Background: Perioperative adverse cardiac events (PACE), a composite of myocardial infarction, coronary revascularization, congestive heart failure, arrhythmic attack, acute pulmonary embolism, cardiac arrest, and stroke during 30-day postoperative period, is associated with long-term mortality, but with limited clinical evidence. We compared long-term mortality with PACE using data from nationwide multicenter electronic health records. Methods: Data from 7 hospitals, converted to Observational Medical Outcomes Partnership Common Data Model, were used. We extracted records of 277,787 adult patients over 18 years old undergoing non-cardiac surgery for the first time at the hospital and had medical records for more than 180 days before surgery. We performed propensity score matching and then an aggregated meta‑analysis. Results: After 1:4 propensity score matching, 7,970 patients with PACE and 28,807 patients without PACE were matched. The meta‑analysis showed that PACE was associated with higher one-year mortality risk (hazard ratio [HR]: 1.33, 95% CI [1.10, 1.60], P = 0.005) and higher three-year mortality (HR: 1.18, 95% CI [1.01, 1.38], P = 0.038). In subgroup analysis, the risk of one-year mortality by PACE became greater with higher-risk surgical procedures (HR: 1.20, 95% CI [1.04, 1.39], P = 0.020 for low-risk surgery; HR: 1.69, 95% CI [1.45, 1.96], P < 0.001 for intermediate-risk; and HR: 2.38, 95% CI [1.47, 3.86], P = 0.034 for high-risk). Conclusions A nationwide multicenter study showed that PACE was significantly associated with increased one-year mortality. This association was stronger in high-risk surgery, older, male, and chronic kidney disease subgroups. Further studies to improve mortality associated with PACE are needed.

In primary prevention for cardiovascular diseases, there are significant barriers to adherence including freedom from symptoms, long latency for therapeutic benefits, life-long duration of treatment, and need for combined lifestyle changes. However, to implement more systematic approaches, the focus on adherence improvement needs to be shifted away from patient factors to the effects of the treatment team and healthcare system. In addition to conventional educational approaches, more patient-oriented approaches such as patientcentered clinical communication skills, counseling using motivational strategies, decisionmaking by patient empowerment, and a multi-disciplinary team approach should be developed and implemented. Patients should be involved in a program of self-monitoring, self-management, and active counseling. Because most effective interventions on adherence improvement demand greater resources, the health care system and educational or training system of physicians and healthcare staff need to be supported for systematic improvement.

PURPOSE: Dexrazoxane has been used as an effective cardioprotector against anthracycline cardiotoxicity. This study intended to analyze cardioprotective efficacy and secondary malignancy development, and elucidate risk factors for secondary malignancies in dexrazoxane-treated pediatric patients. MATERIALS AND METHODS: Data was collected from 15 hospitals in Korea. Patients who received any anthracyclines, and completed treatment without stem cell transplantation were included. For efficacy evaluation, the incidence of cardiac events and cardiac event-free survival rates were compared. Data about risk factors of secondary malignancies were collected. RESULTS: Data of total 1,453 cases were analyzed; dexrazoxane with every anthracyclines group (D group, 1,035 patients) and no dexrazoxane group (non-D group, 418 patients). Incidence of the reported cardiac events was not statistically different between two groups; however, the cardiac event-free survival rate of patients with more than 400 mg/m2 of anthracyclines was significantly higher in D group (91.2% vs. 80.1%, p=0.04). The 6-year cumulative incidence of secondary malignancy was not different between both groups after considering follow-up duration difference (non-D, 0.52%±0.37%; D, 0.60%±0.28%; p=0.55). The most influential risk factor for secondary malignancy was the duration of anthracycline administration according to multivariate analysis. CONCLUSION: Dexrazoxane had an efficacy in lowering cardiac event-free survival rates in patients with higher cumulative anthracyclines. As a result of multivariate analysis for assessing risk factors of secondary malignancy, the occurrence of secondary malignancy was not related to dexrazoxane administration.
Anthracyclines ; Cardiotoxicity ; Dexrazoxane ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Multivariate Analysis ; Neoplasms, Second Primary ; Risk Factors* ; Stem Cell Transplantation

Invasive pulmonary aspergillosis (IPA) is the most frequent form of invasive fungal diseases in immunocompromised patients. However, there are only a few studies on IPA in immunocompromised children in Korea. This study was designed to characterize IPA in Korean children with hematologic/oncologic diseases. Medical records of children with hematologic/oncologic diseases receiving antifungal therapy were reviewed. The enrolled children were divided into the IPA group (proven and probable IPA) and non-IPA group, and the clinical characteristics and prognosis were compared between the two groups. During the study period, 265 courses of antifungal therapy were administered to 166 children. Among them, two (0.8%) episodes of proven IPA, 35 (13.2%) of probable IPA, and 52 (19.6%) of possible IPA were diagnosed. More children in the IPA group suffered from neutropenia lasting for more than two weeks (51.4% vs. 21.9%, P<0.001) and showed halo signs on the chest computed tomography (78.4% vs. 40.7%, P<0.001) than in the non-IPA group. No other clinical factors showed significant differences between the two groups. Amphotericin B deoxycholate was administered as a first line antifungal agent in 33 (89.2%) IPA group episodes, and eventually voriconazole was administered in 27 (73.0%) episodes. Ten (27.0%) children in the IPA group died within 12 weeks of antifungal therapy. In conclusion, early use of chest computed tomography to identify halo signs in immunocompromised children who are expected to have prolonged neutropenia can be helpful for early diagnosis of IPA and improving prognosis of children with IPA.
Antifungal Agents/*therapeutic use ; Child ; Child Health/statistics & numerical data ; Comorbidity ; Female ; Hematologic Diseases/*mortality ; Humans ; Incidence ; Invasive Pulmonary Aspergillosis/*diagnosis/drug therapy/*mortality ; Male ; Neoplasms/*mortality ; Prognosis ; Republic of Korea/epidemiology ; Risk Factors ; Survival Rate ; Tomography, X-Ray Computed/statistics & numerical data ; Treatment Outcome

Respiratory viral infection has been reported as a risk factor for invasive pulmonary aspergillosis (IPA) in hematopoietic cell transplantation (HCT) recipients, and IPA following influenza has been reported. We report a 13-year-old boy diagnosed with IPA following influenza. He received allogeneic HCT and then received glucocorticoids for chronic graft-versus-host disease. On admission, he complained of non-neutropenic fever and dyspnea. He was diagnosed with influenza A via a polymerase chain reaction (PCR) test from nasopharyngeal swab, and oseltamivir was administered. Fever re-emerged nine days later and repeat PCR was positive for influenza A. His fever did not resolve despite triple antiviral and empirical antibiotic therapy. On hospital day 22, IPA was diagnosed based on chest computed tomography and positive serum galactomannan results, and his symptoms improved with voriconazole therapy. However, he died of uncontrolled bronchiolitis obliterans on hospital day 128. IPA should be considered a complication of influenza in immunocompromised children.
Adolescent ; Bronchiolitis Obliterans ; Cell Transplantation ; Child ; Dyspnea ; Fever ; Glucocorticoids ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Humans ; Influenza, Human ; Invasive Pulmonary Aspergillosis ; Leukemia, Myeloid, Acute ; Male ; Oseltamivir ; Polymerase Chain Reaction ; Risk Factors ; Thorax ; Transplants

The concurrent occurrence of both aplastic anemia and thyroid cancer in a child is a very rare event. Although cancer may occur in patients with aplastic anemia who previously received immunosuppressive therapy or hematopoietic stem cell transplantation (HSCT), cancer in patients who are naive to such therapies is rare. We report a 12-year-old patient with idiopathic very severe aplastic anemia who was subsequently diagnosed with papillary thyroid cancer. This patient had a unique clinical presentation in that thyroid cancer was diagnosed prior to hematopoietic stem cell transplantation given to treat very severe aplastic anemia.
Anemia, Aplastic ; Child ; Hematopoietic Stem Cell Transplantation ; Humans ; Thyroid Gland ; Thyroid Neoplasms

The efficacy of tandem high-dose chemotherapy and autologous stem cell rescue (HDCT/ASCR) was investigated in patients with high-risk neuroblastoma. Patients over 1 yr of age who were newly diagnosed with stage 4 neuroblastoma from January 2000 to December 2005 were enrolled in The Korean Society of Pediatric Hematology-Oncology registry. All patients who were assigned to receive HDCT/ASCR at diagnosis were retrospectively analyzed to investigate the efficacy of single or tandem HDCT/ASCR. Seventy and 71 patients were assigned to receive single or tandem HDCT/ASCR at diagnosis. Fifty-seven and 59 patients in the single or tandem HDCT group underwent single or tandem HDCT/ASCR as scheduled. Twenty-four and 38 patients in the single or tandem HDCT group remained event free with a median follow-up of 56 (24-88) months. When the survival rate was analyzed according to intent-to-treat at diagnosis, the probability of the 5-yr event-free survival+/-95% confidence intervals was higher in the tandem HDCT group than in the single HDCT group (51.2+/-12.4% vs. 31.3+/-11.5%, P=0.030). The results of the present study demonstrate that the tandem HDCT/ASCR strategy is significantly better than the single HDCT/ASCR strategy for improved survival in the treatment of high-risk neuroblastoma patients.
Adolescent ; Child ; Child, Preschool ; Combined Modality Therapy/mortality ; Drug Therapy/*mortality ; Female ; Humans ; Infant ; Korea/epidemiology ; Longitudinal Studies ; Male ; Neuroblastoma/*mortality/*therapy ; Prevalence ; Risk Assessment/methods ; Risk Factors ; Stem Cell Transplantation/*mortality ; Survival Analysis ; Survival Rate ; Treatment Outcome

We investigated the outcome of idarubicin plus N4-behenoyl-1-beta-D-arabinofuranosyl cytosine (BHAC)-based chemotherapy (BHAC group, n=149) compared to idarubicin plus cytarabine-based chemotherapy (cytarabine group, n=191) for childhood acute myeloid leukemia (AML). Between January 1996 and December 2005, 340 children with AML from 5 university hospitals in Korea received the BHAC-based or cytarabine-based chemotherapy, with or without hematopoietic stem cell transplantation. After induction therapy, 264 (77.6%) of 340 children achieved a complete remission (CR) and 43 (12%) achieved a partial remission (PR). The CR rate in the BHAC group was higher than in the cytarabine group (85.2% vs. 71.7%, P=0.004). However, the overall response rate (CR+PR) was not different between the two groups (93.3% vs. 87.9%, P=0.139). The 5-yr estimates of overall survival (OS) of children in the two groups were similar (54.9% for the BHAC group vs. 52.4% for the cytarabine group, P=0.281). Although the results were analyzed according to the treatment type and cytogenetic risk, the OS showed no significant difference between the BHAC group and the cytarabine group. In the present study, the clinical outcomes of the BHAC-based chemotherapy, consisting of BHAC, idarubicin, and 6-TG, are comparable to that of the cytarabine-based chemotherapy for childhood AML.
Adolescent ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Child ; Child, Preschool ; Combined Modality Therapy ; Cytarabine/*analogs & derivatives/*therapeutic use ; Cytogenetics ; Female ; Hematopoietic Stem Cell Transplantation ; Humans ; Idarubicin/*therapeutic use ; Infant ; Infant, Newborn ; Leukemia, Myeloid, Acute/*drug therapy/mortality ; Male ; Republic of Korea ; Retrospective Studies ; Survival Analysis ; Thioguanine/*therapeutic use ; Young Adult

House-residual spraying and insecticide-treated bed nets have achieved some success in controlling anthropophilic and endophagic vectors. However, these methods have relatively low efficacy in Korea because Anopheles sinensis, the primary malaria vector, is highly zoophilic and exophilic. So, we focused our vector control efforts within livestock enclosures using ultraviolet black light traps as a mechanical control measure. We found that black light traps captured significantly more mosquitoes at 2 and 2.5 m above the ground (P < 0.05). We also evaluated the effectiveness of trap spacing within the livestock enclosure. In general, traps spaced between 4 and 7 m apart captured mosquitoes more efficiently than those spaced closer together (P > 0.05). Based on these findings, we concluded that each black light trap in the livestock enclosures killed 7,586 female mosquitoes per trap per night during the peak mosquito season (July-August). In May-August 2003, additional concurrent field trials were conducted in Ganghwa county. We got 74.9% reduction (P < 0.05) of An. sinensis in human dwellings and 61.5% reduction (P > 0.05) in the livestock enclosures. The black light trap operation in the livestock enclosures proved to b9e an effective control method and should be incorporated into existing control strategies in developed countries.
Animals ; Anopheles/*radiation effects ; Female ; Housing, Animal ; Humans ; Korea ; Mosquito Control/*methods ; *Ultraviolet Rays

PURPOSE: Cytomegalovirus(CMV) infection still remains as a major cause of morbidity and mortality after stem cell transplantation. In this study, we analyzed the results of antigenemia-guided pre-emptive therapy among children with allogeneic hematopoietic stem cell transplantation to determine the incidence and risk factors associated with CMV antigenemia, and evaluated the efficacy of the CMV antigenemia based preemptive therapy. METHODS: We enrolled 213 pediatric patients following allogeneic hematopoietic stem cell transplantation(HSCT), at the Catholic HSCT center between October 1998 and December 2003. Pre-emptive ganciclovir was started when more than 5 CMV Ag-positive cells were detected in matched sibling HSCT, and when any Ag-positive cells were seen in unrelated allogenic HSCT. RESULTS: CMV antigenemia was observed in 88(41.3 percent) of 213 patients on median day 28(day 11-99). In univariated analysis, use of unrelated donors(other than siblings), age of recipient(more than 5 years at transplant) at transplantation, the presence of recipient CMV-IgG before transplantation, TBI-based conditioning regimen and the presence of acute GvHD(grade > or=II) were the risk factors for positive CMV antigenemia. In multivariate analysis, unrelated bone marrow transplantation, positive recipient CMV serology and acute GvHD(grade > or=II) were the independent risk factors for positive CMV antigenemia. CONCLUSION: Risk factors of CMV infection in children were CMV serostatus of the recipient, the source of stem cells, and acute graft-versus-host disease. The pre-emptive therapy based on CMV antigenemia was effective in the prevention of CMV disease.
Bone Marrow Transplantation ; Child ; Cytomegalovirus ; Ganciclovir ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells* ; Humans ; Incidence ; Mortality ; Multivariate Analysis ; Risk Factors ; Siblings ; Stem Cell Transplantation ; Stem Cells