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면역억제제 혹은 항암 치료가 필요한 B형간염 환자의 치료
장정원 ( Jeong Won Jang ) 대한내과학회 2012 대한내과학회지 Vol.82 No.2
Reactivation of hepatitis B virus (HBV) has been well documented as a complication in HBV surface antigen (HBsAg) carriers who receive cytotoxic or immunosuppressive therapy. With the recent introduction of newer agents with a high level of immunosuppressive effect, this unfavorable event often occurs in patients with HBsAg-negative and/or occult HBV infection. The first step in HBV reactivation management is the identification of the patients at risk of viral reactivation by testing for HBV serology prior to commencing immunosuppressive treatment or chemotherapy. Multiple publications have consistently indicated the benefit of prophylactic or preemptive antiviral therapy in this setting, and justified such approach before the start of cytotoxic therapy. Unresolved issues concerning such prophylactic approach remain in the situations of HBsAg-negative/anti-HBc-positive or negative status, which presumably consists of a large number of occult HBV infection cases. This topic review will summarize clinical issues related to HBV reactivation, focusing clinical manifestations, risk factors associated with HBV reactivation, and a growing body of evidence supporting preventive antiviral therapy in high-risk patients. (Korean J Med 2012;82:149-158)
2종 항만배후단지 입지시설의 법적 성격과 개발 활성화를 위한 개선방안
장정원 ( Jeongwon Jang ),이향숙 ( Hyangsook Lee ) 한국로지스틱스학회 2021 로지스틱스연구 Vol.29 No.6
Through the complete revision of the Port Act in 2020, a new regulation has been established that prohibits the rental of port facilities in principle if the port facilities built by private investors do not belong to the state and are owned by the private sector, and the transfer of the port facilities for ten years after creation unless there are special reasons such as inheritance. With the introduction of this regulation, the development of port facilities by private investors has faced a major crisis. This has a greater impact on the revitalization of the second-class port hinterland where facilities for general business, commerce, and residence are located to support the port’s function than those of the first-class port hinterland, which perform original logistics roles. However, for facilities in and around the second-class port hinterland to be subject to the new regulation, it must be premised that those are port facilities, and there have been disagreements within the Ministry of Oceans and Fisheries as to whether they correspond to port facilities. As a result of requesting legal interpretation from the Ministry of Government Legislation, it was suggested that the facilities located in the second-class port hinterland correspond to port facilities. The opinion of the Ministry of Government Legislation is questionable, however, in its validity considering the legislative purpose of the second-class port hinterland. Therefore, this study examines the meaning, function, and future development plans for the port hinterland, and highlights problems in the interpretation by the Ministry through interviews with experts in the subject matter, literary interpretations of related regulations, and research on the legislative purpose. According to the history of the revision of the Port Act, it is clear that the facilities in the second-class port hinterland do not correspond to port facilities. Furthermore, this study proposes legislative improvement plans to address the problem caused by uncertainty in the legal character of the facilities.
Cons: Treating CHB patients in Immune-tolerance phase
장정원 ( Jeong Won Jang ) 대한간학회 2017 간학회 싱글토픽 심포지움 Vol.2017 No.1
Despite the availability of potent antiviral drugs, current guidelines do not recommend anti-HBV therapy but close monitoring with serial aminotransferases and HBV DNA measurements for chronic hepatitis B patients in the immune tolerant phase. Such recommendation is based on the previous observations that the risk of disease progression and the chance of a sustained response with anti-HBV agents are low. However, only monitoring instead of treating immune tolerant patients can raise a concern especially when managing elderly patients or those with a family history of hepatocellular carcinoma (HCC). In fact, some of them often reportedly have advanced fibrosis or are at higher risk of advanced liver diseases. Continued high HBV replication in such patients could increase the risk of disease progression or development of HCC. Thus, the optimal management of patients in the immune tolerant phase can often be individualized according to age or family history. A liver biopsy and/or non-invasive assessment of fibrosis may be helpful to determine the therapeutic strategy when patients’ age is over 40 or there is clinical suspicion of advanced liver disease. Recent studies suggest that T cell immunity against HBV is relatively preserved especially in young patients. Thus, it is urgent that definitive criteria for immune tolerant phase of chronic HBV infection should be introduced before we develop the optimal management strategy in this setting.