• Clinical and Experimental Pediatrics
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• v.59 no.10
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• pp.408-413
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• 2016

Purpose: This study investigated predictors of unresponsiveness to second-line intravenous immunoglobulin (IVIG) treatment for Kawasaki disease (KD). Methods: This was a single-center analysis of the medical records of 588 patients with KD who had been admitted to Asan Medical Center between 2006 and 2014. Related clinical and laboratory data were analyzed by univariate and multivariate logistic regression analyses. Results: Eighty (13.6%) of the 588 patients with KD were unresponsive to the initial IVIG treatment and received a second dose. For these 80 patients, univariate analysis of the laboratory results obtained before administering the second-line IVIG treatment showed that white blood cell count, neutrophil percent, hemoglobin level, platelet count, serum protein level, albumin level, potassium level, and C-reactive protein level were significant predictors. The addition of methyl prednisolone to the second-line regimen was not associated with treatment response (odds ratio [OR], 0.871; 95% confidence interval [CI], 0.216-3.512; P=0.846). Multivariate analysis revealed serum protein level to be the only predictor of unresponsiveness to the second-line treatment (OR, 0.160; 95% CI, 0.028-0.911; P=0.039). Receiver operating characteristic curve analysis to determine predictors of unresponsiveness to the second dose of IVIG showed a sensitivity of 100% and specificity of 72% at a serum protein cutoff level of <7.15 g/dL. Conclusion: The serum protein level of the patient prior to the second dose of IVIG is a significant predictor of unresponsiveness. The addition of methyl prednisolone to the second-line regimen produces no treatment benefit.

• Clinical and Experimental Pediatrics
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• v.59 no.7
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• pp.298-302
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• 2016

Purpose: Recent reports showed that plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) could be a useful biomarker of intravenous immunoglobulin (IVIG) unresponsiveness and coronary artery lesion (CAL) development in Kawasaki disease (KD). The levels of these peptides are critically influenced by age; hence, the normal range and upper limits for infants and children are different. We performed an age-adjusted analysis of plasma NT-proBNP level to validate its clinical use in the diagnosis of KD. Methods: The data of 131 patients with KD were retrospectively analyzed. The patients were divided into 2 groups-group I (high NT-proBNP group) and group II (normal NT-proBNP group)-comprising patients with NT-proBNP concentrations higher and lower than the 95th percentile of the reference value, respectively. We compared the laboratory data, responsiveness to IVIG, and the risk of CAL in both groups. Results: Group I showed significantly higher white blood cell count, absolute neutrophil count, C-reactive protein level, aspartate aminotransferase level, and troponin-I level than group II (P<0.05). The risk of CAL was also significantly higher in group I (odds ratio, 5.78; P=0.012). IVIG unresponsiveness in group I was three times that in group II (odds ratio, 3.35; P= 0.005). Conclusion: Age-adjusted analysis of plasma NT-proBNP level could be helpful in predicting IVIG unresponsiveness and risk of CAL development in patients with KD.

• IMMUNE NETWORK
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• v.10 no.3
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• pp.81-84
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• 2010

B cells, by virtue of their diverse roles in immune responses to foreign and self antigens, have become of increasing interest to the clinician as well as the basic immunologist. In particular, it is now apparent that the development of B cell unresponsiveness in antibody and T cell mediated autoimmune disorders and the transplant setting is both worthwhile and achievable.

• The Journal of Pediatrics of Korean Medicine
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• v.30 no.3
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• pp.42-51
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• 2016

Objectives The purpose of this study is to report a case of iron deficiency anemia in a child with repetitive bleeding in the upper gastrointestinal tract caused by Helicobacter pylori infection, and summarize review of a western literature. Methods A 13-year-old patient, who were suffering from iron deficiency anemia from repetitive bleeding in the upper gastrointestinal tract, was administered by Ikwiseungyang-tang gamibang (益胃升陽湯加味方) and Samchulgeonbitang (蔘出健脾湯). After several tests, we realized that an iron deficiency anemia was related to Helicobacter pylori. Results By herb medication, the patient's symptoms were alleviated. Conclusions Helicobacter pylori infection is one of the reasons of refractory iron-deficiency anemia which is unresponsiveness to oral iron therapy. We report the findings of herb medication along with summarization of a western literature.

• Korean Journal of Clinical Laboratory Science
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• v.36 no.1
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• pp.64-68
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• 2004

Brain death is defined as the irreversible cessation of all brain function. The diagnosis of brain death is primarily based on a careful neurological examination demonstrating unresponsiveness, absent of brain stem reflexes, and no respiratory activity. Several conditions which may mimic brain death must be excluded. In some cases investigations such as electroencephalography, angiography, transcranial doppler or evoked potentials can contribute to the diagnosis. The brief review will introduce medical technologist and clinician to the key issues in the definition and management of brain death.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.3
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• pp.235-240
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• 2017

Pulseless electrical activity (PEA) is a clinical condition characterized by unresponsiveness and lack of palpable pulse in the presence of organized cardiac electrical activity and is caused by a profound cardiovascular insult (e.g., severe prolonged hypoxia or acidosis, extreme hypovolemia, or flow-restricting pulmonary embolus). Amyotrophic lateral sclerosis (ALS) is a disease that is characterized by progressive degeneration of all levels of the motor nervous system. Damage to the respiratory system and weakness of the muscles may increase the likelihood of an emergency situation occurring in patients with ALS while under general anesthesia. We report a case of PEA during the induction of general anesthesia in a patient with ALS who presented for dental treatment and discuss the causes of PEA and necessary considerations for general anesthesia in patients with ALS.

• Korean Journal of Child Studies
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• v.21 no.3
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• pp.53-68
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• 2000

This study investigated differences between the ability of children and young adults to describe their experience. Forty 5-year-olds and 40 16-year-olds viewed 12 pictures(Azmitia, 1987) and responded to open-ended, closed and misleading questions. Responses were categorized by the SPSS WIN program into rate of correctness, incorrectness, unresponsiveness and "don't know". Data were analyzed by t-test. On open-ended questions, the rate of incorrectness by young adults was higher than that of children. On closed questions, children had a higher rate of incorrectness than young adults. On misleading questions, children showed a lower performance in the rate of correctness and "don't know" and the rate of incorrectness by children was higher than that of young adults.

• Clinical and Experimental Pediatrics
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• v.50 no.12
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• pp.1165-1172
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• 2007

Self/non-self discrimination and unresponsiveness to self is the fundamental properties of the immune system. Self-tolerance is a state in which the individual is incapable of developing an immune response to an individual's own antigens and it underlies the ability to remain tolerant of individual's own tissue components. Several mechanisms have been postulated to explain the tolerant state. They can be broadly classified into two groups: central tolerance and peripheral tolerance. Several mechanisms exist, some of which are shared between T cells and B cells. In central tolerance, the recognition of self-antigen by lymphocytes in bone marrow or thymus during development is required, resulting in receptor editing (revision), clonal deletion, anergy or generation of regulatory T cells. Not all self-reactive B or T cells are centrally purged from the repertoire. Additional mechanisms of peripheral tolerance are required, such as anergy, suppression, deletion or clonal ignorance. Tolerance is antigen specific. Generating and maintaining the self-tolerance for T cells and B cells are complex. Failure of self-tolerance results in immune responses against self-antigens. Such reactions are called autoimmunity and may give rise to autoimmune diseases. Development of autoimmune disease is affected by properties of the genes of the individual and the environment, both infectious and non-infectious. The host's genes affect its susceptibility to autoimmunity and the environmental factors promote the activation of self-reactive lymphocytes, developing the autoimmunity. The changes in participating antigens (epitope spreading), cells, cytokines or other inflammatory mediators contribute to the progress from initial activation to a chronic state of autoimmune diseases.

• The Korean Journal of Pain
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• v.14 no.1
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• pp.114-117
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• 2001

A significant injury of ligament or tendon that might result in hypermobility and/or instability has been termed connective tissue insufficiency (CTI). Load bearing on CTI can sometimes create a malfunction of the mechanoreceptor and this in turn can aggravate the problem thus creating a chronic condition. Prolotherapy means the injection of growth factors or growth factor stimulators into the fibroosseous junction of the disabled ligament, tendon or cartilages in order to strengthen and promote proliferation of the injured Connective tissue. In the case of frequent recurrence or unresponsiveness to conservative treatment including nerve blocks in the chronic musculoskeletal disorder. We obtained good results after the prolotherapy treatment. This study will report on 5 cases of prolotherapy treatment.

• The Journal of Pediatrics of Korean Medicine
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• v.14 no.1
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• pp.137-152
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• 2000

The purpose of this study was on effect of Bopejungcheuntang(BPJC) for atopic dermatitis. During 5 months between January and May 2000, BPJC water extract administered to patient suffering from atopic dermatitis, in Dep. of Pediatrics, Dongguk university Pundang Oriental Hospital and this study was conducted for 27 patient (male 17, female 10) The result were as follows 1. The distribution of remedial values were improvement (51.9%), unresponsiveness(37.0%), depravation(11.1%). 2. After dispensing BPJC, ordinal sites of atopic dermatitis were inner space of elbow and knee joint, face and neck, back and abdomen, wrist and ankle. Befor and after dispensing BPJC this ordinal sites were similar but after dispensing BPJC, the other sites except head is improved. Order of symptomatic improvement is itching, licheniasis, erythema, exudate. Both itching and exudate is significantly improved. 3. According to way of water extract, symptomatic improvement is most excellent with general water extract & distiled water, the second is general water extract, the third is distiled water. 4. BPJC effect on atopic dermatitis is not significantly affected by sex, day of falling ill, medical treatment, resident environment, feeding, character and duration of medical treatment.