OBJECTIVE: To examine the first-trimester maternal serum placental growth factor (PlGF) and pregnancy-associated plasma protein A (PAPP-A) levels in pregnancies associated with pre-eclampsia (PE) or small-for-gestational-age (SGA) infants, and determine the predictive accuracy of PlGF and of PAPP-A for either PE or SGA infants. METHODS: This prospective, observational study included 175 pregnant women, and of these women, due to participant withdrawal or loss to follow-up, delivery data were collected from the medical records of 155 women, including 4 who had twin pregnancies. The women's maternal history was recorded, and the PlGF and PAPP-A levels at 11 to 13 gestational weeks were measured. During the second trimester, the maternal uterine artery's systolic/diastolic ratio was measured. Multiples of the median (MoM) of PlGF and PAPP-A were determined, and the associations of these values with the risk factors of SGA and PE were evaluated. Logistic regression analysis was used to determine whether PlGF and PAPP-A are useful markers for predicting SGA infants. RESULTS: The PAPP-A MoM level was significantly lower in women with advanced maternal age, multipara women, and women with gestational diabetes than in their counterparts. The PlGF and PAPP-A MoM levels were higher in women with a twin pregnancy than in those with a singleton pregnancy. There was a significant relationship between the maternal serum PAPP-A MoM level in the first trimester and the uterine artery systolic/diastolic ratio in the second trimester. Results of logistic regression analysis showed that low PlGF and PAPP-A MoM levels were predictors of SGA infants (odds ratio, 0.143; 95% confidence interval, 0.025 to 0.806; odds ratio, 0.191; 95% confidence interval, 0.051 to 0.718, respectively). CONCLUSION: PlGF and PAPP-A are potentially useful as first-trimester markers for SGA infants and some hypertensive disorders of pregnancy.
Diabetes, Gestational ; Female ; Follow-Up Studies ; Humans ; Infant* ; Logistic Models ; Maternal Age ; Medical Records ; Observational Study* ; Odds Ratio ; Plasma* ; Pre-Eclampsia* ; Pregnancy ; Pregnancy Trimester, First* ; Pregnancy Trimester, Second ; Pregnancy, Twin ; Pregnancy-Associated Plasma Protein-A ; Pregnant Women ; Prospective Studies* ; Risk Factors ; Staphylococcal Protein A* ; Uterine Artery

Background: A national immunization program (NIP) to prevent disease and reduce mortality from vaccine preventable diseases (VPD) is very important. Methods: We analyzed only the anaphylaxis cases that occurred between 2001 and 2016 that Korea Centers for Disease Control and Prevention (KCDC) determined had a definite causal relationship with a vaccine. The clinical symptoms were assessed according to the Brighton Collaboration case definition (BCCD) level. Results: During the period, there were 13 cases of vaccine-related anaphylaxis. The median age was 9 years (range, 1 month to 59 years). The incidence of anaphylaxis per million doses was 0.090 in 2005, 0.079 in 2012, 0.071 in 2013, 0.188 in 2015, and 0.036 in 2016. Of those cases, 23.1% were influenza vaccines, and 76.9% were BCCD level 2. Epinephrine was used in 46.2%. Conclusion Vaccine-related anaphylaxis seems to have been very rare in the past, but health care professionals must always be aware of anaphylaxis.

BACKGROUND: Testing for possible microorganism contamination in umbilical cord blood (UCB) is essential for validating the product safety of allogeneic cellular therapeutics. We analyzed the level of contamination and related factors at the largest public cord blood bank in Korea. In addition, we also studied the influence of cryopreservation on contaminating microorganisms. METHODS: UCB was collected, transported, processed, and stored according to standard operating procedures. Microbial detection and identification was performed using a conventional automated blood culture system (BacT/ALERT; bioMerieux, France) with an inoculum of 5-10 mL plasma for pre-freezing UCB. Forty randomly selected non-conforming units were thawed and studied for microbiologic recovery with an inoculum of 2.5 mL. RESULTS: Among a total of 21,236 UCB, 677 (3.19%) were positive for culture. The most frequently identified organism was Lactobacillus spp. (17.2%), followed Bacteroides spp. (10.1%), coagulase negative staphylococcus (6.4%), except the unidentified gram-positive bacillus (21.4%). The contamination rate was higher in vaginal delivery specimens than in cesarean section specimens (4.1% vs. 0.7%, P<0.001), and differed by collection center (0.7-25.4%, P<0.001). Only 55% after-thaw cultures of non-conforming units were positive. CONCLUSION: We determined the contamination rate of UCB in Korea in a large sample size. The results of this study could be used as baseline data at collection centers for quality control purposes. The low recovery rate of microorganisms after cryopreservation presents a possible way to rescue some non-conforming cord blood units, although further study is needed to confirm the reduction of microbiological burden.
Bacillus ; Bacteria ; Bacteroides ; Biological Specimen Banks ; Cesarean Section ; Coagulase ; Cryopreservation ; Female ; Fetal Blood ; Korea ; Lactobacillus ; Plasma ; Pregnancy ; Quality Control ; Sample Size ; Staphylococcus ; Umbilical Cord

The purpose of this study was to investigate factors related to bone mineral contents (BMC) at os calcis of adolescents. The subjects were 604 students (327 boys and 277 girls) between 7th and 9th grade in Seoul, Korea. The mean age was 14.2 +/- 0.9 years. General characteristics were collected by a questionnaire, bone mineral contents (BMC) were measured in os calcis by Duel Energy X-ray Absorptiometry (PIXI, General Electronics, USA) and height and weight were measured by bioelectrical impedance analysis method (Inbody 4.0, Biospace Co. Ltd, Seoul, Korea). Mean BMC of os calsis were 2.241 g. Height (p < .0001), weight (p < .0001), BMC (p < .0001) of boys were higher than those of girls. Percent body fat of girls, however, was higher than that of boys (p < .0001). Anthropometric measurement, pocket money, sibling, experience of fracture, pubertal stage, intake of supplements, physical or outdoors activity, and eating habit had significant influence on BMC of boys. Anthropometric measurement, physical or outdoors activity, and eating habit had significant influence on BMC of girls. Multivariate regression with adjustment for sex and age showed that BMC was associated positively with height, BMI, frequency of regular activity, and intake of spinach or radish leaves (all p < 0.05), and negatively with percent body fat (p < .0001) and Korean traditional diet pattern (p = 0.01). On the basis of these results, it is recommended to develop nutrition education and physical activity program for adolescents to improve BMC and prevent osteoporosis.
Absorptiometry, Photon ; Adipose Tissue ; Adolescent ; Bone Density ; Diet ; Eating ; Electric Impedance ; Electronics ; Electrons ; Humans ; Korea ; Motor Activity ; Osteoporosis ; Surveys and Questionnaires ; Raphanus ; Siblings ; Spinacia oleracea

BACKGROUND AND OBJECTIVES: This study was designed to compare sinonasal distribution of topical nasal drops and spray according to head positions and to suggest optimal head position for effective topical delivery. SUBJECTS AND METHODS: The study group included five healthy subjects (normal group) and five patients who had got endoscopic sinus surgery (ESS group). A visual assessment of the intranasal distribution of nasal drops and spray was made using Fluorescein Blue Filter System after instillation of TobraDex(R) drops and Nasonex(R) dyed with 0.2% fluorescein. Each group took five kinds of head position for nasal drops and two for nasal spray. RESULTS: Drops instilled with head back position were found along the nasal floor, and drops with Mecca position and vertex to ground position were found in the olfactory cleft in both groups. Drops instilled in Mygind position and Ragan position were found in the middle meatus and head of the middle turbinate in the normal group, and in the middle meatus, ethmoidectomized cavity, and maxillary sinus in the ESS group. The head neutral position showed effective distribution to the septum, lateral nasal wall, and middle turbinate in the normal group, and in the ethmoidectomized cavity in the ESS group, compared to the head forward position which distributed the drops lower depending portion. CONCLUSION: These results suggest that, for the effective delivery of nasal drops, Mecca position and vertex to ground position are recommended to the olfactory cleft, and Mygind position and Ragan position are proposed to the middle meatal region in non-surgery patients and ethmoidectomized cavity and maxillary sinus in post-ESS patients. Head neutral position is recommendable for effective delivery of nasal spray compared to head forward position regardless of ESS.
Fluorescein ; Head* ; Humans ; Maxillary Sinus ; Turbinates

Purpose: The report of adverse events following immunization (AEFI) in Korea has continued since 1994, and the most frequently reported cases of AEFI of Korea Centers for Disease Control and Prevention (KCDC) is bacille Calmette-Guérin (BCG). Meanwhile, various inoculation methods and strains have been used in the past 6 years in Korea. Therefore, we investigated AEFI of BCG by strain types and inoculation methods using immunization safety surveillance of KCDC. Materials and Methods: We reviewed BCG AEFIs registered in the KCDC from January 2013 to June 2018. Results: There were 336 AEFI cases during the period, and average time interval from vaccination to symptom onset was within 2 months. AEFI proportion was 6.4 cases per 100,000 doses for BCG percutaneous Tokyo strain, 41.6 cases per 100,000 doses of BCG intradermal Danish strain, and 25.9 cases per 100,000 doses of BCG intradermal Tokyo strain. Intradermal type was more reported AEFI than percutaneous type in the same strain. The most common adverse events were local reaction like BCG lymphadenitis and severe adverse reactions such as osteomyelitis or disseminated BCG disease were 0.1 to 0.2 cases per 100,000 doses which are correlated with the range of World Health Organization published AEFI rates. Conclusion The AEFI reporting rate does not equal the actual proportion of AEFI occurrence. Because AEFI monitoring is a passive surveillance system, various factors might influence the number of events reported. Nevertheless, it is important to analyze BCG AEFI by vaccine strains and inoculation method using surveillance data of KCDC.

Purpose: The report of adverse events following immunization (AEFI) in Korea has continued since 1994, and the most frequently reported cases of AEFI of Korea Centers for Disease Control and Prevention (KCDC) is bacille Calmette-Guérin (BCG). Meanwhile, various inoculation methods and strains have been used in the past 6 years in Korea. Therefore, we investigated AEFI of BCG by strain types and inoculation methods using immunization safety surveillance of KCDC. Materials and Methods: We reviewed BCG AEFIs registered in the KCDC from January 2013 to June 2018. Results: There were 336 AEFI cases during the period, and average time interval from vaccination to symptom onset was within 2 months. AEFI proportion was 6.4 cases per 100,000 doses for BCG percutaneous Tokyo strain, 41.6 cases per 100,000 doses of BCG intradermal Danish strain, and 25.9 cases per 100,000 doses of BCG intradermal Tokyo strain. Intradermal type was more reported AEFI than percutaneous type in the same strain. The most common adverse events were local reaction like BCG lymphadenitis and severe adverse reactions such as osteomyelitis or disseminated BCG disease were 0.1 to 0.2 cases per 100,000 doses which are correlated with the range of World Health Organization published AEFI rates. Conclusion The AEFI reporting rate does not equal the actual proportion of AEFI occurrence. Because AEFI monitoring is a passive surveillance system, various factors might influence the number of events reported. Nevertheless, it is important to analyze BCG AEFI by vaccine strains and inoculation method using surveillance data of KCDC.

Lymphomatoid granulomatosis (LYG) is an Epstein-Barr virus (EBV)-associated lymphoproliferative disease. It is considered a rare entity in pediatric patients. An adolescent male with lobar consolidation suspected of having pneumonia was resistant to antibiotics and had persistently abnormal radiographs with chest pain. The patient was diagnosed with pulmonary LYG through video-assisted thoracoscopic surgery (VATS) lung biopsy. He received eight cycles of rituximab, vincristine, cyclophosphamide, and prednisolone (R-CVP) but had progressive disease. As the patient developed hypogammaglobulinemia after eight courses of rituximab, he received intravenous gamma globulin (IVIG) at regular interval. With immune augmentation effect of IVIG and immune modulation treatment with prednisolone, the patient has shown no aggravation of the lung lesions. Considering its rarity, high mortality, and frequent relapses, diagnostic methods investigating the radiologic abnormalities can help in early treatment initiation.

A hemodialysis room is the healthcare facility utmost demanding an infection control because dialysis patients have chronic serious underlying conditions and high risks of bloodborne infection due to a indwelling intravascular catheter, a frequent exposure to bloods or body fluids, and a blood transfusion as well as a hemodialysis room can be a mixing vessel to encounter both hospital-acquired pathogens and community-acquird pathogens. Therefore the Korean Society for Nosocomial Infection Control (KOSNIC) purposed to develop a guideline for the infection control in a hemodialysis room with support of Korean Center for Disease Control (KCDC). This guideline was composed of 11 chapters including vascular access control, dialysis water, microbiological and chemical monitoring of dialysis water and dialysates, components and passage of dialysates, maintenance of dialysis machines, disinfection, waste management, infection surveillance, aseptic techniques and standard precaution, environmental control, prevention of bloodborne infections and 5 appendices composing basic infection control techniques. This is the first official guideline approved by KOSNIC and KCDC of the infection control in a hemodialysis room in Korea. Here the guideline was published except appendices and entire guideline including those can be downloaded on hompages of KOSNIC (http://www.kosnic.org/) and KCDC (http//www.cdc.go.kr/).
Blood Transfusion ; Body Fluids ; Catheters ; Centers for Disease Control and Prevention (U.S.) ; Cross Infection ; Delivery of Health Care ; Dialysis ; Dialysis Solutions ; Disinfection ; Glycosaminoglycans ; Humans ; Infection Control ; Korea ; Renal Dialysis ; Waste Management ; Water

A 47-year-old female was admitted for an evaluation of a left mediastinal mass. The chest X-ray performed 16 months ago was normal, but the chest X-ray upon admission showed a large mass adjacent to the anterior aspect of the left hemidiaphragm. The CT scan demonstrated a large mass with a fat density in the left lower hemithorax. A focal diaphragmatic defect behind the xiphoid process was suspected. A thoracoscopic examination revealed omental herniation through the diaphragmatic defect. Therefore, a left thoracotomy was performed and the defect was repaired. We believe that a differential diagnosis should be needed to include a diaphragmatic omental hernia when a fat density mass is observed in the mediastinum.
Diagnosis, Differential ; Female ; Hernia ; Humans ; Mediastinum* ; Middle Aged ; Thoracotomy ; Thorax ; Tomography, X-Ray Computed