PURPOSE: Fever is one of the most common symptoms in children. In previous studies, infectious disease was the most common cause of pediatric fever of unknown origin (FUO). The aim of this study is to investigate the etiology, clinical characteristics and prognosis of pediatric FUO in 21 century with more diagnostics available and to analyze the factors for certain disease categories. METHODS: Among the children under 18 years old who were hospitalized at Samsung Medical Center from January 2000 to December 2014, the patients who met the criteria including fever of ≥38.0℃ for longer than ≥14 days and failure to reach a diagnosis after one week of investigations were included. RESULTS: Total 100 patients were identified. Confirmed diagnosis was achieved in 57 patients (57%). Among them, infectious diseases (n=19, 19%) were most common, followed by connective tissue diseases (n=15, 15%), necrotizing lymphadenitis (n=8, 8%), and malignancies (n=7, 7%). Children with fever duration over 28 days had a trend for higher frequency of connective tissue diseases (28.3%) except undiagnosed etiology. The symptoms such as arthritis, lymph node enlargement and only fever without other symptoms were significantly related with connective tissue diseases, necrotizing lymphadenitis and undiagnosed respectively (P<0.001). Ninety-two patients have become afebrile at discharge and 1 patient died (1%). CONCLUSION: Almost half of our patients were left without diagnosis. Although it has been known that infectious disease was most common cause of pediatric FUO in the past, undiagnosed portion of FUO have now increased due to development of diagnostic techniques for infectious diseases.
Arthritis ; Child* ; Communicable Diseases ; Connective Tissue Diseases ; Diagnosis ; Fever of Unknown Origin* ; Fever* ; Humans ; Lymph Nodes ; Lymphadenitis ; Prognosis

BACKGROUND: We hypothesized that intermittent pneumatic compression device (IPCD) compression system might induce more decreases on the core temperature by increasing the lower extremity blood flow. This study investigated the effects of IPCD compression system on the body temperature in patients undergoing minor surgery under propofol-remifentanil anesthesia. METHODS: Forty female patients were randomly assigned to treat with either elastic stockings (ES group, n = 20) or IPCD (IPCD group, n = 20). Anesthesia was induced and maintained with propofol and remifentanil. The core temperature and arteriovenous shunt in the lower leg were measured using esophageal temperature and the calf to toe skin-surface temperature gradient, respectively. The measurements were taken at 15-minute intervals immediately after anesthesia induction (baseline values, T0) until the end of the surgery. RESULTS: During the study period, the core temperature and skin temperature gradient were comparable between the two groups. The core temperature decreased from 60 min in both groups. And, skin-surface temperature gradient decreased from 15 min in the IPCD group and 30 min in the ES group after anesthesia induction, without intergroup differences across time. CONCLUSIONS: This study demonstrated that the IPCD system did not affect the change in the core temperature when compared to the ES, in patients undergoing minor surgery during propofolremifentanil anesthesia. Thus, the IPCD system could be safely used during propofol-remifentanil anesthesia, without increasing the risk of the intraoperative hypothermia.
Anesthesia ; Body Temperature ; Female ; Humans ; Hypothermia ; Leg ; Lower Extremity ; Piperidines ; Propofol ; Skin Temperature ; Stockings, Compression ; Surgical Procedures, Minor ; Toes

The epithelial-mesenchymal transition (EMT) is important for embryonic development and the formation of various tissues or organs. However, EMT dysfunction in normal cells leads to diseases, such as cancer or fibrosis. During the EMT, epithelial cells are converted into more invasive and active mesenchymal cells. E-box-binding proteins, including Snail, ZEB and helix-loop-helix family members, serve as EMT-activating transcription factors. These transcription factors repress the expression of epithelial markers, for example, E-cadherin, rearrange the cytoskeleton and promote the expression of mesenchymal markers, such as vimentin, fibronectin and other EMT-activating transcription factors. Signaling pathways that induce EMT, including transforming growth factor-beta, Wnt/glycogen synthase kinase-3beta, Notch and receptor tyrosine kinase signaling pathways, interact with each other for the regulation of this process. Although the mechanism(s) underlying EMT in cancer or embryonic development have been identified, the mechanism(s) in embryonic stem cells (ESCs) remain unclear. In this review, we describe the underlying mechanisms of important EMT factors, indicating a precise role for EMT in ESCs, and characterize the relationship between EMT and ESCs.
Animals ; Cadherins/metabolism ; Embryonic Stem Cells/*cytology/metabolism ; *Epithelial-Mesenchymal Transition ; Humans ; Signal Transduction ; Transcription Factors/metabolism

Scatter radiation considerably affects radiographic image quality by reducing image contrast and contributing to a non-uniform background. Images containing a large portion of scatter radiation may result in an incorrect diagnosis. In the past few years, many efforts have been made to reduce the effects of scatter radiation on radiographic images. The purpose of this study is to accurately measure scatter fractions and evaluate the effectiveness of beam-stop arrays. To measure scatter fraction accurately, a beam-stop array and the SFC (Scatter Fraction Calculator) program were developed. Images were obtained using the beam-stop array for both an anti-scatter technique with an anti-scatter grid and an air gap technique. The scatter fractions of the images were measured using the SFC program. Scatter fractions obtained with an anti-scatter grid were evaluated and compared to scatter fractions obtained without an anti-scatter grid. Scatter fractions were also quantitatively measured and evaluated with an air gap technique. The effectiveness of the beam-stop array was demonstrated by quantifying scatter fractions under various conditions. The results showed that a beam-stop array and the SFC program can be used to accurately measure scatter fractions in radiographic images and can be applied for both developing scatter correction methods as well as systems.
Radiographic Image Enhancement

BACKGROUND: Laparoscopic gastrectomy requires a reverse-Trendelenburg position and prolonged pneumoperitoneum and it could cause significant changes in cerebral homeostasis and lead to cognitive dysfunction. We compared changes in regional cerebral oxygen saturation (rSO2), early postoperative cognitive function and hemodynamic variables in patients undergoing laparoscopic gastrectomy with those patients that underwent conventional open gastrectomy. METHODS: Sixty patients were enrolled in this study and the patients were distributed to receive either laparoscopic gastrectomy (laparoscopy group, n = 30) or open conventional gastrectomy (open group, n = 30). rSO2, end-tidal carbon dioxide tension, hemodynamic variables and arterial blood gas analysis were monitored during the operation. The enrolled patients underwent the mini-mental state examination 1 day before and 5 days after surgery for evaluation of early postoperative cognitive function. RESULTS: Compared to baseline value, rSO2 and end-tidal carbon dioxide tension increased significantly in the laparoscopy group after pneumoperitoneum, whereas no change was observed in the open group. No patient experienced cerebral oxygen desaturation or postoperative cognitive dysfunction. Changes in mean arterial pressure over time were significantly different between the groups (P < 0.001). CONCLUSIONS: Both laparoscopic and open gastrectomy did not induce cerebral desaturation or early postoperative cognitive dysfunction in patients under desflurane anesthesia. However, rSO2 values during surgery favoured laparoscopic surgery, which was possibly related to increased cerebral blood flow due to increased carbon dioxide tension and the effect of a reverse Trendelenburg position.
Anesthesia ; Arterial Pressure ; Blood Gas Analysis ; Carbon Dioxide ; Gastrectomy* ; Head-Down Tilt ; Hemodynamics ; Homeostasis ; Humans ; Laparoscopy ; Oxygen* ; Pneumoperitoneum

PURPOSE: Transcatheter device closure of patent ductus arteriosus (PDA) is challenging in early infancy. We evaluated PDA closure in infants less than 6 months old. METHODS: We performed a retrospective review of infants less than 6 months of age who underwent attempted transcatheter device closure in our institution since 2004. To compare clinical outcomes between age groups, infants aged 6–12 months in the same study period were reviewed. RESULTS: A total of 22 patients underwent transcatheter PDA closure during the study period. Patient mean age was 3.3±1.5 months, and weight was 5.7±1.3 kg. The duct diameter at the narrowest point was 3.0±0.8 mm as measured by angiography. The most common duct type was C in the Krichenko classification. Procedural success was achieved in 19 patients (86.3%). Major complications occurred in 5 patients (22.7%), including device embolization (n=1), acquired aortic coarctation (n=2), access-related vascular injury requiring surgery (n=1), and acute deterioration requiring intubation during the procedure (n=1). Two patients had minor complications (9.1%). Twenty-four infants aged 6–12 months received transcatheter device closure. The procedural success rate was 100%, and there were no major complications. The major complication rate was significantly higher in the group less than 6 months of age (P=0.045). There was a trend toward increased major complication and procedural failure rates in the younger age group (P < 0.01). CONCLUSION: A relatively higher incidence of major complications was observed in infants less than 6 months of age. The decision regarding treatment modality should be individualized.
Angiography ; Aortic Coarctation ; Classification ; Ductus Arteriosus* ; Ductus Arteriosus, Patent ; Heart Defects, Congenital ; Humans ; Incidence ; Infant* ; Intubation ; Retrospective Studies ; Vascular System Injuries

Purpose: This study aimed to investigate the perceptions and behaviors of Korean women of reproductive age in regards to contraception counseling. Materials and Methods: The study sample was collected in Korea and comprised 1011 women aged 20–44 years and 150 obstetrics and gynecology (OB/GYN) doctors. Participants completed online questionnaires assessing their current methods of contraception, knowledge of and satisfaction with contraceptive methods, and willingness to learn about and use other contraceptive methods. Results: Women used condoms (74.2%), natural methods (cycle control or withdrawal, 52.4%), and combined oral contraceptives (COCs) (36.9%) more frequently than long-acting reversible contraception (LARC) methods, such as hormone-releasing intrauterine system (IUS) (4.5%), copper-intrauterine devices (3.3%), and subdermal implants (1.4%). Although the proportion of women who used LARC was low, those who used hormone-releasing IUS or subdermal implants reported high levels of satisfaction. The findings revealed discordant results between women and OB/GYN doctors regarding the initiation and quality of information provided by doctors about contraception and overall satisfaction with counseling. Most women (83.1%) expressed a desire to have more information about various contraceptive methods. More than 60% of women reported a willingness to use LARC, such as hormone-releasing IUS or subdermal implants, when provided with detailed information in counseling. Conclusion The majority of Korean women are familiar with condoms and natural methods, but lack knowledge about alternative contraceptive methods, including LARC. Women who used LARC reported higher levels of satisfaction than those who used other methods.

Purpose: This study aimed to investigate the perceptions and behaviors of Korean women of reproductive age in regards to contraception counseling. Materials and Methods: The study sample was collected in Korea and comprised 1011 women aged 20–44 years and 150 obstetrics and gynecology (OB/GYN) doctors. Participants completed online questionnaires assessing their current methods of contraception, knowledge of and satisfaction with contraceptive methods, and willingness to learn about and use other contraceptive methods. Results: Women used condoms (74.2%), natural methods (cycle control or withdrawal, 52.4%), and combined oral contraceptives (COCs) (36.9%) more frequently than long-acting reversible contraception (LARC) methods, such as hormone-releasing intrauterine system (IUS) (4.5%), copper-intrauterine devices (3.3%), and subdermal implants (1.4%). Although the proportion of women who used LARC was low, those who used hormone-releasing IUS or subdermal implants reported high levels of satisfaction. The findings revealed discordant results between women and OB/GYN doctors regarding the initiation and quality of information provided by doctors about contraception and overall satisfaction with counseling. Most women (83.1%) expressed a desire to have more information about various contraceptive methods. More than 60% of women reported a willingness to use LARC, such as hormone-releasing IUS or subdermal implants, when provided with detailed information in counseling. Conclusion The majority of Korean women are familiar with condoms and natural methods, but lack knowledge about alternative contraceptive methods, including LARC. Women who used LARC reported higher levels of satisfaction than those who used other methods.

Background and Objectives: The directed differentiation of pluripotent stem cells into motor neurons is critical for the development of disease modelling and therapeutics to intervene degenerative motor neuron diseases. Cell surface receptor Cdo functions as a coreceptor for Sonic hedgehog (Shh) with Boc and Gas1 in the patterning of ventral spinal cord neurons including motor neurons. However, the discrete function of Cdo is not fully understood. Methods: and Results: In this study, we examined the role of Cdo in motor neuron generation by utilizing in vitro differentiation of Cdo＋/＋ and Cdo−/− embryonic stem cells (ESCs). In response to Shh, Cdo−/− ESCs exhibited impaired expression of motor neuron specification markers while dorsal interneuron specification markers were significantly increased, compared to Cdo＋/＋ ESCs. Reactivation of Shh signalling pathway with Smoothened (Smo) agonist (SAG) restored motor neuron specification in Cdo−/− ESCs. In addition, electrophysiological analysis revealed the immature electrical features of Cdo−/− ESCs-derived neurons which was restored by SAG. Conclusions Taken together, these data suggest that Cdo as a Shh coreceptor is required for the induction of motor neuron generation by fully activating Shh signalling pathway and provide additional insights into the biology of motor neuron development.

PURPOSE: This study was done to analyze how a death preparation education program have the effects on awareness of hospice palliative care and withdrawing life sustaining treatment in older adults. METHODS: This study employed a non-equivalent control group design among quasi-experimental designs. The experimental group was comprised with 35 adults and the control group with 40 adults. The death preparation program consisted of five two-hour sessions and was administered once a week for five straight weeks. Data were analyzed by descriptive statistics, t-test, chi2 test, Fisher's exact test, and ANCOVA using SPSS version 18.0. RESULTS: The mean age of the participants was 66.2 years. A significant difference between the experimental and control groups was observed in withdrawing life sustaining treatment (F=3.380, P=0.040). However, no significant difference was found in awareness of hospice palliative care (F=0.163, P=0.850). CONCLUSION: The study results indicate that death preparation training could positively affect people's awareness of withdrawing life sustaining treatment. More studies should be conducted to explore effects of death preparation education for all ages and help people better understand hospice palliative care.
Adult ; Education* ; Hospices* ; Humans ; Life Support Care ; Palliative Care*