Anaphylaxis ; Asia ; Beer ; Child ; Eating ; Food Hypersensitivity ; Hordeum ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulins ; Korea ; Medical Records ; Pediatrics ; Phenotype ; Respiratory System ; Retrospective Studies ; Sensitivity and Specificity ; Triticum ; Wheat Hypersensitivity

BACKGROUND: Barley is a grain that is consumed in various forms in Asia. Studies on barley allergy are limited to a few case reports about hypersensitivity reactions to beer, but there is no barley allergy study in children. This study aimed to identify the phenotype and immunologic findings in Korean children with barley allergy. METHODS: Forty-two participants with a history of ingesting barley who underwent serum specific immunoglobulin E to barley (barley-sIgE) assay at the Department of Pediatrics in Ajou Medical Center were enrolled through a retrospective analysis of medical records from March 2008 to February 2018. The demographic characteristics, symptoms, and immunologic parameters of the patients were assessed. RESULTS: Twenty subjects presented with clinical barley allergy (B-allergic group), and 22 were atopic controls without allergic reactions after the ingestion of barley (B-tolerant group). The median ages of the B-allergic and B-tolerant groups were 1 and 3 years, respectively. In the B-allergic group, the cutaneous system (90.0%) was most frequently affected, followed by the respiratory system (40.0%). Anaphylaxis was observed in 35.0% of the B-allergic group. The median level of barley-sIgE was 13.90 kU(A)/L (range, 0.14–101.00 kU(A)/L) in the B-allergic group, and this value was significantly higher (P < 0.001) than that of the B-tolerant group (0.30 kU(A)/L; range, 0.01–24.40 kU(A)/L), with an optimal cutoff level of 1.24 kU(A)/L (sensitivity, 85.0%; specificity, 86.4%). A positive correlation was found between the serum levels of barley-sIgE and wheat-sIgE in the B-allergic group with clinical wheat allergy. CONCLUSION Barley is an important allergen for children in Korea. This study showed the clinical characteristics of barley allergy and suggested optimal cut-off levels of barley-sIgE for clinical barley allergy. Clinically, cross-reactivity or co-sensitization is often observed between barley and wheat.

Methods: Using a common data model of electronic medical records at a university medical center in South Korea, the study populations were extracted if the depressive patients were treated either with antidepressants only or along with antipsychotics. The suicidal risks were compared with the Kaplan-Meier plot and log-rank test, and the risk factors were accessed using the Cox proportional hazard model. Results: All demographic characteristics were similar in the monotherapy group taking only antidepressants and the combination therapy group taking antipsychotics with antidepressants, except for the smoking characteristic (p=0.023). The combination therapy group showed a lower suicidal risk [hazard ratio=0.58, 95% confidence interval (CI)=0.282–1.190] compared to the monotherapy group, which was not significant (p=0.138). Conclusion The combination therapy had no beneficial effects on reducing the suicidal risk in patients with depressive symptoms. This study is meaningful in that it is the first attempt to explore a psychiatric behavior/symptom using real-world data based on a common data model of general electronic medical records as well as narrative textual data.

PURPOSE: Transcatheter device closure of patent ductus arteriosus (PDA) is challenging in early infancy. We evaluated PDA closure in infants less than 6 months old. METHODS: We performed a retrospective review of infants less than 6 months of age who underwent attempted transcatheter device closure in our institution since 2004. To compare clinical outcomes between age groups, infants aged 6–12 months in the same study period were reviewed. RESULTS: A total of 22 patients underwent transcatheter PDA closure during the study period. Patient mean age was 3.3±1.5 months, and weight was 5.7±1.3 kg. The duct diameter at the narrowest point was 3.0±0.8 mm as measured by angiography. The most common duct type was C in the Krichenko classification. Procedural success was achieved in 19 patients (86.3%). Major complications occurred in 5 patients (22.7%), including device embolization (n=1), acquired aortic coarctation (n=2), access-related vascular injury requiring surgery (n=1), and acute deterioration requiring intubation during the procedure (n=1). Two patients had minor complications (9.1%). Twenty-four infants aged 6–12 months received transcatheter device closure. The procedural success rate was 100%, and there were no major complications. The major complication rate was significantly higher in the group less than 6 months of age (P=0.045). There was a trend toward increased major complication and procedural failure rates in the younger age group (P < 0.01). CONCLUSION: A relatively higher incidence of major complications was observed in infants less than 6 months of age. The decision regarding treatment modality should be individualized.
Angiography ; Aortic Coarctation ; Classification ; Ductus Arteriosus* ; Ductus Arteriosus, Patent ; Heart Defects, Congenital ; Humans ; Incidence ; Infant* ; Intubation ; Retrospective Studies ; Vascular System Injuries

Background: /Aim: There has been a long-standing debate about the association of directacting antiviral (DAA) therapy and hepatocellular carcinoma (HCC) recurrence. This study aimed to investigate the association between DAA therapy and HCC recurrence after curative therapy. Methods: We retrospectively enrolled 1,021 patients with HCV-related (hepatitis C virus) HCC who underwent radiofrequency ablation (RFA), liver resection, or both as the first treatment modality from January 2007 to December 2016 and without a history of HCV therapy before HCC treatment from a nationwide database. The effect of HCV treatment on HCC recurrence and all-cause mortality was also investigated. Results: Among the 1,021 patients, 77 (7.5%) were treated with DAA, 14 (1.4%) were treated with interferon-based therapy, and 930 (91.1%) did not receive HCV therapy. DAA therapy was an independent prognostic factor for lower HCC recurrence rate (hazard ratio [HR], 0.04; 95% confidence interval [CI], 0.006-0.289; P=0.001 for landmarks at 6 months after HCC treatment and HR, 0.05; 95% CI, 0.007-0.354; P=0.003 for landmarks at 1 year). Furthermore, DAA therapy was associated with lower all-cause mortality (HR, 0.049; 95% CI, 0.007-0.349; P=0.003 for landmarks at 6 months and HR, 0.063; 95% CI, 0.009-0.451; P=0.006 for landmarks at 1 year). Conclusions DAA therapy after curative HCC treatment can decrease HCC recurrence and all-cause mortality compared to interferon-based therapy or no antiviral therapy. Therefore, clinicians should consider administering DAA therapy after curative HCC treatment in patients with HCV-related HCC.

Objective: To compare the progression of muscle fibrosis of various site and its relation between cardiac deterioration in Duchenne muscular dystrophy (DMD). In this study aimed to examine the associations between echocardiogram-based cardiac function indices and fibrosis of the abdominal and lower extremity muscles in patients with DMD to facilitate early detection of cardiac dysfunction and identify its predictors. Methods: Twenty-one patients with DMD patients were enrolled in the study. The association between cardiac dysfunction and fibrosis of the abdominal and lower extremity muscles was determined by analyzing the echocardiography and elastography. Non-parametric Spearman rank correlation coefficients were used to examine the pairwise relationships between cardiac function and muscle elasticity. Results: All patients were male and non-ambulant. Their mean age was 18.45±4.28 years. The strain ratios of the abdominal muscle and quadriceps muscles were significantly higher than those of the medial gastrocnemius. The strain ratio of the rectus abdominis muscle has a significant negative correlation with left ventricular ejection fraction. Cardiac function and valvular insufficiency were not significantly correlated with muscle strain ratio. According to the result of our study, the only skeletal muscle which showed significant correlation with cardiac dysfunction was degree abdominal muscle fibrosis. Conclusion The degree of fibrosis of respiratory muscles was also significantly associated with cardiac dysfunction; therefore, it can be used as a predictor of cardiac dysfunction in patients with DMD in clinical practice.

Objective: To compare the progression of muscle fibrosis of various site and its relation between cardiac deterioration in Duchenne muscular dystrophy (DMD). In this study aimed to examine the associations between echocardiogram-based cardiac function indices and fibrosis of the abdominal and lower extremity muscles in patients with DMD to facilitate early detection of cardiac dysfunction and identify its predictors. Methods: Twenty-one patients with DMD patients were enrolled in the study. The association between cardiac dysfunction and fibrosis of the abdominal and lower extremity muscles was determined by analyzing the echocardiography and elastography. Non-parametric Spearman rank correlation coefficients were used to examine the pairwise relationships between cardiac function and muscle elasticity. Results: All patients were male and non-ambulant. Their mean age was 18.45±4.28 years. The strain ratios of the abdominal muscle and quadriceps muscles were significantly higher than those of the medial gastrocnemius. The strain ratio of the rectus abdominis muscle has a significant negative correlation with left ventricular ejection fraction. Cardiac function and valvular insufficiency were not significantly correlated with muscle strain ratio. According to the result of our study, the only skeletal muscle which showed significant correlation with cardiac dysfunction was degree abdominal muscle fibrosis. Conclusion The degree of fibrosis of respiratory muscles was also significantly associated with cardiac dysfunction; therefore, it can be used as a predictor of cardiac dysfunction in patients with DMD in clinical practice.

Objective: To compare the progression of muscle fibrosis of various site and its relation between cardiac deterioration in Duchenne muscular dystrophy (DMD). In this study aimed to examine the associations between echocardiogram-based cardiac function indices and fibrosis of the abdominal and lower extremity muscles in patients with DMD to facilitate early detection of cardiac dysfunction and identify its predictors. Methods: Twenty-one patients with DMD patients were enrolled in the study. The association between cardiac dysfunction and fibrosis of the abdominal and lower extremity muscles was determined by analyzing the echocardiography and elastography. Non-parametric Spearman rank correlation coefficients were used to examine the pairwise relationships between cardiac function and muscle elasticity. Results: All patients were male and non-ambulant. Their mean age was 18.45±4.28 years. The strain ratios of the abdominal muscle and quadriceps muscles were significantly higher than those of the medial gastrocnemius. The strain ratio of the rectus abdominis muscle has a significant negative correlation with left ventricular ejection fraction. Cardiac function and valvular insufficiency were not significantly correlated with muscle strain ratio. According to the result of our study, the only skeletal muscle which showed significant correlation with cardiac dysfunction was degree abdominal muscle fibrosis. Conclusion The degree of fibrosis of respiratory muscles was also significantly associated with cardiac dysfunction; therefore, it can be used as a predictor of cardiac dysfunction in patients with DMD in clinical practice.

Hypersensitivity reactions to antituberculosis medicine are obstacles to the treatment of tuberculosis. However, rapid drug desensitization can secure successful treatment with essential antituberculosis medicines in pediatric patients. A 17-year-old boy with active pulmonary tuberculosis complained of generalized erythematous rashes, pruritus on the 11th day of tuberculosis treatment. He was diagnosed with hypersensitivity reactions to isoniazid and rifampin by the oral provocation test. After desensitization, the patient continued to take antituberculosis treatment with isoniazid, rifampin, pyrazinamide, and ethambutol. We report here a case of successful desensitization in an adolescent with hypersensitivity to isoniazid and rifampin.
Adolescent* ; Antitubercular Agents ; Desensitization, Immunologic ; Drug Hypersensitivity ; Ethambutol ; Exanthema ; Humans ; Hypersensitivity ; Isoniazid* ; Male ; Pruritus ; Pyrazinamide ; Rifampin* ; Tuberculosis ; Tuberculosis, Pulmonary*

Familial hypophosphatemic rickets (FHR) is a disorder characterized by phosphate wasting and hypophosphatemia due to defects in renal phosphate transport regulation. There are 4 known inherited forms of FHR that differ in their molecular causes. Very few studies have been conducted that focused on the molecular analysis of FHR in Koreans. Eighteen mutations of the PHEX gene have been identified to this date in Korea. Herein, we report the clinical case of a 24-month-old boy presenting with bowed legs and short stature. The biochemical profile showed hypophosphatemia with decreased tubular reabsorption of phosphate. Several family members were identified with short stature and genu varum. Therefore, he was diagnosed with FHR. To identify the molecular causes of FHR, we performed targeted gene panel sequencing and found a novel hemizygous missense variant, c.1949T>C (p.Leu650Pro), in the PHEX gene. This variant was also detected in the boy’s mother who exhibited genu varum and short stature.