Purpose: The declining recruitment rate of pediatric residents in Korea has led to a decrease in the number of emergency departments (EDs) offering a 24/7 pediatric emergency care (PEC). This study evaluated the impact of reduced PEC hours on the utilization patterns of a single ED. Methods: We reviewed medical records of pediatric patients who were defined as individuals aged 14 years or younger undergoing pediatricians’ practices in a tertiary hospital ED in Korea. Given the reduction of PEC hours from full-time to 08:00-24:00 on September 27, 2022, the patients were grouped as those who visited during March 27, 2022-September 26, 2022 (“control”), and those who visited during September 27, 2022-March 26, 2023 (“reduction”). The following variables were analyzed between the 2 periods: the number of patients, age, sex, visits via ambulances, severity by the Korean Triage and Acuity Scale with high acuity (a level 1-2 of the scale), disease-related visits, time of visit, ED length of stay (EDLOS), disposition, chief complaints, and diagnoses. Results: Among 3,577 pediatric patients, 1,315 visited the ED during the reduction period, down by 41.9% in numbers from the control period. From the control to reduction periods, we observed an increase in the median age (from 3.0 years [interquartile range, 1.0-7.0] to 4.0 years [1.0-8.0]; P = 0.005) and decreases in the median EDLOS (from 140.0 minutes [80.0-217.0] to 104.0 minutes [54.0-169.8]; P < 0.001) and proportion of hospitalization (from 22.1% to 12.6%; P < 0.001). No change was observed in the proportions of highacuity cases or chief complaints. We noted decreases in infection-related diagnoses during the reduction. Conclusion Reducing PEC hours was associated with shorter EDLOS, fewer hospitalizations, and older age, with no difference in the severity. Even with reduced PEC hours, relevant resources should be redistributed to ensure the accessibility to PEC.

The objective of this study was to compare changes in the simplified disease activity index (SDAI) between biologic (b) and conventional (c) disease-modifying antirheumatic drugs (DMARD) users with seropositive rheumatoid arthritis (RA) in daily clinical practice. Methods: This was a nationwide multicenter observational study. Patients who had three or more active joint counts and abnormal inf lammatory marker in blood test were enrolled. The selection of DMARDs was determined by the attending rheumatologist. Clinical parameters, laboratory findings, and Health Assessment Questionnaire (HAQ) scores were obtained at baseline and at 6 and 12 months. Serial SDAI changes and clinical remission rate at 6 and 12 months were assessed. Results: A total of 850 patients participated in this study. The mean baseline SDAI score in bDMARD group was higher than that in cDMARD group (32.08 ± 12.98 vs 25.69 ± 10.97, p < 0.0001). Mean change of SDAI at 12 months was –19.0 in the bDMARD group and –12.6 in the cDMARD group (p < 0.0001). Clinical remission rates at 12 months in bDMARD and cDMARD groups were 15.4% and 14.6%, respectively. Patient global assessment and HAQ at 12 months were also significantly improved in both groups. Multivariate logistic regression showed that baseline HAQ score was the most notable factor associated with remission. Conclusions: There was a significant reduction in SDAI within 12 months after receiving DMARDs in Korean seropositive RA patients irrespective of bDMARD or cDMARD use in real-world practice. Clinical remission was achieved in those with lower baseline HAQ scores.

BACKGROUND/AIMS: Direct sequencing is the gold standard for the detection of drug-resistance mutations in hepatitis B virus (HBV); however, this procedure is time-consuming, labor-intensive, and difficult to adapt to high-throughput screening. In this study, we aimed to develop a dendron-modified DNA microarray for the detection of genotypic resistance mutations and evaluate its efficiency. METHODS: The specificity, sensitivity, and selectivity of dendron-modified slides for the detection of representative drug-resistance mutations were evaluated and compared to those of conventional slides. The diagnostic accuracy was validated using sera obtained from 13 patients who developed viral breakthrough during lamivudine, adefovir, or entecavir therapy and compared with the accuracy of restriction fragment mass polymorphism and direct sequencing data. RESULTS: The dendron-modified slides significantly outperformed the conventional microarray slides and were able to detect HBV DNA at a very low level (1 copy/μL). Notably, HBV mutants could be detected in the chronic hepatitis B patient sera without virus purification. The validation of our data revealed that this technique is fully compatible with sequencing data of drug-resistant HBV. CONCLUSIONS: We developed a novel diagnostic technique for the simultaneous detection of several drug-resistance mutations using a dendron-modified DNA microarray. This technique can be directly applied to sera from chronic hepatitis B patients who show resistance to several nucleos(t)ide analogues.
DNA ; Drug Resistance ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis B, Chronic ; Hepatitis* ; Humans ; Lamivudine ; Mass Screening ; Oligonucleotide Array Sequence Analysis ; Sensitivity and Specificity

PURPOSE: The goal of this study was to develop a model of risk factors for depression in hospitalized burned patients. METHODS: Seventy-seven patients over 20 tears of age who were admitted to the Hangang Sacred Heart Hospital for burn injury, completed Structured Interview Post-traumatic stress disorder (PTSD), Beck Depression Inventory (BDI), Visual Analogue Scale (VAS) for pain and itching after 1 month from burn. A path analytic strategy was used to develop a model of risk factors for depression in burned patients. RESULTS: Two pathways to depression were developed. 1) From sleep disturbance and then to depression 2) from burn pain to PTSD and then to depression. It was revealed that sleep disturbance and PTSD had a direct effect on depression, pain had both direct and indirect effect on depression. CONCLUSION: Sleep disturbance and PTSD are associated with depression in burned patients. The identification of two developmental pathways suggests the importance of establishing preventive interventions for depression.
Burns ; Depression ; Heart ; Humans ; Pruritus ; Risk Factors ; Stress Disorders, Post-Traumatic

PURPOSE: Burn is an unusual medical situation with limited information open to common people. This study was designed to evaluate the communication gap and different understandings between doctor and patient about burn treatment and to improve quality of the treatment. METHODS: Cross-sectional studies were done with interview and questionnaire. 25 doctors and nurses of burn ward and 50 burn patients in Han-gang Sacred Heart Hospital Burn Center were participated. To understand the communication gap and different perception between doctors' and patients' on 1) burn sequela and recovery, 2) disease course and prognosis, 3) healing environment, cost, hospitalization, 4) nurse-physician collaboration, 5) psychiatric consultation, 6) extra incentive were analyzed. RESULTS: Patients tend to expectation positive answer about their prognosis from their physician but they have recognized chronic and negative prognosis of burn treatment. Patients want to know clear and detailed explanation about their test result or treatment methods. Physicians thought that it is important to consider patients' economic status and provide different treatment principle. Short duration of hospitalization is not related to the anxiety of rehabilitation. Patients thought that nurses could manage superficial or repeated treatment. It is more likely that physicians warn the disadvantages of psychiatric consultation than patients. Both groups thought that extra incentive or gratitude money is not helpful for the doctor patient relationship. CONCLUSION: Given the discrepant views of physicians and patients on the burn treatment, physician should be aware of the discrepancies and attempts to resolve any differences.
Anxiety ; Burn Units ; Burns ; Cooperative Behavior ; Cross-Sectional Studies ; Heart ; Hospitalization ; Humans ; Motivation ; Prognosis ; Surveys and Questionnaires

A liposarcoma is the most common soft tissue sarcoma in adults with an incidence of about 20% of all soft tissue sarcomas. Although incidence differs from a region of origination, a case arisen from mesentery has rarely been reported. We experienced a case of liposarcoma arising from the mesentery of a 51-year-old male patient. He was treated by wide excision. Histologically, the tumor was composed of a mixed well-differentiated liposarcoma with myxoid and spindle cell type.
Diagnosis, Differential ; Fluorodeoxyglucose F18/diagnostic use ; Humans ; Liposarcoma/*diagnosis/pathology/surgery ; Magnetic Resonance Imaging ; Male ; Mesentery/*pathology ; Middle Aged ; Tomography, X-Ray Computed

PURPOSE: Severe burn patients are easily exposed to infection due to immune compromise and loss of skin barrier. But in spite of advances in burn treatment, complication due to infection has significant influence in mortality and morbidity. Broad spectrum antibiotics are used empirically to reduce bacterial infection in severe burn patients but results in suppression of normal flora and mucosal damage in intestine which facilitates fungal growth. We investigated the incidence, frequent onset time, characteristics of patients with candidemia and found appropriate time for use of antifungal agents and treatment of infection. METHODS: We reviewed the medical records of patients who were admitted to Hangang sacred heart hospital burn ICU between January 2007 and December 2008. RESULTS: In 2007 395 patients were admitted to BICU and 66 patients (16.7%) had fungal infection. In 2008 331 patients were admitted to BICU and 77 patients (23.3%) had fungal infection. Fungus was isolated in blood culture in 22 patients (5.6%) and 7 patients (2.1%) in 2007 and 2008 respectively. 20 patients out of 28 patients with candidemia received ventilator care (p=0.037), mean stay in ICU was 52.2 days in patients with positive blood culture compared with 36.5 days in patients with negative blood culture (p=0.049). Mortality in candidemia patients was 42.9% (p=0.022) which was high. CONCLUSION: Candidemia frequently occurs in patients receiving ventilator care, and as stay in ICU lengthens financial burden increases and results in higher mortality and morbidity. Lowering morbidity through strict infection control and monitoring is needed.
Anti-Bacterial Agents ; Antifungal Agents ; Bacterial Infections ; Burns ; Candida ; Candidemia ; Fungi ; Heart ; Humans ; Incidence ; Infection Control ; Intestines ; Medical Records ; Skin ; Ventilators, Mechanical

Insular carcinoma of the thyroid is a rare thyroid malignancy, and this was named in 1984 by Carcangiu when he described its characteristic histology. Histologically, insular carcinoma is characterized by uniform cells arranged in distinct nests or an insular pattern that contain variable numbers of small follicles. Clinically and morphologically, it is considered to be in an intermediate position between well-differentiated carcinoma of the thyroid (papillary or follicular) and undifferentiated or anaplastic carcinoma of the thyroid. This thyroid malignancy is distinctive, aggressive and often lethal. However, most authors believe it to be an independent entity. The prognosis of this tumor is worse than that of classic differentiated thyroid carcinoma, and most authors advise aggressive therapy, which can achieve pro-longed survival in some cases. We describe here a patient (a 42 years-old woman) who was managed with completion thyroidectomy after unilateral lobectomy of the thyroid with confirmation of the permanent pathology as insular carcinoma. I-131 ablation (175 mCi) was performed on the remnant thyroid tissues after follow-up of I~131 whole-body scanning.
Carcinoma ; Follow-Up Studies ; Humans ; Pathology ; Prognosis ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroidectomy

Perinatal transmission and infection of hepatitis B virus (HBV) in early childhood were observed in the offsprings of hepatitis B surface antigen (HBsAg)-positive mothers who had been vaccinated against HBV immediately after giving birth. This prophylaxis failure of perinatal HBV infection is likely due to the interplay of the virus and host immune response. To investigate whether the HLA polymorphism affected the outcome of the perinatal prophylaxis, HLA class I (HLA-A, B and Cw) and class II (HLA-DRB1, DQA1, DQB1 and DPB1) were typed using serology, PCR-SSOP (polymerase chain reaction-sequence specific oligonucleotide probe), and PCR-ARMS (amplification refractory modification system) methods in 22 HBeAg-positive mothers and their 10 prophylaxis-succeeded and 12 prophylaxis- failed children. The HLA types of the mothers and their children were compared with 198 HBsAg-negative healthy controls in a Korean population. HLA-B35 (relative risk=4.2, p<0.01), B51 (relative risk=3.2, p<0.02), DRB1*07 (relative risk=3.8, p<0.03), and DQA1*02 (relative risk=3.8, p<0.03) alleles were more frequent in HBeAg-positive mothers than in the controls. Also, HLA-DRB1*13 (relative risk=0.1, p<0.02) and DPB1*0401 (relative risk=0.1, p<0.02) alleles were less frequent in HBeAg-positive mothers. However, HLA alleles did not affect the outcome of the perinatal prophylaxis against HBV. These results suggest that the reported influences of some HLA alleles on the natural chronic HBV infections may not operate in the HBV infections in children received perinatal prophylaxis.
Alleles* ; Child ; Hepatitis B Surface Antigens ; Hepatitis B virus* ; Hepatitis B* ; Hepatitis* ; HLA-B35 Antigen ; Humans ; Mothers ; Parturition

BACKGROUND: As all HLA class II genes, the DQ genes show their polymorphic variation mainly in the second exon, which encodes the first extracellular domain of the molecule. PCR-SSOP (Polymerase chain reaction-Sequence specific oligonucleotide probe) techniques were frequently used for HLA-DQA1 and DQB1 typing but certain alleles, DQA1*0101/0104/0105, *0302/0303, *0501/0505 and DQB1*0201/*0202, which differ from each other in segment other than exon 2, could not be unequivocally assigned. METHODS: To overcome this problem, we applied additional PCR-SSP (PCR-Sequence specific primer) method to analyze DQA1 exons 1, 3 and 4 and DQB1 exon 3. And we investigated the distributions and haplotypes of HLA-DRB1, DQA1 and DQB1 alleles in 406 unrelated Korean healthy individuals. RESULTS: Using this method the indistinguishable alleles of DQA1 and DQB1 in PCR-SSOP were typed definitively. We also found several important associations between DQA1 and DQB1 alleles in the Korean population; DQA1*0101-DQB1*0501, DQA1*0104-DQB1*0502 or -*0503, DQA1 *0105-DQB1*0501, DQA1*0302-DQB1*0303, DQA1*0303-DQB1*0401 or -*0402, DQA1 *0501-DQB1*0201, DQA1*0505-DQB1*0301, and DQA1*0201-DQB1*0202. The haplotypes of DRB1-DQA1-DQB1 associated with DQA1*01, *03, *05, and DQB1*02 subtypes were investigated. Several haplotypes associated with these alleles were observed in the Korean population. CONCLUSION: Our results can be helpful to find potential unrelated donors for bone marrow registries and study the HLA-associated disease and anthropology at high-resolution allelic level.
Alleles ; Anthropology ; Bone Marrow ; Exons ; Genes, MHC Class II ; Haplotypes* ; HLA-DRB1 Chains ; Humans ; Registries ; Unrelated Donors