• Pediatric Infection and Vaccine
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• v.18 no.1
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• pp.23-30
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• 2011

Purpose : Acinetobacter baumannii is an aerobic, gram negative coccobacillus. Due to its pathogenicity and ability to accumulate diverse mechanisms of resistance, the importance of this organism is increasing. Many reports have targeted adults, and studies of pediatric patients are limited. This study aims to investigate the current status of A. baumannii infection in children. Methods : From January 2001 to December 2008, 505 patients hospitalized with A. baumannii infection were enrolled. Admission records for underlying disease, duration of hospitalization, previous antibiotic use, location of admission, presence of ventilator care, and resistance to antibiotics were retrospectively reviewed and analyzed. Results : Hemato-oncological disease and neurological disease were 30.6% and 24.3% of all cases; therefore, these were the most common underlying diseases of patients with A. baumannii infection. Prevalence of A. baumannii infection was 78.1% in patients with previous antibiotic use, which was higher than that of the group not using previous antibiotic. And prevalence of multi-drug resistant and pan-drug resistant A. baumannii infection was 76.4% and 38.3% in patients with ICU care, 76.8% and 38.9% with ventilator care, and these were higher than the others. Rate of resistance to all groups of antibiotics showed a gradual increase to over 50% in 2008. Multi-drug resistant A. baumannii was 63.5% and pan-drug resistant A. baumannii was 48.2% of all cases. Conclusion : Prevalence of A. baumannii infection and resistance to antibacterial agents of A. baumannii is increasing. Adequate use of antibiotics and infection control should be emphasized in pediatric patients.

• Clinical and Experimental Pediatrics
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• v.48 no.7
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• pp.760-765
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• 2005

Purpose : We studied the changes in antibiotic sensitivity to the causative organisms of urinary tract infection(UTI), in order to provide useful information on the choice of adequate drugs in the treatment of UTI. Methods : We retrospectively analyzed the major causative organisms and their antibiotic sensitivities in 69 patients diagnosed with UTI in the Department of Pediatrics, Samsung Cheil Hospital from 2002 to 2003. Results : The frequency of UTI was the highest in infants younger than 1 year of age(88.4 percent). The male to female ratio was 3.05 : 1. Escherichia coli was the most frequent organism(78.3 percent), followed by Klebsiella(11.6 percent), Pseudomonas(2.9 percent), Proteus(2.9 percent), Enterobacter, Morganelle, and Enterococcus(1.4 percent) in descending order. Antibiotic sensitivity of gram negative organisms was above 90 percent against imipenem, amikacin, 80 percent against aztreonam, cefepime, ceftriaxone, 50-70 percent against gentamicin, trimethoprime-sulfamethoxazole (TMP/SMX), and 23 percent against ampicillin(23.4 percent). Conclusion : Antibiotict sensitivity of gram negative organisms was high to amikacin and third generation cephalosporins but low to ampicillin, gentamicin and TMP/SMX. The use of ampicillin or TMP/SMX, as the first choice of the empiric and prophylactic treatment for UTI, should be reconsidered and investigated further.

• Tuberculosis and Respiratory Diseases
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• v.67 no.1
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• pp.21-26
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• 2009

Background: Non-invasive positive pressure ventilation (NPPV) ensures adequate gas exchange during bronchoscopy in spontaneously breathing, hypoxemic patients, thus avoiding endotracheal intubation. However, in some patients, endotracheal intubation is eventually required after bronchoscopy. This study investigated the incidence of intubation and predictors of a need for emergency intubation prior to NPPV bronchoscopy initiation. Methods: On a retrospective basis, we reviewed the medical records of 36 patients (median age, 55 years; interquartile range [IQR], 43~65 years) with acute hypoxemic respiratory failure who required NPPV during bronchoscopy between January 2005 and October 2007. Results: All patients were hypoxemic (median $PaO_2/FiO_2$ ratio 155; IQR 90~190), but tolerated bronchoscopy with NPPV support. SOFA score and SAPS II score immediately before NPPV initiation were 4 (3~7) and 36 (30~42), respectively. Seventeen (47%) patients needed endotracheal intubation at a median time of 22 (2~50) hours after bronchoscopy. Patients who needed intubation after bronchoscopy had a higher in-hospital mortality (11 [65%] vs. 4 [21%], p=0.017). Upon multiple logistic regression analysis, the need for intubation after bronchoscopy was independently associated with a $P_aO_2/FiO_2$ ratio (OR, 0.961; 95% CI, 0.924~0.999; p=0.047) immediately before NPPV initiation for bronchoscopy. Conclusion: The severity of the hypoxemia immediately prior to NPPV initiation for bronchoscopy was associated with the need for intubation after bronchoscopy in patients with hypoxemic respiratory failure.

• KDI Journal of Economic Policy
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• v.13 no.2
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• pp.41-67
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• 1991

Local autonomy of Korea's lower-level local council has been reinstated following elections last March for the first time in thirty years. Last June, we had elections for the upper-level local council. Mayors, governors, and administrative chiefs of cities, provinces and other local government bodies are slated for elections in the first half of next year. The impacts of local autonomy are taking effect in not only the political sphere, but also the administrative and economic spheres. In fact, it seems that some modification of all economic policy making and administration is inevitable. Since the initiation of local autonomy, in order to make the economy work more efficiently, it has become quite important to examine the impact of local autonomy on the national economy. The areas of local autonomy include independent legislative power, administrative power, organizational power, and most important of all, the independent public financial power of the local governments. The purpose of this paper is to examine the effects of local autonomy on the national economy and ways of enhancing the role of local public finance to facilitate settlement and development of the local autonomy system. Local autonomy will contribute to the continuous growth of our economy, allow balanced development, and generate greater efficiency. However, local autonomy can also incur economic costs causing at times short-term price instability, inefficient resource allocation, through tax competition and tax exporting, and insolvency of local government due to abusive fiscal operation. To reduce these side effects, different alternatives must be considered. Local autonomy systems generally provide more efficient resource allocation than centralization. But in the model used in Chapter 3 of this paper, the relative efficiencies of both local autonomy and centralization are determined by comparing the elasticity of substitution between national public goods and local public goods. If the elasticity of substitution is bigger than one, centralization provides a more efficient resource allocation. The development of local autonomy could be attained through democratization of the local public finance system including the following three propositions. I) The independence of public financial power of local governments should be established over central government. Furthermore, a democratically operated scheme of intergovernmental fiscal coordination is especially necessary. 2) In the operation of local finance, direct democracy is needed to induce the voluntary participation of local residents. The residents can take part in planning both the local budget and the development of the community. To attain this goal, all the results of local finance operations should be made public. 3) Among economic ill-effects of the local autonomy system, the most serious one is the possibility of insolvency of local governments. Therefore, measures to limit abusive spending by the local governments should be introduced, such as the fiscal restraints system adopted in the United States.

• Journal of Radiation Protection and Research
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• v.27 no.1
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• pp.37-49
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• 2002

The accuracy of radiation dose delivery to target volume is one of the most important factors for good local control and less treatment complication. In vivo dosimetry is an essential QA procedure to confirm the radiation dose delivered to the patients. Transmission dose measurement is a useful method of in vivo dosimetry and it's advantages are non-invasiveness, simplicity and no additional efforts needed for dosimetry. In our department, in vivo dosimetry system using measurement of transmission dose was manufactured and algorithms for estimation of transmission dose were developed and tested with phantom in various conditions successfully. This system was applied in clinic to test stability, reproducibility and applicability to daily treatment and the accuracy of the algorithm. Transmission dose measurement was performed over three weeks. To test the reproducibility of this system, X-tay output was measured before daily treatment and then every hour during treatment time in reference condition(field size; $10 cm{\times} 10 cm$, 100 MU). Data of 11 patients whose pelvis were treated more than three times were analyzed. The reproducibility of the dosimetry system was acceptable with variations of measurement during each day and over 3 week period within ${\pm}2.0%$. On anterior- posterior and posterior fields, mean errors were between -5.20% and +2.20% without bone correction and between -0.62% and +3.32% with bone correction. On right and left lateral fields, mean errors were between -10.80% and +3.46% without bone correction and between -0.55% and +3.50% with bone correction. As the results, we could confirm the reproducibility and stability of our dosimetry system and its applicability in daily radiation treatment. We could also find that inhomogeneity correction for bone is essential and the estimated transmission doses are relatively accurate.

• Tuberculosis and Respiratory Diseases
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• v.53 no.4
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• pp.389-400
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• 2002

Background : The rapid diagnostic tests for tuberculosis are needed to facilitate early treatment of tuberculosis and prevention of Mycobacterium tuberculosis transmission. The Xeniss Rapid TB kit is a rapid, card-based immunochromatographic test for the detection of antibodies directed against M. tuberculosis antigens including antigen 5(38-kDa antigen). The objective of this study was to evaluate the performance of the Xeniss Rapid TB kit for the diagnosis of active tuberculosis with serums from patients, asymptomatic healthy and close contact controls. Methods : 188 patients with active tuberculosis were tested; 177 with pulmonary tuberculosis(18 with combined pleurisy), and 11 with extrapulmonary tuberculosis. The control groups were composed of 82 close contacts and 57 healthy adults. Study subject were drawn from one national tuberculosis hospital for patients and close contacts, and another private hospital for healthy adults in Masan city, Korea. The Xeniss Rapid TB kit(Xeniss Life Science Co., Ltd., Seoul, Korea) was evaluated by using serum samples according to the instructions of the manufacturer by an investigator masked to the clinical and microbiological status of the study subjects. Results : The diagnostic sensitivity of the Xeniss Rapid TB kit was 73.9% in patients and specificities were 73.2% and 93.0% in close contact and healthy adults respectively. The positive predictive value in patients was 84.2% and the negative predictive value in controls was 85.8%. Conclusion : This study shows that the Xeniss Rapid TB test is a simple and fast method to diagnose active TB. The results of the sensitivity and specificites suggest that serodiagnosis using this point of care testing(POCT) device would be valuable and advantageous for screening tuberculosis in the clinical field.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.7 no.1
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• pp.61-73
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• 2004

Purpose: Liver function test abnormalities have been reported frequently in patients receiving total parenteral nutrition (TPN). In adults, it is known that liver complications decrease with the use of cyclic parenteral nutrition (CPN), especially if the shift to cycling was not too late. However, there are few studies about the effects of cycling on liver injury in children beyond the neonatal period. The aim of this study is to evaluate the effect of the early use of CPN on total parenteral nutrition induced hepatic dysfunction. Methods: Twelve sets of CPN in 11 children (2 months to 17 years) were included in this study. Data on underlying diseases, age, length of time on TPN, macronutrient intake, complications, and biochemical parameters were collected from clinical records. All children had received CPN in the early period of persistent transaminase elevation or cholestasis complicated by previous continuous PN. The duration of infusion off-time in CPN was 2 hours in patients less than 3 months of age and 4 hours in the older children. Results: All 12 cases showed elevated aminotransferase and 5 of them also showed cholestasis. Serum total bilirubin concentration was normalized in all 5 cases with median periods of 8 days (p<0.05) after initiation of CPN. ALT either decreased significantly or was normalized in all cases with median periods of 30 days (p<0.05) on CPN. The CPN was well tolerated without significant complication except for one case of hyperglycemia. Conclusion: The early use of cyclic parenteral nutrition had a beneficial effect in improving hepatic dysfunction complicated by TPN in children.

• The Korean Journal of Food And Nutrition
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• v.29 no.6
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• pp.998-1007
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• 2016

The objective of this study was to investigate the effects of a lettuce (Lactuca sativa L.) extract on the inflammation of human umbilical vein endothelial cell (HUVEC) and blood lipid improvement in hypercholesterolemic mice fed a high cholesterol diet. The lettuce extract (100% ethanol extract) inhibited the expression of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 in HUVEC treated with tumor necrosis factor-${\alpha}$ (TNF-${\alpha}$). The lettuce extract suppressed the adhesion of THP-1 to TNF-${\alpha}$-treated HUVEC. The lettuce extract decreased the TNF-${\alpha}$-stimulated production of proinflammatory cytokine interleukin-6, interleukin-8 and chemokine monocyte chemotactic protein 1. In hypercholesterolemic mice, the lettuce extract reduced serum total cholesterol, triglyceride, and low-density lipoprotein-cholesterol level, while the lettuce extract elevated high-density lipoprotein-cholesterol level, resulting in the decrease of atherogenic index and cardiac risk factor level. These results suggested that lettuce extract can be an useful resource to show an anti-inflammatory effect and improve lipid metabolism.

• Journal of agricultural medicine and community health
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• v.27 no.1
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• pp.9-19
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• 2002

This study was conducted to compare the health behaviors of patient s before and after a stroke and propose health education program to reduce risk factors related to stroke recurrence. Data were collected from eighty- eight stroke patients registered at the Gyeongju-si Health Center between July 1, to August 30, 1999, by interviewing patients from a prepared structured questionnaire, which included questions on that patients ' general characteristics, health- related behaviors, family-related characteristics, and pre- and post - stroke health status. Smoking rate of 51.1% before stroke reduced to 25.0% after stroke; drinking rate of 52.3% before stroke reduced to 17.0% after stroke; daily smoking amount of 20.1 packs per day before stroke significantly reduced to 14.9 packs per day after stroke; and daily drinking amount of 92.4ml before stroke significantly reduced to 23.7ml after stroke. Smoking rate according to sex showed a marked decrease in the male subjects, but 31.6% still smoked even after their stroke. Among the female subjects, smoking rate of 16.1% before stroke reduced to 12.9% after stroke. Observation of the change in health- related behaviors of stroke patient s showed significant change in smoking rate, drinking rate and intake of regular meals etc. of patient s with a spouse and patients who received preventive health education. Health education on quitting smoking, temperance, low fat diet, exercise and regular meals for stroke patient s are needed, and public and private organizations can do their part in development and providing continuing health education programs and health education.

• Tuberculosis and Respiratory Diseases
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• v.65 no.6
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• pp.471-475
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• 2008

Background: In order to achieve a maintenance level and to prevent hemorrhagic complications, regular monitoring of the INR is mandatory for patients on oral anticoagulation therapy (OAT). A point-of-care instrument for INR monitoring is convenient for users, but the accuracy of the results has been controversial, and so this calls for exact evaluation of the point-of-care instrument that is used for INR monitoring. Methods: From Aug 2007 through Feb 2008, 85 patients on OAT among the all the patients who were admitted to Soonchunhyang University Bucheon Hospital were involved in this study. Parallel measurements of the PT INR were performed using a CoaguChek-XS and, a CA-7000 laboratory reference instrument and the results were analyzed. In addition, the patients' clinical data, including the diagnosis and the frequency and interval of the INR measurements, were also analyzed. Results: Of the 85 patients, 25 were admitted more than once to undergo INR testing and the mean interval between testing was 8.6 weeks with 39% and 38% of the tests being less than INR 2 units with using the CoaguChek-XS and the reference method, respectively. The coefficients of variation of CoaguChek-XS were 4.50 and 2.45 for the high and low INR patients, respectively. An excellent correlation was found between the two methods with a $R^2$ of 0.966 (p<0.001). Through Bland-Altman analysis, the mean INR difference between the two methods was 0.13 with the limit of agreement being -0.47~+0.72 with a 95% confidence interval. CoaguChek-XS was shown to overestimate the INR value for patients with an increasing INR, as compared to the reference method. Conclusion: CoaguChek-XS demonstrated great precision and accuracy for patients on OAT when compared to the laboratory INR results. Accordingly, the instrument should help to monitor the INR in the patients on OAT.