• Clinical and Experimental Pediatrics
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• 제53권4호
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• pp.538-547
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• 2010

목 적 : 본 연구의 목적은 소아백혈병 환자에서 이식 전처치로서 전신방사선조사(total body irradiation, TBI)군과 비방사선조사(non-TBI)군과의 이식 성적 및 예후를 비교하고자 하였다. 방 법: 1996년 1월에서 2007년 12월까지 전남대학교병원에서 조혈모세포이식을 시행 받은 소아백혈병 환자 77명을 TBI군(n=40)과 non-TBI군(n=37)으로 나누어 각 군 간의 이식 유형, 이식 시 질병상태, 전처치 방법, 이식 세포 수, 생착 속도, 이식편대숙주반응(graft-versus-host disease, GVHD)의 발생빈도, 이식 합병증, 사망원인, 전체생존율(overall survival, OS)과 무사건생존율(event free survival, EFS) 및 후기 합병증을 비교 분석하였다. 결 과 : 급성림프구성백혈병(acute lymphoblastic leukemia, ALL) 환자의 82.4% (28/34)는 TBI를 받았고, 골수계열 백혈병 환자의 72.7% (24/33)는 non-TBI 군이었다. 전체 환자를 대상으로 TBI 여부에 따른 5년 EFS은 두 군간 차이는 없었으나 (62% vs. 63%), ALL 환자에서는 TBI군이 non-TBI군에 비해 통계적으로 유의하게 우수한 5년 EFS을 보였다(65% vs. 17%; $P$=0.005). AML (acute myelogenous leukemia) 환자에서는 non-TBI군이 TBI군보다 더 높은 5년 EFS을 보였으나 통계적인 유의성은 없었다(73% vs. 38 %; $P$=0.089). GVHD 발생률, 생착, 사망원인과 후기 합병증은 두 군간 차이는 없었다. 결 론 : 전처치로서 TBI군과 non-TBI군은 비슷한 결과를 보였으나, ALL환자에서는 TBI군이 non-TBI군에 비하여 유의하게 우수한 5년 EFS을 보였다. 두 군간 후기 합병증의 발생 및 사회경제적 삶의 질을 비교하기 위하여는 많은 환자를 대상으로한 전향적 무작위 연구가 필요하리라 사료된다.

• Clinical and Experimental Pediatrics
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• 제49권2호
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• pp.173-180
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• 2006

목 적 : CMV 감염은 여전히 조혈모세포 이식 후 가장 중요한 감염 중 하나로 이환율과 사망률의 주요 원인이다. 조혈모세포 이식 후 CMV 감염 발생에 대한 위험인자의 분석 및 CMV pp65 항원혈증에 입각한 선제치료의 효과와 질환의 경과를 평가하고자 본 연구를 시행하였다. 방 법 : 1998년 10월부터 2003년 12월까지 가톨릭대학교 성모병원 소아과에서 이식을 시행받은 환아를 대상으로 하였다. pp66항원을 이용한 항원혈증검사를 토대로 혈연간 이식 환아의 경우 CMV 항원 양성세포가 5개 이상 발견된 경우, 비혈연간 이식 환아의 경우는 CMV 항원 양성세포가 하나라도 발견된 경우 ganciclovir 선제치료를 시작하였다. 결 과 : CMV 항원혈증은 대상 환아 213명 중 88명(41.3%)에서 관찰되었고, 각각 비혈연간 골수이식(62.5%), 비혈연간 제대혈이식(36.8%), HLA-일치 혈연간 이식(25.3%)이었다. 이식유형에 따른 CMV 항원혈증 발생확률은 비혈연간 골수이식($62.5{\pm}5.4%$)이 비혈연간 제대혈이식($36.8{\pm}7.8%$) 또는 HLA-일치 혈연간 이식($25.3{\pm}4.5%$)보다 통계적으로 유의하게 높았다. 단변량 분석에 의하면 비혈연간 이식, 이식 시 환자 연령(5세 이상), 이식 전 환자의 CMV-IgG, 전처치로 전신방사선조사의 사용 및 2도 이상의 급성 이식편대 숙주병의 발생이 CMV 항원혈증 발생의 위험인자이었다. 다변량분석에 의하면 비혈연간 이식, 이식전 환자의 CMV-IgG 양성상태 및 2도 이상의 급성 이식편대 숙주병의 발생이 독립적인 위험인자이었다. 이식환자 213명 중 7례(3.3%)에서 CMV 질환이 발생하였다(고항원혈증에서 6례 발생). 결 론 : 소아 조혈모세포 이식에 있어서 CMV 감염의 위험인자는 이식 전 환자의 CMV 혈청학적 상태, 조혈모세포 공급원, 급성 이식편대 숙주병이었으며, CMV 항원혈증에 입각한 ganciclovir 선제치료는 CMV 질환의 발생을 예방하는데 효과적이었다.

• Parasites, Hosts and Diseases
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• 제50권4호
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• pp.353-355
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• 2012

We report here a case of inguinal sparganosis, initially regarded as myeloid sarcoma, diagnosed in a patient undergone allogeneic hematopoietic transplantation (HSCT). A 56-year-old male patient having myelodysplastic syndrome was treated with allogeneic HSCT after myeloablative conditioning regimen. At day 5 post-HSCT, the patient complained of a painless palpable mass on the left scrotum and inguinal area. Pelvic magnetic resonance imaging and computed tomography revealed suspected myeloid sarcoma. Gun-biopsy was performed, and the result revealed eosinophilic infiltrations without malignancy. Subsequent serologic IgG antibody test was positive for sparganum. Excisional biopsy as a therapeutic diagnosis was done, and the diagnosis of sparganosis was confirmed eventually. This is the first report of sparganosis after allogeneic HSCT mimicking myeloid sarcoma, giving a lesson that the physicians have to consider the possibility of sparganosis in this clinical situation and perform adequate diagnostic and therapeutic approaches.

• IMMUNE NETWORK
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• 제15권2호
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• pp.66-72
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• 2015

Currently, detecting biochemical differences before and after allogeneic stem cell transplantation (SCT) for improved prediction of acute graft-versus-host disease (aGVHD) is a major clinical challenge. In this pilot study, we analyzed the kinetics of circulating adipokine levels in patients with or without aGVHD before and after allogeneic SCT. Serum samples were obtained and stored at $-80^{\circ}C$ within 3 hours after collection, prior to conditioning and at engraftment after transplantation. A protein array system was used to measure the levels of 7 adipokines of patients with aGVHD (n=20) and without aGVHD (n=20). The resistin level at engraftment was significantly increased (p<0.001) after transplantation, regardless of aGVHD occurrence. In the non-aGVHD group, the concentrations of the hepatocyte growth factor (HGF) (mean values${\pm}$SD; $206.6{\pm}34.3$ vs. $432.3{\pm}108.9pg/ml$, p=0.040) and angiopoietin-2 (ANG-2) (mean values${\pm}$SD; $3,197.2{\pm}328.3$ vs. $4,471.8{\pm}568.4pg/ml$, p=0.037) at engraftment were significantly higher than those of the pre-transplant period, whereas in the aGVHD group, the levels of adipokines did not change after transplantation. Our study suggests that changes in serum HGF and ANG-2 levels could be considered helpful markers for the subsequent occurrence of aGVHD.

• Molecules and Cells
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• 제38권11호
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• pp.966-974
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• 2015

Despite the presence of toll like receptor (TLR) expression in conventional $TCR{\alpha}{\beta}$ T cells, the direct role of TLR signaling via myeloid differentiation factor 88 (MyD88) within T lymphocytes on graft-versus-host disease (GVHD) and graft-versus-leukemia (GVL) effect after allogeneic stem cell transplantation (allo-SCT) remains unknown. In the allo-SCT model of C57BL/6 ($H-2^b$) ${\rightarrow}$ B6D2F1 ($H-2^{b/d}$), recipients received transplants of wild type (WT) T-cell-depleted (TCD) bone marrow (BM) and splenic T cells from either WT or MyD88 deficient (MyD88KO) donors. Host-type ($H-2^d$) P815 mastocytoma or L1210 leukemia cells were injected either subcutaneously or intravenously to generate a GVHD/GVL model. Allogeneic recipients of MyD88KO T cells demonstrated a greater tumor growth without attenuation of GVHD severity. Moreover, GVHD-induced GVL effect, caused by increasing the conditioning intensity was also not observed in the recipients of MyD88KO T cells. In vitro, the absence of MyD88 in T cells resulted in defective cytolytic activity to tumor targets with reduced ability to produce IFN-${\gamma}$ or granzyme B, which are known to critical for the GVL effect. However, donor T cell expansion with effector and memory T-cell differentiation were more enhanced in GVHD hosts of MyD88KO T cells. Recipients of MyD88KO T cells experienced greater expansion of Foxp3- and IL4-expressing T cells with reduced INF-${\gamma}$ producing T cells in the spleen and tumor-draining lymph nodes early after transplantation. Taken together, these results highlight a differential role for MyD88 deficiency on donor T-cells, with decreased GVL effect without attenuation of the GVHD severity after experimental allo-SCT.

• 생명과학회지
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• 제17권12호
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• pp.1654-1659
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• 2007

4주령의 돼지에서 여러 용량의 방사선 조사를 하고 경시적으로 혈액 수치의 변화, helper T-cell 및 cytotoxic T-cell에 대한 변화를 관찰하였다. 6 Gy 이상을 조사한 돼지에 3일 이후 백혈구와 혈소판의 수의 감소되어 회복되지 않았으며, 식욕 부진,설사 등의 부작용을 보이며, 조사 후 10일부터 15일 사이에 모두 폐사 하였다. 4 Gy 전신 단일 조사한 돼지에서는 조사 후 임상적인 부작용을 보이지 않았으며, 9일 이후 백혈구, 혈소판이 증가하여 회복되는 경향을 보였다. 본 연구의 결과는 돼지를 사용한 방사선 생물학적 실험에서 혈액변화 및 면역억압 관찰에 대한 기초 자료로 활용 될 수 있을 것이다.

• 대한설비공학회:학술대회논문집
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• 대한설비공학회 2008년도 하계학술발표대회 논문집
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• pp.1195-1200
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• 2008

This study have goal with conceptual design for Offshore Structures of high pressure control valve for localization. Ball valve for development accomplished with flow analysis based on provision of ANSI B16.34, ANSI B16.10, ANSI B16.25 In order to localize the Offshore Structures high pressure control valve. Numerical simulation using CFD(Computational Fluid Dynamic) in order to predict a mass flow rate and a flow coefficient form flow dynamic point of view. The working fluid assumed the glycerin($C_3H_8O_3$). The valve inlet and outlet setup a pressure boundary condition. The outlet pressure was fixed by atmospheric pressure and calculated until increasing 1bar to 10bar. CFD analysis used STAR-CCM+ which is commercial code and Governing equations were calculated by moving mesh which is rotated 90 degrees when ball valve operated opening and closing in 1 degree interval. The result shows change of mass flow rate according to opening and closing angle of valve. Flow decrease observed open valve that equal percentage flow paten which is general inclination of ball valve. Relation with flow and flow coefficient can not be proportional according to inlet pressure when compare with mass flow rate. Because flow coefficient have influence in flow and pressure difference. Namely, flow can be change even if it has same Cv value. The structural analysis used ANSYS which is a commercial code. Stress analysis result of internal pressure in valve showed lower than yield strength. This is expect to need more detail design and verification for stem and seat structure.

• Clinical and Experimental Pediatrics
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• 제54권3호
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• pp.111-116
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• 2011

Childhood chronic myelogenous leukemia (CML) is a rare hematologic disease, with limited literature on the methods of treatment. Previously, allogeneic hematopoietic stem cell transplantation (HSCT) was considered the only curative treatment for this disease. Treatment with imatinib, a selective inhibitor of the BCR-ABL tyrosine kinase (TKI), has resulted in prolonged molecular response with limited drug toxicity. Imatinib is now implemented in the primary treatment regimen for children, but the paucity of evidence on its ability to result in permanent cure and the potential complications that may arise from long-term treatment with TKIs have prevented imatinib from superseding HSCT as the primary means of curative treatment in children. The results of allogeneic HSCT in children with CML are similar to those observed in adults; HSCT-related complications such as transplant-related mortality and graft-versus-host disease remain significant challenges. An overall consensus has been formed with regards to the need for HSCT in patients with imatinib resistance or those with advanced-phase disease. However, issues such as when to undertake HSCT in chronic-phase CML patients or how best to treat patients who have relapsed after HSCT are still controversial. The imatinib era calls for a reevaluation of the role of HSCT in the treatment of CML. Specific guidelines for the treatment of pediatric CML have not yet been formulated, underscoring the importance of prospective studies on issues such as duration of imatinib treatment, optimal timing of HSCT and the type of conditioning utilized, possible treatment pre-and post-HSCT, and the role of second-generation TKIs.

• IMMUNE NETWORK
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• 제2권1호
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• pp.49-52
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• 2002

Background: The possibility that G-CSF recruits leukemic cells from the G0 to S phase, which may lead to a greater susceptibility to cytotoxic drugs, such as ara-C, has been presented in Harada's study. Methods: In this study, we referred to the protocol of Harada et al 1 to try G-CSF combined marrow-ablative chemotherapy and autologous PBSCT, for the treatment of AML patients in CR1 status. Between January 1997 and March 1998, six AML patients (3: children, 3: adults) in CR1 status were autografted and followed up to 3 years. Results: The major regimen related toxicity was composed of mucositis and diarrhea without death. The time of ANC recovery to 500/L and 1,000/L was 11~48 and 16~81 days, respectively. The mean time of platelet recovery to 20,000/L and 50,000/L was 21~233 and 35~370 days, respectively. The platelet recovery time to 50,000/L was markedly prolonged for more than 100 days in four patients (66.7%). Moreover, four patients (66.7%) experienced a relapse of leukemia after transplantation, with a mean interval of 147.5 days after PBSCT. Two patients were in CR status for 53 and 51 months after PBSCT, respectively. Conclusion: The G-CSF combined marrow-ablative chemotherapy and autologous PBSCT resulted in a markedly delayed platelet recovery and no advantages for decreasing the relapse rate of AML. But, further studies will be warranted.

• 대한설비공학회:학술대회논문집
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• 대한설비공학회 2008년도 동계학술발표대회 논문집
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• pp.357-362
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• 2008

This study have goal with reverse engineering for petrochemistry of high pressure ball valve for localization. Ball valve for development accomplished with flow analysis based on provision of ANSI B16.34, ANSI B16.10, ANSI B16.25 In order to localize the petrochemistry high pressure control valve. Numerical simulation using CFD(Computational Fluid Dynamic) in order to predict a mass flow rate and a flow coefficient form flow dynamic point of view. The working fluid assumed the water($H_2O$). The valve inlet and outlet setup a pressure boundary condition. The outlet pressure was fixed by atmospheric pressure and calculated inlet velocity 5m/s. CFD solver used STAR-CCM+ which is commercial code. The result shows change of mass flow rate according to opening and closing angle of valve. Flow decrease observed open valve that equal percentage flow paten which is general inclination of ball valve. The structural analysis used ANSYS which is a commercial code. Stress analysis result of internal pressure in valve showed lower than yield strength. This is expect to need more detail design and verification for stem and seat structure.