This study aimed to assess and evaluate the prevalence and methodological quality of systematic reviews (SRs) published in major Korean medical journals (KMJs). The top 15 journals with the highest Korean Medical Citation Index, published between 2018 to 2021, were selected. We assessed the methodological quality of SRs using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). In total, 126 SRs were included, with an average of 32 SRs being reported annually. The overall prevalence of SRs in KMJs was 2.8%, with an increase from 2.6% in 2018 to 3.4% in 2021. Overall, the methodological quality of SRs was low (9.5% low, 90.5% critically low). More than 80% of the studies adhered to critical domain items such as a comprehensive literature search and risk of bias assessment, but for items such as protocol registration and listing excluded studies and the justification for exclusion, the adherence rate was less than 15%. While the number of SRs in KMJs steadily increased, the overall confidence in the methodological quality was low to critically low. Therefore, in order to provide the best evidence for decision-making in clinical and public health areas, editors, reviewers, and authors need to pay more attention to improving the quality of SRs.

BACKGROUND/AIMS: Surgical resection or ablation is recommended for the treatment of early hepatocellular carcinoma (HCC), whereas transarterial chemoembolization (TACE) is frequently used in early HCC ineligible for curative resection. We evaluated the clinical effects and safety of radiofrequency ablation (RFA) shortly after TACE in patients with Barcelona clinic liver cancer (BCLC) stage A HCC. METHODS: Sixty-seven BCLC stage A HCC patients who failed to achieve complete response to TACE as either a first line treatment and who subsequently received RFA at the Konkuk University Medical Center from January 2005 to December 2017 were included. Evaluation indices included treatment response, overall survival rate, recurrence-free survival, prognostic factors, and procedure-related complications. RESULTS: Median follow-up was 46.9 months. Fifty-four (80.6%) patients were of Child-Pugh class A, and 13 (19.4%) were of class B. Modified UICC stages were I in 10 (14.9%), II in 46 (68.7%), and III in 11 (16.4%) patients. In the 67 study subjects, cumulative recurrence-free survival rates were 86.8%, 55.9% and 29.7% at 1, 3, and 5 years, respectively, and overall survival rates were 100%, 93.4%, and 83.5% at 1, 3, and 5 years, respectively. Tumor size significantly predicted recurrence. No treatment-related death occurred. CONCLUSIONS: Combination of RFA was an efficient and safe treatment for BCLC stage A HCC patients that failed to achieve complete response to initial TACE. We suggest TACE plus RFA be considered as a curative option for early HCC patients ineligible for curative resection of RFA.
Academic Medical Centers ; Carcinoma, Hepatocellular ; Catheter Ablation ; Follow-Up Studies ; Humans ; Liver Neoplasms ; Liver ; Recurrence ; Survival Rate ; Treatment Outcome

BACKGROUND: The intestinal microflora varies according to the factors such as age, diet and environment. It is debated whether the changes of microbiota after birth are associated with atopic disease. The purpose of this study was to investigate colonization rates of some intestinal microflora during the initial 9 months after birth, and their association with the development of atopy. METHODS: Stool specimens were collected at 1, 3, 7 days and at 1, 2, 4, 6, 9 months after birth, and Escherichia coli, Lactobacillus, Bifidobacterium, Staphylococcus aureus were cultured with selective media. Diagnosis for atopy was accomplished via clinical history of atopy, serum total IgE, and skin prick test. RESULTS: By 12 months of age, among 48 infants, 36 (75.0%) were non-atopic while 12 (25.0%) had developed atopy. Although not statistically significant, the intestinal microflora of infants with atopy vs. non-atopy was characterized by being less often colonized with E. coli (12.5% vs. 52.4%; P=0.093) and S. aureus (0% vs. 38.1%; P=0.066) at three days after birth. Colonization rates of E. coli reached 50% after 3 days of birth in non-atopy group whereas this rate was not achieved until after 1 month in the atopy group. CONCLUSION: The intestinal colonization rates of bacteria in this study were not statistically different between atopy and non-atopy groups. Rapid colonization of E. coli and S. aureus was observed within 1 week after birth in the non-atopy group. The exact association between atopy and the bacterial colonization and/or diversity in the early days after birth has yet to be determined.
Bacteria ; Bifidobacterium ; Colon ; Diagnosis ; Diet ; Escherichia coli ; Humans ; Immunoglobulin E ; Infant* ; Lactobacillus ; Microbiota ; Parturition ; Skin ; Staphylococcus aureus

PURPOSE: Measurement of testicular volume is useful for the evaluation of puberty and testicular development in boys. Four mililiter of testicular volume means Tanner stage 2, the beginning of puberty, and its ethnic differences were reported. However, there is no reference value for Korean children. We tried to establish the standard testicular volume for Korean boys. METHODS: The subjects were selected among the children who visited the out-patient clinic of Kangdong Sacred Heart Hospital and Korea Cancer Center Hospital for the evaluation of growth from 2003 to 2008. Three hundred seventy two healthy Korean boys, 3 to 17 years of age, were included. We excluded the patients who were diagnosed as precocious puberty, delayed puberty, hypopituitarism, adrenal disorder and other endocrinologic disorder. The testicular volume was determined with Prader orchidometer. Clinical data were collected from patient's chart retrospectively. RESULTS: Right and left testicular volumes were 3.65 +/- 1.82 mL and 3.55 +/- 1.80 mL at 10 (10.0 - 10.9) year of age (n = 53), 6.17 +/- 3.60 mL and 6.13 +/- 3.69 mL at 11 (11.0 - 11.9) year of age (n = 52), respectively. There was no significant difference between right and left testicular volumes. CONCLUSION: The time when testicular volume reached 4 mL seemed to be not changed than previous Korean data. However, further study will be required to determine the secular trend of pubertal timing in Korean boys.
Child ; Heart ; Humans ; Hypopituitarism ; Korea ; Outpatients ; Puberty ; Puberty, Delayed ; Puberty, Precocious ; Reference Values ; Retrospective Studies

PURPOSE: Being small for gestational age (SGA) is a risk factor of short stature in children. Genetic background such as mid-parental height (MPH) is known to influence growth of children born SGA. We studied the relationship between growth of children born SGA and MPH and studied the effects of insulin-like growth factor (IGF-I) and insulin-like growth factor binding protein 3 (IGFBP-3) on postnatal growth in children born SGA according to MPH. METHODS: Forty-nine neonates born SGA were included in this study. We defined corrected height standard deviation score (cHtSDS) by modified height SDS (HtSDS) based on their MPH. We categorized subjects into group 1 consisting of children with cHtSDS > or =0 (n=35) and group 2 consisting of children with cHtSDS <0 (n=14), and compared IGF-I and IGFBP-3 between the two groups. RESULTS: The HtSDSs and cHtSDSs in groups 1 and 2 were 0.06+/-1.05 vs. -0.95+/-0.85 (P=0.000) and 0.78+/-0.93 vs. -0.46+/-0.67 (P=0.000), respectively. IGF-I SDS was higher in group 1 than in group 2 (2.82+/-3.69 vs. 0.23+/-2.42, P=0.012). Total cHtSDS (0.42+/-1.03) was significantly higher than HtSDS (-0.22+/-1.10) (P=0.000). CONCLUSION: Our results show that cHtSDS differs significantly from HtSDS. Growth assessment by standardized growth curve does not uniformly show effects of genetic factors. A more accurate assessment of growth uses a personalized corrected growth curve that considers the genetic factor measured by MPH.
Child ; Gestational Age ; Humans ; Infant, Newborn ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Phenazines ; Risk Factors

PURPOSE: Being small for gestational age (SGA) is a risk factor of short stature in children. Genetic background such as mid-parental height (MPH) is known to influence growth of children born SGA. We studied the relationship between growth of children born SGA and MPH and studied the effects of insulin-like growth factor (IGF-I) and insulin-like growth factor binding protein 3 (IGFBP-3) on postnatal growth in children born SGA according to MPH. METHODS: Forty-nine neonates born SGA were included in this study. We defined corrected height standard deviation score (cHtSDS) by modified height SDS (HtSDS) based on their MPH. We categorized subjects into group 1 consisting of children with cHtSDS > or =0 (n=35) and group 2 consisting of children with cHtSDS <0 (n=14), and compared IGF-I and IGFBP-3 between the two groups. RESULTS: The HtSDSs and cHtSDSs in groups 1 and 2 were 0.06+/-1.05 vs. -0.95+/-0.85 (P=0.000) and 0.78+/-0.93 vs. -0.46+/-0.67 (P=0.000), respectively. IGF-I SDS was higher in group 1 than in group 2 (2.82+/-3.69 vs. 0.23+/-2.42, P=0.012). Total cHtSDS (0.42+/-1.03) was significantly higher than HtSDS (-0.22+/-1.10) (P=0.000). CONCLUSION: Our results show that cHtSDS differs significantly from HtSDS. Growth assessment by standardized growth curve does not uniformly show effects of genetic factors. A more accurate assessment of growth uses a personalized corrected growth curve that considers the genetic factor measured by MPH.
Child ; Gestational Age ; Humans ; Infant, Newborn ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Phenazines ; Risk Factors

PURPOSE: The aim of this study is to assess the usefulness of skin test by an inactivated, 1/50 diluted solution of attenuated varicella vaccine in evaluating the immune status to varicella. METHODS: Total 41 subjects (22 males, 19 females, aged 1-32 years) were enrolled from July to August, 2005. Past medical history including varicella infection, varicella vaccination were investigated through questionnaires. The skin test solution was prepared from solution of attenuated varicella vaccine(Oka strain) which was inactivated by exposure to room temperature for 10 days and diluted at 1/50 with normal saline. Skin test was done by injecting 0.1 mL of the solution intradermally into the volar surface of the right forearm and sterile normal saline was used as a control on the left forearm. Positive reaction was defined when the transverse diameter of the induration was 5 mm or more. Serum varicella zoster virus specific IgG antibody test by ELISA (enzyme-linked immunosorbent assay) was done. RESULTS: In adults, the sensitivity of the varicella zoster virus skin test compared to ELISA was 94.7% and the positive predictive value was 100%. In children, both the positive predictive value and specificity were 100% but the sensitivity and the negative predictive value were 50% and 30.7% respectively. Children showed smaller skin test reactivity compared to adults. CONCLUSION: The varicella zoster virus skin test using inactivated, 1/50 diluted solution of attenuated varicella vaccine was proved as one of the useful tools for evaluating the immunity and susceptibility of the varicella zoster virus.
Adult ; Aged ; Chickenpox ; Chickenpox Vaccine ; Child ; Enzyme-Linked Immunosorbent Assay ; Female ; Forearm ; Herpesvirus 3, Human ; Humans ; Immunoglobulin G ; Male ; Surveys and Questionnaires ; Sensitivity and Specificity ; Skin ; Skin Tests ; Vaccination

PURPOSE: The aim of this study was to determine whether insulin resistance may be present and to analyze factors affecting the development of insulin resistance in children and adolescents born small for gestational age (SGA). METHODS: This study includes 24 children and 18 SGA adolescents and 13 children and 14 control adolescents. All patients underwent a standard, 2-hour oral glucose tolerance test (OGTT). Serum levels of fasting blood sugar, insulin, leptin, adiponectin, homeostasis model assessment-insulin resistance (HOMA- IR), quantitative insulin sensitivity check index (QUICKI), insulin sensitivity index (ISI), mean serum insulin (MSI) and mean serum glucose (MSG) were evaluated. RESULTS: The insulin responses at 30 min and 120 min after glucose load were significantly higher in pubertal SGA than control groups (P<0.05). Impaired glucose tolerance was found from 2 subjects (8.7 %) in prepubertal SGA group and from 3 subjects (15.0%) in pubertal SGA group. None of the patients had developed type 2 diabetes. MSI levels during OGTT were higher in pubertal SGA than in control. Pubertal SGA group had a significantly lower mean serum adiponectin level than control group (9.04+/-4.51 vs. 18.83+/-11.65 microgram/mL, P<0.05). Adiponectin level was correlated with HOMA-IR, QUICKI and ISI (r=-0.37, r=0.32, r=0.51, respectively, P<0.05). CONCLUSION: Adiponectin level was correlated with HOMA-IR, QUICKI and ISI. Pubertal SGA group had a significantly lower mean serum adiponectin level than control group. We suggest the check of insulin resistance using HOMA-IR, QUICKI, ISI and adiponectin is important for the prevention of metabolic syndrome (MS) in adolescents born SGA.
Adiponectin ; Adolescent ; Blood Glucose ; Child ; Fasting ; Gestational Age ; Glucose ; Glucose Tolerance Test ; Homeostasis ; Humans ; Infant ; Insulin ; Insulin Resistance ; Leptin ; Succinimides

PURPOSE: This study was designed to examine the effects of adiponectin, leptin, insulin, insulin-like growth factor (IGF)-I and IGF binding protein (BP)-3 levels in cord blood on weight, length, and adiposity at birth in healthy term infants. In addition, we evaluated the mechanism to change the hormone levels in appropriate for gestational age (AGA) during the first month. METHODS: We collected cord blood from 200 term neonates (109 males, 91 females) with no perinatal problems, and measured the hormone levels and anthropometric parameters including weight, length, and skin-fold thickness. Term neonates were divided into 3 groups as follows: birth weight appropriate for gestational age (AGA) (n=132), birth weight less for gestational age (SGA) (n=29), and birth weight more for gestational age (LGA) (n=39). Venous blood samples of 15 fullterm healthy neonates were obtained at 3, 7, and 30 d after birth. RESULTS: The adiponectin, insulin, and IGF-I levels were significantly lower in the SGA group than in the AGA and LGA groups. The leptin levels were significantly higher in the LGA group than in the AGA and SGA groups. Cord blood adiponectin, leptin, insulin, IGF-I, and IGFBP-3 levels correlated significantly and positively with birth weight and the sum of the skin-fold thickness. A significant positive correlation was observed between adiponectin, leptin, and IGF-I levels and birth weight. Adiponectin level correlated significantly with that leptin level (r=0.191, P=0.038), but not with insulin, IGF-I and IGFBP-3 levels. IGF-I levels were higher in females than in males. At 7 d after birth, the leptin level decreased along with physiologic weight loss, and then increased. IGF-I, also decreased at 3 d, significantly increased 1 month later. CONCLUSION: We suggest that adiponectin, leptin, insulin, IGF-I, and IGFBP-3 play an important role in regulating fetal growth. Adiponectin may be involved in regulating fetal growth through mechanisms different from those mediated by insulin or IGF-I. High levels of IGF-I in female neonates indicates a gender difference which serves as evidence for in utero sexual dimorphism. It is likely that IGF-I has a more important role than that of hormones in postnatal growth.
Adiponectin ; Adiposity ; Birth Weight ; Carrier Proteins ; Female ; Fetal Blood ; Fetal Development ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Insulin ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Leptin ; Male ; Parturition ; Weight Loss

PURPOSE: A new health policy, referred to as the National Health Screening Program for Infants and Children, was launched in November 2007 by the Ministry of Health and Welfare and National Health Insurance Corporation in Korea. We have developed a nutrition-counseling program that was incorporated into this project. METHODS: We reviewed the nutritional guidelines published by The Korean Pediatric Society and internationally well-known screening programs such as Bright Future in the United States. We also reviewed the recent Korean national surveys on nutritional issues, including the Korea National Health and Nutrition Examination Survey (KNHANES) and the 2005 National Survey of Physical Body and Blood Pressure in Children and Adolescents. The development of questions, pamphlets, computer programs, and manuals for doctors was carried out after several meetings of researchers and governmental officers. RESULTS: We summarized the key nutritional issues according to age, including breastfeeding in infants, healthier complementary feeding, and prevention of iron deficiency anemia, establishment of healthier diets, as well as dietary prevention of overweight children with an emphasis on physical exercise. We have constructed a new Korean nutrition questionnaire and an anticipatory guidance program based on the primary care schedule of visits at 4, 9, 18, 30, and 60 months of age. Five to eight questions were asked at each visit and age-matched pamphlets for parents and guidelines for doctors were provided. CONCLUSION: We developed a nutrition-counseling program based on recent scientific evidence for Korean infants and children. Further research on this national program for screening the nutritional problems in detail and setting the therapeutic approaches may help identify areas of success as well as those that need further attention.
Adolescent ; Anemia, Iron-Deficiency ; Appointments and Schedules ; Blood Pressure ; Breast Feeding ; Child ; Counseling ; Diet ; Exercise ; Health Policy ; Humans ; Infant ; Infant Nutritional Physiological Phenomena ; Korea ; Mass Screening ; National Health Programs ; Nutrition Surveys ; Obesity ; Overweight ; Pamphlets ; Parents ; Primary Health Care ; Surveys and Questionnaires ; Software ; United States