A Case of Wegener’s Granulomatosis Presenting with Cerebral Infarction and Intracerebral Hemorrhage

Wegener’s granulomatosis is a multisystem necrotizing vasculitis that primarily involves the upper and lower respiratory tract and kidneys but can affect almost any organ, including the central nervous system. Cerebral infarction and intracerebral hemorrhage are rare neurologic complications of Wegener’s granulomatosis. We report on a 52-year-old male patient with Wegener’s granulomatosis presenting with a cerebral infarction and subsequent intracerebral hemorrhage. He was successfully treated with high dose corticosteroid and cyclophosphamideope

Salvage therapy using self-expandable metal stents for recalcitrant anastomotic strictures after living-donor liver transplantation

BACKGROUND: Recently, there has been an increase in clinical success rates using nonsurgical methods to resolve anastomotic biliary strictures (ABSs) that develop after liver transplantation (LT). However, some strictures are particularly refractory and cannot be completely resolved by an endoscopic or percutaneous procedure. Consequently, the aim of this study was to examine the feasibility and efficacy of using a newly designed fully covered self-expandable metal stent (FCSEMS) to resolve refractory ABS. METHODS: A total of 35 patients with an ABS that developed after LT, but could not be resolved by an endoscopic or percutaneous procedure, were included in this study. FCSEMSs were positioned endoscopically and removed after 2-3 months. After stent removal, the patients were followed to assess complications, including re-stenosis. RESULTS: The mean period from LT to stricture was 13.7 months, and the mean duration of the stricture was 31.8 months. The type and mean number of procedures previously attempted were endoscopic retrograde cholangiopancreatography (ERCP) (9.1 ± 5.1) in 19 patients and percutaneous transhepatic biliary drainage (9.2 ± 4.8) in 16 patients. All patients had successful FCSEMS insertions and removals; the mean stent indwelling time was 3.2 months. The mean follow-up period was 18.7 months (range: 6.4-37.8 months). Stricture recurrence was observed in 6 of 29 patients (recurrence rate: 20.7%). The anastomotic stricture resolved with the FCSEMS insertion in 29 of 35 patients (clinical success rate: 82.9%). CONCLUSIONS: The newly designed FCSEMS is a potentially feasible and effective treatment for anastomotic strictures that develop after LT but are not amenable to treatment by conventional procedures.ope

Decitabine as a First-Line Treatment for Older Adults Newly Diagnosed with Acute Myeloid Leukemia

PURPOSE: Decitabine, a DNA hypomethylating agent, was recently approved for use in Korea for older adults with acute myeloid leukemia (AML) who are not candidates for standard chemotherapy. This study aimed to evaluate the role of decitabine as a first-line treatment for older adults with AML. MATERIALS AND METHODS: Twenty-four patients with AML who received at least one course of decitabine (20 mg/m²/d intravenously for 5 days every 4 weeks) as a first-line therapy at Severance Hospital were evaluated retrospectively. RESULTS: The median age of the patients was 73.5 years. The longest follow-up duration was 502 days. A total of 113 cycles of treatment were given to 24 patients, and the median number of cycles was four (range, 1-14). Thirteen patients dropped out because of death, no or loss of response, patient refusal, or transfer to another hospital. Twenty-one (87.5%) and 12 (50%) patients completed the second and fourth cycles, respectively, and responses to treatment were evaluated in 17. A complete response (CR) or CR with incomplete blood-count recovery was achieved in six (35.3%) patients, and the estimated median overall survival was 502 days. Ten patients developed grade >2 hematologic or non-hematologic toxicities. In univariate analysis, bone marrow blasts, lactate dehydrogenase, serum ferritin level, and bone marrow iron were significantly associated with response to decitabine. CONCLUSION: Five-day decitabine treatment showed acceptable efficacy in older patients with AML who are unfit for conventional chemotherapy, with a CR rate 35.3% and about a median overall survival of 18 months.ope

Renal masses in end-stage renal disease patients on dialysis

Renal masses in end-stage renal disease patients on dialysisope

HBsAg-Negative, Anti-HBc-Negative Patients Still Have a Risk of Hepatitis B Virus-Related Hepatitis after Autologous Stem Cell Transplantation for Multiple Myeloma or Malignant Lymphoma

PURPOSE: Although hepatitis B surface antigen (HBsAg)-negative, hepatitis B core antibody (anti-HBc)-negative patients are not considered to be at risk for hepatitis B virus (HBV)-related hepatitis, the actual risk remains to be elucidated. This study aimed to evaluate the risk of HBV-related hepatitis in HBsAg-negative, anti-HBc-negative patients receiving autologous stem cell transplantation (ASCT) for multiple myeloma (MM) or malignant lymphoma. Materials and Methods: We retrospectively reviewed data from 271 HBsAg-negative patients (161 anti-HBc-negative and 110 anti-HBc-positive at the time of ASCT) who received ASCT for MM or lymphoma. The risk of HBV-related hepatitis was analyzed according to the presence of anti-HBc. HBV serology results at the time of ASCT were compared with those at the time of diagnosis of MM or lymphoma. RESULTS: Three patients (two anti-HBc-negative MMs and one anti-HBc-positive MM) developed HBV-related hepatitis after ASCT. The rate of HBV-related hepatitis did not differ among patients with or without anti-HBc status (p=0.843). HBV-related hepatitis more frequently occurred in MM patients than in lymphoma patients (p=0.041). Overall, 9.1% of patients (16.7% with MM and 5.4% with lymphoma) who were HBsAg-negative and anti-HBc-positive at the time of diagnosis had lost anti-HBc positivity during chemotherapy prior to ASCT. CONCLUSION: Our data suggest that HBsAg-negative, anti-HBc-negative patients at the time of ASCT for MM or lymphoma still might be at a risk for HBV-related hepatitis.ope

A Framework Research For Materializing Business Models : A New Service Blueprint Development - Orientation Of Platform-Based Service Design Examples

A revolutionary business model is a trend that attracts the mind of businesses and even governments, and to claim a business model that is distinctive appears lots of researches and effort such as application of service design. But the result may easily be concluded as a temporary remedy by only just providing an overall direction of a business, thus does not progress till the bridging process which is needed for an actual commencing. So the research began by realizing the need to study the framework that implies the role of K.P.I .;a present or futuristic guideline, during the process of materialization. The objective of the following research is to observe a consistency of a framework that is related to a business model development and to provide more effective and applicable framework by materializing the business model from a service-designing point of view. This is to dedicate to materializing a revolutionary business model through a service blueprint framework which is an output of this research. A new service blueprint has been limited to being a development tool that targets a platform service business model, and the layouts of the research are as followings : Firstly, Observation has been made to understand the related business model development framework, service blueprint, and the definition of KPI. Secondly, by the above analysis printed a new service blueprint that is more appropriate to materializing a business model. Thirdly, applying a new service blueprint framework to a platform business model that has been developed by an existing service design led to a conclusion of an existing developments' final frame work and stating a comparison analysis of the research content.;혁신적인 비즈니스 모델은 최근 다양한 분야의 기업에서 정부까지 크게 관심을 두고 있는 트렌드로써 빠르게 진화하고 있는 비즈니스 모델의 차별성을 확보하기 위하여 서비스 디자인을 적용하는 등, 현재 다양한 방법과 연구를 통한 노력이 나타나고 있다. 그러나 그 결과가 자칫 비즈니스의 전체적인 방향성을 제시하는 것에서만 그쳐 임시변통으로 변질되기 쉬우며 실제 실행을 위한 연결과정이 결여 된 경우가 많다. 따라서 구체화 및 관리하는 과정에서 현재 또는 미래지향적인 측정지표로써의 KPI (핵심성과지표) 역할을 접목한 프레임 워크에 대한 연구가 필요하다는 인식을 전제로 연구를 진행하였다. 본 연구의 목적은 비즈니스 모델 개발과 관련해서 필요로 하는 프레임 워크에 대한 구성요소에 대해 살펴보고 서비스 디자인 관점에서의 비즈니스 모델 구체화에 적합한 프레임 워크를 제시하는 것이다. 이는 본 연구의 결과물인 새로운 서비스 블루프린트 프레임 워크를 통하여 혁신적인 비즈니스 모델의 실현화에 기여하기 위함이다. 새로운 서비스 블루프린트는 플랫폼 서비스 비즈니스 모델을 대상으로 개발하는 도구로 범위를 한정하였으며 연구의 전개는 다음과 같다. 첫째, 비즈니스 모델 개발관련 프레임 워크에 필요한 비즈니스 모델과 서비스 블루프린트,KPI(핵심성과지표)의 정의 및 구성요소를 파악하고 연관성을 살펴봄. 둘째, 앞서 분석을 통해 비즈니스 모델 구체화에 적합한 프레임 워크로써의 새로운 서비스 블루프린트를 도출함. 셋째, 실제 서비스 디자인을 활용하여 개발된 플랫폼 비즈니스 모델에 새로운 서비스 블루프린트 프레임 워크를 적용하여, 기존 개발의 최종 프레임 워크와 비교 분석을 통한 연구내용에 대해 종합하고 한계점과 향후 연구방향에 대해 서술하여 결론을 맺음.INTRODUCTION 3 RESEARCH 10 DEVELOPMENT 17 CASE APPLICATION 22 WRAPPING UP 54 BIBLIOGRAPHY 58 ABSTRACT 59 ACKNOWLEDGEMENTS 6

Machine learning method를 이용한 임플란트 예후 예측 요소

학위논문 (석사)-- 서울대학교 치의학대학원 : 치의학과, 2015. 2. 김홍기.Purpose: Despite the high success rate of oral implants, usually described as osseointegration, the practitioner occasionally encounters difficulties caused by trade-offs between various factors during surgery. The purpose of this study was to discover the most significant factors predicting implant success using non-traditional statistical analysis. Materials and Methods: The study was based on a systematic search of chart files at Seoul National University Bundang Hospital from June 2004 to October 2005. Oral and maxillofacial surgeons inserted 667 implants in the mouths of 198 patients after consultation with a prosthodontist. The implants were judged as favorably or unfavorably placed and the associated outcome was assessed 1 year after treatment by a prosthodontist from a biomechanical point of view. We processed descriptive evaluations for several features in binary form for the analysis. Unfortunately, some cases were excluded due to lack of information during this process. In this study, we used the machine learning method of a decision tree model and a support vector machine for analysis. Results: We identified mesio-distal position of the fixture as the most significant factor determining the prognosis of the implant. Both of the machine learning methods yielded this result. Discussion: The strength of the machine learning method is that it can be applied to a small sample size. To verify the conclusion of this study, traditional statistical tools could be applied with large samples1. Introduction ----------------------------------------------------------------------- 1. 2. Materials and methods ---------------------------------------------------------- 5. 3. Results ----------------------------------------------------------------------------- 13. 4. Discussion ------------------------------------------------------------------------- 20. 5. References -------------------------------------------------------------------------23. Figures and Tables Figure 1. ------------------------------------------------------------------------------ 14. Figure 2. ------------------------------------------------------------------------------ 15. Table 1. ------------------------------------------------------------------------------- 10. Table 2. ------------------------------------------------------------------------------- 12. Table 3. ------------------------------------------------------------------------------- 17. Table 4. ------------------------------------------------------------------------------- 18.Maste

개구리(Xenopus laevis)의 초기 발생과정에서 발현이 조절되는 SNARE 유전자의 발견과 동정

Maste

Deep Belief Networks를 이용한 휴대단말기에서의 시선 분류

2

Serum ferritin as a prognostic factor for myelodysplastic syndromes after allogenic hematopoietic stem cell transplantation

의학과/석사골수형성이상증후군은 난치성 혈액질환 중 하나이다. 현재까지 알려져 있는 유일한 완치 가능한 치료법은 동종조혈모세포이식술이지만 새로 진단되는 환자의 85% 이상이 60세 이상의 고령이어서 이식에 수반되는 높은 독성과 사망률이 발생할 수 있다. 이와 같은 독성과 사망률을 감소시키기 위해서는 적절한 이식 적응증의 확립과 이식 방법의 개선이 필요하다. 따라서 본 연구에서는 골수형성이상증후군 환자의 이식 후 예후를 예측할 수 있는 인자를 확인하기 위하여 1997년부터 2008년까지 세브란스 병원에서 골수형성이상증후군으로 진단되고 동종조혈모세포이식술을 시행 받은 19명의 환자를 대상으로 이식 후 성적을 조사하였다. 골수형성이상증후군의 진단은 French-American-British (FAB) 분류와 World Health Organization (WHO) 분류에 근거하였다.대상 환자의 1년 및 5년 전체 생존율은 각각 68.4% 와 40.2% 이었으며 중앙 추적 관찰 기간은 625일 이었다. 1년 및 5년 무병 생존율은 각각 68.4%와 40.2% 이었으며 관찰 기간 중 1명의 환자에서 이식 후 142일째에 재발이 확인되었다. 19명의 환자 중 11명의 환자가 사망하였으며 치료와 연관된 사망은 10명이었다. 간정맥 폐쇄증은 4명에서 발생하였으며 이들의 이식 전 혈청 페리틴의 중앙값은 2420.5 ng/ml (범위, 1113.4 ng/ml 부터 4555.6 ng/ml 까지) 이었다. 이식 전 혈청 페리틴이 1000 ng/ml 미만이었던 환자 중 간정맥 폐쇄증이 발생한 환자는 없었다. 이식 전 혈청 페리틴이 1000 ng/ml 이상이었던 환자는 1000 ng/ml 미만인 환자보다 간정맥 폐쇄증이 많이 발생하는 경향을 보였다 (p=0.087, Fisher의 검사). 전체 생존율에 유의한 영향을 미치는 인자를 확인하기 위하여 시행한 단변량 분석에서 이식 전 혈청 페리틴 1000 ng/ml 미만, 조혈세포이식-동반질환 지수 (hematopoietic cell transplantation-specific comorbidity index; HCT-CI) 점수 0, 그리고 혈연간 공여자로부터의 이식이 생존율 향상에 유의한 인자로 확인되었다. 이식 전 혈청 페리틴이 1000 ng/ml 미만인 환자와 1000 ng/ml 이상인 환자의 이식 후 5년 전체 생존율은 각각 63.5%와 20.0% 이었다 (p=0.028, log-rank 검정). HCT-CI 점수가 0점인 환자와 1점 이상인 환자의 이식 후 5년 전체 생존율은 각각 83.3%와 16.7% 이었다 (p=0.004, log-rank 검정). 혈연간 공여자로부터 이식을 시행 받았을 경우와 비혈연 공여자로부터 이식을 시행 받았을 경우의 이식 후 5년 전체 생존율은 각각 83.3%와 16.7% 이었다 (p=0.010, log-rank 검정). 생존율에 영향을 미칠 수 있는 다른 요인들을 더 조사해본 결과, FAB 분류와 WHO 분류, international prognostic scoring system (IPSS), WHO classification-based prognostic scoring system (WPSS), Kantarjian의 새 위험 모형, 골수파괴성 또는 골수비파괴성 전처치요법 여부, 진단부터 이식까지의 기간, 골수 또는 말초혈 조혈모세포이식 여부, 이식 시의 질병 상태, 이식 전 치료 여부는 생존율에 유의한 차이를 보이지 못하였다. 다변량 분석을 시행하였을 때 이식 전 혈청 페리틴과 HCT-CI는 유의한 생존율의 차이를 보였지만 혈연간 공여자로부터의 이식 여부는 유의한 차이를 보이지 못하였다.상기의 결과를 종합하여볼 때 이식 전 혈청 페리틴과 HCT-CI는 동종조혈모세포이식을 시행 받는 골수형성이상증후군 환자의 의미 있는 예후 인자라 하겠으며 이를 고려한 새로운 동종조혈모세포이식 지침의 개발이 골수형성이상증후군 환자의 이식 후 성적 향상에 도움이 되리라 생각된다. 아울러 고페리틴혈증과 동종조혈모세포이식 예후와의 상관성은 이식 전 철분 킬레이트화 치료 (iron chelation therapy) 필요성의 이론적 근거를 제공할 수 있으므로 임상적으로 의미 있는 결과라 하겠다.ope