PURPOSE:Insulin-like growth factor-I(IGF-I) is an essential anabolic factor for postnatal rat brain development and IGF-I expression is highly abundant during the first 21 days, critical growth period. Hypoxic-ischemic brain insults occurring during the perinatal period result in neuronal necrosis and permanent brain damage. To investigate the regulation of the action of IGF-I in response to such a hypoxic insult, we examined the gene expression of IGF-I and IGFBP-5 during the first 72 hr after hypoxic-ischemic injury in immature rat brain. METHODS:Ligation of the right carotid artery of 7-day-old rats was followed by 2 hour exposure to 8% oxygen to produce severe hypoxic brain damage. Using reverse transcriptase-polymerase chain reaction(RT-PCR), the expression of IGF-I mRNA and IGFBP-5 mRNA was determined in both hypoxic and control brains at post 1, 4, 12, 24, 48 hr and 72 hr after hypoxic-ischemic insult. RESULTS:The IGF-I mRNA and IGFBP-5 mRNA expression of hypoxic brain were not different from those of controls at 1 hr of recovery but IGF-I mRNA expression was decreased rapidly at post 4 hr, this decrease more pronounced at 12 hr of recovery. IGF-I mRNA and IGFBP-5 mRNA expression were increased at 48 hr and 24 hr of recovery, respectively and both IGF-I mRNA and IGFBP-5 mRNA expression showed similar level of controls at 72 hr of recovery. CONCLUSION: Out findings suggest that IGF-I play a important role in both neuronal loss and repair process following hypoxic-ischemic brain injury and IGFBP-5 is also strongly involved in the repair of damaged brain tissue by mediating IGF-I action. (J Korean Soc Pediatr Endocrinol 2003;8:56-63)
Animals ; Brain Injuries* ; Brain* ; Carotid Arteries ; Gene Expression ; Hypoxia, Brain ; Insulin-Like Growth Factor Binding Protein 5 ; Insulin-Like Growth Factor I ; Necrosis ; Negotiating ; Neurons ; Oxygen ; Rats* ; RNA, Messenger*

The hypervariable short tandem repeat (STR) locus D12S391 was investigated in a Korean population. A total of 14 alleles were detected by size under denaturing conditions in 517 unrelated individuals. To confirm all of the alleles detected in a Korean population, a total of 34 fragments were sequenced. Prior to allele designation, we constructed the allelic ladders containing 11 alleles sequenced in this study. Allele 18 is the most common with a frequency of 0.281 in Koreans, and one variant allele 19.3 which have been confirmed by sequencing, was detected. The observed heterozygosity, the power of discrimination (PD), and the mean exclusion chance (MEC) for the locus D12S391 is 0.781, 0.946 and 0.652, respectively. No deviation from Hardy-Weinberg equilibrium was observed in a Korean population (p=0.557). In the 424 meioses in 105 Korean families confirmed using other 17 STR loci, no mutation was detected in locus D12S391. The STR locus D12S391system is useful both for the analysis identification and parternity.
Alleles ; Discrimination (Psychology) ; Gene Frequency ; Genetics, Population* ; Humans ; Meiosis ; Microsatellite Repeats ; Sequence Analysis

BACKGROUND: Biologic disease-modifying antirheumatic drugs (bDMARDs) extend the treatment choices for rheumatoid arthritis patients with insufficient response or intolerance to conventional DMARDs (cDMARDs). These agents have considerable efficacy compared with conventional DMARDs, but only a few head-to-head comparisons among these agents have been performed. The objective of this systematic review and network meta-analysis (NMA) was to compare the relative efficacy of Certolizumab with conventional DMARD to licensed bDMARD with cDMARD therapy for patients who failed to prior cDMARD treatment under the condition of the reimbursement coverage criteria in Korea. METHODS: A systematic review was conducted using MEDLINE and Cochrane library. Key endpoints were the American College of Rheumatology (ACR) responses of 20/50/70 at six months. Bayesian outcomes were calculated as median of treatment effect, probability of the best, Odds Ratio (OR) and probability that OR was greater than one. RESULTS: Compared with other bDMARDs, Certolizumab were associated with higher or comparable ACR response rates; in ACR20, the OR (probability of OR>1) was 2.08 (92.6%) for Adalimumab, 1.86 (85.7%) for Etanercept, 1.89 (79.5%) for Golimumab, 2.36 (92.1%) for Infliximab, 1.79 (87.0%) for Abatacept, 1.74 (80.8%) for Rituximab and 1.82 (86.8%) for Tocilizaumab. In ACR50 and ACR70, the ORs did not present significant differences. CONCLUSION: Certolizaumab with cDMARD was more effective or comparable than other bDMARDs in patients who failed prior cDMARD treatment.
Antirheumatic Agents* ; Arthritis, Rheumatoid* ; Humans ; Korea ; Odds Ratio ; Rheumatology ; Abatacept ; Adalimumab ; Infliximab ; Rituximab ; Etanercept

BACKGROUND: There is little research regarding whether working as a physician affects cancer risk. Moreover, there is no research on cancer prevalence among physicians in Korea. This study utilized the Korea National Cancer Incidence Database to determine whether the prevalence of cancer among physicians differs from the prevalence of cancer within the general population. METHODS: We analyzed the medical records of a representative sample of 382 doctors who underwent a health examination between 2010 and 2013 at a health examination center in a Ewha Womans University Medical Center.Cancer incidence was measured as cases that were eventually diagnosed as cancer according to a biopsy. RESULTS: We collected medical records from 382 physicians (mean age, 51.9±8.1 years) and calculated the standardized prevalence ratios compared to the general population. Thirty physicians (9 male and 21 female) were identified as having cancer. Physicians had a significantly higher prevalence of cancer compared to the general population.Cancer prevalence in male physicians was found to be 2.47 times higher than the prevalence expected within the general population (P=0.006). Among female physicians, cancer prevalence was 3.94 times higher than that in the general population (P<0.001). CONCLUSION: This study revealed that physicians had a higher prevalence of cancer compared to the general population in Korea, which suggests that there may be a problem present in the health care of physicians. Changes to the working environment of physicians will be needed to reduce the high prevalence of cancer among physicians.
Biopsy ; Delivery of Health Care ; Female ; Humans ; Incidence ; Korea* ; Male ; Medical Records ; Prevalence*

PURPOSE: Febrile seizure, the most common type of pediatric convulsive disorder, is a benign seizure syndrome distinct from epilepsy. However, as epilepsy is also common during childhood, we aimed to identify the prognostic factors that can predict epilepsy in children with febrile seizures METHODS: The study comprised 249 children at the Korea University Ansan Hospital who presented with febrile seizures. The relationship between the subsequent occurrence of epilepsy and clinical factors including seizure and fever-related variables were analyzed by multivariate analysis. RESULTS: Twenty-five patients (10.0%) had additional afebrile seizures later and were diagnosed with epilepsy. The subsequent occurrence of epilepsy in patients with a history of febrile seizures was associated with a seizure frequency of more than 10 times during the first 2 years after seizure onset (P<0.001). Factors that were associated with subsequent occurrence of epilepsy were developmental delay (P<0.001), preterm birth (P=0.001), multiple seizures during a febrile seizure attack (P=0.005), and epileptiform discharges on electroencephalography (EEG) (P=0.008). Other factors such as the age at onset of first seizure, seizure duration, and family history of epilepsy were not associated with subsequent occurrence of epilepsy in this study. CONCLUSION: Febrile seizures are common and mostly benign. However, careful observation is needed, particularly for prediction of subsequent epileptic episodes in patients with frequent febrile seizures with known risk factors, such as developmental delay, history of preterm birth, several attacks during a febrile episode, and epileptiform discharges on EEG.
Child* ; Electroencephalography ; Epilepsy* ; Gyeonggi-do ; Humans ; Korea ; Multivariate Analysis ; Premature Birth ; Risk Factors ; Seizures ; Seizures, Febrile*

PURPOSE: The purpose of this study is to investigate the trends and traits of moral sensitivity and reasoning over six years of medical school. METHODS: The participants in this study consisted of 217 first to sixth-year medical students of Sungkyunkwan University School of Medicine in Korea. Essay type questionnaire was used for evaluating moral sensitivity and the Korean-Defining Issues Test (KDIT) was used for evaluating moral reasoning. RESULTS: It was found that the medical students' sensitivity of 'public welfare', 'prospective result' and 'role-taking as a doctor' was significantly higher than that of the pre-medical students'. Moral sensitivity increased in the 3rd and the 4th years but decreased in the 5th and the 6th years. Moral reasoning decreased in the 3rd and the 4th years but increased in the 5th and the 6th years. No correlation was observed between moral sensitivity and reasoning(r=0.033). Developmental trends of moral sensitivity and reasoning showed a significant difference in terms of year of medical school. CONCLUSION: The results suggest that medical school curriculum tends to impct students' moral sensitivity. This school has implemented the problem-based learning curriculum into the 3rd and the 4th years. It is necessary to consider the developmental state of the student's morality when developing an effective medical ethics program.
Curriculum ; Ethics, Medical ; Humans ; Korea ; Morals ; Problem-Based Learning ; Schools, Medical ; Students, Medical* ; Surveys and Questionnaires

BACKGROUND: Liver cirrhosis causes substantial socio-economic burden and is one of the major severe liver diseases in Korea. Nonetheless, there is only a few studies that analyzes disease burden of liver cirrhosis in Korea. Such study must be carried out due to its increasing need from the invention of new drugs for chronic hepatitis and demand for cost-effectiveness analyses. METHODS: Patient sample data with ensured representativeness was analyzed retrospectively to compare the medical costs and uses for patients with compensated cirrhosis and decompensated cirrhosis. Patient claims data that include K74 and K703 from the year of 2014 were selected. Within the selected data, decompensated cirrhosis patient was identified if complications such as ascites (R18), encephalopathy (B190), hepatic failure (K72), peritonitis (K65), or esophageal varices (I85) were included, and they were compared to compensated cirrhosis patients. RESULTS: 6,565 patients were included in the analysis. The average cost per patient was 6,471,020 (SD 8,848,899) KRW and 2,173,203 (4,220,942) KRW for decompensated cirrhosis and compensated cirrhosis, respectively. For inpatients, the average hospitalized days was 38.0 (56.4) days and 27.2 (57.2) days for decompensated cirrhosis and compensated cirrhosis, respectively. For outpatients, the average number of visits was 8.7 (9.1) days and 5.3 (7.5) days for compensated cirrhosis and decompensated cirrhosis, respectively. CONCLUSION: Compared to compensated cirrhosis patients, decompensated cirrhosis patients had higher costs, especially for hospitalization, injection, examination, and drugs administrated within medical institutions.
Ascites ; Brain Diseases ; Esophageal and Gastric Varices ; Fibrosis ; Hepatitis, Chronic ; Hospitalization ; Humans ; Inpatients ; Inventions ; Korea ; Liver Cirrhosis* ; Liver Diseases ; Liver Failure ; Liver* ; Outpatients ; Peritonitis ; Retrospective Studies

PURPOSE: Infiltrating lobular carcinomas (ILC) represent 5-10% of all breast cancers. Compared to infiltrating ductal carcinomas (IDC), ILC has a trend to be a more indistinct and multicentric form of cancer, thus, they are detected later and are less frequently treated using breast conserving surgery. The objective of this study was to determine the difference between ILC and IDC and the utility of using breast conserving surgery for ILC. METHODS: We studied 26 ILC and 319 IDC patients surgically treated at the Department of Surgery, Samsung Medical Center. Age, size of tumor, mammographic findings, operative method and pathologic findings were analysed retrospectively. For the microvessel count, tumor sections were immunohistochemically stained using CD31 monoclonal antibody, and microvessels were counted at 200 magnification in three separate fields selected from areas of highest vascularity. RESULTS: There were no differences between patients with ILC and IDC with respect to the mean age (45.4 and 47), the mean size of the tumors (2.59 cm and 2.63 cm), the malignant findings on mammography (13/15 (86.6%) and 203/237 (85.7%)(p=0.636)), and the number of breast conservaing surgeries (10/26 (38.5%) and 103/311 (33.1%)(p=0.361)). Axillary nodal metastasis was slightly more common in patients with ILC (15/25, 60%) than in those with IDC (141/284, 9.6%)(p=0.217) but there was no difference in TNM staging. More frequent estrogen receptor expression and less frequent P53 mutations were found in ILC than in IDC. Unlike IDC, there was no association between tumor microvessel density and pathologic stagings in ILC. CONCLUSION: ILC was found in patients of similar age, and the size was not different from that of IDC. The mammographic accuracy in diagnosing malignancy was about the same in ILCas in IDC. Breast conserving surgery can be performed in ILC patients at the same rate as in IDC patients. Microvessel density was not a prognostic factor in ILC patients.
Breast* ; Carcinoma, Ductal* ; Carcinoma, Lobular* ; Estrogens ; Humans ; Mammography ; Mastectomy, Segmental ; Microvessels ; Neoplasm Metastasis ; Neoplasm Staging ; Retrospective Studies

PURPOSE: Neutrophils found around an infarcted area in the brain was once considered as only the physiologic response following the brain injury, but recent studies have shown that inflammatory responses by neutrophils play an important role in the reperfusion injury. The presence of polymorphonuclear leukocytes(PML) is proven by biochemical assay of myeloperoxidase(MPO) secreted in the cytoplasmic granules. We observed the process of PML infiltration on hypoxic-ischemic brain injury of immature rats by the assay of MPO activity and changes of the MPO activity after the administration of fucoidin, inhibitor of P- and L-selectin. METHODS: We used a well characterized model of the brains of 7 day-old-rats, which had unilateral hypoxic and ischemic injuries(HI). Those injuries were induced by unilateral carotid artery ligation followed by timed exposure to hypoxic inspiratory gas mixture(8% O2). MPO activity was measured in the brain tissue homogenates of HI rats(n=18) at 0, 2, 8, 24 and 48 hrs and in rats that received fucoidin immediately before and again after hypoxia(50 mg/kg, n=6) at 8 and 24 hrs. Controls(n=2) were rats with neither hypoxia nor ischemia. The brain samples were homogenized in 20 mM potassium phosphate buffer(pH 7.4) for 50 secs. The homogenate was centrifuged at 14,000 g at 4degrees C for 15 mins and the supernatant was discarded. The tissue was pulverized, weighed, and suspended in 1 mL of 50 mM potassium phosphate buffer solution(pH 6.0) containing 0.5% cetylditrimethylammonium bromide(wt/vol). The tissue was sonicated and centrifuged at 10,000 g for 15 mins. 200 micro L of the supernatant was mixed with 1 mL of 50 mM potassium phosphate buffer solution(pH 6.0) containing 10 micro L of 1.325 mM o-dianisidine hydrochloride and 170 micro L of 3% hydrogen peroxide(vol/vol). Changes in absorbance at 460 nm were measured for 5 mins by using microplate reader. One unit of MPO activity was defined as that degrading 1 micro mol peroxide/min at 25degrees C, and the result was expressed as units of MPO/100 mg tissue. RESULTS: In HI rats, MPO activity increased at 2 hrs after HI and peaked at 24 hrs in the right hemisphere. In rats with fucoidin treatment immediately before and again after hypoxia, the MPO activity significantly decreased in both hemispheres compared with HI rats(P<0.05). MPO activity in the tissue of control rats was insignificant. CONCLUSION: The dynamic changes of the MPO activity suggest the important role of PMN on hypoxic-ischemic brain injuries in immature rats. MPO activity could be used as an index of the severity of injuries of hypoxic-ischemic brains.
Animals ; Anoxia ; Brain Injuries* ; Brain Ischemia ; Brain* ; Carotid Arteries ; Cerebral Infarction ; Cytoplasmic Granules ; Dianisidine ; Humans ; Hydrogen ; Infant, Newborn ; Ischemia ; L-Selectin ; Ligation ; Neutrophils ; Peroxidase* ; Potassium ; Rats* ; Reperfusion Injury

CT and MR appearance of the brain in three children with ornithine transcarbamylase (OTC) deficiency are described. They showed clinical signs of vomiting and convulsion and were diagnosed by measurement of plasma ammonium, amino acids, acid-base balance, and urinary orotic acid levels. CT and MR were performed within one month from the onset of the symptom. CT and MRI demonstrated brain swelling with small ventricles and diffuse low density of white matter, which indicated cerebral hypoperfusion secondary to elevated intracranial pressure. With more prolonged survival hyperammonemia may cause cerebral atrophy. CT and MR appearance in these cases resembled a hypoxic brain damage and this finding should be included in the differential diagnosis.
Acid-Base Equilibrium ; Amino Acids ; Ammonium Compounds ; Atrophy ; Brain ; Brain Edema ; Child ; Diagnosis, Differential ; Humans ; Hyperammonemia* ; Hypoxia, Brain ; Intracranial Hypertension ; Magnetic Resonance Imaging* ; Ornithine Carbamoyltransferase Deficiency Disease* ; Ornithine Carbamoyltransferase* ; Ornithine* ; Orotic Acid ; Plasma ; Seizures ; Vomiting