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Background: Pediatric patients who received hematopoietic stem cell transplantation (HSCT) tend to have high morbidity and mortality. While, the prognostic factors of adult patients received bone marrow transplantation were already known, there is little known in pediatric pateints. This study aimed to identify the prognostic factor for pediatric intensive care unit (PICU) mortality of critically ill pediatric patients with HSCT. Method: Retrospectively reviewed that the medical records of patients who received HSCT and admitted to PICU between January 2010 and December 2019. Mortality was defined a patient who expired within 28 days. Results: A total of 131 patients were included. There were 63 boys (48.1%) and median age was 11 years (interquartile range, 0–20 years). The most common HSCT type was haploidentical (38.9%) and respiratory failure (44.3%) was the most common reason for PICU admission. Twenty-eight–day mortality was 22.1% (29/131). In comparison between survivors and non-survivors, the number of HSCT received, sepsis, oncological pediatric risk of mortality-III (OPRISM-III), PRISM-III, pediatric sequential organ failure assessment (pSOFA), serum lactate, B-type natriuretic peptide (BNP) and use of mechanical ventilator (MV) and vasoactive inotropics were significant predictors (p

Objective The purpose of this study was to investigate oral health status and oral health behaviors in elderly Koreans with periodontal disease. Methods The data of the Seventh Korea National Health and Nutrition Examination Survey (2016-2018) were used. This cross-sectional study included 2981 individuals who were at least 65 years of age. Periodontal disease was assessed in oral health exams. Subjective oral health status (e.g., toothache) and oral health behaviors (e.g., tooth brushing and oral health examination) were assessed in health interviews. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression. Results The overall prevalence of periodontal disease in the study population was 47.5%. Individuals with periodontal disease were more likely to have a toothache than those without periodontal disease (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI] = 1.20-1.77). Individuals with periodontal disease were also more likely to have chewing discomfort (aOR = 1.21, 95% CI = 1.01-1.44) and less likely to use oral hygiene products (aOR = 0.74, 95% CI = 0.60-0.91) than those without periodontal disease. Conclusions About half of elderly had the periodontal disease. Elderly Koreans with periodontal disease were more likely to have poor oral health and behavior than those without periodontal disease. The results of this study provide an insight into social and behavioral factors associated with periodontal diseases in older Koreans. It is necessary to confirm these results through prospective studies.

Background Topical calcineurin inhibitors have been used to treat vitiligo, either alone or in combination with phototherapy; however, the long-term safety of these agents remains controversial. Objective To investigate the risk of lymphoma and skin cancer in vitiligo patients who received topical calcineurin inhibitors or phototherapy. Methods A multicenter retrospective cohort study of 25,694 vitiligo patients who received topical calcineurin inhibitors or phototherapy for 6 weeks or more between 2001 and 2019 was performed. Cumulative doses of topical calcineurin inhibitors and total phototherapy sessions were determined. Outcomes were the development of lymphoma or skin cancer after enrollment, confirmed through chart review and pathology reports. Results During 95,203 person-years, 13 cases of lymphoma, 22 of actinic keratosis, 15 of nonmelanoma skin cancer, and 5 of melanoma were observed. The risk of lymphoma and skin cancer was not significantly increased by topical calcineurin inhibitor dose or phototherapy sessions. The interaction between the topical calcineurin inhibitors and phototherapy was not associated with an increased risk of skin cancer. Limitations Retrospective study, individual follow-up duration less than 4 years, and no adjustment for comorbidities and medication history. Not generalizable to other races. Conclusion The long-term risk of skin cancer or lymphoma was not associated with the use of topical calcineurin inhibitors, phototherapy, and both treatments in combination in patients with vitiligo.

Complications and failures after carpal tunnel release have been reported from 3% to 25%. And the revision surgeries usually show poorer outcomes than the primary surgeries. There are diverse etiologies causing neuropathic symptoms after the carpal tunnel release, which became a clinical challenge. Potential causes of the symptoms are categorized into three by those natures; persistent symptom, recurrent symptom, and new symptom. The decision of proper management should be based on the etiologies of reproduced symptoms. This article described an overview of the clinical presentation, etiologies, diagnosis, and treatments of the recalcitrant carpal tunnel syndrome.

Vitamin D plays pivotal role in bone mineral homeostasis. But the association of vitamin D with muscle mass remains obscure, especially among young adults. Therefore, we assessed the association between muscle mass and 25-hydroxyvitamin D (25[OH]D) in South Korean adults using data from the 2009-2010 Korean National Health and Nutrition Examination Survey (KNHANES). This study involved 12,324 (5,375 males and 6,949 females) participants in the 2009-2010 KNHANES aged 20 y or older. Appendicular skeletal muscle mass (ASM) was measured by dual X-ray absorptiometry. Low muscle mass was defined as an ASM divided by body mass index (BMI) (ASM [kg]÷BMI [kg/m2]) value of

Background Coagulopathy is a common serious complication of sepsis and septic shock; thus, its early detection and prompt management are important. For this purpose, recently the sepsis-induced coagulopathy (SIC) score was proposed. Methods We modified the SIC score for critically ill children with septic shock and evaluated its performance in comparison to several coagulopathy diagnostic scoring systems. Results Among 135 included patients, a significant number of patients were diagnosed with coagulopathy using different coagulopathy diagnostic criteria (up to 84.4% using the SIC score). The modified SIC score, comprising the pediatric sequential organ failure assessment (pSOFA) score, prothrombin time, and D-dimer, was used to diagnose SIC in 68 (50.4%) patients. It was well correlated with the pSOFA score and the International Society on Thrombosis and Haemostasis disseminated intravascular coagulation (DIC) score, as well as the SIC score (p Conclusion Critically ill pediatric patients with septic shock frequently had concomitant coagulopathy. The modified SIC score showed good ability to predict 28-day mortality, suggesting its potential as a prognostic factor in these critically ill pediatric patients.

OBJECTIVES To develop a modified pediatric Sequential Organ Failure Assessment score using the acute kidney injury diagnostic criteria and evaluate its performance in predicting mortality. DESIGN A single-center retrospective study. SETTING Fourteen-bed PICU in a tertiary care academic children's hospital. PATIENTS Critically ill children admitted to the PICU between January 2017 and September 2019 with at least more than two serum creatinine measurements-one for baseline and the other within the first 48 hours of PICU admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 755 patients were included. Overall, 265 patients were diagnosed with acute kidney injury using the current acute kidney injury diagnostic criteria. The overall PICU mortality was 5.8%. Patients with acute kidney injury required more vasoactive-inotropic drugs and showed higher illness severity scores, including the Pediatric Risk of Mortality III, Pediatric Logistic Organ Dysfunction 2, pediatric Sequential Organ Failure Assessment, and modified pediatric Sequential Organ Failure Assessment scores, as well as higher PICU mortality than patients without acute kidney injury (p < 0.001). As acute kidney injury stages increase, PICU mortality also increased (p < 0.001). Based on multivariable logistic regression analysis adjusted for age and sex, the modified pediatric Sequential Organ Failure Assessment score was an independent prognostic factor of PICU mortality. The modified pediatric Sequential Organ Failure Assessment score showed better performance in predicting PICU mortality (area under the receiver operating characteristic curve, 0.821; 95% CI, 0.759-0.882) than other severity scores (area under the receiver operating characteristic curve [95% CI] of Pediatric Risk of Mortality III, Pediatric Logistic Organ Dysfunction 2, and pediatric Sequential Organ Failure Assessment scores: 0.788 [0.723-0.853], 0.735 [0.663-0.807], and 0.785 [0.718-0.853], respectively). CONCLUSIONS Acute kidney injury is prevalent and associated with poor clinical outcomes in critically ill children. The modified pediatric Sequential Organ Failure Assessment score, based on the acute kidney injury diagnostic criteria, showed improved performance in predicting PICU mortality. The modified pediatric Sequential Organ Failure Assessment score could be a promising prognostic factor for critically ill children.

Background/purpose Vitiligo remains a major challenge in dermatology. However, much of the treatment remains unclear, because little evidence is available. We sought to answer some critical questions pertaining to management of vitiligo patients. Methods A modified Delphi process among 31 vitiligo experts was conducted. A total of 12 clinical vitiligo treatment questions without clear answers were collected via a vote. To address each question, two members performed systematic literature reviews and prepared draft statements along with the levels of evidence and strength of recommendation. After reviewing the draft, all expressed their extent of agreement from 1 (strong disagreement) to 9 (strong agreement) for each item. The drafts were revised to reflect suggested comments. Discussion continued until all members agreed with the ultimate decision. Results The consensus process was completed after five rounds. We identified the best answers to 12 key questions, including issues on long-term phototherapy, systemic and topical corticosteroids, topical calcineurin inhibitors, immunosuppressants, excimer laser treatment, and surgical interventions. Conclusion This consensus would complement current guidelines and aid both physician and patient decision-making in the treatment of vitiligo.

Background Disseminated intravascular coagulation (DIC) is a serious complication in septic shock. This study aimed to evaluate DIC and associated clinical outcomes using the International Society on Thrombosis and Hemostasis (ISTH) and modified ISTH overt DIC scores in critically ill pediatric hemato-oncology patients with septic shock. Methods Pediatric hemato-oncology patients with septic shock admitted to the pediatric intensive care unit (PICU) of a tertiary children's hospital between January 2013 and February 2020 were included. We modified the ISTH overt DIC score by eliminating the platelet domain and compared the performances of the ISTH and the modified ISTH overt DIC scores in DIC diagnosis and PICU mortality prediction of these patients. Results DIC was diagnosed in 56.4 and 38.5% of patients by ISTH and modified ISTH overt DIC scores, respectively. Patients with DIC showed a higher pediatric risk of mortality (PRISM) III, pediatric sequential organ failure assessment (pSOFA) scores, and PICU mortality than those without DIC (p Conclusion Critically ill pediatric hemato-oncology patients with septic shock frequently experience DIC, which was adequately evaluated by both ISTH and modified ISTH overt DIC scores. Considering the characteristics of these patients, the modified ISTH overt DIC score may be a promising prognostic factor for clinical outcomes in these critically ill pediatric patients.

Background To evaluate the facial asymmetry, three-dimensional computed tomography (3D-CT) has been used widely. This study proposed a method to quantify facial asymmetry based on 3D-CT. Methods The normal standard group consisted of twenty-five male subjects who had a balanced face and normal occlusion. Five anatomical landmarks were selected as reference points and ten anatomical landmarks were selected as measurement points to evaluate facial asymmetry. The formula of facial asymmetry index was designed by using the distances between the landmarks. The index value on a specific landmark indicated zero when the landmarks were located on the three-dimensional symmetric position. As the asymmetry of landmarks increased, the value of facial asymmetry index increased. For ten anatomical landmarks, the mean value of facial asymmetry index on each landmark was obtained in the normal standard group. Facial asymmetry index was applied to the patients who had undergone orthognathic surgery. Preoperative facial asymmetry and postoperative improvement were evaluated. Results The reference facial asymmetry index on each landmark in the normal standard group was from 1.77 to 3.38. A polygonal chart was drawn to visualize the degree of asymmetry. In three patients who had undergone orthognathic surgery, it was checked that the method of facial asymmetry index showed the preoperative facial asymmetry and the postoperative improvement well. Conclusions The current new facial asymmetry index could efficiently quantify the degree of facial asymmetry from 3D-CT. This method could be used as an evaluation standard for facial asymmetry analysis.

This study presents our technique of arthroscopic scaphoid excision and four-corner arthrodesis and compares the clinical and radiological outcomes with those achieved with the open method. Twenty-seven patients (14 in arthroscopy group and 13 in open group) were included. Bone union was achieved in 13 of 14 patients in the arthroscopy group and in all 13 patients in the open group. In the open group, severe stiffness (flexion–extension arc was 10°) occurred in one patient after surgery. The mean postoperative flexion–extension arc was 75° and 51° in the arthroscopy group and open group, respectively. The pain, clinical scores, and radiological indices were improved in both arthroscopy and open groups. Arthroscopic and open scaphoid excision and four-corner arthrodesis did not show significant differences in clinical outcomes and bone union rates. The arthroscopic method provided a superior range of motion. Level of evidence: III

Purpose: The purpose of this study was to evaluate the relationship between the progression of arthritis and the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) through the treatment-resistant mono joint rheumatoid arthritis treated with arthroscopic synovectomy.Methods: We retrospectively reviewed 65 patients who underwent arthroscopic synovectomy for rheumatoid wrist or elbow which had not responded to systemic treatment for at least 6 months. The main treatment response evaluation methods of rheumatologists were the American College of Rheumatology (ACR) response criteria, and the ACR/EULAR (European League Against Rheumatism) remission criteria. The medical records, results of laboratory tests and radiographs of wrist or elbow that had been performed by rheumatologists before arthroscopic synovectomy were investigated. We examined whether the results of laboratory tests and arthritic change of radiograph had statistically significant correlation. Results: The mean duration of joint symptom until referral to orthopedic department was 23 months (range, 1 month to 9.2 years). During this period, rheumatologists had took average one X-ray (range, 0–3). Forty-seven patients (72.3%) had CRP of 1 mg/dL or less as included in the ACR/EULAR remission criteria. Seventeen out of 65 patients who had two or more X-ray were able to evaluate the progression of arthritis. The change of arthritis and mean ESR (p=0.787) or CRP (p=0.303) the same period didn’t have statistically significant relationship (Spearman correlation analysis).Conclusion: Since the method of evaluating the treatment response of rheumatologists is to assess the systemic condition, arthritis of one joint that is resistant to treatment is considered to require periodic radiographs as method to assess itself.

Background: Some studies have investigated the relationship between sarcopenia and metabolic syndrome, and they have focused mainly on older subjects. Therefore, we assessed the association between sarcopenia and metabolic syndrome in South Korean adults 20 years of age or older using data from the 2009–2010 Korean National Health and Nutrition Examination Survey (KNHANES). Methods: This study involved 12,256 (5350 males and 6906 females) participants from the 2009–2010 KNHANES 20 years of age or older. Appendicular skeletal muscle mass (ASM) was measured by dual X-ray absorptiometry. Sarcopenia index (SI) was calculated as ASM/body mass index and sarcopenia was defined as an SI of

PURPOSE Psychological factors have been identified as an important factor underlying physical activity behavior in adults. However, the extent to which these psychological factors impact physical activity behavior remains poorly understood. The aim of the study was to examine the association between psychological stress and physical inactivity in subsets of data from the Korean Genome and Epidemiology Study (KoGES). METHODS 69,219 participants (24,025 men) aged 40-69 were drawn from urban and rural community based cohort studies, which are subprojects of KoGES. We analyzed the association between psychological stress and physical inactivity using logistic regression. Cox’s proportional hazard regression analysis was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of exercise behavior changes according to psychological stress level changes. RESULTS Compared to the healthy stress group, the likelihood of physical inactivity was increased in high-risk stress group (men OR=1.88, 95% CI 1.63-2.17, p

Background Living donor liver transplantation (LDLT) is a significant advancement for the treatment of children with end-stage liver disease given the shortage of deceased donors. The ultimate goal of pediatric LT is to achieve complete donor safety and zero recipient mortality. Methods We conducted a retrospective, single center assessment of the outcomes as well as the clinical factors that may influence graft and patient survival after primary LDLTs conducted between 1994 and 2020. A Cox's proportional hazards model was used for multivariate analysis. The trends for independent prognostic factors were analyzed according to the treatment era, i.e. I (1994~2002), II (2003~2011), and III (2012~2020). Result Primary LDLTs were conducted on 287 children during the study period. Biliary atresia (52%), acute liver failure (ALF) (26%) and monogenic liver disease (11%) were the leading indications. There were 45 graft losses (16%) and 27 patient deaths (7%) in this population during the study period. During era I (n=81), the cumulative survival rates at one and five years after LDLT were 90.1% and 81.5% for patients, and 86.4% and 77.8% for grafts, respectively. During era II (n=113), the corresponding rates were 92.9% and 92% for patients, and 89.4% and 86.7% for grafts. During era III (n=93), the corresponding rates were 100% and 98.6% for patients, and 98.9% and 95.4% for grafts. By multivariate analysis, primary diagnosis ALF, bloodstream infection, posttransplant lymphoproliferative disease, and chronic rejection were found to be negative prognostic indicators for patient survival. Conclusion Based on generalized care guidelines and our center-oriented experiences, comprehensive advances in appropriate donor selection, refinement of surgical techniques, and meticulous medical management may eventually realize a zero-mortality rate in pediatric LDLT.

Background and Purpose— The TST trial (Treat Stroke to Target) evaluated the benefit of targeting a LDL (low-density lipoprotein) cholesterol of 4 mm, in a French and Korean population. The follow-up lasted a median of 5.3 years in French patients (similar to the median follow-up time in the SPARCL trial [Stroke Prevention by Aggressive Reduction in Cholesterol Level]) and 2.0 years in Korean patients. Exposure duration to statin is a well-known driver for cardiovascular risk reduction. We report here the TST results in the French cohort. Methods— One thousand seventy-three French patients were assigned to Results— After a median follow-up of 5.3 years, the achieved LDL cholesterol was 66 (1.69 mmol/L) and 96 mg/dL (2.46 mmol/L) on average, respectively. The primary end point occurred in 9.6% and 12.9% of patients, respectively (HR, 0.74 [95% CI, 0.57–0.94]; P =0.019). Cerebral infarction or urgent carotid revascularization following transient ischemic attack was reduced by 27% ( P =0.046). Cerebral infarction or intracranial hemorrhage was reduced by 28% ( P =0.023). The primary outcome or intracranial hemorrhage was reduced by 25% ( P =0.021). Intracranial hemorrhages occurred in 13 and 11 patients, respectively (HR, 1.17 [95% CI, 0.53–2.62]; P =0.70). Conclusions— After an ischemic stroke of documented atherosclerotic origin, targeting a LDL cholesterol of Registration— URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01252875.

Background The US Centers for Disease Control and Prevention and the World Health Organization emphasized vaccination against COVID-19 because physical distancing proved inadequate to mitigate death, illness, and massive economic loss. Objective This study aimed to investigate Korean citizens’ perceptions of vaccines by examining their views on COVID-19 vaccines, their positive and negative perceptions of each vaccine, and ways to enhance policies to increase vaccine acceptance. Methods This cross-sectional study analyzed posts on NAVER and Instagram to examine Korean citizens’ perception of COVID-19 vaccines. The keywords searched were “vaccine,” “AstraZeneca,” and “Pfizer.” In total 8100 posts in NAVER and 5291 posts in Instagram were sampled through web crawling. Morphology analysis was performed, overlapping or meaningless words were removed, sentiment analysis was implemented, and 3 public health professionals reviewed the results. Results The findings revealed a negative perception of COVID-19 vaccines; of the words crawled, the proportion of negative words for AstraZeneca was 71.0% (476/670) and for Pfizer was 56.3% (498/885). Among words crawled with “vaccine,” “good” ranked first, with a frequency of 13.43% (312/2323). Meanwhile, “side effect” ranked highest, with a frequency of 29.2% (163/559) for “AstraZeneca,” but 0.6% (4/673) for “Pfizer.” With “vaccine,” positive words were more frequently used, whereas with “AstraZeneca” and “Pfizer” negative words were prevalent. Conclusions There is a negative perception of AstraZeneca and Pfizer vaccines in Korea, with 1 in 4 people refusing vaccination. To address this, accurate information needs to be shared about vaccines including AstraZeneca, and the experiences of those vaccinated. Furthermore, government communication about risk management is required to increase the AstraZeneca vaccination rate for herd immunity before the vaccine expires.

Objectives: The hair follicle is composed of more than 20 kinds of cells, and mesoderm derived dermal papilla cells and keratinocytes cooperatively contribute hair growth via Wnt/β-catenin signaling pathway. We are to investigate β-catenin expression and regulatory mechanism by CBD in alopecia hair tissues and dermal papilla cells. Methods : : We performed structural and anatomical analyses on alopecia patients derived hair tissues using microscopes. Pharmacological effect of CBD was evaluated by β-catenin expression using RT-PCR and immunostaining experiment. Results : : Morphological deformation and loss of cell numbers in hair shaft were observed in alopecia hair tissues. IHC experiment showed that loss of β-catenin expression was shown in inner shaft of the alopecia hair tissues, indicating that β-catenin expression is a key regulatory function during alopecia progression. Consistently, β-catenin expression was decreased in testosterone or PMA treated dermal papilla cells, suggesting that those treatments are referred as a model on molecular mechanism of alopecia using dermal papilla cells. RT-PCR and immunostaining experiments showed that β-catenin expression was decreased in RNA level, as well as decreased β-catenin protein might be resulted from ubiquitination. However, CBD treatment has no changes in gene expression including β-catenin, but the decreased β-catenin expression by testosterone or PMA was restored by CBD pretreatment, suggesting that potential regulatory effect on alopecia induction of testosterone and PMA. Conclusion : : CBD might have a modulating function on alopecia caused by hormonal or excess of signaling pathway, and be a promising application for on alopecia treatment.

Background The renal benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2) are now well established, and these agents are recommended by the American Diabetes Association and Kidney Disease: Improving Global Outcomes guidelines for patients with type 2 diabetes and chronic kidney disease. However, the safety profile of SGLT2 inhibitors in chronic kidney disease is not as clear. We describe the adverse event rates of SGLT2 inhibitors, primarily empagliflozin, in Kaiser Permanente Southern California members with diabetic kidney disease. Methods This study was a multicenter retrospective descriptive analysis evaluating Kaiser Permanente Southern California members with type 2 diabetes and chronic kidney disease 1, 2, or 3 who first filled an SGLT2 inhibitor prescription in 2018, with follow-up through 2019. Primary outcomes were event rates of diabetic ketoacidosis, bone fracture, amputation, urinary tract infection, genital mycotic infection, hyperkalemia, and acute kidney injury. Secondary outcomes were mean changes in estimated glomerular filtration rates, serum creatine levels, urine albumin-to-creatinine ratios, and hemoglobin A1c percentages during the follow-up period. Results Of 213 patients, 39 experienced at least 1 adverse event, for a total of 50 adverse events. Urinary tract infection had the highest incidence (62.1 events/1000 person-years), followed by genital mycotic infection (58.0 events/1000 person-years). Favorable changes were observed during the follow-up period for urine albumin-to-creatinine ratios and hemoglobin A1c percentages, with mean decreases of 81.8 mg/g and 0.7%, respectively. SGLT2 inhibitors were discontinued in 47.4% of patients, with the top reasons including increase in serum creatinine (8%) and urinary or genital side effects (5.6%). Conclusion Although most patients did not experience adverse events, urinary tract infections and genital mycotic infections were more common. Our detection of rates and types of adverse effects replicated most results reported in clinical trials. Discontinuations were largely attributed to reasons other than adverse events.

Purpose : The purpose of this study was to investigate the effect of wearing plus lens on reading ability in college students with normal binocular function. Methods : Accommodative lag and reading ability were measured in 42 college students with normal binocular function, and no eye disease. For the control lag test the subjective cross cylinder method was applied, and for the reading ability the duration of fixation, number of regression, saccadic in return sweep and reading rate were measured using the Readalyzer. The subjects reading abilities were measured before and after with the plus lens corresponding to the amount of accommodative lag. Statistical analysis using SPSS version 21.0(SPSS Inc, Chicago, IL, USA) was used to analyze the change of the ability before and after wearing the plus lens through a paired t-test. Results : When the subjects wore the plus lens corresponding to the accommodative lag, the duration of fixation was slightly increased, the number of regression was significantly decreased, and the reading rate was significantly increased. Conclusion : It was considered that wearing plus lens with low refractive power may affect the time to look at words during reading. During reading with the lens, it may also have an effect changes such as reducing the number of regression and increasing the reading rate.

BACKGROUND/OBJECTIVES Vitamin D is a pleiotropic hormone that affects various body organ systems. We evaluated the prevalence of a vitamin D deficiency (VDD) and its potential role in the clinical condition of critically ill Korean children. SUBJECTS/METHODS Patients under 18 years old with a 25(OH) vitamin D measurement on the first day of PICU admission were included from among the children admitted to the pediatric intensive care unit (PICU) of our tertiary children's hospital between October 2017 and January 2019. RESULTS A total of 172 pediatric patients were enrolled. The mean 25(OH) vitamin D level was 17.5 ± 12.8 ng/mL. There was a 65.1% prevalence of VDD (25(OH) vitamin D level < 20 ng/mL). VDD was associated with age at PICU admission, gastrointestinal/hepatobiliary disorders, International Society of Thrombosis and Hemostasis disseminated intravascular coagulation (ISTH DIC) score, pediatric multiple organ dysfunction syndrome (pMODS) score and with several laboratory test findings including hemoglobin, platelet, C-reactive protein, serum albumin, total bilirubin, prothrombin time, and anti-thrombin III levels. Most of these parameters also showed significant linear correlations with the 25(OH) vitamin D level (P < 0.05). However, no statistically meaningful association was found between VDD and other clinical conditions such as the need for a mechanical ventilator, requirement for vasoactive drugs, duration of the PICU and hospital stays, or PICU mortality. CONCLUSION There is a high prevalence of VDD in critically ill Korean children. There were significant associations between the 25(OH) vitamin D level and gastrointestinal/hepatobiliary disorders, the pMODS score and with coagulation related factors. Further large-scale studies with more specific subgroup analyses are required to more precisely assess the clinical implications of VDD in critically ill pediatric patients.

The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are known to be markers of the systemic inflammatory response. However, the few studies that have been done on the relationship between the NLR and PLR and osteoporosis have yielded inconsistent results. Therefore, we assessed the relationship between the NLR and PLR and bone mineral density (BMD). This study was conducted with postmenopausal patients admitted to an orthopaedic hospital. Data including BMD, NLR, PLR and covariates were obtained from the subjects' medical records. In total, 407 postmenopausal patients were enrolled in this study. Analysis of covariance was performed to identify significant differences in BMD according to NLR and PLR. After adjusting for other covariates, a quartile of NLR was negatively associated with the mean value of lumbar BMD (p=0.040, p for trend=0.005) but not with the mean value of femur neck BMD. However, there were no significant associations among the PLR, the BMD of the lumbar and the femur neck. In conclusion, the quartile of NLR was negatively associated with the mean value of lumbar BMD in Korean postmenopausal patients.

To analyze postoperative outcomes after arthroscopic transosseous triangular fibrocartilage complex (TFCC) foveal repair and identify factors affecting the clinical outcomes.This study retrospectively enrolled patients who were treated for TFCC foveal tears by arthroscopic transosseous TFCC foveal repair. The diagnosis of TFCC foveal tear was made based on medical history, physical examination, and magnetic resonance imaging, with confirmation via arthroscopic examination. Outcome evaluation was completed at a minimum of 2 years postoperatively, and patients were classified into 2 groups according to the minimal clinically important difference of the Patient-Rated Wrist Evaluation. Various factors including age, sex, trauma history, body mass index, symptom duration, hand dominance, ulnar variance, subluxation of the distal radioulnar joint, preoperative pain score, and functional status, as well as the cross-sectional area (CSA) of the pronator quadratus (PQ) muscle, were retrospectively analyzed using both univariate and multivariate analyses.During the study period, 42 patients were treated for TFCC foveal tears. The functional status significantly improved after surgery. Overall, 27 and 15 patients showed good and poor functional outcomes, respectively, which were assessed according to the minimal clinically important difference of the Patient-Rated Wrist Evaluation. On univariate analysis, clinical outcomes were better in male patients (P = .035), younger patients (P = .022), and those with higher CSAs of the PQ muscles (P.001). However, on multivariable logistic regression analysis, only a higher CSA of the PQ muscle was identified as an independent prognostic factor affecting clinical outcome after TFCC foveal repair (P = .004).Arthroscopic transosseous TFCC complex foveal repair led to satisfactory results. However, lower PQ muscle CSA on magnetic resonance imaging was the most independent prognostic factor negatively affecting clinical outcomes.Level III, retrospective comparative study.

Pectus excavatum (PE) is known as one of the most common congenital deformities of the anterior chest wall. The Nuss procedure is an effective surgical therapy to correct PE. Here, we report a case of recurrent cardiac tamponade due to hemopericardium that occurred after 16 months following the Nuss procedure. The cause of recurrent hemopericardium was thought to be local, repetitive irritation of the pericardium by the Nuss steel bar. We should keep in mind that this serious complication can occur after the Nuss procedure, even in the late phase.

Although reconstruction of the lateral ulnar collateral ligament (LUCL) has been considered the procedure of choice for posterolateral rotatory instability (PLRI), recent studies have reported that the entire lateral collateral ligament complex (LCLC), rather than its posterior part only, contributes to preventing PLRI. Thus, it was hypothesized that dual reconstruction of the radial collateral ligament (RCL) and LUCL for the treatment of elbow PLRI could provide favourable clinical results regardless of the mechanism of injury. This retrospective study reviewed the clinical results of 21 patients who underwent dual reconstruction of the RCL and LUCL between 2011 and 2016. Functional outcomes were assessed using the numeric rating scale (NRS) score, Mayo Elbow Performance Score (MEPS), quick Disabilities of the Arm, Shoulder, and Hand (quick DASH) score, and manual varus instability. To identify any difference in outcomes according to the aetiologies for LCLC insufficiency, our patients were divided into LCLC insufficiency associated with elbow dislocation and that with lateral epicondylitis. At a median follow-up of 27 months (range 13–65 months), all patients showed resolved instability and achieved a functional arc of motion. In addition, lateral pivot shift tests were negative in all patients. The median MEPS significantly improved after surgery from 70 (range 60–75) to 85 (range 75–100) (p

Purpose : The purpose of this study was to investigate the correlation between visual function and reading ability by Tait-Wick and Duke-Elder methods. Methods : In this study, 151 subjects without ocular disease and refractive error were classified by the Tait-Wick and Duke-Elder methods and their reading ability was examined. The visual function test was distance and near heterophoria, near point of convergence, amplitude of accommodation, distance and near fusional vergence, accommodative facility. The reading ability test was performed using ReadAlyzer to measure duration of fixation, numner of regression, reading rate, saccadic in return sweep, and comprehension. Results : Convergence insufficiency significantly decreased by duration of fixation(t=-2.423, p=0.019), significantly increased by numner of regression(t=4.770, p=0.000), and significantly decreased by reading rate than normal group(t=-5.674, p=0.000). In the accommodative facility, the numner of regression view increased and the reading rate decreased with a significant difference compared with the normal group. The other abnormal groups showed no significant correlation with the reading factor. Conclusion : As a result of this study, convergence insufficiency group seems that the reading rate is decreased because the duration of fixation is decreased and the numner of regression is increased because the convergence is not enough when reading. As the facility of accommodation decreased, increased the number of regression and decreased the reading rate. This suggests that even when the test distance is fixed at 40cm, a slight change in the accommodation stimulus occurs during reading and maladjustment has occurred. Some binocular dysfunction may affect the motional elements of reading, but they do not affect cognitive factors.

Hepatic pseudolymphoma is a rare benign liver mass that is characterized by proliferation of non-neoplastic lymphocytes extranodally. To the best of our knowledge, only 46 cases have been reported in the English literature. We described the case of a 75-year-old woman with hepatic pseudolymphoma mimicking a hypervascular tumor. After the histological confirmation of the rectal neuroendocrine tumor, CT scan revealed a 1.0 cm-sized, poorly-defined and low-density nodule in the liver. On MRI, the hepatic nodule showed an arterial enhancement and a low-signal intensity on the hepatobiliary phase. On diffusion-weighted imaging, the hepatic nodule showed a high signal intensity on a high b-value. On fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT, it revealed a high standardized uptake value nodule. The US showed the hypoechoic nodule and the US-guided biopsy confirmed the hepatic pseudolymphoma.

COVID-19 is an ongoing worldwide infectious disease pandemic. The purpose of this study was to investigate post-traumatic stress and related factors among hospital nurses during the COVID-19 outbreak. The subjects of this study were 300 nurses who worked in three general hospitals that operated National Designated Isolation Unit (NDIU) wards during the COVID-19 outbreak. Self-reporting questionnaires were used to collect data on post-traumatic stress, general characteristics, and work-related information. The average post-traumatic stress score was 20.68 ± 19.5 points and 36.7% of participants were at high risk of post-traumatic stress disorder (PTSD). The odds ratio (OR) for PTSD was higher for nurses who worked in the NDIU ward (OR = 16.31, 95% CI = 3.79-70.32), who responded that nurse staffing was poor (OR = 3.03, 95% CI = 1.01-9.10), and who responded that they experienced COVID-19 symptoms (OR = 3.83, 95% CI = 1.89-7.75). Total 36.7% of nurses were at risk of PTSD and the factors related to PTSD were the work department, nurse staffing, and experiencing COVID-19 symptoms. These results could be used to manage PTSD and provide psychological support of nurses during infectious disease epidemics, such as COVID-19.

Malunion after distal radius fracture is common in older patients; however, whether patient-perceived outcomes are influenced by radiologic outcome is controversial. This study evaluated patient-perceived outcomes according to radiologic parameters in older patients who underwent nonoperative treatment. The records of 167 patients older than 55 years who had a distal radius fracture were reviewed. All fractures were treated nonoperatively, and average length of follow-up was 7 years. Outcomes were evaluated using numeric rating scales for pain and satisfaction, as well as Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores. Radiographs were evaluated for dorsal tilt, radial inclination, and ulnar variance. Fifty-one patients (30%) developed malunion. The pain numeric rating scale score was 0.8 for patients with malunion and 0.4 for patients with acceptable alignment; this difference was not statistically significant. The QuickDASH score was higher for patients with malunion (14.9 vs 11.1 for patients with acceptable alignment); however, this difference was not clinically meaningful. Satisfaction scores were lower for patients with malunion than for patients with acceptable alignment (80.8 vs 92.3). Patients with malunion stated they would choose surgery rather than a cast (13.3% vs 7.2%) if they developed another fracture; this difference was not statistically significant. The subanalysis according to radiologic parameters showed dorsal tilt and ulnar variance affected patient satisfaction but not other outcomes. This study indicated nonoperative treatment in older adults obtained acceptable patient-perceived outcomes despite residual deformity. However, patients whose radiologic parameter exceeded the tolerable range were less satisfied. [ Orthopedics . 2021;44(2):e190–e196.]

BackgroundAccumulating evidence suggests that alterations in inflammatory biomarkers are important in depression. However, previous meta-analyses disagree on these associations, and errors in data extraction may account for these discrepancies.MethodsPubMed/MEDLINE, Embase, PsycINFO, and the Cochrane Library were searched from database inception to 14 January 2020. Meta-analyses of observational studies examining the association between depression and levels of tumor necrosis factor-α (TNF-α), interleukin 1-β (IL-1β), interleukin-6 (IL-6), and C-reactive protein (CRP) were eligible. Errors were classified as follows: incorrect sample sizes, incorrectly used standard deviation, incorrect participant inclusion, calculation error, or analysis with insufficient data. We determined their impact on the results after correction thereof.ResultsErrors were noted in 14 of the 15 meta-analyses included. Across 521 primary studies, 118 (22.6%) showed the following errors: incorrect sample sizes (20 studies, 16.9%), incorrect use of standard deviation (35 studies, 29.7%), incorrect participant inclusion (7 studies, 5.9%), calculation errors (33 studies, 28.0%), and analysis with insufficient data (23 studies, 19.5%). After correcting these errors, 11 (29.7%) out of 37 pooled effect sizes changed by a magnitude of more than 0.1, ranging from 0.11 to 1.15. The updated meta-analyses showed that elevated levels of TNF- α, IL-6, CRP, but not IL-1β, are associated with depression.ConclusionsThese findings show that data extraction errors in meta-analyses can impact findings. Efforts to reduce such errors are important in studies of the association between depression and peripheral inflammatory biomarkers, for which high heterogeneity and conflicting results have been continuously reported.

The involvement of genital lesions in patients with atopic dermatitis (AD) is poorly understood. Moreover, clinical characteristics, potentially related factors, and impact on the quality of life (QOL) of genital eczema in patients with AD are also largely unknown. This study aims to evaluate the prevalence and burden of genital eczema in patients with AD. A prospective cross-sectional study recruited a total of 220 patients diagnosed with AD. The participants were asked to complete the self-administrated questionnaire asking sociodemographic characteristics, details about their AD, and individual experiences of their genital eczema. Among 220 responders, 99 patients (45.00%) reported that they had experienced genital eczema at some time during the course of AD. Longer disease duration (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.13-4.62; p = 0.02), marital status (OR, 0.43; 95% CI, 0.21-0.89; p = 0.003), involvement of the trunk (OR, 3.44; 95% CI, 1.81-6.52; p = 0.001), and involvement of the nipple (OR, 6.20; 95% CI, 1.39-27.63; p = 0.017) were the significant associated factors for the presence of genital eczema among patients with AD. Of note, the severe impairment of genital eczema-specific QOL was observed in 28.29% of AD patients with genital eczema. Especially, female sex (OR, 2.22; 95% CI, 0.84-5.82; p = 0.04) was more associated with severe impairment of genital eczema-specific QOL. Many patients with AD suffer from the genital presentation of the disease. Moreover, genital involvement of the disease has a significant impact on the QOL of patients with AD. We suggest that more attention should be paid to the genital presentation of the disease to increase QOL and provide further delicate treatment of patients with AD.

PURPOSE: The current study aimed to demonstrate the outcomes of patients with Lichtman stage II and IIIA Kienböck’s disease with mild pain and good range of motion (ROM) after conservative management. We hypothesized that we can conservatively manage patients with early-stage Kienböck’s disease including those with stage IIIA. PATIENTS AND METHODS: This study is a retrospective case series. Between January 2012 and December 2017, 38 patients were enrolled in this study. The mean follow-up period of conservatively managed group was 49.1 months. The flexion–extension (FE) arc, grip strength, Pain Visual Analog Scale (pVAS), Modified Mayo Wrist Score (MMWS), and disabilities of the arm, shoulder, and hand (DASH) score were determined for functional evaluation. The radiographic parameters were assessed using the Stahl’s index and carpal height ratio. The morphological changes in the lunate were also evaluated with plain radiographs. RESULTS: A total of 31 of 38 patients (81.6%) showed favorable outcomes after conservative treatment. The mean pVAS score, MMWS, and DASH score showed statistically significant improvement, as well as the morphology of lunates on the plain radiograph. The mean FE arc was slightly decreased without statistical significance. The grip strength showed improvement with statistical significance. One patient showed the same radiographic morphology, but did not manifest any pain. A total of five (13.2%) patients who experienced aggravated pain and decreased ROM underwent surgical treatment. The other patient required surgical intervention but was provided conservative treatment due to her circumstances. CONCLUSION: Favorable outcomes can be expected in patients with Lichtman stages II and IIIA avascular necrosis of the lunate (Kienböck’s disease) with mild pain and good ROM who undergo conservative management. LEVEL OF EVIDENCE: IV.

Red blood cell distribution width (RDW) is a component of routine complete blood count, which reflects variability in the size of circulating erythrocytes. Recently, there have been many reports about RDW as a strong prognostic marker in various disease conditions in the adult population. However, only a few studies have been performed in children. This study aimed to investigate the association between RDW and pediatric intensive care unit (PICU) mortality in critically ill children. This study includes 960 patients admitted to the PICU from November 2012 to May 2018. We evaluated the associations between RDW and clinical parameters including PICU mortality outcomes. The median age of the study population was 15.5 (interquartile range, 4.8–54.5) months. The mean RDW was 15.6% ± 3.3%. The overall PICU mortality was 8.8%. As we categorized patients into 3 groups with respect to RDW values (Group 1: ≤14.5%; Group 2: 14.5%–16.5%; and Group 3: >16.5%) and compared clinical parameters, the higher RDW groups (Groups 2 and 3) showed more use of vasoactive-inotropic drugs, mechanical ventilator support, higher severity scores, including pediatric risk of mortality III, pediatric sequential organ failure assessment, pediatric logistic organ dysfunction-2 (PELOD-2), and pediatric multiple organ dysfunction syndrome scores, and higher PICU mortality than the lower RDW group (Group 1) (P

Psoriasis and psoriatic arthritis (PsA) have been recently considered as chronic systemic inflammatory disorders. Over the past decades, enormous evidence indicates that patients with psoriasis and PsA have a higher risk of developing various comorbidities including cardiovascular disease, metabolic disease, cancers, infections, autoimmune disease, and psychiatric diseases. However, reported risks of some comorbidities in those with psoriasis and PsA are somewhat different according to the research design. Moreover, pathomechanisms underlying comorbidities of those with psoriasis and PsA remain poorly elucidated. The purpose of this review is to provide the most updated comprehensive view of the risk of systemic comorbidities in those with psoriasis and PsA. Molecular mechanisms associated with the development of various comorbidities in those with psoriasis and PsA are also reviewed based on recent laboratory and clinical investigations. Identifying the risk of systemic comorbidities and its associated pathomechanisms in those with psoriasis and PsA could provide a sufficient basis to use a multi-disciplinary approach for treating patients with psoriasis and PsA.

Background Early detection and prompt intervention for clinically deteriorating events are needed to improve clinical outcomes. There have been several attempts at this, including the introduction of rapid response teams (RRTs) with early warning scores. We developed a deep-learning-based pediatric early warning system (pDEWS) and validated its performance. Methods This single-center retrospective observational cohort study reviewed, 50,019 pediatric patients admitted to the general ward in a tertiary-care academic children's hospital from January 2012 to December 2018. They were split by admission date into a derivation and a validation cohort. We developed a pDEWS for the early prediction of cardiopulmonary arrest and unexpected ward-to-pediatric intensive care unit (PICU) transfer. Then, we validated this system by comparing modified pediatric early warning score (PEWS), random forest (RF); an ensemble model of multiple decision trees and logistic regression (LR); a statistical model that uses a logistic function. Results For predicting cardiopulmonary arrest, the pDEWS (area under the receiver operating characteristic curve (AUROC), 0.923) outperformed modified PEWS (AUROC, 0.769) and reduced the mean alarm count per day (MACPD) and number needed to examine (NNE) by 82.0% (from 46.7 to 8.4 MACPD) and 89.5% (from 0.303 to 0.807), respectively. Furthermore, for predicting unexpected ward-to-PICU transfer pDEWS also showed superior performance compared to existing methods. Conclusion Our study showed that pDEWS was superior to the modified PEWS and prediction models using RF and LR. This study demonstrates that the integration of the pDEWS into RRTs could increase operational efficiency and improve clinical outcomes.

Exposure-response and clinical outcome (CO) model for inhaled budesonide/formoterol was developed to quantify the relationship among pharmacokinetics (PK), pharmacodynamics (PD) and CO of the drugs and evaluate the covariate effect on model parameters. Sputum eosinophils cationic proteins (ECP) and forced expiratory volume (FEV1) were selected as PD markers and asthma control score was used as a clinical outcome. One- and two-compartment models were used to describe the PK of budesonide and formoterol, respectively. The indirect response model (IDR) was used to describe the PD effect for ECP and FEV1. In addition, the symptomatic effect on the disease progression model for CO was connected with IDR on each PD response. The slope for the effect of ECP and FEV1 to disease progression were estimated as 0.00008 and 0.644, respectively. Total five covariates (ex. ADRB2 genotype etc.) were searched using a stepwise covariate modeling method, however, there was no significant covariate effect. The results from the simulation study were showed that a 1 puff b.i.d. had a comparable effect of asthma control with a 2 puff b.i.d. As a result, the 1 puff b.i.d. of combination drug could be suggested as a standardized dose to minimize the side effects and obtain desired control of disease compared to the 2 puff b.i.d.

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IMPORTANCE: Narrowband UV-B (NBUVB) phototherapy has been the mainstay in the treatment of vitiligo, but its long-term safety in terms of photocarcinogenesis has not been established. OBJECTIVES: To investigate the risks of skin cancer and precancerous lesions among patients with vitiligo undergoing NBUVB phototherapy, based on the number of NBUVB phototherapy sessions. DESIGN, SETTING, AND PARTICIPANTS: This nationwide population-based retrospective cohort study enrolled 60 321 patients with vitiligo 20 years or older between January 1, 2007, and December 31, 2017. Patients and outcomes were identified through nationwide cohort data from the Korean national health insurance claims database, and frequency matching by age and sex was performed. EXPOSURES: The number of phototherapy sessions each patient received between 2008 and 2017. Patients were classified into 5 groups according to the number of phototherapy sessions (0 sessions, 20 105 patients; 1-49 sessions, 20 106 patients; 50-99 sessions, 9702 patients; 100-199 sessions, 6226 patients; and ≥200 sessions, 4182 patients). We also identifed patients who underwent at least 500 phototherapy sessions (717 patients). MAIN OUTCOMES AND MEASURES: Primary outcomes were the development of actinic keratosis, Bowen disease, nonmelanoma skin cancer, or melanoma after enrollment. RESULTS: Among the 60 321 patients with vitiligo in this study (33 617 women; mean [SD] age, 50.2 [14.9] years), the risks of Bowen disease (

Aims: The present study was conducted to assess the association of metabolic syndrome (MetS) and the MetS score (MSS) with β-cell function by gender in Korean non-diabetic populations.Methods: This...

To evaluated the outcome predictability of DIC scores in critically ill children with septic shock.Pediatric patients with septic shock who were admitted to the pediatric intensive care unit of a tertiary care children's hospital between January 2013 and December 2017 were enrolled. We analyzed the association between DIC and clinical outcomes. DIC was diagnosed based on the International Society on Thrombosis and Hemostasis (ISTH), Japanese Association for Acute Medicine (JAAM), and modified JAAM DIC criteria.Among the 89 patients, DIC was diagnosed in 66.3%, 61.8%, and 41.6% of patients using the JAAM, modified JAAM, and ISTH DIC criteria, respectively. Overall 28-day mortality was 14.6%. DIC patients had worse outcomes, including a higher 28-day mortality and multiorgan dysfunction syndrome (MODS) than those without DIC. The DIC scores were well correlated with the MODS scores. The JAAM and modified JAAM DIC scores showed good outcome predictability (p 0.05) with areas under the receiver operating characteristic curve of 0.765 and 0.741, respectively.Critically ill children with septic shock frequently experience DIC. Patients with DIC had worse outcomes than those without DIC. JAAM and modified JAAM DIC scores could be promising outcome predictors in these patients.

Purpose : The purpose of this study was to investigate the correlation between binocular visual function and reading ability. Methods : This study was conducted to examine the binocular function and reading ability of 120 men and women with a mean age of 22.74 and a corrected visual acuity 1.0 or more. The binocular visual function was measured by horizontal heterophoria, near point of convergence, accommodative facility and classified into normal group and abnormal group by clinical criterion. The variables of reading ability were measured by reading rate, number of fixation, number of regression, duration of fixation, comprehension, reading level and using VisagrapⅡ (Readalyzer). The difference in reading ability between the normal and abnormal groups was examined by independent t-test. The correlation of the reading ability variables according to the degree of visual function was analyzed by Pearson's correlation analysis. p〈0.05 was considered significant. Results : In the near and distance, the reading speed of exophoria group decreased and the average number of fixation was increased (p

To determine international surgeon practice patterns for transient postoperative hypocalcemia in patients undergoing total thyroidectomy.All member surgeons of the American Thyroid Association and the International Association of Thyroid Surgeons were contacted via email to complete a 20-question survey which included both questions about demographic information and preventing and managing postoperative hypocalcemia after thyroidectomy. Univariate analysis was performed to determine whether providers check preoperative vitamin D levels, postoperative calcium trends and/or PTH to assess for postoperative hypocalcemia.A total of 332 surgeons responded to the survey with 72.26% in practice for10 years and 82.18% performing50 total thyroidectomies per year. 13.29% of surgeon's surveyed reported that they routinely check preoperative vitamin D levels. Surgeon case volume, type of practice (academic vs non-academic practice), and geographic location in the US were significant predictors of whether surgeons check preoperative Vitamin D levels. International surgeons were significantly more likely to check both postoperative serum Ca and PTH compared to US based surgeons (p .01). There was no significance difference in practice patterns based on whether the surgeon was a General Surgeon or an Otolaryngologist.Using a questionnaire distributed to both General Surgeons and Otolaryngologists, we demonstrated that there is significant variation in practice patterns between surgeons practicing in the United States and surgeons practicing in other countries, and practice often differs from recommended guidelines.