• Title/Summary/Keyword: Risk Excluded

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Subtle inflammation: a possible mechanism of future cardiovascular risk in obese children

  • Sontichai, Watchareewan;Dejkhamron, Prapai;Pothacharoen, Peraphan;Kongtaweelert, Prachya;Unachak, Kevalee;Ukarapol, Nuthapong
    • Clinical and Experimental Pediatrics
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    • v.60 no.11
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    • pp.359-364
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    • 2017
  • Purpose: The risk of cardiovascular disease (CVD) has been shown to be associated with systemic inflammation in obese adults with metabolic syndrome (MetS). The aims of this study were to evaluate the prevalence of MetS and its relation to inflammatory markers in obese Thai children. Methods: A cross-sectional study was conducted. Children with history of endogenous obesity, chronic diseases, drug ingestion, and any acute illness within 2 weeks prior to enrollment were excluded. Their fasting blood glucose (FBG) levels, oral glucose tolerance tests, insulin, lipid profiles, and selected inflammatory markers, including interleukin-6, tumor necrosis factor-alpha, and high-sensitivity C-reactive protein (hs-CRP) levels, were tested. Results: In this study, 58 obese Thai children (female, 20; male, 38) with a mean body mass index z score of $5.1{\pm}2.2$ were enrolled. The prevalence of MetS and prediabetes was 31% and 17.2%, respectively. None of the children had diabetes. FBG levels, 2-hour glucose levels, and lipid profiles were not statistically different between those with and without MetS. However, obese children with MetS had higher insulin levels and homeostasis model assessment of insulin resistance values. Elevated hs-CRP levels were found in 69% of the cases, although it was not statistically different between the 2 groups. Conclusion: We described a substantial prevalence of MetS in Thai obese children. Regardless of MetS status, two-thirds of the obese children had elevated hs-CRP level, indicating subtle ongoing inflammatory process. This chronic inflammation feasibly predisposes them to CVD in the future, even in children without MetS.

The Role of Lumbar Drainage to Prevent Shunt-Dependent Hydrocephalus after Coil Embolization for Aneurysmal Subarachnoid Hemorrhage in Good-Grade Patients

  • Yong, Cho-In;Hwang, Sung-Kyun;Kim, Sung-Hak
    • Journal of Korean Neurosurgical Society
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    • v.48 no.6
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    • pp.480-484
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    • 2010
  • Objective : To evaluate the role of lumbar drainage in the prevention of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms by coil embolization in good-grade patients. Methods : One-hundred-thirty consecutive patients with aneurysmal subarachnoid hemorrhage in good-grade patients (Hunt & Hess grades I-III), who were treated by coil embolization between August 2004 and April 2010 were retrospectively evaluated. Poor-grade patients (Hunt & Hess grades IV and V), a history of head trauma preceding the development of headache, negative angiograms, primary subarachnoid hemorrhage (SAH), and loss to follow-up were excluded from the study. We assessed the effects on lumbar drainage on the risk of shunt-dependent hydrocephalus related to coil embolization in patients with ruptured intracranial aneurysms. Results : One-hundred-twenty-six patients (96.9%) did not develop shunt-dependent hydrocephalus. The 2 patients (1.5%) who developed acute hydrocephalus treated with temporary external ventricular drainage did not require permanent shunt diversion. Overall, 4 patients (3.1%) required permanent shunt diversion; acute hydrocephalus developed in 2 patients (50%). There was no morbidity or mortality amongst the patients who underwent a permanent shunt procedure. Conclusion : Coil embolization of ruptured intracranial aneurysms may be associated with a lower risk for developing shunt-dependent hydrocephalus, possibly by active management of lumbar drainage, which may reflect less damage for cisternal anatomy than surgical clipping. Coil embolization might have an effect the long-term outcome and decision-making for ruptured intracranial aneurysms.

Evaluation of Drain Pump System by Inundation Analysis in Urban Underground Passage (도시 지하차도 침수 분석을 통한 강제배제시설 평가)

  • Lee, Jung-Ho
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.8 no.5
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    • pp.1192-1200
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    • 2007
  • A general rainfall outflow in urban drainage has early time of concentration because urban drainage areas are most paved area. In general, rainfall outflow is flowed in drainage pump station and is discharged to rivers in urban areas. However it is excluded through drainage pumps about a heavy rainfall which exceed the design rainfall and the rainfall outflows increase the urban inundation risk. A current pump operation is control according to water level of collecting well or reservoir in drain pump station. But recently, the localized downpours are happened frequently in urban drainage and the current pump stations are frequently incapable of the heavy rainfall outflows. In this study, a real urban inundation was simulated and the drain capacity of drain pump station was evaluated by analysis about flood-factor in urban underground passage. Then the analysis about the inundation was done by the simulation about the real rainfall which cause the inundation. Also, in the simulation the inundation risk and the evaluation of flood-factor were analyzed according to change of the pump operation rule.

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Safety Assessment on the Incineration Disposal of Regulation Exempt Waste by RESRAD Code (RESRAD 코드를 활용한 규제해제 폐기물 소각처분에 대한 안정성 평가)

  • Kim, Hui-Gyeong;Han, Sang-Wook;Park, Su-Ri;Kim, Byung-Jick
    • Journal of radiological science and technology
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    • v.41 no.1
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    • pp.67-73
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    • 2018
  • In this paper, risk assessment was conducted to verify self - disposal requirements by landfill for exempted incineration ash by using Resrad Ver.6.5 computer code. The result of risk assessment by landfill for the incineration by-product is that individual dose is $6.91{\times}10^{-2}{\mu}Sv\;y-1$ and collective dose is $3.475{\times}10^{-7}man-Sv\;y-1$. It proved that the result meets reference dose of individual dose $10{\mu}Sv\;y-1$ and collective dose 1 man-Sv y-1 for general public. According to the current 'Nuclear Safety Commission Notice [No. 2014-3]', it states that the exempted wastes can be disposed of by incineration, landfill and recycling. However, most of recently documents and papers related to exempted wastes are disposed of by landfill and recyling and it could not confirm the case of exempt by incineration. If the national consensus is derived and treating the waste by using process of incineration is activated, it could be considered to treat low level of radiation wastewater and activated carbon excluded from exempted waste because of nuclide $^3H$ and $^{14}C$.

Clinical Analysis of Hemodialysis Vascular Access: Comparision of Autogenous Arterioveonus Fistula & Arteriovenous Prosthetic Graft

  • Kim, Duk-Sil;Kim, Sung-Wan;Kim, Jun-Chul;Cho, Ji-Hyung;Kong, Joon-Hyuk;Park, Chang-Ryul
    • Journal of Chest Surgery
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    • v.44 no.1
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    • pp.25-31
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    • 2011
  • Background: Mature autogenous arteriovenous fistulas have better long term patency and require fewer secondary interventions compared to arteriovenous prosthetic graft. Our Study evaluated vascular patency rates and incidence of interventions in autogenous arteriovenous fistulas and grafts. Material and Methods: A total of 166 vascular access operations were performed in 153 patients between December 2002 and November 2009. Thirty seven caeses were excluded due to primary access failure and loss of follow-up. One group of 92 autogenous arterioveous fistulas and the other group of 37 arteriovenous prosthetic grafts were evaluated retrospectively. Primary and secondary patency rates were estimated using the Kaplan-Meier method. Results: The primary patency rate (84%, 67%, 51% vs. 51%, 22%, 9% at 1, 3, 5 year; p=0.0000) and secondary patency rate (96%, 88%, 68% vs. 88%, 65%, 16% at 1, 3, 5 year; p=0.0009) were better in autogenous fistula group than prosthetic graft group. Interventions to maintain secondary patency were required in 23% of the autogenous fistula group (average 0.06 procedures/patient/year) and 65% of prosthetic graft group (average 0.21 procedures/patient/year). So the autogenous fistula group had fewer intervention rate than prosthetic graft group (p=0.01) The risk factor of primary patency was diabetus combined with ischemic heart disease and the secondary patency's risk factor was age. Conclusion: Autogenous arteriovenous fistulas showed better performance compared to prosthetic grafts in terms of primary & secondary patency and incidence of interventions.

Parenteral Nutrition-Associated Cholestasis in Very Low Birth Weight Infants: A Single Center Experience

  • Kim, Ah-Young;Lim, Ryoung-Kyoung;Han, Young-Mi;Park, Kyung-Hee;Byun, Shin-Yun
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.19 no.1
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    • pp.61-70
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    • 2016
  • Purpose: Parenteral nutrition (PN)-associated cholestasis (PNAC) is one of the most common complications in very low birth weight infants (VLBWIs). The aim of this study is to evaluate the risk factors of PNAC in VBLWIs. Methods: We retrospectively reviewed the medical records of 322 VLBWIs admitted to the neonatal intensive care unit of our hospital from July 1, 2009 to December 31, 2013. We excluded 72 dead infants; 6 infants were transferred to another hospital, and 57 infants were transferred to our hospital at 2 weeks after birth. The infants were divided into the cholestasis and the non-cholestasis groups. PNAC was defined as a direct bilirubin level of ${\geq}2.0mg/dL$ in infants administered with PN for ${\geq}2weeks$. Results: A total of 187 VLBWI were enrolled in this study; of these, 46 infants developed PNAC. Multivariate logistic regression analysis showed that the risk factors of PNAC in VLBWI were longer duration of antimicrobial use (odds ratio [OR] 4.49, 95% confidence interval [95% CI] 4.42-4.58), longer duration of PN (OR 2.68, 95% CI 2.41-3.00), long-term lack of enteral nutrition (OR 2.89, 95% CI 2.43-3.37), occurrence of necrotizing enterocolitis (OR 2.40, 95% CI 2.16-2.83), and gastrointestinal operation (OR 2.19, 95% CI 2.03-2.58). Conclusion: The results of this study suggest that shorter PN, aggressive enteral nutrition, and appropriate antimicrobial use are important strategies in preventing PNAC.

Effect of National Implementation of Telephone CPR Program to Improve Outcomes from Out-of-Hospital Cardiac Arrest: an Interrupted Time-Series Analysis

  • Lee, Yu Jin;Hwang, Seung-sik;Shin, Sang Do;Lee, Seung Chul;Song, Kyoung Jun
    • Journal of Korean Medical Science
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    • v.33 no.51
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    • pp.328.1-328.12
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    • 2018
  • Background: In cardiac arrest, the survival rate increases with the provision of bystander cardiopulmonary resuscitation (CPR), of which the initial response and treatment are critical. Telephone CPR is among the effective methods that might increase the provision of bystander CPR. This study aimed to describe and examine the improvement of neurological outcomes in individuals with out-of-hospital acute cardiac arrest by implementing the nationwide, standardized telephone CPR program. Methods: Data from the emergency medical service-based cardiac arrest registry that were collected between 2009 and 2014 were used. The effectiveness of the intervention in the interrupted time-series study was determined via a segmented regression analysis, which showed the risk ratio and risk difference in good neurological outcomes before and after the intervention. Results: Of 164,221 patients, 148,403 were analyzed. However, patients with unknown sex and limited data on treatment outcomes were excluded. Approximately 64.3% patients were men, with an average age of 63.7 years. The number of bystander CPR increased by 3.3 times (95% confidence interval [CI], 3.1-3.5) after the intervention, whereas the rate of good neurological outcomes increased by 2.6 times (95% CI, 2.3-2.9 [1.6%]; 1.4-1.7). The excess number was identified based on the differences between the observed and predicted trends. In total, 2,127 cases of out-of-hospital cardiac arrest (OHCA) after the intervention period received additional bystander CPR, and 339 cases of OHCA had good neurological outcomes. Conclusion: The nationwide implementation of the standardized telephone CPR program increased the number of bystander CPR and improved good neurological outcomes.

The Review of Clinical Studies Published in The Journal of Korean Medical Ophthalmology & Otolaryngology & Dermatology (한방안이비인후피부과학회지에 게재된 임상실험연구에 대한 고찰)

  • Kim, Chul-Yun;Seo, Hyung-Sik;Kim, Nam-Kwen;Lee, Dong-Jin;Kwon, Kang
    • The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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    • v.27 no.4
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    • pp.1-15
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    • 2014
  • Objective : This study was carried out to analyze the quality and quantity of Clinical Trials that have been published in the journal of korean medical ophthalmology, otolaryngology, dermatology(JKOOD). Methods : We analyzed 25 clinical trials that published in JKOOD from 1988 to 2014. We excluded case reports, protocol and retrospective studies and classified searched papers into three categories; Randomized Clinical Trials(RCT), Non Randomized Clinical Trials(NRCT), Before After Study(BAS) by using study Design Algorithm for Medical literature of Intervention(DMAI). All articles were analyzed according to diagnosis, statistics program and intervention period. The bias of RCTs were evaluated by Cochrane Risk of Bias(RoB). Result : 1. The number of searched journals is 25 papers; 13 RCT, 2 NRCT, 10 BAS 2. Distribution of clinical trial; 'Atopic dermatitis' ranked the highest(44%) in disease, 'External application' raked the highest(71%) in treatment method. 3. 'allocation sequence' and 'prevention of allocated intervent to patients and therapists' are graded 'Low' but 'incomplete outcome date' and 'selective outcome' are graded 'Uncertain'. Conclusions : It is necessary to study more RCT. It will be helpful to study systematic reviews and meta analysis in JKOOD.

Relationship between Risk Assessment Based on Urinary Bisphenol A Concentration and Allergic Diseases in Children (어린이의 요 중 비스페놀 A 농도에 근거한 위해성 평가와 알레르기 질환과의 관련성)

  • Choi, Jihee;Hong, Soyoung;Kim, KyooSang
    • Journal of Environmental Health Sciences
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    • v.45 no.1
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    • pp.18-29
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    • 2019
  • Objectives: The purpose of this study was to examine the relationship between urinary bisphenol A concentration and allergic diseases in children. Methods: This study was conducted in Seoul, South Korea. We collected urine samples from 231 children from a single elementary school in June 2014. Among these, 69 children with urinary creatinine levels outside the normal range were excluded. Information on allergic diseases was obtained from the parents of the children. Urinary bisphenol A was analyzed using a liquid chromatography tandem mass spectrometer. Logistic regression analysis was used to determine if allergic disease was affected by urinary bisphenol A concentration. Results: Girls had a significantly higher concentration of urinary bisphenol A than did boys (p<0.05). Children of 10-12 years old had a significantly higher concentration of urinary bisphenol A than did children 7-9 years old (p<0.01). Concentration of urinary bisphenol A was increased from underweight to overweight (p<0.05). As the concentration of urinary bisphenol A was increased by $1{\mu}g/L$ or $1{\mu}g/g$ creatinine, the risks of lifetime symptoms of atopic dermatitis in children was 1.22 times (95% CI; 1.05-1.41) or 1.08 times (95% CI; 1.01-1.15). Conclusion: Concentration of urinary bisphenol A was associated with gender, age, body mass index, and allergic disease. Particularly, urinary bisphenol A concentration was associated with lifetime symptoms of atopic dermatitis. The findings of this study could contribute to the management of health effects among sensitive groups such as children.

Urine Cotinine Should Be Involved in Initial Evaluation of Tinnitus in Adolescents

  • Lee, Doh Young;Kim, Young Ho
    • Clinical and Experimental Otorhinolaryngology
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    • v.11 no.4
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    • pp.242-249
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    • 2018
  • Objectives. Smoking is associated with hearing loss, while the correlation between tinnitus and smoking is not fully elucidated. This study aimed to evaluate risk factors of tinnitus in adolescents in terms of smoking, and we identified a rectifiable parameter that can be serially monitored. Methods. A cross-sectional study was conducted using data from the Korea National Health and Nutrition Examination Survey, with 2,782 participants aged 12 to 18 years, from 2008 through 2011. Participants with history of ear disease, hearing loss, and inadequate responses to questionnaires were excluded. We investigated the prevalence of tinnitus and tinnitus-related annoyance by questionnaire and sought potential risk factors in blood and urine tests and smoking history. Results. The prevalence of tinnitus in the 12- to 18-year-old population was 17.5%, with 3.3% reporting tinnitus-related annoyance. On univariate analysis, the prevalence of tinnitus increased with age (P<0.001) and was higher among girls (P=0.012). Blood tests and urinalysis showed significant correlation between tinnitus and red blood cell count, alkaline phosphatase levels, and urine cotinine (P=0.002, P<0.001, P=0.018, respectively). In multivariate analysis, the urine cotinine level was the only parameter associated with tinnitus (odds ratio, 1.000; 95% confidence interval, 0.999 to 1.000; P=0.038). Smoking was also significantly correlated with tinnitus (P=0.043), and amount of smoking with tinnitus-related annoyance (P=0.045). However, current smoking and past smoking were not correlated with tinnitus. Conclusion. Urine cotinine may be a rectifiable marker for management of tinnitus in adolescents. This suggests that smoking cessation should be incorporated in the management of tinnitus in adolescents.