BACKGROUND: Unlike other diseases, the management of sepsis has not been fully integrated in our daily practice. The aim of this study was to determine whether repeated training could improve compliance with a 6-h resuscitation bundle in patients with severe sepsis and septic shock. METHODS: Repeated education regarding a sepsis bundle was provided to the intensive care unit and emergency department residents, nurses, and faculties in a single university hospital. The educational program was led by a multidisciplinary team. A total of 175 adult patients with severe sepsis or septic shock were identified (88 before and 87 after the educational program). Hemodynamic resuscitation bundle and timely antibiotics administration were measured for all cases and mortality at 28 days after sepsis diagnosis was evaluated. RESULTS: The compliance rate for the sepsis resuscitation bundle before the educational program was poor (0%), and repeated training improved it to 80% (p < 0.001). The 28-day mortality was significantly lower in the intervention group (16% vs. 32%, p = 0.040). Within the intervention group, patients for whom the resuscitation bundle was successfully completed had a significantly lower 28-day mortality than other patients (11% vs. 41%, p = 0.004). CONCLUSIONS: Repeated education led by a multidisciplinary team and interdisciplinary communication improved the compliance rate of the 6-h resuscitation bundle in severe sepsis and septic shock patients. Compliance with the sepsis resuscitation bundle was associated with improved 28-day mortality in the study population.
Adult ; Anti-Bacterial Agents ; Compliance ; Critical Pathways ; Diagnosis ; Education ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Intensive Care Units ; Interdisciplinary Communication ; Mortality ; Resuscitation* ; Sepsis* ; Shock, Septic

Purpose: We aimed to evaluate the effects of baked egg and milk diets on the prognosis of immunoglobulin E (IgE)-mediated food allergy in young children. Methods: In this retrospective study, we enrolled children under 36 months of age who were diagnosed with egg or milk allergy between January 2020 and July 2023. The consumption group underwent oral food challenges with baked egg or milk, and was instructed to include baked eggs and milk in their diet for at least 6 months. The control group, matched for age and specific IgE (sIgE) levels, restricted these foods. We compared the age at which tolerance was achieved, and analyzed changes in total IgE and sIgE levels against egg white (EW), ovomucoid (OM), and cow’s milk (CM) in both groups. Results: Data were collected from 24 children in both the consumption and control groups. The consumption group demonstrated a significantly earlier acquisition of tolerance to egg and milk allergies compared to the control group (median: 24 vs. 31 months, P= 0.045). In the consumption group, total IgE and CM-sIgE levels showed no significant changes (P= 0.073 and P= 0.118, respectively), while EW- and OM-sIgE levels significantly decreased (P < 0.001 and P = 0.016, respectively). In the control group, total IgE and CM-sIgE levels significantly increased from baseline (P = 0.038 and P < 0.001, respectively), whereas there were no significant changes in EW- and OM-sIgE levels (P = 0.054 and P = 0.190, respectively). Between the consumption and control groups, no significant differences were observed in the changes in total IgE or specific IgE to EW, OM, and CM before and after the observation period (P = 0.404, P = 0.238, P = 0.531, and P = 0.167, respectively). Conclusion These findings suggest that diets of baked eggs and milk may accelerate the development of tolerance in children with egg or milk allergies.

Purpose: We aimed to evaluate the effects of baked egg and milk diets on the prognosis of immunoglobulin E (IgE)-mediated food allergy in young children. Methods: In this retrospective study, we enrolled children under 36 months of age who were diagnosed with egg or milk allergy between January 2020 and July 2023. The consumption group underwent oral food challenges with baked egg or milk, and was instructed to include baked eggs and milk in their diet for at least 6 months. The control group, matched for age and specific IgE (sIgE) levels, restricted these foods. We compared the age at which tolerance was achieved, and analyzed changes in total IgE and sIgE levels against egg white (EW), ovomucoid (OM), and cow’s milk (CM) in both groups. Results: Data were collected from 24 children in both the consumption and control groups. The consumption group demonstrated a significantly earlier acquisition of tolerance to egg and milk allergies compared to the control group (median: 24 vs. 31 months, P= 0.045). In the consumption group, total IgE and CM-sIgE levels showed no significant changes (P= 0.073 and P= 0.118, respectively), while EW- and OM-sIgE levels significantly decreased (P < 0.001 and P = 0.016, respectively). In the control group, total IgE and CM-sIgE levels significantly increased from baseline (P = 0.038 and P < 0.001, respectively), whereas there were no significant changes in EW- and OM-sIgE levels (P = 0.054 and P = 0.190, respectively). Between the consumption and control groups, no significant differences were observed in the changes in total IgE or specific IgE to EW, OM, and CM before and after the observation period (P = 0.404, P = 0.238, P = 0.531, and P = 0.167, respectively). Conclusion These findings suggest that diets of baked eggs and milk may accelerate the development of tolerance in children with egg or milk allergies.

Purpose: We aimed to evaluate the effects of baked egg and milk diets on the prognosis of immunoglobulin E (IgE)-mediated food allergy in young children. Methods: In this retrospective study, we enrolled children under 36 months of age who were diagnosed with egg or milk allergy between January 2020 and July 2023. The consumption group underwent oral food challenges with baked egg or milk, and was instructed to include baked eggs and milk in their diet for at least 6 months. The control group, matched for age and specific IgE (sIgE) levels, restricted these foods. We compared the age at which tolerance was achieved, and analyzed changes in total IgE and sIgE levels against egg white (EW), ovomucoid (OM), and cow’s milk (CM) in both groups. Results: Data were collected from 24 children in both the consumption and control groups. The consumption group demonstrated a significantly earlier acquisition of tolerance to egg and milk allergies compared to the control group (median: 24 vs. 31 months, P= 0.045). In the consumption group, total IgE and CM-sIgE levels showed no significant changes (P= 0.073 and P= 0.118, respectively), while EW- and OM-sIgE levels significantly decreased (P < 0.001 and P = 0.016, respectively). In the control group, total IgE and CM-sIgE levels significantly increased from baseline (P = 0.038 and P < 0.001, respectively), whereas there were no significant changes in EW- and OM-sIgE levels (P = 0.054 and P = 0.190, respectively). Between the consumption and control groups, no significant differences were observed in the changes in total IgE or specific IgE to EW, OM, and CM before and after the observation period (P = 0.404, P = 0.238, P = 0.531, and P = 0.167, respectively). Conclusion These findings suggest that diets of baked eggs and milk may accelerate the development of tolerance in children with egg or milk allergies.

Purpose: We aimed to evaluate the effects of baked egg and milk diets on the prognosis of immunoglobulin E (IgE)-mediated food allergy in young children. Methods: In this retrospective study, we enrolled children under 36 months of age who were diagnosed with egg or milk allergy between January 2020 and July 2023. The consumption group underwent oral food challenges with baked egg or milk, and was instructed to include baked eggs and milk in their diet for at least 6 months. The control group, matched for age and specific IgE (sIgE) levels, restricted these foods. We compared the age at which tolerance was achieved, and analyzed changes in total IgE and sIgE levels against egg white (EW), ovomucoid (OM), and cow’s milk (CM) in both groups. Results: Data were collected from 24 children in both the consumption and control groups. The consumption group demonstrated a significantly earlier acquisition of tolerance to egg and milk allergies compared to the control group (median: 24 vs. 31 months, P= 0.045). In the consumption group, total IgE and CM-sIgE levels showed no significant changes (P= 0.073 and P= 0.118, respectively), while EW- and OM-sIgE levels significantly decreased (P < 0.001 and P = 0.016, respectively). In the control group, total IgE and CM-sIgE levels significantly increased from baseline (P = 0.038 and P < 0.001, respectively), whereas there were no significant changes in EW- and OM-sIgE levels (P = 0.054 and P = 0.190, respectively). Between the consumption and control groups, no significant differences were observed in the changes in total IgE or specific IgE to EW, OM, and CM before and after the observation period (P = 0.404, P = 0.238, P = 0.531, and P = 0.167, respectively). Conclusion These findings suggest that diets of baked eggs and milk may accelerate the development of tolerance in children with egg or milk allergies.

Purpose: We aimed to evaluate the effects of baked egg and milk diets on the prognosis of immunoglobulin E (IgE)-mediated food allergy in young children. Methods: In this retrospective study, we enrolled children under 36 months of age who were diagnosed with egg or milk allergy between January 2020 and July 2023. The consumption group underwent oral food challenges with baked egg or milk, and was instructed to include baked eggs and milk in their diet for at least 6 months. The control group, matched for age and specific IgE (sIgE) levels, restricted these foods. We compared the age at which tolerance was achieved, and analyzed changes in total IgE and sIgE levels against egg white (EW), ovomucoid (OM), and cow’s milk (CM) in both groups. Results: Data were collected from 24 children in both the consumption and control groups. The consumption group demonstrated a significantly earlier acquisition of tolerance to egg and milk allergies compared to the control group (median: 24 vs. 31 months, P= 0.045). In the consumption group, total IgE and CM-sIgE levels showed no significant changes (P= 0.073 and P= 0.118, respectively), while EW- and OM-sIgE levels significantly decreased (P < 0.001 and P = 0.016, respectively). In the control group, total IgE and CM-sIgE levels significantly increased from baseline (P = 0.038 and P < 0.001, respectively), whereas there were no significant changes in EW- and OM-sIgE levels (P = 0.054 and P = 0.190, respectively). Between the consumption and control groups, no significant differences were observed in the changes in total IgE or specific IgE to EW, OM, and CM before and after the observation period (P = 0.404, P = 0.238, P = 0.531, and P = 0.167, respectively). Conclusion These findings suggest that diets of baked eggs and milk may accelerate the development of tolerance in children with egg or milk allergies.

Delayed cerebral necrosis is a well-known complication of radiation therapy (RT). Because of its irreversible nature, it should be avoided if possible, but avoidance occurs at the expense of potentially compromised tumor control, despite the use of the modern advanced technique of conformal RT that minimizes radiation to normal brain tissue. Risk factors for radiation-induced cerebral necrosis include a higher dose per fraction, larger treatment volume, higher cumulative dose, and shorter time interval (for re-irradiation). The same principle can be applied to proton beam therapy (PBT) to avoid delayed cerebral necrosis. However, conversion of PBT radiation energy into conventional RT is still short of clinical support, compared to conventional RT. Herein, we describe two patients with excessively delayed cerebral necrosis after PBT, in whom follow-up MRI showed no RT-induced changes prior to 3 years after treatment. One patient developed radiation necrosis at 4 years after PBT to the resection cavity of an astroblastoma, and the other developed brainstem necrosis that became symptomatic 6 months after its first appearance on the 3-year follow-up brain MRI. We also discuss possible differences between radiation changes after PBT versus conventional RT.

PURPOSE: This study aimed to investigate the incidence and clinical features of late-onset circulatory collapse (LCC) in preterm infants. METHODS: Medical records of 327 preterm infants (born before 32 gestational weeks) admitted to the neonatal intensive care unit of Seoul National University Bundang Hospital between January 2014 and December 2017 were reviewed. LCC was defined as sudden onset of refractory hypotension occurring after 7 days of life without obvious causes, which responded to glucocorticoid administration. Clinical characteristics and outcomes in infants with LCC were compared with those in infants with hypotension associated with identifiable causes, which developed after 7 days of life. RESULTS: Among 327 preterm infants who enrolled in this study, 65 infants developed hypotension with oliguria after 7 days of life. Among these 65 infants, 35 (53.8%) met the criteria for LCC and 30 (46.2%) were diagnosed with hypotension associated with other identifiable causes. No statistically significant differences were observed in the baseline pre- and perinatal characteristics between infants with LCC and those with hypotension associated with other causes. Infants with hypotension associated with other causes showed a higher mortality rate than those with LCC (33.3% vs. 5.7%, P=0.004). The mean gestational age and birth weight of infants with LCC were 27+5±2+1 weeks and 963±245 g, respectively. LCC occurred at a mean postnatal age of 18 days. The median body weight at the time of diagnosis of LCC was 1,200 g. No association was observed between LCC and gestational age. CONCLUSION: Among preterm infants born before 32 gestastional weeks who developed hypotension after 7 days of life, nearly 50% were diagnosed with LCC without apparent identifiable causes. Infants with LCC showed a lower mortality rate than those with hypotension associated with other causes.
Birth Weight ; Body Weight ; Diagnosis ; Gestational Age ; Humans ; Hydrocortisone ; Hypotension ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Medical Records ; Mortality ; Oliguria ; Seoul ; Shock

BACKGROUND: Unlike other diseases, the management of sepsis has not been fully integrated in our daily practice. The aim of this study was to determine whether repeated training could improve compliance with a 6-h resuscitation bundle in patients with severe sepsis and septic shock. METHODS: Repeated education regarding a sepsis bundle was provided to the intensive care unit and emergency department residents, nurses, and faculties in a single university hospital. The educational program was led by a multidisciplinary team. A total of 175 adult patients with severe sepsis or septic shock were identified (88 before and 87 after the educational program). Hemodynamic resuscitation bundle and timely antibiotics administration were measured for all cases and mortality at 28 days after sepsis diagnosis was evaluated. RESULTS: The compliance rate for the sepsis resuscitation bundle before the educational program was poor (0%), and repeated training improved it to 80% (p < 0.001). The 28-day mortality was significantly lower in the intervention group (16% vs. 32%, p = 0.040). Within the intervention group, patients for whom the resuscitation bundle was successfully completed had a significantly lower 28-day mortality than other patients (11% vs. 41%, p = 0.004). CONCLUSIONS: Repeated education led by a multidisciplinary team and interdisciplinary communication improved the compliance rate of the 6-h resuscitation bundle in severe sepsis and septic shock patients. Compliance with the sepsis resuscitation bundle was associated with improved 28-day mortality in the study population.
Adult ; Anti-Bacterial Agents ; Compliance ; Critical Pathways ; Diagnosis ; Education ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Intensive Care Units ; Interdisciplinary Communication ; Mortality ; Resuscitation ; Sepsis ; Shock, Septic

Purpose: To identify factors associated with the clinical response to low-dose dexamethasone therapy (LDDT) in preterm infants for bronchopulmonary dysplasia (BPD). Methods: We used a retrospective medical record review to evaluate preterm infants who were born before 32 weeks of gestation or with a birth weight less than 1,500 g. All infants were admitted to the neonatal intensive care unit at a tertiary academic hospital between January 2010 and June 2019, and received LDDT for BPD. The preterm infants’ respiratory severity scores (RSS) were calculated from the first day of LDDT to the day of extubation, or the last day of LDDT. A good response was defined as a decreasing RSS with a slope greater than 0.181. A poor response was defined as a non-decreasing RSS, or a decreasing RSS with a slope less than 0.181 during LDDT. A total dose of 1.1 mg/kg was administered for 10 days for each single course of LDDT. Results: A total of 51 preterm infants were included in the final analysis. Thirty preterm infants (58.8 %) were in the good response group, and 21 preterm infants (41.2%) were in the poor response group. There were no significant differences in gestational age, birth weight, and sex between the good response group and poor response group. Preterm premature rupture of membrane and histologic chorioamnionitis were significantly associated with a poor response to LDDT. Higher RSS on the first day of the LDDT was associated with a good response to LDDT. Conclusion Antenatal infection and/or inflammation may be associated with an unfavorable response to postnatal LDDT for BPD. Preterm infants with more severe respiratory failure seem to benefit more from LDDT for BPD.