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A Phase I/II Trial of $DCVac/IR^{(R)}$ Dendritic Cell Immunotherapy Combined with Irradiation in Cases of Refractory Colorectal Cancer with Multiple Liver Metastases (기존의 치료에 반응하지 않는 다발성 간전이 대장암 환자에서 방사선조사와 병합한 수지상세포 면역치료의 1, 2상 임상시험)

  • Choi, Young-Min;Lee, Hyung-Sik;Kwon, Hyuk-Chan;Han, Sang-Young;Choi, Jong-Cheol;Chung, Ju-Seop;Kim, Chang-Won;Kim, Dong-Won;Kang, Chi-Duk
    • Radiation Oncology Journal
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    • v.26 no.2
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    • pp.104-112
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    • 2008
  • Purpose: To assess the toxicity and tumor response induced by $DCVac/IR^{(R)}$ dendritic cell(DC) immunotherapy combined with irradiation for refractory colorectal cancer patients with multiple liver metastases. Materials and Methods: Between May 2004 and November 2006, applicants from a pool of refractory colorectal cancer patients with multiple liver metastases were enrolled. The patients were registered after having signed the informed consent form, which had been approved by the Institutional Review Board from the Dong-A University and Busan National University Hospital. DCs were obtained from peripheral blood of each patient, and then cultured in vitro. A total of $6{\times}10^6$ DCs were packed into a vial($DCVac/IR^{(R)}$, 0.5 ml) at the convenience of each patient's schedule. On the day before and on the day of each vaccination, each patient received a 4 Gy radiation dose to the target tumor. On the day of vaccination, the indicated dose of autologous DCs was injected into the irradiated tumor using ultrasound-guided needle injection procedures. A total of four vaccinations were scheduled at three 2-week intervals and one 4 week interval at the Dong-A University and Busan National University Hospital. If the tumor status was deemed to be stable or responding to therapy, an additional vaccination dose or two was approved at 4 week intervals beyond the fourth immunization. A tolerance test for DCs was conducted by injecting a range of doses($3{\times}10^6\;to\;12{\times}10^6$ DCs) after the 3rd injection. Moreover, the maximal tolerable dose was applied to additional patients. Treatment safety was evaluated in all patients who had at least one injection. Treatment feasibility was evaluated by the 10th week by assessing the response of patients having at least 4 injections. For systemic toxicities, the evaluation was performed using the National Cancer Institute Common Toxicity Criteria, whereas adverse effects were recorded using common WHO toxicity criteria. Results: Of the 24 registered patients, 22 received the DCs injections. Moreover, of the 14 patients that applied for the tolerance test, only 11 patients completed it because 3 patients withdrew their testing agreement. A grade 3 or more side effect, which was possibly related to the DC injection, did not occur in additional patients. The $12{\times}10^6$ DC injection was identified as the maximum tolerable dose, and was then injected in an additional 8 patients. Patients tolerated the injection fairly well, with no fatal side effects. In order to assess the feasibility of DC immunotherapy, the response was evaluated in other hepatic lesions outside of the targeted hepatic lesion. The response evaluation was performed in 15 of the 17 patients who received at least 4 injections. Stable and progressive disease was found in 4 and 11 patients, respectively. Conclusion: The DC-based immunotherapy and radiotherapy is theoretically synergistic for the local control and systemic control. The $DCVac/IR^{(R)}$ immunotherapy combined with irradiation was tolerable and safe in the evaluated cases of refractory colorectal cancer with multiple liver metastases. Future work should include well designed a phase II clinical trials.

CLINICAL CHARACTERISTICS OF CHILDREN AND ADOLESCENTS WITH CONDUCT PROBLEMS ADMITTED INTO A PSYCHIATRIC UNIT (소아정신과 병동에 입원한 품행장애 소아 청소년의 임상 특성)

  • Pyo, Kyung-Sik;Kang, Yun-Hyong;Bahn, Geon-Ho;Cho, Soo-Churl;Lee, Eun-Jung
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.9 no.2
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    • pp.227-236
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    • 1998
  • Objectives:Conduct disorder is one of the most frequent diagnosis in outpatient and inpatient mental health facilities for children and adolescents. This study investigated the clinical characteristics of children and adolescents with conduct disorder. Methods:The study employed a retrospective review of 45 inpatients diagnosed with conduct disorder by DSM-IV criteria at SNUH Child Psychiatric Unit from 1993, March to 1998, September. Results:The results were as follows:1) The sex ratio was 2:1, male dominant. Mean age on admission was $12.8{\pm}2.4$ years old(male:$12.2{\pm}2.3$, female:$14.1{\pm}2.1$). The mean age of male subjects was significantly lower than that of female subjects(p<.05). 2) We classified all subjects according to child- or adolescent-onset type by DSM-Ⅳ. Childhoodonset type was 42.2%, and adolescent-onset, 57.8%. The onset of male subjects were significantly earlier than that of female subjects(p<.05). 3) The most common complaint was 'serious violation of rules'(77.8%) by DSM-Ⅳ dimensions, while the most common single symtom was 'run away from home overnight at least twice while living in parental or parental surrogate home'(48.9%). 4) The comorbid psychopathology of the subjects were frequently described as follows, in order of frequency:substance use(42.2%), ADHD(35.6%), depression(20.0%), tic disorder(11.1%), bipolar disorder(4.4%). 5) On MMPI, both Pd and Ma subscales got the highest scores. The mean of total IQ by KEDIWISC was $100.0{\pm}15.1$. Female subjects' IQ was higher than that of male subjects. 6) Regarding the number of visits to the OPD after discharge, many subjects(33.3%) had visited OPD fewer than four times. Conclusions:In this study, the male to female ratio of adolescent type showed a decreasing trend. An interesting finding was the fact that socio-economic circumstances, as well as the level of education among patients, were higher than those of previous studies. The subjects' problem were also principally self contered and posed no threat to others.

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A clinical review of community acquired methicillin resistant staphylococcal scalded skin syndrome (지역사회 획득 메치실린 내성 포도알균에 의한 포도알균 열상 피부 증후군의 임상적 고찰)

  • Heo, Soon Young;Song, Yoon Jeong;Kim, Sung Jun;Park, Sun Young;Kang, Du Cheul;Ma, Sang Hyuk
    • Pediatric Infection and Vaccine
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    • v.14 no.1
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    • pp.83-90
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    • 2007
  • Purpose : Staphylococcal scalded skin syndrome (4S) is a well known disease defined by clinical, microbiological and histological criteria caused by Staphylococcus aureus. This disease is uncommon but has been increasingly recognized. We investigated the clinical features of staphylococcal scalded skin syndrome. Methods : We reviewed retrospectively medical records of 53 patients diagnosis of staphylococcal scalded skin syndrome who were admitted to Changwon Fatima hospital from February 2002 to December 2005. These patients were divided into 3 clinical types; generalized type, intermediate type, abortive type. Age, sex ratio, clinical manifestations, laboratory findings, response to therapy and prognosis were investigated. Result : 1)The mean age of patients was 2.8 years, ranging from 20 days to 7 years. Male-to-female ratio was 1.9:1. 2) By clinical types, 6 patients were in the generalized type (11%), 29 patients in the intermediate type (55%), 18 patients in the abortive type (34%). The coexisting diseases were variable, including conjunctivitis (25 cases), atopic dermatitis (11 cases), otitis media (1 case). On laboratory findings, most of patients didn't have leukocytosis or increased C-reactive protein. 4) A total of fifteen Methicillin Resistant Staphylococcal Aureus (MRSA) strains were isolated from September 2003 through December 2005. Fourteen strains were positive for exfoliative toxin B gene by PCR and negative for enterotoxin, toxic shock syndrome toxin and Panton-Valentine leukocidin genes. 5) The mean duration of admission was 7.3 days. Patients were treated with vancomycin or amoxacillin/clavulanate or ampicillin/sulbactam or cefuroxime without significant sequelaes. Conclusion : Recently, Staphylococcal scalded skin syndrome caused by exfoliative toxin B produced by MRSA in the Changwon area has been increasing.

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Clinical Analysis of Infective Endocarditis (감염성 심내막염의 임상적 고찰)

  • Kim, Hyuck;Kim, Young-Hak;Chung, Won-Sang;Shin, Kyung-Wook;Kim, Ji-Hoon
    • Journal of Chest Surgery
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    • v.43 no.6
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    • pp.619-626
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    • 2010
  • Background: The indications and the optimal time of surgery of infective endocarditis are controversial. We report the surgical results of our hospital during the last 10 years with literature review. Material and Method: Between January 2000 and December 2009, we enrolled 23 infective endocarditis patients who underwent surgery, and analyzed retrospectively. In the preoperative blood culture, 8 cases (34.8%) were positive. The average preoperative antibiotics treatment period was $20.78{\pm}16.00$ days. There were 12 (52.2%) urgent operations. The average follow up period was $49.26{\pm}33.21$ months. Result: 20 mechanical valve replacements were performed, 9 in aortic position, 8 in mitral position and 3 in the both positions. The other procedures were one mitral valvuloplasty, one infected myxoma extirpation, and one infected pacemaker lead removal with debridement. The average period of postoperative intravenous antibiotic treatment was $24.39{\pm}15.98$ days. There were 5 complications, including 2 cases of postoperative bleeding, one postcardiotomy syndrome, one cerebral ischemia, and a low cardiac output syndrome. There were statistically significant postoperative improvement in NYHA class, left ventricle end diastolic/end systolic volume, and left atrium size (p-value < 0.05). Conclusion: We could obtain the satisfactory results without any moftalities by using sufficient preoperative antibiotics in hemodynamically stable patients, and by prompt surgery in unstable patients.

A Study on Design Techniques of Palace Gardens presented in Donggwoldo (동궐도에 보이는 궁궐정원의 조영수법)

  • Chin, Sang-Chul
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.33 no.4
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    • pp.26-37
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    • 2015
  • This paper aims to review all landscaping elements of Donggwoldo by building and identify the palatial garden landscaping characteristics and landscaping methods in a bid to explore landscaping methods applicable for modern-time gardens of Korea through Succession of Tradition. The research methodology was adopted by which the palatial gardens appearing in Donggwoldo were observed according to garden elements to identify their characteristics. Garden elements in Donggwoldo include oddly shaped stones, ponds, buildings and Madang, borders and areas, and trees. Their characteristics were analyzed, and as a result they are outlined as follows. Location : Buildings in Donggwoldo were located in the optimal areas within the Myungdang (the best location), with the building sites being created by transforming the natural topography positively according to the existing topography and uses. Tree planting : The construction of the buildings involved using the existing trees. There were no specific principle and method of planting trees, and no specific criteria for choosing the kind of tree. Symmetrical planting was adopted and its is considered embracing the viewpoint of making gardens based on the expression of Yin and Yang. Strongly symbolical kinds of trees were also adopted. Bangji : it takes a nearly circular shape in palatial gardens, and such shapes represent conceptual and abstract symbols. They were also frequently used as the place of public entertainment. Pavilions : they did not take a certain standard shape. They had diverse shapes, including a triangle, square, pentagon, hexagon, and octagon and cross. Oddly shaped stones : Oddly shapes stones and stone cases were deployed mainly near the bedroom and the crow prince's residence and in the rear garden. Hwagye : it appeared mainly in the back of the bedroom, the crown prince's residence, the princess's residence, and other women's quarters. Chwibyeong : it was installed for the purpose of drawing the natural energy like a natural inlet instead of being the nature-dividing wall. Korea's garden composition method was very different from the Western and Chinese method. Overall, Chosun palatial garden style was characterized by strict and Confucian features, while the garden construction method adopted the Taoism thought. Yet, the gardens had a carefree aspect.

Development and Application of the Explicit and Reflective Learning Strategy for Enhancement of the Elementary School Students' Basic Inquiry Skills -Based on Observation and Classification- (초등학생의 과학탐구기능 향상을 위한 명시적이고 반성적인 교수.학습전략 개발 및 적용 -관찰과 분류를 중심으로-)

  • Lee, Hye-Won;Min, Byeong-Mee;Son, Yeon-A
    • Journal of The Korean Association For Science Education
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    • v.32 no.1
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    • pp.95-112
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    • 2012
  • The research evaluated the effects of the improvements in scientific inquiry for elementary school students and focused on the development and application of the explicit and reflective learning strategy through observation and classification. The explicit and reflective learning strategy was modified and completed with the review of the experts after the development of the draft based on the theoretical approach. The students were evaluated for their academic achievements in scientific inquiry skills before and after taking the course. The results were as follows: First, the steps of the developed learning strategy (1) to motivate, (2) to explore reflectively, (3) to guide explicitly, (4) to inquire explicitly, and (5) to verify reflectively were set to reflect the verification. Second, the results of applying the developed model to the lessons based on the quantitative analysis was effective for observation and classification skills in the quest for improved performance of the whole (the sum of observation and classification, inquiry skills) and the observed features, but there was no effect on classification. Also, the lessons applied the developed teaching strategy and showed effectiveness in improving academic achievement. Particularly in analyzing the relationship between the academic achievement and exploration capabilities, in order to improve academic achievement, the importance of improving inquiry skills was found. Third, the qualitative analysis of teaching and learning strategy developed by applying the lessons of this teacher guide and small group activities through the explicit and reflective observation and classification of the student learning activities showed the significant improvement of ability of the scientific inquiry skills. In addition to the improvement in the abilities of the classification showed after the formation of the most basic observation skills of the scientific inquiry.

A study on sagittal root position of maxillary anterior teeth in Korean (한국인에서 상악 전치의 시상 치근 위치에 대한 연구)

  • Kong, Hyun-Jun
    • Journal of Dental Rehabilitation and Applied Science
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    • v.36 no.2
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    • pp.88-94
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    • 2020
  • Purpose: The purpose of this study was to analyze the sagittal root position of maxillary anterior teeth and report the frequency of each classification in Korean for immediate implant placement. Materials and Methods: A retrospective review of cone-beam computed tomography (cone-beam CT) images was conducted on 120 patients (60 male and 60 female) who fulfilled the inclusion criteria. After reorientation of the axis, cone-beam CT images were evaluated and the relationship of the sagittal root position (SRP) of the maxillary anterior teeth to its associated osseous housing was recorded. Class I, II, and III were classified respectively when the root was positioned on the labial, central, and palatal aspect of the alveolar bone. Class IV was the position that at least two thirds of the root is engaging both the labial and palatal cortical plates. Then, the angulation of the root axis and the alveolar bone axis was measured. Descriptive statistics and Kruskal-Wallis test were used to compare the angulation according to the root position and SRP class. Results: The frequency distribution of sagittal root position of maxillary anterior teeth indicated that 81.1%, 10.3%, 1.9%, and 6.7% were classified as Class I, II, III, and IV, respectively. The sagittal angulation at approximately 77.5% of central incisor, lateral incisor, and canine was < 20 degrees, but the angle at more than 42.7% of canine was ≥ 20 degrees. Within the class, the angulation was statistically significantly greater in Class I (16.19) compared to Class II (8.72) and Class III (9.93), and smaller in Class IV (3.79). Conclusion: Within the limitation of this study, a majority of the maxillary anterior roots were positioned close to the buccal cortical plate. However, some roots have very thin alveolar bone and sagittal angulation larger than 30 degrees. Therefore, cone-beam CT analyses of the sagittal root position and the sagittal angulation are recommended for the selection of the appropriate dental implant treatment approach.

Repair of Complete Atrioventricular Septal Defect with Surgical Modification (변형술식에 의한 완전방실중격결손의 교정)

  • 김웅한;김수철;이택연;한미영;정철현;박영관;김종환
    • Journal of Chest Surgery
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    • v.32 no.7
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    • pp.628-636
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    • 1999
  • Background: Recent advances in understanding the anatomy of the complete atrioventricular septal defect(including right-dominant unbalanced atrioventricular septal defect) have led to alternative methods of repairing these defects. Material and Method: From May 1997 to July 1998, 8 consecutive infants(age range, 2 to 28 months, mean body weight 6.0$\pm$2.2 kg) received a single-stage intracardiac repair of the complete atrioventricular septal defect with modified surgical methods. Depending on the specific anatomic structure, the procedure was simplified in 3 patients by a direct closure of the ventricular element of the defect(Group I). Two patients judged unsuitable for direct closure due to a potential left ventricular outflow tract obstruction had received a standard two-patch repair(Group II). The remaining 3 patients with right-dominant unbalanced complete atrioventricular septal defect underwent biventricular repair; to enlarge the orifice of the left atrioventricular valve, the ventricular septal patch was placed slightly more to the right of the ventricular crest, a left sided bridging leaflet was augmented with an autologous pericardial patch, and the leaflet was repaired with a double- orifice(Group III . Result: In all 8 patients, the postoperative echocardiography demonstrated good hemodynamics. Seven patients were weaned from the ventilators after a mean 3$\pm$1 days, and 1 patient was weaned after 24 days due to a reoperation and emphysematous lung problem. A reoperation was performed in 1 patient for progressive left atrioventricular valve regurgitation due to leaflet tearing. There were no early and late mortalities. At the time of the latest review, judging from the echocardiographic criteria, left atrioventricular valve stenosis was mild in 1 patient(mean pressure gradient 6.5 mmHg, 13.5%), left atrioventricular valve regurgitation was absent or grade I in 7 patients(87.5%). The right atrioventricular valve regurgitation was absent or grade I in all 8 patients(100%). Conclusion: Infants with complete atrioventricular septal defect were treated with either a simplified approach with direct closure of the ventricular element of the defect or a modified surgical technique for a right-dominant unbalanced atrioventricular septal defect, depending on the anatomic structure. The results were no operative mortalities and low morbidity.

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Validation of NCS based Vocational Curriculum Procedures Developing Models Recognized by National Competency Standards Experts (국가직무능력표준 개발 전문가들이 인식하는 NCS 기반 직업교육과정 개발 절차 모형의 타당화)

  • Kim, Dong-Yeon;Kim, Jinsoo
    • 대한공업교육학회지
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    • v.40 no.1
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    • pp.64-86
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    • 2015
  • The objective of this study is to develop NCS-based vocational curriculum procedures developing models recognized by experts in the National Skill Standards and to verify them. As for a research method for efficiently achieving this study, Delphi research has been conducted three times based on the result of preliminary Delphi investigation, contents of in-depth interview (review and advice), and consideration of previous studies and literature research related to NCS in Korea and abroad. Major results of study in regard of validation of NCS-based vocational curriculum procedures developing models recognized by experts of National Skill Standards are as follows. First, validity of conceptual model(plan) of NCS-based vocational curriculum developing procedures was verified. According to the result of implementing it on 10 members of verification for Delphi preliminary investigation tools, the average was higher than 4.70, and validity of contents was turned out to be outstanding in 1.00. Secondly, validity of conceptual model(plan) of NCS-based vocational curriculum developing procedures was verified by using Delphi preliminary investigation tools. According to the result of verifying it in order on 10 members of verification for Delphi preliminary investigation tools, validity of contents on questions in each area from the development procedures model(plan) was all 1.00, and appropriateness of contents on the components was turned out to be outstanding in 1.00. In addition, validity of contents on interrelation and comprehensiveness of components in the development procedures model(plan) was all turned out to be very satisfying in 1.00. Third, Delphi investigation was implemented in three rounds on 26 Delphi panel members for the verification. As a result consistency rate of interrelation and comprehensiveness among questions in each area of development procedures model(plan), components on the contents, and elements was turned out to be outstanding in .75 from all of three rounds. Here, consistency rate from all three rounds was turned out to be 1.00, and convergence rate was shown to be .00 that very well satisfied the conditions(except for 1 question out of 29). Therefore, it was confirmed that opinion from Delphi panel members was completely consistent in the third round of Delphi investigation research. Such a result in the study was from how Delphi selection criteria were strictly reinforced, and, at the same time, implies how will of participation of Delphi panel members was important.

Analysis of the 'Problem Solving and Invention' Units of Technology and Home Economics 1 Textbook (기술.가정 1 교과서 '문제해결과 발명' 단원 분석)

  • Jung, Jin Woo
    • 대한공업교육학회지
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    • v.38 no.1
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    • pp.49-67
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    • 2013
  • The purpose of this study is to analyze the external systems and the units 'problem solving and invention' of the middle school technology and home economics 1 textbooks of the revised 2011 national curriculum in an effort to provide some information on the content system of invention education in technology class, as invention education was provided as part of a regular subject for the first time. The findings of the study were as follows: First, 'Technology and Inventions' chapter of Technology and Home Economics 1 Textbooks occupied 10-18% share, with the subchapter of 'Problem Solving and Invention' unit taking up 6.7-29% of the textbooks. Second, for most textbooks, 'Technological Problem Solving', 'Idea Generation' 'Multi-dimensional Projection Method', 'Expansive Thought-Processing Methodology', 'Converging Thought Methodology' and 'Invention in Everyday Lives' were included as main contents based on the accomplishment criteria presented in education process interpretation documents. Third, the detailed structures were generally made up as follows: Introduction (Broad Chapter Title, Subchapter Table of Contents, Introduction, Subchapter Title, Study Objectives, Open Thinking); Development (Unit Title, Thinking Ahead, Core Terms, Main Text, Study Helper, Activities, Research Exercises, Supplemental Readings, In-depth Study Topics, Technology in Everyday Lives, Reading Topics, Discussion Topics, and Career Helpers); and Summary (Subchapter Summary, Study Summary, Terms Summary, Writing Follow-up, Self Review, Broad Chapter Evaluation). Fourth, based on the analysis of figures included, photographs had the largest share, followed by figures, tables, and graphs. The photos were used to illustrate various inventions, invention methodologies, and exercise activities, while figures were included to depict the contents included in the main text, and the tables to assist to preparation of process diagrams or materials lists. Fifth, based on the analysis of content weights, greater weights were placed on 'Inventions and Thoughts', and 'Invention Experiment Activities,' while 'Understanding Inventions' and 'Invention and Patents' chapters did not have a lot of texts involved. Sixth, based on the analysis of content presentation methods, most textbooks combined figures, tables, illustrations and texts to discuss the topics. Based on the above study results, we suggest the following: First, a consistent education curriculum should be developed over the topic of invention; and second, more precise and systematic analysis of textbooks would need to be performed.