• Childhood Kidney Diseases
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• v.16 no.1
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• pp.38-45
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• 2012

Purpose: The incidence of community-acquired urinary tract infection (UTI) due to extended-spectrum ${\beta}$-lactamase producing $Escherichia$ $coli$ (ESBL(+) $E.$ $coli$) has increased worldwide. ESBL causes resistance to various types of the newer ${\beta}$-lactam antibiotics, including the expanded spectrum cephalosporins and monobactams. We aimed to investigate the severity of UTI and associated genitourinary malformations in children with febrile UTI caused by ESBL(+) $E.$ $coli$. Methods: We retrospectively reviewed the medical records of 290 patients diagnosed as febrile UTI caused by $E.$ $coli$ between January 2008 and October 2010 at Korea University Medical center. We classified the patients into two groups with ESBL(+) and ESBL(-) $E.$ $coli$ group according to the sensitivity of urine culture. Fever duration, admission period, white blood cell (WBC) counts and C-reactive protein (CRP) in peripheral blood, the presence of hydronephrosis, cortical defects, vesicoureteral reflux (VUR) and renal scar were compared between the two groups. Results: Patients with ESBL(+) $E.$ $coli$ were 32, and those with ESBL(-) $E.$ $coli$ were 258. If we excluded those tested with a sterile urine bag, patients with ESBL(+) $E.$ $coli$ were 22, and those with ESBL(-) $E.$ $coli$ were 212. Whether the results of sterile urine bag tests were included or not, there was no significant difference in all parameters between the two groups statistically. Conclusion: Our data shows that ESBL(+) $E.$ $coli$ may not be related to the severity of UTI and associated genitourinary malformations.

• Childhood Kidney Diseases
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• v.13 no.2
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• pp.138-145
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• 2009

Purpose : This study was aimed to evaluate the changes of immunologic parameters during hospitalization, and the relationship between IgG and other laboratory or clinical indices in patients with acute poststreptococcal glomerulonephritis (APSGN). Methods : We reviewed the medical charts of 36 children with APSGN who showed ASO titer>250 Todd U/L and C3<70 mg/dL. We evaluated the levels of IgG and other laboratory parameters including C3 and ASO at admission and at discharge (14 cases). Results : The mean age of APSGN patients was $7.5{\pm}2.6$ year of age, and male-to-female ratio was 2.3:1. At presentation, hypertension (systolic blood pressure>125 mmHg), gross hematuria, and weight gain were observed in 27.8% (10/36), 80.1% (29/36), and 80% (24/30) of the patients, respectively. The mean IgG level was $1,432{\pm}322$ mg/dL ($1,025{\pm}234$ mg/dL in control group, P<0.001), and C3 and ASO levels were $26.1{\pm}16.1$ mg/dL and $1,068{\pm}730$ Todd U, respectively. There were no correlation between IgG level and the levels of any of the parameters analyzed (ASO, C3, BUN, creatinine and white blood cell count), and the severity of the disease assessed by the weight-change during admission. The patients aged<6 years of age (10 cases) had less degree of the weight-change, compared to those of the patients aged>8 years of age (15 cases) (-0.6% vs. -5.7%, P=0.01). The IgG and ASO levels did not change, but C3 (P=0.001) and IgM (P=0.02) levels increased during admission. Conclusion : Increased IgG and ASO levels in APSGN did not change, but C3 level increased during admission. IgG level was not correlated with other laboratory parameters (ASO and C3) and the severity of the disease. Younger children seem to have less severe clinical course compare to older children. With our hypothetic pathogenesis of APSGN, further studies are needed to resolve the pathogenesis of the disease including the increase of IgG.

• Childhood Kidney Diseases
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• v.16 no.2
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• pp.102-108
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• 2012

Purpose: We investigated the clinical presentation of febrile pediatric patients with acute pyelonephritis (APN) with a mixed urine culture from an aseptic urine sample, and compared with that of those with a single culture. Methods: We retrospectively reviewed the medical charts of 95 patients diagnosed as APN with fever between January 2008 and October 2010 at Korea University Medical Center. We classified the patients with APN into two groups with a positive single culture (S group) and a positive mixed culture (M group) from an aseptic urine sample of suprapubic bladder aspiration or urethral catheterization and compared the fever duration, laboratory markers such as serum white blood cell (WBC) counts and C-reactive protein (CRP) values in peripheral blood, and the presence of hydronephrosis, renal scar and vesicoureteral reflux (VUR) between the two groups (If presence of hydronephrosis, scar and VUR=1 and no=0). Results: Total pediatric patients with febrile APN were 95 patients, a positive S group was 89 patients and a positive M group was 6 patients. Fever duration (S vs. M, $4.7{\pm}3.1$ vs. $6{\pm}5.7$ days), serum WBC (S vs. M, $18,630{\pm}6,483$ vs. $20,153{\pm}7,660/{\mu}L$) and CRP (S vs. M, $100.6{\pm}2.46$ vs. $81.1{\pm}0.09\;mg/L$) values, and the presence of hydronephrosis, renal scar and VUR were not different between the two groups. Conclusion: Our data shows that there were no specific differences of clinical manifestation between a positive single urine culture and a positive mixed urine culture in pediatric APN. A mixed urine culture from an aseptic urine sample should be interpreted cautiously.

• Korean Journal of Poultry Science
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• v.38 no.2
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• pp.121-128
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• 2011

This study was conducted to investigate the effects of dietary supplementation of Cu-sulfate, Cu-methionine chelate (Cu-Met) and Cu-soy proteinate (Cu-SP) on the performance, blood parameters and mineral contents of muscle. It was conducted with a total of 1,000 one d old broilers chickens (Ross$^{(R)}$) which were assigned to four dietary treatments; Control, Cu sulfate (200 ppm Cu as $CuSO_4{\cdot}5H_2O$), Cu-Met (200 ppm Cu as Cu-methionine chelate), Cu-SP (200 ppm Cu as Cu-soy proteinate). There were significant differences (p<0.05) among treatments in weight gain. Weight gain of Cu treated groups were higher than the control during 3~5 wk. There were significant differences (p<0.05) among treatments in feed intake during 0~3 wk. Cu-Met was significantly (p<0.05) lower than the control but the differences among Cu treatments were not significant. There were significant differences (p<0.05) among treatments in feed conversion rate (FCR). Cu treated groups were lower than the control during the whole period. Production efficiency factor (PEF) was significantly higher (p<0.01) in Cu treated groups than the control. Nutrient availabilities of diets were not significantly different among the treatments. The count of white blood cell (WBC) and eosinophil (EO) were lower in Cu-SP treatment than in the control. Copper concentration in the liver was significantly (p<0.01) higher in Cu treated groups than the control. Zinc concentration in the breast and wing muscle was lower in Cu treated and that of leg muscle was higher in Cu-Met than the control. The result of this experiment showed that Cu supplementation at the level of 200 ppm as Cu sulfate, Cu-Met and Cu-SP improves weight gain (4~5 wk), FCR and PEF. Differences among Cu sources were not significant.

• Korean Journal of Poultry Science
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• v.34 no.4
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• pp.245-251
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• 2007

This study was conducted to investigate the effects of modification of a herbal recipe(Herb $Mix^{(R)}$) on the growth of pullet and laying performance of hens. The formula of Herb $Mix^{(R)}$, a mixture of Rehmannia glutinosa, Angelica gigas, Discorea japonica, Glycyrrhiza uralensis, Schisandra chinensis and Ligusticum jeholense, was modified in mixing ratio. A total of 1,120 pullets(Hy-Line Brown) of 14 wks old were assigned to seven treatments; control, Herb $Mix^{(R)}$(HM), R. glutinosa fortified HM, A. gigas fortified HM, D. japonica fortified HM, G. uralensis fortified HM, S. chinensis fortified HM, L. jeholense fortified HM and Flavomycin supplemented diet. Each treatment had 8 replicates of 20 birds each housed in 2 birds cages. Body weight at 10% egg production was significantly(P<0.05) influenced by treatments. Birds fed A. gigas fortified HM diet were heaviest followed by L. jeholense fortified HM, HM-original and D. japonica fortified HM, Flavomycin supplemented diet and R. glutinosa while those fed control diet were lightest. Also, age reaching 50% egg production and peak production was earliest in A. gigas fortified HM and latest in the control. Egg production, feed intake, feed conversion and egg weight were significantly influenced by treatments. Significant improvement in egg production and feed intake was shown in A. gigas fortified HM treatment. Feed conversion ratio was lowest in antibiotic(Flavomycin) treatment and egg weight was heaviest in L. jeholense fortified HM treatment. There were no significant differences among treatments in intestinal microflora but cfu of Cl. perfringnes and E. coli tended to be lower in HM treatments than the control. Among the leucocytes of blood, the HM treatments were lower than the control in counts of white blood cell and heterophils. It was concluded that modification of Herb $Mix^{(R)}$ fortifying with A. gigas, D. japonica and L. jeholense significantly influence growth and laying performance of birds.

• Clinical and Experimental Pediatrics
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• v.49 no.2
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• pp.192-197
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• 2006

Purpose : Vascular endothelial growth factor(VEGF) is a key cytokine for controlling vascular permeability and angiogenesis, which is one of the major findings in airway remodeling. However, it is not well known if it is associated with acute lower respiratory tract disease such as lobar pneumonia. The aim of this study is to compare serum VEGF levels in patients with asthma according to its severity and duration of cough, and to compare its levels with children with lobar pneumonia. Methods : Using a sandwich enzyme-linked immunosorbent assay, the serum VEGF levels were measured in 16 mild asthmatics, 14 moderate to severe asthmatics, six children with lobar pneumonia, and 22 control subjects. The asthmatics were also classified into three groups according to the duration of cough. Serum VEGF levels were compared in each group. Results : Serum VEGF levels were significantly increased in the children with moderate to severe asthma and lobar pneumonia compared to the children with mild asthma and control subjects. Serum VEGF levels were higher in children with chronic coughs of more than two weeks than in children with coughs lasting less than two weeks. Serum levels of VEGF showed positive correlations with blood platelet and white blood cell counts. Conclusion : VEGF increased according to the severity of asthma and duration of cough in children with asthma. It may play an important role not only in chronic airway inflammation, but also in the acute inflammation in children with lower respiratory tract disease.

• Tuberculosis and Respiratory Diseases
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• v.45 no.6
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• pp.1214-1222
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• 1998

Background : The intrapleural hypofibrinolysis is caused by mainly excessive concentration of pleural plasminogen activator inhibitor-1 antigen(PAI-1 Ag), which binds tissue type plasminogen activator. In pleural inflammation induced by sclerosing agents for pleurodesis, levels of pleural PAI-1 antigen increase in relation to decreasing D-dimer levels. It has been known that the pleural mesothelial cells have the capability of secreting PAI-1 Ag in response to inflammation in vivo. Therefore, we estimated whether pleural inflammation changes the balance between fibrinolytic and coagulative properties in exudative pleural effusions. Method : The thirty cases was included in our study. We determined the pleural levels of glucose, lactic dehydrogenase(LDH), pH and the counts of white blood cell(WBC), polymorpho leukocyte(PMN), lymphocyte as the parameters of pleural inflammation and cellular components of pleural fluid. The plasma level of fibrinogen in fluid and the neutrophil count in blood were determined. The levels of D-dimer, PAI-1 Ag and thrombinantithrombin III complex(TAT) were determined by ELISA(Behring, Marburg, Germany). Result : The causes of pleural effusion were as following : tuberculous in 14 cases, malignant in 10 cases and parapneumonic in 6 cases. The levels of pleural D-dimer, PAI-1 Ag and TAT was significantly higher than that of plasma(p<0..001). The severity of pleural inflammation did not correlated with pleural D-dimer, PAI-1 Ag, TAT and their plasma levels. But the level of pleural TAT correlated with pleural WBC and lymphocyte count. Conclusion : We found that the severity of pleural inflammations did not correlated with pleural D-dimer, PAI-1 Ag, TAT and the possibility of local production of PAI-1 antigen is present.

• Journal of agricultural medicine and community health
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• v.36 no.2
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• pp.101-112
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• 2011

Objectives: The aim of this study is to determine arterial stiffness levels as measured by brachial-ankle pulse wave velocity (baPWV) and to identify the association between arterial stiffness and inflammatory markers, in healthy adults over 50 years old. Methods: The study population consisted of 4617 persons over the age of 50 years who participated in the baseline survey of the Dong-gu Study, which was conducted in 2007 and 2008. Arterial stiffness was measured using baPWV. A multiple regression analysis was performed to assess the relationship between conventional cardiovascular risk factors and inflammatory markers, including white blood cell (WBC) counts, high-sensitive C-reactive protein (hs-CRP), and gamma glutamyltransferase (GGT). Results: After adjustment for conventional cardiovascular risk factors including sex, age, smoking status, body mass index, systolic blood pressure, fasting glucose, hypertension or diabetic medication, total cholesterol, triglycerides, uric acid, and alanine aminotransferase, baPWV was significantly associated with WBC counts (${\beta}$=0.158, p<0.0001), hs-CRP (${\beta}$=0.244, p=0.026), and GGT (${\beta}$=0.003, p<0.0001). Conclusion: This study shows that arterial stiffness correlates with inflammatory markers. Arterial stiffness may be used as a composite risk factor to identify persons with higher risk for cardiovascular disease. Additionally, arterial stiffness may be a marker for future cardiovascular disease and a target for prevention.

• Pediatric Infection and Vaccine
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• v.16 no.1
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• pp.40-46
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• 2009

Purpose : The purpose of this study was to identify useful predictors for diagnosing bacterial meningitis and performing CSF studies in febrile infants three months or younger. Methods : Six hundred and fifty two febrile infants with a rectal temperature ${\geq}38.0^{\circ}C$ presented from January 2003 to April 2008 and were retrospectively studied. The total white blood cell count (WBC), band count, absolute neutrophil count (ANC), quantitative C-reactive protein (CRP) and blood cultures were performed on admission. The clinical variables associated with bacterial meningitis were analyzed. Results : In patients with bacterial meningitis, the clinical variables including CRP (P=0.036), band count (P=0.037), ANC (P=0.036) and age (P=0.001) were significantly different. The area under the receiver-operating characteristic curve was 0.969 for CRP, 0.946 for the band count, 0.765 for the ANC and 0.235 for age. A CRP cutoff point of 8 mg/dL was determined to maximize both the sensitivity and specificity (sensitivity 83%, specificity 95%, likelihood ratio 16.6). A CRP concentration of <7 mg/dL "ruled-out" bacterial meningitis, with a likelihood ratio of 0.17, a posttest probability of <0.1% and negative predictive value 91%. A CRP concentration greater than 9 mg/dL had a much higher likelihood ratio (20.1) than the band count (16.6) and ANC (2.2). Conclusion : The CRP concentration was a useful laboratory test for the differential diagnosis of bacterial meningitis among febrile infants three months of age or younger. A CRP concentration of <7 mg/dL effectively ruled out bacterial meningitis; a value ${\geq}9mg/dL$ increased the clinical suspicion of bacterial meningitis and the need for CSF evaluation.

• Childhood Kidney Diseases
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• v.17 no.2
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• pp.65-72
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• 2013

Purpose: Urinary tract infection (UTI) caused by gram-positive uropathogens is usually hospital-acquired and associated with predisposing conditions. However, the incidence of gram-positive bacteria in community-acquired UTIs has recently increased worldwide. We aimed to investigate the clinical significance of UTI and associated genitourinary malformations in young children with febrile UTIs caused by gram-positive bacteria. Methods: We retrospectively reviewed the medical records of 566 patients (age, <1 year) who visited the Korea University Medical Center for febrile UTIs between January 2008 and May 2013. We classified the patients into the following two groups: gram-positive (P group) and gram-negative (N group), according to the results of urine culture. The fever duration; white blood cell (WBC) counts and C-reactive protein (CRP) levels in peripheral blood; and the presence of hydronephrosis, cortical defects, vesicoureteral reflux (VUR), and renal scarring were compared between the two groups. Results: The number of patients with gram-positive bacteria was 23 (4.1%) and with gram-negative bacteria was 543 (95.9%). The most common pathogen was Escherichia coli, and Enterococcus faecalis showed the highest incidence among gram-positive uropathogens. Patients with gram-positive bacteria showed longer fever duration compared to that in patients with gram-negative bacteria (P vs. N, $3.4{\pm}1.2$ vs. $2.9{\pm}1.6$ days, P <0.05). The incidence of VUR was increased in the gram-positive group compared to that in the gram-negative group (P vs. N, 55.6 vs. 17.8%, P<0.05). However, there were no significant differences in other laboratory and radiologic findings. Conclusion: The findings of our study show that community-acquired UTIs in patients younger than 1 year of age, caused by gram-positive uropathogens, can be associated with prolonged fever duration and the presence of VUR.