The Severity of COVID-19 in Patients with Nonalcoholic Fatty Liver Disease in Korea

( Hyeki Park ),( Hyun Joe ) 한국보건행정학회 2021 보건행정학회지 Vol.31 No.4

Background: Early identification of patients who are highly likely to develop severe illness among confirmed cases of coronavirus disease 19 (COVID-19) can be expected to lead to effective treatment. This study therefore aimed to determine whether the presence of nonalcoholic fatty liver disease (NAFLD) has an impact on the exacerbation of COVID-19 symptoms. Methods: The study used the Korean National Health Insurance claim data for treatment of COVID-19 patients in 2020. NAFLD includes nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). The outcome variables used were hospitalization and the use of medical devices. Hospitalization was defined by a length of stay exceeding one day and the use of medical devices was defined as one or more uses of a ventilator or extracorporeal membrane oxygenation. Multivariable logistic regression analysis was performed to determine if there was a difference in the hospitalization and use of medical devices of COVID-19 patients depending on the presence of NAFLD. Results: The odds ratio of hospitalization was 1.059, indicating slightly higher odds of hospitalization for patients with NAFL or NASH compared to those without the conditions, but it was not statistically significant (0.969-1.156). On the other hand, the odds ratio of use of medical devices was high at 1.667 and was statistically significant (1.111-2.501). Conclusion: The study results found NAFLD to be a risk factor that can exacerbate symptoms in COVID-19 patients. Accordingly, it is necessary to identify NAFLD patients through preemptive screening and provide them with appropriate treatments.

코로나19 유행에 따른 보건소 진료량 변화분석

박혜기 ( Hyeki Park ),양유선 ( Yu Seon Yang ) 대한보건협회 2021 대한보건연구 Vol.47 No.3

연구목적 : 한국은 코로나19 유행기간 동안 보건소의 건강증진사업과 진료서비스를 긴급히 축소하고 의료진을 방역 업무에 배치하였다. 이 연구는 코로나19 대응이 보건소의 진료제공에 미치는 영향을 평가하고자 하였다. 연구방법 : 2018년 12월부터 2020년 8월(85주)까지 국민건강보험과 의료급여 청구 자료를 사용하였다. 코로나19 유행 전, 확산기, 회복기의 세 단계를 기준으로 단적절 시계열 분석을 시행하였으며, 지역별 차이를 확인하기 위한 시도별 하위 그룹 분석 또한 수행되었다. 주요결과 : 코로나19의 발생(β: -64,448, P value <0.0001)과 확산(β: -7,346, P value: 0.0003)이 보건소 이용량을 감소시키는 것으로 나타났다. 진료량은 사회적 거리두기를 완화한 시점에(β: 27,650, P value: 0.0176) 증가했으며, 이후에도 점차 증가했다(β: 8,507, P value <0.0001). 결론 : 코로나19 유행에 따라 보건소에서 의료 서비스 제공량이 감소했으며, 유행이 약화 되었음에도 불구하고 완전히 회복되지 않았다. 이는 보건소의 의료제공에 공백이 존재했음을 의미하며, 보건소의 주요 이용자인 취약 계층을 위한 지원의 필요성을 시사한다. Background : In the Republic of Korea, medical personnel at the Public health centers (PHCs) were urgently deployed to the quarantine while the healthcare projects and medical treatments are scaled back during the COVID-19 pandemic. This study aimed to evaluate the impact of COVID-19 response on the number of visits at PHCs. Materials and methods : The Republic of Korean National Health Insurance and Medical Aid claims data between December 2018 and August 2020 (85 weeks) were used. Interrupted time series and segmented regression model was conducted for statistical analysis by three stages (pre-wave period, the spreading period during the wave and recovery period). Subgroup analysis was performed based on the regions. Results : The results showed that the outbreak (β: -64,448, P value < 0.0001) and the spreading (β: -7,346, P value: 0.0003) of COVID-19 decreased the number of visits. The volume increased when the social distancing was eased (β: 27,650, P value: 0.0176), and gradually increased (β 8,507, P value < 0.0001). Conclusion : In conclusion, the COVID-19 pandemic decreased the volume of healthcare services at PHCs. However, it was not fully recovered again despite the weakening of the prevalence, implying that the vacuum of healthcare has existed at PHCs. The findings suggest the importance of alternative supports for healthcare for the vulnerable, who are the main user of health centers.

예술사를 통해 바라본 코드에 대한 고찰

민혜기(주저자) ( Hyeki Min ),박승호(교신저자) ( Seung Ho Park ) 디자인융복합학회 2015 디자인융복합연구 Vol.14 No.1

본 연구는 코드가 예술에 있어 창의적인 표현이 가능한 주요한 질료로서 예술가의 작업의 영역을 확장해왔음을 예술사의 흐름 속에서 발견해 내고 이를 심도 있게 고찰하는 것을 그 목적으로 한다. 코드를 바라보는 시각을 컴퓨터 등장 이전과 이후로 나누어, 먼저 컴퓨터 등장 이전의 형식적인 지시문을 사용하여 작업을 통제하는 예술 방식의 개념 예술로 대표되는 실험적 작업들을 다룬다. 다음 컴퓨터 등장 이후의 컴퓨터 예술 초기부터 소프트웨어 아트에 이르기까지 정리하며 이를 생성 예술과의 비교를 통해 기존의 알고리즘이 강조되는 디지털 예술과 그 구분을 명료히 하였다. 예술 작품에 있어 항상 가려져 있던 코드에 대한 고찰을 시도하고자 하였으며, 그저 작품의 구상이나 완성을 위한 수단으로서가 아닌 코드 그 자체로 가지는 예술적인 표현 가능성에 대해 논구하였다. 또한 결국 코드가 예술가의 철학을 담는 주요 질료가 됨은 그의 언어적 특성에 기반하고 있음을 예술사적으로 개념 예술과의 연관성을 통해 확고히 하였다. The purpose of this study is to address that code is not simply a functional tool but a new material for extending the criticalpotential of arts practice in the history of art. A general overview of art history concentrated on code is presented, divided by before and after the invention of the computer. First of all, experimental artworks including some of the historical influences that have developed in the conceptual tradition in concept art havebeen examined. Furthermore, it argues the different approaches to digital art in terms of a dichotomy drawn between generative art and software art. Clearly, in generative art, art works which approaches use of technology as black box, with focus on endresults. In contrast, software art focuses on technological culture, where the software itself holds meaning. In particular, my discussion takes in the wider context of code as a new material for expression, based on the use of language compared to concept art.

The Effect of Chronic Disease Management Program on the Risk of Complications in Patients With Hypertension in Korea

Lee Sang Ah,Park Hyeki,Kim Woorim,Song Sun Ok,Lim Hyunsun,Chun Sung-Youn 대한의학회 2022 Journal of Korean medical science Vol.37 No.31

Background: A chronic disease management program was implemented in April 2012 to lower out-of-pocket costs for repeat visits to the same clinic. The aim of this study was to investigate the association between participating in this program and the onset of complications among patients with hypertension using whole-nation claims data. Methods: We used National Health Insurance Service data (2011–2018) and patients with newly detected hypertension from 2012 to 2014 were selected. Chronic disease management program reduces the out-of-pocket expenses of consultation fee from 30% to 20% when patients enroll in this program by agreeing to visit the same clinic for the treatment of hypertension or diabetes. As the dependent variable, acute myocardial infarction (MI), stroke, chronic kidney disease (CKD), and heart failure (HF) were selected. For analysis, cox proportional hazards model was used. Results: Total participants were 827,577, among which 102,831(12.6%) subjects participated in the chronic disease management. Participants of the chronic disease management program were more likely to show lower hazard ratios (HRs) than those of non-participants in terms of all complications (MI: HR, 0.75; 95% confidence interval [CI], 0.68–0.82; stroke: HR, 0.75; 95% CI, 0.72–0.78; CKD: HR, 0.90; 95% CI, 0.85–0.96; HF: HR, 0.56; 95% CI, 0.52–0.61). Conclusion: The results showed that participants of the chronic disease management program were less likely to have hypertension complications compared to non-participants. Enhancing the participation rate may be related to better outcomes and reducing medical expenses among patients with chronic diseases.

Ownership of Long-Term Care Facility and Incidence of Pressure Ulcers among Republic of Korea

( Sung-youn Chun ),( Hyeki Park ),( Woorim Kim ),( Yeong-jun Joo ),( Tae-hoon Lee ),( Eun-cheol Park ) 한국보건행정학회 2020 보건행정학회지 Vol.30 No.4

Background: In 2008, Korea implemented a new type of social insurance known as “long-term care insurance”. We examined the association between ownership of long-term care facilities and the incidence of pressure ulcers after the implementation of “long-term care insurance”. This study is a population-based retrospective cohort study from 2006 to 2013. Methods: We used medical claims data from the Korean National Health Insurance Corporate Elderly Cohort Database from 2006 to 2013. These data comprise a nationally representative sample. To avoid confounders, only patients admitted to one long-term care facility and who stayed for >70% of the follow-up time were included; as a result, 3,107 individuals were enrolled. The main independent variable was the operating entity of the long-term care facility (local government, corporate bodies, and private for-profit owners), and the dependent variable was the 1-year incidence of pressure-ulcers. Survival analysis (Cox proportional hazard model) was used as an analysis method. Results: Compared to patients admitted to local government long-term care facilities, patients admitted to private long-term care facilities had a significantly higher 1-year risk of pressure ulcers (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.29-2.91); the risk was especially high among patients who were cognitively dependent (HR, 2.34; 95% CI, 1.25-4.37). Conclusion: Patients admitted to private for-profit long-term care facilities were more likely to have pressure ulcers compared to those in local government and corporate body long-term care facilities. Appropriate assessment tools and publicly available information, as well as more restricted legal requirements, are needed to improve the care quality and outcomes of patients in long-term care facilities. Keywords: Long-term care; Ownership

Do Long Term Cancer Survivors Have Better Health-Promoting Behavior than Non-Cancer Populations?: Case-Control Study in Korea

Chun, Sung-Youn,Park, Hyeki,Lee, Tae Hoon,Park, Eun-Cheol Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.4

Background: We compared the health-promoting behavior of long-term cancer survivors with those of the general population to identify necessary behavioral interventions to reduce the health risk among cancer patients. Materials and Methods: We used data from the 2007 and 2012 Korea National Health and Nutrition Examination Surveys (KNHANES IV [2007~2009] and KNHANES V [2010~2012]) on smoking status, alcohol use, physical exercise, and disease screening. We compared long-term cancer survivors with members of the general population; the controls were matched by propensity score matching. A multiple logistic regression model was used to investigate the association between cancer status and health-promoting behavior. Results: Long-term cancer survivors had a lower risk of smoking than the general population controls (OR: 0.42, 95%CI: 0.25-0.71). In addition, the long-term cancer survivors had a lower risk of alcohol use than the general population controls (OR: 0.70, 95%CI: 0.50-0.98). However, in terms of physical exercise and disease screening, no statistically significant differences were detected (physical exercise OR: 1.01, 95%CI: 0.75-1.35; disease screening OR: 1.27, 95%CI: 0.93-1.74). All covariates were adjusted. Conclusions: The long-term cancer survivors had a much lower risk of smoking and alcohol use than the general population controls. However, almost no differences in physical exercise and screening for cancer recurrence or secondary disease were detected between the long-term cancer survivors and general population controls. To reduce the health risks and challenges facing long-term cancer survivors, interventions to encourage physical exercise and screening for cancer recurrence and secondary disease should be implemented.

EDN1 Expression as a Novel Biomarker for Predicting Sorafenib Responsiveness in Patients with Hepatocellular Carcinoma

( Jae-kyung Won ),( Su Jong Yu ),( Chae Young Hwang ),( Joong-won Park ),( Won-mook Choi ),( Hyeki Cho ),( Eun Ju Cho ),( Jeong-hoon Lee ),( Kyung Bun Lee ),( Yoon Jun Kim ),( Kyung-suk Suh ),( Ja-jun 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Predictive biomarkers for sorafenib in hepatocellular carcinoma (HCC) are still not available, despite the modest benefit of sorafenib. We present a novel and sensitive biomarker that can predict the responsiveness to sorafenib. Methods: A candidate biomarker was found through differential mRNA expression analysis between sorafenib-sensitive and resistant cell lines from The Cancer Cell Line Encyclopedia (CCLE), a public data base. It was tested with in vitro shRNA experiments for its effect to sorafenib-resistance. Consecutive patients with HCC who had undergone sorafenib treatment were included from a prospective cohort and the test set (n=48) and the validation set (n=46) were established. Specimens were archived before sorafenib treatment and a candidate marker was evaluated by the quantitative digital analysis algorithm for immunohistochemistry with regard to their association with response assessment by mRECIST, time to progression (TTP) and overall survival (OS). Further, we performed additional validation study using serum samples before sorafenib treatment obtained from different set of HCC patients (n=40). Results: Endothelin-1 (EDN1, ET-1) was the only differentially expressed molecule between sorafenib-sensitive and resistant cell lines. Knock-down of EDN1 in HCC cell line increased sorafenib sensitivity. In test set, low EDN1 expression group showed significantly better response to sorafenib (non-progressive disease) compared to high EDN1 expression group (72.7% versus 2.7%, respectively; P<0.001). With the same criteria for the validation set, EDN1 expression maintained predictability for sorafenib responsiveness. Survival analysis showed that high EDN1 expression was an independent prognostic factor for poor OS (hazard ratio [HR〕, 2.374; 95% confidence interval [CI〕, 1.051-5.360; P=0.037) and short TTP (HR, 1.907; 95% CI, 1.085-3.350; P=0.025) after sorafenib treatment. We confirmed our results in serum samples of another set. Conclusions: EDN1 expression can distinguish responders to sorafenib and can be a useful predictive biomarker for sorafenib in HCC.

Protein Disulfide Isomerase Inhibition Synergistically Enhances the Efficacy of Sorafenib for Hepatocellular Carcinoma

( Jae-kyung Won ),( Su Jong Yu ),( Chae Young Hwang ),( Sung- Hwan Cho ),( Sang-min Park ),( Kwangsoo Kim ),( Won-mook Choi ),( Hyeki Cho ),( Eun Ju Cho ),( Jeong-hoon Lee ),( Kyung Bun Lee ),( Yoon J 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Sorafenib is the only approved targeted drug for hepatocellular carcinoma (HCC), but its effect on patients’ survival gain is limited and varies over a wide range depending on patho-genetic conditions. Thus, enhancing the efficacy of sorafenib and finding a reliable predictive biomarker are crucial to achieve efficient control of HCCs. Methods: In this study, we employed a systems approach by combining transcriptome analysis of the mRNA changes in HCC cell lines in response to sorafenib with network analysis to investigate the action and resistance mechanism of sorafenib. Results: Gene list functional enrichment analysis and gene set enrichment analysis (GSEA) revealed that proteotoxic stress and apoptosis modules are activated in the presence of sorafenib. Further analysis of the endoplasmic reticulum (ER) stress network model combined with in vitro experiments showed that introducing an additional stress by treating the orally active protein disulfide isomerase (PDI) inhibitor (PACMA 31) can synergistically increase the efficacy of sorafenib in vitro and in vivo, which was confirmed using a mouse xenograft model. We also found that HCC patients with high PDI expression show resistance to sorafenib and poor clinical outcomes, compared to the low PDI expression group. Conclusions: These results suggest that PDI is a promising therapeutic target for enhancing the efficacy of sorafenib and can also be a biomarker for predicting sorafenib responsiveness.

Metagenomic Analysis of Bacteria-Derived Extracellular Vesicles as Biomarkers for Chronic Liver Disease

( Eun Ju Cho ),( Young Youn Cho ),( Hyo Young Lee ),( Joon Yeul Nam ),( Young Chang ),( Hyeki Cho ),( Jeong-hoon Lee ),( Su Jong Yu ),( Yoon Jun Kim ),( Yoon-keun Kim ),( Taesung Park ),( Jung-hwan Yo 대한간학회 2017 춘·추계 학술대회 (KASL) Vol.2017 No.1

Aims: Gut dysbiosis promotes the development and progression of various liver diseases through interactions with the host’s immune systems. Bacteria-derived extracellular vesicles (EVs) have been suggested to be important in host-microbe communications. In this study, we evaluated whether disease-specific microbiome alterations are present in the bacteria-derived EVs from patients with cirrhosis and HCC, and their potential as diagnostic biomarkers. Methods: We performed cross-sectional metagenomic analyses of serum samples from 94 patients with HCC, 100 with cirrhosis and matching healthy controls. DNA was extracted from bacteria-derived EVs after EV isolation using the differential centrifugation method. Bacterial genomic DNA sequencing was performed using high-throughput pyrosequencing after amplification of the V3-V4 hypervariable regions of 16S rDNA. Results: There were specific differences in the proportion of several bacterial taxa in blood EVs that correlate with the presence of cirrhosis and HCC, thus defining a specific signature of the liver disease, compared with healthy controls. We identified 4 microbial gene markers that differentiated HCC and control microbiomes, and 2 markers distinguishing LC from control. These microbiome signatures distinguished metagenomes of HCC and cirrhosis from controls with areas under the receiver-operating curve (AUC) of 0.98 and 0.99, respectively, whereas overall microbial composition did not differ significantly between HCC and LC groups. Conclusions: Microbiome-based signatures may be potential biomarkers for the early diagnosis of cirrhosis or HCC.

Tenofovir Monotherapy versus Tenofovir plus Lamivudine or Telbivudine Combination Therapy in Treatment of Lamivudine-Resistant Chronic Hepatitis B

Lee, Yun Bin,Jung, Eun Uk,Kim, Bo Hyun,Lee, Jeong-Hoon,Cho, Hyeki,Ahn, Hongkeun,Choi, Won-Mook,Cho, Young Youn,Lee, Minjong,Yoo, Jeong-Ju,Cho, Yuri,Lee, Dong Hyeon,Cho, Eun Ju,Yu, Su Jong,Park, Sung J American Society for Microbiology 2015 Antimicrobial Agents and Chemotherapy Vol.59 No.2

<P>Tenofovir disoproxil fumarate (TDF) monotherapy is a therapeutic option for chronic hepatitis B (CHB) patients infected with hepatitis B virus (HBV) variants resistant to lamivudine (LAM). We evaluated the antiviral efficacy and safety of TDF alone compared to those of TDF plus LAM or telbivudine (LdT) combination in patients harboring HBV variants with genotypic resistance to LAM. This multicenter retrospective study included consecutive patients who had LAM-resistant HBV variants and were treated with TDF alone (monotherapy group) or TDF combined with LAM or LdT (combination therapy group) for at least 6 months. Inverse probability of treatment weighting (IPTW) for the entire cohort was applied to control for treatment selection bias. Overall, 153 patients (33 in the monotherapy group and 120 in the combination therapy group) were analyzed. The overall probability of achieving complete virologic suppression at month 12 was 91.6%: 88.6% in the monotherapy group and 92.6% in the combination therapy group. Combination therapy was not superior to monotherapy in viral suppression before and after IPTW (<I>P</I> = 0.562 and <I>P</I> = 0.194, respectively). Hepatitis B e antigen (HBeAg) loss, biochemical response, and virologic breakthrough did not differ between treatment groups. The probabilities of complete virologic suppression were comparable between treatment groups in the subsets according to HBeAg status and HBV DNA levels at baseline. No patient experienced any significant renal dysfunction during the treatment period. In conclusion, TDF monotherapy has antiviral efficacy comparable to that of TDF plus LAM or LdT combination therapy, with a favorable safety profile in CHB patients with LAM-resistant HBV variants.</P>