PURPOSE: The present study aimed to evaluate progression and prognosis according to the palliation method used in neonates and early infants aged 3 months or younger who were diagnosed with pulmonary atresia with ventricular septal defect (PA VSD) or tetralogy of Fallot (TOF) with severe pulmonary stenosis (PS) in a single tertiary hospital over a period of 12 years. METHODS: Twenty with PA VSD and 9 with TOF and severe PS needed initial palliation. Reintervention after initial palliation, complete repair, and progress were reviewed retrospectively. RESULTS: Among 29 patients, 14 patients underwent right ventricle to pulmonary artery (RV-PA) connection, 11 palliative BT shunt, 2 central shunt, and 2 ductal stent insertion. Median age at the initial palliation was 13 days (1–98 days). Additional procedure for pulmonary blood flow was required in 5 patients; 4 additional BT shunt operations and 1 RV-PA connection. There were 2 early deaths among patients with RV-PA connection, one from RV failure and the other from severe infection. Finally, 25 patients (86%) had a complete repair. Median age of total correction was 12 months (range, 2–31 months). At last follow-up, 2 patients had required reintervention after total correction; 1 conduit replacement and 1 right ventricular outflow tract (RVOT) patch enlargements. CONCLUSION: For initial palliation of patients with PA VSD or TOF with severe PS, not only shunt operation but also RV-PA connection approach can provide an acceptable outcome. To select the most proper surgical strategy, we recommend thorough evaluation of cardiac anomalies such as RVOT and PA morphologies and consideration of the patient's condition.
Follow-Up Studies ; Heart Septal Defects, Ventricular* ; Heart Ventricles ; Humans ; Infant ; Infant, Newborn ; Methods ; Palliative Care ; Prognosis ; Pulmonary Artery ; Pulmonary Atresia* ; Pulmonary Valve Stenosis* ; Retrospective Studies ; Stents ; Tertiary Care Centers ; Tetralogy of Fallot*

Hyperactivation of phosphoinositol 3-kinase (PI3K) has been suggested to be a potential mechanism for endoplasmic reticulum (ER) stress-enhanced airway hyperresponsiveness, and PI3K inhibitors have been examined as asthma therapeutics. However, the regulatory mechanism linking PI3K to ER stress and related pathological signals in asthma have not been defined. To elucidate these pathogenic pathways, we investigated the influence of a selective PI3Kδ inhibitor, IC87114, on airway inflammation in an ovalbumin/lipopolysaccharide (OVA/LPS)-induced asthma model. In OVA/LPS-induced asthmatic mice, the activity of PI3K, downstream phosphorylation of AKT and activation of nuclear factor-κB (NF-κB) were all significantly elevated; these effects were reversed by IC87114. IC87114 treatment also reduced the OVA/LPS-induced ER stress response by enhancing the intra-ER oxidative folding status through suppression of protein disulfide isomerase activity, ER-associated reactive oxygen species (ROS) accumulation and NOX4 activity. Furthermore, inositol-requiring enzyme-1α (IRE1α)-dependent degradation (RIDD) of IRE1α was reduced by IC87114, resulting in a decreased release of proinflammatory cytokines from bronchial epithelial cells. These results suggest that PI3Kδ may induce severe airway inflammation and hyperresponsiveness by activating NF-κB signaling through ER-associated ROS and RIDD–RIG-I activation. The PI3Kδ inhibitor IC87114 is a potential therapeutic agent against neutrophil-dominant asthma.

We previously reported that the extract from cuttlebone (CB) has wound healing effect in burned lesion of rat. In present study, the main component of CB extract was analyzed and its wound healing activity was evaluated by using in vitro acute inflammation model. The extract of CB stimulated macrophages to increase the production of TNF-alpha. The extract also enhanced the production of TGF-beta and VEGF, which were involved in angiogenesis and fibroblast activation. The treatment with CB extract enhanced proliferation of murine fibroblast. CB extract also induced the activation of fibroblast to increase the secretion of matrix metalloproteases 1 (MMP1). The constituent of CB extract which has wound healing activity was identified as chitin by HPLC analysis. The mechanism that the CB extract helps to promote healing of burned lesion is associated with that chitin in CB extracts stimulated wound skins to induce acute inflammation and to promoted cell proliferation and MMP expression in fibroblast. Our results suggest that CB or chitin can be a new candidate material for the treatment of skin wound such as ulcer and burn.
Animals ; Burns ; Cell Proliferation ; Chitin* ; Chromatography, High Pressure Liquid ; Fibroblasts ; Inflammation* ; Macrophages ; Metalloproteases ; Rats ; Skin ; Transforming Growth Factor beta ; Tumor Necrosis Factor-alpha ; Ulcer ; Vascular Endothelial Growth Factor A ; Wound Healing ; Wounds and Injuries

Elderly people comprise an increasing proportion of the population, and nutritional impairments may contribute to health problems among this group. This study was conducted to evaluate the nutritional status by Mini-Nutritional Assessment (MNA) and to identify relationships among anthropometric measurements, biochemical indicators, bone Mineral Density (BMD) and MNA results among older adults (> or =65 yrs, n=98, 66.7+/-2.5 yrs; M=52, F=46, BMI 24.5+/-2.8 kg/m2) at a Health Care Center. A dietitian administered MNA and collected anthropometric measurements (weight, height, waist circumference), biochemical indicators (albumin, hemoglobin, hematocrit, TLC, glucose, lipids) and the BMD (spine, femur, F=46). Subjects were grouped into a normal nutrition group (0~2 risk factors of malnutrition) and a high risk of malnutrition group (>=3 risk factors of malnutrition) based on their risk factor status for malnutrition. The risk factors for malnutrition include age > or =65 years, PIBW <90%, albumin <3.5 g/dl, TLC <1,500%, Hgb <14 g/dl (men), Hgb <10 g/dl (women), loss of appetite and weight loss 1~3 kg/last 3 months. In addition, subjects were grouped into a normal, osteopenia and osteoporosis group by BMD. We found that 12% of the subjects were at risk of malnutrition (MNA score, 21.4+/-2.1) and that 88% were well nourished (27.3+/-1.5) according to the MNA. Full-MNA scores were positively and significantly (p<0.05) associated with BMI, mid-arm circumference (MAC), calf circumference (CC), albumin and hemoglobin, respectively. The full-MNA score of the high risk of malnutrition group (23.0+/-3.8) was lower than that of the normal nutrition group (27.0+/-2.1) (p<0.05). In addition, the Full-MNA score was negatively associated with the risk factor of malnutrition (r=-0.35, p=0.0004). We found that 39.1% of the subjects had osteoporosis, 45.7% had osteopenia and 15.2% were normal according to their BMD. The MNA score of osteoporosis group (24.58+/-3.3) was lower than that of the normal (27.4+/-1.1) and osteopenia group (26.9+/-1.5) (p<0.05). These results suggested that MNA can be useful as a nutritional screening tool of older adults in Health Care Centers.
Adult ; Aged ; Appetite ; Bone Density ; Bone Diseases, Metabolic ; Delivery of Health Care ; Femur ; Glucose ; Hematocrit ; Hemoglobins ; Humans ; Malnutrition ; Mass Screening ; Nutrition Assessment ; Nutritional Status ; Osteoporosis ; Risk Factors ; Weight Loss

PURPOSE: The purpose of this study was to provide fundamental materials for improving school health promotion programs by investigating school nurses' awareness of the importance, performance level, and perceived competence level of school health promotion programs in Gangwon-do. METHODS: The subjects of this study were 173 school nurses who were working in Gangwon-do. The instrument for this study was a scale for awareness of importance, performance level, and perceived competence level. Data were collected on December 15, 2007 and analyzed using SPSS 13.0 for Windows. RESULTS: The mean score of awareness of importance was 3.51 (range: 1~4). The mean score of performance level and the mean score of perceived competence level were 3.35 (range: 1~4) and 3.29 (range: 1~4), respectively. The younger school nurses were (F=4.380, p=.014), the higher their awareness of importance was. The performance level was lowest in high school nurses (F=5.013, p=.008). There were significant correlations between awareness of importance, performance level, and perceived competence level in school nurses. CONCLUSION: In order to improve the effectiveness of school health promotion programs, training and education programs for school nurses' competencies and technical support systems for school nurses should be provided.
Education ; Gangwon-do ; Health Promotion ; Humans ; Mental Competency* ; School Health Services*

Metastatic tumor to ovary are uncommon, but there is a situation in which a metastatic adenocarcinoma to ovary appears as a large mass and resembles a primary tumor: a Krukenberg tumor of ovary which has a signet ring histologic pattern and usually is metastatic principally from a gastrointestinal tract cancer. We have an experience of one case of metastatic Krukenberg tumor from stomach and report the case with brief review of literature.
Adenocarcinoma ; Female ; Gastrointestinal Neoplasms ; Krukenberg Tumor* ; Ovary ; Stomach

This study was performed to investigate the preference and consumption pattern on milk and milk products of middle and high school students. The subjects were 1,195 students(590 middle school and 605 high school students) living in Geochang area. The survey was conducted by using a self-administered questionnaire in November, 2004. The results were as follows. Sixty-three point four percent of the subjects liked milk, and the main reason was 'accelerate growth and development'(55.4%). Preferred tastes of milk were 'savory taste'(35.4%) and 'sweet taste' (29.9%). Banana milk, chocolate milk, strawberry milk, ice cream, yoplait and yogurt were highly preferred. General preference for different kinds of milk was significantly higher in high school students and male students than in middle school students and female ones. With regard to preference for dairy products, cream (p<0.01) and butter(p<0.05) was preferred more by male students than by female ones, ice cream(p<0.05), yoplait (p<0.05) more by female students than male ones. The score of milk intake frequency was 3.84(3~4 times a week) out of 5 points(7 times a week) for white milk, and that of chocolate milk was 1.98, banana milk 1.96, strawberry milk 1.72, coffee milk 1.65, showing that these products were drank less then once a week. In addition, the white milk intake frequency was significantly higher in middle school students and male students than in high school students and female students(p<0.001). Preference for milk showed a positive correlation with preference for dairy products (r=0.543, P<0.001) and frequency of milk intake(r=0.429, P<0.001). This suggests that those who prefer milk high tend to prefer dairy products and to show high milk intake frequency. In addition, milk intake frequency was in a high positive correlation with dairy product intake frequency(r=0.648, P<0.001).
Cacao ; Coffee ; Dairy Products ; Female ; Fragaria ; Humans ; Ice ; Ice Cream ; Male ; Milk* ; Musa ; Surveys and Questionnaires ; Yogurt

BACKGROUND: The participation of children in clinical research requires parental permission. We designed this study to evaluate the extent to which the risk associated with a clinical study affects the parents' decision to provide permission. Simultaneously, we evaluated factors which led parents to allow or decline their child's participation in such clinical studies. METHODS: We interviewed 82 parents of children of ASA class I-II scheduled to receive general anesthesia for elective surgery. Parents were presented with either of two sham protocols: no risk (Control, n = 44), or pain (Pain, n = 38) and asked to complete a questionnaire detailing the reasons for their decision. RESULTS: There were no differences in the demographics of the two groups. Whereas comprehension of the doctor's explanation was similar in both groups, consenting rates were higher in the control group (54.5% versus 28.7%; P <0.01). The importance of the study was the primary factor in the parents' decision to consent, and the child's safety was the main concern for parents that declined. Only 4.2% of the control group and 3.7% of the risk group reported having felt pressured to consent. CONCLUSIONS: Results of this study show that the contents of study itself is an important factor that influences a parent's decision to consent to a child's participation in clinical studies. Therefore it is important that researchers produce an adequate protocol and a reasonable explanation for obtaining consent, to reduce the potential for selection bias, and to ensure that the legal and ethical rights of patients are protected.
Anesthesia, General ; Child* ; Comprehension ; Demography ; Human Rights ; Humans ; Informed Consent ; Parents ; Surveys and Questionnaires ; Selection Bias

OBJECTIVE: The purpose of this study was to evaluate the effectiveness and limitations of the Risk of Malignancy Index (RMI) for discriminating malignant from benign adnexal masses. METHODS: This study was based on 382 women who have visited Korea University Hospital for surgical exploration of adnexal masses between July 2000 and December 2003. RMI was based on menopausal status, serum CA 125 levels, and ultrasound feature. A cutoff level of 200 was chosen as the threshold for discriminating malignant from benign adnexal masses. This setup was evaluated by sensitivity, specificity, positive predictive (PPV) and negative predictive values (NPV) with respect to the ability to distinguish malignant from benign adnexal masses. RESULTS: The sensitivity was 57.1%, specificity 93.3%, PPV 74.7% and NPV 86.3%. If stage I disease is considered "benign", the sensitivity was 95.1%, specificity 89.3%, PPV 52.7%, and NPV 99.3%. The statistical significance of RMI over other factors was proven. However, it had limitations of high false negative rate (68.4%) in stage 1 ovarian malignancy including borderline malignancy. Moreover, its relationship with RMI1, RMI2, and RMI3 had no statistical significance. CONCLUSION: RMI is a simple, easily applicable method for the primary evaluation of patients with adnexal masses and an effective method to selectively refer to an oncological unit for further management due to its relatively high specificity observed from this study. However this method has significant limitations in stage I ovarian malignancy including borderline malignancy. Other methods should be evaluated to increase the diagnostic accuracy.
Female ; Humans ; Korea ; Sensitivity and Specificity ; Ultrasonography

OBJECTIVE: The goal of this clinical study was to evaluate clinical and pathological findings, surgical procedures, and postoperative treatment in women with ovarian granulosa cell tumor. METHODS: A clinical study was made on 28 cases of ovarian granulosa cell tumor that were treated at the department of Obstetrics and Gynecology in Korea University Hospital between January 1978 and December 2002. Data for 28 women with granulosa cell tumor were collected retrospectively. Follow-up data were collected from the hospital records or telephone survey. Fisher's exact test and Kaplan-Meier survival analysis were applied, as appropriate. RESULTS: The mean age of patients was 49 years (range, 28 to 71 years). The most common present symptom was vaginal bleeding (11/28, 39.3%). 82.6% of patients were with FIGO stage I, 3.6% with stage II, 7.1% with stage III, and none with stage IV. Follow-up time was 62 months (5-128 months). The five year disease free survival rate was 90.4% and 10 year disease free survival rate was 86.5%. Significant prognostic factors were FIGO stage and the rupture of tumor. CONCLUSION: Even though granulosa cell tumor usually has good prognosis, it is a tumor of unquestionable malignant potential and has a tendency for late relapse. Long term follow-up is recommended. Multicenter prospective randomized studies are needed to identify the more rational treatment strategies of these rare malignant tumors.
Disease-Free Survival ; Female ; Follow-Up Studies ; Granulosa Cell Tumor* ; Granulosa Cells* ; Gynecology ; Hospital Records ; Humans ; Korea ; Obstetrics ; Ovary ; Prognosis ; Recurrence ; Retrospective Studies ; Rupture ; Telephone ; Uterine Hemorrhage