To determine effects of the direction of the rotational work shifting on the circadian rhythm and adaptation of physiological and psychological components were investigated with nursing students. Two groups of seven volunteers participated as experimental subjects, and eight nursing students participated as a control group. The directions of rotation work shift were as follows : CW(clockwise)-shift system rotation in the direction of day shift(3 lays), evening shift(3days), off duty(1day) and night shift(5days). and CCW(counterclockwise)-shift system rotation in the reverse direction. Urinary free cortisol and 17-hydroxycorticoster oids in the urine were measured by the solid-phase radioimmunoassay and the colorimetry methods, re spectively. Plasma melatonin was measured by radioimmunoassay. The urinary free cotisol rhythm changed to ir-regular on the evening and night shift in the CCW shift system, whereas the rhythm seems to adapt on night shift in the CW shift system. The daily rhythms of urinary 17-OHCS indicate that they are well synchronized to shift work. These results show that the rotation of shift in the CW direction is more acceptable in terms of the adaptation of hormonal rhythms. These results indicate that the CCW rotation of shift work makes it more difficult for the workers to adapt on a physiological level, and has many more negative effects on nurses when compared with the CW rotation. Thus, a clockwise rotating shift systern seems to be more desirable for the optimal health and performance of nurses.
Circadian Rhythm* ; Colorimetry ; Humans ; Hydrocortisone* ; Melatonin ; Plasma ; Radioimmunoassay ; Students, Nursing ; Volunteers

Acute myeloid leukemia (AML) is a heterogeneous malignancy that comprises 25-30% of pediatric leukemias in Korea. Several inherited diseases, such as Down syndrome and Fanconi anemia, predispose towards AML leukemogenesis. Subgrouping of AML is a key diagnostic step, previously done with the French-American-British (FAB) classification and recently complemented by that of the World Health Organization (WHO). An important feature of AML is the possibility of chloroma at diagnosis, which, if detected, requires follow-up evaluation to determine treatment response. Numerous genetic abnormalities with prognostic relevance have recently been found, the most important of which include those of the core-binding factor (CBF) leukemias, and FLT3-ITD mutation. These genetic abnormalities, combined with patient response to initial treatment, allow for a scheme of risk stratification, and the current consensus is to treat low risk patients with chemotherapy only, whereas high risk patients may receive allogeneic transplant in first remission, although the benefits of transplant remain inconclusive. Overall, the outcome of children and adolescents with AML has improved significantly so that many clinical trials now report event-free survival of around 60%. However, much of this improvement stems from better supportive care and transplant methods, and the genetics-based diagnostic advances in AML have yet to result in enhanced treatment. New therapeutics, including possibly targeted therapy, are necessary to further improve the outcome of pediatric AML.
Adolescent ; Child ; Classification ; Complement System Proteins ; Consensus ; Core Binding Factors ; Diagnosis ; Disease-Free Survival ; Down Syndrome ; Drug Therapy ; Fanconi Anemia ; Humans ; Korea ; Leukemia ; Leukemia, Myeloid, Acute ; Sarcoma, Myeloid ; World Health Organization

Fusariosis is a rare infectious disease caused by species of the genus Fusarium that has been increasingly documented as an emerging agent of opportunistic infections in immunocompromised patients and, occasionally, immunocompetent hosts. We describe an 18-year-old Korean male, previously diagnosed as acute lymphocytic leukemia, presented with 2~4 cm-sized erythematous to necrotic papulonodules on the trunk and extremities for a week. White blood cell count was 200 cells/L and biopsy specimen showed structures resembling fungal elements in the dermis and subcutaneous fat. Cultures from a biopsy sample growing whitish cottony colonies contained fusoid multiseptated macroconidia. He was diagnosed as fusariosis and treated with intravenous amphotericin B. But white blood cell count and clinical symptoms didn't improve and he was expired after 6 days of treatment.
Adolescent ; Amphotericin B ; Biopsy ; Communicable Diseases ; Dermis ; Extremities ; Fusariosis ; Fusarium* ; Humans ; Immunocompromised Host ; Leukocyte Count ; Male ; Opportunistic Infections ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Subcutaneous Fat

No abstract available.
Humans ; Infant*

Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infection in infants. Life-threatening RSV infection is often reported in young children and immunocompromised hosts. Since there is no report on ribavirin therapy for RSV pneumonia in pediatric cancer patients in Korea, we report one case of RSV pneumonia that developed in an infant with acute lymphoblastic leukemia (ALL). Despite administration of oral ribavirin and intravenous immunoglobulin, the patient's respiratory distress worsened and admission to an intensive care unit was necessary. Chest x-ray showed multifocal consolidation, pneumothorax, and pneumomediastinum. Treatment with aerosolized ribavirin led to significant clinical improvement. The role of aerosolized ribavirin is still controversial, but it might have a therapeutic potential for severe RSV pneumonia in children with leukemia.
Child ; Humans ; Immunocompromised Host ; Immunoglobulins ; Infant ; Intensive Care Units ; Korea ; Leukemia ; Mediastinal Emphysema ; Pneumonia ; Pneumothorax ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Ribavirin ; Thorax

The event-free survival (EFS) for pediatric acute lymphoblastic leukemia (ALL) has shown remarkable improvement in the past several decades. In Korea also, a recent study showed 10-year EFS of 78.5%. Much of the improved outcome for pediatric ALL stems from the accurate identification of prognostic factors, the designation of risk group based on these factors, and treatment of appropriate duration and intensity according to risk group, done within the setting of cooperative clinical trials. The schema of first-line therapy for ALL remains mostly unchanged, although many groups have now reported on the elimination of cranial irradiation in all patients with low rates of central nervous system relapse. Specific high risk subgroups, such as Philadelphia chromosome-positive (Ph+) ALL and infant ALL continue to have significantly lower survival than other ALL patients. The introduction of tyrosine kinase inhibitors into therapy has led to enhanced outcome for Ph+ ALL patients. Infant ALL patients, particularly those with MLL rearrangements, continue to have poor outcome, despite treatment intensification including allogeneic hematopoietic cell transplantation. Relapsed ALL is a leading cause of mortality in pediatric cancer. Recent advances in immunotherapy targeting the CD19 of the ALL blast have shown remarkable efficacy in some of these relapsed and refractory patients. With improved survival, much of the current focus is on decreasing the long-term toxicities of treatment.
Cell Transplantation ; Central Nervous System ; Child ; Cranial Irradiation ; Disease-Free Survival ; Humans ; Immunotherapy ; Infant ; Korea ; Mortality ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Protein-Tyrosine Kinases ; Recurrence ; Transplants

OBJECTIVE: The purpose of this study was to find clinical factors affecting the operation time of the classical intrafascial supracervical hysterectomy (CISH) performed on patients with uterine disease. METHODS: From January 2001 to December 2006, a total of 148 patients were reviewed and 130 patients with CISH were entered into the study. We investigated clinical factors, such as age, parity, BMI, height, weight, transverse diameter of uterus, previous operation number, operation assistant, period in sequence of operation date, pathology of uterus and operation time of surgery. The statistical assessment was used to find out the main factor determining the operation time of CISH. RESULTS: The mean operation time of CISH was 135.5 minutes and the mean transverse diameter of uterus was 7.2 cm. The main indications for CISH were uterine myoma or adenomyosis with dysmenorrhea, menorrhagia and vaginal bleeding. The operation time of CISH was affected by the transverse diameter of uterus and period which was categorized in sequence of operation date. CONCLUSION: Mainly, pre-operative ultrasonographic evaluation of uterine transverse diameter could predict the operation time of CISH.
Adenomyosis ; Dysmenorrhea ; Female ; Humans ; Hysterectomy ; Menorrhagia ; Myoma ; Parity ; Uterine Hemorrhage ; Uterus

Background: The integrase strand transfer inhibitor dolutegravir has been indicated in Korea since 2014 for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in combination with other antiretroviral agents. This regulatory post-marketing surveillance (PMS) study evaluated the real-life safety and effectiveness of dolutegravir in patients with HIV-1 in clinical practice in Korea. Materials and Methods: This open-label PMS study examined data from consecutive patients (aged ≥12 years) with HIV-1 infection receiving dolutegravir according to locally approved prescribing information; treatment-naïve and treatment-experienced patients were permitted. Data regarding patient demographics, medical history, clinical characteristics, medications (HIV-related and concomitant), and comorbidities were extracted from patient records over a 1-year treatment period. Outcomes included the safety of dolutegravir (primary endpoint) and real-life effectiveness according to the Physician Global Assessment (PGA) and the proportion of patients with plasma HIV-1 RNA count <50 copies/mL at 48 weeks. Results: Of 147 patients treated with dolutegravir at 18 centers in Korea (August 2014 – August 2020), 139 were eligible for the safety analyses and 75 for effectiveness analyses.Patients (mean age 47 years) were mostly male (92.8%) and received dolutegravir in combination with nucleoside reverse transcriptase inhibitor (70.5%) or protease inhibitors (21.6%). Adverse events (AEs) (n = 179 in total) were mostly mild in severity, with the most common being nasopharyngitis (5.0%), dyspepsia (5.0%), pruritus (4.3%), and rash (4.3%).Of 16 adverse drug reactions (ADRs), the most frequent were rash, diarrhea, headache, insomnia, and somnolence (1.4% each). Of 2 serious ADRs, only 1 (gastroenteritis) was unexpected, and both resolved. The risk of experiencing an AE while receiving dolutegravir appeared to be especially increased in patients receiving concomitant medications for other conditions. Dolutegravir effectively suppressed HIV-1 (93.3% of patients had plasma HIV-1 RNA <50 copies/mL), and 100% of patients showed symptom improvement based on physician global assessment. Conclusion Results of this PMS study showed that dolutegravir administered as highly active antiretroviral therapy was well tolerated and effective in patients with HIV-1 infection.

Hemophagocytic lymphohistiocytosis-like toxicity following chimeric antigen receptor (CAR)-T cell therapy (carHLH) is a rare and fulminant complication. Currently, there are neither well-established diagnostic criteria nor optimal treatment option for carHLH. Given the similarities of hyperinflammatory process and cytokine profiles between cytokine release syndrome (CRS) and carHLH, tocilizumab and corticosteroids are the suggested front-line treatment options for both conditions. However, when carHLH is refractory to front-line treatment, alternative or adjunctive agents should be introduced to ameliorate ongoing hyperinflammation. Anakinra, a recombinant interleukin (IL)-1 receptor antagonist, has shown promising results in the management of carHLH. Although prospective trials are limited, the use of anakinra for severe CRS and carHLH has been increasing. In this case report, we present two cases of carHLH to discuss its characteristic clinical features, diagnostic criteria, and treatment option. In addition, we also highlight the clinical efficacy of anakinra for managing carHLH which was refractory to tocilizumab and dexamethasone.

BACKGROUND: Numerous studies tried to find new markers that after hematopoietic stem cell transplantation predict engraftment earlier than the conventional marker, absolute neutrophil count (ANC >500/microL). Early engraftment prediction can be achieved by a marker that reflects the release of neutrophils and monocytes into the leukopenic peripheral blood. METHODS: We analyzed blood cell parameters, including cell population data such as volume, conductivity, and light scatter in 77 patients who underwent HSCT (allogeneic, n=63; autologous, n=11) to detect possible markers. RESULTS: We identified 2 early engraftment markers of neutrophils (NEUTRO) and monocytes (MONO); a pair of mean-volume-neutrophils (MNV) and mean-conductivity-neutrophils (MNC) for NEUTRO; and a pair of mean-volume-monocytes (MMV) and mean-conductivity-monocytes (MMC) for MONO. The new markers showed distinct patterns for early engraftment wherein 1) on the engraftment day, MNV peaked as MNC notched simultaneously for every case, and 2) MMV peaked as MMC notched simultaneously in most cases. Engraftment was predicted 3.8+/-2.7 days earlier than by ANC in 74 successful engraftment cases by using NEUTRO and/or MONO: 1) 72 cases (97.3%), in which NEUTRO and/or MONO predicted earlier engraftment than ANC, 2) 1 case, in which the 3 markers predicted engraftment on the same day, and 3) 1 case, in which NEUTRO predicted engraftment on the same day as ANC and MONO failed to predict engraftment. CONCLUSIONS: By analyzing the data from daily complete blood counts, engraftment can be predicted approximately 4 days earlier than ANC >500/microL using NEUTRO as a base marker and MONO as a supplementary marker.
Adolescent ; Adult ; Child ; Child, Preschool ; Female ; *Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells/*cytology ; Humans ; Infant ; Leukocyte Count ; Male ; Middle Aged ; Monocytes/*cytology ; Neutrophils/*cytology ; Time Factors ; Transplantation, Autologous ; Transplantation, Homologous ; Young Adult