A Multi-Center Educational Research Regarding Breastfeeding for Pediatrics Residents in Korea

Yong Sung Choi,정성훈,김은선,Eun Sun Kim,Eunhee Lee,Euiseok Jung,So-Yeon Lee,이우령,Hye Sun Yoon,Yong Joo Kim,Ji Kyoung Park,Son Moon Shin,Ellen Ai-Rhan Kim 대한신생아학회 2022 Neonatal medicine Vol.29 No.1

Purpose: Pediatricians have a significant responsibility to educate mothers about the importance of breastfeeding. However, there have been minimal efforts in the courses of resident training in Korea. The purpose of this study is to evaluate the change in knowledge and attitude before and after a 4-week breastfeeding educational intervention among multicenter residents. Methods: Prospective interventional educational research was designed for residents at eight training hospitals in Korea. Institutional reviews were obtained in each hospital. The education curriculum consisted of 14 courses regarding breastfeeding theory and practice. These materials were used to teach pediatric residents for 4 weeks. Knowledge-based tests were administered before the course, and re-tests were administered after the course using different test items of similar levels. Test scores and survey responses were compared before and after the intervention. Results: A total of 73 residents (1st year 20, 2nd year 23, 3rd year 16, and 4th year residents 14) from eight training hospitals completed the intervention. Their average age was 30.3±2.9 years, 17 (23.3%) were male, 22 (30.1%) were married, and eight had more than one child of their own. The mean pre-test score was 61.8±13.4 and the mean post-test score was 78.3±7.5 (P<0.001). The inter-grade difference in the score was significant in the pre-test (P=0.005), but not significant in the post-test (P=0.155). There were more responses of obtaining confidence after the intervention (P<0.001). Conclusion: In our study, pediatric residents showed improvement in their knowledge and confidence level after 4 weeks of the breastfeeding curriculum. This will provide a basis for future policymaking in the training of pediatric residents regarding breastfeedReceived: 6 January 2022 Revised: 15 February 2022 Accepted: 15 February 2022 Correspondence to: Ellen Ai-Rhan Kim, MD Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-3390 Fax: +82-2-3010-6978 E-mail: arkim@amc.seoul.kr A Multi-Center Educational Research Regarding Breastfeeding for Pediatrics Residents in Korea Yong-Sung Choi, MD,PhD1, Sung-Hoon Chung, MD, PhD2, Eun Sun Kim, MD, PhD3, Eun Hee Lee, MD4, Euiseok Jung, MD5, So Yeon Lee, MD, PhD5, Wooryoung Lee, MD6, Hye Sun Yoon, MD, PhD7, Yong Joo Kim, MD, PhD8, Ji Kyoung Park, MD, PhD9, Son Moon Shin, MD, PhD9, and Ellen Ai-Rhan Kim, MD, PhD5 1Department of Pediatrics, Kyung Hee University Hospital, Seoul, Korea 2Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Korea 3Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Korea 4Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea 5Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea 6Department of Pediatrics, Soonchunhyang University Seoul Hospital, Seoul, Korea 7Department of Pediatrics, Nowon Eulji Medical Center, Eulji University, Seoul, Korea 8Department of Pediatrics, Hanyang University Seoul Hospital, Seoul, Korea 9Department of Pediatrics, Inje University Busan Paik Hospital, Busan, Korea Neonatal Med 2022 February;29(1):28-35 https://doi.org/10.5385/nm.2022.29.1.28 pISSN 2287-9412 . eISSN 2287-9803 Copyright(c) 2022 By Korean Society of Neonatology This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Original Article 29 Neonatal Med 2022 February;29(1):28-35 https://doi.org/10.5385/nm.2022.29.1.28 ing in Korea.

Poster Session : PS 0813 ; Upper GI Tract : Difference in Endoscopic Vacuum-Assisted Closure (E-VAC) and Esophageal Stenting in Postsurgical Gastroesophageal Leakage

( Yeon Sang Jeong ),( Young Soo Park ),( Ju Yup Lee ),( Yoon Jin Choi ),( Yong Hwan Kwon ),( Jae Jin Hwang ),( Ki Chul Yoon ),( Ae Ra Lee ),( Hyun Joo Lee ),( Hyuk Yoon ),( Cheol Min Shin ),( Na Young 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: After esophagectomy or proximal gastrectomy, the reported incidence of esophageal leakage ranges from 5% to almost 30%. Gastroesophageal leakage increases morbidity and mortality rates, and conventional treatments are used to control leakage by endoscopic implantation with self-expendable metal stents (SEMS). E-VAC therapy has recently been reported as an effective treatment modality for postsurgical anastomotic leakage. The aims of this study are to show the relative differences therapy of between esophageal stenting and E-VAC in treating postsurgical gastroesophageal leakage. Methods: From 2003 to 2014, 18 patients treated with postsurgical gastroesophageal leakage in one medical center were evaluated (Male : Female = 13 : 5). Mean age were 71.1 ± 2 years in E-VAC group and 67.3 ± 3 years in stenting group. Among the patients, 7 patients were treated by E-VAC. On the other hand, 11 patients were treated by covered SEMS. The followings were compared: clinical success rate, recurrence, closure time, hospital stay, and costs. Results: Of 7 patients treated with E-VAC, 6 patients were treated successfully. Among 11 patients treated with stenting, 7 patients were treated successfully. However, one patient in stenting group died of cancer progression without control of leakage by stenting. One of 3 patients that treated with stenting have been persisted to leakage, changed treatment in E-VAC and then successfully treated. Two patients in the stenting group failed. Mean closure time was 19.6 ± 6 days in E-VAC group and 35.4 ± 12 days in stenting group. Mean hospital stay were 34.0 ± 12 days in E-VAC group and 69.1 ± 31 days in stenting group. The Costs were $585 ± $239 in E-VAC group and $1,456 ± $287 in stenting group. Conclusions: E-VAC therapy might be effective treatment option for postsurgical gastroesophageal leakage.

Directed Evolution of the 3-Hydroxypropionic Acid Production Pathway by Engineering Aldehyde Dehydrogenase using a Synthetic Screening Device

Joo Yeon SEOK,Jina YANG,Sang Jin CHOI,Hyun Gyu LIM,Un Jong CHOI,Kyung-Jin KIM,Sunghoon PARK,Tae Hyeon YOO,Gyoo Yeol JUNG 한국생물공학회 2018 한국생물공학회 학술대회 Vol.2018 No.4

Poloxamer 407 Hydrogels for Intravesical Instillation to Mouse Bladder

Sang Hyun Kim,Sung Rae Kim,Ho Yub Yoon,In Ho Chang,Young Mi Whang,Min Ji Cho,Myeong Joo Kim,Soo Yeon Kim,Sang Jin Lee,Young Wook Choi 대한비뇨기종양학회 2017 대한비뇨기종양학회지 Vol.15 No.3

Purpose: Poloxamer 407 (P407) thermo-sensitive hydrogel formulations were developed to enhance the retention time in the urinary bladder after intravesical instillation. Materials and Methods: P407 hydrogels (P407Gels) containing 0.2 w/w% fluorescein isothiocyanate dextran (FD, MW 4 kDa) as a fluorescent probe were prepared by the cold method with different concentrations of the polymer (20, 25, and 30 w/w%). The gel-forming capacities were characterized in terms of gelation temperature (G-Temp), gelation time (G-Time), and gel duration (G-Dur). Homogenous dispersion of the probe throughout the hydrogel was observed by using fluorescence microscopy. The in vitro bladder simulation model was established to evaluate the retention and drug release properties. P407Gels in the solution state were administered to nude mice via urinary instillation, and the in vivo retention behavior of P407Gels was visualized by using an in vivo imaging system (IVIS). Results: P407Gels showed a thermo-reversible phase transition at 4°C (refrigerated; sol) and 37°C (body temperature; gel). The G-Temp, G-Time, and G-Dur of FD-free P407Gels were approximately 10°C–20°C, 12–30 seconds, and 12–35 hours, respectively, and were not altered by the addition of FD. Fluorescence imaging showed that FD was spread homogenously in the gelled P407 solution. In a bladder simulation model, even after repeated periodic filling-emptying cycles, the hydrogel formulation displayed excellent retention with continuous release of the probe over 8 hours. The FD release from P407Gels and the erosion of the gel, both of which followed zero-order kinetics, had a linear relationship (r²=0.988). IVIS demonstrated that the intravesical retention time of P407Gels was over 4 hours, which was longer than that of the FD solution (<1 hour), even though periodic urination occurred in the mice. Conclusions: FD release from P407Gels was erosion-controlled. P407Gels represent a promising system to enhance intravesical retention with extended drug delivery.

The Korean Academy of Tuberculosis and Respiratory Diseases : Slide Session ; OS-049 : COPD ; The Impact of Static Hyperinfl ation in The Patients with Chronic Obstructive Pulmonary Disease

( Joo Hun Park ),( Tae Rim Shin ),( Seung Soo Sheen ),( Joon Beom Seo ),( Kwang Ha Yoo ),( Ji Hyun Lee ),( Tae Hyung Kim ),( Seong Yong Lim ),( Ho Il Yoon ),( Jae Seung Lee ),( Yeon Mok Oh ),( Sang Do 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: The progression of emphysema and airfi ow limitation in chronic obstructive pulmonary disease (COPD) leads to static hyperinfi ation. However, few studies have been conducted so far regarding the prognostic value of static hyperinfi ation marked by residual volume (RV)/ total lung capacity (TLC). Therefore we attempted to fi nd the independent factors related to static hyperinfi ation and to test the hypothesis that static hyperinfi ation is associated with the prognosis of COPD. Methods: We analyzed 380 COPD patients of our Korean Obstructive Lung Disease (KOLD) cohort who were recruited from 16 hospitals in Korea from June 2005 to April 2012. Hyperinfi ated COPD was defi ned as 40% or more of RV/ TLC. Results: Patients with hyperinfi ated COPD was older and male dominant, and had worse pulmonary function (represented by lower FEV1, FEV1/FVC, and FVC), higheremphysema index, and severer air-trapping, compared to non-hyperinfiated COPD group (p<0.05). Multiple logistic regression analysis demonstrated that age (OR = 1.071), FEV1 (OR = 0.923), FEV1/FVC (OR = 0.948), and emphysema index (OR = 1.036) were independently associated with severe static hyperinfiation ( RV/TLC =40%) (p<0.05). According to the severity of static hyperinfi ation, mean survival period was shorter (RV/TLC = 60% : 77.7 ± 4.6 months, 40 = RV/TLC <60 : 94.3 ± 1.9 months, RV/TLC < 40 % : 95.1 ± 1.8 months, p<0.05) and acute exacerbation was more frequent (p<0.05). Conclusions: Old age, emphysema index, FEV1, and FEV1/FVC were independent factors associated with hyperinfi ated COPD. The survival period was shorter according to the severity of static hyperinfi ation. This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for health and welfare (A102065).

The Korean Association of lnternal Medicine : Poster Session ; PS 1366 : Nephrology ; Severe Hyponatremia (95 Mmol/l) Associated with Desmopressin Diacetate Arginine Vasopressin (DDAVP)

( Yeon Kyung Park ),( Hyae Jin Yoon ),( Joo Hark Yi ),( Sang Woong Han ),( Ho Jung Kim ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Desmopressin diacetate arginine vasopressin (DDAVP) is a synthetic analogue of the natural pituitary hormone 8-arginine vasopressin (AVP). DDAVP affects renal water balance as an antidiuretic hormone, which was used in various disease, but hyponatremia could be developed. Until now, some case reports were documented regarding DDAVP-induced mild to moderate hyponatremia. A 76-year-old female with chronic DDAVP administration for managing nocturia by a local neurologist was transferred with severe hyponatremia (95 mmol/L) associated with general weakness, dizziness, and headache. Although the dose of DDAVP increased two times recently, serum sodium level was not checked, past 10 months. When she was transferred at our emergency room with 3% saline intravenous infusion (estimated amount was more than 100 ml for 2 hours), her serum sodium level was rapidly overcorrected to 106 mmol/L (11 mmol/L in 2 hours) without developing neurologic symptoms. We decided to re-lower her serum sodium level with intravenous administration of 5% dextrose water and DDAVP in order to preventing osmotic demyelination syndrome (ODS). After that re-lowering treatment, serum sodium level increased by 12 mmol/L during the fi rst 24 hours. Until discharge, any other neurologic symptoms and complications were not occurred, and her serum sodium level was 134 mmol/L at discharge. In conclusion, through the present case, as it has been an increased in using DDAVP for managing nocturia in older patients, regular and serial test for serum sodium level should be performed. When using 3% saline, the physician should consider a rapid correction of serum sodium level. The overcorrection of serum sodium could be managed by re-lowering treatment with intravenous dextrose water and DDAVP for preventing ODS.

Effects of sun exposure and dietary vitamin D intake on serum 25-hydroxyvitamin D status in hemodialysis patients

Yeon Joo Lee,Il Hwan Oh,Hee Jun Baek,Chang Hwa Lee,Sang Sun Lee 한국영양학회 2015 Nutrition Research and Practice Vol.9 No.2

BACKGROUND/OBJECTIVES: Vitamin D deficiency is common in hemodialysis patients. The aim of this study was to identify whether or not sun exposure and dietary vitamin D intake have effects on serum 25-hydroxyvitamin D (25(OH)D) status in hemodialysis (HD) patients. The objective was to identify the main determinants of serum vitamin D status in the study subjects. SUBJECTS/METHODS: A cross-sectional study of 47 HD patients (19 males and 28 females) was performed. We assessed serum 25(OH)D and 1,25(OH)2D levels between August and September 2012 and analyzed the prevalence of vitamin D deficiency in HD patients. To evaluate the determinants of serum 25(OH)D levels, we surveyed dietary vitamin D intake, degree of sun exposure, and outdoor activities. To compare biological variables, serum 25(OH)D was stratified as below 15 ng/ml or above 15 ng/ml. RESULTS: Mean 25(OH)D and 1,25(OH)2D levels were 13.5 ± 5.8 ng/ml and 20.6 ± 11.8 pg/ml, respectively. The proportions of serum 25(OH)D deficiency (< 15 ng/ml), insufficiency (15-< 30 ng/ml), and sufficiency (≥ 30 ng/ml) in subjects were 72.4%, 23.4%, and 4.3%, respectively. Prevalence of vitamin D deficiency in female patients was 78.6%, whereas that in males was 63.2% (P = 0.046). Vitamin D intake and sun exposure time were not significantly different between the two stratified serum 25(OH)D levels. Dietary intake of vitamin D did not contribute to increased serum 25(OH)D levels in HD patients. The main effective factors affecting serum 25(OH)D status were found to be the sun exposure and active outdoor exercise. CONCLUSIONS: Hypovitaminosis D is common in HD patients and is higher in females than in males. Sun exposure is the most important determinant of serum 25(OH)D status in HD patients.

Rational Design of Succinic Semialdehyde Reductase (AKR7A5) by Employing Enzyme-substrate Interatomic Contact Analysis

Sang-Yeon SHIM,Choong JEON,Young Joo YEON 한국생물공학회 2017 한국생물공학회 학술대회 Vol.2017 No.10

Autophagy Is Mediated by Oxidative Signaling in Lipopolysaccharide Induced Acute Lung Injury Model

( Yeon Joo Lee ),( Chul Gyu Yoo ),( Sang Min Lee ) 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

Background: Acute lung injury (ALI) and acute respiratory distress syndrome have still high mortality. However, there are few therapeutic options. We have to devise the method to decrease cell death of lung epithelium and endothelium in ALI. Autophagy is involved in both cell survival and cell death, which is not known well in the field of ALI. In this work, we wished to determine the role of autophagy in ALI and the physiological significance of the autophagic response. Materials and Methods: In vitro experiment, lipopolysaccharide(LPS) was exposed to RAW 264.7 cell and autophagy was monitored by measurement of expression level of LC3-I and LC3-II using western blotting(WB). In vivo experiment, LPS was instilled into C57BL/6 mice intratracheally and fixed lung tissue and mouse lung lysates were analyzed by WB, LM and EM. N-acetylcysteine was treated to in vivo and in vitro ALI models and protein extracts from lung and cells were prepared for western blot analysis. Results: Preliminary studies indicated that LPS induced autophagy in RAW 264.7 cells in dose and time dependent manner, as assessed by increased expression of LC3II. Parallel studies in mice also showed an increase in LC3II in lung by LPS, which also induced ALI. We next investigated the effect of NAC upon the LPS induced autophagy. We observed that LPS induced autophagy was attenuated by NAC both in vitro and vivo experiment. Conclusion: We found that LPS induced autophagy in the model of ALI. Oxidative signaling might be involved in the induction mechanism of autophagy by LPS.

Original Article : Changes in the seroprevalence of IgG anti-hepatitis A virus between 2001 and 2013: experience at a single center in Korea

( Sung Jun Chung ),( Tae Yeob Kim ),( Sun Min Kim ),( Min Roh ),( Mi Yeon Yu ),( Jung Hoon Lee ),( Chang Kyo Oh ),( Eun Young Lee ),( Seung Lee ),( Yong Cheol Jeon ),( Kyo Sang Yoo ),( Joo Hyun Sohn ) 대한간학회 2014 Clinical and Molecular Hepatology(대한간학회지) Vol.20 No.2

Background/Aims: The incidence of symptomatic hepatitis A reportedly increased among 20- to 40-year-old Korean during the late 2000s. Vaccination against hepatitis A was commenced in the late 1990s and was extended to children aged <10 years. In the present study we analyzed the changes in the seroprevalence of IgG anti-hepatitis A virus (HAV) over the past 13 years. Methods: Overall, 4903 subjects who visited our hospital between January 2001 and December 2013 were studied. The seroprevalence of IgG anti-HAV was analyzed according to age and sex. In addition, the seroprevalence of IgG anti-HAV was compared among 12 age groups and among the following time periods: early 2000s (2001-2003), midto- late 2000s (2006-2008), and early 2010s (2011-2013). The chi-square test for trend was used for statistical analysis. Results: The seroprevalence of IgG anti-HAV did not differ significantly between the sexes. Furthermore, compared to the seroprevalence of IgG anti-HAV in the early 2000s and mid-to-late 2000s, that in the early 2010s was markedly increased among individuals aged 1-14 years and decreased among those aged 25-44 years (P<0.01). We also found that the seroprevalence of IgG anti-HAV in individuals aged 25-44 years in the early 2010s was lower than that in the early 2000s and mid-to-late 2000s. Conclusions: The number of symptomatic HAV infection cases in Korea is decreasing, but the seroprevalence of IgG anti-HAV is low in the active population. (Clin Mol Hepatol 2014;20:162-167)