• Clinical and Experimental Pediatrics
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• 제46권8호
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• pp.758-762
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• 2003

목 적 : 저자들은 발열을 주소로 입원한 3세 이하의 소아에서 초기 총 백혈구 수, 적혈구 침강 속도, C-반응성 단백질 정량적 검사를 통해 민감도와 특이도가 최대치에 이르는 수치를 차단점으로 선택하여 세균성 감염의 고위험군을 예측하고 항생제 치료의 지표로 삼고자 연구를 하였다. 방 법 : 2001년 6월부터 2002년 6월까지 조선대학교병원 소아과에 발열을 주소로 입원치료 하였던 환아 중 진찰 소견에서 발열에 대한 원인을 발견할 수 없었던 1개월에서 36개월 사이의 71명을 대상으로 하여 후향적으로 조사하였다. 대상 환아들을 세균성 감염과 비세균성 감염으로 분류한 후 각각의 진단 기준의 양성 예측치와 우도비를 계산하고 민감도와 특이도가 최대치에 이르는 수치를 차단점(cut-off point)으로 선택하여 그 수치에서의 민감도와 특이도를 조사하였다. 결 과 : 대상 환아 총 71명(남아 44명, 여아 27명)이고, 평균 연령은 12.7개월이었다. 세균성 감염인 경우는 20례(28%)이었으며, 요로 감염 12례, 세균혈증 5례, 뇌막염 3례 순이었다. 감염균은 E.coli 6례, K.pneumoniae 3례, E. faecalis 3례, Streptococcus ganguinis 3례, Salmonella 2례, S.aureus 1례, Stenotrophomonas maltophilia 1례, Streptococcus constellatus 1례였다. 총 백혈구 수, 적혈구 침강 속도, C-반응성 단백질은 세균성 감염군과 비세균성 감염군간의 유의한 차이를 보였다(P=0.038, 0.009, 0.002). 양성예측치와 우도비는 총 백혈구 수는 20,000/mm^3$ 이상에서 75%, 7.65이었으며, 적혈구 침강 속도는 30-50 mm/hr에서 60%, 3.83이었다. C-반응성 단백질의 양성 예측치와 우도비는 3-6 mg/dL에서 63%, 4.25이었다. 민감도와 특이도가 최대치에 이르는 수치는 총 백혈구 수 $20,000/mm^3$, 적혈구 침강 속도 30 mm/hr, C-반응성 단백질 3.0 mg/dL이었으며, 이 값에서의 민감도는 각각 75%, 79%, 83%, 특이도는 75%, 68%, 77%이었다. 결 론 : 비특이적 소견을 보이는 3세 이하 발열 환아에서 차단점을 총 백혈구 수 20,000/mm^3$, 적혈구 침강 속도 30 mm/hr, C-반응성 단백질 3.0 mg/dL으로 적용할 때 세균성 감염에서 선택적 치료 방침을 세울 수 있게 되리라 생각된다.

• Clinical and Experimental Pediatrics
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• 제61권3호
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• pp.84-89
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• 2018

Purpose: Timely antibiotic therapy in selected cases of diarrhea associated with bacterial infections can reduce the duration and severity of illness and prevent complications. The availability of a predictive index before identification of causative bacteria would aid in the choice of a therapeutic agent. Methods: The study included patients admitted to the pediatrics unit at Konyang University Hospital for acute inflammatory diarrhea from August 1, 2015 to July 31, 2016 who underwent multiplex polymerase chain reaction testing. Of 248 patients, 83 had positive results. The clinical symptoms and blood test results were examined in 61 patients with Campylobacter spp. (25 patients), Salmonella spp. (18 patients), and Clostridium perfringens (18 patients) infections. The mean age of the 61 patients (male:femal=31:30) was $84.0{\pm}54.8months$, and the mean hospital stay was $4.6{\pm}1.7days$. Results: There were no statistical differences in sex, age, clinical symptoms, or signs. Patients with Campylobacter infection were significantly older (P=0.00). C-reactive protein (CRP) levels in patients with Campylobacter infection were higher than those in the other 2 groups, at $9.6{\pm}6.1mg/dL$. The results of receiver-operating characteristic curve analysis showed that the cutoff age was ${\geq}103.5months$ (sensitivity, 72%; specificity, 86%) and the CRP cutoff level was ${\geq}4.55mg/dL$ (sensitivity, 80%; specificity, 69%). Conclusion: Age (${\geq}103.5months$) and higher CRP level (${\geq}4.55mg/dL$) were good predictors of Campylobacter enterocolitis. If neither criterion was met, Campylobacter enterocolitis was unlikely (negative predictive value 97.2%). When both criteria were met, Campylobacter enterocolitis was highly likely.

• Clinical and Experimental Pediatrics
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• 제52권2호
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• pp.137-141
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• 2009

Depending on the definition used, between 3% and 10% of live neonates are small for gestational age (SGA). The definition of SGA requires the following: (1) accurate knowledge of gestational age; (2) accurate measurements at birth of weight, length, and head circumference; (3) a cutoff, which has been variably set at the 10th percentile, 3rd percentile, or at less than 2 standard deviation from the mean, and (4) race and ethnicity-specific growth curve. Consensus statements are needed on the management of growth hormone therapy in SGA children, as well as treatment and long-term health outcomes such as impaired cognitive function, increased risk of adult cardiovascular disease, and type 2 diabetes.

• Clinical and Experimental Pediatrics
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• 제59권11호
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• pp.425-431
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• 2016

The waist-to-height ratio (WHtR), calculated by dividing the waist circumference (WC) by height, has recently gained attention as an anthropometric index for central adiposity. It is an easy-to-use and less age-dependent index to identify individuals with increased cardiometabolic risk. A WHtR cutoff of 0.5 can be used in different sex and ethnic groups and is generally accepted as a universal cutoff for central obesity in children (aged ${\geq}6$ years) and adults. However, the WHtR has not been validated in preschool children, and the routine use of WHtR in children under age 6 is not recommended. Prospective studies and meta-analysis in adults revealed that the WHtR is equivalent to or slightly better than WC and superior to body mass index (BMI) in predicting higher cardiometabolic risk. In children and adolescents, studies have shown that the WHtR is similar to both BMI and WC in identifying those at an increased cardiometabolic risk. Additional use of WHtR with BMI or WC may be helpful because WHtR considers both height and central obesity. WHtR may be preferred because of its simplicity and because it does not require sex- and age-dependent cutoffs; additionally, the simple message 'keep your WC to less than half your height' may be particularly useful. This review article summarizes recent publications on the usefulness of using WHtR especially when compared to BMI and WC as a screening tool for obesity and related cardiometabolic risks, and recommends the use of WHtR in clinical practice for obesity screening in children and adolescents.

• Clinical and Experimental Reproductive Medicine
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• 제23권3호
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• pp.283-292
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• 1996

Objective: To determine the cutoff value of clomiphene citrate challenge test(CCCT) that can predict the normal and abnormal(diminished) ovarian response group and to assess the usefulness of CCCT as a predictor of ovarian reserve. Materials and Methods: From March 1994 to Februry 1996, CCCT was performed to 129 infertile patients and among them, 20 patients whose basal FSH on the third day of menstrual cycle was more than 20 mIU/ml were excluded. At the same time, the same CCCT was performed to the fifteen healthy volunteers with proven fertility to determine the cutoff value of CCCT. Results; 1) A FSH value higher than 23.4 mIU/ml, measured on the 10th day of menstrual cycle, was defined as a abnormal ovarian response. The cutoff value of 23.4 mIU/ml is more than 2 standard deviations(SD) above the mean value of 15 healthy women after CCCT. 2) The abnormal CCCT group, the subpopulation with a FSH value of 23.4 mIU/ml or more, was 7.3%(8/109) and their mean age was higher than the normal CCCT group($36.5{\pm}4.5$ vs. $32.9{\pm}4.8$, P = 0.059). And the percentage of the patients older than 35 years of the abnormal CCCT group was significantly higher than that of the normal CCCT group(62.5% vs. 38.6%, p <0.05). 3) There was no correlation between the hormone values of the third day and the 10th day of menstrual cycle before and after CCCT except between FSH of the third day and the 10th day. Conclusion: The CCCT is a good method to predict the individual ovarian response to COH for ART, especially in the patients who has no other abnormal findings that predict poor prognosis. And it is neccessary to determine the cutoff value of CCCT by the large numbers of randomized study, and combining the previously proven prognostic factors, it can be applicated in many individual centers for evaluate the ovarian response before ART program.

• 한국지형학회지
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• 제19권2호
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• pp.1-15
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• 2012

본 연구에서는 우리나라에 분포하는 3가지 유형의 5개 자연 구하도를 대상으로 형성시기와 형성과정을 분석하였다. 울진군 성산동 구하도는 약 2만5천~2만6천 년 전에 왕피천의 감입곡류 목 절단이 발생하면서 이전의 곡류부가 구하도로 변화되었고, 울진군 불영사 구하도는 약 9만 년 전에 감입곡류가 매우 심한 왕피천에 의한 곡류 목절단으로 형성되었다. 이를 통해 추론하면, 감입곡류 목 절단 구하도는 활발한 측방침식에 의해 목 절단이 발생하기 좋은 간빙기 또는 아간빙기의 후반에 주로 형성되는 것으로 판단된다. 태백시 구문소 구하도는 황지천과 철암천 사이 능선부 지하의 석회암에서 발생한 절리의 용식작용으로 인해, 약 4만 년 전에 두 하천이 동굴로 연결되어 합쳐지는 하천쟁탈 과정으로 형성된 것이며, 영양군 선바위 구하도는 약 1만4천 년 전에 동천과 반변천 사이의 하천쟁탈로, 고도가 높은 동천의 하류 쪽 유로가 구하도로 변화된 것이다. 그리고 충주시 장천리에서는 지난 빙기 최성기를 거치면서 약 1만년 전에 형성된 하중도로 인해 남한강의 유수가 동서로 분류되었고, 서쪽의 유로가 최근에 들어 구하도로 변화되었다.

• 가정∙방문간호학회지
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• 제15권1호
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• pp.5-13
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• 2008

Purpose: The purpose of this study was to evaluate for the presence of posttraumatic stress disorder (PTSD)-related symptoms, anxiety, and depression after stroke. Eighty-four patients were enrolled between 2 and 12 months after their first ischemic or hemorrhagic stroke. Methods: PTSD symptoms were evaluated using the Impact of Event Scale (IES). The IES is a 15-item scale measuring intrusion and avoidance symptoms. The authors assessed mood alterations using the Hospital Anxiety and Depression Scale (HAD). The HAD is a brief, 14-item, self-reported questionnaire used to detect symptoms of anxiety (HADA) and depression (HADD). The survey data were analyzed using the SPSS 10.0 program. Frequency, mean, standard deviation, percentage t-test, and Pearson correlation coefficient were determined. Results: Twenty nine of the 84 (34.5%) patients scored higher than the cutoff for PTSD on the IES (IES>26). With use of the HAD scale, 44% of the patients reached the cutoff for anxiety ($HADA\;{\geq}8$). On the HSD scale, 44.1% of the patients reached the cutoff for depression ($HADD\;{\geq}8$). PTSD symptoms and anxiety were more frequent in women under age 39, without spouses, who had operations. Depression was more frequent in patients without spouses. There was a statistically significant correlation among posttraumatic stress symptoms, anxiety, and depression. Conclusion: There was statistically significant correlation among PTSD symptoms, anxiety, and depression in stroke patients. Therefore, it is necessary to develop nursing intervention for stroke patients with these clinical manifestations.

• Korean Journal of Radiology
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• 제23권8호
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• pp.821-827
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• 2022

Objective: To determine the anatomical characteristics of the petrous ridge and trigeminal nerve in trigeminal neuralgia (TN) without neurovascular compression (NVC). Materials and Methods: From May 2017 to March 2021, 66 patients (49 female and 17 male; mean age ± standard deviation [SD], 56.8 ± 13.3 years) with TN without NVC and 57 controls (46 female and 11 male; 52.0 ± 15.6 years) were enrolled. The angle of the petrous ridge (APR) and angle of the trigeminal nerve (ATN) were measured using magnetic resonance imaging with a high-resolution three-dimensional T2 sequence. Data on the symptomatic side were compared with those on the asymptomatic side in patients and with the mean measurements of the bilateral sides in controls. Receiver operating characteristic (ROC) analysis was conducted to evaluate the performance of APR and ATN in distinguishing TN patients from controls. Results: In TN patients without NVC, the mean ± standard deviation (SD) of APR on the symptomatic side (98.40° ± 19.75°) was significantly smaller than that of the asymptomatic side (105.59° ± 22.45°, p = 0.019) and controls (108.44° ± 15.98°, p = 0.003). The mean ATN ± SD on the symptomatic side (144.41° ± 8.92°) was significantly smaller than that of the asymptomatic side (149.67° ± 8.09°, p = 0.003) and controls (150.45° ± 8.48°, p = 0.001). The area under the ROC curve for distinguishing TN patients from controls was 0.673 (95% confidence interval [CI]: 0.579-0.758) for APR and 0.700 (CI: 0.607-0.782) for ATN. The sensitivity and specificity using the diagnostic cutoff yielding the highest Youden index were 81.8% (54/66) and 49.1% (28/57), respectively, for APR (with a cutoff score of 94.30°) and 65.2% (43/66) and 66.7% (38/57), respectively, for ATN (cutoff score, 148.25°). Conclusion: In patients with TN without NVC, APR and ATN were smaller than those in controls, which may explain the potential cause of TN and provide additional information for diagnosis.

• 노동경제논집
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• 제41권2호
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• pp.89-106
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• 2018

초등학교 취학기준일이 2010년 입학생부터 1월 1일로 변경되어 1~12월생이 동급생이다. 이에 1월생이 동급생 중 나이가 가장 많고 12월생이 가장 어려, 부모는 12월 출산을 기피할 유인이 있다. 이 경우 12월에 출산하는 엄마는 자녀 교육에 관심이 많지 않은, 즉 사회경제적 배경이 좋지 않은 엄마일 가능성이 있는데, 본고는 이를 분석하는 것이 목적이다. 분석 결과 12월생 엄마는 다른 월 엄마 대비 학력 수준이 낮고 나이가 어리며 근로 확률이 낮다. 이 결과는 12월생이 동급생 중 나이가 가장 어릴 뿐 아니라 부모 배경역시 좋지 않아 학교나 노동시장에서 이중으로 불리할 가능성이 있음을 시사한다.

• Clinical and Experimental Reproductive Medicine
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• 제48권3호
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• pp.194-197
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• 2021

Polycystic ovary syndrome (PCOS) is a common disorder in reproductive-age women. In 2018, an international evidence-based guideline announced recommendations spanning a wide range of issues on the assessment and management of PCOS. From the 166 recommendations, the present study reviews those that are of particular clinical relevance for daily practice and introduces other relevant studies that have been published since the global guideline. The 2018 guideline increased the antral follicle count cutoff for the diagnosis of PCOS from 12 to 20 when using a high-frequency probe. Hirsutism was defined as having a score of ≥4-6 based on a lower percentile of 85%-90% or cluster analysis, which was lower than the traditionally used 95th percentile-based cutoff. The diagnosis of PCOS in adolescents is challenging, and irregular menstruation was defined carefully according to years from menarche. The use of ultrasonography for the diagnosis of PCOS was restricted to those 8 years after menarche. As medication for non-fertility indications, combined oral contraceptives are the first-line drug. Metformin, in addition to lifestyle modifications, should be considered for adult patients with a body mass index ≥25 kg/m² for the management of weight and metabolic outcomes. An aromatase inhibitor is the recommended first-line medication for ovulation induction, a subsequent individual patient data meta-analysis also reported the same conclusion. Whether the new global guideline will be fully adopted by many specialists and change clinical practice is open to question. Further studies are needed to better understand and manage PCOS patients well.