• Clinical and Experimental Pediatrics
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• v.53 no.2
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• pp.173-177
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• 2010

Purpose : Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen that causes nosocomial infection in NICU. It contributes to neonatal morbidity and mortality with variable complications. This study was conducted to identify the risk factors associated with complicated MRSA bacteremia in neonates. Methods : We reviewed the medical records of 44 neonates with positive blood culture for MRSA who were admitted to the NICU of Pusan National University Hospital from January 2002 to December 2007. We compared various factors of the complicated and uncomplicated MRSA bacteremia cases. Results : Of the 44 neonates, 31 were male and 13, female. The mean gestational age and birth weight were $33.2{\pm}4.9$ weeks and $1,859.9{\pm}962.2g$, respectively. Twenty-one of infants were treated with a mechanical ventilator during a mean of $8.8{\pm}13.8$ days. There were 13 cases of complicated and 31 cases of uncomplicated MRSA bacteremia. Between the 2 groups, we compared the following variables: gestational age, birth weight, ventilator use, umbilical catheter use and central catheter insertion, $O_2$ inhalation, first oral feeding day after birth, underlying disease, transfusion, and initial vancomycin use. The underlying disease and transfusion were the risk factors related to complicated MRSA bacteremia. Conclusion : Complicated MRSA bacteremia is related to underlying disease and transfusion. Since this was a retrospective study with a small sample size, it offered limited capacity to compare complicated and uncomplicated MRSA bacteremia. A prospective study with a larger population is needed to determine the exact characteristics of MRSA bacteremia in NICU.

• Journal of Nutrition and Health
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• v.42 no.2
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• pp.119-127
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• 2009

Malnutrition of hospitalized patients can adversely affect clinical outcomes and cost. Several nutritional screening tools have been developed to identify patients with malnutrition risk. However, many of those possess practical pitfalls of requiring much time and labor to administer and may not be highly applicable to a Korean population. This study sought to develop and evaluate a Nutrition Risk Screening Tool (NRST) which is simple and quick to administer and widely applicable to Korean hospitalized patients with various diseases. The study was also designed to generate a screening tool predictable of various clinical outcomes and to validate it against the Nutritional Risk Screening 2002 (NRS 2002). Electronic medical records of 424 patients hospitalized at a general hospital in Seoul during a 14-month period were abstracted for anthropometric, medical, biochemical, and clinical outcome variables. The study employed a 4-step process consisting of selecting NRST components, searching a scoring scheme, validating against a reference tool, and confirming clinical outcome predictability. NRST components were selected by stepwise multiple regression analysis of each clinical outcome (i.e., hospitalization period, complication, disease progress, and death) on several readily available patient characteristics. Age and serum levels of albumin, hematocrit (Hct), and total lymphocyte count (TLC) remained in the last model for any of 4 dependent variables were decided as NRST components. Odds ratios of malnutrition risk based on NRS 2002 according to levels of the selected components were utilized to frame a scoring scheme of NRST. A NRST score higher than 3.5 was set as a cut-off score for malnutrition risk based on sensitivity and specificity levels against NRS 2002. Lastly differences in clinical outcomes by patients' NRST results were examined. The results showed that the NRST can significantly predict the in-hospital clinical outcomes. It is concluded that the NRST can be useful to simply and quickly screen patients at high-nutritional risk in relation to prospective clinical outcomes.

• Journal of the Korean Institute of Landscape Architecture
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• v.37 no.3
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• pp.33-45
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• 2009

In the industry of landscape architecture, in which the core of production is manpower, the management of manpower is of utmost importance. The industry of landscape architecture, however, is highly sensitive to economic shifts and policy changes; this sensitivity renders the management of manpower-maintaining the balance between supply and demand-often times difficult. Currently, this vicious circle appears to persist in the sense that the industry suffers from a lack of skilled employees, and a new body of skilled laborers from the paucity of jobs. This study, in analyzing current manpower management as well as the prospective supply and demand in the field, looks forward to the stability of the supply and demand in landscape architecture in the nation. According to this study, the number of new skilled laborers-those who have a higher credential than that of "landscape architect-engineer"-is expected to increase by 10% per year. The number of new skilled laborers being 1,137 in 2008, it can be inferred that there will be a new group of 1,251 skilled laborers in the field in 2009. Meanwhile, estimating that the number of current skilled laborers in the field of landscape architecture is 14,783, the demand for new skilled laborers remains approximately 540. The supply of 1,251 skilled laborers outnumbers the demand of 540 by nearly 230%. Hence, the educational institutions of landscape architecture must be prepared to deal with this imbalance between the excessive supply and the lesser demand of skilled laborers. The issue of the excessive supply of manpower is particularly critical, because it may well undermine the competitiveness of the industry as a whole: compared to other related industries such as architecture and civil engineering, for instance. With the customary validation of long work experience no longer in effect, the need for an engineer's license will keep on increasing. It is time that educational institutions took this issue into full account and helped their students to be better qualified and more competent.

• Clinical and Experimental Pediatrics
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• v.50 no.2
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• pp.182-189
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• 2007

Purpose : The primary purpose of this study was to evaluate the growth and neuropsychologic function following treatments for pediatric hematologic and oncologic diseases. Healthy monozygotic twins served as ideal controls for comparison to exclude possible confounding factors. Methods : Seven children treated with various hematologic and oncologic diseases were included in the study: acute lymphoblastic leukemia (ALL; n=2), Diamond-Blackfan anemia twins (n=2), and aplastic anemia (n=3). The median age at the diagnosis was 5.2 (0.3-15) years. The median duration of follow-up was 7.2 (4.9-10) years. Controls were healthy monozygotic twins. Growth was measured and the percentile channels were evaluated sequentially for patients. The K-WISC III was applied and compared in 5 pairs of patients and controls. Results : Similar growth profiles were noted for the twins. The percentiles at diagnosis was 3-10 in 3, 25-50 in 2, and 50-75 in 2 cases. All patients stayed in their growth percentiles through follow-up, except for 1 patient who became obese. For IQ tests, the mean behavioral, verbal and full scale IQ scores of patients were 88.0, 93.8, and 89.8, respectively, and those from their corresponding controls were 92.2, 97.0, and 91.7 (P>0.05). However, 2 children who were treated for ALL had lower IQ scores. Conclusion : Similar growth profiles were observed in the monozygotic twins in terms of height and weight. The IQ scores of patients were similar to those of monozygotic twins. However, prophylactic CNS-directed therapy for leukemia might adversely affect the IQ scores. A further prospective study on larger number of twins is warranted.

• Childhood Kidney Diseases
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• v.18 no.1
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• pp.36-41
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• 2014

Purpose: Urinary tract infections (UTIs) are the most common source of bacterial infections in infants and young children. Accurate diagnosis and treatment is important because of their association with renal scarring, which can lead to complications. Urine endothelin-1 (ET-1) is the major renal isoform produced and released by renal mesangial cells in response to glomerular injury. This study aimed to investigate whether urinary levels of ET-1 can be used as a biomarker for UTI diagnosis. Method: We conducted a prospective study using medical records of 70 patients below the age of 18 years, who visited Chung-Ang University Hospital from July 2012 to July 2013. We classified the patients into the UTI and control groups based on urine culture studies. The UTI group was further divided into upper and lower UTI groups using 99m-Technetium dimercaptosuccinic acid scintigraphy. Urine ET-1 was measured using enzyme linked immunosorbent assay with 0.3 mL urine. Results: The UTI and control groups were comprised of 45 and 25 patients, respectively. Mean urine ET-1 levels were significantly higher in the UTI group than in the control group ($1.41{\pm}0.35$ pg/mL vs. $0.33{\pm}0.07$ pg/mL, P =0.04). There was no significance difference in the quantitative value between the upper and lower UTI groups (P =0.552). There was no correlation between urine ET-1 and serum C-reactive protein (Pearson correlation [R]=0.24), urine ET-1 and serum white blood cell count (R=0.19). Conclusion: Our study suggests that urine ET-1 can be used for early diagnosis of UTI in children.

• Childhood Kidney Diseases
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• v.18 no.1
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• pp.18-23
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• 2014

Purpose: The pharmacokinetics of tacrolimus, one of the most widely used immunosuppressive drugs, are known to vary by sex, age, and ethnicity during pediatric transplantation. This study assessed the pharmacokinetic characteristics and associated factors of tacrolimus in Korean children receiving a kidney transplant. Methods: We retrospectively reviewed the pharmacokinetic data (therapeutic dose, trough level, clearance, and half-life) of 9 children who were given tacrolimus as one of their initial immunosuppressive drugs after kidney transplantation. In addition, we compared the findings to data from 10 adult kidney transplant recipients. Results: The mean age of our pediatric patients was 13.9 years, and the maleto- female ratio was 4:5. The mean dose of tacrolimus was $0.19{\pm}0.14$ mg/kg/day. The mean dose of tacrolimus for males was $0.23{\pm}0.12$ mg/kg/day, which was significantly higher than the dose for females ($0.16{\pm}0.14$ mg/kg/day). The trough level was not significantly different between both groups. The clearance rate of tacrolimus for males was also significantly higher than females. Although the dosage of tacrolimus for patients over the age of 12 years was lower ($0.18{\pm}0.13$ vs. $0.21{\pm}0.16$ mg/kg/day) and the trough level was higher ($8.2{\pm}4.5$ vs. $7.2{\pm}4.2$ mg/mL) than that for patients under the age of 12 years, there was no significant difference between them. However, there were significant differences between children and adults in dose, clearance, and half-life of tacrolimus. Conclusion: Out study suggests that the pharmacokinetics of tacrolimus tends to vary with sex and age. Therefore, large-scale prospective studies are required to verify the proper therapeutic dosage of tacrolimus in Korean children.

• Journal of Preventive Medicine and Public Health
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• v.14 no.1
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• pp.81-88
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• 1981

The present study was conducted to investigate the status of industrial injuries through a prospective study for a year from August 1980 to July 1981. The subjects were 15 textile industries which were selected by random sampling in Daegu. The results obtained are as follows: Anual over-all incidence rate of industrial injuries was 3.3 percent and the rate showed 6.7 percent in male and 2 percent in female. The rate showed decreasing tendency with larger scale of industries. By the age group, $15{\sim}19$ age group was the highest as 49.3 percent. Age specific incidence rate of industrial injuries revealed highest as 4.7 precent among the group the group of 30 years old and over. By the years of service, 57.1 percent of the total cases belonged to the the group less than 1 year and the rate revealed increasing tendency with shorter period of service. The highest frequency of industrial injuries was observed at the point of 3 hours after the beginning of the work in a day as 18.1 percent. Frequency of industrial injuries showed highest as 20.3 percent on Monday. Frequency of industrial injuries was highest as 27.7 percent in winter time and showed 14 percent and 11.8 percent in January and August, respectively. By the cause of injuries, machinery accidents showed the highest as 39.2 percent and followed by the accidents due to striking against object as 17.8 percent, fall of ground as 16.3 percent and hand tool as 7.2 percent. Frequency of injured parts of body was highest as 43.9 percent in fingers. The frequency was much higher in upper extremities (66.9%) than in lower extremities (17.6%). By the kind of injuries, laceration wound was highestas 35.7 percent and the next was superficial injury and contusion as 35.1 percent. By the duration of treatment, most of the cases was belonged to the group less than 1 month as 79.1 percent and the duration showed prolonging tendency with larger scale of industries.

• Journal of Preventive Medicine and Public Health
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• v.37 no.4
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• pp.359-365
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• 2004

Objectives : This study was performed to determine whether an increase in abdominal obesity is an independent risk factor for impaired fasting glucose and type 2 DM. Methods : Among 24,212 adults over 30 years who undertook comprehensive medical screening examinations from Jan to Dec 1999, in a university hospital in Seoul, a total of 11,183 subjects were selected who had no DM at baseline and who were followed up more than once by Dec 2002. The average follow up period was 2.4 (${\pm}0.5$) years. DM was defined as having a fasting glucose level $\geq$ 126mg/dl, and impaired fasting glucose as showing a fasting glucose level between 110 and 125 mg/dl. Body weight, height and waist circumference (WC) were simultaneously measured with blood sampling. The relative risks (RRs) for DM and impaired fasting glucose by WC were calculated using Cox proportional hazard model. Ageadjusted rates were estimated by direct standardization using a reference population of 2000 from 30 to 80 years. Results : The average age of the subjects was 41.7 (${\pm}7.0$) years; males 41.2 (${\pm}6.5$) and females 45.6 (${\pm}9.2$). RRs for type 2 DM by WC with the reference group of WC < 80cm were as follows: 2.66 (95%, CI $0.55{\sim}12.8$) for WC of $80{\sim}89cm$ in men, 5.92 (95%, CI $1.08{\sim}32.3$) for WC $\geq$ 90 cm in men, and 2.64 (95%, CI $0.23{\sim}29.8$) for WC of $80{\sim}89cm$ in females. RRs for impaired fasting glucose by WC were 3.03 (95%, CI $2.18{\sim}4.22$) for WC $80{\sim}89cm$ in men, 6.10 (95%, CI $4.25{\sim}8.75$) for WC $\geq$ 90cm in men, and 1.56 (95%, CI $0.43{\sim}5.67$) for WC $80{\sim}89cm$ in women, and 8.08 (95%, CI $2.22{\sim}29.4$) for WC $\geq$ 90cm in females. These results remained significant after adjustment for age, BMI and fasting glucose concentrations at baseline in both sexes. Annual increment of more than 1 cm in WC was associated with the development of DM and impaired fasting glucose independently of age, sex, BMI, or presence of abdominal obesity. Conclusion : In Korean adults, abdominal obesity increased the risk for the development of type 2 diabetes and impaired fasting glucose. This result supports many other prospective studies suggesting abdominal obesity as a risk factor for type 2 diabetes.

• Radiation Oncology Journal
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• v.11 no.2
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• pp.355-361
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• 1993

Since May 1991, authors have conducted a pilot study to determine the feasibility and evaluate the effect of concurrent radiation therapy and chemotherapy with 5-FU and Cis-platinum for locally advanced cervical cancer (stage IIB-IVA). Radiation therapy consisted of external irradiation to whole pelvis (4140 cGy/23 fx) in 4.5 weeks followed by high dose rate intracavitary radiation therapy (HDR ICRT) to deliver a dose of 30 to 35 Gy to A point in 6 to 7 fractions. After the intracavitary radiation therapy, parametrial boost was delivered for B point dose of 60 Gy in Stage IIB and 65 Gy in stage IIIB. 5-FU (1000 $mg/m^2/24hr$ for 96 hour iv infusion) and Cis-platinum (20 $mg/m^2/day$ IV bolus for 3 days) were given during the second week of external RT and the second course chemotherapy administered at the first HDR ICRT with the same method as the first chemotherapy. Sixteen patients (10 stage IIB,4 stage IIIB,2 stage IVA) were registered to this protocol. Among these 16 patients, two refused treatment after 2 fractions of external irradiation, and one could not continue intracavitary irradiation because of treatment related genitourinary toxicity. So 14 patients were evaluated for toxicity and 13 patients were evaluated for response analysis. Five of 14 patients developed grade 3 gastrointestinal toxicity but 4 of them recovered at the completion of treatment. One stage IIIB patient with inguinal lymph node metastasis who received higher dose of radiation in spite of initial poor performance status did not recover from gastrointestinal toxicity at the completion of treatment. And she died of distant metastasis at one month after the completion of treatment. Two of 14 evaluable patients showed weight loss, more than $10\%$ of initial weight. One patient developed grade 3 leukopenia. In this study, the average total treatment period of completely treated patients was 75 days and three of them took more than 80 days (84, 84, 89 days). Toxicities were generally acceptable and there were no treatment related death. At the last follow-up, complete response was achieved in $62\%(8/13)$ and especially of nine patients with stage IIB, eight patients showed complete response. This study suggests that concurrent radiation therapy and chemotherapy (5-FU and Cis-platinum) is tolerable and effective. Further follow-up is needed to determine whether this protocol will have a favorable impact on survival and to evaluate the late effect on normal tissues. In future, prospective randomized trials are needed to compare the standard radiation therapy alone with concurrent chemotherapy and radiation therapy for locally advanced cervical carcinoma.

• The Journal of Internal Korean Medicine
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• v.28 no.3
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• pp.531-543
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• 2007

Backgrounds : Gastric cancer is one of the most frequent causes of cancer-related deaths worldwide. Gastric cancer patients frequently exhibit distant metastasis at the time of diagnosis and at present, there is no standard regimen after operation or chemotherapy to prevent metastasis and recurrences. Aims : The objective of the study was to compare the overall survival and disease free survival in patients treated with wheel balance therapy (WBT) with patients treated with WBT alone or the combination of WBT and conventional therapy and see if there were any significant improvements in survival between the two groups. Setting & Design : East-West Cancer Center at Daejeon University: retrospective study. Materials & Methods : We retrospectively analyzed 62 patients with stage III (40 patients) and stage IV (22 patients) gastric cancer who have received operation or chemotherapy 2 months prior to beginning WBT. The patients followed the WBT protocol which includes herbal medicine such as PSM capsules, OnePlus syrup, or HAD capsules which prevent metastasis and recurrences. Overall survival and disease free survival were analyzed and the patients were treated for 89.55 weeks and 49.27 weeks (median value) for stages III and IV, respectively. Statistical analysis used : Overall survival and disease free survival were estimated using the Kaplan-Meier method and the WBT and combination treatment arms were compared using the log rank test. Results : For stage III, the 3 year overall survival was 78.5% and disease free survival was 78.3%. Metastasis and recurrence occurred in 13 of 40 patients (32.5%). For stage IV, the 2 year overall survival was 18.2% and disease free survival was also 18.2%. Metastasis and recurrence occurred in 19 of 22 patients (86.4%). No significant difference was found statistically between the WBT alone and combination treatment arms though the combination regimen showed superiority (overall survival p=0.5093, disease free survival p=0.5175). Conclusions : WBT yielded satisfactory results in prolonging survival and preventing metastasis and recurrence in gastric cancer patients. The major treatment unit of WBT is composed of herbal medications (HAD, PSM capsules, OnePlus syrup) and a randomized, prospective study should be carried out using only this treatment unit in the future.