Hydrocephalus is a common malformation of the central nervous system and its cause may be either congenital or acquired. The imbalance between CSF formation and absorption, obstruction of CSF pathways, impaired venous absorption, and over secretion of CSF results in excessive accumulation of the fluid in the ventricles, leading to hydrocephalus. Although ventriculo-peritoneal shunt is regarded as the main and definitive therapy for rapidly progressive hydrocephalus, shunts in newborns have a high failure rate and thus there have been a search for alternative non-invasive techniques. Acetazolamide is a carbonic anhy- drase inhibitor, which acts by reducing production of CSF in the choroid plexus. Admini- stration of acetazolamide will decrease the rate of CSF production, preventing progressive ventricular enlargement. We experienced three cases of neonatal hydrocephalus successfully treated by long-term administration of acetazolamide. Brief review and related literatures were also presented.
Absorption ; Acetazolamide* ; Carbon ; Central Nervous System ; Choroid Plexus ; Humans ; Hydrocephalus* ; Infant, Newborn ; Ventriculoperitoneal Shunt

Th17 cells (Th17) are a distinct lineage of CD4+ T cells that secrete high amounts of IL-17 under orphan nuclear receptor retinoic acid receptor-related orphan receptor gammat (RORgammat) which is a lineage-specific transcription factor. TGF-beta and inflammatory cytokines, such as IL-6, IL-21, IL-1beta, and IL-23, play central roles in the generation of Th17 cells. Th17 cells and their effector molecules, such as IL-17A, IL-17F, IL-21, IL-22, and CCL20, contribute to the progression and pathogenesis of several autoimmune and inflammatory diseases, such as rheumatoid arthritis, psoriasis, multiple sclerosis, inflammatory bowel disease and systemic lupus erythematosus. Studies of Th17 development and the effects of IL-17 signaling in autoimmune responses suggest a high potential for targeting this pathway in immune pathologies. In this review, we discuss Th17 biology in relation to autoinflammatory disorders and the various therapeutic strategies under investigation which target the IL-17-Th17 cell pathway in chronic inflammatory autoimmune disorders.
Arthritis, Rheumatoid ; Autoimmune Diseases ; Autoimmunity ; Biology ; Child ; Child, Orphaned ; Cytokines ; Humans ; Inflammatory Bowel Diseases ; Interleukin-17 ; Interleukin-23 ; Interleukin-6 ; Interleukins ; Lupus Erythematosus, Systemic ; Multiple Sclerosis ; Psoriasis ; Receptors, Interleukin-17 ; T-Lymphocytes ; Th17 Cells ; Transcription Factors ; Transforming Growth Factor beta ; Tretinoin

PURPOSE: The purpose of this study was to assess the clinical application of a bar code medication administration and blood transfusion system and to identify its effects from the aspect of patient safety and nurse satisfaction in a tertiary hospital. METHODS: The system in this study was PDA with bar code reading capability and wireless networking function. The logs created during application of the system and administration error reports were analyzed. For nurses' satisfaction with the system, data were collected from 337 nurses using the instrument developed by Otieno et al. and analyzed using descriptive statistics. RESULTS: The system application rate was 98.8%, and the main failure cases in the system application included bar code or network related factors. When the system was applied, 0.02% of errors were prevented. The nurses were satisfied with the system from the aspect of patient safety, however relatively less satisfied with the system from the aspect of work efficiency. CONCLUSION: The results of the study indicate the usefulness for patient safety of applying the bar code medication administration and blood transfusion system to clinical practice. However technological improvements including bar code and network communication are necessary to ensure higher work efficiency in nursing practice.
Automatic Data Processing ; Blood Transfusion ; Dietary Sucrose ; Information Systems ; Patient Safety ; Tertiary Care Centers

OBJECTIVE: Human embryonic stem (ES) cells have a great potential in regenerative medicine and tissue engineering. The human ES cells could be differentiated into specific cell types by treatments of growth factors and alterations of gene expressions. However, the efficacy of guided differentiation and isolation of specific cells are still low. In this study, we characterized isolated cells from differentiated human ES cells by magnetic activated cell sorting (MACS) system using specific antibodies to cell surface markers. METHODS: The undifferentiated hES cells (Miz-hESC4) were sub-cultured by mechanical isolation of colonies and embryoid bodies were spontaneously differentiated with DMEM containing 10% FBS for 2 weeks. The differentiated cells were isolated to positive and negative cells with MACS system using CD34, human epithelial antigen (HEA) and human fibroblast (HFB) antibodies, respectively. Observation of morphological changes and analysis of marker genes expression were performed during further culture of MACS isolated cells for 4 weeks. RESULTS: Morphology of the CD34 positive cells was firstly round, and then it was changed to small polygonal shape after further culture. The HEA positive cells showed large polygonal, and the HFB positive spindle shape. In RT-PCR analysis of marker genes, the CD34 and HFB positive cells expressed endodermal and mesodermal genes, and HEA positive cells expressed ectodermal genes such as NESTIN and NF68KD. The marker genes expression pattern of CD34 positive cells changed during the extension of culture time. CONCLUSION: Our results showed the possibility of successful isolation of specific cells by MACS system from undirected differentiated human ES cells. Thus, MACS system and marker antibodies for specific cell types might be useful for guided differentiation and isolation of specific cells from human ES cells.
Antibodies ; Ectoderm ; Embryoid Bodies ; Endoderm ; Fibroblasts ; Gene Expression ; Humans* ; Intercellular Signaling Peptides and Proteins ; Mesoderm ; Nestin ; Regenerative Medicine ; Tissue Engineering

Recently, we have experienced with various changes in the health insurance. Korean government is implementing the prospective payment system(PPS) as a pilot project to reduce medical expenditure. Case management is an effective way to reduce costs, while not sacrificing quality of service, under the PPS. In this study, the integrated decision support system(DSS) for case management was presented to support two case management activities ; utilization management and discharge planning. This system can be used in three ways ; prospective, concurrent, and retrospective management. By monitoring cases from medical record database, the DSS provides basic patient information, payment information, medical service information to the case manager. In the future, data warehouse should be introduced to integrate various databases related to case management and to improve quality of information produced by the DSS.
Case Management* ; Cesarean Section* ; Critical Pathways ; Diagnosis-Related Groups* ; Female ; Health Expenditures ; Humans ; Insurance, Health ; Medical Records ; Patient Discharge ; Pilot Projects ; Pregnancy

OBJECTIVES: Autism is a complex neurodevelopmental spectrum disorder with a strong genetic component. Previous neurochemical and genetic studies have suggested the possible involvement of the serotonin system in autism. Tryptophan 2,3-dioxygenase(TDO2) is the rate-limiting enzyme in the catabolism of tryptophan, which is the precursor of serotonin synthesis. The aim of this study was to investigate the association between the TDO2 gene and autism spectrum disorders(ASD) in a Korean population. METHODS: The patients were diagnosed with ASD on the basis of the DSM-IV diagnostic classification outlined in the Korean version of the Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule. The present study included the detection of four single nucleotide polymorphisms(SNPs) in the TDO2 gene(rs2292536, rs6856558, rs6830072, rs6830800) and the family-based association analysis of the single nucleotide polymorphisms in Korean ASD trios using a transmission disequilibrium test(TDT) and haplotype analysis. The family trios of 136 probands were included in analysis. 87.5% were male and 86.0% were diagnosed with autism. The mean age of the probands was 78.5+/-35.8 months(range: 26-264 months). RESULTS: Two SNPs showed no polymorphism, and there was no significant difference in transmission in the other two SNPs. We also could not find any significant transmission in the haplotype analysis(p>.05). CONCLUSION: We could not find any significant statistical association between the transmission of SNPs in the TDO2 gene and ASD in a Korean population. This result may not support the possible involvement of the TDO2 gene in the development of ASD, and further exploration might be needed to investigate other plausible SNP sites.
Appointments and Schedules ; Autistic Disorder* ; Child ; Autism Spectrum Disorder* ; Classification ; Diagnostic and Statistical Manual of Mental Disorders ; Haplotypes ; Humans ; Male ; Metabolism ; Polymorphism, Single Nucleotide ; Serotonin ; Tryptophan

Maple syrup urine disease (MSUD) is an autosomal recessive disease caused by a deficiency in subunits of the branched-chain alpha-ketoacid dehydrogenase complex (BCKDH). The disease is characterized by the accumulation of the branched-chain amino acids leucine, isoleucine, valine, alloisoleucine, and their corresponding alpha-ketoacid in blood and urine. MSUD is a heterogenous disorder, and classic, intermittent, intermediate and thiamine-responsive phenotypes have been identified. We experienced a case of Maple syrup urine disease (classic type) in a female neonate, who suffered from lethargy, poor feeding, apnea, alternating periods of hypertonicity and flaccidity, generalized convulsions, and a peculiar burned sugar smell from the body and urine. She died of respiratory failure 22 days after the birth. The brief review of the literature was made.
Acer* ; Amino Acids, Branched-Chain ; Apnea ; Burns ; Female ; Humans ; Infant, Newborn ; Isoleucine ; Lethargy ; Leucine ; Maple Syrup Urine Disease* ; Oxidoreductases ; Parturition ; Phenotype ; Respiratory Insufficiency ; Seizures ; Smell ; Valine

PURPOSE: The purpose of this study was to identify risk factors for pediatric inpatients falls. METHODS: The study was a matched case-control design. The participants were 279 patients under the age of 6 who were admitted between January 1, 2004 and December 31, 2009. Through chart reviews, 93 pediatric patients who fell and 186 ones who did not fall were paired by gender, age, diagnosis, and length of stay. Five experts evaluated the 38 fall risk factors selected by the researchers. RESULTS: In a general hospital, pediatric patients with secondary diagnosis, tests that need the patient to be moved, intravenous lines, hyperactivity, anxiolytics, sedatives and hypnotics, and general anesthetics showed significance for falls on adjusted-odds ratios. Conditional logistic regression analysis was performed to elucidate the factors that influence pediatric inpatient falls. The probability of falls increased with hyperactivity and general weakness. Patients who didn't have tests that required them to be moved and intravenous line had a higher risk of falls. CONCLUSION: These findings provide information that is relevant in developing fall risk assessment tools and prevention programs for pediatric inpatient falls.
Accidental Falls/*prevention & control ; Age Factors ; Analgesics ; Case-Control Studies ; Child ; Child, Preschool ; Female ; Hematologic Diseases/pathology ; Hospitalization ; Hospitals, General ; Humans ; Infant ; Length of Stay ; Logistic Models ; Male ; Neoplasms/pathology ; Odds Ratio ; Retrospective Studies ; Risk Factors ; Sex Factors

PURPOSE: The purpose of this study was to determine handwashing-related factors in nurses. Specific purposes of this study were to examine 1) the applicability of the hypothetical model constructed for this study, on the basis of Theory of Planned Behavior(TPB), and 2) relationships between handwashing practice and other variables such as age, career, level of education, and level of recognition about handwashing. METHOD: Data were collected from 187 nurses in one university hospital in Kyung-Ki province. RESULT: The hypothetical model based on TPB was revealed applicable, but the degree of the variance explaining handwashing practice was small(26%). Perceived behavioral control(PBC) was the most strong variable explaining handwashing practice, and intention didn't have a significant effect on handwashing practice. Norm and PBC had significant effects on intention, but attitude was not a significant factor of intention. Age, career, and the level of awareness of handwashing practice were significantly related to handwashing practice. CONCLUSION: The result of this study suggests that we should focus on perceived behavioral control, awareness of handwashing practice and subjective norm about handwashing practice to increase the level of nurses' handwashing practice.
Education ; Gyeonggi-do ; Hand Disinfection* ; Intention

PURPOSE: The purpose of this study was to determine handwashing-related factors in nurses. Specific purposes of this study were to examine 1) the applicability of the hypothetical model constructed for this study, on the basis of Theory of Planned Behavior(TPB), and 2) relationships between handwashing practice and other variables such as age, career, level of education, and level of recognition about handwashing. METHOD: Data were collected from 187 nurses in one university hospital in Kyung-Ki province. RESULT: The hypothetical model based on TPB was revealed applicable, but the degree of the variance explaining handwashing practice was small(26%). Perceived behavioral control(PBC) was the most strong variable explaining handwashing practice, and intention didn't have a significant effect on handwashing practice. Norm and PBC had significant effects on intention, but attitude was not a significant factor of intention. Age, career, and the level of awareness of handwashing practice were significantly related to handwashing practice. CONCLUSION: The result of this study suggests that we should focus on perceived behavioral control, awareness of handwashing practice and subjective norm about handwashing practice to increase the level of nurses' handwashing practice.
Education ; Gyeonggi-do ; Hand Disinfection* ; Intention