No abstract available.
Cerebral Palsy*

To compare mortality rate, the adjustment of case-mix variables is needed. The Pediatric Index of Mortality (PIM) 3 score is a widely used case-mix adjustment system of a pediatric intensive care unit (ICU), but there has been no validation study of it in Korea. We aim to validate the PIM3 in a Korean pediatric ICU, and extend the validation of the score from those aged 0–16 to 0–18 years, as patients aged 16–18 years are admitted to pediatric ICU in Korea. A retrospective cohort study of 1,710 patients was conducted in a tertiary pediatric ICU. To validate the score, the discriminatory power was assessed by calculating the area under the receiver-operating characteristic (ROC) curve, and calibration was evaluated by the Hosmer-Lemeshow goodness-of-fit (GOF) test. The observed mortality rate was 8.47%, and the predicted mortality rate was 6.57%. For patients aged < 18 years, the discrimination was acceptable (c-index = 0.76) and the calibration was good, with a χ² of 9.4 in the GOF test (P = 0.313). The observed mortality rate in the hemato-oncological subgroup was high (18.73%), as compared to the predicted mortality rate (7.13%), and the discrimination was unacceptable (c-index = 0.66). In conclusion, the PIM3 performed well in a Korean pediatric ICU. However, the application of the PIM3 to a hemato-oncological subgroup needs to be cautioned. Further studies on the performance of PIM3 in pediatric patients in adult ICUs and pediatric ICUs of primary and secondary hospitals are needed.
Adult ; Benchmarking ; Calibration ; Child ; Cohort Studies ; Critical Care* ; Discrimination (Psychology) ; Humans ; Intensive Care Units* ; Korea* ; Mortality* ; Retrospective Studies ; Risk Adjustment

OBJECTIVE: To investigate the serum vitamin D level and its determinant factors in stroke patients. METHODS: Fifty-one stroke patients who had documented serum level of 25-hydroxyvitamin D(25(OH)D) were included. Patients were divided into subacute (n=23) and chronic groups (n=28). The mean levels of 25(OH)D of the two groups were compared. Correlations between each 25(OH)D level and post-stroke duration were also analyzed. To assess other possible influencing factors, patients were subdivided by ambulation ability and feeding methods for comparison of 25(OH)D level. RESULTS: The mean level of 25(OH)D was significantly lower in the chronic group than in the subacute group (12.3 vs. 16.3 ng/mL; p < 0.05). The serum 25(OH)D level decreased according to the duration after stroke (r=−0.52, p=0.01). Patients with a history of total parenteral nutrition had lower 25(OH)D levels than subjects who had enteral nutrition in the subacute group (7.3 vs. 18.8 ng/mL; p < 0.01). However, the levels of 25(OH)D were not different between the oral feeding and tube feeding groups. Among the chronic group subjects, patients who could walk without assistance had higher 25(OH)D levels than non-ambulatory patients (ambulatory vs. non-ambulatory group; 18.3 vs. 11.3 ng/mL; p < 0.05). CONCLUSION: After stroke onset, serum vitamin D level decreases with time regardless of feeding methods, and total parenteral nutrition may aggravate its deficiency. In terms of long-term care, non-ambulatory patients might be at a higher risk of vitamin D deficiency. Supplementation of vitamin D should be considered especially for stroke patients who are non-ambulatory and on total parenteral nutrition.
Enteral Nutrition ; Feeding Methods ; Humans ; Long-Term Care ; Parenteral Nutrition, Total ; Stroke* ; Vitamin D Deficiency ; Vitamin D* ; Vitamins* ; Walking

OBJECTIVE: To investigate the serum vitamin D level and its determinant factors in stroke patients. METHODS: Fifty-one stroke patients who had documented serum level of 25-hydroxyvitamin D(25(OH)D) were included. Patients were divided into subacute (n=23) and chronic groups (n=28). The mean levels of 25(OH)D of the two groups were compared. Correlations between each 25(OH)D level and post-stroke duration were also analyzed. To assess other possible influencing factors, patients were subdivided by ambulation ability and feeding methods for comparison of 25(OH)D level. RESULTS: The mean level of 25(OH)D was significantly lower in the chronic group than in the subacute group (12.3 vs. 16.3 ng/mL; p < 0.05). The serum 25(OH)D level decreased according to the duration after stroke (r=−0.52, p=0.01). Patients with a history of total parenteral nutrition had lower 25(OH)D levels than subjects who had enteral nutrition in the subacute group (7.3 vs. 18.8 ng/mL; p < 0.01). However, the levels of 25(OH)D were not different between the oral feeding and tube feeding groups. Among the chronic group subjects, patients who could walk without assistance had higher 25(OH)D levels than non-ambulatory patients (ambulatory vs. non-ambulatory group; 18.3 vs. 11.3 ng/mL; p < 0.05). CONCLUSION: After stroke onset, serum vitamin D level decreases with time regardless of feeding methods, and total parenteral nutrition may aggravate its deficiency. In terms of long-term care, non-ambulatory patients might be at a higher risk of vitamin D deficiency. Supplementation of vitamin D should be considered especially for stroke patients who are non-ambulatory and on total parenteral nutrition.
Enteral Nutrition ; Feeding Methods ; Humans ; Long-Term Care ; Parenteral Nutrition, Total ; Stroke* ; Vitamin D Deficiency ; Vitamin D* ; Vitamins* ; Walking

PURPOSE: Comorbidities have been considered a mortality risk factor in pediatric critical care patients. We studied the characteristics and prognostic factors of children without comorbidities who were admitted to the intensive care unit (ICU) due to respiratory failure. METHODS: We reviewed the medical charts of patients (< 18 years) admitted to the ICU for respiratory support in a single tertiary center between January 2006 and December 2016. Patients with comorbidities and perioperative statuses were excluded. RESULTS: Of the 4,712 ICU patients, 73 (1.5%) were included in this study. The median age was 31 months (8–57) and 51 (69.9%) were boys. Twenty-nine patients (39.7%) presented with pneumonia, 14 (19.2%) with acute respiratory distress syndrome (ARDS), and 11 (15.1%) with obstructive airway disease. The median duration of ICU hospitalization was 5 days (2–14.5), and 45 of the 73 patients (61.6%) needed mechanical ventilation. Mortality was 13.7% (10/73). None of the patients with pneumonia or obstructive airway disease died. The most frequent cause of death was ARDS (5 of 10, 50%). In adjusted analysis, the extent of extrapulmonary organ dysfunction was significantly associated with mortality (odds ratio, 2.89; 95% confidence interval, 1.17–7.11; P=0.023). CONCLUSION: The mortality rate of previously healthy pediatric patients needing respiratory support in the ICU should not be negligible. Multiple organ dysfunctions might be a significant risk factor for mortality in such patients.
Cause of Death ; Child* ; Comorbidity ; Critical Care* ; Hospitalization ; Humans ; Intensive Care Units* ; Mortality ; Pneumonia ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Risk Factors

Objective: To generate a Korean version of the Oxford Cognitive Screen (K-OCS) and obtain cutoff scores that determine the impairment of each subdomain. Post-stroke cognitive impairment (PSCI) negatively impacts the rehabilitation process and independence in daily life. Its obscure manifestations require effective screening for appropriate rehabilitation. However, in most rehabilitation clinics, psychological evaluation tools for Alzheimer’s dementia have been used without such considerations. The OCS is a screening assessment tool for PSCI and vascular dementia that can evaluate the cognitive domains most often affected by stroke, including language, attention, memory, praxis, and numerical cognition. It comprises 10 subtasks and enables quick and effective cognitive evaluation. Methods: The K-OCS, which considers Korea’s unique cultural and linguistic characteristics, was developed with the approval and cooperation of the original author. Enrollment of participants without disabilities was announced at Duksung Women’s University, Yongin Sevrance Hospital, CHA Bundang Medical Center. The study was conducted between September 2020 and March 2022 on 97 male and female participants aged ≥30 years. Results: All the 97 participants completed the task. In this study, the 5th percentile score was presumed to be the cutoff value for each score, and the values are provided here. The cutoff score for each OCS subtask was similar to that of the original British version. Conclusion We suggest the usability of the K-OCS as a screening tool for PSCI by providing the cutoff value of each subtask.

Gastric inflammatory myofibroblastic tumor (IMT) is an extremely rare lesion with mimicking malignant features and accompanied with various clinical manifestations. Here we present a 2-yr-old boy who had a gastric IMT with a huge extragastric mass, which closely resembled a neuroblastoma on imaging studies. He experienced intermittent fever and poor appetite for 6 weeks. Fever remained up to 38degrees C even on the operation day. He underwent partial gastrectomy and distal pancreatectomy with splenectomy including the tumor. The preoperative fever disappeared and did not recur in the postoperative course.
Child, Preschool ; Fever of Unknown Origin/*etiology ; Granuloma, Plasma Cell/*complications/*diagnosis/surgery ; Humans ; Male ; Stomach Diseases/*complications/*diagnosis/surgery

PURPOSE: Hepatocyte growth factor (HGF) stimulates proliferation, migration, and morphogenesis of epithelial cells by specifically binding to its receptor c-met. Abnomalities of the c-met oncogene have been studied in cancers of many organs including thyroid, lung, pancreas, and stomach. However, little is known about the clinical significance of c-met oncogene abnormalities in colorectal carcinomas. In this study, we investigated over- expression of the c-met protein in colorectal adenomas and adenocarcinomas, and analyzed the clinicopathologic significance of this over-expression. METHODS: Expression of the c-met protein localized in colorectal adenoma and adenocarcinoma tissues was analyzed by using immunohistochemistry. The results were compared with clinicopathologic parameters to find clinical correlation. RESULTS: c-met protein was detected in 42.5% (17/40) of colorectal cancers and in 10.0% (4/40) of colorectal adenomas (P= 0.001). In colorectal cancer, the proportion of expression of c-met protein was 0% (0/40) in stage I, 47.6% (10/40) in stage II, 53.8% (7/40) in stage III and, 0% (0/40) in stage IV. c-met protein expression was 18.8% (3/40) in tumors with invasion into the muscularis propria (MP), and 58.3% (14/40) in tumors with invasion beyond the MP. The depth of tumor invasion was a statistically significant factor (P=0.022) for c-met expression. CONCLUSIONS: The c-met protein expression was related to the depth of invasion of colorectal cancer and showed a significant difference in its rate of expression between adenoma and adenocarcinomas.
Adenocarcinoma ; Adenoma* ; Colorectal Neoplasms* ; Epithelial Cells ; Hepatocyte Growth Factor ; Immunohistochemistry ; Lung ; Morphogenesis ; Oncogenes ; Pancreas ; Stomach ; Thyroid Gland

PURPOSE: Transilluminated powered phlebectomy (TIPP) offers a minimally invasive operation alternative to stab avulsion for varicose veins. The purpose of this study is to compare the safety and efficacy of TIPP with conventional phlebectomy (CP) for removal of varicose veins. METHOD: A retrospective review was performed on the clinical records from March 2001 to March 2002. We divided the patients into 2 groups. The first group consisted of 87 patients (107 limbs) who had undergone TIPP. The second group of 27 patients (29 limbs) had undergone CP by the stab avulsion. We compared operation time, number of skin incisions, duration of hospital stay, patient's satisfaction scores, and complications. RESULT: Mean operation time was significantly shorter in the TIPP group than in the CP group (47.3 min vs. 64.0 min). The number of skin incision was also significantly less in the TIPP group (3.4 vs. 4.9). Length of hospital stay was significantly shorter in the TIPP group (2.5 days vs. 4.0 days). However, postoperative patient's satisfaction score was similar in both groups. 81 patients (93%) in the TIPP group developed ecchymosis postoperatively, resolved spontaneously within approximately 8 weeks. CONCLUSION: TIPP can make the better cosmetic result, shorter duration of hospitalization and operation time. These results suggest that TIPP is a feasible surgical treatment modality for varicose veins of the lower extremity. However, we should minimize postoperative ecchymosis and improve the surgical technique.
Ecchymosis ; Hospitalization ; Humans ; Length of Stay ; Lower Extremity* ; Retrospective Studies ; Skin ; Varicose Veins*

OBJECTIVE: To investigate the energy expenditure (EE) of Korean young adults based on activities refined to a deskbound lifestyle. METHODS: Sixty-four healthy office workers aged between 25 and 46 years participated in this study. EE was expressed as metabolic equivalent of task (MET). Participants were evaluated in terms of their EE during physical activities of sleeping (n=22), typing (n=37), folding laundry (n=34), dishwashing (n=32), studying (n=18), mopping (n=35), walking (n=33), stair climbing (n=23), and running (n=29). Volume of oxygen consumption was measured by indirect calorimetry K4b² (COSMED). The results were compared to the established Compendium MET. RESULTS: The MET of activities were: sleeping, 1.24±0.43; typing, 1.35±0.25; folding laundry, 1.58±0.51; dishwashing, 2.20±0.51; studying, 2.11±0.90; mopping, 2.72±0.69; walking at 4 km/hr, 3.48±0.65; stair climbing of five stories, 6.18±1.08; and running at 8 km/hr, 7.57±0.57. The values of typing and mopping were similar to those in the Compendium, whereas those of sleeping, folding laundry, dishwashing, studying, walking, stair climbing and running were different. CONCLUSION: To our knowledge, this estimation of EE in MET during activities of daily living is the first data of young adults in Korea. These data could be used as a reference to modify the guidelines of physical activities for the age group examined in this study.
Activities of Daily Living* ; Calorimetry, Indirect ; Energy Metabolism* ; Humans ; Korea ; Life Style ; Metabolic Equivalent ; Motor Activity ; Oxygen Consumption ; Physical Exertion ; Running ; Walking ; Young Adult*