Orthosiphon aristatus (Lamiaceae) is a perennial herbaceous plant native to tropical Southeast Asia countries. The chemical investigation on this plant led to the isolation and structure elucidation of a new vomifoliol derivative (1) along with eighteen known phenolic compounds [cystosiphonin (2), 5,7,8-trimethoxyflavanone (3), scutellarein-7,4′-methylether (4), eupatorin (5), 5,6,7,8,4′-pentamethoxyflavone (6), 5,6,7,4′-tetramethylscutellarein (7), 5,6,7,8,3′,4′-hexamethoxyflavone (8), 6-hydroxy-5,7,4′-trimethoxyflavone (9), 6,7,8,3′,4′-pentamethoxyflavone (10), 5,6,3′-trihydroxy-7,4′-dimethoxyflavone (11), 5,6-dihydroxy-7,3′,4′-trimethoxy flavone (12), 4′-hydroxy-5,6,7,3′-tetramethoxyflavone (13), 2′-hydroxy-3,4,4′,5′,6′-pentamethoxy-chalcone (14), isoquercetin (15), quercetin 3-O-α-L-arabinopyranosyl (1→6)-β-Dglucopyranoside (16), caffeic acid (17), rosmarinic acid (18), and (6S,9R)-roseoside (19)]. The structures of isolates were confirmed via spectroscopic data such as one- and two-dimensional nuclear magnetic resonance,circular dichroism, mass, ultraviolet and optical rotation.

Food allergy is a rare form of feeding intolerance in preterm infants, with symptoms similar to necrotizing enterocolitis. We report a case of clinically diagnosed cow’s milk-induced eosinophilic enterocolitis in an infant with extremely low birth weight. The patient was born at 24 weeks and 1 day gestation, weighing 610 g, had repeated episodes of gastrointestinal symptoms after feeding, and was placed on nil per os. On day 67, the eosinophil count increased suddenly (7,852.8/mL), and the formula was changed to amino acid-based (Neocate). Gradually, the eosinophil count returned to normal. Ileostomy was performed and full enteral feeding was achieved with Neocate. Intraoperatively, the intestine was nonnecrotic and viable; the biopsy report showed massive mucosal eosinophilic infiltration. The patient was diagnosed with cow’s milk-induced eosinophilic enterocolitis.

Aegle marmelos (Rutaceae) is a deciduous shrub or tree and typically known as bael throughout Southeast Asia and has been used as a medicinal plant and a food ingredient. In this study eight compounds were determined to be O-(3,3-dimethylallyl) halfordinol (1), (R)-aegeline (2), (R)-marmeline (3), imperatorin (4), xanthotoxol (5), valencic acid (6), vanillic acid (7) and rutin (8). The chemical structures of the isolates were elucidated through spectroscopic evidence including 1D, 2D NMR, ESI-Q-TOF-MS and optical rotation.

Purpose: Non-vitamin K antagonist oral anticoagulants (NOACs) are widely used in patients with atrial fibrillation (AF) because of their effectiveness in preventing stroke and their better safety, compared with warfarin. However, there are concerns for an increased risk of bleeding associated with concomitant use of non-steroidal anti-inflammatory drugs (NSAIDs) or selective serotonin reuptake inhibitors (SSRIs) with NOACs. In this study, we aimed to evaluate the risk of bleeding events in individuals taking concomitant NSAIDs or SSRIs with NOACs after being diagnosed with AF. Materials and Methods: A nested case-control analysis to assess the safety of NSAIDs and SSRIs among NOAC users with AF was performed using data from Korean National Health Insurance Service from January 2012 to December 2017.Among patients who were newly prescribed NOACs, 1233 cases hospitalized for bleeding events were selected, and 24660 controls were determined. Results: The risk of bleeding events was higher in patients receiving concomitant NSAIDs [adjusted odds ratio (aOR) 1.41; 95% confidence interval (CI) 1.24–1.61] or SSRIs (aOR 1.92; 95% CI 1.52–2.42) with NOACs, compared to no use of either drug, respectively.The risk of upper gastrointestinal bleeding was higher in patients receiving concomitant NSAIDs or SSRIs without proton pump inhibitors (PPIs) (NSAIDs: aOR 2.47; 95% CI 1.26–4.83, SSRI: aOR 10.8; 95% CI 2.41–2.48) compared to no use. Conclusion When NSAIDs or SSRIs are required for NOAC users with AF, physicians need to monitor bleeding events and consider the use of PPIs, especially for combined use of both drugs or when initiating NOACs treatment.

Objective: To describe patterns of spontaneous reporting on adverse events following immunization (AEFIs) using the human papilloma virus (HPV) vaccine according to the Brighton Collaboration (BC) criteria. Methods: We used the Korea Adverse Event Reporting System (KAERS) database including vaccinations between 2008 and 2017. To apply BC criteria, we classified 58 BC AEFIs into World Health Organization Adverse Reaction Terminology (WHO-ART) codes. We applied MedDRA standard medical queries that were pre-defined as five BC AEFIs. Terminology mapping between MedDRA and WHO-ART terms was performed by three researchers. Descriptive statistics of individual case safety reports were analyzed according to BC applicability.Disproportionality analyses were performed on each BC AEFI and each preferred AEFI term according to the case-noncase approach; reporting odds ratio (ROR) and 95% confidence intervals (CI) were calculated. Results: Among the 30,266 reports of vaccinations between 2008 and 2017, 2,845 reports included the HPV vaccine. Of these reports, 1,511 (53.1%) included at least one BC AEFI. Reports from physicians or manufacturers included more BC AEFIs than from other reporters. Injection site reactions and fever were frequently reported in BC AEFIs; spontaneous abortion and ectopic pregnancy (ROR, 14.29 [95% CI, 4.30-47.49]) and vasculitic peripheral neuropathy (ROR, 8.57 [95% CI, 2.61-28.10]) showed the highest ROR. Among non-BC AEFIs, dizziness or myalgia were frequently reported; exposure during pregnancy (ROR, 23.95 [95% CI, 16.27-35.25]) and inappropriate schedule of administration (ROR, 22.89 [95% CI, 16.74-31.31]) showed the highest ROR. Conclusion BC criteria would be applicable for labeled AEFIs, whereas analyzing non-BC AEFIs would be useful for detecting unlabeled AEFIs.

Objective: To describe patterns of spontaneous reporting on adverse events following immunization (AEFIs) using the human papilloma virus (HPV) vaccine according to the Brighton Collaboration (BC) criteria. Methods: We used the Korea Adverse Event Reporting System (KAERS) database including vaccinations between 2008 and 2017. To apply BC criteria, we classified 58 BC AEFIs into World Health Organization Adverse Reaction Terminology (WHO-ART) codes. We applied MedDRA standard medical queries that were pre-defined as five BC AEFIs. Terminology mapping between MedDRA and WHO-ART terms was performed by three researchers. Descriptive statistics of individual case safety reports were analyzed according to BC applicability.Disproportionality analyses were performed on each BC AEFI and each preferred AEFI term according to the case-noncase approach; reporting odds ratio (ROR) and 95% confidence intervals (CI) were calculated. Results: Among the 30,266 reports of vaccinations between 2008 and 2017, 2,845 reports included the HPV vaccine. Of these reports, 1,511 (53.1%) included at least one BC AEFI. Reports from physicians or manufacturers included more BC AEFIs than from other reporters. Injection site reactions and fever were frequently reported in BC AEFIs; spontaneous abortion and ectopic pregnancy (ROR, 14.29 [95% CI, 4.30-47.49]) and vasculitic peripheral neuropathy (ROR, 8.57 [95% CI, 2.61-28.10]) showed the highest ROR. Among non-BC AEFIs, dizziness or myalgia were frequently reported; exposure during pregnancy (ROR, 23.95 [95% CI, 16.27-35.25]) and inappropriate schedule of administration (ROR, 22.89 [95% CI, 16.74-31.31]) showed the highest ROR. Conclusion BC criteria would be applicable for labeled AEFIs, whereas analyzing non-BC AEFIs would be useful for detecting unlabeled AEFIs.

PURPOSE: The objective of this study was to investigate physicians' attitudes toward ethical end-of-life decision making about dying newborns. METHODS: Between October and December 2015, we surveyed 185 neonatal staff members working at 6 neonatal intensive care units to investigate their attitudes toward ethical end-of-life decision making about dying newborns. RESULTS: The respondents generally agreed with using sedatives/analgesics to suppress pain despite the risk of fatality (80%), continuing current treatment without using other treatment methods (56.2%), and withholding emergency treatment in the form of cardiac arrest resuscitation (48.1%). In contrast, most respondents disagreed with administering drugs for the purpose of ending life, withholding neonatal intensive care, and withholding mechanical ventilation. Although the respondents believed that it is necessary to suggest that the parents of dying neonates sign do-not-resuscitate (DNR) orders (62.7%), most of them found it difficult to talk to parents/families about DNR orders (90.8%), or wanted to refrain from obtaining families' consent in person (84.9%). CONCLUSION: Korean neonatal staff members believed that withholding or withdrawal of treatment is necessary when making ethical decisions about dying neonates; however, they preferred to use conservative, rather than active interventions.
Decision Making* ; Emergency Treatment ; Ethics ; Heart Arrest ; Humans ; Infant, Newborn* ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Parents ; Respiration, Artificial ; Resuscitation ; Surveys and Questionnaires

In addition to classical triad such as gait disturbance, urinary incontinence and dementia, parkinsonian extrapyramidal motor signs and neuropsychiatric symptoms can be observed in patients with normal pressure hydrocephalus (NPH). In our case, a 46 year old female patient showed extrapyramidal symptoms such as bradykinesia, rigidity and neuropsychiatric symptoms such as agitation, anxiety, restlessness and regressed behavior beside two(gait disturbance & urinary incontinence) symptoms of three classical triad. It was difficult to diagnose this patient as NPH from the beginning because of her relatively young age and previous psychiatric mediation history for controlling advanced anxiety and affective disorder. Antiparkinsonian agents and discontinuation of psychiatric medications did not work for this patient. Patient's brain computed tomographic finding showed enlarged ventricles. We suspected NPH and did empirical drainage of 30mL CSF. Finally, patient's pyramidal and neuropsychiatric symptoms as well as two of three classical triad of NPH were improved dramatically within several days. It is important to consider NPH as one of the differential diagnosis in patient with parkinsonian symptoms and various neuropsychiatric symptoms who did not respond to usual clinical management especially in case of ventricular enlargement in neuroimaging because of its treatable property by CSF shunt operation.
Antiparkinson Agents ; Anxiety* ; Bipolar Disorder* ; Brain ; Dementia ; Diagnosis, Differential ; Dihydroergotamine ; Drainage ; Female ; Gait* ; Humans ; Hydrocephalus, Normal Pressure* ; Hypokinesia* ; Mood Disorders ; Negotiating ; Neuroimaging ; Psychomotor Agitation ; Urinary Incontinence

Interstitial deletions involving the chromosome band 15q22q24 are very rare and only nine cases have been previously reported. Here, we report on a 12-day-old patient with a de novo 15q22q23 interstitial deletion. He was born by elective cesarean section with a birth weight of 3,120 g at 41.3-week gestation. He presented with hypotonia, sensory and neural hearing loss, dysmorphism with frontal bossing, flat nasal bridge, microretrognathia with normal palate and uvula, thin upper lip in an inverted V-shape, a midline sacral dimple, severe calcanovalgus at admission, and severe global developmental delay at 18 months of age. Fluorescence in situ hybridization findings confirmed that the deleted regions contained at least 15q22. The chromosome analysis revealed a karyotype of 46,XY,del(15) (q22q23). Parental chromosome analysis was performed and results were normal. After reviewing the limited literature on interstitial 15q deletions, we believe that the presented case is the first description of mapping of an interstitial deletion involving the chromosome 15q22q23 segment in Korea. This report adds to the knowledge of the clinical phenotype associated with the 15q22q23 deletion.
Birth Weight ; Cesarean Section ; Developmental Disabilities ; Female ; Fluorescence ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; In Situ Hybridization ; Karyotype ; Korea ; Lip ; Muscle Hypotonia* ; Palate ; Parents ; Phenotype ; Pregnancy ; Uvula

This study aimed to investigate current therapeutic strategies for patent ductus arteriosus (PDA) in very-low-birth-weight (VLBW) infants in Korea. A total of 2,254 VLBW infants among 2,386 from Korean Neonatal Network cohort born from January 2013 to June 2014 were included. No PDA was seen for 1,206 infants (53.5%) and the infants diagnosed or treated for PDA were 1,048 infants (46.5%). The proportion of infants with PDA was decreased according to the increase in gestational age (GA) and birthweight. Infants with PDA were divided into groups according to the therapeutic strategies of PDA: prophylactic treatment (PT, n = 69, 3.1%), pre-symptomatic treatment (PST, n = 212, 9.4%), symptomatic treatment (ST, n = 596, 26.4%), and conservative treatment (CT, n = 171, 7.6%). ST was the most preferred treatment modality for preterm PDA and the proportion of the patients was decreased in the order of PST, CT, and PT. Although ST was still the most favored treatment in GA < 24 weeks group, CT was more preferred than PST or ST when compared with GA > or = 32 weeks group [CT vs. PST, OR 5.3, 95% CI 1.56-18.18; CT vs. ST, OR 2.9, 95% CI 1.03-8.13]. A total of 877 infants (38.9%) received pharmacological or surgical treatment about PDA, and 35.5% (801 infants) received pharmacological treatment, mostly with ibuprofen. Seventy-six infants (3.4%) received primary ligation and 8.9% (201 infants) received secondary ligation. Diverse treatment strategies are currently used for preterm PDA in Korea. Further analyses of neonatal outcomes according to the treatment strategies are necessary to obtain a standardized treatment guideline for preterm PDA.
Cohort Studies ; Databases, Factual ; Ductus Arteriosus, Patent/surgery/*therapy ; Echocardiography ; Gestational Age ; Humans ; Ibuprofen/therapeutic use ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Natriuretic Peptide, Brain/analysis ; Republic of Korea