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Hypertension is a major health problem in most developed and developing countries. Worldwide, approximately 1 billion people have hypertension, and 13% of all deaths are closely related to hypertension. Recently, the prevalence of elevated blood pressure (BP) in children and adolescents has increased, probably due to the increased prevalence of overweight and obesity among youths. Increasing evidence suggests that adult hypertension has its antecedents in childhood, as childhood BP predicts adult BP. Additionally, pediatric hypertension may cause premature atherosclerosis and early development of cardiovascular disease. Therefore, the identification and treatment of hypertension in childhood is likely to have an important impact on long-term outcomes of cardiovascular disease. International hypertension guidelines for children and adolescents have recently been significantly revised, especially regarding the diagnosis of hypertension. This review presents the recent guidelines for the diagnosis, evaluation, management, and treatment of hypertension in children and adolescents.

Transparent and conductive IGZO/Ni/IGZO tri-layer films were deposited on a poly-carbonate substrate using RF and DC magnetron sputtering in order to achieve high transmittance in the visible range and low emissivity in the infrared range. The influence of the Ni interlayer on the structural and optical properties of the films was then investigated. Although the observed XRD pattern indicates that the IGZO films are amorphous structures, the surface roughness and electrical conductivity increased as the thickness of the Ni interlayer increased. In addition, the rough surface and enhanced carrier density of the films due to the Ni interlayer results in the decreased visible transmittance and low emissivity of the films.

Background Adults with unoperated congenitally corrected transposition of the great arteries are rare but form a distinct group among adults with congenital heart disease. Patients with congenitally corrected transposition of the great arteries often have one or more associated cardiac anomalies that dictate the need for, and timing of, surgical intervention in childhood. However, in a proportion of patients, the hemodynamics does not require surgical attention during childhood, and, in some patients, a correct diagnosis is not established until adulthood. Here we report an adult case of unoperated congenitally corrected transposition of the great arteries with a large ventricular septal defect and probable pulmonary arterial hypertension. Case presentation Our patient was a 46-year-old Korean man. Transthoracic echocardiography and cardiac catheterization demonstrated hemodynamically balanced ventricles with a non-regurgitant systemic atrioventricular valve, normal pulmonary arterial pressure, and a reasonable difference between the oxygen saturation values of the aorta and pulmonary trunk, even with the presence of a large ventricular septal defect. Further morphological assessments using cardiac computed tomography and three-dimensional modeling/printing of his heart revealed that the mitral valve was straddling over the posteriorly positioned ventricular septal defect, which could explain the functional and anatomical subvalvular pulmonary stenosis and a small amount of shunt flow through the large ventricular septal defect. We interpreted this combination of cardiac defects as able to sustain his stable cardiac function. Thus, we decided to maintain his unoperated status. Conclusion A detailed anatomical understanding based on transthoracic echocardiography, cardiac computed tomography, and three-dimensional printing can justify a decision to not operate in cases of congenitally corrected transposition of the great arteries with hemodynamically balanced pulmonary stenosis and a ventricular septal defect, as observed in the present case. Electronic supplementary material The online version of this article (10.1186/s13256-019-2145-1) contains supplementary material, which is available to authorized users.

Background and objectives Hypertension is becoming one of the most common health conditions in children and adolescents due to increasing childhood obesity. We aimed to provide the auscultatory blood pressure (BP) normative reference values for Korean non-overweight children and adolescents. Methods BP measurements in children and adolescents aged 10 to 18 years were performed in the Korean National Health and Nutrition Examination Survey (KNHANES) from 1998 to 2016. BP was measured using a mercury sphygmomanometer. Sex-, age- and height-specific systolic BP (SBP) and diastolic BP (DBP) percentiles were calculated in the non-overweight children (n=10,442). We used the General Additive Model for Location Scale and Shape method to calculate BP percentiles. Results The 50th, 90th, 95th, and 99th percentiles of SBP and DBP tables and graphs of non-overweight children and adolescents aged 10 to 18 years were presented by age and height percentiles. We found that the SBP and DBP at the 95th percentile were well correlated with height. The BP tables presented by height contained BP values from 124 cm to 190 cm for boys and from 120 cm to 178 cm for girls. Boys had higher SBP and DBP. Conclusions We provided the sex-, age- and height-specific auscultatory BP values using the KNHANES big data. These may be useful in diagnosis and treatment of hypertension in Korean children and adolescents.

We have considered the influence of electron irradiation on the optical and electrical properties ofIn 2 O 3 /Ti bi-layered films prepared with RF and DC magnetron sputtering. The In 2 O 3 /Ti thin films irradiated at 600eV shows the lowest resistivity of 6.9×10 −4 Ωcm. The optical transmittance in a visible wave length region alsoinfluenced with the electron irradiation energy. The film that electron irradiated at 600 eV shows 82.9% of opticaltransmittance in this study. By comparison of figure of merit, it is concluded that the opto-electrical performance ofIn 2 O 3 /Ti bi-layered film is improved with electron irradiation.(Received October 13, 2015; Revised October 19, 2015; Accepted October 29, 2015)Key words : In 2 O 3 , Ti, Magentron sputtering, Electron irradiation, Figure of Merit 1. 서론 산화인듐(In 2 O 3 ) 박막은 높은 가시광 투과도와 낮은 전기비저항을 동시에 갖는 투명전극재(Trans-parent Conducting Oxide; TCO)로서 박막형 태양전지(Solar cell) 및 다양한 디스플레이 소자의 전극재로 활용되고 있다[1]. 최근에는 유연성을 갖는 표시소자에 다양한 TCO 박막을 적용하기 위하여 유리기판 대신 Poly Carbonate(PC), Poly EthyleneTerephthalate(PET) 그리고 Poly Ether Sulfon(PES)기판을 이용한 투명전극 증착에 대한 연구가 보고되고 있다[2-4]. 그러나 PC, PET, PES 등의 고분자기판을 사용한 TCO 증착은 열처리 온도에 제약을받기 때문에 박막의 전기적, 광학적 물성을 개선시키는 방법으로 TCO/metal[2], TCO/Oxide[5], TCO/Metal/TCO[6] 등의 적층형태의 증착기술이 연구되고있으며, 전자빔(Electron Irradiation) 표면조사를 이용한 표면개질 기술 또한 제시되고 있다[7].본 연구에서는 박막의 증착율과 화학적 조성비를용이하게 조절 할 수 있는 Direct current(DC) 및Radio Frequency(RF) 마그네트론 스퍼터를 이용하여 유리기판에 10 nm의 Ti 완충막을 증착하고 상부에 90 nm의 In

Background and objectives High waist circumference (WC) is associated with increased cardiovascular risk (CVR) in adulthood. We investigated this association in adolescents. Methods We performed a cross-sectional analysis of data for 10-18-year-olds included in the Korea National Health and Nutrition Examination Survey (KNHANES) (2005-2014). The association between WC and CVR factors was evaluated. We analyzed this relationship according to age. Results We analyzed 8,153 participants (4,319 boys and 3,834 girls) from the KNHANES. High WC was associated with increased incidence of CVR factors: hypertension (odds ratio [OR], 3.5 in boys, 1.9 in girls), high total cholesterol (OR, 3.9 in boys, 1.9 in girls), high triglycerides (OR, 4.9 in boys, 3.2 in girls), high low-density lipoprotein (LDL) cholesterol (OR, 5.0 in boys, 1.8 in girls), low high-density lipoprotein (HDL) cholesterol (OR, 2.6 in boys, 3.0 in girls), and hyperglycemia (OR, 2.8 in girls). In boys, the association between high WC and hypertension, high triglycerides, and low HDL cholesterol was noted in early adolescence. High WC was associated with high total cholesterol and high LDL cholesterol in middle adolescence. In girls, high WC was correlated with high total cholesterol, high triglycerides, and low HDL cholesterol in early adolescence. High WC was shown to be associated with hyperglycemia in middle adolescence, and with hypertension and high LDL cholesterol in late adolescence. Conclusions High WC in adolescents is associated with increased CVR. The timing of this association differs according to sex and CVR factors.

Background Although oseltamivir is a common influenza treatment, there is a lack of data on the economic benefits of timely oseltamivir treatment. Methods From February 2004 through June 2007, 116 hospitalized children ≤15 years of age with laboratory-confirmed influenza who received oseltamivir were identified via retrospective medical chart review. Demographic, clinical, and cost data were abstracted and multivariate linear regression was used to assess the association between oseltamivir time to treatment and treatment-related costs among hospitalized children with laboratory-confirmed influenza. Results Overall, 28% (n = 33) of patients were treated with oseltamivir ≥day 3 of admission. Rapid influenza diagnostic test was used in a significantly lower proportion of patients treated with oseltamivir ≥day 3 of admission compared with those who received oseltamivir earlier. On multivariate linear regression, initiation of oseltamivir ≥day 3 of admission was associated with a 60.84% increase (95%CI: 32.59–95.11) in treatment-related hospital costs, compared with initiation on admission. Conclusion Delayed initiation of oseltamivir was found to be associated with increased treatment-related hospital costs among children hospitalized with laboratory-confirmed influenza.

There has been a wide range of inter-individual variations in platelet responses to clopidogrel. The variations in response to clopidogrel can be driven by genetic polymorphisms involved in the pathway of absorption, distribution, metabolism, excretion, and the target receptor P2Y12. A set of genetic variants known for causing variations in clopidogrel responses was selected, which included CYP2C19*2, *3, *17, CYP2B6*4, *6, *9, CYP3A4*18, CYP3A5*3, MDR1 2677G &gt, T/A, 3435C &gt, T, and P2Y12 H2 (742T &gt, C). The simultaneous detection of these 10 variants was developed by using a multiplex PCR and single-base extension (MSSE) methodology. The newly developed genotyping test was confirmed by direct DNA sequencing in the representative positive control samples and validated in an extended set of 100 healthy Korean subjects. Genotyping results from the developed MSSE exhibited a perfect concordance with the direct DNA sequencing data and all of variants tested in 100 healthy Korean subjects were in agreement with Hardy-Weinberg equilibrium (p &gt, 0.05). The present molecular diagnostic studies provide an accurate, convenient, and fast genotyping method for the detection of multiple variants. This would be helpful for researchers, as well as clinicians, to use genetic information toward more personalized medicine of clopidogrel and other antiplatelet drugs in the future.

Objective: Obesity in adolescence is associated with increased cardiovascular risk. The patterns of obesity and body composition differ between boys and girls. It is uncertain how body composition correlates with the cardiovascular system and whether such correlations differ by sex in adolescents. Methods: Body composition (fat-free mass (FFM), adipose mass, waist circumference (WC)) and cardiovascular parameters and functions were studied in 676 healthy Korean adolescents aged 12-16 years. Partial correlation and path analyses were done. Results: WC correlated with stroke volume (SV) and cardiac output (CO), systolic blood pressure (SBP) and pulse pressure (PP), cardiac diastolic function (ratio of early to late filling velocity (E/A ratio)), and vascular function (pulse wave velocity (PWV)) in boys. Adipose mass was related to SV, CO, SBP, PP, left ventricular mass (LVM), and PWV in girls - and to E/A ratio in both sexes. FFM affected SV, CO, SBP, and PP in both sexes and LVM in boys. Cardiac systolic functions had no relation with any body composition variable in either sex. Conclusion: In adolescence, the interdependence of the cardiovascular system and the body composition differs between sexes. Understanding of those relations is required to control adolescent obesity and prevent adult cardiovascular disease.

BACKGROUND AND OBJECTIVES Cardiac catheterization is used to diagnose structural heart disease (SHD) and perform transcatheter treatment. This study aimed to evaluate complications of cardiac catheterization and the associated risk factors in a tertiary center over 10 years. SUBJECTS AND METHODS Total 2071 cardiac catheterizations performed at the Seoul National University Children's Hospital from January 2004 to December 2013 were included in this retrospective study. RESULTS The overall complication, severe complication, and mortality rates were 16.2%, 1.15%, and 0.19%, respectively. The factors that significantly increased the risk of overall and severe complications were anticoagulant use before procedure (odds ratio [OR] 1.83, p=0.012 and OR 6.45, p

Objective To investigate the effect of medium- or higher-dose acetylsalicylic acid (ASA) for treating acute-phase Kawasaki disease to prevent coronary artery aneurysm (CAA). Study design Among the children with acute Kawasaki disease investigated in the eighth nationwide survey in the Republic of Korea, 8456 children with adequate data were included in this study. The subjects were divided into 2 groups according to the use of medium- or higher-dose ASA (≥30 mg/kg/day), or-low dose ASA (3-5 mg/kg/day) during the acute febrile phase. Both z- score–based criteria and Japanese criteria for CAA were used. Results The prevalence of CAA based on z -score (24.8% vs 18.3%; P = .001) and on the Japanese criteria (19.0% vs 10.4%; P z -score: OR, 1.472, 95% CI, 1.169-1.854, P = .001; based on Japanese criteria: OR, 2.013, 95% CI, 1.507-2.690, P P = .003 and OR, 2.198, 95% CI, 1.563-3.092, P Conclusions The use of medium- or higher-dose ASA in acute Kawasaki disease did not prevent CAA. A future randomized controlled trial is needed to determine the optimum dose of ASA.

Hirame rhabdovirus (HIRRV) was first reported from flounder (Paralichthys olivaceus) in Japan, and has recently been isolated from an aquaculture farm in the Tongyoung area of Korea. Total RNA isolated from RTG-2 cells infected with HIRRV was used in RT-PCR to obtain a cDNA coding for the glycoprotein of HIRRV Korean strain, CA-9703. Around half sized G protein in the C-terminal region was expressed as glutathione-S-transferase fusion protein, and used as viral vaccine against HIRRV. Flounder fry were vaccinated with low (50μg/mL) and high (300μg/mL) doses of vaccine by immersing them for 7 min in vaccine solution. After 1 month, the fish were challenged with HIRRV either by immersion or intraperitoneal injection. Specific losses of fish treated with low and high vaccine doses by intraperitoneal injection challenge were both 6.7%, in contrast to 43.3% in non-vaccinated fish. Losses of vaccinated fish by immersion challenge were 1.7% and 0% for low and high vaccine doses, respectively, and 15% for the non-vaccinated control.

Purpose Only a few studies have explored nationwide trends in lipid profiles among Asian adolescents. We aimed to assess trends in lipid profiles and the associated lifestyle factors among Korean children. Methods We analyzed data for 2,094 adolescents who were aged 10–18 years and had participated in the Korea National Health and Nutrition Examination Surveys in 1998 and 2010. Results During 1998–2010, the prevalence of obesity significantly increased in boys, but no changes were observed in girls. Over this period, there was a small but significant decrease in the mean low-density lipoprotein (LDL)-cholesterol level in boys (1998, 87.5 mg/dL; 2010, 83.6 mg/dL; P=0.019) and mean triglyceride levels in girls (1998, 90.8 mg/dL; 2010, 85.8 mg/dL; P=0.020). There were no significant changes in the prevalence of dyslipidemia in boys, but a modest decrease was noted in girls (1998, 25.1%; 2010, 18.3%; P=0.052). During the study period, the prevalence of breakfast skipping decreased, whereas that of regular exercise increased in both groups. Daily total energy intake did not change between these years. In multivariable logistic regression analyses, breakfast skipping was associated with increased risk of hyper-LDL-cholesterolemia in boys (odds ratio [OR], 5.77) and hypertriglyceridemia (OR, 2.27) in girls. Regular exercise was associated with decreased risk of hypo-HDL-cholesterolemia (OR, 0.40) in boys. Conclusion Although the prevalence of obesity in boys increased, favorable or constant trends in lipid profiles were observed among Korean adolescents during 1998–2010. Decrease in breakfast skipping and increase in regular exercise may have contributed to these trends.

Purpose: Height-specific blood pressure (BP) is the standard parameter used to diagnose childhood hypertension. However, there has been some argument that weight may be a better variable than height in the reference BP standards. Therefore, before assessing the BP status using the reference BP standards, a basic understanding of the fundamental association of weight and height with BP is required. Methods: In the present study, we analyzed the correlation of BP with height and weight in Korean adolescents (age, 10–19 years), using data from the Korean National Health and Nutrition Examination Surveys (2009–2011). Results: Systolic BP (SBP) was more closely correlated with weight than with height in the normal weight (body mass index [BMI], ≤85th percentile) and overweight (BMI, >85th percentile) groups and in the normal waist circumference (WC, ≤90th percentile) and high WC (>90th percentile) groups in both sexes. Diastolic BP (DBP) had a higher correlation with height than with weight in the normal weight and normal WC groups, whereas weight was more closely associated with DBP than height in the overweight and high WC groups in both boys and girls. Conclusion: In Korean adolescents, weight had a greater effect on SBP than height in both the normal weight and overweight groups. DBP was mainly affected by height in the normal weight group, whereas weight was the major determinant of DBP in the overweight group. Therefore, it may be necessary to consider weight in the establishment of reference BP standards.

There are limited data evaluating the relationship between influenza treatment and hospitalization duration. Our purpose assessed the association between different treatments and hospital stay among Korean pediatric influenza patients. Total 770 children ≤ 15 yr-of-age hospitalized with community-acquired laboratory-confirmed influenza at three large urban tertiary care hospitals were identified through a retrospective medical chart review. Demographic, clinical, and cost data were extracted and a multivariable linear regression model was used to assess the associations between influenza treatment types and hospital stay. Overall, there were 81% of the patients hospitalized with laboratory-confirmed influenza who received antibiotic monotherapy whereas only 4% of the patients received oseltamivir monotherapy. The mean treatment-related charges for hospitalizations treated with antibiotics, alone or with oseltamivir, were significantly higher than those treated with oseltamivir-only (P < 0.001). Influenza patients treated with antibiotics-only and antibiotics/oseltamivir combination therapy showed 44.9% and 28.2%, respectively, longer duration of hospitalization compared to those treated with oseltamivir-only. Patients treated with antibiotics, alone or combined with oseltamivir, were associated with longer hospitalization and significantly higher medical charges, compared to patients treated with oseltamivir alone. In Korea, there is a need for more judicious use of antibiotics, appropriate use of influenza rapid testing. Graphical Abstract

Purpose: Overweight can be defined by the body mass index (BMI) and is likely associated with an increased cardiovascular disease risk. However, waist circumference (WC), a central adiposity index, may be a better indicator of cardiovascular disease risk. Studies comparing the effects of BMI and WC on cardiovascular risk factors, such as high blood pressure (BP), are rare in adolescents. Methods: We analyzed the correlations of BMI and WC with BP in 3,363 Korean adolescents (aged 10–19 years), using data from the Korean National Health and Nutrition Examination Surveys (2009– 2011). Results: Systolic BP (SBP) in both sexes and diastolic BP (DBP) in boys were higher in the high BMI (>85th percentile) and high WC (>90th percentile) groups. High BMI and high WC were positively correlated with high SBP (>90th percentile) in both sexes, and high DBP (>90th percentile), in boys. BMI maintained its positive associations with SBP, DBP, high SBP, and high DBP in the normal weight (BMI≤85th percentile) and overweight (BMI>85th percentile) groups in both boys and girls, as well as in all subjects of both sexes, even after adjustment for WC. However, WC did not correlate with SBP, DBP, high SBP, or high DBP after adjustment for BMI in any group in either sex. Conclusion: In Korean adolescents, BMI correlated better with BP and high BP levels than WC. Further, BMI was positively associated with BP and high BP in the normal weight group as well as in the overweight group.

목적: 극소 저체중 출생아 동맥관 개존증의 약물 치료로 경구용 ibuprofen과 정주용 indomethacin의 효과 및 부작용을 비교분석해 보고 경구용 ibuprofen군 내에서도 48시간 이전에 사용한 경우와 이후에 사용한 경우를 나누어 각 군에서의 효과와 부작용의 차이를 조사하여 경구용 ibuprofen 제제의 효용성과 치료 시기 결...

Purpose Obesity is an important risk factor for hypertension in adolescents. We investigated the relationship of obesity-related indices (body mass index [BMI], waist-to-height ratio [WHR], and body fat percentage [%BF]) with blood pressure and the hemodynamic determinants of blood pressure in Korean adolescents. Methods In 2008, 565 adolescents, aged 12-16 years, were examined. The %BF of the participants was measured by bioelectrical impedance analysis. Echocardiography and brachial artery pulse tracing were used to estimate the stroke volume (SV), cardiac output (CO), total vascular resistance (TVR), and total arterial compliance (TAC). Results We noted that BMI, WHR, and %BF were positively correlated with systolic blood pressure (SBP) and diastolic blood pressure (DBP). The positive correlation between BMI and blood pressure (SBP and DBP) persisted after adjustment for WHR and %BF. However, after adjustment for BMI, the positive associations between blood pressure (SBP and DBP) and WHR as well as %BF, were not noted. With regard to the hemodynamic factors, BMI, but not WHR and %BF, was an independent positive factor correlated with SV and CO. TVR had an independent negative association with BMI; however, it was not associated with WHR or %BF. Moreover, we noted that BMI, WHR, and %BF did not affect TAC. Conclusion In Korean adolescents, BMI had an independent positive correlation with SBP and DBP, possibly because of its effects on SV, CO, and TVR. WHR and %BF are believed to indirectly affect SBP and DBP through changes in BMI.

Arrhythmias can develop in various cardiac diseases, such as ischemic heart disease, cardiomyopathy and congenital heart disease. It can also contribute to the aggravation of heart failure and sudden cardiac death. Redox stress and Ca(2+) overload are thought to be the important triggering factors in the generation of arrhythmias in failing myocardium. From recent studies, it appears evident that Ca(2+)/calmodulin-dependent protein kinase II (CaMKII) plays a central role in the arrhythmogenic processes in heart failure by sensing intracellular Ca(2+) and redox stress, affecting individual ion channels and thereby leading to electrical instability in the heart. CaMKII, a multifunctional serine/threonine kinase, is an abundant molecule in the neuron and the heart. It has a specific property as "a memory molecule" such that the binding of calcified calmodulin (Ca(2+)/CaM) to the regulatory domain on CaMKII initially activates this enzyme. Further, it allows autophosphorylation of T287 or oxidation of M281/282 in the regulatory domain, resulting in sustained activation of CaMKII even after the dissociation of Ca(2+)/CaM. This review provides the understanding of both the structural and functional properties of CaMKII, the experimental findings of the interactions between CaMKII, redox stress and individual ion channels, and the evidences proving the potential participation of CaMKII and oxidative stress in the diverse arrhythmogenic processes in a diseased heart.

It is well known that hemodynamic load is one of the most important determinants of cardiac structure and function. Circadian variations in blood pressure (BP) are usually accompanied by consensual changes in peripheral resistance and/or cardiac output. In recent years, reduction in circadian variations in BP and, in particular, loss of nocturnal decline of BP were observed in hypertensive patients with left ventricular hypertrophy (LVH). The patients with only a slight or no loss of nocturnal decline of BP were considered 'non-dippers'. Regression of LVH was observed after prolonged antihypertensive therapy. Restoration of the circadian rhythm of BP was also observed. However, the classification of patients into 'dippers' and 'non-dippers' is arbitrary and poorly standardized and repeatable, and in the recent studies, most hypertensive patients with LVH were 'dippers'. Therefore, we should be particularly cautious about the conclusions drawn using this index. On the other hand, reduced activity of low- pressure cardiopulmonary baroreceptors and impaired day-to-night modulation of autonomic nervous system activity were observed in patients with only LVH. Therefore, alterations in cardiac structure may impair BP modulation. On the other hand, the reverse can also be trueprimary alterations in BP modulation, through a persistently elevated afterload, can increase cardiac mass. Thus, the interrelationship between cardiac structure and BP modulation is complex. Hence, new and more specific methods of evaluating circadian changes in BP are needed to better clarify the abovementioned reciprocal influences.

Background and Objectives:Cardiovascular morbidities and mortalities due to persistent hypertension, left ventricular (LV) dysfunction and increased LV mass have been reported in adolescents and adults with successful coarctoplasty. We evaluated progressive properties by measuring resting blood pressures (BP), LV functions and the masses in young children with successful coarctoplasty in infancy. Subjects and Methods: BP in the right arm and the left ankle, LV function and mass, by the use of M-mode and pulsed wave Doppler ultrasound, were measured in 25 patients, with a mean age of 6.4±3 years;and a mean age at the time of repair of 0.22±0.24 years, and in 22 control subjects, with a mean age of 5.8±2.4 years. All subjects were divided into two groups based on age (more than 5 years of age and less than 5 years of age) and were analyzed independently. Results:BP in the right arm and left ankle, LV function and mass showed no consistent differences between the two groups. However, as age increased, there was a tendency of wide pulse pressure (PP) in the right arm of patients contrary to that in the control subjects. The relative increase in the PP was mainly due to a relative decrease in the diastolic BP. There was a significant increase in the LV mass index of patients with increasing age (p