PURPOSE: Cholestatic liver disease is a frequent complication of prolonged parenteral nutrition, especially in premature infants. The purpose of present study is to evaluate the clinical and biochemical efficacy of ursodeoxycholic acid (UDCA) in premature infants with total parenteral nutrition (TPN) cholestasis. METHODS: Retrospective chart review of 31 prematures with TPN cholestasis in Neonatal Intensive Care Unit of Chonnam University Hospital from January 1995 and December 2002 was done. Prematures were divided into two groups based on UDCA treatment: the study group (n=22, with UDCA treatment) and the control group (n=9, without UDCA treatment). Treatment efficacy of UDCA was evaluated by monitoring the changes of serum direct bilirubin level for more than one to two months. RESULTS: In study group, cholestasis appeared at a mean age of 23+/-18.8 days after a mean of 21+/-19.7 days of TPN. UDCA was initiated (ranged 15-30 mg/kg/day) at a mean age of 54+/-22.3 days for a mean of 32+/-19.0 days. There was no significant difference in decrease of direct bilirubin level between the study and control group. However, the day of initial enteral feeding and full enteral feeding were earlier in control group compared with study group. CONCLUSIONS: This study shows that UDCA treatment is not effective in the treatment of TPN cholestasis among premature infants unlike that of results reported in children and adults. To reduce the incidence of TPN cholestasis in premature infants, early introduction of enteral feeding as soon as possible is most important.
Adult ; Bilirubin ; Child ; Cholestasis* ; Enteral Nutrition ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Jeollanam-do ; Liver Diseases ; Parenteral Nutrition ; Parenteral Nutrition, Total* ; Retrospective Studies ; Treatment Outcome ; Ursodeoxycholic Acid*

The N-terminal sequence of HIV1 gp41 (amino acid residues 584-623) was known to be the immundominant region of HIV1 gp41 protein. In order to determine epitope for gp41 protein of Korean anti-HIV1 positive sera, multiple antigenic peptides (MAPs) for the sequences corresponding to 584-604, 590-612, 604-623 and 584-618 of HIV1 gp41 were synthesized by solid phase method using Fmoc-Lys (Fmoc)-OH and used as coating antigens for ELISA. The reactivities of the synthetic peptides with Korean HIV1 positive (21 samples) and anti-HIV1 negative sera (22 samples) obtained from healthy blood doner were estimated by an indirect ELISA. MAPs for 584-604, 590-612 and 604-623 of gp41 reacted with 62 %, 100 % and 81 % of Korean anti-HIV1 positive sera tested, respectively. The results suggest that the epitope for HIV1 gp 41 for Korean anti-HIV1 positive sera is located in the region of amino acid 590-612 of gp41. MAP for gp41 (584-618) reacted with all (100 %) of anti-HIV1 positive sera tested, but did not react with anti-HlV1 negative sera. In addition, this MAP reacted stronger with seven samples of anti-HIV1 positive sera of anti-HIV1/2 combo performance panel than the mixture of 584-604, 590-612 and 604-623 of gp41, but did not react with anti-HIV negative serum. The high sensitivity and selectivity of MAP of gp41 (584-618) suggest that this peptide as a coating antigen in an ELISA system will be useful for antibody detection of HIV1.
Enzyme-Linked Immunosorbent Assay ; Epitope Mapping* ; Immune Sera* ; Peptides*

PURPOSE: This study aimed to validate the psychometric properties of the CRAFFT (Car, Relax, Alone, Forget, Family/Friends, Trouble) by using item response theory (IRT) and further examine gender differences in item-level responses.METHODS: This study used the 13(th) (2017) Korea Youth Risk Behavior Survey data conducted by the Korean Centers for Disease and Prevention and analyzed data of 8,568 students who reported drinking alcohol in the previous 30 days. IRT assumptions including unidimensionality, local independence, and monotonicity were tested. A one-factor two-parameter IRT model was fitted for item parameterization (M₂ = 76.92, 20 df, p < .001, root mean square error of approximation = 0.02). Graphics for item characteristic curves and item and test information curves were provided. Differential item functioning (DIF) analysis was evaluated to measure item equivalence between boys and girls.RESULTS: Unidimensionality and local independence were satisfied, and the dominant factor eigenvalue and variance were 2.48 and 41.3% in boys and 2.08 and 34.7% in girls, respectively, and residual correlations in paired items were less than .2. The discrimination parameters were estimated as 1.32–3.59 for boys and 1.30–3.64 for girls. The severity parameters estimated verity as −0.23 to 1.67 for boys and −0.32 to 2.17 for girls. DIF was detected for four of six items, “Car,” “Relax,” “Forget,” and “Family/friends.” However, its impact on the total score was negligible.CONCLUSION: The CRAFFT is a valid and reliable screening tool to identify alcohol use problems for both boys and girls, exhibiting good discrimination, good coverage of severity, and negligible DIF.
Adolescent ; Alcohols ; Discrimination (Psychology) ; Drinking ; Female ; Humans ; Korea ; Mass Screening ; Psychometrics ; Risk-Taking

PURPOSE: It is known that single umbilical artery is frequently associated with gastrointestinal or urogenital anomaly, however, routine renal sonography has been debated in healthy neonate with isolated single umbilical artery. This study is designed to determine the usefulness of routine renal sonography in apparently healthy infants with an isolated single umbilical artery. METHODS: Thirty healthy neonates with a single umbilical artery without a major anomaly from January 1995 to July 2002 were enrolled. The authors investigated the clinical background of babies and their mothers after renal sonography after 72 hours of age. When the abnormalities were found at the first renal sonography, the severity of hydronephrosis and degree of obstruction and renal function were analyzed by follow up renal sonography, voiding cystourethrography(VCUG) and technetium-99m-dimercaptosuccinic acid(DMSA) scan or technetium-99m-mercaptoacetyl-triglycerine (MAG3) scan. RESULTS: Among the 30 healthy patients with isolated single umbilical artery, five patients(16.7%) showed abnormalities on first renal sonography with one major(3.3%) and four(13.4%) minor renal anomaly(minimal or mild hydroneohrosis). One major renal anomaly(severe hydronephrosis) showed severe decreased renal function on MAG3 scan without reflux, and the other four minor regressed spontaneously on follow up study. CONCLUSION: The value of routine early renal sonograpy for detecting renal anomaly in healthy infants with an isolated single umbilical artery remained unclear because most of the anomalies would regress spontaneously in the follow up study.
Follow-Up Studies ; Humans ; Hydronephrosis ; Infant* ; Infant, Newborn ; Mass Screening* ; Mothers ; Single Umbilical Artery*

Feto-maternal hemorrhage, the presence of fetal red blood cells in the maternal circulation, occurs in up to 75% of pregnancies. But its volume is usually very small. Feto-maternal hemorrhage of more than 30 ml of whole blood is relatively rare. The key features that lead to early diagnosis are the maternal history, fetal monitoring, the clinical and laboratory findings of anemia and a negative Coombs' test. Diagnosis is confirmed by Kleihauer-Betke test. Perinatal problems include fetal distress, neonatal anemia, hypovolemic shock, and death. The fetal outcome depends on the amount and rate of bleeding. The initial hemoglobin level was a better predictor than the volume of bleeding. We present two cases of severe neonatal anemia associated with massive feto-maternal hemorrhage, which was confirmed by Kleihauer-Betke test.
Pregnancy ; Female ; Infant, Newborn ; Humans

Behcet's disease (BD) involves multisystem vasculitis of unknown origin. Ocular manifestations of BD mostly include bilateral panuveitis and retinal vasculitis, which are very challenging to treat. Interferon alfa-2a (IFN) has been recently introduced for treating refractory Behcet uveitis, mainly in Germany and Turkey. Nonetheless, there is so far no consensus about the ideal treatment regimen of IFN for Behcet uveitis. We report our experience of IFN treatment in five Korean BD patients with refractory uveitis. All patients complained of oral ulcers; one patient had a positive pathergy test and 2 showed the presence of HLA-B51. Immunosuppressive agents used prior to IFN treatment included cyclosporine and methotrexate. The IFN treatment was commenced with a dose of 6-9 MIU/day for 7 days, adjusted according to individual ocular manifestations, tapered down to 3 MIU three times in a week, and then discontinued. All patients showed positive response to IFN treatment; 50% of them showed complete response without additional major ocular inflammation during the follow-up period. Other BD symptoms also improved after IFN treatment in most cases. After treatment, the relapse rate and the required dose of oral corticosteroid were decreased in most cases, showing a significant steroid-sparing effect. However, the visual acuity was not improved in most cases due to irreversible macular sequelae. Despite the small sample size of this study, we suggest that, in Korean patients, IFN is an effective treatment modality for BD uveitis as was observed in German and Turkish patients.
Adult ; Behcet Syndrome/complications/diagnosis/*drug therapy ; Chronic Disease ; Cyclosporine/therapeutic use ; Female ; Humans ; Immunosuppressive Agents/administration & dosage ; Interferon-alpha/*therapeutic use ; Male ; Recombinant Proteins/therapeutic use ; Recurrence ; Remission Induction ; Treatment Outcome ; Turkey ; Uveitis/diagnosis/*drug therapy/etiology ; Visual Acuity

Severe respiratory difficulty can be more prominent, when combined with severe pectus excavatum and cardiovascular manifestations in infants with Marfan syndrome. There have been few reports on severe laryngomalacia as a cause of severe respiratory difficulty in an infant with Marfan syndrome. A 1-month-old boy was admitted due to severe respiratory difficulty. Immediately after birth, he had dysmorphic features, such as micrognathia, wrinkles on the forehead, and down-slanting palpebral fissures. On echocardiography, aortic root dilation with a mitral valve prolapse was observed. Due to severe laryngomalacia accompanied by severe respiratory difficulty and feeding difficulty, a partial epiglottectomy was performed at 1 month of age. After the surgery, suprasternal retraction and inspiratory stridor disappeared, and he started gaining weight with improvement in respiratory difficulty. On whole exome sequencing, a missense mutation on the FBN1 gene (c.3560A> C on exon 29, p.His1187Pro, calcium-binding epidermal growth factor-like #21) was identified. Despite higher perioperative risk due to comorbidities in Marfan syndrome, early intervention of laryngomalacia can be helpful in improving quality of life even in infants with Marfan syndrome.

PURPOSE: To investigate the prevalence of amblyogenic risk factors in the primary family members (parents, siblings) of patients with exotropia. METHODS: The authors of the present study examined primary family members including parents and siblings of 58 exotropia patients in our clinic. Best corrected visual acuity, refractive error, and cover-uncover test were performed. A total of 49 normal children's family members (control group) were examined in a similar manner. The prevalence of significant ocular findings were determined and compared to the control group. RESULTS: In 58 eligible families (153 subjects except proband), 65.4% had significant ocular findings: In parents, anisometopia, astigmatism, hyperopia, and strabismus were found at a rate of 18.1%, 31.1%, 2.5%, and 11.2%, respectively. In siblings, anisometropia, astigmatism, hyperopia, and strabismus were found at a rate of 24.3%, 24.3%, 5.4%, and 18.9%, respectively. Compared to the control group, in parents of exotropia patients, anisometropia, astigmastim, and strabismus were observed at a higher rate. In siblings, anisometropia, and strabismus were observed at a higher rate. CONCLUSIONS: Primary family members of exotropia patients have a high prevalence of amblyogenic risk factors. The present study offers rationale for providing comprehensive eye exams for parents and children with a family history of exotropia.
Anisometropia ; Astigmatism ; Child ; Exotropia ; Eye ; Humans ; Hyperopia ; Parents ; Prevalence ; Refractive Errors ; Risk Factors ; Siblings ; Strabismus ; Visual Acuity

In the present study, we show that the expression of type 2 glucose transporter isoform (GLUT2) could be regulated by PPAR-gamma in the liver. Rosiglitazone, PPAR-gamma agonist, activated the GLUT2 mRNA level in the primary cultured hepatocytes and Alexander cells, when these cells were transfected with PPAR-gamma/RXR-alpha. We have localized the peroxisome proliferator response element in the mouse GLUT2 promoter by serial deletion studies and site-directed mutagenesis. Chromatin immunoprecipitation assay using ob/ob mice also showed that PPAR-gamma rather than PPAR-alpha binds to the -197/-184 region of GLUT2 promoter. Taken together, liver GLUT2 may be a direct target of PPAR-gamma ligand contributing to glucose transport into liver in a condition when PAPR-gamma expression is increased as in type 2 diabetes or in severe obesity.
Animals ; Cells, Cultured ; Chromatin Immunoprecipitation ; Gene Expression Regulation ; Genes, Reporter ; Hepatocytes/*metabolism ; Liver/metabolism ; Male ; Mice ; Mice, Inbred ICR ; Mice, Transgenic ; Monosaccharide Transport Proteins/*biosynthesis/genetics ; Mutagenesis, Site-Directed ; PPAR alpha/genetics/metabolism ; PPAR gamma/agonists/genetics/*metabolism ; *Promoter Regions (Genetics) ; Protein Isoforms/biosynthesis ; Research Support, Non-U.S. Gov't ; *Response Elements ; Thiazolidinediones/pharmacology

BACKGROUND: Recent studies have shown that Mohs micrographic surgery (MMS) decreased the recurrent rate of tumors and conserved the normal, unaffected tissue. Therefore, MMS is accepted as the first choice treatment modality for cutaneous malignant tumors. OBJECTIVE: The purpose of this study was to review the use of MMS and reconstruction of cutaneous malignant tumors over the past 10 years. METHOD: We retrospectively evaluated 104 patients who had been diagnosed with cutaneous malignant tumors between January 1994 and December 2003, and had been treated with MMS and tumor reconstruction. RESULTS: There were 54 males and 50 females. The mean age was 62. Basal cell carcinoma was the most common skin tumor, and the most common anatomical site was the face. Mean number of stages of MMS were 1.91, and the mean size of the final defect after MMS was 19.46x25.4 mm. A local flap was most commonly used to repair the surgical defects (59%). Recurrent cases totalled 2 out of 104 over the 4-60 months of follow up. CONCLUSION: MMS and proper reconstruction are a reliable and effective method for the treatment of cutaneous malignant tumors and offers the lowest functional and cosmetic morbidity in skin cancer treatment.
Carcinoma, Basal Cell ; Female ; Follow-Up Studies ; Humans ; Male ; Mohs Surgery* ; Retrospective Studies ; Skin ; Skin Neoplasms