Allergen immunotherapy (AIT) has been used for over a century and has been demonstrated to be effective in treating patients with various allergic diseases. AIT allergens can be administered through various routes, including subcutaneous, sublingual, intralymphatic, oral, or epicutaneous routes. Sublingual immunotherapy (SLIT) has recently gained clinical interest, and it is considered an alternative treatment for allergic rhinitis (AR) and asthma. This review provides an overview of the current evidence-based studies that address the use of SLIT for treating AR, including (1) mechanisms of action, (2) appropriate patient selection for SLIT, (3) the current available SLIT products in Korea, and (4) updated information on its efficacy and safety. Finally, this guideline aims to provide the clinician with practical considerations for SLIT.

Allergen immunotherapy (AIT) is a causative treatment of allergic diseases in which allergen extracts are regularly administered in a gradually escalated doses, leading to immune tolerance and consequent alleviation of allergic diseases. The need for uniform practice guidelines in AIT is continuously growing as the number of potential candidates for AIT increases and new therapeutic approaches are tried. This updated version of the Korean Academy of Asthma Allergy and Clinical Immunology recommendations for AIT, published in 2010, proposes an expert opinion by specialists in allergy, pediatrics, and otorhinolaryngology. This guideline deals with the basic knowledge of AIT, including mechanisms, clinical efficacy, allergen standardization, important allergens in Korea, and special consideration in pediatrics. The article also covers the methodological aspects of AIT, including patient selection, allergen selection, schedule and doses, follow-up care, efficacy measurements, and management of adverse reactions. Although this guideline suggests the optimal dosing schedule, an individualized approach and modifications are recommended considering the situation for each patient and clinic.

Purpose: This study examined the outcomes of additional medial locking plate fixation and autogenous bone grafting in the treatment of nonunions that occurred after initial fixation for distal femoral fractures using lateral locking plates. Materials and Methods: The study involved eleven patients who initially underwent minimally invasive lateral locking plate fixation for distal femoral fractures between January 2008 and December 2020. The initial procedure was followed by additional medial locking plate fixation and autogenous bone grafting for clinically and radiographically confirmed nonunions, while leaving the stable lateral locking plate in situ. A clinical evaluation of the bone union time, knee joint range of motion, visual analog scale (VAS) pain scores, presence of postoperative complications, and functional evaluations using the lower extremity functional scale (LEFS) were performed. Results: In all cases, bone union was achieved in an average of 6.1 months after the secondary surgery. The range of knee joint motion, weight-bearing ability, and VAS and LEFS scores improved at the final follow-up compared to the preoperative conditions. All patients could walk without walking assistive devices and did not experience pain at the fracture site. On the other hand, three patients complained of pain in the lateral knee joint caused by irritation by the lateral locking plate; hence, lateral hardware removal was performed. One patient complained of mild paresthesia at the anteromedial incision site.Severe complications, such as deep infection or metal failure, were not observed. Conclusion For nonunion with stable lateral locking plates after minimally invasive lateral locking plate fixation of distal femur fractures, additional medial locking plate fixation and autogenous bone grafting, while leaving the lateral locking plate intact, can achieve successful bone union.

Objectives: This study investigated the impacts of exercise on irisin and fibroblast growth factor 21 (FGF-21) expression, as well as triiodothyronine (T3) and free fatty acid (FFA) levels in elderly women. Methods: Thirty women aged 65 to 70 years (10 per group) were randomly assigned to aquatic exercise, land exercise, and control groups. The aquatic and land groups engaged in 3 exercise sessions per week (60 min/session) for 16 weeks. The intensity was progressively increased every 4 weeks. Results: Irisin and FGF-21 levels significantly increased in the aquatic exercise group. In the post-test, the aquatic exercise group had the highest irisin levels. Significant findings were observed for irisin and FGF-21 for the main effect between aquatic and band exercise groups (p<0.05 for both), the main effect between measurement times (p<0.01 and p<0.001, respectively), and the interaction effect (p<0.05 and p<0.001, respectively). The irisin level was significantly higher in the aquatic than in the land group 30 minutes after the last session (p<0.05). In both exercise groups, T3 levels were significantly higher 30 minutes after the final session (p<0.05) than before the program. The FFA level was significantly higher in the aquatic exercise group than the others. In the aquatic group, FFA levels were significantly higher 30 minutes after both the first (p<0.01) and the last (p<0.001) session compared to pre-program values. Conclusion Differences in exercise type and environment can promote fat metabolism by stimulating hormonal changes that induce brown fat activity and browning.

Purpose: We aimed to investigate changes in visiting patterns after the lifting of mask mandates in a single pediatric emergency medical center in Seoul, Korea. Methods: This retrospective study was based on the data of patients’ (≤ 18 years) visits to the emergency department (ED) of the center from January 1, 2022 through June 30, 2023. Clinical characteristics, Korean Triage and Acuity Scale (KTAS) level, ED outcomes, and length of stay were compared between before (March 20-June 30, 2022) and after (March 20-June 30, 2023) the lifting of mask mandates. The comparisons were iterated in the patients with infectious disease. Results: During the study period, a total of 18,654 children visited the ED. After the lifting of mask mandates, ED visits increased from 7,146 to 11,508 (61.0%; 95% confidence interval, 59.5-62.6; P < 0.001). The increase was more prominent in the age of 2-5 years (82.9%), infectious diseases (175.3%), KTAS level 3 (127.7%), and length of stay shorter than 3 hours (78.8%-92.6%). The number of patients per hour increased by 151.2% for 5 patients or more and over 3,000% for 10 or more. Median length of stay decreased (2.3 hours [interquartile range, 1.2-4.1] to 1.9 hours [1.1-3.5]; P < 0.001). The patients with infectious disease (n = 7,139) showed similar patterns of increase in the age of 2-5 years, KTAS level 3, and length of stay shorter than 3 hours, with an additional increase in the age of 6-18 years. Conclusion After the lifting of mask mandates, pediatric visits increased by 61%, with the highest increase in children with mild infectious diseases on weekends and at night, and the proportion of more than 10 visits per hour significantly increased. We need urgent and realistic support measures from health authorities.

Purpose: This study was performed to analyze clinical features and use of renal replacement therapy (RRT) for children who visit the pediatric emergency department with benign acute childhood myositis (BACM) or rhabdomyolysis. Methods: We retrospectively reviewed medical records of 289 children who visited the emergency department with BACM or rhabdomyolysis from January 2013 through December 2022. Clinical features, laboratory and microbiological findings, and outcomes were compared between children with the two diagnoses. Subsequently, multivariable logistic regressions were performed to identify factors associated with applying RRT. Results: Of the 289 children, a total of 212 were analyzed, including 93 with BACM and 119 with rhabdomyolysis. Influenza (70 of the 145 children [48.3%]) was the most common cause, followed by exercise (36 of 212 [17.0%]). Compared with the children with BACM, those with rhabdomyolysis showed significantly higher frequencies of being boys and hematuria, and higher concentrations of hemoglobin, creatinine, creatine kinase, and myoglobin. Continuous venovenous hemofiltration, a modality of RRT, was applied to 8 children (6.7%) with rhabdomyolysis, of whom 1 died. Creatine kinase was independently associated with the application of RRT (adjusted odds ratio, 1.06; 95% confidence interval, 1.00-1.12; P = 0.036). Conclusion Rhabdomyolysis in children who require RRT may be associated with a higher concentration of creatine kinase.

Purpose: This study evaluated the role of donor kidney ultrasonography (US) for predicting functional kidney volume and identifying ideal kidney grafts in deceased donor kidney transplantation. Methods: In total, 272 patients who underwent deceased donor kidney transplantation from 2000 to 2020 at Samsung Medical Center were enrolled. Donor kidney information (i.e., right or left) was provided to the radiologist who performed US image re-analysis. To binarize each kidney’s ultrasound parameters, an optimal cutoff value for estimated glomerular filtration rate (eGFR) of less than 30 mL/min/1.73 m2 within 1 year after kidney transplantation was selected using the receiver operating characteristic curve with a specificity >60%. Cox regression analysis was performed for an eGFR less than 30 mL/min/1.73 m2 within 1 year after kidney transplantation and graft failure within 2 years after kidney transplantation. Results: The product of renal length and cortical thickness was a statistically significant predictor of graft function. The odds ratios of an eGFR less than 30 mL/min/1.73 m2 within a year after kidney transplantation and the hazard ratio of graft failure within 2 years after kidney transplantation were 5.91 (P=0.003) and 5.76 (P=0.022), respectively. Conclusion Preoperative US of the donor kidney can be used to evaluate donor kidney function and can predict short-term graft survival. An imaging modality such as US should be included in the donor selection criteria as an additional recommendation. However, the purpose of this study was not to narrow the expanded criteria but to avoid catastrophic consequences by identifying ideal donor kidneys using preoperative US.

As the aging population increases, the number of patients with osteoporosis is gradually rising. Osteoporosis is a metabolic bone disease characterized by low bone mass and the microarchitectural deterioration of bone tissue, resulting in reduced bone strength and an increased risk of low-energy or fragility fractures. Thus, the use of anti-resorptive agents, such as bisphosphonates (BPs), to prevent osteoporotic fractures is growing annually. BPs are effective in reducing hip and other fractures. However, the longer a patient takes BPs, the higher the risk of an atypical femoral fracture (AFF). The exact mechanism by which long-term BP use affects the development of AFFs has not yet been clarified. However, several theories have been suggested to explain the pathogenesis of AFFs, such as suppressed bone remodeling, impaired bone healing, altered bone quality, and femoral morphology. The management of AFFs requires both medical and surgical approaches. BPs therapy should be discontinued immediately, and calcium and vitamin D levels should be evaluated and supplemented if insufficient. Teriparatide can be used for AFFs. Intramedullary nailing is the primary treatment for complete AFFs, and prophylactic femoral nailing is recommended if signs of an impending fracture are detected.

A 45-year-old woman diagnosed with breast cancer reported disease progression in the form of metastatic lung and recurrent breast lesions following chemotherapy and human epidermal growth factor receptor 2 (HER2)-targeted therapy. The patient underwent 64 Cu-tetra-azacyclododecanetetra-acetic acid (DOTA)-trastuzumab positron emission tomography/computed tomography (PET/CT) to evaluate the HER2 expression status.64 Cu-DOTA-trastuzumab accumulated in the left breast and lymph nodes but not in the lung lesions. Following trastuzumab emtansine treatment, there was a significant improvement in the lesions with 64 Cu-DOTA-trastuzumab accumulation. However, the lesions that did not accumulate 64 Cu-DOTA-trastuzumab aggravated. Therefore, it was concluded that 64 CuDOTA-trastuzumab PET/CT can be used to predict the outcome of HER2-targeted treatment by evaluating HER2 expression in breast cancer patients.

Purpose: We investigated the clinicopathological features and management for superficial nonampullary duodenal tumors (SNADTs). The safety and feasibility of laparoscopic management, especially laparoscopic endoscopic cooperative surgery (LECS), were evaluated. Methods: A total of 59 patients with SNADTs who underwent operations from January 2009 to December 2018 at all 8 institutions of the Catholic Medical Center were identified in our comprehensive multi-institutional database. Clinicopathological and surgical data on the 4 anatomical regions of the duodenum were collected and compared.Characteristics of laparoscopic procedure (laparoscopy-only) and LECS procedures were also compared. Results: There were significantly more asymptomatic patients with tumors in the first and second vs. third and fourth duodenal regions. Gastrointestinal stromal tumors (GISTs), carcinoids, and ectopic pancreatic tumors were identified in 32, 12, and 5 cases, respectively. Forty-two patients (71.2%) underwent laparoscopy. Of patients undergoing laparoscopy, the LECS group exhibited significantly more endophytic features and smaller tumor sizes (P < 0.001 and P < 0.001, respectively). Although no significant difference in the wedge resection or postoperative complication rate was seen between the 2 groups (P = 0.096 and P = 0.227, respectively), the wedge resection rate was higher, and the complication rate lower, in the LECS group than the conventional laparoscopic surgery group. Conclusion Most of the SNADTs located in proximal duodenum were detected incidentally. GISTs were the most common diagnoses of SNADTs in all locations. In treating these tumors, laparoscopic resection is safe and feasible. Especially, LECS may be ideal for treating small endophytic tumors, minimizing over-resection and postoperative complications.