Different roles of surveillance positron emission tomography according to the histologic subtype of non-Hodgkin’s lymphoma

( Yu Ri Kim ),( Soo-jeong Kim ),( June-won Cheong ),( Yundeok Kim ),( Ji Eun Jang ),( Hyunsoo Cho ),( Haerim Chung ),( Yoo Hong Min ),( Woo Ick Yang ),( Arthur Cho ),( Jin Seok Kim ) 대한내과학회 2021 The Korean Journal of Internal Medicine Vol.36 No.0

Background/Aims: Although the use of surveillance 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is discouraged in patients with diffuse large B-cell lymphoma, its usefulness in different subtypes has not been thoroughly investigated. Methods: We retrospectively evaluated 157 patients who showed positive results on surveillance FDG-PET/CT every 6 months following complete response for up to 5 years. All of the patients also underwent biopsies. Results: Seventy-eight (49.6%) of 157 patients had true positive results; the remaining 79 (50.3%), including eight (5.1%) with secondary malignancies, were confirmed to yield false positive results. Among the 78 patients with true positive results, the disease in seven (8.9%) had transformed to a different subtype. The positive predictive value (PPV) of FDG-PET/CT for aggressive B-cell non-Hodgkin’s lymphoma (NHL) was lower than that for indolent B-cell or aggressive T-cell NHL (p = 0.003 and p = 0.018, respectively), especially in patients with a low/low-intermediate international prognostic index (IPI) upon a positive PET/CT finding. On the other hand, indolent B-cell and aggressive T-cell NHL patients showed PPVs of > 60%, including those with low/low-intermediate secondary IPIs. Conclusions: The role of FDG-PET/CT surveillance is limited, and differs according to the lymphoma subtype. FDG-PET/CT may be useful in detecting early relapse in patients with aggressive T-cell NHL, including those with low/low-intermediate risk secondary IPI; as already known, FDG-PET/CT has no role in aggressive B-cell NHL. Repeat biopsy should be performed to discriminate relapse or transformation from false positive findings in patients with positive surveillance FDG-PET/CT results.

Survival impact of adherence to tyrosine kinase inhibitor in chronic myeloid leukemia

( Yundeok Kim ),( Tae-Hwa Go ),( Jaeyeon Jang ),( Jii Bum Lee ),( Seung Taek Lim ),( Kwang Yong Shim ),( Jong In Lee ),( Jee Hyun Kong ) 대한내과학회 2021 The Korean Journal of Internal Medicine Vol.36 No.6

Background/Aims: Adherence to tyrosine kinase inhibitors (TKIs) has become a critical aspect of care in chronic myeloid leukemia (CML). We aimed to examine the association of TKI adherence with overall survival (OS) outcomes in Korean patients diagnosed with CML and treated with TKIs using data from the National Health Information Database. Methods: This study included 2,870 CML patients diagnosed between 2005 and 2013. Drug adherence was evaluated according to the medication possession ratio (MPR) and classified as high adherence (i.e., MPR ≥ 0.95 [upper 50%]), moderate adherence (i.e., MPR ≥ 0.68 and < 0.95 [middle 25%]), and low adherence (i.e., MPR < 0.68 [lower 25%]). Results: The median MPR was 0.95 (range, 0 to 4.67). Male sex (p = 0.003), age < 70 years (p < 0.001), high income (≥ 30%, p < 0.001), and maintaining frontline TKI (< 0.001) were associated with better adherence. Adherence to dasatinib was the lowest (vs. imatinib or nilotinib, p < 0.001). Compared with high MPR patients, those with moderate MPR (hazard ratio [HR], 4.90; 95% confidence interval [CI], 3.87 to 6.19; p < 0.001) and low MPR (HR, 11.6; 95% CI, 9.35 to 14.42; p < 0.001) had poorer OS. Conclusions: Adherence to TKI treatment is an important factor predicting survival outcomes in Korean CML patients. Male sex, age < 70 years, high income, and maintaining frontline TKI are associated with high adherence to TKI. Thus, those without these characteristics should be closely monitored for treatment adherence.

부모-교사의 협력적 부모교육 경험의 의미: 유아 창의성 주제를 중심으로

김윤덕 ( Kim Yundeok ) 한국영유아교육보육학회 2022 영유아교육.보육연구 Vol.15 No.1

본 연구는 유아 창의성 발달을 위한 부모-교사의 협력적 부모교육이 부모의 인식에 어떤 변화를 일으키며, 부모-교사의 관계형성에 어떠한 의미를 가지는지 탐색하여 부모교육의 활성화를 위한 기초자료를 제공하고자 하였다. 이를 위해 창의성 부모교육을 10회 실시하고 부모-교사간 대화식 반성적 토론을 60분간 진행하였으며, 토론 과정 중에 이루어진 대화를 녹음하여 전사하였다. 그 외 부모 이야기쓰기와 교사저널 등을 작성하여 수집된 자료들을 개방적 코딩방법으로 분석하였다. 그 결과 첫째, 협력적 부모교육 모임내에서 부모는 적극적이고 지속적인 반성적 사고를 통해 부모가 소유한 문제 상황을 주체적으로 해결해나가고 그 과정에서 느낀 기쁨과 자신감은 부모로서 성장하는 계기로 작용했다. 둘째, 부모-교사는 협력적 부모교육과 반성적 토론을 통해 서로 소통하고 신뢰를 회복하여 배움의 공동체로 협력적 관계를 맺게 되었다. The purpose of this study is to provide a foundation contributing to the revitalization of parent education by exploring how parents and teacher cooperative parent education for the development of child creativity changes parents’ perceptions and behaviors. To this end, creative parent education was conducted 10 times, an interactive reflective discussion between parents and teachers was conducted for 60 minutes, and conversations made during the discussion process were recorded and transcribed. In addition, the collected data were analyzed using an open coding method by writing parents’ stories and teachers’ journals. Second, parents-teachers communicated with each other and restored trust through cooperative parent education and reflective discussions to form a cooperative relationship as a learning community.

Poster Session : PS 1411 ; Hemato-Oncology(Hematology) : Peripheral Blood and Bone Marrow Involvement of Post-Transplant Lymphoproliferative Disorder Following Haploidentical Hematopoietic Stem Cell Transplantation Presenting with Early Peripheral Lymphoc

( Jung Yeon Lee ),( Gyuri Kim ),( Eunyoung Lee ),( Se Hee Park ),( Hyun Sung Park ),( Ji Eun Jang ),( Yundeok Kim ),( Soo Jeong Kim ),( Jin Seok Kim ),( June Won Cheong ),( Yoo Hong Min ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background : Post-transplant lymphoproliferative disorder (PTLD) represents a spectrum of clinically and morphologically heterogeneous group of lymphoid proliferations of varying clonal composition seen following hematopoietic stem cell transplantation (HSCT) or solid organ transplantation. However overt peripheral or bone marrow (BM) involvement by PTLD is uncommon as early lesion. Case: A 38-year-old woman was diagnosed with Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ALL) in October 2013. Complete remission was achieved after chemotherapy using hyperfractionated CVAD regimen with imatinib, and she received haploidentical HSCT from mother in January 2014. Conditioning chemotherapy consisted of BU/fiU/ATG, and G-CSF mobilized peripheral graft with 6.08 x 10^6 CD34+ cells/kg and 2.62 x 10^8 CD3+ T cells/kg was transplanted. Engraftment and complete donor chimerism were confirmed by BM study and STR test on day 14, respectively. On day 32, WBC was suddenly increased, and up to 217.30 x 10^3/uL on day 37. BM study, donor chimerism study, and RQ-PCR for Bcr/Abl were performed on day 34, however, there were no evidences of leukemic relapse or loss of complete donor chimerism except polymorphic proliferation in B cell lineage expressing EBV latency-associated RNA in BM. Quantitative PCR for EBV-DNA on peripheral blood was also increased as high as 38,825,576 copies/mL on day 39. Pneumonia and septic shock were developed from day 38, and she finally died of pneumonia with multi-organ failure on day 51 in spite of intensive treatments. Conclusion: PTLD has to be considered as one of treatment related complications in HSCT. Although peripheral blood and/or bone marrow involvement of PTLD after HSCT is uncommon as early lesion, early peripheral lymphocytosis can be initial presenting manifestation of PTLD like in this case.

The prognostic role of CD68 expression in patients with primary central nervous system lymphoma

( Hyunsoo Cho ),( Soo-jeong Kim ),( Hyunsung Park ),( Jung Yeon Lee ),( Ji Eun Jang ),( Yundeok Kim ),( June-won Cheong ),( Yoo Hong Min ),( Jin Seok Kim ) 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1

Background: The prognostic role of the tumor microenvironment, including CD68+ tumor-associated macrophages (TAMs) and FoxP3+ regulatory T-cells (Tregs) in primary central nervous system lymphoma (PCNSL) has not been evaluated. Methods: We studied the prognostic role CD68 and FoxP3 expression by immunohistochemistry using FFPE tumor samples of 76 newly diagnosed immunocompetent PCNSL patients. Results: All patients were treated initially with high-dose methotrexate (HD-MTX)-based chemotherapy, and 16 (21.1%) patients underwent upfront ASCT after a median of 4 cycles (range, 2-4) of HD-MTX-based chemotherapy. High CD68 expression was associated with inferior overall survival (OS) and progression-free survival (PFS) in multivariate analysis (HR 3.71, 95% CI: 1.25-11.02, p=0.018, and HR 4.83, 95% CI: 1.91-12.27, p=0.001, respectively). In the non-upfront ASCT (N=60) cohort,high CD68 expression was also associated with inferior OS and PFS in multivariate analysis (p= 0.013 and p<0.001, respectively). However, high CD68 expression was not associated with neither OS nor PFS in the upfront ASCT cohort (p=0.426 and p=0.848, respectively). The expression of FoxP3 was not significantly associated with survival. Conclusions: We identified a prognostic role for high CD68 expression in PCNSL, and suggest that consolidation treatment with upfront ASCT might overcome the negative impact of high CD68 expression in PCNSL.

S-567 The role and significance of MDSC-like myeloid blasts in immune-tolerance of AML

( Haerim Chung ),( Jung Yeon Lee ),( Yundeok Kim ),( Soo Jeong Kim ),( Jin Seok Kim ),( June-won Cheong ),( Yoo Hong Min ),( Shin Young Hyun ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1

Myeloid-derived suppressor cells (MDSCs) is a heterogenous cell population, consisting of myeloid progenitor cells and immature myeloid cells and having an ability to suppress T-cell function. Due to their suppressive effects on immunity, MDSCs can lead to facilitate tumor development and growth, and has been known to be associated with poor prognosis in various solid cancers. However, the role of MDSC in myeloid neoplasm are unclear. So, we elucidated the role of leukemic subpopulation showing CD11b+CD33+HLA-DR- immunophenotype, which resembles MDSCs. CD11b+CD33+HLA-DR- blast were isolated using flow-cytometry from bone marrow mononuclear cell sample, which were collected at the time of diagnosis by Acute Leukemia Cohort Study in Severance. The clinical impact of MDSC-like blasts was retrospectively reviewed in 63 patients. CD33+HLA-DR- leukemic cells from each patients showed various range of expression for CD11b (Mean±SD, 21.02±22.19%). MDSCs can be divided into two subtypes, monocytic MDSC expressing CD14 and granulocytic MDSC expressing CD15, and CD14 expression on MDSC-like blast expression was more frequent than CD15 expression (67.5% vs. 39.3%). To figure out the immunosuppressive activity in MDSC-like blasts, Arg1 and iNOS expression were checked, and MDSC-like blasts showed significantly higher expression of Ara1(77.1% vs. 38.5%, p<0.001) and iNOS (33.0% vs. 1.1%, p<0.0001) compared to non-MDSC-like blasts. Compared to ‘Lower MDSC group’, WBC count, serum LDH, fraction of blasts in bone marrow, and frequency of adverse cytogenetics were significantly higher in ‘Higher MDSC group’. Patients in ‘High MDSC group’ had significantly shorter overall survival (331±42 vs. 758±114 days, p=0.027). On multivariate analysis, higher fraction of CD11b+CD33+HLA-DR- leukemic cells (HR 2.966, 95%CI 1.086-8.095, p=0.034), old age (p=0.001), adverse cytogenetics (p=0.013), and FAB classification (p=0.035) were poor prognosis factors. CD33+HLA-DR- MDSC-like blasts subgroup is existed in myeloid leukemic blasts with various range. Because they suppressed T cell immunity, also showed adverse prognostic effect on survival, MDSC-like blasts might play a certain role in immune-tolerance in leukemia.

Clinical characteristics and treatment outcomes of isolated myeloid sarcoma without bone marrow involvement: a single-institution experience

Lee, Jung Yeon,Chung, Haerim,Cho, Hyunsoo,Jang, Ji Eun,Kim, Yundeok,Kim, Soo-Jeong,Kim, Jin Seok,Hyun, Shin Young,Min, Yoo Hong,Cheong, June-Won Korean Society of Hematology; Korean Society of Bl 2017 Blood Research Vol.52 No.3

<P><B>Background</B></P><P>Isolated myeloid sarcoma (MS) is a rare extramedullary tumor mass composed of malignant myeloid precursor cells without any evidence of leukemia in the peripheral blood and bone marrow. We describe the clinical characteristics and outcomes of patients diagnosed with isolated MS at our institution.</P><P><B>Methods</B></P><P>We retrospectively reviewed 9 of 497 acute myeloid leukemia (AML) patients (1.8%) with isolated MS. Isolated MS patients were divided into 2 groups according to the first-line treatment strategy: systemic treatment only (S) or local treatment with or without systemic treatment (LS).</P><P><B>Results</B></P><P>The most common site of MS occurrence was the head and neck area (N=4, 44.4%), followed by the anterior mediastinum (N=2, 22.2%) and the gastrointestinal tract (N=2, 22.2%). The tumors of 4 patients (44.4%) eventually evolved to AML, in a median time of 13.4 months (range, 2.4–20.1 mo). The number of patients achieving complete remission after first-line treatment was higher in the LS group (N=5, 83.3%) than in the S group (N=1, 33.3%) (<I>P</I> =0.226). All patients in the LS group survived, but those in the S group died (<I>P</I>=0.012).</P><P><B>Conclusion</B></P><P>Accurate and rapid diagnosis using various modalities and the early initiation of intensive combined treatment may be the optimal strategies to reduce the risk of isolated MS subsequently evolving to AML. To fully understand the characteristics of isolated MS, a larger number of patients from a multinational study is necessary.</P>

Energy-cost analysis of HVAC system for office buildings: Development of a multiple prediction methodology for HVAC system cost estimation

Cho, Jinkyun,Kim, Yundeok,Koo, Junemo,Park, Woopyeng Elsevier 2018 Energy and buildings Vol.173 No.-

<P><B>Abstract</B></P> <P>Buildings targeted at high energy performance levels have been proven to be technically feasible, but are relatively expensive. This research examined the cost relationship between sub-systems of HVAC (Heating, Ventilation and Air Conditioning) for energy efficient buildings. <I>Because of</I> inadequate information to estimate investment cost of HVAC systems in the early stage of building projects, this study was carried out the cost analysis method in the process of formulating predictive models for cost of HVAC systems. The relationship between the variables in the cost estimation was examined with the use of descriptive statistics and multiple correlation analysis. One of the major findings of the research was that the cost of HVAC systems of any given office building project can be assessed from the same building conditions with <I>high</I> confidence limits using multiple matrix models of HVAC sub-systems and this provided a basis for developing 960 cost models. There is potentially large variability in the range −26–460% with an average at 179% in investment costs for the sub-systems. The cost of a HVAC system has a range of about 125–335 unit rate, which represents a variety of system combinations. Decision tree analysis of energy performance and investment cost of HVAC systems were obtained, yielding information on optimal combination HVAC sets in the office buildings.</P> <P><B>Highlights</B></P> <P> <UL> <LI> We examined the cost relationship between sub-systems of HVAC for energy efficient buildings. </LI> <LI> The method for predicting the investment cost of the possible 960 combinations of HVAC system was suggested. </LI> <LI> The design rules to optimize the energy-cost level for HVAC system were investigated. </LI> <LI> The effects of the HVAC design factors of investment cost on the energy performance were analyzed quantitatively. </LI> <LI> The air conditioning system, sub-system of HVAC was found to be the most significant design factor. </LI> </UL> </P>

Enhanced autophagy in cytarabine arabinoside-resistant U937 leukemia cells and its potential as a target for overcoming resistance

CHEONG, JUNE-WON,KIM, YUNDEOK,EOM, JU IN,JEUNG, HOI-KYUNG,MIN, YOO HONG SPANDIDOS PUBLICATIONS 2016 MOLECULAR MEDICINE REPORTS Vol. No.

<P>Autophagy is a lysosomal degradation mechanism that is essential for cell survival, differentiation, development, and homeostasis. Autophagy protects cells from various stresses, including protecting normal cells from harmful metabolic conditions, and cancer cells from chemotherapeutics. In the current study, a cytarabine arabinoside (Ara-C)-sensitive U937 leukemia cell line and an Ara-C-resistant U937 (U937/AR) cell line were assessed for baseline autophagy activity by investigating the LC3-I conversion to LC3-II, performing EGFP-LC3 puncta, an acidic autophagolysosome assay, and measuring the expression of various autophagy-related genes. The results demonstrated significantly higher autophagic activity in the U937/AR cells compared with the U937 cells, when the cells were cultured with or without serum. Furthermore, an increase in the autophagic activity in starved U937/AR cells was demonstrated, compared with that in the starved U937 cells. Administration of an autophagy inhibitor demonstrated no change in cell death in the two cell lines when cultured with serum, however, it induced cell death regardless of the Ara-C sensitivity when the cell lines were cultured without serum. In addition, the U937 cells demonstrated an Ara-C resistance when cultured without serum. Co-treatment with Ara-C and the autophagy inhibitor significantly induced cell death in the U937/AR and Ara-C-sensitive U937 cells. In conclusion, autophagy serves an important role in protecting U937 cells from Ara-C and in the development of Ara-C resistance. Inhibition of autophagy combined with the Ara-C treatment in the U937 cells augmented the anti-leukemic effect of Ara-C and overcame Ara-C resistance, suggesting that autophagy may be an important therapeutic target to further improve the treatment outcome in patients with acute myeloid leukemia.</P>

스마트폰과 중계서버를 이용한 Smart Heart System

송승한(Seunghan Song),엄윤덕(Yundeok Eom),최기복(Kibok Choi),이정혁(Junghyuk Lee),김영돈(Youngdon Kim),정미연(Miyeon Jeong),이창석(Changsuk Lee),박현주(Hyun-Ju Park) 한국정보과학회 2014 한국정보과학회 학술발표논문집 Vol.2014 No.12