Background: Pediatric alopecia areata (AA) can affect the quality of life (QoL) of patients and their family members. Research on the QoL and burden on family members in pediatric AA is limited. Objective: This nationwide multicenter questionnaire study described the QoL and burden of the family members of patients with pediatric AA. Methods: This nationwide multicenter questionnaire study enrolled AA patients between the ages of 5 and 18 years from March 1, 2017 to February 28, 2018. Enrolled patients and their parents completed the modified Children’s Dermatology Life Quality Index (CDLQI) and the modified Dermatitis Family Impact (mDFI). The disease severity was measured using the Severity of Alopecia Tool (SALT) survey scores. Results: A total of 268 patients with AA from 22 hospitals participated in this study. Our study found that the efficacy and satisfaction of previous treatments of AA decreased as the severity of the disease increased. The use of home-based therapies and traditional medicines increased with the increasing severity of the disease, but the efficacy felt by patients was limited. CDLQI and mDFI scores were higher in patients with extensive AA than those with mild to moderate AA. The economic and time burden of the family members also increased as the severity of the disease increased. Conclusion The severity of the AA is indirectly proportional to the QoL of patients and their family members and directly proportional to the burden. Physicians need to understand these characteristics of pediatric AA and provide appropriate intervention to patients and their family members.

PURPOSE: There is cumulative evidence that changes in biomarker status occur frequently during the metastatic progression of breast cancer and affect treatment response. The purpose of this study was to evaluate the frequency of biomarker changes in metastatic breast cancer (MBC) and its impact on prognosis. METHODS: A total of 152 patients diagnosed with MBC at the time of initial diagnosis or during post-surgical follow-up were included. Changes in biomarker status in MBCs, their frequency according to various metastatic sites, tumor characteristics, and their association with patient survival were analyzed. RESULTS: Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67 status changed in 9 (6.0%), 40 (26.3%), 12 (7.9%), and 29 (19.1%) patients, respectively. ER, PR, and HER2 mainly showed positive to negative conversion, whereas Ki-67 changed mostly from a low to high index. There were no differences in the frequencies of biomarker changes according to the metastatic sites. As for ER and HER2, cases with negative conversion showed low expression levels in the primary tumor. Survival analyses indicated that a positive to negative conversion of ER was an independent poor prognostic factor in patients with primary ER-positive breast cancer. CONCLUSION: Changes in biomarker status are not rare, and usually occur in an unfavorable direction in breast cancer metastases. Negative conversion of ER status is a predictor of poor prognosis. Thus, it is beneficial to evaluate changes in biomarker status in MBC not only for the purpose of determining treatment options but also for prognostication of patients.
Biomarkers ; Breast Neoplasms ; Breast ; Diagnosis ; Estrogens ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Prognosis ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone

Bioresorbable vascular scaffold (BRS) is an innovative device that provides structural support and drug release to prevent early recoil or restenosis, and then degrades into nontoxic compounds to avoid late complications related with metallic drug-eluting stents (DESs). BRS has several putative advantages. However, recent randomized trials and registry studies raised clinical concerns about the safety and efficacy of first generation BRS. In addition, the general guidance for the optimal practice with BRS has not been suggested due to limited long-term clinical data in Korea. To address the safety and efficacy of BRS, we reviewed the clinical evidence of BRS implantation, and suggested the appropriate criteria for patient and lesion selection, scaffold implantation technique, and management.
Coronary Disease ; Drug Liberation ; Drug-Eluting Stents ; Humans ; Korea ; Stents ; Thrombosis

PURPOSE: Flumazenil is an effective benzodiazepine antagonist. However, serious adverse effects, including seizures, cardiac arrhythmias, and even death, have been reported in patients treated with flumazenil. These adverse effects are commonly associated with co-ingested tricyclic antidepressants and benzodiazepine withdrawal. Herein, we examined the safety, effectiveness, and risk of using flumazenil to treat suspected benzodiazepine overdose in the emergency department (ED). METHODS: This is a retrospective observational study of adult patients administered with flumazenil for a known or suspected benzodiazepine overdose in the ED between July 2010 and January 2016. The outcomes included mental status improvement, incidence of seizures, and intubation rate after flumazenil administration. RESULTS: Seventy-six patients were included in the analysis. Thirty-eight (50%) patients experienced clinically significant mental status improvement. One patient had a seizure (1.3%), despite 17 reported proconvulsant coingestants. No patient required endotracheal intubation, and no patient had arrhythmias after flumazenil administration. Flumazenil was given intravenously bolus in all cases, and the average dose was 0.44mg. There were no significant changes in the vital signs after flumazenil administration. CONCLUSION: Flumazenil was effective and associated with a low frequency of seizure. However, patients with contraindications may develop seizures. The benefits with respect to risk of adverse effects should be considered carefully in all patients.
Adult ; Antidepressive Agents, Tricyclic ; Arrhythmias, Cardiac ; Benzodiazepines* ; Drug Overdose ; Emergencies* ; Emergency Service, Hospital* ; Flumazenil* ; Humans ; Incidence ; Intubation ; Intubation, Intratracheal ; Observational Study ; Retrospective Studies ; Seizures ; Vital Signs

The change of compressing personnel will inevitably accompany hands off time when cardiopulmonary resuscitation (CPR) is performed by two or more rescuers. The present study assessed whether changing compression by a second rescuer located on the opposite side (OS) of the first rescuer can reduce hands-off time compared to CPR on the same side (SS) when CPR is performed by two rescuers. The scenario of this randomized, controlled, parallel simulation study was compression-only CPR by two laypersons in a pre-hospital situation. Considering sex ratio, 64 participants were matched up in 32 teams equally divided into two gender groups, i.e. , homogenous or heterogeneous. Each team was finally allocated to one of two study groups according to the position of changing compression (SS or OS). Every team performed chest compression for 8 min and 10 sec, with chest compression changed every 2 min. The primary endpoint was cumulative hands-off time. Cumulative hands-off time of the SS group was about 2 sec longer than the OS group, and was significant (6.6 +/- 2.6 sec vs. 4.5 +/- 1.5 sec, P = 0.005). The range of hands off time of the SS group was wider than for the OS group. The mean hands-off times of each rescuer turn significantly shortened with increasing number of turns (P = 0.005). A subgroup analysis in which cumulative hands-off time was divided into three subgroups in 5-sec intervals revealed that about 70% of the SS group was included in subgroups with delayed hands-off time > or = 5 sec, with only 25% of the OS group included in these subgroups (P = 0.033). Changing compression at the OS of each rescuer reduced hands-off time compared to the SS in prehospital hands-only CPR provided by two bystanders.
Cardiopulmonary Resuscitation/methods/*statistics & numerical data ; Clinical Competence/*statistics & numerical data ; Emergency Medical Services/*statistics & numerical data ; Female ; Heart Arrest/epidemiology/*prevention & control ; Heart Massage/methods/*statistics & numerical data ; Humans ; Male ; Republic of Korea/epidemiology ; Treatment Outcome ; Workload/*statistics & numerical data ; Young Adult

PURPOSE: Recently, glyphosate-surfactant herbicide has been used increasingly because it is known for its low toxicity in mammals. However, some cases presented severe clinical complications including hypotension. Previous studies have shown that hypotension is a predictor of poor outcome and mortality. Therefore, we aimed to identify factors that may be related to hypotension in glyphosate intoxication. METHODS: This retrospective study targeted patients with glyphosate intoxication who were admitted to the emergency department of a single hospital from January 1st, 2004 to November 2014. The data were collected retrospectively from clinical records and laboratory files. Using multivariate logistic analysis, data were analyzed retrospectively for association with hypotension. RESULTS: Of the 245 patients, 63 patients (25.7%) had hypotension. The results of this study showed statistically significant differences in old age, underlying disease, amount of ingestion, GCS (Glasgow coma scale), White blood cell, hemoglobin, total bilirubin, glucose level, pH, bicarbonate, base excess, lactate level, AST (aspartate aminotransferase), creatinine level, saturation, Chest X-ray abnormality, and prolonged QTc (corrected QT interval) between hypotension group and non-hypotension group. By multivariate logistic analysis, GCS, creatinine level, chest X-ray abnormality, and prolonged QTc interval were associated with the cases presenting with hypotension. CONCLUSION: GCS, creatinine level, chest X-ray abnormality, and prolonged QTc interval were significant factors associated with hypotension in patients with glyphosate intoxication.
Bilirubin ; Coma ; Creatinine ; Eating ; Emergency Service, Hospital ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Hypotension* ; Lactic Acid ; Leukocytes ; Mammals ; Mortality ; Poisoning* ; Retrospective Studies ; Statistics as Topic ; Thorax

The dramatic increase in the prevalence of obesity and its accompanying comorbidities are major health concerns in Korea. Obesity is defined as a body mass index > or =25 kg/m2 in Korea. Current estimates are that 32.8% of adults are obese: 36.1% of men and 29.7% of women. The prevalence of being overweight and obese in national surveys is increasing steadily. Early detection and the proper management of obesity are urgently needed. Weight loss of 5% to 10% is the standard goal. In obese patients, control of cardiovascular risk factors deserves the same emphasis as weight-loss therapy. Since obesity is multifactorial, proper care of obesity requires a coordinated multidisciplinary treatment team, as a single intervention is unlikely to modify the incidence or natural history of obesity.
Adult ; Body Mass Index ; Comorbidity ; Female ; Humans ; Incidence ; Korea ; Male ; Natural History ; Obesity* ; Overweight* ; Prevalence ; Risk Factors ; Weight Loss

BACKGROUND: Nephrotic syndrome (NS) and proteinuria are uncommon, often unrecognized manifestations of graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT). Only a few isolated case reports and case series involving smaller number of patients who developed NS after HSCT have been published. METHODS: We reviewed the renal histopathological examination findings and clinical records of 15 patients who developed proteinuria after HSCT at Seoul and Yeouido St. Mary's Hospital (Seoul, Korea). We also measured the anti-PLA2 Rantibodies (M-type phospholipase A2 receptor) in the serum samples from the seven patients at the time of renal biopsy. RESULTS: All patients had GVHD. The most common indication for biopsy was proteinuria ( > 1 g/day), with nine patients having nephrotic range proteinuria. The most common histopathological finding was membranous nephropathy (MN; n = 12).Other findings were membranoproliferative glomerulonephritis, C1q nephropathy, and diabetic nephropathy. Eleven patients were treated with immunosuppressive agents, and three patients were treated only with angiotensin II receptor blocker. The overall response rate, including complete remission (urinary protein level < 0.3 g/day) and partial remission (urinary protein level = 0.31-3.4 g/day), was 73%. The mean follow-up period was 26 months, and none of the patients developed end-stage renal disease. All of the seven patients with MN had negative findings for anti-PLA2R antibodies, measured using an enzyme-linked immunosorbent assay kit. CONCLUSION: In this study the findings of 15 renal biopsies were analyzed and to our knowledge this is the largest clinicopathological study of GVHD-related biopsy-proven nephropathy. Approximately 80% of the patients were MN and 73% responded either partially or completely to immunosuppressive treatment. Currently, there is an increase in the incidence of GVHD-mediated renal disease, and therefore, renal biopsy is essential for diagnosing the nephropathy and preventing the progression of renal disease.
Antibodies ; Biopsy ; Diabetic Nephropathies ; Enzyme-Linked Immunosorbent Assay ; Follow-Up Studies ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Graft vs Host Disease* ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Immunosuppressive Agents ; Incidence ; Kidney Failure, Chronic ; Nephrotic Syndrome ; Phospholipases A2 ; Proteinuria ; Receptors, Angiotensin

PURPOSE: To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea. METHODS: Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were up-loaded. RESULTS: Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.7+/-8.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans. CONCLUSIONS: Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.
Aged ; Angiography ; Choroid ; Ethnic Groups ; Eye ; Female ; Fluorescein ; Humans ; Hypertension ; Incidence ; Korea ; Macular Degeneration ; Male ; Membranes ; Photography ; Retinaldehyde ; Smoke ; Smoking ; Specialization

PURPOSE: Laparoscopic totally extraperitoneal (TEP) herniorrhaphy is an effective surgical technique for recurrent inguinal hernia. The recent introduction of various types of prosthetic mesh and the technical improvements in laparoscopic herniorrhaphy have allowed this modality to be used for various types of recurrent inguinal hernias, although careful selection of surgical techniques is required according to the patient's condition and the type of previous surgery. METHODS: One thousand and thirty cases were scheduled to undergo laparoscopic TEP herniorrhaphies from December of 2000 to August of 2008. We retrospectively collected and analyzed the data on the patient characteristics, the types of hernia, the number of previous recurrences, the operating technique, the operating time, the postoperative hospital stay and the postoperative complications. RESULTS: A total of 86 herniorrhaphies were performed in 83 patients with recurrent inguinal hernias. The mean patient age was 50.4 years. The total number of recurrences among the 83 patients was 118 cases and the number of recurrences was as follows: 1st in 65 patients, 2nd in 12 patients, 3rd in 7 patients and 4th in 2 patients. Eighty one laparoscopic TEP herniorrhaphies were performed, and 5 cases were performed by laparoscopic transabdominal preperitoneal repair or laparoscopic intraperitoneal onlay mesh repair. The mean operative time was 29.9 minutes, and there was no statistical correlation between the type of prior herniorrhaphy and the operative time. The mean postoperative hospital stay was 0.9 days and no major complications occurred. CONCLUSION: Selecting the type of surgery to perform for treating recurrent inguinal hernia has become complicated due to many recent diversified techniques of herniorrhaphy. Although laparoscopic TEP herniorhaphy is effective for treating recurrent inguinal hernia, a meticulous approach and various surgical techniques are required when prosthetic mesh has been previously placed on the preperitoneal space.
Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Inlays ; Length of Stay ; Operative Time ; Postoperative Complications ; Pyrazines ; Recurrence ; Retrospective Studies