• Childhood Kidney Diseases
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• v.17 no.2
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• pp.49-56
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• 2013

Purpose: IgA nephropathy (IgAN) is one of the major causes of end-stage renal disease. Mass school urine screening (SUS) has been performed to enable early detection of chronic renal diseases, including IgAN. We wanted to evaluate the patients with IgAN, including those diagnosed through SUS. Methods: Between 1998 and 2010, 64 children were diagnosed with IgAN based on renal biopsy results obtained at the Pediatric Nephrology Department, ${\bigcirc\bigcirc}$ University Hospital. We divided these patients into the SUS group (37 cases), diagnosed through SUS, and the symptomatic (Sx) group (27 cases), diagnosed clinically. The medical records of both groups were analyzed retrospectively. Results: The mean age of the SUS and Sx groups was $10.8{\pm}2.7$ and $9.5{\pm}3.4$ years (P >0.05), respectively. Both groups had a higher proportion of male patients. The time from the notification of an abnormal urinary finding to a hospital visit or renal biopsy was shorter in the Sx group than in the SUS group. Regarding clinical manifestations, there were fewer cases with gross hematuria (P <0.001) and edema (P =0.008) in the SUS group, but there were no differences in terms of the therapeutic regimen and treatment duration. Regarding laboratory parameters, the Sx group had a higher white blood cell count (P =0.007) and lower hemoglobin (P =0.007) and albumin (P =0.000) levels. There were no differences in the renal biopsy findings in both groups, based on the history of gross hematuria or the severity of proteinuria. However, in all 64 patients with IgAN, the light microscopy findings (Hass classification) were related to a history of gross hematuria or the severity of proteinuria. Conclusion: There were no significant clinical and histological differences between the groups, as both had early stage IgAN. Although SUS facilitates the early detection of IgAN, long-term, large-scale prospective controlled studies are needed to assess the benefits of early diagnosis and treatment in chronic renal disease progression.

• Childhood Kidney Diseases
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• v.17 no.2
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• pp.110-116
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• 2013

Purpose: The $^{99m}Tc$-Dimercaptosuccinic acid (DMSA) renal scan is used primarily for the diagnosis of renal scarring and acute pyelonephritis in children with urinary tract infections (UTI). This study aimed to evaluate clinical differences based on the positive or negative results of DMSA scans and kidney ultrasonography (US) in pediatric UTI. Method: We retrospectively reviewed 142 pediatric patients with UTI who were admitted to Myongji Hospital from January 2004 to December 2012. We performed a comparative analysis of clinical parameters such as age, sex, white blood cell (WBC) count, neutrophil count, blood urea nitrogen (BUN) level, creatinine (Cr) level, C-reactive protein (CRP) level, and durations of hospitalization and fever, grouped by the results of the DMSA scans and kidney US. Results: The mean age of the patients was $33.8{\pm}48.3$ months, and 78 (55%) were male. Fifty-two patients had abnormal DMSA findings, and 71 patients had abormal kidney US findings (test positive groups). In the DMSA scan positive group, there were significant differences in age, WBC counts, neutrophil counts, CRP level, BUN level, Cr level, hospitalization duration, number of abnormal findings on kidney US, and incidence of vesicoureteral reflux (VUR) compared with the scan negative group. The kidney US positive group had significant differences in age, neutrophil count, CRP level, BUN level, Cr level, hospitalization duration, number of abnormal findings on the DMSA scans, and more frequent VUR compared with the US negative group. Conclusion: Our data suggest that there were no major differences in clinical parameters based on the results of the DMSA scans compared with kidney US in pediatric UTI. However, as kidney US and DMSA scan were performed to predict VUR, the sensitivity and negative predictive value was increased.

• Journal of Dental Rehabilitation and Applied Science
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• v.34 no.4
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• pp.280-289
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• 2018

Purpose: The purpose of this randomized clinical trial is to determine whether implant length and the crown-to-implant (C/I) ratio influence implant stability and peri-implant marginal bone loss (MBL). Materials and Methods: 46 patients with single tooth missing in the posterior molar region of the mandible were included in this study. 19 implants (CMI IS-III $active^{(R)}$ long implant) of 5.0 mm diameter and 10 mm length were installed for the control group, while 27 implants (CMI IS-III $active^{(R)}$ short implant) of 5.5 mm diameter and 6.6, 7.3 or 8.5 mm length were placed for the experimental group. Each implant was inserted and immediately loaded using the digitally pre-fabricated surgical template and provisional restoration. The CAD-CAM monolithic zirconia crown was fabricated at 3 months after the surgery as a definitive restoration. The ISQ value and the MBL was measured at 48 weeks after the surgery. The correlation between the C/I ratio, MBL, and secondary implant stability was analyzed. Results: Successful results in terms of ISQ and MBL were achieved with both groups. There was no significant difference between the groups in terms of ISQ values and MBL at 48 weeks after the surgery (P > 0.05). No significant correlation was found between the C/I ratio and secondary stability as well as the C/I ratio and the MBL (P > 0.05). Conclusion: The influence of C/I ratio in both groups was not shown on the stability nor the marginal bone loss in implants supporting single crown of the mandible. Short implant could be a preferable alternative option in the reduced bone height mandible under the limited condition despite its higher C/I ratio.

• The Korean Society of Law and Medicine
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• v.24 no.4
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• pp.67-101
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• 2023

The utilization of generative AI in the medical field is also being rapidly researched. Access to vast data sets reduces the time and energy spent in selecting information. However, as the effort put into content creation decreases, there is a greater likelihood of associated issues arising. For example, with generative AI, users must discern the accuracy of results themselves, as these AIs learn from data within a set period and generate outcomes. While the answers may appear plausible, their sources are often unclear, making it challenging to determine their veracity. Additionally, the possibility of presenting results from a biased or distorted perspective cannot be discounted at present on ethical grounds. Despite these concerns, the field of generative AI is continually advancing, with an increasing number of users leveraging it in various sectors, including biomedical and life sciences. This raises important legal considerations regarding who bears responsibility and to what extent for any damages caused by these high-performance AI algorithms. A general overview of issues with generative AI includes those discussed above, but another perspective arises from its fundamental nature as a large-scale language model ('LLM') AI. There is a civil law concern regarding "the memorization of training data within artificial neural networks and its subsequent reproduction". Medical data, by nature, often reflects personal characteristics of patients, potentially leading to issues such as the regeneration of personal information. The extensive application of generative AI in scenarios beyond traditional AI brings forth the possibility of legal challenges that cannot be ignored. Upon examining the technical characteristics of generative AI and focusing on legal issues, especially concerning the protection of personal information, it's evident that current laws regarding personal information protection, particularly in the context of health and medical data utilization, are inadequate. These laws provide processes for anonymizing and de-identification, specific personal information but fall short when generative AI is applied as software in medical devices. To address the functionalities of generative AI in clinical software, a reevaluation and adjustment of existing laws for the protection of personal information are imperative.

• Health Policy and Management
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• v.34 no.3
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• pp.319-333
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• 2024

Background: This study aims to identify the factors that influence the incidence of catastrophic health expenditure (CHE) for the elderly living alone and to discuss how to manage CHE for the elderly living alone. Methods: This study utilizes 6th (2016), 7th (2018), and 8th (2020) data from the Korean Longitudinal Study of Aging to identify the incidence rate of CHE among the elderly living alone and conducts a panel logit analysis. The dependent variable is the incidence of CHE (thresholds: 10%, 20%, 30%), and the independent variables include demographic factors (gender, age group, region), socioeconomic factors (education level, economic activity status, income quintile, financial support rate from children), health-related factors (subjective health status, regular exercise, smoking, drinking, number of chronic diseases), and healthcare coverage factors (type of health insurance, private health insurance). Results: Descriptive statistics classified by gender show that female elderly living alone are more vulnerable than male elderly living alone in terms of disease prevalence and socioeconomic status. In addition, the incidence of CHE is higher for elderly women living alone than for elderly men living alone across all thresholds. The main results of the panel logit analysis show that higher education, income quintile, and financial support rate from children are associated with lower odds of CHE, while poorer subjective health and a higher number of chronic diseases are associated with higher odds of CHE. Medical aid recipients are less likely to incur CHE than those covered by national health insurance. Conclusion: The implications of this study are as follows. First, vulnerable elderly living alone with multiple chronic diseases and low income and education levels are more likely to incur CHE. Second, it is necessary to review policies such as a CHE support program and chronic disease management programs focused on vulnerable elderly individuals living alone. Third, the CHE support program should be operated in a patient-centered manner, with consideration given to a customized system for selecting and supporting elderly individuals living alone who are in need.

• Childhood Kidney Diseases
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• v.5 no.2
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• pp.136-146
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• 2001

Purpose : One of the most difficult problems in the care of children with nephrotic syndrome remains the occurrence of relapses, despite initial response to steroids. Constantinescu reported that rapidity of initial response to steroid therapy could predict fewer relapses in the first year. So we evaluated the changes in serum lipid abnormalities in children with corticosensitive nephrotic syndrome before steroid treatment and the correlation between serum lipid levels and renal function, days to remission. Methods . We analyzed the Medical records of children who were managed by us between October 1994 and August 2000. In 33 patients with corticosensitive nephrotic syndrome, we evaluated the correlation between serum lipid levels and renal function [Creatinine clearance(Ccr)] and proteinuria before steroid treatment, and days to remission defined as the third day when the patient's urine becomes protein free. Results : There were 21 males and 12 females. Median age at presentation was 6.4 years (range: 1.8-17.3 years). Median days to remission were 15.4 days (range 4-42 days) on Prednisolone $60mg/m^2$ daily. The increased levels of triglyceride, total cholesterol, LDL cholesterol, apolipoprotein B, total cholesterol/HDL cholesterol, Lipoprotein(a) were observed. But the level of HDL cholesterol was not increased. Serum albumin was decreased a]id proteinuria was increased before steroid treatment. But Ccr was not decreased. There were negative correlation between serum albumin and total cholesterol (r = -0.5157, P<0.005), LDL cholesterol (r = -0.5543, P<0.005), total cholesterol/HDL cholesterol (r = -0.4506, P<0.01), lipoprotein(a) (r = -0.4570, P<0.025), apolipoprotein B (r = -0.5297, P<0.025), apolipoprotein B/apolipoprotein Al (r = -0.5851, P<0.01), apolipoprotein B/HDL cholesterol (r = -0.4961, P<0.05) before steroid treatment. There was no correlation between proteinuria and serum lipid profiles. Also Ccr and serum lipid profiles were not correlated. There was positive correlation between days to remission and HDL cholesterol (r = +0.4511, P<0.05), apolipoprotein B (r = +0.5190, P<0.05), apolipoprotein B/HDL cholesterol (r = +0.7169, P<0.005). Conclusions : This results reveal that HDL cholesterol, apolipoprotein B and apolipoprotein B/HDL cholesterol can be used as a predictive factor in corticosensitive nephrotic syndrome. We could not determine the significant level of these lipids for insufficient patients number, but these level may predict future relapses of corticosensitive nephrotic syndrome patients and thus may allow to better management and treatment protocols. More data and long term follow up studies should be needed. (J Korean Soc Pediatr Nephrol 2001;5 : 136-46)

• Journal of Sasang Constitutional Medicine
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• v.8 no.1
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• pp.101-186
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• 1996

The clinical application of constitutional Diagnosis is the most important part of Sasang constitutional medicine. It has been studied in various way. However, the study of morphologic characteristics on the face is applied for the first time. For quantitative analysis of the correlation between the sasang constitution and the shape of the face, the head-facial part of 170 cases were measured by Martin's measurement and analysis of a) the measurement value of height and the component ratio from the Gnathion to each part of face by constitution. b) the measurement value of depth and the component ratio from T-projected to each part of the face by constitution. c) the measurement value of breadth and component ratio between each parts of the facial breadth by constitution. d) the ratio of square on every part of face by constitution. e) the characteristics on each part of the face by constitution. f) the contour line of the forehead. g) the result of discriminant analysis about the constitution. Authors obtained the results from the study as follows; 1. The characteristics of Taeum-IN (1) The measurement value of Height, Breadth, T-Projected had a tendency to maximum value in general. (2) The value of lower opthal height and the square of lower opthal part was maximum. (3) The value of Pronasal T-projected length and Subnasal T-projected length was minimum, so Taeum-In has characteristics of depression in middle face, nasal part. (4) In the ratio of Breadth, T-Projected, T-Projected was minimum. (5) It was maximum that the square of nose, Alare, Middle face, Lower face and it was minimum that the square of eye. The square of nose, Alare, Middle facc, Lower face was maximum and the square of eye was minimum. (6) The curvature of the eyebrow was minimum. (7) The projection of jaw (Pogonion T-projection length) was maximum. (8) The breadth of eye was minimum. (9) There was a tendency that the projection of the forehead to the right in general. 2. The characteristics of Soeum-In (1) In all cases of projected length the measurement value was minimum. (2) The value of lower opthal height and the square of lower opthal part was minimum. (3) By the Pupulare T-projected length, the value of Pronasal T-projected length and Subnasal T-projected length was minimum, so the Soeum In's face shape is flat. (4) The square of eye, mouth, forehead was maximum and the square of nose, Alare, Middle face, Lower face was minimum. (5) The curvature of the eyebrow was maximum. (6) The projection of mouth was minimum. (7) The jaw was flat. (8) The breadth of eye was maximum. (9) There was a tendency that the projection of the forehead to the left in general. 3. The characteristics of Soyang-In. (1) In most cases of 고경 length the measurement value was minimum. (2) By the Pupulare T-projected length, each ratio of projected length was maximum, so the Soyang-In's face shape has many protrusions (3) In the ratio of Breadth, T-Projected, T-Projected was maximum. (4) The square of mouth was minimum. (5) The inclination of the forehead was minimum. (6) The projection of mouth was maximum. (7) The breadth of eye was minimum. (8) There was a tendency that the projection of the forehead to the left in general. (9) The middle face was protruded. 4. Discriminant about the constitution. According to the result of discriminant, the accuracy probability of discriminant was 85.58% in total and Taeum-In was 90.5%, Soeum-In was 70.8%, Soyang-In was 89.5%. The accuracy probability of discriminant about 3 constitutional group increased by 49.03% than the accident probility 36.55% 5. Suggestion (1) The study which gather and analysis the data should be continued. (2) The study which subdivide the characteristics of each part of the face by the constitution should be continued. (3) The analysis method about Moire should be supplement. (4) The study about the morphologic characteristics of the whole body should be continued. (5) Computer program of constitution diagnosis should be developed. (6) To increase utility of this method, the measurement should be automation.