HCV, Acute, LT : Predictive Factors of a Sustained Virological Response in Chronic HCV Genotype 2 and 3 during SOC Treatment in Koreans

( Hyunhwa Yoon ),( Young Kul Jung ),( Seung Jun Jang ),( Seung Kak Shin ),( Hae Lim Baek ),( Soo Yong Park ),( Min Young Rim ),( Hyeonsu Park ),( In Ku Yo ),( Oh Sang Kwon ),( Yun Soo Kim ),( Duck Joo 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background: The combination theraphy with peginterferon and ribavirin has been used to treat chronic hepatitis C for several years in Korea, yet there is a few reports regarding the results of the genotype 2, 3. We evaluated factors influencing SVR in Korean patients with genotype 2 and 3 chronic hepatitis C after combination theraphy conducted at a single center. Methods: This study was performed to investigate the factors that affect sustained virologic response (SVR) who underwent combination theraphy consist of peginterferon and ribavirin. Reptrosepctively, a total of 98 patients untreated genotype 2 and 3 chronic hepatitis C were enrolled and completed the treatment (52 males(53.06%), genotype 2: 96 (97.96%)). Duration of the treatment was 16-24 weeks. Response of the treatment was evaluated by rapid virologic response (RVR), end treatment virologic response (ETR) and sustained virologic response (SVR). Results: The RVR, ETR, SVR were 88.78%, 92.86% and 91.84% respectively. The total number of patients who did not have SVR were 8, of which 3 patients were non responsive to antiviral agents, and 5 patients showed evidence of relapse of HCV infection. Among the 5 patients with relapse, dose was not reduced in 2 patients, whereas dose reduction was done to 3 patients who showed adverse effects, such as hematologic disorders (anemia, leukopenia, thrombocytopenia), poor oral intake, and general weakness. Univariate analysis showed that the RVR was the only independent factor that affected the SVR(odds ratio=11.857, 95% confidence interval: 2.427-57.920, P<0.001). Conclusions: Our study showed that combination theraphy with peginterferon and ribavirin as an initial treatment for genotype 2 and 3 chronic hepatitis C is very effective, and that the SVR rate is significantly associated with the RVR and might be a useful response factor that is readily available in clinical practice, and especially for genotype 2 and 3 patients.

HCC : Vascular Enhancement Patterns of HCC with Contrast-Enhanced Ultrasound

( Hae Lim Baek ),( Yun Soo Kim ),( Young Kul Jung ),( Oh Sang Kwon ),( Ju Hyun Kim ),( Duck Joo Choi ),( Yeon Suk Kim ),( Yang Suh Ku ),( Seung Jun Jang ),( Seung Kak Shin ),( Hyunhwa Yoon ),( Soo Yon 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background: Classic enhancement pattern of hepatocellular carcinoma(HCC) with dynamic CT or MRI includes hyperenhancement in arterial phase and hypoenhancement during portal and delayed phase. It is known that vascular pattern after SonoVue injection is similar to that observed with CT or MRI. However, atypical enhancement and washout pattern are not unusually encountered with CEUS. We have studied CEUS patterns of HCC in 32 consecutive patients with HCC. Methods: 32 HCCs were analysed(mean age 55.5, 6 females, 26 males). Twenty two were diagnosed with liver biopsy, and in 10 patients diagnosis was made with typical dynamic CT or MRI findings. CEUS using SonoVue(Bracco, Milan, Italy) were performed. Arterial, portal and delayed phases were determined as -30s, 31-120s and 121-360s. Results: HBsAg and anti-HCV were positive in 24 (75%) and 5 (15%) patients, respectively. Mean tumor size was 5.3±4.3 cm (1.1-20.0 cm). Mean serum alpha fetoprotein was 9,174 ng/mL (1.3-200,000 ng/mL). All the HCCs showed arterial enhancement (hyper or iso-). Arterial hyperenhancement was observed in 26 (81%) lesions, and remaining 6 (19%) HCCs showed isoenhancement relative to the adjacent liver parenchyme. Hypoenhancement (wash-out) in portal phase was observed in only 9 (28%) lesions (mean diameter: 5.1±4.2 cm), and remaining 23 lesions (72%) were isodense in portal phase (mean diameter: 5.4±4.5 cm). Hypoenhancement in delayed phase was observed in 28 lesions (88%) (mean diameter: 5.8±4.4 cm). And remaining 4 lesions showed persistent isoenhancement until 6 min, and their mean diameter was 2.2±0.9 cm (P=0.126). Enhancement during arterial phase, isoenhancement during portal and hypoenhancement during delayed phase was observed in 19 (59%) lesions, which was most common enhancement pattern. Conclusions: Arterial hyperenhancement with isodense portal phase and hypoenhancement in delayed phase was most common CEUS finding in HCC. It seems that tumor size affects on the hypoenhancement during delayed phase in CEUS.

Impact of Previous Acute Decompensation on Tolerance to Acute-on-Chronic Liver Failure

( Eileen L. Yoon ),( Do Seon Song ),( Hee Yeon Kim ),( Chang Wook Kim ),( Jin Mo Yang ),( Young Kul Jung ),( Hyung Joon Yim ),( Baek Gyu Jun ),( Jung Gil Park ),( Young Chang ),( Jeong-ju Yoo ),( Sang 대한간학회 2021 춘·추계 학술대회 (KASL) Vol.2021 No.1

HBV : Efficacy of Entecavir and Adefovir Combination Therapy in Patients with Multi-antiviraldrug resistant Hepatitis B Virus

( Seung Kak Shin ),( Young Kul Jung ),( Seung Jun Jang ),( Hae Lim Baek ),( Hyun Hwa Yoon ),( Soo Yong Park ),( Min Young Rim ),( Hyeonsu Park ),( In Ku Yo ),( Oh Sang Kwon ),( Yun Soo Kim ),( Duck Jo 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background: Multi-antiviral drug resistance is a major problem in the treatment of patients with chronic hepatitis B (CHB). Tenofovir disoproxil fumarate (TDF) is recommended for ADV or entecavir (ETV). However, until recently TDF was not available in Korea. ADV and ETV combination therapy may be a viable alternative to TDF in patients with either ADV or ETV resistance. This study investigated the efficacy of ADV and ETV combination therapy in patients with multidrug resistance. Methods: Forty-one patients were enrolled and were administered ADV and ETV combination therapy for at least 12 months. Blood was drawn at baseline and at 12, 24, 36, 48, and 60 months after commencing treatment, and virological response was analyzed. Results: After ADV and ETV combination therapy, ALT normalization was 68%, 73%, 80% 90%, and 93% in 12wks, 24wks, 36wks, 48wks, and 60 wks, respectively. HBV DNA reduction was -1.5, -1.8, -1.9, -1.8, and -1.9 log10IU/mL in 12wks, 24wks, 36wks, 48wks, and 60 wks, respectively. 29 of HBeAg positive patients showed the following low HBeAg seroconversion rate: 3%, 7%, and 10% in 24wks, 48wks, and 60wks, respectively. In addition, virological response group showed lower initial HBV DNA level (P=0.014) and lower HBeAg positive rate (P=0.016) compared with non-virological response group. Conclusions: ADV and ETV combination therapy could be considered in selected chronic hepatitis B patients who have low initial HBV DNA level and HBeAg negative status.

HBV : Reactivation of Hepatitis B Virus Following Anti- TNFα Treatment

( Seung Jun Jang ),( Young Kul Jung ),( Hae Lim Baek ),( Hyun Hwa Yoon,),( Seung Kak Shin ),( Oh Sang Kwon ),( Yun Soo Kim ),( Duck Joo Choi ),( Ju Hyun Kim ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background: Tumor necrosis factor-α (TNF-α), one of the most important pro-inflammatory cytokines, plays a key role in the immune or inflammatory responses to infectious disease. TNF-α inhibitors have been increasingly in the treatment of several rheumatic diseases or inflammatory bowel diseases. Treatment with TNF-α inhibitors in patients with concurrent HBV or HCV infection can promote viral reactivation and potentially fatal liver failure. The aim of our study is to evaluate the predictive factors of HBV reactivation after TNF-α treatment. Methods: We retrospectively analyzed medical records of the patients who were treated with TNF-α inhibitors(infliximab, etenercept, adalimumab) at Gachon University Gil Medical Center. From January 2010 to April 2013, one hundred seventy- six patients were treated with TNF-α inhibitors and followed up. We determined status of HBsAg, HBcAb, HBVDNA, anti-HCV, ALT. Results: A total of 114 of 176(64.8%) in the study population was tested status for HBsAg at baseline. 6 patients (6/114,5.2%) were HBsAg positive and 109 patients (109/114,94.8%) were negative. Only 10 patient of the HBsAg negative patients (10/109,9.2%) were checked HBcAb. 91 patients were check anti-HCV and 2 patients (2/91,2.2%) were positive. After TNF-α inhibitor treatment, total 3 patients were confirmed reactivation of HBV. All of them was HBsAg positive patients and one of them was treated with entecarvir. Conclusions: Reactivation of HBV after TNF-α inhibitor treatment was observed in HBsAg positive patients. For prevent of reactivation of HBV, screening of HBV infection status and close follow-up is needed. Especially, in HBsAg positive patients should be treated anti viral agent before TNF-α inhibitor inhibitor treatment.

소화기; 악성 림프종 환자에서 항암화학요법 후 발생하는 B형 간염의 재활성화

장승준 ( Seung Jun Jang ),정영걸 ( Young Kul Jung ),백혜림 ( Hae Lim Baek ),윤현화 ( Hyun Hwa Yoon ),신승각 ( Seung Kak Shin ),홍준식 ( Jun Shik Hong ),박진희 ( Jin Ny Park ),권오상 ( Oh Sang Kwon ),김연수 ( Yun Soo Kim ),최덕주 ( 대한내과학회 2013 대한내과학회지 Vol.85 No.6

목적: 악성 림프종 환자에서 항암 치료 후 발생하는 B형간염의 재활성화는 중요한 합병증 중 하나이다. 이러한 B형간염의 재활성화는 항암 치료의 연기 혹은 심각한 간부전을 초래함으로써 결국 악성 림프종 환자의 생존율에 악영향을 준다. B형 간염의 재활성화는 항암 치료 전 검사에서 HBsAg양성인 환자뿐만 아니라 HBsAg 음성인 환자에서도 발생할 수 있다. 실제로 HBsAg이 음성일지라도 과거 B형 간염을 앓았거나 잠재감염 상태인 환자는 anti-HBc 양성 소견을 보인다. 본 연구는 단일 의료센터에서 6년간 항암 치료를 받은196명의 환자를 후향적으로 분석하여 B형 간염의 재활성화 율과 이를 예방하기 위한 방법에 대해 알고자 한다. 방법: 2005년 1월부터 2010년 12월까지 가천대 길병원에서 악성 림프종을 진단받고 항암 치료를 시행받은 196명이 환자들의 검사 결과 및 임상경과 자료를 후향적 분석하였다. 결과: 악성 림프종을 진단받은 총 196명의 환자에 대해항암 치료 전 HBsAg 검사율은 88% (172/196)였으며 11명이 양성이었다. Anti-HBc 검사율은 13% (26/196)에 그쳤으며 HBsAg 음성이면서 Anti-HBc 양성인 환자는 15명이었다. 재활성화는 HBsAg 양성군에서 27.3% (3/11), HBsAg 음성군에서 6.7% (1/15) 발생하였으며 이들은 entecavir 혹은 lamivudine복용 후에 모두 후유증 없이 간기능을 회복하였으며 항암치료를 종료하였다. 결론: HBsAg 양성인 환자뿐만 아니라 과거감염이나 회복된 감염을 의미하는 Anti-HBc 양성인 환자에서도 재활성화는 발생하였다. 따라서 항암 치료 시작 전에 B형 간염 바이러스에 대한 상태를 평가하고 재활성화를 예방하기 위한 적절한 검사와 선제 치료가 필요하다. Background/Aims: Reactivation of hepatitis B virus (HBV) has been reported in HBV surface antigen (HBsAg)-positive patients undergoing chemotherapy, as well as HBsAg-negative patients with antibodies against HBV core antigen (HBcAg) and/or HBsAg (HBsAb). Chemotherapy-including rituximab-has recently been identified as a predictive factor for HBV reactivation in HBsAg- negative patients with malignant lymphoma. The aim of our study was to identify the factors predictive of HBV reactivation after chemotherapy in patients with malignant lymphoma. Methods: We conducted a retrospective analysis of medical records from patients diagnosed with malignant lymphoma at Gachon University Gil Medical Center in City, County from January 2005 to December 2010. We subsequently determined HBsAg, HBsAb and anti-HBc status in the 196 patients treated with chemotherapy. Results: The mean age of the patients was 57.3 ± 14.5 years; 56.3% were male. A total of 172 of 196 (88%) patients in the study population were HBsAg (+) prior to chemotherapy. Three patients (3/11, 27.3%) in the HBsAg (+) group had confirmed HBV reactivation after chemotherapy. In addition, 26 of 196 (13%) patients in the study population tested HBcAg (+) positive prior to chemotherapy. One patient (1/15, 6.7%) in the HBsAg (-)/HBcAb (+) group had confirmed HBV reactivation. In the four patients with HBV reactivation, infection was resolved after treatment with 0.5 mg entecavir or 100 mg lamivudine. Conclusions: Reactivation of HBV after systemic chemotherapy can occur in HBsAg (-) patients. We recommend that malignant lymphoma patients undergoing chemotherapy be screened for HBV infection status, including HBcAg, and followed closely to prevent HBV reactivation. (Korean J Med 2013;85:598-603)

어름치의 생활사에 관하여 ( 예보 )

최기철,백윤걸 ( Ki Chul Choi,Yoon Kul Baek ) 한국하천호수학회 1970 생태와 환경 Vol.3 No.1·2

1. The life-cycle of Gonoproktopterus mylodon was not studied up to date. 2. In this report, the young stage from fertilized egg to 50 mm in total length of Gonoproktopterus mylodon was studied by Baek and the growth rate mainly by Choi. 3. Spawning activities of this species continued from May 8 to May 16, 1969 and from April 27 to April 30 under 16.5∼18℃ of water temperature at Tong River in Yung-Wul, Kangwun-Do. 4. In the spawning season, pearl organs around mouth and nuptiale coloration of male were very distinct and, besides, silver white color on the ventral side of male changed to dark black. 5. At night, this species spawned at the river bottom, 42∼62 cm deep, covered with stones and gravels, and where stream velocity was 28.6∼36.3 cm per second. After the eggs were deposited in the hole of 13∼17 cm in long diameters, 3∼13 cm in short diameters and 5∼8 cm in height dug by the fish, gravels were carried and piled up to cover the hole. The size of the gravel piles was as follows: long diameter was 40∼58cm, short diameter 22∼35 cm, and height 5∼18 cm. 6. The number of eggs laid in a hole was 1,200∼2,300. The egg was about 3 mm in diameter and each egg of the grape -cluster-like egg mass stuck to one another with muccous substance. 7. The embryo of the fish hatched 5 days after spawned, and the yolk sac of the embryo was absorbed within 20 days after hatched. 8. Tatal length of the embryo was 8 mm just after hatching from egg, and 30∼50 mm 111 days after hatching. Young fish grew up to 90 mm in total length in 1 year, 190 mm in 2 years, and 250 mm in 3 years. 9. Young fish group of this species was found near riversides where it was less than 1 m deep, and the velocty of current was slow and the bottom of which was covered with rocks and gravels. The young fish schooled with those of Hemibarbus longirostris, Pungtungia herzi, Pseudogobio esocinus and Zacco platypus. The authors noticed that the young fish of this species gradually moved to deeper places as they grew larger.