Purpose: This study aimed to evaluate the feasibility, safety, and immunological outcomes of low-dose cow’s milk oral immunotherapy (CM OIT) in school-aged children and adolescents with severe, persistent cow’s milk allergy (CMA), a group typically considered at a high risk for OIT. Methods: We conducted a retrospective study involving 12 patients (median age, 11.4 years) with immunoglobulin E (IgE)-mediated CMA, who underwent individualized low-dose CM OIT in the outpatient setting at a single tertiary hospital. Baseline and longitudinal clinical and immunological data, including casein-specific IgE and immunoglobulin G4 (IgG4) levels, were analyzed. Patients were classified as either desensitized or unsuccessful based on treatment outcomes. Results: Of the 12 patients with severe CMA, 6 achieved desensitization up to the target dose, while the remaining 6 discontinued treatment because of intolerance or poor adherence. The desensitized and unsuccessful groups showed no significant differences in baseline age, OIT starting dose, or serum casein-specific IgE level. Immunological evaluation revealed a significantly greater increase in serum casein-specific IgG4 (0.87 vs. -0.37 mg/L, P = 0.004) and a significantly lower natural log-transformed fold change in the IgE/IgG4 ratio (-1.38 vs. 0.44, P = 0.008) in the desensitized group. None of the patients required epinephrine during OIT, and adverse events were generally mild. Conclusion In selected high-risk pediatric populations with severe CMA, outpatient-based low-dose OIT using individualized flexible protocols may provide a relatively safe approach that improves tolerability and adherence. Increased casein-specific IgG4 levels and a reduced casein-specific IgE/IgG4 ratio may serve as valuable biomarkers for treatment response.

Purpose: Early adolescence is a pivotal developmental stage characterized by rapid physical, emotional, and social changes. Happiness during this period is crucial as it influences later life outcomes. This study examined 4-year changes in happiness and identified predictors among Korean early adolescents. Methods: A secondary analysis of longitudinal panel data was conducted using latent growth modeling to assess changes in happiness over 4 years, utilizing data from the Panel Study on Korean Children (11th–14th waves) with a total of 1,177 participants. Descriptive statistics were computed using IBM SPSS ver. 29.0, and latent growth modeling, including unconditional and conditional models with associated factors variables, was conducted using IBM AMOS ver. 29.0. Results: A nonlinear trajectory was identified with a sharp decline in happiness, particularly between the ages of 11 and 12 years. Self-esteem, peer attachment, and a creative school environment emerged as protective factors mitigating this decline, whereas parental attachment influenced baseline happiness but not its trajectory. Higher self-esteem, stronger peer attachment, and supportive school environments were associated with a slower decline in happiness. Conclusions Our findings highlight the importance of early interventions beginning around the age of 11 years, a critical period when happiness decreases more steeply. Practical implications include developing school-based and psychosocial programs that strengthen self-esteem and positive peer relationships, and fostering autonomy-supportive, creative educational environments. Coordinated efforts between schools and families are essential to promote adolescents’ emotional well-being and ensure balanced development in academic and socio-emotional domains.

Background/Aims: Helicobacter pylori infection is reportedly associated with iron-deficiency anemia. However, little is known about the association between the endoscopic features of H. pylori in the Kyoto classification of gastritis and iron deficiency. Therefore, we analyzed the endoscopic features of H. pylori gastritis and studied the association between these endoscopic features and iron deficiency. Methods: We retrospectively analyzed patients diagnosed with H. pylori gastritis between May 2022 and June 2023 who also underwent laboratory tests, including anemia profiling. Iron deficiency was defined as a ferritin level below 55 ng/mL. Multivariate analysis was used to assess the association between endoscopic features and iron deficiency. Results: Of the included patients, 47 had iron deficiency. Female patients were significantly more common in the iron-deficient group (87.2% vs. 33.4%, p<0.001). Endoscopically, nodularity (46.8% vs. 23.4%, p=0.001) and hyperplastic polyps (17.0% vs. 3.7%, p=0.001) were more common in patients with iron deficiency. Multivariate analysis identified younger age, female sex, and larger hyperplastic polyps (≥5 mm) as independent risk factors for iron deficiency. Conclusions Younger age, female sex, and larger hyperplastic polyps (≥5 mm) are associated with iron deficiency in patients with H. pylori gastritis. These features may help identify patients at higher risk of iron deficiency.

Purpose: This study aimed to investigate the influence of uncertainty-related factors on the health behavior of individuals with coronary artery disease (CAD) based on Mishel’s uncertainty in illness theory (UIT). Methods: We conducted a cross-sectional study and path analysis to investigate uncertainty and factors related to health behavior. The study participants were 228 CAD patients who visited the outpatient cardiology department between September 2020 and June 2021. We used SPSS 25.0 and AMOS 25.0 software to analyze the data. Results: The final model demonstrated a good fit with the data. Eleven of the twelve paths were significant. Uncertainty positively affected danger and negatively affected self-efficacy and opportunity. Danger had a positive effect on perceived risk. Opportunity positively affected social support, self-efficacy, perceived benefit and intention, whereas it negatively affected perceived risk. Social support, self-efficacy, perceived benefit and intention had a positive effect on health behavior. We found that perceived benefit and intention had the most significant direct effects, whereas self-efficacy indirectly affected the relationship between uncertainty and health behavior. Conclusion The path model is suitable for predicting the health behavior of CAD patients who experience uncertainty. When patients experience uncertainty, interventions to increase their self-efficacy are required first. Additionally, we need to develop programs that quickly shift to appraisal uncertainty as an opportunity, increase perceived benefits of health behavior, and improve intentions.

Urinary tract infections (UTIs) are one of the most common bacterial infections in febrile children and a common cause of hospitalization, especially in very young children. We examined the clinical characteristics and predictive factors of concomitant bacteremia in pediatric patients with febrile UTI aged ≤24 months. Methods: This retrospective multicenter study reviewed medical data from 2,141 patients from three centers from January 2000 to December 2019. Enrolled cases were classified into the bacteremic UTI and non-bacteremic UTI groups according to the presence of blood culture pathogens. Results: Among 2,141 patients with febrile UTI, 40 (1.9%) had concomitant bacteremia. All patients in the bacterial group were aged ≤6 months. Multivariate analysis revealed that younger age, lower blood lymphocyte counts and serum albumin levels, higher C-reactive protein (CRP) levels, blood urea nitrogen (BUN) levels, and BUN/serum albumin ratio were independent risk factors of concomitant bacteremia. The area under the receiver-operating characteristic curves predicting bacteremia were 0.668 for CRP, 0.673 for lymphocytes, and 0.759 for the BUN/albumin ratio. Conclusion: The present study identified the BUN/albumin ratio and lower blood lymphocyte counts as novel predictive factors for bacteremia in young infants with febrile UTI in addition to the previously identified factors of younger age and higher CRP levels. Our findings could help to identify patients at high risk of bacteremia and benefit decision-making in the management of infants with febrile UTI.

Purpose: We investigated the consistent efficacy and safety of eflapegrastim, a novel long-acting granulocyte-colony stimulating factor (G-CSF), in Koreans and Asians compared with the pooled population of two global phase 3 trials. Materials and Methods: Two phase 3 trials (ADVANCE and RECOVER) evaluated the efficacy and safety of fixed-dose eflapegrastim (13.2 mg/0.6 mL [3.6 mg G-CSF equivalent]) compared to pegfilgrastim (6 mg based on G-CSF) in breast cancer patients who received neoadjuvant or adjuvant docetaxel/cyclophosphamide. The primary objective was to demonstrate non-inferiority of eflapegrastim compared to pegfilgrastim in mean duration of severe neutropenia (DSN) in cycle 1, in Korean and Asian subpopulations. Results: Among a total of 643 patients randomized to eflapegrastim (n=314) or pegfilgrastim (n=329), 54 Asians (29 to eflapegrastim and 25 to pegfilgrastim) including 28 Koreans (14 to both eflapegrastim and pegfilgrastim) were enrolled. The primary endpoint, DSN in cycle 1 in the eflapegrastim arm was non-inferior to the pegfilgrastim arm in Koreans and Asians. The DSN difference between the eflapegrastim and pegfilgrastim arms was consistent across populations: –0.120 days (95% confidence interval [CI], –0.227 to –0.016), –0.288 (95% CI, –0.714 to 0.143), and –0.267 (95% CI, –0.697 to 0.110) for pooled population, Koreans and Asians, respectively. There were few treatment-related adverse events that caused discontinuation of eflapegrastim (1.9%) or pegfilgrastim (1.5%) in total and no notable trends or differences across patient populations. Conclusion This study may suggest that eflapegrastim showed non-inferior efficacy and similar safety compared to pegfilgrastim in Koreans and Asians, consistently with those of pooled population.