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OBJECTIVE: Codeine may result in death or respiratory depression in children, particularly who are rapid metabolizer of CYP2D6, therefore it should be used cautiously among children under 12 years of age. This study was to investigate the prescribing pattern of codeine among children according to the age group, prescribed diagnosis, type of medical service and medical specialties. METHOD: We used Korea Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) database. Study subjects included inpatients or outpatients, who were prescribed codeine between January, 1, 2011 and December, 31, 2011. Contraindicated use of codeine was defined as the use of codeine at least one times under aged 12. Age groups were sub-classified according to the <2 years, 2-4 years, 5-8 years, and 9-11 years. Frequently prescribed diagnosis (ICD-10), type of medical service, and medical specialties were also described among codeine users under aged 12. RESULTS: Codeine users were 6,411 inpatients (9,958 prescriptions), and 3,397 outpatients (6,258 prescriptions), respectively. Codeine prescription under 12 years of age were 2.1% (210 prescriptions) among inpatients, and 12.3% (776 prescriptions) among outpatients (p-value<0.05). Outpatient prescriptions of codeine under 12 aged were issued mostly from primary care clinics and frequent diagnosis were unspecified bronchopneumonia (51.6%), and vasomotor rhinitis (23.7%). CONCLUSION: This study found prescribing of codeine under 12 aged is common in outpatient and primary clinics. Nationwide and community-based efforts should be needed to reduce inappropriate prescribing among children.
Bronchopneumonia ; Child* ; Codeine* ; Cytochrome P-450 CYP2D6 ; Diagnosis ; Drug Utilization Review ; Humans ; Inappropriate Prescribing ; Inpatients ; Insurance, Health ; Korea* ; Outpatients ; Prescriptions ; Primary Health Care ; Respiratory Insufficiency ; Rhinitis, Vasomotor

BACKGROUND: Cytokine-mediated ex vivo expansion has been proposed as a means of increasing the number of cord blood (CB) hematopoietic stem cells for transplantation. As well as stem cell number, stromal cells are necessary for functional maturation of hematopoiesis. The purpose of this study was to analyze the development of stromal cells during ex vivo expansion of CB CD34+ cells. METHODS: CD34+ cells were purified from CB by magnetic bead selection. The levels of of interleukin-3, interleukin-1 beta, interleukin-6, granulocyte macrophage-colony stimulating factor and tumor necrosis factor-alpha were measured in culture supernatants on 0, 1, 2, and 3 weeks, using ELISA techniques. CB CD34+ cells were expanded in Iscoves modified Dulbeccos medium in the presence of several cytokines. The expression of E-selectin, vascular cell adhesion molecule- 1, intercellular adhesion molecule- 1, platelet/endothelial cell adhesion molecule-1, von Willebrand factor, vimentin, and CD14 in newly developed stromal cells was examined by immunocytochemical method. Relevant extracellular matrix (ECM) proteins and proper cytokines were also assayed for the most suitable condition for expansion of stromal cells. RESULTS: Several cytokines were found to have been produced by CB CD34+ cells as well as bone marrow-derived CD34+ cells. During ex vivo expansion of CB CD34+ cells, stromal cells appeared in the culture by day 4 and expanded over the following 7- 10 days before being confluent by day 2 1. These cells expressed surface markers characteristic of cells of endothelial lineage. Furthermore, these stroaml cells also expanded effectively when treated with thrombopoietin+flt-3 ligand+stem cell factor+leukemia inhibitory factor or 0. 1% poly-L-lysine-coated wells. CONCLUSION: Stromal cells were developed during ex vivo expansion of CB CD34+ cells and that this development could be enhanced further by treating the stromal cells with cytokines or ECM.
Cell Adhesion ; Cytokines ; E-Selectin ; Enzyme-Linked Immunosorbent Assay ; Extracellular Matrix ; Fetal Blood* ; Granulocytes ; Hematopoiesis ; Hematopoietic Stem Cells ; Interleukin-1beta ; Interleukin-3 ; Interleukin-6 ; Stem Cells ; Stromal Cells* ; Tumor Necrosis Factor-alpha ; Vimentin ; von Willebrand Factor

OBJECTIVE: Anxiolytics and antidepressants are commonly used to treat depressive disorders in pregnant women. Specific and clear evidence is required when managing pregnant patients with such medications to ensure safety. However, information provided by approval label information is insufficient and often different among many countries. By analyzing label information of approval label and other references, this study aims to show the limitations and suggest appropriate directions for retrieving safety information. METHODS: We selected five anxiolytics and eleven antidepressants, which belongs to Korea drug classification codes 117 (psychotropic agents). We chose four countries, Korea, the United States of America (USA), the United Kingdom, Japan and collected safety information for pregnant women in label information. We evaluated the safety information based on recommendation level and evidence level. Then, kappa value and overall agreement were calculated using SAS 9.3. to assess data homogeneity. We further searched Reprotox and a textbook about contraindicated drugs in label information. RESULTS: Recommendation level and evidence level was different in each country. The number of commonly contraindicated drug in label information of four countries was none, and contraindicated drugs in labels were different respectively. Kappa value of evidence level between label information of Korea and Japan, the USA and Japan was 0.61, 0.43 respectively, corresponding to 'substantial agreement' and 'moderate agreement'. The overall agreement was 75%, 62.5% respectively. The information of label was different from that of other references, Reprotox and a textbook in terms of the clinical evidences and recommendation levels. CONCLUSION: Safety information of anxiolytics and antidepressants in label information needs to be updated on a regular basis both for health professionals and patients. With the implication of the inconsistent guidance for the safety information in pregnant women, reliable safety information in pregnant women would be needed.
Americas ; Anti-Anxiety Agents* ; Antidepressive Agents* ; Classification ; Depressive Disorder ; Female ; Great Britain ; Health Occupations ; Humans ; Japan* ; Korea* ; Pregnancy ; Pregnant Women* ; United States

Thirty consecutive patient seen in a pediatric out patient and emergency department, in whom the diagnosis of intussusception was considered, had an ultrasound examination of the abdomen before the barium enema. The peak age was 5~12 month (range 4~34 month). Intussusception was detected by ultrasonography in all 25 cases proved by barium enema (sensitivity 100%). Normal findings on ultrasonography correlated with a negative barium enema results in 5 of 5 cases (negative predictive value=100%). No intussusception was missed by ultrasonography. To determine which patient would most benefit from ultrasonography, we divided patients into either a high risk group (100% intussusception) or a low risk group (37.5% intussusception) on the basis of clinical symptoms. We conclude that ultrasonography can be used as a rapid sensitive screening procedure in the diagnosis or exclusion of childhood intussusception. Probability of surgical reduction was associated with size of of total thickness and external rim thickness.
Abdomen ; Barium ; Child* ; Diagnosis* ; Emergency Service, Hospital ; Enema ; Humans ; Infant* ; Intussusception* ; Mass Screening ; Ultrasonography*

Much has been learned of the pathogenesis and pathophysiology of the toxic shock syndrome (TSS) since the initial description in 1978 by Dr. James K, Todd. The clinical illness is defined by the criteria listed in the case definition formulated for epidemiologic studies. With the advent of widespread recognition of TSS, there have been numerous published reports describing the clinical and laboratory findings, primarily in menstruating females. And there have been also reported about six cases in Korea. Moreover, TSS is uncommon in the prepubertal age group and no case report in infant in Korea. We experienced two cases of TSS in infants aged 11/2 yrs and 9 months associated with respiratory infection-pneumonia, pyopneumothorax and localized skin abscess that were confused with Kawasaki disease (KD). The diagnosis was made on the basis of clinical features and laboratory findings, and the cases met the Centers of Disease Control case definition of TSS. And thus we report these cases and review related literatures.
Abscess ; Diagnosis ; Female ; Humans ; Infant* ; Korea ; Mucocutaneous Lymph Node Syndrome ; Shock, Septic* ; Skin

OBJECTIVES: This study evaluated the effectiveness of school-based mental health screening and treatment linkage programs, focusing on attention-deficit hyperactivity disorder (ADHD) and adolescent depression. METHODS: All 11,158 children and adolescents aged 8-14 years in Seoul received a school-based mental health screening, consisting of the Korean versions of the ADHD rating scale and the Child Behavior Checklist (CBCL), for ADHD, and the Center for Epidemiological Studies Depression Scale (CES-DS) and the Suicidal Ideation Questionnaire-Junior (SIQ-JR), for depression. The high-risk children's and adolescents' diagnoses were confirmed using the Diagnostic Interview Schedule for Children-IV (DISC-IV). Treatment linkage programs were managed by the Seoul Metropolitan Community Mental Health Center (Program 1), the Seoul Metropolitan Office of Education (Program 2), or the Dongjak District Office of Education (Program 3). We estimated and compared the referral rates of the three programs. RESULTS: Program 1 screened and referred 22.9% of ADHD youths to mental health services, Program 2, 68.8%, and Program 3, 40.0%. Program 1 screened and referred 22.8% of depressed youths to mental health services, Program 2, 53.8%, and Program 3, 88.9%. Key elements for successful screening and referral programs were an effective school/community mental health center/Office of Education network, the parents' financial support and perception of their child's mental health status as being problematic, and the teachers' active engagement. CONCLUSION: This is the first study investigating the effectiveness of school-based mental health screenings' linkage to treatment for primary and middle school students in Korea. An effective network for community mental health and improvements in parents' and teachers' perceptions regarding mental health are needed for more successful treatment linkage.
Adolescent ; Aged ; Appointments and Schedules ; Checklist ; Child ; Child Behavior ; Depression ; Epidemiologic Studies ; Financial Support ; Humans ; Korea ; Mass Screening ; Mental Health ; Mental Health Services ; Referral and Consultation ; Suicidal Ideation

PURPOSE: Thrombopoietin (TPO) has been currently used for ex vivo expansion of hematopoietic stem cells. Previously, we have reported that TPO induces apoptosis during ex vivo expansion of cord blood CD34 cells. In this study, we have investigated the stem cell factor (SCF) to determine whether it affects the TPO-induced apoptosis. METHPDS: CD34+ cells, purified from four separate human cord bloods by magnetic bead selection, were expanded in Iscoves modified Dulbeccos medium with several cytokines. Apoptosis has been confirmed by several ways; 7-amino-actinomycin D (7-AAD) or annexin V staining, and morphologic analysis with light and electron microscopic examinations. And cell maturation was also analysed with DNA staining. RESULTS: Apoptosis was reached peak (67.8+/-5.24% of total cells) at day 9 in the cultures with TPO alone. Morphological examination of Giemsa-stained cytospin preparations revealed many immature cells with cytoplasmic blebbing and eccentric nuclei. However, multilobed nuclei were rarely observed while bilobed nuclei were frequently observed. These results suggest that premature senescence occurs in the megakaryocytic cells before full polyploidization. SCF was affective for the TPO-induced apoptosis; the peak apoptotic fraction was significantly decreased to 37.2+/-3.31% at day 9. In the cultures with SCF, the fractions of CD41+ cells were also decreased in parallel with decrease in apoptosis. Notwithstanding reduction of differentiation into megakaryocytic lineage, polyploidization(> 6N) in CD41 cell faction was significantly increased in the cultures with SCF at day 9 and day 11, respectively (P<0.05). CONCLUSION: These results suggest that SCF inhibits premature senescence of the differentiating cells of megakaryocytic lineage during ex vivo expansion using TPO.
Aging* ; Annexin A5 ; Apoptosis ; Blister ; Cytokines ; Cytoplasm ; DNA ; Fetal Blood* ; Hematopoietic Stem Cells ; Humans* ; Megakaryocytes* ; Polyploidy ; Stem Cell Factor* ; Stem Cells* ; Thrombopoietin*

PURPOSE: We aimed to study the feasibility of arsenic trioxide as a treatment of neuroblastoma which has the ability to differentiate into nonmalignant cells like acute promyelocytic leukemia. METHODS: To determine the effects of arsenic trioxide in various concentrations and exposure time on the survivial of neuroblastoma cell lines, SH-SY5Y and SK-N-AS cells were cultured in RPMI 1640 media with 1 to 20muM concentration of arsenic trioxide. Apoptosis was measured with flow cytometry by staining with 7-aminoactinomycin D. Cell cycle was assessed by monitoring the DNA contents by flow cytometry. Arsenic trioxide induced cell morphologic changes were also observed with May-Grunwald-Giemsa stain under a light microscope. RESULTS: Arsenic trioxide induced apoptosis in SH-SY5Y cells earlier in the same concentration and to a more severe degree with the same exposure time than in HL-60 cells. The apoptosis induced by arsenic trioxide was steeply increased to 79.3 10.1% at 24 hours and then maintained a plateau on 20muM concentration, while increasing steadily to 40.2 6.5% until 72 hours on 5muM concentration. The proliferating cell proportion in S/G2/M phase was decreased with arsenic trioxide concentration and with exposure time in both SH-SY5Y and HL-60 cells, especially more so with the SH-SY5Y cells. The cellularity was decreased and more apoptotic cells could be observed in the arsenic trioxide treatment group than in untreated control group. CONCLUSION: As in acute promyelocytic leukemic cells, arsenic trioxide induced apoptosis and cell cycle arrest of proliferating phase in neuroblastoma cells.
Apoptosis ; Arsenic* ; Cell Cycle ; Cell Cycle Checkpoints ; Cell Line ; DNA ; Flow Cytometry ; HL-60 Cells ; Humans ; Leukemia, Promyelocytic, Acute ; Neuroblastoma*

Blue nevus may rarely appear in a plaque form. Because of its rarity and unusual appearance, this nevus may present a diagnostic problem and gives no definite prognosis. We report a case of plaque -type blue nevus in a 25-year-old man. He presented an irregularly demarcated plaque, measuring 1.5 x 3 cm, composed of multiple grouped slate gray to blue papules of varying size with intervening faint gray-blue discoloration on the back, which had existed for 10 years. Histopathological examination showed clumps of numerous heavily melanin-laden dendritic melanocytes in the reticular dermis with intervening stromal fibrosis. Numerous melanophages were intermingled with the melanocytes. There were no islands of pale cells seen in the cellular blue nevus and no malignant changes such as nuclear and cytoplasmic pleomorphism, mitotic figures and so on. The diagnosis of plaque-type blue nevus was made and its histopathological features were consistent with a common blue nevus.
Adult ; Cytoplasm ; Dermis ; Diagnosis ; Fibrosis ; Humans ; Islands ; Melanocytes ; Nevus ; Nevus, Blue* ; Prognosis