The Effects of Computerized Gaming Program on Cognition in Children with Mental Retardation: A Case Study

PURPOSE: The purpose of this study was to analysis of effectiveness between cognitive function assessment scores and gaming cognitive rehabilitation system in children with intellectual impairment. METHODS: Five children (male=5, age=10.00±0.80) with intellectual impairment participated in this study and were randomly assigned to the experiment that played (received) gaming cognitive rehabilitation system (Neuroworld). The children were applied 2 times a week for 30 minutes during 3 months. The children were assessed K-WSIC-VI (Korean-Wechsler intelligence scale for children-fourth edition) and recorded that gained score in gaming cognitive rehabilitation system before and after intervention. K-WSIC-VI contained five primary index scores: verbal comprehension index, visual spatial index, fluid reasoning index, working memory index, and processing speed index. Gaming cognitive rehabilitation system scoring was composed visual recall, target recall, sequence recall, selective attention, continuous attention, and exploration. RESULTS: In the intelligence quotient (IQ) of K-WSIC-VI, there were significant increased in all children. The visual recall item was highest effective in all children. However, sequential recall showed the lowest improvement in all children. The performance speed of selective attention item was decreased, this means that children's skills have improved. Also, their ability to explore has improved significantly. CONCLUSION: In conclusion, gaming cognitive rehabilitation system was significant effectiveness in cognitive function in some categories for children with intellectual impairment. However, the visual recall and performance speed don't represent of all cognitive function. Therefore, further studies will need to verify by applying more subject and longer duration.

Outpatient Follow-up Status and Neurodevelopmental Outcomes of Extremely Low Birth Weight Infants

PURPOSE: To report the follow-up status and neurodevelopmental outcomes of extremely low birth weight (ELBW) survivors at 18 months' corrected age (CA). METHOD: We performed a retrospective study of 130 ELBW infants admitted to neonatal intensive care unit of Seoul National University Children's Hospital between January 2005 and May 2009. The follow-up status and neurodevelopmental outcomes were evaluated until the CA of 18 months. The assessment of outcomes included cerebral palsy, cognitive developmental delay, blindness, deafness and catch-up growth. Clinical data were collected to identify the factors influencing neurodevelopmental disability. RESULTS: Of the 130 survivors at discharge, 122 (93.8%) participated in the follow-up at 18 months' CA. Study characteristics included a mean birth weight of 783 g and a mean gestation of 27 weeks. One hundred and eleven infants (85.4%) were evaluated for cerebral palsy (CP) and 11 (9.9%) were identified with CP. Eighty five infants (74.6%) were assessed with the Bayley Scales of Infant Development-III (BSID-III) at 8 months' CA and 2 (2.4%) had a cognitive scale <70. Fifty four infants (41.9%) were assessed with BSID-III at 18 months' CA and 2 (3.7%) had a cognitive scale <70. There were 2 (1.2%) cases of blindness and the case of deafness was not present in this study. The failure of catch-up growth was seen in 40 (32.8%) infants. Severe intraventricular hemorrhage, periventricular leukomalacia, hydrocephalus and shunt insertion were the most important risk factors for neurologic abnormality. CONCLUSION: In our institution, neurodevelopmental outcomes of ELBW survivors were comparable to recent reports from the USA. ELBW infants need to be monitored on multidisciplinary follow-up programs and more efforts should be made to improve the follow-up.

Association between Tumor Necrosis Factor-alpha Gene Polymorphism and Bronchopulmonary Dysplasia in Preterm Infants

PURPOSE: Several factors including prolonged inflammatory response are thought to contribute to the pathogenesis of bronchopulmonary dysplasia (BPD). The clinical findings can be explained by an increased production of proinflammatory cytokines such as tumor necrosis factor alpha (TNF-alpha). We investigated the relationship between susceptibility to BPD and TNF-alpha promoter polymorphisms to identify genetic factors of the disease. METHODS: Thirty-eight preterm infants who had developed BPD and 55 controlled infants with a birth weight <1,500 g were analyzed for TNF-alpha genotypes. The alleles of five promoter sites (-1031/-863/-857/-308/-238) of TNF-alpha gene were determined using Taqman(R)-based allelic discrimination assays. RESULTS: Gestational age (27(+5)+/-2(+0) wk vs. 29(+2)+/-1(+4) wk, P<0.0001) and birth weight (990+/-270 g vs. 1,220+/-230 g, P<0.0001) were lower in the BPD group compared to the control group. The incidence of respiratory distress syndrome (71.1% vs. 49.1%, P=0.035) and patent ductus arteriosus (71.1% vs. 50.9%, P=0.052) was higher in the BPD group compared to the control group. The frequencies of the alleles and genotypes of five promoter sites (-1031/-863/-857/-308/-238) of TNF-alpha gene did not show differences between the BPD group and the control group. CONCLUSION: TNF-alpha promoter polymorphisms are not associated with susceptibility to BPD in Korean preterm infants.

Two Cases of Dry Lung Syndrome

Preterm infants with oligohydramnios after preterm premature rupture of membranes can present with severe respiratory distress immediately after birth, and the most common cause is pulmonary hypoplasia. Unlike infants with pulmonary hypoplasia, some cases have shown dramatic improvement with aggressive ventilatory support during the initial 1-2 days of distress; those patients have been defined as having dry lung syndrome. It is assumed that oligohydramnios leads to functional pulmonary hypoplasia by compression of the fetal lungs; some of the improvement in dry lung syndrome may thus have resulted from inflation of compressed lung tissue and increase of lung compliance. We report two incidences of dry lung syndrome that were treated successfully with high inflation pressure and inhaled nitric oxide (NO); these are the first dry lung syndrome cases to be reported in Korean infants.

The Impact of Delayed Interval Delivery on Neonatal Mortality and Morbidity

PURPOSE: To evaluate the impact of delayed interval delivery on neonatal outcomes. METHODS: This was a retrospective study of infants who were born at Seoul National University Hospital by delayed interval delivery from June 2005 to July 2010. Outcomes (neonatal mortality and morbidity) of later babies were compared to those of the first babies and the control group whose gestational ages and birth weights were similar to them. RESULTS: There were 4 twin and 5 triplet pregnancies. The first babies (group 1, n=9) were delivered at 22(+6) to 27(+5) weeks of gestational age, and the later babies (group 2, n=14) were born at 24(+6) to 28(+0) weeks. The mean interval between the first and later deliveries was 10 days, and there was no delay between the second and third deliveries in all triplet pregnancies. There were more small for gestational age (SGA) infants in group 1 than group 2 (66.7% and 21.4% respectively, P=0.03). Two of three babies who died in group 1 were born before 24 weeks of gestational age and expired within a week after birth. The mortality rate of group 2 (7.1%) was lower than group 1 (33.3%), but not significantly (P=0.106). The control group matched to group 2 consisted of 28 infants. There were no significant differences in neonatal mortality and morbidity between the two groups. CONCLUSION: Although there is a limitation to the number of infants in this study, it suggested that delayed delivery in a multiple pregnancy could decrease the incidence of SGA of the remaining fetuses and that prolonged gestation would not be harmful to those fetuses after birth.

A Validity Study of the Korean Ages and Stages Questionnaires: Screening for Developmental Delay in Preterm Infant

PURPOSE: To evaluate the validity of the Korean Ages and Stages Questionnaire (K-ASQ) in premature infants. METHODS: Infants with a gestational age of less than 37 weeks were assessed with K-ASQ and Bayley Scales of Infant Development-III (BSID-III) at the outpatient clinic of Seoul National University Children's Hospital between October 30, 2006 and August 1, 2010. Less than 1 standard deviation of the ASQ was defined as positive, and the results were compared with those of BSID-III. RESULTS: The mean gestational age of subjects in the study group was 28+/-2.87 weeks (median, 28.43 weeks; range, 23.57-35.86 weeks), and the mean birth weight was 1,027+/-363 g (median, 950 g; range, 480-2,870 g). The sensitivity of K-ASQ at 8 month was 0.2, and the specificity was 0.93. The sensitivity of K-ASQ at 18 months was 0.72, and the specificity was 0.94. The validity of each of the 4 matched subunits was separately compared, and it also had a high specificity and a low sensitivity. In addition, K-ASQ showed a higher sensitivity at 18 months than at 8 months. CONCLUSION: ASQ was developed to screen the general population, and its specificity has been powered. The specificity was also proven in our study. The results of this study suggest that although screening use of K-ASQ in preterm infants may have some limitations, the specificities at 8 and 18 months can be clinically implicated. Further studies are needed to confirm our results.

A Validity Study of the Korean Ages and Stages Questionnaires: Screening for Developmental Delay in Preterm Infant

PURPOSE: To evaluate the validity of the Korean Ages and Stages Questionnaire (K-ASQ) in premature infants. METHODS: Infants with a gestational age of less than 37 weeks were assessed with K-ASQ and Bayley Scales of Infant Development-III (BSID-III) at the outpatient clinic of Seoul National University Children's Hospital between October 30, 2006 and August 1, 2010. Less than 1 standard deviation of the ASQ was defined as positive, and the results were compared with those of BSID-III. RESULTS: The mean gestational age of subjects in the study group was 28+/-2.87 weeks (median, 28.43 weeks; range, 23.57-35.86 weeks), and the mean birth weight was 1,027+/-363 g (median, 950 g; range, 480-2,870 g). The sensitivity of K-ASQ at 8 month was 0.2, and the specificity was 0.93. The sensitivity of K-ASQ at 18 months was 0.72, and the specificity was 0.94. The validity of each of the 4 matched subunits was separately compared, and it also had a high specificity and a low sensitivity. In addition, K-ASQ showed a higher sensitivity at 18 months than at 8 months. CONCLUSION: ASQ was developed to screen the general population, and its specificity has been powered. The specificity was also proven in our study. The results of this study suggest that although screening use of K-ASQ in preterm infants may have some limitations, the specificities at 8 and 18 months can be clinically implicated. Further studies are needed to confirm our results.

Patient Distribution and Hospital Admission Costs in Neonatal Intensive Care Units: Collective Study of 7 Hospitals in Korea during 2006

PURPOSE:The characteristics of hospitalized patients in neonatal intensive care units (NICUs), including hospitalization costs (HC) and National Health Insurance (NHI) status were studied. METHODS:We gathered the following data from 7 hospitals in Korea during 2006: the distribution of patients according to birth weight (BW), and the duration of the hospital stay according to BW and HC. RESULTS:The patients who were admitted to the NICU consisted of high-risk neonates, including low birth weight or premature neonates, which comprised 50% of all neonates admitted to the NICU. The duration of hospitalization was 75-90 days for neonates with BW 25% of the total HC. For this matter, additional NHI is needed.

mage-Based Assessment and Clinical Significance of Absorbed Radiation Dose to Tumor in Repeated High-Dose (131)I Anti-CD20 Monoclonal Antibody (Rituximab) Radioimmunotherapy for Non-Hodgkin's Lymphoma / 핵의학분자영상

PURPOSE: We assessed the absorbed dose to the tumor (Dosetumor) by using pretreatment FDG-PET and whole-body (WB) planar images in repeated radioimmunotherapy (RIT) with 131I rituximab for NHL. MATERIALS AND METHODS: Patients with NHL (n=4) were administered a therapeutic dose of (131)I rituximab. Serial WB planar images after RIT were acquired and overlaid to the coronal maximum intensity projection (MIP) PET image before RIT. On registered MIP PET and WB planar images, 2D-ROIs were drawn on the region of tumor (n=7) and left medial thigh as background, and Dosetumor was calculated. The correlation between Dosetumor and the CT-based tumor volume change after RIT was analyzed. The differences of Dosetumor and the tumor volume change according to the number of RIT were also assessed. RESULTS: The values of absorbed dose were 397.7+/-646.2cGy (53.0~2853.0cGy). The values of CT-based tumor volume were 11.3+/-9.1 cc (2.9~34.2cc), and the % changes of tumor volume before and after RIT were -29.8+/-44.3% (-100.0%~+42.5%), respectively. Dosetumor and the tumor volume change did not show the linear relationship (p>0.05). Dosetumor and the tumor volume change did not correlate with the number of repeated administration (p>0.05). CONCLUSION: We could determine the position and contour of viable tumor by MIP PET image. And, registration of PET and gamma camera images was possible to estimate the quantitative values of absorbed dose to tumor.

Clinical Manifestations of Ureaplasma urealyticum Colonization in Infants / 대한주산의학회잡지

OBJECTIVE: Ureaplasma urealyticum colonization is a significant cause of fetal and neonatal pneumonia and is associated with the prevalence of bronchopulmonary dysplasia (BPD) in preterm infants. This study was aimed to evaluate the relationship between U. urealyticum colonization and neonatal morbidity. METHODS: We tested 476 infants for U. urealyticum on the first day of life among infants admitted to the neonatal intensive care unit of Bun-dang Seoul National University Hospital from June 2003 to July 2006. Urine and endotracheal aspirates were processed by PCR (polymerase chain reaction) or culture for U. urealyticum colonization. We compared the morbidity in the colonized group with the non-colonized group. RESULTS: The study group consisted ot 136 infants less than 32 weeks of gestational age and 340 infants more than 32 weeks of gestational age. In infants less than 32 weeks of gestational age, 18 (13%) of 136 infants had 1 or more positive specimens by culture or PCR. BPD occurred more in the colonized group than in the non-colonized group (p=0.058) and respiratory distress syndrome (RDS) occurred significantly less in the colonized group (p=0.043). Total WBC counts on the third day of life was significantly increased in the colonized group (p=0.003) and this significance was prominent in the neutrophil fraction (p=0.001). There was no significant relation between U. urealyticum colonization and IgM levels nor C-reactive protein (CRP) level nor U. urealyticum colonization of the mother. Twenty-three(7%) of 340 infants more than 32 weeks of gestational age had 1 or more positive specimens by culture or PCR. BPD didn't occur and RDS didn't decrease significantly in the colonized group (p=0.605). Total IgM levels didn't increase significantly in the colonized group (p < 0.006) but total WBC counts and CRP levels didn't increase significantly in the colonized group. There was no significant relation between U. urealyticum colonization and U. urealyticum colonization of the mother (p=0.21). CONCLUSION: U. urealyticum colonization in infants less than 32 weeks of gestational age was associated with an increased prevalence of BPD and a decreased prevalence of RDS.

Clinical Usefulness of the New Definition of Bronchopulmonary Dysplasia

PURPOSE: The aim of our study was to determine the incidence of bronchopulmonary dysplasia (BPD) using the newly proposed definition for BPD and investigate the relationship between the severity of BPD by new definition and clinical severity of illness and radiographic change. METHODS: We selected very low birth weight infants <1,500 g with gestational age <32 weeks born in the Bun-Dang Seoul National University Hospital from June 2003 to May 2005. The datas were categorized in four weight groups, <751, 751 to 1,000, 1,001 to 1,250 and 1,251 to 1,500 g and the incidence of BPD was computed in survivors based on the oxygen need at postnatal 28 days and 36 weeks postmenstrual age (PMA). Further, BPD-associated comorbidities and radiographic changes at 36 weeks PMA were compared among the groups defined by the new severity of BPD criteria. RESULTS: Among VLBW <1,500 g, the incidence of BPD at 28 days and 36 weeks PMA were 67 and 39%, respectively. Using the newly defined criteria, the incidence of mild, moderate and severe BPD were 29, 33 and 6%, respectively. Associated comorbidities correlated significantly with severity of BPD. Significantly longer hospital stay, longer duration of mechanical ventilation, higher score of radiography at 36 weeks PMA was observed with increasing severity of BPD. CONCLUSIONS: The severity of BPD by new definition significantly related to clinical severity and radiographic changes. Whether it will have a role in predicting long-term pulmonologic and neurologic outcome remains to be determined.

SUV Analysis of PET Scan for Prognostic Factor of Head and Neck Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Previous studies have shown that uptake of 18Fluoro-2-deoxy-glucose in head and neck cancer, as determined by the standardized uptake value (SUV) on positron emission tomography scan (PET scan), is associated with the biology of tumor. The aims of this study were to confirm the association with the biology of tumor and to establish whether a high SUV had prognostic significance. MATERIALS AND METHOD: Thirty patients with the head and neck cancer diagnosed as squamous cell carcinoma underwent a PET scan before treatment. SUVs were analyzed for possibility correlated with diseasefree survival. RESULTS: In univariate survival analysis, when patients were divided into two groups based on the SUV cut-off value of 8, the group whose SUV was greater than 8 in the pre-treatment PET scan showed significantly worse outcome (p=0.029). Correlation analysis demonstrated that SUV provided prognostic information independent of the tumor size, pathologic differentiation and stage. CONCLUSION: We conclude that high FDG uptake on PET (SUV >8 in pre-treatment PET scan) is an important prognostic indicator for poor outcome. Identified patients are thought to require intensive treatment protocol and more careful follow up.