• Clinical and Experimental Pediatrics
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• v.64 no.2
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• pp.68-75
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• 2021

The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been spreading worldwide since December 2019. Hundreds of cases of children and adolescents with Kawasaki disease (KD)-like hyperinflammatory illness have been reported in Europe and the United States during the peak of the COVID-19 pandemic with or without shock and cardiac dysfunction. These patients tested positive for the polymerase chain reaction or antibody test for SARS-CoV-2 or had a history of recent exposure to COVID-19. Clinicians managing such patients coined new terms for this new illness, such as COVID-19-associated hyperinflammatory response syndrome, pediatric inflammatory multisystem syndrome temporally associated with COVID-19, or COVID-19-associated multisystem inflammatory syndrome in children (MIS-C). The pathogenesis of MIS-C is unclear; however, it appears similar to that of cytokine storm syndrome. MIS-C shows clinical features similar to KD, but differences between them exist with respect to age, sex, and racial distributions and proportions of patients with shock or cardiac dysfunction. Recommended treatments for MIS-C include intravenous immunoglobulin, corticosteroids, and inotropic or vasopressor support. For refractory patients, monoclonal antibody to interleukin-6 receptor (tocilizumab), interleukin-1 receptor antagonist (anakinra), or monoclonal antibody to tumor necrosis factor (infliximab) may be recommended. Patients with coronary aneurysms require aspirin or anticoagulant therapy. The prognosis of MIS-C seemed favorable without sequelae in most patients despite a reported mortality rate of approximately 1.5%.

• Nuclear Engineering and Technology
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• v.53 no.12
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• pp.4158-4165
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• 2021

In this study, tissue equivalency (TE) of a newly developed epoxy-based phantom to 3-5 years child's tissue was investigated in paediatric energy range. Epoxy-based TE-phantoms were produced at different glandular/adipose (G/A) ratios of 17/83%, 31/69%, 36/64% and 10/90%. A procedure was developed in which specific amounts of boron, calcium, magnesium, sulphur compounds are mixed with epoxy resin, together with other minor substitutes. In paediatric energy range of 40-60 kV_p half-value layer (HVL) values were measured and then Hounsfield Units (HU) were determined from Computed Tomography(CT) scans taken in the X-ray energy range of 80-120kV_p. It is found that radiation absorption properties of these phantoms in terms of the measured HVL values related to linear attenuation coefficients (µ) are very well mimicking a 3 years child's soft tissue in case a ratio of 10/90%G/A. Additionally, the HU values of phantoms were determined from the CT scans. The HU = 47.8 ± 4.8 value was found for the epoxy-based phantom produced at a ratio of 10/90%G/A. The obtained HVL and HU values also support the suitability of the new epoxy based-phantom produced at a ratio of 10/90%G/A for a satisfactory mimicking a 3 years child's soft tissue by 5%. Thus they can have a potential use to perform the quality controls of medical X-ray systems and dose optimization studies.

• Journal of Environmental Health Sciences
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• v.47 no.2
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• pp.144-154
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• 2021

Objectives: This study was intended to identify hazard contribution by region, media, and chemical by calculating a hazard-based index using pollutant release and transfer register (PRTR) data. Methods: PRTR data for the period 2011 to 2016 was analyzed to examine the regional trends in toxic releases in terms of quantity and to create a corresponding hazard-based index. For the hazard-based index, the Risk-Screening Environmental Indicators (RSEI) Model was used. Results: The results of the trend analysis show that total releases decreased slightly, but health hazard levels increased consistently. According to the outcome of regional contribution analysis of the hazard-based index, Chungcheongnam-do, Jeollabuk-do and Gyeonggi-do Provinces showed a high ratio in the index for air and water release pollutants, while Gyeongsangbuk-do and Gyeongsangnam-do Provinces showed a high ratio in the index of soil release and waste transfer pollutants. Also, as a result of the analysis of the top ranked substances in the hazard-based index, it was found that chromium, cobalt and its compounds, and ethylene oxide contributed greatly to air release substances, while chromium, benzene, and lead and its compounds contributed greatly to water release substances. Conclusion: These results showed considerable disparities between total release and health hazard levels, especially in the analysis of contribution by regions and by chemical substance. Therefore, the hazard-based index should be used both to support a more comprehensive and robust approach to screening of chemicals for environmental health policy and for management.

• Neurospine
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• v.15 no.4
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• pp.329-337
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• 2018

Objective: Machine learning algorithms excel at leveraging big data to identify complex patterns that can be used to aid in clinical decision-making. The objective of this study is to demonstrate the performance of machine learning models in predicting postoperative complications following anterior cervical discectomy and fusion (ACDF). Methods: Artificial neural network (ANN), logistic regression (LR), support vector machine (SVM), and random forest decision tree (RF) models were trained on a multicenter data set of patients undergoing ACDF to predict surgical complications based on readily available patient data. Following training, these models were compared to the predictive capability of American Society of Anesthesiologists (ASA) physical status classification. Results: A total of 20,879 patients were identified as having undergone ACDF. Following exclusion criteria, patients were divided into 14,615 patients for training and 6,264 for testing data sets. ANN and LR consistently outperformed ASA physical status classification in predicting every complication (p < 0.05). The ANN outperformed LR in predicting venous thromboembolism, wound complication, and mortality (p < 0.05). The SVM and RF models were no better than random chance at predicting any of the postoperative complications (p < 0.05). Conclusion: ANN and LR algorithms outperform ASA physical status classification for predicting individual postoperative complications. Additionally, neural networks have greater sensitivity than LR when predicting mortality and wound complications. With the growing size of medical data, the training of machine learning on these large datasets promises to improve risk prognostication, with the ability of continuously learning making them excellent tools in complex clinical scenarios.

• Journal of The Korean Society of Maternal and Child Health
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• v.21 no.3
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• pp.159-165
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• 2017

The thalidomide tragedy in the 1960s has resulted in a perpetuation of a certain perception amongst physicians and pregnant women that the use of medication during pregnancy is a potential teratogen. Consequently, physicians hesitate in prescribing medication to pregnant women. In addition, pregnant women often refuse medication despite therapeutic necessity because of this existing perception. Recently there have been frequent adverse pregnancy outcomes related to the recurrence of chronic diseases, such as hypertension and diabetes, following pregnancy in older women. And there are lots of unnecessary termination of pregnancy due to the of information of medication exposed to medication following over 50% of unintended pregnancy. In light of this, better dissemination of information regarding the safe usage of medication for pregnant women is required. This would not only be cost-effective in terms of medical expenditure, but also prove beneficial for the treatment of diseases. In addition, Korea needs to adapt to the increasing changes of the international information system regarding supporting the safe usage of medication during pregnancy. An example of this is shown by the recent changes to the labeling of medication by the United States Food and Drug Administration. The new labeling includes information on the risk of usage, rather than just an arbitrary alphabetic classification of B, C, D, or X. Furthermore, this information is limited in Korea because of the lack of research, which in turn is due to several limitations on ethics and methodology, as well as present regulations on the research of pregnant women. From this, we can learn that government support is critical for the establishment of research so that we can alter the perception that all medication is harmful to pregnant women.

• 재활복지
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• v.18 no.4
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• pp.25-45
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• 2014

The present report aims to examine the assistive technology(AT) service operating system for the Disabled in Sweden, and will give it to NHIS(National Health Insurance Service) to manage of policy for AT service operating system. The user of AT is around 10% of the Disabled in Sweden which is introduced the AT service system to support the independence for the Disabled. To provide AT service, the role of the Ministry of Health(planning and regulation, controling Handisam and Hi as a subsidiary), County councils(providing and follow up medical AT service, operating AT service center) and Municipalities(providing general AT service) in Sweden is decentralized strictly. Specially, all the AT device is lent freely and recycled suitably for persons with Disabilities, moreover nurses, physical therapist and occupational therapist has a qualification for prescription of AT device . This finding will be the basis to improve Assistive Technology Operating System in Korea.

• Journal of Biomedical Engineering Research
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• v.40 no.1
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• pp.1-6
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• 2019

Human mesenchymal stem cells (hMSC) are multipotent stromal cells that have great potential to differentiate into a variety of cell types such as osteocytes, chondrocytes, and myocytes. Although there have been many studies on their clinical availability, little is known about how intracellular signals can be modulated by topographic features of the extracellular matrix (ECM). In this study, we investigated whether and how microwavy-patterned extracellular matrix (ECM) could affect the signaling activity of focal adhesion kinase (FAK), a key cellular adhesion protein. The fluorescence resonance energy transfer (FRET)-based FAK biosensor-transfected cells are incubated on microwavy-patterned surfaces and then platelet derived growth factor (PDGF) are treated to trigger FAK signals, followed by monitoring through live-cell FRET imaging in real time. As a result, we report that PDGF-induced FAK was highly activated in cells cultured on microwavy-patterned surface with L or M type, while inhibited by H type-patterned surface. In further studies, PDGF-induced FAK signals are regulated by functional support of actin filaments, microtubules, myosin-related proteins, suggesting that PDGF-induced FAK signals in hMSC upon microwavy surfaces are dependent on cytoskeleton (CSK)-actomyosin networks. Thus, our findings not only provide new insight on molecular mechanisms on how FAK signals can be regulated by distinct topographical cues of the ECM, but also may offer advantages in potential applications for regenerative medicine and tissue engineering.

• Physical Therapy Rehabilitation Science
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• v.8 no.3
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• pp.125-133
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• 2019

Objective: To compare the postural control between non-specific chronic low back pain (NSCLBP) subgroups and healthy people during dynamic balance performance using a modified Star Excursion Balance Test (mSEBT). Design: Cross-sectional study. Methods: Eighteen NSCLBP subjects (9 active extension pattern [AEP], 9 flexion pattern [FP]), and 10 healthy controls were enrolled in this study. All subjects performed mSEBT on their dominant leg on a force plate. Normalized reach distance and balance parameters, including the center of pressure (COP) displacement and velocity, were recorded. Results: There were significant differences in mean reach distances in both posterolateral and posteromedial (PM) reach directions between AEP and healthy subjects (p<0.001) and between FP and healthy subjects (p<0.001). However, there were no significant differences among the three groups in the anterior reach direction. Also, the results showed no significant differences in mean COP variables (velocity and displacement) between pooled NSCLBP and healthy subjects. However, the subjects were reclassified into AEP, FP and healthy groups and the results showed a significant difference in mean COP velocity in the PM direction between AEP and FP subjects (p=0.048), and between AEP and healthy subjects (p=0.024). Conclusions: The findings in this study highlight the heterogeneity of the individuals with NSCLBP and the importance of identifying the homogenous subgroups. Individuals with AEP and FP experience deficits in dynamic postural control compared to healthy controls. In addition, the findings of this study support the concept of the Multidimensional Classification System.

• Journal of Home Health Care Nursing
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• v.26 no.2
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• pp.219-229
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• 2019

Purpose: This study aimed to investigate the difference between primary caregivers' self-efficacy and coping strategy according to the communication styles of home care nurses. Methods: Data were collected from 123 primary caregivers of patients who were registered at a home care nursing center in D city and who had been receiving home care for more than 3 months from January 1 to February 27, 2018. The questionnaire included items on communication style, self-efficacy, and stress coping strategy. The data were analyzed using descriptive statistics, t-test, and ANOVA. Results: Regarding primary caregivers' self-efficacy in terms of communication style, the caregivers showed higher efficacy in providing informative and friendly communication (F=14.07, p=.001). Regarding home care nurses' communication style and the stress coping strategy of the primary caregivers, the informative-friendly communication style was adopted the most for the problem-solving coping strategy (F=7.17, p=.001). Regarding the social support-seeking coping, home care nurses' friendly communication style was the most adopted (F=4.40, p=.014). Conclusion: This study suggests that home care nurses will plan to provide informative and friendly communication-oriented nursing care, and to improve self-efficacy and positively influence the coping method by using the communication styles appropriate to the state of the primary caregiver.

• Journal of Hospice and Palliative Care
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• v.22 no.2
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• pp.49-66
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• 2019

Along with the advances in medical technology and the economic development, more terminally ill patients are receiving hospice and palliative care services. Moreover, hospice and palliative care clinicians have been showing considerable interest in studies that aim to improve the quality of said care for patients and their families. Meanwhile, after the government has strengthened its policy to protect research participants, the institutional review boards (IRBs) are more closely examining various ethical issues related to patients' vulnerability when reviewing protocols for hospice and palliative care research. However, terminally ill patients should be provided with guaranteed qualities of hospice and palliative care to improve and maintain their quality of life. To that end, support should be provided for efforts to conduct ethical and safe studies with hospice and palliative care patients. Thus, this review paper proposes ethical guidelines for hospice and palliative care research. The guidelines could be appropriately used as a reference for researchers who should prepare for ethically safe and scientifically valued research protocols and the IRBs that will review the protocols.