Background: Chronic kidney disease (CKD) has a negative impact on growth and development in children and is a risk factor for neurocognitive impairment; however, there is limited research on the cognitive function of children and adolescents with CKD. This study therefore aimed to investigate the mean intelligence and risk factors for low intelligence in children and adolescents with CKD. Methods: Eighty-one patients with CKD under 18 years old were included in the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease (KNOW-Ped CKD). Participants completed either the Wechsler Intelligence Scale for Children (6–16 years), or Wechsler Adult Intelligence Scale (> 16 years). Results: The mean full-scale intelligence quotient (IQ) was 91 ± 19; 24.7% of participants scored a full-scale IQ below 80. Participants with a short stature (height Z scores < −1.88), failure to thrive (weight Z scores < −1.65), more severe CKD stage (≥ IIIb), longer duration of CKD (≥ 5 years), and those who were Medicare or Medicaid beneficiaries, had significantly lower mean full-scale IQs. Conclusion On linear regression analysis, the association between the full-scale IQ, and longer duration of CKD and growth failure, remained significant after controlling for demographic and clinical variables. It is therefore necessary to investigate cognitive impairment in pediatric patients with CKD who exhibit growth failure or for a longer postmorbid period. It is believed that early interventions, such as kidney transplantation, will have a positive effect on IQ in children with CKD, as the disease negatively affects IQ due to poor glomerular filtration rate over time.

Background: Chronic kidney disease (CKD) has a negative impact on growth and development in children and is a risk factor for neurocognitive impairment; however, there is limited research on the cognitive function of children and adolescents with CKD. This study therefore aimed to investigate the mean intelligence and risk factors for low intelligence in children and adolescents with CKD. Methods: Eighty-one patients with CKD under 18 years old were included in the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease (KNOW-Ped CKD). Participants completed either the Wechsler Intelligence Scale for Children (6–16 years), or Wechsler Adult Intelligence Scale (> 16 years). Results: The mean full-scale intelligence quotient (IQ) was 91 ± 19; 24.7% of participants scored a full-scale IQ below 80. Participants with a short stature (height Z scores < −1.88), failure to thrive (weight Z scores < −1.65), more severe CKD stage (≥ IIIb), longer duration of CKD (≥ 5 years), and those who were Medicare or Medicaid beneficiaries, had significantly lower mean full-scale IQs. Conclusion On linear regression analysis, the association between the full-scale IQ, and longer duration of CKD and growth failure, remained significant after controlling for demographic and clinical variables. It is therefore necessary to investigate cognitive impairment in pediatric patients with CKD who exhibit growth failure or for a longer postmorbid period. It is believed that early interventions, such as kidney transplantation, will have a positive effect on IQ in children with CKD, as the disease negatively affects IQ due to poor glomerular filtration rate over time.

Severe hypercalcemia is rarely encountered in children, even though serum calcium concentrations above 15-16 mg/dL could be life-threatening. We present a patient having severe hypercalcemia and azotemia. A 14-year-old boy with no significant past medical history was referred to our hospital with hypercalcemia and azotemia. Laboratory and imaging studies excluded hyperparathyroidism and solid tumor. Other laboratory findings including a peripheral blood profile were unremarkable. His hypercalcemia was not improved with massive hydration, diuretics, or even hemodialysis, but noticeably reversed with administration of calcitonin. A bone marrow biopsy performed to rule out the possibility of hematological malignancy revealed acute lymphoblastic leukemia. His hypercalcemia and azotemia resolved shortly after initiation of induction chemotherapy. Results in this patient indicate that a hematological malignancy could present with severe hypercalcemia even though blast cells have not appeared in the peripheral blood. Therefore, extensive evaluation to determine the cause of hypercalcemia is necessary. Additionally, appropriate treatment, viz., hydration or administration of calcitonin is important to prevent complications of severe hypercalcemia, including renal failure and nephrocalcinosis.
Acute Kidney Injury* ; Adolescent ; Azotemia ; Biopsy ; Bone Marrow ; Calcitonin ; Calcium ; Child ; Diuretics ; Hematologic Neoplasms ; Humans ; Hypercalcemia* ; Hyperparathyroidism ; Induction Chemotherapy ; Leukemia ; Male ; Nephrocalcinosis ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Renal Dialysis ; Renal Insufficiency

The Clinical Research Center for Dementia of South Korea (CREDOS), a nation-wide clinical dementia research group, has prepared clinical practice guidelines (CPG) for dementia tailored to the Korean population. In this article, a summary of the CREDOS CPG is presented with the Korean and English version of full report included in the appendix. The CREDOS CPG in intended not only for psychiatrists and neurologists, but also internists, family physicians, and other primary care physicians involved in the prevention and early diagnosis of dementia. While our CPG for dementia mainly covers Alzheimer's disease (AD) and vascular dementia (VaD), it also includes mild cognitive impairment (MCI) and vascular MCI, which are currently known to be the preclinical stages of AD or VaD, respectively, with emphasis placed on early diagnosis. The CREDOS CPG aims to achieve the following goals by developing CPG for dementia: to establish evidence-based, objective and clear clinical standards for dementia; to improve the clinical decision-making process for patients with dementia; to provide scientific and systematic scales to aid in the work of dementia specialists; to suggest comprehensive and systematic healthcare services tailored to each dementia subtype. The CREDOS CPG focuses on diagnosis and evaluation of clinical practice available domestically, and provides useful concepts of dementia. Its emphasis is on etiologies and epidemiology, diagnostic criteria and evaluation, neuropsychological tests, behavioral and psychological symptoms, the activities of daily living, laboratory tests, and brain imaging.
Activities of Daily Living ; Alzheimer Disease ; Appendix ; Delivery of Health Care ; Dementia ; Dementia, Vascular ; Early Diagnosis ; Humans ; Mild Cognitive Impairment ; Neuroimaging ; Neuropsychological Tests ; Physicians, Family ; Physicians, Primary Care ; Psychiatry ; Republic of Korea ; Weights and Measures

OBJECTIVE: To evaluate pregnancy outcomes after electrosurgical conization. METHODS: We retrospectively analyzed the outcomes of 56 singleton pregnancies after electrosurgical conization of the uterine cervix. Of the 56 cases, 25 women underwent prophylactic cerclage with McDonald procedure (cerclage group), and 31 were managed expectantly (expectant group). Pregnancy outcomes including rate of preterm delivery were compared, and the effect of potential risk factors such as depth of cone, interval between conization and pregnancy, and cervical length on the risk of preterm delivery was assessed. RESULTS: The rate of preterm delivery was significantly higher in women with a history of electrosurgical conization than those without (32.1% vs. 15.2%, p<0.001). However, preterm delivery rate was not different between the two groups (expectant group vs. cerclage group; <28 week, 6.5% vs. 8.0%, p=1.000; <34 week, 19.4% vs. 20.0%, p=1.000; <37 week, 29.0% vs. 36.0%, p=0.579). All obstetric and neonatal outcomes were similar in the two groups. Even when we confined the study subjects to 19 women (19/56, 33.9%) with cervical length less than 25 mm, the preterm delivery rate also was not significantly different between the expectant (n=7) and cerclage group (n=12). Finally, the potential risk factors for preterm delivery were not associated with risk of preterm delivery in patients with a history of electrosurgical conization. CONCLUSION: The rate of preterm delivery was significantly higher in women with a history of electrosurgical conization before pregnancy. However, prophylactic cervical cerclage did not prevent preterm delivery in these patients.
Cerclage, Cervical ; Cervix Uteri ; Conization ; Female ; Humans ; Pregnancy ; Pregnancy Outcome ; Premature Birth ; Retrospective Studies ; Risk Factors

To investigate the expressions of Fas and Fas ligand (FasL) in human placenta, we studied the expressions of Fas and FasL in placenta with RT-PCR, immunoblotting and immunostaining. We observed amplified products of Fas and FasL transcripts, the band of Fas (52 kDa) and multiple bands of FasL (42-52 kDa) in pla-centa. Fas and FasL localized mainly on fetal vessels and on syncytiotrophoblasts respectively. The differential distribution of Fas and FasL in human placenta may reflect intrinsic expressions of them by trophoblasts during differentiation. The increased expression of Fas in trophoblasts may promote apoptosis of placenta in pathologic condition such as preeclampsia.
Antigens, CD95/biosynthesis/*genetics ; Fas Ligand Protein ; *Gene Expression ; Gene Expression Profiling ; Glycosylation ; Humans ; Immunoblotting/methods ; Membrane Glycoproteins/biosynthesis/*genetics ; Placenta/*metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Trophoblasts/cytology/metabolism

OBJECTIVE: To determine the clinical value of human papillomavirus deoxyribonucleic acid(HPV DNA) testing by polymerase chain reaction(PCR), specifically to examine whether HPV testing could identify the women with Pap smears read as mostly atypical squamous cells of undetermined significance(ASCUS) or more. METHODS: HPV DNA testing by PCR for 3 high-risk cancer associated genotypes(HPV 16, 18, 33), repeat Pap smears and colposcopically directed punch biopsies were performed concurrently on 169 women referred for cervical cancer screening test with a previous Pap smear read as ASCUS or more. RESULTS: HPV DNA testing positivity was significantly associated with abnormal cytology and high-grade squamous intraepithelial lesion(HSIL) and squamous cell carcinoma(SCC) in histology(P=0.034). The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) of Pap smear and HPV testing for identifying 38 cases of histologically confirmed HSIL and carcinoma by different triage protocols(HPV positive or HSIL or SCC) among 169 women were 65.8%(25/38), 85.5%(112/131), 56.8%(25/44) and 89.6%(112/125), respectively. Also sensitivity, specificity, PPV and NPV were varied by ages and more higher in older. CONCLUSION: HPV DNA testing by PCR appears to offer an effective means by which women whose cervical Pap smears have been read as ASCUS or more could be triaged for colposcopically directed biopsy. The sensitivity for HSIL could be maintained in high and specificity markedly improved by HPV genotypes 16, 18, 33.
Biopsy ; Chromosome Aberrations* ; Female ; Genotype ; Human Papillomavirus DNA Tests ; Humans ; Mass Screening ; Polymerase Chain Reaction ; Sensitivity and Specificity ; Triage ; Uterine Cervical Neoplasms

OBJECTIVE: To explore the intracellular signal transduction pathways of IL-1beta and TNF-alpha in inducing matrix metalloproteinase-9 (MMP-9) in human myometrial smooth muscle cells. METHODS: We studied the expression of MMP-9 induced by cytokines (TNF-alpha and IL-1beta) with zymography. The influence of TNF-alpha and IL-1beta on the phosphorylation of Jun N-terminal kinase (JNK) and IkB were studied with immunoblotting for p-JNK and p-IkB. The intranuclear shifting of NF-kB and AP-1 after treatment with TNF-alpha and IL-1beta were evaluated by EMSA. RESULTS: TNF-alpha- and IL-1beta-induced MMP-9 expression was not suppressed by NF-kB inhibitor (CAPE), AP-1 inhibitor (curcumin) and PKC inhibitor (calphostin C) but was inhibited by tyrosine kinase inhibitor (genistein). After treatment of myometrial smooth muscle cells with TNF-alpha and IL-1beta, phosphorylation of JNK and phosphorylation of IkB with degradation of IkB were evidently observed. The intranuclear translocations of NF-kB and AP-1 were strongly enhanced after treatment with TNF-alpha and IL-1 beta as demonstrated in EMSA. CONCLUSION: In myometrial smooth muscle cells, MMP-9 is induced by TNF-alpha and IL-1beta through PKC activation and transcriptional activations of NF-kB and AP-1. Independent of PKC activation, the signaling of TNF-alpha and IL-1beta in the induction of MMP-9 seems to be transmitted by way of either NF-kB or AP-1 activation in myometrial smooth muscle cells.
Cytokines* ; Female ; Humans ; Immunoblotting ; Interleukin-1beta ; Matrix Metalloproteinase 9 ; Muscle, Smooth* ; Myocytes, Smooth Muscle* ; NF-kappa B ; Phosphorylation ; Phosphotransferases ; Pregnancy ; Pregnant Women* ; Protein-Tyrosine Kinases ; Signal Transduction* ; Transcription Factor AP-1 ; Tumor Necrosis Factor-alpha ; Uterus

Since introduce of antithyroid drugs (ATDs) in 1941, they have been widely used for treatment of Graves' disease and other hyperthyroid disorders. However, agranulocytosis, the most serious adverse effect of ATD treatment, has been occasionally reported. Agranulocytosis should be diagnosed and be treated promptly due to possible fatality.We have experienced a 17 year-old girl with PTU (propylthiouracil)-induced agranulocytosis. Initial graulocyte count was 400/mm2, and presenting symtoms were fever and sore throat. She has recovered from agranulocytosis without complications after use of G-CSF (granulocyte-colony stimulating factor). We reviewed and analyzed additional 7 cases of ATD-induced agranulocytosis in Yonsei University Hospital (From 1988 to 1998). We found that ATD-induced agranulocytosis, of which incidence is known to be ranged from 0.1 to 1 per cent, does not seem to have a distinct correlation with sex, age, dosage, and the kind of ATD. Event of agranulocytosis has a tendency to occur within 3 months, and in a few case it has been occasionally detected in asymptomatic patients, routine monitoring of the white blood cell count within 3 months after the start of ATD medication can be helpful in predicting and in detecting agranulocytosis. The treatment of ATD-induced agranulocytosis has been mainly composed of conservative care, but according to introduction and popular application of G-CSF, the use of G-CSF seems to be a promise of a reduction in morbidity and mortality.
Adolescent ; Agranulocytosis* ; Antithyroid Agents ; Female ; Fever ; Granulocyte Colony-Stimulating Factor ; Graves Disease* ; Humans ; Incidence ; Leukocyte Count ; Mortality ; Pharyngitis

BACKGROUND: There have been unexpected cases of failed alcoholic sympathectomy, even though satisfactory effects had been obtained in test blocks with a mixture of contrast media and local anesthetics. It was plausible to suspect the contrast media as a cause of the failure of alcoholic sympathectomy. So, the purpose of this study was to evaluate whether the contrast media can hinder the action of alcohol in alcoholic sympathectomy or not. METHODS: In Sprague - Dawley rats (200 300g), thoracic paravertebral sympathetic chains were exposed and planned regimens were injected in these regions. The rats were divided randomly into seven groups, group C (control group), group D (administration of dye just after exposure), group D-A30 (administration of dye just after exposure, administration of alcohol 30 min. after dye), group A30 (administration of alcohol 30 min. after exposure), group D-A0 (administration of dye just after exposure, administration of alcohol just after dye), group D-A60 (administration of dye just after exposure, administration of alcohol 60 min. after dye) and group D-A90 (administration of dye just after exposure, administration of alcohol 90 min. after dye). Degrees of cytoplasmic contraction were evaluated in the ganglion cells of each member of the experimental groups. RESULTS: The contraction ratios of cytoplasms in group D-A30 and A30 were greater than that of group C and D. The contraction ratios of cytoplasm in group D-A60 and D-A90 were greater than those of group D-A0 and D-A30. CONCLUSIONS: According to our results, the contrast media seems to hinder the action of alcohol in alcoholic sympathectomy.
Alcoholics* ; Anesthetics, Local ; Animals ; Contrast Media* ; Cytoplasm ; Ganglion Cysts ; Humans ; Rats ; Sympathectomy*