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The Effects of $1{\alpha}-(OH)D_3$ and Pamidronate on Steroid Induced Osteoporosis (SIO) in Children with Nephrotic Syndrome (NS) (신증후군 환아에서 스테로이드에 의한 골다공증 치료에 $1{\alpha}-(OH)D_3$와 Pamidronate의 효과)

  • Kim Sung-Do;Jhon Hye-One;Cho Byoung-Soo
    • Childhood Kidney Diseases
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    • v.6 no.2
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    • pp.209-217
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    • 2002
  • Purpose : Corticosteroid has been used as the mainstay therapy of childhood NS. But SIO is one of the serious complications of long-term steroid therapy, especially in growing children. Recently calcium, calcitonin, PTH, vitamin D and bisphosphonate has been used to treat or prevent SIO in adult, which is rare in children with NS. We studied the effect of $1{\alpha}-(OH)D_3$ and Pamidronate on SIO using dual energy X-ray absorptiometry (DEXA). Patients and methods : We studied thirty patients who admitted in the Dept. of Pediatrics of Kyung Hee Medical Hospital with NS. All patients was received longterm steroid therapy. There was no history of bone, liver, or endocrine disease. The samples, serum protein, albumin, BUN, creatinine, calcium, phosphorus, and BMD were obtained before and the six months after the dose of $1{\alpha}-(OH)D_3$ and Pamidronate, respectively Results : The mean age was $6.9{\pm}3.3\;and\;6.5{\pm}2.5$ years old. The mean duration of steroid therapy was $28.8{\pm}1.8\;and\;27.6{\pm}1.0$ months. The changes of serum protein, albumin, BUN, creatinine, calcium and phosphorus level between pre-treatment and post-treatment did not show statistical significance in both $1{\alpha}-(OH)D_3$ and Pamidronate treatment group. However, BMD was increased in both from $0.472{\pm}0.12\;and\;0.457{\pm}0.10\;g/cm^2\;to\;0.533{\pm}0.12$ and $0.529{\pm}0.09\;g/cm^2$ after treatment. (P<0.05) Conclusion : Both $1{\alpha}-(OH)D_3$ and Pamidronate appears to be effective in treating and preventing SIO in children with nephrotic syndrome requiring long-term steroid therapy.

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Pulmonary Valve Replacement with Tissue Valves After Pulmonary Outflow Tract Repair in Children (소아에서 폐동맥유출로 재건 후 시행한 조직판막을 이용한 폐동맥판 대치술)

  • Lee, Jeong-Ryul;Hwang, Ho-Young;Chang, Ji-Min;Lee, Cheul;Choi, Jae-Sung;Kim, Yong-Jin;Rho, Joon-Ryang;Bae, Eun-Jung
    • Journal of Chest Surgery
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    • v.35 no.5
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    • pp.350-355
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    • 2002
  • Background: Most of pulmonary regurgitation with or without stenosis appears to be well tolerated early after the repair of pulmonary outflow tract. However, it may result in symptomatic right ventricular dilatation, dysfunction and arrhythmias over a long period of time. We studied the early outcome of pulmonary valve replacement with tissue valves for patients with the above clinical features. Material and Method: Sixteen consecutive patients who underwent pulmonary valve replacement from September 1999 to February 2002 were reviewed(9 males and 7 females). The initial diagnoses included tetralogy of Fallot(n=11), and other congenital heart anomalies with pulmonary outflow obstruction(n=5). Carpentier-Edwards PERIMOUNT Pericardial Bioprostheses and Hancock porcine valves were used. The posterior two thirds of the bioprosthetic rim was placed on the native pulmonary valve annulus and the anterior one third was covered with a bovine pericardial patch. Preoperative pulmonary regurgitation was greater than moderate degree in 13 patients. Three patients had severe pulmonary stenosis. Tricuspid regurgitation was present in 12 patients. Result: Follow-up was complete with a mean duration of 15.8 $\pm$ 8.5months. There was no operative mortality. Cardiothoracic ratio was decreased from 66.0 $\pm$ 6.5% to 57.6 $\pm$ 4.5%(n=16, p=0.001). All patients remained in NYHA class I at the most recent follow-up (n=16, p=0.016). Pulmonary regurgitation was mild or absent in all patients. Tricuspid regurgitation was less than trivial in all patients. Conclusion: In this study we demonstrated that early pulmonary valve replacement for the residual pulmonary regurgitation with or without right ventricular dysfunction was a reasonal option. This technique led to reduce the heart size, decrease pulmonary regurgitation and tricuspid regurgitation as well as to improve the patients'functional status. However, a long term outcome should be cautiously investigated.

Bivalvation Valvuloplasty for Common Atrioventricular Valve Regurgitation in Functional Single Ventricle; Early and Mid-term Results (기능적 단심설에서 공통방실판 역류의 판막성형술; 판막 이분성형술(bivalvation)의 조기 및 중기 결과)

  • Chang, Yun-Hee;Sung, Si-Chan;Kim, Seon-Hee;Lee, Hyoung-Doo;Ban, Ji-Eun
    • Journal of Chest Surgery
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    • v.42 no.5
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    • pp.597-603
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    • 2009
  • Background: Atrioventricular valve regurgitation in pediatric patients with a functional single ventricles (FSV) - has been known as one of the important risk factors for death and unfavorable long-term results after a Fontan operation. We evaluated early and mid-term results of bivalvation valvuloplasty in FSV patients. Material and Method: We retrospectively evaluated 11 patients with a functional single ventricle who underwent bivalvationvalvuloplasty between 1999 and 2007. The degree of common atrioventricular valve regurgitation (CAVVR) was determined by color Doppler echocardiography (regurgitation grade scoring, trivial; 1, mild; 2, moderate; 3, severe; 4). Mean age at valve surgery was $6.9{\pm}7.0$ months (median 4 months, 24 days$\sim$21 months)and mean body weight was $6.2{\pm}2.8\;kg$ ($3.1{\sim}11.3\;kg$). Nine patients had isomerism heart and two of them had TAPVC. The concomitant procedures were performed in all but one patient. Additional commissural closure was performed in 3 patients and commissural annuloplasty in another 3 patients. Result: There was one hospital death after. surgery. A 32-day old patient who had been preoperatively dependent on a ventilator died of air way and lung problems 4.3 months after pulmonary artery banding and bivalvation valvuloplasty. Mean follow-up duration was 40 months ($4.3{\sim}114$ months). Mean preoperative CAVVR score was $3.3{\pm}0.6$, which decreased to $1.9{\pm}0.7$ postoperatively (p<0.0001). This residual regurgitation slightly increased to $2.2{\pm}0.4$ (no statistical significance) after a mean follow-up of 1.4.3 months. Six patients (60%) required re-operations for residual regurgitation at a subsequent bidirectionalcavopulmonary shunt or Fontan operation. One patient with Ebsteinoid malformation of the right sided atrioventricular valve required valve replacement due to stenoinsufficiency. Another patient required edge-to-edge repair at the right sided AV valve (between the right mural leaflet and the bridging leaflets). The remaining 4 patients required additional suture placements between bridging leaflets with or without commissural annuloplasty. All survivor had trivial or mild CAVVR at the latest follow-up. Conclusion: Bivalvation valvuloplasty for CAVVR in FSV patients is. an effective and safe procedure. However, significant numbers of the patients have small residual regurgitation and require additional valve procedures at subsequent operations. Long-term observations to monitor progression of the CAVVR is mandatory.

Longitudinal Root Anatomy, Cell Dynamics, and Physiological Cell Responses in Root Growth Zones of Two Tall Fescue Genotypes at Two Nitrogen Levels (톨페스큐 뿌리생장부위의 종적해부구조, 세포역학 및 생리적 반응에 대한 질소효과)

  • Beom Heon, Song;Curtis J, Nelson
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.40 no.3
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    • pp.285-296
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    • 1995
  • Anatomical studies of sink tissues are required for better understanding the biological plant growth system and energy metabolism. Kinematics of root growth zones of two genotypes of tall fescue (Festuca arundinacea Schreb.) receiving 50 or 200 ppm N were determined. Longitudinal anatomy and cell dynamics of root growth zones were studied and calculated. The root growth zone is organized similarly to the leaf growth zone which has cell division, elongation, and maturation zones, but the root growth zone is only about 3.0 mm long compared to 25 to 30 mm for the leaf growth zone. The root cap extends about 0.4 to 0.5 mm from the apical initial, while the cell elongation zone for both cortical and metaxylem cells extends about 3.3 mm from the apical initial for both genotypes and N levels. Root cap cells elongate from an initial length of about 5$\mu{m}$ long to a final length of about 40$\mu{m}$ before being sloughed. Initial lengths of cortical and metaxylem cells were about 8.5 $\mu{m}$ and 13.0 $\mu{m}$, respectively. Elongation of cortex and metaxylem cell showed sigmoidal curves with final lengths of about 120 $\mu{m}$ for cortex cells and 650 $\mu{m}$ for metaxylem cells. Initial size and final size for both types were not affected by N level, but cell fluxes and cell elongation rates of cortical and metaxylem cells were about double in low N. Cell production rates were about 5 to 6 times higher in cortical cells than in metaxylem cells. Differences in N caused a larger change in cell production rate, duration of cell elongation, and relative cell elongation rate than did the genotypes. These data indicate that N application affects root growth longitudinally by changing cell production rate and elongation rate.

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Temporal Changes of Hyalessa fuscata Songs by Climate Change (기후변화에 의한 참매미 번식울음 시기 변화 연구)

  • Kim, Yoon-Jae;Ki, Kyong-Seok
    • Korean Journal of Environment and Ecology
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    • v.32 no.2
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    • pp.244-251
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    • 2018
  • The present study aimed to identify the influence of climate change on mating songs of Cicadidae in a phenological perspective. The research sites were located in the central part of the Korean peninsula in which phenological observations by the Meteorological Office are made. The material provided by the Meteorological Office was used for long term phenological analysis. The findings demonstrated, First, the phenological monitoring of cicada is an effective index to detect ecological changes due to climate change, thus indicating the importance of long term phenological investigations for future studies. Second, the analysis on the phenological changes of H. fuscata presented a trend in which the first songs were made at increasingly earlier and later dates, respectively. The phenological data on H. fuscata and average temperatures exhibited a significant negative correlation between the initial mating song period and the average temperatures of June. Furthermore, there was also a significant negative correlation for precipitation in October with the end time and total duration of H. fuscata song. Third, in the regression analysis of the start of H. fuscata song and meteorological factors in Seoul, increasing average air temperature in spring (March to June), which includes June, was associated with an earlier start time of H. fuscata song, with calling starting approximately 3.0-4.5 days earlier per $1^{\circ}C$ increase. Fourth, in the regression analysis of the end of H. fuscata song and meteorological factors in Seoul, increased mean precipitation in October was associated with an early end time and an overall reduction in the length of the song period. The end time of song decreased by approximately 0.78 days per 1mm increase in precipitation, and the total length of the song period decreased by 0.8 days/1mm. This research is important, as it is the initial research to identify the phenological changes in H. fuscata due to climate change.

Outcomes of Patients with COPD Requring Mechanical Ventilation (만성폐쇄성폐질환 환자의 기계호흡시 생존 예측 인자 분석)

  • Baik, Jae-Joong;Kim, Sang-Chul;Lee, Tae-Hoon;Chung, Yeon-Tae
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.2
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    • pp.179-188
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    • 2000
  • Background : The decision to institute mechanical ventilation for patients with COPD is very difficult. The accurate information regarding weaning success and long-term survival will improve communication with patients and family and enhance informed consent. The aims of this study are to describe outcomes and identify variables associated with survival for patients experiencing mechanical ventilation with an acute respiratory failure of COPD. Methods : The 53 cases of mechanical ventilation in the intensive care unit in the National Medical Center from 1989 to 1998 were included. Data were collected retrospectively from medical records. Weaning success rate and 3 month and 1 year survival rates were estimated. Factors associated with weaning success and survival were determined. Results : Weaning sucess was 55%. For success group with 29 cases, 3 months survival rate was 61% and 1 year survival rate 37%. APACHE II scores in weaning success group were significantly lower than those in the failure group. Factors such as age, sex, comorbid-illnes. previous steroid use, causes of respiratory failure, RVH or arrhythmia on EKG, serum albumin level, arterial blood pH, $PaO_2$, $PaCO_2$, $FEV_1$ duration of mechanical ventilation and steroid use during mechanical ventilation were not associated with weaning success. Only age and serum albumin level were associated with 3 month and 1 year survival. No COPD patients of age more than 75 years and serum albumin level less than 3g/dl had survived at 1 year after weaning success. Conclusion : While weaning success from mechanical ventilation can be predicted by APACHE II score in COPD patients, long-term outcomes of survivors may be influenced by nutritional status and age.

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Colon Interposition as a Gastric Substitute after Performing Gastrectomy in Patients with Gastric Cancer (위암 환자에서 위 절제술 후 결장 간치술)

  • Lee, Jun-Hyun;Hur, Hoon;Jeon, Hae-Myung;Kim, Wook
    • Journal of Gastric Cancer
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    • v.8 no.4
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    • pp.217-224
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    • 2008
  • Purpose: For most surgeons, colon interposition after gastrectomy remains an infrequently performed procedure because of its complexity. The aim of this study was to assess its technical feasibility and safety as a post-gastrectomy reconstruction method by reviewing our experience with colon interposition. Materials and Methods: From March 2001 to February 2002, 30 colon interpositions after-gastrectomy were done with using the ileo-ascending or transverse colon. We analyzed the clinicopathologic features and the surgical outcomes. Results: There were 16 males and 14 females in this study with a mean age of 67.5 years (range: 31 to 76 years). Twenty-five ascending colons and 5 transverse colons were used for the interposition, respectively. The mean operation time was 373 minutes (range: 204 to 600 minutes). There were 9 operative morbidities (30%) and 1 operative mortality. The restoration of bowel motility was noted at 3.8 postoperative days; a soft diet was started at 4.9 postoperative days and the duration of the hospital stay was 18.2 days. The percentage of weight loss in the patients with total, proximal and distal gastrectomy was 16.3%, 14.0% and 8.8%, respectively, at 6 months, and thereafter the weight loss gradually recovered as 8.1%, 7.5% and 5.6%, respectively, at 5 years postoperatively. Gastric stasis was the one of the most meaningful long-term complications, and especially in the patients who underwent distal gastrectomy with colon interposition. Conclusion: Colon interposition after gastrectomy was a very complex procedure with a long operating time and many anastomosis sites. The postoperative outcomes failed to achieve satisfactory weight gain and the patients displayed postprandial symptoms. This suggested that this procedure was not an appropriate procedure for conventional reconstruction after gastrectomy.

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Diving patterns and diving related disease of diving fishermen in Korea (수산물채취 잠수부의 작업특성과 잠수관련질환의 양상)

  • SaKong, Joon
    • Journal of Preventive Medicine and Public Health
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    • v.31 no.1 s.60
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    • pp.139-156
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    • 1998
  • Diving related disease including decompression sickness is an important occupational health problem and diving fishermen remain a fairly hazardous occupation in Korea. To prevent diving related disease, we investigate diving patterns, incidence of diving related diseases, and contributing factors of 433 diving fishermen of three coast interviewing and mailing questionnaire in 1996. Mean age of divers was 39.7 years, ranged from 24 to 58 years, 92.8% of these were male, and 58.4% of divers were high school graduates. Mean duration of work as a diver was 12.9 years, ranged from 2 to 40 years. It was found that 70.4% of divers were using hookah system, 22.2% of helmet, and only 2.5% SCUBA. About half of them have learned diving skills from other divers. The peak season of diving was from April to June and mean working days were 20.3 days per month during the peak season. On the average, the divers dived 5-6 times, ranged from 1 to 10 times a day with 51.1 minutes of diving time, ranged from 20 to 120 minutes, at 30 m or 40 m in depth, and 35.5 minute of interval on surface. Most divers ascended slowly making decompression stop, yet the decompression profile used was not based on any scientific knowledge except for their own experiences. It appeared that each diving system had slightly different diving patterns. There were 282(65.0%) divers that suffered from DCS in 1995 and 31.2% of divers were given recompression therapy at a medical facility since they worked as diving fishermen. Skin and musculoskeletal complaints were common symptoms of DCS and 39% of divers experienced a voiding difficulty. In univariate analysis, females have an increased frequency of DCS(93% vs 66% for males). Old age, long duration of work, helmet diving, diving time, diving depth, repetitive diving, and blow up were all contributing factors to DCS. It was found that most diving patterns exceed no decompression limit and did not use the standard decompression table. This suggests that most of divers are at high risk of developing diving related disease with prolonged dives and lengthy repetitive diving in deep depth. Considering the diving patterns and economic aspect of professional diving, the incidence of DCS among diving fishermen in Korea will not decrease in the near future. These findings suggest that periodical health surveillance for divers, and education of health and safety are important for reducing the risk of diving related disease in the population of diving fishermen.

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Comparision of Medical Care Utilization Patterns between Beneficiaries of Medical Aid and Medical Insurance (의료보호대상자의 의료이용양상)

  • Kim, Bok-Youn;Kim, Seok-Beom;Kim, Chang-Yoon;Kang, Pock-Soo;Chung, Jong-Hak
    • Journal of Yeungnam Medical Science
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    • v.8 no.2
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    • pp.185-201
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    • 1991
  • A household survey was conducted to compare the patterns of morbidity and medical care utilization between medical aid beneficiaries and medical insurance beneficiaries. The study population included 285 medical aid beneficiaries that were completely surveyed and 386 medical insurance benficiaries selected by simple random sampling from a Dong(Township) in Taegu. Well-trained surveyers mainly interviewed housewives with a structured questionnaire. The morbidity rates of acute illness during the 15-day period, were 63 per 1,000 medical aid beneficiaries and 62 per 1,000 medical insurance beneficiaries. The rates for chronic illness were 123 per 1,000 medical aid beneficiaries and 73 per 1,000 medical insurance beneficiaries. The most common type of acute illness in medical aid and medical insurance beneficiaries was respiratory disease. In medical aid beneficiaries, musculoskeletal disease was most common, but in medical insurance beneficiaries, gastrointestinal disease was most common. The mean duration of acute illness of medical aid beneficiaries was 3.8 days and that of medical insurance beneficiaries was 6.8 days. During the one year period, mean duration of medical aid beneficiaries chronic illnesses was 11.5 months which was almost twice as long compared to medical insurance beneficiaries. Pharmacy was most preferrable facility among the acute illness patient in medical aid beneficiaries, but acute cases of medical insurance beneficiaries visited the clinic most commonly. Chronic cases of both groups visited the clinic most frequently. There were some findings suggesting that much unmet need existed among the medical aid beneficiaries. In acute cases, the average number of days of medical aid users utilized medical facilities was less than medical insurance users. On the other hand, the length of medical care utilization of chronic cases was reversed. Geographical accessibility was the most important factors in utilization of medical facilities. Almost half of the study population answered the questions about source of funds on medical security correctly. Most respondents considered that the objective of medical security was afford ability. The chief complaint on hospital utilization was the complicated administrative procedures. These findings suggest that there were some problems in the medical aid system, especially in the referral system.

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Motives for Writing After-Purchase Consumer Reviews in Online Stores and Classification of Online Store Shoppers (인터넷 점포에서의 구매후기 작성 동기 및 점포 고객 유형화)

  • Hong, Hee-Sook;Ryu, Sung-Min
    • Journal of Distribution Research
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    • v.17 no.3
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    • pp.25-57
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    • 2012
  • This study identified motives for writing apparel product reviews in online stores, and determined what motives increase the behavior of writing reviews. It also classified store customers based on the type of writing motives, and clarified the characteristics of internet purchase behavior and of a demographic profile. Data were collected from 252 females aged 20s' and 30s' who have experience of reading and writing reviews on online shopping. The five types of writing motives were altruistic information sharing, remedying of a grievance and vengeance, economic incentives, helping new product development, and the expression of satisfaction feelings. Among five motives, altruistic information sharing, economic incentives, and helping new product development stimulate writing reviews. Store customers who write reviews were classified into three groups based on their writing motive types: Other consumer advocates(29.8%), self-interested shoppers(40.5%) and shoppers with moderate motives(29.8%). There were significant differences among three groups in writing behavior (the frequency of writing reviews, writing intent of reviews, duration of writing reviews, and frequency of online shopping) and age. Based on results, managerial implications were suggested. Long Abstract : The purpose of present study is to identify the types of writing motives on online shopping, and to clarify the motives affecting the behavior of writing reviews. This study also classifies online shoppers based on the motive types, and identifies the characteristics of the classified groups in terms of writing behavior, frequency of online shopping, and demographics. Use and Gratification Theory was adopted in this study. Qualitative research (focus group interview) and quantitative research were used. Korean women(20 to 39 years old) who reported experience with purchasing clothing online, and reading and writing reviews were selected as samples(n=252). Most of the respondents were relatively young (20-34yrs., 86.1%,), single (61.1%), employed(61.1%) and residents living in big cities(50.9%). About 69.8% of respondents read and 40.5% write apparel reviews frequently or very frequently. 24.6% of the respondents indicated an "average" in their writing frequency. Based on the qualitative result of focus group interviews and previous studies on motives for online community activities, measurement items of motives for writing after-purchase reviews were developed. All items were used a five-point Likert scale with endpoints 1 (strongly disagree) and 5 (strongly agree). The degree of writing behavior was measured by items concerning experience of writing reviews, frequency of writing reviews, amount of writing reviews, and intention of writing reviews. A five-point scale(strongly disagree-strongly agree) was employed. SPSS 18.0 was used for exploratory factor analysis, K-means cluster analysis, one-way ANOVA(Scheffe test) and ${\chi}^2$-test. Confirmatory factor analysis and path model analysis were conducted by AMOS 18.0. By conducting principal components factor analysis (varimax rotation, extracting factors with eigenvalues above 1.0) on the measurement items, five factors were identified: Altruistic information sharing, remedying of a grievance and vengeance, economic incentives, helping new product development, and expression of satisfaction feelings(see Table 1). The measurement model including these final items was analyzed by confirmatory factor analysis. The measurement model had good fit indices(GFI=.918, AGFI=.884, RMR=.070, RMSEA=.054, TLI=.941) except for the probability value associated with the ${\chi}^2$ test(${\chi}^2$=189.078, df=109, p=.00). Convergent validities of all variables were confirmed using composite reliability. All SMC values were found to be lower than AVEs confirming discriminant validity. The path model's goodness-of-fit was greater than the recommended limits based on several indices(GFI=.905, AGFI=.872, RMR=.070, RMSEA=.052, TLI=.935; ${\chi}^2$=260.433, df=155, p=.00). Table 2 shows that motives of altruistic information sharing, economic incentives and helping new product development significantly increased the degree of writing product reviews of online shopping. In particular, the effect of altruistic information sharing and pursuit of economic incentives on the behavior of writing reviews were larger than the effect of helping new product development. As shown in table 3, online store shoppers were classified into three groups: Other consumer advocates (29.8%), self-interested shoppers (40.5%), and moderate shoppers (29.8%). There were significant differences among the three groups in the degree of writing reviews (experience of writing reviews, frequency of writing reviews, amount of writing reviews, intention of writing reviews, and duration of writing reviews, frequency of online shopping) and age. For five aspects of writing behavior, the group of other consumer advocates who is mainly comprised of 20s had higher scores than the other two groups. There were not any significant differences between self-interested group and moderate group regarding writing behavior and demographics.

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