• Tuberculosis and Respiratory Diseases
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• v.55 no.1
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• pp.59-68
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• 2003

Background : In intubated patients, cultures of endotracheal aspirates (EA) are apt to contamination throughout the endotracheal tube. Therefore, the identification of etiologic agents via conventional EA cultures is not always reliable. In order to differentiate a pulmonary infection from a non-infectious disease, and to identify the true etiologic agent of acute pulmonary infection, blinded protected specimen brushing (PSB) was used, and its efficacy evaluated. Methods : In 51 intubated patients, with suspected pneumonia, blind PSB were performed, and the results compared with blood and EA cultures. A protected specimen brush was introduced through the endotracheal tube, and settled at the affected large bronchus. A specimen brush was introduced to the expected region using the blind method. The tip of the brush was introduced with an aseptic technique after vigorously mixed for 1 minute in $1cm^3$ of Ringer's lactate solution. The specimens were submitted for quantitative culture within 15 minutes, with a culture being regarded as positive if the colony forming units were above $10^3/ml$. Results : Of the 51 patients, 15 (29.4%) had community-acquired pneumonia (CAP), 27 (52.9%) hospital-acquired pneumonia (HAP) and 9 (17.6%) non-infectious diseases. The sensitivity and specificity of the quantitative PSB culture for the diagnosis of pneumonia were 52.4 and 88.9%, respectively. The sensitivity and specificity of EA were 78.6 and 77.8%, respectively. The blind PSB was superior to the EA for the identification of true etiologic agents. Of 53 episodes of 27 HAP patients, MRSA (Methicillin-resistant staphylococcus aureus) (41.5%) was the most common causative agent followed by Pseudomonas aeruginosa (15.1%), Klebsiella sp. (7.5%) and Acinetobacter sp. (7.5%). Conclusions : As a simple, non-invasive diagnostic modality, the blind PSB is a useful method for the differentiation of a pulmonary infection from non-infectious diseases and to identify the etiologic agents in intubated patients. A blind PSB can be performed without bronchoscopy, so is safer, more convenient and cost-effectiveness for patients where bronchoscopy can not be performed.

• Clinical and Experimental Pediatrics
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• v.49 no.3
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• pp.292-297
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• 2006

Purpose : In medulloblastoma, craniospinal radiation therapy combined with chemotherapy improves the prognosis of tumors but results in significant endocrine morbidities. We studied the endocrine morbidity, especially growth pattern changes. Methods : The medical records of 37 patients with medulloblastoma were reviewed retrospectively for evaluation of endocrine function and growth. We performed the growth hormone stimulation test in 16 patients whose growth velocity was lower than 4 cm/yr. Results : The height loss was progressive in most patients. The height standard deviation score (SDS) decreased from $-0.1{\pm}1.3$ initially to $-0.6{\pm}1.0$ after 1 year(P<0.01). Growth hormone deficiency(GHD) developed in 14 patients. During the 2 years of growth hormone(GH) treatment, the improvements of height gain or progressions of height loss were not observed. Twelve patients(32.4 percent) revealed primary hypothyroidism. One of six patients diagnosed with compensated hypothyroidism progressed to primary hypothyroidism. Primary and hypergonadotropic hypogonadism were observed in two and one patients respectively. There was no proven case of central adrenal insufficiency. Conclusion : Growth impairment developed frequently, irrespective of the presence of GHD in childhood survivors of medulloblastoma. GH treatment may prevent further loss of height. The impairment of the hypothalamic-pituitary-gonadal and hypothalamic-pituitary-thyroidal axis is less common, while central adrenal insufficiency was not observed.

• Clinical and Experimental Pediatrics
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• v.51 no.9
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• pp.1012-1017
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• 2008

Purpose : This study aimed to assess the mechanical properties of the abdominal aorta in school-aged patients treated for Kawasaki disease and in normal, healthy children. Methods : This study examined 28 children with Kawasaki disease who had been followed up on and 30 healthy subjects of the same age and gender. We recorded systolic (Ps) and diastolic (Pd) blood pressure values and the aortic diameter at both minimum diastolic (Dd) and maximum systolic (Ds) expansion using two-dimensional echocardiography. These measurements were used to determine 1) aortic strain: S=(Ds-Dd)/Dd; 2) pressure strain elastic modulus: Ep=(Ps-Pd)/S; and 3) normalized Ep: $Ep^*=Ep/Pd$. Results : Ep (P=0.008) and $Ep^*$ (P=0.043) of the Kawasaki disease group were relatively high compared to those of the control group. Ep (P=0.002) and $Ep^*$ (P=0.015) of patients with coronary aneurysm were also relatively high compared with those of patients without coronary aneurysm, but lipid profiles did not differ, except for homocysteine (P=0.008). Therefore, in patients with coronary aneurysm, aortic stiffness was higher, compared to not only the control group but also patients without coronary aneurysm. However, in patients without coronary aneurysm, aortic stiffness was not significant, different compared to the control group. Conclusion : Measuring aortic distensibility may be helpful in assessing the risk of early atheroscletic change in the long-term management of Kawasaki disease.

• Pediatric Infection and Vaccine
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• v.7 no.1
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• pp.136-142
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• 2000

Purpose : Although there are a lot of the reports about the persistence of anti HBs titer of plasma derives HBV vaccine, it is difficult to find the follow up studies of the recombinant HBV vaccine. We performed this study to compare the persistence of anti HBs titer by vaccination schedule and the seronegative rate of 5 years later according to Anti HBs titer after basic immunization in neonatal period by recombinant HBV vaccination. Methods : This study was performed on 420 neonates at Pusan Moon Hwa Hospital from April to December 1993, followed up for 5 years after basic immunization by recombinant HBV vaccine. The anti HBs titer test was done by radioimmunoassay(RIAAUSAB, Abbott laboratories). The positive anti HBs level that would protect against HBV infection was defined as a level equal to or greater than 10mIU/mL. Results : In this study the seronegative rate after 5 years was 5% in 2 month schedule group, 25.5% in 6 month schedule group(P>0.05). In 2 month schedule group the seronegative rate was 20% when anti HBs titer is lower than 200mIU/mL, 0% when more than 200mIU/mL(P>0.05). In 6 month schedule group the seronegative rate was 66.7% when anti HBs titer was lower than 200mIU/mL, 40% when 200~499.9mIU/mL, 23.9% when 500~999.9mIU/mL, 22.5% when more than 1000mIU/mL. Conclusion : In this study the seronegative rate after 5 years of recombinant HBV vaccination was 5~25.5%. The persistence of anti HBs titer was statistically irrelevant to schedule. The seronegative rate after 5 years was statistically irrelevant to anti HBs titer after basic immunization.

• The Korean Journal of Nuclear Medicine Technology
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• v.17 no.1
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• pp.76-79
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• 2013

Purpose: It is very important to establish the appropriate reference range in the laboratory for preventing mistakes like false positive or false negative. Because the reference range in the laboratory is standard of patient test results interpretation. Proinsulin is precursor hormone of insulin, and the importance is increasing for diagnosing diabetes or insulinoma. Proinsulin reagent used in our laboratory is produced in the USA, and the reference range provided by manufacturer was adapted to our reference range after the validation test. But, it is generally recommend for the every laboratory to establish the their own reference range. So, we decided to re-evaluate the reference range with our patients' test results. Materials and Methods: Among 737 patients who had been to health promotion center in our hospital between Dec. $8^{th}$ 2011 and Dec. $21^{st}$ 2011, 563 patients are chosen with exception of diabetics patients and patients showing abnormal test results in Fasting Glucose, HbA1c, Insulin, and C-peptide. The 563 test results (275 males and 288 females) were classified with three groups(entire, male, female), and analysis of normal distribution was performed with aid of SPSS(version 19.0). Because Each group didn't show normal distribution, the reference range was set from the lowest limit of 2.5% to the highest limit of 97.5% with Percentile method used in non-normal distribution. Results: When evaluation values are sorted in ascending order, the entire range is 4.5~52.0 pM and 5.3~51.9 pM for male and 4.5~52.0 pM for female. The calculated reference range with percentile method shows 6.7~26.5 pM for entire group, 6.8~26.5 pM for male and 6.7~26.5 pM for female, respectively. Conclusion: The reference range provided by reagent manufacturer is 6.4~9.4 pM and the one established in this study is 6.7~26.5 pM. This difference might be caused by racial characteristics between Western people and Koreans. So an ideal reference range can be gotten with normal population visiting to every hospital. Our hospital has been using the newly re-establishing reference range under consultation with the department of endocrinology since Aug. $1^{st}$ 2012.

• Asian Journal of Turfgrass Science
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• v.20 no.1
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• pp.65-76
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• 2006

Scz1, an isolate of Sclerotinia homoeocarpa, was recently reported as a novel pathogen responsible for dollar spot disease in Zoysiagrass, a warm season turfgrass. Scz1 possessed different characteristics on mycelial pigment, mycelial affinity and host pathogenecity compared to those of Scb1, a typical isolate, obtained from creeping bentgrass, a cool season turfgrass. In this study, only three isolates, Scz1, Scz2(another analogous isolate of Sclerotinia homoeocarpa from zoysiagrass), and Scb1, were examined at the molecular level using the internal transcribed spacer(ITS) and random amplified polymorphic DNA(RAPD) assays to verify their identification and genetic variation. As a result of ITS assay, partial ITS sequences of three isolates showed 94-97% similarity with a standardized ITS sequence of S. homoeocarpa registered on BLAST. In the analysis of RAPD, range value through similarity matrix was 0.167 between Scz1 and Scb1, 0.139 between Scz2 and Scb1, and 0.713 between Scz1 and Scz2, respectively. Furthermore, tendegram analysis indicated that Scz1 and Scz2, unlike Scb1, were clustered together as accompanying a high genetic similarity. In in vitro fungicide bioassay, $EC_{50}$ value representing the sensitivity degree to propiconazole, a well-known fungicide for dollar spot disease, was 0.012 ${\mu}g/ml$ for Sczl, 0.003 ${\mu}g/ml$ for Scz2, and 0.030 ${\mu}g/ml$ for Scb1. From all data taken, we concluded that both Scz1 and Scz2 belonged to one group of S. homoeocarpa, since they exhibit the same host range and high level of genetic similarity, whereas their chemical competences to a fungicide were different. This study would provide further approach for assessing genetic diversity of S. homoeocarpa isolates as well as characterizing individual isolate against chemical exposure.

• Journal of Hospice and Palliative Care
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• v.17 no.2
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• pp.66-74
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• 2014

Purpose: This study is aimed to investigate perceptions of caregivers and medical staff toward do not resuscitate (DNR) and advance directives (AD). Methods: Participants were 141 caregivers and 272 medical staff members from five general hospitals. A questionnaire used for the study consisted of 20 items: 14 about DNR perceptions, three about AD, one each for age, gender and employment. Results: Both medical staff and caregivers strongly recognized the need for DNR and AD, and the level of recognition was higher with medical staff than caregivers (DNR ${\chi}^2=44.56$, P=0.001; AD ${\chi}^2=16.23$, P=0.001). The main reason for the recognition was to alleviate sufferings of patients in the terminal phase. In most cases, DNR and AD were filled out when patients with terminal conditions were admitted, and patients made the decisions by consulting with their guardians. Medical staff better recognized the need and for growing demand for guidelines for the DNR and AD decision making process than caregivers (${\chi}^2=7.41$, P=0.0025). Conclusion: This study showed that patients highly rely on their caregivers when making decisions for DNR and AD. Thus, it is important that patients and caregivers are provided with objective information about the decisions. Since participants' strong support for DNR and AD was mainly aimed at alleviating patients' suffering, further study is needed in the association with hospice care. Medical staff also needs to understand the different views held by caregivers and fully consider the disparity when informing patients/caregivers to make the DNR and AD decisions.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.3 no.1
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• pp.23-29
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• 2000

Purpose: It has recently been recognized that Helicobacter pylori (H. pylori) is an important factor in the pathogenesis of recurrent abdominal pain (RAP) in children. But, the best treatment for H. pylori infection is still unsettled. This study was performed to evaluate the efficacy of 2 weeks dual therapy with proton pump inhibitor (PPI) and amoxicillin for children with H. pylori infection associated with RAP. Method: Our study included 24 children with RAP who were H. pylori positive assessed by CLO test and histologic examination (silver stain). We used the regimen consisted of PPI (omeprazole, 0.7 mg/kg/day) and amoxicillin (50 mg/kg/day) for 2 weeks to eradicate H. pylori. Eradication of H. pylori was determined 4 weeks after the termination of treatment using the CLO test and histologic examination. Results: The endoscopic diagnoses of patients were nodular gastritis in 11 cases, superficial gastritis in 7 cases, peptic ulcer in 4 cases and normal finding in 2 cases. H. pylori was eradicated in 12 cases by omeprazole and amoxicillin dual therapy for 2 weeks and the eradication rate was 50%. In 4 of 12 children in whom H. pylori had not been eradicated with that regimen, we successfully eradicated H. pylori with other regimens of which 2 or 3 drugs among omeprazole, amoxicillin, clarithromycin, colloidal bismuth subcitrate ($Denol^{(R)}$) and metronidazole were used. Conclusion: The dual therapy with PPI and amoxicillin for 2 weeks had no clear advantage over other regimens for the eradication of H. pylori infection in children. We concluded that the combi-nation of PPI and amoxicillin for 2 weeks is not so good for H. pylori eradication as other commonly used regimens.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.2
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• pp.130-136
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• 2008

Purpose: Lamivudine is known to be effective for the treatment of chronic hepatitis B in adults. However, data on lamivudine therapy in pediatrics is limited. The aim of this study was to evaluate the efficacy and durability of lamivudine therapy for chronic hepatitis B in Korean children. Methods: A total of 44 children (27 males and 17 females, ages 6 months to 14.8 years, mean age 6.7 years) with chronic hepatitis B who received lamivudine (3 mg/kg/day, max 100 mg) for at least 12 months were enrolled. We evaluated the serum AST, ALT and serological HBV markers (HBsAg and anti-HBs, HBeAg and anti HBe, and HBV DNA) periodically. Predictive three year cumulative seroconversion rates were obtained using the Kaplan-Meier method. Results: Twenty one (48%) of 44 children achieved seroconversion of HBeAg by three years, while 23 (42%) children did not. HBV DNA was cleared in 34 (77%) children and the serum ALT levels were normalized in 41 children (93%). The three year cumulative seroconversion rates were 60% for HBeAg, and the clearance rates were 76% for HBV DNA. Eighteen children who discontinued lamivudine after HBeAg seroconversion maintained the therapeutic response for three years (treatment duration 13~58 months mean 24 months). Viral breakthrough developed in 12 children (27%) during the therapy and the YMDD mutation was documented in 11 children (25%). The mean duration for the development of a mutation was 22.7 months. Loss of HBsAg occurred in 6 children (14%). The pretreatment ALT levels were higher in responders; however, the differences were not statistically significant (p>0.05). Conclusion: The results of this study showed that lamivudine treatment had a favorable effect and durable therapeutic response in children with chronic hepatitis B. Long term follow-up and alternative therapy are warranted for those patients who do not respond to this treatment.

• Journal of Sericultural and Entomological Science
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• v.18 no.2
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• pp.83-88
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• 1976

A study was made on the interstrain difference in dose-infection response and induction response of silkworm to the two strains of cytoplasmic polyhedrosis virus to obtain some informations on screening the leading strains. Comparison of dose-infection responses of larvae following the inoculation of the inclusion body of cytoplasmic polyhedrosis virus revealed that there is no significance in the resistance to dose-infection and any of strains were more resistant at advanced stage(4th instar) than younger stage(2nd instar). In the pathogenicity between cytoplasmic polyhedrosis virus with hexagonal and tetragonal outline, the hexagonal polyhedra showed higher pathogenicity than the tetragonal polyhedra. However, the averages of $LC_{50}$ of cytoplasmic polyhedrosis virus with hexagonal outline to larvae of parental inbred line were 6.12${\times}$10$\^$6//$m\ell$ at 2nd instar and 1.57${\times}$10$\^$7//$m\ell$ at 4th instar in spring and those to their hybrids were 1.28${\times}$10$\^$6//$m\ell$ at 2nd ins tar and 4.99${\times}$10$\^$6//$m\ell$ at 4th ins tar in autumn. Meanwhile the $LC_{50}$ averages of tetragonal polyhedra. to larvae of parental inbred line were 2.06${\times}$10$\^$7//$m\ell$ at 2nd instar and 5.67${\times}$10$\^$7//$m\ell$ at 4th instar in spring and those to their hybrids were 9.84${\times}$10$\^$6//$m\ell$ at 2nd instar and 3.86${\times}$10$\^$7//$m\ell$ at 4th instar in autumn, respectively. In comparison of induction response of silkworm larvae to inoculation of tetragonal polyhedra of cytoplasmic polyhedrosis virus, the induction rate of hexagonal polyhedra was remarkably higher in the treatment of inoculation at 2nd instar than at 4th instar and at the concentration of 1.3${\times}$10$\^$6//$m\ell$ than at any others. Most of induction showed a mixed infection with hexagonal and tetragonal polyhedra of cytoplasmic polyhedrosis virus.