열성 경련시 발열 정도와 열성 경련의 재발

문세나(Sena Moon),최병준·(Byung Jun Choi),이인구(In Goo Lee),황경태(Kyung Tai Whang) 대한소아신경학회 2006 대한소아신경학회지 Vol.14 No.1

목 적: 본 저자들은 이전 보고에서 열의 정도가 열성 경련 재발에 영향을 줄 수 있어 체온이 낮은 경우 열성 경련 재발이 다소 증가 될 수 있다는 점을 시사하였다. 따라서, 본 저자들은 이전 보고보다 연구 대상 열성 경련 환아 수와 기간을 늘려 열성 경련의 재발에 관한 인자 중 직계 가족의 열성 경련 기왕력을 조사하였고 초발 연령과 특히 열의 정도가 열성 경련 재발에 어떠한 영향을 미치는지 알아보았다. 방 법 : 6년 동안 초회의 열성 경련을 주소로 내원한 환아를 대상으로 하여 최고 2년간 추적 검사하였다. 대상 환아는 열의 정도에 따라 39.5℃ 이상군, 38.5℃ 이상 39.5℃ 미만군 및 38.5℃ 미만군의 3군으로 나누었고 연령은 6개월 이상 18개월 이하군, 19개월 이상 30개월 이하군 및 31개월 이상군으로 나누어 열성 경련의 재발률을 조사하였다. 결 과: 열성 경련 재발을 살펴보면 직계 가족이 열성 경련 가족력이 있는 경우는 19명(41.3%)이며, 간질의 가족력이 있는 경우는 5명(35.7%)이었다. 열의 정도에 따라 열성 경련의 재발률을 보면 I군의 경우 6개월 이상 18개월 이하 연령군에서는 5명(13.5%)이었고, 19개월 이상 30개월 이하는 5명(19.2%)이었다. II군의 경우 6개월 이상 18개월 이하는 22명(36.1%)이었고 19개월 이상 30개월 이하는 8명(24.2%)이었다. III군은 6개월 이상 18개월이하는 21명(42.0%)이었고 19개월 이상 30개월 이하는 8명(38.1%)이었다. 6개월 이상 18개월 이하 연령에서 I군에 비해 III군이 4.6배 재발이 많았으 며 이는 통계학적으로 의의가 있었다. 결 론 : 본 논문 결과에 따르면, 어린 연령에서 비교적 높지 않은 열이 있을 때 열성 경련이 생기는 경우에는, 추후 열성 경련의 재발이 높을 것을 시사하며 이에 대해서는 앞으로 임상 및 동물 실험 등이 더욱 많이 필요할 것으로 생각된다. Purpose : Recently, many studies on febrile convulsions again suggest that the degree of pyrexia may be related to the recurrence of febrile convulsions. In a previous study, we advocated that a low body temperature during the initial febrile convulsions is associated with an increase of recurrent febrile convulsions. Therefore, we have expanded the study by including 246 febrile convulsions during 6 years and investigated risk factors and especially the relationship between pyrexia and the recurrence rates. Methods : Children with febrile convulsions were divided into three groups according to the degree of fever. Group I showed body temperatures higher than 39.5℃, group II from 38.5 to 39.4℃, and group III lower than 38.4℃. Then, we analyzed the recurrence rates of febrile convulsions. Results : There occurred recurrent febrile convulsions in 19(41.3%) children with family history of febrile convulsion and 5(35.7%) children whose first-degree relatives diagnosed epilepsy. In group I, 5(13.5%) infants aged 6-18 months and 5(19.2%) aged 19-30 months had recurrent febrile convulsions. In group II, 22(36.1%) infants aged 6-18 months and 8(24.2%) aged 19-30 months had recurrent febrile convulsions. In group III, 21(42.0%) infants aged 6-18 months and 8(38.1%) aged 19-30 months had recurrent febrile convulsions. Concl usi on : Children with a lower degree of pyrexia and also younger age at the onset of the first febrile convulsion were more susceptible to recurrent febrile convulsios than otherwise.

적정체중아 제대혈의 ghrelin 및 leptin 농도와신체계측치의 관계

이진,문세나,박소현,정민호,서병규,이병철 대한소아청소년과학회 2006 Clinical and Experimental Pediatrics (CEP) Vol.49 No.1

Purpose : Ghrelin stimulates the secretion of growth hormone and other pituitary hormones, and has orexigenic effects. It may have a physiologic role in fetal and neonatal growth. Leptin secreted by the adipocytes reflects fat mass in infants as well as adults. The aim of this study was to evaluate the relation of cord blood ghrelin and leptin levels to body weight(BW), body mass index(BMI), insulin-like growth factor-I(IGF-I) and insulin-like growth factor binding protein-3(IGFBP-3) levels in appropriate for gestational age(AGA) newborns. Methods : Sixty healthy AGA newborns(31 males and 29 females, gestational age[GA] 34-42 weeks) were included in this study, whose BW and BMI were measured at delivery. Umbilical cord venous blood samples were withdrawn, and ghrelin and leptin were measured by radioimmunoassay. Cord blood IGF-I and IGFBP-3 were determined by immunoradiometric assay. Results : The mean levels of ghrelin were inversely correlated with BW(r=-0.29, P<0.05) and GA (r=-0.28, P<0.05), but were not affected by gender. The mean levels of leptin levels showed positive correlation with BW(r=0.44, P<0.01), GA(r=0.36, P<0.01), and BMI(r=0.28, P<0.05). The leptin levels of females were higher than those of males. There was no gender difference in leptin levels in neonates under GA 37 weeks. However, the leptin levels of females were higher than those of males (P<0.01) in newborns with GA 37 weeks or over. There was no correlation between ghrelin and leptin levels. Ghrelin and leptin levels showed no relations to cord blood IGF-I and IGFBP-3 levels. Conclusion : These data suggest that cord blood ghrelin may have an inverse correlation with BW in AGA newborns, and leptin levels are positively correlated with BW and fat mass. Further study of ghrelin concentrations in cord blood is necessary to elucidate the physiological and pathological roles of ghrelin during the fetal and neonatal periods. 목 적 : 재태연령 34주 이상의 적정체중아(appropriate for gestational age, AGA)에서 제대혈의 ghrelin과 leptin의 농도를 측정하고 출생체중, 체질량지수(body mass index, BMI) 등의 신체계측치와의 연관성 및 IGF-I, IGFBP-3와 같은 성장과 관련된 호르몬과의 관계에 대해 알아보았다.방 법 : 재태연령 34주에서 42주 미만의 신생아 중 재태기간과 비교해 적정체중을 가진 건강한 남아 31명과 여아 29명을 대상으로 하였다. 대상 신생아의 출생체중, 체질량지수를 계측하고 제대정맥혈을 채취하여 ghrelin, leptin, IGF-Ⅰ 및 IGFBP-3 농도를 측정하여 분석하였다.

정상 성인의 하지 길이 차이에 관한 문헌 고찰

김경진,문세나,박지혜,서현선,홍준혁 한국지역사회건강관리협회 대한건강과학학회 2005 대한건강과학학회지 Vol.2 No.1

Production of Interleukin-5, Interleukin-13 and Interferon-γ in Peripheral Blood CD8+ T Cells from Children with Wheezing

이문희,문세나,장지현,정명숙,김유진,김현희,이준성,윤종서 대한 소아알레르기 호흡기학회 2008 Allergy Asthma & Respiratory Disease Vol.18 No.3

Purpose : Our objective was to investigate the role of CD8+ T cells in pathogenesis of wheezing in children with atopic nature. Methods : Twelve atopic wheezers, 8 nonatopic wheezers, 8 disease controls and 8 healthy controls were enrolled in the study. We isolated CD8+ T cells from peripheral blood samples, incubated them for 72 hours either in the absence or presence of phytohemagglutinin (PHA) and compared the concentrations of interleukin (IL)-5, IL-13, and interferon (IFN)-γ in the cell culture supernatants. Results : In the atopic wheezer group, the IL-5 concentration was significantly higher after PHA stimulation than after non-stimulated incubation. This difference was not observed in the nonatopic wheezer, disease control and healthy control groups. IL-13 was undetectable in all of the cell culture supernatants. There was no significant difference in the IFN-γ concentration between the PHA-stimulated and non-stimulated conditions in all 4 groups. Conclusion : The results of this study suggest that CD8+ T cells may play a role in the pathogenesis of wheezing in children with atopic nature through the production of IL-5. Purpose : Our objective was to investigate the role of CD8+ T cells in pathogenesis of wheezing in children with atopic nature. Methods : Twelve atopic wheezers, 8 nonatopic wheezers, 8 disease controls and 8 healthy controls were enrolled in the study. We isolated CD8+ T cells from peripheral blood samples, incubated them for 72 hours either in the absence or presence of phytohemagglutinin (PHA) and compared the concentrations of interleukin (IL)-5, IL-13, and interferon (IFN)-γ in the cell culture supernatants. Results : In the atopic wheezer group, the IL-5 concentration was significantly higher after PHA stimulation than after non-stimulated incubation. This difference was not observed in the nonatopic wheezer, disease control and healthy control groups. IL-13 was undetectable in all of the cell culture supernatants. There was no significant difference in the IFN-γ concentration between the PHA-stimulated and non-stimulated conditions in all 4 groups. Conclusion : The results of this study suggest that CD8+ T cells may play a role in the pathogenesis of wheezing in children with atopic nature through the production of IL-5.

Baseline heart rate variability in children and adolescents with vasovagal syncope

심선희,박선영,문세나,오진희,이재영,김현희,한지환,이순주 대한소아청소년과학회 2014 Clinical and Experimental Pediatrics (CEP) Vol.57 No.4

Purpose: This study aimed to evaluate the autonomic imbalance in syncope by comparing the baselineheart rate variability (HRV) between healthy children and those with vasovagal syncope. Methods: To characterize the autonomic profile in children experiencing vasovagal syncope, weevaluated the HRV of 23 patients aged 7–18 years and 20 healthy children. These children weredivided into preadolescent (<12 years) and adolescent groups. The following time-domain indices werecalculated: root mean square of the successive differences (RMSSD); standard deviation of all averageR-R intervals (SDNN); and frequency domain indices including high frequency (HF), low frequency (LF),normalized high frequency, normalized low frequency, and low frequency to high frequency ratio (LF/HF). Results: HRV values were significantly different between healthy children and those with syncope. Student t test indicated significantly higher SNDD values (60.46 ms vs. 37.42 ms, P =0.003) andRMSSD (57.90 ms vs. 26.92 ms, P=0.000) in the patient group than in the control group. In thepatient group, RMSSD (80.41 ms vs. 45.89 ms, P =0.015) and normalized HF (61.18 ms vs. 43.19ms, P =0.022) were significantly higher in adolescents, whereas normalized LF (38.81 ms vs. 56.76ms, P =0.022) and LF/HF ratio (0.76 vs. 1.89, P =0.041) were significantly lower in adolescents. Incontrast, the control group did not have significant differences in HRV values between adolescents andpreadolescents. Conclusion: The results of this study indicated that children with syncope had a decreased sympathetictone and increased vagal tone compared to healthy children. Additionally, more severeautonomic imbalances possibly occur in adolescents than in preadolescents.

Early Left Ventricular Dysfunction in Children after Hematopoietic Stem Cell Transplantation for Acute Leukemia: A Case Control Study Using Speckle Tracking Echocardiography

윤지홍,김혜진,이은정,문세나,이재영,이재욱,정낙균,조빈,김학기 대한심장학회 2015 Korean Circulation Journal Vol.45 No.1

Background and Objectives: Cardiovascular complications are the leading cause of morbidity and mortality in childhood cancer survivors. Hematopoietic stem cell transplantation (HSCT) is a curable therapy for pediatric cancer. However, changes in cardiac function in childrenafter HSCT are not well known. We assessed left ventricular (LV) function in children after HSCT using speckle tracking echocardiography(STE). Subjects and Methods: Forty consecutive patients with median age of 11.9 years (range, 1.5–16 years) who received HSCT for acuteleukemia and had comprehensive echocardiography before and after (median 9.2 month) HSCT were included in this study. The LV functionparameters including conventional tissue Doppler imaging (TDI) and STE data were collected from pre- and post-HSCT echocardiography. These data were compared to those of 39 age-matched normal controls. Results: Compared to normal controls, post HSCT patients had similar (p=0.06) LV ejection fraction. However, the following three LV functionparameters were significantly decreased in post HSCT patients: rate-corrected velocity of circumferential fiber shortening (p=0.04),mitral inflow E velocity (p<0.001), and mitral septal annular E’ velocity (p=0.03). The following four STE parameters were also significantlydecreased in post HSCT patients: LV global circumferential systolic strain (p<0.01), strain rate (SR, p=0.01), circumferential diastolic SR(p<0.01), and longitudinal diastolic SR (p<0.001). There was no significant change in TDI or STE parameters after HSCT compared to pre-HSCT. Patients with anthracycline cumulative dose >400 mg/m2 showed significantly (p<0.05) lower circumferential systolic strain andcircumferential diastolic SR. Conclusion: Subclinical cardiac dysfunction is evident in children after HSCT. It might be associated with pre-HSCT anthracycline exposurewith little effect of conditioning regimens. Serial monitoring of cardiac function is mandatory for all children following HSCT.

천명이 있는 소아의 CD8+ T 세포의 IL-5, IL-13, IFN-γ 생산

이문희 ( Moon Hee Lee ),문세나 ( Se Na Moon ),장지현 ( Ji Hyun Jang ),정명숙 ( Myung Sook Chung ),김유진 ( Eu Gene Kim ),윤종서 ( Jong Seo Yoon ),김현희 ( Hyun Hee Kim ),이준성 ( Joon Sung Lee ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2008 소아알레르기 및 호흡기학회지 Vol.18 No.3

목적: 소아 천명 환자에서 CD8+ T 세포의 IL-5, IL-13, 그리고 IFN-γ의 생산을 비교하여 천명성 질환의 병인에 있어서 CD8+ T 세포의 역할에 대한 이해의 폭을 넓히고자 하였다. 방법: 천명을 주소로 입원한 소아 환자를 대상으로 하여 알레르겐 특이 IgE의 양성여부를 기준으로 아토피성 천명군과 비아토피성 천명군으로 분류하였다. 반복적인 하기도 감염의 병력이 있으나 천명의 병력은 없었던 소아환자를 질병 대조군으로 하고, 비감염성 비염증성 질환으로 입원한 비아토피 소아 환자를 건강 대조군으로 하였다. 말초혈액에서 CD8+ T 세포를 분리하여 phytohemagglutinin (PHA)과 함께 또는 PHA 없이 72시간 동안 시험관에서 배양하였다. 배양 상층액에서 IL-5, IL-13과 IFN-γ의 농도를 측정하였다. 결과: 아토피성 천명군에서 PHA와 함께 배양된 CD8+ T 세포로부터의 IL-5의 생산이 PHA없이 배양된 경우보다 높았다. 비아토피성 천명군, 질병 대조군, 건강 대조군에서는 CD8+ T 세포의 IL-5 생산이 PHA 자극 유무에 따라 다르지 않았다. IL-13의 농도는 모든 CD8+ T 세포 배양 상층액에서 측정되지 않았다. 모든 군에서 CD8+ T 세포로부터 IFN-γ의 생산은 PHA 자극 유무에 따라 유의한 차이가 없었다. 결론: CD8+ T 세포는 IL-5의 생산을 통하여 아토피 소인을 가진 소아의 천명 발생에 기여할 가능성이 있다. Purpose: Our objective was to investigate the role of CD8+ T cells in pathogenesis of wheezing in children with atopic nature. Methods: Twelve atopic wheezers, 8 nonatopic wheezers, 8 disease controls and 8 healthy controls were enrolled in the study. We isolated CD8+ T cells from peripheral blood samples, incubated them for 72 hours either in the absence or presence of phytohemagglutinin (PHA) and compared the concentrations of interleukin (IL)-5, IL-13, and interferon (IFN)-γ in the cell culture supernatants. Results: In the atopic wheezer group, the IL-5 concentration was significantly higher after PHA stimulation than after non-stimulated incubation. This difference was not observed in the nonatopic wheezer, disease control and healthy control groups. IL-13 was undetectable in all of the cell culture supernatants. There was no significant difference in the IFN-γ concentration between the PHA-stimulated and non-stimulated conditions in all 4 groups. Conclusion: The results of this study suggest that CD8+ T cells may play a role in the pathogenesis of wheezing in children with atopic nature through the production of IL-5. [Pediatr Allergy Respir Dis(Korea) 2008;18: 228-235]

극소저체중 출생아에서 메티실린 내성 포도상구균으로 인한 카테터 연관 혈류감염의 위험인자

조일현,정태웅,이주영,문세나,빈중현,이현승,이정현,김소영,성인경 대한신생아학회 2011 Neonatal medicine Vol.18 No.2

Purpose: The incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection has increased in children and in neonates,and is particularly associated with frequent use of central venous catheter in very low birth weight (VLBW) infants. It is known that the morbidity and mortality of MRSA infection are low in neonates, as compared with adults. The objective of this study was to examine the difference in clinical characteristics between VLBW infants that survived and those that did not, a catheter-related bloodstream infection (CRBSI) of MRSA. Methods: Thirty-four VLBW infants had laboratory-confirmed bloodstream infection with S. aureus . We examined the incidence,mortality and morbidity of CRBSI, and predictive factors associated with mortality. Results: Twenty-six infants had same pathogen (24 MRSA, 2 Methicillin-sensitive Staphylococcus aureus) in the blood and in the catheter tip. Eight infants (25.8%) died in the CRBSI and they all had MRSA blood infections. Sex ratio, gestational age, duration between blood collection and identification of pathogens, and WBC and platelet count were not significantly different between patients that died from and patients that survived CRBSI of MRSA. C-reactive protein (CRP) was significantly higher in VLBW infants that died. Mean age of onset and hospital day was earlier (9.1±6.6 vs. 26.9±20.2; P=0.005) and shorter for patients that died (10.1±7.0 vs. 73.0±32.4; P=0.000). Two survivors had complications of pyogenic arthritis of the lower extremities and soft tissue infection, respectively. Conclusion: Mortality of CRBSI was likely to be high in VLBW infants and might be anticipated by CRP and early onset of disease. 목적: 소아와 신생아에서의 MRSA 감염의 발병률은 증가되었고, 특히 극소저체중 출생아에서 중심정맥카테터의 빈번한 사용과 연관되었다. 이번 연구는 NICU에 입원한 극소저체중 출생아를 대상으로 MRSA로 인한 CRBSI의 임상적 특징을 조사하고, CRBSI로 인해 사망한 환자와 생존한 그룹 간의 차이를 분석하여, 사망과 관련된 위험인자를 예측해보고자 하였다. 방법: 34명의 극소저체중 출생아는 실험실적으로 확인된 S. aureus 의 혈류감염을 보였고 카테터 연관 혈류감염의 발병률, 사망률, 유병률 그리고 사망률과 연관된 예측인자를 조사하였다. 결과: 26명의 환아는 혈액과 카테터 tip에서 같은 병원균(24 MRSA, 2 MSSA)을 보였다. 8명(25.8%)은 CRBSI로 사망하였고 모두 MRSA 혈액 감염을 보였다. MRSA로 인한 CRBSI으로부터 생존한 그룹과 사망한 환자 간에 성비, 재태연령, 병원균 확인과 혈액채취의 기간, 백혈구, 혈소판 수는 분명한 차이를 보이지 않았다. CRP는 사망한 환자에서 분명히 증가되었다. 사망한 환자에서 발현 나이의 평균값은 빠르고(9.1±6.6 vs. 26.9±20.2; P= 0.005) 입원일수는 짧았다(10.1±7.0 vs. 73.0±32.4; P=0.000). 2명의 생존아는 하지에 화농성 관절염과 연부조직염의 합병증을 가졌다. 결론: 카테터 연관 혈류감염의 사망률은 극소저체중 출생아에서 높은 것으로 보이고 CRP와 질환의 조기발병에 의해 예측되었다.

엉덩 관절 벌림 운동 시 압력 생체 되먹임 장치와 골반 벨트의 사용이 엉덩 벌림근의 선택적 근 활성도에 미치는 영향

이동규 ( Dong Kyu Lee ),문세나 ( Se Na Moon ),노경희 ( Kyung Hee Noh ),박경희 ( Kyung Hee Park ),김태호 ( Tae Ho Kim ),오재섭 ( Jae Seop Oh ) 대한물리의학회 2011 대한물리의학회지 Vol.6 No.3

Purpose:The purpose of this study was to examine the effects of using a pressure bio-feedback unit (PBFU) and a pelvic belt (PB) on the electromyographic (EMG) signal amplitude of the gluteus medius (Gmed) and the quadratus lumborum (QL) during hip abduction exercise when lying on the side. Methods:Twenty able-bodied volunteers (10 male, 10 female) were recruited for this study. The EMG signal amplitude was randomly measured during hip abduction with preferred hip abduction (PHA), with PBFU, and with PB. The surface EMG signal was recorded from the Gmed and the QL. Data were analyzed using a one-way repeated ANOVA. Results:Muscle activity of Gmed was significantly higher in PBFU and in PB than in PHA (p<05). There were no significant difference between PBFU and PB (p>.05). Muscle activity of the QL was significantly lower in PB than in PHA (p<.05). The Gmed/QL muscle activity ratio was also significantly higher in PBFU and in PB than in PHA (p<.05), with no significant difference between PBFU and PB (p>.05). Conclusion:Based on these findings, using a PBFU and a PB is an effective method to disassociate QL use from Gmed use during hip abduction exercises when lying on the side.

엎드려 누운 자세에서 엉덩관절 폄시 내적, 외적 안정화 방법이 큰 볼기근의 선택적 근활성에 미치는 영향

노경희 ( Kyung Hee Noh ),문세나 ( Se Na Moon ),이동규,윤지연,김태호 ( Tae Ho Kim ),오재섭 ( Jae Seop Oh ) 한국전문물리치료학회 2011 한국전문물리치료학회지 Vol.18 No.3

The effects of an abdominal drawing-in maneuver (ADIM) using a pressure bio-feedback unit (PBFU) were compared to the effects of a pelvic belt (PB) on the muscle activities of the hip and back extensor muscles during hip extension in the prone position. Fifteen healthy male participants all performed prone hip extensions under three conditions: 1) prefened hip extension (PIlE), 2) performing an ADIM, and 3) using a PB. The muscle activities of the erector spinae, the gluteus maximus, and the medial hamstring on the right side were recorded by surface electromyography. The muscle activity of the erector spinae was significantly lower while performing an ADIM during prone hip extension than during PHE or with a PB (p<.05). Gluteus maximus muscle activity was significantly higher while performing an ADIM (p<.05). No significant dlifference was found for the medial hamstring muscle among the three conditions (p>.05). We concluded that the internal stabilization of the pelvis and lumbar spine afforded by the ADIM using a PBFU could be more effective than the external stabilization provided by a PB in terms of in-creasing selectively gluteus maximus activation during prone hip extension.