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( Sang Jun Suh ),( Hyung Joon Yim ),( Sun Jae Lee ),( Hyun Jung Lee ),( Eileen L Yoon ),( Sun Young Yim ),( Hae Rim Kim ),( Seoung Hee Kang ),( Keun Hee Kang ),( Ji Hoon Kim ),( Yeon Seok Seo ),( Jong 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1
Background and aims: Sorafenib is the only approved treatment to advanced hepatocellular carcinoma (HCC). However, its efficacy was relatively worse in the Asian-Pacific trial compared with the Global trial and clinical utility is limited by high cost. Several reports suggested survival benefit of hepatic arterial infusion chemotherapy (HAIC) in patients with advanced HCC with main portal vein invasion. This study is aimed to compare the efficacy of HAIC with sorafenib in HCC patients with main portal vein invasion. Methods: Patients of advanced HCC with main portal vein invasion who had received treatment between 2008 and 2012 at Korea University Medical Center were included. Sorafenib was initiated with 400 mg twice daily, and HAIC was performed with infusion of cisplantin 60mg/m2 for 1 day and 5-flurouracil 500mg/m2 for 3 days every 4 weeks. We evaluated overall survival (OS), time-to-progression (TTP), and disease control rate (DCR). Results: Seventy six patients were treated by sorafenib (n=37) or HAIC (n=39). Proportion of patients with Child-Pugh class A liver function (70% vs. 72%, P=1.000), ECOG performance status 0-1 (68% vs. 70%, p=0.431) and lymph node metastasis (41% vs. 36%, P=0.814) was not significantly different. Solid organ metastasis was more common in sorafenib group than HAIC group (46% vs. 7.7%, P<0.001). Median OS was 6.9 months and 11.1 months in sorafenib and HAIC group (P=0.100). TTP was 1.9 months (sorafenib) and 5.3 months (HAIC) (P<0.001). DCR was 34% (sorafenib) and 72% (HAIC) (P=0.006). In patients without solid organ metastasis, OS was 8.8 months (sorafenib) and 11.1 months (HAIC) (P=0.097). TTP was 1.9 months (sorafenib) and 6.0 months (HAIC) (P<0.001). DCR was 29% (sorafenib) and 76% (HAIC) (P=0.031). Conclusions: HAIC can be alternative treatment option for advanced HCC with main portal vein invasion, and could provide favorable disease control rate in those patients without solid organ metastasis.
Seo, In-Yong,Ha, Bok-Nam,Lee, Sung-Woo,Shin, Chang-Hoon,Kim, Seong-Jun Korean Nuclear Society 2010 Nuclear Engineering and Technology Vol.42 No.2
In nuclear power plants (NPPs), periodic sensor calibrations are required to assure that sensors are operating correctly. By checking the sensor's operating status at every fuel outage, faulty sensors may remain undetected for periods of up to 24 months. Moreover, typically, only a few faulty sensors are found to be calibrated. For the safe operation of NPP and the reduction of unnecessary calibration, on-line instrument calibration monitoring is needed. In this study, principal component-based auto-associative support vector regression (PCSVR) using response surface methodology (RSM) is proposed for the sensor signal validation of NPPs. This paper describes the design of a PCSVR-based sensor validation system for a power generation system. RSM is employed to determine the optimal values of SVR hyperparameters and is compared to the genetic algorithm (GA). The proposed PCSVR model is confirmed with the actual plant data of Kori Nuclear Power Plant Unit 3 and is compared with the Auto-Associative support vector regression (AASVR) and the auto-associative neural network (AANN) model. The auto-sensitivity of AASVR is improved by around six times by using a PCA, resulting in good detection of sensor drift. Compared to AANN, accuracy and cross-sensitivity are better while the auto-sensitivity is almost the same. Meanwhile, the proposed RSM for the optimization of the PCSVR algorithm performs even better in terms of accuracy, auto-sensitivity, and averaged maximum error, except in averaged RMS error, and this method is much more time efficient compared to the conventional GA method.
( Sang Jun Suh ),( Hyung Joon Yim ),( Yeon Seok Seo ),( Chang Wook Kim ),( Chang Don Lee ),( Sang Hoon Park ),( Myung Seok Lee ),( Choong Kee Park ),( Hee Bok Chae ),( Moon Young Kim ),( Soon Koo Baik 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1
Background/Aim: Many patients with lamivudine-resistant (LAM-R) chronic hepatitis B (CHB) had been treated by switching to entecavir (ETV) 1.0mg. Although rate of resistance to ETV (ETV-R) is reported high, current medical insurance system doesn`t pay-back for change from ETV to other agent in patients whose resistance to ETV was not identified. This study was aimed to stratify ETV therapy in LAM-R patients. Methods: One hundred and ten CHB patients who occurred LMV-R and received ETV 1.0mg up to 5 years were evaluated prospectively. At 12 months of switching to ETV, we divided subjects into non-detection group (HBV DNA<20 IU/mL) and detection group (HBV DNA≥20 IU/mL), which was subdivided into low viral load group (20≤HBV DNA<2,000 IU/mL) and high viral load group (2,000 IU/mL≤ HBV DNA). Virologic response rate (VR; HBV DNA<20 IU/mL) and ETV-R were evaluated as end point. Results: One hundred and ten patents were enrolled. The mean age was 45±11years, the proportion of male and HBeAgpositive patient was 71% (80/110) and 77% (85/110), respectively. The mean serum HBV DNA levels were 6.89±1.03, 3.26±1.81, 3.06±1.82, 2.49±1.53, 2.43±1.35 and 1.73±0.87 log10IU/ ml at baseline, month 12, 24, 36, 48 and 60, respectively. The VR (95% vs. 29%, P<0.001) was higher and ETV-R (10% vs. 54%, P=0.001) was lower in non-detection group than in detection group. The VR (27% vs. 29%, P=0.853) and ETV-R (45% vs. 57%, P=0.367) was not significantly different between low viral load and high viral load group. Resistance to ETV occurred at 26±10.3 months (median 24 months, 12-48 months) in detection group. Conclusion: Resistance rates were high in patients with detectable HBV DNA at 12 months of ETV therapy. Therefore, switching to or adding a potent nucleotide analogue (e.g. tenofovir) is warranted in LAM-R CHB patients whose HBV DNA is detected after 12 months of ETV therapy.
( Sang Jun Suh ),( Jong Eun Yeon ),( Sun Jae Lee ),( Hyun Jung Lee ),( Eileen L. Yoon ),( Ji Hoon Kim ),( Yeon Seok Seo ),( Hyung Joon Yim ),( Kwan Soo Byun ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1
Background: Current guidelines suggest the criteria for discontinuation of nucleos(t)ide analogues (NA) in selected patients. However treatment induced virological response is not permanent. Aim of our study is to evaluate the clinical significance of HBsAg titer in predicting sustained virologic response after NA therapy discontinuation. Methods: From Jun 1998 to Dec 2010, medical record of 81 chronic hepatitis B patients who discontinued NA was analyzed retrospectively. Sustained virologic response (SVR) was arbitrarily defined as undetectable HBV DNA by real-time PCR(with lower limit of detection of 116 copies/mL, 20 IU/mL) persisted more than 12 months after treatment discontinuation. Results: Median age was 51 years, 54 (67%) patients were male, and 50 (62%)patients were HBeAg positive. Median baseline ALT, HBV DNA and HBsAg were 292 IU/mL, 7.1log10 IU/mL and 3.3log10 IU/mL. NA were lamivudine (n=53), adefovir (n=15), lamivudine combined with adefovir (n=4), and entecavir (n=9). Median treatment duration and follow-up period were 26 and 27 months. 11/81 (14%) patients had SVR. The cumulative relapse rates were 37/81 (46%) at 6 months and 42/81 (52%) 12 months after treatment discontinuation. The baseline ALT, HBV DNA and presence of HBeAg were not different between patients with or without SVR. In univariate analysis, age, treatment duration and HBsAg level at treatment discontinuation were different in patients with or without SVR; 51 vs. 43 years, p=0.033; 53 vs. 25 months, p=0.011; 2.1 vs. 3.3log10 IU/mL, p=0.003. In multivariate analysis, only HBsAg level at treatment discontinuation remained as an independent factor associated with SVR (p=0.019). The cutoff value of HBsAg level <2log10 IU/mL was predictive of SVR [(AUROC, 0.991; 95% confidence interval[CI], 0.000-1.000; p<0.05); sensitivity, 100%; specificity, 93%; positive predictive value, 69%; negative predictive value, 100%]. Conclusions: Large proportion of patients treated with oral antivirals relapsed after the treatment discontinuation. In the decision of the treatment discontinuation, HBsAg level <2log10 IU/mL at treatment discontinuation can predict sustained viral suppression in selected patients.