Outcome of allogeneic hematopoietic stem cell transplantation for childhood acute lymphoblastic leukemia in second complete remission: a single institution study

Eun-Jung Lee,Ji Yoon Han,Jae Wook Lee,장필상,정낙균,정대철,조빈,김학기 대한소아청소년과학회 2012 Clinical and Experimental Pediatrics (CEP) Vol.55 No.3

Purpose: The survival rate for childhood acute lymphoblastic leukemia (ALL) has improved significantly. However, overall prognosis for the 20to 25% of patients who relapse is poor, and allogeneic hematopoietic stem cell transplantation (HSCT) offers the best chance for cure. In this study, we identified significant prognostic variables by analyzing the outcomes of allogeneic HSCT in ALL patients in second complete remission (CR). Methods: Fifty-three ALL patients (42 men, 79%) who received HSCT in second CR from August 1991 to February 2009 were included (26sibling donor HSCTs, 49%; 42 bone marrow transplantations, 79%). Study endpoints included cumulative incidence of acute and chronic graft-versus-host disease (GVHD), relapse, 1-year transplant-related mortality (TRM), disease-free survival (DFS), and overall survival (OS). Results: Cumulative incidences of acute GVHD (grade 2 or above) and chronic GVHD were 45.3% and 28.5%, respectively. The estimated 5-year DFS and OS for the cohort was 45.2±6.8% and 48.3±7%,respectively. Only donor type, i.e., sibling versus unrelated, showed significant correlation with DFS in multivariate analysis (P=0.010). The rates of relapse and 1 year TRM were 28.9±6.4% and 26.4±6.1%,respectively, and unrelated donor HSCT (P=0.002) and HLA mismatch (P =0.022) were significantly correlated with increased TRM in univariate analysis. Conclusion: In this single institution study spanning more than 17 years,sibling donor HSCT was the only factor predicting a favorable result in multivariate analysis, possibly due to increased TRM resulting from unrelated donor HSCT.

지능정보 교육과 기술 지원 정책 및 전략

이태규,정대철,김용갑,Lee, Tae-Gyu,Jung, Dae-Chul,Kim, Yong-Kab 한국정보처리학회 2017 정보처리학회논문지. 컴퓨터 및 통신시스템 Vol.6 No.8

최근 지속적으로 논의하고 있는 '지능정보사회'란? 지능정보기술을 기반으로 사회 전 영역에서 인간능력의 한계를 뛰어넘는 자동화가 보편화된 미래사회상을 의미한다. 특히, 인간의 개입을 최소화하고, 데이터(또는 빅데이터) 기반 완전 자동화로의 진화를 지속적으로 추구하는 개념이다. 예를 들어, 자율형자동화는 인공지능을 핵심요소로 무인자동차를 지속적으로 지향하고 있다. 그러나 지금까지의 지능정보 연구는 지능화 자체를 중심으로 지능화 논리를 고도화하여, 인간의 뇌와 지능을 대체하고자 하는 노력을 기울여 왔다. 또한, 다른 한편으로 인간의 노동력을 대체하기 위해서 노동자의 작업 원리를 분석하여 최적화된 단순논리를 개발하여 노동자를 로봇으로 대체하려는 노력을 지속해왔다. 본 연구는 지능정보기술 연구 전략 및 교육서비스에 관한 접근전략, 교육방법, 세부정책 로드맵 등을 제안하여, 지능정보 교육 정책 및 지능정보기술 연구 전략을 시행하는데 중요한 기준과 방향을 제시하고자 한다. 특히, 교육방법으로 기초지능교육, 지능콘텐츠교육, 지능응용교육 등의 지능정보교육의 단계적 접근 방안을 제시한다. 또한, 지능화 및 자동화가 중심이 되는 4차 산업혁명 성패를 가를 수 있는 중요한 요소로서 지능정보기술, 지능교육콘텐츠, 지능형 교육시스템 개선을 위한 교육정책 방안을 제안한다. What is the term "intelligence information society", which is a term that has been continuously discussed recently? This means that the automation beyond the limits of human ability in the whole societies based on intelligent information technology is a universalized social future. In particular, it is a concept that minimizes human intervention and continuously pursues evolution to data (or big data) -based automation. For example, autonomous automation is constantly aiming at unmanned vehicles with artificial intelligence as a key element. However, until now, intelligent information research has focused on the intelligence itself and has made an effort to improve intelligence logic and replace human brain and intelligence. On the other hand, in order to replace the human labor force, we have continued to make efforts to replace workers with robots by analyzing the working principles of workers and developing optimized simple logic. This study proposes important strategies and directions to implement intelligent information education policy and intelligent information technology research strategy by suggesting access strategy, education method and detailed policy road map for intelligent information technology research strategy and educational service. In particular, we propose a phased approach to intelligent information education such as basic intelligence education, intelligent content education, and intelligent application education. In addition, we propose education policy plan for the improvement of intelligent information technology, intelligent education contents, and intelligent education system as an important factor for success and failure of the 4th industrial revolution, which is centered on intelligence and automation.

유리피판 이식에서 정맥이식의 임상적 의의

이광석,우경조,정대철,정재효,Lee, Kwang-Suk,Woo, Kyung-Jo,Jung, Dae-Chul,Jung, Jae-Hyo 대한미세수술학회 1996 Archives of reconstructive microsurgery Vol.5 No.1

From January 1980 to May 1995, ninety-six patients had been treated by free-flap transfer for the soft tissue defects of the extremities. Ninety-eight cases of free-tissue transfer were reviewed to evaluate the clinical reliability in terms of survival and quality of long-time function after reconstructive surgery. Among these 98 cases(27 cases in latissimus dorsi myocutaneous flap, 25 in dorsalis pedis flap, 20 in forearm fasciocutaneous flap, 9 in groin flap, 7 in gracilis myocutaneous flap, 6 in 1st web space flap of foot and 4 cases in tensor fascia lata flap), 92 cases of then were survived. 7 cases were performed with vein grafts. We ananalyzed the reconstruction of the extremities on 98 cases with the soft tissue defects which had been reconstructed free-flap transfer and followed for minimum 1 year period at Korea University Hospital. 1. 92 cases(93.9%) of the total 98 cases were successful and can be obtained the excellent results in soft tissue free-flap transfer. 2. While there were no clinically significant differences in survival rate of flaps transferred from different potential flap donor sites,3 cases of 9 groin flaps were showed higher failure rate due to the complications such as arterial thrombosis, infection and anatomical variation of vessels. 3. Postoperative thrombectomy was performed in 30 cases to be occured in the arterial and venous thrombosis. The revision was failed in 2 cases due to persistent arterial thrombosis and infection, then treated with skin graft. 4. Vein graft was frequently required in severely compromised-soft tissue defects resulted from high-energy trauma. The vein graft was not stitistically significant on the frequency of flap failure rate(P<0.04). 5. Meticulous monitoring, careful planning, early revision and technical considerations will provide for a high clinical success of the free-flap transfer.

호산구성 대장염 1례

나주희,박영실,김선미,이정현,정대철,김진택,정승연,이안희,강진한,이준성,Nah, Joo-Hee,Park, Young-Shil,Kim, Sun-Mi,Lee, Jung-Hyun,Jeong, Dae-Chul,Kim, Jin-Tack,Chung, Seung-Yun,Lee, An-Hi,Kang, Jin-Han,Lee, Joon-Sung 대한소아소화기영양학회 2002 Pediatric gastroenterology, hepatology & nutrition Vol.5 No.1

저자들은 설사와 우복부통증 및 체중감소의 증상을 보인 11세 남아에서 말초혈액의 호산구수 증가와 IgE가 정상범위이며 대장내시경하에 채취한 S자결장 생검조직에서 특징적인 호산구침윤 소견이 관찰되어 비 IgE 매개성 호산구성 대장염으로 진단된 1례를 경험하였으며 부신피질 호르몬 투여로 증상 호전을 보여 문헌고찰과 함께 보고하는 바이다. Eosinophilic gastroenteritis, which shows characteristic eosinophilic inflammation, involves any part of the intestine from esophagus to colon. The immunopathogenesis is expected to be associated with IgE-mediated or non-IgE-mediated reaction, but the precise mechanism is not revealed yet. The clinical manifestation is variably dependent on the extent of eosinophilic infiltration. Usually the symptoms, such as abdominal pain, diarrhea, vomiting, wax and wane for a few months result in failure to thrive, which implicates the importance of early detection. Although the diagnosis is made through clinical and histopathologic evidences, we should suspect the illness in a case of anemia, hypoalbuminemia, and peripheral eosinophilia. Recently, we experienced a case of non-IgE-mediated eosinophilic colitis in a 11-year-old male who complained of diarrhea, right lower abdominal pain, body weight loss, was diagnosed with peculiar histopathologic finding of sigmoid colon specimens obtained by sigmoidoscopy.

Clinical manifestations of CNS infections caused by enterovirus type 71

최철순,강진한,Yun Jung Choi,Ui Yoon Choi,한지환,정대철,김현희,김종현 대한소아청소년과학회 2011 Clinical and Experimental Pediatrics (CEP) Vol.54 No.1

Purpose: Enterovirus 71, one of the enteroviruses that are responsible for both hand-foot-and-mouth disease and herpangina, can cause neural injury. During periods of endemic spread of hand-foot-andmouth disease caused by enterovirus 71, CNS infections are also frequently diagnosed and may lead to increased complications from neural injury, as well as death. We present the results of our epidemiologic research on the clinical manifestations of children with CNS infections caused by enterovirus 71. Methods: The study group consisted of 42 patients admitted for CNS infection by enterovirus 71 between April 2009 and October 2009at the Department of Pediatrics of 5 major hospitals affiliated with the Catholic University of Korea. We retrospectively reviewed initial symptoms and laboratory findings on admission, the specimen from which enterovirus 71 was isolated, fever duration, admission period,treatment and progress, and complications. We compared aseptic meningitis patients with encephalitis patients. Results: Of the 42 patients (23 men, 19 women), hand-foot-and-mouth disease was most prevalent (n=39), followed by herpangina (n=3),upon initial clinical diagnosis. Among the 42 patients, 15 (35.7%) were classified as severe, while 27 (64.3%) were classified as mild. Factors such as age, fever duration, presence of seizure, and use of intravenous immunoglobulin (IVIG) were statistically different between the 2groups. Conclusion: Our results indicate that patients with severe infection caused by enterovirus 71 tended to be less than 3 years old, presented with at least 3 days of fever as well as seizure activity, and received IVIG treatment.

고출력 무전극램프의 점등회로 설계를 통한 특성분석 및 최적화에 관한 연구

정영일(Young-Il Chung),정대철(Dae-Chul Jung),박대희(Dae-Hee Park),김용갑(Yong-Kab Kim) 한국정보전자통신기술학회 2017 한국정보전자통신기술학회논문지 Vol.10 No.1

본 논문에서는 고출력 무전극 램프 시스템 개발에서 램프 내에 가스종류, 혼합비, 압력과 방전관 사이즈, 아말감 종류 및 혼합비, 페라이트코어의 특성등의 최적화를 통한 램프 설계 부분을 연구하였다. 또한 구동방식에 따른 점등회로의 역율 및 효율개선, 파형이나 인가 주파수에 따른 특성 분석을 통한 점등회로설계 부분 등을 고려하였으며, 최종적으로 주변 환경을 고려 무전극 등기구 설계를 수행 하였다. 고출력 무전극 램프용 점등회로의 설계를 통한 특성분석을 진행하여 개선 보완을 통하여 효울을 향상 시켰으며 점등회로의 구동주파수에 따른 무전극 램프의 광학적 특성 및 시스템 영향을 확인한 결과, 7~10℃ 정도 낮은 특성의 135kHz로 구동하는 점등회로를 최적화하였다. 실험적으로 Peak Noise 발생으로 인한 FET(Q3,Q4) demage 현상을 개선하였다. 최종적으로 무전극램프용 점등회로 최종 설계도을 통해 약 2~3배 이상의 수명을 확보함으로써 안정기의 신뢰성 및 무전극 램프 시스템의 효율이 높음을 알 수 있었다. In this paper, we implemented for the development of a high output induction lamp system, which lamp design is optimized by gas type, mixing ratio, pressure and discharge tube size, amalgam type and mixing ratio, and characteristics of ferrite core in the lamp. It’s the circuit design by improving the power factor and efficiency according to the driving method, which has analyzing the characteristics according to the waveform and frequency. Finally, luminaries design part for applying the optimal lighting system considering the surrounding environment, the characteristics of the lighting circuit for electrodeless lamp has analyzed and the improvement has been proceeded. In conclusion, the driving frequency has optimized at 135kHz with degrading 7~10℃ based on the results of the optical characteristics of the induction lamp on peak noise FET(Q3,Q4) damage.

Enterovirus 71에 의한 급성 파종성 뇌척수염 1례

황희승,조성희,김선미,정대철,정승연,강진한,Hwang, Hui Sung,Cho, Sung Hee,Kim, Sun Mi,Jung, Dae Chul,Chung, Seung Yun,Kang, Jin Han 대한소아감염학회 2003 Pediatric Infection and Vaccine Vol.10 No.1

본 저자들은 상기도 감염 후 발열과 배뇨곤란, 하지의 근력저하를 주소로 내원한 7세 환아에서, 급성 횡단성 척수염 증상으로 시작하여 의식 변화와 호흡부전의 급성 파종성 뇌척수염으로 진행한 1례에서 enterovirus 71을 증명하고 고용량 methylprednisolone 정주 후 증상의 호전을 경험하였기에 문헌 고찰과 함께 보고하는 바이다. Acute transverse myelitis is a focal inflammatory disorder of the spinal cord, resulting in motor, sensory, and autonomic dysfunction which would be the initial manifestation of acute disseminated encephalomyelitis. A 7-year-old boy developed weakness of lower extremities associated with dizziness and urinary dysfunction after upper respiratory infection. He showed gradual decreased mental status with respiratory difficulty. Spinal MRI showed diffuse spinal cord swelling from C3 to C7 levels with high signal intensity lesion on T2-weighted image, which is involved central gray matter of spinal cord from C3 to C7, proximal portion to cervicomedullary junction, and distal portion to the cornus medullaris. After the supplement of high dose intravenous methylprednisolone therapy with ventilator care, he showed gradual improvement. The brain MRI after extubation showed multifocal high signal intensity lesions in bilateral cerebral white matter on axial T2-weighted image. Immunoserologic test(neutral antibody test) for enterovirus 71 was positive. Dysfunction of the bladder lasted for 33 days. We report a case of transverse myelitis which progressed to acute disseminated encephalomyelitis by enterovirus 71 in a 7-year-old boy with related literatures.

생애 첫 발열성 요로 감염 환아에 대한 평가에서 배뇨성 방광 요도 조영술을 대체하기 위한 검사로서 $^{99m}technetium$ dimercaptosuccinic acid(DMSA) scan의 의의

한승범,고용민,이수영,정대철,강진한,이경연,엄미령,김웅흠,김정수,Han, Seung-Beom,Ko, Yong-Min,Lee, Sue-Young,Jeong, Dae-Chul,Kang, Jin-Han,Lee, Kyung-Yeon,Uhm, Mee-Ryung,Kim, Woong-Heum,Kim, Jung-Sue 대한소아신장학회 2007 Childhood kidney diseases Vol.11 No.2

목 적: 환아의 임상 양상과 검사실 소견 및 DMSA scan 검사 결과를 이용하여 방광 요관 역류에 대한 예측성을 연구하였다. 방 법 : 생애 첫 요로 감염이 진단되어 입원 치료를 받았던 환아 중, 요로 감염 급성기에 DMSA scan 및 배뇨성 방광 요도 조영술을 모두 시행한 84명의 환아를 대상으로 후향적 연구를 하였다. 환아들은 배뇨성 방광 요도 조영술 결과에 따라 역류가 없는 집단, 경증 역류가 있는 집단(grade I-II), 중증 역류가 있는 집단(grade III-V)으로 분류되었고, 환아의 성별, 나이, 발열 기간, 혈중백혈구 수치, 혈장 CRP수치, 원인 균주 및 DMSA scan 결과와 방광 요관 역류 사이의 연관성을 조사하였다. 결 과 : 84명의 환아 중, 6명은 경증, 17명은 중증 역류를 보였다. DMSA scan 결과 급성 신장손상 소견은 38명에서 관찰되었다. 방광 요관 역류를 갖는 환아는 역류가 없는 환아에 비해 유의하게 나이가 많은 결과를 보였다(P<0.01). 요로감염 원인균주로서의 E. coli 감염의 빈도는 중증역류 환아에서 나머지 두 집단에 비해 유의하게 낮았다(P<0.01). DMSA scan에서의 급성 신장손상 소견은 역류 현상 및 역류의 중증도와 유의한 연관성을 보였다(P<0.05). DMSA scan에서 정상 소견을 보였던 환아 중 10.9%는 중증의 방광요관 역류를 보였다. 방광 요관 역류를 진단하는데 있어서 DMSA scan은 민감도 69.6%, 특이도 63.9%, 양성예측도 42.1%, 음성예측도 84.8%의 결과를 보였다. 결 론 : 방광 요관 역류 및 그 중증도는 DMSA scan에서의 급성 신장 손상 소견과 연관성이 있으나 낮은 민감도, 특이도, 양성 예측도를 볼 때, 급성기 DMSA scan에서 이상 소견을 보인 환아에서는 배뇨성 방광 요도 조영술을 시행하여 방광 요관 역류의 정도를 진단하여야 하며, DMSA scan에서 이상 소견이 없더라도 10.9%에서 중증의 방광 요관 역류가 동반되므로 배뇨성 방광 요도 조영술을 시행해야 할 것으로 생각한다. Purpose : We studied the value of clinical signs, laboratory findings and $^{99m}technetium$ dime-rcaptosuccinic acid(DMSA) scan in predicting the presence of vesicoureteral reflux(VUR) in children with first febrile urinary tract infection(UTI). Methods : A retrospective analysis of 84 hospitalized children with first febrile UTI was performed. They underwent DMSA scan and voiding cystourethrography(VCUG) during the acute phase, and were divided into three groups according to the results of the VCUG: absence of VUR, mild(grade I-II) and severe VUR(grade III-V). We studied the relation of VUR to age, gender, fever duration, causative organism, white blood cell count, serum C-reactive protein and result of DMSA scan. Results : Among 84 patients, 6 had mild and 17 had severe VUR. Thirty-eight had abnormal DMSA scan. results Patients with VUR were older than those without VUR(P<0.01). There was a lower probability of infection with Escherichia coli in patients with severe VUR than in those with mild and absent VUR(P<0.01). An abnormal DMSA scan correlated with the presence and severity of VUR(P<0.05). Severe VUR was present in 10.9% of patients with normal DMSA scan. The sensitivity, specificity, positive and negative predictive values of the DMSA scan in predicting the presence of VUR were 69.6%, 63.9%, 42.1%, and 84.8%, respectively. Conclusion : An abnormal DMSA scan correlated to the presence and severity of VUR, but the sensitivity, specificity and positive predictive value of the DMSA scan were low. There-fore, patient with an abnormal DMSA scan requires a VCUG. In order to prevent missing the 10.9% of patients with severe VUR but normal DMSA scans, a VCUG should be performed in patient with normal DMSA scan.

고출력 무전극램프의 가스압 및 아말감종류에 따른 특성분석 및 최적화에 관한 연구

정영일(Young-Il Chung),정대철(Dae-Chul Jung),김용갑(Yong-Kab Kim),박대희(Dae-Hee Park) 한국정보전자통신기술학회 2017 한국정보전자통신기술학회논문지 Vol.10 No.1

현재는 도로조명의 경우 기존 메탈할라이드 램프 400W이하로 설치되어 있어 에너지절약형 조명으로 대체가 이루어지고 있으며, 무전극 램프는 터널조명과 고천정조명 적용분야를 타겟으로 더욱 활발한 교체가 이루어질 것으로 예상된다. 따라서 추가적으로 고효율, 고출력 무전극 램프 시스템 개발이 필요한 상황이다. 본 연구에서는 고출력 무전극 램프의 설계 및 제작을 진행하여 가스종류 및 가스압에 따른 비교 분석, 아말감 종류에 따른 특성 분석 등을 통한 무전극 램프 최적화를 진행하였다. 현재 고출력 무전극 램프 방전관 및 페라이트코어에 맞는 가스압 300~350[mmHg] 사이로 최적화 하였다. 인듐(In) 아말감을 적용한 무전극 램프로 점등회로 매칭을 완료하여 250W(정격±10%)로 정격소비전력으로 최적화를 완료하였다. Currently, road lightings are installed with less than 400W of existing metal halide lamps. These road lightings are being replaced by energy-saving lightings. Induction lamps are expected to be more actively replaced with targets for tunnel lighting and high ceiling lighting. Therefore, it is necessary to develop high efficiency, high power induction lamps system. In this study, the gas type & pressure, amalgam type were designed for the high power of the induction lamps. And induction lamp system was optimized through electrical, optical characteristics analysis. It is optimized to the gas pressure 300~350 [mmHg] for the discharge tube of high power induction lamp and ferrite core. The driving circuit matching was completed with a induction lamp using indium amalgam. The rated power consumption of the induction lamp was optimized with 250 W (rated ± 10%).

생후 90일 이하의 영아에서 호흡기 바이러스 검출과 관련된 위험인자

임연주 ( Yeun-joo Eem ),배이영 ( E Young Bae ),이정현 ( Jung-hyun Lee ),정대철 ( Dae-chul Jeong ) 대한소아감염학회 2014 Pediatric Infection and Vaccine Vol.21 No.1

목적: 임상적으로 중증 세균성 감염과 바이러스성 질환의 감별이 어려운 어린 영아에서 호흡기 바이러스를 검출하고 이것과 연관된 임상적 위험인자를 분석하였다. 방법: 2011년 9월부터 2012년 8월까지 생후 90일 이하 영아 중 패혈증을 포함한 감염성 질환이 의심된 227명을 대상으로 비인두 검체를 채취하였으며 임상적 특성에 대한 후향적 연구를 시행하였다. 채취한 검체 내 호흡기 바이러스의 검출은 real-time PCR 검사를 통해 측정되었다. 결과: 총 157명(69.2%)의 영아에서 한 가지 이상의 호흡기 바이러스가 검출되었다. 빈도는 RSV (75명), RV(42명), influenza virus (18명), parainfluenza virus (15명), human metapneumovirus (9명), coronavirus (9명), adenovirus (4명), bocavirus (3명) 순이었다. 이 중 24명(10.6%)에서 세균성 감염을 진단하였다. 기침, 호흡기 질환의 가족력이 있는 경우 혹은 가을/겨울 철에 호흡기 바이러스가 의미있게 높은 빈도로 검출되었으며 로지스틱 회귀분석에서도 같은 경향을 확인하였다. 가을과 겨울에는 세균성 감염 환자보다 그렇지 않은 환자에서 호흡기 바이러스 검출이 유의하게 많은 것을 알 수 있었다. 결론: 호흡기 바이러스는 감염성 질환이 의심되어 입원한 어린 영아의 중요한 병원체이며 그 검출률은 호흡기 증상, 가을/겨울철 발생, 호흡기 증상의 가족력이 있는 환자에서 유의하게 높았다. Purpose: This study aimed at determining the detection rate of respiratory viruses and at investigating the risk factors associated with respiratory virus detection in young infants. Methods: From September 2011 to August 2012, nasopharyngeal swabs were obtained from 227 infants aged ≤90 days with suspected infectious diseases, including sepsis. We performed a retrospective analysis of their clinical characteristics. The prevalence of respiratory viruses in their nasopharyngeal swabs was assayed by real time polymerase chain reaction (real-time PCR). Results: In total, 157 (69.2%) infants had more than one of the following respiratory viruses: respiratory syncytial virus (n= 75), rhinovirus (n=42), influenza virus (n=18), parainfluenza virus (n=15), human metapneumovirus (n=9), coronavirus (n=9), adenovirus (n=4), and bocavirus (n=3). During the same period, bacterial infections were confirmed in 24 infants (10.6%). The detection of respiratory viruses was significantly associated with the presence of cough, a family history of respiratory illness, and a seasonal preference (fall/winter). Using logistic regression analysis, these 3 variables were also identified as significant risk factors. During fall and winter, detection of respiratory viruses was significantly higher in infants who did not have a bacterial infection. Conclusion: Respiratory virus is an important pathogen in young infants admitted to a hospital, who are suspected with infectious diseases. Detection of respiratory viruses in young infants was associated with seasonality (fall/winter), presence of respiratory symptoms and a family history of respiratory illness.