Background: People with special needs tend to require diverse behavioral management in dentistry. They may feel anxious or uncomfortable or may not respond to any communication with the dentists. Patients with medical, physical, or psychological disorders may not cooperate and therefore require sedation (SED) or general anesthesia (GA) to receive dental treatment. Using the healthcare big data in Korea, this study aimed to analyze the trends of SED and GA in special needs patients undergoing dental treatment. It is believed that these data can be used as reference material for hospitals and for preparation of guidelines and related policy decisions of associations or governments for special needs patients in dentistry. Methods: The study used selected health information data provided by the Korean National Health Insurance Service. Patients with a record of use of one of the eight selected drugs used in dental SED between January 2007 and September 2019, those with International Classification of Diseases-10 codes for attention deficit hyperactivity disorder (ADHD), phobia, brain disease, cerebral palsy, epilepsy, genetic disease, autism, mental disorder, mental retardation, and dementia were selected. The insurance claims data were analyzed for age, sex, sedative use, GA, year, and institution. Results: The number of special needs patients who received dental treatment under SED or GA from January 2007 to September 2019 was 116,623. Number of SED cases was 136,018, performed on 69,265 patients, and the number of GA cases was 56,308, implemented on 47,257 patients. In 2007, 3100 special needs patients received dental treatment under SED while in 2018 the number of cases increased 6 times to 18,528 SED cases. In dentistry, ADHD was the most common disability for SED cases while phobia was the most common cause of disability for GA. The male-to-female ratio with respect to SED cases was higher for males (M : F = 64.36% : 35.64%). Conclusion The application of the SED method and GA for patients with special needs in dentistry is increasing rapidly; thus, preparing guidelines and reinforcing the education and system are necessary.

In order to investigate the incidence, clinical and microbiologic characteristics of Clostridium difficile infection (CDI) in Korea, a prospective observational study was performed. From September 2008 through January 2010, all patients whose stool was tested for toxin assay A&B and/or C. difficile culture were studied for clinical characteristics. Toxin types of the isolates from stool were tested. The mean incidence of CDI per 100,000 patient-days was 71.6 by month (range, 52.5-114.0), and the ratio of CDI to antibiotic-associated diarrhea was 0.23. Among 200 CDI patients, 37.5% (75/200) was severe CDI based on severity score. Clinical outcome of 189 CDI was as followed; 25.9% (49/189) improved without treatment, 84.3% (118/140) achieved clinical cure and attributed mortality was 0.7% (1/140) with the treatment. Recurrence rate was 21.4% (30/140) and cure without recurrence was 66.4% (93/140). The most common type of toxin was toxin A-positive/toxin B-positive strain (77.5%), toxin A-negative/toxin B-positive strains or binary toxin-producing strains comprised 15.4% or 7.1%, respectively. In conclusion, the incidence of CDI in Korea is a little higher than other reports during the non-epidemic setting. We expect that the change of epidemiology and clinical severity in CDI can be evaluated based on these results.
Aged ; Bacterial Proteins/analysis ; Bacterial Toxins/analysis ; Clostridium Infections/*epidemiology/physiopathology ; Clostridium difficile/*isolation & purification/*pathogenicity ; Diarrhea/epidemiology/microbiology ; Enterocolitis, Pseudomembranous/*epidemiology/microbiology/pathology ; Enterotoxins/analysis ; Feces/microbiology ; Female ; Hospitals ; Humans ; Incidence ; Male ; Metronidazole/therapeutic use ; Middle Aged ; Prospective Studies ; Recurrence ; Republic of Korea/epidemiology ; Treatment Outcome ; Vancomycin/therapeutic use

The selection of allergen panel is very important to test for innumerable allergens throughout the Korea. However, the allergens studied are heterogeneous depending on the area the patient live and there is no methodological unification. Although, testing panel of allergens should be tailored according to the geographical areas, considering the relatively small Korean Peninsula, common inhalant allergens for test could be retrieved from the published data. Hence, this study is aimed to review the longitudinal variance of allergens in patients with allergic rhinitis live in several regional provinces of Korea, figure out the similarity and differences of sensitized allergens results derived from each study and finally make a guideline for physician in selecting the offending allergens to test. From the inception, studies which analyzing the offending allergens by either ImmunoCAP®, Multiple Allergen Simultaneous Test or Skin testing were reviewed and we found that the common sensitized allergens are house dust mites, pollen and mold plus 1–2 notable different allergens according to the specific regions. Especially, a total of 10±3 allergens adequately detected most of the sensitization of the major regions of Korea according to each age groups and special regional features. This study suggest that physicians should perform the screening of allergic rhinitis with minimally selected allergen in the light of age categories and special regional features. Standardization of allergens selection process would be predicted to have enormous benefits in establishing an insurance policy, giving sound scientific evidence and monitoring the antigenic variations of the Korean Peninsula.

Purpose: A comprehensive evaluation item was developed to assess adolescent dietary habits and nutritional practices, considering food intake, eating behaviors, and food culture, such as social support and food environment. Methods: The 59 candidate items of the evaluation checklist were obtained based on the results of the eighth Korea National Health and Nutrition Examination Survey data, Korea Dietary Reference Intakes, dietary guidelines for adolescents, Youth Risk Behavior Survey data, national nutrition policies and dietary guidelines, and literature reviews. Four hundred and three middle and high school students residing in metropolitan areas participated in a survey using the 58-item checklist, which was selected through expert evaluation and content validity ratio analysis.The construct validity of the assessment tool for the quality of adolescent diets was assessed by exploratory factor analyses to determine if the checklist items were organized properly and whether the responses to each item were distributed adequately. Results: The Bartlett sphericity test was significant for each area (p <0.001), and the eigen values were greater than one. The Kaiser-Meyer-Olkin and cumulative proportions by areas were food intake (0.765 and 56.8%, respectively), eating behaviors (0.544 and 64.8%, respectively), and food environment (0.699 and 62.4%, respectively). Twenty-two checklists were determined for the final evaluation items for the adolescents’ dietary habits and nutritional practices and were categorized into three distinct factors: food intake (10 items), eating behaviors (4 items), and food environment (8 items). Conclusion The evaluation items for adolescent dietary habits and nutritional practices is a useful checklist for easily and quickly assessing the dietary qualities and reflecting Korean adolescents and their food environmental factors related to a sustainable diet.

We report a case of bilateral pulmonary agenesis (BPA), which was suspected during a prenatal US examination and diagnosed by fetal magnetic resonance imaging (MRI). BPA is an extremely rare congenital anomaly and, although many fetal structural defects can be detected with a high degree of confidence after introducing high-resolution US, the prenatal diagnosis of BPA remains problematic. Other thoracic abnormalities, such as a congenital diaphragmatic hernia, congenital cystic adenomatoid malformation, and pulmonary sequestration, should be excluded from the list of possible diagnoses before coming to the conclusion of BPA, because BPA is absolutely incompatible with extrauterine life, and an accurate internal diagnosis can prevent a futile intervention from being performed.
Abnormalities, Multiple ; Female ; Humans ; Infant, Newborn ; Lung/*abnormalities/ultrasonography ; *Magnetic Resonance Imaging ; Male ; Pregnancy ; *Prenatal Diagnosis ; *Ultrasonography, Prenatal

To establish an appropriate policy for robotic surgery in Korea, the National Evidence-based Collaborating Agency (NECA) and the Korean Society of Health Policy and Administration held a round-table conference (RTC) to gather opinions through a comprehensive discussion of scientific information in gastric cancer. The NECA RTC is a public discussion forum wherein experts from diverse fields and members of the lay public conduct in-depth discussions on a selected social issue in the health and medical field. For this study, representatives from the medical field, patient groups, industry, the press, and policy makers participated in a discussion focused on the medical and scientific evidence for the use of robotic surgery in gastric cancer. According to the RTC results, robotic surgery showed more favorable results in safety and efficacy than open surgery and it is similar to laparoscopy. When the cost-effectiveness of robotic surgery and laparoscopy is compared, robotic surgery costs are higher but there was no difference between the two of them in terms of effectiveness (pain, quality of life, complications, etc.). In order to resolve the high cost issue of the robotic surgery, a proper policy should be implemented to facilitate the development of a cost-effective model of the robotic surgery equipment. The higher cost of robotic surgery require more evidence of its safety and efficacy as well as the cost-effectiveness issues of this method. Discussions on the national insurance coverage of robotic surgery seems to be necessary in the near future.
Adenosine-5'-(N-ethylcarboxamide) ; Administrative Personnel ; Consensus* ; Health Policy ; Humans ; Insurance Coverage ; Korea ; Laparoscopy ; Quality of Life ; Stomach Neoplasms*

Pyrazinamide (PZA) is an anti-tuberculosis drug and an essential component of the standard four-drug regimen for tuberculosis. Here, we report a case of immediate angioedema secondary to PZA administration intended for pulmonary tuberculosis treatment. A previously healthy 48-year-old woman was diagnosed with pulmonary tuberculosis and tuberculous lymphadenitis. Thirty minutes after taking the first dose of isoniazid, rifampicin, pyrazinamide, and ethambutol, the patient developed facial edema, generalized rash, and dizziness. An oral provocation test was performed on the four drugs, and 1,000 mg pyrazinamide showed a positive result characterized by 50 minutes of urticaria, angioedema, and hypotension. As the prevalence of tuberculosis increases, prescriptions for anti-tuberculosis drugs may increase as well. Clinicians should be aware of the possibility of immediate hypersensitivity as well as delayed hypersensitivity to anti-tuberculosis drugs.
Angioedema* ; Dizziness ; Drug Hypersensitivity ; Edema ; Ethambutol ; Exanthema ; Female ; Humans ; Hypersensitivity, Delayed ; Hypersensitivity, Immediate ; Hypotension ; Isoniazid ; Middle Aged ; Prescriptions ; Prevalence ; Pyrazinamide ; Rifampin ; Tuberculosis ; Tuberculosis, Lymph Node ; Tuberculosis, Pulmonary ; Urticaria*

BACKGROUND: Tauopathies, a class of neurodegenerative diseases that includes Alzheimer's disease (AD), are characterized by the deposition of neurofibrillary tangles composed of hyperphosphorylated tau protein in the human brain. As abnormal alterations in histone acetylation and methylation show a cause and effect relationship with AD, we investigated the role of several Jumonji domain-containing histone demethylase (JHDM) genes, which have yet to be studied in AD pathology. METHODS: To examine alterations of several JHDM genes in AD pathology, we performed bioinformatics analyses of JHDM gene expression profiles in brain tissue samples from deceased AD patients. Furthermore, to investigate the possible relationship between alterations in JHDM gene expression profiles and AD pathology in vivo, we examined whether tissue-specific downregulation of JHDM Drosophila homologs (kdm) can affect tauR406W-induced neurotoxicity using transgenic flies containing the UAS-Gal4 binary system. RESULTS: The expression levels of JHDM1A, JHDM2A/2B, and JHDM3A/3B were significantly higher in postmortem brain tissue from patients with AD than from non-demented controls, whereas JHDM1B mRNA levels were downregulated in the brains of patients with AD. Using transgenic flies, we revealed that knockdown of kdm2 (homolog to human JHDM1), kdm3 (homolog to human JHDM2), kdm4a (homolog to human JHDM3A), or kdm4b (homolog to human JHDM3B) genes in the eye ameliorated the tauR406W-engendered defects, resulting in less severe phenotypes. However, kdm4a knockdown in the central nervous system uniquely ameliorated tauR406W-induced locomotion defects by restoring heterochromatin. CONCLUSION: Our results suggest that downregulation of kdm4a expression may be a potential therapeutic target in AD.
Acetylation ; Alzheimer Disease ; Brain ; Central Nervous System ; Computational Biology ; Diptera ; Down-Regulation ; Drosophila melanogaster ; Drosophila ; Heterochromatin ; Histones ; Humans ; Locomotion ; Methylation ; Neurodegenerative Diseases ; Neurofibrillary Tangles ; Pathology ; Phenotype ; RNA, Messenger ; tau Proteins ; Tauopathies ; Transcriptome

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis and multisystem disease. First described in 1930, there are no more than 750 cases reported. The etiology remains unknown, but a majority of cases of ECD and Langerhans cell histiocytosis were found to have clonal mutations involving genes of the mitogen-activated protein kinase pathway. We recently encountered a 53-year-old male patient with extensive ECD involving the systemic lymph nodes, pleura, liver, and long bones clinically mimicking malignant lymphoma. Biopsies were performed at multiple sites, including a pleural mass, an external iliac lymph node, bone marrow, and the liver. Based on histopathological and immunohistochemical findings of positivity for CD68 and negativity for CD1a and S-100, the patient was diagnosed with ECD. Interferon-α was administered as the first-line treatment, but the patient rapidly progressed to hepatic failure after 2 months of treatment. We report this rare case of ECD clinically mimicking malignant lymphoma and diagnosed by careful pathological review.
Biopsy ; Bone Marrow ; Erdheim-Chester Disease ; Histiocytosis ; Histiocytosis, Langerhans-Cell ; Humans ; Liver Failure ; Liver ; Lymph Nodes ; Lymphoma ; Male ; Middle Aged ; Pleura ; Protein Kinases ; Spine

BACKGROUND: Extended-spectrum cephalosporins (ESCs)-resistant Enterobacter cloacae is one of the pathogens of nosocomial infection the incidence of which is on the rise. Moreover, plasmid-mediated quinolone resistance genes (PMQR genes) that reduce quinolone sensitivity have been shown to be widely distributed among clinical isolates of Enterobacteriaceae. This study was carried out to observe the distribution of PMQR genes in clinical isolates of E. cloacae resistant to ESCs. MATERIALS AND METHODS: Fourty-three ESCs-resistant E. cloacae strains from the blood collected during the span of 7 years, from 1994 to 2001, at Seoul National University Children's Hospital (SNUCH) were included in this study. Isoelectric focusing and enzyme specific PCR were performed to characterize beta-lactamase. The presence of qnrA, qnrB, qnrC, qnrS, qepA, and aac(6')-Ib-cr was determined by PCR, restriction enzyme analyses of PCR products, and DNA sequencing. Minimal inhibitory concentration (MIC) of several quinolones was measured by agar dilution method. RESULTS: The PMQR genes were detected in 9 (21%) of 43 ESCs-resistant E. cloacae isolates. Among them, five isolates were positive for qnrB2, and each two isolates harbored qnrB4 or qnrB5, respectively. qnrA, qnrC, qnrS or qepA was not identified. aac(6')-Ib was detected in 27 isolates, but aac(6')-Ib-cr was not found. Among the 9 qnrB-positive isolates, 5 produced SHV-12, 3 were derepressed mutants, and 1 produced pI 7.5 beta-lactamase. MIC ranges and percent resistances of nalidixic acid, ofloxacin, levofloxacin, and moxifloxacin for the PMQR genes-positive isolates were higher than PMQR genes-negative isolates. CONCLUSION: In this study, ESCs-resistant E. cloacae showed a high prevalence of PMQR genes, and qnrB was the only PMQR gene identified.
Agar ; Aza Compounds ; beta-Lactamases ; Cephalosporins ; Cloaca ; Cross Infection ; Enterobacter ; Enterobacter cloacae ; Enterobacteriaceae ; Incidence ; Isoelectric Focusing ; Nalidixic Acid ; Ofloxacin ; Polymerase Chain Reaction ; Prevalence ; Quinolines ; Quinolones ; Restriction Mapping ; Sequence Analysis, DNA