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Objective@#To develop a deep-learning-based bone age prediction model optimized for Korean children and adolescents and evaluate its feasibility by comparing it with a Greulich-Pyle-based deep-learning model. @*Materials and Methods@#A convolutional neural network was trained to predict age according to the bone development shown on a hand radiograph (bone age) using 21036 hand radiographs of Korean children and adolescents without known bone development-affecting diseases/conditions obtained between 1998 and 2019 (median age [interquartile range {IQR}], 9 [7–12] years; male:female, 11794:9242) and their chronological ages as labels (Korean model). We constructed 2 separate external datasets consisting of Korean children and adolescents with healthy bone development (Institution 1: n = 343;median age [IQR], 10 [4–15] years; male: female, 183:160; Institution 2: n = 321; median age [IQR], 9 [5–14] years; male:female, 164:157) to test the model performance. The mean absolute error (MAE), root mean square error (RMSE), and proportions of bone age predictions within 6, 12, 18, and 24 months of the reference age (chronological age) were compared between the Korean model and a commercial model (VUNO Med-BoneAge version 1.1; VUNO) trained with Greulich-Pyle-based age as the label (GP-based model). @*Results@#Compared with the GP-based model, the Korean model showed a lower RMSE (11.2 vs. 13.8 months; P = 0.004) and MAE (8.2 vs. 10.5 months; P = 0.002), a higher proportion of bone age predictions within 18 months of chronological age (88.3% vs. 82.2%; P = 0.031) for Institution 1, and a lower MAE (9.5 vs. 11.0 months; P = 0.022) and higher proportion of bone age predictions within 6 months (44.5% vs. 36.4%; P = 0.044) for Institution 2. @*Conclusion@#The Korean model trained using the chronological ages of Korean children and adolescents without known bone development-affecting diseases/conditions as labels performed better in bone age assessment than the GP-based model in the Korean pediatric population. Further validation is required to confirm its accuracy.
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Purpose@#The aim of this study was to validate the postnatal urinary tract dilation (UTD) classification system by correlating it with the need for surgical intervention. @*Methods@#Young infants who underwent ultrasound (US) examinations for prenatal hydronephrosis were retrospectively identified. The kidney units (KUs; right, left, or bilateral) were graded from UTD P0 (very low risk) to P3 (high risk) based on seven US criteria from the UTD system. Surgery-free survival curves were constructed using the Kaplan-Meier method. Univariable and multivariable Cox proportional-hazards regression analysis clustered by patients was performed. Interobserver agreement was analyzed using the weighted kappa coefficient. @*Results@#In total, 504 KUs from 336 patients (mean age, 18.3±15.9 days; range, 1 to 94 days; males, n=276) were included, with a median follow-up of 24.2 months. Fifty-eight KUs underwent surgical intervention. Significant differences were observed among the Kaplan-Meier curves stratified into UTD groups (P<0.001). The presence of anterior-posterior renal pelvic diameter ≥15 mm (hazard ratio [HR], 8.602; 95% confidence interval [CI], 1.558 to 43.065), peripheral calyceal dilation (HR, 8.190; 95% CI, 1.558 to 43.065), ureteral dilation (HR, 2.619; 95% CI, 1.274 to 5.380), parenchymal thickness abnormality (HR, 3.371; 95% CI, 1.574 to 7.223), bladder abnormality (HR, 12.209; 95% CI, 3.616 to 41.225) were significantly associated with the occurrence of surgery. The interobserver agreement was moderate to almost perfect agreement for US features (κ=0.564-0.898) and substantial for final UTD grades (κ=0.716). @*Conclusion@#The UTD classification system is reliable and appropriately stratifies the risk of surgical intervention.
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Purpose@#In 2017, the Children’s Hepatic Tumors International Collaboration-Hepatoblastoma Stratification (CHIC-HS) system was introduced. We aimed to evaluate the accuracy of CHIC-HS System for the prediction of event-free survival (EFS) in Korean pediatric patients with hepatoblastoma. @*Materials and Methods@#This two-center retrospective study included consecutive Korean pediatric patients with histopathologically confirmed hepatoblastoma from March 1988 through September 2019. We compared EFS among four risk groups according to the CHIC-HS system. Discriminatory ability of CHIC-HS system was also evaluated using optimism-corrected C-statistics. Factors associated with EFS were explored using multivariable Cox regression analysis. @*Results@#We included 129 patients (mean age, 2.6±3.3 years; female:male, 63:66). The 5-year EFS rates in the very low, low, intermediate, and high-risk groups, according to the CHIC-HS system were 90.0%, 82.8%, 73.5%, and 51.3%, respectively. The CHIC-HS system aligned significantly well with EFS outcomes (p=0.004). The optimism-corrected C index of CHIC-HS was 0.644 (95% confidence interval [CI], 0.561 to 0.727). Age ≥ 8 (vs. age ≤ 2; hazard ratio [HR], 2.781; 95% CI, 1.187 to 6.512; p=0.018), PRE-Treatment EXTent of tumor (PRETEXT) stage IV (vs. PRETEXT I or II; HR, 2.774; 95% CI, 1.228 to 5.974; p=0.009), and presence of metastasis (HR, 2.886; 95% CI, 1.457 to 5.719; p=0.002), which are incorporated as the first three nodes in the CHIC-HS system, were independently associated with EFS. @*Conclusion@#The CHIC-HS system aligned significantly well with EFS outcomes in Korean pediatric patients with hepatoblastoma. Age group, PRETEXT stage, and presence of metastasis were independently associated with EFS.
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Purpose@#This study evaluated the accuracy of attenuation imaging (ATI) for the assessment of hepatic steatosis in pediatric patients, in comparison with the FibroScan vibration-controlled transient elastography controlled attenuation parameter (CAP). @*Methods@#Consecutive pediatric patients referred for evaluation of obesity who underwent both ATI and FibroScan between February 2020 and September 2021 were included. The correlation between attenuation coefficient (AC) and CAP values was assessed using the Spearman test. The AC cutoff value for discriminating hepatic steatosis corresponding to a CAP value of 241 dB/m was calculated. Multivariable linear regression analysis was performed to estimate the strength of the association between AC and CAP. The diagnostic accuracy of AC cutoffs was estimated using the imperfect gold-standard methodology based on a two-level Bayesian latent class model. @*Results@#Seventy patients (median age, 12.5 years; interquartile range, 11.0 to 14.0 years; male:female, 58:12) were included. AC and CAP showed a moderate-to-good correlation (ρ =0.646, P<0.001). Multivariable regression analysis affirmed the significant association between AC and CAP (P<0.001). The correlation was not evident in patients with a body mass index ≥30 kg/m2 (ρ=-0.202, P=0.551). Linear regression revealed that an AC cutoff of 0.66 dB/cm/MHz corresponded to a CAP of 241 dB/m (sensitivity, 0.93; 95% confidence interval [CI], 0.85 to 0.98 and specificity, 0.87; 95% CI, 0.56 to 1.00). @*Conclusion@#ATI showed an acceptable correlation with CAP values in a pediatric population, especially in patients with a body mass index <30 kg/m2. An AC cutoff of 0.66 dB/cm/MHz, corresponding to a CAP of 241 dB/m, can accurately diagnose hepatic steatosis.
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Purpose@#To evaluate the applicability of Greulich-Pyle (GP) standards to bone age (BA) assessment in healthy Korean children using manual and deep learning-based methods. @*Materials and Methods@#We collected 485 hand radiographs of healthy children aged 2–17 years (262 boys) between 2008 and 2017. Based on GP method, BA was assessed manually by two radiologists and automatically by two deep learning-based BA assessment (DLBAA), which estimated GP-assigned (original model) and optimal (modified model) BAs. Estimated BA was compared to chronological age (CA) using intraclass correlation (ICC), Bland-Altman analysis, linear regression, mean absolute error, and root mean square error. The proportion of children showing a difference >12 months between the estimated BA and CA was calculated. @*Results@#CA and all estimated BA showed excellent agreement (ICC ≥0.978, p12 months in 44.3%, 44.5%, 39.2%, and 36.1% for radiologist 1, radiologist 2, original, and modified DLBAA models, respectively. @*Conclusion@#Contemporary healthy Korean children showed different rates of skeletal development than GP standard-BA, and systemic bias should be considered when determining children’s skeletal maturation.
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Congenital isolated hydronephrosis encompasses a spectrum of physiologic states that spontaneously resolve and pathologic obstruction that necessitates surgical intervention. Distinguishing patients whose condition will resolve, those who will require stringent follow-up, and those who will eventually need surgical intervention present a challenge to clinicians, particularly because no unified guidelines for assessment and follow-up have been established. The recognition of the natural course and prognosis of hydronephrosis and a comprehensive understanding of the currently proposed consensus guidelines may aid in multidisciplinary treatment and in providing proper counseling to caregivers. In this review, we aimed to summarize the literature on the grading systems and management strategies for congenital isolated hydronephrosis.
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Background@#Androgenetic alopecia (AGA) is characterized by terminal hair miniaturization, which progressively decreases hair density and thickness. Genetic predisposition and the role of androgen in AGA have been widely accepted; however, its definite mechanism has not been clarified. AGA may also occur in adolescents, although its clinical characteristics including the disease prevalence have not yet been fully established. @*Objective@#To analyze the clinical differences of AGA between adolescents and adults. @*Methods@#Six-hundred fourteen patients with AGA were recruited and information about age, sex, and family history, comorbidities were collected. @*Results@#A total of 74.5% of adolescents and 66.4% of adults had family history of AGA, with “paternal only” as the most common pattern. A total of 27.3% of adolescents and 44.5% of adults had comorbidities, with seborrheic dermatitis being the most common. Other common comorbidities were acne, folliculitis, and atopic dermatitis in adolescents, dyslipidemia, hypertension, mood disorder, and diabetes mellitus in adults. A total of 12.7% and 15.0% of adolescents and adults, respectively, had abnormal serum testosterone levels, and 5.5% of adolescents and 7.5% of adults had abnormal serum dehydroepiandrosterone sulfate (DHEA-S) levels. Regardless of age, the proportion of patients with abnormal testosterone levels was higher in the female group than in the male group. @*Conclusion@#AGA showed paternal predominance in family history regardless of sex or age, suggesting paternal history as an important factor of AGA. Testosterone and DHEA-S abnormalities were found in patients with AGA, indicating a need for further studies on therapeutic effects associated with differences in hormonal profiles.
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An 80-year-old Korean woman who previously experienced penicillin allergy presented to a dental hospital for treatment of a fractured tooth. A dentist extracted the tooth and prescribed her A-cillin (amoxicillin hydrate) 250 mg orally 3 times a day for 3 days and Carol-F® (ibuprofen arginine) orally 3 times a day for 3 days. She received the prescriptions, returned home, and took one dose of each drug. One hour later, she experienced hypertension, itching, shortness of breath, and was unable to move her tongue to pronounce words. Approximately 6 hours after drug administration, the symptoms persisted, and the patient was admitted to an emergency medical center (EMC). The patient was discharged from the EMC after a one-night stay in the hospital for symptomatic treatment.
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Background@#Although the identification of clinical and laboratory features in pediatric COVID-19 patients is essential in establishing an appropriate treatment plan, a systematic review and meta-analysis on the topic has yet to be reported. @*Methods@#We searched MEDLINE, Embase, and Web of Science to access clinical and laboratory characteristics as well as clinical outcomes of children with COVID-19 infection. A meta-analysis using random-effect model was performed to estimate pooled prevalence and 95% confidence intervals. @*Results@#Among the 532 studies initially collected, 12 articles were finally included in the meta-analysis. Among the investigated 320 pediatric patients with COVID-19, fever (48.2%) and cough (39.3%) were the most common symptoms.Almost one third of patients (30.4%) were asymptomatic. In laboratory findings, only 11.4% of pediatric patients experienced lymphocytopenia. Increased inflammatory markers including c-reactive protein (18.6%) and procalcitonin (32.4%) were observed.Only a few patients needed mechanical ventilation and intensive care support, and only one death was reported. @*Conclusion@#Pediatric patients with COVID-19 infection exhibited milder symptoms and more favorable outcomes compared to adults. However, considering the high rate of asymptomatic pediatric patients, close monitoring is required to prevent community infection in asymptomatic conditions and hidden disease progression.
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An 80-year-old Korean woman who previously experienced penicillin allergy presented to a dental hospital for treatment of a fractured tooth. A dentist extracted the tooth and prescribed her A-cillin (amoxicillin hydrate) 250 mg orally 3 times a day for 3 days and Carol-F® (ibuprofen arginine) orally 3 times a day for 3 days. She received the prescriptions, returned home, and took one dose of each drug. One hour later, she experienced hypertension, itching, shortness of breath, and was unable to move her tongue to pronounce words. Approximately 6 hours after drug administration, the symptoms persisted, and the patient was admitted to an emergency medical center (EMC). The patient was discharged from the EMC after a one-night stay in the hospital for symptomatic treatment.
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Background@#Although the identification of clinical and laboratory features in pediatric COVID-19 patients is essential in establishing an appropriate treatment plan, a systematic review and meta-analysis on the topic has yet to be reported. @*Methods@#We searched MEDLINE, Embase, and Web of Science to access clinical and laboratory characteristics as well as clinical outcomes of children with COVID-19 infection. A meta-analysis using random-effect model was performed to estimate pooled prevalence and 95% confidence intervals. @*Results@#Among the 532 studies initially collected, 12 articles were finally included in the meta-analysis. Among the investigated 320 pediatric patients with COVID-19, fever (48.2%) and cough (39.3%) were the most common symptoms.Almost one third of patients (30.4%) were asymptomatic. In laboratory findings, only 11.4% of pediatric patients experienced lymphocytopenia. Increased inflammatory markers including c-reactive protein (18.6%) and procalcitonin (32.4%) were observed.Only a few patients needed mechanical ventilation and intensive care support, and only one death was reported. @*Conclusion@#Pediatric patients with COVID-19 infection exhibited milder symptoms and more favorable outcomes compared to adults. However, considering the high rate of asymptomatic pediatric patients, close monitoring is required to prevent community infection in asymptomatic conditions and hidden disease progression.
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The dietary behavior of immigrants starts changing upon their arrival in a new country. We evaluated changes in dietary quality of Vietnamese women immigrants in Korea and compared dietary quality with that of Korean women. Fifty-six Vietnamese women immigrants and 56 age-matched Korean women were recruited. Dietary quality were assessed using index of nutritional quality (INQ) and diet quality index-international (DQI-I). Dietary habits were assessed according to 4 dietary behaviors: a prudent, calorie control, dietary fat control, and sodium or salt control diet. DQI-I scores of Vietnamese immigrants decreased after immigration, especially the moderation score, although the variety score increased. Scores were significantly lower than those of Korean subjects (45.1 vs. 64.5; p < 0.001). Vietnamese women immigrants had significantly poorer nutrient balance and calorie intake control, although their fat and sodium control was better than that of Korean woman (p < 0.001). INQs of protein, niacin, phosphorus, iron, zinc were lower in immigrants who had lived longer in Korea than more recent immigrants (p < 0.05). Lower INQs of protein, fiber, vitamin A, B1, B6, C, folate, and phosphorus were related to higher body fat in Vietnamese immigrants (p < 0.05). In conclusion, dietary quality of Vietnamese immigrants decreased after migration, and dietary intake was inadequate compared with that of Korean women. In addition, diet quality of Vietnamese immigrants decreased with length of residence in Korea. There was a negative correlation between diet quality and body fat percent in Vietnamese women immigrants. Findings from this study may help improve diet quality and prevent obesity in Vietnam women immigrants.
Subject(s)
Female , Humans , Adipose Tissue , Asian People , Diet , Dietary Fats , Emigrants and Immigrants , Emigration and Immigration , Folic Acid , Feeding Behavior , Iron , Korea , Niacin , Nutritive Value , Obesity , Phosphorus , Republic of Korea , Sodium , Vietnam , Vitamin A , ZincABSTRACT
Previous animal studies have not conclusively determined the association between exposure to humidifier disinfectants (HDs) containing 5-chloro-2-methyl-4-isothiazolin-3-one (CMIT) and/or 2-methyl-4-isothiazolin-3-one (MIT) and development of HD-associated lung injuries. Nonetheless, patients exposed to HDs containing only CMIT and/or MIT showed clinically similar lung injuries to those exposed to HDs containing polyhexamethylene guanidine (PHMG) or oligo (2-[2-ethoxy]ethoxyethyl) guanidinium chloride (PGH). Here, we report twin sisters with lung injuries associated with exposure to CMIT/MIT-containing HDs. At 6 months of age, a younger twin sister presented with the 3-day history of cough, sputum, and respiratory difficulty. Chest radiography revealed multiple patchy consolidation and ground-glass opacities with pneumothorax and pneumomediastinum. Thoracostomy was performed due to pneumothorax at admission and she was discharged at 11 days of hospitalization. At 5 years of age, multiple tiny nodules and faint centrilobular ground-glass opacities were observed with the small pneumatocele. The elder sister visited a tertiary hospital due to dyspnea at 12 months of age. Chest radiography showed consolidation, pneumomediastinum, and pulmonary interstitial emphysema. There was no response to the administration of immunosuppressant drugs and antifibrotic agents. At 5 years of age, chest CT revealed ground-glass opacity and multiple tiny centrilobular ground-glass opacities nodules in both lungs with exercise intolerance.
Subject(s)
Animals , Humans , Cough , Disinfectants , Dyspnea , Emphysema , Guanidine , Hospitalization , Humidifiers , Lung Injury , Lung , Mediastinal Emphysema , Pneumothorax , Radiography , Siblings , Sputum , Tertiary Care Centers , Thoracostomy , Thorax , Tomography, X-Ray Computed , TwinsABSTRACT
Focal epithelial hyperplasia (FEH) is a human papillomavirus (HPV)-induced alteration of the oral mucosa that presents with a clinically distinct appearance. While other HPV-infected lesions such as squamous papilloma, verruca vulgaris, and condyloma acuminatum involve the skin, oral mucosa, and genital mucosa, FEH occurs only in the oral mucosa. The affected oral mucosa exhibits multiple papules and nodules with each papule/nodule being flat-topped or sessile. The affected region resembles the normal color of oral mucosa rather than appearing as a white color since the epithelial surface is not hyperkeratinized. Almost all cases present with multiple sites of occurrence. This rare, benign epithelial proliferation is related to low-risk HPV, especially HPV-13 and -32, and is not transformed into carcinoma. We report a case of FEH that arose on the attached gingiva of an East Asian male adult related to prosthesis without detection of any HPV subtype in HPV DNA chip and sequencing.
Subject(s)
Adult , Humans , Male , Asian People , Dental Prosthesis , Focal Epithelial Hyperplasia , Gingiva , Mouth Mucosa , Mucous Membrane , Oligonucleotide Array Sequence Analysis , Papilloma , Prostheses and Implants , Skin , WartsABSTRACT
PURPOSE: To assess the feasibility and effectiveness of transperineal ultrasonography (TPUS) for the evaluation of perianal Crohn disease (PCD) in pediatric patients. METHODS: Between September 2010 and August 2013, 64 TPUS examinations were performed in 43 patients (34 males and 9 females; mean age+/-standard deviation, 13.3+/-2.4 years; age range, 6 to 17 years) to evaluate PCD. The pain severity, location, and activity of perianal fistula, the presence of an abscess, and anal canal hyperemia were retrospectively evaluated. Spearman rank correlation analysis was performed to assess the relationship between the severity of the pain and the fistula activity, the presence of an abscess, and anal canal hyperemia. RESULTS: All examinations were successfully performed. Thirty-nine examinations (60.9%) were performed without any pain experienced by the patient, 19 examinations (29.7%) with mild pain, five examinations (7.8%) with moderate pain, and one examination (1.6%) with severe pain. The pain severity was correlated with the fistula activity (P<0.01). An anterior fistula location was more common than a posterior location. Active fistulas and abscesses were identified during 30 examinations (46.9%) and 12 examinations (18.8%), respectively. Anal canal hyperemia was identified in 31 examinations (48.4%). CONCLUSION: TPUS with a color Doppler study is useful for visualizing a perianal fistula or abscess and for assessing its inflammatory activity in pediatric Crohn patients.
Subject(s)
Female , Humans , Male , Abscess , Anal Canal , Crohn Disease , Fistula , Hyperemia , Pediatrics , Perineum , Retrospective Studies , UltrasonographyABSTRACT
Interstitial lung disease in children (chILD) is a group of disorders characterized by lung inflammation and interstitial fibrosis. In the past recent years, we noted an outbreak of child in Korea, which is possibly associated with inhalation toxicity. Here, we report a series of cases involving toxic inhalational injury-associated chILD with bronchiolitis obliterans pattern in Korean children. This study included 16 pediatric patients confirmed by lung biopsy and chest computed tomography, between February 2006 and May 2011 at Asan Medical Center Children's Hospital. The most common presenting symptoms were cough and dyspnea. The median age at presentation was 26 months (range: 12-47 months), with high mortality (44%). Histopathological analysis showed bronchiolar destruction and centrilobular distribution of alveolar destruction by inflammatory and fibroproliferative process with subpleural sparing. Chest computed tomography showed ground-glass opacities and consolidation in the early phase and diffuse centrilobular nodular opacity in the late phase. Air leak with severe respiratory difficulty was associated with poor prognosis. Although respiratory chemicals such as humidifier disinfectants were strongly considered as a cause of this disease, further studies are needed to understand the etiology and pathophysiology of the disease to improve the prognosis and allow early diagnosis and treatment.
Subject(s)
Child, Preschool , Humans , Infant , APACHE , Bronchi/pathology , Cough/etiology , Cyclophosphamide/therapeutic use , Disinfectants/toxicity , Dyspnea/etiology , Enzyme Inhibitors/therapeutic use , Hydroxychloroquine/therapeutic use , Immunoglobulins/therapeutic use , Inhalation , Lung Diseases, Interstitial/chemically induced , Prognosis , Retrospective Studies , Steroids/therapeutic use , Tomography, X-Ray ComputedABSTRACT
Subject(s)
Humans , Carcinoma, Mucoepidermoid , Carcinoma, Squamous Cell , Cystadenocarcinoma , Incidence , Leiomyosarcoma , Mouth , Mouth Neoplasms , Oligonucleotide Array Sequence Analysis , Papillomavirus Infections , Prevalence , Tongue , Uterine Cervical NeoplasmsABSTRACT
Subject(s)
Humans , Anemia , Bone Marrow , Dentists , Diagnosis, Differential , Early Diagnosis , Hematologic Neoplasms , Hemorrhage , Inflammation , Leukemia , Molar , Mouth , Pediatrics , Precursor Cell Lymphoblastic Leukemia-Lymphoma , ToothABSTRACT
PURPOSE: To compare the abilities of radionuclide salivagrams (RS) and videofluoroscopic swallow studies (VFSS) to diagnose aspiration in children with aspiration pneumonia. METHODS: The records of children who were referred to the Asan Medical Center between April, 2006 and April, 2012 and who underwent both VFSS and RS to evaluate their recurrent aspiration pneumonia were reviewed (n=67). The aspiration positivity rates of the two tests were determined. The agreement between the tests was assessed by using the kappa statistic. RESULTS: VFSS was more frequently positive (n=26, 39%) than RS (n=23, 34%) (p=0.68). In the 11 children who repeat two test, Repeated examination increased positive rate in each tests (n=11), repeated RS (54%, p=1) is more frequent positive than repeated VFSS (46%, p=0.37). If a cumulative positive test had been defined as at least one positive result, the positive rate of two test was 56% (p<0.05). There was a fair agreement between RS and VFSS (kappa=0.26). CONCLUSION: The RS and VFSS positivity rates in children with aspiration pneumonia were similar but there was fair agreement between the two tests. This result suggests that these investigations to demonstrate aspiration are not interchangeable but complementary.