The Effect of Breastfeeding on Prevention of Maternal Hypertension: Systematic Review

PURPOSE: The purpose of this study is to clarify the relevance of breastfeeding and its preventive effect on maternal hypertension as well as to evaluate the theoretical mechanism behind of it through systematic evaluation of existing articles. METHODS: For systematic evaluation of literatures in recent 5 years, 5 most suitable articles were selected with the key words, (breastfeeding or breastfeed or lactation) AND (hypertension or high blood pressure or hypertensive disorders) from PubMed, EMBASE, and Cochran Library, and carefully reviewed by 2 researchers. RESULTS: Breastfeeding women have less frequently developed hypertension in their later life. Depending on the duration of breastfeeding, compared to nonbreastfeeding women, breastfeeding women's odds ratio for developing hypertension are 0.87 (95% confidence interval [CI], 0.76–0.99), 0.83 (95% CI, 0.68–1.00), and 0.79 (95% CI, 0.65–0.97) each for 0–6 months, 6–12 months, and greater than 12 months of breastfeeding. As the number of breastfeeding children increases, the incidence of maternal hypertension decreases. In addition, both partial and exclusive breastfeeding lower the risk of developing maternal hypertension. Though the mechanism of prophylactic effect of breastfeeding on hypertension is not conclusive, reset hypothesis, oxytocin release, the increase of ghrelin and protein peptide YY, as well as epigenetic programming are considered to be relevant to the etiology of the condition. CONCLUSION: Breastfeeding prevents maternal hypertension later in life. Studies show dose-response relationship of breastfeeding as the duration matters. In addition, both partial and exclusive breastfeeding have preventive effect on maternal hypertension. Numerous mechanisms are continuously being reported and further studies are needed for clarification.

Population Pharmacokinetics of Cyclosporine after Hematopoietic Stem Cell Transplantation in Pediatric Patients

BACKGROUND: Cyclosporine is an immunosuppressive agent used to treat and prevent graft versus host reaction (GVHR)-a complication associated with stem cell transplantation. This study aimed to develop a population pharmacokinetic model of cyclosporine and investigate factors affecting cyclosporine clearance in pediatric hematopoietic stem cell transplant patients. METHODS: A total of 650 cyclosporine concentrations recorded in 65 patients who underwent hematopoietic stem cell transplantation were used. Data including age, sex, weight, height, body surface area (BSA), type of disease, chemotherapy before stem cell transplantation, type of donor, serum creatinine levels, total bilirubin concentration, hematocrit value, and type of concomitant antifungal agents and methylprednisolone used were retrospectively collected. Data related to cyclosporine dosage, administration time, and blood concentration were also collected. All data were analyzed using the non-linear mixed effect model; a two-compartment model with first-order elimination was used. RESULTS: The population pharmacokinetic model of cyclosporine using the NONMEM program was as follows: CL (L/h) = 5.9 × (BSA / 1.2)0.9, V2 (L) = 54.5, Q (L/h) = 3.5, V3 (L) = 1080.0, ka (h-1) = 0.000377. BSA was selected as a covariate of cyclosporine clearance, which increased with an increase in BSA. CONCLUSION: A population pharmacokinetic model for Korean pediatric hematopoietic stem cell transplant patients was developed, and the important factor affecting cyclosporine clearance was found to be BSA. The model might contribute to the development of the most appropriate dosing regimen for cyclosporine. Further studies on population pharmacokinetics should be carried out, prospectively targeting pediatric patients.

Comparisons of Efficacy between Dapagliflozin and Sitagliptin in Combination with Metformin in Type 2 Diabetes Mellitus Patients

OBJECTIVE: This study aimed to compare effects on glycemic control and weight loss between the metformin/dapagliflozin combination and the metformin/sitagliptin combination in type 2 diabetic patients. METHODS: This study retrospectively reviewed the medical records, from January 1(st) 2015 to March 31(st) 2016, of type 2 diabetic patients who were older than 18 and were prescribed with dapagliflozin or sitagliptin in combination with metformin. Hemoglobin A(1c) (HbA(1c)) levels and weights were measured every 3 months. RESULTS: The dapagliflozin group showed a greater decrease in HbA(1c) levels after 3 months (-0.75% vs. 0.01%, P<0.001), 6 months (-0.36% vs. 0.08%, P=0.029), and 9 months (-0.53% vs. 0.08%, P=0.046) compared to the sitagliptin group. Also, the dapagliflozin group showed a greater significant decrease in the rate of change in HbA1c levels after 3 months (-0.09 vs. 0.01, P<0.001), 6 months (-0.04 vs. 0.01, P=0.031), 9 months (-0.07 vs. 0.02, P=0.029), and 12 months (-0.05 vs. 0.05, P=0.047). Furthermore, the dapagliflozin group showed a greater decrease in amount of weight change after 3 months (-2.46 kg vs. 0.37 kg, P<0.001), 6 months (-3.02 kg vs. 0.13 kg, P<0.001), and 9 months (-2.27 kg vs. 0.50 kg, P=0.002). Finally, the dapagliflozin group showed a greater decrease in the rate of change in weight after 3 months (-3.10% vs. 0.52%, P<0.001), 6 months (-3.83% vs. 0.21%, P<0.001), 9 months (-2.84% vs. 0.79%, P=0.002), and 12 months (-4.91% vs. 0.44%, P<0.001). CONCLUSION: It was concluded that dapagliflozin is more effective than sitagliptin for type 2 diabetic patients.

Pediatric adverse drug reactions collected by an electronic reporting system in a single tertiary university hospital

PURPOSE: The incidence of adverse drug reactions (ADRs) is increasing. However, studies on the prevalence of ADRs in children are rare. The aim of this study was to investigate the causative drugs and clinical features of ADRs for children in a tertiary university hospital of Korea. METHODS: We retrospectively collected ADRs by a computerized self-reporting system in Asan Medical Center. ADRs of children under the age 18 were collected from January 2005 to August 2015, and we analyzed only ADRs containing current symptoms among total ADR data. RESULTS: A total of 1,408 ADR cases were reported, There were 764 male (54.3%) and 644 female patients (45.7%), and the mean age was 11.5±5.8 years (range, 0–18 years). Antibiotics (n=479, 34.0%) were the most common causative drugs, followed by tramadol (n=173, 12.3%), nonsteroidal anti-inflammatory agents (NSAIDs) and acetylsalicylic acid (n=103, 7.3%), narcotics (n=91, 6.5%), antineoplastics (n=87, 6.2%), and sedatives (n=82, 5.8%). The most common clinical features were skin manifestations (n=500, 34.4%). Gastrointestinal symptoms (n=435, 29.9%) were the second most common clinical features, followed by neuropsychiatric symptoms (n=155, 10.7%) and respiratory symptoms (n=123, 8.5%). Among antibiotics, glycopeptides (n=110, 23.0%), third-generation cephalosporins (n=83, 17.3%), and penicillin/β-lactamase inhibitors (n=60, 12.7%) were the most frequently reported causative drugs. CONCLUSION: Antibiotics were the most reported common causative drugs of ADRs in children, followed by tramadol, NSAID, and narcortics. Compared with adults, the prevalence of contrast medium-induced ADR was lower in children with a higher prevalence of sedative-associated ADR. Greater attention to possible ADRs in children is needed among medical personnel.

Erratum to: The relationship between quality of sleep and night shift rotation interval

There was an error in one of the author names in this article. The publisher apologises for any inconvenience caused.

The relationship between quality of sleep and night shift rotation interval

BACKGROUND: Shift work is closely related with workers' health. In particular, sleep is thought to be affected by shift work. In addition, shift work has been reported to be associated with the type or direction of shift rotation, number of consecutive night shifts, and number of off-duty days. We aimed to analyze the association between the night shift rotation interval and the quality of sleep reported by Korean female shift workers. METHODS: In total, 2,818 female shift workers from the manufacturing industry who received an employee physical examination at a single university hospital from January to August in 2014 were included. Subjects were classified into three groups (A, B, and C) by their night shift rotation interval. The quality of sleep was measured using the Korean version of the Pittsburgh Sleep Quality Index (PSQI). Descriptive analysis, univariate logistic regression, and multivariate logistic regression were performed. RESULTS: With group A as the reference, the odds ratio (OR) for having a seriously low quality of sleep was 1.456 (95% CI 1.171-1.811) and 2.348 (95% CI 1.852-2.977) for groups B and C, respectively. Thus, group C with the shortest night shift rotation interval was most likely to have a low quality of sleep. After adjustment for age, obesity, smoking status, alcohol consumption, exercise, being allowed to sleep during night shifts, work experience, and shift work experience, groups B and C had ORs of 1.419 (95% CI 1.134-1.777) and 2.238 (95% CI 1.737-2.882), respectively, compared to group A. CONCLUSION: Our data suggest that a shorter night shift rotation interval does not provide enough recovery time to adjust the circadian rhythm, resulting in a low quality of sleep. Because shift work is influenced by many different factors, future studies should aim to determine the most optimal shift work model and collect accurate, prospective data.

Comparative Effectiveness between Dipeptidylpeptidase-4 Inhibitors and Sulfonylureas in Combination with Metformin in Type 2 Diabetes Mellitus Patients

OBJECTIVE: Treatment with sulfonylureas in combination with metformin improves glycemic control in type 2 diabetes mellitus (T2DM), but is associated with hypoglycemia and weight gain. This retrospective study aims to compare the effectiveness of dipeptidylpeptidase-4 (DPP-4) inhibitors and sulfonylureas as an add-on therapy to metformin in patients with T2DM. METHODS: Data from medical records of 355 T2DM patients received therapy either DPP-4 inhibitors (DPP-4 inhibitor group) or sulfonylurea (SU group) in combination with metformin from 1 March 2009 to 30 September 2011 were retrospectively reviewed. Of total 355 patients, 231 patients were in DPP-4 inhibitor group and 124 patients were in SU group. Baseline Hemoglobin A1c (HbA(1c)) level in SU group was higher than DPP-4 inhibitor group with a statistically significant difference (8.6% vs. 7.8%). Comparative analysis between DPP-4 inhibitor group and SU group was performed for HbA(1c) values, amounts of HbA(1c) changes, and rates of HbA(1c) changes from baseline at 6-month intervals and incidence rates of major cardiocerebral events. RESULTS: SU group showed larger HbA(1c) changes in both amounts and rates compared to DPP-4 inhibitor group, although statistical significance was not found in all study periods. Proportions of patients with stable HbA(1c) <6.5% or 7% were significantly higher in DPP-4 inhibitor group than SU group (<6.5%: 30.4% vs. 13.4%, <7%: 72.3% vs. 41.2%). Time to achieve stable HbA(1c) <6.5% was not significantly different, but time to achieve stable HbA(1c) <7% was shorter in DPP4 inhibitor group than SU group with a significant difference. The incidence rate of cardiocerebral events in group of patients with or without previous events was 1.7%, not significantly lower than that in DPP-4 inhibitor group (4.0%). For newly encountered cardiocerebral events during the treatment, incidence rates of two groups did not differ significantly. CONCLUSION: DPP-4 inhibitors were as effective as sulfonylureas in achieving the HbA(1c) goal of less than 6.5% or 7% and cardiocerebral event rates did not differ between the two drugs.

Compressive Trigeminal Neuropathy after Caldwell-Luc Operation

Most postoperative maxillary cysts develop more than 10 years after a Caldwell-Luc operation. They can manifest with cheek pain, swelling and dental and visual symptoms. Brain imaging should be performed to distinguish trigeminal nerve compression from various other possible causes. It should be treated by surgical intervention to relieve the above-mentioned symptoms. We report a patient who presented with compressive trigeminal neuropathy caused by a postoperative maxillary cyst.

Compressive Trigeminal Neuropathy after Caldwell-Luc Operation

Most postoperative maxillary cysts develop more than 10 years after a Caldwell-Luc operation. They can manifest with cheek pain, swelling and dental and visual symptoms. Brain imaging should be performed to distinguish trigeminal nerve compression from various other possible causes. It should be treated by surgical intervention to relieve the above-mentioned symptoms. We report a patient who presented with compressive trigeminal neuropathy caused by a postoperative maxillary cyst.

High degree of supervision improves adherence to inhaled corticosteroids in children with asthma / 소아과

PURPOSE: Adherence to treatment with inhaled corticosteroids (ICS) is a critical determinant of asthma control. The objective of this study was to assess factors that determine adherence to ICS therapy in children with asthma. METHODS: Fifty-eight children with asthma, aged 5 to 16 years, used ICS with or without a spacer for 3 months. Adherence rates as measured from questionnaires and canisters, asthma symptom scores, and inhalation technique scores were assessed every 30 days. The degree of supervision by caregivers was assessed at day 30. RESULTS: Adherence rates measured using canisters were lower at day 60 than at day 30 (P=0.044) and did not change thereafter (74.4%+/-17.4% at day 30, 66.5%+/-18.4% at day 60, and 67.4%+/-22.2% at day 90). Adherence rates at days 60 and 90 and during the total study period were significantly different when measured by using questionnaires versus canisters (P<0.001, P=0.022, and P=0.001, respectively). In the comparison of adherence rates repeatedly measured at days 30, 60, and 90 and adherence rates during the total study period among the 3 groups, adherence rates in the high-degree supervision group were significantly higher than those in the low-degree supervision group (82.0+/-16.0 vs. 66.1+/-14.5, 75.4+/-14.4 vs. 56.2+/-18.4, 75.0+/-18.3 vs. 55.0+/-19.7 [P=0.027]; 77.9+/-12.2 vs. 59.1+/-11.4 [P=0.021]) after adjustment for sex and age. CONCLUSION: The level of caregiver supervision is an important factor affecting adherence to ICS therapy in children with asthma. Therefore, a high degree of supervision may be required to increase adherence to ICS therapy in children with asthma.

Successful Treatment of Intractable Hiccups with Benztropine

In general, intractable hiccups are uncommon. Various drugs and interventions have been reported, but there is no consensus on the treatment of intractable hiccups. We report a patient with meningitis and rhombencephalitis who presented with intractable hiccups that were resolved following treatment with benztropine. A 17-year-old boy was admitted to another hospital with a two-week history of fever and headache. A cerebrospinal fluid (CSF) test showed an increased white blood cell (WBC) count (290/muL, monocytes 100%). He was diagnosed with meningitis and treated with ceftriaxone. Two days after admission, hiccups started and lasted for eight days, despite treatment with phenobarbital, diazepam, haloperidol, phenytoin, and chlorpromazine. He was transferred to our hospital for further evaluation and treatment. He was clinically diagnosed with rhombencephalitis based upon the findings of brain magnetic resonance imaging (MRI). The fever and headache disappeared one day later. However, the hiccups persisted, despite symptomatic treatment with chlorpromazine, gabapentin, and metoclopramide. The hiccups disappeared after one day of adding benztropine without relapse. Benztropine can be considered in the treatment of intractable hiccups.

The Relationship of Serum Vitamin D Levels and the Framingham Risk Score among Male Workers in the Manufacturing Sector / 대한산업의학회지

OBJECTIVES: A growing body of evidence states that vitamin D deficiencies may adversely affect cardiovascular disease, however data from Korean workers are lacking. The purpose of this study was to investigate the vitamin D level of the Korean worker and the relationship between vitamin D levels and the Framingham Risk Score. METHODS: 11,448 male workers who visited a university hospital for health screening between March 2010 and August 2011, were enrolled in the study. We measured their of serum vitamin D(25(OH)D) levels and calculated their Framingham Risk Score. RESULTS: The mean serum vitamin D(25(OH)D) level of the surveyed workers was 13.03+/-6.47 ng/mL. 12.4% of the total workers had adequate vitamin D levels. It was found that the lower the vitamin D level, the higher the risk of cardiovascular disease. The Framingham Risk Score and vitamin D levels were found to be significantly related (OR=1.39, 95% CI 1.14~1.68) through a multivariate logistic regression analysis. CONCLUSIONS: 87.6% of workers possessed inappropriate vitamin D levels. Management for this high risk group in regards to cardiovascular disease should be included in the evaluation and vitamin D levels should be corrected.

Acute Health Effects of the Hebei Oil Spill on the Residents of Taean, Korea / 예방의학회지

OBJECTIVES: On December 7, 2007, the Hebei Spirit oil tanker spilled out 12,547 kl of crude oil on the Yellow Sea 10 km away from the cost of Taean Province, Korea. As the coastline has been contaminated, local residents have been exposed to crude oil. Because the residents were showing many symptoms, we investigated the acute health effects of this oil spill on them. METHODS: We conducted a cross-sectional study consisting of the heavy and moderately oil soaked area in Taean and the lightly oil soaked area in Seocheon. Ten seashore villages were selected from each area, and 10 male and female adults were selected from each village. We interviewed the subjects using a structured questionnaire on the characteristics of residents, the cleanup activities, the perception of oil hazard, depression and anxiety, and the physical symptoms. The odds ratios and 95% confidence intervals were analyzed using logistic regression analysis. The logistic regression model was adjusted for age, gender, education, smoking, the perception of oil hazard and anxiousness. RESULTS: The more highly contaminated the area, the more likely it was for residents to be engaged in cleanup activities and have a greater chance of exposure to oil. The indexes of anxiety and depression were higher in the heavy and moderately oil soaked areas. The increased risks of headache, nausea, dizziness, fatigue, tingling of limb, hot flushing, sore throat, cough, runny nose, shortness of breath, itchy skin, rash, and sore eyes were significant. CONCLUSIONS: The results suggest that exposure to crude oil is associated with various acute physical symptoms. Long-term investigation is required to monitor the residents' health.

A Clinical Observation of Newborns of Unmarried Mothers

PURPOSE: The purpose of this study was to assess the importance of prenatal care of the unmarried mothers. METHODS: Clinical characteristics of 131 newborn babies of unmarried mothers who were hospitalized at National Medical Center from April, 1998 to August, 1999 were compared to 131 newborn babies of married mothers who were also hospitalized at National Medical Center from June, 1999 to August, 1999 by reviewing their medical records retrospectively. RESULTS: Average age of mothers were 20.1+/-4.0 years in unmarried group and 28.8+/-4.4 years in married group, which was statistically significant. In unmarried group, the highest rate of maternal age (55.8%) was below 20 years of age, which showed increased tendency compared to previous report. In cesarean section rate, there was significant difference; 11.4% in unmarried group and 48.1% in married group. In the birth order, the first baby was most frequent in both groups. The sex ratio showed 1.78 : 1 with male preponderance in unmarried group and 1 : 1.02 with slight female preponderance in married group. In average gestational age, birth weight, height, head circumference, chest circumference, 5 minutes Apgar score, and admission rate, there was no significant difference. The unmarried group had more babies in postmaturity and meconium-stained condition. CONCLUSION: There was no significant difference in growth and morbidity rate between newborn babies from unmarried mothers who had prenatal care and those from married mothers.

Changing Social Background Pattern of Children in Adoption Institutions(the 4th Report)

PURPOSE: A study was undertaken to assess the social background of abandoning children at adoption institutions. The results were compared to those of three previous reports from the institution. METHODS: A total of 536 children who had been admitted to the institution during the period of 1993 to 1996 were subjected to the study. The medical records were reviewed retrospectively. RESULTS: The sex ratio of male to female was 1 : 0.9, which was opposite compared to previous studies. Mean birth weight was 2.76+/-0.58kg. The proportion of prematurity was 27.2% and their mean gestational age was 34.0+/-2.25 weeks. The academic background of the mother was mainly high school, comprising 58.4%. The highest rate of maternal age(75.9%) was between 16 to 25 years of age. Maternal age below 15 years was 2.8%, which showed increased in tendency compared to previous studies. Classifying the mother's occupation, they were unemployed(19.4%), office workers(16.8%), store clerks(15.9%), students(13.6%), factory workers(12.3%) and waitresses (5.6%) in this order of frequency. The order of birth showed that the first baby was 89.4%. The reasons for putting their baby up for adoption were they were unmarried(83.2%), poor(8.6%), extramarital birth(3.2%), divorce(2.9%) and death of parents(0.4%) in this order of frequency, showing a significant increased in the rate of unmarried mothers. Only 38.4% of mothers had taken antenatal care. Most of the children (90.8%) were adopted by parents in foreign countries. CONCLUSION: The main reason for adoption was the mothers were unmarried and the maternal age tended to be younger. The rate of foreign adoption was still high.

Changing Social Background Pattern of Children in Adoption Institutions(the 4th Report)

PURPOSE: A study was undertaken to assess the social background of abandoning children at adoption institutions. The results were compared to those of three previous reports from the institution. METHODS: A total of 536 children who had been admitted to the institution during the period of 1993 to 1996 were subjected to the study. The medical records were reviewed retrospectively. RESULTS: The sex ratio of male to female was 1 : 0.9, which was opposite compared to previous studies. Mean birth weight was 2.76+/-0.58kg. The proportion of prematurity was 27.2% and their mean gestational age was 34.0+/-2.25 weeks. The academic background of the mother was mainly high school, comprising 58.4%. The highest rate of maternal age(75.9%) was between 16 to 25 years of age. Maternal age below 15 years was 2.8%, which showed increased in tendency compared to previous studies. Classifying the mother's occupation, they were unemployed(19.4%), office workers(16.8%), store clerks(15.9%), students(13.6%), factory workers(12.3%) and waitresses (5.6%) in this order of frequency. The order of birth showed that the first baby was 89.4%. The reasons for putting their baby up for adoption were they were unmarried(83.2%), poor(8.6%), extramarital birth(3.2%), divorce(2.9%) and death of parents(0.4%) in this order of frequency, showing a significant increased in the rate of unmarried mothers. Only 38.4% of mothers had taken antenatal care. Most of the children (90.8%) were adopted by parents in foreign countries. CONCLUSION: The main reason for adoption was the mothers were unmarried and the maternal age tended to be younger. The rate of foreign adoption was still high.

The Significance of Collateral Vessels, as Seen on Chest CT, in Predicting SVC Obstruction

PURPOSE: To evaluate the significance of collateral veins, as seen on chest CT, in the diagnosis of superiorvena cava obstruction. MATERIAL AND METHOD: We retrospectively reviewed the records of 81 patients in whomcollateral veins were seen on chest CT. On spiral CT(n=49), Contrast material was infused via power injector, andon conventional CT(n=32), 50ml bolus infusion was followed by 50ml drip infusion. Obstruction of the SVC wasevaluated on chest CT ; if, however, evaluation of the SVC or its major tributaries was difficult, as in fivecases, the patient underwent SVC phlebography. Collateral vessels were assigned to one of ten categories. RESULT: On conventional CT, the common collaterals showing statistically significant difference between the two groupswere the jugular venous arch in the group with venous obstruction(n=6/15, 40.0%), and around the back and scapula(n=15/17, 88.2%) and paravertebral system(n=12/17, 70.6%) in the group without venous obstruction. On helical CT,the most common collaterals were around the back and scapular (n=9/14, 64.3%; n=26/35, 74.3%, respectively) andthe paravertebral system (n=9/14, 64.3%, n=22/35, 62.9%, respectively) in both groups, with or without venousobstruction. No collateral showed a statistically significant difference between the two groups. CONCLUSION: Onconventional CT, the jugular venous arch is the only collateral vessel to predict SVC obstruction ; on spiral CT,however, collateral vessels are not helpful in the diagnosis of SVC obstruction, but are a nonspecific finding.

Effects of amino acids and some drugs related to gaba receptors on the neuronal activity in isolated medullary dorsal horn of rat

No abstract available.

A case of congenital hypertrophic pyloric stenosis in two siblings

Congenital hypertrophic pyloric stenosis is the most common intra-abdominal disease required surgery during the first few months of life. The expression of pyloric stenosis is dependent upon the genetic influence of ancestors affected with the disease, as well as unknown environmental influences in the postnatal period. Pyloric stenosis has been reported in multiple sibs in a family, which suggests the genetic influence on the expression of this disease. Until now, the genetic influence is thought a sex-modified polygenic or multifactorial background which facilitates the expression of a common dominant gene. We experienced a case of congenital hypertrophic pyloric stenosis in a two siblings. The siblings suffered projectile vomiting for 2~4 days at 16 days old of age and 15 days old of age. After we confirmed the diagnosis by upper gastrointestinal series and abdominal sonogram, the Fredet-Ramstedt pyloromyotomy was done successfully. This case suggests the genetic influence on the expression of this disease.

A Clinical Study of Methicillin Resistant Staphylococcus Aurus

No abstract available.