BACKGROUND: Recently, the prevalence of food allergies during childhood is increasing, with fruits being common allergens. However, data on allergens that cause fruit and vegetable allergies and pollen-food allergy syndrome (PFAS) in childhood are relatively few. This study aimed to examine the allergens in fruit and vegetable allergies in pediatric patients and to determine the association between fruit and vegetable allergies and PFAS.OBJECTIVE: This study aimed to examine the current status of fruit and vegetable allergies in Japanese children.METHODS: This was a multicenter case series observational study. The participants included children aged <15 years who developed allergic symptoms after eating fruits and vegetables and subsequently received treatment in the Pediatric Department of 6 hospitals in the Osaka Prefecture in Japan during the study period from August 2016 to July 2017. Participants' information was obtained using a questionnaire, and data were obtained by performing several types of allergy tests using blood samples.RESULTS: A total of 97 children (median age, 9 years; 56 males) were included in the study. Apple was the most common allergen, followed by peach, kiwi, cantaloupe, and watermelon. A total of 74 participants (76%) exhibited allergic symptoms due to PFAS; moreover, pathogenesis-related protein-10 (PR-10) was the most common allergen superfamily. On the contrary, in the group where neither PR-10 nor profilin was sensitized, kiwi and banana were the most common allergens, and the age of onset was lower than that in the PFAS group. Specific antibody titer was significantly associated with Birch for Bet v1 and latex for Bet v2 (r = 0.99 and r = 0.89).CONCLUSION: When we examine patients with fruit and vegetable allergies, we should first consider PFAS even in childhood specifically for children greater than 4 years old.
Age of Onset ; Allergens ; Asian Continental Ancestry Group ; Betula ; Child ; Citrullus ; Clinical Study ; Cucumis melo ; Eating ; Food Hypersensitivity ; Fruit ; Humans ; Hypersensitivity ; Japan ; Latex ; Musa ; Observational Study ; Prevalence ; Profilins ; Prunus persica ; Rhinitis ; Rhinitis, Allergic, Seasonal ; Vegetables

Introduction: The aim of this study was to investigate the clinical effectiveness, health related quality of life (HRQoL) and cost effectiveness of selective laser trabeculoplasty (SLT) compared to topical anti-glaucoma medications in step-up treatment of patients with primary open angle glaucoma (POAG). Methods: Seventeen POAG patients with suboptimal IOP control despite pre-existing topical medications were subjected to adjunct SLT (50 applications 180 degrees) or second line medical therapy. Current medications were continued, and patients were followed up for 6 months for degree of intraocular pressure (IOP) lowering. HRQoL was assessed using Glaucoma Quality of Life 36-item (GlauQoL-36), Assessment of Quality of Life-7D (AQoL-7D) and Vision related Quality of Life (VisQoL). Costs involved were calculated and compared to the effect (IOP reduction) achieved in each arm. Results: Ten patients were in the SLT group and 7 in the topical medication (MED) group. Mean baseline intraocular pressure (IOP) was 18.90±3.48mmHg in SLT group and 15.57±2.23mmHg in MED group. Mean reduction of IOP was 4.30±1.64mmHg in SLT group and 2.71±2.56 mmHg in MED group at 6 months which was not statistically significant (p=0.14) between two groups. All the HRQoL questionnaires did not show significant changes in the groups or between groups when compared baseline with 6-month post treatment (p-values ranging from 0.247 to 0.987). For every 1mmHg reduction in IOP, cost involved in MED group (RM53.61) was 165% of the cost involved in SLT group (RM32.56). Discussion and Conclusion: This study has shown that SLT was as effective clinically and tolerable as topical anti glaucoma medications and was possibly more cost effective in the step-up treatment of patients with POAG at 6 months follow- up.
selective laser traeculoplasty ; topical antiglaucoma, clinical effectiveness ; quality o0f life ; cost effectiveness ; primary open angle glaucoma ; prospective pilot cohort study

OBJECTIVE: The functional information of ¹¹C-methionine positron emission tomography (MET-PET) images can be applied for Gamma knife radiosurgery (GKR) and its image quality may affect defining the tumor. This study conducted the phantom-based evaluation for geometric accuracy and functional characteristic of diagnostic MET-PET image co-registered with stereotactic image in Leksell GammaPlan® (LGP) and also investigated clinical application of these images in metastatic brain tumors.METHODS: Two types of cylindrical acrylic phantoms fabricated in-house were used for this study : the phantom with an array-shaped axial rod insert and the phantom with different sized tube indicators. The phantoms were mounted on the stereotactic frame and scanned using computed tomography (CT), magnetic resonance imaging (MRI), and PET system. Three-dimensional coordinate values on co-registered MET-PET images were compared with those on stereotactic CT image in LGP. MET uptake values of different sized indicators inside phantom were evaluated. We also evaluated the CT and MRI co-registered stereotactic MET-PET images with MR-enhancing volume and PET-metabolic tumor volume (MTV) in 14 metastatic brain tumors.RESULTS: Imaging distortion of MET-PET was maintained stable at less than approximately 3% on mean value. There was no statistical difference in the geometric accuracy according to co-registered reference stereotactic images. In functional characteristic study for MET-PET image, the indicator on the lateral side of the phantom exhibited higher uptake than that on the medial side. This effect decreased as the size of the object increased. In 14 metastatic tumors, the median matching percentage between MR-enhancing volume and PET-MTV was 36.8% on PET/MR fusion images and 39.9% on PET/CT fusion images.CONCLUSION: The geometric accuracy of the diagnostic MET-PET co-registered with stereotactic MR in LGP is acceptable on phantom-based study. However, the MET-PET images could the limitations in providing exact stereotactic information in clinical study.
Brain Neoplasms ; Clinical Study ; Electrons ; Magnetic Resonance Imaging ; Multimodal Imaging ; Phantoms, Imaging ; Positron-Emission Tomography and Computed Tomography ; Positron-Emission Tomography ; Radiosurgery ; Tumor Burden

BACKGROUND/AIMS: Bicarbonate-containing alginate formulations are reported to be effective for controlling reflux symptoms. However, the efficacy of Lamina G alginate without gas production has not been reported. The aim is to evaluate the efficacy of a non-bicarbonate alginate in individuals with reflux symptoms without reflux esophagitis. METHODS: Participants who had experienced heartburn or regurgitation for 7 consecutive days were randomized to one of the following treatment groups: proton pump inhibitors (PPI) plus alginate (combination) or PPI plus placebo (PPI only). In addition, as a reference group, patients received placebo plus alginate (alginate only). The primary endpoint compared the percentage of patients with complete resolution of symptoms for the final 7 days of the treatment. Secondary endpoints compared changes in symptom score, symptom-free days during the treatment period, the Reflux Disease Questionnaire, Patient Assessment of Upper Gastrointestinal Disorders (PAGI)-Quality of Life and PAGI-Symptoms Severity Index scores, the investigator's assessment of symptoms, and incidence of adverse events. RESULTS: Complete resolution of heartburn or regurgitation was not significantly different between the combination and PPI only groups (58.7% vs 57.5%, p=0.903). The secondary endpoints were not significantly different between the two groups. Complete resolution of heartburn or regurgitation, did not differ between the alginate only reference group and the PPI only group (75.0% vs 57.5%, p=0.146). CONCLUSIONS: The addition of non-bicarbonate alginate to PPI was no more effective than PPI alone in controlling reflux symptoms.
Alginates ; Clinical Study ; Esophagitis, Peptic ; Gastroesophageal Reflux ; Heartburn ; Humans ; Incidence ; Proton Pump Inhibitors ; Treatment Outcome

OBJECTIVE: We report the results of a pilot clinical study that evaluated the safety and efficacy of a newly-developed, retrievable flow diverter (FloWise; Taewoong Medical) for the treatment of internal carotid artery (ICA) aneurysm. MATERIALS AND METHODS: A total of 10 patients were enrolled. Inclusion criteria were 1) unruptured aneurysm with a dome size of ≥ 8 mm and a neck size of ≥ 4 mm at the ICA, or 2) two or more unruptured aneurysms of any size able to be spanned by a single FloWise at the ICA. Co-primary effectiveness end points were technical success of FloWise placement, and a 50% or greater decrease in aneurysm volume at the 6-month follow-up angiogram. The primary safety end point was the new development of neurological deficits persisting for more than 1-month post-treatment. RESULTS: Ten patients harboring 14 ICA aneurysms (median diameter, 9.4 mm; range, 2.3–31.0 mm) were enrolled between January 2016 and July 2017. FloWise placement was successful in all patients. There were no newly-developed neurological deficits during the 6-month clinical follow-up period. One patient did not receive follow-up imaging due to pregnancy. Nine patients with 12 aneurysms received a 6-month angiographic follow-up. Ten aneurysms (83.3%) showed decreases in volume greater than 50% (mean volume decrease, 82.8 ± 32.9%), of which 8 (66.7%, 95% confidence interval, 35.4–98.0%) showed complete occlusion. One patient was retreated due to mass symptom aggravation. CONCLUSIONS: In this pilot study, FloWise appeared to be safe and effective for ICA aneurysm treatment. A prospective multicenter study to validate the effectiveness and safety of FloWise would be worthwhile.
Aneurysm ; Carotid Artery, Internal ; Clinical Study ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; Neck ; Pilot Projects ; Pregnancy ; Prospective Studies

PURPOSE: This study was aimed to compare the survival and success rates, and long-term crestal bone loss according to the use of 2 connection types of dental implants (submerged-USII and non-submerged-SSII; Osstem Implant®) by analyzing the change in alveolar bone height after 1 year under load and during final follow-up period. MATERIALS AND METHODS: Between December 2004 and August 2008, patients with two types of Osstem implants (USII and SSII) were retrieved retrospectively. A total of 92 patients with 284 implants (USII=60, SSII=224) was finally selected. Their mean follow-up period was 7.5 years. The mesial and distal alveolar crestal bone changes were measured using radiographic images and the average was calculated at 1 year after loading and during final follow-up period. RESULT: Among the 284 implants, 4 USII and 7 SSII implants were removed, indicating 93.3% and 96.9% survival rates. Of the survived implants, mean crestal bone loss 1 year after loading was 0.39 mm for USII and 0.19 mm for SSII (P=0.018). During the final follow-up, mean crestal bone loss was 0.63 mm and 0.35 mm for USII and SSII, respectively, without statistical significance (P=0.092). According to the criteria for the success and failure of the implant by Albreksson and colleagues, final success rate was estimated as 86.7% for USII and 91.5% for SSII, respectively. CONCLUSION: At 1 year after loading, the average crestal bone loss was significantly different between USII and SSII; however, both types met the criteria for implant success. During the final follow-up, both groups showed insignificant bone resorption patterns and did not show any pathological clinical symptoms. Therefore, both implants exhibited high long-term stability.
Alveolar Bone Loss ; Bone Resorption ; Clinical Study ; Dental Implant-Abutment Design ; Dental Implants ; Follow-Up Studies ; Humans ; Retrospective Studies ; Survival Rate

STUDY DESIGN: Retrospective study. OBJECTIVES: The purpose of this study was to analyze and report the results of caudal epidural injections using a catheter in patients in whom conventional epidural block had failed. SUMMARY OF LITERATURE REVIEW: Epidural nerve block is often used to treat chronic back pain and radicular pain in degenerative lumbar disease, and percutaneous epidural neuroplasty or surgery may be an alternative if it fails. MATERIALS AND METHODS: In total, 146 patients who were treated with caudal epidural block using a catheter were recruited for this study from January 1, 2015 to June 30, 2019. Forty-five patients who had not undergone any epidural block in the past were excluded from the study. Among patients who did not have a fracture and were followed up for at least 1 month, the medical records of 61 patients with degenerative disc herniation, spondylosis, and stenosis were reviewed retrospectively. Visual analogue scale (VAS) scores were evaluated before and after the procedure. RESULTS: Of the 61 patients who had undergone epidural block through a transforaminal caudal approach with no pain control effect, there were 18 males and 43 females. Their mean age was 66.3 years and the average follow-up period was 2.64 months. There were 46 cases of spinal stenosis, 33 cases of spondylosis, 2 cases of spondylolisthesis, 9 cases of disc herniation and 1 case of ankylosing spondylitis. The mean number of epidural blocks was 5.85 (times) before the procedure. The mean initial VAS score was 5.34 and the final follow-up VAS score was 2.70. There was a significant difference between before and after the procedure (p<0.05). The mean duration of effect after the procedure was 1.84 months and the mean number of procedures was 2.30. After the procedure, there were 4 cases of surgical treatment, 2 cases of neuroplasty, and 3 cases of epidural block using other methods over more than 1 year of follow-up. CONCLUSIONS: The result of this clinical study suggests that caudal epidural injections using a catheter may be effective for patients with low back pain who have not responded to previous epidural blocks before surgical treatment.
Back Pain ; Catheters ; Clinical Study ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Humans ; Injections, Epidural ; Low Back Pain ; Male ; Medical Records ; Nerve Block ; Retrospective Studies ; Spinal Stenosis ; Spondylitis, Ankylosing ; Spondylolisthesis ; Spondylosis

PURPOSE: The purpose of this study was to evaluate whether eye dominance changes after conventional pseudophakic monovision, and to identify factors that affect changes in eye dominance. METHODS: This retrospective study included 70 patients who underwent bilateral conventional monovision cataract surgery. Patients were divided into two groups based on whether they experienced a change in the dominant eye. We compared patients' uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), best-corrected visual acuity (BCVA), spherical equivalent, stereopsis, and time interval between cataract surgeries. RESULTS: The mean age was 71.26 ± 10.84 (range, 25–90) years, mean interval between surgery in each eye was 118.46 ± 183.50 (range, 17–1,018) days, and mean postoperative diopter difference was 1.16 ± 0.53 (range, 0.00–2.75) diopters. After bilateral cataract surgery, 22 patients (31.43%) experienced a change in eye dominance, whereas 48 patients (68.57%) experienced no change. There were no differences in the time interval between cataract surgeries, preoperative UCDVA and UCNVA, pre- and postoperative BCVA, or stereopsis in either group. Patients who experienced a change in eye dominance showed smaller differences between preoperative and postoperative spherical equivalent, compared with patients who experienced no change in eye dominance (t-test, p < 0.05). CONCLUSIONS: Twenty-two (31.43%) patients whose nondominant eyes were targeted for near vision showed altered eye dominance after conventional monovision cataract surgery. Eye dominance shows greater plasticity in patients with smaller differences between preoperative and postoperative spherical equivalent.
Cataract ; Clinical Study ; Depth Perception ; Dominance, Ocular ; Humans ; Plastics ; Presbyopia ; Retrospective Studies ; Visual Acuity

BACKGROUND: This study aimed to determine the optimal location of local anesthetic injection in the interspace between the popliteal artery and posterior capsule of the knee (iPACK), using the anatomical pattern of the articular branch of tibial nerve (ABTN). We hypothesized that injection at the level of ABTN forming a popliteal plexus would mainly spread throughout the popliteal fossa without contacting the tibial or peroneal nerves. METHODS: The anatomical study included 30 soft cadavers. Ultrasound-guided dye injection was performed in legs of 10 cadavers after identifying the position of the ABTN and surrounding structures, followed by dissection to assess its spread. Clinical study was conducted in 15 patients undergoing total knee arthroplasty (TKA) with ultrasound-guided injection in the iPACK. All patients also received continuous adductor canal block. Sensorimotor function of the tibial and common peroneal nerves was determined. RESULTS: In the distal portion of the popliteal fossa, the tibial nerve and popliteal vessels ran superficially and closely together. The trajectory of ABTN ran lateral to the popliteal vasculature, forming a plexus towards the posterior capsule of the knee below the medial side of the upper edge of lateral femoral condyle. In cadavers, the ABTN and surrounding area of the popliteal plexus were stained with dye after injection. In the clinical study, no patients experienced complete motor or sensory blocks. CONCLUSIONS: We described a modified iPACK technique injection at the level of the ABTN forming the popliteal plexus, and it may constitute an optional anesthetic regimen to promote early ambulation following TKA.
Arthroplasty, Replacement, Knee ; Cadaver ; Clinical Study ; Early Ambulation ; Humans ; Knee ; Leg ; Pain, Postoperative ; Peroneal Nerve ; Popliteal Artery ; Tibial Nerve

BACKGROUND: Rosacea is a relatively common inflammatory skin disease characterized by central facial erythema that persists for several months or longer. Experimental studies have demonstrated that rosacea compromises the epidermal barrier protection against allergens and irritants, rendering rosacea patients susceptible to contact hypersensitivity and skin irritation. OBJECTIVE: This study aimed to investigate allergic and irritant reactions to topical agents and cosmetics in rosacea patients using patch tests. METHODS: Rosacea signs and subtypes of 40 patients were recorded and subjective symptoms and clinical experiences related to topical agents and cosmetics were assessed using a questionnaire. Patch tests were performed in these patients using the Korean Standard Series (Chemotechnique Diagnostics, Sweden), the TRUE test® (Mekos Laboratories ApS, Denmark), and 26 selected fragrance and 31 cosmetic antigens (TROLAB, Germany). RESULTS: Of 40 patch-tested patients, 26 (65%) showed at least 1 positive reaction and 13 (32.5%) showed 2 or more positive reactions. The most common allergens were nickel (II) sulfate (50%), cobalt chloride (10%), epoxy resin (7.7%), and thimerosal (7.5%). Thirteen patients (32.5%) experienced irritant patch test reactions. There were no significant differences in allergic or irritant positive reactions between mild, moderate, and severe cases of rosacea or between rosacea subtypes. Irritant reactions were more common in fair-skinned participants. CONCLUSION: Different topical medications are used in the treatment of rosacea patients. Exacerbation of rosacea may be caused by a hypersensitivity reaction or irritation induced by the topical agent or by cosmetics.
Allergens ; Clinical Study ; Cobalt ; Dermatitis, Contact ; Erythema ; Humans ; Hypersensitivity ; Irritants ; Nickel ; Patch Tests ; Rosacea ; Skin ; Skin Diseases ; Thimerosal