Incidence and Mortality Trends in Critically Ill Children: A Korean Population-Based Study

Background@#Monitoring mortality trends can help design ways to improve survival, but observation of national mortality trends in critically ill children is lacking for the Korean population Methods: We analyzed the incidence and mortality trends of children younger than 18 years admitted to an intensive care unit (ICU) from 2012 to 2018 using the Korean National Health Insurance database. Neonates and neonatal ICU admissions were excluded. Multivariable logistic regression analyses were performed to estimate the odds ratio of in-hospital mortality according to admission year. Trends in incidence and in-hospital mortality of subgroups according to admission department, age, presence of intensivists, admissions to pediatric ICU, mechanical ventilation, and use of vasopressors were evaluated. @*Results@#The overall mortality of critically ill children was 4.4%. There was a significant decrease in mortality from 5.5% in 2012 to 4.1% in 2018 (Pfor trend < 0.001). The incidence of ICU admission in children remained around 8.5/10,000 population years (Pfor trend = 0.069). In-hospital mortality decreased by 9.2% yearly in adjusted analysis (P < 0.001). The presence of dedicated intensivists (Pfor trend < 0.001, mortality decrease from 5.7% to 4.0%) and admission to pediatric ICU (Pfor trend < 0.001, mortality decrease from 5.0% to 3.2%) were associated with significant decreasing trends in mortality. @*Conclusion@#Mortality among critically ill children improved during the study period, and the improving trend was prominent in children with high treatment requirements. Varying mortality trends, according to ICU organizations, highlight that advances in medical knowledge should be supported structurally.

A retrospective comparison for prediction of optimal length of right subclavian vein catheterization in infants: landmark-based estimation vs. linear regression model

Background@#The optimal insertion length for right subclavian vein catheterization in infants has not been determined. This study retrospectively compared landmark-based and linear regression model-based estimation of optimal insertion length for right subclavian vein catheterization in pediatric patients of corrected age < 1 year. @*Methods@#Fifty catheterizations of the right subclavian vein were analyzed. The landmark related distances were: from the needle insertion point (I) to the tip of the sternal head of the right clavicle (A) and from A to the midpoint (B) of the perpendicular line drawn from the sternal head of the right clavicle to the line connecting the nipples. The optimal length of insertion was retrospectively determined by reviewing post-procedural chest radiographs. Estimates using a landmark-based equation (IA + AB – intercept) and a linear regression model were compared with the optimal length of insertion. @*Results@#A landmark-based equation was determined as IA + AB – 5. The mean difference between the landmark-based estimate and the optimal insertion length was 1.0 mm (95% limits of agreement –18.2 to 20.3 mm). The mean difference between the linear regression model (26.681 – 4.014 × weight + 0.576 × IA + 0.537 × AB – 0.482 × postmenstrual age) and the optimal insertion length was 0 mm (95% limits of agreement –16.7 to 16.7 mm). The difference between the estimates using these two methods was not significant. @*Conclusion@#A simple landmark-based equation may be useful for estimating optimal insertion length in pediatric patients of corrected age < 1 year undergoing right subclavian vein catheterization.

RNA-Seq De Novo Assembly and Differential Transcriptome Analysis of Korean Medicinal Herb Cirsium japonicum var. spinossimum

Cirsium japonicum belongs to the Asteraceae or Compositae family and is a medicinal plant in Asia that has a variety of effects, including tumour inhibition, improved immunity with flavones, and antidiabetic and hepatoprotective effects. Silymarin is synthesized by 4-coumaroyl-CoA via both the flavonoid and phenylpropanoid pathways to produce the immediate precursors taxifolin and coniferyl alcohol. Then, the oxidative radicalization of taxifolin and coniferyl alcohol produces silymarin. We identified the expression of genes related to the synthesis of silymarin in C. japonicum in three different tissues, namely, flowers, leaves, and roots, through RNA sequencing. We obtained 51,133 unigenes from transcriptome sequencing by de novo assembly using Trinity v2.1.1, TransDecoder v2.0.1, and CD-HIT v4.6 software. The differentially expressed gene analysis revealed that the expression of genes related to the flavonoid pathway was higher in the flowers, whereas the phenylpropanoid pathway was more highly expressed in the roots. In this study, we established a global transcriptome dataset for C. japonicum. The data shall not only be useful to focus more deeply on the genes related to product medicinal metabolite including flavolignan but also to study the functional genomics for genetic engineering of C. japonicum.

Characteristics and prognostic factors of previously healthy children who required respiratory support in a pediatric intensive care unit

PURPOSE: Comorbidities have been considered a mortality risk factor in pediatric critical care patients. We studied the characteristics and prognostic factors of children without comorbidities who were admitted to the intensive care unit (ICU) due to respiratory failure. METHODS: We reviewed the medical charts of patients (< 18 years) admitted to the ICU for respiratory support in a single tertiary center between January 2006 and December 2016. Patients with comorbidities and perioperative statuses were excluded. RESULTS: Of the 4,712 ICU patients, 73 (1.5%) were included in this study. The median age was 31 months (8–57) and 51 (69.9%) were boys. Twenty-nine patients (39.7%) presented with pneumonia, 14 (19.2%) with acute respiratory distress syndrome (ARDS), and 11 (15.1%) with obstructive airway disease. The median duration of ICU hospitalization was 5 days (2–14.5), and 45 of the 73 patients (61.6%) needed mechanical ventilation. Mortality was 13.7% (10/73). None of the patients with pneumonia or obstructive airway disease died. The most frequent cause of death was ARDS (5 of 10, 50%). In adjusted analysis, the extent of extrapulmonary organ dysfunction was significantly associated with mortality (odds ratio, 2.89; 95% confidence interval, 1.17–7.11; P=0.023). CONCLUSION: The mortality rate of previously healthy pediatric patients needing respiratory support in the ICU should not be negligible. Multiple organ dysfunctions might be a significant risk factor for mortality in such patients.

Modification of nutrition strategy for improvement of postnatal growth in very low birth weight infants / 소아과

PURPOSE: To identify the effects of modified parenteral nutrition (PN) and enteral nutrition (EN) regimens on the growth of very low birth weight (VLBW) infants. METHODS: The study included VLBW infants weighing <1,500 g, admitted to Chungnam National University Hospital between October 2010 and April 2014, who were alive at the time of discharge. Subjects were divided according to 3 periods: period 1 (n=37); prior to the PN and EN regimen being modified, period 2 (n=50); following the PN-only regimen modification, period 3 (n=37); following both PN and EN regimen modification. The modified PN regimen provided 3 g/kg/day of protein and 1 g/kg/day of lipid on the first day of life. The modified EN regimen provided 3.5-4.5 g/kg/day of protein and 150 kcal/kg/day of energy. We investigated growth rate, anthropometric measurements at 40 weeks postconceptional age (PCA) and the incidence of extrauterine growth restriction (EUGR) at 40 weeks PCA. RESULTS: Across the 3 periods, clinical characteristics, including gestational age, anthropometric measurements at birth, multiple births, sex, Apgar score, surfactant use and PDA treatment, were similar. Growth rates for weight and height, from time of full enteral feeding to 40 weeks PCA, were higher in period 3. Anthropometric measurements at 40 weeks PCA were greatest in period 3. Incidence of weight, height and head circumference EUGR at 40 weeks PCA decreased in period 3. CONCLUSION: Beginning PN earlier, with a greater supply of protein and energy during PN and EN, is advantageous for postnatal growth in VLBW infants.

Repair of Inferomedial Orbital Wall Fractures with Bony Strut Loss by Overlapping Absorbable Copolymer

PURPOSE: To report the results of surgical repairing of inferomedial orbital wall fractures accompanied with loss of bony strut by an overlapping method using Resorb X(R) plates (poly(D,L)-lactic acid). METHODS: To repair inferomedial orbital wall fractures with loss of bony strut, we bent the medial aspect of the plate for floor fracture according to the anatomical structure and then inserted the floor implant, which was supported by anterior, posterior and lateral margins of the floor fracture. Then, the medial implant, which was supported by the bent medial edge of the floor implant, was inserted. Postoperatively, we analyzed the outcomes of 21 patients regarding postoperative enophthalmos, limitation of eye movement (LOM) and diplopia. The diagonal lengths of the orbit in the operated side were compared with the non-traumatized side based on the coronal view of the postoperative CT scans to determine the success or failure of the reconstruction. RESULTS: The average postoperative enophthalmic value was 0.5 mm, and no significant differences between the orbital diagonal lengths of the operated and non-operated eyes were observed. The LOM shown in 7 out of 8 patients was completely resolved during the postoperative follow-up period. All patients with diplopia, including one patient who showed partial remission of LOM, experienced complete symptom resolution. No other complications related to the implant were recorded. CONCLUSIONS: Inferomedial orbital wall fractures with the loss of bony strut can be successfully repaired by the overlapping method using Resorb X(R) implants.

A Case of Abducens Nerve Palsy after Percutaneous Nerve Block for Trigeminal Neuralgia

PURPOSE: To report a case of abducens nerve palsy after a percutaneous nerve blocking procedure for trigeminal neuralgia. CASE SUMMARY: A 35-year-old female complaining of stabbing pain in the right maxillary area 4 months in duration was diagnosed with trigeminal neuralgia at a pain clinic. The patient underwent a percutaneous trigeminal nerve blocking procedure using alcohol at the right maxillary nerve. After the procedure, the patient was referred to an ophthalmologic service for horizontal diplopia and abduction defect of her right eye. Her corrected visual acuity, intraocular pressure, pupillary response, anterior segment and fundus were normal bilaterally. The patient had right esotropia of 38 prism diopters in primary gaze (70 prism diopters in right gaze, 20 prism diopters in left gaze) with limited abduction of -3 in the right eye. She was diagnosed with abducens nerve palsy of the right eye. Three months after initial presentation, the patient had intermittent esotropia of 4 prism diopters at right gaze and orthophoria at the other diagnostic gazes; she presented no diplopia. CONCLUSIONS: In the present case study, abducens nerve palsy following a percutaneous trigeminal nerve blocking procedure resolved over 3 months. Because the abducens nerve is adjacent to the trigeminal nerve near the foramen ovale based on anatomical structure, when performing a percutaneous trigeminal blocking procedure, the surgeon should be aware that deep needle puncture could cause abducens nerve palsy.

Myopic Progression and Postoperative Exodrift in Patients with Intermittent Exotropia

PURPOSE: To investigate the relationship between myopic progression and exodrift after surgery in patients with intermittent exotropia (X[T]). METHODS: Eighty-five patients who underwent bilateral lateral rectus recession for X(T) and had a follow-up of more than 1 year were recruited for the present study. Progression of myopia was determined by measuring the difference in spherical equivalent of both eyes between the initial and final refraction divided by the total follow-up time per patient. Postoperative exodrift was calculated by subtracting the deviation at postoperative 6 weeks from the deviation at the last follow-up, and the deviation at postoperative day 1 from the deviation at postoperative 6 weeks. Linear regression was conducted to determine the relationship between postoperative exodrift and myopic progression. The risk factors for recurrence, defined as exodeviation of 10 prism diopters or more at the final examination, were also analyzed. RESULTS: Sixty-eight (80.0%) subjects showed myopic progression of -0.50 diopters or more, and 47 (55.3%) had recurrence of exotropia during the mean follow-up period of 37.9 months. Patients with myopic progression showed more exotropic drift after postoperative 6 weeks than the patients without myopic progression (p < 0.01). Immediate postoperative overcorrection, oblique dysfunction, and a short follow-up period were associated with a low recurrence, whereas preoperative angle of exodeviation, sensory status, and age at the time of surgery were not. CONCLUSIONS: In patients who underwent bilateral lateral rectus recession for X(T), a greater myopic progression was related with greater postoperative exodrift. As the development of myopia was observed to be axial in nature, the results from the present study raises the possibility that ocular elongation may reduce the effect of recession.

A STUDY ON THE ANALYSIS OF THE CURVE OF SPEE ON THE GNATHOLOGICAL CAST AND THE CEPHALOMETRIC RADIOGRAPH / 대한치과보철학회지

Clinically, the curve of Spee is widely applied as a determined level of the occlusal curvature when the oral rehabilitation and the reconstruction of the prosthesis is needed at the malalignment dentition due to the missing, extrusion, and the inclination of the teeth. The purpose of this study was to analyze the curve of Spee of the occlusal curvature which influences to the occlusal form and the location three dimensionally, and then was to measure the radius and the degree of curvature of the curve of Spee and also was to investigate the influence to the cuspal inclination according to the change of the inclination of the curve of Spee which was analyzed by AutoCAD R.13 program at the gnathological cast and the cephalometric radiograph. The following results were obtained : 1. The radius of the curve of Spee was the mean of 11.74+/-3.64cm in the model, 12.75+/-4.63cm in the radiograph and there was no significant difference statistically between the model and the radiograph(P >0.001). 2. The radius and the degree of curvature of the curve of Spee showed negative correlation(r=-0.80), while the radius and the degree of curvature of the curve of Spee in relation to the length of the curve of Spee did not show correlation. 3. The case of the curve of Spee inclined to the posterior, that is, Post.Mtheta group showed the mean of 4.73+/-3.64 , positive cerrelation to the P2m, M1mm, M1dm, M2dm, and especially the greatest correlation coefficient to the mesial inclination angle of the mesio-buccal cusp tip of the first molar(r=0.70). 4. The case of the curve of Spee inclined to the anterior, that is, Ant.Mtheta group showed the mean of 3.28+/-3.59, positive cerrelation to the P2m, M1mm, and also the greatest correlation coefficient to the mesial inclination angle of the mesio-buccal cusp tip of the first molar(r=0.78)

A FINITE ELEMENT ANALYSIS ON THE DEFLECTION OF IMC IN THE TOOTH AND IMPLANT SUPPORTED FIXED PARTIAL DENTURE / 대한치과보철학회지

A lot of the research paper was reported about the result of influence of IMC (Intramobile connector)in the IMZ implant placed solely in the alveolar bone, but reports about the effect of IMC on functional load at state of connecting with natural teeth were rare. The major purpose of this study was find the mechanical character of IMC itself by using the finite element analysis program after simulated variance of condition connected with the natural teeth and implant on functional load. When first and second premolar was lost, IMZ implant was placed with a diameter of 3.3 mm and a length of 13mm with IMC in second premolar area. Rigid connection was done and the non-figid connection was located on the female part of the canine abutment and the implant respectively and then both the infraocclusion of 30um and the non-infraocclusion under the load of 40kg applied to the portion of the natural teeth, the pontic and the implant. The displacement and the stress of it was estimated and analyzed IMC itself of the rigid connection and the non-rigid connection was grouped. The following results were obtainded. 1. In all groups, the displacement of Y-axis was greater than that of X-axis and the aspect of displacement showed that IMC was displaced downward and to the center. 2. There was no differences in the displacement of IMC regardless of the connection type. 3. In the displacement of IMC, I 4 was the least, I 1 and I 3 are similar and I 2 was the greatest. 4. There was no differences in the peak value of miximal stress of IMC regardless of the connection type. 5. In the peak value of maximal stress of IMC, I 4 was the least, I 1 and I 3 ere similar, and I 2 was the largest.