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S-471 Successful treatment with rituximab in cisplatin-induced refractory HUS patient
( Ji Ae Yang ),( Hyun Woo Kim ),( Sun Ae Han ),( Byungchul Shin ),( Hyun Lee Kim ),( Jong Hoon Chung ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1
Successful treatment with rituximab in cisplatin-induced refractory hemolytic-uremic syndrome patient Ji ae Yang, Hyun Woo Kim, Sun Ae Han, Byung Chul Shin, Hyun Lee Kim and Jong Hoon Chung Department of Internal Medicine, Division of Nephrology, Chosun University Medical School, Gwangju, Republic of Korea Abstract Hemolytic uremic syndrome (HUS) is a relatively rare disease that can have devastating consequences. It classically includes the triad of microangiopathic hemolytic anemia, thrombocytopenia and acute kidney injury. HUS may be associated with a variety of etiologies, and chemotherapeutic agents including mitomycin, cisplatin, bleomycin and gemcitabine have also been reported to be associated with HUS. A36-year-old woman patient with cervical cancer wasreceived chemotherapy with four cycles of cisplatin at 60 mg/m2 and radiotherapy. She complained of dizziness and oliguria. Microangiopathic hemolytic anemia was developed and rapidly declining renal function with proteinuria and hematuria. In spite of hemodialysis, plasmapheresis and corticosteroid therapy, the patient’s condition continued to deteriorate. After aggressive therapy with rituximab, MHA and thrombocytopenia was recovered. However, renal function was not recovered and the patient was maintained on regular hemodialysis. In this case, we report the successful treatment with rituximab in cisplatin-induced refractory HUS patient. Keywords: Hemolytic uremic syndrome, Cisplatin, Rituximab
( Ji Ae Yang ),( Jeong Seok Lee ),( Jin Kyun Park ),( Eun Bong Lee ),( Yeong Wook Song ),( Eun Young Lee ) 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.2
Background/Aims: To analyze clinical characteristics of interstitial lung disease (ILD) associated with rheumatoid arthritis (RA), especially in patients with poor prognosis. Methods: Seventy-seven RA patients with ILD and 231 age, sex, and disease duration-matched RA patients without ILD were enrolled in this retrospective study. Epidemiologic, clinical, and laboratory information were obtained through a medical chart review. Logistic regression analysis was used to estimate the risk of mortality in RA patients with ILD. Results: Compared to the RA without ILD group, the RA with ILD group had significantly higher titers of rheumatoid factor and the anti-cyclic citrullinated peptide (p = 0.001 for both), higher levels of C-reactive protein (CRP) at the time of RA diagnosis (p = 0.014), and a higher erythrocyte sedimentation rate (p = 0.022) and CRP levels (p < 0.001) throughout the 10-year follow-up period. These patients also received a higher mean daily dose of corticosteroids (p < 0.001). In the subgroup analysis of RA patients with ILD, 28 patients (36.4%) died during follow-up. Multivariate analysis revealed that older age at the time of ILD diagnosis was significantly associated with mortality. Usual interstitial pneumonia (UIP) subtype on high-resolution computed tomography (HRCT) was also suggested as a poor prognostic factor. Conclusions: The survival of RA patients with ILD is adversely affected by age at the time of ILD diagnosis. RA-ILD patients diagnosed after age 65 or with a UIP subtype on HRCT may have a poor prognosis.
( Ji Ae Yang ),( Jae Hyun Lee ),( Eun Young Lee ),( Eun Bone Lee ),( Yeong Wook Song ),( Jin Kyun Park ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Clinical experiences suggest that gout attacks in elderly patients are accompanied by stronger systemic infi ammatory response including fever, higher C-reactive protein(CRP) and erythrocyte sediment ratio(ESR) as compared those in younger patients. As such, it is often diffi cult to differentiate them from septic arthritis. To defi ne whether gout attacks in elderly patients have higher infi ammtory markers. Methods: In this retrospective study, medical records of patients who were evaluated for a possible gout attack between January 2000 and April 2014 were examined. The presence of fever (>37.8°), levels of CRP and ESR on attack were compared between young (=50 years), middle aged (51- 65 years) and elderly patients (>65 years). Results: Gout attacks were observed in 188 patients with 34 young, 54 middle aged and 100 elderly patients. Baseline characteristics of three groups differed; elderly patients had more comorbidities including diabetes mellitus (p<0.001), hypertension (p<0.001), coronary artery disease (p=0.015), cerebrovascular accident (p<0.001), and cancer (p=0.031) as compared other groups. The elderly patients had a low body mass index (BMI) (24.60 ± 4.65, 24.55 ± 3.30, 23.27 ± 3.12, p=0.041) and longer disease duration (2.76 ± 5.16, 4.20 ± 6.13, 6.58 ± 9.23 years, p=0.028 by ANOVA). Fever was more often present in the elderly patients (17.6% in young vs. 29.6% in middle aged vs. 50.0% in elderly, p=0.001 by chi-square test). Although numbers of involved joints during attacks did not differ between groups (p=0.656), CRP and ESR levels during gout attack increased signifi cantly with age (figure 1). Conclusions: Since gout attacks in elderly patients are accompanied by stronger systemic infi ammatory response, often resembling sepsis or septic arthritis, it is crucial to correctly diagnose them as gout so that unnecessary invasive diagnostics including joint lavage and prolonged antibiotic treatment can be avoided.
유치원 교사를 위한 유초연계교육 교사연수 프로그램 개발
양지애(Yang, Ji-Ae),이정욱(Lee, Jeong-Wuk) 한국영유아교원교육학회 2018 유아교육학논집 Vol.22 No.3
본 연구의 목적은 유치원 교사의 유초연계교육 교수역량 증진을 위한 교사연수 프로그램을 개발하는 것이다. 이를 위해 ADDIE 모형에 근거하여 분석단계, 설계 단계, 개발 단계, 실행 단계, 평가 단계를 거쳐 프로그램 최종안을 개발하였다. 분석단계에서는 관련 문헌고찰, 전문가 심층면담, 현직교사 설문조사를 통해 프로그램에 대한 요구를 조사한 후, 이를 바탕으로 설계 단계에서는 프로그램의 시안을 구성하였다. 개발단계에서는 전문가 타당도를 검증받아 프로그램을 시안을 수정하였고, 실행단계에서는 ‘현장으로 찾아가는 수요자 중심의 맞춤형 교사연수’를 지향하는 본 프로그램의 특성을 고려하여 프로그램 참여자들의 요구를 반영하여 프로그램을 실행하였다. 평가 단계에서는 실행 단계에서 수집한 자료를 분석하여 프로그램의 현장적합성과 타당성을 확인하였고, 그 결과를 반영하여 프로그램 최종안을 확정하였다. 유치원 교사를 위한 유초연계교육 교사연수 프로그램은 ‘계속성/연속성 개념으로 접근하는 유초연계교육’, ‘유초연계와 관련된 유아의 감정에 공감하는 학습자 중심의 교육’, ‘현장으로 찾아가는 수요자 맞춤형 연수 과정’, ‘다양한 참여형 교수학습전략 사용’, ‘유아교육 전문가와 초등교육 현장전문가가 함께 연수 운영’이라는 기본방향에 맞춰 프로그램의 목적 및 목표, 교육내용, 교수학습방법, 평가, 운영방법으로 이루어져 있다. This study aims to develop a teacher training program that is designed to improve kindergarten teachers’ teaching competence for educational continuity between kindergarten and elementary school. The program was developed with ADDIE model development process. In the “analysis” phase, the researcher conducted literature reviews of the related topics, investigated and analyzed demands for this program through an in-depth interview with experts and a survey of in-service teachers. In the “design” phase, a draft proposal of the program was composed, which reflected the demands examined in the “analysis” phase. In the “development” phase, the draft proposal of the program was modified through considering the results of the validity by experts. In the “implementation” phase, the researcher implement the program to reflect the needs of the program participants. In the “evaluation” phase, the data from the implementation phase was analyzed and was identified the on-site suitability and validity of the program. Reflecting the evaluation results, the final version of the kindergarten teacher training program was confirmed. The directions of the program development are “educational continuity between kindergarten and elementary school which approaches with the concept of the continuity”, “the learners-centered education empathizing with children’s emotions related to the continuity between kindergarten and elementary school”, “the consumer-customized training course by visiting the site”, “the use of various participatory teaching-learning strategies”, and “the operation of training by experts in early childhood education and on-site experts in elementary education”.