거대 자궁 근종의 1예

전혜숙,강경화,이보연,이선경,허주엽,김승보 경희대학교 2000 慶熙醫學 Vol.16 No.3-4

Predictive Performance of CAGE-B and SAGE-B Models in Asian Treatment Naive Patients who Started Entecavir for Chronic Heaptitis B

( Hye Yeon Chon ),( Jae Seung Lee ),( Hye Won Lee ),( Ho Soo Chun ),( Beom Kyung Kim ),( Won Young Tak ),( Jun Yong Park ),( Young-oh Kweon ),( Do Young Kim ),( Sang Hoon Ahn ),( Se Young Jang ),( Soo 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Recently, CAGE-B and SAGE-B models were used to assess the risk of developing hepatocellular carcinoma (HCC) in Caucasian patients with chronic hepatitis B (CHB) under sustained antiviral therapy (AVT). We checked the predictive performance of these models in Asian patients with CHB. Methods: We reviewed 737 treatment-naïve patients with CHB who started entecavir between 2006 and 2011, and who were followed up for more than 5 years without HCC development within 5 years of AVT. The predictive performance of CAGE-B and SAGE-B scores were calculated using area under the receiver operating curves (AUROCs). Results: A total of 338 (45.9%) patients had liver cirrhosis at the start of AVT. And liver stiffness value at 5 years of AVT was 8.8 kPa. CAGE-B and SAGE-B scores at 5 years of AVT were 7.5 and 6.5, respectively. After 5 years of AVT, 66 (9.0%) patients developed HCC. The AUROC of CAGE-B and SAGE-B scores were 0.775 and 0.770 at 7 years and 0.805 and 0.793 at 10 years of AVT, respectively. The cumulative incidence rate of HCC was significantly higher in the high-risk group according to CAGE-B and SAGE-B-based risk stratification than in those of medium and low-risk groups (all P<0.05). The SAGE-B score showed a higher likelihood ratio (χ2) (55.2 vs. 52.0) and linear trend (χ2) (53.3 vs. 47.5) than the CAGE-B score, whereas the SAGE-B score showed lower akaike information criteria (50.4 vs. 63.7) than the CAGE-B score. Conclusions: Both SAGE-B and CAGE-B showed acceptable predictive performance in predicting HCC after 5 years of AVT in Asian patients with CHB.

The Outcomes of Entecavir, Tenofovir Disoproxil Fuma-rate, and Tenofovir Alafenamide in Treatment-Naïve Patients with Chronic Hepatitis B Infection

( Hye Yeon Chon ),( Sang Hoon Ahn ),( Yoon Jun Kim ),( Jung-hwan Yoon ),( Jeong-hoon Lee ),( Dong Hyun Sinn ),( Seung Up Kim ) 대한간학회 2021 춘·추계 학술대회 (KASL) Vol.2021 No.1

Addition of Liver Stiffness Enhances the Predictive Accuracy of the PAGE-B Model for Hepatitis B-Related Hepatocellular Carcinoma

( Hye Yeon Chon ),( Han Ah Lee ),( Sang Jun Suh ),( Jung Il Lee ),( Byung Seok Kim ),( In Hee Kim ),( Chang Hyeong Lee ),( Byoung Kuk Jang ),( Hyun Woong Lee ),( Jae Seok Hwang ),( Chang Hun Lee ),( J 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: The modified PAGE-B (mPAGE-B) and PAGE-B models reliably predict the risk of developing chronic hepatitis B (CHB)-related hepatocellular carcinoma (HCC). We investigated whether the addition of liver stiffness (LS) value assessed using transient elastography enhanced the predictive accuracies of these models. Methods: Patients with CHB who started to receive antiviral therapy (AVT) between 2007 and 2017 were enrolled. The training (Yonsei University Hospital) and validation (7 Korean referral institutes) cohorts contained 1,211 and 973 patients, respectively. Results: Based on multivariate analysis, older age (hazard ratio [HR]=1.051, 95% confidence interval [CI]=1.031-1.071), male sex (HR=2.265, 95% CI=1.463-3.506), lower platelet count (HR=0.993, 95% CI=0.989-0.997), and greater LS values (HR=1.015, 95% CI=1.002-1.028) were independently associated with an increased risk of HCC development (all P<0.05). Thus, we developed an mPAGE^LS-B model (maximum score 34) that included age, male sex, platelet count, and LS value. The integrated area under the curve (iAUC) of the mPAGE^LS model was greater than those of the PAGE-B and mPAGE-B models (0.760 vs. 0.714 and 0.716, respectively) in the derivation dataset. The cumulative HCC incidence was significantly higher in the high-risk (mPAGE-B^LS score ≥ 24) group than in the intermediate-risk (mPAGE^LS-B score 12-24) or low-risk (mPAGE^LS-B score < 12) group (all P<0.001). Similar results were observed in the validation cohort. Conclusions: The predictive accuracies of the PAGE-B and mPAGE-B models were validated in Korean patients with CHB receiving AVT. However, the mPAGE^LS-B model featuring the addition of LS value showed higher predictability than the PAGE-B and mPAGE-B models.

Clinical Characteristics of Non-Alcoholic Fatty Liver Disease in Korea

( Hye Yeon Chon ),( Hye Won Lee ),( Beom Kyung Kim ),( Seung Up Kim ),( Jun Yong Park ),( Do Young Kim ),( Sang Hoon Ahn ),( Kwang-hyub Han ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Recently, in South Korea, the prevalence of non-alcoholic fatty liver disease (NAFLD) has been gradually increasing along with westernized lifestyle and aging society. This study investigated the characteristics and lifestyle of NAFLD patients and identified the modifiable factors. Methods: Patients with NAFLD who visited Severance Hospital between 2015 and 2017 were prospectively enrolled. All patients underwent ultrasonography, transient elastography, bioelectrical impedance analysis, and laboratory tests and answered the questionnaire concerning their lifestyle. NAFLD was diagnosed based on history, ultrasonography and transient elastography. Results: A total of 225 patients were finally analyzed. Mean age was 45 years, with female predominance (64%) and mean body mass index (BMI) was 27.9 kg/m2. Obese patients (BMI=25kg/m2, 79.1%) showed significantly higher waist circumference, hip circumference, higher risk of liver damage, higher liver stiffness values, controlled attenuation parameter (CAP), body fat percentage and less appendicular skeletal muscle (ASM)/height2, compared to non-obese patients (20.9%). (P<0.05). Compared to male NAFLD patients, females showed older age (52.9 years vs. 40.5 years, P<0.001), higher proportion of diabetes mellitus (32.1% vs. 16.7, P=0.008), and less muscle power exercise (9.9% vs. 20.1%, P=0.046). Patients with metabolic syndrome (MS) (n=126, 56%) tended to have higher abdominal fat ratio (1.0 vs. 0.9 P=0.003), waist circumference (99cm vs. 92cm, P=0.005), do less aerobic exercise (30.2% vs. 40.4%, P=0.109) and muscle power exercise (15.1% vs. 18.2%, P=0.533) than those without. There was no significant difference in liver enzyme and CAP score according to the presence or absence of MS. Total skeletal mass was also similar between two groups, but the muscle mass of the upper was significantly less in those without MS. Conclusions: Based on our data, female patients with NAFLD showed older age and more diabetes mellitus and less tendency of exercise.

Impact of Antiviral Therapy on Risk Prediction Models for Hepatocellular Carcinoma Development in Patients with Chronic Hepatitis B

( Hye Yeon Chon ),( Tae Seop Lim ),( Mi Young Jeon ),( Hye Won Lee ),( Beom Kyung Kim ),( Jun Yong Park ),( Do Young Kim ),( Sang Hoon Ahn ),( Kwang-hyub Han ),( Seung Up Kim ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Risk prediction models for hepatocellular carcinoma (HCC) development have been proposed. However, the influence of antiviral therapy (AVT) on these models in patients with chronic hepatitis B (CHB) is unknown. Methods: We investigated the dynamics of risk prediction models during AVT and the association between on-treatment values from these models and the risk of HCC development. Results: Between 2005 and 2017, 6,098 patients with CHB (1,758 non-cirrhotic, 4,340 cirrhotic) in whom AVT was initiated with entecavir (n=3,818) or tenofovir (n=2,280) were recruited. The mean age of the study population was 49.1 years and 61.4% (n=3,742) of the patients were male. The mean CU-HCC value was 12.7 at baseline in the entire study population; it was significantly lower (mean, 8.6) after 1-year of AVT (P< 0.001) and was maintained throughout 5-years of AVT (mean, 8.2-8.4; P >0.05). The proportion of high-risk patients (CU-HCC score ≥ 20) was 28.9% at baseline, which significantly decreased after 1-year of AVT (4.8%; P< 0.001) and was then maintained through 5-years of AVT (2.6-3.5%; P >0.05). The CU-HCC score after 1-year of AVT independently predicted the risk of HCC development (hazard ratio=1.037), together with age, male gender, liver cirrhosis, and platelet count (all P<0.05). Similar findings were obtained when the REACH-B criteria were used for non-cirrhotic patients. Conclusions: CU-HCC and REACH-B scores were significantly lower after 1-year of AVT and were maintained thereafter. CU-HCC and REACH-B scores after 1-year of AVT independently predicted the risk of HCC development in patients with CHB in whom AVT was initiated.

Liver Cirrhosis and Sarcopenia

( Hye Yeon Chon ),( Tae Hee Lee ) 한국정맥경장영양학회 2022 한국정맥경장영양학회지 Vol.14 No.1

Malnutrition is one of the most common complications in patients with liver cirrhosis. In previous studies, cirrhotic patients with severe malnutrition have been associated with higher morbidity and mortality rates before and after liver transplantation. Frailty and sarcopenia are phenotypes of severe malnutrition that have been associated with complications requiring hospitalization or mortality during the wait for transplantation in patients with cirrhosis. Tools for evaluating frailty include the Activities of Daily Living scale, the Karnofsky Performance Status scale, and the Liver Frailty Index. Diagnosed by using computed tomography, sarcopenia is measured with the skeletal muscle index at L3 and is normalized by height. Nutritional status should be evaluated within the first 24~48 hours of hospitalization in every patient with cirrhosis. Among the various available screening tools, the Royal Free Hospital-Nutritional Prioritizing Tool proposed in the UK is recommended. Nutritional counseling with a multidisciplinary team is recommended to improve long-term survival in patients with cirrhosis. Multidisciplinary nutrition management should include evaluating nutritional status and providing guidance for achieving nutritional goals. Most guidelines suggest a calorie intake of 25~35 kcal/kg/day, and the recommended protein intake is 1.2~1.5 g/kg/day. One beneficial technique for patients is to divide the total recommended intake across four to five daily meals, including a nighttime snack. The principles of nutritional intervention in cirrhotic patients are not different from those in noncirrhotic patients. For improvement of sarcopenia, a strategic approach including physical activity and exercise, hormone replacement therapy, ammonia-lowering agents, and treatment of underlying liver disease is required.

Management of Non-Variceal, Active Bleeding in Various Clinical Scenario

전혜연 ( Hye Yeon Chon ) 대한간학회 2021 간학회 싱글토픽 심포지움 Vol.2021 No.2

Suppression of Cyclooxygenase-2 Expression in Colonic Epithelial Cells by Ilekudinol B Isolated from Weigela subsessilis

Hye-Jung Park,Yeon-A Choi,Jin Tae,Chon-Sik Kang,김대기,Phuong Thien Thuong,김영호,배기환,이영미 한국생약학회 2006 Natural Product Sciences Vol.12 No.1

B is one of the flavonoids isolated from Weigela subsessilis (Caprifoliaceae). In the presentstudy, the suppresion effect of ilekudinol B on tumor necrosis factor (TNF)-α-induced cyclooxygenase-2 (COX-prostaglandin E2 (PGE2) secretion was measured by enzyme-linked immunosorbent assay (ELISA). COX-2 andnuclear factor (NF)-κB expresion were determined by Western blot analysis. Ilekudinol B significantly inhibitedTNF-α-induced secretion of IL-8 and prostaglandin E2 (PGE2) from the human colon epithelial cell line HT-29 ina concentration-dependent manner. In addition, ilekudinol B remarkably diminished TNF-α-induced COX-2expression and NF-κB p65 subunit translocation to the nucleus. In conclusion, our results indicate that ilekudinolα-dependent colonic inflamation.KeywordsWeigela subsesilis, ilekudinol B, Caprifoliaceae, cyclooxygenase-2, human colon epithelial cells

중학교 학습부진아의 수학 기피성향 치유방안

박혜숙,박기양,김영국,박규홍,박윤범,권혁천,박노경,백은정,황정연 한국수학교육학회 2004 수학교육 Vol.43 No.2

In this paper, we verified the effect and appropriateness of the scheme to cure the math. disliking disposition which is the cause of underachievement in learning. We choose 3 schools as the subject of experiment for this research. Each experiment experiment class consists of 27~30 students(underachievers) whose final test results of 1st school year in the middle school are 30~60 points. In this case, we also select some middle level students whose test results are more than 60 points for the normal experimental condition. For this research, we developed the suitable test materials to cure the mathematics disliking disposition of underachievers. We applied those test materials to the experiment schools during 2.5 months and we analysed the variation of disliking disposition, the variation of math. dislike students' number and the cure rate of the math. disliking disposition. From the results of this experimental study, we find that the factors of teacher and math recognition environment have only the significant difference of math. disliking disposition between experiment class and comparison class under the 5% significance level in one middle school. We understand that this results caused by teachers' careful advice and guidance in that middle school. We also find that the number of student who dislike mathematics decreased in two middle schools. Furthermore 50% of math. disliking dispositions are cured for 9 disliking factors in the lower grade group(the group of underachievers) and as a whole, we can see that 50% of cure rate for the 7 factors of math. disliking in two middle schools. So we can understand that the experiment of our research was performed successfully in two middle schools. In this research, we find out that the scheme to cure the disliking dispositions for the factors of math. disliking depends on the factors of teacher who take charge of cure. So teachers must take interest in and must have careful concem to students and their math. disliking.