• Clinical and Experimental Pediatrics
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• v.51 no.1
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• pp.1-25
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• 2008

Purpose : Since 1967, The Korean Pediatric Society and Korean Government have developed Korean Growth Standards every 10 years. Last version was published in 1998. During past 40 years, Korean Growth Standards were mainly descriptive charts without any systematic nor statistical standardization. With the global epidemic of obesity, many authorities such as World Health Organization (WHO) and United States' Centers for Disease Control (CDC) have been changed their principles of growth charts to cope with the situations like ours. This article summarizes and reviews the whole developmental process of new 2007 Korean Growth Charts with discussion. Methods : With the initiative of Division of Chronic Disease Surveillance in Korea Centers for Disease Control and Prevention, we have performed new national survey for the development of new Standards in 2005 and identified marked increase of childhood obesity and plateau of secular increment of final height in late adolescents. We have developed new Growth Standards via adapting several innovative methods, including standardization of all available raw data, which were acquired in 1997 and 2005 national survey and full application of LMS method. Results : We could get new standardized charts; weight-for-age, length/height-for-age, weight-for-height, head circumference-for-age and BMI-for-age. Other non-standardized charts based on 2005 survey data were also published; waist circumference-for-age, mid-arm circumference-for-age, chest circumference-for-age and skinfold-for-age. Clinical guideline was also developed. Conclusion : Developmental process and results of new Korean Growth Charts are comparable with other internationally well-known Growth Standards, WHO 2006 Growth Standards and CDC Growth Charts. 2007 Korean Growth Charts are relevant especially in Korea and Korean ethnic groups.

• Clinical and Experimental Pediatrics
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• v.50 no.11
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• pp.1116-1124
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• 2007

Purpose : Juvenile dermatomyositis (JDM) is the most common of the idiopathic inflammatory myopathies in children. The purpose of this study is to observe demographic, initial presentations, duration of time between disease onset and diagnosis, clinical manifestations and laboratory findings at diagnosis of patients with JDM. Methods : Forty seven patients identified at Seoul National University Children's Hospital from January 1986 to May 2007. Medical records were reviewed retrospectively focusing on initial presentations, clinical manifestations and laboratory findings at the time of diagnosis of patients with JDM. Results : Male and female patients were 25 and 22, respectively and sex ratio was 1.14:1. The average age at the time of diagnosis was 6.51 years. Skin rash (94%) was the most common symptom, followed by the proximal muscle weakness (89%). The disease activity score was 10.8. The duration between the onset of the skin rash and the muscle weakness and diagnosis was 7.18 and 4.70 months, respectively. The serum muscle enzymes, LDH, AST, CK and aldolase, were elevated in the patient with JDM. Autoimmune antibodies, antinuclear antibody, anti SSA antibody and anti SSB antibody, were negative findings. Electromyography findings were consistent with JDM in 88% of the patients, the muscle biopsy was in 91% and all MRI findings were compatible with those of patients with JDM. The most common symptom besides musculocutaneous lesions was the calcinosis (62.5%). The most common site of calcinosis was the pelvic area and buttocks. Conclusion : This study shows that the major symptoms are proximal muscle weakness and cutaneous lesion, and they are important to diagnose JDM.

• Journal of agricultural medicine and community health
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• v.38 no.3
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• pp.182-194
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• 2013

Objectives: To identify and compare the health behaviors and health status of the elderly between urban and rural areas using the data of the Korean National Health and Nutrition Examination Survey (KNHANES). Methods: The study population comprised 3,823 elderly people aged 65 years or older who participated in the $4^{th}$ KNHANES (2007-2009). The areas were classified into "large cities," "cities," and "rural areas" using the administrative and residential areas. The health behaviors and health status of the elderly between the rural and urban areas were compared using a complex sample design with the Rao-Scott chi-square test and weighted multiple logistic regression analysis. Results: Compared to large cities, the odds ratios (ORs) (95% confidence interval [CI]) of rural areas were as high as 1.58 (1.25-2.01) for the influenza vaccination and as low as 0.47 (0.37-0.59) for flexibility exercises, 0.56 (0.38-0.81) for muscular exercises, and 0.76 (0.62-0.92) for obesity. The ORs (CI) for osteoarthritis and diabetes mellitus were as low as 0.81 (0.66-0.99) and 0.70 (0.55-0.89), respectively. Conclusions: The health behaviors and health status of the elderly are better in rural areas than in urban areas despite the fact that the socioeconomic conditions in rural areas are poorer that those in urban areas. These findings suggest that programs suitable for residential areas should be developed and that studies to explain the differences in residential areas are needed.

• Radiation Oncology Journal
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• v.10 no.1
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• pp.7-14
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• 1992

Between August 1988 and December 1991, 24 patients with intracranial tumors were treated with stereotactic radiosurgery(RS) using a 10 MV linear accelerator at Severance Hospital, Yonsei University College of Medicine. There were 5 meningiomas, 3 craniopharyngiomas, 9 glial tumors, 2 solitary metastases, 2 acoustic neurinomas, 2 pineal tumors, and 1 non-Hodgkin's lymphoma. Ten patients were treated as primary treatment after diagnosis with stereotactic biopsy or neuroimaging study. Nine patients underwent RS for post-op. residual tumors and three patients as a salvage treatment for recurrence after external irradiation. Two patients received RS as a boost followed by fractionated conventional radiotherapy. Among sixteen patients who were followed more than 6 months with neuroimage, seven patients (2 meningiomas, 4 benign glial tumors, one non-Hodgkin's lymphoma) showed complete response on neuroimage after RS and nine patients showed decreased tumor size. There was no acute treatment related side reaction. Late complications include three patients with symptomatic peritumoral brain edema and one craniopharyngioma with optic chiasmal injury. Through this early experience, we conclude that stereotactically directed single high doses of irradiation to the small intracranial tumors is effective for tumor control. However, in order to define the role of radiosurgery in the management of intracraniai tumors, we should get the long-term results available to demonstrate the benefits versus potential complications of this therapeutic modality.

• Tuberculosis and Respiratory Diseases
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• v.64 no.2
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• pp.109-124
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• 2008

Background: The incidence of chronic obstructive pulmonary disease (COPD) is increasing and the disease is becoming an important cause of morbidity and mortality worldwide. It is important to implement evidence-based guidelines by primary care physicians (PCPs) to establish qualified management of COPD patients. The aim of this survey is to investigate the pattern of COPD management among PCPs and to apply it to the development of Korean COPD guidelines. Methods: A web-based questionnaire was prepared that consisted of 25 questions on the pattern of COPD management. A total of 217 PCPs participated in the survey from June 2006 to May 2007. Results: Many PCPs (61.8%) possessed a spirometer, but the application rate was relatively low (35.8%) and more than half of the COPD patients (57%) did not receive a diagnosis based on spirometry. Administration of oral medication was preferred than the administration of inhaled medication for both stable COPD and acutely exacerbated COPD. More than 90% of the PCPs endorsed educational measures to quit smoking and vaccinate against influenza. It was noted that 56.7% of the PCPs were aware of the GOLD guidelines, but only 7.3% tended to fully implement the recommendations of the guidelines in daily practice. Conclusion: The results of the survey indicate that despite the high awareness rate of the current COPD guidelines, deficits exist among the PCPs with respect to the diagnosis and treatment of COPD. The results of this survey should be applied for the development of new COPD guidelines in order to decrease the discrepancy between the guidelines and the daily practice of the PCPs.

• Journal of Society of Preventive Korean Medicine
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• v.18 no.2
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• pp.11-30
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• 2014

Objective : To compare the differences in health behaviors by chronic diseases of middle-aged living in Seoul's low-income housing Method : Of the 1469 residents aged 35 to 60 living in low-income housing in Seoul's District A, 318 were equal probability of selection method selected. t-test, ANOVA, $x^2$, OR(95% CI, P-value) were selected to analyze the data, and the confidence interval was 5%. Results : There were no significant differences in all health behaviors by vascular and metabolic, But there was a statistically significant difference for gastrointestinal diseases caused by sleep hours(p=0.001), liver diseases caused by smoking, drinking and sleep hours(p=0.004, p=0.001, and p=0.033, respectively), musculoskeletal diseases caused by sleep hours and health exam(p=0.0000 and p=0.002, respectively). Also, statistically significant differences were found for tumors caused by sleep hours(p=0.004), depression by the sleep hours and health exam(p=0.001 and p=0.013, respectively), allergies by in sleep hours(p=0.004), thyroid diseases by smoking and health exam(p=0.013 and p=0.007, respectively). After adjusting for the confounding factors for diseases, OR was obtained for each health behavior. There were no statistically significant differences in all health behaviors for vascular, metabolic, and tumors. However, the OR for gastrointestinal diseases 4.10(1.63-10.36, 0.0028) and 2.96(1.05-8.41, 0.0041) at 5-7 and 7-9 sleep hours. The OR for liver diseases was 3.13(1.03-9.48, 0.0437) at 7-9 sleep hours, the OR values for musculoskeletal diseases were 2.91(1.23-6.88, 0.00149), and 4.46(1.68-11.86, 0.0027) at 5-7 and 7-9 sleep hours. OR for depression were 4.82(1.70-13.66, 0.0031) and 4.13(1.19-14.31, 0.0026) at 5-7 and 7-9 sleep hours. OR for allergy were 2.78(1.22-6.32, 0.0015) and 3.93(1.49-10.39, 0.0058) at 5-7 and 7-9 sleep hours. There were statistical significances for liver diseases for 1-2 times of health exam at 0.35(0.14-0.90, 0.00301), for liver diseases for 1-2 times of health exam at 0.35(0.14-0.90, 0.00301), for musculoskeletal diseases for 3-4 times of health exam at 0.26(0.09-0.79, 0.0175), for depression for 3-4 times of health exam at 0.17(0.04-0.66, 0.0106), for allergies for 1-2 times of health exam at 0.30(0.13-0.70, 0.0055), and for thyroid diseases for 1-2 times and annually of health exam at 0.07(0.01-0.60, 0.00154), 0.09(0.01-0.96, 0.0461). We known significant difference the health behaviors by the diseases. especially in sleep hours and health exam times Conclusion : Only sleep hours and health exam caused statistically significant differences in chronic diseases. but the sleep hours was postitively correlated with the risk of disease, while health exam were inversely related.

• Journal of the korean veterinary medical association
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• v.44 no.9
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• pp.803-818
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• 2008

동물의 결핵은 Mycobacterium bovis의 감염에 의한 만성 소모성 질병이며 인수공통전염병이다. 동물로부터 사람으로의 결핵 전염은 생유 섭취하던 시대에 상당히 많이 보고되었다. 우유의 살균처리와 소에서 피내진단에 의한 양성우 살처분 및 보상금 지급 정책을 전개하면서 M. bovis의 사람전염은 급격히 감소하였다. 소 결핵은 우리나라에서 연간 0.15% 내외의 발생을 보이고 있으며, 발생의 주원인으로는 외부입식소, 인근발생농장, 과거발생농장의 사후관리소홀 등이다. 사람 결핵의 주원인균인 M. tuberculosis와 M. bovis는 유전체가 99.9% 유사하며, M. bovis를 M. tuberculosis의 아종으로 분류하기도 한다. 두 세균은 M. tuberculosis complex에 속하며, M. tuberculosis와 M. bovis이외에도 M. africanum, M. canettii, M. microti, M. pinnipedii 등이 있다. M. bovis는 M. tuberculosis complex중에서 가장 넓은 숙주범위를 가진다. M. bovis의 대표적인 숙주는 종이름에도 나타나 있듯이 소이다. 소결핵 전파원으로서는 M. bovis에 감염된 소가 가장 중요하다. 소 이외에도 면양, 산양, 말, 돼지, 사슴, 엘크, 영양 (antelope, kudus, elands, sitatungas, oryxes, addaxes), 개, 고양이, 흰족제비 (ferrets), 낙타, 여우, 밍크, 오소리, 쥐, 영장류, 라마, 맥 (tapirs), 코끼리, 코뿔소 (rhinoceroses), 주머니쥐, 땅다람쥐 (ground squirrels), 수달 (otters), 물개, 산토끼 (hares), 두더쥐 (moles), 너구리 (raccoons), 코요테, 사자, 호랑이, 표범, 살쾡이 (lynx) 등에 감염될 수 있으나, 대부분 종결숙주 (spillover host)로 가축의 결핵방제가 유지되고 있는 국가에서는 야생동물 결핵의 가축 전염이 문제시되고 있다. M. bovis는 주로 호흡기와 소화기를 통하여 감염되며, 결핵결절이 형성되는 부위를 관찰하면 감염경로를 추정할 수 있다. 결핵에 감염되면, 초기에는 뚜렷한 임상증상을 보이지 않으나, 아침, 추운 날씨, 또는 운동 중에 심한 기침을 하며, 호흡곤란을 일으킬 수 있다. 결핵은 감염되어도 대부분 무증상이기 때문에 피내진단, 결핵결절 병리소견, 원인균 분리 등에 의해 진단하여야 한다. 감염된 결핵균은 탐식세포에 탐식되어 특징적인 육아종성 결절 병변으로 진행된다. 현재 결핵은 피내진단과 결핵결절 병리소견 등에 의해 판정하고 있다. 최신 진단법으로는 피내진단을 대체할 수 있는 인터페론 감마 검사법과 우군의 결핵 스크리닝과 말기 결핵 검사에 우수한 항체진단법이 개발되어 있다. 그러나, 소 결핵 근절을 위해서는 일관성있는 진단법과 진단기준을 적용하는 것이 중요한 성공요인중 하나이다. 소결핵 청정국인 호주와 캐나다에서는 피내진단과 도축장 결절검사를 결핵 양성우 색출방법의 근간으로 삼고 있으며, 소결핵 근절의 최종단계에 이르러서는 특이적인 검사법을 적용하였지만, 근절목적상 민감성이 높은 피내진단법을 사용하였다. 이와 더불어, 피내진단 양성우의 부검소견과 원인균 분리를 통해 결핵을 확진하여 출처농장의 역추적 검사를 통하여 결핵 양성소를 제거하였다. 한편, 결핵의 농장간 및 지역간 전파방지를 위해 결핵 청정농장과 결핵 오염농장, 결핵 청정지역과 결핵 오염지역 구분을 통하여 결핵 오염농장과 결핵 오염지역으로부터 결핵 청정농장과 결핵 청정지역으로의 이동전 결핵 검진을 통해 개체 이동에 따른 결핵 전파를 근본적으로 차단하는 시스템을 엄격히 적용한 것이 주요한 성공 요인중 하나였다. 호주 결핵 근절정책 성공요인을 요약하면, 일관성 있는 결핵진단법 적용, 양성우 출처농장의 철저한 역추적 검사, 개체 이동전 결핵 음성증명 확인, 농가단체의 경제적 및 방역상 적극적인 지원 및 협조 결핵의 지속적인 모니터 링과 현장요구에 부응하는 방제신기술의 지속적인 연구개발 등을 들 수 있다. 최근 들어 국내 동물 결핵은 소, 특히, 한우의 결핵발생이 증가하고 있으며, 사슴 결핵발생도 증가하고 있다. 농장간 및 지역간에 결핵 감수성 가축, 특히, 소와 사슴의 거래가 아주 복잡하게 이루어지고 있는 현실을 고려할 때, 결핵전파의 주원인인 결핵감염 소나 사슴의 농장내 반입을 철저히 차단해야 할 것이다. 이때, 개체 검사는 물론이고, 출처농장에 대한 결핵 음성을 확인한 후 입식하여야 할 것이며, 입식 후에도 60일정도 격리사육하면서 피내진단등 결핵검진 후 음성인 경우에만 합사하여야 할 것이다. M. bovis는 사람을 비롯한 거의 모든 온혈동물에서 결핵을 일으킬 수 있기 때문에, 결핵 감염소로 판정된 농장 종사자는 각 시도 보건소의 협조를 받아 결핵검진을 받도록 해야 한다. 농장 가축에 접촉할 수 있는 야생동물의 접촉을 차단하여야 하며, 특히, 농장 사료의 야생동물에 의한 오염을 방지할 수 있는 사료창고관리를 철저히 해야 한다. 결핵 감염소를 다룰 때는 분비물 또는 가검물에 의해 감염될 수 있기 때문에 개인방역장비 - 방역복, 마스크, 비닐장갑, 비닐장화 - 를 착용한 상태에서 다루어야 한다. 특히, 결핵 감염소를 매몰 또는 소각하는 과정에서 결핵 감염소의 배설물 및 분비물 처리를 철저히 하여야 한다. 모든 작업을 마친 후에는 개인방역장비, 매몰 또는 소각에 사용하였던 장비 등을 청소 및 소독하고 필요시 소각 또는 매몰하여야 하며, 개인감염위험과 타인 감염위험을 방지하기 위해 노출부위를 세척하여야 한다.

• Tuberculosis and Respiratory Diseases
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• v.47 no.1
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• pp.57-65
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• 1999

Backround : Pneumoconiosis is the parenchymal lung disease that results from the inhalation and deposition of dust, usually mineral dust of occupational or environmental origin. Most of the pneumoconiosis can be categorized to coal workers' pneumoconiosis (CWP) in Korea. No effective treatement is currently available, and the therapy for symptomatic CWP is limited to treatment of complication. Therefore authors analyzed and reviewed clinical features and radiological findings of 95 patients with pneumoconiosis for assessing the prognostic factors in disease progression. Method: We reviewed medical records of 95 cases with pneumoconiosis including history, chest X-ray, pulmonary function test, electrocardiography, AFB stain and culture of sputum, and routine blood examination between June 1995 and June 1997 in Seonam University Namkwang Hospital. Results: All of cases are male(mean age, 57.4 years), 91 cases out of them are miners. The mean duration of exposure to dust is 18.8 years. Major clinical symptoms are dyspnea (100%), sputum (71.6%), chest pain (55.8%), cough (23.2%), and hemoptysis (6.3%). 82 % of cases are over Morgan-Seaton Grade 2 in the degree of dyspnea. Small opacity on chest x-ray is 82.1 % and large opacity is 17.9%. Small opacity has tit type (37.2%), q/q type (25.6%) and r/r type (11.5%). B type is 42.2% in large opacity. For the pulmonary function test, restrictive type is 40.3%, mixed type 19.5% and obstructive type 8.3%. The more increasing chest Xray density, the more decreasing $FEV_1$ (p<0.01). 38% of patients show tuberculosis in chest X-ray, 15.8% positive smear of acid fast bacilli in sputum. The prevalence of pulmonary tuberculosis is high in patients with poor clinical condition. The cases with the active pulmonary tuberculosis have severe dyspnea. Expired cases show 100% and 75% of positive pulmonary tuberculosis in chest X-ray and sputum examination, respectively. 75% of expired cases show the chronic cor pulmonale, who died of acute respiratory failure. Conclusion: These findings indicate that tuberculoois infection has a decisive influence on the progress and prognoois of pneumoconioois.

• Korean Journal of Microbiology
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• v.48 no.2
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• pp.109-115
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• 2012

Helicobacter pylori is an important factor of chronic gastritis, digestive ulcer, and stomach cancer. CagL, a virulence factor of H. pylori, is well-known as a pilus protein which acts as adhesion to host cell and a component of Type 4 secretion system. In this study, we evaluated the protective response of recombinant CagL protein (rCagL) using Mongolian gerbil animal model for H. pylori infection. The cagL gene was cloned from 26695 H. pylori followed by over-expression and purification of the protein in E. coli. Mongolian gerbils were immunized with rCagL protein mixed with aluminum adjuvant via intramuscular injections once a week during 4 weeks. At a week after the last immunization, the Mongolian gerbils were administrated with H. pylori 7.13 strain into the stomach and sacrificed to measure antibody titer on rCagL by ELISA and bacterial colonization in the stomach, and to examine the histopathological changes and cytokine expression at 6 week after challenge. Antibody titers on recombinant protein were significantly increased from a week after the first immunization. There was no significant change of the number of bacterial colony between control group and immunized group. The relative stomach weight was significantly decreased in immunized group, but the significant change of histopathological assessment was not observed in the stomach. Cytokine expression such as IL-$1{\beta}$ and KC also was not significantly different between control and immunized groups. These results indicate that rCagL could effectively induce the formation of the specific IgG antibodies. However, bacterial colonization and histopathological lesions could not be inhibited by the immunization in the stomach, indicating not enough protection against H. pylori infection. We consider that along with CagL other adequate antigens could be needed stimulating immune response and inducing protective effects against gastric disease, and also a better adjuvant could be considered.

• Sleep Medicine and Psychophysiology
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• v.22 no.1
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• pp.30-34
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• 2015

Obesity hypoventilation syndrome (OHS) is characterized by severe obesity, excessive daytime sleepiness, hypoxemia and hypercapnea. Because OHS mimics pulmonary hypertension or cor pulmonale, clinicians should recognize and treat this syndrome appropriately. A 58-year-old female visited the emergency room because of dyspnea. She was obese and had kyphoscoliosis. The patient also experienced snoring, recurrent choking during sleep and daytime hypersomnolence which worsened after gaining weight in the recent year. The arterial blood gas analysis showed she experienced hypoxemia and hypercapnea not only during nighttime but also daytime. We suspected OHS and the patient underwent polysomnography to confirm whether obstructive sleep apnea was present. During the polysomnography test, sleep obstructive apnea was observed and apnea-hypopnea index was 9.2/hr. The patient was treated with bilevel positive airway pressure therapy (BiPAP). After BiPAP for 4 days, hypoxemia and hypercapnia were resolved and she is currently well without BiPAP. We report a case successfully treated with clinical improvement by presuming OHS early in a patient who had typical OHS symptoms, even while having other conditions which could cause hypoventilation.