A Bivalent Inactivated Vaccine Prevents Enterovirus 71 and Coxsackievirus A16 Infections in the Mongolian Gerbil

Hand-foot-and-mouth disease (HFMD) is a viral infectious disease that occurs in children under 5 years of age. Its main causes are coxsackievirus (CV) and enterovirus (EV). Since there are no efficient therapeutics for HFMD, vaccines are effective in preventing the disease. To develop broad coverage against CV and EV, the development of a bivalent vaccine form is needed. The Mongolian gerbil is an efficient and suitable animal model of EV71 C4a and CVA16 infection used to investigate vaccine efficacy following direct immunization. In this study, Mongolian gerbils were immunized with a bivalent inactivated EV71 C4a and inactivated CVA16 vaccine to test their effectiveness against viral infection. Bivalent vaccine immunization resulted in increased Ag-specific IgG antibody production; specifically, EV71 C4a-specific IgG was increased with medium and high doses and CVA16-specific IgG was increased with all doses of immunization. When gene expression of T cell-biased cytokines was analysed, Th1, Th2, and Th17 responses were found to be highly activated in the high-dose immunization group. Moreover, bivalent vaccine immunization mitigated paralytic signs and increased the survival rate following lethal viral challenges. When the viral RNA content was determined from various organs, all three doses of bivalent vaccine immunization were found to significantly decrease viral amplification. Upon histologic examination, EV71 C4a and CVA16 induced tissue damage to the heart and muscle. However, bivalent vaccine immunization alleviated this in a dose-dependent manner. These results suggest that the bivalent inactivated EV71 C4a/CVA16 vaccine could be a safe and effective candidate HFMD vaccine.

The Influence of Women Dental Hygienists’ Work–Family Balance on Happiness Level in Dental Clinics / 치위생과학회지

Background@#To identify work–family balance and level of happiness among married women dental hygienists in Seoul and Gyeonggi Province. The goal of this study is to use the outcome as basic data to determine the compatibility of dental hygienists with work and family, systems, and improvement of happiness levels. @*Methods@#From July 3 to August 10, 2020, 250 dental hygienists in Seoul and Gyeonggi Province were targeted. The questionnaire comprised 65 questions, including general characteristics (perception of work–family balance, perception of work–family balance system, job satisfaction, parenting type, happiness level) whether or not they were implemented. The results were obtained through a self-control questionnaire. @*Results@#The perception of work–family balance was significantly different in job rank and average income, while that of the work– family balance system had significant differences in workplace type, total work experience, current job work experience, childcare system status, and parental leave period. Happiness level and job satisfaction were significantly different in job rank, average income, and childcare system status. Additionally, the perception of work–family balance and that of the work–family balance system showed a positive correlation with job satisfaction and happiness level. Finally, the perception of married women dental hygienists toward work–family compatibility was determined, where the higher the satisfaction with the job, the higher the level of happiness. @*Conclusion@#To improve the work–family balance and job satisfaction of dental hygienists and their levels of happiness, changes in social perception and improvement of the working environment such as proper staffing, flexible work systems, and incentive systems should be considered.

First Case of Peroxisomal D-bifunctional Protein Deficiency with Novel HSD17B4 Mutations and Progressive Neuropathy in Korea

Peroxisomal D-bifunctional protein (DBP), encoded by the HSD17B4 gene, catalyzes β-oxidation of very long chain fatty acids (VLCFAs). The deficiency of this peroxisomal enzyme leads to the accumulation of VLCFAs, causing multisystemic manifestations including the brain, retina, adrenal gland, hearing, and skeletal system. Herein, we report the first Korean neonatal case of peroxisomal DBP deficiency and the clinical prognosis over 2 years. This patient showed craniofacial dysmorphism, club foot, and seizures with cyanosis one day after birth. Elevated VLCFAs levels were indicative of a peroxisomal disorder.Targeted exome sequencing was performed and two missense mutations p.Asp117Val and p.Phe279Ser in the HSD17B4 gene were identified. The patient had type III DBP deficiency;therefore, docosahexaenoic acid and non-soluble vitamins were administered. However, progressive nystagmus, optic nerve atrophy, and bilateral hearing defects were observed and follow-up brain imaging revealed leukodystrophy and brain atrophy. Multiple anti-epileptic drugs were required to control the seizures. Over two years, the patient achieved normal growth with home ventilation and tube feeding. Hereby, the subject's parents had support during the second pregnancy from the proven molecular information. Moreover, targeted exome sequencing is an effective diagnostic approach, considering genetic heterogeneity of Zellweger spectrum disorders.

Successful Treatment of Mycoplasma hominis Meningitis, Diagnosed Using Real-Time Polymerase Chain Reaction, with Ciprofloxacin in a Neonate

Mycoplasma hominis can cause life-threatening central nervous system infections in neonates following intrauterine infection or during delivery. In newborns, the dia gnosis and treatment of M. hominis meningitis are challenging, because cultures are often negative and the bacterium is not susceptible to empirical antibiotics. Herein, we describe a case of neonatal M. hominis meningitis diagnosed using real-time polymerase chain reaction (RT-PCR) and treated with ciprofloxacin. The patient was a 3-day-old female hospitalized for a fever and lethargy. Her blood laboratory findings were non-specific; cerebrospinal fluid (CSF) examination showed a white blood cell count of 580/µL and indicated meningitis. Her symptoms could not be controlled with empirical antibiotics. Urine culture on a special medium revealed ciprofloxacinsusceptible M. hominis. Furthermore, the RT-PCR performed with the CSF sample revealed M. hominis. Therefore, the patient was administered cipro­floxacin; after 2 days, the fever subsided. The patient was discharged on day 30 without complications.

Gray-brown skin discoloration following phototherapy for hyperbilirubinemia due to anti-E alloimmunization / 소아과

No abstract available.

A pediatric case of idiopathic Harlequin syndrome / 소아과

Harlequin syndrome, which is a rare disorder caused by dysfunction of the autonomic system, manifests as asymmetric facial flushing and sweating in response to heat, exercise, or emotional factors. The syndrome may be primary (idiopathic) with a benign course, or can occur secondary to structural abnormalities or iatrogenic factors. The precise mechanism underlying idiopathic harlequin syndrome remains unclear. Here, we describe a case of a 6-year-old boy who reported left hemifacial flushing and sweating after exercise. He had an unremarkable birth history and no significant medical history. Complete ophthalmological and neurological examinations were performed, and no other abnormalities were identified. Magnetic resonance imaging was performed to exclude lesions of the cerebrum and cervicothoracic spinal cord, and no abnormalities were noted. His final diagnosis was classic idiopathic harlequin syndrome. Herein, we report the first pediatric case of idiopathic harlequin syndrome in Korea.

The Effect and Safety of Steroid Injection in Lumbar Spinal Stenosis: With or Without Local Anesthetics

OBJECTIVE: To compare the long-term effect and safety of an epidural steroid injection in spinal stenosis patients, with or without local anesthetics. METHODS: Twenty-nine patients diagnosed with spinal stenosis were included and randomly divided into two groups. Translaminar epidural and selective nerve root spinal injection procedures were performed using steroids mixed with local anesthetics or normal saline. The effects of spinal injection procedures were measured with visual analogue scale (VAS) and functional rate index (FRI). These measurements were performed before injection, at 1 month after injection and at 3 months after injection. The occurrence of side effects was investigated each time. RESULTS: The VAS and FRI scores were significantly reduced in both the local anesthetics group and normal saline group at 1 and 3 months after the injection. However, there was no significant difference in VAS and FRI score reduction between the two groups each time. Side effects are not noted in both groups. CONCLUSION: The spinal injection procedures using steroids mixed either with local anesthetics or normal saline have an effect in reducing pain and improving functional activities. However, there was no significant difference between the two groups in relation to side effects and the long-term effects of pain and function.

Evaluation of three glucometers for whole blood glucose measurements at the point of care in preterm or low-birth-weight infants / 소아과

PURPOSE: We evaluated three blood glucose self-monitoring for measuring whole blood glucose levels in preterm and low-birth-weight infants. METHODS: Between December 1, 2012 and March 31, 2013, 230 blood samples were collected from 50 newborns, who weighed, 60 mg/dL, the correlation coefficients were 0.822, 0.819, and 0.839, respectively. All correlation coefficients were statistically significant. And the values from the blood glucose self-monitoring were not significantly different from the value of the laboratory equipment , after correcting for each device's average value (P>0.05). When using laboratory equipment (blood glucose < or =60 mg/dL), each device had a sensitivity of 0.458, 0.604, and 0.688 and a specificity of 0.995, 0.989, and 0.989, respectively. CONCLUSION: Significant difference is not found between three blood glucose self-monitoring and laboratory equipment. But correlation between the measured values from blood glucose self-monitoring and laboratory equipment is lower in preterm or low-birth-weight infants than adults.

Usefulness of Videofluoroscopic Swallow Study in Treacher Collins Syndrome With Cleft Palate: A Case Report

A 3-year-old girl had multiple anomalies compatible with Treacher Collins Syndrome (TCS). From the neonatal period, sucking was poor, making tube feeding necessary. Excessive saliva was retained in the oral cavity. Nasal leakage caused by the cleft palate was observed when she spoke. The initial videofluoroscopic swallow study (VFSS) showed a poor posterior bolus transit and nasopharyngeal regurgitation. A delayed swallow reflex and bolus stasis at the vallecular and pyriform sinuses were recognized. Based on the VFSS findings, the patient underwent palatoplasty at 20 months of age. At approximately 23 months of age, a follow-up VFSS was performed; poor posterior bolus transit, nasopharyngeal regurgitation, and delayed swallow reflex were not observed. Finally, the patient was able to eat ground or chopped foods and solid foods orally. We deem VFSS to be helpful in deciding the appropriate management of dysphagia in TCS.

Pneumonectomy Case in a Newborn with Congenital Pulmonary Lymphangiectasia

Congenital pulmonary lymphangiectasia (CPL) is a rare lymphatic pulmonary abnormality. CPL with respiratory distress has a poor prognosis, and is frequently fatal in neonates. We report a case of pneumonectomy for CPL in a newborn. An infant girl, born at 39 weeks' after an uncomplicated pregnancy, exhibited respiratory distress 1 hr after birth, which necessitated intubation and aggressive ventilator care. Right pneumonectomy was performed after her symptoms worsened. Histologic examination indicated CPL. She is currently 12 months old and developing normally. Pneumonectomy can be considered for treating respiratory symptoms for improving chances of survival in cases with unilateral CPL.

Longitudinal Study on Trace Mineral Compositions (Selenium, Zinc, Copper, Manganese) in Korean Human Preterm Milk

We measured selenium, zinc, copper and manganese concentrations in the human milk of Korean mothers who gave birth to preterm infants, and compared these measurements with the recommended daily intakes. The samples of human milk were collected postpartum at week-1, -2, -4, -6, -8, and -12, from 67 mothers who gave birth to preterm infants (< 34 weeks, or birth weight < 1.8 kg). All samples were analyzed using atomic absorption spectrophotometry. The concentrations of selenium were 11.8 +/- 0.5, 11.4 +/- 0.8, 12.7 +/- 0.9, 11.4 +/- 0.8, 10.8 +/- 0.9, and 10.5 +/- 1.3 microg/L, zinc were 7.8 +/- 0.5, 9.1 +/- 0.8, 7.2 +/- 0.9, 8.0 +/- 0.8, 7.4 +/- 0.9, and 6.6 +/- 1.2 mg/L, copper were 506 +/- 23.6, 489 +/- 29.4, 384 +/- 33.6, 356 +/- 32.9, 303 +/- 35.0, and 301 +/- 48.0 microg/L and manganese were 133 +/- 4.0, 127 +/- 6.0, 125 +/- 6.0, 123 +/- 6.0, 127 +/- 6.0, and 108 +/- 9.0 microg/L at week-1, -2, -4, -6, -8, and -12, respectively. The concentrations of selenium and zinc meet the daily requirements but that of copper is low and of manganese exceeds daily requirements recommended by the American Academy of Pediatrics, Committee on Nutrition.

Two Pediatric Osteosarcoma Cases with Delayed Methotrexate Excretion: Its Clinical Course and Management / Journal of the Korean Cancer Association, 대한암학회지

High-dose methotrexate (MTX) chemotherapy extends the duration of hospitalization and introduces the risks of serious complications related to delayed MTX excretion. The treatment of delayed MTX excretion is largely dependent on invasive measures such as hemodialysis because the clinical data regarding the efficacy or safety of carboxypetidase G2 is limited. We report here on the cases of two pediatric osteosarcoma patients with delayed MTX excretion and who were successfully managed using supportive measures. Potential life-threatening complications were prevented by administering high doses of leucovorin.

Assessment of Chemotherapy Response Using FDG-PET in Pediatric Bone Tumors: A Single Institution Experience / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Response to neo-adjuvant chemotherapy is an important prognostic factor for osteosarcoma (OS) and the Ewing sarcoma family of tumors (ESFT). [F-18]-fluorodeoxy-D-glucose (FDG)-positron emission tomography (PET) is a non-invasive imaging modality that predicts histologic response to chemotherapy of various malignancies; however, limited data exist about the usefulness of FDG-PET in predicting the histologic response of pediatric bone tumors to chemotherapy. We analyzed the FDG-PET imaging characteristics of pediatric bone tumors and determined the association with response to chemotherapy. MATERIALS AND METHODS: Pediatric patients with OS (n=19) or ESFT (n=17) were evaluated for FDG-PET standard uptake values before (SUV1) and after (SUV2) chemotherapy. The relationship to the chemotherapy response was assessed by histopathology in surgically-excised tumors. A complete data set (SUV1, SUV2, and histologic response) was available in 23 patients. RESULTS: While the mean SUV1s were not different between patients with OSs and ESFTs (9.44 vs. 6.07, p=0.24), the SUV2s were greater in the patients with OSs than ESFTs (4.55 vs. 1.66, p=0.01). The ratios of SUV2-to-SUV1 (SUV2 : SUV1) were 0.65 and 0.35 for OS and ESFT, respectively (p=0.08). All of the patients with ESFTs and 47% of the patients with OS had a favorable histologic response to chemotherapy. The SUV2 : 1 [(SUV1-SUV2)/SUV1]> or =0.5 and SUV2< or =2.5 were related to favorable histologic responses to chemotherapy; the sensitivity and specificity of SUV2 : 1 at 0.5 and SUV2 at 2.5 were 93% and 88%, and 88% and 78%, respectively. CONCLUSION: FDG-PET can be used as a non-invasive surrogate to predict response to chemotherapy in children with bone tumors.

Assessment of Chemotherapy Response Using FDG-PET in Pediatric Bone Tumors: A Single Institution Experience / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Response to neo-adjuvant chemotherapy is an important prognostic factor for osteosarcoma (OS) and the Ewing sarcoma family of tumors (ESFT). [F-18]-fluorodeoxy-D-glucose (FDG)-positron emission tomography (PET) is a non-invasive imaging modality that predicts histologic response to chemotherapy of various malignancies; however, limited data exist about the usefulness of FDG-PET in predicting the histologic response of pediatric bone tumors to chemotherapy. We analyzed the FDG-PET imaging characteristics of pediatric bone tumors and determined the association with response to chemotherapy. MATERIALS AND METHODS: Pediatric patients with OS (n=19) or ESFT (n=17) were evaluated for FDG-PET standard uptake values before (SUV1) and after (SUV2) chemotherapy. The relationship to the chemotherapy response was assessed by histopathology in surgically-excised tumors. A complete data set (SUV1, SUV2, and histologic response) was available in 23 patients. RESULTS: While the mean SUV1s were not different between patients with OSs and ESFTs (9.44 vs. 6.07, p=0.24), the SUV2s were greater in the patients with OSs than ESFTs (4.55 vs. 1.66, p=0.01). The ratios of SUV2-to-SUV1 (SUV2 : SUV1) were 0.65 and 0.35 for OS and ESFT, respectively (p=0.08). All of the patients with ESFTs and 47% of the patients with OS had a favorable histologic response to chemotherapy. The SUV2 : 1 [(SUV1-SUV2)/SUV1]> or =0.5 and SUV2< or =2.5 were related to favorable histologic responses to chemotherapy; the sensitivity and specificity of SUV2 : 1 at 0.5 and SUV2 at 2.5 were 93% and 88%, and 88% and 78%, respectively. CONCLUSION: FDG-PET can be used as a non-invasive surrogate to predict response to chemotherapy in children with bone tumors.

Effects of Topical Anesthetics to Reduce Pain in Preterm Infants During Percutaneous Cental Venous Catheterization (PCVC) / 대한주산의학회잡지

PURPOSE: The purpose of this study is to prove the effects of topical anesthetics (EMLA) to control pain in preterm infants during invasive procedure (percutaneous central venous catheterization, PCVC). METHODS: A total of 18 preterm infants of birth weight <2,000 g and gestational age <36 weeks born at EulJi University Hospital, at Daejeon in 2010 were randomly included in this study. EMLA was applied in nine preterm infants 40 minutes before starting PCVC and placebo was applied in another nine preterm infants. Based on PIPP (preterm infant pain profile), we evaluated their heart rate, oxygen saturation before, 15 seconds during and 30 seconds after procedure. Behavioral responses were also recorded for 2 minutes after procedure. RESULTS: Experimental group showed significantly less behavioral response during procedure (P=0.005) and 2 min after procedure (P=0.001). Also, experimental group showed less increase in heart rate (P=0.033) and reduction of behavioral state (P=0.017). CONCLUSION: Despite limitation of small size in this study, experimental group showed lower pain score compared with placebo control group during catheterization. In neonatal care unit (NICU), we recommend the use of topical anesthetics such as EMLA to control pain during invasive procedures.

Risk Factors of Nosocomial Sepsis in Very Low Birth Weight Infants

PURPOSE: This study was performed to estimate the incidence of nosocomial sepsis and to identify the most relevant risk factors for nosocomial sepsis in high-risk very low birth weight (VLBW) infants. METHODS: A retrospective review of 341 VLBW infants, admitted to the Neonatal Intensive Care Unit of the Eulji University Hospital (Daejeon & Seoul) between January 2002 and June 2009, who survived more than 72 hours was performed. The incidence, causative organisms, risk factors and prognosis of nosocomial sepsis in VLBW infants were analyzed. RESULTS: The incidence of nosocomial sepsis was 16.1% and the onset date of nosocomial sepsis was 21.5+/-15.9 days (mean+/-SD) after delivery. Staphylococcus aureus (21.3%) was the most common organism in the patients with nosocomial sepsis in VLBW infants. The multiple logistic regression analysis showed that, gestational age [odds ratio (OR), 0.87; 95% CI, 0.83-0.91], umbilical artery catheter use for more than 5 days (OR, 2.2; 95% CI, 1.15-4.46), umbilical venous catheter use for more than 5 days (OR, 2.1; 95% CI, 1.11-4.16), peripheral arterial line use (OR, 2.1; 95% CI, 1.14-4.04) and intravenous intralipids (OR, 4.3; 95% CI, 1.13-14.32) were identified as risk factors. CONCLUSION: The limited usage of intravascular catheter related procedures and the short providence of intravenous nutrition may decrease the incidence of nosocomial sepsis in VLBW infants.

A Case of Amniotic Band Syndrome Associated with Retinopathy of Prematurity / 대한주산의학회잡지

Amniotic band syndrome is an uncommon congenital fetal abnormality with defects of skin resulting in ringlike strictures about the limbs and occasionally the trunk. Its pathogenesis has been still debated in the literature for many years. Amniotic band syndrome features multiple disfiguring and disabling manifestations. A clinical deformities include limb defects, craniofacial defect, visceral defect, body wall defect and other anomalies. We had experienced a case of amniotic band syndrome with retinopathy of prematurity, bilateral orofacial cleft, aphalangia of right hand, ventricular septal defect and atrial septal defect. We report this case with a brief review of the literature.

A Case of Neonatal Alloimmune Thrombocytopenia due to Anti-HLA-B35

Neonatal alloimmune thrombocytopenia (NAIT) is induced by maternal antibodies to fetal platelet alloantigens. Because the main cause of NAIT is incompatibility to platelet specific antibodies, NAIT due to HLA antibodies are relatively rare. We managed a case of NAIT induced by maternal anti-HLA-B35 antibodies. The patient was a second born male. He had no petechiae or purpura at birth. He was admitted to the hospital due to fever for 5 days and a platelet count of 106x10(9)/L. The fever subsided after admission but on the 2nd day of admission, petechiae developed on the chest wall and the platelet count decreased to 25x10(9)/L. Other laboratory findings included C-reactive protein, prothrombin time, and partial thromboplastin time were normal. His mother's platelet count was normal and she had no history of bleeding. Anti-HLA-B35, B52, B56, C3, and C14 were identified in the mother's serum by a panel reactive antibody test and HLA-B35 antigen was identified in the father's and patient's sera. These finding suggested that maternal Anti-HLA-B35 antibody was a response to neonatal HLA-B35 antigen inherited from the father. The patient received concentrated platelet and intravenous immunoglobulin. The platelet count rose to 248x10(9)/L and was maintained thereafter.

Comparison of the Therapeutic Effects of Curosurf(R) and Newfactan(R) in Respiratory Distress Syndrome

PURPOSE: The aim of this study was to compare the clinical effects of modified porcine (Curosurf(R)) and bovine (Newfactan(R)) surfactants in the treatment of neonatal respiratory distress syndrome. METHODS: Between April 2004 and December 2006, 65 neonates (birth weight < or =2,500 g and gestational age < or =35 weeks) with neonatal respiratory distress syndrome were treated in our neonatal intensive care unit with surfactant. Thirty-one neonates received Curosurf(R) and 34 neonates received Newfactan(R). The neonates were not enrolled if they had major congenital anomalies or meconium aspiration syndrome. We compared the changes in respiratory parameters after surfactant instillation, the incidences of acute and chronic complications, and the mortality between the two treatment groups. RESULTS: Neonatal and maternal demographic characteristics were not different between the groups. The patterns of change in the respiratory parameters after surfactant instillation were not statistically different between the groups. The incidences of surfactant reinstillation and acute complications, such as pneumothorax, patent ductus arteriosus, pulmonary hemorrhage, and grade 3-4 intraventricular hemorrhage, were not different between the neonates who received Curosurf(R) and the neonates who received Newfactan(R). There were no statistically significant differences in the duration of mechanical ventilation, oxygen therapy, hospitalization, prevalence of bronchopulmonary dysplasia, periventricular leukomalacia, retinopathy of prematurity, necrotizing enterocolitis, and mortality between the groups. CONCLUSION: In the present comparative study, no significant differences in the clinical effects of Curosurf(R) and Newfactan(R) were observed.

The Effect of Schizotypal Personality Trait on the Ability of Facial Affect Identification in Healthy Person

OBJECTIVES: The purpose of this study is to investigate whether the ability of facial affect perception is associated with schizotypal personality traits in healthy normal controls. METHODS: 241 normal subjects were recruited in this study. The age range of all subjects was from 19 to 63 years. The schizotypal personality questionnaire(SPQ) and facial affect identification test(FAIT), which were developed and standardized in Korea, were applied. Subjects from high 1 standard deviation(H group, N=40) and low 1 standard deviation(L group, N=26) on SPQ score were compared. RESULTS: We found that the H group showed significantly reduced ability on the correctness of sadness and neutral compared with the L group. But, no significant association between SPQ and intensity or reaction point was observed in all subjects. CONCLUSION: This study suggests the individuals with high schizotypal personality trait have impairments on the facial affect identification. Also, these findings may provide the reasonable explanation of social cognition deficit of schizotypal personality disorder.