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A Clinical Review of Acute Respiratory Distress Syndrome (ARDS) Due to Miliary Tuberculosis (급성호흡곤란증후군으로 발현된 속립성 결핵의 임상적 고찰)

  • Ahn, Young-Soo;Lee, Sang-Moo
    • Tuberculosis and Respiratory Diseases
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    • v.53 no.1
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    • pp.17-26
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    • 2002
  • Background : The detection and early elimination of the causes for acute respiratory distress syndrome(ARDS) at the initial stage can result in a more favorable prognosis. Miliary tuberculosis as a cause of the ARDS is quite rare. A diagnosis of miliary tuberculosis is difficult due to the diversity of radiological patterns and non-specific clinical finfings, and low sensitivity of sputum examinations for acid-fast bacilli(AFBs). An analysis of the clinical data is the first step in diagnosing these unusual, rare cases. Materials and Methods : In this study the clinical features, laboratory data, radiological findings and diagnostic methods were analyzed in 9 cases with an initial presentation of ARDS due to miliary tuberculosis. The ARDS was defined by the definition of the American-Europian consensus conference 1992. Results : The mean age of the patients was $67{\pm}18$ years (F:M=7:2). The chief complaints were dyspnea(5/9), coughing (3/9) and fever(5/9). On a physical examination, fine or coarse crackles were noted(6/9). The ARDS developed on average 6.7 days after the initial respiratory symptoms. The mean $PaO_2/FiO_2$ of the patients was $133.5{\pm}53.4$, the number of cases with a WBC<5000/$mm^3$ was 4 out of 9 cases. A platelet count<70,000/$mm^3$ was observed in 2 out of 9 cases, and the serum albumin level was $2.6{\pm}0.6$ g/dL. The initial simple chest PA showed ground glass appearances and consolidation in all cases, However, the miliary nodular densities were observed in only 4 out of the 9 cases. HRCT revealed alveolar densities and a consolidation in 5 out of 6 cases, and miliary nodules in 5 out of 6 cases, The diagnosis of tuberculosis was made by a liver biopsy (4/4, 100% sensitivity), a bone marrow biopsy (1/2, 50% sensitivity), and an open lung biopsy (1/1), the sputum AFB was positive in only 2 out of 9 cases. The patient was treated with INH, RFP, EMB, PZA, and steroids. The survival rate was 55.5%. Conclusion : Miliary tuberculosis should be considered as one of the causes for ARDS in areas where there is a high prevalence of tuberculosis. The chief complaints of the patients on admission are dyspnea, fever and coughing without any specific riskfactors. A liver biopsy is particularly useful in ARDS patients with mechanical ventilation to determine the causes of the ARDS if miliary tuberculosis is suspected as being the underlying disease.

The Ross Procedure in Pediatric Patients: 10 Years Experience at the Asan Medical Center (소아 환자에서 Ross 수술 성적 보고: 아산병원 10년 경험)

  • Kim, Hee-Jung;Seo, Dong-Man;Yun, Tae-Jin;Park, Jeong-Jun;Park, In-Sook;Kim, Young-Hwue;Ko, Jae-Kon
    • Journal of Chest Surgery
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    • v.42 no.3
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    • pp.305-310
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    • 2009
  • Background: The Ross procedure is known as a good surgical option for a young age group with aortic valve problems, but few reports on the Ross procedure are available in the Korean literature. This study is a review of our midterm results of 10 year experience with the pediatric Ross operation in Asan Medical Center. Material and Method: From March 1997 to October 2008, eighteen patients who were aged less than 16 years underwent the Ross procedure. There were 11 males and 7 females. The patients median age was 8.5 years (range: $0.5\sim14.0$). The aortic valve pathophysiology was 6 patients with aortic insufficiency, 4 patients with aortic stenosis, 7 patients with mixed aortic stenoinsufficiencey and 1 patient with infective endocarditis. The valve morphology was bicuspid in 11 and tricuspid in 7. All the patients were operated on with the root replacement technique. All the pumonic valves were replaced with an allograft except for one pericardial monocusp valve. The mean follow up duration was 52.8 months (range: 5.8$\sim$138.2 months). We reviewed the echocardiographic data with focusing on the, auto-graft dysfunction and reoperation. Result: There was no hospital mortality and late mortality. According to the last echocardiographic data, 2 autografts showed aortic regurgitation grade 2, 4 autografts showed aortic regurgitation grade 1 and the others were less than trivial. Reoperation of the pulmonic position conduit was performed 4 times in three patients. The rate of freedom from reoperation at 5 years was 72.2%. On the serial follow up, the Z-values of the aortic annulus/aortic sinus were changed from $1.6{\pm}1.7/0.9{\pm}1.7$ at preoperation to $1.8{\pm}1.6$(p=0.64)/$2.2{\pm}0.9$ (p=0.01) at the last follow-up. There was no significant relation between the growth of the neoaortic root and neoaortic insufficiency. Conclusion: Our midterm results of the Ross procedure in pediatric patients showed good autograft function and growth potential. Vet reoperation due to allograft dysfunction was a major concern.

Impacts assessment of Climate changes in North Korea based on RCP climate change scenarios II. Impacts assessment of hydrologic cycle changes in Yalu River (RCP 기후변화시나리오를 이용한 미래 북한지역의 수문순환 변화 영향 평가 II. 압록강유역의 미래 수문순환 변화 영향 평가)

  • Jeung, Se Jin;Kang, Dong Ho;Kim, Byung Sik
    • Journal of Wetlands Research
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    • v.21 no.spc
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    • pp.39-50
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    • 2019
  • This study aims to assess the influence of climate change on the hydrological cycle at a basin level in North Korea. The selected model for this study is MRI-CGCM 3, the one used for the Coupled Model Intercomparison Project Phase 5 (CMIP5). Moreover, this study adopted the Spatial Disaggregation-Quantile Delta Mapping (SDQDM), which is one of the stochastic downscaling techniques, to conduct the bias correction for climate change scenarios. The comparison between the preapplication and postapplication of the SDQDM supported the study's review on the technique's validity. In addition, as this study determined the influence of climate change on the hydrological cycle, it also observed the runoff in North Korea. In predicting such influence, parameters of a runoff model used for the analysis should be optimized. However, North Korea is classified as an ungauged region for its political characteristics, and it was difficult to collect the country's runoff observation data. Hence, the study selected 16 basins with secured high-quality runoff data, and the M-RAT model's optimized parameters were calculated. The study also analyzed the correlation among variables for basin characteristics to consider multicollinearity. Then, based on a phased regression analysis, the study developed an equation to calculate parameters for ungauged basin areas. To verify the equation, the study assumed the Osipcheon River, Namdaecheon Stream, Yongdang Reservoir, and Yonggang Stream as ungauged basin areas and conducted cross-validation. As a result, for all the four basin areas, high efficiency was confirmed with the efficiency coefficients of 0.8 or higher. The study used climate change scenarios and parameters of the estimated runoff model to assess the changes in hydrological cycle processes at a basin level from climate change in the Amnokgang River of North Korea. The results showed that climate change would lead to an increase in precipitation, and the corresponding rise in temperature is predicted to cause elevating evapotranspiration. However, it was found that the storage capacity in the basin decreased. The result of the analysis on flow duration indicated a decrease in flow on the 95th day; an increase in the drought flow during the periods of Future 1 and Future 2; and an increase in both flows for the period of Future 3.

Review of Policy Direction and Coupled Model Development between Groundwater Recharge Quantity and Climate Change (기후변화 연동 지하수 함양량 산정 모델 개발 및 정책방향 고찰)

  • Lee, Moung-Jin;Lee, Joung-Ho;Jeon, Seong-Woo;Houng, Hyun-Jung
    • Journal of Environmental Policy
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    • v.9 no.2
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    • pp.157-184
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    • 2010
  • Global climate change is destroying the water circulation balance by changing rates of precipitation, recharge and discharge, and evapotranspiration. The Intergovernmental Panel on Climate Change (IPCC 2007) makes "changes in rainfall pattern due to climate system changes and consequent shortage of available water resource" a high priority as the weakest part among the effects of human environment caused by future climate changes. Groundwater, which occupies a considerable portion of the world's water resources, is related to climate change via surface water such as rivers, lakes, and marshes, and "direct" interactions, being indirectly affected through recharge. Therefore, in order to quantify the effects of climate change on groundwater resources, it is necessary to not only predict the main variables of climate change but to also accurately predict the underground rainfall recharge quantity. In this paper, the authors selected a relevant climate change scenario, In this context, the authors selected A1B from the Special Report on Emission Scenario (SRES) which is distributed at Korea Meteorological Administration. By using data on temperature, rainfall, soil, and land use, the groundwater recharge rate for the research area was estimated by period and embodied as geographic information system (GIS). In order to calculate the groundwater recharge quantity, Visual HELP3 was used as main model for groundwater recharge, and the physical properties of weather, temperature, and soil layers were used as main input data. General changes to water circulation due to climate change have already been predicted. In order to systematically solve problems associated with how the groundwater resource circulation system should be reflected in future policies pertaining to groundwater resources, it may be urgent to recalculate the groundwater recharge quantity and consequent quantity for using via prediction of climate change in Korea in the future and then reflection of the results. The space-time calculation of changes to the groundwater recharge quantity in the study area may serve as a foundation to present additional measures for the improved management of domestic groundwater resources.

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Clinical significance of follow-up laboratory tests, performed at 6 weeks after the onset of Kawasaki disease (가와사끼병에서 발병 6주째에 시행하는 추적검사의 임상적 유용성에 관한 고찰)

  • Oh, Il Ji;Moon, Kyung Hee;Hong, Myung Eun;Kim, Yeon Soon;Lee, Chang Woo;Yoon, Hyang Suk
    • Clinical and Experimental Pediatrics
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    • v.49 no.6
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    • pp.672-676
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    • 2006
  • Purpose : Low dose aspirin is used due to its antiplatelet effect for the subacute phase of Kawasaki disease(KD). It is usually used for 6-8 weeks, then various hematologic laboratory tests and follow up echocardiography for evaluating coronary abnormalities are performed. Our review investigated the usefulness of various follow up laboratory tests performed at 6 weeks after the onset of KD. Methods : Two hundred eighty-two children diagnosed and hospitalized with KD were identified by reviewing patient's charts. Cases which were diagnosed between January 1997 and December 2004 were included in this study. We reviewed laboratory data including leukocytes, platelet counts, antistreptolysin O(ASO), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), aspartate aminotransferase(AST), alanine aminotransferase(ALT), urinalysis, and echocardiograms performed at admission and 6 weeks after the onset of KD. Paired t-test and Fisher's exact test, as well as logistic regression tests, were used for the statistical analysis. Results : At 6th week data, ESR and CRP were still elevated in 35(12.4 percent) and 12(4.3 percent) patients, respectively. Sterile pyuria were all normalized. But, 36 patients(12.8 percent) showed thrombocytosis, 22(7.8 percent) elevated AST, 15(5.3 percent) leukocytosis, and 6(2.1 percent) coronary abnormalities. Coronary abnormalities at the 6th week were only shown in patients with initial abnormalites. Younger age and initial thrombocytosis were risk factors for thrombocytosis at the 6th week. Conclusion : All children with initial coronary abonormalites should have an echocardiogram at 6 weeks after the onset of fever. In view of case-effectiveness, additional echocardiographic studies are justified only if abnormalities are present at admission. ESR, CRP, and urinalysis performed at the 6 weeks after onset of KD is not significant for clinical information of progression. Platelet count should be estimated at 6th week for a judgement of continuous antiplatelet therapy.

Case Study on Revising Curriculum of a Industrial High School through Analysis of Manufacturing Workforce demand focused on Chungnam Province in Korea (지역 기반 산업의 인력 수요 분석을 통한 공업 계열 특성화 고등학교의 교육과정 개편 사례 연구)

  • Yi, Sangbong;Choi, Jiyeon
    • 대한공업교육학회지
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    • v.38 no.1
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    • pp.221-238
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    • 2013
  • The purpose of this study was to revise and reorganize the direction of the department of ${\bigcirc}{\bigcirc}$Industrial High School though analysis of manufacturing status and workforce demand in Chungnam province focused on the Geumsan Area. In the study, ${\bigcirc}{\bigcirc}$Industrial High School of the status and actual conditions were identified through interview, literature review and data analysis. Surveys of the school teachers, parents and students was conducted in order to investigate the awareness of renaming and reorganization of school departments, curriculum revision of the school. Statistical data was collected and analyzed in order to figure out manufacturing industry and its workforce demand of Chungnam Province in Korea. Findings of the study were as follows: Small and medium enterprises of manufacturing industry have been developed a lot in Geumsan Area in Chungnam province. Four major industries including (1) automobile parts, (2) electronic and information equipment, (3) Cutting edge culture, and (4) Agricultural-livestock and bio are intensively fostered as regional strategic industries in the Chungnam province. The manufacturing industry has a 33.6-percent, and then service-mining and manufacturing industry has a 80.0-percent of total number of employee in Geumsan Area. It is expected that industrial workforce demand of Geumsan Area come out of manufacturing and service-mining industrial sector. The following is recommended for the school curriculum revision: (1) focussing on mechanical control for the revision of computer applying mechanical department, (2) focussing on automation electric equipment for the revision of electric control department, (3) focussing on food process control for revising of bio-food industrial department. It's helpful to make a progress of the school that establish identification of industrial specialized high school as an institution of vocational education at the secondary level through supplying qualified workforce to Manufacturing industry in Chungnam Province.

Stenotrophomonas maltophilia and Ventilator-Associated Pneumonia in Critically Ill Pediatric Patients: a Retrospective Analysis at a Single Center (소아 환자에서 Stenotrophomonas maltophilia와 인공 환기요법 관련 폐렴에 관한 연구)

  • Lee, Byung-Kee;Choi, Soo-Han;Kim, Soo Jin;Cho, Joong Bum;Ae, Hong;Yoo, So-young;Kim, Ji Hye;Lee, Nam Young;Kim, Yae-Jean
    • Pediatric Infection and Vaccine
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    • v.22 no.2
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    • pp.75-80
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    • 2015
  • Purpose: Ventilator-associated pneumonia (VAP) is a serious threat in critically ill pediatric patients. Data regarding Stenotrophomonas maltophilia VAP in pediatric population is limited. We evaluated the clinical data of S. maltophilia associated VAP in critically ill pediatric patients. Methods: A retrospective chart review was performed in pediatric patients 18 years old or younger who developed S. maltophilia associated VAP at Samsung Medical Center, Seoul Korea from January 2008 to December 2012. Results: A total of 31 patients were identified S. maltophilia associated VAP. Median age was 8 months (range, 0.5 month to 16.6 years) and 13 patients were male (40.6%). Underlying illnesses were cardiologic diseases (n=11, 34.4%), hematologic oncologic malignancies (n=7, 25%), neurologic diseases (n=4, 12.5%), pulmonary diseases (n=3, 9.4%), and others (n=4, 12.5%). The median duration of ventilator use before S. maltophilia VAP diagnosis was 14 days (range, 4-256 days). Overall mortality at 30 days was 12.5% (4/32). Conclusions: S. maltophilia should be also considered as a possible pathogen for VAP in critically ill pediatric patients. Empiric antibiotic choice should include agents that are active against S. maltophilia in patients who are deteriorating on broad spectrum beta-lactam antimicrobial agents.

Prediction of the risk of skin cancer caused by UVB radiation exposure using a method of meta-analysis (Meta-analysis를 이용한 UVB 조사량에 따른 피부암 발생 위해도의 예측 연구)

  • Shin, D.C.;Lee, J.T.;Yang, J.Y.
    • Journal of Preventive Medicine and Public Health
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    • v.31 no.1 s.60
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    • pp.91-103
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    • 1998
  • Under experimental conditions, UVB radiation, a type of ultra violet radiation, has shown to .elate with the occurrence of skin erythema (sun-burn) in human and skin cancer in experimental animal. Cumulative exposure to UVB is also believed to be at least partly responsible for the 'aging' process of the skin in human. It has also been observed to have an effect of altering DNA (deoxyribonucleic acid). UVB radiation is both an initiator and a promoter of non-melanoma skin cancer. Meta-analysis is a new discipline that critically reviews and statistically combines the results of previous researches. A recent review of meta-analysis in the field of public health emphasized its growing importance. Using a meta-analysis in this study, we explored more reliable dose-response relationships between UVB radiation and skin cancer incidence. We estimated skin cancer incidence using measured UVB radiation dose at a local area of Seoul (Shin chou-dong). The studies showing the dose-response relationships between UVB radiation and non-melanoma skin cancer incidence were searched and selected for a meta-analysis. The data for 7 reported epidemiological studies of three counties (USA, England, Australia) were pooled to estimated the risk. We estimated rate of incidence change of skin cancer using pooled data by meta-analysis method, and exponential and power models. Using either model, the regression coefficients for UVB did not differ significantly by gender and age. In each analysis of variance, non-melanoma skin cancer incidence after removing the gender and age and UVB effects was significant (p>0.01). The coefficients for UVB dose were estimated $2.07\times10^{-6}$ by the exponential model and 2.49 by the power model. At a local area of Seoul (Shinchon-Dong), BAF value were estimated 1.90 and 2.51 by the exponential and power model, respectively. The estimated BAP value were increased statistical power than that of primary studies that using a meta-analysis method.

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Phenotype-genotype correlations and the efficacy of growth hormone treatment in Korean children with Prader-Willi syndrome (프래더 윌리 증후군의 유전학적 발병 기전에 따른 표현형 및 성장 호르몬 치료 효과에 관한 연구)

  • Bae, Keun Wook;Ko, Jung Min;Yoo, Han Wook
    • Clinical and Experimental Pediatrics
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    • v.51 no.3
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    • pp.315-322
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    • 2008
  • Purpose : Prader-Willi syndrome (PWS) is a complex genetic disorder, caused by the deletion of the paternally derived 15q11-13 region or the maternal uniparental disomy of chromosome 15 (mUPD(15)). In this study, we compared phenotypic differences between those patients whose disease was caused by microdeletion and those caused by mUPD(15). In addition, a comparison of the efficacy of growth hormone (GH) therapy between these two PWS genotypes was analyzed. Methods : Fifty-three patients were diagnosed as having PWS based on molecular and cytogenetic analyses and clinical features. Data that included maternal age, birth weight, a feeding problem in the neonatal period, cryptorchidism, developmental delay or mental retardation, short stature, hypopigmentation, changes in height, weight, and body mass indexes (BMI) before and after GH treatment were obtained by a retrospective review of medical records. The data from the patients with microdeletion were compared with those from the patients with mUPD(15). Results : Of the 53 patients with genetically confirmed PWS, 39 cases had microdeletion and 14 mUPD(15). Maternal ages were significantly higher in the mUPD(15) group, and hypopigmentation and a feeding problem in the neonatal period were more frequent in the microdeletion group. Growth hormone was administered to 20 patients [14 with microdeletion, 6 with mUPD(15)]. There were no differences between the two groups in height velocity, weight and height SDS, and BMI after GH therapy. Conclusion : Phenotype and genotype correlations were observed in Korean PWS patients, such as more advanced maternal ages in the mUPD(15) group and more feeding problems and hypopigmentations in the microdeletion group. Further long-term prospective studies are needed to correlate other aspects of the phenotypes.

E-Commerce in the Historical Approach to Usage and Practice of International Trade ("무역상무(貿易商務)에의 역사적(歷史的) 어프로치와 무역취인(貿易取引)의 전자화(電子化)")

  • Tsubaki, Koji
    • THE INTERNATIONAL COMMERCE & LAW REVIEW
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    • v.19
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    • pp.224-242
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    • 2003
  • The author believes that the main task of study in international trade usage and practice is the management of transactional risks involved in international sale of goods. They are foreign exchange risks, transportation risks, credit risk, risk of miscommunication, etc. In most cases, these risks are more serious and enormous than those involved in domestic sales. Historically, the merchant adventurers organized the voyage abroad, secured trade finance, and went around the ocean with their own or consigned cargo until around the $mid-19^{th}$ century. They did business faceto-face at the trade fair or the open port where they maintained the local offices, so-called "Trading House"(商館). Thererfore, the transactional risks might have been one-sided either with the seller or the buyer. The bottomry seemed a typical arrangement for risk sharing among the interested parties to the adventure. In this way, such organizational arrangements coped with or bore the transactional risks. With the advent of ocean liner services and wireless communication across the national border in the $19^{th}$ century, the business of merchant adventurers developed toward the clear division of labor; sales by mercantile agents, and ocean transportation by the steam ship companies. The international banking helped the process to be accelerated. Then, bills of lading backed up by the statute made it possible to conduct documentary sales with a foreign partner in different country. Thus, FOB terms including ocean freight and CIF terms emerged gradually as standard trade terms in which transactional risks were allocated through negotiation between the seller and the buyer located in different countries. Both of them did not have to go abroad with their cargo. Instead, documentation in compliance with the terms of the contract(plus an L/C in some cases) must by 'strictly' fulfilled. In other words, the set of contractual documents must be tendered in advance of the arrival of the goods at port of discharge. Trust or reliance is placed on such contractual paper documents. However, the container transport services introduced as international intermodal transport since the late 1960s frequently caused the earlier arrival of the goods at the destination before the presentation of the set of paper documents, which may take 5 to 10% of the amount of transaction. In addition, the size of the container vessel required the speedy transport documentation before sailing from the port of loading. In these circumstances, computerized processing of transport related documents became essential for inexpensive transaction cost and uninterrupted distribution of the goods. Such computerization does not stop at the phase of transportation but extends to cover the whole process of international trade, transforming the documentary sales into less-paper trade and further into paperless trade, i.e., EDI or E-Commerce. Now we face the other side of the coin, which is data security and paperless transfer of legal rights and obligations. Unfortunately, these issues are not effectively covered by a set of contracts only. Obviously, EDI or E-Commerce is based on the common business process and harmonized system of various data codes as well as the standard message formats. This essential feature of E-Commerce needs effective coordination of different divisions of business and tight control over credit arrangements in addition to the standard contract of sales. In a few word, information does not alway invite "trust". Credit flows from people, or close organizational tie-ups. It is our common understanding that, without well-orchestrated organizational arrangements made by leading companies, E-Commerce does not work well for paperless trade. With such arrangements well in place, participating E-business members do not need to seriously care for credit risk. Finally, it is also clear that E-International Commerce must be linked up with a set of government EDIs such as NACCS, Port EDI, JETRAS, etc, in Japan. Therefore, there is still a long way before us to go for E-Commerce in practice, not on the top of information manager's desk.

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