untitled
|
|
|
- 서화 낭
- 5 years ago
- Views:
Transcription
1 Clinical Pediatric Hematology-Oncology Volume 22 ㆍ Number 2 ㆍ October 2015 ORIGINAL ARTICLE 소아청소년환자에서의동종조혈모세포이식후발생한폐쇄성세기관지염증후군의임상적특성 임주연ㆍ한승민ㆍ김효선ㆍ한정우ㆍ유철주 연세대학교의과대학소아과학교실 Bronchiolitis Obliterans Syndrome after Allogenic Hematopoietic Stem Cell Transplantation in Pediatric Patients Ju Yeon Lim, M.D., Seung Min Hahn, M.D., Hyo Sun Kim, M.D., Jung Woo Han, M.D. and Chuhl Joo Lyu, M.D., Ph.D. Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea Background: Bronchiolitis obliterans syndrome (BOS) is a life-threatening lung complication after allogenic hematopoietic stem cell transplantation (HSCT). As long-term survival following allogenic HSCT has improved, the number of BOS patients has been steadily increased. However, the survival and treatment of BOS have not improved significantly for decades. Identification of risk factors of BOS would improve the clinical outcome of allogenic HSCT recipients. Methods: We retrospectively investigated medical records of 147 allogenic HSCT recipients between 2005 and 2014 in Yonsei Cancer Center. Risk factors for BOS were analyzed with Chi-square test, logistic regression analysis, and the Student s t-test. Results: BOS occurred to 23 patients (15.6%). Pulmonary function test (PFT) results before transplantation were similar in all patients, but patients with BOS had a significant decrease in forced expiratory volume in one second (FEV1) after transplantation compared with controls (68.4±26.4% vs. 91.6±21.0%, P<0.05). Acute graft-versus-host disease (GVHD) (OR 5.98, P=0.009) and peripheral blood as sources of stem cell (OR 4.00, P=0.031) increased risk for BOS, respectively. On the other hand, previously reported risk factors, such as age of donors and recipients, pulmonary infection within 100 days after allogenic HSCT and deference of immunosuppressant were not associated with increased the incidence of BOS in our study. Conclusion: We report here the result of a single-center study on the incidence, clinical factors, and outcome of BOS after allogenic HSCT. BOS is an important cause of post-transplantation morbidity and mortality. Risk reduction can be achieved by better prevention and control of BOS. Key Words: Bronchiolitis obliterans syndrome, Hematopoietic stem cell transplantation, Graft versus host disease pissn / eissn Clin Pediatr Hematol Oncol 2015;22: Received on September 15, 2015 Revised on September 30, 2015 Accepted on October 13, 2015 Corresponding Author: Chuhl Joo Lyu Department of Pediatrics, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: Fax: cj@yuhs.ac 127
2 Ju Yeon Lim, et al 서 론 동종조혈모세포이식 (hematopoietic stem cell transplantation, HSCT) 은악성혈액질환에서선택할수있는근치적치료방법으로, 최근 20년간다양한질환에서시행되고있으며그건수가해마다증가하고있다. 하지만보존적치료방법의발전에도불구하고, 이식과관련된합병증과사망률증가는여전히의료계에서주요관심사가되고있다 [1]. 특히호흡기계합병증은 HSCT 후사망과관련된주요한원인으로알려져있고, 40-60% 의환자에서발생하는것으로알려져있다 [2]. 다른호흡기계합병증에비해상대적으로흔하지않지만, 폐쇄성세기관지염증후군 (Bronchiolitis obliterans syndrome, BOS) 은 HSCT 후이환율을증가시키고, 생존율을감소시키는중요한호흡기계합병증이다 [3,4]. BOS는이식후발생하는감염이동반되지않은소기도의비가역적폐쇄성폐질환으로 1982 년에 Roca 등에 [5] 의해처음으로보고되었으며, 이후발생률이증가하여 2-26% HSCT 환자에서발생하는것으로다수의보고를통해알려져있다 [6-8]. 다양한치료방법에도불구하고 BOS의사망률은매우높아, 21% 에서 100% 에달하는것으로보고되었으며, 최근 20년간치료성공률이나, 생존율이크게증가하지않고있다 [3,4,9-12]. HSCT 후발생하는 BOS의병인은정확히밝혀진바가없으며, 조직검사를통해병리학적확진해야하는것으로알려져있었고, 진단기준이명확하지않았었다. 그러나, 최근진단기준을단일화하려는노력으로 2014년 NIH (National Institute of Health) 에서새로운기준을제시하여조직학적확인이없이도폐기능검사 (pulmonary function test, PFT) 혹은영상학적방법을통해확진가능한것으로변경되었다 (Table 1)[13]. BOS는호흡기계증상이없고, 흉부 X선촬영에서특이소견없는경우에도발병하는경우도있으며, 임상양상또한다양하여조기에진단하거나치료를시작하기어려움이있다 [10]. 따라서정기적인 PFT의중요성이대두되고있으며이식전후 PFT를기준으로하여 BOS의진단및발병과관련된임상적특성에대한연구가필요할것으로생각된다. 기존의연구에서급, 만성이식편대숙주반응 (graft-versus-host disease, GVHD) 의유무, 조혈모세포 (stem cell) 의종류, 이식전처치 (conditioning), 면역억제제의종류등의차이가 BOS의발생에영향을주는것으로보고되었으나 [3,4,14-16], 국내에서는몇몇사례보고외의전, 후향적연구는부족한실정이다. 따라서본연구는최근 10년간연세암병원에서동종 HSCT를받은환자들을대상으로 PFT, 폐전산화단층촬영 (computed tomography, CT) 을통한 BOS의진단및발병위험요인, 임상적인특징, 예후및사망률에관해비교분석해보고자하였다. 1) 대상환자 Table 1. Bronchiolitis obliterans syndrome diagnostic criteria FEV1<75% FEV1/FVC <0.7 Absence of infection Air trapping on CT RV>120% Confirmed by lung biopsy 대상및방법 연세암병원소아혈액종양과에서 2005년 1월부터 2014년 12월까지동종 HSCT를받았던환자들의의무기록을후향적으로분석하였고연세의료원의학연구윤리심의위원회의승인을받았다. 연구기간에 HSCT를받은환자는총 151명이었으며그중추적관찰이불가능하였던 4명을제외한 147명 ( 남성 90명, 여성 57명 ) 이분석대상이되었다. 이들을대상으로진단당시나이, 이식당시나이, 조혈모세포의종류, 이식전처치, T세포의수, 면역억제제의종류, 급성 GVHD의유무등에따른 BOS의발생과예후의차이를비교분석하였다. 2) 진단기준 BOS의진단은 2014 NIH criteria를기준으로했으며, 급성및만성 GVHD의진단또한같은기준에따라판단하였으며 (1) 1초내 forced expiratory volume (FEV1) 이예측치의 75% 이하이거나 2년내에 10% 이상의 FEV1 감소가있으면서 albuterol 사용후에도 75% 이상으로회복되지않을것. (2) FEV1/ FVC (functional vital capacity) 가 0.7 이하이거나 predicted FEV1<75% (+albuterol) FEV/VC<0.7 Or The 5 th percentile of predicted Absence of infection One supportive of BOS: Air trapping or small airway thickening or bronchiectasis on CT Or RV or RV/TLC>120% Diagnostic feature of chronic GVHD of the lungs in the presence if another distinctive manifestation of chronic GVHD FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; VC, vital capacity (forced vital capacity or slow vital capacity, whichever is greater); CT, computed tomography; BOS, bronchiolitis obliterans syndrome; RV, residual volume; TLC, total lung capacity; GVHD, Graft versus Host Disease. The 5 th percentile of predicted is equivalent to the lower value of predicted confidence interval. 128 Vol. 22, No. 2, October 2015
3 Clinical Factors of Bronchiolitis Obliterans Syndrome confidence interval의최저값이예측치의 5% 이하일것. (3) 감염의증거가없을것. (4) 다른만성 GVHD의임상증상이있을것, 네가지를모두만족하며추가적으로 CT (computed tomography) 에서 air trapping이보이거나 PFT에서 residual volume이 120% 이상일경우보조적진단기준이될수있다. 또한 biopsy를통해확진하는것이필수요소가아닌것으로바뀌었다 (Table 1)[13]. 급성 GVHD는이식후 100일이내에피부, 위장관, 간등의장기에발생한경우진단하였고, 만성 GVHD는 100일이후에피부, 위장관, 간, 눈, 호흡기, 생식기등에발생한거부반응으로진단하였다 [13]. 3) 검사 (1) 폐기능검사 2008년이후모든 HSCT 환자들은 (n=117) 이식전 3개월이내, 이식후 3개월이후부터매 3개월마다 PFT를추적하였으며, 2008년이전의환자들은 (n=30) 정기적검사를시행하지않아 BOS 진단과관련된통계에서는제외되었다. PFT는 spirometer를통해 FEV1 (Forced expiratory volume in one second), FVC (Forced vital capacity), RV (Residual volume), VC (Vital capacity) 등을구하고 BOS 진단에는 FEV1, FEV1/FVC 값을이용하였다. (2) 영상검사 PFT결과가 BOS 진단기준에부합하거나, PFT 결과가정상범주이더라도비가역적인폐쇄성폐질환의임상양상을보일때, 발열이동반되지않는호흡기계증상이지속될경우고해상도폐 CT를시행하였고, 검사상기관지확장증 (bronchiectasis) 또는공기포획 (air trapping) 의특징적소견이보일때진단의보조적근거로사용하였다 [17]. 4) 고용량스테로이드치료본원에서의고용량스테로이드치료는 Methylprednisolone를사용하여 30 mg/kg ( 최대 1,000 mg) 정맥투여하였고, 첫달에는 3일연속으로투여하고이후 6개월간매달 1회씩시행하며이후 PFT는매달, chest CT는 3개월마다시행하였다. 또한보조적으로흡입형스테로이드제제를매일투여하도록하였다. 5) 통계분석 BOS의위험요인정의를위해연속형변수에대해서는 Independent sample T-test, 범주형변수에대해서는 Chi square test, univariate binary logistic regression analysis를이용하여군간의차이를살펴보았다. 각항목은 T세포수를제외하고는모두범주형변수로처리하였으며, 나이는 10세기준, 조혈모세포원은 Bone marrow, peripheral blood, cord blood로구분하였고이식전처치는 TBI (Total body irradiation) 가포함된경우와그렇지않은경우로나누었다. 면역억제제는 cyclosporine 혹은 tacrolimus가포함된군으로각각나누었고, 면역억제제중단시기는 3개월이하, 3-6개월, 6개월이상으로구분하였으며, 이식후 100일까지호흡기계감염유, 무로나누어분석하였다. BOS의유무로발생군과대조군으로나누어생존율및중앙생존기간을비교분석하였고 BOS를진단받은환자들중각각의차이점에따른 ( 이식당시나이, 이식전처치, 고용량스테로이드치료유무 ) 생존율, 중앙생존기간의차이를 Kaplan-Meier method로구하고, 그차이를 log-rank test를이용해비교분석하였다. 통계학적분석에는 IBM SPSS statistics version 22.0 (SPSS Inc., Chicago, IL, USA) 를이용하였으며 P-value가 0.05 미만인경우를통계학적으로유의하다고판단하였다. 결과 1) 환자특성및 BOS의발생률본연구의대상환자는총 147명으로평균연령은 9.6±6.3 세이었고, 남자는 90명 (61.2%) 여자는 57명 (38.8%) 였다. 그중백혈병 (leukemia) 환자는 90명 (61.2%), 재생불량빈혈 (aplastic anemia) 20명 (13.6%), 림프종 (lymphoma) 11명 (7.5%), 기타질환이 26명 (17.7%) 였고이식된조혈모세포의종류로는말초혈액이 76명 (51.7%), 골수가 63명 (42.9%), 제대혈이 8명 (5.4%) 이었다. 초기에투여된면역억제제의종류는 cyclosporin이 62명으로전체의 42.2% 였으며 tacrolimus가 85명으로전체의 57.8% 에해당되었고이식전처치로전신방사선조사 (total body irradiation, TBI) 가포함된경우가 57명으로 38.8% 를차지하였다. BOS가진단된환자는총 23명으로전체의 15.6% 에해당되었으며평균연령은 9.9±5.5세였으며, 이식부터진단까지의평균기간은 9.8±6.5개월이었다. 진단명은급성림프구성백혈병이 13명 (56.5%), 급성골수성백혈병이 5명 (21.7%) 이었고이식된조혈모세포의종류는말초혈액이 19명 (82.6%) 였으며공여자는비혈연공여자가 20명으로전체의 87% 로확인되었다. 이식부터 BOS가발병하기까지의평균기간은 8.3±6.4개월이었다. 이식후 3개월째 PFT에서 Forced expiratory volume in 1 Clin Pediatr Hematol Oncol 129
4 Ju Yeon Lim, et al second (FEV1) 의평균값은 BOS 환자군이 68.4±26.4 liter, 대조군은 91.6±21 liter로통계적으로유의한차이를보였다 (P<0.01) (Table 2). 2) BOS의위험인자 BOS 환자군중 14명이 10세이상으로전체 10세이상환자의 22.6% 에해당되었고 (P=0.048), 이식된조혈모세포종류로는말초혈액이 19명으로전체말초혈액이식환자의 25% (P= 0.005) 에해당되어통계적으로유의미한차이를보였다. 그러나이식전처치중 TBI가포함된환자중 BOS가진단된환자는 13.3% (12/90), TBI가포함되지않은경우는 19.3% (11/57) 으로통계적으로유의한차이를보이지않았다 (P=0.332). 이식된 T세포의값은평균 19.4±13.2 ( 10 7 )/kg으로대조군 13.2±10.1 ( 10 7 )/kg과통계적으로유의한차이를보였다. (P=0.027). 면역억제제의경우 tacrolimus를투여한환자군중 BOS가발병한환자는 22.4% (19/85), cyclosporin을투여한 Table 2. Comparison of Pulmonary function test result between bronchiolitis oblierans syndrome and control group in pre and post hematopoietic stem cell transplantation BOS (+) BOS ( ) t P-value Pre FEV ± ± Pre FEV1/FVC 105.1± ± Post FEV1 68.4± ± <0.01 (D+ 3 month) Post FEV1/FVC 96.3± ± (D+ 3 month) Dx FEV1 49.8±18.6 Dx FEV1/FVC 89.1±21.6 Dx FEV1, forced expiratory volume in 1 second at diagnosis; FVC, forced vital capacity. Table 3. Risk factors of Bronchiolitis obliterans syndrome by Chi square test Clinical factors BOS (+) BOS ( ) Odd Ratio P-value Age at diagnosis (years) <10 9 (10.6%) 76 (89.4%) 1 >10 14 (22.6%) 48 (77.4%) HSCT age (years) <10 9 (11.8%) 67 (88.2%) 1 >10 14 (19.7%) 57 (80.3%) Gender Male 15 (16.7%) 75 (83.3%) Female 8 (14.0%) 49 (86.0%) 1 Stem cell source BM 4 (6.3%) 59 (93.7%) PB 19 (25.0%) 57 (75.0%) CB 0 (0.0%) 8 (100.0%) Conditioning regimen TBI 11 (19.3%) 46 (80.7%) Non-TBI 12 (13.3%) 78 (86.7%) GVHD prophylaxis Cyclosporin 4 (6.5%) 58 (93.5%) 1 GVHD prophylaxis Tacrolimus 19 (22.4%) 66 (77.6%) agvhd (+) 21 (21.0%) 79 (79.0%) agvhd Pulmonary infection (After HSCT<D+100) Pulmonary infection (After HSCT<D+100) ( ) 2 (4.3%) 45 (95.7%) 1 ( ) 18 (16.6%) 90 (83.4%) 1 (+) 5 (12.8%) 34 (87.2%) Fungal 1 (11.1%) 8 (88.9%) Viral 0 (0.0%) 16 (100.0%) Bacterial 4 (28.6%) 10 (71.4%) BOS, bronchiolitis obliterans syndrome; BM, bone marrow; PB, peripheral blood; CB, cord blood; TBI, total body irradiation; agvhd, acute Graft-versus-Host disease; HSCT, hematopoietic stem cell transplantation. 130 Vol. 22, No. 2, October 2015
5 Clinical Factors of Bronchiolitis Obliterans Syndrome 환자군에서는 6.5% (4/62) 으로통계적으로유의한차이를보였고 (P=0.01), 급성 GVHD가발생했던환자중 BOS에진단된환자는전체급성 GVHD 환자중에 21% (21/100) (P=0.01) 로급성 GVHD가동반되지않았던환자에비해통계적으로유의하게 BOS가진단된확률이높았다 (P=0.01) (Table 3). Univariate logistic regression test 에서이식된 T세포의수가많을수록 OR 1.05 (P=0.035), 조혈모세포의종류는말초혈액일경우 OR 4.92 (P=0.006), 면역억제제로 Tacrolimus를사용했을경우 OR (P=0.014) 로통계적으로유의하게 BOS에걸릴확률이높았다. 또한급성 GVHD가있었던환자들이없던환자들에비해 BOS에진단될확률이 5.98배높은것으로확인되었다 (P=0.019) (Table 4). 그러나결과중 P-value 0.25 이하의항목들의 multivariate logistic regression test에서는급성 GVHD가있었던환자들만이유의미하게 BOS에진단될확률이높은것을확인하였다 (P=0.034) (Table 5). Table 4. Risk factors of Bronchiolitis obliterans syndrome by univariate logistic regression analysis Odd ratio CI (95%) P-value Age (Diagnosis) <10 1 > T-cell (N=101) Source BM 1 PB CB HLA type (N=63) Full match 1 Mismatch A DR Type of GVHD prophylaxis Cyclosporin 1 Tacrolimus Immunosuppressant Tapering off duration <3 mo mo >6 mo Acute GVHD ( ) 1 (+) Pulmonary infection ( ) 1 (After HSCT<D+100) (+) BM, bone marrow; PB, peripheral blood; CB, cord blood; Age Dx, age at diagnosis; GVHD, Graft-versus-Host disease. Table 5. Risk factors of Bronchiolitis obliterans syndrome by multivariate logistic regression analysis Odd ratio CI (95%) P-value Age (Diagnosis) <10 > T-cell (N=101) Source BM PB CB Type of GVHD prophylaxis Cyclosporin Tacrolimus Immunosuppressant Tapering off duration Acute GVHD <3 mo 3-6 mo >6 mo ( ) (+) Clin Pediatr Hematol Oncol 131
6 Ju Yeon Lim, et al 3) 폐기능검사 BOS 진단당시 FEV1의평균값은 49.8±18.6, FEV1/FVC (forced vital capacity) 의평균값은 89.2±21.6이었고, 가장폐기능이저하되었을때 FEV1의평균값은 44.9±27.16, FEV1/ FVC의평균값은 78.1±27.7이었다 (Table 2). 4) 예후및생존율 (1) 예후 BOS 환자군의평균생존율은 31.9%, 대조군의평균생존 율은 53.1% 로통계적으로유의한차이를보이지는않았다 (P=0.63) (Fig. 1). (2) BOS 환자군에서예후에영향을주는인자전체 BOS 환자중 10세미만인환자의평균생존율은 61.0%, 10세이상은 21.0% 였으나통계적으로유의한차이를보이지는않았지만 (corrected P=0.07), TBI가포함된이식전처치를받은환자의평균생존율은 23.9% 로그렇지않은경우 38.6% 에비해낮았으며통계적으로유의미한차이를보였다 (Corrected P=0.04). 치료목적으로고용량스테로이드요법 Fig. 1. Survival rate after HSCT (Hematopoietic stem cell transplantation). BOS, Bronchiolitis obliterans syndrome. Fig. 3. Comparison of survival rate according to the conditioning regimen between including total body irradiation and control group in bronchiolitis obliterans syndrome. TBI, Total body irradiation. Fig. 2. Comparison of survival rate according to the age at hematopoietic stem cell transplantation between <10 years and >10 years age subgroups in bronchiolitis obliterans syndrome. BOS, Bronchiolitis obliterans syndrome; HSCT, Hematopoietic Stem Cell Transplantation. Fig. 4. Comparison of survival rate according to treatment between including steroids pulse treatment and control group in bronchiolitis obliterans syndrome. Steroid pulse tx, steroid pulse treatment. 132 Vol. 22, No. 2, October 2015
7 Clinical Factors of Bronchiolitis Obliterans Syndrome 을시행받은환자의평균생존율은 37.5% 로대조군 48.27% 에비해오히려낮은생존율을보였지만통계적으로의미있는차이를보이지는않았다 (corrected P=0.15) (Fig. 2-4). 5) 사망원인전체 147명의환자중 66명 (44.9%) 이생존하였고사망원인으로는감염이 64% (42/147), 기저질병의악화가 16.6% (11/147), BOS의악화가 9% (6/147) 순이었다. 총 BOS 환자 23명중 11명 (47.8%) 이사망하였고, 사망원인으로는 BOS의악화가 6명 (54.5%), 감염이 3명 (27.3%), 기저질병의악화가 2명 (18.2%) 으로확인되었다. 고찰 GVHD는동종 HSCT 후흔하게발생하는합병증이다 [18]. 그중폐와관련된합병증인 BOS의경우상대적으로이환율과사망률이높아원인, 위험요인과치료에대한관심이높은실정이다. 말초조혈모세포이식이확대되면서생착까지의기간이짧아지고이는초기감염합병증을감소시켰지만상대적으로 BOS와같은비감염성호흡기계합병증이증가하고있는것으로보여진다. BOS의발병기전에대해아직정립된사항은없지만, 급성및만성 GVHD에서면역관련세포및다양한 cytokine들의역할에대해서논란이되고있으며, 공여자의 T세포가폐실질손상에영향을줄가능성이있다는의견이다수있다. 그러나, T세포를 immunomodulation 했을경우에도 GVHD는발생하므로 B세포와도연관되어있을가능성도대두되고있어이러한 alloimmunity와의관련성에대한정립이필요한상태이다 [20,21]. 기존의연구에서는만성 GVHD 과거력, 고연령공여자와수혜자, 낮은이식전 FEV1/FVC, 남성, HLA 불일치, Methotrexate를포함한면역억제제사용, TBI, Busulfan이포함된이식전처치, 이식후 100일이내에호흡기계합병증의과거력이있을경우등이 BOS의위험요인으로작용한다고보고되었다 [8,9,22,23]. 본연구에서는 2008년이후로 BOS가진단된환자들을대상으로하여추적기간이짧아서 5년생존율대신 3년생존율을측정했으며그값은 53.7% 였고, 중앙생존기간은 41.1개월이었다. BOS의위험인자로는 univariate analysis 시에는진단시나이, 급성 GVHD의과거력, 이식시주입된 T세포의수, 면역억제제의종류, 조혈모세포의종류등이통계적으로유의미하였지만 multivariate analysis 시에는급성 GVHD의 유무만이통계적으로의미있는차이를보였다. HLA 불일치정도, TBI 유무등의차이는통계적으로유의미하게 BOS의발생률을증가시키지는않았다. 기존의연구결과에서만성 GVHD가 BOS의발생과통계적으로의미있는연관관계가있다고보고되었으나 [4], 본연구에서는만성 GVHD에 BOS가포함되어기록되어있어통계에서제외하였다. 의료의발전에도 BOS의발병률과그로인한사망률이감소하지않고있어 BOS의발병원인과위험요인에대한중요성이날로커지고있는가운데, 본연구에서는소아 HSCT 환자들의임상적특징과위험요인에대한단일기관에서의지속적인연구로 BOS의예방과치료에대한밑바탕이될가능성을제시하고있다. 이번연구를통해 BOS는다양한면역과관련된기전, 이식전처치, 면역억제제나스테로이드등과같은치료로인한독성등다양한원인이복합적으로영향을주는것을생각해볼수있고, 이를기반으로앞으로전, 후향적연구가지속된다면예방및치료에대한보다효과적이고구체적인결과를얻을수있을것이다. BOS는진단되기전까지증상이없거나흉부방사선촬영에서정상소견을보일수있어본연구에서처럼이식후에정기적인 PFT를시행하는것이조기진단및치료성공률상승에도움이될수있을것으로생각된다. Williams 등의사례보고에서와같이이식후증상이없어경과관찰하던중 1년만에시행한 PFT에서폐기능이이식전보다 50% 감소한사례를여러보고에서확인할수있다 [24]. Chien 등의연구에서이식후 1년동안정기적인 PFT를통해추적관찰을하는것에대한중요성이언급되는데, 이는이식후첫 1년동안 FEV1이급격히저하될경우사망률이상승하기때문이다 [25]. 따라서정기적인 PFT 및추적관찰이매우중요하며, 앞선연구에서흡입형스테로이드나 macrolides 계열의항생제가 BOS의예방및치료에도움이된다는보고가있어 [26] 조기치료를시작했을때예후의변화에대한추가적인연구가필요하겠다. 그러나본연구는후향적인자료수집으로인해 GVHD의정도, 이식된조혈모세포의수, HLA 일치정도, 공여자에대한정보가부족했던한계점이있었다. 또한 2008년부터이식전, 그리고이식후 3, 6, 9, 12개월에정기적으로 PFT를시행하였기에 2008년이전환자들의데이터는비교가불가능하였으며, 따라서최근에 BOS의진단율이높아져생존기간이 1년미만인경우가많아생존율을확인하는데오차가발생했을가능성이있어향후지속적인연구가필요하겠다. 요약하면, 본연구에서는소아환자들에서동종 HSCT 후 BOS의발생위험요인과예후에대해보고하였고, multivariate analysis를바탕으로하였을때통계적으로유의한결과 Clin Pediatr Hematol Oncol 133
8 Ju Yeon Lim, et al 는급성 GVHD 과거력이있었던경우한가지였다. 그러나, 진단시나이, 이식시주입된 T세포의수, 면역억제제의종류, 말초조혈모세포이식등도 univariate analysis 시의미있는결과를보여결국은다양한이식전후의요인과관련이될가능성이높을것으로예측되어, 관련된지속적이며대규모의연구가필요할것이다. References 1. Patriarca F, Skert C, Sperotto A, et al. Incidence, outcome, and risk factors of late-onset noninfectious pulmonary complications after unrelated donor stem cell transplantation. Bone Marrow Transplant 2004;33: Soubani AO, Miller KB, Hassoun PM. Pulmonary complications of bone marrow transplantation. Chest 1996;109: Dudek AZ, Mahaseth H, DeFor TE, Weisdorf DJ. Bronchiolitis obliterans in chronic graft-versus-host disease: analysis of risk factors and treatment outcomes. Biol Blood Marrow Transplant 2003;9: Santo Tomas LH, Loberiza FR Jr, Klein JP, et al. Risk factors for bronchiolitis obliterans in allogeneic hematopoietic stemcell transplantation for leukemia. Chest 2005;128: Roca J, Grañeña A, Rodriguez-Roisin R, Alvarez P, Agusti- Vidal A, Rozman C. Fatal airway disease in an adult with chronic graft-versus-host disease. Thorax 1982;37: Yoshihara S, Yanik G, Cooke KR, Mineishi S. Bronchiolitis obliterans syndrome (BOS), bronchiolitis obliterans organizing pneumonia (BOOP), and other late-onset noninfectious pulmonary complications following allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2007;13: Au BK, Au MA, Chien JW. Bronchiolitis obliterans syndrome epidemiology after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2011;17: Gazourian L, Rogers AJ, Ibanga R, et al. Factors associated with bronchiolitis obliterans syndrome and chronic graft-versus-host disease after allogeneic hematopoietic cell transplantation. Am J Hematol 2014;89: Paz HL, Crilley P, Topolsky DL, Coll WX, Patchefsky A, Brodsky I. Bronchiolitis obliterans after bone marrow transplantation: the effect of preconditioning. Respiration 1993;60: Alonso Riofrío R, Villa Asensi JR, Sequeiros González A, Díaz Pérez MA, González Vicent M, Madero López L. Obstructive lung disease after allogenic stem cell transplantation in children. An Pediatr (Barc) 2004;61: Philit F, Wiesendanger T, Archimbaud E, Mornex JF, Brune J, Cordier JF. Post-transplant obstructive lung disease ("bronchiolitis obliterans"): a clinical comparative study of bone marrow and lung transplant patients. Eur Respir J 1995;8: Kim SH, Kook H, Kim SY, et al. Fatal bronchiolitis obliterans with very severe subcutaneous emphysema and pneumomediastinum after unrelated BMT. Korean J Pediatr Hematol Oncol 2003;10: Jagasia MH, Greinix HT, Arora M, et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in chronic graft-versus-host disease: I. The 2014 Diagnosis and Staging Working Group Report. Biol Blood Marrow Transplant 2015;21: e Duncker C, Dohr D, Harsdorf S, et al. Non-infectious lung complications are closely associated with chronic graft-versus-host disease: a single center study of incidence, risk factors and outcome. Bone Marrow Transplant 2000;25: Sakaida E, Nakaseko C, Harima A, et al. Late-onset noninfectious pulmonary complications after allogeneic stem cell transplantation are significantly associated with chronic graftversus-host disease and with the graft-versus-leukemia effect. Blood 2003;102: Miflin G, Russell NH, Hutchinson RM, et al. Allogeneic peripheral blood stem cell transplantation for haematological malignancies-an analysis of kinetics of engraftment and GVHD risk. Bone Marrow Transplant 1997;19: Gunn ML, Godwin JD, Kanne JP, Flowers ME, Chien JW. High-resolution CT findings of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. J Thorac Imaging 2008;23: Sullivan KM, Agura E, Anasetti C, et al. Chronic graft-versushost disease and other late complications of bone marrow transplantation. Semin Hematol 1991;28: Afessa B, Litzow MR, Tefferi A. Bronchiolitis obliterans and other late onset non-infectious pulmonary complications in hematopoietic stem cell transplantation. Bone Marrow Transplant 2001;28: Sengsayadeth SM, Srivastava S, Jagasia M, Savani BN. Time to explore preventive and novel therapies for bronchiolitis obliterans syndrome after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2012;18: Forslöw U, Mattsson J, Gustafsson T, Remberger M. Donor lymphocyte infusion may reduce the incidence of bronchiolitis obliterans after allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2011;17: Clark JG, Schwartz DA, Flournoy N, Sullivan KM, Crawford SW, Thomas ED. Risk factors for airflow obstruction in recipients of bone marrow transplants. Ann Intern Med 1987;107: Crawford SW, Clark JG. Bronchiolitis associated with bone marrow transplantation. Clin Chest Med 1993;14: Williams KM, Chien JW, Gladwin MT, Pavletic SZ. Bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation. JAMA 2009;302: Vol. 22, No. 2, October 2015
9 Clinical Factors of Bronchiolitis Obliterans Syndrome 25. Chien JW, Martin PJ, Flowers ME, Nichols WG, Clark JG. Implications of early airflow decline after myeloablative allogeneic stem cell transplantation. Bone Marrow Transplant 2004;33: Khalid M, Al Saghir A, Saleemi S, et al. Azithromycin in bronchiolitis obliterans complicating bone marrow transplantation: a preliminary study. Eur Respir J 2005;25: Clin Pediatr Hematol Oncol 135
<30372EC1F5B7CA D B1E8BEE7BCF62E687770>
대한내과학회지 : 제 77 권제 6 호 2009 증례 08-311 조혈모세포이식후에만성이식편대숙주반응과동반된종격동기종 1예 고신대학교의과대학복음병원내과 이호섭 신성훈 김양수 A case of pneumomediastinum combined with chronic graft-versus-host disease following allogeneic hematopoietic
00약제부봄호c03逞풚
경희대학교 동서신의학병원 약품 정보지 2 0 0 7. S P R I N G. V O L. 0 1 신약 소개 02 Journal Review 03 Special Subject 04 복약 지도 06 의약품 안전성 정보 07 약제부 알림 07 약제부 업무 소개 08 E A S T - W E S T N E O M E D I C A L C E N T E R 본 약품
한국성인에서초기황반변성질환과 연관된위험요인연구
한국성인에서초기황반변성질환과 연관된위험요인연구 한국성인에서초기황반변성질환과 연관된위험요인연구 - - i - - i - - ii - - iii - - iv - χ - v - - vi - - 1 - - 2 - - 3 - - 4 - 그림 1. 연구대상자선정도표 - 5 - - 6 - - 7 - - 8 - 그림 2. 연구의틀 χ - 9 - - 10 - - 11 -
386-390.hwp
386 HANYANG MEDICAL REVIEWS Vol. 29 No. 4, 2009 우리나라 미숙아의 통계와 의료비용 Statistics and Medical Cost of Preterm in Korea 윤혜선 을지대학교 노원을지병원 소아청소년과학교실 Hye Sun Yoon, M.D., Ph.D., Department of Pediatrics, Nowon
012임수진
Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar
황지웅
Comparison of Laparoscopy and Exploration in the Distal Pancreatectomy BACKGROUND: To determine the benefits of laparoscopic surgery compared with exploration, the clinical outcomes of open and laparoscopic
- i - - ii - - iii - - iv - - v - - vi - - 1 - - 2 - - 3 - 1) 통계청고시제 2010-150 호 (2010.7.6 개정, 2011.1.1 시행 ) - 4 - 요양급여의적용기준및방법에관한세부사항에따른골밀도검사기준 (2007 년 11 월 1 일시행 ) - 5 - - 6 - - 7 - - 8 - - 9 - - 10 -
A 617
Special Issue Diabetic Retinopathy Won Ki Lee, M.D. Department of Ophthalmology The Catholic University of Korea College of Medicine Kangnam St. Mary s Hospital E mail : wklee@catholic.ac.kr Abstract R
Jkbcs016(92-97).hwp
Expression of bcl-2 and Apoptosis and Its Relationship to Clinicopathological Prognostic Factors in Breast Cancer - A Study with Long Term Follow-up correlated with the survival rate.(journal of Korean
Lumbar spine
Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical
( )Jkstro011.hwp
비인강암의방사선치료결과및생존율에관한예후인자분석 2005 2 1 2005 3 28. :, Tel: 053)250-7665, Fax: 053)250-7984 E-mail: jhkim@dsmc.or.kr 정영연외 2 인 : 비인강암의예후인자분석 정영연외 2 인 : 비인강암의예후인자분석 Carcinoma of the nasopharynx treated by radiotherapy
1..
Volume 12, Number 1, 6~16, Factors influencing consultation time and waiting time of ambulatory patients in a tertiary teaching hospital Jee-In Hwang College of Nursing Science, Kyung Hee University :
Abstract Musculoskeletal Symptoms and Related Factors for Nurses and Radiological Technologists Wearing a Lead Apron for Radiation Pro t e c t i o n Jung-Im Yoo, Jung-Wan Koo 1 ) Angio Unit, Team of Radiology,
김범수
Analysis of Outcomes after Resection of Sarcomatous Hepatocellular Carcinoma Purpose: Sarcomatous hepatocellular carcinoma (HCC) is rare. Therefore, the clinicopathologic characteristics and prognosis
Abstract Background : Most hospitalized children will experience physical pain as well as psychological distress. Painful procedure can increase anxie
Volume 12, Number 1, 92~102, An Intervention Study of Pain Reduction during IV Therapy in Hospitalized Children Myo-Jin Kim 1), Joung-Hae Bak 1), Won-Seok Seo 2) Mi-Young Kim 3), Sun-Kyoung Park 3), Jai-Soung
기관고유연구사업결과보고
기관고유연구사업결과보고 작성요령 2001 ~ 2004 2005 ~ 2007 2008 ~ 2010 2001 ~ 2004 2005 ~ 2007 2008 ~ 2010 1 2/3 2 1 0 2 3 52 0 31 83 12 6 3 21 593 404 304 1,301 4 3 1 8 159 191 116 466 6 11 (`1: (1: 16 33 44 106
7.ƯÁýb71ÎÀ¯È« š
J KMA Special Issue Myelodysplastic Syndrome June Won Cheong, MD Yoo Hong Min, MD Department of Internal Medicine, Yonsei University College of Medicine E mail : jwcheong70@yumc.yonsei.ac.kr minbrmmd@yumc.yonsei.ac.kr
DBPIA-NURIMEDIA
The e-business Studies Volume 17, Number 4, August, 30, 2016:319~332 Received: 2016/07/28, Accepted: 2016/08/28 Revised: 2016/08/27, Published: 2016/08/30 [ABSTRACT] This paper examined what determina
( )Kju269.hwp
만성세균성전립선염모델흰쥐에서 의항염효과 Anti-inflammatory Effect of Lycopene on Chronic Bacterial Prostatitis Rat Model Cho Hwan Yang, Dong Wan Sohn, Yong-Hyun Cho From the Department of Urology, The Catholic University
Pharmacotherapeutics Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee Univ
Application of New Pathogenesis on the Drug Treatment of Diabetes Young Seol Kim, M.D. Department of Endocrinology Kyung Hee University College of Medicine & Hospital E mail : ycell2@yahoo.co.kr Abstract
歯1.PDF
200176 .,.,.,. 5... 1/2. /. / 2. . 293.33 (54.32%), 65.54(12.13%), / 53.80(9.96%), 25.60(4.74%), 5.22(0.97%). / 3 S (1997)14.59% (1971) 10%, (1977).5%~11.5%, (1986)
K O R E A C E N T E R S F O R D I S E A S E C O N T R O L & P R E V E N T I O N PHWR Vol. 5 No. 41 www.cdc.go.kr/phwr 2012 10 12 5 41 ISSN:2005-811X Comparison of drug-susceptibility test to the anti-tuberculosis
노영남
Purpose: Delayed massive hemorrhages from pseudoaneurysm rupture of the peripancreatic large arteries, after pancreaticoduodenectomy, are fatal. We reviewed the clinical course and outcome of bleeding
원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 연세대학교대학원 의학과 남상현
원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 연세대학교대학원 의학과 남상현 원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 연세대학교대학원 의학과 남상현 원위부요척골관절질환에서의초음파 유도하스테로이드주사치료의효과 - 후향적 1 년경과관찰연구 - 지도김석원교수 이논문을석사학위논문으로제출함
<283732372D3733312920B4D9C3CAC1A120BCD2C7C1C6AEC4DCC5C3C6AEB7BBC1EEC0C720B3EBBEC8C0C720BDC3B7C2BAB8C1A4BFA120B4EBC7D120C0AFBFEBBCBA20C6F2B0A1283035292E687770>
대한안과학회지 제 49 권 제 5 호 2008 J Korean Ophthalmol Soc 49(5):727-731, 2008 DOI : 10.3341/jkos.2008.49.5.727 다초점 소프트콘택트렌즈의 노안의 시력보정에 대한 유용성 평가 김현경 1 김효명 2 정성근 1 가톨릭대학교 의과대학 성모병원 안과학교실 1, 고려대학교 의과대학 안암병원 안과학교실
(
317 318 319 320 1 3 5 5 5 5 2 321 : 1.,,,,, 06 2. X-ray beam penetration (density) (contrast) 03 3. patch coating, precipitation, flaking 03 4. centering 03 5. Esophagus, cardia, fundus, body, angle, antrum,
¼Û±âÇõ
223 Table 1. Results of FEV 1.0, Methacholine Challenge Test, and Exercise Provocation Test in Eight Patients Who Performed PFT Pts Tests 1 2 3 4 5 6 7 8 FEV 1.0 (%pred) 66.6 88.8 120 101 90.5 95.4 91.6
Journal of Educational Innovation Research 2018, Vol. 28, No. 1, pp DOI: * A Study on the Pe
Journal of Educational Innovation Research 2018, Vol. 28, No. 1, pp.405-425 DOI: http://dx.doi.org/10.21024/pnuedi.28.1.201803.405 * A Study on the Perceptions and Factors of Immigrant Background Youth
<303320C6AFC1FD20B1E8C1A4BEC62E687770>
대한내과학회지 : 제 78 권제 5 호 2010 특집 (Special Review) - 개원의를위한혈액검사와혈액질환의이해 혈액질환에서의새로운조혈모세포이식기법 가톨릭대학교의과대학내과학교실 김정아 New therapeutic modalities on hematopoietic stem cell transplantation Jeong Kim, M.D., Ph.D.
달생산이 초산모 분만시간에 미치는 영향 Ⅰ. 서 론 Ⅱ. 연구대상 및 방법 達 은 23) 의 丹 溪 에 최초로 기 재된 처방으로, 에 복용하면 한 다하여 난산의 예방과 및, 등에 널리 활용되어 왔다. 達 은 이 毒 하고 는 甘 苦 하여 氣, 氣 寬,, 結 의 효능이 있
대한한방부인과학회지 THE JOURNAL OF ORIENTAL OBSTETRICS & GYNECOLOGY VOL.17, NO.2 : 115-122 (2004) 달생산이 초산모 분만시간에 미치는 영향 * 북경한의원, ** 윤산부인과의원, *** 최은림산부인과의원, 상지대학교 한의과대학 부인과학교실 ****, 경희대학교 동서의학대학원 김성준 *****, 윤왕준
Kor. J. Aesthet. Cosmetol., 및 자아존중감과 스트레스와도 밀접한 관계가 있고, 만족 정도 에 따라 전반적인 생활에도 영향을 미치므로 신체는 갈수록 개 인적, 사회적 차원에서 중요해지고 있다(안희진, 2010). 따라서 외모만족도는 개인의 신체는 타
RESEARCH ARTICLE Kor. J. Aesthet. Cosmetol., 20-40대 여성의 외모만족도가 미용관리태도에 미치는 영향 홍수남 1, 김효숙 2 * 1 건국대학교 뷰티사이언스디자인학과, 2 건국대학교 의상디자인과 Effects of Extrinsic Body Satisfaction on Beauty Management Behavior of
139~144 ¿À°ø¾àħ
2 139 DOI : 10.3831/KPI.2010.13.2.139 2 Received : 10. 04. 08 Revised : 10. 04. 26 Two Case Report on Wrist Ganglion Treated with Scolopendrid Pharmacopuncture Accepted : 10. 05. 04 Key Words: Wrist Ganglion,
ÀÇÇа�ÁÂc00Ì»óÀÏ˘
Common Allergic Diseases in Children Sang - Il Lee, M.D. Department of pediatrics Sungkyunkwan University School of Medicine, Samsung Medical Center E - mail : silee@smc.samsung.co.kr Abstract Allergy
- iii - - i - - ii - - iii - 국문요약 종합병원남자간호사가지각하는조직공정성 사회정체성과 조직시민행동과의관계 - iv - - v - - 1 - - 2 - - 3 - - 4 - - 5 - - 6 - - 7 - - 8 - - 9 - - 10 - - 11 - - 12 - - 13 - - 14 - α α α α - 15 - α α α α α α
04_이근원_21~27.hwp
1) KIGAS Vol. 16, No. 5, pp 21~27, 2012 (Journal of the Korean Institute of Gas) http://dx.doi.org/10.7842/kigas.2012.16.5.21 실험실의 사례 분석에 관한 연구 이근원 이정석 한국산업안전보건공단 산업안전보건연구원 (2012년 9월 5일 투고, 2012년 10월 19일
16(1)-3(국문)(p.40-45).fm
w wz 16«1y Kor. J. Clin. Pharm., Vol. 16, No. 1. 2006 x w$btf3fqpsu'psn û w m w Department of Statistics, Chonnam National University Eunsik Park College of Natural Sciences, Chonnam National University
Journal of Educational Innovation Research 2017, Vol. 27, No. 2, pp DOI: : Researc
Journal of Educational Innovation Research 2017, Vol. 27, No. 2, pp.251-273 DOI: http://dx.doi.org/10.21024/pnuedi.27.2.201706.251 : 1997 2005 Research Trend Analysis on the Korean Alternative Education
γ
경락경혈학회지 Vol.27, No.1, pp.87 106, 2010 Journal of Meridian & Acupoint Dept. of 1 Meridian & Acupoint, 3 Acupuncture & Moxibustion, College of Oriental Medicine, Daejeon University 2 Division of Clinical
전립선암발생률추정과관련요인분석 : The Korean Cancer Prevention Study-II (KCPS-II)
전립선암발생률추정과관련요인분석 : The Korean Cancer Prevention Study-II (KCPS-II) 전립선암발생률추정과관련요인분석 : The Korean Cancer Prevention Study-II (KCPS-II) - i - - ii - - iii - - iv - - v - - vi - - vii - - viii - - ix - -
A Study on the Relationships between Self-Differentiation and Adaptability Factors for Senior Dementia Patients Care Givers Department of Social Welfare, Seoul Welfare Graduate University Full-time Lecturer
DBPIA-NURIMEDIA
The e-business Studies Volume 17, Number 6, December, 30, 2016:3~20 Received: 2016/12/04, Accepted: 2016/12/27 Revised: 2016/12/27, Published: 2016/12/30 [ABSTRACT] This study aims to comprehensively analyze
°Ç°�°úÁúº´6-2È£
K O R E A C E N T E R S F O R D I S E A S E C O N T R O L & P R E V E N T I O N PHWR Vol. 6 No. 2 www.cdc.go.kr 2013 1 11 6 2 ISSN:2005-811X Flavivirus surveillance in mosquitoes collected from the quarantine
자기공명영상장치(MRI) 자장세기에 따른 MRI 품질관리 영상검사의 개별항목점수 실태조사 A B Fig. 1. High-contrast spatial resolution in phantom test. A. Slice 1 with three sets of hole arr
Original Article pissn 1738-2637 J Korean Soc Radiol 2012;67(2):129-134 The Survey of Magnetic Resonance Imaging Quality according to in Korea 1 자기공명영상장치(MRI) 자장세기에 따른 MRI 품질관리 영상검사의 개별항목점수 실태조사 1 Hyun-Hae
Can032.hwp
Chromosomal Alterations in Hepatocellular Carcinoma Cell Lines Detected by Comparative Genomic Hybridization Sang Jin Park 1, Mahn Joon Ha, Ph.D. 1, Hugh Chul Kim, M.D. 2 and Hyon Ju Kim, M.D. 1 1 Laboratory
A Study on Married Female Immigrants Life Style and Marriage Satisfaction in Terms of Preparing Their Old Age in Chungcheongnam-do Department of Gerontology, Hoseo University Doctoral Student : Hi Ran
Trd022.hwp
김신태, 이선녕, 이석정, 정필문, 박홍준, 신명상, 김종환, 이부길, 김상하, 리원연, 신계철, 용석중 Shin-Tae Kim, M.D., Shun Nyung Lee, M.D., Seok Jeong Lee, M.D., Pil Moon Jung, M.D., Hong Jun Park, M.D., Myung Sang Shin, M.D., Chong Whan Kim,
Crt114( ).hwp
cdna Microarray Experiment: Design Issues in Early Stage and the Need of Normalization Byung Soo Kim, Ph.D. 1, Sunho Lee, Ph.D. 2, Sun Young Rha, M.D., Ph.D. 3,4 and Hyun Cheol Chung, M.D., Ph.D. 3,4 1
590호(01-11)
T H E K O R E A N D O C T O R S W E E K L Y www.docdocdoc.co.kr I N S I D E 38 3 5 6 7 10 13 28 29 30 31 38 41 42 2 Advertisement Government & Medicine 3 Government & Medicine 4 Government & Medicine Government
Kaes025.hwp
고위험군유두상갑상선암환자에대한방사성옥소최대허용선량측정법및치료법의검증 Verification of Measurement Methods and Therapeutic Efficacy of Maximum Permissible Dose of I-131 in High Risk Patients with Differentiated Papillary Thyroid Cancer
서론
- i - - ii - - iii - - iv - - v - - vi - - 1 - - 2 - - 3 - - 4 - - 5 - - 6 - - 7 - - 8 - - 9 - - 10 - - 11 - - 12 - - 13 - - 14 - - 15 - - 16 - - 17 - - 18 - - 19 - - 20 - - 21 - - 22 - - 23 - - 24 - -
서론 34 2
34 2 Journal of the Korean Society of Health Information and Health Statistics Volume 34, Number 2, 2009, pp. 165 176 165 진은희 A Study on Health related Action Rates of Dietary Guidelines and Pattern of
레이아웃 1
대한위장관기질종양연구회 01 GIST 06 02 11 03 Imatinib 14 04 05 06 07 Sunitinib 32 40 44 48 GIST 6 01 7 GIST Guide book GIST 8 01 9 GIST Guide book GIST (CT) MRI FDG-PET 10 02 11 GIST Guide book 12 02 (Imatinib)
Jkbcs032.hwp
Clinical Correlation of HER-2/neu Overexpression in Patients with Breast Cancer Sung Yong Kim, Tae Yoon Kim, Jae Jun Kim, Chang Ho Kim, Ok Pyung Song, Min Hyuk Lee, Eui Han Kim 1, and Moo Sik Cho Departments
±è¹ÎÁö
531 김민지 외: 미숙아에 발생한 의인성 식도천공과 기종격증 및 종격동염 A B C D E F Fig. 1. Chest radiographs and CT scans of a premature infant. Chest radiograph at 6 days after birth (A) shows left paravertebral radiolucency at the
:,,.,. 456, 253 ( 89, 164 ), 203 ( 44, 159 ). Cronbach α= ,.,,..,,,.,. :,, ( )
:,,.,. 456, 253 ( 89, 164 ), 203 ( 44, 159 ). Cronbach α=.83.91.,.,,..,,,.,. :,, (402-751) 253 E-mail : yspark@inha.ac.kr ..,.,.,. Bandura(1997),.,,,,., (,,, 2009), (,,,, 2014).?.,,,.. Bandura (1995) (Resiliency
09권오설_ok.hwp
(JBE Vol. 19, No. 5, September 2014) (Regular Paper) 19 5, 2014 9 (JBE Vol. 19, No. 5, September 2014) http://dx.doi.org/10.5909/jbe.2014.19.5.656 ISSN 2287-9137 (Online) ISSN 1226-7953 (Print) a) Reduction
..........5-45..
K O R E A C E N T E R S F O R D I S E A S E C O N T R O L & P R E V E N T I O N PHWR Vol. 5 No. 45 www.cdc.go.kr 2012 11 9 5 45 ISSN:2005-811X Monitoring of antimicrobial resistance on non-tertiary hospitals
( )KJH059.hwp
Korean J Hematol Vol. 4, No. 4, December, 007 Original Article 단일기관에서시행한소아조혈모세포이식성적 영남대학교병원조혈모세포이식센터 이용직ㆍ이현동ㆍ하정옥ㆍ김민경ㆍ이경희ㆍ현명수 Outcome of Hematopoietic Stem Cell Transplantation: In Children and Adolescent
YI Ggodme : The Lives and Diseases of Females during the Latter Half of the Joseon Dynasty as Reconstructed with Cases in Yeoksi Manpil (Stray Notes w
497 의사학 제24권 제2호(통권 제50호) 2015년 8월 Korean J Med Hist 24 ː497-532 Aug 2015 c대한의사학회 http://dx.doi.org/10.13081/kjmh.2015.24.497 pissn 1225-505X, eissn 2093-5609 역시만필( 歷 試 漫 筆 ) 의 사례로 재구성한 조선후기 여성의 삶과 질병
부속
04 Definitions of terminology in neonatal, infant, and perinatal epidemiology.,. (perinatal period),,,, (morbidity) (mortality).,,,.,,,.,., 2. (World Health Organization, WHO) International Statistical
歯kjmh2004v13n1.PDF
13 1 ( 24 ) 2004 6 Korean J Med Hist 13 1 19 Jun 2004 ISSN 1225 505X 1) * * 1 ( ) 2) 3) 4) * 1) ( ) 3 2) 7 1 3) 2 1 13 1 ( 24 ) 2004 6 5) ( ) ( ) 2 1 ( ) 2 3 2 4) ( ) 6 7 5) - 2003 23 144-166 2 2 1) 6)
untitled
Clinical Pediatric Hematology-Oncology Volume 23 ㆍ Number 2 ㆍ October 2016 ORIGINAL ARTICLE 소아급성골수성백혈병에서공여자유형에따른조혈모세포이식결과 최하영ㆍ김건ㆍ이우진ㆍ최준식ㆍ백희조ㆍ국훈 전남대학교의과대학화순전남대학교병원소아과학교실 Outcomes of Hematopoietic Stem Cell
°Ç°�°úÁúº´5-44È£ÃÖÁ¾
K O R E A C E N T E R S F O R D I S E A S E C O N T R O L & P R E V E N T I O N PHWR Vol. 5 No. 44 www.cdc.go.kr/phwr 2012 11 2 5 44 ISSN:2005-811X Vector surveillance after elimination of lymphatic filariasis
(Exposure) Exposure (Exposure Assesment) EMF Unknown to mechanism Health Effect (Effect) Unknown to mechanism Behavior pattern (Micro- Environment) Re
EMF Health Effect 2003 10 20 21-29 2-10 - - ( ) area spot measurement - - 1 (Exposure) Exposure (Exposure Assesment) EMF Unknown to mechanism Health Effect (Effect) Unknown to mechanism Behavior pattern
2009;21(1): (1777) 49 (1800 ),.,,.,, ( ) ( ) 1782., ( ). ( ) 1,... 2,3,4,5.,,, ( ), ( ),. 6,,, ( ), ( ),....,.. (, ) (, )
Abstract Kim Dal-Rae, Kim Sun-Hyung* Dept. of Sasang Constitutional Medicine, College of Oriental Medicine, Kyung-Hee Univ. *Dept. of Sasang Constitutional Medicine, East-West Neo Medical Center, Kyung-Hee
untitled
대한마취과학회지 2008; 55: 190~6 Korean J Anesthesiol Vol. 55, No. 2, August, 2008 임상연구 대한민국의 마취통증의학 임상실습 현황 연세대학교 의과대학 마취통증의학교실 및 마취통증의학연구소 장동진ㆍ안소운ㆍ안지원ㆍ김종훈 The current status of anesthesiology clerkship in Korea
54 한국교육문제연구제 27 권 2 호, I. 1.,,,,,,, (, 1998). 14.2% 16.2% (, ), OECD (, ) % (, )., 2, 3. 3
27 2, 53-70, 2009. (Nursing Home) * ** (Nursing Home). 5 50 5 2 1,,,,, SPSS t.,,,,,,,. :,, : 2009/08/27 : 2009/09/24 : 2009/09/30 * ** (: hjkim@daelim.ac.kr) 54 한국교육문제연구제 27 권 2 호, 2009. I. 1.,,,,,,, (,
Sheu HM, et al., British J Dermatol 1997; 136: Kao JS, et al., J Invest Dermatol 2003; 120:
Sheu HM, et al., British J Dermatol 1997; 136:884-890 Kao JS, et al., J Invest Dermatol 03; 1:446-464 1 10 0 3 Day Normal MLE Lotion Lotion MLE Cream Cream 80 7 70 6 3 Day Normal MLE Lotion Lotion MLE
ECG & EP CASES Young-Keun On, MD, PhD Division of Cardiology, Department of Medicine Cardiac & Vascular Center, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Korea A case of
untitled
Korean J Hematol Vol. 44, 4, December, 2009 Original Article 소아에서스테로이드저항성이식편대숙주병에대한 Etanercept 의효과 충남대학교의과대학소아과학교실 한혜영ㆍ신지혜ㆍ김선영 Effect of Etanercept on Steroid Refractory Graftversushost Disease in Children
Àå¾Ö¿Í°í¿ë ³»Áö
Disability & Employment 55 Disability & Employment 56 57 Disability & Employment 58 59 Disability & Employment 60 61 Disability & Employment 62 63 Disability & Employment 64 65 Disability & Employment
ºÎÁ¤¸ÆV10N³»Áö
case of brugada syndrome presented as chest pain STRCT rugada syndrome was described in 1992 as a new clinical entity characterized by electrocardiographic STsegment elevation in the right precordial leads
연하곤란
2015.03.04 부울경소화기내시경지회 Intramucosal gastric cancer: The rate of lymph node metastasis in signet ring cell carcinoma was as low as that in welldifferentiated adenocarcinoma 인제대부산백병원 소화기내과 지삼룡 Signet ring
untitled
DOI: 10.4046/trd.2009.66.2.122 ISSN: 1738-3536(Print)/2005-6184(Online) Tuberc Respir Dis 2009;66:122-126 CopyrightC2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.
Jksvs019(8-15).hwp
Grade I Grade II Grade III 12 대한혈관외과학회지 : 제 20 권 제 1 호 2004 Control Group A Group B Fig. 4. Microscopic findings of vein wall in control, group A and group B on the day of 7 after venous occlusion. The
( )Kjhps043.hwp
Difference of Fistula Maturation Degree and Physical Property by the Types of Tube Material: An Experimental Study Sang Koo Kang, M.D. 1, Hee Chul Yu, M.D. 1,4, Woo Sung Moon, M.D. 2,4, Ju Hyoung Lee,
Kbcs002.hwp
Does Real-time Compound Imaging Improve Evaluation of reast Cancer Compared to Conventional Sonography? o Kyoung Seo, M.D., Yu Whan Oh, M.D., Kyu Ran Cho, M.D., Young Hen Lee, M.D., Hyung Joon Noh, M.D.,
Rheu-suppl hwp
Objective: This paper reviews the existing Korean medical and public health, and nursing academy articles on disease-specific and domain-specific quality of life, and provides recommendations for the universally
005송영일
Received : 2015. 12. 09 Reviewed : 2015. 12. 16 Accepted : 2015. 12. 16 Sternal Fracture occurred after Thai Massage : A Case Report Young-Il Song, K.M.D. 1, Dong-Eun Kim, K.M.D. 1 1 Department of Rehabilitation
충북의대학술지 Chungbuk Med. J. Vol. 27. No. 1. 1~ Charcot-Marie-Tooth Disease 환자의마취 : 증례보고 신일동 1, 이진희 1, 박상희 1,2 * 책임저자 : 박상희, 충북청주시서원구충대로 1 번지, 충북대학교
충북의대학술지 Chungbuk Med. J. Vol. 27. No. 1. 1~5 2017 Charcot-Marie-Tooth Disease 환자의마취 : 증례보고 신일동 1, 이진희 1, 박상희 1,2 * 책임저자 : 박상희, 충북청주시서원구충대로 1 번지, 충북대학교의과대학마취통증의학교실, 의학연구소 (28644), happycat19@hanmail.net
May 10~ Hotel Inter-Burgo Exco, Daegu Plenary lectures From metabolic syndrome to diabetes Meta-inflammation responsible for the progression fr
May 10~12 2012 Hotel Inter-Burgo Exco, Daegu Plenary lectures From metabolic syndrome to diabetes Meta-inflammation responsible for the progression from obesity to metabolic syndrome originates in the
<31342EBCBAC7FDBFB52E687770>
일본 기혼여성의 취업 및 취업형태 결정요인 성 혜 영 (국민연금연구원) 본 연구의 목적은 일본 기혼여성의 취업실태를 고찰하고 취업 여부에 영향을 미치는 요인과 상시 또는 파트타임과 같은 취업형태를 결정하는 요인을 일본 내 전국 수준의 조사 데이터를 활용해 실증적으로 검토해 보는데 있다. 일본 기혼여성취업의 특징은 파트타임 취업 비율이 특히 높다는 것이며 이에
???? 1
The Korean Journal of Applied Statistics (2014) 27(1), 13 20 DOI: http://dx.doi.org/10.5351/kjas.2014.27.1.013 Maximum Tolerated Dose Estimation by Stopping Rule and SM3 Design in a Phase I Clinical Trial
석사논문.PDF
ABO Rh A study on the importance of ABO and Rh blood groups information in Public Health 2000 2 1 ABO Rh A study on the importance of ABO and Rh blood groups information in Public Health 2000 2 2 ABO Rh
<494352503131335FC1F8B9E6B1B3C0B02E687770>
ICRP 간행물 113 진단 및 중재 절차를 위한 방사선방호 교육훈련 Education and Training in Radiological Protection for Diagnostic and Interventional Procedures 대한방사선방어학회 이 번역본 발간은 2011년도 원자력안전위원회 방사선안전기술 개 발사업 과제 지원(한국동위원소협회로 부터
( )Kju225.hwp
비임균성비뇨생식기감염에서 의진단적효용성 Usefulness of the Mycofast Test (MYCOFAST Evolution 2) for the Diagnosis of Nongonococcal Genitourinary Infections Hang Ro Park, Yang Hyun Kim, Ho Jae Lee, Jea Sang Oh, Hyoung Jin
Journal of Educational Innovation Research 2019, Vol. 29, No. 2, pp DOI: 3 * Effects of 9th
Journal of Educational Innovation Research 2019, Vol. 29, No. 2, pp.357-378 DOI: http://dx.doi.org/10.21024/pnuedi.29.2.201906.357 3 * Effects of 9th Grade Students Participation in Career Curriculum Cluster
44-4대지.07이영희532~
A Spatial Location Analysis of the First Shops of Foodservice Franchise in Seoul Metropolitan City Younghee Lee* 1 1 (R) 0 16 1 15 64 1 Abstract The foodservice franchise is preferred by the founders who
- i - - ii - - iii - - iv - - v - - 1 - - 2 - - 3 - - 4 - - 5 - - 6 - - 7 - - 8 - - 9 - - 10 - - 11 - - 12 - - 13 - - 14 - - 15 - - 16 - - 17 - - 18 - - 19 - α α - 20 - α α α α α α - 21 - - 22 - - 23 -
Microsoft Word - HMC_Company_Medipost_110518.doc
211.. 18 Company Comment (7816) 최종경 선임연구원 2) 3787-2228 cjk@hmcib.com 수확의 계절이 다가온다 Not Rated[] 목표주가(6M) -원 현재주가 (/17) 상승여력 2주 최고가/최저가 시가총액 발행주식수 일평균 거래대금(6일) 자본금/액면가 32,3원 -% 47,3원/27,9원 2,4억원 631만주 26억원
Journal of Educational Innovation Research 2019, Vol. 29, No. 1, pp DOI: * Suggestions of Ways
Journal of Educational Innovation Research 2019, Vol. 29, No. 1, pp.65-89 DOI: http://dx.doi.org/10.21024/pnuedi.29.1.201903.65 * Suggestions of Ways to Improve Teaching Practicum Based on the Experiences
책임연구기관
2009. 2. 책임연구기관 - i - - ii - - iii - - iv - 6.3.1 Sample Collection and Analysis 161 6.3.1.1 Sample Collection 161 6.3.1.2 Sample Analysis 161 6.3.2 Results 162 6.3.2.1 Dalian 162 6.3.2.2 Xiamen 163 6.3.3
대한한의학원전학회지24권6호-전체최종.hwp
小兒藥證直訣 의 五臟辨證에 대한 小考 - 病證과 處方을 중심으로 1 2 慶熙大學校大學校 韓醫學科大學 原典學敎室 ㆍ 韓醫學古典硏究所 白裕相1,2*1)2) A study on The Diagnosis and Treatment Using The Theory of Five Organs in Soayakjeungjikgyeol(小兒藥證直訣) 1 Dept. of Oriental
2 1896 2 26 ( ) 2 7-20 2) 1897 1898 ( )3) 6 1902 8 1904 10 10 (19 05-1914 ) ( ) ( ) 4) 1915 ( ) ( ) 1917 2) 3) 4) 285
13 2 ( 25 ) 2004 12 Korean J Med Hist 13 284 296 Dec 2004 ISSN 1225 505X 1) * ** ** 1 1920 1930 40 ( 1896-1973) 80 * ** 1) 2003 284 2 1896 2 26 ( ) 2 7-20 2) 1897 1898 ( )3) 6 1902 8 1904 10 10 (19 05-1914
DBPIA-NURIMEDIA
e- 비즈니스연구 (The e-business Studies) Volume 17, Number 1, February, 28, 2016:pp. 293~316 ISSN 1229-9936 (Print), ISSN 2466-1716 (Online) 원고접수일심사 ( 수정 ) 게재확정일 2015. 12. 04 2015. 12. 24 2016. 02. 25 ABSTRACT
Journal of Educational Innovation Research 2018, Vol. 28, No. 1, pp DOI: * A Analysis of
Journal of Educational Innovation Research 2018, Vol. 28, No. 1, pp.99-117 DOI: http://dx.doi.org/10.21024/pnuedi.28.1.201803.99 2015 * A Analysis of the Characters and Issues about the 2015 Revised Social
KIM Sook Young : Lee Jungsook, a Korean Independence Activist and a Nurse during the 이며 나름 의식이 깨어있던 지식인들이라 할 수 있을 것이다. 교육을 받은 간 호부들은 환자를 돌보는 그들의 직업적 소
1 의사학 제24권 제1호(통권 제49호) 2015년 4월 Korean J Med Hist 24 ː1-34 Apr 2015 c대한의사학회 http://dx.doi.org/10.13081/kjmh.2015.24.1 pissn 1225-505X, eissn 2093-5609 간호부 이정숙의 독립운동 김숙영* 1. 서론 2. 본론 1) 출생에서 정신여학교 수학시절까지
12이문규
Review on Conservative Treatment of Spinal Scoliosis Moon-kyu Lee, O.M.D., Gil-jae Lee, O.M.D., Yun-kyung Song, O.M.D., Hyung-ho Lim, O.M.D. Dept. of Oriental Rehabilitation Medicine College of Oriental
<3030352D31312D313428C0B1C3A2C8A32DBCD5C0BAB0E6293135342D3135392E687770>
Original Article Korean J Health Promot 2011;11(3):154-159 pissn: 2234-2141 eissn: 2093-5676 건강검진 수진자에서 체질량지수 변화와 폐기능의 관련성 손은경, 윤창호, 고혜진, 김효민, 문경민 경북대학교 의학전문대학원 경북대학교병원 가정의학과 Relationship between Changes