Association between endotoxin levels in dust from indoor swine housing environments and the immune responses of pigs

Indoor animal husbandry environments are inevitably contaminated with endotoxins. Endotoxin exposure is associated with various inflammatory illnesses in animals. This cross-sectional study evaluated the relationship between the degree of endotoxin exposure and the cellular and humoral immune profiles of fattening pigs. Blood samples were taken from the jugular vein of 47 pigs from ten pig farms in Korea. Whole blood cell counts and plasma immunoglobulin (Ig) classes were determined. Peripheral-blood mononuclear cells were stimulated in vitro with concanavalin A for 48 h, and cytokines released into culture supernatants were measured. The barns in which the pigs lived were assessed for endotoxin levels in the total and respirable dust by using the limulus amebocyte lysate kinetic QCL method. Low and high endotoxin exposures were defined as ≤ 30 and > 30 EU/m³, respectively. Compared to pigs with low endotoxin exposure (n = 19), highly exposed pigs (n = 28) had higher circulating neutrophil and lymphocyte (particularly B cells) counts, IgG and IgE levels, interferon-gamma (IFNγ) and interleukin (IL)-4 productions, and lower IgA levels and tumor necrosis factor-alpha (TNFα) production. The IL-4, IFNγ, and TNFα levels significantly correlated with endotoxin level and/or pig age. Constant exposure of pigs to high levels of airborne endotoxins can lead to aberrant immune profiles.

Prevention of Cytomegalovirus Transmission via Breast Milk in Extremely Low Birth Weight Infants

PURPOSE: Extremely low birth weight infants (ELBWIs) have a high risk of acquiring cytomegalovirus (CMV) infection via breast milk and consequently developing serious symptoms. We evaluated whether freeze-thawing or pasteurization could prevent postnatal CMV infection transmitted through breast milk in ELBWIs. MATERIALS AND METHODS: Medical records of 385 ELBWIs with whole milk feeding, and freeze-thawed or pasteurized breast milk feeding were reviewed retrospectively. Postnatally acquired CMV infection was defined as an initial negative and a subsequent positive on follow-up urine CMV DNA polymerase chain reaction screening tests. The incidence, clinical characteristics, symptoms, sequelae, and long-term outcome at corrected age [(CA): 2 years of CMV infection] were analyzed. RESULTS: While no infant developed CMV infection with whole milk (0/22) or pasteurized breast milk (0/62) feeding, postnatal CMV infection was diagnosed in 8% (27/301) of ELBWIs who were fed freeze-thawed breast milk. Gestational age in the CMV group was significantly lower than the control group. In 82% (22/27) of cases, CMV infection was symptomatic and was associated with increased ventilator days and > or =moderate bronchopulmonary dysplasia (BPD). Neurodevelopmental outcome and growth status at CA 2 years were not different between the study groups. Lower gestational age and freeze-thawed breast milk feeding >60% of total oral intake during the first 8 postnatal weeks were independent risk factors for acquiring postnatal CMV infection. BPD (> or =moderate) was the only significant adverse outcome associated with this CMV infection. CONCLUSION: Pasteurization but not freeze-thawing of breast milk eradicated the postnatal acquisition of CMV infection through breast milk.

Study on Relationship between Elderly Group Lifestyle and Selection Attributes in the Health Functional Foods

OBJECTIVE: This experiment is to study how elderly group and their various lifestyles interact with health functional foods, according to their selection behavior. Different lifestyles will be observed closely, as well as how different health conditions and consumer involvements will affect critical decision making in selecting health functional foods. METHOD: Theories and discoveries from original advanced research were compared parallel to the new study. RESULTS: First, cluster analysis and exploratory analysis were performed amongst different elder lifestyles. Lifestyle exploratory analysis was used for healthy, unique, leisure, and economical-style elders. Cluster analysis was used for material trend oriented, health oriented, complacent oriented-style elders. Health Functional Foods' selection trait Exploratory Factor Analysis showed that product's originality (function, uniqueness, specialty, compatibility, distributor, expiration date), quality (amount, daily dose, visual representation, accessibility, portability, natural ingredients), and popularity (product container, brand image, taste and smell, advertised product, domestic or import, well-known function) were the three main causes. Secondly, the amount of benefits for the elderly group health lifestyle were affected by 'Interest in health', 'Notability of the health functional food', and 'Functionality approved mark'. Specifically, the importance of, 'Interest in health', 'Notability of health functional food', and 'Functionality approved mark' were noticeably high within health oriented elders. Lastly, after examining the data from elder lifestyle's relationship with health functional food selection trait, all three different results showed equal importance. If you closely examine material trend oriented elderly group, selection trait showed distinctively high regards in 'Fundamental Attribute', 'Typical Attribute', and 'Cognitive Attribute'. Health oriented elders showed their distinctively high regards in 'Natural Attribute', and less consideration in 'Typical Attribute' and 'Cognitive Attribute'. Complacent oriented-style elderly group showed less focus on 'Fundamental Attribute', and even less in 'Typical Attribute', and 'Cognitive Attribute'. Health oriented elderly group concluded with above data from the fact that they showed most importance and involvement in health beneficial products that are scientifically proven. Material trend oriented elderly group showed balanced traits in their concluded data, showing that they prefer function, safety, as well as the brand image and their reputation. Also, they consider the products' outer elements, such as design and product name, in order to sense inner functions. CONCLUSION: So, Silver Business corporations must develop products to fulfill the market demands, and strategize marketing plans to better target the correct audience.

The Timing of Surgical Ligation for Patent Ductus Arteriosus Is Associated with Neonatal Morbidity in Extremely Preterm Infants Born at 23-25 Weeks of Gestation

The purpose of this study was to evaluate prognostic factors associated with surgical ligation for patent ductus arteriosus (PDA) in extremely preterm infants born at the limits of viability. Ninety infants who were born at 23-25 weeks of gestation and who received surgical ligation were included and their cases were retrospectively reviewed. Infants were classified into two different groups: survivors with no major morbidity (N), and non-survivors or survivors with any major morbidity (M). Clinical characteristics were compared between the groups. Possible prognostic factors were derived from this comparison and further tested by logistic regression analysis. The mean gestational age and the mean birth weight of M were significantly lower than those of N. Notably, the mean postnatal age at time of ligation in N was significantly later than that of the other group (17+/-12 vs 11+/-8 days in N and M, respectively). An adjusted analysis showed that delayed ligation (>2 weeks) was uniquely associated with a significantly decreased risk for mortality or composite morbidity after surgical ligation (OR, 0.105; 95% CI, 0.012-0.928). In conclusion, delayed surgical ligation for PDA (>2 weeks) is associated with decreased mortality or morbidities in extremely preterm infants born at 23-25 weeks of gestation.

Neonatal Presentation and Follow-up of Goldenhar Syndrome / 대한주산의학회잡지

PURPOSE: Expression patterns, associated anomalies and progress of the patients with Goldenhar syndrome from the neonatal period were systematically investigated. This allows us to evaluate the need for early diagnosis. METHODS: This is a retrospective study of 29 infants with Goldenhar syndrome whose diagnosed in Samsung Medical Center between 1994 and 2013. Associated anomalies and procedures between neonatal group (n=13) and non-neonatal group (n=16) were systematically compared. RESULTS: Mean gestational age in the neonatal group were 38+1+/-2+4 weeks and 3 patients (23%) were preterm infants. The average birth weight in the neonatal group were 2,853+/-544 grams. Goldenhar syndrome was mainly diagnosed by ear and face anomalies during the neonatal period. The associated anomalies in neonatal group were cardiovascular anomaly (54%), genitourinary anomaly (30%), vertebral anomaly (15%), and others (31%). About 40% of patients who had long-term follow-up revealed hearing abnormalities and about 1/4 of all patients had bilateral hearing problem, which resulted in requiring hearing aid devices. In addition, the most common procedure performed during follow-up was preauricular skin tag removal. And other procedures or surgery related to oral, eyes, and others were performed in each 1/4 of the patients. Cardiac surgery was done in 15% of total patients. Frequency of associated anomalies and performed procedures between the patients diagnosed at neonatal and non-neonatal period was not significantly different. CONCLUSION: A multidisciplinary approach should be undertaken by multi-departments when evaluating patients with Goldenhar syndrome. In particular if the patient has an ear anomaly, careful hearing test is required in early life.

Social Services Information for Children and Adolescents with Diabetes Mellitus / 임상당뇨병

Numerous challenges arise when diabetes develops in young children and adolescents. Beginning self-management at the earliest stages of diabetes diagnosis is critical in dealing with the many issues related to diabetes and physical growth, psychological development, and social integration. The primary goal of diabetes self-management for diabetic children and adolescents is to maintain good physical and mental health, both of which require strong family support, social acceptance, and a nurturing environment. Diabetes educators must first encourage public understanding of the psycho-social needs of diabetic children and adolescents, and then individualize treatment using a patient/family-centered approach to diabetes education. The national support system and private social welfare resources can support children and adolescents with diabetes mellitus by providing accessible information and connections between patients and financial sponsors, and by promoting a campaign to change social attitudes toward diabetes mellitus. With supportive programs, the integration of diabetic children and adolescents into society as healthy contributors to family and school is possible.

Ultrasonography of Gynecologic Causes of Acute Pelvic Pain

Acute pelvic pain is one of the most common complaints of woman presenting in the emergency department. When gynecologic disorders are suspected, ultrasonography (US) is the modality of choice, enabling rapid diagnosis and decision making with regard to appropriate management. Frequent gynecologic etiologies include a large or enlarging simple ovarian cyst, hemorrhagic ovarian cyst or rupture of an ovarian cyst, acute pelvic inflammatory disease, and ovarian torsion. Endometriosis, uterine leiomyoma, and peritoneal inclusion cyst can also present as acute pelvic pain. Gynecologic disorders that cause acute pelvic pain frequently show characteristic ultrasonographic findings that enable specific diagnosis. In this review, the authors review ultrasonographic findings of gynecologic causes of acute pelvic pain.

Operational Outcomes of Bowel Perforation Due to Necrotizing Enterocolitis in Preterm Infants of Less than or Equal to 25 Weeks' Gestational Age

PURPOSE: Even though the improved survival rate of extremely preterm infants, the incidence of necrotizing enterocolitis (NEC) requiring operation has not decreased. Thus, this report demonstrates our experience of clinical course of bowel perforation due to necrotizing enterocolitis in preterm infants of less than or equal to 25 weeks' gestational age. METHODS: We retrospectively reviewed the medical records of 38 infants who underwent an operation for bowel perforation because of NEC from January 2000 to December 2012 at Samsung Medical Center. RESULTS: 38 infants out of a total 53 infants diagnosed with NEC required operation due to bowel perforation. The mortality rate was 44.7% (alive group n=21, dead group n=17). Age when NEC was diagnosed 18.4+/-14.8 days, mean enteral feeding volume on day of early NEC was 16.7+/-8.6 cc/kg. The platelet count was significantly lower in the dead group. All alive infants, with the exception of one infant who underwent total small bowel resection, were successful in full enteral feeding. Ostomy closure was performed 159.0+/-43.6 days after the initial operation. The average body weight at ostomy closure operation was 3,566+/-1,118 g. CONCLUSION: 71.7% of the premature with a gestational age of 25weeks or less with a diagnosis of NEC required operation due to bowel perforation. But the infants who survived showed successful establishment of full enteral feeding and achieved catch up growth at 18 months of corrected gestational age.

Permissive Hyperglycemia in Extremely Low Birth Weight Infants

The aim of this study is to evaluate the outcomes of permissive hyperglycemia up to or = 300 mg/dL with insulin. Only 15% of patients were grouped as N, with 39% as P and 46% as T. Although P had lower birth weight, P had a similar daily calorie and glucose intake as well as urine output compared to N. There was no significant correlation between blood glucose level and urine output on day 7. Compared to N, P showed faster weight gain and similar mortality, morbidities, and long-term neurological outcomes. Permissive hyperglycemia up to < 300 mg/dL without insulin treatment during the first 14 days of life is not associated with osmotic diuresis or increased mortality or morbidities, suggesting that it is not detrimental in ELBWIs.

Insensible Water Loss during the First Week of Life of Extremely Low Birth Weight Infants Less than 25 Gestational Weeks under High Humidification

PURPOSE: Extremely-low-birth-weight infants (ELBWIs), especially those or =26-GW (n=65) infants nursed in 60% humidity. RESULTS: Survival rate until discharge was 33%, 82%, 75% and 89.3% in 22-GW, 23-GW, 24-GW and > or =26-GW infants, respectively. Compared to > or =26-GW infants, fluid intake and IWL was higher in 22-GW and 23-WG, but not as different in 24-GW. At postnatal day (P) 3-5, urine output was significantly lower in > or =26-GW infants than in the other age groups. Serum sodium level was significantly higher in 22-, 23- and 24-GW (P1-2) than in > or =26-GW infants. Hypernatremia (>150 mEq/dl sodium) was more frequent in 22-GW (71%), 23-GW (41%) and 24-GW (21%) than in > or =26-GW infants (14%). CONCLUSION: High-humidity environments significantly decreased fluid intake and improved electrolyte imbalance in 24-GW, but not in 22- and 23-GW infants. Increased IWL in the latter might be related to more immature skin, implicating the need for additional nurturing conditions.

May-Hegglin Anomaly Diagnosed by Genetic Study in a Newborn Infant / 대한주산의학회잡지

May-Hegglin anomaly is an autosomal dominant platelet disorder characterized by giant platelets, thrombocytopenia, and Dohle-like cytoplasmic inclusion bodies in granulocyte. Usually, diagnosis was delayed because they do not have life-threatening bleeding. We experienced a case of May-Hegglin anomaly, which was diagnosed with genetic study at neonate. A 3 days old female has bilateral cephalhematoma at birth after a Caesarean section delivery. Thrombocytopenia with inclusion bodies in granulocyte was observed at peripheral blood cell morphology. Her mother had thrombocytopenia at pregnancy and was diagnosed May-Hegglin anomaly through MYH9 mutation gene study. Accordingly, infant had genetic study and found same gene mutation with mother. Based on the family history, we can diagnose May-Hegglin anomaly in a newborn infant who has cephalhematoma and thrombocytopenia by genetic study.

Pleural Effusion and Diaphragmatic Palsy Associated with Peripherally Inserted Central Venous Catheter in a Preterm Infant / 대한주산의학회잡지

Pleural effusion and diaphragmatic palsy secondary to fluid extravasation after central line insertion in the neonate are rare complications. Here we report a case of right pleural effusion and diaphragmatic palsy caused by fluid extravasation associated with peripherally inserted central venous catheter in the preterm infant.

A Case of Pacemaker Implantation in Premature Newborn with Congenital Complete Atrioventricular Block

The congenital complete atrioventricular block(CCAVB) is a rare disease, which is the most serious complication of neonatal lupus erythematosus. Newborn with CCAVB are at risk of diminished cardiac output and the subsequent development of congestive heart failure. Transplacental steroid and beta-adrenergic agonist therapies are useful for the first and second degree atrioventricular block. But those therapies are usually not effective for complete atrioventricular block. If the fetus has a complete atrioventricular block, delivery should be considered unless other delivery contraindications. In this situation, early pacemaker implantation surgery can improve the survival rate of patients. We report one case of premature newborn with congenital complete atrioventricular block who is successfully recovered by pacemaker implantation.

Nomogram of Transcutaneous Bilirubin Level after Birth Driven from a Single Center

PURPOSE: The goal of this study was to measure bilirubin levels over 6 hours using a transcutaneous bilirubinometer. The change in the bilirubin levels were recorded in a nomogram. The natural progress of jaundice in neonates was monitored using the nomogram and cases were identified that needed further follow-up observation and treatment. METHODS: The subjects of this study were 986 healthy term or near-term infants at the age of 35 weeks or older who were born at Sung-Ae General Hospital during the period from October 1, 2007 to April 30, 2009 and whose parents were both Koreans. Transcutaneous bilirubin measurements were obtained using a transcutaneous bilirubinometer (Minolta, JM-103) from 6 hours of life to discharge at intervals of 6 hours. A nomogram was derived from the obtained data and compared to the delivery method, gestational age, and feeding method. RESULTS: Percentile graphs were drawn according to time. Based on the graphs, phototherapy was necessary in more than 90 percent of the infants between 35 and 37.6 weeks of age and in 95 percent of the infants 38 weeks and older. The mean bilirubin level at 24, 48, 72 and 96 hours after birth were compared according to the delivery method, gestational age, and feeding method. The bilirubin level in 48 hours was significantly higher in neonates born via cesarean section delivery compared to the neonates born via vaginal delivery, however the levels were not statistically different at the other hours. CONCLUSION: The results of this study show the nomogram derived from hour-specific transcutaneous bilirubin levels. This information can be used to predict the risk for subsequent significant hyperbilirubinemia.

A Multicenter Study of Preterm Birth Weight and Gestational Age-Specific Neonatal Survival Rate and Causes of Death / 대한주산의학회잡지

OBJECTIVES: This multi-institutional study aims to investigate the survival rate of premature infants and the causes of death according to gestational age and birth weight during the past three years. METHODS: This study retrospectively examined medical records of 1,400 premature infants who were born at 23 to 34 weeks gestation and were hospitalized in the neonatal intensive care unit of seven hospitals from 2004 to 2006. Gestational age, birth weight, gender, plurality, survival rate, and cause of death were examined, and the survival rate was measured according to gestational age and birth weight. RESULTS: The average gestational age and the average birth weight of the subjects was 31+/-1.8 weeks and 1,775+/-530 g, respectively. The survival rate showed no difference by gender, plurality and years. The survival rate of very premature babies, low birth weight infants, very low birth weight infants, and extremely low birth weight infants were 87.6%, 93.8%, 83.2%, and 62.7% respectively. Causes of death were the complications of prematurity (83.8%), congenital anomalies (15.2%), birth asphyxia (5.0%) and others (2.5%). The survival rate increased significantly according to the gestational age and also by the birth weight. CONCLUSIONS: Our data do not represent of the survival rate and the causes of death in Korea. However, our data may reflect the common survival rate and the causes of death in Korean NICU, because the 7 hospitals participated in this study were common facilities and manpower in Korea.

The relationship between catechol-O-methyltransferase gene polymorphism and coronary artery abnormality in Kawasaki disease / 소아과

PURPOSE: Many gene polymorphisms are associated with coronary artery abnormalities in Kawasaki disease. Catechol-O-methyltransfe rase (COMT) plays an important role in the metabolism of catecholamines, catechol estrogen, and catechol drugs. Polymorphisms of the COMT gene are reported to be associated with myocardial infarction and coronary artery abnormalities. The aim of this study was to evaluate the relationship between COMT gene polymorphisms and coronary artery abnormalities in Kawasaki disease patients. METHODS: One hundred and one Korean children with Kawasaki disease and 306 healthy Korean control subjects were enrolled in this study. The polymorphisms of the COMT gene were analyzed by direct sequencing. RESULTS: There were no differences in the genotype and allelic frequency of the rs4680 and rs769224 polymorphic sites between Kawasaki disease and control subjects. Further, no significant difference was found in the rs4680 polymorphism between patients with coronary artery abnormalities and patients without coronary artery abnormalities (codominant P=0.32, dominant P=0.74, recessive P=0.13). However, the distribution of the rs769224 polymorphism was significantly different between patie nts with coronary artery abnormalities and patients without coronary artery abnormalities (codominant P=0.0077, dominant P=0.0021, recessive P=0.16). CONCLUSION: Our results indicate that the polymorphisms of the rs769224 gene might be related to the development of coronary artery abnormalities in Kawasaki disease.

In Utero Development of the Fetal Gall Bladder in the Korean Population

OBJECTIVE: To provide reference ranges of the fetal gall bladder in the Korean population. MATERIALS AND METHODS: Fetal gall bladder development was evaluated in well-dated, non-anomalous fetuses in the Korean population between February and April 2003 and the visualization rate and reference values were determined from the obtained data. RESULTS: The visualization rate of the fetal gall bladder increased as gestation advanced to a plateau above 90%, which was maintained between 16 and 34 weeks. The measured parameters from the fetal gall bladder had a significant positive relationship with gestational age (p = 0.000 for all cases), and the correlation of length and area with the gestational age (r = 0.741 and r = 0.690, respectively) was better than the correlation of width, height, and volume with gestational age. The repeatability coefficients and coefficients of variation between the two operators were 5.56 mm and 12.9% for the length and 344.11 mm(2) and 33.52% for the area. The median length of the fetal gall bladder in the Korean population was not significantly different from the mean length of gall bladders in the Caucasian and African-American populations (p = 0.915). CONCLUSION: We have provided reference values for the fetal gall bladder throughout the gestation period in the Korean population.

Sonographic Findings of Uterine Endometrial Stromal Sarcoma

OBJECTIVE: The study was performed to present the sonographic findings of uterine endometrial stromal sarcoma (ESS). MATERIALS AND METHODS: We conducted a retrospective review of sonographic findings of 10 cases that were diagnosed as uterine ESS. The patients' ages ranged from 25 to 51 years (mean age: 36.1 years). The reviews focused on the location, margin, size, number and echotexture of the lesions. Hysterectomy (n = 9) and myomectomy (n = 1) were performed and a pathologic diagnosis was obtained in all cases. RESULTS: The masses were located in the uterine wall (n = 6), or they presented as a polypoid mass protruding into the endometrial cavity from the myometrium (n = 3) or as a central cavity mass (n = 1). The lesion margins were smooth (n = 5), ill defined (n = 2), or smooth with partially nodular extensions (n = 3). The maximal mass length was 38 mm to 160 mm with a mean mass length of 83.5 mm. There were single lesions in eight cases and multiple lesions in two cases. The lesion echotextures were hypoechoic solid (n = 3), heterogeneously intermediate echoic (n = 5), diffuse myometrial thickening with heterogeneous echogenicity (n = 1) and septated cystic (n = 1). CONCLUSION: Endometrial stromal sarcoma presents with four patterns of its sonographic appearance; a polypoid mass with nodular myometrial extension, an intramural mass with an ill defined margin and heterogeneous echogenicity, an ill defined large central cavity mass or, diffuse myometrial thickening.

Investigation on the Immunity to Pertussis in the Korea

Acellular pertussis vaccine has been used widely in Korea since 1984. However, because many of the former generations were not inoculated with pertussis vaccine, they may infect infants with pertussis. With this background, we investigated the prevalence of pertussis antibodies in all age groups. Enzyme-linked immunosorbent assay (ELISA) to assess IgG antibodies to pertussis toxin (PT) and filamentous hemagglutinin (FHA) and bacterial agglutination (BA) to assess antibodies to agglutinogen were compared on 842 serum samples which were donated from 11 hospitals in Seoul area. In comparison with age groups under 20 years, antibodies of adults against PT and FHA were maintained. But antibodies against agglutinogen showed no pattem in all age groups. Antibodies to PT were correlated with antibodies to FHA. There was no significant difference in antibody levels between male and female (p<0.05).

The Lived Experience of Mothers Mentally Handicapped Daughters Having Menarche at Puberty / 간호학회지

The purpose of this study is to understand the structure of mothers of mentally handicapped daughters' lived experience, to apprehend the connectedness of the structure of the experience with concept of Parse's human becoming theory, and to provide a foundation for nursing research and education. Data collection was conducted from October 1995 to April 1996. Research participants were eight mothers of mentally handicapped daughters whose ages ranged from 12 to 18 attending special schools located in either Inchon or Seoul. The researcher had interviews with them over their lived experience conducted tape recorded, and made an analysis according to Parse's "human becoming research methodology." The data were collected using the dialogical engagement process "I and You," the participant researcher and the participant subject. The data were analyzed using the extraction-synthesis and heuristic interpretation. The structural integration is illustrated in the following: 1) Realizing the mother's role of mentally handicapped daughters and admitting situation. 2) Concealing a part of their relationship with others is interpreted as revealing-concealing. 3) Their fight back voluntarily to improve the situation is interpreted as powering. The conceptual integration which emerged was the lived experience of mothers is powering through the revealing-concealing and connection-separating of valuing.