Radiologic Assessment of Lung Edema Score as a Predictor of Clinical Outcome in Children with Acute Respiratory Distress Syndrome.

PURPOSE: The radiographic assessment of lung edema (RALE) score enables objective quantification of lung edema and is a valuable prognostic marker of adult acute respiratory distress syndrome (ARDS). We aimed to evaluate the validity of RALE score in children with ARDS. MATERIALS AND METHODS: The RALE score was measured for its reliability and correlation to other ARDS severity indices. ARDS-specific mortality was defined as death from severe pulmonary dysfunction or the need for extracorporeal membrane oxygenation therapy. The C-index of the RALE score and other ARDS severity indices were compared via survival analyses. RESULTS: Among 296 children with ARDS, 88 did not survive, and there were 70 ARDS-specific non-survivors. The RALE score showed good reliability with an intraclass correlation coefficient of 0.809 [95% confidence interval (CI), 0.760-0.848]. In univariable analysis, the RALE score had a hazard ratio (HR) of 1.19 (95% CI, 1.18-3.11), and the significance was maintained in multivariable analysis adjusting with age, ARDS etiology, and comorbidity, with an HR of 1.77 (95% CI, 1.05-2.91). The RALE score was a good predictor of ARDS-specific mortality, with a C-index of 0.607 (95% CI, 0.519-0.695). CONCLUSION: The RALE score is a reliable measure for ARDS severity and a useful prognostic marker of mortality in children, especially for ARDS-specific mortality. This score provides information that clinicians can use to decide the proper time of aggressive therapy targeting severe lung injury and to appropriately manage the fluid balance of children with ARDS.

Estimating Nationwide Prevalence of Live Births with Down Syndrome and Their Medical Expenditures in Korea.

BACKGROUND: This study aimed to estimate the nationwide prevalence of live births with Down syndrome (DS) and its trends and compare the observed and model-based predicted prevalence rates. Further, we compared the direct medical expenditures among DS and non-DS patients. METHODS: Using the health administrative data of Health Insurance Review and Assessment in Korea, we selected 2,301 children with DS who were born between 2007 and 2016 to estimate the prevalence of live births with DS, and 12,265 non-DS children who were born between 2010 and 2014 to compare the direct medical expenditures among patients. RESULTS: The prevalence of live births with DS was 5.03 per 10,000 births in 9 years, and 13% of children with DS were medical aid recipients during the study period. The medical expenditure of children with DS was about 10-fold higher than that of non-DS children and their out-of-pocket expenditure was about twice as high. CONCLUSION: The prevalence of live birth with DS is high in the low socioeconomic group and the healthcare costs for the children with DS are significantly higher than those for non-DS children. Therefore, health authorities should help mothers at lower socioeconomic levels to receive adequate antenatal care and consider the cost of medical care for children with DS.

Risk assessment of human antibiotics in Korean aquatic environment.

In Korea, antibiotic usage has received a lot of attention from the public due to the increasing number of bacteria resistant to the currently used antibiotics. In this study based on FDA regulation and EU draft guideline, the most concerned antibiotics regarding their environmental risk in Korea were assessed and the refined predicted environmental concentration in surface water (PEC(surface water)) was obtained by applying a GIS-based KORea ECOlogical Risk assessment (KOREOCORisk) model. Thirteen antibiotics, which expected introductory concentration (EIC) greater than the trigger value (1.0µg/L), were chosen to assess ecological risk and the PEC/PNEC ratio exceeded 1.0 for amoxicillin, erythromycin and roxithromycin. The results in this study using conservative assumptions did not represent that there is a risk for acute toxic effects in the environment based on today's use of pharmaceuticals in Korea. However, the results do not exclude the potential for chronic environmental effects.

Development and evaluation of an aquatic ecological risk assessment system (KORECORisk) for the management of industrial complexes.

KORea ECOlogical Risk assessment (KORECORisk) was developed to support decision making for the ecological risk-based management of chemicals in industrial complexes in South Korea. The system is based on a geographical information system and consists of a release rate estimation module, an exposure estimation module, and an ecological risk assessment module. For release rate and exposure estimation, the chemical use data from the national chemical inventory database and a dynamic multimedia fate model, respectively, were used. The ecological risk was assessed by calculating the risk quotient. A case study was presented to demonstrate an application of KORECORisk to setting a risk-based priority among the 6 major industrial complexes or among the chemicals used in the individual industrial complexes. Furthermore, a more detailed assessment was performed to demonstrate and evaluate a potential use of KORECORisk for the management of individual complexes. With 3 phthalates (1,2-benzenedicarboxylic acid dibutyl ester; 1,2-benzenedicarboxylic acid dimethyl ester; and 1,2-dibenzenedicarboxylic acid dioctyl ester) as model chemicals, KORECORisk provided prediction in time and space that are of sufficient resolution required for the aquatic risk assessment but with varying uncertainty. The uncertainty associated with the use of KORECORisk appeared to vary widely (from <10 to 10(3)) with the chemical. Within the range of the chemicals tested, the release rate estimation appeared to introduce larger uncertainty than the exposure estimation. A more accurate chemical use inventory would improve the accuracy of not only the chemical release estimation but the exposure estimation module by reducing the influence of the unidentified sources. The release estimation module should be modified to provide temporal variation with a time resolution relevant to the exposure duration for which toxic effects could occur.