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Pediatric Urolithiasis: Our 22-year Experience at a Single Center (소아에서의 요로결석: 단일기관에서 22년간의 경험)

  • Kim, Su-Yon;Kim, Min-Jee;Lee, Joo Hoon;Kim, Kun Suk;Park, Young Seo
    • Childhood Kidney Diseases
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    • v.17 no.2
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    • pp.101-109
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    • 2013
  • Purpose: Pediatric urolithiasis is uncommon in children but is a cause of significant morbidity and damage to the kidney. Although much information on adult urolithiasis is available in the literature, large studies on the pediatric population are still scarce. In this report, we review our experience with pediatric urolithiasis over 22 years at a tertiary referral center. Method: We retrospectively reviewed the records of children with newly diagnosed urolithiasis between January 1991 and May 2013. We assessed the age, sex, family history, initial symptoms, location of stones, underlying cause, stone analysis, treatment, and recurrence among the patients. Results: In total, 137 patients (96 male, 41 female) were assessed. The age range was 0-17 years (mean age, 6.0 years). Forty-three (31%) children were aged <1 year, and 37% (16/43) had a history of intensive care unit (ICU) admission. Thirteen patients (9.5%) had a family history of stones. The most common symptoms at presentation among the patients were gross hematuria (56/137, 41%) and flank or abdominal pain (46/137, 34%). The stones were located in the kidney (85/137, 62%), ureter (29/137, 21%), bladder (2/137, 1.4%), and multiple locations (20/137, 15 %). Congenital abnormalities of the genitourinary (G-U) tract, with or without metabolic abnormality, or urinary tract infection (UTI) was detected in 26 children (19%). Ninety-one patients (66%) underwent metabolic examination, and 38% of these patients exhibited an abnormality. UTI, with or without abnormalities of the G-U tract, or metabolic abnormality was detected in 26 children (19%). Of the 35 stones analyzed, the majority were calcium stones (20/35, 57%), followed by infected stones (5/35, 14%), uric acid stones (4/35, 11%), carbonate apatite stones (3/35, 7%), cystine stones (2/35, 6%), and phosphate stones (1/35, 3%). Five patients (4%) required open procedures, with or without non-open procedures, whereas 77 patients (56%) were managed conservatively; the remaining 55 patients (40%) received some other form of intervention. Eighteen patients (13%) had stone recurrence during the follow-up period. Conclusions: Pediatric urolithiasis is commonly associated with abnormalities of the G-U tract and/or metabolic disorders and/or UTI. Half of the patients will pass their stones spontaneously, and all the techniques of minimally invasive surgery are applicable in the treatment of children with stones. As the recurrence rates are high among this population, long-term follow-up is recommended and the complete clearance of stones is important.

Effect of n-3 fatty acid deficiency on fatty acid compositions of nervous system in rats reared by artificial method. (N-3 지방산 결핍이 혈청 및 신경조직의 지방산 조성에 미치는 영향)

  • Lim, Sun-Young
    • Journal of Life Science
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    • v.17 no.5 s.85
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    • pp.634-640
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    • 2007
  • Our previous study suggested that n-3 fatty acid deficiency was associated with significantly reduced spatial learning as assessed by Morris water maze test. Here we investigated an effect of n-3 fatty acid deficiency on rat brain, retina and serum fatty acyl compositions at 15 wks age using a first generational artificial rearing technique. Newborn Rat pups were separated on day 2 and assigned to two artificial rearing groups or a dam-reared control group. Pups were hand fed artificial milk via custom-designed nursing bottles containing either 0.02%(n-3 Deficient) or 3.1% (n-3 Adequate) of total fatty acids as a-linolenic acid(LNA). At day 21, rats were weaned to either n-3 deficient or n-3 adequate pelleted diets and fatty acid compositions of brain, retina and liver were analyzed at 15 wks age. Brain docosahexaenoic acid(DHA) was lower(58% and 61%, P<0.05) in n-3 deficient in comparison to n-3 adequate and dam-reared groups, receptively, while brain docosapentaenoic acid(DPAn-6) was increased in the n-3 deficient group. In retina and serum fatty acid compositions, the decreased precentage of DHA and increased precentage of DPAn-6 were observed. These results suggested that artificial rearing method can be used to produce n-3 fatty acid deficiency in the first generation and that adequate brain DHA levels are required for optimal brain function.

Decrease of Aflatoxin M1 Level in Raw Cow’s Milk using the Hazard Analysis and Critical Control Points (HACCP) System (HACCP 제도에 의한 우유의 아플라톡신 M1의 저감화)

  • Kim, Ki-Hwan;Nam, Myoung Soo
    • Journal of Life Science
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    • v.26 no.2
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    • pp.190-197
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    • 2016
  • Aflatoxin M1 can be produced in cow’s milk when cows eat contaminated produce. Milk is a major source of food for infants and for children who have a weak level of immunity, and the detection of Aflatoxin M1 for risk assessment is necessary in order to reduce the amount of it in milk. In this study, the Aflatoxin M1 level was monitored for one year in raw milk samples obtained from Chungnam Province, Korea. The milk samples were divided into three categories: 1. milk samples from a standard general farm, 2. milk samples from a HACCP controlled farm, and 3. milk samples from the supply of Aflatoxin M1 reduced fodder. The average concentrations of Aflatoxin M1 in milk were 0.023±0.005 ug/l for the standard general farm, 0.017±0.004 ug/l for the HACCP controlled farm, and 0.013±0.003 ug/l for the supply of Aflatoxin M1 reduction fodder. Milk collected from the supply of Aflatoxin M1 reduction fodder had the lowest level of Aflatoxin M1. However, when efficiency and economic aspects are considered the most effective way of reducting Aflatoxin M1, could be taking milk from the HACCP controlled farm and implementing good feed management. Institutional support from the government, careful management of dairy farming, and a strict farm sanitation program are required in order to lower the level of Aflatoxin M1 in milk.

Estimation of Linkage Disequilibrium and Effective Population Size using Whole Genome Single Nucleotide Polymorphisms in Hanwoo (한우에서 전장의 유전체 정보를 활용한 연관불평형 및 유효집단크기 추정에 관한 연구)

  • Cho, Chung-Il;Lee, Joon-Ho;Lee, Deuk-Hwan
    • Journal of Life Science
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    • v.22 no.3
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    • pp.366-372
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    • 2012
  • This study was conducted to estimate the extent of linkage disequilibrium (LD) and effective population size using whole genomic single nucleotide polymorphisms (SNP) genotyped by DNA chip in Hanwoo. Using the blood samples of 35 young bulls born from 2005 to 2008 and their progenies (N=253) in a Hanwoo nucleus population collected from Hanwoo Improvement Center, 51,582 SNPs were genotyped using Bovine SNP50 chips. A total of 40,851 SNPs were used in this study after elimination of SNPs with a missing genotyping rate of over 10 percent and monomorphic SNPs (10,730 SNPs). The total autosomal genome length, measured as the sum of the longest syntenic pairs of SNPs by chromosome, was 2,541.6 Mb (Mega base pairs). The average distances of all adjacent pairs by each BTA ranged from 0.55 to 0.74 cM. Decay of LD showed an exponential trend with physical distance. The means of LD ($r^2$) among syntenic SNP pairs were 0.136 at a range of 0-0.1 Mb in physical distance and 0.06 at a range of 0.1-0.2 Mb. When these results were used for Luo's formula, about 2,000 phenotypic records were found to be required to achieve power > 0.9 to detect 5% QTL in the population of Hanwoo. As a result of estimating effective population size by generation in Hanwoo, the estimated effective population size for the current status was 84 heads and the estimate of effective population size for 50 generations of ancestors was 1,150 heads. The average decreasing rates of effective population size by generation were 9.0% at about five generations and 17.3% at the current generation. The main cause of the rapid decrease in effective population size was considered to be the intensive use of a few prominent sires since the application of artificial insemination technology in Korea. To increase and/or sustain the effective population size, the selection of various proven bulls and mating systems that consider genetic diversity are needed.

Understanding the Relationship between Value Co-Creation Mechanism and Firm's Performance based on the Service-Dominant Logic (서비스지배논리하에서 가치공동창출 매커니즘과 기업성과간의 관계에 대한 연구)

  • Nam, Ki-Chan;Kim, Yong-Jin;Yim, Myung-Seong;Lee, Nam-Hee;Jo, Ah-Rha
    • Asia pacific journal of information systems
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    • v.19 no.4
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    • pp.177-200
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    • 2009
  • AIn the advanced - economy, the services industry hasbecome a dominant sector. Evidently, the services sector has grown at a much faster rate than any other. For instance, in such developed countries as the U.S., the proportion of the services sector in its GDP is greater than 75%. Even in the developing countries including India and China, the magnitude of the services sector in their GDPs is rapidly growing. The increasing dependence on service gives rise to new initiatives including service science and service-dominant logic. These new initiatives propose a new theoretical prism to promote the better understanding of the changing economic structure. From the new perspectives, service is no longer regarded as a transaction or exchange, but rather co-creation of value through the interaction among service users, providers, and other stakeholders including partners, external environments, and customer communities. The purpose of this study is the following. First, we review previous literature on service, service innovation, and service systems and integrate the studies based on service dominant logic. Second, we categorize the ten propositions of service dominant logic into conceptual propositions and the ones that are directly related to service provision. Conceptual propositions are left out to form the research model. With the selected propositions, we define the research constructs for this study. Third, we develop measurement items for the new service concepts including service provider network, customer network, value co-creation, and convergence of service with product. We then propose a research model to explain the relationship among the factors that affect the value creation mechanism. Finally, we empirically investigate the effects of the factors on firm performance. Through the process of this research study, we want to show the value creation mechanism of service systems in which various participants in service provision interact with related parties in a joint effort to create values. To test the proposed hypotheses, we developed measurement items and distributed survey questionnaires to domestic companies. 500 survey questionnaires were distributed and 180 were returned among which 171 were usable. The results of the empirical test can be summarized as the following. First, service providers' network which is to help offer required services to customers is found to affect customer network, while it does not have a significant effect on value co-creation and product-service convergence. Second, customer network, on the other hand, appears to influence both value co-creation and product-service convergence. Third, value co-creation accomplished through the collaboration of service providers and customers is found to have a significant effect on both product-service convergence and firm performance. Finally, product-service convergence appears to affect firm performance. To interpret the results from the value creation mechanism perspective, service provider network well established to support customer network is found to have significant effect on customer network which in turn facilitates value co-creation in service provision and product-service convergence to lead to greater firm performance. The results have some enlightening implications for practitioners. If companies want to transform themselves into service-centered business enterprises, they have to consider the four factors suggested in this study: service provider network, customer network, value co-creation, and product-service convergence. That is, companies becoming a service-oriented organization need to understand what the four factors are and how the factors interact with one another in their business context. They then may want to devise a better tool to analyze the value creation mechanism and apply the four factors to their own environment. This research study contributes to the literature in following ways. First, this study is one of the very first empirical studies on the service dominant logic as it has categorized the fundamental propositions into conceptual and empirically testable ones and tested the proposed hypotheses against the data collected through the survey method. Most of the propositions are found to work as Vargo and Lusch have suggested. Second, by providing a testable set of relationships among the research variables, this study may provide policy makers and decision makers with some theoretical grounds for their decision making on what to do with service innovation and management. Finally, this study incorporates the concepts of value co-creation through the interaction between customers and service providers into the proposed research model and empirically tests the validity of the concepts. The results of this study will help establish a value creation mechanism in the service-based economy, which can be used to develop and implement new service provision.

A Meta Analysis of Using Structural Equation Model on the Korean MIS Research (국내 MIS 연구에서 구조방정식모형 활용에 관한 메타분석)

  • Kim, Jong-Ki;Jeon, Jin-Hwan
    • Asia pacific journal of information systems
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    • v.19 no.4
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    • pp.47-75
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    • 2009
  • Recently, researches on Management Information Systems (MIS) have laid out theoretical foundation and academic paradigms by introducing diverse theories, themes, and methodologies. Especially, academic paradigms of MIS encourage a user-friendly approach by developing the technologies from the users' perspectives, which reflects the existence of strong causal relationships between information systems and user's behavior. As in other areas in social science the use of structural equation modeling (SEM) has rapidly increased in recent years especially in the MIS area. The SEM technique is important because it provides powerful ways to address key IS research problems. It also has a unique ability to simultaneously examine a series of casual relationships while analyzing multiple independent and dependent variables all at the same time. In spite of providing many benefits to the MIS researchers, there are some potential pitfalls with the analytical technique. The research objective of this study is to provide some guidelines for an appropriate use of SEM based on the assessment of current practice of using SEM in the MIS research. This study focuses on several statistical issues related to the use of SEM in the MIS research. Selected articles are assessed in three parts through the meta analysis. The first part is related to the initial specification of theoretical model of interest. The second is about data screening prior to model estimation and testing. And the last part concerns estimation and testing of theoretical models based on empirical data. This study reviewed the use of SEM in 164 empirical research articles published in four major MIS journals in Korea (APJIS, ISR, JIS and JITAM) from 1991 to 2007. APJIS, ISR, JIS and JITAM accounted for 73, 17, 58, and 16 of the total number of applications, respectively. The number of published applications has been increased over time. LISREL was the most frequently used SEM software among MIS researchers (97 studies (59.15%)), followed by AMOS (45 studies (27.44%)). In the first part, regarding issues related to the initial specification of theoretical model of interest, all of the studies have used cross-sectional data. The studies that use cross-sectional data may be able to better explain their structural model as a set of relationships. Most of SEM studies, meanwhile, have employed. confirmatory-type analysis (146 articles (89%)). For the model specification issue about model formulation, 159 (96.9%) of the studies were the full structural equation model. For only 5 researches, SEM was used for the measurement model with a set of observed variables. The average sample size for all models was 365.41, with some models retaining a sample as small as 50 and as large as 500. The second part of the issue is related to data screening prior to model estimation and testing. Data screening is important for researchers particularly in defining how they deal with missing values. Overall, discussion of data screening was reported in 118 (71.95%) of the studies while there was no study discussing evidence of multivariate normality for the models. On the third part, issues related to the estimation and testing of theoretical models on empirical data, assessing model fit is one of most important issues because it provides adequate statistical power for research models. There were multiple fit indices used in the SEM applications. The test was reported in the most of studies (146 (89%)), whereas normed-test was reported less frequently (65 studies (39.64%)). It is important that normed- of 3 or lower is required for adequate model fit. The most popular model fit indices were GFI (109 (66.46%)), AGFI (84 (51.22%)), NFI (44 (47.56%)), RMR (42 (25.61%)), CFI (59 (35.98%)), RMSEA (62 (37.80)), and NNFI (48 (29.27%)). Regarding the test of construct validity, convergent validity has been examined in 109 studies (66.46%) and discriminant validity in 98 (59.76%). 81 studies (49.39%) have reported the average variance extracted (AVE). However, there was little discussion of direct (47 (28.66%)), indirect, and total effect in the SEM models. Based on these findings, we suggest general guidelines for the use of SEM and propose some recommendations on concerning issues of latent variables models, raw data, sample size, data screening, reporting parameter estimated, model fit statistics, multivariate normality, confirmatory factor analysis, reliabilities and the decomposition of effects.

The Usefulness of Postoperative Pinhole Bone Scintigraphy in the Assessment of Prognosis after Multiple Drilling or Vascularized Bone Graft in Patients with Avascular Necrosis of Femoral Head (다발성 천공술 및 혈관 부착 골이식술을 시행한 대퇴골두 무혈관성 괴사의 예후: 수술 후 바늘구멍 골신티그라피의 유용성)

  • Chung, Yong-An;Kim, Sung-Hoon;Chun, Kyung-Ah;Park, Young-Ha;Sohn, Hyung-Seon;Chung, Soo-Kyo;Song, Mun-Kab
    • The Korean Journal of Nuclear Medicine
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    • v.33 no.4
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    • pp.405-412
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    • 1999
  • Purpose: It is important to evaluate the healing process of avascular necrosis (AVN) involving femoral head after treatment. The purpose of this study was to assess the usefulness of pinhole bone scintigraphy in the AVN of femoral head after surgery. Materials and Methods: We analyzed the changing pattern of pinhole bone scintigram in 21 femoral heads of 16 patients (14 lesions/11 male, 7 lesions/5 female, mean age: 39.4 yrs) before and after multiple drilling or vascularized bone grafting for AVN of the femoral head. In all patients, pre-operative scintigrams were obtained at 1 to 3 months before treatment and the first post-operative scintigrams were obtained at 1 to 3 months after treatment. All patients were followed for 2 to 4 years after operation. Results: The findings of the pinhole scintigrams were divided into three patterns: 1) curvilinear, 2) scattered spotty and 3) undetermined. The 10 of 11 lesions with curvilinear pattern had good postoperative clinical and radiological follow-up findings. However, all 6 lesions with scattered spotty pattern showed poor postoperative findings, which necessitated total hip joint replacement. Of the 4 lesions with undetermined pattern, 2 required total hip joint replacement. There was significant difference in postoperative prognosis between the curvilinear and scattered spotty patterns (p<0.05). Conclusion: We conclude that the pattern of pinhole bone scintigram obtained within 1 to 3 months after multiple drilling or vascularized bone graft operation is a useful prognostic indicator in the AVN of femoral head.

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Effect of Carrier on Labeling and Biodistribution of Re-188-Hydroxyethylidene diphosphonate (담체가 Re-188-Hydroxyethylidene Diphosphonate의 표지와 생체내분포에 미치는 영향)

  • Chang, Young-Soo;Jeong, Jae-Min;Kim, Bo-Kwang;Cho, Jung-Hyuk;Lee, Dong-Soo;Chung, June-Key;Lee, Seung-Jin;Jin, Ren-Jie;Lee, Sang-Eun;Lee, Myung-Chul
    • The Korean Journal of Nuclear Medicine
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    • v.34 no.4
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    • pp.344-352
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    • 2000
  • Purpose: Re-188-Hydroxyethylidene diphosphonate (HEDP) is a new cost-effective agent for systemic radioisotope therapy of metastatic bone pain. We investigated the influence of carrier for labeling and biodistribution of Re-188-HEDP using HEDP kit with or without carrier ($KReO_4$). Materials and Methods: The kits (HEDP 15 mg, gentisic acid 4 mg and $SnCl_2.2H_2O_2$ 4.5 mg) with or without carrier ($KReO_4$ 0.1 mg) were labeled with Re-188 solution, made available from an in-house generator by boiling for 15 min. We compared the labeling efficiency and stability of carrier-added and carrier-free preparations of Re-188-HEDP Biodistribution and imaging studies of each preparation were performed in ICR mice ($1.85{\sim}3.7MBq/0.1ml$) and SD rats ($74.1{\sim}85.2MBq/0.5ml$). Results: The carrier-added preparation showed high labeling efficiency (95% at pH 5) and high stability in serum (88%, 3 hr). However, the carrier-free preparation showed low labeling efficiency (59% at pH 5) and low stability (43%, 3 hr). The carrier-added preparation showed high uptake in bone and low uptake in stomach and kidneys. However, the carrier-free preparation showed lower uptake in bone and higher uptake in both stomach and kidneys, which is supposed to be due to released perrhenate. The carrier-added preparation also showed better images with higher skeletal accumulation, lower uptake in other organs and lower soft tissue uptake than the carrier-free preparation. Conclusion: The results of these studies clearly demonstrate that addition of carrier perrhenate is required for high labeling efficiency, stability, bone uptake and good image quality of Re-188-HEDP.

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Comparative Evaluation of 25-OH-VitD and 25-OH-VitD3 by Radioimmunoassay (방사면역 측정법에 의한 25-OH-VitD와 25-OH-VitD3의 비교 평가)

  • Lee, Young-ji;Park, Ji-hye;Lim, Soo-yeon;Cheon, Jun-hong;Lee, Sun-ho
    • The Korean Journal of Nuclear Medicine Technology
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    • v.24 no.1
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    • pp.33-38
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    • 2020
  • Purpose Vitamin D is essential for maintaining bone health, controling cell proliferation or differentiation, strengthening immune function by controlling calcium metabolism in the body. Vitamin D deficiency can lead to increase the risk of rickets, osteoporosis, cardiovascular disease, diabetes and cancer. Especially, South Korea is one of the highest population proportion of vitamin D deficiency. Accurate determination of levels of 25-OH-VitD or 25-OH-VitD3 in blood serum is required for the diagnosis and treatment of vitamin D deficiency. In this study, radioimmunoassay of 25-OH-VitD and 25-OH-VitD3 was performed and compared to evaluate the effectiveness of Vitamin D radioimmunoassay. Materials and Methods Serum 25-OH-VitD and 25-OH-VitD3 levels were measured using radioimmunoassay. The interrelationship, reproducibility and population distribution rate were evaluated. In addition, the internal quality control was performed at Asan Medical Center from April 2017 to June 2019 and the result of external quality control (Interagency proficiency evaluation) of first and second half of 2018 hosted by the Korean Society of Nuclear Medicine Technology (KSNMT). Both tests were measured by same manufacturer's reagent. Results 25-OH-VitD showed a strong positive correlation on 97 samples, as 25-OH-VitD3 x 0.9 + 0.3 (R>0.9). In repeated measurement, the average Diff(%) value of the reproducibility evaluation of 25-OH-VitD and 25-OH-VitD3 were 7.7% and 7.4%, respectively. Population distribution results showed no statistically significant differences(p>0.05). The resultant value of internal quality control, which measured from April, 2017 to June 2019 in Blood test room of Nuclear Medicine at Asan Medical Center, showed average (CV%) 6.2% and 6.8%, respectively. As a result of the external quality control (interagency proficiency evaluation) Z value obtained under 2.0, as shown below; Conclusion The interrelationship, reproducibility, population distribution rate, internal quality control and external quality control between 25-OH-VitD and 25-OH-VitD3 radioimmunoassay shows superior outcome. Radioimmunoassay, which can be alone measured in the blood as 25-OH-VitD or 25-OH-VitD3, is considered suitable screening tests for the diagnosis of vitamin D deficiency.

Effects of Mixed-Sowing of Legume and Applying of Cattle Manure on the Productivity, Feed Values and Organic Hanwoo Carrying Capacity of Rye in Southern Area of Gyeongbuk Province (경북남부지방에서 콩과 사료작물의 혼파와 우분의 시용이 호밀의 생산성, 사료가치 및 단위면적당 유기한우 사육능력에 미치는 영향)

  • Hwangbo, Soon;Choi, Kwang-Won;Jung, Soon-Mi;Jo, Ik-Hwan
    • Korean Journal of Organic Agriculture
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    • v.23 no.3
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    • pp.583-593
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    • 2015
  • This study was conducted to investigate the effects of mixed-sowing of legume forage and applying of cattle manure on the productivity of organic rye to provide dairy farmers with safe organic feeds. Also the present study aimed to evaluate optimal applying level of cattle manure and carrying capacity of Korean native cattle (Hanwoo) per unit area. The amount of crude protein was significantly higher in the mixed-sowing of legume forage (average 760~786 kg/ha) than in the single-sowing of rye (average 353 kg/ha) (p<0.05). The mixed-sowing of forage peas and the single-sowing of rye tended to improve by increasing the level of nitrous fertilization rather than the fertilization treatment. The amount of crude protein on the rye according to the mixed-sowing of legume was significantly higher in the mixture (average 8.29~9.90%) than in the single (average 4.93%) (p<0.05). The comparison by the level of nitrogen fertilization indicated significantly high for the rye in 50 kg N/ha than in fertilization treatments (p<0.05). Total digestible nutrients (TDN) amount in the single-sowing of rye was average 46.86% and has lower than average 49.96~50.12% of the mixed-sowing of legume, and especially the mixed-sowing of forage pea was the highest with 54.55% in 150 kg N/ha for the level of nitrogen fertilization (p<0.05). The breeding ability of annual organic livestocks per unit area according to the feed value of rye presented significantly higher ability in the mixed-sowing of legume (3.72~4.12 heads) than the single-sowing of rye (average 2.26 heads) (p<0.05). By summarizing above results, the mixed-sowing of legume is required to improve the productivity and the feed value of rye for increasing organic livestock breeding ability in southern area of Gyeongbuk regions, and the study for identifying the appropriate fertilization level using livestock excretions is further necessary.