Purpose: To examine the prevalence and clinical manifestations of eosinophilic esophagitis (EoE) in Korea children. Methods: The study was designed as a 1:2 matching case-control study. Using information from the endoscopic database of a tertiary center, we retrospectively reviewed the medical records of patients aged 18 years or younger who underwent upper gastrointestinal endoscopy between January 2014 and December 2017. A total of 21 patients were diagnosed with EoE based on current diagnostic criteria. In addition, 42 controls with normal esophageal biopsy findings matched to each EoE case by sex, age (±1 months), and season were randomly selected during the study period. Results: The mean age of EoE diagnosis was 12.1±4.0 years and the male-to-female ratio was 2:1. The proportion of allergic diseases in patients with EoE (28.6%) was higher than that in the controls (6.8%) (p=0.04). Most EoE patients tested for allergy were positive for at least one antigen, which was significantly different to the controls (88.2% vs. 47.4%, p=0.01). Characteristic endoscopic findings of EoE were noted in 19 patients (90.5%), but 2 patients (9.5%) showed normal esophageal mucosa. The clinical symptoms of EoE were improved by a proton-pump inhibitor in 10 patients (50.0%), and by an H2 blocker in 9 patients (45.0%). Only one patient (5.0%) required inhaled steroids. Conclusion While EoE is rare in the Korean pediatric population, the results of this study will improve our understanding of the clinical manifestations of the disease.

Myositis ossificans (MO) is a benign condition of non-neoplastic heterotopic bone formation in the muscle or soft tissue. Trauma plays a role in the development of MO, thus, non-traumatic MO is very rare. Although MO may occur anywhere in the body, it is rarely seen in the lumbosacral paravertebral muscle (PVM). Herein, we report a case of non-traumatic MO in the lumbosacral PVM. A 42-year-old man with no history of trauma was referred to our hospital for pain in the low back, left buttock, and left thigh. On physical examination, a slightly tender, hard, and fixed mass was palpated in the left lumbosacral PVM. Computed tomography showed a calcified mass within the left lumbosacral PVM. Magnetic resonance imaging (MRI) showed heterogeneous high signal intensity in T1- and T2-weighted image, and no enhancement of the mass was found in the postcontrast T1-weighted MRI. The lack of typical imaging features required an open biopsy, and MO was confirmed. MO should be considered in the differential diagnosis when the imaging findings show a mass involving PVM. When it is difficult to distinguish MO from soft tissue or bone malignancy by radiology, it is necessary to perform a biopsy to confirm the diagnosis.
Biopsy ; Buttocks ; Diagnosis, Differential ; Magnetic Resonance Imaging ; Muscles ; Myositis ; Myositis Ossificans ; Osteogenesis ; Physical Examination ; Thigh

Hypersensitivity to mosquito bites (HMB) is a rare disease characterized by intense skin reactions such as bulla and necrotic ulcerations at bite sites, accompanied by general symptoms such as high-grade fever and malaise occurred after mosquito bites. It has been suggested that HMB is associated with chronic Epstein-Barr virus (EBV) infection and natural killer (NK) cell leukemia/lymphoma. We describe here a Korean child who presented with 3-yr history of HMB without natural killer cell lymphocytosis. He has been ill for 6 yr with HMB. Close observation and examination for the development of lymphoproliferative status or hematologic malignant disorders is needed.
Child ; Epstein-Barr Virus Infections/complications ; Humans ; Hypersensitivity/*diagnosis/etiology ; Insect Bites and Stings/*diagnosis/pathology ; Killer Cells, Natural/immunology ; Lymphocytosis/complications/pathology ; Male ; Republic of Korea ; Skin/pathology

Herein, we describe cases of pulmonary acute graft-versus-host disease (aGVHD) in two patients occurring after allogeneic hematopoietic stem cell transplantation (HSCT) due to precursor B-cell acute lymphoblastic leukemia in a 6-year-old patient and in acute myeloid leukemia in a 14-year-old boy. In both cases, chest CT revealed confluent ground-glass attenuation along the bronchovascular bundles, as well as some bronchial dilatation. Microscopically, in both cases we noted a characteristic bronchiolocentric pattern and bronchiolar epithelial changes, which included denudation of the bronchiolar epithelium, regenerating atypical cells, and wall thickening with subepithelial or transmural fibroblast proliferation, along with some lymphocytic infiltration. One patient died on day 86 after allogeneic HSCT due to sudden acute respiratory distress syndrome, and the other patient currently remains alive without active aGVHD. The authors' experiences in these two cases demonstrate that intense awareness of the pathologic findings of GVHD is mandatory after allogeneic HSCT.
Adolescent ; Child ; Dilatation ; Epithelium ; Fibroblasts ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Leukemia ; Leukemia, Myeloid, Acute ; Lung ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Precursor Cells, B-Lymphoid ; Respiratory Distress Syndrome, Adult ; Thorax

BACKGROUND: The purpose of this study was to investigate the prognostic significance of the Epstein-Barr virus (EBV) infected non-neoplastic lymphocytes in patients with Hodgkin lymphoma (HL). METHODS: Seventy-seven cases of HL were evaluated by immunohistochemical analysis and EBV-encoded RNA in situ hybridization. The cases were divided into three groups according to the EBV status. EBV was negative in 48 cases (group 1), EBV was located in the Hodgkin/Reed-Sternberg (HRS) cells, but not in the non-neoplastic lymphocytes in 20 cases (26%) (group 2) and EBV was located in both the HRS cells and the non-neoplastic lymphocytes in 9 cases (12%) (group 3). RESULTS: The groups differed with respect to the age distribution, the clinical presentation and the prognosis. The median ages were 30 (group 1), 47.5 (group 2) and 23 years (group 3) (p = 0.011). B symptoms (p = 0.007) and the histologic subtype of mixed cellularity classical HL (p = 0.001) were more common in the EBV-positive patients than in their EBV-negative counterparts. Two patients from group 3 had associated chronic EBV infection syndrome. The five-year survival rate was 97.56% in group 1, 75.76% in group 2 and 100% in group 3 (p = 0.0178). CONCLUSIONS: HL with EBV located in both the HRS cells and the non-neoplastic lymphocytes is a distinct prognostic subgroup that has better survival than the HL with EBV located in only the HRS cells.
Age Distribution ; Epstein-Barr Virus Infections ; Herpesvirus 4, Human ; Hodgkin Disease ; Humans ; In Situ Hybridization ; Lymphocytes ; Prognosis ; RNA ; Survival Rate

With fragments of brittle materials including glasses, ceramics, metals, plastics, and stones, various wounds can be formed by accident or homicide. We experienced two cases with fatal injury from shattering of brittle materials accidentally. In the first case, a woman died from the left subclavian artery transection by a projected fragment from a mug shattering. In the second case, a man pilfer died of the right popliteal artery and vein transection by fragments from shattering of a glass bottle. We represented these cases to adress it in depth the significance of deaths associated with fatal injuries caused by shattered fragments of brittle materials on the viewpoints of forensic pathology.
Ceramics ; Eyeglasses ; Female ; Forensic Pathology ; Glass ; Homicide ; Humans ; Metals ; Plastics ; Popliteal Artery ; Subclavian Artery ; Veins

Purpose: Access block due to the lack of hospital beds causes crowding of emergency departments (ED). We initiated the “boarding restriction protocol” that limits the time of stay in the ED for patients awaiting hospitalization to 24 hours from arrival. The purpose of this study was to determine the effect of the boarding restriction protocol on ED crowding. Materials and Methods: The primary outcome was ED occupancy rate, which was calculated as the ratio of the number of occupying patients to the total number of ED beds. Time factors, such as length of stay (LOS), treatment time, and boarding time, were investigated. Results: The mean of the ED occupancy rate decreased from 1.532±0.432 prior to implementation of the protocol to 1.273±0.353 after (p<0.001). According to time series analysis, the absolute effect caused by the protocol was -0.189 (-0.277 to -0.110) (p=0.001). The proportion of patients with LOS exceeding 24 hours decreased from 7.6% to 4.0% (p<0.001). Among admitted patients, ED LOS decreased from 770.7 (421.4–1587.1) minutes to 630.2 (398.0–1156.8) minutes (p<0.001); treatment time increased from 319.6 (198.5–482.8) minutes to 344.7 (213.4–519.5) minutes (p<0.001); and boarding time decreased from 298.9 (109.5–1149.0) minutes to 204.1 (98.7–545.7) minutes (p<0.001). In pre-protocol period, boarding patients accumulated in the ED during the weekdays and resolved on Friday, but this pattern was alleviated in post-period. Conclusion The boarding restriction protocol was effective in alleviating ED crowding by reducing the accumulation of boarding patients in the ED during the weekdays

OBJECTIVES: The purpose of this study was to explore the influence of high school students' mental health on their academic achievement and school dropout rate by using longitudinal data. METHODS: For this study, 153 high schools were randomly sampled on a nationwide scale. The descriptive data was collected from a school information internet site which is organized by the Korean Ministry of Education. We used the schools' mean scores on the Adolescent Mental Health Problem-Behavior Questionnaire-II (AMPQ-II) scale which was used for estimating students' mental health in the 2013 school-based mental health screening test. The data analysis was conducted by using hierarchical regression analysis. RESULTS: The results of this study showed that the AMPQ-II scale's mean scores have significant effects on the following year's academic achievement and annual dropout rates. Especially, the AMPQ-II scale's mean scores tend to increase the school dropout rate in vocational schools. CONCLUSION: The finding of this study is that Korean high school students' mental health states significantly influence their academic achievement and school dropout rate.
Adolescent ; Education ; Humans ; Internet ; Mass Screening ; Mental Health* ; Statistics as Topic ; Student Dropouts*

BACKGROUND: Hypercholesterolemia is a risk factor of cardiovascular diseases and metabolic syndrome. Cholesterol level in childhood is related to the development of cardiovascular diseases in adulthood. This study aimed to investigate cholesterol levels of first grade students in elementary school, to analyze the relationship between the children's cholesterol levels and those of parents' and to evaluate the factors influencing children's cholesterol levels. METHODS: In 2004, a sample of 108 first-graders in elementary school in Gwacheon city and their 216 parents were included in this study. Height, weight, body mass index, waist and hip circumference and blood pressure were measured and bio-chemical data were obtained. The children's birth weight, eating habits, physical activity, occupation, educational background, married status, mean monthly income of each family were obtained by questionnaire. RESULTS: The correlation coefficient between children's cholesterol and fathers' cholesterol was 0.331 (P<0.001). The correlation coefficient between children's cholesterol and mothers' cholesterol was 0.364 (P<0.001). The mean total cholesterol level in children differed significantly according to mother's smoking status, mother's overeating due to stress and mother's diet restriction tendency for weight control. In multiple linear regression analysis of children's cholesterol as dependent variable, the explanation power (R(2)) of the model including children's sex, father's age and cholesterol levels, mother's age and cholesterol levels was 0.281. The explanation power (R(2)) of the other model including variables of the previous model and children's fruit consumption, parent's eating out tendency, mother's smoking status, mother's other behavior during mealtime, mother's overeating due to stress and mother's diet restriction tendency for weight control was 0.388. In final model, only the parent's cholesterol levels had significant effect on children's cholesterol levels. CONCLUSION: It was parent's cholesterol level that affected significantly on the children's cholesterol level.
Birth Weight ; Blood Pressure ; Body Weight ; Cardiovascular Diseases ; Child* ; Cholesterol* ; Diet ; Eating ; Fruit ; Gyeonggi-do* ; Hip ; Humans ; Hypercholesterolemia ; Hyperphagia ; Linear Models ; Meals ; Motor Activity ; Occupations ; Parents* ; Risk Factors ; Smoke ; Smoking ; Surveys and Questionnaires

Objective: Insomnia is associated with elevated high-frequency electroencephalogram power in the waking state. Although affective symptoms (e.g., depression and anxiety) are commonly comorbid with insomnia, few reports distinguished objective sleep disturbance from affective symptoms. In this study, we investigated whether daytime electroencephalographic activity explains insomnia, even after controlling for the effects of affective symptoms. Methods: A total of 107 participants were divided into the insomnia disorder (n = 58) and healthy control (n = 49) groups using the Mini-International Neuropsychiatric Interview and diagnostic criteria for insomnia disorder. The participants underwent daytime resting-state electroencephalography sessions (64 channels, eye-closed). Results: The insomnia group showed higher levels of anxiety, depression, and insomnia than the healthy group, as well as increased beta [t(105) = −2.56, p = 0.012] and gamma [t(105) = −2.44, p = 0.016] spectra. Among all participants, insomnia symptoms positively correlated with the intensity of beta (r = 0.28, p ＜ 0.01) and gamma (r = 0.25, p ＜ 0.05) spectra. Through hierarchical multiple regression, the beta power showed the additional ability to predict insomnia symptoms beyond the effect of anxiety (ΔR2 = 0.041, p = 0.018). Conclusion Our results showed a significant relationship between beta electroencephalographic activity and insomnia symptoms, after adjusting for other clinical correlates, and serve as further evidence for the hyperarousal theory of insomnia. Moreover, resting-state quantitative electroencephalography may be a supplementary tool to assess insomnia.