BACKGROUND: Various tools for the acute response system (ARS) predict and prevent acute deterioration in pediatric patients. However, detailed criteria have not been clarified. Thus we evaluated the effectiveness of bradycardia as a single parameter in pediatric ARS. METHODS: This retrospective study included patients who had visited a tertiary care children's hospital from January 2012 to June 2013, in whom ARS was activated because of bradycardia. Patient's medical records were reviewed for clinical characteristics, cardiologic evaluations, and reversible causes that affect heart rate. RESULTS: Of 271 cases, 261 (96%) had ARS activation by bradycardia alone with favorable outcomes. Evaluations and interventions were performed in 165 (64.5%) and 13 cases (6.6%) respectively. All patients in whom ARS was activated owing to bradycardia and another criteria underwent evaluation, unlike those with bradycardia alone (100.0% vs. 63.2%, p = 0.016). Electrocardiograms were evaluated in 233 (86%) cases: arrhythmias were due to borderline QT prolongation and atrioventricular block (1st and 2nd-degree) in 25 cases (9.2%). Bradycardia-related causes were reversible in 202 patients (74.5%). Specific causes were different in departments at admission. Patients admitted to the hemato-oncology department required ARS activation during the night (69.3%, p = 0.03), those to the endocrinology department required ARS activation because of medication (72.4%, p < 0.001), and those to the gastroenterology department had low body mass indexes (32%, p = 0.01). CONCLUSIONS: Using bradycardia alone in pediatric ARS is not useful, because of its low specificity and poor predictive ability for deterioration. However, bradycardia can be applied to ARS concurrently with other parameters.
Arrhythmias, Cardiac ; Atrioventricular Block ; Body Mass Index ; Bradycardia* ; Electrocardiography ; Endocrinology ; Gastroenterology ; Heart Arrest ; Heart Rate ; Hospital Rapid Response Team ; Humans ; Medical Records ; Pediatrics ; Retrospective Studies ; Sensitivity and Specificity ; Tertiary Healthcare

No Abstract available.
Ankle* ; Sarcoidosis* ; Tenosynovitis*

Drash syndrome, which was first reported by Denys et al. in 1967 is a complex disorder which associates a nephropathy, Wilms' tumor, and male pseudohermaphroditism. The common denominator is a nephropathy. The nephropathy may be associated with either genital abnormalities or Wilms' tumor, and these associations are called incomplete form of Drash syndrome. This syndrome appears early in life and the first sign usually is genital ambiguity. The nephropathy presents with proteinuria, hematuria and hypertension, and eventually progresses to end stage renal failure. Renal biopsy may reveal a variety of glomerular and interstitial changes. Wilms' tumor may appear as s mass on ultrasound or it may not be recognized until nephrectomy or even autopsy. We report on a boy with nephropathy and genital abnormalities. A nephrotic syndrome with hypertension was present when first seen at 15 days of age. The karyotype was 46, XY and external genitalia was ambiguous. The nephrotic syndrome and signs of renal insufficiency persisted and he died at the age of 40 days. Histopathologic findings of kidney at autopsy revealed those of diffuse mesangial sclerosis. The case was presented with brief review of literatures.
46, XY Disorders of Sex Development ; Autopsy ; Biopsy ; Denys-Drash Syndrome* ; Disorders of Sex Development ; Genitalia ; Hematuria ; Humans ; Hypertension ; Karyotype ; Kidney ; Male ; Nephrectomy ; Nephrotic Syndrome ; Proteinuria ; Renal Insufficiency ; Sclerosis ; Ultrasonography ; Wilms Tumor

OBJECTIVES: This study was designed to assess the change of heart rate variability (HRV) at resting, upright, and psychological stress in anxiety disorder patients. METHODS: HRV was measured at resting, upright, and psychological stress states in 60 anxiety disorder patients. We used visual analogue scale (VAS) score to assess tension and stress severity. Beck depression inventory (BDI) and state trait anxiety inventories I and II (STAI-I and II) were used to assess depression and anxiety severity. Differences between HRV indices were evaluated using paired t-tests. Gender difference analysis was accomplished with ANCOVA. RESULTS: SDNN (Standard deviation of normal RR intervals) and low frequency/high frequency (LF/HF) were significantly increased, while NN50, pNN50, and normalized HF (nHF) were significantly decreased in the upright position compared to resting state (p < 0.01). SDNN, root mean square of the differences of successive normal to normal intervals, and LF/HF were significantly increased, while nHF was significantly decreased in the psychological stress state compared to resting state (p < 0.01). SDNN, NN50, pNN50 were significantly lower in upright position compared to psychological stress and nVLF, nLF, nHF, and LF/HF showed no significant differences between them. CONCLUSION: The LF/HF ratio was significantly increased after both physical and psychological stress in anxiety disorder, but did not show a significant difference between these two stresses. Significant differences of SDNN, NN50, and pNN50 without any differences of nVLF, nLF, nHF, and LF/HF between two stresses might suggest that frequency domain analysis is more specific than time domain analysis.
Anxiety ; Anxiety Disorders* ; Autonomic Nervous System ; Depression ; Equipment and Supplies ; Heart Rate* ; Humans ; Stress, Psychological*

BACKGROUND: Nutrition label reading is helpful in attaining a healthy diet. Nutrition label use and its related factors have been studied in many Korean articles, but their research samples were the general population and not chronic disease patients. This study aimed to explore the use of nutrition labels and its relation to dietary intake among chronic disease patients in Korea. METHODS: A total of 3160 respondents aged> or =20 years from the 2008-2009 Fourth Korean National Health and Nutrition Examination Survey (KNHANES-IV) participated in the study. Their chronic medical conditions included hypertension, hyperlipidemia, coronary artery disease, diabetes and/or stroke and they were interviewed regarding their use of nutrition labels. Nutrition intake was also estimated by 24-hour dietary recalls. RESULTS: Overall, 10.4% of the chronic disease patients reported to using nutrition labels. The nutrients they looked at first were total calories, fat and cholesterol. Factors related to reading nutrition labels were relatively higher education, high body mass index and lower frequency of alcohol intake in males and relatively younger age and higher education in females. Nutrition label users consumed lower total calories, protein and fat in the male CAD group, lower total calories and carbohydrate in both diabetes and total groups and lower total calories and fiber in the female stroke group. CONCLUSIONS: Our study found that, in Korea, a significantly lower rate of patients with chronic disease read nutrition labels. Strategies need to be developed to improve clinical application of nutrition labels in this population.
Body Mass Index ; Cholesterol ; Chronic Disease* ; Coronary Artery Disease ; Surveys and Questionnaires ; Diet ; Education ; Female ; Food Labeling ; Humans ; Hyperlipidemias ; Hypertension ; Korea ; Male ; Nutrition Surveys* ; Stroke

INTRODUCTION: Premature ejaculation is the most prevalent form of male sexual dysfunction, but its cause has not been well established. Recently some studies indicated that penile sensitivity is decreased in men with premature ejaculation. MATERIALS AND METHODS: To clarify the association between penile sensitivity and premature ejaculation, we evaluated penile sensitivity in 18 patients with premature ejaculation without erectile dysfunction and neurologic deficit, and 15 normal potent male volunteers by SMV-5 digital vibrometer (Teknologue, Tokyo, Japan), which has higher precision and reproducibility than analogue type biothesiometers. Vibration thresholds were recorded at the glans penis, penile shaft, and frenulum of the penis in flaccid and erectile state induced by PGE1 10 ug. We also recorded those at ulnar process and medial maleolus of the tibia. RESULTS: There was no difference in vibration threshold at the ulnar process and the medial maleolus of the tibia between the two groups (p>0.05). And we found no difference in penile sensitivity at the glans penis, penile shaft, frenulum of the penis between the two groups, in both erectile and flaccid states (p>0.05). Penile sensitivity was decreased in erectile state compared to flaccid state, but it is not statistically significant (p>0.05). CONCLUSION: Based on our results, penile hypersensitivity measured by SMV-5 vibrometer does not appear to be a major factor contributing to premature ejaculation. And further study aimed at other somatic or cognitive factors awaits implementation.
Alprostadil ; Erectile Dysfunction ; Humans ; Hypersensitivity ; Male ; Neurologic Manifestations ; Penis ; Premature Ejaculation* ; Tibia ; Vibration ; Volunteers

OBJECTIVES: Sleep disorders cause changes of autonomic nervous system (ANS) which affect cardiovascular system. Primary insomnia (PI) makes acceleration of sympathetic nervous system (SNS) tone by sleep deficiency and arousal. Obstructive sleep apnea syndrome (OSAS) sets off SNS by frequent arousals and hypoxemias during sleep. We aimed to compare the changes of heart rate variability (HRV) indices induced by insomnia or sleep apnea to analyze for ANS how much to be affected by PI or OSAS. METHODS: Total 315 subjects carried out nocturnal polysomnography (NPSG) were categorized into 4 groups - PI, mild, moderate and severe OSAS. Severity of OSAS was determined by apnea-hypopnea index (AHI). Then we selected 110 subjects considering age, sex and valance of each group's size [Group 1 : PI (mean age=41.50+/-13.16 yrs, AHI <5, n=20), Group 2 : mild OSAS (mean age=43.67+/-12.11 yrs, AHI 5-15, n=30), Group 3 : moderate OSAS (mean age 44.93+/-12.38 yrs, AHI 16-30, n=30), Group 4 : severe OSAS (mean age=45.87+/-12.44 yrs, AHI >30, n=30)]. Comparison of HRV indices among the four groups was performed with ANCOVA (adjusted for age and body mass index) and Sidak post-hoc test. RESULTS: We found statistically significant differences in HRV indices between severe OSAS group and the other groups (PI, mild OSAS and moderate OSAS). And there were no significant differences in HRV indices among PI, mild and moderate OSAS group. In HRV indices of PI and severe OSAS group showing the most prominent difference in the group comparisons, average RR interval were 991.1+/-27.1 and 875.8+/-22.0 ms (p=0.016), standard deviation of NN interval (SDNN) was 85.4+/-6.6 and 112.8+/-5.4 ms (p=0.022), SDNN index was 57.5+/-5.2 and 87.6+/-4.2 (p<0.001), total power was 11,893.5+/-1,359.9 and 18,097.0+/-1,107.2 ms2 (p=0.008), very low frequency (VLF) was 7,534.8+/-1,120.1 and 11,883.8+/-912.0 ms2 (p=0.035), low frequency (LF) was 2,724.2+/-327.8 and 4,351.6+/-266.9 ms2 (p=0.003). CONCLUSIONS: VLF and LF which were correlated with SNS tone showed more increased differences between severe OSAS group and PI group than other group comparisons. We could suggest that severe OSAS group was more influential to increased SNS activity than PI group.
Acceleration ; Anoxia ; Arousal ; Autonomic Nervous System ; Cardiovascular System ; Heart ; Heart Rate ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders ; Sympathetic Nervous System

Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology. We report a case of KD with acute respiratory distress syndrome (ARDS) after intravenous immunoglobulin (IVIG) infusion. Lung manifestations associated with KD have previously been reported in the literature. Although IVIG infusion is an effective therapy for acute KD, there are some reported complications related to IVIG infusion: hypotension, aseptic meningitis, acute renal failure, hemolytic anemia, etc. The case of KD reported here was treated with IVIG and aspirin. A few days after recovery from KD, the patient developed fever and maculopapular rash. A diagnosis of relapse KD was made and retreated with IVIG infusion. However, the patient developed ARDS four days after the second IVIG infusion. The patient recovered from ARDS after nine days of ICU care, which included high frequency oscillation ventilation with inhaled nitric oxide, steroid treatment and other supportive care.
Acute Kidney Injury ; Anemia, Hemolytic ; Aspirin ; Diagnosis ; Exanthema ; Fever ; High-Frequency Ventilation ; Humans ; Hypotension ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Lung ; Meningitis, Aseptic ; Mucocutaneous Lymph Node Syndrome* ; Nitric Oxide ; Recurrence ; Respiratory Distress Syndrome, Adult* ; Systemic Vasculitis

OBJECTIVES: Despite the great contribution made by chemical substances to the development of modern civilization, their indiscriminate use has caused various kinds of damage to the global environment and human beings. Accordingly, the major developed countries and international society have tried to ensure the safe use of chemicals and a reduction in the use of hazardous chemicals through the establishment of the United Nations Environment Programme and various international agreements. In this reason, we tried to introduce about Green Chemistry progress at the present in worldwide and Korea. METHODS: We checked and analyzed relative journals, reports using keyword as like Green Chemistry, alternative chemicals, eco-friendly etc. and major country's government homepage search. RESULTS: Green Chemistry theory, which argues for the reduction or removal of harmfulness in chemicals throughout their entire life-cycle, has been spreading, and major developed countries, such as the US and Denmark, have developed and operate programs to provide reliable chemical information to help replace hazardous chemicals. Korea has also been conducting studies as like eco-innovation project. Through this project the "Alternative Chemical Search program," has been developed, distributed, and operated since 2011 to provide reliable information to small and medium-sized businesses that have difficulties collecting information to ensure conformity to international regulations. The program provides information that includes the regulations of major countries and Korea, information on 340 alternative chemicals, 70 application cases, and 1:1 consulting. CONCLUSIONS: The Alternative Chemical Search program is expected to contribute to the establishment of response systems for regulation of Korean small and medium-sized businesses, and it also will be used to provide basic data for Korean hazardous chemical regulation, together with the Act on the Registration and Evaluation, etc. of Chemical Substances and the Chemical Control act, making it possible to establish an infrastructure for Green Chemistry in Korea and to increase national competitiveness.
Chemistry* ; Civilization ; Denmark ; Developed Countries ; Hazardous Substances ; Humans ; Korea* ; Small Business ; Social Control, Formal ; United Nations

OBJECTIVES: Despite the great contribution made by chemical substances to the development of modern civilization, their indiscriminate use has caused various kinds of damage to the global environment and human beings. Accordingly, the major developed countries and international society have tried to ensure the safe use of chemicals and a reduction in the use of hazardous chemicals through the establishment of the United Nations Environment Programme and various international agreements. In this reason, we tried to introduce about Green Chemistry progress at the present in worldwide and Korea. METHODS: We checked and analyzed relative journals, reports using keyword as like Green Chemistry, alternative chemicals, eco-friendly etc. and major country's government homepage search. RESULTS: Green Chemistry theory, which argues for the reduction or removal of harmfulness in chemicals throughout their entire life-cycle, has been spreading, and major developed countries, such as the US and Denmark, have developed and operate programs to provide reliable chemical information to help replace hazardous chemicals. Korea has also been conducting studies as like eco-innovation project. Through this project the "Alternative Chemical Search program," has been developed, distributed, and operated since 2011 to provide reliable information to small and medium-sized businesses that have difficulties collecting information to ensure conformity to international regulations. The program provides information that includes the regulations of major countries and Korea, information on 340 alternative chemicals, 70 application cases, and 1:1 consulting. CONCLUSIONS: The Alternative Chemical Search program is expected to contribute to the establishment of response systems for regulation of Korean small and medium-sized businesses, and it also will be used to provide basic data for Korean hazardous chemical regulation, together with the Act on the Registration and Evaluation, etc. of Chemical Substances and the Chemical Control act, making it possible to establish an infrastructure for Green Chemistry in Korea and to increase national competitiveness.
Chemistry* ; Civilization ; Denmark ; Developed Countries ; Hazardous Substances ; Humans ; Korea* ; Small Business ; Social Control, Formal ; United Nations