Purpose: This study aimed to investigate the presence of autoantigens in the gastric juices of children. Methods: Gastric juice and serum samples were obtained from 53 children <15 years of age who underwent gastric endoscopy. Among these, 8, 22, and 23 participants were in the age groups 0–5, 6–10, and 11–15 years, respectively. These samples were analyzed using two-dimensional electrophoresis (2-DE), immunoblot analysis, and matrix-assisted laser desorption ionization-time of-flight mass spectrometry. Furthermore, we reviewed the histopathological findings and urease test results and compared them with the results of 2-DE and immunoblot analysis. Results: There were no statistically significant differences in urease test positivity, grades of chronic gastritis, active gastritis, or Helicobacter pylori infiltration of the antrum and body among the three age groups. Three distinct patterns of gastric juice were observed on 2-DE. Pattern I was the most common, and pattern III was not observed below the age of 5 years.Histopathological findings were significantly different among active gastritis (p=0.037) and H. pylori infiltration (p=0.060) in the gastric body. The immunoblots showed large spots at an approximate pH of 3–4 and molecular weights of 31–45 kDa. These distinct, large positive spots were identified as gastric lipase and pepsin A and C. Conclusion Three enzymes, which are normally secreted under acidic conditions were identified as autoantigens. Further investigation of the pathophysiology and function of autoantigens in the stomach is required.

Purpose: Sodium is an essential nutritional electrolyte that affects growth. A low serum sodium concentration in healthy premature infants beyond 2 weeks of life is called lateonset hyponatremia (LOH). Here, we investigated the association between LOH severity and growth outcomes in premature infants. Methods: Medical records of premature infants born at ≤32 weeks of gestation were reviewed. LOH was defined as a serum sodium level <135 mEq/L regardless of sodium replacement after 14 days of life. Cases were divided into two groups, <130 mEq/L (severe) and ≥130 mEq/L (mild). Characteristics and growth parameters were compared between the two groups. Results: A total of 102 premature infants with LOH were included. Gestational age ([GA] 27.7 vs. 29.5 weeks, p<0.001) and birth weight (1.04 vs. 1.34 kg, p<0.001) were significantly lower in the severe group. GA was a risk factor of severe LOH (odds ratio [OR], 1.328, p=0.022), and severe LOH affected the development of bronchopulmonary dysplasia (OR, 2.950, p=0.039) and led to a poor developmental outcome (OR, 9.339, p=0.049). Growth parameters at birth were lower in the severe group, and a lower GA and sepsis negatively affected changes in growth for 3 years after adjustment for time. However, severe LOH was not related to growth changes in premature infants. Conclusion Severe LOH influenced the development of bronchopulmonary dysplasia and developmental outcomes. However, LOH severity did not affect the growth of premature infants beyond the neonatal period.

Nephrogenic diabetes insipidus (DI) is a rare disease in which the patient cannot concentrate urine despite appropriate or high secretion of antidiuretic hormone. Congenital nephrogenic DI is caused by the arginine vasopressin receptor 2 (AVPR2) or aquaporin 2 (AQP2) gene mutation; the AVPR2 genetic mutation accounts for 90% of the cases. National health screening for infants and children was launched in 2007 in order to prevent accidents and promote public health in infants and children in Korea. The program has been widely used as a primary clinical service in Korea. We treated an infant with faltering growth and delayed development detected by the National health screening program, and diagnosed the problem as nephrogenic DI caused by a rare missense mutation of c.490T>C on the AVPR2 gene. This case can be a good educational nephrogenic DI with a rare AVPR2 mutation, which was well screened and traced by the national health screening program for infants and children in Korea.

Background: The objective of this study was to examine changes in the prevalence of cytotoxic-associated gene A (CagA) positive Helicobacter pylori infection in Jinju, Korea, over the last 20 years. Methods: Three cross-sectional analyses were conducted concurrently. A total of 1,305 serum samples were collected from 1994–1995, 2004–2005, and 2014–2015, respectively. The presence of immunoglobulin (Ig) G, IgA, and IgM antibodies against H. pylori CagA protein was examined by western blotting. Results: Overall, seropositivity for anti-CagA IgG antibody was significantly decreased from 63.2% to 42.5% over the last 20 years (P < 0.001). Anti-CagA IgG seropositivities in children and young adults aged 10–29 years decreased from 1994 (60.0%–85.0%) to 2015 (12.5%– 28.9%). The age when plateau of increasing IgG seropositivity was reached in each study period shifted from the 15–19 year-old group in 1994–1995 (85.0%) to the 40–49 year-old group in 2014–2015 (82.5%). Overall seropositive rates of anti-CagA IgA and IgM antibodies did not change significantly either over the last 20 years. Conclusion H. pylori infection rate in children and young adults declined over 20 years in Jinju, probably due to improved sanitation, housing, or economy.

Cytomegalovirus is a common virus that is mostly asymptomatic when infected, but rarely causes life-threatening hemolysis especially in immunocompromised children. We report a case of antiglobulin test negative severe hemolytic anemia caused by cytomegalovirus infection developed in an immune competent 9-year-old girl. The patient's hemoglobin level was 4.8 g/dL on the day of admission. The diagnosis was achieved by exclusion of other causes of hemolytic anemia and serological evidence of recent CMV infection. The patient was successfully treated with anti-viral agents and steroids resulting in recovery from anemia. Clinicians should consider cytomegalovirus infection in the differential diagnosis of hemolytic anemia in pediatric patients.
Anemia ; Anemia, Hemolytic* ; Child ; Coombs Test* ; Cytomegalovirus ; Cytomegalovirus Infections ; Diagnosis ; Diagnosis, Differential ; Female ; Hemolysis ; Humans ; Steroids

No abstract available.
Abdominal Pain* ; Ankle Fractures* ; Ankle* ; Female* ; Humans ; Pulmonary Embolism*

We report the case of a 12-year-old girl who had mild encephalopathy with a reversible splenial lesion (MERS) associated with acutepyelonephritis caused by Escherichia coli. The patient was admitted with a high fever, and she was diagnosed with acute pyelonephritis based on pyuria and the results of urine culture, which detected cefotaxime-sensitive E. coli. Although intravenous cefotaxime and tobramycin were administered, her fever persisted and her C-reactive protein level increased to 307 mg/L. On day 3 of admission, she demonstrated abnormal neuropsychiatric symptoms, such as delirium, ataxia, and word salad. Magnetic resonance imaging (MRI) of the brain performed on day 4 showed marked hyperintensities in the bilateral corpus callosum and deep white matter on diffusion-weighted images, with corresponding diffusion restriction on apparent diffusion coefficient mapping. No abnormalities or pathogens were detected in the cerebrospinal fluid; however, lipopolysaccharides (LPS, endotoxin) were detected in plasma (41.6 pg/mL), associated with acute neurological deterioration. Her clinical condition gradually improved, and no neurological abnormalities were observed on day 6. Follow-up brain MRI performed 2 weeks later showed near-disappearance of the previously noted hyperintense lesions. In this patient, we first proved endotoxemia in a setting of MERS. The release of LPS following antibiotic administration might be related to the development of MERS in this patient. The possibility of MERS should be considered in patients who present with acute pyelonephritis and demonstrate delirious behavior.
Ataxia ; Brain ; Brain Diseases ; C-Reactive Protein ; Cefotaxime ; Cerebrospinal Fluid ; Child ; Corpus Callosum ; Delirium ; Diffusion ; Endotoxemia ; Escherichia coli ; Female ; Fever ; Follow-Up Studies ; Humans ; Lipopolysaccharides ; Magnetic Resonance Imaging ; Plasma ; Pyelonephritis ; Pyuria ; Tobramycin ; White Matter

To identify the Helicobacter pylori antigens operating during early infection in sera from infected infants using proteomics and immunoblot analysis. Two-dimensional (2D) large and small gel electrophoresis was performed using H. pylori strain 51. We performed 2D immunoglobulin G (IgG), immunoglobulin A (IgA), and immunoglobulin M (IgM) antibody immunoblotting using small gels on sera collected at the Gyeongsang National University Hospital from 4–11-month-old infants confirmed with H. pylori infection by pre-embedding immunoelectron microscopy. Immunoblot spots appearing to represent early infection markers in infant sera were compared to those of the large 2D gel for H. pylori strain 51. Corresponding spots were analyzed by matrix-assisted laser desorption/ionization time of flight-mass spectrometry (MALDI-TOF-MS). The peptide fingerprints obtained were searched in the National Center for Biotechnology Information (NCBI) database. Eight infant patients were confirmed with H. pylori infection based on urease tests, histopathologic examinations, and pre-embedding immunoelectron microscopy. One infant showed a 2D IgM immunoblot pattern that seemed to represent early infection. Immunoblot spots were compared with those from whole-cell extracts of H. pylori strain 51 and 18 spots were excised, digested in gel, and analyzed by MALDI-TOF-MS. Of the 10 peptide fingerprints obtained, the H. pylori proteins flagellin A (FlaA), urease β subunit (UreB), pyruvate ferredoxin oxidoreductase (POR), and translation elongation factor Ts (EF-Ts) were identified and appeared to be active during the early infection periods. These results might aid identification of serological markers for the serodiagnosis of early H. pylori infection in infants.
Biotechnology ; Electrophoresis ; Flagellin ; Gels ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunoblotting ; Immunoglobulin A ; Immunoglobulin G ; Immunoglobulin M ; Infant* ; Microscopy, Immunoelectron ; Peptide Elongation Factors ; Peptide Mapping ; Proteomics ; Pyruvate Synthase ; Serologic Tests ; Spectrum Analysis ; Urease

BACKGROUND/AIMS: The standard guideline for the management Helicobacter pylori infection in Korean children is not present until now. In present study, we conducted the questionnaire survey to investigate the real situation of H. pylori eradication in children. MATERIALS AND METHODS: Questionnaire concerning the indications of H. pylori eradication, the first choice of treatment modality, the decision method of eradication result, experience of eradication failure, the second choice of treatment modality was sent to doctors who are members of the Korean Society for Pediatric Gastorenterology, Hepatology, and Nutrition. RESULTS: A total of 28 doctors (90.3%) answered the questionnaires among 31 doctors. The most common indication for eradication of H. pylori was peptic ulcer (n=24) followed by chronic abdominal pain (n=17) and positive family history of gastric cancer (n=12). The most common choice of first-line eradication therapy was omeprazole, amoxicillin, clarithromycin triple therapy (n=21) and followed by bismuth subsalicylate, amoxicillin, metronidazole, clarithromycin quadruple therapy (n=7). The results of treatment were judged by C13-urea breath test after 2 months later in 19 doctors (67.8%). Twenty four (85.7%) out of 28 doctors had experienced treatment failure. The most common second-line therapy was the sequential therapy (58.3%, 14 doctors among 24). CONCLUSIONS: This was the first study for the survey of the treatment of H. pylori infection to Korean pediatricians. The results of this study showed that most pediatric gastroenterologists used to treat H. pylori infection according to the textbook and the common use of bismuth-based quadruple therapy for the first-line treatment was notable.
Abdominal Pain ; Amoxicillin ; Bismuth ; Breath Tests ; Child* ; Clarithromycin ; Gastroenterology ; Helicobacter pylori* ; Helicobacter* ; Humans ; Methods ; Metronidazole ; Omeprazole ; Peptic Ulcer ; Pilot Projects* ; Stomach Neoplasms ; Treatment Failure

PURPOSE: Bacterial meningitis score (BMS) has been introduced as a clinical predictive parameter for diagnosing cerebrospinal fluid (CSF) pleocytosis in children at very low risk of bacterial meningitis in the postconjugate vaccine era. This study aimed to examine the usefulness of the BMS and to identify an additional index to distinguish between enteroviral meningitis and bacterial meningitis. METHODS: We retrospectively included 289 patients with enteroviral meningitis and 10 patients with bacterial meningitis between the aged 2 months to 16 years. We applied the BMS to all the included patients, and compared the initial laboratory and clinical characteristics between the two groups. RESULTS: Of the 210 patients categorized as having a very low risk of bacterial meningitis based on BMS, 2 (1%) had bacterial meningitis, both of whom were younger than 3 months. The sensitivity, specificity, and negative predictive value of the BMS for bacterial meningitis were 80%, 72%, and 99%, respectively. Compared with patients with enteroviral meningitis, those with bacterial meningitis were younger (0.3 years vs. 5.0 years, P<0.01), had higher leukocyte count (530/mm³ vs. 43/mm³, P=0.04), neutrophil count (490/mm³ vs. 20/mm³, P<0.01), and protein level (106 mg/dL vs. 30 mg/dL, P<0.01) in the CSF, and increased serum C-reactive protein (CRP) level (79 mg/L vs. 4.5 mg/L, P<0.01). CONCLUSION: Although the BMS is a useful clinical predictive parameter for identifying children with CSF pleocytosis who are at very low risk of bacterial meningitis, it should be applied with caution in young infants. In addition to applying BMS, clinical parameters such as CSF profiles and serum CRP levels are useful in clinical decision making for the management of children with CSF pleocytosis.
C-Reactive Protein ; Cerebrospinal Fluid ; Child ; Clinical Decision-Making ; Humans ; Infant ; Leukocyte Count ; Leukocytosis ; Meningitis* ; Meningitis, Aseptic ; Meningitis, Bacterial* ; Neutrophils ; Retrospective Studies ; Sensitivity and Specificity