조현병 및 조현정동장애 환자에서 항정신병약물에 의한 체중증가에 미치는 메트포르민의 영향: 체계적 문헌고찰 및 메타분석

신혜연,천부순,Sin, Hye Yeon,Chun, Pusoon 한국임상약학회 2018 한국임상약학회지 Vol.28 No.3

Background: In this systematic review and meta-analysis, the effect of metformin on weight loss was assessed to determine whether metformin should be recommended for the prevention or treatment of weight gain in patients receiving antipsychotic medication for the treatment of schizophrenia or schizoaffective disorder. Methods: The PubMed, Embase, and Cochrane Library databases were searched for all published randomized controlled trials (RCTs) from inception to June 2018. In addition, the references of relevant articles were also examined. Using Review Manager 5, the pooled estimates of the weighted mean difference (WMD) of the changes in body weight and body mass index (BMI) and the corresponding 95 % confidence intervals (CIs) were calculated. Results: The meta-analysis included 15 RCTs. The pooled analysis showed that compared with placebo, metformin led to significant reductions in body weight (WMD: -2.09, 95% CI: -2.59, -1.60; p<0.00001) and BMI (WMD: -0.90, 95% CI: -1.08, -0.72; p<0.00001). The effect of metformin on weight loss was greater in patients receiving olanzapine than in patients receiving clozapine (body weight, WMD: -2.39, 95% CI: -3.76, -1.02; p=0.0006 for olanzapine; -1.99, 95% C: -3.47, -0.51; p=0.009 for clozapine; BMI, WMD: -1.15, 95% CI: -1.74, -0.57, p=0.0001 for olanzapine; WMD: 0.76, 95% CI: -1.23, -0.28; p=0.002 for clozapine). Conclusion: Metformin can be recommended to manage olanzapine-induced weight gain in patients with schizophrenia or schizoaffective disorder. The magnitude of the reductionss in body weight and BMI implieds that the use of metformin to attenuate olanzapine-induced weight gain can minimize the risk of coronary heart disease.

노인과 중년 당뇨병 환자의 골절의 발생 빈도 위험과 혈당조절의 관계

신혜연,Sin, Hye Yeon Korean College Of Clinical Pharmacy 2018 한국임상약학회지 Vol.28 No.3

Background: Bone fractures are high in elderly patients with type 2 diabetes mellitus (T2DM). Hyperglycemia and chronic kidney disease may increase the risk of fracture prevalence via altered bone metabolism, but whether glycemic control and kidney function are associated with the risk of fracture prevalence remains unclear. This study evaluated the relationship between glycemic control and baseline estimated glomerular filtration rate (eGFR) and risk of fracture prevalence in older and middle-aged patients with T2DM. Methods: Patients who underwent a general medical check-up between 2009 and 2013 were selected from the Korean National Health Insurance Sharing Service records. Chi-square test and multiple logistic regression analysis were used to assess the relationship between glycemic control and eGFR and risk of fracture prevalence. Results: Cumulative fracture prevalence were higher in patients with T2DM, irrespective of whether they had tight or less stringent glycemic control (fasting blood glucose [FBG] ${\geq}110mg/dL$). After adjustment for baseline age and FBG, tight and less stringent glycemic control was significantly associated with increased adjusted risk of fracture prevalence in middle-aged patients with T2DM (OR=1.13, 95% CI, 1.05-1.21, p=0.0005 vs OR=1.13, 95% CI, 1.06-1.20, p=0.0001), but not in older patients. Baseline eGFR was not significantly related to fracture prevalence in either older or middle-aged patients. Conclusion: Less stringent glycemic control significantly increased the adjusted risk of fracture prevalence in middle-aged patients with T2DM. Further studies are needed to confirm the effect of tight glycemic control on fracture prevalence.

벌점화 영과잉 음이항 회귀 분석 방법에 대한 비교 연구

신혜연(Hye-Yeon Sin),강준성(Joonsung Kang) 한국데이터정보과학회 2021 한국데이터정보과학회지 Vol.32 No.4

계수형 데이터 (count data)를 반응변수로 갖는 경우 일반적으로 포아송 회귀 모형과 음이항 회귀 모형이 고려되는데 과대 산포가 있는 경우 포아송 회귀 모형보다는 음이항 회귀 모형, 과도한 0이 존재하는 경우에는 영과잉 계수 모형 (zero inflated count model)이 선호된다. 이 논문에서는 변수선택, 영과잉과 과산포를 동시에 고려하여 벌점화 영과잉 음이항 회귀 (penalized zero inflated negative binomial regression)를 분석해본다. 수치적 연구에서는 여러 가지 벌점 함수들을 이용하여 계수형 반응변수에 대한 벌점화된 영과잉 음이항 회귀들을 서로 비교한다. 여러 가지 방법들의 유한 표본 수행도를 평가하기 위해 모의실험이 수행되며 이에 제곱근 평균제곱 오차와 예측 정확도를 제공한다. 실제 데이터도 예시를 위해 또한 분석되어진다. 수치적 연구 결과 영과잉과 과산포를 가진 데이터에서 각 벌점화 회귀 모형이 거의 비슷한 제곱근 평균제곱 오차와 예측 정확도를 보여주었다. Mnet 벌점을 이용한 모형이 상대적으로 낮은 제곱근 평균제곱 오차와 높은 예측 정확도를 가진 것으로 나타났다. We take Poisson regression and negative binomial regression dealing with a count data as a response variable into account. The negative binomial regression considers overdispersion more than the Poisson regression. On the other hand, with a high frequency of 0 values, zero inflated count model is preferred. In the paper, as we consider variable selection, frequent 0 values, and overdispersion, a penalized zero inflated negative binomial regression is applied. In numerical studies, we compare penalized zero inflated negative binomial regression methods for count data by using those penalties. The simulation studies are conducted to show the finite sample performance of various methods by providing root mean square error and prediction accuracy measure. Real data analysis is also demonstrated for illustration purpose. Numerical studies show that each penalized method has almost similar root mean square error and prediction accuracy measure in the zero inflated overdispersed data. Mnet method has relatively lower root mean square error and higher prediction accuracy.

ABCB1 C3435T가 신장이식 수혜자에서 tacrolimus의 최저혈중농도에 미치는 영향: 체계적 문헌고찰 및 메타분석

신혜연(Hye Yeon Sin),천부순(Pu soon Chun) 대한약학회 2018 약학회지 Vol.62 No.5

A large number of studies have investigated the influence of ABCB1 C3435T polymorphism on blood trough concentrations of tacrolimus in kidney transplant recipients. However, the results are inconsistent. The aim of the present study was to clarify the effects of ABCB1 C3435T on trough blood levels of tacrolimus in renal transplant recipients at different post-transplantation times. The databases of PubMed, Embase, Ovid, and Cochrane Library were searched for all published studies from inception to March 2018. In addition, reference lists of articles were also examined. Using the Review Manager 5, weighted mean differences of dose-adjusted trough concentration of tacrolimus were pooled to estimate the effects of ABCB1 C3435T on tacrolimus levels. A total of 11 studies (968 recipients) were included in the present metaanalysis. The adult recipients with CC genotype had lower dose-adjusted trough concentration of tacrolimus than the CT and TT carriers at the first week after kidney transplantation (CC vs CT, WMD: -14.82; 95% CI: -24.73, -4.90; p=0.003; CC vs TT, WMD: -30.73; 95% CI: -47.9, -13.57; p=0.0004). Similar results were observed in adult recipients at the first month after transplantation (CC vs CT, WMD: -19.61; 95% CI: -27.66, -11.56; p<0.00001; CC vs TT, WMD: -25.45; 95% CI: -47.68, -3.22; p=0.02). Furthermore, at 3 months, the pediatric and adult recipients with CC or CT genotype had lower dose-adjusted trough concentration than the TT carriers (CT vs TT, WMD: -11.85; 95% CI: -18.65, -5.04; p=0.0006; CC vs TT, WMD: -30.98; 95% CI: -37.46, -24.50; p<0.00001). In addition, at the time of 6 months, the adult recipients carrying 3435C allele had lower dose-adjusted trough concentration than the TT carriers (CC vs CT, WMD: -19.00; 95% CI: -23.60, -14.39; p<0.00001; CT vs TT, WMD: -6.57; 95% CI: -12.87, -0.28; p=0.04; CC vs TT, WMD: -26.46; 95% CI: -32.04, -20.88; p<0.00001). These results imply that the adult recipients carrying ABCB1 3435C allele need higher dose of tacrolimus to prevent acute rejection after kidney transplantation.

당뇨병환자에게 부적절하게 사용된 Metformin의 처방빈도 분석

신혜연(Hye Yeon Sin),정기화(Ki Hwa Jung) 대한약학회 2010 약학회지 Vol.54 No.6

We evaluated the inappropriateness of metformin use in patients with type 2 diabetes and chronic medical conditions to identify the frequency of the prescription metformin in violation of the food and drug administration (FDA) black box warning. We reviewed medical records of 307 outpatients who received metformin at endocrinology department in a hospital setting between January 1, 2005 and August 30, 2009. Of the 307 outpatients, 25 discontinued treatment of metformin due to elevated serum creatinine level (Scr≥1.5 mg/dl in male, Scr≥1.4 mg/dl in female), cancers, and/or liver disease. 5 were lost to follow-up. 89 (29.0%) of the patients had cardiovascular disease, 54.1% for hypertension, 9.8% for liver disease, and 60 (20.8%) for chronic kidney disease. 12 patients (3.9%) with chronic kidney disease and/or elevated serum creatinine level, and 1 patient (0.3%) with lactic acidosis were contraindicated to metformin use. Metformin should be avoided in 7 outpatients (2.3%) with active hepatitis and 1 patient (2.6%) with liver cirrhosis. Of the 307 outpatients, 13 (4.2%) patients who received metformin at the first visit and 16 (8.7%) patients who received metformin at the last visit violated to black box warning. 8 (2.6%) of the patients were in precautionary conditions to metformin use. Adjusted mean difference of serum creatinine was -0.16 mg/dl [95% CI: -0.22 to -0.11 (p<0.05)] and adjusted mean difference of alanine aminotransferase was 4.46 IU/l [95% CI: 2.47 to 6.44 (p<0.05)] between the first visit and the last visit. Critical number of elderly patients who are at the high risks of drug-disease and drug-laboratory interaction is exposed to the inappropriate metformin use in violation of black box warning. The periodic evaluation of metformin use and monitoring prescription through drug utility review (DUR) system is needed to improve patients’ safety and to reduce adverse drug events.

병원약국 대상으로 정맥영양제 조제 실행에 관한 연구-2009

신혜연(Hye Yeon Sin),정기화(Ki Hwa Jung) 대한약학회 2010 약학회지 Vol.54 No.4

Standardized parenteral nutrition is required to improve patient’s safety, clinical appropriateness and to increase uniformity between institution and institutions. We assessed the consistency with the American society for parenteral and enteral nutrition (A.S.P.E.N.) practice guideline for PN by evaluating current practice process for parenteral nutrition formulation in inpatients pharmacies in Korea. Each question in this survey was based on 2007 A.S.P.E.N. recommendations of standard parenteral nutrition formulation, the American society of health-system pharmacists (ASHP), and the United State Pharmacopoeia (USP) Chapter 797 guideline for compounding parenteral nutritions. All 90 Korean society of hospital pharmacist (KSHP) member directors of pharmacy were requested to respond to the survey in order to compare the survey results to ASHP national survey of pharmacy practice in hospital settings (2002) in compliance with A.S.P.E.N. guideline. We had final response rate of 35.6%. 25 (100%) hospitals complied with this Garb guideline (response rate was 84.4%) which was the highest compliance. Only 17.9% of hospital pharmacies were actively involved in complications monitoring. Monitoring complications and efficacy were least in compliance with the A.S.P.E.N. guideline. 69.0% of Korean pharmacists adjusted medication dosage based on disease state or monitoring laboratory data in compliance with the A.S.P.E.N. guideline. Over 50% of the hospital pharmacies failed to provide and evaluate staff training in aseptic manipulation skills periodically. Korean hospital pharmacies need to comply with the standard practice guideline for compounding sterile preparation in order to provide better quality of parenteral nutrition service for specific patient population.

건강기능식품의 Cytochrome P450에 대한 영향

신혜연(Hye Yeon Sin),천부순(Pusoon Chun) 대한약학회 2018 약학회지 Vol.62 No.2

Increasing evidence has shown the involvement of health functional foods (HFFs) in inhibition or induction of cytochrome P450 (CYP), affecting the pharmacokinetics of co-administered drugs. To optimize the use of HFFs, it is nec-essary to understand the effects of them on CYPs. In this review we summarize the findings from clinical and in vitro studies evaluating the effects of HFFs on CYPs. In in vitro studies, CYP2C9 and 3A4 were strongly inhibited by allicin in garlic, boswellia extract, fermented curcuma, licorice extract, pomegranate concentrate, and red yeast rice. Furthermore, CYP2C9 was suppressed by hydrolyzed soy extract, lycii fructus extract, and Rhus verniciflua extract. Moreover, red yeast rice strongly inhibited CYP2D6, whereas CYP 2C19 was strongly suppressed by garlic, licorice extract, lycii fructus extract, red yeast rice, and Rhus verniciflua extract. Meanwhile, ginkgo biloba leaf extract showed a potent inductive effect on CYP2C19. In clinical studies, the long-term consumption of ginseng or ginkgo biloba leaf extract caused moderate inductive effects on CYP3A, whereas intake of milk thistle extract led to a moderate inhibition of CYP2C9. Further clinical studies are needed to verify the effects of HFFs on CYPs.

Application of Informer for time-series NO2 prediction

Hye Yeon Sin(신혜연),Minchul Kang(강민철),Joonsung Kang(강준성) 한국컴퓨터정보학회 2023 韓國컴퓨터情報學會論文誌 Vol.28 No.7

본 논문에서는 딥러닝 시계열 예측 모형을 평가한다. 최근 연구에 따르면 이 모형은 ARIMA와 같은 기존 예측 모형보다 성능이 우수하다고 결론짓는다. 그 중 히든 레이어에 이전 정보를 저장하는 순환 신경망이 이를 위한 예측 모형 중 하나이다. 네트워크의 그래디언트 소실 문제를 해결하기 위해 LSTM은 데이터 흐름의 반대 방향으로 숨겨진 레이어가 추가되는 BI-LSTM과 함께 순환 신경망 내부의 작은 메모리로 사용된다. 본 논문은 서울의 2018년 1월 1일부터 2022년도 1월 1일까지의 NO2 자료에 대해 Informer의 성능을 LSTM, BI-LSTM, Transformer와 비교하였다. 이에 실제 값과 예측값 사이의 평균 제곱근 오차와 평균 절대 오차를 구하였다. 그 결과 Test 데이터 (2021.09.01.~2022.01.01.)에 대해 Informer는 다른 방법에 비해 가장 높은 예측 정확도 (가장 낮은 예측 오차: 평균 제곱근 오차: 0.0167, 평균 절대 오차: 0.0138)를 보여 타 방법에 비해 그 우수성을 입증하였다. Informer는 당초 취지와 부합되게 다른 방법들이 갖고 있는 장기 시계열 예측에 있어서의 문제점을 개선하는 결과를 나타내고 있다. In this paper, we evaluate deep learning time series forecasting models. Recent studies show that those models perform better than the traditional prediction model such as ARIMA. Among them, recurrent neural networks to store previous information in the hidden layer are one of the prediction models. In order to solve the gradient vanishing problem in the network, LSTM is used with small memory inside the recurrent neural network along with BI-LSTM in which the hidden layer is added in the reverse direction of the data flow. In this paper, we compared the performance of Informer by comparing with other models (LSTM, BI-LSTM, and Transformer) for real Nitrogen dioxide (NO2) data. In order to evaluate the accuracy of each method, mean square root error and mean absolute error between the real value and the predicted value were obtained . Consequently, Informer has improved prediction accuracy compared with other methods.

아로마 오일과 일반 오일을 이용한 복부마사지가 간호사의 월경 곤란증과 생리통에 미치는 효과 -서울소재 일개병원 일개팀 간호사를 대상으로

이혜진 ( Hye Jin Lee ),이영선 ( Young Sun Lee ),신혜연 ( Hye Yeon Sin ),송은영 ( Eun Young Song ),손현진 ( Hyun Jin Son ),김인옥 ( In Ock Kim ),임상희 ( Sang Hee Im ),최순영 ( Sun Young Choi ),권정순 ( Jung Sun Kwon ),이인미 ( Min 병원간호사회 2006 임상간호연구 Vol.11 No.2