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A nationwide survey was conducted to clarify the clinical features and outcomes of Korean children with Langerhans cell histiocytosis (LCH). Korea Histiocytosis Working Party analyzed the data of 603 patients who were diagnosed with LCH between 1986 and 2010 from 28 institutions in Korea. Median age at diagnosis was 65 months (range, 0 to 276 mo). Bone was the most frequently affected organ (79.6%) followed by skin (19.2%). Initially, 419 patients (69.5%) had single-system involvement (SS), 85 (14.1%) with multisystem (MS) disease without risk organ involvement (MS-RO), and 99 (16.4%) multisystem disease with risk organ involvement (MS-RO). The 5-year overall survival (OS) rates in the SS, MS-RO, and MS-RO groups were 99.8%, 98.4%, and 77.0%, respectively (P

Summary To produce clay nanocomposites, photopolymerizable organoclays can react with monomers and incorporate into polymer matrices during the UV curing process. This research investigates the effects of polymerizable organoclays on the reaction behavior as well as the ultimate composite properties based on in-situ thiol-ene photopolymerization. To this end, different types of polymerizable organoclays, prepared by changing the functional group structure, were examined in various thiol-acrylate systems. Small angle X-ray diffraction was used to examine the degree of clay exfoliation. Photopolymerization behavior was characterized using real time infrared spectroscopy. Dynamic mechanical analysis was used for analyzing both mechanical and thermal properties. With sufficient clay exfoliation, the incorporation of thiol groups on the clay surfaces significantly increases the photopolymerization rate and final thiol conversion, whereas acrylate group conversion does not change significantly. While increasing monomer functionality does decrease final thiol conversion, the increase of thiol functionality of organoclays enhances thiol-ene step growth reaction. Dark curing results suggest that the structure of propagating radicals on the clay surface varies by the type of polymerizable organoclays, changing the reaction behavior of the system. In accordance with the reaction behavior, the incorporation of acrylated organoclays significantly increases the storage modulus by inducing dominant acrylate homopolymerization. Addition of thiolated organoclays, on the other hand, makes more flexible polymer chains due to increased thio-ether linkages.

Purpose Meckel's diverticulum (MD) has various clinical manifestations, and diagnosis or selectection of proper diagnostic tools is not easy. This study was conducted in order to assess the clinical differences of MD diagnosed by scintigraphic and non-scintigraphic methods and to find the proper diagnostic tools. Methods We conducted a retrospective review ofthe clinical, surgical, radiologic, and pathologic findings of 34 children with symptomatic MD, who were admitted to Gachon University Gil Medical Center, Inha University Hospital, and The Catholic University of Korea, Incheon St. Mary's Hospital between January 2000 and December 2012. The patients were evaluated according to scintigraphic (12 cases; group 1) and non-scintigraphic (22 cases; group 2) diagnosis. Results The male to female ratio was 7.5: 1. The most frequent chief complaint was lower gastrointestinal (GI) bleeding in group 1 and nonspecific abdominal pain in group 2, respectively. The most frequent pre-operative diagnosis was MD in both groups. Red blood cell (RBC) index was significantly lower in group 1. MD was located at 7 cm to 85cm from the ileocecal valve. Four patients in group 1 had ectopic gastric tissues causing lower GI bleeding. The most frequent treatment modality was diverticulectomy in group 1 and ileal resection in group 2, respectively. Conclusion To diagnose MD might be delayed unless proper diagnostic tools are considered. It is important to understand indications of scintigraphic and non-scintigraphic methods according to clinical and hematologic features of MD. Scintigraphy would be weighed in patients with anemia as well as GI symptoms.

The electronic structure of p(2 × 3) Ag films on Si(100) is studied by using electron energy loss spectroscopy (EELS) and scanning tunneling spectroscopy (STS). We observe three energy loss peaks with their loss energies around 1.28, 1.63, and 4.0 eV, respectively. They are assigned to the interband transition in the p(2×3) islands, the interface plasmon between Si(100) and Ag crystallites formed concomitantly with the p(2 × 3) islands, and a combination of the surface plasmon and interband transition of the Ag crystallites, respectively. STS over the p(2 × 3) surface also reveals a band gap around 1 eV in good agreement with the EELS observation of the interband transition. The present observation of the band gap suggests that the p(2 × 3) surface is semiconducting. Furthermore, we examine two models previously proposed for the p(2 × 3) surface against the present experimental observation by ab initio band structure calculations.

School bullying has become a major social problem in Korea after the emergence of media reports on children who committed suicide after being victimized by bullies. In this article, we review the characteristics of bullying, and investigate the role of the pediatrician in the prevention of and intervention against bullying and school violence. Bullying can take on many forms such as physical threat, verbal humiliation, malicious rumors, and social ostracism. The prevalence of bullying in various countries is approximately 10% to 20%. In Korea, the prevalence of school violence is similar but seems to be more intense because of the highly competitive environment. From our review of literature, we found that children who were bullied had a significantly higher risk of developing psychosomatic and psychosocial problems such as headache, abdominal pain, anxiety, and depression than those who were not bullied. Hence, it is important for health practitioners to detect these signs in a child who was bullied by questioning and examining the child, and to determine whether bullying plays a contributing role when a child exhibits such signs. Pediatricians can play an important role in the prevention of or intervention against school violence along with school authorities, parents, and community leaders. Moreover, guidelines to prevent school violence, such as the Olweus Bullying Prevention Program, KiVa of the Finish Ministry of Education, and Connected Kids: Safe, Strong, Secure of the American Academy Pediatrics, should be implemented.

Background Diamond Blackfan anemia (DBA), characterized by impaired red cell production, is a rare condition that is usually symptomatic in early infancy. The purpose of this study was to assess nationwide experiences of DBA encountered over a period of 20 years. Methods The medical records of 56 patients diagnosed with DBA were retrospectively reviewed from November 1984 to July 2010. Fifteen institutions, including 13 university hospitals, participated in this study. Results The male-to-female ratio of patients with DBA was 1.67:1. The median age of diagnosis was 4 months, and 74.1% were diagnosed before 1 year of age. From 2000 to 2009, annual incidence was 6.6 cases per million. Excluding growth retardation, 38.2% showed congenital defects: thumb deformities, ptosis, coarctation of aorta, ventricular septal defect, strabismus, etc. The mean hemoglobin concentration was 5.1±1.9 g/dL, mean corpuscular volume was 93.4±11.6 fL, and mean number of reticulocytes was 19,700/mm3. The mean cellularity of bone marrow was 75%, with myeloid:erythroid ratio of 20.4:1. After remission, 48.9% of patients did not need further steroids. Five patients with DBA who received hematopoietic transplantation have survived. Cancer developed in 2 cases (3.6%). Conclusion The incidence of DBA is similar to data already published, but our study had a male predilection. Although all patients responded to initial treatment with steroids, about half needed further steroids after remission. It is necessary to collect further data, including information regarding management pathways, from nationwide DBA registries, along with data on molecular analyses.

Oxygen inhibition is of great concern in radical photopolymerization. This research investigates the effects of polymerizable organoclays on oxygen inhibition of acrylate and thiol-acrylate systems. Without use of thiol monomers, oxygen inhibition is difficult to overcome, although adding acrylated polymerizable organoclays slightly enhances polymerization in air. By incorporating thiols, on the other hand, polymerization rates and conversion continue to increase until thiol concentration reaches 30 mol% reaching rates and conversions approximately 80% of those observed in nitrogen. Further improvements have been observed by adding suitable polymerizable organoclays. Addition of only 5 wt% thiolated organoclays into the thiol-acrylate systems including 20 mol% thiol enhances the conversion in air to almost identical levels of that achieved under nitrogen. Interestingly, addition of either non-reactive or acrylated organoclays usually decreases the polymerization. In addition, higher thiol conversions are achieved by adding thiolated organoclays due to increased thiol-ene reaction induced by the functional groups on the clay surfaces.

Because of the inherent characteristics of the thiolene step growth mechanism in preparation of thiol-ene photopolymer clay nanocomposites, the ratio between thiol and ene functional groups at and near the organoclay surfaces may have a significant effect on the polymerization behavior. This study investigates the influence of monomer composition and the type of polymerizable organoclay on thiol-acrylate photopolymerization behavior in preparation of photocurable clay nanocomposite systems. To this end, two types of polymerizable organoclays with acrylate or thiol functional group on the clay surfaces were compared in monomer compositions with different polarity and functionality. Real-time infrared spectroscopy was used to characterize polymerization behavior in conjunction with photo-DSC. The degree of clay exfoliation was evaluated using small angle X-ray scattering and correlated with photopolymerization behavior. Higher chemical compatibility of components induced enhanced clay exfoliation resulting in increase in photopolymerization rate. By affecting the stoichiometric ratio of functional groups in the clay gallery, thiolated organoclays enhance thiol-ene reaction, whereas acrylated organoclays encourage acrylate homopolymerization. In addition, inducing more propagating thiyl radicals on the organoclay surfaces by increasing functionality of thiol monomer also facilitates thiol-ene copolymerization, whereas the increase of acrylate functionality reduces final thiol conversion.

G8 summit meeting held in July 2008 decided to set up a long-term goal, by 2050, reducing the world greenhouse emissions by half of those emitted in 1990. In November 2009, the Government announced to reduce the national emission by 30[%] of BAU by 2020. Electric power industries in Korea produce most of their electricity by burning fossil fuels, and emit approximately 28[%] of national emissions. Monitoring the emissions. Monitoring the emission of electric power plants is very important. This paper presents a method to calculate the hourly emission for a thermal power plant burning mixture of coal and oil using the performance test data and coal-oil mix rate. An example of emission calculation is also demonstrated.

This retrospective study investigated the clinical characteristics and outcomes of second malignant neoplasms (SMNs) in survivors of childhood cancer from multiple institutions in Korea. A total of 102 patients from 11 institutions who developed SMN after childhood cancer treatment between 1998 and 2011 were retrospectively enrolled. The most common primary malignant neoplasms (PMNs) were central nervous system (CNS) tumors (n = 17), followed by acute lymphoblastic leukemia (n = 16), non-Hodgkin lymphoma (n = 13), and osteosarcoma (n = 12). The most common SMNs were therapy-related myeloid neoplasms (t-MNs; acute myeloid leukemia [AML], 29 cases; myelodysplastic syndrome [MDS], 12 cases), followed by thyroid carcinomas (n = 15) and CNS tumors (n = 10). The median latency period was 4.9 years (range, 0.5–18.5 years). Among 45 patients with solid tumors defined as an SMN, 15 (33%) developed the lesion in a field previously subjected to radiation. The 5-year overall survival (OS) rate of patients with an SMN was 45% with a median follow-up time of 8.6 years. Patients with AML, MDS, and CNS tumors exhibited the poorest outcomes with 5-year OS rates of 18%, 33%, and 32%, respectively, whereas those with second osteosarcoma showed comparable outcomes (64%) to patients with primary counterpart and those with second thyroid carcinoma had a 100% OS rate. Further therapeutic efforts are recommended to improve the survival outcomes in patients with SMNs, especially in cases with t-MNs and CNS tumors., Graphical Abstract

Thrombopoietin (TPO) is one of the most promising stimulants for ex vivo expansion of haematopoietic stem cells. Previously, we have found that TPO induces a characteristic pattern of apoptosis during ex vivo expansion of human cord blood (CB) CD34+ cells and that the TPO-induced apoptotic cells belong to megakaryocyte (MK) lineage. In this study, we have examined the maturation of MK and platelet production in association with the TPO-induced apoptosis. CD34+ cells, purified from human CB, were expanded in serum-free conditions stimulated with TPO. Apoptosis was confirmed by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labelling (TUNEL) assay and electron microscopy (EM). Simultaneous measurement of DNA content and immunophenotyping revealed that the cells with higher DNA content (>8 N) constituted less than 5% of the CD41+ fractions until day 14, implying premature apoptosis of MKs before full polyploidization. Nevertheless, EM observation showed not only platelet territories but also newly produced platelets in which granules and microfilaments could be identified. Furthermore, flow cytometry demonstrated that the platelet fraction expressed P-selectin and an activation motif on GPIIb/IIIa recognized by monoclonal antibody PAC-1 upon stimulation with adenosine diphosphate (ADP). In addition, periodic acid-Schiff (PAS)-positive materials and nonspecific esterase activities could be demonstrated. Therefore, it is suggested that platelet production and the accompanying processes, rather than apoptosis only, be hastened during the ex vivo expansion of CB CD34+ cells when using TPO.

High serum inorganic phosphorus level is related with atherosclerosis and an elevated risk of cardiovascular disease. At the same time, the association of phosphorus with erectile dysfunction (ED) is not well reported. We studied the effect of serum phosphorus on ED and the relationship with other clinical variables.From March to September 2013, 1,899 police men aged 40 to 59 years who entered in a prostate health screening were targeted. All subjects underwent a clinical checking using the International Index of Erectile Function-5 (IIEF-5) questionnaire translated into Korean. Serum prostate-specific antigen (PSA), testosterone, inorganic phosphorus, body mass index, metabolic syndrome (MetS), and prostate ultrasound were also examined.Serum inorganic phosphorus (r=-0.108, p0.001) had the highest correlation coefficient with IIEF-5 score other than age, followed by prostate volume (PV) (r=-0.065, P0.001). Using logistic regression analysis, age, phosphorus, and MetS were predictive factors for moderate to severe ED in univariate analysis. PSA, testosterone, body mass index, and PV could not predict ED. Age, MetS, and phosphorus were independent predictive factors of moderate to severe ED (p0.001; odds ratio [OR], 1.119; 95% confidence interval [CI] 1.086-1.153; p=0.048; OR, 1.283; 95% CI, 1.003-1.641; and p=0.048; OR, 1.101; 95% CI, 1.076-1.131) in the multivariate analysis.In our study, phosphorus level is related with ED. Phosphorus is a significant predictor of ED and a strong factor that can be modified in the middle-age. Controlling phosphorus in men may have a particular meaning of preventing the occurrence of ED.

To evaluate the relationship of carotid artery plaque with international prostate symptom score (IPSS) and international index of erectile function-5 (IIEF). We enrolled 799 men who had participated in a health examination. They received an IPSS, IIEF, a carotid duplex ultrasound, and a full metabolic work-up. Data were analyzed using Spearman’s correlation test, the Mantel–Haenszel Extension test, and logistic regression analyses. The median age of the study population was 57 years, and the median IPSS and IIEF were 11 and 15, respectively. The IPSS voiding sub-score was significantly correlated with maximum intima-media thickness (max IMT) (P = 0.002). We observed a significant increase in the severity of the voiding sub-score with increasing severity of plaque size (P = 0.003). Additionally, there was an increased likelihood of having a higher IPSS voiding sub-score as severity of plaque size increased after adjusting for age and components of metabolic syndrome. The IIEF showed a significant negative correlation with max IMT (P

To investigate the influence of iron deficiency and iron supplementation on nitric oxide (NO) production, we measured serum iron markers, serum nitrate and nitrite (NOx) concentrations, reticulocyte maturity index (RMI), and serum transferrin receptor (sTfR) levels in 369 females aged 14-19 years. RMI was analyzed by flow cytometry, sTfR concentrations were measured by enzyme immunoassay, and serum NOx levels were tested by the Griess reaction. NOx concentrations of the subjects in iron depletion phase were significantly higher than those of healthy controls. NOx concentrations increased gradually as iron deficiency progressed and were threefold higher than for the healthy controls, when the subjects attained a frank iron deficiency anemia. In particular, the NOx concentrations were 7.5-fold higher in the patients with severe iron deficiency anemia (Hb80 g/l) than for the subjects with high hemoglobin value (Hbor=140 g/l). The increased NOx concentrations (132.6+/-42.1 microM) observed in the group with severe anemia decreased significantly (46.3+/-15.8 microM) after hemoglobin levels were normalized by iron supplementation ( P0.01). NOx concentrations correlated inversely with hemoglobin levels ( r(2)=0.202, P0.01), but correlated positively with the sTfR concentrations ( r(2)=0.322, P0.01) and the RMI ( r(2)=0.369, P0.01). In conclusion, iron deficiency anemia increases NO production, and elevated NOx concentrations in iron deficiency anemia return to normal with iron supplementation.

Objectives. This study was aimed at investigating the usefulness of serum transferrin receptor (sTfR) and ferritin in anemic patients with rheumatoid arthritis (RA) compared with bone marrow storage iron and other tests for anemia. Methods. Fifty-five anemic RA patients underwent anemia study. Bone marrow iron stain was performed in 18 patients. sTfR and serum ferritin levels were compared with bone marrow iron stores. Results: (1) Mean sTfR concentration was 2.63±1.91 mg/L, (2) sTfR correlated with most indicators of anemia, (3) sTfR showed no correlation with CRP and ESR, whereas ferritin did, and (4) sTfR was higher in the "iron depleted" subgroup than in the "iron nondepleted" subgroup in bone marrow study. Conclusion. The measurement of sTfR and ferritin is useful in finding the cause of anemia in RA and is a possible substitute for invasive bone marrow iron study.

NO is produced in many different cells and is involved in the regulation of such physiological and pathophysiological processes as inflammation, vasodilation, and metabolism (1). Depending on the cell type, NO is produced in an enzymatic reaction catalyzed by one of the three isoforms of NO synthase (NOS): neuronal NOS, endothelial NOS, and inducible NOS (2). Measurement of the NO metabolites, nitrate and nitrite (NOx), is also important as a marker of NOS enzyme activity. Obesity is a condition involving an excess accumulation of body fat, and the prevalence of obesity is rapidly increasing worldwide. Excessive weight and obesity are leading to nutrition-related disorders of clinical and public health concern. Recent studies have suggested a role for NO in the regulation of food intake in an animal experiment (3)(4). Endothelial and inducible NOS have been shown to be present in adipose tissue of the rat (5), suggesting that adipose tissue may be a potential source of NO production. Previous reports demonstrated that NOS activity and inducible NOS protein were also present in human subcutaneous adipose tissue (6) and showed that inhibition of NOS led to increased lipolysis in this tissue (7). However, how NO production changes as body mass index (BMI) increases in apparently healthy subjects has not been studied extensively. Moreover, correlation studies of serum NOx concentrations, body fat mass, and blood lipid concentrations in healthy subjects are limited. Therefore, in the present study, we investigated the changes in NOx concentrations according to BMI and evaluated the relationships among NOx concentrations, total body fat, and lipid profiles in adolescents. We measured serum NOx concentrations, complete blood cell counts, iron markers, and serum lipid profiles in 185 males and 178 females, 14–19 years of age, selected from 1473 students attending middle or high school. Eight anthropometric measurements were …

Background: There has been increasing interest in the patients perspective on the outcome of the treatment. The Haemophilia Activity List (HAL) has been developed as a disease-specific questionnaire for haemophilia patients and is a validated self-report measure of function developed according to WHO International Classification of Functioning, Disability and Health. In this study, we performed a cross-cultural adaptation and linguistic validation of the HAL questionnaire to assess the health-related quality of life in Korean hemophilia patients in the future. Methods: To validate HAL in Korean, the English versions of HAL were translated into Korean using the forward-backward translation method and merged into a final Korean version. Validation was performed against the Korean version of the questionnaires EQ-5D-5L (EQ-5D) as general tool and Routine Assessment of Patient Index Data (RAPID3) as similar disease-specific tool. All processes were done with permission of the developer and according to WHO guidelines. Results: One hundred patients with severe and moderate forms of haemophilia A and B from Korea Hemophlia Foundation were invited to participate in the study. Spearmans rank correlation test was used for validation and internal consistency of the HAL was calculated with Cronbach alpha. Eighty-seven patients (87%) (18-62 years old) answered the questionnaires. The internal consistency of the Korean version of HAL was high, with Cronbachs alpha being 0.80-0.95. Upper extremity function had the highest consistency and leisure activities and sport had the lowest. The correlation was good between the HAL overall score and EQ-5D overall (r=0.78), EQ-5D usual activity (r=0.79), and RAPID3 physical function (r=0.82). Conclusion: The Korean version of HAL has reliability from internal consistency and intraclass correlation by test-retest analysis. The Korean version of HAL has validity which correlated with EQ-5D as general tool and RAPID3 as similar disease-specific tool. This questionnaire of Korean version can be useful as a hemophilia disease-specific instrument for evaluation of the health-related quality of life in Korean patients. Disclosures No relevant conflicts of interest to declare.

We investigated the effect of Helicobacter pylori eradication on sideropenic refractory anaemia in adolescent girls with H. pylori-associated antral gastritis without evidence of haemorrhage or clinical symptoms other than sideropenic anaemia. We conducted an open therapeutic trial in 21 adolescent girls aged 15-17 y with sideropenic refractory anaemia, which was defined as iron-deficiency anaemia refractory to oral iron therapy for 3 mo. All subjects underwent gastroduodenal endoscopy. Thirteen patients with confirmed H. pylori infection were given a 2-wk course of triple therapy and 6 wk of oral ferrous sulfate. We compared the mean levels of haemoglobin and serum ferritin among the "initial sample" (the time when the sampling was done before treatment with oral iron), "before eradication" (the time prior to triple therapy for eradication after subjects had been given oral iron for 3 mo) and "after eradication" (the time when the follow-up endoscopy was performed) data in 11 subjects in whom H. pylori infection was eradicated. Haemoglobin levels (g/dl) were 8.6+/-1.9, 8.6+/-1.4 and 11.3+/-2.3, respectively. Serum ferritin levels (microg/l) were 4.6+/-2.4, 4.2+/-2.3 and 17.5+/-6.7, respectively. After eradication of H. pylori, mean levels of haemoglobin (p = 0.0002) and serum ferritin (p = 0.0002) showed a prominent increase between "before eradication" and "after eradication". In conclusion, adolescent girls with sideropenic refractory anaemia should be evaluated for H. pylori infection. If H. pylori infection is coexistent, its eradication along with iron supplementation could correct the anaemia.

Background. A few cases relating H. pylori infection to iron-deficiency anemia have been described recently. We investigated the role of H. pylori infection in iron-deficiency anemia in preadolescent children and adolescents. Patients and Methods. We conducted a double-blind, placebo-controlled therapeutic trial in 43 subjects (mean age, 15.4 years) with iron-deficiency anemia. Endoscopy was performed, and biopsy specimens were examined by urease test and histological analysis. Twenty-two of 25 H. pylori–positive patients were assigned randomly to three groups. Group A patients were given oral ferrous sulfate and a 2-week course of bismuth subcitrate, amoxicillin, and metronidazole. Group B patients were given placebo for iron and a 2-week course of triple therapy. Group C patients were given oral ferrous sulfate and a 2-week course of placebo. Iron status was reassessed 4 weeks and 8 weeks after the 2-week regimen ended. Results. Of the 43 subjects with iron-deficiency anemia, 25 (58.1%) had H. pylori in the antrum. Group A and B subjects, who received eradication therapy, showed a significant increase in hemoglobin level as compared with group C subjects at 8 weeks after therapy (p = .0086). Conclusions. Treatment of H. pylori infection was associated with more rapid response to oral iron therapy as compared with the use of iron therapy alone. Such treatment also led to enhanced iron absorption even in those subjects who did not receive oral iron therapy.

Purpose Iron deficiency remains a very common nutritional problem despite the improvement in nutrition and increased understanding of methods for its prevention. Thus, we try to create a new method for screening iron nutrition through infant nutrition history. Methods Among the children who visited Inha University Hospital from March 2006 to July 2012, 181 children with iron deficiency anemia (IDA) and 52 children without IDA ranging from 6 to 36 months of age were reviewed in this study. We used the age when they began to wean food, the type of sort weaning foods, the time required for successful weaning, iron content in weaning foods, and the duration of breastfeeding for scoring infant nutrition history based on a questionnaire. Results The mean score of the IDA group was 7.8±2.6 points, which was significantly higher than that of the control group (5.6±2.1) (p=0.000). If we set up the cutoff value at 6 points, this screening has 86.8% sensitivity and 36% specificity. In addition, as the IDA score increased, there was a falling trend of hemoglobin. Conclusion The IDA score does not have high specificity or high sensitivity. However, this study conveys that those patients who record a high score have low hemoglobin. Therefore, we suggest this score system for screening more IDA patients via nonpainful techniques.

With the electronic counters routinely used, it has become practical to determine the concentration of hemoglobin, red cell indices, and RDW concurrently in association with transferrin saturation and ferritin in accordance with feeding practices. The 1028 infants and children aged 6 to 24 months, who had been mainly admitted with acute infectious or inflammatory diseases, were divided into three groups, i.e., children who were exclusively breast-fed more than 6 months (group A), those who had been given iron-fortified formula milk since birth (group B), and those who had been given breast milk for 5-6 months and then switched to the iron-fortified formula (group C). Children with anemia comprised 34.8% (104/299) of group A, significantly more than 5.6% (34/608) of group B and 6.6% (8/121) of group C (p0.001, respectively). Children with MCV70 fl comprised 39.5% (118/299) of group A, significantly more than 7.1% (43/608) of group B and 13.2% (16/121) of group C. Out of the total 146 patients with anemia, 82.2% (n = 120) had laboratory evidence of iron deficiency, which was mostly suggested by a dietary history. The sensitivity of MCV values70 fl in IDA patients was 90.0%; specificity was 53.8%. The sensitivity of RDW valuesor = 15% was 83.3%; specificity was 57.7%. The positive predictive value could be increased to 97.8% by combining MCV70 fl and RDWor = 15%. The sensitivity of serum ferritin concentrations10 ng/ml was 62.4% and specificity was 100%. The sensitivity of transferrin saturation12% was 72.3% and specificity was 81.3%. By combining the hemoglobin with MCV and RDW in screening for iron deficiency, the diagnostic accuracy of IDA can be increased. We support the use of appropriately iron-fortified weaning foods or the routine iron supplement starting at 6 months of age in exclusively breast-fed infants.

Immunization to eliminate measles is recommended at 15 months of age with the option of giving vaccine at 6 to 9 months of age during measles outbreaks in Korea. Because of the recent resurgence of measles and concern about the possibility of reduced vaccine efficacy caused by genomic differences between vaccine virus and contemporary wild measles viruses, we conducted a measles vaccine efficacy study involving children with household exposure ages 1 to 5 years during measles outbreak that had occurred 1993 in Seoul and Seong-nam city, with the demographic analysis of patients brought to the hospitals. A total of 380 patients (M:F = 216:164) were included in this study. Two hundred nine cases (55.0%) occurred in children less than 5 years of age, and 167 (43.9%) were younger than 16 months of age. The recorded age-specific incidence rates showed bimodal patterns, i.e. highest peak in those below 16 months of age and second peak in those ages 6 to 9 years of age. Only 9.6% (16 of 167) of the measles cases less than 16 months, 59.5% (25 of 42) of those 16 months to 4 years and 91.8% (157 of 171) of the cases in school age children have been vaccinated. Attack rates among the 122 vaccinated siblings and 12 unvaccinated siblings ages 1 to 5 years who contacted measles were 5.7 and 75%, respectively, and the clinical vaccine efficacy was 92.4% (95% confidence interval, 83.6, 96.4). The high vaccine efficacy in household exposures suggests that measles outbreaks in Korea are not caused by reduced vaccine efficacy.

Klinefelter syndrome (KS) is one of the most common disease entities characterized by X-chromosomal aberration causing the primary hypogonadism in adult men. Patients with KS seem to be typically characterized by tall, slender bodies with delayed puberty and hypergonadotropic hypogonadism. However, it has been known that they have a broad spectrum of phenotype ranging from almost normal external appearances to typical phenotype. Only 25% KS Patients are ever diagnosed because KS remains unrecognized. Also, boys with KS have an onset of pubertal development within the normal range, not delayed onset of puberty. Adolescents with KS are generally diagnosed as having the lack of pubertal progress. Early detection of KS can be difficult without awareness. We report an unusual case of early onset of puberty in obese boy with KS who presented with a unilateral non-hormone secreting testicular teratoma.

목적: 소아에서 엔테로바이러스 감염증은 무증상 감염부터 비특이적 발열성 질환, 수족구병, 수막뇌염등 다양한 질환으로 나타날 수 있다. 본 연구는 소아 입원 환자들을 대상으로 엔테로바이러스 감염의 유전자형 별 임상양상에 대하여 알아보고자 하였다. 방법: 2014년 3월부터 2015년 3월까지 인하대병원에 입원한 환자들 중 400명을 대상으로 real-time reverse transcriptase-polymerase chain reaction (RT-PCR)로 엔테로바이러스를 검출하였으며, RT-seminested PCR로 혈청형을 분석하였다. 염기서열의 계통분석을 시행하여 neighbor-joining tree를 작성하였다. 결과: 전체 연구대상 400명 중 112명(28%)에서 엔테로바이러스 양성이 확인되었으며 엔테로바이러스 양성 환자의 평균연령은 2.66세(3일-14세), 남녀 성비는 1.73:1 이었다. 65개의 검체에서 엔테로 바이러스의 혈청형을 확인할 수 있었고, coxsackievirus B5 17례(15.2%), coxsackievirus A16 13례 (11.6%), enterovirus 71 10례(8.9%), coxsackievirus A2 9례(8.0%) 순이었다. 엔테로바이러스 양성 환자들 중 96명(86%)에서 비특이적 발열 증상이 있었으며, 0-11일의 다양한 발열기간을 나타냈고, 평균 발열기간은 3.13일이었다. 발진은 전체 양성환자 중 44명(39%)에서 나타났으며, 수막뇌염은 43명 (38%)에서 나타났다. 염기서열에 따른 계통 분석에서 6개의 유전적 군집이 관찰되었다. 결론: 저자들은 인천지역 단일기관에 입원한 환자에서 분리된 엔테로바이러스의 혈청형과 임상양상을 확인하였다. 본 연구 결과가 앞으로 국내 엔테로바이러스 감염의 역학을 파악하는 데에 도움을 줄 것으로 생각한다.

Purpose: High serum inorganic phosphorus level is related with atherosclerosis and an elevated risk of cardiovascular disease. At the same time, the association of phosphorus with erectile dysfunction (ED) is not well reported. We studied the effect of serum phosphorus on ED and the relationship with other clinical variables. Materials and Methods: From March to September 2013, 1,899 police men aged 40 to 59 years who entered in a prostate health screening were targeted. All subjects underwent a clinical checking using the International Index of Erectile Function-5 (IIEF-5) questionnaire translated into Korean. Serum prostate-specific antigen (PSA), testosterone, inorganic phosphorus, body mass index, metabolic syndrome (MetS), and prostate ultrasound were also examined. Results: Serum inorganic phosphorus (r=–0.108, p

Anemia, iron deficiency (ID), and iron deficiency anemia (IDA) are common disorders. This study was undertaken to determine the prevalence of anemia, ID, and IDA in Korean females. We examined the associations between IDA, heavy metals in blood, vitamin D level and nutritional intakes. The study was performed using on data collected from 10,169 women (aged ≥10 yr), including 1,232 with anemia, 2,030 with ID, and 690 with IDA during the fifth Korea National Health and Nutrition Examination Survey (KNHANES V; 2010-2012). Prevalence and 95% confidence intervals were calculated, and path analysis was performed to identify a multivariate regression model incorporating IDA, heavy metals in blood, vitamin D level, and nutritional intakes. The overall prevalence of anemia, ID and IDA was 12.4%, 23.11%, and 7.7%, respectively. ID and IDA were more prevalent among adolescents (aged 15-18 yr; 36.5% for ID; 10.7% for IDA) and women aged 19-49 yr (32.7% for ID; 11.3% for IDA). The proposed path model showed that IDA was associated with an elevated cadmium level after adjusting for age and body mass index (β=0.46, P, Graphical Abstract

BACKGROUND Anemia and iron depletion continue to be common disorders in the world. This study was aimed at assessing the prevalence of anemia and iron depletion in apparently healthy Koreans aged 10 years or more. METHODS We used the data of the 4(th) Korean National Health & Nutrition Examination Survey (KNHANES), which assessed 7,607 individuals (3,337 males and 4,270 females). Iron depletion was defined as serum ferritin less than 15 ng/mL. RESULTS In males, mean hemoglobin (Hb) concentration decreased after the age of 50. The prevalence of anemia was 7.1% in 60 to 69 year olds and 12.3% in men aged 70 or older. As for females, the prevalence of anemia was 8.8% in 15 to 17 year olds, 16.7% in 18 to 49 year olds, 10.9% in 60 to 69 year olds, and 18.2% women aged 70 or older. In males, the prevalence of iron depletion was 8.6% at ages 10 to 14 years, 3.9% at 15 to 17, and 2.6% at 70 years or older. In females, the prevalence of iron depletion was 17.2% at ages 10 to 14 years, 24.1% at 15 to 17, 33.0% at 18 to 49, and 5.7% at 70 years or older. Although normocytic anemia was most common in both males and females, the proportion of microcytosis and macrocytosis increased at age 70 or older. CONCLUSION The prevalence of anemia and iron depletion was high in women of reproductive age and in the elderly. Considering the rapid increase in the older population, an intervention to prevent anemia and iron depletion is imperative.

Hepatocellular carcinoma (HCC) remains chemoresistant and, therefore, the principal treatment of HCC is surgical resection. After a 9-year-old boy with huge HCC with lung metastasis received the 5 cycles of chemotherapy (cisplatin and Adriamycin), the lung metastasis had been resolved completely and the size of HCC in liver had decreased. Right hepatic trisegmentectomy was performed, and then the additional 3 cycles of chemotherapy was given. Currently, the patient shows no recurrence of HCC 42 months after surgical extirpation.

We report a case of acute severe hepatitis with Mycoplasma pneumoniae (M. pneumoniae) infection and transient depression of multiple coagulation factors. A 5-year-old boy, previously healthy, was admitted with pneumonia. M. pneumoniae infection was confirmed by serology testing. Liver enzymes were elevated on admission without any past medical history. After treatment with azithromycin for 3 days, pneumonia improved, but the hepatitis was acutely aggravated. Partial thromboplastin time (PTT) was prolonged and depression of multiple coagulation factors developed. Liver biopsy revealed features consistent with acute hepatitis. A week later, liver enzymes were nearly normalized spontaneously. Normalization of prolonged PTT and coagulation factors were also observed several months later. This may be the first case of transient depression of multiple coagulation factors associated with M. pneumoniae infection.

Purpose: We researched microbial profiles and the antimicrobial resistance profile of wound infection of the pelvic area in Korea for the recent 5 years in order to provide useful information on the choice of adequate drugs in the treatment of pelvic wound infection. Materials and Methods: We retrospectively analyzed 211 pelvic wound culture samples and their antimicrobial resistance in 198 inor out-patients of the Urology and Plastic surgery department from January 2010 to December 2014. Results: Of the total samples, Staphylococcus aureus was isolated most frequently (35.3%), followed by Escherichia coli (15.1%), Staphylococcus epidermidis (12.6%), Staphylococcus haemolyticus (12.6%), Staphylococcus lugdunensis (8.4%), Pseudomonas aeruginosa (6.7%), Enterococcus spp. (4.2%), and Streptococcus spp. (3.3%). There were no notable changes of bacterial distribution for 5 years. For Gram-positive isolates, the oxacillin resistance rate for Gram-positive bacteria was 42.6% and showed an increasing tendency for the recent 5 years. Piperacillin, rifampicin, and vancomycin had low resistance for Gram-positive bacteria. Carbapenems, piperacillin/tazobactam had low resistance for Gram-negative bacteria. The Gram-positive organisms were more sensitive to many antibiotics in contrast to the Gram-negative organisms. Conclusions: Of varied causative organisms and susceptibility of the pelvic wound site, the most frequently infected organisms of the pelvic area were S. aureus, followed by E. coli. The methicillin resistive S. aureus (MRSA) incidence showed a tendency to increase yearly, thus selection or early change of antibiotics considering MRSA is recommended if the antibiotic response is poor. Gram-negative bacteria has a higher resistance rate compared with Gram-positive bacteria and had carbapenems and piperacillin/tazobactam.

Purpose To analyze the differences of semen parameters in Korean young population for three periods from 2002 to 2013. Materials and methods A total of 516 semen samples were collected from Korean men presenting for infertility, varicoceles or other infectious problems for three periods from 2002 to 2012: January 2002-December 2003, January 2007-December 2008, and January 2012-December 2013. A standard World Health Organization procedure for semen analysis was performed for assessment of semen concentration, volume, motility, morphology, and pH. Results A total of 160, 162, 194 men constituted the study populations in 2002 to 2003, in 2007 to 2008, and in 2012 to 2013, respectively. The overall sperm parameter results suggested a statistically significant difference between 2002 to 2003 and 2012 to 2013 except pH. However, considering the data from 2007 to 2008, there were no trends in changes in overall semen parameters. Negative correlations were observed in all semen parameters with increasing age in all patients, except for pH. In addition, semen volume, motility, and morphology had higher negative correlation coefficients with age, from 2002 to 2013, serially. Conclusions There were no significant changes in the semen parameters of Korean men from 2002 to 2013. In addition, semen volume, motility, and morphology showed higher negative correlation coefficients with age from 2002 to 2013, serially.

Purpose: There is no reported evidence for an anthropometric index that might link obesity to men's sexual health. We evaluated the ability of an anthropometric index and the symptom scores of five widely used questionnaires to detect men's health prob - lems. We determined the predictive abilities of two obesity indexes and other clinical parameters for screening for lower urinary tract symptoms and sexual dysfunction in middle-aged men. Materials and Methods: A total of 1,910 middle-aged men were included in the study. Participants underwent a detailed clinical evaluation that included recording the symptom scores of five widely used questionnaires. The participants' body mass index and waist-to-hip ratio were determined. Serum prostate-specific antigen, urinalysis, testosterone, estimated glomerular filtration rate, evaluation of metabolic syndrome, and transrectal ultrasonography were assessed. Results: By use of logistic regression analysis, age and total prostate volume were independent predictors of lower urinary tract symptoms. Metabolic syndrome was the only significant negative predictive factor for chronic prostatitis symptoms. Age and met - abolic syndrome were independent predictive factors for erectile dysfunction. Waist-to-hip ratio had a statistically significant value for predicting erectile dysfunction. Conclusions: Our data showed that total prostate volume is a significant predictor of lower urinary tract symptoms, and central obesity has predictive ability for erectile dysfunction. Metabolic syndrome was the only significant negative predictive factor for chronic prostatitis-like symptoms. The management of correctable factors such as waist-to-hip ratio and metabolic syndrome may be considered preventive modalities against the development of men's health problems.

Insulinoma, which arises from insulin-producing pancreatic beta cells, is a rare tumor in children. Only 5%-10% of insulinomas are malignant and undergo metastasis. We report a case of an 11-year-old girl who experienced hypoglycemia-related seizures induced by an insulinoma; after resection of the primary tumor, she developed hepatic focal nodular hyperplasia (FNH). Laboratory test results indicated marked hypoglycemia with hyperinsulinemia. Abdominal ultrasonography (US) and computed tomography results were normal; however, magnetic resonance imaging (MRI) showed a solid mass in the pancreatic tail. Therefore, laparoscopic distal pancreatectomy was performed. Two months after the surgery, an abdominal MRI revealed multiple nodular lesions in the liver. An US-guided liver biopsy was then performed, and histological examination revealed FNH without necrosis or mitotic activity. The patient has been free of hypoglycemia for 2 years, and recent MRI studies showed a decrease in the size of FNH lesions, without any evidence of metastasis. Even though no metastatic lesions are noted on imaging, close observation and follow-up imaging studies are required in a child with insulinoma that has malignant potential on histopathologic findings.

Purpose: Catheter associated urinary tract infection and discomfort is common in patients with an indwelling urinary catheter. We investigated the effectiveness of prophylactic topical antibiotic ointment for genitourinary post-operative patients with a urinary catheter. Materials and Methods: We investigated 112 inpatients between March 2013 and October 2013, who had an indwelling urinary catheter ≥24 hours after a genitourinary operation in our institution from medical records. Among 112 patients, 59 patients applied ofloxacin ointment to urethral meatus around the indwelling catheter twice a day (ointment group: 52.7%) and 53 patients did not (non-ointment group: 47.3%). All patients were examined by urine analysis and urine culture before the operation, urethral sweep culture after catheter removal, and severity of pain was recorded as visual analogue scale (VAS) score while having an indwelling urinary catheter. Results: Mean duration of urinary catheter of both groups did not differ statistically (3.08±2.19 day, 2.91±2.25 day). Patients with pyuria detected at pre-operative urinalysis were 22.1% vs. 15.1%, pre-operative urine culture positive were 6.8% vs. 9.4%, urethra meatal culture positive after urethral catheter removal were 16.9% vs. 13.2%, respectively, and all results showed no significant differences between two groups. VAS scores of the ointment group (3.52±1.66) while having an indwelling urinary catheter were significantly lower than those of the non-ointment group (5.61±1.75) (p

A novel combined treatment of conventional chemotherapy with an intratumoral injection of syngeneic dendritic cells (DCs) has emerged as a potent cancer treatment strategy. In this study, we evaluated the synergistic effect of an intraperitoneal (i.p.) injection of a chemotherapeutic drug, paclitaxel, and an intratumoral (i.t.) injection of syngeneic bone marrow-derived DCs for the treatment of pre-existing fibrosarcoma. Subcutaneous tumors were established using MCA102 fibrosarcoma cells in syngeneic C57BL/6 mice. The results demonstrated that the combined treatment of paclitaxel chemotherapy and the injection of DCs led to complete tumor regression, in contrast to only partial eradication of the tumors with chemotherapy or DCs alone. Furthermore, the tumor-free mice were able to resist a repeat challenge with the same type of tumor. These findings suggest that a combination therapy of systemic chemotherapy along with the intratumoral administration of DCs is a potent treatment strategy for fibrosarcoma.

To investigate the relationships of trace element concentrations vs hematopoiesis and iron parameters, we measured lead, copper, zinc, cadmium, and ferritin levels in 251 healthy adolescents. Concentrations of trace metals were determined by atomic absorption spectrophotometry. There were no significant gender-related differences in serum copper or serum cadmium concentrations. However, blood lead and serum zinc levels were significantly higher in males than females (3.82+/- 1.24 and 118.4 +/- 43.7 microg/dl vs 2.86+/- 1.06 and 83.5+/- 35.2 microg/dl, p0.05, respectively). Subjects with elevated lead and copper concentrations exhibited significantly higher leukocyte counts and significantly lower serum iron levels than those with decreased lead and copper concentrations, but no significant differences were observed in blood erythrocyte counts or hemoglobin levels between the 2 groups. Blood lead concentrations were 2-fold higher in male adolescents with leukocytes9.1 x 10(3)/microl than in those with leukocytes4.3 x 10(3)/microl (5.04+/- 1.67 microg/dl vs 2.51+/- 0.75 microg/dl, p0.05). Leukocyte counts had significant correlations with blood lead (r=0.39, p0.05) and serum copper (r=0.26, p0.05) in males and zinc (r=0.28, p0.05) in females. Serum iron levels were inversely correlated with blood lead and serum copper concentrations but were not correlated with serum zinc or cadmium levels. In short, blood lead and serum copper concentrations have important relationships to leukocyte counts and iron parameters in adolescents.

To investigate the relationships of apoptosis with obesity and lipid parameters, we measured serum soluble APO-1 (sAPO-1) concentrations, body mass index (BMI), and serum lipid profiles in 176 healthy adults. Serum sAPO-1 levels were measured by enzyme immunoassay. There were no significant differences in mean sAPO-1 concentrations between men and women, nor between subjects with and without obesity. However, women with high-density lipoprotein cholesterol (HDL-C)50.2 mg/dl exhibited significantly higher sAPO-1 concentrations than those with HDL-C50.2 mg/dl (ie, 45.6 +/- 10.4 pg/ml vs 31.5 +/- 11.3 pg/ml, p0.05). Serum sAPO-1 concentrations averaged 46.8 +/- 10.7 pg/ml in women with serum triglyceride137.4 mg/dl, which was significantly above the mean value (32.6 +/- 12.0 pg/ml, p0.05) in those with serum triglyceride137.4 mg/dl. Men with elevated sAPO-1 concentrations showed significantly higher waist-to-hip ratio (WHR) and total body fat (TBF) compared to those with diminished sAPO-1 levels, although no differences were noted in mean values of lipid profiles between the 2 groups of men. Serum sAPO-1 concentrations correlated significantly with HDL-C (r = - 0.41, p0.05) and triglyceride (r = 0.35, p0.05) in women and WHR (r = 0.25, p0.05) and TBF (r = 0.21, p0.05) in men. In conclusion, serum sAPO-1 appears to have an important relationship to serum lipid levels and body adiposity in healthy adults.

This study investigated the associations between serum insulin-like growth factor-I (IGF-I) concentrations and erythropoietic activities in relation to body iron status. Serum IGF-I concentrations, free erythrocyte protoporphyrin (FEP), hemograms, and serum iron markers were measured in 71 female adolescents, age 14 to 17 yr. No significant differences were observed in hemograms, iron parameters, or FEP between the subjects with IGF-I681.2 ng/ml and IGF-I 681.2 ng/ml. However, blood hemoglobin and serum iron concentrations averaged 13.4 +/- 0.8 g/dl and 93.7 +/- 41.2 microg/dl in the subjects with IGF-I809 ng/ml, which were above the values in those with IGF-I523 ng/ml (12.3 +/- 0.9 g/dl and 50.5 +/- 30.8 microg/dl, p0.05, respectively). On the other hand, FEP was significantly lower in the adolescents with IGF-I809 ng/ml than in those with IGF-I523 ng/ml (38.9 +/- 16.2 microg/dl vs 63.4 +/- 23.1 microg/dl, p0.05). Prevalences of iron deficiency or iron deficiency anemia were 3- or 5-fold higher in the subjects with IGF-I523 ng/ml, compared to those with IGF-I809 ng/ml. Serum IGF-I correlated significantly with FEP (r = -0.45, p0.05) and serum iron concentrations (r = 0.40, p0.05) in iron deficient subjects. In summary, IGF-I seems to have an important relationship to iron metabolism and protoporphyrin synthesis in adolescents.

Efficient gene delivery of a baculovirus-derived vector (BV-p53-lacZ) to a human osteogenic sarcoma cell line, Saos-2, was serendipitously found while evaluating the vector for gene delivery to human p53-null tumour cells in a previous study. Therefore, we investigated other human, rat and mouse osteogenic sarcoma and other types of tumour cell lines for transduction efficiency via baculovirus vectors containing a lacZ reporter gene under the control of either a cytomegalovirus or Rous sarcoma virus promoter. The expression of β-galactosidase protein, assessed by X-Gal staining and β-galactosidase ELISA, demonstrated an extremely high level of transduction efficiency in some osteogenic sarcoma cell lines, such as U-2OS, Saos-2 and Saos-LM2. These human osteogenic sarcoma cell lines showed levels of β-galactosidase expression 5–40 times greater than HepG2 cells, which were previously thought to be the mammalian cells most susceptible to baculovirus-mediated gene delivery. The level of acetylated histone proteins in these tumour lines did not correlate well with the high level of reporter gene expression. These results strongly suggest that some osteogenic sarcoma cells are highly susceptible to baculovirus-mediated gene delivery and that a baculovirus-derived vector is an efficient gene delivery vehicle into human osteogenic sarcoma cells.

Helicobacter pylori infection has been reported to be associated with various unexpected manifestations in childhood. One of them is iron deficiency anaemia at puberty. In 1999, we conducted a double blind, placebo controlled trial in pubescent children with iron deficiency anaemia and coexisting H pylori infection.1 We found that H pylori eradication led to resolution of iron deficiency. We have carried out a study of seroprevalence to examine the epidemiological relationship between H pylori infection and iron deficiency …

Obesity is currently an increasing disease that affects many countries in the world including the United States where this condition is responsible for 300,000 deaths annually1. Adolescent obesity has rapidly increased in recent years in Korea due to westernized lifestyle2.

To investigate the relationships between obesity and serum lipid concentrations, we measured eight anthropometric parameters, body mass index (BMI), total body fat (TBF), and serum lipid profiles in 790 apparently healthy adolescents. TBF was assessed using a body fat analyzer. Serum concentrations of triglyceride, total cholesterol, and low- or high-density lipoprotein-cholesterol (LDL-C or HDL-C) were determined by standard enzymatic procedures. There were no significant differences in serum lipid concentrations between obese adolescents (BMIor = 95th percentile) and lean adolescents (BMI5th percentile), nor between overweights (BMI25 kg/m2) and underweights (BMI19 kg/m2). However, serum lipid concentrations were significantly higher in males with TBF37% (TBF95th percentile) than in males with TBF6% (TBF5th percentile; p0.01). Serum lipid concentrations were more strongly correlated with TBF than with BMI. Correlation coefficients between serum lipid concentrations and TBF were higher in males than in females for cholesterol (r = 0.37 vs 0.23), triglycerides (r = 0.29 vs 0.27), HDL-C (r = -0.34 vs 0.12), and LDL-C (r = 0.24 vs 0.15). In short, compared to BMI, TBF reflects serum lipid concentrations more closely. During adolescence, the association between TBF and serum lipid concentrations is stronger in males than in females.