백동원 / 공보의

백동원 대한의사협회 의료정책연구소 2015 의료정책포럼 Vol.13 No.4

스펙트럼 영역 빛간섭단층촬영으로 측정한 사상판 두께의 연령에 따른 변화

백동원,이주화,김재석 대한안과학회 2013 대한안과학회지 Vol.54 No.8

Purpose: To measure the lamina cribrosa thickness (LCT) in vivo of healthy people and to determine any association between the LCT and age or sex. Methods: We evaluated 100 eyes of 100 healthy volunteers. Forty eyes were selected and divided into 2 specific age groups (38-49 and 78-89 years) and the differences were assessed with respect to age and sex. Each participant underwent a complete eye examination and the LCT was evaluated with spectral domain optical coherence tomography (OCT) using enhanced depth imaging (EDI) mode. Results: Eighty-seven eyes were considered for the measurement and analysis of the LCT and 13 eyes were excluded because of an unclear image for identifying the LCT. The mean age was 55.0 ± 19.5 years. The mean LCT in healthy volunteers was 231.3 ± 41.6 μm (range, 152.5 - 327.5 μm) and a negative relationship was found between LCT and age (LCT = -1.614 × age + 320.191 μm, 95% CI for slope -1.91 to -1.32, r = 0.572, p < 0.001). Regarding differences related to sex, males had relatively thicker LCT than females, irrespective of age, although not statistically significant (p = 0.623). Conclusions: The present study results showed a decrease in human LCT with increasing age. Therefore, a decreasing LCT with an increasing age could be considered a strong risk factor for the development of glaucoma. In addition, measuring the LCT may help to understand the disease prognosis.

문학의 향기 : 아버지의 지갑

백동원 대한지방행정공제회 2010 地方行政 Vol.59 No.684

Salt cress 유전자의 형질전환을 통한 내염성 식물체 선별

백동원,최원균,강송화,신길옥,박수정,김찬민,박형철,윤대진 한국식물생명공학회 2014 식물생명공학회지 Vol.41 No.2

Salt cress (Thellungiella halophila or Thellungiellaparvula), species closely related to Arabidopsis thaliana,represents an extremophile adapted to harsh saline environments. To isolate salt-tolerance genes from this species, we constructeda cDNA library from roots and leaves of salt cress plantstreated with 200 mM NaCl. This cDNA library was subsequentlyshuttled into the destination binary vector [drivenby the cauliflower mosaic virus (CaMV) 35S promoter]designed for plant transformation and expression via recombination-assisted cloning. In total, 305,400 pools of transgenicBASTA-resistant lines were generated in Arabidopsis usingeither T. halophila or T. parvula cDNA libraries. These wereused for functional screening of genes involved in salttolerance. Among these pools, 168,500 pools were used forprimary screening to date from which 7,157 lines showedapparent salt tolerant-phenotypes in the initial screen. Asecondary screen has now identified 165 salt tolerant transgeniclines using 1,551 (10.6%) lines that emerged in the firstscreen. The prevalent phenotype in these lines includes acceleratedseed germination often accompanied by faster root growthcompared to WT Arabidopsis under salt stress condition. Inaddition, other lines showed non-typical development of stemsand flowers compared to WT Arabidopsis. Based on the closerelationship of the tolerant species to the target species wesuggest this approach as an appropriate method for the largescaleidentification of salt tolerance genes from salt cress.

The Predictive Value of Epstein-Barr Virus-Positivity in Patients Undergoing Gastrectomy Followed by Adjuvant Chemotherapy

백동원,강병욱,김종광 전남대학교 의과학연구소 2018 전남의대학술지 Vol.54 No.3

The present study evaluated the survival impact of standard adjuvant chemotherapy and prognostic differences between Epstein-Barr virus (EBV)-associated gastric cancer (EBVaGC) and EBV-negative gastric cancer (EBVnGC). A total of 276 patients were enrolled according to the following criteria: 1) pathologically diagnosed with primary gastric adenocarcinoma, 2) test results from EBV-encoded RNA in situ hybridization, 3) stage II/III according to the 7th edition of UICC/AJCC staging system for gastric cancer, and 4) postoperative adjuvant chemotherapy. Fifty-nine (21.4%) and 217 (78.6%) patients exhibited EBVaGC and EBVnGC, respectively, while 129 (46.7%) patients were classified as stage II and 147 (53.3%) as stage III. As for adjuvant chemotherapy, 87 (31.5%) patients received capecitabine and oxaliplatin, while 189 (68.5%) received S-1 monotherapy. With a median follow-up duration of 21.3 (6.4-89.0) months, the estimated 3-year disease-free survival (DFS) and overall survival (OS) rates were 74.8% and 83.0%, respectively. In univariate analysis and multivariate analysis using a Cox proportional hazard model including age, gender, stage, Lauren classification, and the type of chemotherapy, EBV-positivity was not significantly associated with DFS (p-value=0.630) regardless of the type of chemotherapy. Therefore, no association was found between EBV positivity and the survival outcomes in patients with curatively resected gastric cancer who received standard adjuvant chemotherapy.

미간에 히알루론산 필러 주입 후 발생한 전체 외안근마비를 동반한 시력소실 1예

백동원,장인범,김재석,이주화,최진,Dong Won Paik,MD,In Bum Jang,MD,Jae Suk Kim,MD,Joo Hwa Lee,MD,Jin Choi,MD 대한안과학회 2013 대한안과학회지 Vol.54 No.6

Purpose: To report a case of sudden unilateral visual loss and total external ophthalmoplegia combined with multifocal brain infarction following injection of hyaluronic acid (Restylane; Q-Med AB, Uppsala, Sweden) into the glabella area. Case summary: A 25-year-old woman was referred for sudden unilateral visual loss and blepharoptosis. Visual acuity was no light perception in the right eye and 0.15 in the left eye. The best corrected visual acuity was no light perception in the right eye and 1.0 in the left eye. The right pupil was dilated and a relative afferent pupillary defect was detected. The patient showed blepharoptosis and total external ophthalmoplegia on the right side. Fundus examination revealed central retinal artery occlusion and pale disc in the right eye. The patient had developed skin necrosis and a surrounding reddish reticular pattern on her face around the glabella. She was injected with hyaluronic acid for 5 times into the glabella area. Fluorescein angiography of the right eye revealed markedly prolonged choroidal filling around the optic disc with no retinal arterial filling. Brain MRI showed multifocal punctuate acute infarction in both frontal lobes. After 2 months, ophthalmoplegia improved partially although her right eye vision did not, and 15 PD right exotropia was observed. Conclusions: Although most complications of dermal fillers are mild and transient, severe and persistent adverse effects can occur including tissue necrosis, retinal artery occlusion, and brain infarction. Therefore cosmetic procedures should be carefully performed when administering periocular dermal filler injection. A prompt consultation with an ophthalmologist is recommended when there is evidence of visual problems after injection.

The Therapeutic Effect of Cyclin-Dependent Kinase 4/6 Inhibitor on Relapsed Ectopic Male Breast Cancer

백동원,박지영,이수정,채이수 한국유방암학회 2020 Journal of breast cancer Vol.23 No.5

Ectopic male breast cancer is very rare. Consequently, there is a lack of prospective clinical trials, and most recommendations for treatment are based on the experiences of clinicians and data from female breast cancer patients. The United States Food and Drug Administration has recently approved palbociclib combined with endocrine therapy for advanced male breast cancer because of the positive results of its use in metastatic female breast cancer. Therefore, it is worth considering cyclin-dependent kinase 4/6 inhibitors as alternatives to conventional chemotherapies for advanced male breast cancer patients with hormone receptor-positive and human epidermal growth factor receptor 2-negative cancers. The present case report introduces the use of palbociclib plus letrozole as first-line therapy for an elderly male patient with relapsed ectopic breast cancer, notwithstanding the limitations of the current national health insurance policy.

2009년 단일기관에서 확인된 장바이러스 감염의 임상양상 및 특징에 관한 연구

백동원,김정민,김기환,안종균,김동수 대한소아감염학회 2010 Pediatric Infection and Vaccine Vol.17 No.2

Purpose : Enteroviral infection is a common viral illness in children. We undertook this study in attempt to comprehend the epidemiologic and clinical features of enteroviral infections, particularly EV71 in children. Methods : We enrolled 63 children with enteroviral infection at Severance Children's Hospital in Seoul between May and August 2009. Reverse transcriptase-polymerase chain reaction (RT-PCR) was performed from stool or cerebrospinal fluid samples, which were then tested for enteroviral infection. Viral isolation and serotype identification also were performed by RT-PCR. Results : A total of 63 patients with clinical diagnosis of enteroviral infections were enrolled; of those, 38 (60%) were positive for enterovirus. The mean age of the patients was 2 years and 7 months and the sex ratio of male to female was 0.9:1. Their clincal manifestations included aseptic meningitis (21 cases, 55%), HFMD (16 cases, 42%), herpangina (5 cases,13%), neonatal fever (2 cases, 5%), encephalitis (1 case, 3%), and myocarditis (1 case, 3%). Serotypes of isolated enteroviruses were EV71 (8 cases, 21%), coxsackievirus B1 (8 cases, 21%), coxsackievirus A16 (2 cases, 6%), coxsakievirus A2(1 case, 3%), coxsakievirus A5 (1 case, 3%), and echovirus 9 (1 case, 3%). Clinical symptoms of EV71 infection included HFMD (5 cases, 63%), aseptic meningitis (3 cases, 38%), encephalitis (1 case, 13%), and myocarditis (1 case, 13%). A positive rate of C-reactive protein in EV71 was higher than those in other enterviral infections. However, there was no statistically significant difference in other laboratory findings. Conclusion : We reported on identified enteroviruses, including EV71, during a period of 3 months in the summer of 2009. In this study, EV71 infection frequently occurred in male and clinical manifestation caused by EV71 was a more severe disease than that due to other enterviral infections. There is a need for continuous surveillance of enteroviral infection and its clinical manifestations for diagnosis and treatment of enteroviral infection. 목 적 : 장바이러스 감염은 소아에서 흔하게 일어나며무균성 수막염, 수족구병, 포진성 구협염, 신생아 감염,결막염 등의 원인이 된다. 특히 enterovirus 71형에 의한 감염은 증가하고 있으며 국내에서도 치명적인 사례가보고되고 있어 본 저자들은 장바이러스의 임상 양상을분석하고 그 중 enterovirus 71형으로 감염된 환아들의임상 양상을 비교 분석하고자 하였다. 방 법: 2009년 5월 1일부터 8월 31일까지 신촌 세브란스병원 소아청소년과 외래를 방문하거나 입원한 환자중 장바이러스 감염이 의심된 63명의 환아를 대상으로급성기에 뇌척수액 또는 분변을 채취하여 질병관리본부에 의뢰하여 혈청형을 분석하였다. 그리고 장바이러스가배양된 환아를 대상으로 성별, 연령. 임상양상 등을 비교분석하였다. 결 과:임상적으로 장바이러스 감염이 의심된 63명중 38명(60%)에서 양성을 보였다. 양성 환아의 평균 연령은 2년 7개월 이고 성별은 남아 18명, 여아 20명으로남녀비는 0.9:1 이었다. 장바이러스 감염의 임상증상은발열(95%). 발진(39%), 식욕부진(24%), 구토와 복통의 소화기 증상(18%), 두통(16%), 기침, 콧물의 호흡기증상(13%)이 나타났다. 장바이러스 감염은 무균성 수막염(55%), 수족구병(42%). 포진성 구협염(13%), 신생아 감염(5%), 뇌염(3%), 심근염(3%)이 있었다. 분리된장바이러스는 coxsakie B1형 8례(21%), enterovirus 71형 8례(21%), coxsakievirus A16형 2례(6%)였고,coxsakievirus A2형, coxsakievirus A5형, echovirus 9형이 각각 1례씩, 미분류 장바이러스가 17례였다. 무균성 수막염의 원인 바이러스는 coxsakievirus B1형 8례,enterovirus 71형 3례, coxsakievirus A16형 1례,echovirus 9형 1례, 미분류 장바이러스 8례였고 수족구병은 enterovirus 71형 5례, coxsakievirus A16형 1례, 미분류 장바이러스 10례가 검출되었다. 포진성 구협염은 coxsakievirus A16형 1례, coxsakievirus A2형1례, coxsakievirus A형 1례, 미분류 장바이러스 2례가보고 되었고, 신생아 감염은 coxsakievirus 2례, 뇌염과심근염에서 enterovirus 71형이 1례씩 검출되었다. Enterovirus 71형 감염이 확인된 8명은 남아 6명, 여아2명으로 남녀비는 3:1 이고 발열(88%), 발진(63%), 식욕부진(50%)의 증상을 보였다. Enterovirus 71형의 감염은수족구병은 5례, 무균성 수막염 3례, 뇌염, 심근염이 1례씩 있었다. Enterovirus 71형과 다른 장바이러스의 혈액검사는 CRP 에서 enterovirus 71형이 양성률이높았고 다른 혈액학적 검사와 뇌척수액 검사는 통계학적으로 유의한 차이는 없었다. 결 론: 2009년 5월과 8월에 다양한 장바이러스가 유행하였고 특히 신경계 감염을 초례하는 enterovirus 71형도 보고되었다. Enterovirus 71형과 다른 장바이러스감염과 비교할 때 남자에서 더 많이 발생했고 임상적 증상은 차이가 없었으나 중증의 질병이 발생했고 수족구병에서 중추신경계 합병은 더 많이 발생하였다. 앞으로 장바이러스 감염 환아의 진단 및 치료를 위해 지속적인 역학적 연구가 필요할 것으로 생각된다.

Apparent diffusion coefficient as a valuable quantitative parameter for predicting clinical outcomes in patients with newly diagnosed primary CNS lymphoma

백동원,조희정,Bae Jae Heung,손상균,문준호 대한혈액학회 2020 Blood Research Vol.55 No.2

BackgroundThis study attempted to identify novel prognostic factors in patients with newly diagnosed primary central nervous system lymphoma (PCNSL) using magnetic resonance imaging (MRI).MethodsWe retrospectively evaluated 67 patients diagnosed with central nervous system (CNS) tumors. The enrollment criteria were as follows: i) pathologic diagnosis of CNS lympho-ma, ii) no evidence of systemic involvement, iii) no evidence of human immunodeficiency virus-1 infection or other immunodeficiencies, and iv) MRI scans available at diagnosis. Fifty-two patients met these criteria and were enrolled.ResultsThe 3-year overall survival (OS) and failure-free survival rates were 69.7% and 45.6%, respectively, with a median follow-up duration of 36.2 months. OS of patients with low apparent diffusion coefficient (ADC) was lower than those with higher ADC. Multivariate analysis revealed that old age (>60 yr) [hazard ratio (HR), 20.372; P=0.001], Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2 (HR, 10.429; P<0.001), higher lactate dehydrogenase (LDH) levels (HR, 7.408; P=0.001), and low ADC (HR, 0.273; P=0.009) were associated with lower OS. We modified the conventional prognostic scoring system using low ADC, old age (>60 yr), ECOG PS ≥2, and higher LDH. The risk of death was categorized as high (score 3-4), intermediate-2 (score 2), inter-mediate-1 (score 1), and low (score 0), with three-year OS rates of 33.5%, 55.4%, 88.9%, and 100%, respectively.ConclusionADC demonstrated significant prognostic value for long-term survival in patients with newly diagnosed PCNSL. Low ADC was an independent unfavorable prognostic factor, suggesting that ADC obtained from MRI can improve the current prognostic scoring system.

Clinical Effects of Hypomethylating Agents in Patients with Newly Diagnosed Myelodysplastic Syndrome Who Received DNA-Damaging Chemotherapy for Metastatic Breast Cancer

백동원,이수정,손상균,문준호,채이수 한국유방암학회 2019 Journal of breast cancer Vol.22 No.4

The cumulative risk of therapy-related myelodysplastic syndrome (t-MDS) in breast cancer patients exposed to chemotherapy and/or radiotherapy is significantly high compared to that in other cancer patients. This report reviews the use of hypomethylating agents (HMAs) to treat a 57-year-old woman newly diagnosed with MDS during palliative chemotherapy for metastatic breast cancer. Over a period of 6 years, the patient received several DNA-damaging chemotherapeutics including doxorubicin, cyclophosphamide, and paclitaxel. Repeated thrombocytopenia was the main reason for suspecting secondary hematologic malignancy. She was diagnosed with t-MDS based on bone marrow examination and her treatment history for breast cancer. While azacitidine was originally administered to stabilize MDS, it also stabilized the patient's lung and lymph node metastases without any major toxicity. Therefore, the current case highlights the promising effects of HMAs for treating t-MDS following heavily pretreated breast cancer.