Radiology plus ileocolonoscopy versus radiology alone in Crohn’s disease: prognosis prediction and mutual agreement

Background/aims: The optimal tools for monitoring Crohn's disease (CD) are controversial. We compared radiology plus ileocolonoscopy and radiology alone in terms of prognosis prediction and evaluated the agreement between radiologic and ileocolonoscopic findings in patients with CD. Methods: Patients with CD who were followed up with computed tomography enterography (CTE) or magnetic resonance enterography (MRE) alone or CTE or MRE plus ileocolonoscopy were retrospectively recruited. Time to relapse was investigated to evaluate the difference in prognosis using the log-rank and Cox regression tests, and the agreement between radiologic and ileocolonoscopic findings was determined using a kappa value. Results: A total of 501 patients with CD in clinical remission who underwent CTE or MRE and/or ileocolonoscopy were analyzed. Of these, 372 (74.3%) patients underwent CTE or MRE alone and 129 (25.7%) patients underwent CTE or MRE plus ileocolonoscopy. The cumulative maintenance rate of clinical remission between the two groups was not significantly different (p = 0.526, log-rank test). In multivariate analysis, age <40 years (hazard ratio [HR], 2.756; 95% confidence interval [CI], 1.263 to 6.013) and a history of steroid use (HR, 2.212; 95% CI, 1.258 to 3.577) were found to independently predict an increased risk for clinical relapse in patients with CD in clinical remission. Radiologic and ileocolonoscopic findings had a moderate degree of agreement (κ = 0.401, -0.094 to 0.142). The comparison of agreement between radiologic and ileocolonoscopic findings was the highest in the anastomotic site (κ = 0.749, -0.168 to 0.377). Conclusion: Radiology plus ileocolonoscopy was not superior to radiology alone in predicting the prognosis of CD.ope

Comparative effectiveness of second-line biological therapies for ulcerative colitis and Crohn's disease in patients with prior failure of anti-tumour necrosis factor treatment

Background: Therapeutic options for inflammatory bowel disease (IBD) have increased since the introduction of tumour necrosis factor (TNF) inhibitors a few decades ago. However, direct comparisons of the effectiveness of second-line biological agents in patients with ulcerative colitis (UC) and Crohn's disease (CD) are lacking. Methods: Patients with UC or CD who experienced anti-TNF treatment failure and subsequently used vedolizumab, ustekinumab, or tofacitinib as a second-line drug were retrospectively recruited. The primary outcomes were the clinical remission rate at week 16 and the cumulative relapse rate 48 weeks after receiving induction therapy. Results: A total of 94 patients with UC or CD experienced anti-TNF treatment failure and received vedolizumab (UC: 37; CD: 28), ustekinumab (CD: 16), or tofacitinib (UC: 13). The clinical remission rates were not significantly different between the vedolizumab and tofacitinib groups in UC patients (56.8% vs. 46.2%, p = 0.509). In CD patients, the clinical remission rates were not significantly different between the vedolizumab and ustekinumab groups (53.6% vs. 50.0%, p = 0.820). Moreover, the cumulative rates of clinical relapse were not significantly different between the vedolizumab and tofacitinib groups in UC patients and between the vedolizumab and ustekinumab groups in CD patients (p = 0.396 and p = 0.692, respectively). Safety profiles were also similar among the treatment groups in both UC and CD patients. Conclusions: After prior anti-TNF therapy failure, vedolizumab and tofacitinib in UC patients and vedolizumab and ustekinumab in CD patients were not significantly different in terms of the efficacy in inducing and maintaining a clinical response.ope

Continued Postoperative Use of Tumor Necrosis Factor-α Inhibitors for the Prevention of Crohn's Disease Recurrence

Background/aims: Many patients with Crohn's disease (CD) undergo intestinal resection during the disease course. Despite surgery, postoperative recurrence (POR) commonly occurs. Although postoperative use of tumor necrosis factor α (TNF-α) inhibitors is known to be effective in preventing POR, few studies have evaluated the effectiveness of continuing the same TNF-α inhibitors postoperatively in patients who received TNF-ɑ inhibitors before surgery. Methods: This retrospective observational study was performed in a single tertiary medical center. We retrospectively reviewed patients who had undergone the first intestinal resection due to CD and divided them into two groups: TNF-α inhibitor users in both the preoperative and postoperative periods, and TNF-α inhibitor users in only the preoperative period. We compared the clinical outcomes between these two groups. Results: In total, 45 patients who used TNF-α inhibitors preoperatively were recruited. Among them, TNF-α inhibitors were used postoperatively in 20 patients (44.4%). The baseline characteristics except age at diagnosis were similar in both groups. The rates of surgical and endoscopic recurrence were not different between the two groups, but the cumulative clinical recurrence rate was significantly lower in the postoperative TNF-α inhibitors group (log-rank p=0.003). In multivariate Cox regression analysis, postoperative TNF-α inhibitors use was significantly associated with a decreased risk of clinical recurrence (adjusted hazard ratio, 0.204; 95% confidence interval, 0.060 to 0.691; p=0.011). Conclusions: Continuing TNF-α inhibitors postoperatively in patients who were receiving TNF-α inhibitors before surgery significantly reduced the rate of clinical recurrence. For patients with CD who received TNF-α inhibitors preoperatively, continuing their use after surgery could be recommended.ope

家族新小說을 中心으로

To describe the history of Korean literature rightly, the non-subjective and western-oriented theory of implanted culture should be overcome. To meet this requirement, Sin-So-Seol Has begun to be noticed and studied from the new point of view based on the developmental, nationlistic view of history. From the same point of view, dealing with 27 familily Sin-So-Seol, this article analyzes and considers the structure of work as preparation in Chapter 2, the general theme in Chapter 3, the Character of social history in Chapter 4 respectively. Most scholars who had studied Sin-So-Seol ascribed the general them to the arousal of enlightment thoughts, and appreciated the enlightening and reforming role. But these conclusions contradict the real contents of works. Except a few works, most works preserves the structure of the previous novels, and they arc only decorated by enlightment thoughts. In case of some works, there is not any indication of enlightment thoughts. Enlightment thoughts are not structualized in the w works, and moreover it has a perious limitation in itself. The conclusion of these analyses supplements the results of the recent study which recognized the same hidden theme of the previous novels. Though born in conflict and crisis, neglecting the crucial problems of that era, the family Sin-So-Seol reveals the distorted value conciousness of adaptism compromising the foreign power and the superficial enlightment. And the interest-oriented secularity is due to these character. Though in character this article is chiefly concerned with the negative estimation of the family Sin-So-Seol, by referring to this article, the study after can find the self-sown process of modernization along the context of literature tradition.;韓國文學史의 정당한 敍述을 위하여 沒主體的이며 西歐指向的인 移植文化論은 극복되어야 한다. 이러한 當爲를 구체화하는 작업의 일환으로, 新小說은 發展的 民衆史觀에 입각한 새로운 각도에서 주목, 연구되기 시작했으며, 현재 論議가 활발히 진행되고 있다. 本 論文에서는 이와 동일한 관점에서 27편의 家族新小說을 對象으로, II章에서는 本 論文의 基礎 作業으로 作品 構造를, III章에서는 普遍主題를, IV章에서는 社會史的 性格을 각각 分析, 考察하고자 한다. 신소설을 연구한 대부분의 旣存 學者들은 新小說의 普遍主題를 開化思想의 表出로 파악하고 그 啓蒙性과 革新性을 높이 평가했다. 그러나 이러한 見解는 作品 實相과 어긋나는 것이다. 27편의 家族新小說은 소수의 作品을 제외한 대다수가 前代小說的 作品 構造를 긍정적으로 계승하고 開化思想으로 粉飾하였을 뿐이다. 심지어는 개화사상이 전혀 나타나지 않는 作品도 있다. 開化思想은 作品 構造로 용해되지 못하고 있을 뿐만 아니라, 그 자체로서도 심각한 한계를 드러낸다, 이러한 分析 결과는 최근, 신소설의 前代小說的 裏面 主題를 인식한 학자들의 연구 결과를 보완, 극복할 수 있는 것으로 생각된다. 混亂과 危機 속에서 태어나 개화기 가족신소설은 시대의 核心課題를 등진채 外勢迎合的 順應主義와 虛名開化의 顚倒된 價値意識을 드러내고 있으며 이러한 성격은 興味 本位의 通俗性으로 연결되고 있다. 本 論文은 論旨의 性格上, 가족신소실에 對해 否定的 評價로만 一貫하고 있으나 이를 토대로 以後 연구에서는 文學 傳統의 脈絡위에서 自生的 近代化 過程을 파악할 수 있을 것으로 생각된다.I. 서론 1 II. 작품구조 7 III. 가족신소설의 주제 30 A. 주제 연구사를 통한 문제 제기 30 B. 작품에 나타난 개화 사상 35 1. 자주 독립 사상 37 2. 관료의 부패성 폭로와 민중의 저항 의식 41 3. 신교육관 49 4. 신결혼관 57 5. 미신 타파 사상 63 6. 계급 타파 사상과 하층민의 자각 의식 67 7. 개화사상이 부재한 작품 73 C.작품 구조를 통한 주제 82 IV. 가족신소설의 시대적 성격 88 A. 외세영합적 순응주의 90 B. 허명 개화 의식 98 C. 시장지향적 성격 104 V. 결론 114 참고문헌 117 ABSTRACT 12

지인지감유형 고전소설 연구

The aim of this thesis is to establish a clear understanding of the narrative pattern and meaning of Jiinjigam type Gojeonsoseul(지인지감유형 고전소설) and also to accord a proper evaluation on this type of novel in the history of Gojeonsoseul.(고전소설) The second chapter deals, in the main, with the defining the notion of Jiinji gam-motif(지인지감화소), followed by the examination of the way the folktale is appropriated in the Jigam type novel. Jigam type novel is characterized by an unusual character gifted with the clairvoyance and other abilities rare among ordinary human beings(jija, 知者) who would give prophesy on a likewise unusual individual singled out by Jija for his outstanding traits in terms of physical features and character(Pijija, 被知者), followed by an episode in which the prophesy of Jija is fulfilled. Materials of written folktale are classified into three types; &amp;lt;Munmug wanjiindam&amp;gt; (文·武官知人談) &amp;lt;Yiinjiindam&amp;gt;(異人知人談) &amp;lt;Hyunnyujiindam&amp;gt;(賢女知人談). These three types, sharing the common structural pattern, display a clear distinction in terms of its narrative detail. Some elements of written folktale have a significant similarity with elements of Jigam type novel, which provides a close link between the two. In examining the way the folktale is appropriated into Jigam motif novel, this thesis deals with the background in which Jiinjigam was developed. This approach, the author of this thesis is convicted, affords a viewpoint from which the study of Gojeunsoseul gains a greater depth. Chapter III deals with the analysis of each individual works as representatives of Jijigam type novel; &amp;lt;Sodaesungjeun&amp;gt;(蘇大成傳) &amp;lt;Naksungbiryong&amp;gt;(落星飛龍) &amp;lt;Sinyubokjeun&amp;gt;(申遺腹傳) &amp;lt;Yungyirok&amp;gt;(靈異錄). These five works, sharing a common narrative framework, differ in its narrative detail. The common sturural parallel is found in the format: the introduction of ‘Pijija’ and ‘Jija’?the suffering of Jija ? the link established between Pijija and Jija whose unusual intuition locates the plight of Pijija ? the rescue by the Jija and the obstacle before the Pijija ? the able performance of the Pijija fulfills the prophesy by the Jija. The major difference one work has from the other is as follows: &amp;lt;Sodaesungjeun&amp;gt;episode in which a figure of humble birth delivers his country from the crisis through his bravery as a warrior. &amp;lt;Naksungbiryong&amp;gt;represents an attempt to portray an ideal character whose magnitude of character is coupled with bravery and learning, and incredibly with a fortunated career, &amp;lt;Sinyubokjeun&amp;gt;is a story in which a figure of another modest and humble birth rises to the status of a government bureaucrat, and displays the feat of the bravery as a warrior in Chosun dynasty(朝鮮朝) in a patriotic fight against the foreign invaders. &amp;lt;Bakssibuinjeun&amp;gt;has a female character as it’s protagonist whose heroic achievements amounts to the God in human, shown especially in her fighting off the foreign invaders. &amp;lt;Yungyirok&amp;gt;features another figure of lowly birth whose supernatural power drives out a dragon figure who sneaked into the royal palace and delivers the life of a son of heaven from danger. These differences and others dealth with in the body of this thesis as residing in each of these five works is an important ground for the exploration of the meaning inherent in the structure of this type of novel and its implications in the history of Gojeunsoseul. Chapter IV is devoted to the exploration of structural implications in the structure of Jiinjigam type novel in terms of the ontological and sociological significance. The five novels discussed in this thesis suggests an approach to life defined and directed by one’s own judgment and will in an active struggle against the fatalistic approach to life. This assertive and enlightening struggle in these works promotes the vitality in the flow of these Gojeunsoseul. Jigam type novel has as its outstanding features the issue of the rise in status of the underrepresented class which is shown in the selection of a character who will be Pijija in the plot. &amp;lt;Sodaesungjeun&amp;gt;&amp;lt;Naksungbiryong&amp;gt;&amp;lt;Sinyubokjenn&amp;gt;represents a strong desire for the move up in the status on the part of low class. This can be a reflection of the social trend in which the solidity of feudal caste begin to break down by the strong manifestion of desire for change in the formation of social class on the part of low class. &amp;lt;Bakssibuinjeun&amp;gt;&amp;lt;Yungyirok&amp;gt;portays a strong desire of an outsider for success in life as a means of being integrated into the mainstream of the society in late Chosun dynasty(朝鮮朝). This treatment can be regarded as an attempt to bring up an social issue into a literary ground, an issue which reveals the contradiction in which an able man from a low class was seldom given a chance to develop his ability in his own society. The five works examined I this thesis, by dealing with the coupling of characters, attempt to bring up the contradiction into focus of inequality inherent in the inter ? marriage(marriage exclusively among the same social class) prevalent in the late Chosun dynasty, and to portray the desire to overcome the inequality. This is significant if seen in the historical context of late chosun society in which the inter ?marriage is beginning to loosen up as the society moves toward the modernization. Chapter V examines the significance which Jiinjigam type novel has in the history of development of Gojeunsoseul. Jiinjigam type novel is the subgenera of ‘heroic novel’. In terms of techniques of narration, Jiinjigam introduced an interesting and a significant variation on ‘hero novel’s live of a hero by its unique element of Jigam motif. In terms of intellectual development, Jigam novels embody a clear recognition of the value of the will and desire for human autonomy in directing individuals life, and more significantly these recognition is coupled with the expression of the desire for the move-up among the low class people, both of which share the same context with the general historical trend of late Chosun society in the modern history of Korea. Besides these five works, there are a great wealth of Gojeonsoseul which use Jigam motif. As this thesis will demonstrate, Jiinjigam type novel, I believe, has a considerable significance in the history of Korean novel. ; 본 논문은 知人之鑑類型 고전소설의 문학적 형상화의 實狀과 그 意味를 체계적으로 정확히 파악하고 그 가치를 올바르게 평가하는 것을 목적으로 삼고 있다. II장에서는 지인지감화소의 개념을 규정한 후에 지감화소의 설화적 수용양상을 고찰하였다. 지감화소는 비범하고 신비스러운 감식안을 가진 특정인이 뛰어난 인물의 잠재력과 장래성에 대해 예견한 후에 뛰어난 인물이 잠재력을 발휘함으로써 知鑑이 적중되는 이야기를 그 내용으로 하고 있다. 문헌설화 자료는 중심인물의 인물유형에 따라 文·武官知人談, 異人知人談, 賢女知人談으로 분류된다. 세 유형의 문헌설화는 구조적 공통성을 근간으로 하면서 그 구체적인 서사양상에 있어서는 각 유형별로 성격을 달리하고 있다. 문헌설화 자료의 구성요소들은 지인지감유형 소설의 중요제재와 매우 유사한 성격을 띄고 있어서 상호간의 관련성이 밀접한 것으로 생각된다. 지감화소의 설화적 수용양상을 검토하는 작업을 통하여 지인지감유형 소설의 성립배경을 살피고 고전소설 연구자료를 지감화소를 중심으로 하여 검토할 때 작품을 더욱 심도있게 이해할 수 있다는 연구시각의 입각점을 마련할 수 있었다. III장에서는 지인지감유형 소설자료인 &amp;lt;소대성전&amp;gt; &amp;lt;낙성비룡&amp;gt; &amp;lt;신유복전&amp;gt; &amp;lt;박씨부인전&amp;gt; &amp;lt;영이록&amp;gt;의 서사구조를 각 작품별로 분석했다. 5편의 작품은 지감화소를 중심으로 하는 공통된 서사골격을 바탕으로 하면서 그 구체적인 서사양상에서는 차이를 나타내고 있다. 공통 서사구조는 대체로 被知者 혹은 知者 提示→피지자의 처지몰락→지자의 지감에 의한 피지자의 結緣→피지자에 대한 후원과 장애→피지자의 잠재력발휘 (知鑑的中)’로 나타난다. 각 작품구조 상호간의 가장 중요한 차이점은 다음과 같다. &amp;lt;소대성전&amp;gt;은 미천한 인물이 탁월한 武將으로서 나라를 위기에서 구하기까지의 과정을 그리고 있다. &amp;lt;낙성비룡&amp;gt;에서는 賢聖大器的인 자질을 지니고 文武를 겸비했으며 福祿까지도 두루 갖춘 理想的인 人間像을 구현하고 있다. &amp;lt;신유복전&amp;gt;에서는 미천한 인물이 立身하여 文官으로서 명망을 얻으며 또 朝鮮武將으로서 明國을 위기에서 구하기까지 과정을 형상화하고 있다. &amp;lt;박씨부인전&amp;gt;은 영웅적인 여성인물이 神人으로서의 능력을 발휘했는데 특히 外敵을 물리치는 사건이 강조된다. &amp;lt;영이록&amp;gt;은 보잘것없어 보이는 한 인물이 神仙으로서 신통력을 발휘했는데 특히 궁중에 잠복한 業龍을 물리치고 天子의 목숨을 구하는 과정이 부각된다. 이 밖에도 작품구조 상호간에는 공통점을 근간으로 하면서도 그 구체적인 서사양상에서 중요한 차이점이 많이 나타난다. 이러한 차이점은 작품구조에 내포된 의미나 소설사적 의의를 파악하는데 중요한 근거가 된다. IV장에서는 지인지감유형 소설의 작품구조에 내포된 의미를 인간존재론적 측면과 사회적인 측면에서 규명했다. 5편의 작품에서 지감화소를 중심으로 전개되는 작품구조에는 인간 스스로의 판단과 주체적인 의지에 의거해서 삶을 전개하는 의미가 함축되어 있다. 삶에 대한 운명론적 체념을 극복하고 인간 스스로가 주체가 되어 뜻하는 방향으로 운명을 열어가고자 하는 의지를 보게 된다. 이같은 적극적인 존재론적 인식은 고전소설의 정신사에 있어서 역동적인 활력을 불어 넣고 있다. 지감유형 고전소설에서는 인물선택 문제를 둘러싼 소외계층의 신분상승의식이 두드러지게 부각되고 있다. &amp;lt;소대성전&amp;gt; &amp;lt;낙성비룡&amp;gt; &amp;lt;신유복전&amp;gt;에서는 하층민이 신분상승을 이루고자 하는 강한 욕구가 형상화 되고 있다. 이러한 작품실상은 조선조 후기에 하층민의 신분상승욕구의 분출로 공고하던 봉건적 신분제가 붕괴되는 근대적 동향의 반영이라 볼 수 있다. &amp;lt;박씨부인전&amp;gt; &amp;lt;영이록&amp;gt;에서는 뛰어난 異人의 삶을 통하여 소외계층의 체재내적 立身에 대한 열망을 표출하고 있다. 이러한 현상은 당대사회에서 불우한 처지에 있던 유능한 인물들이 사회체제에서 외면당하고 있는 현실의 모순을 문학내적 문제로 제기한 것으로 보인다. 5편의 작품에서는 落婚을 제재로 취택하여 조선조 사회에서 엄격하게 지켜지던 階級內婚制에 기인하는 불평등한 가족질서의 모순을 제기하는 한편 그러한 모순을 극복하고자 하는 꿈을 반영하고 있다. 이는 계급내혼제가 완화되어 가는 근대적인 역사적 동향과 그 궤를 같이 하고 있다. V章에서는 지인지감유형 小說의 小說史的 意義를 검토했다. 지인지감유형 고전소설은 영웅소설의 하위유형으로 설정될 수 있다. 서사기법의 측면에서는 지감화소를 중심으로 하는 독특한 서사논리로 인하여 영웅소설의 ‘영웅의 一生’ 구조에 흥미롭고도 중대한 변화를 초래했다. 정신사적 측면에서는 작품구조를 통하여 인간주체적 판단과 의지에 바탕을 둔 인간존재론적 인식과 하층민의 신분상승의식이 형상화 되고 있는데, 이같은 의미는 조선조 후기 근대적인 역사적 동향과 맥락이 닿아 있다. 또 5편 이외에도 지감이야기가 내용의 일부로 수용된 고전소설은 방대한 분량에 달한다. 이상과 같은 논의 결과, 지인지감유형 고전소설은 한국소설사에서 주목할 만한 뚜렷한 意義를 지니고 있음을 파악할 수 있었다.I. 서론 -------------------------------------------------------------- 1 A. 연구의 목적과 의의 ----------------------------------------------- 1 B. 연구의 방법과 자료 ----------------------------------------------- 3 II. 知人之鑑話素의 본질과 설화적 수용 -------------------------------- 7 A. 지인지감화소의 개념과 영역 --------------------------------------- 7 B. 지인지감화소의 설화적 수용양상 ----------------------------------- 10 III. 知人之鑑類型 소설의 서사구조 ------------------------------------ 34 A. 〈蘇大成傳〉 ----------------------------------------------------- 34 B. 〈朴氏夫人傳〉 --------------------------------------------------- 46 C. 〈靈異錄〉 ------------------------------------------------------- 57 D. 서사구조 상호간의 관계 ------------------------------------------- 69 IV. 知人之鑑類型 소설 서사구조의 의미 -------------------------------- 71 A. 인간주체적 의지에 의한 삶의 전개 --------------------------------- 71 B. 소외계층의 신분상승의식 ------------------------------------------ 81 C. 가족구성원간의 갈등과 극복 --------------------------------------- 98 V. 知人之鑑類型 소설의 소설사적 의의 ---------------------------------107 VI. 결론 -------------------------------------------------------------118 참고문헌 -------------------------------------------------------------122 영문초록 -------------------------------------------------------------12

Direct-Acting Antivirals Improve Treatment Outcomes in Patients with Hepatitis C Virus-Related Hepatocellular Carcinoma Treated with Transarterial Chemoembolization: A Nationwide, Multi-center, Retrospective Cohort Study

Background and aims: The influence of direct-acting antivirals (DAAs) on chronic hepatitis C (CHC)-related hepatocellular carcinoma (HCC) remains controversial. We investigated the effect of eradicating CHC using DAAs on treatment outcomes in patients with CHC-related HCC treated with transarterial chemoembolization (TACE). Methods: This nationwide, multi-center, retrospective study recruited patients with CHC-related HCC treated with TACE as the first-line anti-cancer treatment, and who achieved a sustained virological response (SVR) using DAAs (DAA group) between 2006 and 2017. Patients achieving an SVR following interferon-based treatment (IFN group) and those without treatment (control group) were also recruited for comparison. Results: A total of 425 patients were eligible for the study. Of these, 356 (83.8%), 26 (6.1%), and 43 (10.1%) were allocated to the control, IFN, and DAA groups, respectively. A multivariate analysis showed that liver cirrhosis, segmental portal vein thrombosis, and larger maximal tumor size independently predicted an increased risk of progression (all p < 0.05), whereas, the DAA group (vs. IFN and control groups) independently predicted a reduced risk of progression (hazard ratio (HR) = 0.630, 95% confidence interval 0.411-0.966, p = 0.034). The cumulative incidence rate of HCC progression in the DAA group was significantly lower than that in the IFN and control groups (p = 0.033, log-rank test). In addition, the DAA group (vs. IFN and control groups) was independently associated with a reduced risk of mortality (p = 0.042). Conclusions: DAA treatment provided significantly prolonged progression-free survival in patients with CHC-related HCC treated with TACE compared to that in patients administered IFN or no treatment.restrictio