• Neonatal Medicine
• /
• v.18 no.2
• /
• pp.310-319
• /
• 2011

Purpose: The aim of this study was to investigate the effect of perinatal risk factors on brain maturation and the relationship of brain maturation and neurodevelopmental outcomes with brain maturation scoring system in brain MRI. Methods: ELBWI infants born at the Seoul National University Children's Hospital from January 2006 to December 2010 were included. A retrospective analysis was performed with their medical record and brain MR images acquired at near full term. We read brain MRI and measured maturity with total maturation score (TMS). TMS is a previously developed anatomic scoring system to assess brain maturity. The total maturation score was used to evaluate the four parameters of maturity: (1) myelination, (2) cortical infolding, (3) involution of glial cell migration bands, and (4) presence of germinal matrix tissue. Results: Images from 124 infants were evaluated. Their mean gestational age at birth was 27.1${\pm}$2.1 weeks, and mean birth weight was 781.5${\pm}$143.9 g. The mean TMS was 10.8${\pm}$2.0. TMS was significantly related to the postmenstrual age (PMA) of the infant, increasing with advancing postmenstrual age (P<0.001). TMS showed no significance with neurodevelopmental delay, and with brain injury, respectively. Conclusion: TMS was developed for evaluating brain maturation in conventional brain MRI. The results of this study suggest that TMS was not useful for predicting neurodevelopmental delay, but further studies are needed to make standard score for each PMA and to re-evaluate the relationship between brain maturation and neurodevelopmental delay.

• Clinical and Experimental Pediatrics
• /
• v.46 no.5
• /
• pp.447-453
• /
• 2003

Purpose : This study was performed to compare complications and perinatal factors according to the birth weight groups in the infants of diabetic mothers(IDM). Methods : Three hundred and one singleton diabetic mothers and their babies of more than 30 weeks' gestational age admitted in the department of Pediatrics, Chonnam University Hospital from January 1996 to March 2002 were enrolled. Complications and perinatal factors were compared between large for gestational age(LGA) and appropriated for gestational age(AGA) infants. Results : Hypomagnesemia was observed in 37.5%, jaundice in 21.3%, hypoglycemia in 11.1%, hypocalcemia in 7.0%, and birth injury in 19.6%. Congenital anomaly was noted in 24.9% with cardiovascular anomaly most commonly. In the LGA group, the frequencies of jaundice, hypoglycemia, tachypnea, and birth injuries were higher, and the interventricular septum was thicker than the AGA group. In the LGA group, Cesarean section rate, maternal height, weight before pregnancy, weight gain during pregnancy, and the incidence of unawareness of gestational DM were significant compared with the AGA group. Conclusion : In the LGA group, the frequencies of jaundice, hypoglycemia, tachypnea, and birth injuries were higher, and the interventricular septum was thicker than the AGA group. In the LGA group, maternal height, weight before pregnancy and weight gain during pregnancy were larger, and the incidence of unawareness of gestational DM was higher compared with the AGA group. These results suggest that careful examination and management are needed to detect the high risk, pregnant DM mothers with possible LGA babies.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.18 no.1
• /
• pp.336-344
• /
• 2017

This study was conducted to identify factors related to the musculoskeletal symptoms of 340 family caregivers who have a patient with brain damage based on self-administered questionnaires. The questionnaires included general characteristics, characteristics of care activities and caregivers' musculoskeletal symptoms. Data were collected from many long-term care hospitals and rehabilitation centers during March 17 to March 21, 2014. The results indicated that complaint rates of work-related musculoskeletal systems of the body sites differed. Factor analysis revealed that neck complaints were related to education (under mid), while shoulder complaints were related to sex (female), age (50-59), education (mid) and duration of care (< 2 years). Arm/elbow complaints were related to age (40-49), education (high) and duration of care (12-24). Complaints regarding the hand/wrist/finger were related to age (50-59) and duration of care (12-24), while those associated with the legs/feet were related to age (50-59) and duration of care (< 6[ED highlight - years? Please specify.]). Back problems were related to education (under mid, mid stage, high) and gait. The complaint rate regarding musculoskeletal symptoms during daily life was not statistically significant. Logistic regression analysis of significant factors related to subjective musculoskeletal symptoms identified ambulation and gait as having the greatest influence and complaint factor among family caregivers. The complaint rate of family caregivers differed among body parts. Being a caregiver for less than one year was found to have a significant impact on pain. Overall, long term family caregivers could be faced with risk factors for musculoskeletal problems, but there are many different factors that affect musculoskeletal symptoms with regards to their activities. Accordingly, comprehensive and systematic prevention plans for family caregivers who have patients with brain damage should be developed.

• Journal of Chest Surgery
• /
• v.42 no.4
• /
• pp.441-446
• /
• 2009

Background: Side clamping of ascending aorta during proximal graft anastomosis in coronary bypassing surgery in-creases the risk of direct aortic injury as well as embolization of intimal atheroma. Heartstring proximal sealing system (Guidant Corporation, Santa Clara, Calif), developed to avoid aortic side clamping, may minimize risks of such complications. The aim of the current study is to compare the surgical outcomes of the two proximal anastomosis techniquesi.e., Heartstring system versus aortic side clamping in off pump coronary bypassing' surgery (OPCAB). Material and Method: From January 2003 to August 2008, 499 patients underwent OPCAB. Of them, proximal graft anastomosis was performed using Heartstring system in 182 patients (Group I) and conventional manual anastomosis in 317 patients (Group II). The two groups were compared for postoperative major complications and mortality. Result: Two groups showed similar characteristics in terms of preoperative demographic data, left ventricular ejection fraction, renal function and history of diabetes, hypertension and smoking. Although there was no inter-group difference in the history of cerebral ischemia (p=0.48), preoperative brain magnetic resonance angiography revealed greater incidence of severe carotid artery stenosis (>75% of lumen) in the Group I than in the. Group II (44.5% in the Group I and 30.0% in the Group II, p=0.003). There were no inter-group differences in postoperative mortality (p=0.40) and complications (p=0.47) including neurologic events (3 in the Group land 2 in the Group II, p=0.258). Whereas neurologic events all comprised transient ischemic attacks in the Group I, they comprised multiple embolic strokes in the Group II. One patient in the Group II experienced aortic dissection during proximal anastomosis which resulted in ascending aortic replacement. Conclusion: Although proximal anastomosis using Heartstring system did not show statistically significant benefit over aortic side clamping, the. absence of embolic stroke maybe a definite benefit which may be better defined through further studies over a larger cohort.

• Journal of Bio-Environment Control
• /
• v.23 no.4
• /
• pp.349-355
• /
• 2014

This study was performed to evaluate influences of tunnel covering materials and seeding dates on the growth and productivity of water spinach (Ipomoea aquatic F.) cultured early in unheated greenhouse. During tunnel installation period, from March 5 to April 30 and from October 11 to November 10, air and soil temperature in tunnel covered with polyethylene film (PEF) had risen $2.0-2.4^{\circ}C$ and $0.9-1.0^{\circ}C$, respectively, compared to those in non-tunnel (NT). Air and soil temperature in tunnel with illite non-fabric (INF) also had risen $1.6-1.8^{\circ}C$ and $0.6-0.8^{\circ}C$, respectively. Especially, it showed greater effects of the rise at low temperature time zones of the day. In plots of seeding on March 15 in tunnel covered with PEF or INF, temperature during emergence period, emergence days and rate were similar to plot seeding on April 5 in NT. There were two more harvesting in plots of seeding on March 5 or March 15 in tunnel, and increasing of total yield by 22.5-25.7% compared to plot of seeding on April 5 in NT. But there was observed no significant differences between PEF and INF. Whereas PEF was necessary to be removed at midday sometimes because it had risk of high temperature injury, INF was not necessary. All above suggest that it was suitable to sow seed on the middle of March in tunnel covered with INF, for early culture of water spinach in unheated greenhouse.

• Clinical and Experimental Pediatrics
• /
• v.46 no.1
• /
• pp.42-50
• /
• 2003

Purpose : The acute respiratory distress syndrome(ARDS), an acute form of severe alveolar-capillary injury evolving after a direct or indirect lung insult is thought to be a common cause of respiratory failure though not many clinical studies on the subject have been made yet. Methods : Between January 1992 and December 2001, we conducted a retrospective study on 33 children who fulfilled the definition of the ARDS recommended by the American-European Consensus Conference in 1994. Results : A total of 33 patients(20 boys and 13 girls) were selected. Their age ranged from 4 months to 12 years with seven children younger than 1 year. The overall mortality rate was 78.8% and no significant difference was noted based on age or sex. Concerning seasonal variation, incidence of the ARDS increased in spring, especially in May(21.2%). Pneumonia(66.7%) was found to be the most common risk factor of the ARDS followed by sepsis(24.2%) and aspiration(3.0%). In immune compromised children(six cases), including a recipient of bone marrow transplantation, the mortality rate was 100%. Compared with children with multiple organ failure recording a 83.3% mortality rate, those with isolated respiratory failure, showed a lower mortality rate of 33.3%, although stastistically insignificant. Between survivor and non-survivor groups, significant differences were shown in hematocrit, $PaO_2$, $PaCO_2$, PEEP, and $PaO_2/FiO_2$ on the seventh day after the onset of the ARDS. Conclusion : According to our study, respiratory failure proved to have a great effect on mortality rate in the ARDS. More aggressive intervention and further studies on this subject should be done to improve the survival rate.

• The Korean Society of Law and Medicine
• /
• v.17 no.2
• /
• pp.3-28
• /
• 2016

While product liability has been settled as a technical term in civil law, criminal law does not commonly accept technical term for it. Not like civil law, product liability in criminal law point outs individual responsibility and disability of normative order. Meaning that causation between individual's action of violation of duty and the result of danger of legal interest or infringement of legal interest must be proved. In criminal law excluding "non-result-constituted crimes (Unternehmensdelikt)", charge of injuring, accidental infliction of injury, homicide or involuntary manslaughter is problematic in product liability. Of course, it is necessary to distinguish whether the action related to the outcome is act or ommission. Also the causal relationship between the action and the result must be proved, and the intention or negligence should be recognized. In this paper, it analyzes cases that were problematic in Korea, Germany, Spain, etc. Mainly focusing on the problems revealed in the determination of causal relationship, especially recognizing criminal liability related to products. Furthermore it is followed by the view of reviewing the cause-and-effect relationship by 2 steps, dividing natural scientific causation and the normative causal relationship. In this process, to acknowledge criminal product liability in accordance with recognizing cause-and-effect relationship, there should be general risk of specific substance causing the outcome. This only premise can be meaningful to examine the casual relationship from specific cases. As it shows in some cases and theories, it is not contradicting general law of cause and effect by determining specific causal relationship by free evaluation of evidence if a general causal relationship does not exist. Also since judge's testimony does not hold a dominant position from rule of thumb, it is possible to recognize specific causal relationship. However this paper takes position that if there is no objective and reasonably undeniable cause and effect law. If there is no objective and reasonably undeniable causal law, which is the premise for recognizing concrete causal relations, judge should sentence guilty according to "in dubio pro reo" principle. In addition, it is not allowed for the defendant to burden unproven fact by free evaluation of evidence which has an effect of shift of burden of proof.

• Journal of Chest Surgery
• /
• v.44 no.2
• /
• pp.115-122
• /
• 2011

Background: The intramural coronary artery has been known as a risk factor for early death after an arterial switch operation (ASO). We reviewed the morphological characteristics and evaluated the early and mid-term results of ASO for patients with an intramural coronary artery. Materials and Methods: From March 1994 to September 15th 2010, 158 patients underwent ASO at Dong-A and Pusan National University Hospitals for repair of transposition of the great arteries and double outlet right ventricle. Among these patients, 14 patients (8.9%) had an intramural coronary artery. Mean age at operation was $13.4{\pm}10.2$ days (4 to 39 days) and mean body weight was $3.48{\pm}0.33$ kg (2.88 to 3.88 kg). All patients except one were male. Eight patients had TGA/IVS and 4 patients had an aortic arch anomaly. Two patients (14.3%) had side-by-side great artery relation, of whom one had an intramural right coronary artery and the other had an intramural left anterior descending coronary artery. Twelve patients had anterior-posterior relation, all of whom had an intramural left coronary artery (LCA). The aortocoronary flap technique was used in coronary transfer in 8 patients, of whom one patient required a switch to the individual coronary button technique 2 days after operation because of myocardial ischemia. An individual coronary button implantation technique was adopted in 6, of whom 2 patients required left subclavian artery free graft to LCA during the same operation due to LCA injury during coronary button mobilization and LCA torsion. Results: There was 1 operative death (7.1%), which occurred in the first patient in our series. This patient underwent an aortocoronary flap procedure for coronary transfer combining aortic arch repair. Overall operative mortality for 144 patients without an intramural coronary artery was 13.2% (19/144). There was no statistical difference in operative mortality between the patients with and without an intramural coronary artery (p>0.1). There was no late death. The mean follow-up duration was $52.1{\pm}43.0$ months (0.5 to 132 months). One patient who had a subclavian artery free graft required LCA stenting 6.5 years after surgery for LCA anastomotic site stenosis. No other surviving patient needed any intervention for coronary problems. All patients had normal ventricular function at latest echocardiography and were in NYHA class 1. Conclusion: The arterial switch operation in Transposition of Great Arteries or Double Outlet Right Ventricle patients with intramural coronary can be performed with low mortality; however, there is a high incidence of intraoperative or postoperative coronary problems, which can be managed with conversion to the individual coronary button technique and a bypass procedure using a left subclavian free graft. Both aortocoronary flap and individual coronary button implantation techniques for coronary transfer have excellent mid-term results.

• Korean Journal of Psychosomatic Medicine
• /
• v.26 no.2
• /
• pp.135-144
• /
• 2018

Objectives : The purpose of this study was to identify the differences of demographic and clinical characteristics between child-adolescents who received medical inpatient care and non-hospitalized adolescents after suicide attempts. Methods : The study included 35 child-adolescents who were hospitalized (Admission group) and 114 child-adolescents who were not hospitalized (Non-Admission group) as a result of a suicide attempt from 2009 to 2015. We compared sociodemographic, clinical, and suicide attempt-related characteristics through a chi-square test and logistic regression analysis to evaluate the differences between the two groups. Results : Child-adolescents of this study most commonly attempted suicide by poisoning, and for motivation of interpersonal problems. Admission group had significantly fewer attempts through injury by sharp objects (${\chi}^2=4.374$, p=0.037) and attempted suicide with a higher chance of actually dying when compared to Risk-Rescue Rating Scale (t=1.981, p=0.049). In addition, Admission group had relatively common motivation for academic problems (${\chi}^2=12.082$, p=0.001) and less motivation for interpersonal difficulties. (${\chi}^2=9.869$, p=0.002) Psychiatric diagnosis at the time of visiting the emergency department showed higher rates of depression in the admission group than Non-Admission group (${\chi}^2=8.649$, p=0.003). The results of logistic regression showed that depression affects hospitalization (OR=2.783, 95% CI 1.092-7.089, p=0.032). Conclusions : This study is meaningful in that it revealed the social and clinical characteristics of all child-adolescents who were hospitalized at a university hospital after attempting suicide. This study identified differences in motivation, methods, and psychiatric diagnosis of hospitalized adolescents and those who were not. Therefore, the results may help adolescent suicide attempters to get a discriminatory approach based on their admission.

• Journal of Life Science
• /
• v.31 no.2
• /
• pp.126-136
• /
• 2021

Oxidative stress causes injury to and degeneration of retinal pigment epithelial (RPE) cells. It is involved in several retinal disorders and leads to vision loss. In the present study, we investigated the effect of 14 kinds of natural compounds and two kinds of synthetic compounds on oxidative stress-induced cellular damage in human PRE cell lines (ARPE-19). From among them, we selected five kinds of compounds, including auranofin, FK-509, hemistepsin A, honokiol, and spermidine, which have inhibitory effects against hydrogen peroxide (H2O2)-mediated cytotoxicity. In addition, we found that four kinds of compounds (excluding auranofin) have protective effects on H2O2-induced mitochondrial dysfunction. Furthermore, the expression of phosphorylation of histone H2AX, a sensitive marker of DNA damage, was markedly up-regulated by H2O2, whereas it was notably down-regulated by FK-506, honokiol, and spermidine treatment. Meanwhile, five kinds of candidate compounds had no effect on H2O2-induced intracellular reactive oxygen species (ROS) levels, suggesting that the five candidate compounds have protective effects on oxidative stress-induced cellular damage through the ROS-independent pathway. Taken together, according to the results of H2O2-mediated cellular damage―such as cytotoxicity, apoptosis, mitochondrial dysfunction, and DNA damage―spermidine and FK-506 are the natural and synthetic compounds with the most protective effects against oxidative stress in RPE. Although further studies on the identification of the mechanism responsible are required, the results of the present study suggest the possibility of using spermidine and FK-506 to suppress the risk of retinal disorders.