• Clinical and Experimental Pediatrics
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• v.52 no.4
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• pp.494-498
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• 2009

Purpose : Applicability of transcatheter closure of atrial septal defect (ASD) has been expanded by accumulation of clinical experiences and evolutions of the device. This study was performed to evaluate the safety and efficacy of transcatheter closure of ASD with Amplatzer septal occluder (ASO) in young children less than 3 years of age. Methods : From May 2003 to December 2005, 295 patients underwent transcatheter closure of ASD with ASO in the Severance Cardiovascular Hospital, Yonsei University Health System. Among them, 51 patients less than 3 years of age were enrolled in this study. We investigated procedural success rate, rate of residual shunt, frequency of complications, procedure/fluoroscopy time, and need of modified techniques for device implantation. Results : The median age was 2.1 years and median body weight was 12 kg. Implantation of device was successful in 50 patients (98%). Seven patients (15%) showed a small residual shunt 1 day after the procedure, but complete occlusion had been documented at 6 month follow-up in all patients (100%). The pulmonary to systemic flow ratio (Qp/Qs), peak systolic pulmonary artery pressure, and peak systolic right ventricular pressure had decreased significantly after closure of ASD. There were 2 complications including device embolization (1, 2%) and temporary groin hematoma (1, 2%). Conclusion : Transcatheter closure of ASD with ASO can be performed with satisfactory results and acceptable risk even in young children less than 3 years of age. We could suggest that even in very young children with ASD, there is no need to wait until they grow to a sufficient size for the transcatheter closure.

• Journal of Christian Education in Korea
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• v.61
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• pp.165-201
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• 2020

The purpose of this study is to explore the development of language education of Christian early childhood education by exploring the change of pre-Christian preschool teachers through the development of biblical language education activities. Interviews, surveys, action plans, and reflections of 19 Christian education students who participated in the development of bible-based language education activities for children based on the language of early childhood language, were conducted from September 3 to December 28, 2018. The data were collected through a portfolio. By analyzing the collected data, the key categories were derived and categorized. For the objectification of data analysis and interpretation, two thematic and early childhood education specialists were identified. As a result, the preparatory Christian teacher experience for the development of bible-based langage education activities for young children was categorized into cognitive change, personality change and practical change. First, through the development of bible-based early childhood language education activities, Christian pre-service early childhood teachers have brought cognitive changes as 'processes not outcomes', 'integration not separation', 'living non-curriculum' and 'meaning not effect'. In developing bible-based language education activities for young children, Christian pre-service early childhood teachers experienced a cognitive change in the 'process of language education activities' rather than the developmental achievements and results of early childhood language education. Christian pre-service early childhood teachers recognized the necessity of 'integration of listening-speaking-reading-writing', not the separation of early childhood language education. They recognized the importance of 'informal language education in kindergarten life', as well as teacher-centered formal language education. In addition, they have made a cognitive change that 'child-centered meaningful language education experience' is more important than the effectiveness of early childhood language education. Second, in developing bible-based language education activities for young children, Christian pre-service early childhood teachers showed personality changes as 'confident teachers', 'professional teachers', and 'teachers with reflective thoughts and attitudes'. Finally, in developing bible-based language education activities for young children, Christian pre-service early childhood teachers recognized the power of positive language and practiced it to form habits of using the right language and to link Christian education with early childhood education. Through the development of bible-based language education activities for young children, Christian pre-service early childhood teachers are equipped with the heart attitude and enthusiasm required to become true early childhood teachers for young children in unpredictable educational conditions and rapidly changing educational realities. Teacher efficacy has improved. In the future, it is expected that various teacher education programs linking Christian education and early childhood education will be continuously and systematically implemented.

• Radiation Oncology Journal
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• v.19 no.2
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• pp.118-126
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• 2001

Purpose : In this study, it was investigated whether dose response relation existed or not in local radiotherapy for primary hepatocellular carcinoma. Materials and Methods : From January 1992 to March 2000, 158 patients were included in present study. Exclusion criteria included the presence of extrahepatic metastasis, liver cirrhosis of Child's class C, tumors occupying more than two thirds of the entire liver, and performance status on the ECOG scale of more than 3. Radiotherapy was given to the field including tumor with generous margin using 6, 10-MV X-ray. Mean tumor dose was $48.2{\pm}7.9\;Gy$ in daily 1.8 Gy fractions. Tumor response was based on diagnostic radiologic examinations such as CT scan, MR imaging, hepatic artery angiography at $4\~8$ weeks following completion of treatment. Statistical analysis was done to investigate the existence of dose response relationship of local radiotherapy when it was applied to the treatment of primary hepatocellular carcinoma. Results : An objective response was observed in 106 of 158 patients, giving a response rate of $67.1\%$. Statistical analysis revealed that total dose was the most significant factor in relation to tumor response when local radiotherapy was applied to the treatment of primary hepatocellular carcinoma. Only $29.2\%$ showed objective response in patients treated with dose less than 40 Gy, while $68.6\%\;and\;77.1\%$ showed major response in patients with $40\~50\;Gy$ and more than 50 Gy, respectively. Child-Pugh classification was significant factor in the development of ascites, overt radiation induced liver disease and gastroenteritis. Radiation dose was an important factor for development of radiation induced gastroduodenal ulcer. Conclusion : Present study showed the existence of dose response relationship in local radiotherapy for primary hepatocellular carcinoma. Only radiotherapy dose was a significant factor to predict the objective response. Further study is required to predict the maximal tolerance dose in consideration of liver function and non-irradiated liver volume.

• Korean Journal of Childcare and Education
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• v.2 no.1
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• pp.41-63
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• 2006

The purpose of this study is to investigate the differences among mother's feeling expression, children's self-regulation, and children's peer competency by socio-demographic background and provide a basic material to develop the parents' education for mother's promosing emotional environment to help development of children by understanding the correlation among mother's feeling expression children's self-regulation, and children's peer competency. The research objects were 361 of 4 to 6-year-old children and their mothers. The tool adapted by Woo Sookyong(2002) was used for Mother's emotional expressivity, and the tool of Lee Jeongran(2003) for the of self regulation and the tool of park Joohee and Lee Eunhae for the children's peer competency. Data analysis was performed with population, percentage, t-test, Cronbach $\alpha$, F-test, and co-relation of LSD posteriori test. The summary of this study are as follows; First, the more negative expressivity was shown as mother's academic career was higher and the more positive one was appeared as family income was greater according to the background of socio-demography. Female children showed the higher self-regulation, and the self-decision and action control were greater as their age was higher. Children's peer competency was higher as they were social and friendly personality. Second, there was the strong relationship among the mother's feeling expressivity, children's self-regulation and peer competency one. Mother's positive expressivity had the relationship with children's self-regulation and peer competency one while weak expressivity had it with self-decision, regulation and children's peer competency. But the strong negative heartstrings' expressivity was an improper co-relation with action control and no relation with similar age competent ability. A definitive relation existed between all low level area except the emotion of self-regulation and children's peer competency. Form the above study, it was Known that there was the relationship among the mother's feeling expressivity, children's self-regulation and peer competency. In particular, there was strong relationship between positive and weak positive expressivity, and children's self-regulation and peer competency. These results could be reflected to parents' heartstrings education by knowing the impact of a positive emotional expressivity and weak-negative one.

• Korean Journal of Psychosomatic Medicine
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• v.19 no.2
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• pp.74-82
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• 2011

Objective:The aim of this study was to evaluate the relationship between sustained attention deficits in Attention-Deficit/Hyperactivity Disorder(ADHD) children and short-term Heart Rate Variability(HRV) parameters. In addition, we evaluate the relationship between The ADHD rating scale(ARS), the computerized ADHD diagnostic system(ADS) and Parenting stress index- short form(PSI-SF). Methods:This study was performed in the department of children and Adolescent psychiatry, Korea university Guro hospital from august 2008 to January 2009. We evaluated HRV parameters by short-term recordings of 5 minutes. K-ARS and ADS are used for screening and identifying ADHD children. Intelligence was measured using Korean educational Developmental Institute-wechsler Intelligence Scale for Children. The caregivers Complete Parenting Stress Index scale for evaluation parent stress. Results:The low frequency(LF) was significantly correlated with response variability of ADS. However, the other variables of ARS and ADS were not significantly correlated with LF. Hyperactivity subscale of ARS was significantly correlated with parental distress subscale and difficult child subscale of PSI-SF and inattention subscale of ARS was also significantly correlated with dysfunctional interaction and difficult child subscale of PSI-SF. Conclusion:The LF, 0.10-Hz component of HRV is known to measure effort allocation. This study shows that the LF component of HRV is significantly correlated with the response variability of ADS. This means that more severe symptoms of ADHD were correlated with the increase in the LF that means decreased effort allocation. These results also support the clinical usability of HRV in the assessment of ADHD. Furthermore, PSI-SF is correlated with hyperactivity and inattention variables of ARS.

• Pediatric Infection and Vaccine
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• v.14 no.1
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• pp.62-68
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• 2007

Purpose : The cause and pathogenesis of Henoch-Sch$\ddot{o}$nlein purpura (HSP) are unknown, but recently the hypothesis that immunoglobulin A may have an important role in the pathogenesis of HSP is being published and HSP associated with mycoplasma infection has been also reported. The aim of this study is to discover relation between HSP and mycoplsma infection. Methods : From Jan. 2002 to Dec. 2005, we retrospectively evaluated 98 children who were diagnosed as HSP at Ilsan Paik Hospital. 84 patients were not associated with mycoplasma infection (group A) and 14 patients were associated with mycoplasma infection (group B). We compared both groups about clinical features. Results : The ratio of male to female patients in group A and B were 1.21:1 and 1.80:1. The number of patients in group A was most in November and December, and in group B was most in November. All patients had non-thrombocytopenic purpura concentrated on the buttocks and lower extremities and joint involvement was most common on the feet and ankle in both groups. 57 (67.9%) cases in group A and 9 (64.3%) cases in group B complained of abdominal pain. And 21 (25.0%) cases in group A and 5 (35.7%) cases in group B had nephritis. Elevated mycoplasma antibody titer (${\geq}1:320$) or 4 fold-rise were noted in 14 of 98 patients (14.3%). In this study, there was one child with HSP preceded by typical mycoplasma pneumonia (mycoplasma antibody titer 1:1280). Conclusion : In this study, elevated mycoplasma antibody titer (${\geq}1:320$) or 4 fold-rise were noted in 14 of 98 patients and the difference of clinical features between group A and B was not specific. The role of mycoplasma infection in the etiology of HSP may have been implicated, so the association with mycoplasma infection should have to be proved by further controlled studies.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.16 no.2
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• pp.231-238
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• 2005

Objectives : This study was done to figure out the incidence of Korean adolescents with gender identity problem and homosexual tendency. Self esteem and sexual liberality were also checked to evaluate the relation with these problems. Method : Subjects were 1,748 adolescents (359 middle school boys, 452 middle school girls, 483 high school boys, and 454 high school girls). DSM-IV-TR gender identity disorder criteria, Kinsey's sexual orientation scale, Hudson's short form sexual liberality scale, and Halter's Self-perception profile for children were applied to them. Result : 1) $15\%$ of the middle school boys, $16.7\%$ of the high school boys, $39.4\%$ of the middle school girls, and $40.5\%$ high school girls showed gender identity problem. Incidence of mild problem was more frequent in girls, however severe problem that suggested gender identity disorder was more frequent in boys, especially in high school boys. 2) Gender identity problem group showed lower self esteem than no problem group, especially in the middle school boys (p=0.033) and high school girls (p=0.020). 3) $17\%$ of the middle school boys, $5.4\%$ of the high school boys, $17.7\%$ of the middle school girls, and $12\%$ of the high school girls showed homosexual tendency. The order of more vivid homosexual orientation incidence was as follows ; $3.3\%$ in the middle school girls, $3.1\%$ in the middle school boys, $2.1\%$ in the high school girls, and $1.7\%$ in the high school boys. 4) There was no difference in the score of sexual liberality according to homosexual tendency. In high school girl, self esteem score was lower in homosexual tendency group than that of heterosexual group (p=0.039). 5) Gender identity problem group showed higher incidence of homosexual tendency than that of gender identity formation group (p=0.001). 6) The incidence of sexual identity problem was not changed by age, but homosexual tendency was decreased with age, especially in boys. Conclusion : Adolescents with gender identity problem or homosexual tendency showed low self esteem. Therefore, more attention on systemic evaluation for early detection in school based mental health and psychiatric management for them are needed.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.7 no.1
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• pp.34-43
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• 1996

In adolescence, the symptoms of depression are more various and different from those of adult. Conduct behaviours are frequently represented in adolescent's depression. The patients who have the depression and conduct disorder are defined as depressive condor disorder in ICD-10. We hypothesized that there might be different parental rearing patterns between the patients with depression alone and the depressive conduct disorder. We applied children's depression inventory (CDI), parental rating form for conduct disorder based on DSM-III-R, and parental bonding instrument (PBI) to patients and normal control adolescent group. The results were as follows : 1) There were no significant differences in severity of depressive symptoms, maternal care, maternal overprotection, and paternal care. 2) Paternal overprotection showed significant higher scores in depressive conduct disorder group than depression group and normal control group. 3) There were positive correlations in the severity of depressive symptoms and behavior problems in all subjects. 4) There were no correlations in maternal care and overprotecion with conduct problems, but with depressive symptoms in all subject. 4) There were no correlations in paternal care with conduct problems and depressive symptoms in all subjects. 5) There were significant correlations in patienral overprotective, intrusive attitudes with conduct problems, not with depressive symptoms in all subjects.

• Sleep Medicine and Psychophysiology
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• v.15 no.2
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• pp.94-99
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• 2008

The most common cause of obstructive sleep apnea syndrome (OSAS) in childhood is adenotonsillar hypertrophy. Adenotonsillectomy improves the symptoms quite well in most cases. However, some patients could experience the OSAS again after adenotonsillectomy, who might have several risk factors such as incomplete operation, misdiagnosis, combined anatomical malformation, sinusitis or chronic allergic rhinitis, obesity, initial severe OSAS, and early onset OSAS. We report a case of 11-year-old obese boy who presented with snoring for several years. He was obese with body mass index (BMI) of $26.3kg/m^2$ and also found to have fatty liver by ultrasonogram. Initial polysomnography (PSG) showed that he met the criteria of severe OSAS with the apnea-hypopnea index (AHI) of 70.5. He underwent adenotonsillectomy and symptoms improved immediately. Four months later symptoms were relieved with AHI of 0, but 1 year after the adenotonsillectomy he started to complain snoring again and the subsequent PSG results showed that OSAS has relapsed with AHI of 43. Paranasal sinus X-ray and physical examination showed sinusitis and re-growth of adenoid. Obesity was proved not to be a contributing factor because his BMI decreased to normal range ($23.1kg/m^2$) after diet control and regular exercise. Also, liver transaminase was normalized and fatty liver was disappeared on follow-up abdominal ultrasonogram. After treatment of sinusitis, symptoms were relieved with decreased AHI (8.5). This case suggests that simple adenotonsillectomy might not be the end of OSAS treatment in childhood. Patients who had adenotonsillectomy should be followed by subsequent PSG if symptoms recur. It is also important to be aware of risk factors in the recurrent OSAS for the proper intervention according to the cause.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.11 no.1
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• pp.3-15
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• 2000

Objectives：There has been a rapid expansion of studies aimed at elucidating the genetic basis of autistic disorder, especially it’ relationship to fragile-X syndrome. The detection of fragile X chromosome(Xq27.3) by cytogenetic analysis has revealed many difficulties in testing. Therefore, to explore the relationship between autistic disorder and fragile X syndrome, this study administered molecular biologic methods which examined an unstable CGG repeat within the fragile X mental retardation-1(FMR-1) gene. Methods：Ninety nine autistic children and eight normal control children were tested. The number of CGG repeats within FMR-1 gene was measured after amplification by PCR, and cytogenetic analysis was also carried out to detect fragile site Xq27.3. Southern blot hybridization, using StB12.3 and/or Pfxa3 probe, was done for the patients showing expansion of more than 50 CGG repeats (premutation). Results：All but two autistic patients had no expansion in CGG repeats by PCR and there was no significant statistical difference in number of CGG repeat in comparison with normal control. Two autistic patients, considered as premutation by PCR analysis, had no full mutation or premutation by Southern blot hybridization. All autistic children tested did not have any abnormal karyotype or fragile site Xq27.3. Conclusions：These results suggest that autistic patients may not have abnormality in FMR-1 gene or abnormal expansion in CGG repeat. In conclusion, fragile X syndrome may not be antecedent of autistic disorder.