Background: The clinical features of pediatric rhabdomyolysis differ from those of the adults with rhabdomyolysis; however, multicenter studies are lacking. This study aimed to investigate the characteristics of pediatric rhabdomyolysis and reveal the risk factors for acute kidney injury (AKI) in such cases. Methods: This retrospective study analyzed the medical records of children and adolescents diagnosed with rhabdomyolysis at 23 hospitals in South Korea between January 2007 and December 2016. Results: Among 880 patients, those aged 3 to 5 years old composed the largest subgroup (19.4%), and all age subgroups were predominantly male. The incidence of AKI was 11.3%. Neurological disorders (53%) and infection (44%) were the most common underlying disorder and cause of rhabdomyolysis, respectively. The median age at diagnosis in the AKI subgroup was older than that in the non-AKI subgroup (12.2 years vs. 8.0 years). There were no significant differences in body mass index, myalgia, dark-colored urine, or the number of causal factors between the two AKI-status subgroups. The multivariate logistic regression model indicated that the following factors were independently associated with AKI: multiorgan failure, presence of an underlying disorder, strong positive urine occult blood, increased aspartate aminotransferase and uric acid levels, and reduced calcium levels. Conclusions Our study revealed characteristic clinical and laboratory features of rhabdomyolysis in a Korean pediatric population and highlighted the risk factors for AKI in these cases. Our findings will contribute to a greater understanding of pediatric rhabdomyolysis and may enable early intervention against rhabdomyolysis-induced AKI.

Carbon nanotubes (CNTs) are nanomaterials that have been employed in generating diverse materials. We previously reported that CNTs induce cell death in macrophages, possibly via asbestosis. Therefore, we generated CNT-attached polyvinylidene fluoride (PVDF), which is an established polymer in membrane technology, and then examined whether CNT-attached PVDF is immunologically safe for medical purposes compared to CNT alone. To test this, we treated RAW 264.7 murine macrophages (RAW cells) with CNT-attached PVDF and analyzed the production of nitric oxide (NO), a potent proinflammatory mediator, in these cells. RAW cells treated with CNT-attached PVDF showed reduced NO production in response to lipopolysaccharide. However, the same treatment also decreased the cell number suggesting that this treatment can alter the homeostasis of RAW cells. Although cell cycle of RAW cells was increased by PVDF treatment with or without CNTs, apoptosis was enhanced in these cells. Taken together, these results indicate that PVDF with or without CNTs modulates inflammatory responses possibly due to activation-induced cell death in macrophages.
Apoptosis ; Asbestosis ; Cell Count ; Cell Cycle ; Cell Death* ; Fluorides* ; Homeostasis ; Inflammation ; Macrophages* ; Membranes ; Nanostructures ; Nanotubes, Carbon ; Nitric Oxide ; Polymers

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

OBJECTIVES: The purpose of this study was to suggest factors related with the job satisfaction of interviewers who participated in Community Health Survey (CHS) in Jeonbuk province. METHODS: An interview survey was carried out, targeting all 70 interviewers who were working at Jeonbuk CHS from Oct. 20 to Oct. 31. 2011. RESULTS: As a result of carrying out a univariate analysis of job satisfaction factors by general characteristics, this study found out that interviewers at the age below 40 showed a higher emotional factor-related score than interviewers at the age over 40, and interviewers having participated a statistic survey more than 6 times showed a higher emotional factor-related score than interviewers having participated a statistic survey less than 5 times. As a result of carrying out a multiple regression analysis of factors by general characteristics, this study found out that as interviewers were older, they showed a lower emotional factor-related satisfaction score and job performance factor-related satisfaction score, and their job satisfaction score was higher when a single interviewer conducts a survey than when more than 2 interviewers conduct a survey. CONCLUSIONS: The interviewer's job satisfaction score was relatively low. This results strongly suggest that it is necessary to understand their job performance environment and work environment most of all. It is expected that the results of this study will be used as basic data needed to increase the job satisfaction of interviewers from CHS and improve the quality of survey data.
Health Surveys* ; Interviews as Topic ; Jeollabuk-do ; Job Satisfaction*

The purpose of this study was to establish a prediction rule for severe illness in adult patients hospitalized with pandemic influenza A (H1N1) 2009. At the time of initial presentation, the baseline characteristics of those with severe illness (i.e., admission to intensive care unit, mechanical ventilation, or death) were compared to those of patients with non-severe illnesses. A total of 709 adults hospitalized with pandemic influenza A (H1N1) 2009 were included: 75 severe and 634 non-severe cases. The multivariate analysis demonstrated that altered mental status, hypoxia (PaO2/FiO2 < or = 250), bilateral lung infiltration, and old age (> or = 65 yr) were independent risk factors for severe cases (all P < 0.001). The area under the ROC curve (0.834 [95% CI, 0.778-0.890]) of the number of risk factors were not significantly different with that of APACHE II score (0.840 [95% CI, 0.790-0.891]) (P = 0.496). The presence of > or = 2 risk factors had a higher sensitivity, specificity, positive predictive value and negative predictive value than an APACHE II score of > or = 13. As a prediction rule, the presence of > or = 2 these risk factors is a powerful and easy-to-use predictor of the severity in adult patients hospitalized with pandemic influenza A (H1N1) 2009.
APACHE ; Adult ; Aged ; Antiviral Agents/therapeutic use ; Female ; Hospitalization ; Humans ; Influenza A Virus, H1N1 Subtype/*isolation & purification ; Influenza, Human/drug therapy/*epidemiology/mortality ; Intensive Care Units ; Male ; Middle Aged ; Pandemics ; Predictive Value of Tests ; ROC Curve ; Respiration, Artificial ; Risk Factors ; Severity of Illness Index

PURPOSE:Vascular endothelial growth factor (VEGF) is known to play an important role in the process of angiogenesis and chronic inflammation. Plasminogen activator inhibitor (PAI)-1 and tissue plasminogen activator (tPA) are main regulators of the plasmin system. The functions of these components are shown to be closely associated and recent studies have reported their potential roles in the asthmatic airways. We determined plasma levels of soluble VEGF (sVEGF), PAI-1, tPA and endothelin (ET)-1 in children with recurrent early wheeze. Our purpose was to examine whether there would be any difference in these biomarkers in relation to the relapse rate of wheezing. METHODS:Fifty-eight children aged 2-6 years who were admitted with acute wheezing were enrolled. They were divided into two groups: patients with more than three relapses of wheezing (group 1, n=34) and those with less than one relapse (group 2, n=24). Plasma levels of sVEGF, PAI-1, ET-1 and tPA on admission were measured using ELISA in the two patient groups and controls (n=16). RESULTS:PAI-1, sVEGF and tPA significantly increased during acute wheezing episode. The levels of these biomarkers were significantly higher in group 1 than in group 2 (P<0.01). ET-1 showed no significant difference between the patient groups and controls. CONCLUSION:Our study showed significantly elevated plasma levels of sVEGF and plasmin system regulators in children with recurrent early wheeze, which was even higher in the group with more frequent relapses. Our results suggest that these biomarkers may be associated with airway inflammation and may contribute to the later development of asthma in these children.
Asthma ; Biomarkers ; Child ; Endothelial Growth Factors ; Endothelins ; Enzyme-Linked Immunosorbent Assay ; Fibrinolysin* ; Humans ; Inflammation ; Plasma* ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators ; Recurrence ; Respiratory Sounds ; Tissue Plasminogen Activator ; Vascular Endothelial Growth Factor A*

PURPOSE:Vascular endothelial growth factor (VEGF) is known to play an important role in the process of angiogenesis and chronic inflammation. Plasminogen activator inhibitor (PAI)-1 and tissue plasminogen activator (tPA) are main regulators of the plasmin system. The functions of these components are shown to be closely associated and recent studies have reported their potential roles in the asthmatic airways. We determined plasma levels of soluble VEGF (sVEGF), PAI-1, tPA and endothelin (ET)-1 in children with recurrent early wheeze. Our purpose was to examine whether there would be any difference in these biomarkers in relation to the relapse rate of wheezing. METHODS:Fifty-eight children aged 2-6 years who were admitted with acute wheezing were enrolled. They were divided into two groups: patients with more than three relapses of wheezing (group 1, n=34) and those with less than one relapse (group 2, n=24). Plasma levels of sVEGF, PAI-1, ET-1 and tPA on admission were measured using ELISA in the two patient groups and controls (n=16). RESULTS:PAI-1, sVEGF and tPA significantly increased during acute wheezing episode. The levels of these biomarkers were significantly higher in group 1 than in group 2 (P<0.01). ET-1 showed no significant difference between the patient groups and controls. CONCLUSION:Our study showed significantly elevated plasma levels of sVEGF and plasmin system regulators in children with recurrent early wheeze, which was even higher in the group with more frequent relapses. Our results suggest that these biomarkers may be associated with airway inflammation and may contribute to the later development of asthma in these children.
Asthma ; Biomarkers ; Child ; Endothelial Growth Factors ; Endothelins ; Enzyme-Linked Immunosorbent Assay ; Fibrinolysin* ; Humans ; Inflammation ; Plasma* ; Plasminogen Activator Inhibitor 1 ; Plasminogen Activators ; Recurrence ; Respiratory Sounds ; Tissue Plasminogen Activator ; Vascular Endothelial Growth Factor A*

PURPOSE: Maternal premature rupture of membrane(PROM) over 24 hours is a risk factor in neonatal sepsis and a main cause of administration to neonatal intensive care unit. Levels of proinflammatory cytokines were studied to diagnose and treat early in newborn infants with sepsis and with a history of maternal PROM. METHODS: Interleukin-1beta(IL-1beta), Interleukin-6(IL-6), Interleukin-8(IL-8), and tumor necrosis factor-alpha(TNF-alpha) were checked using ELISA kits in neonatal infants who were admitted to the Catholic University of Daegu from May, 2002 to Feb, 2003. We divided them into three sets of groups; sepsis group(n=26), PROM group(n=20), and control group(n=24). RESULTS: Levels of IL-1beta, IL-8, and TNF-alpha in the sepsis group were all significantly statistically different from the PROM and the control group, but there was no significant difference between the PROM group and the control group. Levels of IL-6 in the sepsis, the PROM, and the control group were all significantly statistically different from each other. CONCLUSION: Levels of IL-1beta, IL-6, IL-8, and TNF-alpha in the sepsis group increased but only levels of IL-6 in the PROM group increased. Thus we can use cytokines as a marker of neonatal sepsis, especially, in neonatal infants with a history of maternal PROM.
Cytokines* ; Daegu ; Enzyme-Linked Immunosorbent Assay ; Humans ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Interleukin-1beta ; Interleukin-6 ; Interleukin-8 ; Necrosis ; Risk Factors ; Rupture ; Sepsis* ; Tumor Necrosis Factor-alpha

OBJECTIVE: To evaluate the learning achievement and satisfaction levels for the Field Epidemiology Specialist Training Program (FESTP), on infectious disease control between March 19 and October 31, 2002. METHODS: The FESTP was designed as a set of 84 hours curricula including lectures, discussions, self-studies, and field practicals, and organized both centrally and locally by the Division of Communicable Disease Control of the National Institute of Health and 11 universities. Before and after the program, a questionnaire survey on the educational need (49 items) and satisfaction (15 items) was conducted on 484 trainees, who were responsible for communicable disease control and immunization at 242 regional health centers. The data were analyzed with paired t-tests for comparison of the educational needs between the pre and post scores. RESULTS: The average score for satisfaction was 3.06 out of 5.0; with relatively higher scores for sincerity (4.10) and professionalism (4.01) of the tutors, adequacy (3.54) and clearness (3.51) of the evaluation criteria, usefulness (3.54) and fitness (3.52) of the contents, but with relatively lower satisfaction for schedule (2.96) and self-studies (2.91). The average for requirement for education improved, as shown by the decrease from 2.72 to 2.22 (p< .0001) with the biggest decrease in the outbreak investigation from 2.60 to 2.08. CONCLUSION: The FESTP was evaluated as being effective, the trainees showed moderate satisfaction and decrease educational needs. However, the actual schedules and self-studies should be rearranged to improve the satisfaction level.
Appointments and Schedules ; Communicable Disease Control ; Communicable Diseases ; Curriculum ; Education* ; Epidemiology* ; Immunization ; Learning ; Lectures ; Professionalism ; Specialization*

BACKGROUND: Exertional symptoms, dyspnea and impaired effort tolerance are common in patients with Graves' disease. Proposed explanations include: high-output left heart failure, ineffective oxygen utilization and respiratory muscle weakness. In addition, pulmonary hypertension has also been reported in patients with Graves' disease. A high prevalence of hypothyroidism and positive thyroid autoantibody were also observed in patients with pulmonary arterial hypertension. Therefore, the pulmonary artery pressure in patients with Graves' disease was evaluated. METHODS: Two-dimensional and Doppler echocardiographic examinations (Hewlett Packard Sonos 2500) were performed to determine the pulmonary artery (PA) pressure in 26 Graves' disease patients, both before and after treatment (23 patients with propylthiouracil and 3 with RAI), and in 10 euthyroid controls. The changes in the PA pressure after treatment were evaluated in 13 patients with Graves' disease, who became euthyroid after treatment. RESULTS: The pulmonary artery pressure was increased in the untreated Graves' disease patients compared to the normal controls (23.5+/-2.32 vs. 29.6+/-10.3 mmHg). 38.5% of the Graves' disease patients (10/26) showed pulmonary arterial hypertension (PA>30 mmHg) and the serum TBII levelwas higher in the Graves' disease patients with pulmonary arterial hypertension than in those with normal PA pressure (P<0.05). In the Graves' patients who became euthyroid after treatment, the PA pressure was significantly decreased. CONCLUSION: 38.5% of the untreated Graves' disease patients showed pulmonary arterial hypertension, and the pulmonary artery pressure was significantly decreased in those who became euthyroid after treatment. The pathogenesis and clinical importance of pulmonary arterial hypertension in Graves' disease requires further studies.
Dyspnea ; Echocardiography ; Graves Disease ; Heart Failure ; Humans ; Hypertension ; Hypertension, Pulmonary ; Hypothyroidism ; Oxygen ; Prevalence ; Propylthiouracil ; Pulmonary Artery* ; Respiratory Muscles ; Thyroid Gland