• Pediatric Infection and Vaccine
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• v.31 no.1
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• pp.75-82
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• 2024

Purpose: As the coronavirus disease 2019 (COVID-19) pandemic ended, the number of patients with respiratory syncytial virus (RSV) pneumonia increased during the spring/summer of 2022. This study aimed to analyze the clinical features and antibiotic usage of children hospitalized for RSV pneumonia in a recently established general hospital in Sejong city. Methods: In this retrospective review, we included inpatients of the Pediatric Department of Chungnam National University Sejong Hospital diagnosed with RSV pneumonia between March 2022 and April 2023. Patients were divided into 2 groups: with and without antibiotic treatment. Demographic data, initial presentations, and clinical courses were reviewed. Results: A total of 116 patients with RSV pneumonia were hospitalized during this period, of which 102 were analyzed, excluding 14 with underlying diseases or who did not fall within the definition of pneumonia. The median age was 17 months. Diagnoses of bacterial infections (acute otitis media and sinusitis) were documented in 9.8% of cases. Intravenous (IV) antibiotics were administered in 46% of cases. The group receiving IV antibiotics showed higher inflammatory levels (C-reactive protein; CRP), more infiltration on initial chest X-rays, and longer fever duration. There was no difference in the length of hospitalization between the groups with and without IV antibiotics. Conclusions: This study showed a tendency for the attending physician to prescribe IV antibiotics to patients with longer fever duration, pulmonary infiltrations on the initial chest X-ray, and higher CRP levels. However, given the high rate of IV antibiotic usage compared to previous studies, care should be taken in antibiotic use.

• Magazine of the Korean Society of Agricultural Engineers
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• v.17 no.1
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• pp.3642-3654
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• 1975

The purpose of this thesis is to derive a unit hydrograph which may be applied to the ungaged watershed area from the relations between directly measurable unitgraph properties such as peak discharge(qp), time to peak discharge (Tp), and lag time (Lg) and watershed characteristics such as river length(L) from the given station to the upstream limits of the watershed area in km, river length from station to centroid of gravity of the watershed area in km (Lca), and main stream slope in meter per km (S). Other procedure based on routing a time-area diagram through catchment storage named Instantaneous Unit Hydrograph(IUH). Dimensionless unitgraph also analysed in brief. The basic data (1969 to 1973) used in these studies are 9 recording level gages and rating curves, 41 rain gages and pluviographs, and 40 observed unitgraphs through the 9 sub watersheds in Nak Oong River basin. The results summarized in these studies are as follows; 1. Time in hour from start of rise to peak rate (Tp) generally occured at the position of 0.3Tb (time base of hydrograph) with some indication of higher values for larger watershed. The base flow is comparelatively higher than the other small watershed area. 2. Te losses from rainfall were divided into initial loss and continuing loss. Initial loss may be defined as that portion of storm rainfall which is intercepted by vegetation, held in deppression storage or infiltrated at a high rate early in the storm and continuing loss is defined as the loss which continues at a constant rate throughout the duration of the storm after the initial loss has been satisfied. Tis continuing loss approximates the nearly constant rate of infiltration (${\Phi}$-index method). The loss rate from this analysis was estimated 50 Per cent to the rainfall excess approximately during the surface runoff occured. 3. Stream slope seems approximate, as is usual, to consider the mainstreamonly, not giving any specific consideration to tributary. It is desirable to develop a single measure of slope that is representative of the who1e stream. The mean slope of channel increment in 1 meter per 200 meters and 1 meter per 1400 meters were defined at Gazang and Jindong respectively. It is considered that the slopes are low slightly in the light of other river studies. Flood concentration rate might slightly be low in the Nak Dong river basin. 4. It found that the watershed lag (Lg, hrs) could be expressed by Lg=0.253 (L.Lca)0.4171 The product L.Lca is a measure of the size and shape of the watershed. For the logarithms, the correlation coefficient for Lg was 0.97 which defined that Lg is closely related with the watershed characteristics, L and Lca. 5. Expression for basin might be expected to take form containing theslope as {{{{ { L}_{g }=0.545 {( { L. { L}_{ca } } over { SQRT {s} } ) }^{0.346 } }}}} For the logarithms, the correlation coefficient for Lg was 0.97 which defined that Lg is closely related with the basin characteristics too. It should be needed to take care of analysis which relating to the mean slopes 6. Peak discharge per unit area of unitgraph for standard duration tr, ㎥/sec/$\textrm{km}^2$, was given by qp=10-0.52-0.0184Lg with a indication of lower values for watershed contrary to the higher lag time. For the logarithms, the correlation coefficient qp was 0.998 which defined high sign ificance. The peak discharge of the unitgraph for an area could therefore be expected to take the from Qp=qp. A(㎥/sec). 7. Using the unitgraph parameter Lg, the base length of the unitgraph, in days, was adopted as {{{{ {T}_{b } =0.73+2.073( { { L}_{g } } over {24 } )}}}} with high significant correlation coefficient, 0.92. The constant of the above equation are fixed by the procedure used to separate base flow from direct runoff. 8. The width W75 of the unitgraph at discharge equal to 75 per cent of the peak discharge, in hours and the width W50 at discharge equal to 50 Per cent of the peak discharge in hours, can be estimated from {{{{ { W}_{75 }= { 1.61} over { { q}_{b } ^{1.05 } } }}}} and {{{{ { W}_{50 }= { 2.5} over { { q}_{b } ^{1.05 } } }}}} respectively. This provides supplementary guide for sketching the unitgraph. 9. Above equations define the three factors necessary to construct the unitgraph for duration tr. For the duration tR, the lag is LgR=Lg+0.2(tR-tr) and this modified lag, LgRis used in qp and Tb It the tr happens to be equal to or close to tR, further assume qpR=qp. 10. Triangular hydrograph is a dimensionless unitgraph prepared from the 40 unitgraphs. The equation is shown as {{{{ { q}_{p } = { K.A.Q} over { { T}_{p } } }}}} or {{{{ { q}_{p } = { 0.21A.Q} over { { T}_{p } } }}}} The constant 0.21 is defined to Nak Dong River basin. 11. The base length of the time-area diagram for the IUH routing is {{{{C=0.9 {( { L. { L}_{ca } } over { SQRT { s} } ) }^{1/3 } }}}}. Correlation coefficient for C was 0.983 which defined a high significance. The base length of the T-AD was set to equal the time from the midpoint of rain fall excess to the point of contraflexure. The constant K, derived in this studies is K=8.32+0.0213 {{{{ { L} over { SQRT { s} } }}}} with correlation coefficient, 0.964. 12. In the light of the results analysed in these studies, average errors in the peak discharge of the Synthetic unitgraph, Triangular unitgraph, and IUH were estimated as 2.2, 7.7 and 6.4 per cent respectively to the peak of observed average unitgraph. Each ordinate of the Synthetic unitgraph was approached closely to the observed one.

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.871-888
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• 1997

Background : It is now thought that the earliest manifestation of idiopathic pulmonary fibrosis is alveolitis, that is, an accumulation of inflammatory and immune effector cells within alveolar walls and spaces. Inflammatory cells including alveolar macrophages and resident normal pulmonary tissue cells participate through the release of many variable mediators such as inflammatory growth factors and cytokines, which contribute to tissue damage and finally cause chronic pulmonary inflammation and fibrosis. This study was performed to investigate the source and distribution pattern of transforming growth factor-${\beta}_1$(TGF-${\beta}_1$), platelet derived growth factor(PDGF), basic fibroblast growth factor(bFGF), interleukin 1(IL-1), interleukin 6(IL-6), tumor necrosis factor-$\alpha$ (TNF-$\alpha$) and the role of these mediators on bleomycin(BLM)-induced pulmonary injury and fibrosis in rats. Method : Wistar rats were divided into three groups(control group, BLM treated group, BLM and vitamine E treated group). Animals were sacrificed periodically at 1, 2, 3, 4, 5, 7, 14, 21, 28 days after saline or BLM administration. The effects were compared to the results of bronchoalveolar lavage fluid analysis, light microscopic findings, immunohistochemical stains for six different mediators(TGF-${\beta}_1$, PDGF, bFGF, IL-1, IL-6 and TNF-$\alpha$) and mRNA in situ hybridization for TGF-${\beta}_1$. Results : IL-1 and IL-6 are maximally expressed at postbleomycin 1~7th day which are mainly produced by neutrophils and bronchiolar epithelium. It is thought that they induce recruitment of inflammatory cells at the injury site. The expression of IL-1 and IL-6 at the bronchiolar epithelium within 7th day is an indirect evidence of contribution of bronchiolar epithelial cells to promote and maintain the inflammatory and immune responses adjacent to the airways. TNF-$\alpha$ is mainly produced by neutrophils and bronchiolar epithelial cells during 1~5th day, alveolar macrophages during 7~28th day. At the earlier period, TNF-$\alpha$ causes recruitment of inflammatory cells at the injury site and later stimulates pulmonary fibrosis. The main secreting cells of TGF-${\beta}_1$ are alveolar macrophages and bronchiolar epithelium and the target is pulmonary fibroblasts and extracellular matrix. TGF-${\beta}_1$ and PDGF stimulate proliferation of pulmonary fibroblasts and TGF-${\beta}_1$ and bFGF incite the fibroblasts to produce extracellular matrix. The vitamine E and BLM treated group shows few positive cells(p<0.05). Conclusion : After endothelial and epithelial injury, the neutrophils and bronchiolar epithelium secrete IL-1, IL-6, TNF-$\alpha$ which induce infiltration of many neutrophils. It is thought that variable enzymes and $O_2$ radicals released by these neutrophils cause destruction of normal lung architecture and progression of pulmonary fibrosis. At the 7~28th day, TGF-${\beta}_1$, PDGF, bFGF, TNF-$\alpha$ secreted by alveolar macrophages sting pulmonary fibroblasts into proliferating with increased production of extracellular matrix and finally, they make progression of pulmonary fibrosis. TNF-$\alpha$ compares quite important with TGF-${\beta}_1$ to cause pulmonary fibrosis. Vitamine E seems to decrease the extent of BLM induced pulmonary fibrosis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.1 no.1
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• pp.45-55
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• 1998

Purpose: To make objective standards of small intestinal mucosal changes in cow's milk-sensitive enteropathy (CMSE) we analyzed histological changes of endoscopic duodenal mucosa biopsy specimens from normal children and patients of CMSE. Methods: We review the medical records of patients who had been admitted and diagnosed as CMSE by means of gastrofiberscopic duodenal mucosal biopsy following cow's milk challenge and withdrawal. Thirteen babies with CMSE, ranging from 14 days to 56 days of age, were studied. Five non-CMSE patients were used as control, ranging from 22 days to 72 days of age. The morphometric parameters under study were villous height, crypt zone depth, ratio of villous height to crypt zone depth, total mucosal thickness and length of surface epithelium by using H & E stained specimens under the drawing apparatus attached microscope. In addition, the numbers of lymphocytes in the epithelium and eosinophil cells in the lamina propria and epithelium were measured. Results: In the duodenal mucosal biopsy specimens in CMSE we found partial and subtotal villous atrophy with an increased number of interepithelial lymphocytes. The mean villous height($135{\pm}59\;{\mu}m$), ratio of villous height to crypt zone depth ($0.46{\pm}0.28$), total mucosal thickness ($499{\pm}56\;{\mu}m$), length of surface epithelium of small intestinal mucosa ($889{\pm}231\;{\mu}m$) in CMSE was significantly decreased compared with the control (p<0.05). The mean crypt zone depth ($311{\pm}65\;{\mu}m$) was significantly greater than the control ($188{\pm}24\;{\mu}m$)(p<0.05). Infiltration of interepithelial lymphocytes ($34.1{\pm}10.5$) were significantly greater than the control ($13.6{\pm}3.6$)(p<0.05). The number of eosinophil cells in both lamina propria and epithelium was no significant differences between groups (p>0.05). The small intestinal mucosa in treated CMSE showed much improved enteropathy of villous height, crypt zone depth, interepithelial lymphocytes compared with the control as well as untreated CMSE. Conclusion: Quantitation of mucosal dimensions confirmed the presence of CMSE. It seems to be a limitation in the capacity of crypt cells to compensate for the loss of villous epithelium in CMSE. Specimens obtained by gastrofiberscopic duodenal mucosal biopsy were suitable for morphometric diagnosis of CMSE. Improvement of CMSE also can be confirmed histologically after the therapy of protein hydrolysate.

• Journal of Chest Surgery
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• v.36 no.8
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• pp.545-558
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• 2003

Adult respiratory distress syndrome (ARDS) is of particular interest because of its severity of the associated lung injury and its high mortality. However, the pathophysiologies of ARDS in infant and childhood groups are still not well clarified inspite of many previous investigations. To investigate the time course of pathophysiology of ARDS in infant and childhood groups, this study was designed with experimental endotoxin-induced ARDS model using young rabbits (8 week-old). Material and Method: Rabbits were divided into the control group (n=8) and the endotoxin-treated group (n=32). The endotoxin group was subdivided into 4 groups by the sampling times as 3, 6, 12 and 24 hr-groups (G- $E_{3,6,12,24,}$ each n=8). The experimental ARDS was made by a bolus injection of endotoxin (Escherichia coli serotype 055 : B5, 0.50 mg/kg) via rabbit ear vein. For evaluation of the hematologic and inflammatory markers, and superoxide dismutase (SOD) concentrations, the blood samples were taken from the heart. The bronchoalveolar lavage fluid (BALF) were obtained for analysis of the leukocytes and protein concentration. With biopsy of the lung, histopathologic changes of the lung were also evaluated. Result: In the endotoxin groups, significant leukopenia (owing to pancytopenia) occurred in 3 and 6-hr groups, which was followed by significant leukocytosis (owing to neutrophilia) in the 12 and 24-hr groups (p<0.05). Serum levels of tumor necrosis factor-$\alpha$ (TNF-$\alpha$) and interleukin-1 $\beta$ (IL-1 $\beta$) in the endotoxin groups were higher than those of control group (p<0.05). Serum levels of superoxide dismutase (SOD) of G- $E_{3}$ and G- $E_{6}$ were higher than those of control group, whereas those of G- $E_{12}$ were lower than those of control groups (p<0.05). Total leukocyte counts and protein con-centrations in BALF were significantly elevated in the endotoxin groups compared to the control group (p < 0.05). The hemorrhagic pattern of BALF showed occurred in the endotoxin groups. The endotoxin groups (in G- $E_{6}$) had severe infiltration of inflammatory cells (lymphocyte and monocyte) in the pulmonary interstitium and parenchyma, migrations of neutrophil and eosinophil into alveolar spaces and interstitial widening, which are the evidences of acute lung injury. In the endotoxin groups, there were significant positive correlations between the BALF findings and the immunologic markers (TNF-$\alpha$, IL-1$\beta$, SOD) (p<0.05). Conclusion: Severe acute lung injury occurred in all the endotoxin-treated rabbits. The pathophysiologic findings were so progressive until 6-hr by time dependant pattern, and then recovered slowly, Variable hematologic, immuno-logic, and pathologic factors were well correlated in the development and progression of endoxin-induced lung injury. The pathophysiologic responses were sensitive and rapid in young rabbit Young rabbit seemed to be a useful experimental animal model for infant and childhood groups.roups.