비전골수구성 소아 급성 골수성 백혈병에서 FLT3 돌연변이가 예후에 미치는 영향

Thesis(doctoral)--서울대학교 대학원 :의학과 분자종양학전공,2005.Docto

(The) effect of a customized insole for high -arched patients with hindfoot supination

인간공학치료학전공/석사[한글]본 연구는 후족부 회외를 동반한 고궁족(high arch foot) 환자에게 맞춤형 인솔을 착용시켜 그 효과를 관찰하였다. 효과를 알아보는 방법으로는 첫째, 종골피치(calcaneal pitch)의 변화. 둘째, 근전도를 이용하여 전경골근(tibialis anterior)과 비골근(peroneus longus)의 근활성도 변화를 측정. 셋째, 설문을 통하여 불편지수와 통증 상사 척도를 비교하는 방법을 사용하였다. 근골격계 통증을 호소하며 족부의 통증을 동반한 환자 중 총 15명(남자 7명, 여자 8명)을 선정하여 대상자들에게 각각의 맞춤형 인솔을 착용시키고 10주간 생활하면서 3주차와 7주차 그리고 10주차에 보행하는 동안 전경골근(tibialis anterior) 비골근(peronus longus)의 근활성도 변화를 측정하였다. 또한 단순방사선 촬영을 통하여 종골피치의 변화가 있는지 관찰하였다. 매회 검사마다 설문지를 작성하여 불편지수와 통증 상사 척도를 비교하였다. 측정된 근활성도와 종골피치각도값은 유의수준 α=0.05에서 일요인 또는 이요인 반복측정 분산분석(one-way or two-way ANOVA with repeated measures)에 의해 분석되었으며 상용 통계프로그램인 윈도용 SPSS(Statistical Package for the Social Sciences) 12.0 프로그램을 사용하였다. 인솔착용 후 종골피치 30°이상 군에서는 종골피치의 각도가 유의하게 감소하였지만 20~ 25°범위 정도로 감소하지는 않았다(p＜0.05). 종골피치 30°미만 군에서는 유의한 차이가 없었다(p＞0.05). 전경골근의 근활성도는 맞춤형 인솔을 사용할 때 종골피치 30°이상과 30°미만 모두에서 유의하게 감소하였으며(p<0.05), 비골근의 근활성도는 종골피치 30°미만 인솔 착용에서만 유의한 감소가 있었다(p＜0.05). 인솔 착용에 따른 신체불편지수의 변화는 발목 관절및 발 모두 유의하게 감소하였다(p<0.05). 또한 인솔 착용 기간이 경과함에 따라 통증도 유의하게 감소하였다(p<0.05). 따라서 인솔착용이 내측종아치가 상승된 환자에게 통증을 감소시키고 불편지수를 줄여주며 보행시 전경골근 사용에 효율적이지만 비골근의 근활성도에 변화가 없음을 확인하였다. 치료효과를 높이려면 인솔을 착용함과 동시에 비골근의 강화 운동도 병행할 것을 제안한다. [영문]This study investigated the effect of a customized insole on high-arched patients with hindfoot supination. Fifteen patients with musculoskeletal,ankle and foot pain were studied. Each subject wore a suitable insole for 10 weeks. We evaluated changes in the activity of the tibialis anterior and peroneus longus muscle in walking experiment and observed whether there was any change in calcaneal pitch using simple X-Ray. The following results were obtained:1)there were significant differences in the feetwith calcaneal pitch exceeding 30?(p0.05): 2) the activity of the tibialis anterior changed significantly (p<0.05) with any calcaneal pitch :3) the activity of the peroneus longus changed significantly with a calcaneal pitch less then30 (p<0.05):and 4)the insole reduced the discomfort index of the ankle and foot significantly (p<0.05). Wearing an insole reduced pain and the discomfort index and the tibialis anterior was more efficient when walking, while there was no change in the activity of the peroneus longus in patients with an increased medial longitudinal arch. In order to maintain healthy feet, one should were an insole and exercise the peroneus longus.ope

Autologous peripheral blood stem cell transplantation with BCVAC conditioning after intensive induction and consolidation chemotherapy in childhood acute myeloid leukemia

Thesis (master`s)--서울대학교 대학원 :의학과 소아과,2003.Maste

Interplay between IL6 and CRIM1 in thiopurine intolerance due to hematological toxicity in leukemic patients with wild-type NUDT15 and TPMT

NUDT15 and TPMT variants are strong genetic determinants of thiopurine-induced hematological toxicity. Despite the impact of homozygous CRIM1 on thiopurine toxicity, several patients with wild-type NUDT15, TPMT, and CRIM1 experience thiopurine toxicity, therapeutic failure, and relapse of acute lymphoblastic leukemia (ALL). Novel pharmacogenetic interactions associated with thiopurine intolerance from hematological toxicities were investigated using whole-exome sequencing for last-cycle 6-mercaptopurine dose intensity percentages (DIP) tolerated by pediatric ALL patients (N=320). IL6 rs13306435 carriers (N=19) exhibited significantly lower DIP (48.0 +/- 27.3%) than non-carriers (N=209, 69.9 +/- 29.0%; p=0.0016 and 0.0028 by t test and multiple linear regression, respectively). Among 19 carriers, 7 with both heterozygous IL6 rs13306435 and CRIM1 rs3821169 showed significantly decreased DIP (24.7 +/- 8.9%) than those with IL6 (N=12, 61.6 +/- 25.1%) or CRIM1 (N=94, 68.1 +/- 28.4%) variants. IL6 and CRIM1 variants showed marked inter-ethnic variability. Four-gene-interplay models revealed the best odds ratio (8.06) and potential population impact [relative risk (5.73), population attributable fraction (58%), number needed to treat (3.67), and number needed to genotype (12.50)]. Interplay between IL6 rs13306435 and CRIM1 rs3821169 was suggested as an independent and/or additive genetic determinant of thiopurine intolerance beyond NUDT15 and TPMT in pediatric ALL

Effectiveness and Safety of Clofarabine Monotherapy or Combination Treatment in Relapsed/Refractory Childhood Acute Lymphoblastic Leukemia: A Pragmatic, Non-interventional Study in Korea

Purpose: Effectiveness and safety of clofarabine (one of the treatment mainstays in pediatric patients with relapsed/refractory acute lymphoblastic leukemia [ALL]) was assessed in Korean pediatric patients with ALL to facilitate conditional coverage with evidence development. Materials and methods: In this multicenter, prospective, observational study, patients receiving clofarabine as mono/combination therapy were followed-up every 4-6 weeks for 6-months or until hematopoietic stem cell transplantation (HSCT). Response rates, survival outcomes, and adverse events were assessed. Results: Sixty patients (2-26 years old; 65% B-cell ALL, received prior ≥2 regimen, 68.3% refractory to previous regimen) were enrolled and treated with at least one dose of clofarabine; of whom 26 (43.3%) completed six months of follow-up after the last dose of clofarabine. Fifty-eight patients (96.7%) received clofarabine combination therapy. Overall remission rate (complete remission [CR] or CR without platelet recovery [CRp]) was 45.0% (27/60; 95% confidence interval [CI] 32.4 to 57.6) and the overall response rate (CR, CRp, or partial remission [PR]) was 46.7% (28/60; 95% CI, 34.0 to 59.3), with 11 (18.3%), 16 (26.7%), and 1 (1.7%) patients achieving CR, CRp, and PR, respectively. The median time to remission was 5.1 weeks (95% CI: 4.7 to 6.1). Median duration of remission was 16.6 weeks (range: 2.0 to 167.6). Sixteen patients (26.7%) proceeded to HSCT. There were 24 deaths; 14 due to treatment-emergent adverse events. Conclusion: Remission with clofarabine was observed in approximately half of the study patients who had overall expected safety profile; however, there was no favorable long-term survival outcome in this study

Atypical Teratoid/Rhabdoid Tumor of the Central Nervous System in Children under the Age of 3 Years

Purpose Atypical teratoid/rhabdoid tumor (ATRT) is a highly aggressive malignancy with peak incidence in children aged less than 3 years. Standard treatment for central nervous system ATRT in children under the age of 3 years have not been established yet. The objective of this study was to analyze characteristics and clinical outcomes of ATRT in children aged less than 3 years. Materials and Methods A search of medical records from seven centers was performed between January 2005 and December 2016. Results Forty-three patients were enrolled. With a median follow-up of 90 months, 27 patients (64.3%) showed at least one episode of disease progression (PD). The first date of PD was at 160 days after diagnosis. The 1- and 3-year progression-free survivals (PFS) were 51.2% and 28.5%, respectively. The 1- and 3-year overall survivals were 61.9% and 38.1%, respectively. The 3-year PFS was improved from 0% in pre-2011 to 47.4% in post-2011. Excluding one patient who did not receive any further therapy after surgery, 27 patients died due to PD (n=21), treatment-related toxicity (n=5), or unknown cause (n=1). In univariate analysis, factors associated with higher 3-year PFS were no metastases, diagnosis after 2011, early adjuvant radiotherapy, and high-dose chemotherapy (HDCT). In multivariate analysis, the use of HDCT and adjuvant radiotherapy remained significant prognostic factors for PFS (both p &lt; 0.01). Conclusion Aggressive therapy including early adjuvant radiotherapy and HDCT could be considered to improve outcomes of ATRT in children under the age of 3 years