PURPOSE: Atherosclerotic change begins in childhood, elevated blood lipid levels and a family history of premature coronary vascular diseases are important risk factors for coronary artery disease. Identification, follow-up and treatment of children at high risk of cardiovascular diseases are very effective and important for prevention of future coronary artery diseases. The purpose of this study is to determine the relation between parental history coronary artery disease and lipid levels of children in Korea. METHODS: As a cross sectional study, lipids and apolipoproteins were measured in 94 off-spring of patients diagnosed by coronary angiography as a myocardial infarction and an angina pectoris before the age of 55 years, the results were compared with those of 98 controls without family history of coronary artery diseases. RESULTS: The mean levels of total cholesterol, LDL-cholesterol, Apolipprotein B and Lipoprotein(a)(Lp(a)) were significantly higher in study group than in control group(p<0.01). The mean level of HDL-cholesterol was significantly lower in study group than in control group(p<0.05). Also, the percentage of children having abnormal lipid values(total cholesterol < or =200mg/dl, LDL-cholesterol < or =130mg/dl, Lp(a) < or =30mg/dl) were significantly higher in study group than in control group. CONCLUSIONS: The children and adolescents whose parents suffered from early onset coronary heart diseases should be evaluated for lipids and lipoprotein levels to identify and to manage the high risk group for coronary artery disease.
Adolescent* ; Angina Pectoris ; Apolipoproteins ; Cardiovascular Diseases ; Child* ; Cholesterol ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Korea ; Lipoproteins ; Myocardial Infarction ; Parents ; Risk Factors ; Vascular Diseases

PURPOSE: Atherosclerotic change begins in childhood, elevated blood lipid levels and a family history of premature coronary vascular diseases are important risk factors for coronary artery disease. Identification, follow-up and treatment of children at high risk of cardiovascular diseases are very effective and important for prevention of future coronary artery diseases. The purpose of this study is to determine the relation between parental history coronary artery disease and lipid levels of children in Korea. METHODS: As a cross sectional study, lipids and apolipoproteins were measured in 94 off-spring of patients diagnosed by coronary angiography as a myocardial infarction and an angina pectoris before the age of 55 years, the results were compared with those of 98 controls without family history of coronary artery diseases. RESULTS: The mean levels of total cholesterol, LDL-cholesterol, Apolipprotein B and Lipoprotein(a)(Lp(a)) were significantly higher in study group than in control group(p<0.01). The mean level of HDL-cholesterol was significantly lower in study group than in control group(p<0.05). Also, the percentage of children having abnormal lipid values(total cholesterol < or =200mg/dl, LDL-cholesterol < or =130mg/dl, Lp(a) < or =30mg/dl) were significantly higher in study group than in control group. CONCLUSIONS: The children and adolescents whose parents suffered from early onset coronary heart diseases should be evaluated for lipids and lipoprotein levels to identify and to manage the high risk group for coronary artery disease.
Adolescent* ; Angina Pectoris ; Apolipoproteins ; Cardiovascular Diseases ; Child* ; Cholesterol ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Disease ; Coronary Vessels* ; Follow-Up Studies ; Humans ; Korea ; Lipoproteins ; Myocardial Infarction ; Parents ; Risk Factors ; Vascular Diseases

OBJECTIVES: This pilot study aimed to obtain preliminary data on the associations between atherosclerosisand periodontitis, physical health status, and general and oral health behaviors. METHODS: Thirty-three subjects were recruited from among those who underwent carotid computed tomography (CT) angiography and general health check-up at the Seoul National University Hospital Health Examination Center (SNUHHEC). Two trained dentists conducted a periodontal examination to evaluate probing pocket depth and clinical attachment loss. A self-administered questionnaire was completed by study subjects, following informed consent. Data on physical health status were collected through review of medical records from the SNUHHEC. Information on general health behavior was obtainedfrom the self-reported questionnaire. Descriptive and comparative analyses were performed using IBM SPSS Statistics 21.0®. Statistical significance was set at P<0.05. RESULTS: A marginal, but non-significant association was noted between atherosclerosis and periodontitis(P=0.373). Flossing habit showed a significant association with periodontitis (P=0.007) and obesity (P=0.033). A possible association was noted between daily exercise and flossing (P=0.073). The habitual use of interdental brush also showed borderline association with smoking (P=0.098) and a stronger associationwith previous periodontal treatment (P=0.067); however, these associations were not statisticallysignificant. CONCLUSIONS: Our pilot study did not show an association between arteriosclerosis and periodontal disease.However, positive oral health care behavior, especially flossing, seems to alleviate arteriosclerosis. In other words, in this pilot survey, we confirmed the possibility that healthy oral care behavior can help to alleviate arteriosclerosis. Future large-scale studies are needed to confirm whether positive oral health care behaviors improve overall health.
Angiography ; Arteriosclerosis ; Atherosclerosis* ; Dental Care* ; Dentists ; Health Behavior ; Humans ; Informed Consent ; Medical Records ; Obesity ; Oral Health ; Overweight ; Periodontitis* ; Pilot Projects* ; Seoul ; Smoke ; Smoking

PURPOSE: The aims of this project were to increase organ donation by developing potential brain dead donor actively and to provide basic data to settle up independent Organ Procurement Organization (OPO) in Korea. METHODS: Hospital based Organ Procurement Organization (HOPO) of Keimyung university worked as a regional OPO and all the reported potential brain dead patient were treated by OPO team during May through October, 2007. Every reported and confirmed brain dead patient was evaluated for their eligibility of organ donation and these organs were allocated by Korean Network for Organ Sharing (KONOS). In order to increase the development of organ donation, campaign was done for public and medical personnels. To estimate the capacity of brain death donor pool, medical records of the dead patients with brain injury were evaluated. Accommodations and educations to the care-giver to the potential donor, neurosurgeon, neurologist and emergency department physicians were also done. For standardization of potential donor care, frame a clinical pathway of the care of the potential donor from the data of computerized records. The cash flow of whole process from developing potential donor to final procurement of organs were calculated to provide minimum expenses for operating Independent OPO in our environment. RESULTS: Total 33 solid organs were procured from 11 brain dead donor during the experimental period. Twelve more organs were possible to donate but not procured because there were no matched recipient at that time. The reported number of potential donor was increased 2.5 times, compare to the same period of previous year (19 from 5 hospital in 2006 but 47 from 14 collaborating hospitals in 2007). Among 47 notified potential donor, only 11 were succeeded to procure. The reasons of failure for procurement in 36 patients were no familial consent in 12, poor patient condition to donate in 9, not in brain death criteria in 15. These results mean that we have at least 21 more potential donors if we can get familial consent and use marginal donor, and early notification. Mean medical expenses were 3 million won for individual expense beside insurance coverage and 5 million won for management expense of donor care from the detection to organ procurement. CONCLUSION: Our results showed the number of the potential donor and actual organ donation can be increased by continued active relationship with regional hospital and adequate care of the donor. The big gap between the profit from our donor care and calculated donor management expenses of IOPO can be progressively covered by increasing number of brain dead donor, increasing procurement rate and increasing organ fee paid by recipient. But for a certain periods, financial support is necessary to settle up IOPO. Our result can be used as a basic data for management plan of IOPO in the future.
Brain Death ; Brain Injuries ; Critical Pathways ; Emergencies ; Fees and Charges ; Financial Support ; Humans ; Insurance Coverage ; Korea ; Medical Records ; Tissue and Organ Procurement ; Tissue Donors

PURPOSE: The purpose of this study is to clarify the effect of hemodynamic changes of ductal shunt on brain natriuretic peptide(BNP) secretion and to investigate the value of plasma BNP level as a predictor of spontaneous closure of ductus arteriosus(DA) in healthy preterm infants. METHODS: 24 preterm infants were enrolled. Echocardiographic examinations and blood samplings of BNP were carried out in 24 hours, 72 hours and on 5th days after birth. The magnitudes of ductal shunts were estimated using ductal color Doppler flow pattern, left atrial/aortic root ratio(LA/Ao ratio) and antegrade peak diastolic flow velocity(APDFV) in left pulmonary artery. RESULTS: DA in healthy preterm infants were closed spontaneously within 5 days of birth. Plasma BNP levels in infants with ductal shunt were higher than that of infants without shunt in 24 hours and then significantly decreased within 72 hours of birth according to the decreases of flow in ductal shunts. BNP levels of all infants with ductal shunt were significantly correlated with LA/Ao ratio and APDFV. CONCLUSION: Reduction of BNP levels may serve as an indicator of spontaneous closure of DA in healthy preterm infants. Its levels show significant correlations with the magnitudes of ductal shunt. Therefore BNP levels may be used in determining the necessity of and the optimal time to initiating medical and surgical management of preterm infants with significant PDA.
Brain* ; Ductus Arteriosus, Patent ; Echocardiography ; Hemodynamics ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Natriuretic Peptide, Brain* ; Parturition ; Plasma* ; Pulmonary Artery

PURPOSE: Earlier and accurate identification of preterm infants who are likely to develop hemodynamically significant patent ductus arteriosus (hsPDA) would allow for early prophylaxis and thus minimize the risk of neurologic and respiratory morbidity. The purpose of this study is to clarify the usefulness of plasma B-type natriuretic peptide (BNP) as an early biochemical predictive marker of subsequent symptomatic PDA (sPDA) in preterm infants. METHODS: Clinical and echocardiographic findings of PDA were evaluated at 24 and 48 hours of age in 69 infants ranging from 25 to 34 gestational weeks of age. Plasma BNP concentrations were simultaneously measured with a Triage(R) BNP test kit (Biosite Diagnositics, San Diego, California, U.S.A.). When two or more clinical symptoms of PDA and large ductal shunt from echocardiographic findings were found, sPDA was diagnosed and treated with indomethacin. RESULTS: The mean BNP level in sPDA group (N=22) was significantly higher than that of control group (N=47) at 24 and 48 hours. BNP levels were significantly correlated with the magnitudes of the ductal shunt, such as the ratio of left atrial to aortic root diameter and the diastolic flow velocity of the left pulmonary artery. At 24 hours of age, a cutoff BNP value of 468.5 pg/mL had a sensitivity of 90.9%, a specificity of 74.5% and a positive predictive value of 95.2% for prediction of sPDA (area under ROC curve: 0.908, P<0.001, 95% CI: 0.840 to 0.977). CONCLUSION: Rapid BNP assay allows early prediction of subsequent sPDA that may require treatment in preterm infants.
California ; Ductus Arteriosus, Patent* ; Echocardiography ; Humans ; Indomethacin ; Infant ; Infant, Newborn ; Infant, Premature* ; Natriuretic Peptide, Brain* ; Plasma ; Pulmonary Artery ; ROC Curve ; Sensitivity and Specificity

PURPOSE: The purpose of our study is to investigate the usefulness of B-type natriuretic peptide(BNP) assay as a biochemical marker of cardiovascular manifestations in children with Kawasaki disease(KD). METHODS: Blood was obtained to measure and compare plasma BNP concentrations in the acute phases of typical KD(n=56), atypical KD(n=25), viral febrile disease(n=30), Henoch-Shonlein purpura(n=20) and in the subacute phase of typical KD. Plasma BNP concentrations were measured using a commercial kit, Triage(R) BNP test kit. RESULTS: The mean BNP concentration in the acute phase of KD was significantly higher than in the acute phase of atypical KD, viral febrile disease and Henoch-Shonlein purpura(198.7+/-49.6 vs 55.9+/-10.4, 27.0+/-5.7, 13.7+/-3.1 pg/mL, P<0.001). In KD patients, the mean BNP concentration in the subacute phase was decreased significantly after the treatment with intravenous immunoglobulin and high-dose aspirin(78.0+/-23.5 pg/mL, P<0.001). The area under the Receiver Operating Characteristic curve using BNP level to differentiate KD from viral febrile disease was high: 0.826(95% CI, 0.735 to 0.918, P<0.001). A best cutoff of BNP concentrations for the differential diagnosis of Kawasaki disease was determined to be 30.8 pg/mL(sensitivity 76.8%, specificity 76.7%). CONCLUSION: This study shows the possibility that the rapid BNP assay is useful to detect cardiovascular manifestations associated with KD. Further studies are needed to clarify the mechanism by which the elevated levels of plasma BNP occur in the acute phase of KD.
Biomarkers* ; Child* ; Diagnosis, Differential ; Humans ; Immunoglobulins ; Mucocutaneous Lymph Node Syndrome* ; Natriuretic Peptide, Brain* ; Plasma ; ROC Curve ; Sensitivity and Specificity

PURPOSE: The of common carotid artery intima media thickness (IMT) is an acknowledged noninvasive marker for early atherosclerotic changes. We investigate whether common carotid IMT is different between obese and normal-weight children and also evaluate the relationships IMT with cardiovascular risk factors. METHODS: We collected the clinical data (age, sex, pubertal stage, body mass index) and measured blood pressure, glucose, insulin, lipid profiles and adiponectin in 49 obese children (mean age, 12 years) and 24 nonobese children as controls. The control group was composed of 24 nonobese children of the same age, sex and pubertal stage. We measured the carotid IMT of all subjects by B-mode ultrasound with a 7.5-MHz linear transducer and analyzed. RESULTS: Obese children demonstrated a significantly thicker intima media (mean, 0.34 mm, peak, 0.42 mm) compared to the control group (mean, 0.31 mm, peak, 0.38 mm, P<0.01). IMT was significantly correlated to the BMI (r=0.431, P<0.01), age (r=0.317, P<0.01), total cholesterol (r=0.377, P<0.01), triglyceride (r=0.253, P<0.05) and low-density lipoprotein cholesterol (r=0.289, P<0.05). Serum adiponectin was significantly lower in obese children than in controls (11.2 ng/mL vs. 14.7 ng/mL, P<0.05) and negatively related with IMT (r=-0.267, P<0.05). CONCLUSION: Obesity is associated with increased carotid artery IMT in children. Our results suggest vascular changes in obesity seem to occur already in childhood and vascular ultrasonography may helpful for screening cardiovascular complications in obese children.
Adiponectin ; Blood Pressure ; Carotid Arteries* ; Carotid Artery, Common ; Child* ; Cholesterol ; Glucose ; Humans ; Insulin ; Lipoproteins ; Mass Screening ; Obesity ; Risk Factors* ; Transducers ; Triglycerides ; Ultrasonography

PURPOSE: The of common carotid artery intima media thickness (IMT) is an acknowledged noninvasive marker for early atherosclerotic changes. We investigate whether common carotid IMT is different between obese and normal-weight children and also evaluate the relationships IMT with cardiovascular risk factors. METHODS: We collected the clinical data (age, sex, pubertal stage, body mass index) and measured blood pressure, glucose, insulin, lipid profiles and adiponectin in 49 obese children (mean age, 12 years) and 24 nonobese children as controls. The control group was composed of 24 nonobese children of the same age, sex and pubertal stage. We measured the carotid IMT of all subjects by B-mode ultrasound with a 7.5-MHz linear transducer and analyzed. RESULTS: Obese children demonstrated a significantly thicker intima media (mean, 0.34 mm, peak, 0.42 mm) compared to the control group (mean, 0.31 mm, peak, 0.38 mm, P<0.01). IMT was significantly correlated to the BMI (r=0.431, P<0.01), age (r=0.317, P<0.01), total cholesterol (r=0.377, P<0.01), triglyceride (r=0.253, P<0.05) and low-density lipoprotein cholesterol (r=0.289, P<0.05). Serum adiponectin was significantly lower in obese children than in controls (11.2 ng/mL vs. 14.7 ng/mL, P<0.05) and negatively related with IMT (r=-0.267, P<0.05). CONCLUSION: Obesity is associated with increased carotid artery IMT in children. Our results suggest vascular changes in obesity seem to occur already in childhood and vascular ultrasonography may helpful for screening cardiovascular complications in obese children.
Adiponectin ; Blood Pressure ; Carotid Arteries* ; Carotid Artery, Common ; Child* ; Cholesterol ; Glucose ; Humans ; Insulin ; Lipoproteins ; Mass Screening ; Obesity ; Risk Factors* ; Transducers ; Triglycerides ; Ultrasonography

Diabetes mellitus (DM) is a group of metabolic disorders, that have become a major cause of death worldwide. This study aimed to determine the usefulness of diabetes-related laboratory tests for diagnosis of postmortem DM. From March to August 2018, among the autopsy cases investigated by the National Forensic Service, heart blood and vitreous humor samples from 253 cases that had not been decomposed were collected, and the data from 208 cases except 45 cases that were incapable of testing were analyzed for statistical significance and compared with the causes of death on autopsy reports. The levels of C-peptide, insulin, acetoacetate, β-hydroxybutyrate (β-HA), total ketone, and HbA1c were measured in the heart blood, and the levels of glucose, blood urea nitrogen, creatinine, and potassium were measured in the vitreous humor. The levels of glucose in the vitreous humor and HbA1c, β-HA, and total ketone in the heart blood were significantly correlated. C-peptide and insulin levels were lower than normal levels in most cases (C-peptide 92.3%, P=0.480, insulin 97.6%, P=0.589), and were not useful measures indicating diabetic complications. In the group with DM history, the average levels of HbA1c from the heart blood and glucose from the vitreous humor were higher than in those with no or unknown history of DM, indicating their usefulness as diagnostic tools. The results of this study suggest a postmortem DM diagnosis model.Therefore, postmortem DM-related tests can help diagnose the cause of death in forensic medicine.