Background: Coronavirus disease 2019 (COVID-19) outbreaks occur in hospitals in many parts of the world. In hospital settings, the possibility of airborne transmission needs to be investigated thoroughly. Materials and Methods: There was a nosocomial outbreak of COVID-19 in a hematologic ward in a tertiary hospital, Seoul, Korea. We found 11 patients and guardians with COVID-19 through vigorous contact tracing and closed-circuit television monitoring. We found one patient who probably had acquired COVID-19 through airborne-transmission. We performed airflow investigation with simulation software, whole-genome sequencing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results: Of the nine individuals with COVID-19 who had been in the hematologic ward, six stayed in one multi-patient room (Room 36), and other three stayed in different rooms (Room 1, 34, 35). Guardian in room 35 was close contact to cases in room 36, and patient in room 34 used the shared bathroom for teeth brushing 40 minutes after index used.Airflow simulation revealed that air was spread from the bathroom to the adjacent room 1 while patient in room 1 did not used the shared bathroom. Airflow was associated with poor ventilation in shared bathroom due to dysfunctioning air-exhaust, grill on the door of shared bathroom and the unintended negative pressure of adjacent room. Conclusion Transmission of SARS-CoV-2 in the hematologic ward occurred rapidly in the multi-patient room and shared bathroom settings. In addition, there was a case of possible airborne transmission due to unexpected airflow.

Background: Coronavirus disease 2019 (COVID-19) outbreaks occur in hospitals in many parts of the world. In hospital settings, the possibility of airborne transmission needs to be investigated thoroughly. Materials and Methods: There was a nosocomial outbreak of COVID-19 in a hematologic ward in a tertiary hospital, Seoul, Korea. We found 11 patients and guardians with COVID-19 through vigorous contact tracing and closed-circuit television monitoring. We found one patient who probably had acquired COVID-19 through airborne-transmission. We performed airflow investigation with simulation software, whole-genome sequencing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results: Of the nine individuals with COVID-19 who had been in the hematologic ward, six stayed in one multi-patient room (Room 36), and other three stayed in different rooms (Room 1, 34, 35). Guardian in room 35 was close contact to cases in room 36, and patient in room 34 used the shared bathroom for teeth brushing 40 minutes after index used.Airflow simulation revealed that air was spread from the bathroom to the adjacent room 1 while patient in room 1 did not used the shared bathroom. Airflow was associated with poor ventilation in shared bathroom due to dysfunctioning air-exhaust, grill on the door of shared bathroom and the unintended negative pressure of adjacent room. Conclusion Transmission of SARS-CoV-2 in the hematologic ward occurred rapidly in the multi-patient room and shared bathroom settings. In addition, there was a case of possible airborne transmission due to unexpected airflow.

Purpose: Intensity-modulated radiotherapy (IMRT) allows for more precise treatment, reducing unwanted radiation to nearby structures. We investigated the safety and feasibility of IMRT for anaplastic ependymoma patients below 3 years of age. Materials and Methods: A total of 9 anaplastic ependymoma patients below 3 years of age, who received IMRT between October 2011 and December 2017 were retrospectively reviewed. The median equivalent dose in 2 Gy fractions was 52.0 Gy (range, 48.0 to 60.0 Gy). Treatment outcomes and neurologic morbidities were reviewed in detail. Results: The median patient age was 20.9 months (range, 12.1 to 31.2 months). All patients underwent surgery. The rates of 5-year overall survival, freedom from local recurrence, and progression-free survival were 40.6%, 53.3%, and 26.7%, respectively. Of the 9 patients, 5 experienced recurrences (3 had local recurrence, 1 had both local recurrence and cerebrospinal fluid [CSF] seeding, and 1 had CSF seeding alone). Five patients died because of disease progression. Assessment of neurologic morbidity revealed motor dysfunction in 3 patients, all of whom presented with hydrocephalus at initial diagnosis because of the location of the tumor and already had neurologic deficits before radiotherapy (RT). Conclusion Neurologic morbidity is not caused by RT alone but may result from mass effects of the tumor and surgical sequelae. Administration of IMRT to anaplastic ependymoma patients below 3 years of age yielded encouraging local control and tolerable morbidities. High-precision modern RT such as IMRT can be considered for very young patients with anaplastic ependymoma.

The teeth are the hardest structures in the body and can be a biomarker of aging. The aging process and degenerative changes in the teeth are helpful for estimation of age in adults. One of the best-known features of dental aging is a reduction in the size of the pulp chamber as a result of secondary deposition of dentin. In this study, we developed new regression models to estimate chronological age in Korean adults using the mandibular first molars to examine the relationship between age and pulp cavity size on intraoral radiographs. Intraoral periapical digital radiographs of the mandibular first molars were collected from 243 patients (147 male, 96 female) of known age. The radiographic images were analyzed by using the Adobe Photoshop CS5 image editing program. The pulp chamber height ratio (PCHR), pulp chamber width ratio (PCWR) were calculated and found to have a significant negative correlation with age. The correlation was consistently higher for PCHR than for PCWR. The strongest correlation was found for PCHR in female patients (r=−0.824). Multiple regression models were derived using the PCHR and PCWR. The determination coefficients (R²) of the models ranged from 0.660 to 0.730. Our results indicate that the measurement of pulp chamber height and width in the mandibular first molar is a practical, simple and reliable method for estimation of age in Korean adults.
Adult ; Age Determination by Teeth ; Aging ; Dental Pulp Cavity ; Dentin ; Female ; Humans ; Korea ; Male ; Methods ; Molar ; Radiography ; Tooth

The teeth are the hardest structures in the body and can be a biomarker of aging. The aging process and degenerative changes in the teeth are helpful for estimation of age in adults. One of the best-known features of dental aging is a reduction in the size of the pulp chamber as a result of secondary deposition of dentin. In this study, we developed new regression models to estimate chronological age in Korean adults using the mandibular first molars to examine the relationship between age and pulp cavity size on intraoral radiographs. Intraoral periapical digital radiographs of the mandibular first molars were collected from 243 patients (147 male, 96 female) of known age. The radiographic images were analyzed by using the Adobe Photoshop CS5 image editing program. The pulp chamber height ratio (PCHR), pulp chamber width ratio (PCWR) were calculated and found to have a significant negative correlation with age. The correlation was consistently higher for PCHR than for PCWR. The strongest correlation was found for PCHR in female patients (r=−0.824). Multiple regression models were derived using the PCHR and PCWR. The determination coefficients (R²) of the models ranged from 0.660 to 0.730. Our results indicate that the measurement of pulp chamber height and width in the mandibular first molar is a practical, simple and reliable method for estimation of age in Korean adults.

PURPOSE: In this retrospective study, we compared the incidence of leptomeningeal carcinomatosis or dural metastasis (LMCDM) in patients who received whole brain radiotherapy (WBRT), partial radiotherapy (PRT), or no radiotherapy (RT) following resection of brain metastases from breast cancer. MATERIALS AND METHODS: Fifty-one patients with breast cancer underwent surgical resection for newly diagnosed brain metastases in two institutions between March 2001 and March 2015. Among these, 34 received postoperative WBRT (n=24) or PRT (n=10) and 17 did not. RESULTS: With a median follow-up of 12.4 months (range, 2.3 to 83.6 months), 22/51 patients developed LMCDM at a median of 8.6 months (range, 4.8 to 51.2 months) after surgery. The 18-months LMCDM-free survival (LMCDM-FS) rates were 77.5%, 30.0%, and 13.6%, in the WBRT, PRT, and no RT groups, respectively (p=0.013). The presence of a tumor adjacent to cerebrospinal fluid flow and no systemic treatment after treatment for brain metastases were also associated with poor LMCDM-FS rate. Multivariate analysis showed that WBRT compared to PRT (p=0.009) and systemic treatment (p < 0.001) were independently associated with reduced incidence of LMCDM. CONCLUSION: WBRT improved LMCDM-FS rate after resection of brain metastases compared to PRT in breast cancer patients.
Brain* ; Breast Neoplasms* ; Breast* ; Cerebrospinal Fluid ; Follow-Up Studies ; Humans ; Incidence ; Meningeal Carcinomatosis* ; Multivariate Analysis ; Neoplasm Metastasis* ; Radiotherapy* ; Retrospective Studies

PURPOSE: In this retrospective study, we compared the incidence of leptomeningeal carcinomatosis or dural metastasis (LMCDM) in patients who received whole brain radiotherapy (WBRT), partial radiotherapy (PRT), or no radiotherapy (RT) following resection of brain metastases from breast cancer. MATERIALS AND METHODS: Fifty-one patients with breast cancer underwent surgical resection for newly diagnosed brain metastases in two institutions between March 2001 and March 2015. Among these, 34 received postoperative WBRT (n=24) or PRT (n=10) and 17 did not. RESULTS: With a median follow-up of 12.4 months (range, 2.3 to 83.6 months), 22/51 patients developed LMCDM at a median of 8.6 months (range, 4.8 to 51.2 months) after surgery. The 18-months LMCDM-free survival (LMCDM-FS) rates were 77.5%, 30.0%, and 13.6%, in the WBRT, PRT, and no RT groups, respectively (p=0.013). The presence of a tumor adjacent to cerebrospinal fluid flow and no systemic treatment after treatment for brain metastases were also associated with poor LMCDM-FS rate. Multivariate analysis showed that WBRT compared to PRT (p=0.009) and systemic treatment (p < 0.001) were independently associated with reduced incidence of LMCDM. CONCLUSION: WBRT improved LMCDM-FS rate after resection of brain metastases compared to PRT in breast cancer patients.
Brain* ; Breast Neoplasms* ; Breast* ; Cerebrospinal Fluid ; Follow-Up Studies ; Humans ; Incidence ; Meningeal Carcinomatosis* ; Multivariate Analysis ; Neoplasm Metastasis* ; Radiotherapy* ; Retrospective Studies

PURPOSE: To evaluate intracranial control after surgical resection according to the adjuvant treatment received in order to assess the optimal radiotherapy (RT) dose and volume. MATERIALS AND METHODS: Between 2003 and 2015, a total of 53 patients with brain oligometastases from non-small cell lung cancer (NSCLC) underwent metastasectomy. The patients were divided into three groups according to the adjuvant treatment received: whole brain radiotherapy (WBRT) ± boost (WBRT ± boost group, n = 26), local RT/Gamma Knife surgery (local RT group, n = 14), and the observation group (n = 13). The most commonly used dose schedule was WBRT (25 Gy in 10 fractions, equivalent dose in 2 Gy fractions [EQD2] 26.04 Gy) with tumor bed boost (15 Gy in 5 fractions, EQD2 16.25 Gy). RESULTS: The WBRT ± boost group showed the lowest 1-year intracranial recurrence rate of 30.4%, followed by the local RT and observation groups, at 66.7%, and 76.9%, respectively (p = 0.006). In the WBRT ± boost group, there was no significant increase in the 1-year new site recurrence rate of patients receiving a lower dose of WBRT (EQD2) <27 Gy compared to that in patients receiving a higher WBRT dose (p = 0.553). The 1-year initial tumor site recurrence rate was lower in patients receiving tumor bed dose (EQD2) of ≥42.3 Gy compared to those receiving <42.3 Gy, although the difference was not significant (p = 0.347). CONCLUSIONS: Adding WBRT after resection of brain oligometastases from NSCLC seems to enhance intracranial control. Furthermore, combining lower-dose WBRT with a tumor bed boost may be an attractive option.
Appointments and Schedules ; Brain* ; Carcinoma, Non-Small-Cell Lung ; Humans ; Lung Neoplasms* ; Lung* ; Metastasectomy ; Neoplasm Metastasis ; Radiotherapy* ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies*

Age estimation is important in the practice of forensic science to establish the identity of human remains, as well as with living persons. Particularly in Korea, age estimation in adults has been increase in the demand for incorrect birth records in order to be entitled to civil liability, social benefits, employment. The reduction of pulp cavity size as a result of secondary dentin deposit with increasing age could be used to estimate age. This regressive change can be analyzed using radiological techniques; thus, a variety of methods for dental age estimation based on this approach have been proposed. The purpose of this study is to evaluate the concurrence between the Drusini's method and the Jeon's method using the mandibular first molar on orthopantomographs (OPGs) in Korean adults. A total of 232 OPGs (91 females and 141 males) of Korean individuals with ages ranging from 20 to 69 years were analyzed using Drusini's method and Jeon's method. Our results revealed that the correlation of the two methods with age was statistically significant (r=0.501). Both Drusini's method and Jeon's method showed significant correlation with chronological age, and Jeon's method showed a greater correlation with chronological age (r=0.738) than Drusini's method (r=0.586). The mean absolute error was 7.99 years for Jeon's method and 9.79 years for Drusini's method. Our results demonstrate that Jeon's method using the mandibular first molar on OPGs is a practical and suitable method for age estimation in Korean adults.
Adult* ; Age Determination by Teeth ; Birth Certificates ; Dentin ; Dentin, Secondary ; Employment ; Female ; Forensic Sciences ; Humans ; Korea ; Methods* ; Molar* ; Radiography