Here we describe the neurodevelopmental outcomes of very low birth weight (VLBW) infants (birth weight ≤1,500 g) at 3 years of age in the Neonatal Research Network of Japan (NRNJ) database in the past decade and review the methodological issues identified in follow-up studies. The follow-up protocol for children at 3 years of chronological age in the NRNJ consists of physical and comprehensive neurodevelopmental assessments in each participating center. Neurodevelopmental impairment (NDI)-moderate to severe neurological disability-is defined as cerebral palsy (CP) with a Gross Motor Function Classification System score ≥2, visual impairment such as uni- or bilateral blindness, hearing impairment requiring hearing amplification, or cognitive impairment with a developmental quotient (DQ) of Kyoto Scale of Psychological Development score <70 or judgment as delayed by pediatricians. We used death or NDI as an unfavorable outcome in all study subjects and NDI in survivors using number of assessed infants as the denominator. Follow-up data were collected from 49% of survivors in the database. Infants with follow-up data had lower birth weights and were of younger gestational age than those without follow-up data. Mortality rates of 40,728 VLBW infants born between 2003 and 2012 were 8.2% before discharge and 0.7% after discharge. The impairment rates in the assessed infants were 7.1% for CP, 1.8% for blindness, 0.9% for hearing impairment, 15.9% for a DQ <70, and 19.1% for NDI. The mortality or NDI rate in all study subjects, including infants without follow-up data, was 17.4%, while that in the subjects with outcome data was 32.5%. The NRNJ follow-up study results suggested that children born with a VLBW remained at high risk of NDI in early childhood. It is important to establish a network follow-up protocol and complete assessments with fewer dropouts to enable clarification of the outcomes of registered infants.
Seo, Youn Tae;Kim, Deok Su;Kil, Bu Kwan;Shin, SeungHeon;Ye, Mi Kyung
Journal of Clinical Otolaryngology Head and Neck Surgery
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v.29
no.2
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pp.182-189
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2018
Background and Objectives : There were few literatures about the relationship between upper airway disorders and cardiovascular risk factors such as hypertension, although an association between impaired lower respiratory function and cardiovascular alterations was often reported. Our purpose was to assess the relationships between chronic sinusitis and hypertension. Materials and Methods : Three hundred subjects with bilateral chronic sinusitis who underwent functional endoscopic sinus surgery between 2015and 2017 were evaluated. Six hundred forty subjects without any nasal diseases were enrolled as a control group. Blood pressure and body mass index (BMI) were measured using a standardized method, and subjects were asked about current use of any antihypertensive medication, history of diabetes, smoking and alcohol drinking habits.Sinusitis group was assessed by nasal endoscopic examination, paranasal sinus CT scan and allergy test. Results : Average systolic and diastolic blood pressures were statistically significantly higher in subjects with sinusitis than control group. Chronic rhinosinusitis was associated with a 1.415-fold (95% confidence interval 1.053-1.930) increased hazard of hypertension after multivariate adjustment. Conclusions : These results suggest that sinusitis is associated with high blood pressure. Therefore patients with sinusitis may need special attention for blood pressure control. Further studies need to be performed to elucidate the pathogenesis behind such associations.
Upper tract urothelial carcinoma (UTUC) has a relatively low prevalence rate of about 1.8 per 100,000 people. According to the recent literature, the development of diagnostic techniques has gradually increased the prevalence and diagnosis rate. In the past, when UTUC was diagnosed, more than 60% of the patients were diagnosed as locally advanced or metastatic cancer. However, since 2010, approximately 70% of the patients have been diagnosed as operable stage. Although radical nephroureterectomy is known as the basis of treatment for UTUC, overall survival is poor in patients with lymph node invasion. Especially, the finding that a localized UTUC is associated with a high risk of cancer metastasis in approximately 50% of patients suggests that these patients may not have sufficient treatment through surgery alone. The European Association of Urology and the National Comprehensive Cancer Network guideline 2017 suggested that postoperative adjuvant chemotherapy may be considered in patients with advanced UTUC beyond pT2. Also, recent meta-analyses have reported that cisplatin-based adjuvant chemotherapy can be expected to have a synergistic effect of overall survival and disease-free survival. However, many patients with UTUC undergo postoperative renal failure, which may result in failure to perform cisplatin-based adjuvant chemotherapy with adequate dose. For this reason, several researchers have suggested that it is beneficial to apply neoadjuvant chemotherapy when the preoperative renal function is maintained to a certain extent. But, neoadjuvant chemotherapy has not been used by many clinicians because of the lack of studies and the rarity of the disease. We are currently discussing the outcomes and prospects of perioperative chemotherapy.
Journal of the Korea Academia-Industrial cooperation Society
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v.20
no.8
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pp.83-92
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2019
This qualitative study employed focused group interviews to collect data on the forgetfulness experienced by elderly persons (over the age of 65) who suffer with subjective memory impairment. The participants were ten elderly persons who participated in the cognitive function improvement program at an elderly welfare center in D city. They were divided into three groups that were comprised of three/four people each, and each group was interviewed for 40~60 minutes. The results showed that "difficulties in human relations", "feeling uncomfortable in daily life", "exposure to a safety risk", "inexpressible ambivalence" and "family effort to overcome forgetfulness" were all expressed in the interviews. The elderly who participated in this study and who complained of subjective memory impairment had both feelings of anxiety and anxiety about non-dementia, and they were making efforts to overcome forgetfulness themselves. Based on this study, we suggest that interventions should be developed that reflect the individual needs of elderly people with subjective memory impairment.
Farm animals such as piglets are often affected by environmental stress, which can disturb the gut ecosystem. Antibiotics were commonly used to prevent diarrhea in weaned piglets, but this was banned by the European Union due to the development of antibiotic resistance. However, the use of probiotics instead of antibiotics may reduce the risk posed by pathogenic microorganisms and reduce the incidence of gastrointestinal diseases. Therefore, this study was conducted to investigate the effects of Lactobacillus casei Zhang on the mechanical barrier and immune function of early-weaned piglets infected using Escherichia coli K88 based on histomorphology and immunology. Fourteen-day-old weaned piglets were divided into a control group and experimental groups that were fed L. casei Zhang and infected with E. coli K88 with or without prefeeding and/or postfeeding of L. casei Zhang. The L. casei Zhang dose used was $10^7CFU/g$ diet. Jejunum segments were obtained before histological, immunohistochemical, and western blot analyses were performed. In addition, the relative mRNA expression of toll receptors and cytokines was measured. Piglets fed L. casei Zhang showed significantly increased jejunum villus height, villus height-crypt depth ratio, muscle thickness, and expression of proliferating cell nuclear antigen and tight junction proteins ZO-1 and occludin. The use of L. casei Zhang effectively reduced intestinal inflammation after infection. We found that L. casei Zhang feeding prevented the jejunum damage induced by E. coli K88, suggesting that it may be a potential alternative to antibiotics for preventing diarrhea in early-weaned piglets.
Background: Closed reduction of the fracture under general or local anesthesia with elevators or forceps is widely used to treat nasal bone fractures. However, operating under general anesthesia increases the risk of morbidity and raises the cost of management. Furthermore, using forceps or elevators may cause undercorrection, new fractures, mucosal damage, and nasal hemorrhage. We therefore performed manual reduction under local anesthesia, using the little finger, to minimize the demerits of treatment under general anesthesia with forceps or elevators and aimed to assess functional and aesthetic outcomes, and patient satisfaction. Methods: Patients who visited the plastic and reconstructive surgery department between November 2016 and November 2017 with nasal bone fractures and treated by a single surgeon were prospectively followed up. Patients with simple unilateral or bilateral nasal bone fractures were treated with bedside finger reduction under local anesthesia and patients with comminuted nasal bone or septal fractures were scheduled for closed reduction under general anesthesia. Results: Of 84 patients, 28 met the inclusion criterion and underwent bedside finger reduction under local anesthesia. Twenty-seven patients (96.4%) were successfully contacted via telephone for survey. Twenty-three (85.2%) showed good and three (11.1%) showed fair results. All 27 patients (100%) were satisfied with their postoperative function and 25 (92.6%) were satisfied with their postoperative aesthetic result. Twenty-five patients (92.6%) preferred the finger reduction method under local anesthesia over closed reduction under general anesthesia. Conclusion: Finger reduction under local anesthesia in patients with mild unilateral or bilateral nasal bone fractures is an easy and efficient procedure with high patient satisfaction and favorable postoperative functional and aesthetic outcomes.
Journal of Korean Society of Disaster and Security
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v.11
no.2
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pp.83-89
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2018
The significant sedimentation at the estuary in the eastern coast of Korea frequently causes river mouth occlusion where disconnection between the river and sea is observed. River mouth occlusion causing watershed retention raises the environmental risk of the area as it impairs water quality and threatens the area's safety in the event of floods. This study proposes a plan to maintain stability of river channel and flow of flood discharge at the estuary with loss of its function for disaster prevention. To this end, the study tries to change the location and width of stream path, focusing on the center line of stream near the sand bar of river mouth. This allows to identify a shape of stream path that leads the most stable flow. To review the result, this study uses the SRH-2D, a model for two-dimensional hydraulic analysis, and conduct numeric simulation. The simulation result showed that the most effective plan for maintaining the stable flow of running water without having the area sensitive to changes in hydraulic characteristics is to lower the overall river bed height of the sand bar near the center line of stream to a equal level.
Kwak, Min Kyu;Lee, Song Jae;Song, Chang Myeon;Ji, Yong Bae;Tae, Kyung
International journal of thyroidology
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v.11
no.2
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pp.130-136
/
2018
Background and Objectives: Intraoperative neural monitoring (IONM) of recurrent laryngeal nerve (RLN) in thyroid surgery has been employed worldwide to identify and preserve the nerve as an adjunct to visual identification. The aims of this study was to evaluate the efficacy of IONM and difficulties in the learning curve. Materials and Methods: We studied 63 patients who underwent thyroidectomy with IONM during last 2 years. The standard IONM procedure was performed using NIM 3.0 or C2 Nerve Monitoring System. Patients were divided into two chronological groups based on the success rate of IONM (33 cases in the early period and 30 cases in the late period), and the outcomes were compared between the two groups. Results: Of 63 patients, 32 underwent total thyroidectomy and 31 thyroid lobectomy. Failure of IONM occurred in 9 cases: 8 cases in the early period and 1 case in the late period. Loss of signal occurred in 8 nerves of 82 nerves at risk. The positive predictive value increased from 16.7% in the early period to 50% in the late period. The mean amplitude of the late period was higher than that of the early period (p<0.001). Conclusion: IONM in thyroid surgery is effective to preserve the RLN and to predict postoperative nerve function. However, failure of IONM and high false positive rate can occur in the learning curve, and the learning curve was about 30 cases based on the results of this study.
Background: 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) effectively reduce serum levels of low-density lipoprotein (LDL) and total cholesterol. High-intensity statins are recommended for all patients aged ${\leq}75$ with clinical atherosclerotic cardiovascular disease (ASCVD), diabetes mellitus aged 40-75 with ${\geq}7.5%$ estimated 10-year ASCVD risk and LDL-C ${\geq}190mg/dL$. High-intensity statins associated with more frequent adverse events (AEs) compared to moderate- to low-intensity statins. The aim of this study was to compare AEs between high-intensity and moderate- to low-intensity statin group using the Korea Adverse Event Reporting System (KAERS) database. Methods: Adults (${\geq}18years$) with statin-associated AEs from July 2009-June 2014 were included. Only AEs classified as "certain", "probable" and "possible" based on the WHO-Uppsala Monitoring Center criteria were analyzed. Results: In total, 247 AEs from 196 patients [high-intensity statin group (HG), n = 25 (13%); moderate- to low-intensity statin group (MLG), n = 171 (87%)] were included. Mean age was higher in HG compared with MLG ($67{\pm}14$ vs $62{\pm}12$). The HG showed a significant higher frequency of liver/biliary system disorders (37% vs 14%, p = 0.001). Hepatic function abnormal was reported more frequently in HG compared to MLG (26% vs 9%, p = 0.006). Conclusion: According to KAERS data, liver/biliary system disorders were more frequently reported in HG compared to MLG.
International Journal of Advanced Culture Technology
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v.6
no.4
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pp.275-283
/
2018
Cancer show distinct pattern of gene expression when it is compared to normal. This difference results malignant characteristic of cancer. Many cancer drugs are targeting this difference so that it can selectively kill cancer cells. One of the recent demand for personalized treating cancer is retrieving normal tissue from a patient so that the gene expression difference between cancer and normal be assessed. However, in most clinical situation it is hard to retrieve normal tissue from a patient. This is because biopsy of normal tissues may cause damage to the organ function or a risk of infection or side effect what a patient to take. Thus, there is a challenge to estimate normal cell's gene expression where cancers are originated from without taking additional biopsy. In this paper, we propose in-silico based prediction of normal cell's gene expression from gene expression data of a tumor sample. We call this challenge as reverting the cancer into normal. We divided this challenge into two parts. The first part is making a generator that is able to fool a pretrained discriminator. Pretrained discriminator is from the training of public data (9,601 cancers, 7,240 normals) which shows 0.997 of accuracy to discriminate if a given gene expression pattern is cancer or normal. Deceiving this pretrained discriminator means our method is capable of generating very normal-like gene expression data. The second part of the challenge is to address whether generated normal is similar to true reverse form of the input cancer data. We used, cycle-consistent adversarial networks to approach our challenges, since this network is capable of translating one domain to the other while maintaining original domain's feature and at the same time adding the new domain's feature. We evaluated that, if we put cancer data into a cycle-consistent adversarial network, it could retain most of the information from the input (cancer) and at the same time change the data into normal. We also evaluated if this generated gene expression of normal tissue would be the biological reverse form of the gene expression of cancer used as an input.
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