Purpose: This qualitative study used interpretative phenomenological analysis and photovoice methods to explore the meaning of non-suicidal self-injury experienced by adolescents. Methods: Participants were adolescents enrolled in middle and high schools in Gyeonggi-do and Jeollabuk-do who were selected through snowball sampling. Six participants had repeatedly engaged in self-injurious behavior for over a year. Data were collected through in-depth interviews and the photovoice method between November 2020 and July 2021. The collected data were analyzed using six steps of interpretative phenomenological analysis. Results: The results yielded 5 main themes and 18 subthemes. The main themes were ‘a silent cry to an indifferent world’, ‘a heartache that one endures with scars’, ‘an inescapable cycle’, ‘filling the space in one’s heart’, and ‘healing the wounds’. The study findings revealed that the self-injurious behavior of adolescents began as a consequence of feeling lost and struggling with conflicts at home and school, which helped them relieve tension and pain. Nonetheless, inflicting self-injury only left signs of regret and remorse, which became a trace that the participants wanted to hide. However, the wounds healed after receiving attention and support from others. They were determined to stop engaging in repeated self-injurious behaviors and made efforts to do so. Conclusion This study can be used as a basis for the development of educational programs to prevent non-suicidal self-injury in adolescents. Additionally, it can inform nursing interventions that focus on building support systems to help adolescents who attempt self-injury.

Community-acquired pneumonia is the leading cause of pediatric morbidity and mortality. However, there is a lack of data on the epidemiology of pneumonia in Korean children. In this review, we aimed to summarize pneumonia studies in Korea and suggest diagnostic methods and treatment for Korean children who were referred based on the foreign guidelines for pediatric community-acquired pneumonia. A Korean guideline for pediatric pneumonia in tune with domestic circumstances is needed.
Child* ; Epidemiology ; Humans ; Korea ; Mortality ; Pneumonia*

Atopic dermatitis is the most common chronic inflammatory skin disease in children. It usually develops in infancy and early childhood and is an entry point of ‘atopic march’, which may progress to other allergic diseases, including allergic rhinitis and asthma. Although there is no disagreement on the importance of early treatment of atopic dermatitis, it is difficult to treat children with moderate to severe atopic dermatitis due to concerns about treatment-related side effects and age restrictions for effective drugs in real world. As recent researches have extend our understanding of pathogenesis, new agents targeted key pathologic mechanisms have been developed. Therefore, it is time to establish a new paradigm of treatment for children with atopic dermatitis since new biologics have been demonstrated to be effective and safe in children. The objective of this article is to review the clinical characteristics, severity classification, pathogenesis, and treatment, in particular, biologics already approved/undergoing clinical trials for children with atopic dermatitis.

OBJECTIVES: The purpose of this study is to develop a method of evaluation based on finite element analysis (FEA) using micro-CT images for the measurement of trabecular bone strength. METHODS: The primary compressive trabeculae were obtained from the human femoral head of three cadavers (21 year old male (M/21), 51 year old male (M/51), 51 year old female (F/51). All bone specimens were scanned using micro-CT at 24.9microm of spatial resolution under 70 kV's voltage and current of 141microA. The percent bone volume was calculated from the CTAn (SKYSCAN, Belgium) software, it's represented the bone mineral density (BMD). After scanning, the finite element model was reconstructed based on micro-CT images. All models were applied to be linear elastic, isotropic, and uniform with a tissue modulus of 5.17 GPa and a tissue Poisson's ratio of 0.3. RESULTS: The percent bone volume(%) were 31.819 (+/-0.648), 21.513 (+/-2.489), 20.280 (+/-1.891) and Bone strength (MPa) were 187.741 (+/-13.006), 61.585 (+/-11.094), 61.266 (+/-16.744) in M/20, M/51 and F/51. The trabecular bone strength of the primary compressive trabeculae in M/20 was 3 times more than the trabecular bone strength in M/51 and F/51. The percent bone volume in M/20 was 148% and 157% higher than the percent bone volume in M/51 and F/51. CONCLUSIONS: The finite element analysis is more sensitive than the percent bone volume in reflecting the morphometry index of primary compressive trabeculae. The high resolution FEA reconstructed from high resolution MRI or high resolution CT may improve the evaluation of trabecular bone strength in the medical field.
Bone Density ; Cadaver ; Female ; Finite Element Analysis ; Head ; Humans ; Male

No abstract available.
Humans ; Intubation

Purpose: Little is known about blood markers related to eosinophils in healthy individuals. We aimed to identify blood markers from routine tests associated with blood eosinophil count (BEC) in healthy individuals. Methods: Based on the complex interactions among blood markers, we used comprehensive analysis methods (regression, Bayesian network [BN], and partial correlation) and a health check-up database. To test consistency, we repeated the analysis using data from 3 check-ups of the same healthy individual. Results: A total of 12,625 individuals were enrolled in this study. Four groups were defined according to sex and smoking status: nonsmoking men (n=1,737), smoking men (n=6,518), nonsmoking women (n=3,995), and smoking women (n=375). The blood bilirubin and γ-glutamyltransferase levels showed significant associations with BEC by regression analysis. However, BN analysis found that only the bilirubin node was directly connected to the BEC node. By partial correlation analysis, the blood bilirubin level showed significantly negative association with BEC. The same results were obtained across all the 3 health check-ups, except in smoking women. In addition, a lower blood bilirubin level predicted a significantly elevated BEC (especially ≥200/µL). The blood bilirubin levels measured at 3 time-points were significantly associated with BEC in men and nonsmoking women. Conclusion The blood bilirubin level, which is easily obtained by routine test in clinical practice, may be a useful marker for BEC.

PURPOSE: Surgeons may be uncertain about the optimal timing of appendectomy to decrease complications, especially for complicated appendicitis. The aim of the study was to compare clinical outcomes between early and late surgery for complicated appendicitis. METHODS: A prospectively maintained database of complicated appendicitis was queried. Elective interval surgery (EIS) group and early surgery (ES) were matched with propensity score and marked with a prefix ‘p.’ Patient characteristics and surgical outcomes were compared. RESULTS: The propensity score-matched EIS group had a lower chance to underwent ileo-cecectomy or right hemicolectomy (1.5% vs. 6.9%, P = 0.031), a tendency of lower rate of postoperative complication (6.9% vs. 13.7%, P = 0.067), a lower rate of wound infection (1.5% vs. 8.4%, P = 0.010), and shorter postoperative hospital stay (3.72 days vs. 5.82 days, P < 0.001) than the propensity score-matched ES group. Multivariate analysis showed that delayed surgery for more than 48 hours or urgent surgery due to failure of EIS and open conversion were independent risk factors for postoperative complications (P = 0.001 and P = 0.025, respectively). In subgroup analysis, high American Society of Anesthesiologists physical status classification and distant abscess or generalized ascites in initial CT increased the risk of failure of EIS. CONCLUSION: EIS can be a useful option for selected adult patients with complicated appendicitis.
Abscess ; Adult ; Appendectomy ; Appendicitis ; Ascites ; Classification ; Humans ; Length of Stay ; Multivariate Analysis ; Postoperative Complications ; Propensity Score ; Prospective Studies ; Risk Factors ; Surgeons ; Wound Infection

Inflammatory pseudotumor is a benign disease entity, which is histologically composed of inflammatory cells and fibrotic stroma. It is mainly found in the respiratory tract, but it has also been reported in the liver, central nervous system, soft tissues, urological system, and gastrointestinal tract. It is extremely rare in the spleen and there have been no cases of splenic inflammatory pseudotumor associated with autoimmune thyroiditis in Korea. The pathogenesis or etiology is unknown, but hypotheses include infection, autoimmunity, and parenchymal necrosis with hemorrhage. Because inflammatory pseudotumor may mimic malignant tumors on radiologic findings, pathologic confirmation is necessary to distinguish it from lymphoproliferative disorders of the spleen and other malignant tumors. We report a case of inflammatory pseudotumor of the spleen associated with autoimmune thyroiditis in a patient who complained of periumbilical pain.
Autoimmunity ; Central Nervous System ; Gastrointestinal Tract ; Granuloma, Plasma Cell* ; Hemorrhage ; Humans ; Korea ; Liver ; Lymphoproliferative Disorders ; Necrosis ; Respiratory System ; Spleen* ; Thyroiditis, Autoimmune*

We report an anesthetic experience in a clinically euthyroid patient with hyperthyroxinemia (elevated free thyroxine, fT4 and normal 3, 5, 3'-L-triiodothyronine, T3) and suspected impairment of conversion from T4 to T3. Despite marked hyperthyroxinemia, this patient's perioperative hemodynamic profile was suspected to be the result of hypothyroidism, in reference to the presence of T4 to T3 conversion disorder. We suspected that pretreatment with antithyroid medication before surgery, surgical stress and anesthesia may have contributed to the decreased T3 level after surgery. She was treated with liothyronine sodium (T3) after surgery which restored her hemodynamic profile to normal. Anesthesiologists may be aware of potential risk and caveats of inducing hypothyroidism in patients with euthyroid hyperthyroxinemia and T4 to T3 conversion impairment.
Anesthesia ; Conversion Disorder ; Hemodynamics ; Humans ; Hyperthyroxinemia* ; Hypothyroidism ; Sodium ; Thyroxine ; Triiodothyronine

Human embryonic stem cells (hESCs) are considered to be able to stably maintain their characteristics in vitro for prolonged periods, but we had previously encountered changes in proliferative ability and differentiation potential during extended culture of hESCs. Therefore, we investigated the proliferative ability and differentiation potential of hESCs during long-term culture. The hESCs, SNUhES3, were used to analyze population-doubling time, proliferation rate and differentiation potential. We classified hESCs into three groups according to culture period. Ten colonies of hESCs for each group were daily measured colony area and population-doubling time was assessed by the changes of colony area. Proliferation rate of hESCs was measured by 5-bromo-2'-deoxyuridine (BrdU) assay and telomerase activity. To evaluate differentiation potentials for hESCs, expression levels of undifferentiated and/or differentiated hESCs markers were examined by FACS, RT-PCR and immunostaining. Population-doubling time of early passage hESCs was longer than those of middle or late passage. Proliferative ability of hESCs was accelerated depending on culture periods. Cellular morphologies and the expression level of each three germ layer markers were obviously different from each passage of reattached embryoid bodies (EBs) after spontaneous differentiation. Differentiated cells of late passage expressed higher levels of undifferentiated markers such as Oct4 and SSEA4 than those of early and middle passage. But differentiated cells of early and middle passage expressed higher level of differentiated state markers, Nestin (ectoderm), Brachyury (mesoderm), HNF3beta (endoderm). From these results, it can be inferred that hESCs show higher proliferative abilities and reduced differentiation potentials as the passage number increased. Therefore, we conclude that early passage hESCs could be more suitable than middle and late passage hESCs in differentiation studies.
Biological Markers/metabolism ; Bromodeoxyuridine/metabolism ; *Cell Differentiation ; Cell Proliferation ; Cells, Cultured ; Cyclins/metabolism ; DNA-Binding Proteins/genetics/metabolism ; Embryonic Stem Cells/*cytology/enzymology ; Flow Cytometry ; Gene Expression Regulation ; Homeodomain Proteins/genetics/metabolism ; Humans ; Karyotyping ; Octamer Transcription Factor-3/genetics/metabolism ; Telomerase/metabolism ; Time Factors