RBV, 26 patients started Peg-IFN + RBV, none started Peg-IFN + RBV + DAA and 1 patient received other treatment. Among the treated cohort, demographic and disease characteristics were the following: the mean age was 54.5 years; 14 patients were male. 14 had minimal or no fibrosis, 2 portal fibrosis, 3 bridging fibrosis and 6 patients suffered from cirrhosis. HCV Genotype distribution was as follows: genotype 1: 11; genotype 2: 19 and genotype 3: 3. Table 1 describes the results at baseline and changes over 4, 12 and 48 weeks and end-of-treatment (EOT) for the quality of life and work productivity outcome measures (EQ-5D-5L, HCV-PRO and WPAI). Conclusions: Results from the Korean cohort of the MOSAIC study show a moderate trend for deterioration of health-related quality of life and work productivity associated with IFN based treatment for patients with chronic HCV infection during treatment period. Acknowledgements: The design, study conduct, analysis, and financial support of MOSAIC study were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the content of the abstract. All authors had access to all relevant data and participated in writing, review, and approval of this abstract. Medical writing support was provided by Olivier Van de Steen of Medeor-consulting, funded by AbbVie. Disclosures: Sang Hoon Ahn: served as an advisor and lecturer for Bristol-Myers Squibb, Gilead Sciences, F.Hoffmann-La Roche, Merck, AbbVie, and has received unrestricted grants from Bristol-Myers Squibb, Gilead Sciences, and F. Hoffmann-La Roche for investigator- initiated trials Won Hyeok Choe: Nothing to disclosure Yoon Jun Kim: Nothing to disclosure Jeong Heo: received a grant from GSK; Research support from BMS, and Roche; Advisor for Abbvie, BMS, Gilead Sciences, Pharma Essentia, SillaJen, and Johnson & Johnson. Dorota Latarska-Smuga, Jiho Kang: are employees of AbbVie, Inc. and may hold stock or stock options. Seung Woon Paik: received grant and research support from AbbVie, BMS, Gilead, GSK, Merck, Novartis, and Roche

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

기관지천식 환자에서 Furosemide, Disodium cromoglycate 및 Heparin 흡입이 고장액 식염수 기관지유발검사에 미치는 영향

강천일,현상훈,남언정,김건우,윤종수,서영익,이종명,김능수 慶北大學校 醫科大學 1996 慶北醫大誌 Vol.37 No.3

목적 : 기관지천식 환자에서 고장액 식염수의 흡입은 기도수축을 유발할 수 있으며 이는 운동유발성 천식반응과 밀접한 관계가 있는 것으로 알려져 있다. 저자들은 알레르겐 흡입이나 운동에 의해 유발되는 천식에 예방효과가 있는 것으로 알려진 disodium cromoglycate(DSCG), furosemide 및 heparin 흡입이 4.5% NaCl 기관지유발검사(BPT)에 미치는 영향을 조사하였다. 대상 및 방법 : 4.5% NaCl BPT에서 양성반응을 보이는 기관지천식 환자 13명을 대상으로 하였으며 사용된 약물은 furosemide 40㎎, DSCG 40㎎ 및 heparin 1,000μ/㎏이었다. 먼저baseline 4.5% NaCl BPT를 시행한 다음 이들 약물로 전처치후 다시 4.5% NaCl BPT를 시행하여 약물의 효과를 관찰하였다. 결과 : Furosemide 40㎎, DSCG 40㎎및 heparin 1,000μ/㎏의 흡입 전처치는 고장액 식염수에 의한 기도수축 반응에 뚜렷한 예방효과를 보였다. Furosemide와 DSCG로 전처치한 군(n=6)에서 이들의 기도수축 방어율은 각각 100.6±6.6%, 91.1±17.2%였으며 furosemide와 heparin으로 전처치한 군(n=7)에서는 각각 58.7±29.2%, 59.0±51.1%로서 각 군에서 이들 약제간의 방어율에는 유의한 차이가 없었다. 결론 : Furosemide(40㎎), DSCG(40㎎) 및 heparin(1000μ/㎏)의 흡입 전처치는 고장액 식염수에 의한 기도수축 반응에 뚜렷한 예방효과를 보였으며, 적어도 이 용량에서 기도수축 예방 정도에는 유의한 차이가 없음을 알 수 있었다. Background: Hypertonic saline (4.5% NaCl) inhalation is known to induce broncho-constriction by affecting mast cell, epithelial cell and vagal afferent pathway in some asthmatics. Disodium cromoglycate (DSCG) is known to have a preventive effect on allergic asthma and exercise induced asthma, and recently it was reported that furosemide and heparin had similar effect. The purpose of this study was to evaluate the effects of furosemide, DSCG and heparin on hypertonic saline provocation test in asthmatics. Methods: Thirteen asthmatics with a positive response to hypertonic saline challenge were enrolled. Hypertonic saline and test drugs were generated by ultrasonic nebulizer. After taking baseline 4.5% NaCl challenge, subjects were rechallenged with 4.5% NaCl after inhalation of furosemide 40㎎, DSCG 40㎎ or heparin 1,000μ/㎏. Results: 1. There was a significant positive relationship between PC_20-methacholine and PTM-4.5% NaCl(r=0.5575, p = 0.024). 2. Furosemide, DSCG and heparin had no direct bronchodilating effects. 3. Premedication of furosemide and DSCG(n=6) showed significant protective effects on 4.5% NaCl induced broncho-constriction. The average protection rate were 100.6±6.6% and 91.1±17.2%, respectively. 4. Premedication of furosemide and heparin(n=7) showed significant protective effects on 4.5% NaCl induced broncho-constriction. The average protection rate were 58.7±29.2% and 59.0±51.1%. respectively. Conclusions: Furosemide(40㎎), DSCG(40㎎) and heparin(1.000μ/㎏) had significant protective effects on hypertonic saline induced broncho-constriction in asthmatics, and there were no significant differences in their potency of protection rate.

驅動部 動特性을 高慮한 可變構造 制御 알고리듬

강익호,김정욱,신휘범,이정훈,고상호 慶尙大學校生産技術硏究所 1997 生産技術硏究所論文集 Vol.13 No.-

In this paper, the dynamics of actuators for generating the input of plants is considered in a design of the variable structure systems. While the input for plants is usually implemented by means of a certain actuator, the actuator dynamics is not incorporated in most of the VSS researches until now. The control algorithm of a VSS incorporating actuator dynamics is presented. and the simulation is given the usefulness of the algorithms.

두부외상후 우울기분을 보이는 환자의 특성에 관한 연구

강호성,이병회,김상훈 조선대학교 부설 의학연구소 1998 The Medical Journal of Chosun University Vol.23 No.2

Objective : This study was undertaken to identify the clinical and pathoanatomical correlates of depressed mood in patients with closed head injuries. Method : A consecutive series of 66 patients were examined by means of a semistructured psychiatric interview. The Hamilton Depression Rating Scale as well as scales measuring impairment in activities of daily living, intellectual functioning, and social functioning were administered. The patients' CT scans were also examined. Patients fulfilling criteria for depressed symptoms in PSE and DSM-Ⅳ were divided 2 groups based on the presence of depressed mood and compared to patients without depressed mood for background characteristics, impairment variables, and lesion characteristics. Results : There were 19 patients (28.8%) with depressed mood. The presence of left dorsolateral frontal lesion and/or left basal ganglia lesions and, to a lesser extent, parietal lesions was associated with increased probability of developing depressed mood. Conclusions : Depressed mood occures in about one-quarter of patients after traumatic brain injury. The findings suggest that the common symptom of post-brain injury depressed mood appears to be provoked by injury to certain critical brain lesions.

The Effect of Epidural Ketamine used with Patient-Controlled Analgesia on Postoperative Pain

강훈,박상희,이동훈 충북대학교 의과대학 충북대학교 의학연구소 2008 忠北醫大學術誌 Vol.18 No.1

Purpose: Acute pain can be abolished by intravenous administration of ketamine in doses insufficient to induce anesthesia. Therefore we designed this study to see if this subanesthetic dosage of ketamine administered epidurally with patient-controlled analgesia (PCA) after abdominal surgery can also provide sufficient analgesic effect on postoperative pain. Materials and Methods: 20 consecutive patients were allocated randomly to receive either ketamine (n=10) or placebo (n=10) for pain relief after surgery. At 30 minutes before the end of surgery patients were attached to an PCA infusor programmed to epidurally deliver same amount of placebo or ketamine 3-5 mg/h (72-120 mg/day) in combination with background PCA regimen composed of bupivacaine, morphine, fentanyl etc for 48 hours postoperatively. Patients were evaluated for pain on ten-point Verbal Analogue Scale (VAS) and nausea on a four-point scale at 30 minutes, and 1, 6, 12, 24 hours after surgery. Results: The pain score in the placebo group is not significantly higher than in ketamine group postoperatively. While the pain scores in the two groups were very similar, throughout the 24 hours period, the incidence of nausea/emesis was also similarly low in both groups. Conclusion: It was found that a fixed rate epidural infusions of ketamine (3-5 mg/h) are ineffective in controlling pain after surgery. 연구목적: 강력한 진통작용를 나타내는 케타민은 마취농도 이하의 용량을 정맥투여함으로써 수술 후 통증같은 급성 통증을 치료할 수 있다. 저자들은 이와 같은 마취농도 이하의 저용량을 경막외에 투여하는 경우도 급성통증에 비슷한 효과가 있는지 알아보고자 본 연구를 시행하였다. 대상 및 방법: 연구 대상 환자는 충북대학교병원 수술실에서 복부에 정규 외과 수술을 받은 후 48시간 이상 자가통증조절(Patient-Controlled Analgesia)을 이용하여 통증치료를 받은 성인 남녀 환자들이며 환자들은 무작위로 ketamine군(n=10)과 위약 대조군(placebo, n=10)의 두 군으로 나누고 수술 종료 30분 전에 미리 준비한 patient-controlled analgesia에 ketamine (3-5 mg/h) 혹은 placebo를 섞어서 투여하기 시작하였다. 수술 후 회복실 또는 병실에서 필요한 경우 급성통증을 예방하기 위하여 ketorolac 30 mg을 정맥 투여하였다. 환자의 통증과 부작용에 대한 평가는 회복실에서 그리고 수술 후 1, 6, 12, 24 시간에 시행하였다. 결과: 두 군 간에 인구학적 차이는 없었으며 수술 직 후 회복실에서 통증의 정도는 두 군 간에 유의한 차이가 없었으며 오심 및 구토 등의 부작용도 의미 있는 차이를 보여주지 않았다. 결론: 마취농도 이하의 저용량의 ketamine (3-5 mg/h)을 경막외에 투여하는 경우 의미있는 진통효과를 보여주지 못하였다.

地域産業振興政策을 위한 分析의 틀(Framework)에 관한 硏究 : 日本의 事例硏究와, Nutt와 Backoff의 第3섹터에 관한 管理戰略을 中心으로

康榮勳,金性俊 濟州大學校 法과 政策硏究所 1997 法과 政策 Vol.- No.3

전기경련치료(ECT)시 뇌파의 비선형 분석 : 단일증례 연구 A Single Case Study

강웅구,이운철,정선주,윤세창,조맹제,이상훈,김용식 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.5

연구목적 : 비선형 분석을 통해 전기경련 치료(ECT)의 적절성 및 효과를 판정할 수 있는 새로운 변인을 추출해 낼 가능성을 탐색하기 위하여 한 여성 우울증 환자에서 ECT중 기록한 뇌파의 단일증례 분석을 하였다. 방 법 : 1주일 간격을 둔 두 ECT 회기에서 치료전 안정상태, 마취후-경련전상태, 경련상태, 경련후 뇌파억제상태, 치료후 안정상태의 다섯 상태에 따른 뇌파를 디지털 기록한 데이터를 분석하였다. 결 과 : 분석의 결과 1) 뇌파가 10차원 이하 저차원의 결정론적 성질을 가지고있으며 2) 뇌파는 비정상적(non-stationary)이지만 비선형 지수들이 각 상태 뇌파를 안정적으로 구분해 줄 수 있고 3) ECT 회기의 진행에 따라 경련중 뇌파의 결정론적 성질이 증가하며 4) ECT 회기의 진행에 따라 치료전후 안정상태 뇌파의 최대발산지수(PLE) 및 상관차원이 증가한다는 사실을 관찰할 수 있었다. 결 론 : 단일증례에 대한 다양한 비선형 분석의 결과는 ECT의 치료효과를 정량화할 수 있는 변인으로서 PLE, 상관차원 등 비선형 변수들이 사용될 수 있을 가능성을 제시한다. Objectives : In order to search for new parameters for the evaluation of the adequacy of electroconvulsive therapy(ECT), the authors performed a non-linear analysis of electroencephalogram(EEG) recorded during the course of electroconvulsive therapy(ECT) in a single female patient with depression. Methods : Digitized EEG recordings from two ECT sessions spaced one week were analyzed at five different stages ; pretreatment stable, postanesthetic-preictal, ictal, postical suppression and posttreatment stable stages. Results : Our analysis showed that 1) EEG signals had low dimensional(below 10 dimensions) deterministic characteristics 2) although EEG was nonstationary signal, non-linear parameters could reliably differentiate between various stages we examined. 3) the deterministic property of ictal EEG increased according to the progression of sessions and 4) the primary Lyapunov exponent(PLE) and correlation dimension of pre- and post-treatment stable stage EEG increased according to the progression of sessions. Conclusion : In this single case study, results of various non-linear analyses suggested that non-linear variables extracted from EEG recordings during ECT may have utilities as tools for the quantitative evaluation of ECT.

파손된 치면열구전색제의 수리 방법에 따른 미세누출 비교

강명봉,현홍근,김영재,김정욱,장기택,이상훈,한세현,김종철 대한소아치과학회 2007 大韓小兒齒科學會誌 Vol.34 No.2

치면열구전색은 수 십년간 교합면 우식의 예방에 가장 효과적인 방법 중 한가지로 알려져 왔다. 하지만 치면열구전색제의 마모와 파절 때문에 치면열구전색제의 재시술 또는 수리를 필요로 하게 되었다. 본 연구의 목적은 파손된 치면열구전색제를 수리할 때 치질과 잔여 전색제의 표면처리 방법에 따른 미세누출 차이를 알아보고자 하는 것이다. 120개의 영구 대구치에 치면열구전색제를 적용하고 인위적인 파손을 만든 뒤 인공타액에 4주 동안 보관하였다. 4주 후 근심 또는 원심의 치면열구전색제가 완전히 파손 양상을 나타내는 치아 60개를 선택하여 각각 15개씩 4개 군으로 나누어 실험에 사용하였다. 각 군을 산부식만 시행한 경우(1군), air-abrasion만 시행한 경우(2군), 산부식 후 결합제를 적용한 경우(3군), air-abrasion 후 결합제를 적용한 경우(4군)로 나눠 각각의 치아를 표면처리한 후 치면열구전색제를 도포하였다. 고온(55℃)과 저온(5℃)에서 각각 30초씩 500회의 열순환을 시행한 뒤 미세누출도를 검사하여 다음과 같은 결과를 얻었다. 1. 치면열구전색제/치면열구전색제 경계면에서 미세누출도는 결합제 사용 유무에 관계없이 air-abrasion을 처리한 2군, 4군에서 산부식을 사용한 1군, 3군보다 낮은 값을 보였고(p<0.05) 1군과 2군, 3군과 4군 사이에는 통계적 유의차가 없었다(p>0.05). 2. 치면열구전색제/치아 경계면에서 미세누출도는 결합제를 사용한 3군, 4군에서 결합제를 사용하지 않은 1군, 2군보다 낮은 값을 보였고(p<0.05) 산부식을 사용한 1, 3군과 air-abrasion을 사용한 2, 4군 사이에는 통계적 유의차가 없었다(p>0.05). 3. SEM 상에서 치면열구전색제를 산부식 처리하였을 때 표면거칠기의 증가가 적었으나 air-abrasion 하였을 경우 표면거칠기가 현저하게 증가하는 것을 관찰하였다. The aim of this study was to investigate whether differences in surface treatment Prior to repair influenced the seal of a resin fissure sealant placed on the occlusal surfaces of permanent molar teeth. One hundred and twenty extracted human molars were selected and a light curing sealant was placed on their occlusal surface following cleaning by prophylaxis and acid etching. The teeth were deliberately damaged, and then stored in artificial saliva for four weeks. Sixty teeth with the desired morphology of sealant failure were randomly divided into four groups where one group was treated with only etching agent, another by only air-abrasion, another by applying an etching agent followed by a bonding agent, and the last by air-abrasion followed by a bonding agent each. After sealant application, the samples were thermocycled and the degree of microleakage was determined. The results were as follows: 1. In the sealant/sealant interface, group 2(0.22), 4(0.23) using air-abrasion showed a significantly lower microleakage score than group 1(0.38), 3(0.35) using an etching agent(p<0.05). There were no statistically significant differences(p>0.05) between groups 1, 2 and groups 3, 4. 2. In the sealant/tooth interface, group 3(0.20), 4(0.20) which used a bonding agent showed a significantly lower microleakage score than group 1(0.35), 2(0.40)(p<0.05). There were no statistically significant differences (p>0.05) between groups 1, 3 and groups 2, 4. 3. In SEM examination, while sealant surfaces treated with etching did not result in highly rough surfaces, those treated with air-abrasion did show rough surfaces.

2024-T3 Al 합금의 피로거동에 미치는 인장 및 압축 과대하중의 영향에 관한 연구

강상훈 釜山工業大學校 1994 論文集 Vol.36 No.-

Tensile and/or compressive overloads are often a common accurance in service, particularly for aerospace applications, and are known to be of importance in the process of fatigue crack propagation. The present study was carried out for the purpose of investigation the effects of these overloads on the fatigue behavior, such as crack propagation, retardation, arrest and repropagation, using 2024-T3 aluminum alloy. The main results showed that the compressive overload has an acceleration effect on fatigue crack propagation due to the cyclic plastic zone, as that the tensile overload has the reardation effect due to the monotoic plastic zone.