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Diagnosis and Monitoring of Chronic Myeloid Leukemia: Chiang Mai University Experience

  • Tantiworawit, Adisak;Kongjarern, Supanat;Rattarittamrong, Ekarat;Lekawanvijit, Suree;Bumroongkit, Kanokkan;Boonma, Nonglak;Rattanathammethee, Thanawat;Hantrakool, Sasinee;Chai-Adisaksopha, Chatree;Norasetthada, Lalita
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.4
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    • pp.2159-2164
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    • 2016
  • Background: A diagnosis of chronic myeloid leukemia (CML) is made on discovery of the presence of a Philadelphia (Ph) chromosome. The success of the treatment of this form of leukemia with tyrosine kinase inhibitor (TKI) is monitored by reduction of the Ph chromosome. Objective: To compare the role of conventional cytogenetic (CC) methods with a real time quantitative polymerase chain reaction (RQ-PCR) and fluorescence in situ hybridization (FISH) for diagnosis and treatment monitoring of CML patients. The secondary outcome was to analyze the treatment responses to TKI in CML patients. Materials and Methods: This was a retrospective study of CML patients who attended the Hematology clinic at Chiang Mai University Hospital from 2005-2010. Medical records were reviewed for demographic data, risk score, treatment response and the results of CC methods, FISH and RQ-PCR. Results: One hundred and twenty three cases were included in the study, 57.7% of whom were male with a mean age of 46.9 years. Most of the patients registered as intermediate to high risk on the Sokal score. At diagnosis, 121 patients were tested using the CC method and 118 (95.9%) were identified as positive. Five patients failed to be diagnosed by CC methods but were positive for BCR-ABL1 using the FISH method. Imatinib was the first-line treatment used in 120 patients (97.6%). In most patients (108 out of 122, 88.5%), a complete cytogenetic response (CCyR) was achieved after TKI therapy and in 86 patients (70.5%) CCyR was achieved long term by the CC method. Five out of the 35 analyzed patients in which CCyR was achieved by the CC method had a positive FISH result. Out of the 76 patients in which CCyR was achieved, RQ-PCR classified patients to only CCyR in 17 patients (22.4%) with a deeper major molecular response (MMR) in 4 patients (5.3%) and complete molecular response (CMR) in 55 patients (72.4%). In the case of initial therapy, CCyR was achieved in 95 patients (79.1%) who received imatinib and in both patients who received dasatinib (100%). For the second line treatment, nilotinib were used in 30 patients and in 19 of them (63.3%) CCyR was achieved. In half of the 6 patients (50%) who received dasatinib as second line or third line treatment CCyR was also achieved. Conclusions: CML patients had a good response to TKI treatment. FISH could be useful for diagnosis in cases where CC analysis failed to detect the Ph chromosome. RQ-PCR was helpful in detecting any residual disease and determining the depth of the treatment response at levels greater than the CC methods.

Comparative Study on the Nurses' Job Satisfaction between the Oriental Medicine Ward and the General Ward (한방병동과 일반병동 간호사의 직무만족도의 비교연구)

  • Byun, Chang-Ja;Choi, Sang-Soon;Paik, Seung-Nam;Lee, Mi-Aie
    • Journal of Korean Academy of Nursing Administration
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    • v.1 no.1
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    • pp.97-111
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    • 1995
  • In our society today, a variety of medical caring system, along with a scientific development in the area of oriental medical science plus national demand, has increased the augmentation and the opening of oriental wards and hospitals (Han Bang), which has come to create an additional requirement of nursing activity at oriental medicine wards should be different from that of the general wards or the same as the other. In view of this, various studies need to be made in this connection. The purpose of this study is to comprehend the number of nurses who want to work at oriental medicine wards and measure job satisfaction in nursing as compared with those working at general wards so as to provide basic materials for future assignment and supplementary training for the nurses. An attempt was made to contribute toward nursing administration on the one hand improving nursing training course on the other hand. A total of 72 nurses currently working at two oriental medicine hospitals available in Seoul and 82 general nurses were selected for this study using the questionaire from December 1993 to January 1994. An instrument for the study was based on the measurement of work satisfaction developed by Paula L. Stamps including 37 questions complemented by Kim for revision (1993) and 14 questions regarding general characteristics and oriental medicine wards. The instrument to test dependability showed Cronbach's=0.7711. The collected data have been processed by computer package SPSS. General characteristics of the two groups and the matters involved in oriental medicine wards were calculated into real figure and percentage an similarities between the two groups were analyzed by t-test and F-test according to the characteristics of variables. The comparative test on work satisfaction among the two groups including general characteristics and work factors were conducted by t-test and F-test. The major findings as a result of the study are as follows : 1. As general characteristics, age group of $26{\sim}30$ years are more than any segment of age. As to marital status, the number of those in single status is slightly higher than the married. Approximately 80% of them are graduates of nursing schools and nursing colleges. They are mostly in service for one to three years. There is no significant difference between the two groups. 2. The number of those who want to work at oriental medicine wards represents 40.3% against 58.4%, being in favor of general wards. 3. The reason for service at oriental medicine wards is that "there is room for potential research" which happened to rank first, followed by "easy job," "good working atmosphere" and "growing interest in oriental medicine." 4. Work satisfactions among nurses who work at oriental medicine wards prove greater than that of nurses who work at general wards. 5. Work satisfaction between the two groups by work factors is reflected with significant difference statistically on task requirement, interaction and doctor-nurse relationships. 6. The general charcateristics and the work satisfaction by work factors prove that there are significant difference in age, marital status, education and the period of work. They tend to be more satisfied with the work as they grow in age. Significant differneces are found in the work factors such as autonomy, adiministration and professional job in the relationship with doctor-nurse. As to marital status, the married are more satisfied than the unmarried. There are significant differneces in the factors respecting administration and doctor-nurse college graduates are highly satisfied with task requirement. However, satisfaction with the professional level has proven the highest degree for those having master degree. The period of work and satisfaction : There are significant differneces in task requirement, administration, interactions, professional level and doctor-nurse relationships. As a general rule, the degree of satisfactions is in proportion to the lengrh of service. The following conclusions are drawn based on the fndings mentioned above. Even though the work satisfaction of the nurse who work at oriental medicine ward is relatively high, it is desired that personal consultation be given as to disposition of nurses when they are assigned to oriental medicine wards. It is also recommended that lectures on oriental medicine be conducted through supplementary training and/or basic nursing course in order that they may be motivated for ingenious activities with an increasing sense of self-esteem which will eventually enhance positive changes for the patients who are in need of oriental medicine nursing and for the medical teams. In addition, joint reseaches involvingclinical care and education should be in constant process for unique and scientific development for those who are subject to oriental medicine nursing care.

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Internal Structure of the Sense of Place for Parks that were aimed at Reenacting the Place Memory - Focusing on Seoul Park and Seonyudo Park - (장소기억의 재현을 주제로 조성된 서울숲, 선유도공원의 장소성 형성 구조 연구)

  • Im, Seungbin;Kwon, Yoonku;Jeong, Younhee;Hue, Younsun;Byeon, Jaesang;Choi, Hyungsuk
    • Journal of the Korean Institute of Landscape Architecture
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    • v.42 no.5
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    • pp.1-12
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    • 2014
  • Recently, the reenaction of place's memories that were considered sense of place based on its historical and structural characteristic were assumed important topics for recovering and making the park from industrial sites, such as factory, industrial complex, industrial city, labor residential development, landfill, etc., to the public all over the world. This research aimed to conduct some preliminary data for making the park's sense of place highly. So, after conducting the structural forms of sense of place for Seoul Forest and Seonyudo Park that were designed and built by considering its place memories actively, park planning and design implications that were considered its sense of place were suggested. The research results those were derived from the structural forms of sense of place for Seoul Forest and Seonyudo Park's are the following. First, the Structural Equation Modeling(SEM) on Seoul Forest and Seonyudo Park were determined that the natural-physical, artificial-physical, and experiential environmental factors' satisfaction of Seoul Forest and Seonyudo Park have an effect on forming the Sense of Place. In addition, the sense of place was affected by the willingness to visit. Second, according to its physical environment, the experiential factors, such as plays, exercises and etc., were more important relatively. Therefore, experiential factors should be considered significantly with physical factors to make the sense of place highly. Third, even the places were under similar category, the factors' and valuables' relative importance were changed. As the results of structural equation modeling said, specific valuables' related with each factors would be differentiated due to the places' characteristics. For example, the results were showed that natural-physical factor was more important than artificial-physical factor in Seoul Forest. On the other hand, artificial-physical factor was more important than the natural- physical factor. This research carries some significance for applying a quantitative research method(structural equation modeling) to various place to conduct the sense of place's structural model, for suggesting relative specific methods to make the sense of place, and for being a step forward to substance of sense of place. If further studies conduct focusing on various places to draw the forming models of sense of place that were based this research's analysis methods and results, those researches would contribute to make the urban place meaningful, characteristically and affectionately. Furthermore, those researches would contribute in making a humane and competitiveness city.

Potential of River Bottom and Bank Erosion for River Restoration after Dam Slit in the Mountain Stream

  • Kang, Ji-Hyun;So, Kazama
    • Proceedings of the Korea Water Resources Association Conference
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    • 2011.05a
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    • pp.46-46
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    • 2011
  • Severe sediment erosion during floods occur disaster and economic losses, but general sediment erosion is basic mechanism to move sediment from upstream to downstream river. In addition, it is important process to change river form. Check dam, which is constructed in mountain stream, play a vital role such as control of sudden debris flow, but it has negative aspects to river ecosystem. Now a day, check dam of open type is an alternative plan to recover river biological diversity and ecosystem through sediment transport while maintaining the function of disaster control. The purpose of this paper is to verify sediment erosion progress of river bottom and bank as first step for river restoration after dam slit by cross-sectional shear stress and critical shear stress. Study area is upstream reach of slit check dam in mountain stream, named Wasada, in Japan. The check dam was slit with two passages in August, 2010. The transects were surveyed for four upstream cross-sections, 7.4 m, 34 m, 86 m, and 150 m distance from dam in October 2010. Sediment size was surveyed at river bottom and bank. Sediment of cobble size was found at the wetted bottom, and small size particles of sand to medium gravel composed river bank. Discharge was $2.5\;m^3/s$ and bottom slope was 0.027 m/m. Excess shear stress (${\tau}_{ex}$) was calculated for hydraulic erosion by subtracting the values of critical shear stress (${\tau}_{c}$) from the value of shear stress (${\tau}$) at river bottom and bank (${\tau}_{ex}=\tau-{\tau}_c$). Shear stress of river bottom (${\tau}_{bottom}$) was calculated using the cross-sectional shear stress, and bank shear stress (${\tau}_{bank}$) was calculated from the method of Flintham and Carling (1988). $${\tau}_{bank}={\tau}^*SF_{bank}((B+P_{bed})/(2^*P_{bank}))$$ where $SF_{bank}=1.77(P_{bed}/p_{bank}+1.5)^{-1.4}$, B is the water surface width, $P_{bed}$ and $P_{bank}$ are wetted parameter of the bed and bank. Estimated values for ${\tau}_{bottom}$ for a flow of $2.5\;m^3/s$ were lower as 25.0 (7.5 m cross-section), 25.7 (34 m), 21.3 (86 m) and 19.8 (150 m), in N/$m^2$, than critical shear stress (${\tau}_c=62.1\;N/m^2$) with cobble of 64 mm. The values were insufficient to erode cobble sediment. In contrast, even if the values of ${\tau}_{bank}$ were lower than the values for ${\tau}_{bottom}$ as 18.7 (7.5 m), 19.3 (34 m), 16.1 (86 m) and 14.7 (150 m), in N/$m^2$, excess shear stresses were calculated at the three cross-sections of 7.5 m, 34 m, and 86 m distances compare with ${\tau}_c$ is 15.5 N/$m^2$ of 16mm gravel. Bank shear stresses were sufficient for erosion of the medium gravel to sand. Therefore there is potential to erode lateral bank than downward erosion in a flow of $2.5\;m^3/s$. Undercutting of the wetted bank can causes bank scour or collapse, therefore this channel has potential to become wider at the same time. This research is about a potential of sediment erosion, and the result could not verify with real data. Therefore it need next step for verification. In addition an erosion mechanism for river restoration is not simple because discharge distribution is variable by snow-melting or rainy season, and a function for disaster control will recover by big precipitation event. Therefore it needs to consider the relationship between continuous discharge change and sediment erosion.

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Liver Splitting Using 2 Points for Liver Graft Volumetry (간 이식편의 체적 예측을 위한 2점 이용 간 분리)

  • Seo, Jeong-Joo;Park, Jong-Won
    • The KIPS Transactions:PartB
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    • v.19B no.2
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    • pp.123-126
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    • 2012
  • This paper proposed a method to separate a liver into left and right liver lobes for simple and exact volumetry of the river graft at abdominal MDCT(Multi-Detector Computed Tomography) image before the living donor liver transplantation. A medical team can evaluate an accurate river graft with minimized interaction between the team and a system using this algorithm for ensuring donor's and recipient's safe. On the image of segmented liver, 2 points(PMHV: a point in Middle Hepatic Vein and PPV: a point at the beginning of right branch of Portal Vein) are selected to separate a liver into left and right liver lobes. Middle hepatic vein is automatically segmented using PMHV, and the cutting line is decided on the basis of segmented Middle Hepatic Vein. A liver is separated on connecting the cutting line and PPV. The volume and ratio of the river graft are estimated. The volume estimated using 2 points are compared with a manual volume that diagnostic radiologist processed and estimated and the weight measured during surgery to support proof of exact volume. The mean ${\pm}$ standard deviation of the differences between the actual weights and the estimated volumes was $162.38cm^3{\pm}124.39$ in the case of manual segmentation and $107.69cm^3{\pm}97.24$ in the case of 2 points method. The correlation coefficient between the actual weight and the manually estimated volume is 0.79, and the correlation coefficient between the actual weight and the volume estimated using 2 points is 0.87. After selection the 2 points, the time involved in separation a liver into left and right river lobe and volumetry of them is measured for confirmation that the algorithm can be used on real time during surgery. The mean ${\pm}$ standard deviation of the process time is $57.28sec{\pm}32.81$ per 1 data set ($149.17pages{\pm}55.92$).

Noise-robust electrocardiogram R-peak detection with adaptive filter and variable threshold (적응형 필터와 가변 임계값을 적용하여 잡음에 강인한 심전도 R-피크 검출)

  • Rahman, MD Saifur;Choi, Chul-Hyung;Kim, Si-Kyung;Park, In-Deok;Kim, Young-Pil
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.12
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    • pp.126-134
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    • 2017
  • There have been numerous studies on extracting the R-peak from electrocardiogram (ECG) signals. However, most of the detection methods are complicated to implement in a real-time portable electrocardiograph device and have the disadvantage of requiring a large amount of calculations. R-peak detection requires pre-processing and post-processing related to baseline drift and the removal of noise from the commercial power supply for ECG data. An adaptive filter technique is widely used for R-peak detection, but the R-peak value cannot be detected when the input is lower than a threshold value. Moreover, there is a problem in detecting the P-peak and T-peak values due to the derivation of an erroneous threshold value as a result of noise. We propose a robust R-peak detection algorithm with low complexity and simple computation to solve these problems. The proposed scheme removes the baseline drift in ECG signals using an adaptive filter to solve the problems involved in threshold extraction. We also propose a technique to extract the appropriate threshold value automatically using the minimum and maximum values of the filtered ECG signal. To detect the R-peak from the ECG signal, we propose a threshold neighborhood search technique. Through experiments, we confirmed the improvement of the R-peak detection accuracy of the proposed method and achieved a detection speed that is suitable for a mobile system by reducing the amount of calculation. The experimental results show that the heart rate detection accuracy and sensitivity were very high (about 100%).

Neural Bases of Empathy in Competitive vs. non-Competitive situation (경쟁과 비경쟁 상황에서 공감의 신경학적 기제)

  • Hwang, Su-Young;Yoon, Mi-Sun
    • Korean Journal of Cognitive Science
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    • v.27 no.3
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    • pp.441-467
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    • 2016
  • This fMRI study is aim to investigate effects of competitive environment in cognitive empathic process in human brain. Empathy is known as a crucial factor for human's adaptive behavior in aspects of social cognition and it is almost automatic process, on the other hand competitive situation is psychologically devastated environment to win someone for getting rewards. We hypnotized that reading and understanding of other person's mind are a specific characteristic related to survival evolutionarily, however competition would have an effect on the empathic cognitive process because of mechanisms of competition. To manipulate the competitive atmosphere, one researcher took a role of competitor against participants and they were instructed to get monetary rewards when their performance was better than a competitor. 21 participants(9 males and 12 females) performed to judge the emotional valence of the empathic task consisted of illustrated images with various situation could be experienced in real world as on $1^{st}$ person perspective in both competitive and non-competitive condition, and did same performance with objects stimulus in control condition. In order to examine the competition effects on empathic process,, hemodynamic response were obtained during fMRI session and the imaging data were analyzed to identify brain regions where responses to each condition across the two consecutive runs. Participants' reaction time in competitive condition was faster statistically significant than non-competitive one. Activation for competitive condition increased in the following areas: ACC, mPFC, SMG, thalamus extended caudate and Nacc, parahippocampal gyrus, and for non-competitive condition increased paracingulate gyrus, temporal pole, vmPFC, superior occipital gyrus. As a result of regression analysis using empathic scores as covariance, the rSMG, IFG, fusiform gyrus, thalamus, putamen were correlated with higher empathic levels, and TPJ were correlated with lower empathic scores. We suggest that these observations could mean competitive environment have an effect on neural base of cognitive empathic process.

The Types, Roles and Socio-semiotic Features of Visual Materials in Elementary Science Textbooks (초등 과학 교과서에 실린 시각 자료의 종류, 역할 그리고 사회-기호학적 특징 분석)

  • Kim, Hyoungjin;Shin, Myeong-Kyeong;Lee, Gyuho;Kwon, Gyeong-Pil
    • Journal of Science Education
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    • v.38 no.3
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    • pp.641-656
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    • 2014
  • This study aimed at analyzing visual materials included in school science textbooks, specifically the textbooks for first semester courses of 3rd to 6th graders. The purpose was to provide directions for future textbooks by understanding the functions of the images in both pedagogical and social perspectives as well. The study was conducted by investigating the types, roles and socio-semiotic features of the images in science textbooks. The results were as follows. Firstly, the most used types of images in 2007 curriculum textbooks were photographs and drawn pictures. Uses of other visual aids than above were extremely rare. It was also found that as the educational level rises, the use of images for decorative functions drastically declined. The majority of the images were used in providing supplementary explanations or examples. This implies that the images effectively play the role of helping science education. In addition, more use of worksheets images was found, indicating that as educational level increases, students participate more actively in research sessions or data analysis. In socio-semiotic perspective, visual images showed high accessibility to students in 'Type of visual image', 'Function of visual image', 'Distance of shot', 'Horizontal angle of shot', 'Color moduation'. It was implied that there will a close correlation between the type, role and the socio-semiotic characteristics of visual images in textbooks. For example, photograph-type visuals were mostly used as supplementary references. And when applying the socio-semiotic analysis to photograph-type visuals, they showed 'real type', 'narrative-metaphor type', and 'shadow effect' among socio-semiotic features. Such correlations implied that knowing the type of the visual image may help determining the role of the image in the textbook to some extent, and also corresponding socio-semiotic characteristics. As a result, it was possible to infer how accessible certain visual images are to students. The above results have implications for the effective use of visual images in future textbooks.

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Expression profile of defense-related genes in response to gamma radiation stress (방사선 스트레스 반응 방어 유전자의 탐색 및 발현 분석)

  • Park, Nuri;Ha, Hye-Jeong;Subburaj, Saminathan;Choi, Seo-Hee;Jeon, Yongsam;Jin, Yong-Tae;Tu, Luhua;Kumari, Shipra;Lee, Geung-Joo
    • Journal of Plant Biotechnology
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    • v.43 no.3
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    • pp.359-366
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    • 2016
  • Tradescantia is a perennial plant in the family of Commelinaceae. It is known to be sensitive to radiation. In this study, Tradescantia BNL 4430 was irradiated with gamma radiation at doses of 50 to 1,000 mGy in a phytotron equipped with a $^{60}Co$ radiation source at Korea Atomic Energy Research Institute, Korea. At 13 days after irradiation, we extracted RNA from irradiated floral tissues for RNA-seq. Transcriptome assembly produced a total of 77, 326 unique transcripts. In plantlets exposed to 50, 250, 500, and 1000 mGy, the numbers of up-regulated genes with more than 2-fold of expression compared that in the control were 116, 222, 246, and 308, respectively. Most of the up-regulated genes induced by 50 mGy were heat shock proteins (HSPs) such as HSP 70, indicating that protein misfolding, aggregation, and translocation might have occurred during radiation stress. Similarly, highly up-regulated transcripts of the IQ-domain 6 were induced by 250 mGy, KAR-UP oxidoreductase 1 was induced by 500 mGy, and zinc transporter 1 precursor was induced by 1000 mGy. Reverse transcriptase (RT) PCR and quantitative real time PCR (qRT-PCR) further validated the increased mRNA expression levels of selected genes, consistent with DEG analysis results. However, 2.3 to 97- fold higher expression activities were induced by different doses of radiation based on qRT-PCR results. Results on the transcriptome of Tradescantia in response to radiation might provide unique identifiers to develop in situ monitoring kit for measuring radiation exposure around radiation facilities.

The Effect of Information Service Quality on Customer Loyalty: A Customer Relationship Management Perspective (정보서비스품질이 고객로열티에 미치는 영향에 관한 연구: 고객관계관리 관점)

  • Kim, Hyung-Su;Gim, Seung-Ha;Kim, Young-Gul
    • Asia pacific journal of information systems
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    • v.18 no.1
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    • pp.1-23
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    • 2008
  • As managing customer relationship gets more important, companies are strengthening information service using multi-channels to their customers as a part of their customer relationship management (CRM) initiatives. It means companies are now accepting such information services not as simple information -delivering tools, but as strategic initiatives for acquiring and maintaining customer loyalty. In this paper, we attempt to validate whether or not such various information services would impact on organizational performance in terms of CRM strategy. More specifically, our research objective is to answer the next three questions: first, how to construct the instruments to measure not information quality but information service quality?; second, which attributes of information service quality can influence corporate image and customer loyalty?; finally, does each information service type have unique characteristics compared with others in terms of influencing corporate image and customer loyalty? With respect to providing answers to those questions, the previous studies had been limited in that those studies failed to consider the variety of types of information service or restricted the quality of information service to information quality. An appropriate research model answering the above questions should consider the fact that most companies are utilizing multi channels for their information services, and include the recent strategic information service such as customer online community. Moreover, since corporate information service could be regarded as a type of products or services delivered to customer, it is necessary to adopt the criteria for assessing customer's perceived value when to measure the quality of information service. Therefore, considering both multi-channels and multi-traits may enable us to tell the detailed causal routes showing which quality attributes of which information service would affect corporate image and customer loyalty. As information service channels, we include not only homepage and DM (direct mail), which are the most frequently applied information service channels, but also online community, which is getting more strategic importance in recent years. With respect to information service quality, we abstract information quality, convenience of information service, and timeliness of information service through a wide range of relevant literature reviews. As our dependant variables, we consider corporate image and customer loyalty that both of them are the critical determinants of organizational performance, and also attempt to grasp the relationship between the two constructs. We conducted a huge online survey at the homepage of one of representative dairy companies in Korea, and gathered 367 valid samples from 407 customers. The reliability and validity of our measurements were tested by using Cronbach's alpha coefficient and principal factor analysis respectively, and seven hypotheses were tested through performing correlation test and multiple regression analysis. The results from data analysis demonstrated that timeliness and convenience of homepage have positive effects on both corporate image and customer loyalty. In terms of DM, its' information quality was represented to influence both corporate image and customer loyalty, but we found its' convenience have a positive effect only on corporate image. With respect to online community, we found its timeliness contribute significantly both to corporate image and customer loyalty. Finally, as we expected, corporate image was revealed to provide a great influence to customer loyalty. This paper provides several academic and practical implications. Firstly, we think our research reinforces CRM literatures by developing the instruments for measuring information service quality. The previous relevant studies have mainly depended on the measurements of information quality or service quality which were developed independently. Secondly, the fact that we conducted our research in a real situation may enable academics and practitioners to understand the effects of information services more clearly. Finally, since our study involved three different types of information service which are most frequently applied in recent years, the results from our study might provide operational guidelines to the companies that are delivering their customers information by multi-channel. In other words, since we found that, in terms of customer loyalty, the key areas would be different from each other according to the types of information services, our analysis would help to make decisions such as selecting strengthening points or allocating resources by information service channels.