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Purpose To determine the efficacy of a potassium-competitive acid blocker (P-CAB)-based first-line eradication therapy with bismuth compared with that of proton pump inhibitor-based first-line therapy with bismuth. Materials and methods Eradication-naive H. pylori-infected patients were consecutively enrolled from January to November 2020. Before approval of the P-CAB-based eradication therapy, twice daily administration of a regimen containing lansoprazole 30 mg, amoxicillin 1 g, clarithromycin 500 mg, and bismuth potassium citrate 300 mg was prescribed for 7 days. After approval, lansoprazole was replaced with tegoprazan (50 mg). Clarithromycin resistance was examined in patients who underwent gastroscopic biopsy at our center. Efficacy was assessed via the 13C-urea breath test. Results Of the 381 eradication-naive patients, eradication was successful in 88.3% (151/171) treated with tegoprazan and 82.8% (140/169) treated with lansoprazole in per-protocol analysis (p=0.151). In intention-to-treat analysis, eradication rates were 78.8% (152/193) in the tegoprazan and 74.5% (140/188) in the lansoprazole group (p=0.323). Clarithromycin resistance was observed in 30 (20.1%) of the 148 patients (74 from each group), and only four of the 16 clarithromycin-resistant patients in the tegoprazan group achieved successful eradication. Clarithromycin resistance [odds ratio (OR)=42.1, 95% confidence intervals (CIs)=12.6-141.0] and poor patient compliance (OR=17.1, 95% CIs=1.6-189.1) were independent risk factors for eradication failure. Conclusion In eradication-naive patients, eradication success rates for 7-day first-line triple therapy regimen exceeded 82% with bismuth administration. In clarithromycin-resistant patients, neither tegoprazan 50 mg nor lansoprazole 30 mg achieved acceptable eradication rates when administered twice daily for 7 days.

A patient diagnosed with Guillain-Barre syndrome (GBS) suffering from numbness in the toes and fingers, paralysis in the face, and back pain received intravenous immunoglobulin on December 28, 2019. Without an improvement in symptoms the patient was admitted to a Korean medicine hospital on January 1, 2020 to receive combined Korean medicine treatment including herbal medicine (Sipjeondaebo-tanggami and Hyangbujasunkipalmul-tang), acupuncture treatment, moxibustion, cupping treatment, and physical therapy. Treatment was administered over 51 days, of which 17 days were during hospitalization. Paralysis of facial muscle, and numbness in fingers and toes were evaluated using the Yanagihara score and numeric rating scale (NRS) score, respectively. Facial paralysis improved (21 to 40 based on Yanagihara score) and paresthesia of the hands and feet disappeared (NRS score 6-7 to NRS score 0). There were no side effects or sequela. This study suggested combined Korean medicine treatment may be effective for the treatment of GBS.

Background: This study was designed to statistically analyze the year, gender, age, insurance type, and condition/disease of patients who were admitted to the Department of Acupuncture and Moxibustion Medicine at DaeJeon Korean Medicine Hospital over a 5-year period (2015-2020).Methods: Patients who visited the Department of Acupuncture and Moxibustion Medicine at DaeJeon Korean Medicine Hospital were classified according to year, gender, age, insurance type, and condition/disease. The statistical analysis was performed using IBM SPSS 23.0.Results: There is an increasing number of patients attending the Department of Acupuncture and Moxibustion Medicine year-on-year over the 5-year period, with a higher frequency of females than males each year. The largest age groups represented in these patients were those aged in their 50s, followed by those aged in their 40s, and 60s. Furthermore, the number of patients using health insurance was greater than those using automobile insurance each year. Of the 5,061 patients, the most common group was the patients (n = 991) who reported sprain and strain of cervical spine, followed by lumbar spine, lumbar herniation of the intervertebral disc, and facial paralysis.Conclusion: The number of patients seeking traditional Korean medicine treatment continues to increase, particularly in the 40s to 60s age group, with a larger proportion using health insurance and sprain or strain of the cervical spine. The results of this study may be used as a local (Daejeon) reference to develop Korean medicine policies, such as setting up medical benefits for patients using Korean medicine hospitals.

Exposure to particulate matter (PM) has been known to develop asthma in children and the oxidative stress-related mechanisms are suggested. For the development of asthma, not only the exposure dose but also the critical window and the risk modifying factors should be evaluated.We investigated whether prenatal exposure to PM10 increases the risk of childhood asthma and evaluated the modifying factors, such as gender and reactive oxidative stress-related gene.A general population-based birth cohort, the Panel Study of Korean Children (PSKC), including 1572 mother-baby dyads was analyzed. Children were defined to have asthma at age 7 when a parent reported physician-diagnosed asthma. Exposure to PM10 during pregnancy was estimated by land-use regression models based on national monitoring system. TaqMan method was used for genotyping nuclear factor, erythroid 2-related factor, NRF2 (rs6726395). A logistic Bayesian distributed lag interaction model (BDLIM) was used to evaluate the associations between prenatal PM10 exposure and childhood asthma by gender and NRF2.Exposure to PM10 during pregnancy was associated with the development of asthma (aOR 1.03, 95% CI 1.001.06). Stratifying by gender and NRF2 genotype, exposure to PM10 during 26-28 weeks gestation increased the risk of childhood asthma, especially in boys with NRF2 GG genotype.A critical window for PM10 exposure on the development of childhood asthma was during 26-28 weeks of gestation, and this was modified by gender and NRF2 genotype.

Background: This study aims to statistically analyze and compare the curative effect and satisfaction level between typical traditional Korean medicine treatment and nonsurgical spinal decompression treatment.Methods: Of the patients who were diagnosed with the cervical or lumbar herniated intervertebral disc at the Department of Acupuncture and Moxibustion Medicine at the Daejeon Korean Medicine Hospital from April 14th to August 25th, 2019, this study retrospectively analyzed the medical records of 31 patients who underwent nonsurgical spinal decompression treatment and traditional Korean medicine (assigned to Group A) and another 31 patients who received typical traditional Korean medicine alone (assigned to Group B). The clinical data were analyzed using IBM SPSS Version 23.0.Results: No statistically significant differences appeared in terms of sociodemographic, condition, and therapeutic characteristics, except whether the patient received Western medicine treatment, before or after a treatment with traditional Korean medicine. Group A exhibited higher variations in numeric rating scale, EuroQol- 5 dimension and EuroQol visual analogue scale scores compared to Group B as determined by independent sample t test and analysis of covariance. In addition, the satisfaction score of Group A was higher than that of Group B The result of cross analysis revealed that desire for continued treatment in Group A was higher than that of Group B.Conclusion: This retrospective observational study showed that the patients with nonsurgical spinal decompression treatment reported a greater reduction in pain, improved quality of life and satisfaction than patients receiving typical traditional Korean medicine.

This case report describes a 60-year-old female patient diagnosed with intercostal neuropathy and vertebral compression fractures which occurred following an electric shock injury. The patient received acupuncture, pharmacopuncture, and herbal medicine administration between February 10th, 2020 and April 25th, 2020. The pain level in the thoracic and left intercostal areas was assessed using the Numerical Rating Scale. The Self-report of the Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale were used to diagnose neuropathic pain. The Neuropathic-Pain -Scale was used to evaluate the degree of neuropathic symptoms. The Oswestry Disability Index and the European Quality of Life-5 Dimensions were used to assess quality of life scales and functional disorder. Following combined Korean medicine treatment, the patient exhibited reduced levels of pain and significant improvement in functional disorder symptoms and quality of life.

Background: It is challenging to diagnose asthma in preschool children. The asthma predictive index (API) has been used to predict asthma and decide whether to initiate treatment in preschool children.Purpose: This study aimed to investigate the association between questionnaire-based current asthma with API, pulmonary function, airway hyperreactivity (AHR), fractional expiratory nitric oxide (FeNO), and atopic sensitization in preschool children.Methods: We performed a population-based cross-sectional study in 916 preschool children aged 4–6 years. We defined current asthma as the presence of both physician-diagnosed asthma and at least one wheezing episode within the previous 12 months using a modified International Study of Asthma and Allergies in Childhood questionnaire. Clinical and laboratory parameters were compared between groups according to the presence of current asthma.Results: The prevalence of current asthma was 3.9% in the study population. Children with current asthma showed a higher rate of positive bronchodilator response and loose and stringent API scores than children without current asthma. The stringent API was associated with current asthma with 72.2% sensitivity and 82.0% specificity. The diagnostic accuracy of the stringent API for current asthma was 0.771. However, no intergroup differences in spirometry results, methacholine provocation test results, FeNO level, or atopic sensitization rate were observed.Conclusion: The questionnaire-based diagnosis of current asthma is associated with API, but not with spirometry, AHR, FeNO, or atopic sensitization in preschool children.

This paper introduces a new fog-assisted cloud storage which can achieve much higher throughput compared to the traditional cloud-only storage architecture by reducing the traffics toward the cloud storage. The fog-storage service providers are transparency to end-users and therefore, no modification on the end-user devices is necessary. This new system is featured with (1) a stronger audit scheme which is naturally coupled with the proposed architecture and does not suffer from the replay attack and (2) a transparent and efficient compensation mechanism for the fog-storage service providers. We provide rigorous theoretical analysis on the correctness and soundness of the proposed system. To the best of our knowledge, this is the first paper to discuss about a storage data audit scheme for fog-assisted cloud storage as well as the compensation mechanism for the service providers of the fog-storage service providers.

Sex (i.e., female sex) confers one point for the CHA2DS2-VASc score. For this reason, females with atrial fibrillation (AF) always have a CHA2DS2-VASc score of at least 1. To compare the CHA2DS2-VA (excluding female sex) and CHA2DS2-VASc scores in Korean AF patients using the Korean National Health Insurance Service database, we analyzed the risk of ischemic stroke in nonvalvular AF patients between 2013 and 2017. The predictive values of the CHA2DS2-VA and CHA2DS2-VASc scores for ischemic stroke were evaluated using the C-statistic and net reclassification improvement (NRI). The primary outcome was the occurrence of ischemic stroke. A total of 185,637 patients with AF (49.7% women) were included in this study. The mean ages were 66.5 years for females and 64.9 years for males. The incidence of ischemic stroke in male patients was similar to females (3.63%/year vs. 3.72%/year, p = 0.273, respectively). In addition, no sex difference was apparent for stroke risk in AF patients stratified by risk factor component and age group. In the C-statistic analysis, the predictive ability of the CHA2DS2-VA score for ischemic stroke was similar to the CHA2DS2-VASc score. Additionally, CHA2DS2-VA performed better for predicting ischemic stroke in AF patients with risk scores of ≥2 (AUC 0.701 vs. 0.689, z = 4.596, p < 0.001) or those aged ≥75 years (AUC 0.715 vs. 0.701, z = 4.957, p < 0.001). In Korean AF patients, female sex is not a specific risk factor that contributes to the development of ischemic stroke. The CHA2DS2-VA score, which excludes female sex, may be a more suitable risk score for guiding anticoagulation decisions in Korean AF patients.

Inflammatory responses involve the action of inflammatory mediators that are necessary for the clearance of invading bacterial pathogens. However, excessive production of inflammatory mediators can damage tissues, thereby impairing bacterial clearance. Here, we examined the effects of Weigela florida on the expression of inflammatory cytokines induced by Pseudomonas aeruginosa or Staphylococcus aureus infection in macrophages. The results showed that pre-treatment with W. florida markedly downregulated the bacterial infection-mediated expression of cytokines. Additionally, post-treatment also triggered anti-inflammatory effects in cells infected with S. aureus to a greater extent than in those infected with P. aeruginosa. Bacterial infection activated inflammation-associated AKT (Thr308 and Ser473)/NF-κB and MAPK (p38, JNK, and ERK) signaling pathways, whereas W. florida treatment typically inhibited the phosphorylation of AKT/NF-κB and p38/JNK, supporting the anti-inflammatory effects of W. florida. The present results suggest that W. florida decreases the infection-mediated expression of inflammatory mediators by inhibiting the AKT/NF-κB and MAPK signaling pathways, implying that it may have potential use as an inhibitory agent of excessive inflammatory responses.

Background Respiratory infection in children is a major disease that ranks high in outpatient and inpatient cases. In particular, the causes of community acquired pneumonia (CAP) vary depending on the individual susceptibility, epidemiological characteristics of the community, and season, and it is difficult to obtain samples for microbiological diagnosis. This study analysis that laboratory surveillance network of pathogen for pediatric CAP by linking the national community-based hospital and clinics and the Centers for Disease Control and Prevention (KCDC) to identify the distribution trend and prevalence of causative pathogens and to prevent antibiotic resistance of bacterial pathogens. Method The monitoring network was composed of the 28 secondary and tertiary medical institutions based on the national community, and the 24-month prospective study operated a community monitoring network for CAP in children. Results A total of 1023 cases were registered for nasopharyngeal aspirate or sputum in patients with CAP, and 711 cases (69.5%) were isolated by culture, S. aureus 131 cases (12.8%), S. pneumonia 92 cases (9%), H. influenzae 20 cases (2%). PCR of atypical pneumonia revealed 422 cases of M. pneumoniae (41.3%), 5 cases of C. pneumonia (0.5%), and 5 case (0.5%) of B. pertussis. Respiratory virus multiplex PCR test showed positive rates in 65.7%, human rhinovirus 312 (30.5%), RSV(A+B) 212 (20.7%), Adenovirus 123 (12%), Influenza (A+B) 53 (7.8%), CoV (OC43+NL63+229E) 69 (6.7%), HMPV 81 (7.9%), HBoV 51 (5%), PIV (1+2+3+4) 65 (6.4%) and HEV 30 (2.9%) Conclusion It will identify the pathogens that cause respiratory infections, and analyze the current status of antibiotic resistance to provide scientific evidence for management policies of domestic respiratory infection. Also, in preparation for the new epidemic, including COVID19, monitoring of respiratory infections in children and adolescents, especially community pneumonia, has become more important, and research should be continuously conducted in the future. The location and extent of involvement in the medulla were the most important factors associated with the severity of dysphagia after LMI.

Background: The purpose of this study was to analyze the medical dispute cases in Acupuncture and Moxibustion treatment, and present the guidelines of treatment to prevent medical disputes. Methods: Korean Acupuncture and Moxibustion Medicine Society medical dispute cases from January 2013 to September 2018 were collected and analyzed. Results: There were 80 cases, which included acupuncture treatment (54 cases), cupping treatment (7 cases), local infection / inflammation (17 cases), and neurological symptoms (13 cases). Analysis of the correlation between types of medical accidents and the treatment methods, showed that local infection and inflammation (12 cases) were the most reported in acupuncture treatment. Conclusion: This study was performed to analyze the current status of medical disputes in the field of acupuncture and moxibustion, and provide basic data for guidelines to prevent them. Further study preparing for clinical guidelines to prevent medical disputes in specific departments are warranted in the future. ©2019 Korean Acupuncture & Moxibustion Medicine Society. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

This case report relates to a 40-year old male patient diagnosed with ankylosing spondylitis who was treated with acupotomy and traditional Korean medicine. He showed a significant improvement in joint range of motion (ROM) in cervical and lumbar vertebrae, and in pain and functional disorder symptoms. The patient received acupotomy, acupuncture, pharmacopuncture, herbal medicine and physical therapy (November 26, 2018 to December 17, 2018). Joint ROM for cervical and lumbar vertebrae was measured, and the pain level was assessed using a numerical rating scale. The functional disorder and quality of life scales were also assessed using the Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index, Korean Health Assessment Questionnaire, and Modified Health Assessment Questionnaire. After applying acupotomy and traditional Korean medicine, the patient exhibited increased joint ROM and reduced pain, also in conjunction with improved responses in functional disorder and quality of life. ©2019 Korean Acupuncture & Moxibustion Medicine Society. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

The aim of this study was to report on the resorption of herniated nucleus pulposus following acupotomy treatment. Two patients were treated with acupotomy which included integrative Korean Medicine treatment, for either cervical, or lumbar herniated nucleus pulposus. Magnetic Resonance Imaging was used to produce images before and after (several months) treatment. The Numerical Rating Scale scores and Range of Motion were used to assess the patients at admission and discharge. In both cases, substantial resorption of the respective herniated disc was observed in the magnetic resonance images, with a decrease in the Numerical Rating Scale score. Range of Motion improved in 1 case. This study shows that acupotomy treatment may be a clinically effective treatment for herniated nucleus pulposus resorption and pain relief.

The effects of prenatal particulate matter with an aerodynamic diameter ranging from 0.1 μm to 2.5 μm (PMTo determine the critical windows of prenatal PMMother-child pairs were enrolled from the birth cohort of the Cohort for Childhood Origin of Asthma and allergic diseases (COCOA) study. PMPMHigher PM

AIM: Although the incidence of urinary tract infection (UTI) in children with lower respiratory tract infection (LRTI) has been reported as 3.1-10.0%, the exact concomitant prevalence is questionable. Here, we evaluated the prevalence and related risk factors of UTI associated with LRTI in children under 36 months of age. METHODS: We retrospectively reviewed the medical charts of 1574 patients under 36 months of age who were hospitalised with LRTI from January 2017 to December 2019 in a single centre, Seoul, South Korea. Among them, we analysed 278 patients who showed fever and performed urine evaluation. Urine was collected by catheterisation in children under 24 months of age and by voided urine between 24 and 36 months of age. RESULTS: The prevalence of concomitant UTI and LRTI was 13.6% in children under 24 months of age. Mean age was significantly younger in the UTI versus non-UTI group (6.93 ± 7.26 months vs. 12.61 ± 11.70 months; P < 0.001). When the participants were stratified by age, the prevalence of UTI was significantly higher in children younger than 24 months of age compared to older ones (P = 0.006). UTIs were more prevalent in boys than in girls (14.6% vs. 5.8%, P = 0.018). Peak body temperature, fever duration, premature birth and detected respiratory virus type did not differ between groups. CONCLUSIONS: It is not uncommon for children with LRTI with fever to be accompanied by UTI. When evaluating for UTI in children with febrile LRTI, age and sex must be considered.

Quite a few patients with chronic spontaneous urticaria (CSU) are refractory to H₁-antihistamines, even though the dose of H₁-antihistamines is increased up to 4-fold. CSU that is not controlled with H₁-antihistamines results in increased disease burden. Several immunomodulators have been used to manage these patients. The guidelines reported herein are connected to Part 1 of the KAAACI/KDA Evidence-Based Practice Guidelines for Chronic Spontaneous Urticaria in Korean Adults and Children, and aimed to provide evidence-based recommendations for the management of H₁-antihistamine-refractory CSU. Part 2 focuses on the more commonly used additional treatment options for refractory CSU, including omalizumab, cyclosporine, leukotriene receptor antagonist, dapsone, methotrexate, and phototherapy. The evidence to support their efficacy, dosing, safety, and selection of these agents is systematically reviewed. To date, for patients with refractory CSU, the methodologically sound data to evaluate the use of omalizumab has been growing; however, the evidence of other immunomodulators and phototherapy is still insufficient. Therefore, an individualized stepwise approach with a goal of achieving complete symptom control and minimizing side effects can be recommended. Larger controlled studies are needed to elevate the level of evidence to select a rational therapeutic agent for patients with refractory CSU.

Mycoplasma pneumoniae is a major causative pathogen of community-acquired pneumonia in children, and the treatment of choice is macrolides. There is an increasing trend in reports of refractory clinical responses despite macrolide treatment due to the emergence of macrolide-resistant M. pneumoniae. Early discrimination of macrolide-refractory M. pneumoniae pneumonia (MrMP) from macrolide-sensitive M. pneumoniae pneumonia (MSMP) is vital; however, testing for macrolide susceptibility at the time of admission is not feasible. This study aimed to identify the characteristics of MrMP in Korean children, in comparison with those of MSMP. In this multicenter study, board-certified pediatric pulmonologists at 22 tertiary hospitals reviewed the medical records from 2010 to 2015 of 5294 children who were hospitalized with M. pneumoniae pneumonia and administered macrolides as the initial treatment. One-way analysis of variance and the Kruskal-Wallis test were used to compare differences between groups. Of 5294 patients (mean age, 5.6 years) included in this analysis, 240 (4.5%), 925 (17.5%), and 4129 (78.0%) had MrMP, macrolide-less effective M. pneumoniae pneumonia, and MSMP, respectively. Compared with the MSMP group, the MrMP group had a longer fever duration, overall (13.0 days) and after macrolide use (8.0 days). A higher proportion of MrMP patients had respiratory distress, pleural effusion, and lobar pneumonia. The mean aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and C-reactive protein levels were the highest in the MrMP group, along with higher incidences of extrapulmonary manifestations and atelectasis (during and post infection). Pre-existing conditions were present in 17.4% (n = 725/4159) of patients, with asthma being the most common (n = 334/4811, 6.9%). This study verified that MrMP patients show more severe initial radiographic findings and clinical courses than MSMP patients. MrMP should be promptly managed by agents other than macrolides.

Background The most relevant time of PM10 exposure to affect airway hyperresponsiveness (AHR) and new development of asthma in school-aged children is unclear. The aims of this study were to investigate the most critical time of PM10 exposure to affect AHR and new diagnosis of asthma from AHR in school-aged children. Methods Elementary schoolchildren (n = 3570) have been enrolled in a nationwide prospective 4-year follow-up survey in Korea from 2005 to 2006. Individual annual PM10 exposure was estimated by using an ordinary kriging method from the prenatal period to 7 years of age. AHR at 7 years was defined by a methacholine PC20 ≤8 mg/mL. Results PM10 exposure during pregnancy and at 1 year of age showed significant effects on AHR (aOR: 1.694, 95% CI: 1.298-2.209; and aOR: 1.750, 95% CI: 1.343-2.282, respectively). PM10 exposure during pregnancy was associated with the risk of a new diagnosis of asthma (aOR: 2.056, 95% CI: 1.240-3.409), with the highest risk in children with AHR at age 7 (aOR: 6.080, 95% CI: 2.150-17.195). PM10 exposure in the second trimester was associated with the highest risk of a new diagnosis of asthma in children with AHR at age 7 (aOR: 4.136, 95% CI: 1.657-10.326). Conclusions Prenatal PM10 exposure in the second trimester is associated with an increased risk of a new diagnosis of asthma in school-aged children with AHR at 7 years. This study suggests that PM10 exposure during a specific trimester in utero may affect the onset of childhood asthma via AHR.

The aim of this report is to describe improved symptom changes in eye movement disorders and dizziness of a patient with Miller Fisher syndrome after receiving combined Korean medicine treatment (CKMT). A 24-year-old male was diagnosed with MFS accompanied by eye movement disorder, diplopia, and dizziness. For 6 weeks, the patient received acupuncture, electro-acupuncture, pharmacopuncture, herbal medicine, and physical therapy treatment. Visual analogue scale were checked and other outcomes (the range of eye movement, the distance that diplopia appears, diplopia questionnaire) were measured. Following CKMT, the movement of both eyes improved in both the horizontal and vertical direction. Also for diplopia and dizziness, there was a decrease in the visual analogue scale and the distance that diplopia appeared. The present case report suggests that CKMT may have a role in treating eye movement disorders and dizziness in patient diagnosed with MFS.

Prenatal particulate matter

Bronchial hyperresponsiveness (BHR) is a fundamental pathophysiological characteristic of asthma. Although several factors such as airway caliber can affect BHR, no study has established age-dependent cutoff values of BHR to methacholine for the diagnosis of asthma in children. We investigated the cutoff values of the methacholine challenge test (MCT) in the diagnosis of asthma according to age. A total of 2383 individuals aged from 6 to 15 years old were included in this study. MCTs using the five-breath technique were performed in 350 children with suspected asthma based on symptoms by pediatric allergists and in 2033 healthy children from a general population-based cohort. We determined the provocative concentration of methacholine producing a 20% decrease in forced expiratory volume in 1 second from baseline (PC20). A modified Korean version of the International Study of Asthma and Allergies in Childhood questionnaire was used to distinguish asthmatics and healthy subjects. Receiver-operator characteristic curve analysis was used to assess the cutoff value of PC20 for the diagnosis of asthma. Cutoff values of methacholine PC20, which provided the best combination of diagnostic sensitivity and specificity, showed an increasing pattern with age: 5.8, 9.1, 11.8, 12.6, 14.9, 21.7, 23.3, 21.1, 21.1, and 24.6 mg/mL at ages 6, 7, 8, 9, 10, 11, 12, 13, 14, and 15 years, respectively. The application of different cutoff values of methacholine PC20 depending on age might be a practical modification for the diagnosis of asthma in children and adolescents with asthmatic symptoms.

Background: Community–acquired pneumonia (CAP) is one of the leading worldwide causes of childhood morbidity and mortality and its disease burden is affected by age and etiologies with time-dependent changes. We aimed to investigate the annual and seasonal patterns in etiologies of pediatric CAP requiring hospitalization. Methods: We conducted a retrospective study in 30,994 children (0-18 years old) with CAP between 2010 and 2015 at 23 nationwide hospitals in Korea. Mycoplasma pneumoniae (MP) pneumonia was clinically classified into macrolide-sensitive MP, macrolide-less effective MP (MLEP) and macrolide-refractory MP (MRMP) based on fever duration after initiation of macrolide treatment, regardless of the results of in vitro macrolide sensitivity tests. Results: MP and respiratory syncytial virus (RSV) were the two most commonly identified pathogens of CAP. With the two epidemics of MP pneumonia (2011 and 2015), the rates of clinical MLEP and MRMP pneumonia showed increasing trends of 36.36% of the total MP pneumonia. In children less than 2 years of age, RSV (34.01%) was the most common cause of CAP, followed by MP (9.44%), whereas MP was the most common cause of CAP in children 2-18 years of age. Systemic corticosteroid was most commonly administered in MP pneumonia. The rate of hospitalization in intensive care unit was highest for RSV pneumonia, and ventilator care was most commonly needed in cases of adenovirus pneumonia. Conclusions: The present study provides fundamental data for establishment of public health policies to decrease disease burden due to CAP as well as for improvement of pediatric health.

Purpose The roles of gut microbiota on the natural course of atopic dermatitis (AD) are not yet fully understood. We investigated whether the composition and function of gut microbiota and short-chain fatty acids (SCFAs) at 6 months of age could affect the natural course of AD up to 24 months in early childhood. Methods Fecal samples from 132 infants were analyzed using pyrosequencing, including 84 healthy controls, 22 transient AD and 26 persistent AD subjects from the Cohort for Childhood Origin of Asthma and Allergic Diseases (COCOA) birth cohort. The functional profile of the gut microbiome was analyzed by whole-metagenome sequencing. SCFAs were measured using gas chromatography-mass spectrometry. Results Low levels of Streptococcus and high amounts of Akkermansia were evident in transient AD cases, and low Clostridium, Akkermansia and high Streptococcus were found in children with persistent AD. The relative abundance of Streptococcus positively correlated with scoring of AD (SCORAD) score, whereas that of Clostridium negatively correlated with SCORAD score. The persistent AD group showed decreased gut microbial functional genes related to oxidative phosphorylation compared with healthy controls. Butyrate and valerate levels were lower in transient AD infants compared with healthy and persistent AD infants. Conclusions Compositions, functions and metabolites of the early gut microbiome are related to natural courses of AD in infants.

Objectives To investigate the association between particulate matter with an aerodynamic diameter of less than 2.5 μm (PM2.5 ) exposure during each trimester of pregnancy and development of lower respiratory tract infections (LRTIs) during the first 3 years of life and whether GSTM1 gene polymorphisms modify these effects. Methods This study included 1,180 mother-child pairs from the Cohort for Childhood Origin of Asthma and allergic diseases. The PM2.5 levels during pregnancy were estimated by residential address using land-use regression models based on a national monitoring system. A diagnosis of LRTIs was based on a parental report of a physician's diagnosis. Real-time polymerase chain reaction was used for GSTM1 genotyping. Results Higher PM2.5 exposure during the third trimester was associated with LRTIs at 1 year of age (aRR, 1.06; 95% CI, 1.00-1.13). This result did not change after adjusting for PM2.5 exposures during the first and second trimesters (aRR, 1.06; 95% CI, 0.99-1.13). This association was significant after adjusting for PM2.5 exposures during first year of age (aRR, 1.08; 95% CI, 1.02-1.15) and exposures to NO2 and ozone at the third trimester (aRR, 1.07; 95% CI, 1.00-1.16). In addition, PM2.5 exposure during the third trimester increased the risk of LRTIs at 1 year of age in cases with the GSTM1 null genotype (aRR, 1.26; 95% CI, 1.01-1.57; P for interaction .20). Conclusion Higher PM2.5 exposure during the third trimester of pregnancy may increase the susceptibility to LRTIs at 1 year of age. This effect is modified by GSTM1 gene polymorphisms.