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Establishment of Local Diagnostic Reference Levels of Pediatric Abdominopelvic and Chest CT Examinations Based on the Body Weight and Size in Korea

  • Jae-Yeon Hwang;Young Hun Choi;Hee Mang Yoon;Young Jin Ryu;Hyun Joo Shin;Hyun Gi Kim;So Mi Lee;Sun Kyung You;Ji Eun Park
    • Korean Journal of Radiology
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    • v.22 no.7
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    • pp.1172-1184
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    • 2021
  • Objective: The purposes of this study were to analyze the radiation doses for pediatric abdominopelvic and chest CT examinations from university hospitals in Korea and to establish the local diagnostic reference levels (DRLs) based on the body weight and size. Materials and Methods: At seven university hospitals in Korea, 2494 CT examinations of patients aged 15 years or younger (1625 abdominopelvic and 869 chest CT examinations) between January and December 2017 were analyzed in this study. CT scans were transferred to commercial automated dose management software for the analysis after being de-identified. DRLs were calculated after grouping the patients according to the body weight and effective diameter. DRLs were set at the 75th percentile of the distribution of each institution's typical values. Results: For body weights of 5, 15, 30, 50, and 80 kg, DRLs (volume CT dose index [CTDIvol]) were 1.4, 2.2, 2.7, 4.0, and 4.7 mGy, respectively, for abdominopelvic CT and 1.2, 1.5, 2.3, 3.7, and 5.8 mGy, respectively, for chest CT. For effective diameters of < 13 cm, 14-16 cm, 17-20 cm, 21-24 cm, and > 24 cm, DRLs (size-specific dose estimates [SSDE]) were 4.1, 5.0, 5.7, 7.1, and 7.2 mGy, respectively, for abdominopelvic CT and 2.8, 4.6, 4.3, 5.3, and 7.5 mGy, respectively, for chest CT. SSDE was greater than CTDIvol in all age groups. Overall, the local DRL was lower than DRLs in previously conducted dose surveys and other countries. Conclusion: Our study set local DRLs in pediatric abdominopelvic and chest CT examinations for the body weight and size. Further research involving more facilities and CT examinations is required to develop national DRLs and update the current DRLs.

A Study on the Religiosity of Filial Piety Ethics in Daesoonjinrihoe (대순진리회의 효 윤리에 나타난 종교성 연구)

  • Cha, Seon-keun
    • Journal of the Daesoon Academy of Sciences
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    • v.27
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    • pp.171-200
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    • 2016
  • This paper will analyze the filial piety based ethics of Daesoonjinrihoe (大巡眞理會) and the traditional filial piety of Confucianism (儒敎), Buddhism (佛敎) and Taoism (道敎) through comparing and contrasting their unique systems. The traditional Korean ethics regarding filial piety are in great need of reformation as the relationship between the parents and children should not be vertical or unilateral but parallel and reciprocal. However, there have not been sufficient in-depth studies on this specific ideology and alternative approaches. Regarding this prospect, one representative Korean indigenous new religion, Daesoonjinrihoe has emerged and directly engages in the collision between traditionalism and modernity. The modernity of Daesoonjinrihoe, enables the observation of how the filial piety based ethics have developed within a system of doctrine and thereby provides an exemplary model of traditional filial piety reimagined in accordance with modern sensibilities. A brief summary of comparative findings is as follows: First, Daesoonjinrihoe and Confucianism have taken serving parents with respect as an ethic within filial piety, but Confucianism engenders this ideal through the unilateral and unconditional sacrifice of younger people based on patriarchal feudalism whereas Daesoonjinrihoe has rejected such unilateral sacrifice and instead promotes mutual beneficience between parents and children. This difference occurs, in part, due to the filial piety of Confucianism rising in the midst of the feudal order whereas the ideology of Daesoonjinrihoe contains ideals such as "the reciprocation of favor for mutual beneficence (報恩相生)" and "respect for humanity (人尊)," both of which serve as key principles of the new religious world as envisioned by Daesoonjinrihoe. Second, filial piety in Buddhism and Taoism tends to be passive and inactive and is often expressed by praying for happiness and longevity for one's parents while they are alive and later praying for the heavenly rebirth of one's parents after they die. The filial piety of Daesoonjinrihoe also partially contains such ideas, however; they are extended much further and arrive upon novel and profound expressions. The spectrum of the filial piety in Daesoonjinrihoe expands to the extent children perform actions to resolve their parent's sins and pave a new road for their parents. This filial piety requires a cultivation practice from both parents and children. This system of dual cultivation was established because the world-view of Daesoonjinrihoe enables both parents and children to enjoy happiness and wealth both of which are achieved through the completion of religious objectives following cultivation practice. Third, Confucianism and Daesoonjinrihoe hold memorial services for ancestors with sincerity as an expression of filial piety. Filial piety in the Confucian context excludes ideas from Shamanism and thereby memorial services are held for impersonal entities, however; in the Daesoonjinrihoe context, memorial services are held for personal-entities. Accordingly, holding a memorial service for ancestors with sincerity has a greater sense of realism in Daesoonjinrihoe than it does in Confucianism. Fourth, while Confucianism and Daesoonjinrihoe both aim to requite the grace received from ancestors, the contents of grace and reciprocation of favors (報恩) are viewed differently. In Confucianism, since the ancestors existed previously and bestowed the gift of life to their children and indirectly, all of their descendents. Therefore, memorial services for ancestors are held to convey gratitude and filial piety. However, in Daesoonjinrihoe, ancestors not only bestowed the gift of earthly life to their descendents, in the spirit realm, ancestral spirits also spend sixty years accumulating the merit necessary to imbue each of their descendents with spiritual insight. Consequently, filial piety is expressed through memorial services as well as spiritual cultivation. Fifth, in Confucianism, achieving the fame and prestige indicative of success in the mundane world can be an act of filial piety as it would bring pride to one's ancestors, but in Daesoonjinrihoe, succeeding in religious objectives through spiritual cultivation is considered to be a higher form of filial piety. Sixth, Confucianism, Buddhism and Taoism all observe filial piety as system of familial ethics based in morality. This is likewise true of Daesoonjinrihoe, however; Daesoonjinrihoe confers greater importance on filial piety as an essential form of ethics for religious redemption. This is due to the Daesoon interpretation that the absence of filial piety was the direct cause which led to the sickened state of the world and its collapse. Forgetting the grace of parents who have given the gift of life or the grace of ancestral spirits who have accumulated merit on behalf of their descendents are acts of ingratitude which are unacceptable during the period of Reordering of the Universe. Judging from these findings, Daesoonjinrihoe embraces parts of traditional filial piety as it exists in Confucianism, Buddhism and Taoism, but it does so on the ground of its own unique culture. Through re-interpretation and re-creation, ideas regarding filial piety are being further developed. Namely, filial piety in Daesoonjinrihoe is regulations founded upon the reciprocation of favors for mutual beneficence and respect for humanity. Therefore, it is understood as a concept wherein one's own cultivation practice is performed in order to reach religious objectives, the perfection of personal character, and spiritual insight. This requires that even recipents of filial piety (i.e., parents) perform certain cultivation practices to enjoy happiness and wealth. Additionally, filial piety in Daesoonjinrihoe manifests a reinforced religious character and also serves as a system ethics which is soteriologically essential for salvation during the period known as the Reordering of the Universe.

Use of Sodium Saccharin and Sucralose in Foodstuffs and the Estimated Daily Intakes of Both Products in Korea (식품 중 삭카린나트륨과 수크랄로스의 사용실태 파악 및 한국인의 삭카린나트륨과 수크랄로스의 섭취 수준 평가)

  • Suh, Hee-Jae;Choi, Sunghee
    • Korean Journal of Food Science and Technology
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    • v.45 no.5
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    • pp.642-651
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    • 2013
  • This study sought to evaluate the daily intakes of sodium saccharin and sucralose for individuals in Korea with average and high levels of consumption of both these substances. The estimated daily intake of both sweeteners was determined from analytical data and dietary intake data collected as part of the Korean National Health and Nutrition Survey. Analysis of the data showed that sodium saccharin was found in 53 (15.6%) of 339 processed foods analyzed, whereas sucralose was found in 141 (23.9%) of 590 processed foods analyzed. The average intake of sodium saccharin was 1.18% of the acceptable daily intake (ADI) defined by the Joint FAO/WHO Expert committee on Food Additives (JECFA). The average intake of sucralose was 0.55% of ADI. The 95th percentile intakes of sodium saccharin and sucralose were 5.29% and 15.66% of ADI, respectively. Children 6 years old and younger consumed more sodium saccharin and sucralose than did children from any of the other age groups tested. In conclusion, the average daily intakes of sodium saccharin and sucralose within members of the Korean population fall within safe levels.

Clinical significance of follow-up laboratory tests, performed at 6 weeks after the onset of Kawasaki disease (가와사끼병에서 발병 6주째에 시행하는 추적검사의 임상적 유용성에 관한 고찰)

  • Oh, Il Ji;Moon, Kyung Hee;Hong, Myung Eun;Kim, Yeon Soon;Lee, Chang Woo;Yoon, Hyang Suk
    • Clinical and Experimental Pediatrics
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    • v.49 no.6
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    • pp.672-676
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    • 2006
  • Purpose : Low dose aspirin is used due to its antiplatelet effect for the subacute phase of Kawasaki disease(KD). It is usually used for 6-8 weeks, then various hematologic laboratory tests and follow up echocardiography for evaluating coronary abnormalities are performed. Our review investigated the usefulness of various follow up laboratory tests performed at 6 weeks after the onset of KD. Methods : Two hundred eighty-two children diagnosed and hospitalized with KD were identified by reviewing patient's charts. Cases which were diagnosed between January 1997 and December 2004 were included in this study. We reviewed laboratory data including leukocytes, platelet counts, antistreptolysin O(ASO), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), aspartate aminotransferase(AST), alanine aminotransferase(ALT), urinalysis, and echocardiograms performed at admission and 6 weeks after the onset of KD. Paired t-test and Fisher's exact test, as well as logistic regression tests, were used for the statistical analysis. Results : At 6th week data, ESR and CRP were still elevated in 35(12.4 percent) and 12(4.3 percent) patients, respectively. Sterile pyuria were all normalized. But, 36 patients(12.8 percent) showed thrombocytosis, 22(7.8 percent) elevated AST, 15(5.3 percent) leukocytosis, and 6(2.1 percent) coronary abnormalities. Coronary abnormalities at the 6th week were only shown in patients with initial abnormalites. Younger age and initial thrombocytosis were risk factors for thrombocytosis at the 6th week. Conclusion : All children with initial coronary abonormalites should have an echocardiogram at 6 weeks after the onset of fever. In view of case-effectiveness, additional echocardiographic studies are justified only if abnormalities are present at admission. ESR, CRP, and urinalysis performed at the 6 weeks after onset of KD is not significant for clinical information of progression. Platelet count should be estimated at 6th week for a judgement of continuous antiplatelet therapy.

Etiology and Clinical Features of Viral Lower-respiratory Tract Infections in Children in Winter, 2003 (2003년 겨울철 소아의 바이러스성 하기도 감염증에 대한 원인 및 바이러스별 임상양상)

  • Yun, Byung Ho;Lee, Hee Chul;Chun, Jung Mi;Yoon, So Young;Lee, Woo Gill;Shin, Son Moon
    • Clinical and Experimental Pediatrics
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    • v.48 no.7
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    • pp.723-730
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    • 2005
  • Purpose : This study was performed to characterize the etiology and clinical features of acute viral lower-respiratory tract infections(LRI). Methods : Etiologic agents and clinical features of acute viral LRI were studied from October. 2003 through March. 2004 in hospitalized children with LRI(253 cases) at Samsung Cheil Hospital. The viruses were identified by indirect immunofluorescent method. Medical records of patients with proven viral LRI were reviewed retrospectively. Results : Ninety two cases(36.4%) were confirmed as viral infections. The identified pathogens were respiratory syncytial virus(RSV, 76.0%), adenovirus(ADV, 12.0%), influenza virus type A(INFA, 9.8 %), influenza virus type B(INFB, 1.1%) and parainfluenza virus(PIV, 1.1%). Eight four point eight% of patients were younger than 2 years of age. Clinical diagnosis of LRI were pneumonia(56.5%), bronchiolitis(35.9%), tracheobronchitis(4.3%) and croup(3.3%). The clinical symptoms and signs were cough(98.8%), rhinorrhea(82.6%), fever(70.7%), rale(67.4%), wheezing(29.3%), chest retraction(28.3%) and cyanosis(4.3%). The severe respiratory symptoms and signs were more common in RSV-infected patients, even cyanosis could be observed. Seventeen point four percent of patient had fever of $38.5^{\circ}C$ or higher and their most common etiologic agent was INFA(66.7%). Twenty three point nine percent had fever more than 5 days and common etiologic agent was INFA(77.8%). The elevated WBC count($>14{\times}10^3/{\mu}L$) was in 14.1%, and common etiologic agents were INFA(22.2%) and ADV(18.2%). C-reactive protein(CRP >4.0 mg/dL) was increased in 13.0%, and common in ADV(63.6 %). Increased aspartate aminotransferase(AST)/alanine aminotransferase(ALT) was detected in 10.9%, and the most common etiologic agent was RSV(12.9%). Conclusion : The common agents of acute viral LRI were RSV, ADV and INF, respectively. Because the etiologic agents present variable clinical features, it may be helpful to treat and to evaluate acute viral LRI that we should understand their etiologic variability.

Orbital and Periorbital Cellulitis in Children: A Recent 7-Year Clinical Review (소아에서 안와와 안와주위 봉와직염에 관한 최근 7년간의 임상적 고찰)

  • Choi, Jeong Ho;Hon, Sun Yeong;Park, Sung Sin;Cha, Sung Ho;Kim, Eun Jin;Lee, Jin;Chang, Jin Keun
    • Pediatric Infection and Vaccine
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    • v.15 no.1
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    • pp.36-44
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    • 2008
  • Purpose : Orbital cellulitis is rare, but it could be from the serious complication of sinusitis in children. It is often difficult to distinguish periorbital cellulitis from orbital cellulitis. The purpose of this study is to describe the clinical features of orbital and periorbital cellulitis in a pediatric population and to assess the predisposing factors and their complications. Methods : Forty-one patients aged 18 years and younger who were admitted between January 2000 and December 2006 to Hanil General Hospital and Kyunghee University Hospital with orbital or periorbital cellulitis. The retrospective analyses included clinical characteristics of orbital and periorbital cellulitis, dermographics, past history, predisposing factors, clinical presentations, treatments, and complications. Results : Among 41 patients, 34 patients had periorbital cellulitis, 7 patients had orbital cellulitis. While paranasal sinus disease was the most common predisposing cause in orbital cases, skin lesion, insect bite, dacrocystitis and conjunctivitis were the common causes in periorbital cases. In comparison with periorbital cases, orbital cases had higher level of white blood cell count, erythrocyte sedimentation rate, and C-reactive protein. Blood cultures were taken in 23 patients, but only one had Staphylococcus aureus from blood. Only one case had surgical incision and drainage and recovered without complications. Conclusion : From the results of our data, when patient shows erythematous swelling of periorbital area with opthalmoplegia, chemosis and proptosis, orbital CT scan is required to make diagnosis of orbital cellulitis. Most cases of orbital cellulitis can be treated successfully without surgical intervention. If there is no clinical improvement, repeated CT scan and/or surgical intervention should be considered.

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Salmonellosis in Children in Daejeon, Korea, 1994~1999 (대전지역 살모넬라증 환아에 대한 임상적 연구(1994~1999년))

  • Chun, Jung-Soo;Lee, Kyung-Yil;Lee, Hyung-Shin;Kim, Sang-Yong;Han, Ji-Whan;Her, Jae-Kyun;Whang, Tyung-Tai
    • Pediatric Infection and Vaccine
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    • v.7 no.2
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    • pp.211-217
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    • 2000
  • Purpose : Salmonellosis including typhoid fever is still prevalent in Korea. Recently it has been reported that the incidence of salmonella gastroenteritis is increasing with a reduction of typhoid fever. We studied the clinical and laboratory features of salmonellosis. Methods : We evaluated the clinical records of 83 patients with salmonellosis who had been confirmed by stool culture from 1994 to 1999. Results : Annual incidence of salmonellosis showed an increasing tendency during recent 4 years. Seasonally, summer(45.8%) was the most prevalent, followed by fall(32.5%). Male to female ratio was 1.4 : 1. In age distribution, 64 cases(77.1%) were under 5 year-old, and 18 cases(21.7%) were younger than 1 year-old. Clinical features included diarrhea(96.4%), fever(91.6%), vomiting(49.4%), bloody stool(42.1%), abdominal pain(40.1%) and tenesmus(12.0%). In serogroups, there was no group A and group B, group C, group D(including 2 cases of S.typhi) and group E were in 41.0%(34 cases), 3.6%(3 csaes), 51.8%(43cases) and 3.6%(3 cases), respectively. In Widal test, 5 cases(13.5%) and 1 case(2.7%) of group B, C and E(total 37 cases) were observed the O titer above 1 : 80 and 1 : 320, respectively. However, in 36 cases of group D, 19 cases(52.7%) and 9 cases(25.0%) were above the O titer 1 : 80 and 1 : 320, respectively. Antibiotics resistant rates to ampicillin, trimethoprim/sulfamethoxazole and chloramphenicol were 23.2%, 10.1% and 51.4%, respectively. Conclusion : Salmonellosis has become a common cause of gastroenteritis in children, especially under the pre-school age. Isolation of salmonella is neccessary for accurate diagnosis of gastroenteritis and typhoid fever. A careful attention of the use of antibiotics is needed to reduce the muilti-drug resistant strains.

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Clinical Characteristics and Prognostic Factors of Vesicoureteral Reflux (방광요관역류의 임상적 특징 및 예후인자)

  • Kim, Wun-Kon;Ha, Tae-Sun
    • Childhood Kidney Diseases
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    • v.18 no.1
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    • pp.29-35
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    • 2014
  • Introduction: Persistent vesicoureteral reflux (VUR), a major cause of urinary tract infection (UTI) in children, can result in serious renal complications, such as reflux nephropathy and chronic renal failure. We evaluated the clinical characteristics and prognostic factors of VUR. Methods: From December 1993 to May 2011, we examined 117 children with vesicoureteral reflux who were admitted to the Department of Pediatrics and Urology, Chungbuk National University hospital for a UTI. The patients were managed medically or surgically. Results: Male patients had a slightly higher prevalence of VUR than female patients (55%). The degrees of the 161 refluxing ureters, as classified by the International Reflux Study Committee, were as follows: grade I, 15 ureters; grade II, 32 ureters; grade III, 54 ureters; grade IV, 26 ureters; grade V, 34 ureters. One hundred and sixty-one renal units (115 cases) underwent a 99m TC-DMSA renal scan, and 62% showed abnormal findings. The incidence of renal cortical defects showed a direct correlation with the severity of VUR. Ninety-four refluxing ureters were followed up medically, and 66 ureters (67%) either disappeared or improved. However, 9 refluxing ureters persisted. The spontaneous resolution rate of VUR seemed to be higher in younger patients with lower grades of reflux, and without renal cortical defects. Sixty-seven refluxing ureters (41%) were treated surgically, 62 refluxing ureters (92%) disappeared, and 5 refluxing ureters (8%) persisted. Conclusion: The incidence of renal cortical defects in patients with UTIs was 62% (in a 99m TC-DMSA renal scan), and showed a direct correlation with the severity of VUR. The spontaneous resolution rate seemed to be lower in the patients with higher grades of VUR, older age (over 4 years old) and diffuse renal cortical defects.

The Clinical Aspects of Regional Lymphadenitis following BCG Vaccination (BCG 접종 후 국소 림프절염의 임상양상)

  • Bae, Sun Young;Park, Yang Joon;Kim, Jong-Hyun;Oh, Jin Hee;Koh, Dae Kyun;Kang, Jin Han
    • Pediatric Infection and Vaccine
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    • v.13 no.2
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    • pp.137-146
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    • 2006
  • Purpose : A regional lymphadenitis is the most frequent adverse reaction of BCG. In order to find out developmental factors and establish a strategy of management, we investigated the clinical courses of children with lymphadenitis following BCG on the aspect of BCG strains, suppurative rates according to the sizes of lymph node and the clinical difference with or without treatment. Methods : From January 1997 to June 2004, 52 children less than 24 month-age-old diagnosed as BCG lymphadenitis in Department of Pediatrics, St. Vincent's Hospital, The Catholic University of Korea were enrolled. The type of BCG strain, place of vaccination, location and size of lymphadenitis were assessed with medical records, retrospectively. Finally, we analysed the correlations between BCG strains or the sizes of lymph node and natural remission or suppuration. Results : The first detected mean age of BCG lymphadenitis was 5.5 month-age. The larger of the measurement was at the first visiting, the younger of age that was first presented. The most frequent location was the same sided axillary region of BCG injection. Among 52 subjects, 46 cases(88.5%) were vaccinated with intradermal Pastuer strain, and only 5 cases(9.6%) were done with percutaneous multipunctured Tokyo strain. Twenty eight cases(53.8%) were regressed naturally, otherwise 24 cases(46.2%) were suppurated. The larger those were sized, the higher freqeuncies those were suppurated on, significantly. Treatment with medications could not prevent the suppuration and could not shorten the healing periods. Conclusion : We predict that there are differences between the occurrent rate of BCG lymphadenitis and BCG strains or methods. Treatment with medication is not recommended owing to its ineffectiveness. Especially, in case of non-suppurative lymphadenitis should be onlyless influence on the tuberculin skin test, cause less adverse reactions, and is inexpensive. observed without treatment, because it could be regressed naturally. An ideal BCG makes a scar, We should make an effort to choose the best BCG strain that can fulfill such requirements.

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Single or Dual Infection with Respiratory Syncytial Virus and Human Rhinovirus: Epidemiology and Clinical Characteristics in Hospitalized Children in a Rural Area of South Korea (호흡기세포융합바이러스와 라이노바이러스의 단독 혹은 동시감염의 역학 및 임상적 특성: 강원 지역 단일 기관의 후향적 연구)

  • Kwon, Yerim;Cho, Won Je;Kim, Hwang Min;Lee, Jeongmin
    • Pediatric Infection and Vaccine
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    • v.26 no.2
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    • pp.99-111
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    • 2019
  • Purpose: Respiratory syncytial virus (RSV) and human rhinovirus (hRV) are the most common causes of child respiratory viral infections. We aimed to investigate epidemiological and clinical characteristics of RSV and hRV single infections and coinfections. Methods: Nasopharyngeal aspirates of hospitalized children aged <5 years were tested using multiplex reverse transcription polymerase chain reaction (RT-PCR) from October 2014 to April 2017. Their medical records were retrospectively reviewed. Results: RSV or hRV was detected in 384 patients who divided into 3 groups: patients with RSV (R group, n=258); patients with hRV (H group, n=99); and patients with both (RH group, n=27). The R group (median age, 6 months) consisted of 248 (96.1%) patients with lower respiratory tract infection (LRTI), and 14 (5.4%) needed oxygen inhalation. Infants aged <12 months (63.2%) had respiratory difficulty and were supplied oxygen more often. The H group (median age, 16 months) consisted of 56 (56.6%) patients with LRTI, 4 (4%) required oxygen inhalation, and 1 (1.0%) required mechanical ventilation. Infants (40.4%) showed longer hospitalization compared to patients aged ${\geq}12$ months (5 vs. 4 days, P<0.05). The RH group consisted of 24 (88.9%) patients with LRTI, and 2 (7.4%) needed oxygen inhalation. Hospitalization days and oxygen inhalation and mechanical ventilation rates did not differ between single infections (R and H groups) and coinfections (RH group). Conclusions: RSV was detected more often in younger patients and showed higher LRTI rates compared to hRV. Single infections and coinfections of RSV and hRV showed no difference in severity.