Is it necessary to delay antiviral therapy for 3-6 months to anticipate HBeAg seroconversion in patients with HBeAg-positive chronic hepatitis B in endemic areas of HBV genotype C?

Background/AimsSpontaneous HBeAg seroconversion occurs frequently in the immune reactive phase in HBeAg-positive chronic hepatitis B (CHB). Therefore, observation for 3-6 months before commencing antiviral therapy is recommended in patients with alanine aminotransferase (ALT) levels that exceed twice the upper limit of normal (ULN). However, HBeAg seroconversion occurs infrequently in patients infected with hepatitis B virus (HBV) genotype C. The aim of the present study was to determine whether the waiting policy is necessary in endemic areas of HBV genotype C infection.MethodsNinety patients with HBeAg-positive CHB were followed prospectively without administering antiviral therapy for 6 months. Antiviral therapy was initiated promptly at any time if there was any evidence of biochemical (i.e., acute exacerbation of HBV infection or aggravation of jaundice) or symptomatic deterioration. After 6 months of observation, antiviral therapy was initiated according to the patient's ALT and HBV DNA levels.ResultsOnly one patient (1.1%) achieved spontaneous HBeAg seroconversion. Biochemical and symptomatic deterioration occurred before 6 months in 17 patients (18.9%) and 5 patients, respectively. High ALT and HBV DNA levels were both independent risk factors for biochemical deterioration. Of 15 patients with HBV DNA ≥5.1×107 IU/mL and ALT ≥5×ULN, biochemical deterioration occurred in 7 (46.7%), including 1 patient receiving liver transplantation due to liver failure.ConclusionsSpontaneous HBeAg seroconversion in patients with HBeAg-positive CHB is rare within 6 months. Biochemical deterioration was common and may lead to liver failure. Immediate antiviral therapy should be considered, especially in patients with high ALT and HBV DNA levels in endemic areas of genotype C infection

Impact of immunosuppressant therapy on early recurrence of hepatocellular carcinoma after liver transplantation

Background/AimsThe most commonly used immunosuppressant therapy after liver transplantation (LT) is a combination of tacrolimus and steroid. Basiliximab induction has recently been introduced; however, the most appropriate immunosuppression for hepatocellular carcinoma (HCC) patients after LT is still debated.MethodsNinety-three LT recipients with HCC who took tacrolimus and steroids as major immunosuppressants were included. Induction with basiliximab was implemented in 43 patients (46.2%). Mycophenolate mofetil (MMF) was added to reduce the tacrolimus dosage (n=28, 30.1%). The 1-year tacrolimus exposure level was 7.2 ± 1.3 ng/mL (mean ± SD).ResultsThe 1- and 3-year recurrence rates of HCC were 12.9% and 19.4%, respectively. Tacrolimus exposure, cumulative steroid dosages, and MMF dosages had no impact on HCC recurrence. Induction therapy with basiliximab, high alpha fetoprotein (AFP; >400 ng/mL) and protein induced by vitamin K absence/antagonist-II (PIVKA-II; >100 mAU/mL) levels, and microvascular invasion were significant risk factors for 1-year recurrence (P<0.05). High AFP and PIVKA-II levels, and positive 18fluoro-2-deoxy-d-glucose positron-emission tomography findings were significantly associated with 3-year recurrence (P<0.05).ConclusionsInduction therapy with basiliximab, a strong immunosuppressant, may have a negative impact with respect to early HCC recurrence (i.e., within 1 year) in high-risk patients

Cost analysis of depression using the national insurance system in South Korea: a comparison of depression and treatment-resistant depression

The incidence and burden of depressive disorders are increasing in South Korea. There are many differences between pharmaceutically treated depression (PTD) and treatment-resistant depression (TRD), including the economic consequences; however, to our knowledge, the economic burden of depression is understudied in South Korea. Therefore, the objective of the present study was to calculate the different economic costs of PTD and TRD in South Korea, specifically by comparing several aspects of medical care. This study comprised patients aged 18 and over who were newly prescribed antidepressants for more than 28 days with a depression code included from January 1, 2012, to December 31, 2012, by the Health Insurance Review and Assessment Service (HIRA). TRD was classified as more than two antidepressant regimen failures in PTD patients. The cost was calculated based on the cost reflected on the receipt registered with HIRA. Of the 834,694 patients with PTD, 34,812 patients (4.17%) were converted to TRD. The cost of medical care for TRD (6,610,487 KRW, 5881 USD) was approximately 5 times higher than the cost of non-TRD (1,273,045 KRW, 1133 USD) and was significantly higher for patients with or without depression and suicide codes. Medical expenses incurred by non-psychiatrists were roughly 1.7 times higher than those incurred by psychiatrists. TRD patients had significantly higher healthcare costs than PTD patients. Identifying these financial aspects of care for depression can help to establish a more effective policy to reduce the burden on mentally ill patients.This study was funded by the Janssen Korea Ltd. (RRA-17716), and also confirms that Jansen has the author of the study. Two authors (G.J.C. and M.K.2) and the Janssen Korea contributed for conceptualization, investigation, funding acquisition and wrting original draft. However, the funder (Jansen and its employees) had no possibilities to influence the analyses, interpretation of data and and in writing the manuscript

Safety of reduced dose of mycophenolate mofetil combined with tacrolimus in living-donor liver transplantation

Background/AimsThe dose of mycophenolate mofetil (MMF) has been reduced in Asia due to side effects associated with the conventional fixed dose of 2-3 g/day. We aimed to determine the pharmacokinetics of a reduced dose of MMF and to validate its feasibility in combination with tacrolimus in living-donor liver transplantation (LDLT).MethodsTwo sequential studies were performed in adult LDLT between October 2009 and 2011. First, we performed a prospective pharmacokinetic study in 15 recipients. We measured the area under the curve from 0 to 12 hours (AUC0-12) for mycophenolic acid at postoperative days 7 and 14, and we performed a protocol biopsy before discharge. Second, among 215 recipients, we reviewed 74 patients who were initially administered a reduced dose of MMF (1.0 g/day) with tacrolimus (trough, 8-12 ng/mL during the first month, and 5-8 ng/mL thereafter), with a 1-year follow-up. We performed protocol biopsies at 2 weeks and 1 year post-LDLT.ResultsIn the first part of study, AUC0-12 was less than 30 mgh/L in 93.3% of cases. In the second, validating study, 41.9% of the recipients needed dose reduction or cessation due to side effects within the first year after LDLT. At 12 months post-LDLT, 17.6% of the recipients were administered a lower dose of MMF (0.5 g/day), and 16.2% needed permanent cessation due to side effects. The 1- and 12-month rejection-free survival rates were 98.6% and 97.3%, respectively.ConclusionsA reduced dose of MMF was associated with low blood levels compared to the existing recommended therapeutic range. However, reducing the dose of MMF combined with a low level of tacrolimus was feasible clinically, with an excellent short-term outcome in LDLT

A Multimodal User Authentication System Using Faces and Gestures

As a novel approach to perform user authentication, we propose a multimodal biometric system that uses faces and gestures obtained from a single vision sensor. Unlike typical multimodal biometric systems using physical information, the proposed system utilizes gesture video signals combined with facial images. Whereas physical information such as face, fingerprints, and iris is fixed and not changeable, behavioral information such as gestures and signatures can be freely changed by the user, similar to a password. Therefore, it can be a countermeasure when the physical information is exposed. We aim to investigate the potential possibility of using gestures as a signal for biometric system and the robustness of the proposed multimodal user authentication system. Through computational experiments on a public database, we confirm that gesture information can help to improve the authentication performance

The Process of Creating Yongsan Park from the Urban Resilience Perspective

The concept of resilience implies uncertainty and the ability to adapt to unexpected changes. Projects in cities that require long periods of time and extensive budgets, which include large parks, need resilience to flexibly cope with political, economic, social, and physical changes. The concept of resilience emerged from the design of large parks in the early 2000s and has continued in more recent urban design competitions, but there is still a lack of research on specific planning strategies in the literature. This paper aims to interpret the process of creating a large park and to explore the strategies needed for a resilient process by examining the first national urban park being planned in Seoul, Korea as an example. After discussions began in 1990 and the General Basic Plan was established in 2011, the winning design was announced through an international design competition in 2012. Although the park master plan was considered complete as of 2018, its progress seems unclear because of various changes in the surrounding urban planning and political and economic conditions. This study intends to examine the processes that have already been executed and to assist in setting the future direction of the project. Through the framework derived from prior research on the concept of resilience, this project&#8217;s process is examined and analyzed in six main categories: park infrastructure, social dynamics, economic dynamics, health and well-being, governance networks, and planning and institutions. The results show that the categories park infrastructure, health and well-being, and planning and institutions are consistent with the resilience planning strategy to some degree, but social dynamics, economic dynamics, and governance networks are unsatisfactory. From a resilience perspective, a holistic approach to designing the process is most important in planning a large park, beginning from the conceptual stage through to the long-term implementation phase. An integrative process should aim to incorporate specialized knowledge and experiences from a variety of fields, not to resolve single aspects in a piecemeal fashion. This study aims to provide a practical link between large-scale park projects and the concept of resilience for the future

Designing a public engagement process for long-term urban park development project.

Gathering public consensus about long-term urban open space development is more difficult than ever, even though public engagement is crucial for sustainable long-term policymaking. Routine evaluation of public awareness is important for retaining project momentum and designing appropriate public engagement processes for the future. This study focuses on the Yongsan Park Development Project, which has been in progress for more than three decades. An online survey of 2,000 respondents was conducted and analyzed to evaluate the current public awareness and ask questions about respondents' expectations for public engagement. The results of this study reveal that 1) a hybrid methodology is needed to effectively approach different age groups; 2) an online survey can offer new insights for projects that repurpose U.S. army base and military sites into urban open spaces; 3) the survey results will enable us to design a better public participation process that is appropriate for post-pandemic society, in which virtual meetings and socially distanced communications are part of the new norm

A Survey of Recommendation Systems: Recommendation Models, Techniques, and Application Fields

This paper reviews the research trends that link the advanced technical aspects of recommendation systems that are used in various service areas and the business aspects of these services. First, for a reliable analysis of recommendation models for recommendation systems, data mining technology, and related research by application service, more than 135 top-ranking articles and top-tier conferences published in Google Scholar between 2010 and 2021 were collected and reviewed. Based on this, studies on recommendation system models and the technology used in recommendation systems were systematized, and research trends by year were analyzed. In addition, the application service fields where recommendation systems were used were classified, and research on the recommendation system model and recommendation technique used in each field was analyzed. Furthermore, vast amounts of application service-related data used by recommendation systems were collected from 2010 to 2021 without taking the journal ranking into consideration and reviewed along with various recommendation system studies, as well as applied service field industry data. As a result of this study, it was found that the flow and quantitative growth of various detailed studies of recommendation systems interact with the business growth of the actual applied service field. While providing a comprehensive summary of recommendation systems, this study provides insight to many researchers interested in recommendation systems through the analysis of its various technologies and trends in the service field to which recommendation systems are applied