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Background: Although the importance of sleep problems has been increasingly emphasized due to the effects on children's development and children's and families' daytime behaviors, physical health, and quality of life, they have been overlooked in clinical practice. However, there have been few studies on the effects of rehabilitation on sleep problems. Therefore, in this study, we investigated the effects of an intensive rehabilitation program on sleep problems in children with developmental delays (DD). Methods: We included 36 children with DD (30 outpatients, 6 inpatients) and their caregivers who completed all items on the Sleep Disturbance Scale for Children. Of the children with DD, 19 (59.3%) had cerebral palsy (CP) and 13 (40.7%) had DD of non-CP origins, of which 6 (18.8%) had prematurity, 4 (12.5%) had genetic causes, and 3 (9.4%) had an unknown origin. Changes in sleep problems after the intensive rehabilitation program were evaluated using a paired or unpaired t-test, depending on the distribution of the continuous variables. Results: After the intensive rehabilitation program, in 36 children with DD, there was a significant improvement in the difficulty in initiating and maintaining sleep (DIMS) sub-score (p < 0.05). However, there was no significant improvement in the total score or other sub-scores, such as those for sleep breathing disorders (SBD), disorders of arousal (DA), sleep–wake transition disorders (SWTD), disorders of excessive somnolence (DOES), and sleep hyperhidrosis (SH). In the subgroup analysis according to the cause of DD, children with CP had a significant improvement in DIMS and DOES sub-scores (p < 0.05). Conclusion: The intensive rehabilitation program, consisting of more than two sessions per day, effectively alleviated sleep problems in children with DD, especially in those with CP. Among the sleep problems, the intensive rehabilitative program was most effective at improving the DIMS. However, further prospective studies with a larger number of patients with DD and a more standardized protocol are necessary to generalize this effect. [ABSTRACT FROM AUTHOR]

Aims: Prolonged tourniquet inflation produces a hyperdynamic cardiovascular response. We investigated the effect of continuous remifentanil infusion on systemic arterial pressure, heart rate, and cardiac output changes during prolonged tourniquet use in elderly patients under sevoflurane/N2O general anesthesia.Methods: Thirty female patients scheduled for knee replacement arthroplasty were infused with either remifentanil at a target organ concentration of 2.0 ng/mL (remifentanil group, n = 15) or saline (control group, n = 15) after induction of anesthesia. Anesthesia was maintained with sevoflurane and N2O. Heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), cardiac index (CI), total systemic vascular resistance index (TSVRI), BIS, end-tidal sevoflurane concentration (EtSEVO), and end-tidal carbon dioxide concentration (EtCO2) were measured during the study period.Results: There were significant differences in mean HR, SAP, DAP, and EtSEVO over time between the groups (P = 0.047, P < 0.001, P = 0.017, and P < 0.001, respectively). There was a statistically significant time trend effect (P < 0.001) in HR, SAP, DAP, and CI between the groups, with a statistically significant time-group interaction between the two groups (P = 0.02, 0.007, 0.001, 0.01, respectively).Conclusion: The present study demonstrated that infusion with remifentanil prevented an increase in hemodynamic pressure during tourniquet inflation in elderly patients under sevoflurane/N2O general anesthesia.

SUMMARY: Phytochrome B (PhyB), a red‐light receptor, plays important roles in diverse biological processes in plants; however, its function in NH4+ uptake and stress responses of plants is unclear. Here, we observed that mutation in indeterminate domain 10 (IDD10), which encodes a key transcription factor in NH4+ signaling, led to NH4+‐sensitive root growth in light but not in the dark. Genetic combinations of idd10 and phy mutants demonstrated that phyB, but not phyA or phyC, suppressed NH4+‐sensitive root growth of idd10. PhyB mutants and PhyB overexpressors (PhyB OXs) accumulated more and less NH4+, respectively, compared with wild‐type plants. Real time quantitative polymerase chain reaction (RT‐qPCR) revealed that PhyB negatively regulated NH4+‐mediated induction of Ammonium transporter 1;2 (AMT1;2). AMT1 RNAi plants with suppressed AMT1;1, AMT1;2, and AMT1;3 expression exhibited shorter primary roots under NH4+ conditions. This suggested that NH4+ uptake might be positively associated with root growth. Further, PhyB interacted with and inhibited IDD10 and brassinazole‐resistant 1 (BZR1). IDD10 interacted with BZR1 to activate AMT1;2. NH4+ uptake is known to promote resistance of rice (Oryza sativa) to sheath blight (ShB) and saline–alkaline stress. Inoculation of Rhizoctonia solani demonstrated that PhyB and IDD10 negatively regulated and AMT1 and BZR1 positively regulated resistance of rice to ShB. In addition, PhyB negatively regulated and IDD10 and AMT1 positively regulated resistance of rice to saline–alkaline stress. This suggested that PhyB–IDD10–AMT1;2 signaling regulates the saline–alkaline response, whereas the PhyB–BZR1–AMT1;2 pathway modulates ShB resistance. Collectively, these data prove that mutation in the PhyB gene enhances the resistance of rice to ShB and saline–alkaline stress by increasing NH4+ uptake. Significance Statement: PhyB interacts with and inhibits the activity of IDD10 and BZR1 to increase rice (Oryza sativa) resistance to sheath blight and saline–alkaline stress. [ABSTRACT FROM AUTHOR]

Background: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is an important prognostic factor in pediatric out-of-hospital cardiac arrest (OHCA). The recognition of cardiac arrest by dispatcher is a key factor for successful DA-CPR. In this study, we evaluated the association between pediatric age and dispatcher recognition.Methods: A retrospective observational study was designed using a nationwide OHCA registry. Patients under 19 years of age were enrolled. Patients were categorized into four groups according to age (<1 year, 1-6 years, 7-13 years, and 14-18 years). The primary outcome was cardiac arrest recognition by dispatcher. A multivariable logistic regression analysis was performed.Results: A total of 2754 pediatric OHCA patients were enrolled. A negative trend was observed between age and dispatcher performance (p < 0.01). The rate of cardiac arrest recognition was highest in patients under one year of age (61.5%) and lowest in patients ages 14-18 years old (47.1%). Patients in the 7-13 years and 14-18 years age groups were both associated with a decreased rate of recognition (adjusted odds ratio with 95% confidence interval: 0.55 (0.41-0.74) and 0.44 (0.34-0.57), respectively). In the interaction analysis, the association between age and outcomes was more prominent in patients with non-medical causes.Conclusion: Patients ages 7-18 years old were negatively associated with cardiac arrest recognition and DA-CPR instruction provision within optimal timeframes compared to those younger than one year old. Development of a tailored protocol could be considered according to age and cause of arrest for better dispatcher performance in pediatric OHCA patients. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2005.06.006 Byline: Oksoo Kim (a), Jung-Hee Kim (b), Jin-Hee Jung (b) Keywords: Stress; Smoking; Nicotine dependence; Diabetes mellitus; Men; Korean Abstract: The purpose of the study was to investigate the level of stress and cigarette smoking behaviors in Korean men with diabetes and to exam the relationships among them. Data were collected using the questionnaire including background characteristics, modified Brief Encounter Psychosocial Instrument (BEPSI) and the Fagerstrom Tolerance Questionnaire (FTQ). 37% of the participants were current smokers with a mean of 4.22 FTQ score. 22% among the current smokers had a nicotine dependency. 43.1% indicated they were considering quitting smoking within 6 months. The level of stress was not associated with the amount of smoking. However, the level of stress was associated with nicotine dependency. There were no significant differences between the smoking cessation stage and stress. In conclusion, the prevalence of smoking among Korean men with diabetes is high. The large proportion of smokers in the contemplation and preparation stages should be supported by the need for stage-matched interventions targeting this special group of smokers. Author Affiliation: (a) College of Nursing Science, Ewha Womans University, 11-1 Daehyun-dong, Seodaemun-gu, 120750 Seoul, Republic of Korea (b) College of Nursing Science, Ewha Womans University, Seoul, Republic of Korea

The Pediatric Emergency Care Applied Research Network (PECARN) rule is commonly used for predicting the need for computed tomography (CT) scans in children with mild head trauma. The objective of this study was to validate the PECARN rule in Korean children presenting to the pediatric emergency department (PED) with head trauma. This study was a multicenter, retrospective, observational cohort study in two teaching PEDs in Korea between August 2015 and August 2016. In this observational study, 448 patients who visited PEDs were included in the final analysis. Risk stratification was performed with clinical decision support software based on the PECARN rule, and decisions to perform CT scans were subsequently made. Patients were followed-up by phone call between 7 days and 90 days after discharge from the PED. The sensitivity and specificity were analyzed. The sensitivity was 100% for all age groups, and no cases of clinically important traumatic brain injury (ciTBI) were identified in the very-low-risk group. CT scans were performed for 14.7% of patients in this study and for 33.8% in the original PECARN study. The PECARN rule successfully identified low-risk patients, and no cases of ciTBI were missed despite the reduced proportion of patients undergoing CT scans. [ABSTRACT FROM AUTHOR]

Objective. Studies comparing magnetic resonance enterography (MRE) and capsule endoscopy (CE) for the assessment of small bowel (SB) Crohn's disease (CD) are scarce in Korea. In addition, there is no Korean experience of patency capsule (PC) examination prior to CE. The primary aim of this study was to compare diagnostic yields of MRE and CE for the assessment of SB CD. Secondary objectives were to compare the detection rate of proximal SB lesions by each modality in the Montreal classification and evaluate the safety and feasibility of PC in Korean CD patients. Methods. MRE was performed as the first examination to assess SB CD. PC examination and CE were then performed. Diagnostic yields of active SB disease by MRE and CE were then analyzed. Results. Disintegration of the patency capsule was shown in 5 patients out of 26 patients, who did not undergo CE. These 5 patients were accounted as negative CE findings. Overall, MRE and CE detected 80.8% and 65.4% of active SB lesions of CD in 26 patients, respectively (P = 0.212). MRE and CE detected 0% (0/26) and 19.2% (5/26) (P = 0.051) of jejunal lesions, 30.8% (8/26) and 42.3% (11/26) (P = 0.388) of proximal ileal lesions, and 80.8% (21/26) and 53.8% (14/26) (P = 0.039) of terminal ileal lesions, respectively. According to the Montreal classification, MRE and CE independently detected proximal disease (L4) in 30.8% (8/26) and 53.8% (14/26) (P = 0.092), respectively. Conclusions. The diagnostic yields of MRE and CE for the assessment of SB CD including proximal SB lesions were similar. MRE is a more objective tool for detecting clinically relevant stricture than PC although PC examination could be performed safely before CE to prove the patency of SB. This trial is registered with KCT0004305. [ABSTRACT FROM AUTHOR]

Recent studies showed that physical and/or neuropsychiatric impairments significantly affect long-term mortality of ICU survivors. We conducted this study to investigate that simplified measurement of physical function and level of consciousness at hospital discharge by attending nurses could predict long-term outcomes after hospital discharge. A retrospective analysis of prospectively and retrospectively collected data of 246 patients who received medical ICU treatment was conducted. We grouped patients according to physical function and level of consciousness measured by the simplified method at hospital discharge as follow; group A included patients with alert mental and capable of walking or moving by wheel chairs; group B included those with alert mental and bed-ridden status; and Group C included those with confused mental and bed-ridden status. The two-year survival rate after hospital discharge was compared. Of 246 patients, 157 patients were included in the analysis and there were 103 survivors after two-year follow up. Compared to non-survivors, survivors were more likely to be younger (P = 0.026) and have higher body mass index (P = 0.019) and no malignant disease (P = 0.001). There were no statistically significant differences in treatment modalities including medication, use of medical devices, and physical therapy between the survivors and non-survivors. The analysis showed significant differences in survival between the groups classified by physical function (P < 0.001) and level of consciousness (P < 0.01). Multivariate analysis showed that survival rate was significantly lower among the patients in group C than in those in group B or group A (P < 0.001). Simplified method to assess physical function and level of consciousness at hospital discharge can predict long-term outcomes of medical ICU survivors. [ABSTRACT FROM AUTHOR]

Background: Coronary artery dilatation (CAD) is a great concern with Kawasaki disease (KD). This study aimed to investigate the relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and CAD in patients with the hyperacute phase (≤4 days of fever) of KD.Methods: Serum NT-proBNP levels were compared between patients with and those without CAD, who underwent transthoracic echocardiography (TTE) within 24 h of the hyperacute phase of KD in the pediatric emergency department (PED). Electronic medical records of patients aged 1 month to 15 years who visited the PED were retrospectively assessed from January 2010 to December 31, 2014.Results: One hundred nine patients were enrolled in the study. Twenty-three of those patients had CAD within 24 h of TTE. Median serum NT-proBNP levels were significantly higher in patients with CAD (824.1 pg/ml; interquartile range [IQR], 515.4-1570.0184.8-767.8 pg/ml) than in patients without CAD (396.4 pg/ml; IQR, 184.8-767.8 pg/ml) (p ≤ 0.001). The cutoff value of serum NT-proBNP, which predicted CAD during the hyperacute phase of KD, was 515.4 pg/ml, which yielded sensitivity of 78.26% and specificity of 61.63%. The area under the curve for NT-proBNP for predicting CAD during hyperacute KD was 0.749 (95% CI, 0.642-0.856).Conclusion: Serum NT-proBNP might be an additional laboratory marker for detecting early CAD during the hyperacute phase of KD in the PED. [ABSTRACT FROM AUTHOR]

International Maritime Organization recognizes vessel-induced pollution as a global issue. The designation of the Baltic Sea as the special uncontaminated area was the beginning of the regulations for preventing marine pollution. In this regard, a process is needed which meets the provisions of MEPC. 227(64) for the specificity and constrained conditions of vessels, removes both nitrogen and phosphorus, requires convenient operation and low construction cost and is little affected by the load variation of inflow. This study used an SBR(sequencing batch reactor) and MBR(membrane bioreactor) combined process to iterate the stirring and aeration process and maintained the ratio of raw wastewater parameters (C:N:P) to be 10:3:1 in order to assess the quality and future availability of ultimate outflow in each time period of the stirring and aeration process. The removal efficiencies of COD and T-N exceeded 90% and 93% respectively. However, a detailed mechanism will be identified by a further study on nitrogen removal issues like DO aeration condition, stirring duration, ORP and NO3. As the removal efficiency of T-P exceeded 95%, the SBR and MBR process formed anaerobic and aerobic conditions without a separate coagulation process for removing phosphorus, thereby enabling easy phosphorus release and uptake. The optimal stirring and aeration condition seems to be 70–50 min. A further study will be efficiently conducted by focusing on the water quality criteria of the Maritime Environment Protect Committee. 227 (64) for E. coli and chlorine and a detailed mechanism. [ABSTRACT FROM AUTHOR]

Objective: Current studies have not found sufficient evidence to encourage the use of ultrasound for assessing dehydration in children. We introduce a new sonographic parameter, the "aorta/inferior vena cava (IVC) cross-sectional area index" (Ao/IVCA) measured just inferior to the xiphoid process, for the effective evaluation of dehydration in children.Methods: This is a prospective, observational study. We enrolled children who presented to the pediatric emergency department (PED) between May 2014 and January 2015. We measured the maximum diameter of the aorta from inner wall to inner wall, and the long and short axis diameters of IVC using a convex array transducer. Ao/IVCA was calculated and compared with aorta/IVC maximal diameter index (Ao/IVCD) and the clinical dehydration scale (CDS).Results: A total of 34 children were enrolled. We found a statistically significant correlation between Ao/IVCA and CDS (R(2) = 0.30; P <.001). Ao/IVCD did not correlate significantly with CDS (R(2) = 0.08; P =.11). The ability of Ao/IVCA and Ao/IVCD to predict CDS ≥1 was assessed using the receiver operating characteristic analysis. The area under the receiver operating characteristic curve for Ao/IVCA was larger than that for Ao/IVCD (0.87 vs 0.75, P= .04). The cut-off value of Ao/IVCA that yielded the maximum value of Youden index was 1.81 (sensitivity: 72%, specificity: 89%).Conclusions: Ao/IVCA might be a promising index for the assessment of dehydration. The diagnostic performance of Ao/IVCA for dehydration might be higher than that of the method that uses the maximum diameter of IVC and the aorta. [ABSTRACT FROM AUTHOR]