Special Contribution Eun Hee Ha, MD Department of Preventive Medicine, Ewha Womans University College of Medicine E mail : eunheeha@ewha.ac.kr J Korean Med Assoc 2007; 50(2): 1-1 Abstract ultiple Sclerosis (MS) is the commonest demyelinating disease affecting the central nervous system of young Madults living in the western world. The clinical suspicion of demyelination, as a pathological process, is high when a young adult develops one or more neurological episodes consistent with damage to white matter tracts within the central nervous system, especially when these affect the optic nerves, brainstem or spinal cord. The patient with episodes disseminated in time, each of which can be attributed to demyelination, requires no investigation prior to establishing the diagnosis of clinically definite MS if presentation occurs between the ages of 20 and 50 years, separate anatomical sites within the central nervous system have necessarily been affected on different occasions, and the clinical phenotype is typical for multiple sclerosis. MS in Asian populations is characterized by the selective and dominant involvement of the optic nerve and spinal cords, as well as some incidence of brainstem lesion and symptoms. 35-40% of cases of MS in Korea are of this optico-spinal type. Opticospinal MS (OSMS) generally has a higher female to male ratio than conventional MS. OSMS is also characterized by frequent relapses, severe disability, few brain lesions on MRI and an very lower incidence of oligoclonal bands in the CSF. Neuromyelitis Optica (NMO) (Devic syndrome), causing severe optic neuritis (ON) and longitudinally extensive transverse myelits either with monophase or relapse remitting pattern, is rare in Korea. NMO- IgG was reported to help diagnose early stage of NMO and differentiation of MS. Keywords : Demyelinating disease; Multiple sclerosis; Neuromyelitis Optica; NMO-IgG; Opticospinal MS 1
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Ha EH Table 1. 5
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Ha EH Table 2. Model 1 Model 2 Variable SE P Value SE P Value Indoor 0.89001 0.25586 0.0017 0.69702 0.17560 0.0006 7
Table 3. Model 1 Model 2 SE P Value SE P Value Total VOCs Indoor 0.044 0.036 0.24 0.046 0.053 0.40 Personal 0.056 0.025 0.04 0.067 0.034 0.07 Ethylbenzene Indoor 0.091 0.048 0.08 0.100 0.071 0.18 Personal 0.097 0.036 0.02 0.097 0.044 0.046 Xylene Indoor 0.011 0.016 0.50 0.001 0.028 0.97 Personal 0.024 0.016 0.14 0.028 0.022 0.23 Hpetane Indoor 0.094 0.050 0.08 0.101 0.065 0.15 Personal 0.094 0.023 0.001 0.093 0.029 0.008 Model 1: Simple regression Model 2: Adjusted for matemal age and education, past history of preterm births, spontaneous abortion, and preeclampsia, and infant sex Table 4. Model 1 Model 2 SE P Value SE P Value Total VOCs Indoor 7.58 11.02 0.50 4.29 15.11 0.78 Personal 13.57 8.04 0.11 9.89 10.58 0.37 Ethylbenzene Indoor 26.64 14.61 0.09 22.47 21.11 0.31 Personal 24.44 11.67 0.05 20.67 13.71 0.16 Xylene Indoor 1.67 4.76 0.73 8.19 7.70 0.31 Personal 4.32 4.88 0.39 0.51 6.84 0.94 Hpetane Indoor 22.40 14.72 0.15 21.66 15.20 0.18 Personal 20.81 8.29 0.02 15.93 8.78 0.097 Model 1: Simple regression Model 2: Adjusted for matemal age and education, past history of preterm births, spontaneous abortion, and preeclampsia, and infant sex : 18th Conference of the International Society for Environmental Epidemiology Poster Discussion ; September 2 6, 2006, Paris, France 8
Ha EH Figure 5. Figure 6. 9
Figure 6. 1. 2. 2002 3. Air Pollution Exposure and Health Effects in Fetus, 37(4) [2004] 291-299. 4. Bo Eun Lee, Byung Mi Kim, Eun Hee Ha, Ju Hee Sec, Hyun Park, Young Ju Kim, Ok jin Kim, Jong Tae Lee, Yun Chul Hong. A Prospective virth cohort study on the effect of personal, indoor, and outdoor VOCss of pregnancy outcom. 18th Conference of the International Society for Environmental Epidemiology Poster Discussion; September 2-6, 2006, Paris, France 5. Byung Mi Kim, Eun Hee Ha, Bo Eun Lee, Ju Hee Sec, Hyesook Park,Young Ju Kim, Joo Jong Tae Lee, Yun-Chul Hong. 10
Ha EH Jae Hong Ryoo. Exposure to pm2.5 and VOCss of the pregnat women in SBC(Seoul birth & development cohort). [18th Conference of the International Society for Environmental Epidemiology Poster Discussion ; September 2-6, 2006, Paris, France 6. Saldiva PH, Pope CA 3rd, Schwartz J, Dockery DW, Lichtenfels AJ, Salge JM, Barone I, Bohm GM. Air pollution and mortality in elderly people: a time series study in Sao Paulo, Brazil. Arch Environ Health 1995; 50: 159-163. 7. Pope CA 3rd. Epidemiology of fine particulate air pollution and human health: biologic mechanisms and who's at risk Environ Health Perspect 2000; 108 Suppl 4: 713-723. 8. Ritz B, Yu F. The effect of ambient carbon monoxide on low birth weight among children born in southern California between 1989 and 1993. Environ Health Perspect 1999; 107: 17-25. 9. Liu S, Krewski D, Shi Y, Chen Y, Burnett RT. Association between gaseous ambient air pollutants and adverse pregnancy outcomes in Vancouver, Canada. Environ Health Perspect 2003; 111: 1773-1778. 10. Barker DJ. Fetal origins of coronary heart disease. BMJ 1995; 311: 171-174. 11. Wang X, Ding H, Ryan L, Xu X. Association between air pollution and low birth weight: A community based study. Environ Health Perspect 1997; 105: 514-520. 12. Bobak M, Leon DA. Pregnancy outcomes and outdoor air pollution: an ecological study in districts of the Czech Republic 1986-8. Occup Environ Med 1999; 56: 539-543. 13. Bobak M. Outdoor air pollution, low birth weight, and prematurity. Environ Health Perspect 2000; 108: 173-176. 14. Ritz B, Yu F, Chapa G, Fruin S. Effect of air pollution on preterm birth among children born in Southern California between 1989 and 1993. Epidemiology 2000; 11: 502-511. 15. Maisonet M, Bush TJ, Correa A, Jaakkola JJK. Relation between ambient air pollution and low birth weight in the Northeastern United States. Environmen Health Perspect 2001; 109(suppl3): S351-6 16. Ritz B, Yu F, Fruin S, Chapa G, Shaw G.M, Harris JA. Ambient air pollution and risk of birth defects in Southern California. Am J Epidemiol 2002; 155: 17-25. 17. Ha EH, Hong YC, Lee BE, Woo BH, Schwartz J, Christiani DC. "Is air pollution a risk factor for low birth weight in Seoul" Epidemiology 2001; 12: 643-648. 18. Lee BE, Ha EH, Park HS, Kim YJ, Hong YC, Kim H, Lee JT. Exposure to air pollution during different gestational phases contributes to risks of low birth weight. Hum Reprod. 2003; 18: 638-643. 19. Lin MC, Yu HS, Tsai SS, Cheng BH, Hsu TY, Wu TN, Yang CY. "Adverse pregnancy outcome in a petrochemical polluted area in Taiwan." J Toxicol Environ Health A, 2001; 63: 565-574. 20. Williams L, Spence A, Tideman SC. Implication of the observed effect of air pollution on birth weight. Soc Biol, 1977; 24: 1-9. 21. Oliveira LM, Stein N., Sanseverino MT, Vargas VM, Fachel JM, Schuler L. Reproductive outcomes in an area adjacent to a petrochemical plant in southern Brazil. Rev Saude Publica, 2002; 36: 81-87. 11