Non-cardiac chest pain is a common disorder that leads to costly evaluations to distinguish it from cardiac pain. The present study aimed to clarify the clinical characteristics of erosive esophagitis in children with non-cardiac chest pain. Ninety nine patients (mean age, 9.55 ± 2.95 years, 49 girls) with non-cardiac chest pain were enrolled. Patients were classified into two groups: erosive esophagitis and non-erosive esophagitis-related non-cardiac chest pain by esophagogastroduodenoscopy. Children in the erosive esophagitis-related non-cardiac chest pain group were significantly older (10.95 ± 2.54 years vs. 8.52 ± 2.83 years). Multivariate logistic regression analysis identified the following predictors of gastroesophageal reflux: chest pain related to sleep (odds ratio = 18.05, 95% confidence interval: 3.18-102.49); unfavorable dietary habits (odds ratio = 7.11, 95% confidence interval: 1.53-32.87); chest pain related to food (odds ratio = 5.09, 95% confidence interval: 1.37-18.86); epigastric pain (odds ratio = 3.73, 95% confidence interval: 1.12-12.33); and nausea, vomiting, and/or regurgitation (odds ratio = 4.35, 95% confidence interval: 1.22-15.54). Gastroesophageal reflux disease should be considered first in children with non-cardiac chest pain. Children with gastroesophageal reflux disease should receive medical treatment and lifestyle modifications.
Adolescent ; Chest Pain ; Child ; Child, Preschool ; Demography ; Endoscopy, Digestive System ; Esophagitis/*diagnosis ; Female ; Gastroesophageal Reflux/diagnosis ; Humans ; Male ; Odds Ratio ; Retrospective Studies ; Risk Factors ; Sleep ; Surveys and Questionnaires

PURPOSE: Viral gastroenteritis among children is mainly caused by rotavirus, norovirus, astrovirus, or adenovirus strains. However, changing socioeconomic conditions and a rotavirus vaccination program may be affecting the prevalence of these viral infections. Therefore, we aimed to elucidate the season-specific trends in viral infections for facilitating prophylaxis and surveillance in our region. METHODS: We evaluated 345 pediatric patients (203 males, 142 females; age, 1 month to 16 years) who visited the CHA Bundang Medical Center because of gastroenteric symptoms between June 2014 and May 2015. The specimens were simultaneously tested for norovirus, rotavirus, astrovirus, and adenovirus via multiplex reverse transcription polymerase chain reaction. Clinical characteristics of patients were analyzed retrospectively. RESULTS: The most common virus was norovirus, followed by rotavirus, adenovirus, and astrovirus. Of all viral infections, 45.2% occurred mainly between 6 and 24 months of age; in particular, norovirus infection mostly occurred in all age groups except those below 6 months of age, when rotavirus was most prevalent. In addition, seasonal variation was observed, such as norovirus infection from December to February, rotavirus infection from February to April, and adenovirus infection from July to October. CONCLUSION: Our results showed that the most common cause of acute pediatric viral gastroenteritis had changed from rotavirus to norovirus in our patients, because of effective rotaviral vaccination. We recommend the management of food and personal hygiene in accordance with age or seasons as well as active vaccination for preventing viral gastroenteritis.
Adenoviridae ; Adenoviridae Infections ; Child ; Female ; Gastroenteritis* ; Humans ; Hygiene ; Male ; Norovirus ; Pediatrics ; Polymerase Chain Reaction ; Prevalence ; Retrospective Studies* ; Reverse Transcription ; Rotavirus ; Rotavirus Infections ; Seasons ; Tertiary Care Centers* ; Vaccination

PURPOSE: Viral gastroenteritis among children is mainly caused by rotavirus, norovirus, astrovirus, or adenovirus strains. However, changing socioeconomic conditions and a rotavirus vaccination program may be affecting the prevalence of these viral infections. Therefore, we aimed to elucidate the season-specific trends in viral infections for facilitating prophylaxis and surveillance in our region. METHODS: We evaluated 345 pediatric patients (203 males, 142 females; age, 1 month to 16 years) who visited the CHA Bundang Medical Center because of gastroenteric symptoms between June 2014 and May 2015. The specimens were simultaneously tested for norovirus, rotavirus, astrovirus, and adenovirus via multiplex reverse transcription polymerase chain reaction. Clinical characteristics of patients were analyzed retrospectively. RESULTS: The most common virus was norovirus, followed by rotavirus, adenovirus, and astrovirus. Of all viral infections, 45.2% occurred mainly between 6 and 24 months of age; in particular, norovirus infection mostly occurred in all age groups except those below 6 months of age, when rotavirus was most prevalent. In addition, seasonal variation was observed, such as norovirus infection from December to February, rotavirus infection from February to April, and adenovirus infection from July to October. CONCLUSION: Our results showed that the most common cause of acute pediatric viral gastroenteritis had changed from rotavirus to norovirus in our patients, because of effective rotaviral vaccination. We recommend the management of food and personal hygiene in accordance with age or seasons as well as active vaccination for preventing viral gastroenteritis.
Adenoviridae ; Adenoviridae Infections ; Child ; Female ; Gastroenteritis* ; Humans ; Hygiene ; Male ; Norovirus ; Pediatrics ; Polymerase Chain Reaction ; Prevalence ; Retrospective Studies* ; Reverse Transcription ; Rotavirus ; Rotavirus Infections ; Seasons ; Tertiary Care Centers* ; Vaccination

Background: The quality of a vaccine depends strongly on the effects of the adjuvants applied simultaneously with the antigen in the vaccine. The adjuvants enhance the protective effect of the vaccine against a viral challenge. Conversely, oil-type adjuvants leave oil residue inside the bodies of the injected animals that can produce a local reaction in the muscle. The longterm immunogenicity of mice after vaccination was examined. ISA206 or ISA15 oil adjuvants maintained the best immunity, protective capability, and safety among the oil adjuvants in the experimental group. Objectives: This study screened the adjuvant composites aimed at enhancing foot-andmouth disease (FMD) immunity. The C-type lectin or toll-like receptor (TLR) agonist showed the most improved protection rate. Methods: Experimental vaccines were fabricated by mixing various known oil adjuvants and composites that can act as immunogenic adjuvants (gel, saponin, and other components) and examined the enhancement effect on the vaccine. Results: The water in oil (W/O) and water in oil in water (W/O/W) adjuvants showed better immune effects than the oil in water (O/W) adjuvants, which have a small volume of oil component. The W/O type left the largest amount of oil residue, followed by W/O/W and O/W types. In the mouse model, intramuscular inoculation showed a better protection rate than subcutaneous inoculation. Moreover, the protective effect was particularly weak in the case of inoculation in fatty tissue. The initial immune reaction and persistence of long-term immunity were also confirmed in an immune reaction on pigs. Conclusions The new experimental vaccine with immunostimulants produces improved immune responses and safety in pigs than general oil-adjuvanted vaccines.

Graves' disease following subacute thyroiditis is uncommon. Some patients in these cases showed positive for thyroid antibody only transiently in the resolving phase. However, Graves' disease can rarely be caused by the presence of antibodies after subacute thyroiditis, although the pathophysiology of this is unclear. A 40-year-old woman presented with anterior neck pain and swallowing difficulty. Thyroid function testing showed reduced thyroid-stimulating hormone (TSH) and elevated free thyroxine levels. A thyroid scan revealed decreased uptake in the bilateral thyroid gland. The patient was initially diagnosed with subacute thyroiditis and treated with steroids. Five months later, thyroid function testing showed recurrent hyperthyroidism with positive conversion of TSH receptor antibody, indicating Graves' disease. Since then, she needed the long-term methimazole treatment. In summary, we herein report a case of Graves' disease occurring after subacute thyroiditis.
Adult ; Antibodies ; Deglutition ; Female ; Graves Disease* ; Humans ; Hyperthyroidism ; Immunoglobulins, Thyroid-Stimulating ; Methimazole ; Neck Pain ; Receptors, Thyrotropin ; Steroids ; Thyroid Function Tests ; Thyroid Gland ; Thyroiditis, Subacute* ; Thyrotropin ; Thyroxine

Mycobacterium avium complex (MAC) is the most common pathogen in nontuberculous mycobacterial lung diseases, but vertebral osteomyelitis caused by MAC is rare. We experienced a case of vertebral osteomyelitis with epidural abscess in a rheumatoid arthritis patient who received immunosuppressive agents. Initial assessment was tuberculous vertebral osteomyelitis, and then treated with antituberculous drugs. Fifty-six days later, Mycobacterium intracellulare was identified from abscess culture and drugs were altered to clarithromycin, rifabutin, and ethambutol. After 3 months of M. intracellulare treatment, the radiological findings showed increases of epidural abscess. According to the suseptibility, the patient received intravenous amikacin for four weeks, and then, oral ciprofloxacin in addition to clarithromycin, rifabutin, and ethambutol. The patient is being treated with the medication for 13 months and currently showing slow improvements.
Abscess ; Amikacin ; Arthritis, Rheumatoid ; Ciprofloxacin ; Clarithromycin ; Epidural Abscess ; Ethambutol ; Humans ; Immunosuppressive Agents ; Lung Diseases ; Mycobacterium ; Mycobacterium avium Complex ; Nontuberculous Mycobacteria ; Osteomyelitis ; Rifabutin

PURPOSE: The prognosis of breast cancer in very young women is generally considered to be unfavorable. In addition, younger patients (<35 years) with estrogen- receptor (ER) positive tumor had shown a significantly worse disease- free survival than younger patients with ER negative tumors. To confirm the prognostic effects of ER on the survival in very young Korean women with early breast cancer, we performed a retrospective study with survival analyses according to the expression of hormonal receptors. METHODS: Total 74 very young women with early breast cancer (invasive ductal carcinoma, NOS, < or=35 years, and stage Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Case-Control Studies ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Medical Records ; Prognosis ; Retrospective Studies ; Survival Rate

Pelizaeus-Merzbacher disease (PMD) is a rare, X-linked recessive disorder characterized by dysmyelination in the central nervous system. PMD results from deletion, mutation, or duplication of the proteolipid protein gene (PLP1) located at Xq22, leading to the failure of axon myelination by oligodendrocytes in the central nervous system. PMD may be suspected when there are clinical manifestations such as nystagmus, developmental delays, and spasticity, and genetic analysis can confirm the diagnosis. Further diagnostic manifestations of the disease include a lack of myelination on brain magnetic resonance (MR) imaging and aberrant N-acetyl aspartate (NAA) and choline concentrations that reflect axonal and myelination abnormalities on phroton MR spectroscopy. We report 5 cases of PMD (in 1 girl and 4 boys). PLP1 duplication was detected in 2 patients. Brain MR analyses and MR spectroscopy were performed for all the patients. The brain MR images showed white matter abnormalities typical of PMD, and the MR spectroscopic images showed diverse patterns of NAA, creatinine, and choline concentrations. We propose that MR spectroscopic analysis of metabolic alterations can aid the PMD diagnosis and can contribute to a better understanding of the pathogenesis of the disease.
Aspartic Acid ; Axons ; Brain ; Central Nervous System ; Choline ; Creatinine ; Humans ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Muscle Spasticity ; Myelin Sheath ; Oligodendroglia ; Pelizaeus-Merzbacher Disease

PURPOSE: Two different disorders, Prader-Willi syndrome (PWS) and Angelman syndrome (AS) are caused by the deletion of 15q11-13 or the maternal/paternal uniparental disomy of chromosome 15 (mUPD(15)/pUPD(15)) through the genomic imprinting phenomenon. We studied the clinical manifestations of both diseases and genotype-phenotype correlations in PWS. METHODS: We retrospectively analyzed medical records of patients who had been genetically confirmed as PWS or AS from December 1998 to March 2010 at Asan Medical Center. Clinical characteristics at diagnosis and genetic causes were reviewed. In PWS, clinical characteristics of the patients with microdeletions were compared with those with mUPD(15). RESULTS: During the study period, we found 90 patients with PWS and 30 with AS. In cases of PWS, the male to female ratio was 1.65:1 and the mean age at initial diagnosis was 41 months. Symptoms at first diagnosis were hypotonia (70 cases) and developmental delay (66 cases). More hypopigmentation and eye abnormalities occurred in the microdeletion group (n=62) than in the mUPD(15) group (n=21). In AS, the male to female ratio was 1.3:1 and the mean age at initial diagnosis was 23 months. Distinguishing symptoms were speech impairment, seizure, and behavioral uniqueness. Microdeletion by FISH was detected in 19 patients among 20 patients and one of the non-deletion patient showed pUPD(15) on a DNA methylation test. CONCLUSION: PWS and AS, two distinct neurogenetic disorders with different clinical presentations were the first known examples of human diseases involving imprinted genes. This study about clinical characteristics and genetic analysis of PWS and AS may help our understanding of these diseases and thus, assist in making correct diagnoses.
Angelman Syndrome ; Chromosomes, Human, Pair 15 ; DNA Methylation ; Eye Abnormalities ; Female ; Genetic Association Studies ; Genomic Imprinting ; Humans ; Hypopigmentation ; Male ; Medical Records ; Muscle Hypotonia ; Prader-Willi Syndrome ; Retrospective Studies ; Seizures ; Uniparental Disomy

PURPOSE: This study was to examine the relationship between mental health status and suicidal thinking among cancer patients. METHODS: The data set of the 4th Korea National Health and Nutrition Survey (2009) was used and 230 subjects with cancers were included in the present study. Using SPSS/WIN 18.0 program, data were analyzed with descriptive statistics, chi2 test and logistic regression analysis. RESULTS: About one-third of subjects had stress, symptoms of depression and suicidal thinking. Female had more suicidal thinking than male (chi2=5.44, p=.020). In addition, subjects with high income level had more thinking about suicide compared with those in low income level (chi2=7.54, p=.023). There was a significant difference in suicidal thinking according to the educational levels (chi2=13.25, p=.004). In the logistic regression analysis, it was indicated that gender, depression and stress were significant predictors on suicidal thinking, accounting for 26.7~38.1%. CONCLUSION: From the findings in this study, it was suggested that the healthcare providers should try to improve their mental health status in order to prevent suicidal thinking among the individuals diagnosed with cancer.
Accounting ; Depression ; Female ; Health Personnel ; Humans ; Korea ; Logistic Models ; Male ; Mental Health ; Nutrition Surveys ; Suicide ; Thinking