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NEW ANTIDEPRESSANTS IN CHILD AND ADOLESCENT PSYCHIATRY (소아청소년정신과영역의 새로운 항우울제)

  • Lee, Soo-Jung
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.14 no.1
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    • pp.12-25
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    • 2003
  • Objectives:As increasing number of new antidepressants have been being introduced in clinical practice, pharmacological understanding has been broadened. These changes mandate new information and theories to be incorporated into the treatment process of children with depressive disorders. In light of newly coming knowledge, this review intended to recapitulate the characteristics of new antidepressants and to consider the pivotal issues to develope guidelines for the treatment of depression in childhood and adolescence. Methods:Searching the Pub-Med online database for the articles with the key words of 'new', 'antidepressants' and 'children' ninety-seven headings of review articles were obtained. The author selected the articles of pertinent subjects in terms of either treatment guideline or psychopharmacology of new antidepressants. When required, articles about the clinical effectiveness of individual antidepressants were separatedly searched. In addition, the safety information of new antidepressants was acquired by browsing the official sites of the United States Food and Drugs Administration and Department of Health and Human Services. Results:1) For the clinical course, treatment phase, and treatment outcome, the reviews or treatment guidelines adopted the information from adult treatment guidelines. 2) Systematic and critical reviews unambiguously concluded that selective serotonin reuptake inhibitors(SSRIs) excelled tricyclic antidepressants( TCAs) for both efficacy and side effect profiles, and were recommend for the first-line choice for the treatment of children with depressive disorders. 3) New antidepressants generally lacked treatment experiences and randomized controlled clinical trials. 4) SSRIs and other new antidepressants, when used together, might result in pharmacokinetic and/or pharmacodynamic drug-to-drug interaction. 5) The difference of the clinical effectiveness of antidepressants between children and adults should be addressed from developmental aspects, which required further evidence. Conclusion:Treatment guidelines for the pharmacological treatment of childhood and adolescence depression could be constructed on the basis of clinical trial findings and practical experiences. Treatment guidelines are to best serve as the frame of reference for a clinician to make reasonable decisions for a particular therapeutic situation. In order to fulfill this role, guidelines should be updated as soon as new research data become available.

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A Study on the Spatial and Visual Composition of Yi Ung-Jae's Old House, Dundeok-ri (둔덕리 이웅재고가(李雄宰古家)의 공간 및 경관 구성적 특성에 관한 연구)

  • Rho, Jae-Hyun;Lee, Jung-Han
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.38 no.2
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    • pp.60-76
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    • 2020
  • The purpose of this study was to examine the spatial and visual arrangement characteristics of Imsil Yi Ung-jae's old house's spatial and visual aspects in order to discover the value of landscape and traditional house garden. The results of this study are as follows. Dongchon-village in Dundeok-ri, where old house is located, is a typical form of with "Back to the mountain and facing the water(背山臨水)", and is located in the north of the three streams of water, forming a Jeonchaghugwan(前窄後寬). Dongchon Village, which has a traditional scenic spot between Danguidae(丹丘臺) and Samgyeseokmun(三溪石門), is understood to be the main street of Nojeokbong Peak and Gyegwanbong Peak, which is Ansan(案山), where the "A centipede flying in the sky(飛天蜈蚣形)". Yi Ung-jae's old house is the oldest existing high-priced house in the North Jeolla region and the closing price of a royal family of the Joseon Dynasty, which was arranged by Chunseongjeong(春城正), Yi Dam-son(李聃孫) in the mid-16C. The Japanese Invasion of Korea in 1592 and Japanese colonial era, the loyalty of the gate quarters, the filial piety of the gate quarters, and the faithfulness of the tablet(扁額) and Juryeons(柱聯) are enough to contribute to the rise of the value of a physical house. The men's quarters(Sarangchae), which are placed on a high-pocket or a layout without going against the sloping terrain, have the effect of making the distance as far as possible, enhancing its dignity and hierarchy as a royal building. In addition, the entrance to the main quarters(Anchae) through the four pillar gates(四柱門), the extensive support and the appropriation of the Chaewon(vegetable garden), and the official base for the Anchae are very unique compared to the general nobility. However, in the context of the postwar relationship, the shrine seeks to realize Confucian ideals while harmonizing with nature by arranging wide sponsorships around it. On the other hand, it is confirmed that there was a pond in the form of a circle in a square(方池圓島型) with a relatively large area, which is now disturbed and damaged. Written by the high priced planting species are sponsored pine trees, hackberry, persimmon trees, Japanese apricot flower, Ohmomiji, and plum tree in the side garden, as well as cotyledon trees in the outside garden. However, although flower bed(花階), which is built on the stone axis, is a place that clearly shows the expensive garden, it seems to have lost the texture of the plant due to the extremely high variety of species and the splendor that does not match the plant landscape of the flower world. Yi Ung-jae's old house is highly valuable as it is a portrait house of a prince of the blood in the mid-Joseon Dynasty. Based on these findings, this study proposed a plan to improve the management of high prices that could be met.

Feasibility Study of the Stabilization for the Arsenic Contaminated Farmland Soil by Using Amendments at Samkwang Abandoned Mine (삼광광산 주변 비소 오염 토양에 대한 안정화 공법 적용성 평가)

  • Lee, Jung-Rak;Kim, Jae-Jung;Cho, Jin-Dong;Hwang, Jin-Yeon;Lee, Min-Hee
    • Economic and Environmental Geology
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    • v.44 no.3
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    • pp.217-228
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    • 2011
  • The feasibility study for the stabilization process using 5 amendments was performed to quantify As-immobilization efficiency in farmland soils around Samkwang abandoned mine, Korea. For the batch experiments, with 2% and 3% of granular lime(2-5 mm in diameter), leaching concentration of As from the soil decreased by 86% and 95% respectively, compared to that without the amendment. When 5% and 10% of granular limestone was added in the soil, As concentration decreased by 82% and 95%, showing that lime and limestone has a great capability to immobilize As in the soil. From the results of batch experiments, continuous column(15 cm in dimeter and 100 cm in length) tests using granular lime and limestone as amendments was performed. Without the amendment, As concentration from the effluent of the column ranged from 167 ${\mu}g$/L to 845 ${\mu}g$/L, which were higher than Korea Drinking Water Limit(50 ${\mu}g$/L). However, only with 1% and 2% of lime, As concentration from the column dramatically decreased by 97% for 9 years rainfall and maintained below 50 ${\mu}g$/L. With 5% of limestone and the mixed amendment(1% of lime + 2% of limestone), more than 95% diminution of As leaching from the column occurred within I year rainfall and maintained below 20 ${\mu}g$/L, suggesting that the capability of limestone to immobilize As in the farmland soil was outstanding and similar to that of lime. Results of experiments suggested that As stabilization process using limestone could be more available to immobilize As from the soil than using lime because of low pH increase and thus less harmful side effect.

Pulmonary Arterial Growth Pattern after Shunt Operation in Patients of Pulmonary Atresia with Ventricular Septal Defect Associated with Juxtaductal Stenosis (Juxtaductal stenosis가 동반된 PA/VSD환자에서 체폐단락술 부위에 따른 폐동맥 크기의 변화)

  • 이교준;박영환;최재영;조범구
    • Journal of Chest Surgery
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    • v.31 no.9
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    • pp.861-866
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    • 1998
  • Background: Pulmonary atresia (PA) with ventricular septal defect has various morphology of pulmonary arteries and pulmonary blood flow sources, so pulmonary arterial hypoplasia and arborization abnormality make this anomaly difficult to manage surgically. In cases associated with juxtaductal stenosis, we evaluated the change of the pulmonary arterial and juxtaductal stenotic site after shunt operations, and would like to find useful information in surgical planning and methodology of these patients. Material and Method: Among 59 cases diagnosed as PA with ventricular septal defect associated with juxtaductal stenosis, 29 cases who had cardiac catheterization before and after shunt operation were selected from July, 1991 to July, 1996. In 10 cases of right shunt operation(Group I) and 19 cases of left shunt operation (Group II), the diameters of the descending aorta, both pulmonary arteries, and the juxtaductal stenosis site were measured before and after the shunt operation. Result: In both Group I and II, the pre- and postoperative ratio of diameters of the ipsilateral pulmonary artery to the descending aorta was from 0.78${\pm}$0.31 units to 1.01${\pm}$0.26 units and from 0.67${\pm}$0.18 units to 0.84${\pm}$0.27 units respectively, showing a signigicant increase. The contralateral pulmonary artery index was increased from 0.92${\pm}$0.28 units to 1.05${\pm}$0.15 units and from 0.94${\pm}$0.27 units to 1.08${\pm}$0.37 units respectively, but could not be confirmed statistically. In both groups, the change of juxtaductal stenosis showed an aggravating tendency but of no statistical significance from 0.43${\pm}$0.27 units to 0.39${\pm}$0.25 units and from 0.32${\pm}$0.10 units to 0.30${\pm}$0.16 units respectively, and we experienced 2 total obstruction in Group II. Because the increased pulmonary blood flow by shunt operation has a favorable effect to the pulmonary arterial growth, the shunt operation is a recommended treatment in patients with hypoplastic pulmonary arteries. But in PA with ventricular septal defects, the change of juxtaductal stenosis is very important. In conclusion, the growth of ipsilateral (shunt site) pulmonary artery was promoted by shunt operation, but there is a tendency for the juxtaductal stenosis to be aggravated. And we experienced 2 total obstruction in Group II. Conclusion: Thus, in cases operated with shunt method, much careful postoperative follow up study including angiographic evaluation is needed, and after the shunt operation on the side of pulmonary artery associated with juxtaductal stenosis, early precise planning for total correction is recommended.

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Effects of Oyster-Shell Meal on Improving Spring Chinese Cabbage Productivity and Soil Properties (굴 패화석 비료가 배추 수량 및 토양 특성에 미치는 효과)

  • Lee, Ju-Young;Lee, Chang-Hoon;Yoon, Young-Sang;Ha, Byung-Hyun;Jang, Byoung-Choon;Lee, Ki-Sang;Lee, Do-Kyoung;Kim, Pil-Joo
    • Korean Journal of Soil Science and Fertilizer
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    • v.38 no.5
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    • pp.274-280
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    • 2005
  • Enormous amount of oyster-shell waste has been illegally disposed at oyster farm sites along the southern coast of Korea and then made a serious problem in environmental side. To increase the consumption of oyster shell meal as a soil amendment, the effects of oyster shell meal on soil properties and spring Chinese cabbage productivity were evaluated in silt loam soil to which 0, 4, 8, 12 and $16Mg\;ha^{-1}$ of oyster-shell meal fertilizer were added. Hydrated lime treatment ($2Mg\;ha^{-1}$) was selected as a control. Oyster-shell meal fertilizer, which made by a simple crushing and has high alkalinity as a calcium materials, had significant effects on neutralizing acid soil and on supplying calcium element. Spring Chinese cabbage yields increased with shell meal application. Plant uptakes of macro-nutrients such as P and C, and micro-nutrient such as B were significantly increased by oyster-shell meal application and then contributed to promote Chinese cabbage growth. The highest yield was achieved following the addition of $8Mg\;ha^{-1}$ shell meal application, and the same yield with that in lime treatment was at the $4Mg\;ha^{-1}$. Oyster-shell meal had more substantial effect on suppling calcium and on improving soil pH than that of lime. In conclusion, oyster shell meal fertilizer could be a good supplement to other inorganic soil amendments to improve nutrient balances in upland soils.

Clinical Usefulness of Contrast Echocardiography: The Dose Effect for Left Ventricle Visualization in Dogs (심초음파의 조영제의 임상적 유용성: 개에서 좌심영상화에 대한 조영제 용량의 영향)

  • Shin, Chang-ho;Hwang, Tae-sung;Yoon, Young-min;Jung, Dong-in;Yeon, Seong-chan;Lee, Hee-chun
    • Journal of Veterinary Clinics
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    • v.32 no.6
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    • pp.486-490
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    • 2015
  • Two-demensional echocardiography is routinely used for evaluation of cardiac function. Visualization of the endocardial border is essential for the assessment of global and regional left ventricular with cardiac disease. SonoVue$^{TM}$ is a microbubble contrast agent that consists of sulfur hexafluoride-filled microbubbles in a phospholipid shell. There were many studies about contrast echocardiographic examination using SonoVue$^{TM}$ contrast agent, and various doses of SonoVue$^{TM}$ were used. To our knowledge, in published veterinary medicine, there was not reported for diagnostic efficient dose of SonoVue$^{TM}$ to evaluate contrast enhanced left ventricular endocardial border delineation (LVEBD). The purpose of this study is to compare the visualization time of LVEBD and find efficient dose of SonoVue$^{TM}$ for using various doses in dogs. Ten healthy Beagles were recruited to the study. Three different doses (0.03 ml/kg, 0.05 ml/kg and 0.1 ml/kg) of SonoVue$^{TM}$ were injected. Endocardial segments were assigned based on previously established methodology, where by the four-chamber views of the LV were divided into 6 segments. In this study, Contrast enhancement of the LVEBD after each injection was evaluated visually at the time point of overall contrast enhancement (Segmental scoring 5+) in the LV by three investigators in a blind manner. Statistical analysis was performed with SPSS version 14.0. All data were analyzed using one-way ANOVA, the multiple comparison Scheffe test. When data for the three offsite readers were combined, mean durations of useful contrast were $3.54({\pm}2.14)$, $6.15({\pm}2.61)$, and $24.39({\pm}11.10)$ seconds for the 0.03 ml/kg, 0.05 ml/kg, and 0.1 ml/kg SonoVue$^{TM}$ doses, respectively. After injection of contrast agent, there were no significant change in side effects such as urticaria, angioedema, hypersensitivity reactions, and digestive system disorders. This study suggests that efficient dose of SonoVue$^{TM}$ contrast agent for improvement of the left ventricle visualization is 0.1 ml/kg. The duration of useful enhancement of LVEBD and the reproducibility were also the highest at the 0.1 ml/kg dosage.

Classification of Cordyceps spp. by Morphological Characteristics and Protein Banding Pattern (동충하초(冬蟲夏草)(Cordyceps) 속균의 형태적인 특징과 단백질 Pattern에 의한 계통 분류)

  • Sung, Jae-Mo;Lee, Hyun-Kyung;Yang, Keun-Joo
    • The Korean Journal of Mycology
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    • v.23 no.1 s.72
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    • pp.92-104
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    • 1995
  • Ten species of Cordyceps species were collected throughout Kangwon province including Chuncheon Dongsanmyun KNU forest experiment from June to September, 1993. Collected Cordyceps species were identified as Cordyceps militaris, C. roseostromata, C. kyushuensis, C. scarabaeicola, Phytocordyceps ninchukiospora, C. nutans, Paecilomyces tenuipes, C. sphecocephala, Hymenostilbe odonatae, Torrubiella sp.. C. militaris, type species of Cordyceps species, was mainly formed on pupae of Lepidoptera and found after the rainy season around July. Fruiting body of C. roseostromata was morphologically similar to those of C. militaris, but relatively small in size and they were also found on lawn or pupa of Lepidoptera. Fruiting body of C. scarabaeicola was found on adult Scarabaeidae specifically and collect fruiting bodies of C. kyushuensis were on larva of moth. C. nutans and C. sphecocephala had host specificity on Hemiptera and Hymenoptera, respectively. Each species formed elliptical fertile part attach to the slim and carneous stalk and they were collected the most in specimen number through whole season of the summer. Ascospore of Phytocordyceps ninchukiospora on seed was characterized by two viable, multiseptate, fusiform units linked end-to-end by a long, filiform connective. Paecilomyces tenuipes, imperfect stage of the genus Cordyceps is multi-infective fungi that attack all stages of all groups of insects. Hymenostilbe odonatae attacks only adult Odonata and Torrubiella sp. formed on spider was difficult to collect because it was found the back side of leaf. As results of cultural test PDA medium showed the best mycelial growth. In the experiment of effect of the acidity inside of the media, C. militaris was good on pH 5, C. nutans and Phytocordyceps ninchukiospora were good on pH 6 and Paecilomyces tenuipes was on pH 7 and C. scarabaeicola was on pH 9. All isolates tested showed the best mycelial growth at $20^{\circ}C$. Morphologically similar isolates were used to analyze protein banding pattern among and within species. As a result, C. militaris, C. roseostromata and C. kyushuensis were clustered into close species and C. scarabaeicola and Phytocordyceps ninchukiospora were relatively distant from those species.

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Severe Pneumonia Caused by 2009 Pandemic Influenza A (H1N1) Virus in Children and Corticosteroid Treatment (소아에서 2009 신종 인플루엔자 A (H1N1) 중증 폐렴과 스테로이드 치료)

  • Sohn, Yu Rak;Kim, Jong Hee;Ma, Sang Hyuk;Lee, Kyung Yil;Kang, Jin Han
    • Pediatric Infection and Vaccine
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    • v.18 no.2
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    • pp.193-200
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    • 2011
  • Purpose : The effect of corticosteroid on severe pneumonia caused by 2009 pandemic influenza (H1N1) A virus is controversial. This study was aimed to present the effects of early, short-term corticosteroid treatment for severe pneumonia with this virus infection. Methods : A retrospective analysis was performed on severe pneumonia patients (37 patients) who had severe respiratory distress at presentation requiring oxygen therapy and received intravenous methylprednisolone (MP, 8-10 mg/kg, divided in 4 doses/day for 2-3 days) with oseltamivir. The clinical and laboratory characteristics of the patients were evaluated through the medical records and chest radiographic findings. Results : The mean age and male-to-female ratio of the patients were 6.5${\pm}$2.9 years of age, and 3.4:1 (male 29 patients), respectively. The 5-9 aged group was predominant among the age groups (25 patients, 67.6%). Duration of fever prior to admission was 1.4${\pm}$0.6 days and dyspnea developed within 24 h after beginning of respiratory symptoms in all patients. All patients were previously healthy and received oseltamivir within 48 h. Thirteen patients (35.1%) developed dyspnea during oseltamivir treatment. Following MP infusion, all 37 patients including 13 progressive pneumonia patients during oseltamivir treatment showed an immediate halt in the progression of pneumonic infiltration with rapid clinical improvement. There were no side-effects following steroid use. Conclusion : For severe pneumonia patients, early corticosteroid treatment halted clinical exacerbation, and possibly prevented progression to acute respiratory distress syndrome. Further controlled clinical studies are needed for the role of corticosteroids and antivirals on severely affected patients with influenza virus infections.

The Effect of Aging Treatment on the High Temperature Fatigue Fracture Behavior of Friction Welded Domestic Heat Resisting Steels (SUH3-SUS 303) (마찰용접된 국산내열 강 (SUH3-SUS303 )의 시효열처리가 고온피로강도 및 파괴거동에 미치는 영향에 관한 연구)

  • Lee, Kyu-Yong;Oh, Sae-Kyoo
    • Journal of the Korean Society of Fisheries and Ocean Technology
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    • v.17 no.2
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    • pp.93-103
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    • 1981
  • It is well-known that nowadays heat resisting and anti-corrosive materials have been widely used as the components materials of gas turbines, nuclear power plants and engines etc. In the fields of machine production industry. And materials for engine components, like as the exhaust valve of internal combustion engine, have been required to operate under the high temperature range of $700^{\circ}C$-$800^{\circ}C$ and high pressured gas with repeated mechanical load for the high performance of engines. For these components, friction welding for bonding of dissimilar steels can be applied for in order to obtain process shortening, production cost reduction and excellent bonding quality. And age hardening recently has been noticed to the heat resisting materials for further strengthening of high temperature strength, especially high temperature fatigue strength. However, it is difficult to find out any report concerning the effects of age hardening for strengthening high temperature fatigue strength to the Friction welded heat resisting and anti-corrosive materials. In this study the experiment was carried out as the high temperature rotary bending fatigue testing under the condition of $700^{\circ}C$ high temperature to the friction welded domestic heat resisting steels, SUH3-SUS303, which were 10hr., 100hr. aging heat treated at $700^{\circ}C$ after solution treatment 1hr. at $1, 060^{\circ}C$ for the purpose of observing the effects of the high temperature fatigue strength and fatigue fracture behaviors as well as with various mechanical properties of welded joints. The results obtained are summarized as follows: 1) Through mechanical tests and micro-structural examinations, the determined optimum welding conditions, rotating speed 2420 rpm, heating pressure 8kg/mm super(2), upsetting pressure 22kg/mm super(2), the amount of total upset 7mm (heating time 3 sec and upsetting time 2 sec) were satisfied. 2) The solution treated material SUH 3, SUS 303, have the highest inclination gradient on S-N curve due to the high temperature fatigue testing for long time at $700^{\circ}C$. 3) The optimum aging time of friction welded SUH3-SUS 303, has been recognized near the 10hr. at $700^{\circ}C$ after the solution treatment of 1hr. at $1, 060^{\circ}C$. 4) The high temperature fatigue limits of aging treated materials were compared with those of raw material according to the extender of aging time, on 10hr. aging, fatigue limits were increased by SUH 3 75.4%, SUS 303 28.5%, friction welded joints SUH 3-SUS 303 44.2% and 100hr. aging the rates were 64.9%, 30.4% and 36.6% respectively. 5) The fatigue fractures occurred at the side of the base matal SUS303 of the friction welded joints SUH 3-SUS 303 and it is difficult to find out fractures at the friction welding interfaces. 6) The cracking mode of SUS 303, SUH 3-303 is intergranular in any case, but SUH 3 is fractured by transgranular cracking.

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Long-term Results of Gamma Knife Radiosurgery for Craniopharyngioma (두개인두종의 감마나이프 치료 후 장기 추적 결과)

  • Kim, Yun Sok;Lee, Do Heui;Ra, Dong Suk;Chun, Young Il;Ahn, Jae Sung;Jeon, Sang Ryong;Kim, Jeong Hoon;Roh, Sung Woo;Ra, Young Shin;Kim, Chang Jin;Kwon, Yang;Rhim, Seung Chul;Lee, Jung Kyo;Kwun, Byung Duk
    • Journal of Korean Neurosurgical Society
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    • v.30 no.sup2
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    • pp.289-293
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    • 2001
  • Objectives : The optimal treatment of craniopharyngioma is controversial. Despite recent advances in microsurgical management, complete surgical removal of craniopharyngioma remains very difficult. Radiation added to surgery is effective, but radiation therapy resulted in untoward side effect in young patient. Gamma knife radiosurgery offers the theoretical advantage of a reduced radiation dose to surrounding structures during the treatment of residual or recurrent craniopharyngioma compared with fractionated radiotheraphy. We described retrospective analysis of tumor size and clinical symptoms of patients after gamma knife radiosurgery in residual or recurrent craniopharyngioma were performed. Material and Methods : From September 1990 to January 2000, 18 patients of craniopharyngioma were treated by gamma knife radiosurgery. All patient had undergone surgery, but residual or recurrent tumor was found and all of them treated postoperative gamma knife radiosurgery. The mean age was 19(from 6 to 66) and male to female ratio was 10 to 8 and 8 patients were below 15 years old. In young age group(below age 15), the average volume of the tumor was $2904.8mm^3$ and mean maximal gamma knife dose was 34.9Gy. In old age group(older than 15), the average volume of the tumor was $2590.4mm^3$ and mean maximal gamma knife dose was 45.2Gy. The size of the tumor was average $2730.1mm^3$($88-12000mm^3$), mean average radiation dose was 40.7Gy and the mean prescription dose was 17.6 Gy(4-35Gy) delivered to a median prescription 50.7% isodose. Results : The follow up was from 1 year to 9 years(mean 59.1 months) after gamma knife radiosurgery. The tumor was controlled in 13(72.2%) patients. The tumor decreased in 9 patients and not changed in 4 patients. The tumor size increased in 4(22.2%) patients during follow up period. In two cases the tumor size increased because of its cystic portion was increased, but their solid portion of the tumor was not changed. In another two patients, the solid portion of the tumor was increased. So, one patient underwent reoperation and the other patient underwent operation and repeated gamma knife radiosurgery. The tumor recurred in one case(5.6%) that is a outside of irradiated site. The presenting symptoms were improved in 4 patients(improved visual acuity in 1, controlled increased intracranial presure sign in 3 patients). In one case, visual acuity decreased after gamma knife radiosurgery. The endocrine symptoms were not influenced by gamma knife radiosurgery. Conclusion : Craniopharyngioma can be treated successfully by gamma knife radiosurgery. Causes of the tumor regrowth are inadequate dose planning because of postoperatively poor margination of the tumor, close approximation of optic nerve and residual tumors outside the target lesion. Recurrence can develop 4 years after gamma knife radiosurgery. Volume is important, but the accurate targeting is more important to prevent tumor recurrence. If the tumor definition is not clear during planning gamma knife surgery, long-term image follow up is required.

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