• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제24권1호
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• pp.100-108
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• 2021

Purpose: Percutaneous endoscopic gastrostomy (PEG) tube placements are commonly performed pediatric endoscopic procedures. Because of underlying disease, these patients are at increased risk for airway-related complications. This study compares patient characteristics and complications following initial PEG insertion with general endotracheal anesthesia (GETA) vs. anesthesia-directed deep sedation with a natural airway (ADDS). Methods: All patients 6 months to 18 years undergoing initial PEG insertion within the endoscopy suite were considered for inclusion in this retrospective cohort study. Selection of GETA vs. ADDS was made by the anesthesia attending after discussion with the gastroenterologist. Results: This study included 168 patients (GETA n=38, ADDS n=130). Cohorts had similar characteristics with respect to sex, race, and weight. Compared to ADDS, GETA patients were younger (1.5 years vs. 2.9 years, p=0.04), had higher rates of severe American Society of Anesthesiologists (ASA) disease severity scores (ASA 4-5) (21% vs. 3%, p<0.001), and higher rates of cardiac comorbidities (39.5% vs. 18.5%, p=0.02). Significant associations were not observed between GETA/ADDS status and airway support, 30-day readmission, fever, or pain medication in unadjusted or adjusted models. GETA patients had significantly increased length of stay (eβ=1.55, 95% confidence interval [CI]=1.11-2.18) after adjusting for ASA class, room time, anesthesia time, fever, and cardiac diagnosis. GETA patients also had increased room time (eβ=1.20, 95% CI=1.08-1.33) and anesthesia time (eβ=1.50, 95% CI=1.30-1.74) in adjusted models. Conclusion: Study results indicate that younger and higher risk patients are more likely to undergo GETA. Children selected for GETA experienced longer room times, anesthesia times, and hospital length of stay.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제26권1호
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• pp.50-57
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• 2023

Purpose: The purpose of this study was to determine the pattern of human leukocyte antigen (HLA)-DQ genotype in children diagnosed with celiac disease (CD) (biopsy proven), and to compare this with a control group; and secondarily, to correlate HLA genotypes with clinical profiles of CD. Methods: This cross-sectional comparative observational study included 26 controls and 52 patients diagnosed with CD who presented at Sir Padampat Mother and Child Health Institute, Jaipur, from May, 2017 to October, 2018. HLA DQ genotype was assessed for each patients and correlated with clinical profiles. Results: HLA DQ2/DQ8 genotypes were significantly more common in CD (present in 100.0% cases) than in controls (23.1%) in Northern India (Rajasthan). When HLA DQ2.5 and DQ8 were present together, individuals had significantly more atypical presentations and severe findings on duodenal biopsy. Similarly, patients with the HLA DQ 2.5 genotype were also predisposed to more severe endoscopic findings, while HLA DQ2.2 predisposed them to less severe biopsy findings. HLA DQ8 was significantly associated with later age at diagnosis (>5 years) and shorter stature. The highest HLA DQ relative risk (RR) for CD development was associated with HLA DQ2.5 and DQ2.2 in combination, followed by HLA DQ2.5 and DQ8 in combination, while HLA DQx.5 and HLA DQ2.2 together had the lowest risk. Conclusion: HLA DQ2/DQ8 genotypes are strongly associated with pediatric CD patients in northern India. These genotypes and their combinations may be associated with different clinical presentations of CD, and may help predict severity of CD.

• 대한치과교정학회지
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• 제53권1호
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• pp.3-15
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• 2023

Objective: Body dysmorphic disorder (BDD) is a form of obsessive-compulsive disorder that may be negatively associated with the self-image. It might be associated with orthodontic treatment demand and outcome, and therefore is important. Thus, this study was conducted. Methods: The Yale-Brown Obsessive-Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS) questionnaire was used in 699 orthodontic patients above 12 years of age (222 males, 477 females), at seven clinics in two cities (2020-2021). BDD diagnosis and severity were calculated based on the first 3 items and all 12 items of the questionnaire. The dental health component of the index of orthodontic treatment need (IOTN-DHC) was assessed by orthodontists. Multivariable and bivariable statistical analyses were performed on ordinal and dichotomized BDD diagnoses to assess potentially associated factors (IOTN-DHC, age, sex, marital status, education level, and previous orthodontic consultation) (α = 0.05). Results: IOTN-DHC scores 1-5 were seen in 13.0%, 39.9%, 29.8%, 12.4%, and 4.9% of patients. Age/sex/marital status/education were not associated with IOTN-DHC (p > 0.05). Based on 3-item questionnaire, 17.02% of patients had BDD (14.02% mild). Based on 12-item questionnaire, 2.86% had BDD. BDD was more prevalent or severer in females, married patients, patients with a previous history of orthodontic consultation, and patients with milder IOTN-DHCs (p < 0.05). Conclusions: IOTNDHC was negatively/slightly associated with BDD in orthodontic patients. Being female and married may increase BDD risk.

• 대한한의학회지
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• 제43권4호
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• pp.102-130
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• 2022

Objectives: The persistence and unpredictability of coronavirus disease (COVID-19) and new measures to prevent direct medical intervention (e.g., social distancing and quarantine) have induced various psychological symptoms and disorders that require self-treatment approaches and integrative treatment interventions. To address these issues, the Korean Medicine Mental Health (KMMH) center developed a field manual by reviewing previous literature and preexisting manuals. Methods: The working group of the KMMH center conducted a keyword search in PubMed in June 2021 using "COVID-19" and "SARS-CoV-2". Review articles were examined using the following filters: "review," "systematic review," and "meta-analysis." We conducted a narrative review of the retrieved articles and extracted content relevant to previous manuals. We then created a treatment algorithm and recommendations by referring to the results of the review. Results: During the initial assessment, subjective symptom severity was measured using a numerical rating scale, and patients were classified as low- or moderate-high risk. Moderate-high-risk patients should be classified as having either a psychiatric emergency or significant psychiatric condition. The developed manual presents appropriate psychological support for each group based on the following dominant symptoms: tension, anxiety-dominant, anger-dominant, depression-dominant, and somatization. Conclusions: We identified the characteristics of mental health problems during the COVID-19 pandemic and developed a clinical mental health support manual in the field of Korean medicine. When symptoms meet the diagnostic criteria for a mental disorder, doctors of Korean medicine can treat the patients according to the manual for the corresponding disorder.

• 국제학술발표논문집
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• The 9th International Conference on Construction Engineering and Project Management
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• pp.823-830
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• 2022

The risk of project execution increases due to the enlargement and complexity of Engineering, Procurement, and Construction (EPC) plant projects. In the fourth industrial revolution era, there is an increasing need to utilize a large amount of data generated during project execution. The design is a key element for the success of the EPC plant project. Although the design cost is about 5% of the total EPC project cost, it is a critical process that affects the entire subsequent process, such as construction, installation, and operation & maintenance (O&M). This study aims to develop a system using machine-learning (ML) techniques to predict risks and support decision-making based on big data generated in an EPC project's design and construction stages. As a result, three main modules were developed: (M1) the design cost estimation module, (M2) the design error check module, and (M3) the change order forecasting module. M1 estimated design cost based on project data such as contract amount, construction period, total design cost, and man-hour (M/H). M2 and M3 are applications for predicting the severity of schedule delay and cost over-run due to design errors and change orders through unstructured text data extracted from engineering documents. A validation test was performed through a case study to verify the model applied to each module. It is expected to improve the risk response capability of EPC contractors in the design and construction stage through this study.

• 대한한의학회지
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• 제45권1호
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• pp.127-138
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• 2024

Objectives: Cold extremities have been suggested to correlate with sleep disturbances. This study aims to explore the relationship between thermal sensations in body, encompassing both cold and heat sensations, with sleep quality and insomnia. Methods: Self-administered questionnaires were utilized to assess thermal sensations in body, sleep quality and symptoms of insomnia in middle-aged women. A multiple logistic regression analysis was performed to ascertain the association between thermal sensations in body and both sleep quality and insomnia symptoms. Results: Among 899 participants, 255 (28.4%) were categorized in the cold sensation group, 95 (10.6%) in the heat sensation group, 70 (7.8%) in the group with both cold and heat sensations, and 479 (53.3%) in the no-sensation group. Pittsburgh Sleep Quality Index and Insomnia Severity Index were notably higher in the group experiencing both sensations when compared to the no-sensation group. After adjustments for covariates, the odds ratios for poor sleep quality, moderate/severe insomnia, and long sleep latency were significantly elevated in the group with both sensations when compared to the no-sensation group. The odds ratios for poor sleep quality in the cold sensation group and for moderate/severe insomnia and low sleep efficiency in the heat sensation group were significantly higher when compared to the no-sensation group. Conclusions: The risk for sleep disturbances varied depending on the presence of thermal sensations in body, with the greatest risk observed for low sleep quality and insomnia in individuals experiencing both cold and heat sensations.

• 대한소아치과학회지
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• 제43권4호
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• pp.410-418
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• 2016

본 연구는 전주시 8 - 9세 어린이 950명을 대상으로 임상 검사를 통해 MIH 유병률과 MIH 증상을 보이는 치아의 저광화 정도 및 상태에 대해 알아보았으며, MIH 위험 요인에 관한 설문조사를 통해 병인을 조사하였다. MIH 유병률은 7.1%였으며, 이환된 치아의 저광화 정도는 통계적으로 유의한 차이를 보였다(p < 0.05). 제1대구치가 절치에 비해 이환 빈도가 높았으며, 특히 MIH code 2a와 3은 제1대구치에서만 관찰되었다(p < 0.05). 위험 요인에 대한 설문조사에서는 산모의 스트레스와 항생제 복용, 출생 시 저체중과 출생 후 3년 이내의 입원 경력, 빈번한 호흡기 감염, 고열 그리고 항생제의 장기간 복용이 MIH와 유의한 관련성을 보였다(p < 0.05). 위험 요인들 상호간의 관련성은 임신기간 동안 항생제를 복용한 경우에서만 높은 연관성을 보였다(p < 0.05).

• 해양환경안전학회지
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• 제22권7호
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• pp.791-799
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• 2016

본 연구의 목적은 새로운 사고의 위기가 국내 해양안전에 미치는 영향을 분석하기 위함이다. 새로운 사고 위기는 세계 해상운송에서 새롭거나 드물게 또는 예측하지 못한 사건들로부터 유추한 것으로 사전 연구에서 46명의 전문가를 통해서 식별한 것이다. 새로운 해양사고의 위기를 식별하기 위하여 해양안전심판원(KMST)의 통계 데이터를 계산에 사용하였고, IMO의 공식안정성평가기법인 위기지수(RI) = 빈도지수(FI) + 심각성지수(SI)의 개념을 계산에 적용하였다. 통계적인 사고 데이터로부터 FI와 SI의 가중치를 계산한 후 가장 순위가 높은 시나리오를 식별하고 새로운 사고 위기와 시나리오 사이의 관계를 분석하였다. 분석 결과, 가장 순위가 높은 시나리오의 근본적인 원인은 "첨단기술 개발"이었고, 그 결과 "화물 작업 시간 단축"이 발생하는 것으로 나타났다. 이러한 결과는 사전 연구에서 46명의 전문가에 의해 식별한 "영업 경쟁" 및 "선원 문제" 등과 차이가 있음을 보였다.

• Clinical and Experimental Pediatrics
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• 제50권6호
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• pp.519-523
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• 2007

Aplastic anemia is a rare disease, which is characterized by pancytopenia and hypocellular bone marrow without infiltration of abnormal cells or fibrosis. The incidence in Asia is higher than in the West and new cases are diagnosed at a rate of 5.1 per million pediatric populations per year in Korea. The pathophysiology is understood roughly by defective hematopoiesis, impaired bone marrow micro-environment and immune mechanism. Treatments are performed on basis of pathogenesis and selected depending on the severity. Immunosuppressive therapy with antilymphocyte or antithymocyte globulin and cyclosporine is effective in the majority of patients but has some problems including relapse or clonal evolution. Recently, there have been clinical trials of immunosuppression with hematopoietic growth factors or other drugs. Allogeneic hematopoietic stem cell transplantation (HSCT) is curative in children with severe aplastic anemia. The overall survival in HSCT from HLA-identical sibling is higher than alternative donor, including HLA matched unrelated donor or cord blood. We have to consider quality of life after HSCT because of high survival rate. However, chronic graft versus host disease and graft failure are important factors that affect the quality of life and overall survival. We need further investigation to make new regimens aimed at overcoming these risk factors and perform clinical trials.

• Clinical and Experimental Pediatrics
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• 제55권6호
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• pp.185-192
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• 2012

The prevalence of allergic diseases has increased worldwide, a phenomenon that can be largely attributed to environmental effects. Among environmental factors, air pollution due to traffic is thought to be a major threat to childhood health. Residing near busy roadways is associated with increased asthma hospitalization, decreased lung function, and increased prevalence and severity of wheezing and allergic rhinitis. Recently, prospective cohort studies using more accurate measurements of individual exposure to air pollution have been conducted and have provided definitive evidence of the impact of air pollution on allergic diseases. Particulate matter and ground-level ozone are the most frequent air pollutants that cause harmful effects, and the mechanisms underlying these effects may be related to oxidative stress. The reactive oxidative species produced in response to air pollutants can overwhelm the redox system and damage the cell wall, lipids, proteins, and DNA, leading to airway inflammation and hyper-reactivity. Pollutants may also cause harmful effects via epigenetic mechanisms, which control the expression of genes without changing the DNA sequence itself. These mechanisms are likely to be a target for the prevention of allergies. Further studies are necessary to identify children at risk and understand how these mechanisms regulate gene-environment interactions. This review provides an update of the current understanding on the impact of air pollution on allergic diseases in children and facilitates the integration of issues regarding air pollution and allergies into pediatric practices, with the goal of improving pediatric health.