PURPOSE: This study aimed to analyse laboratory values according to fever duration, and evaluate the relationship across these values during the acute phase of Kawasaki disease (KD) to aid in the early diagnosis for early-presenting KD and incomplete KD patients. METHODS: Clinical and laboratory data of patients with KD (n=615) were evaluated according to duration of fever at presentation, and were compared between patients with and without coronary artery lesions (CALs). For evaluation of the relationships across laboratory indices, patients with a fever duration of 5 days or 6 days were used (n=204). RESULTS: The mean fever duration was 6.6±2.3 days, and the proportions of patients with CALs was 19.3% (n=114). C-reactive proteins (CRPs) and neutrophil differential values were highest and hemoglobin, albumin, and lymphocyte differential values were lowest in the 6-day group. Patients with CALs had longer total fever duration, higher CRP and neutrophil differential values and lower hemoglobin and albumin values compared to patients without CALs. CRP, albumin, neutrophil differential, and hemoglobin values at the peak inflammation stage of KD showed positive or negative correlations each other. CONCLUSION: The severity of systemic inflammation in KD was reflected in the laboratory values including CRP, neutrophil differential, albumin, and hemoglobin. Observing changes in these laboratory parameters by repeated examinations prior to the peak of inflammation in acute KD may aid in diagnosis of early-presenting KD patients.
C-Reactive Protein ; Coronary Vessels ; Diagnosis ; Early Diagnosis* ; Fever ; Humans ; Inflammation ; Lymphocytes ; Mucocutaneous Lymph Node Syndrome* ; Neutrophils

OBJECTIVES: The objective of this study was to examine the effects of osmotic-controlled release oral delivery system methylphenidate on changes in regional cerebral blood flow (rCBF) in children with attention-deficit hyperactivity disorder (ADHD) using single photon emission computed tomography (SPECT). METHODS: A total of 26 children with ADHD (21 boys, mean age: 9.2±2.05 years old) were recruited. Each ADHD participant was examined for changes in rCBF using technetium-99m-hexamethylpropylene amine oxime brain SPECT before and after 8 weeks methylphenidate medication. Brain SPECT images of pediatric normal controls were selected retrospectively. SPECT images of ADHD children taken before medication were compared with those of pediatric normal controls and those taken after medication using statistical parametric mapping analysis on a voxel-wise basis. RESULTS: Before methylphenidate medication, significantly decreased rCBF in the cerebellum and increased rCBF in the right precuneus, left anterior cingulate, right postcentral gyrus, right inferior parietal lobule and right precentral gyrus were observed in ADHD children compared to pediatric normal controls (p-value<.0005, uncorrected). After medication, we observed significant hypoperfusion in the left thalamus and left cerebellum compared to pediatric normal controls (p-value<.0005, uncorrected). In the comparison between before medication and after medication, there was significant hyperperfusion in the superior frontal gyrus and middle frontal gyrus and significant hypoperfusion in the right insula, right caudate, right middle frontal gyrus, left subcallosal gyrus, left claustrum, and left superior temporal gyrus after methylphenidate medication (p-value<.0005, uncorrected). CONCLUSION: This study supports dysfunctions of fronto-striatal structures and cerebellum in ADHD. We suggest that methylphenidate may have some effects on the frontal lobe, parietal lobe, and cerebellum in children with ADHD.
Basal Ganglia ; Brain ; Cerebellum ; Child* ; Frontal Lobe ; Humans ; Methylphenidate* ; Parietal Lobe ; Rabeprazole ; Retrospective Studies ; Thalamus ; Tomography, Emission-Computed, Single-Photon

OBJECTIVES: This study was conducted in order to describe prescribing practices in treatment of pediatric bipolar disorder in a Korean inpatient sample. METHODS: We performed a retrospective chart review of 66 youths who had been hospitalized and diagnosed with bipolar disorder according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria. Demographics, clinical characteristics, medications used, doses, and related adverse events were examined. RESULTS: Mood stabilizers and/or atypical antipsychotic medications were the primary treatment. Risperidone, valproate, and lithium were the most commonly used. Thirty seven patients (58.1%) were treated with combination therapy of an atypical antipsychotic and mood stabilizer for improvement of manic/mixed symptoms. CONCLUSION: Combination pharmacotherapy was necessary for most patients in this admission sample group. Conduct of further studies will be needed for evaluation of treatment response according to the clinical characteristics, and the safety and efficacy of treatment for child and adolescent bipolar disorder.
Adolescent ; Bipolar Disorder* ; Child ; Demography ; Diagnostic and Statistical Manual of Mental Disorders ; Drug Therapy ; Humans ; Inpatients* ; Lithium ; Retrospective Studies ; Risperidone ; Valproic Acid

OBJECTIVE: People with attention-deficit/hyperactivity disorder (ADHD) exhibit considerable impairment in social, academic, or occupational functioning. The present study aimed to examine the patterns of associations between ADHD symptoms, depression, and family functioning. METHODS: The sample consisted of 1,022 adults randomly selected from a district in Seoul, South Korea. Several self-assessment scales were utilized to rate ADHD symptoms (both past and current), current symptoms of depression, and level of family functioning. ADHD symptoms in the children of these participants were also assessed. Pearson's correlation and multiple linear regression analyses were performed; structural equation modeling (SEM) was conducted to determine the best fitting model. RESULTS: Adult ADHD symptoms were positively associated with depressive symptoms. Depressive symptoms, in turn, mediated the relationship between adult ADHD symptoms and cohesion among family members. In addition, depressive symptoms mediated the relationship between adult ADHD symptoms and their children's ADHD symptoms. CONCLUSION: The relationship between adult ADHD symptoms and family dysfunction may be influenced by depressive symptoms. When treating ADHD in adults, clinicians should pay attention to the presence or absence of depression.
Adult* ; Child* ; Depression* ; Humans ; Korea ; Linear Models ; Self-Assessment ; Seoul ; Weights and Measures

OBJECTIVES: The slow cortical potential (SCP) training is one of the methods of neurofeedback which is considered as an adjunctive treatment for attention deficit hyperactivity disorder (ADHD). The purpose of this study was to investigate the effect of the SCP training in children with ADHD. METHODS: Subjects were consisted of 12 children aged between 7 and 13 years and all of the subjects have completed neuropsychological tests to assess their cognitive and executive functioning, before and after their neurofeedback training. Their parents have completed the Korean-ADHD Rating Scale (ARS). Each subject was given 30 sessions of SCP training. RESULTS: The inattention scores and total ARS scores of the subjects have decreased (Z=-2.54, p<0.05, Z=-2.26, p<0.05, respectively) after training, but the hyperactivity/impulsivity scores did not show significant improvement. The commission error scores for both the visual and auditory ADHD diagnostic system (ADS) showed a trend toward improvement after training (p=0.053, p=0.092, respectively). The larger improvement of positive task of feedback trial, which is one of the methods of SCP training, was associated with the larger reduction of ARS total scores (p<0.05) and the larger improvement of negative task of transfer trial was associated with a larger reduction of omission error scores of auditory ADS (p<0.05). CONCLUSION: This study suggests that the SCP neurofeedback program may improve ADHD symptoms and assumes that SCP training is a viable treatment option for ADHD treatment.
Aged ; Attention Deficit Disorder with Hyperactivity ; Child ; Humans ; Neurofeedback ; Neuropsychological Tests ; Parents

PURPOSE: Dexmedetomidine, a full agonist of alpha2B-adrenoceptors, is used for analgesia and sedation in the intensive care units. Dexmedetomidine produces an initial transient hypertension due to the activation of post-junctional alpha2B-adrenoceptors on vascular smooth muscle cells (SMCs). The aims of this in vitro study were to identify mitogen-activated protein kinase (MAPK) isoforms that are primarily involved in full, alpha2B-adrenoceptor agonist, dexmedetomidine-induced contraction of isolated rat aortic SMCs. MATERIALS AND METHODS: Rat thoracic aortic rings without endothelium were isolated and suspended for isometric tension recording. Cumulative dexmedetomidine (10(-9) to 10(-6) M) dose-response curves were generated in the presence or absence of extracellular signal-regulated kinase (ERK) inhibitor PD 98059, p38 MAPK inhibitor SB 203580, c-Jun NH2-terminal kinase (JNK) inhibitor SP 600125, L-type calcium channel blocker (verapamil and nifedipine), and alpha2-adrenoceptor inhibitor atipamezole. Dexmedetomidine-induced phosphorylation of ERK, JNK, and p38 MAPK in rat aortic SMCs was detected using Western blotting. RESULTS: SP 600125 (10(-6) to 10(-5) M) attenuated dexmedetomidine-evoked contraction in a concentration-dependent manner, whereas PD 98059 had no effect on dexmedetomidine-induced contraction. SB 203580 (10(-5) M) attenuated dexmedetomidine-induced contraction. Dexmedetomidine-evoked contractions were both abolished by atipamezole and attenuated by verapamil and nifedipine. Dexmedetomidine induced phosphorylation of JNK and p38 MAPK in rat aortic SMCs, but did not induce phosphorylation of ERK. CONCLUSION: Dexmedetomidine-induced contraction involves a JNK- and p38 MAPK-mediated pathway downstream of alpha2-adrenoceptor stimulation in rat aortic SMCs. In addition, dexmedetomidine-induced contractions are primarily dependent on calcium influx via L-type calcium channels.
Adrenergic alpha-2 Receptor Agonists/*pharmacology ; Animals ; Anthracenes/pharmacology ; Aorta/cytology ; Dexmedetomidine/*pharmacology ; Enzyme Inhibitors/pharmacology ; Extracellular Signal-Regulated MAP Kinases/antagonists & inhibitors/physiology ; Flavonoids/pharmacology ; Imidazoles/pharmacology ; JNK Mitogen-Activated Protein Kinases/antagonists & inhibitors/*physiology ; Male ; *Muscle Contraction ; Muscle, Smooth, Vascular/drug effects/enzymology/*physiology ; Protein Isoforms/antagonists & inhibitors/physiology ; Pyridines/pharmacology ; Rats ; Rats, Sprague-Dawley ; p38 Mitogen-Activated Protein Kinases/antagonists & inhibitors/physiology

AMP-activated protein kinase (AMPK), an enzyme involved in energy homeostasis, regulates inflammatory responses, but its precise mechanisms are not fully understood. Recent evidence has shown that resveratrol (RES), an AMPK activator, reduces prostaglandin E2 production in lipopolysaccharide (LPS)-treated microglia. Here, we examined the effect of RES on nuclear factor kappa B (NF-kappaB) dependent cyclooxygenase (COX)-2 activation in LPS-treated RWA 264.7 macrophages. We found that treatment with RES increased AMPK activation. AMPK and acetyl CoA carboxylase phosphorylation were attenuated in cells treated with LPS+RES, compared to cells treated with LPS alone. RES inhibited tumor necrosis factor (TNF)-alpha and TNF receptor 1 in LPS-treated cells. Finally, RES inhibited LPS-induced NF-kappaB translocation into the nucleus and COX-2 expression. Moreover, the effects of 5-aminoimidazole-4-carboxamide ribose and compound C were consistent with the effects of RES in LPS-treated cells. Taken together, these results suggest that the anti-inflammatory action of RES in RAW 264.7 macrophages is dependent on AMPK activation and is associated with inhibition of the LPS-stimulated NF-kappaB-dependent COX-2 signaling pathway.
Acetyl-CoA Carboxylase ; AMP-Activated Protein Kinases ; Dinoprostone ; Homeostasis ; Macrophages ; Microglia ; NF-kappa B ; Phosphorylation ; Prostaglandin-Endoperoxide Synthases ; Receptors, Tumor Necrosis Factor ; Ribose ; Stilbenes ; Tumor Necrosis Factor-alpha

Vascular inflammation process has been suggested to be an important risk factor in the development of atherosclerosis. Recently we reported that induction of peroxisome proliferator-activated receptor-gamma (PPAR-gamma) selectively inhibits vascular cell adhesion molecule-1 (VCAM-1) but not intercellular cell adhesion molecule-1 (ICAM-1) in tumor necrosis factor (TNF)-alpha-activated human umbilical vein endothelial cells (HUVEC). In this study, we investigated whether genipin inhibits expression of cellular adhesion molecules, which is relevant to inflammation. Pretreatment with genipin reduced reactive oxygen species (ROS) production and expression of VCAM-1, but not ICAM-1 in TNF-alpha-activated HUVEC. Genipin dose- and time-dependently increased PPAR-gamma expression and inhibited TNF-alpha-induced phosphorylation of Akt and PKC with different degrees. Finally, genipin prevented TNF-alpha-induced adhesion of U937 monocytic cells to HUVEC. Taken together, these results indicate that upregualtion of PPAR-gamma by genipin selectively inhibits TNF-alpha-induced expression of VCAM-1, in which regulation of Akt and/or PKC play a key role. We concluded that genipin can be used for the treatment of cardiovascular disorders such as atherosclerosis.
Atherosclerosis ; Cell Adhesion ; Endothelial Cells ; Human Umbilical Vein Endothelial Cells ; Humans ; Inflammation ; Intercellular Adhesion Molecule-1 ; Iridoids ; Peroxisomes ; Phosphorylation ; Reactive Oxygen Species ; Risk Factors ; Tumor Necrosis Factor-alpha ; Up-Regulation ; Vascular Cell Adhesion Molecule-1

Due to co-morbidities and treatment resistant nature of pervasive developmental disorder (PDD), diverse combinations of regimens have been tried. This retrospective study aimed to explore adjunctive use of aripiprazole in children with PDD. Changes in illness severity were measured by Clinical Global Impression of Severity (CGI-S) and Clinical Global Impression of Improvement (CGI-I) in 14 aripiprazole-treated patients with PDD. Improvement of illness severity was observed after aripiprazole add-on (5.8+/-0.8 to 4.9+/-1.0, Z=-2.75, p=0.001). Mean dosage was 7.7 mg/day [standard deviation (SD) 3.3, range 5-15]. A higher mean dosage was observed in group with improvement in symptoms (t=-2.33, df =12, p=0.004). The target symptoms most effectively improved after using aripiprazole were positive psychotic symptoms (mean CGI-I: 2.0+/-1.4, 3 responders/4 patients, 75% response) followed by aggressive behavior (2.5+/-1.7, 3/4, 75%), self-injurious behavior (2.0+/-1.0, 2/3, 67%), stereotypic behavior (2.7+/-1.2, 2/3, 67%), tic (2.8+/-1.0, 2/4, 50%), irritability (3.5+/-2.1, 1/2, 50%), obsessive behavior (2.5+/-2.1, 1/3, 33%), hyperactivity (3.4+/-1.6, 3/7, 43%) and mood fluctuation (3, 0/1, no response). Five patients (35%) discontinued aripiprazole due to treatment-emergent adverse effects (akathisia, insomnia, withdrawal). The results of this study suggest that aripiprazole augmentation may be used safely in maladaptive behaviors of some populations of PDD. However, future studies are required to con-firm these preliminary findings.
Autistic Disorder ; Child ; Humans ; Obsessive Behavior ; Piperazines ; Quinolones ; Retrospective Studies ; Self-Injurious Behavior ; Sleep Initiation and Maintenance Disorders ; Tics ; Aripiprazole

Long-term survivors of hematopoietic stem cell transplantation (HSCT) during childhood and adolescence are at risk of developing endocrine complications. The purpose of this study was to evaluate the long-term endocrine complications and their associated risk factors among such patients. We reviewed the data from 111 patients (59 males and 52 females) who underwent HSCT at the mean age of 8.3+/-4.1 yr. Thirty patients (27.0%) had growth impairment, and seven (21.2%) out of 33 patients who attained final height reached final height below 2 standard deviation (SD). The final height SD score of the patients conditioned with total body irradiation (TBI) was significantly lower than that of the patients conditioned without TBI (-1.18+/-1.14 vs. -0.19+/-0.78, P=0.011). Thirteen patients (11.7%) developed hypothyroidism (11 subclinical, 2 central) 3.8+/-1.8 (range 1.6-6.2) yr after HSCT. Nineteen (65.5%) out of 29 females had evidence of gonadal dysfunction, and 18 (64.3%) out of 28 males had evidence of gonadal dysfunction. The risk for gonadal dysfunction was significantly higher in females conditioned with busulfan/cyclophosphamide (P=0.003). These results suggest that the majority of patients treated with HSCT during childhood and adolescence have one or more endocrine complications. Therefore, multiple endocrine functions should be monitored periodically after HSCT until they reach adult age.
Adolescent ; Adult ; Body Height ; Child ; Child, Preschool ; Endocrine System Diseases/*etiology/physiopathology ; Female ; Gonadal Disorders/etiology ; Growth Disorders/etiology ; Hematopoietic Stem Cell Transplantation/*adverse effects ; Humans ; Infant ; Male ; Thyroid Diseases/etiology ; Transplantation Conditioning/adverse effects ; Whole-Body Irradiation/adverse effects