Pediatric management challenges of hyperglycemic hyperosmolar state: case series of Korean adolescents with type 2 diabetes

The hyperglycemic hyperosmolar state (HHS) is considered the most fatal complication of type 2 diabetes mellitus (DM). The number of case reports describing pediatric HHS has increased recently in parallel with obesity and the prevalence of type 2 DM in pediatric patients. In this study, we investigated the patient characteristics and outcomes of HHS in 9 adolescents with obesity and type 2 DM. Almost all patients exhibited mixed clinical features of HHS and diabetic ketoacidosis (DKA), including characteristics such as hyperosmolality and ketoacidosis. These features made definitive diagnosis difficult; 5 out of 9 patients were initially diagnosed with DKA and were treated accordingly. Patients who were initially diagnosed with HHS received a more vigorous and appropriate fluid replacement than other patients did. No patients died, although 3 exhibited complications, such as arrhythmia, acute kidney injury requiring renal replacement therapy, rhabdomyolysis, and acute pancreatitis. Hyperosmolality with consequent severe dehydration is considered a significant factor contributing to the outcomes of patients with HHS. Therefore, early recognition of hyperosmolality is crucial for an appropriate diagnosis and adequate fluid rehydration to restore perfusion in the early period of treatment to improve patient outcomes for this rare but serious emerging condition in pediatric patients.

Change in Severity and Clinical Manifestation of MIS-C Over SARSCoV-2 Variant Outbreaks in Korea

Background@#There is difference in the incidence of multi-system inflammatory syndrome in children (MIS-C) in patients with different variants of severe acute respiratory syndrome coronavirus 2, however, little is known about the epidemiology in Asian countries. We investigated and compared the epidemiology of the MIS-C during omicron-dominant period with that of previous periods in South Korea. @*Methods@#We obtained clinical, epidemiological and laboratory data on MIS-C cases from national MIS-C surveillance in South Korea. We defined pre-delta period as January 2020–May 2021; delta period as June 2021–December 2021; and omicron period as January 2022–April 2022. We describe the clinical characteristics and outcomes of MIS-C patients by period. @*Results@#A total of 91 cases were assessed to be MIS-C cases. Number of MIS-C cases have increased from six cases during pre-delta period to 66 cases during omicron period, while the incidence rate (the number of MIS-C cases per 100,000 cases of reported coronavirus disease 2019) has decreased from 38.5 cases per 100,000 (95% confidence interval [CI], 14.1–83.9) during pre-delta period to 1.6 cases per 100,000 (95% CI, 1.2–2.0) during omicron periods. During pre-delta period, 66.7% and 100% had hypotension and gastrointestinal involvement, respectively; while during omicron period, 12.1% and 6.1% had such clinical manifestations. Fifty percent of pre-delta MIS-C patients were taken intensive care unit (ICU) cares, while 10.6% of patients during omicron periods were in ICUs. @*Conclusion@#Omicron period were associated with less severe clinical manifestation compared to pre-delta and delta periods. Although incidence rate of MIS-C was lower for the omicron period than pre-delta and delta periods, number of patients reported with MIS-C may pose a substantial clinical burden.

Changes in Diagnostic Performance of Thyroid Cancer Screening before and after the Korean Thyroid Imaging Reporting and Data System Revision / 가정의학회지

Background@#Since the era of “thyroid cancer epidemic,” many Korean academic societies discouraged the use of ultrasonography in healthy individuals and revised the Korean Thyroid Imaging Reporting and Data System to address the overscreening and overdiagnosis issues. This study aimed to evaluate the change in the diagnostic effectiveness of thyroid cancer screening over the last decade. @*Methods@#This single-center, retrospective observational study analyzed the data of 125,962 thyroid nodules obtained during cancer screening at the health promotion center of Seoul National University Bundang Hospital from 2010 to 2019. Only 327 thyroid cancer cases pathologically confirmed by fine-needle aspiration (FNA) were included in the study. The strength of the association between the number of FNA and (1) the number of thyroid cancer diagnoses, (2) the positive predictive values (PPVs), and (3) the difference in PPV from the previous year were evaluated using Pearson’s correlation analysis. @*Results@#The number of thyroid FNA biopsies as well as the thyroid cancer diagnoses decreased from 2010 to 2019 (166 to 48 [-71.1%] vs. 43 to 22 [-48.8%]). The PPV of FNA biopsies increased from 25.9% to 45.8% (+76.8%) and was negatively correlated with the number of FNA biopsies performed (R=-0.87, P<0.001). The difference in PPV from the previous year increased similarly but without statistical significance (R=-0.59, P=0.09). @*Conclusion@#The diagnostic efficiency of thyroid cancer screening has increased over the last decade, as evidenced by the increasing PPV of FNA biopsies.

Clinical characteristics and associated factors of Mycoplasma pneumoniaepneumonia with atelectasis in children

Purpose@#Patients with Mycoplasma pneumoniae pneumonia (MPP) can develop atelectasis, and some cases of atelectasis may persist for over 4 weeks. However, the risk factors for the development and persistence of atelectasis ( > 4 weeks) in children with MPP and their clinical characteristics remain understudied. We aimed to investigate the clinical characteristics and associated factors of MPP with atelectasis in children. @*Methods@#We retrospectively analyzed the medical records of 477 children with MPP treated at Pusan National University Yangsan Hospital from November 2014 to March 2020. Demographics, clinical information, laboratory data, and radiological findings were collected from all patients. The patients were divided into 2 groups according to the presence of atelectasis with MPP. The group with atelectasis was further divided into 2 groups according to whether atelectasis was improved. @*Results@#Among 477 children with MPP, 105 developed atelectasis, and 34 showed persistent atelectasis. Children with atelectasis had longer lengths of hospitalization than children without atelectasis. High lactate dehydrogenase (LDH) levels and whole lobar consolidation were independently associated factors for presenting with atelectasis, and long macrolide therapy duration before admission ( > 3 days) was related to persistent atelectasis ( > 4 weeks). @*Conclusion@#High LDH levels and whole lobar consolidation were independent associated factors for presenting with atelectasis, and a long macrolide therapy duration before admission was associated with persistent atelectasis. Careful observation and management of children with these associated factors for atelectasis will improve the prognosis of children with MPP.

Controlling an Outbreak of Multidrugresistant Acinetobacter baumannii in a Pediatric Intensive Care Unit: a Retrospective Analysis

Background@#Multidrug-resistant Acinetobacter baumannii (MDRAB) is widespread among intensive care units worldwide, posing a threat to patients and the health system. We describe the successful management of a MDRAB outbreak by implementing an infection-control strategy in a pediatric intensive care unit (PICU). @*Methods@#This retrospective study investigated the patients admitted to the PICU in periods 1 (8 months) and 2 (7 months), from the index MDRAB case to intervention implementation, and from intervention implementation to cessation of MDRAB spread. An infection-control strategy was designed following six concepts: 1) cohort isolation of colonized patients, 2) enforcement of hand hygiene, 3) universal contact precautions, 4) environmental management, 5) periodic surveillance culture study, and 6) monitoring and feedback. @*Results@#Of the 427 patients, 29 were confirmed to have MDRAB colonization, of which 18 had MDRAB infections. Overall incidence per 1,000 patient days decreased from 7.8 (period 1) to 5.8 (period 2). The MDRAB outbreak was declared terminated after the 6-month followup following period 2. MDRAB was detected on the computer keyboard and in condensed water inside the ventilator circuits. The rate of hand hygiene performance was the lowest in the three months before and after index case admission and increased from 84% (period 1) to 95% (period 2). Patients with higher severity, indicated by a higher Pediatric Risk of Mortality III score, were more likely to develop colonization (P = 0.030), because they had invasive devices and required more contact with healthcare workers. MDRAB colonization contributed to an increase in the duration of mechanical ventilation and PICU stay (P < 0.001), but did not affect mortality (P = 0.273). @*Conclusion@#The MDRAB outbreak was successfully terminated by the implementation of a comprehensive infection-control strategy focused on the promotion of hand hygiene, universal contact precautions, and environmental management through multidisciplinary teamwork.

Food Behavior Using the Nutrition Quotient and Vegetable Preferences of Elementary School Students in the Metropolitan Area

The purpose of this survey was to investigate the food behavior and vegetable preferences of elementary school students in the metropolitan areas of, South Korea. Five hundred and eighty students (277 male and 303 female) studying in grades 5∼6 participated in the survey. We assessed food behavior by evauating the Nutrition Quotient (NQ). Through a questionnaire, which consisted of 20 food behavior checklist items. These items were grouped under five factors: balance, diversity, moderation, practice and environment. All data were analyzed using SPSS 25.0. The average NQ score weighted using the five factors was 61.32 points. Among the five factors, moderation showed the lowest score, whereas environment showed the highest score. The average score of the vegetable preference was 3.36 points out of a total of 5 points. The vegetable preference was found to be highest for bean sprouts and followed by tomatoes, lettuce, spinach, Chinese cabbage, sesame leaf, pumpkin, carrot, radish, chives, lotus roots, onions, broccoli, sweet peppers, and eggplant. The results of vegetable preferences by NQ grade were 4.13±0.63 points for the high grade, 3.68±0.75 points for the medium-high grade, 3.41±0.82 points for the medium-low grade, and 2.94±0.78 points for the low grade. There was a significant positive correlation between NQ and vegetable preferences (r=0.477, P＜0.001). If vegetables with high preference are frequently provided in school meals, it might contribute to improving overall food behavior.

Food Behavior Using the Nutrition Quotient and Vegetable Preferences of Elementary School Students in the Metropolitan Area

The purpose of this survey was to investigate the food behavior and vegetable preferences of elementary school students in the metropolitan areas of, South Korea. Five hundred and eighty students (277 male and 303 female) studying in grades 5∼6 participated in the survey. We assessed food behavior by evauating the Nutrition Quotient (NQ). Through a questionnaire, which consisted of 20 food behavior checklist items. These items were grouped under five factors: balance, diversity, moderation, practice and environment. All data were analyzed using SPSS 25.0. The average NQ score weighted using the five factors was 61.32 points. Among the five factors, moderation showed the lowest score, whereas environment showed the highest score. The average score of the vegetable preference was 3.36 points out of a total of 5 points. The vegetable preference was found to be highest for bean sprouts and followed by tomatoes, lettuce, spinach, Chinese cabbage, sesame leaf, pumpkin, carrot, radish, chives, lotus roots, onions, broccoli, sweet peppers, and eggplant. The results of vegetable preferences by NQ grade were 4.13±0.63 points for the high grade, 3.68±0.75 points for the medium-high grade, 3.41±0.82 points for the medium-low grade, and 2.94±0.78 points for the low grade. There was a significant positive correlation between NQ and vegetable preferences (r=0.477, P＜0.001). If vegetables with high preference are frequently provided in school meals, it might contribute to improving overall food behavior.

Outcome of High Dose Ampicillin-Sulbactam and Colistin Combination Therapy for Treating Ventilator-Associated Pneumonia Caused by Carbapenem-Resistant Acinetobacter baumannii: a Pilot Study

Purpose@#This pilot study aimed to evaluate the efficacy of high dose ampicillin-sulbactam and colistin combination therapy for ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) in the pediatric intensive care unit of Pusan National University Children's Hospital. @*Methods@#We retrospectively reviewed 17 pediatric patients with VAP caused by CRAB from June 2017 to August 2018. Ten (58.8%) patients were treated with high dose ampicillin-sulbactam and colistin combination therapy (combination therapy group), whereas 7 were treated with colistin only or with various combinations with or without colistin (other antibiotics group). Clinical and bacteriological outcomes were compared between the groups. @*Results@#The mean duration of fever after antibiotic use was 1.30±1.70 days in the combination therapy group and 1.71±1.49 days in the other antibiotics group. The mean duration of days for negative conversion of endotracheal aspirate bacterial culture afterantibiotic therapy was 3.40±1.71 days in the combination therapy group and 11.80±8.86 days in the other antibiotics group. The mortality rate within 30 days of antibiotic therapy was 1/10 (10%) in the combination therapy group and 3/7 (42.9%) in the other antibiotics group. @*Conclusions@#High dose ampicillin-sulbactam and colistin combination therapy as early antibiotic treatment in VAP caused by CRAB in children could improve clinical outcomes.

Prognostic influence of Korean public medical insurance system on breast cancer patients

PURPOSE: To investigate the prognostic influence of Korean public medical insurance system on breast cancer patients. METHODS: Data of 1,068 patients with primary invasive breast cancer were analyzed. Korean public medical insurance status was classified into 2 groups: National Health Insurance and Medical Aid. Kaplan-Meier estimator and Cox proportional hazards model were used for survival analysis. RESULTS: The Medical Aid group showed worse prognoses compared to the National Health Insurance group both in overall survival (P = 0.001) and recurrence-free survival (P = 0.006). The Medical Aid group showed higher proportion of patients with tumor size > 2 cm (P = 0.022), more advanced stage (P = 0.039), age > 50 years (P = 0.003), and low education level (P = 0.003). The Medical Aid group showed higher proportion of patients who received mastectomy (P < 0.001) and those who received no radiation therapy (P = 0.013). The Medical Aid group showed a higher rate of distant recurrence (P = 0.014) and worse prognosis for the triple negative subtype (P = 0.006). Medical insurance status was a significant independent prognostic factor in both univariate analysis and multivariate analysis. CONCLUSION: The Medical Aid group had worse prognosis compared to the National Health Insurance group. Medical insurance status was a strong independent prognostic factor in breast cancer. Unfavorable clinicopathologic features could explain the worse prognosis for the Medical Aid group. Careful consideration should be given to medical insurance status as one of important prognostic factors for breast cancer patients.

Diagnostic Odyssey and Application of Targeted Exome Sequencing in the Investigation of Recurrent Infant Deaths in a Syrian Consanguineous Family: a Case of Spinal Muscular Atrophy with Respiratory Distress Type 1

Spinal muscular atrophy with respiratory distress type 1 (SMARD1) is a rare autosomal recessive disorder caused by a defect in the immunoglobulin mu binding protein 2 (IGHMBP2) gene, leading to motor neuron degeneration. We identified an infant with SMARD1 by targeted exome sequencing from a consanguineous Syrian family having a history of recurrent infant deaths. The patient initially presented intrauterine growth retardation, poor sucking, failure to thrive, and respiratory failure at the age of two months, and an inborn error of metabolism was suspected at first. Over a period of one month, the infant showed rapid progression of distal muscular weakness with hand and foot contractures, which were suggestive of neuromuscular disease. Using targeted exome sequencing, the mutation in IGHMBP2 was confirmed, although the first report was normal. Targeted exome sequencing enabled identification of the genetic cause of recurrent mysterious deaths in the consanguineous family. Additionally, it is suggested that a detailed phenotypic description and communication between bioinformaticians and clinicians is important to reduce false negative results in exome sequencing.

A Rare Cause of Life-Threatening Ketoacidosis: Novel Compound Heterozygous OXCT1 Mutations Causing Succinyl-CoA:3-Ketoacid CoA Transferase Deficiency

Succinyl-CoA:3-ketoacid CoA transferase (SCOT) deficiency is a rare inborn error of ketone body utilization, characterized by episodic or permanent ketosis. SCOT deficiency is caused by mutations in the OXCT1 gene, which is mapped to 5p13 and consists of 17 exons. A 12-month-old girl presented with severe ketoacidosis and was treated with continuous renal replacement therapy. She had two previously unrecognized mild-form episodes of ketoacidosis followed by febrile illness. While high levels of ketone bodies were found in her blood and urine, other laboratory investigations, including serum glucose, were unremarkable. We identified novel compound heterozygous mutations in OXCT1:c.1118T>G (p.Ile373Ser) and a large deletion ranging from exon 8 to 16 through targeted exome sequencing and microarray analysis. This is the first Korean case of SCOT deficiency caused by novel mutations in OXCT1, resulting in life-threatening ketoacidosis. In patients with unexplained episodic ketosis, or high anion gap metabolic acidosis in infancy, an inherited disorder in ketone body metabolism should be suspected.

Genetic overgrowth syndrome: A single center's experience

PURPOSE: Overgrowth syndromes are conditions that involve generalized or localized areas of excess growth. In this study, the clinical, molecular, and genetic characteristics of Korean patients with overgrowth syndrome were analyzed. MATERIALS AND METHODS: We recruited 13 patients who presented with overgrowth syndrome. All patients fulfilled inclusion criteria of overgrowth syndrome. Analysis of the clinical and molecular investigations of patients with overgrowth syndrome was performed retrospectively. RESULTS: Among the 13 patients with overgrowth syndrome, 9 patients (69.2%) were found to have molecular and genetic causes. Among the seven patients with Sotos syndrome (SS), two had a 5q35microdeletion that was confirmed by fluorescent in situ hybridization. In two patients with SS, intragenic mutations including a novel mutation, c.5993T>A (p.M1998L), were found by Sanger sequencing. One patient had one copy deletion of NDS1 gene which was confirmed by multiplex ligation-dependent probe amplification. Among five patients with Beckwith-Wiedemann syndrome, three had aberrant imprinting control regions; 2 hypermethylation of the differentially methylated region of H19, 1 hypomethylation of the differentially methylated region of Kv. In one patient displaying overlapping clinical features of SS, a de novo heterozygous deletion in the chromosomal region 7q22.1-22.3 was found by single nucleotide polymorphism-based microarray. CONCLUSION: Considering high detection rate of molecular and genetic abnormalities in this study, rigorous investigations of overgrowth syndrome may be an important tool for the early diagnosis and genetic counseling. A detailed molecular analysis of the rearranged regions may supply the clues for the identification of genes involved in growth regulation.

Effects of Neuromuscular Electrical Stimulation in Combination with Saliva or Dry Swallowing in Stroke Patients with Dysphagia / 대한연하장애학회지

OBJECTIVE: Dysphagia after stroke can cause a range of complications, especially aspiration pneumonia, which can be life-threatening. Therefore, rehabilitation methods to reduce aspiration in patients with dysphagia are important. This study examined the effects of neuromuscular electrical stimulation combined with saliva or dry swallowing on the swallowing function of stroke patients with dysphagia. METHODS: The participants were assigned to either the experimental group (n=9) or control group (n=8). The experimental group received neuromuscular electrical stimulation combined with saliva or dry swallowing, whereas the control group received only voluntary swallowing. Both groups received training 5 days per week for 4 weeks. The oropharyngeal swallowing function was assessed using the video fluoroscopic dysphagia scale (VDS) and penetration-aspiration scale (PAS) based on a video fluoroscopic swallowing study. RESULTS: After the intervention, the experimental group showed greater improvement in the pharyngeal phase of the VDS and PAS scores than the control group (P=0.038, 0.027, respectively). CONCLUSION: Neuromuscular electrical stimulation combined with saliva or dry swallowing improves the pharyngeal swallowing function of stroke patients with dysphagia better than saliva or dry swallowing alone.

BCL2 Regulation according to Molecular Subtype of Breast Cancer by Analysis of The Cancer Genome Atlas Database / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We investigated B-cell lymphoma 2 (BCL2) regulation across DNA, RNA, protein, and methylation status according to molecular subtype of breast cancer using The Cancer Genome Atlas (TCGA) database. MATERIALS AND METHODS: We analyzed clinical and biological data on 1,096 breast cancers from the TCGA database. Biological data included reverse phase protein array (RPPA), mRNA sequencing (mRNA-seq), mRNA microarray, methylation, copy number alteration linear, copy number alteration nonlinear, and mutation data. RESULTS: The luminal A and luminal B subtypes showed upregulated expression of RPPA and mRNAseq and hypomethylation compared to the human epidermal growth factor receptor 2 (HER2) and triple-negative subtypes (all p < 0.001). No mutations were found in any subjects. High mRNA-seq and high RPPA were strongly associated with positive estrogen receptor, positive progesterone receptor (all p < 0.001), and negative HER2 (p < 0.001 and p=0.002, respectively). Correlation analysis revealed a strong positive correlation between protein and mRNA levels and a strong negative correlation between methylation and protein and mRNA levels (all p < 0.001). The high BCL2 group showed superior overall survival compared to the low BCL2 group (p=0.006). CONCLUSION: The regulation of BCL2 was mainly associated with methylation across the molecular subtypes of breast cancer, and luminal A and luminal B subtypes showed upregulated expression of BCL2 protein, mRNA, and hypomethylation. Although copy number alteration may have played a minor role, mutation status was not related to BCL2 regulation. Upregulation of BCL2 was associated with superior prognosis than downregulation of BCL2.

Management of Pediatric Patients Presenting with Acute Abdomen Accompanying Dilatation of the Common Bile Duct / 대한소아소화기영양학회지

PURPOSE: The aim of this study was to describe our treatment experiences with patients who had acute abdomen (AA) with common bile duct (CBD) dilatation. METHODS: The treatment outcomes in children with AA and CBD dilatation were retrospectively reviewed. According to the shape of the intrahepatic bile ducts on ultrasonography (US), the origin of the pain was estimated as choledochal cyst (CC) complication or choledocholithiasis in normal CBD. Patients with complicated CC underwent surgery, and patients with choledocholithiasis in a normal appearing CBD underwent symptomatic treatment initially. RESULTS: Of the 34 patients, 30 (88.2%) were female. The mean age of the patients was 6.4±4.9 (range, 0.8–17) years. Seventeen (50.0%) patients had CBD stones and 17 (50.0%) did not. Surgical treatment was performed in 20 (58.8%) patients, 2 of whom underwent preoperative stone removal with endoscopic retrograde cholangiopancreatography and an operation. Conservative treatment was applied in 12 (35.3%) patients (8 with and 4 without stones), 1 of whom developed symptom relapse and underwent an operation. Among the 8 patients with CBD stones, 4 (4/17, 23.5%) had complete resolution of the stones and recovery of the CBD diameter after conservative treatment. US findings of patients with stone showed a fusiform or cylindrical shape of the CBD in 14 (82.4%) patients. CONCLUSION: The presence of stones in the distal CBD and the US features of CBD dilatation may be helpful to diagnose and treat the causes of biliary dilatation. Conservative treatment can be considered as initial therapy in patients with uncomplicated CBD dilatation with stone.

ABT-737 ameliorates docetaxel resistance in triple negative breast cancer cell line

PURPOSE: This study aimed to validate the synergistic effect of ABT-737 on docetaxel using MDA-MB-231, a triple negative breast cancer (TNBC) cell line overexpressing B-cell lymphoma-2 (Bcl-2). METHODS: Western blot analysis was performed to assess expression levels of Bcl-2 family proteins and caspase-related molecules. Cell viability was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Cell cycle distribution was determined by flow cytometry analysis. Benzyloxycarbonyl-Val-Ala-Asp(OMe)-fluoromethylketone (z-VAD-fmk) was used for pretreatment to assess the role of caspases. RESULTS: Cell viability of MDA-MB-231 after combination treatment with ABT-737 and docetaxel was significantly lower than that after docetaxel or ABT-737 monotherapy based on MTT assay (both P < 0.001), with a combination index of 0.41. The proportion of sub-G1 population after combination treatment was significantly higher than that after docetaxel or ABT-737 monotherapy (P = 0.001, P = 0.003, respectively). Pretreatment with z-VAD-fmk completely restored cell viability of MDA-MB-231 from apoptotic cell death induced by combination therapy (P = 0.001). Although pro-caspase-8 or Bid did not show significant change in expression level, pro-casepase-9 showed significantly decreased expression after combination treatment. Cleaved caspase-3 showed increased expression while poly (ADP-ribose) polymerase cleavage was induced after combination treatment. However, hypoxia-inducible factor 1-alpha and aldehyde dehydrogenase 1 totally lost their expression after combination treatment. CONCLUSION: Combination of ABT-737 with docetaxel elicits synergistic therapeutic effect on MDA-MB-231, a TNBC cell line overexpressing Bcl-2, mainly by activating the intrinsic pathway of apoptosis. Therefore, adjunct of ABT-737 to docetaxel might be a new therapeutic option to overcome docetaxel resistance of TNBCs overexpressing Bcl-2.

Prognostic influence of 3-dimensional tumor volume on breast cancer compared to conventional 1-dimensional tumor size

PURPOSE: The prognostic influence of 3-dimensional tumor volume (Tv) on breast cancer compared to conventional 1-dimensional tumor size (T) was investigated. METHODS: Analysis was performed on a cohort of 8,996 primary breast cancer patients who were initially diagnosed with TNM stage I–III. Tumor size was defined as the maximum tumor dimension, and Tv was calculated by the equation of (4π× r1 × r2 × r3)/3; r1, r2, and r3 were defined as half of the largest, intermediate, and shortest dimension of the tumor, respectively. Tv was classified into Tv1, Tv2, and Tv3 according to the cut off values of 2.056 cm3 and 20.733 cm3. RESULTS: The survival curves according to both the T and Tv categories were clearly differentiated (all P < 0.001), as were those for staging by T and Tv (all P < 0.001). In T1 and T2 tumors, the Tv1 group showed superior survival over the Tv2 group (T1, P < 0.001; T2, P = 0.001). Univariate and multivariate analysis both indicated that Tv was a significant prognostic factor (both P < 0.001). The receiver operating characteristic curve showed that the area under the curves were 0.712 (P < 0.001) for Tv and 0.699 (P < 0.001) for T. Positive correlations were observed between the number of positive nodes and T (coefficient = 0.325; P < 0.001), and between the number of positive nodes and Tv (coefficient = 0.321; P < 0.001). CONCLUSION: Tv classification works well for predicting the prognosis of breast cancer, and it is a better predictor than conventional T classification in several aspects. Further studies are needed to validate the practical usefulness of Tv classification in clinical settings.

The Factors Affecting the Use of Empirical Antibiotics in Febrile Infants from 1 Month to Less than 3 Months

PURPOSE: This study investigated the factors affecting the use of empirical antibiotics in febrile infants from 1 month to less than 3 months. METHODS: We retrospectively reviewed the medical records of hospitalized previously healthy infants with fever in Pusan National University Children's Hospital from January 2010 to December 2016. Clinical features, laboratory findings and antibiotic therapy were analyzed. Respiratory viruses were identified by multiplex reverse transcriptase polymerase chain reaction (RT-PCR) and were reported after 1–3 days. Enterovirus were identified by real time polymerase chain reaction (PCR) and were reported in several hours. RESULTS: The 129 of 366 subjects used empirical antibiotics and 237 patients didn't used empirical antibiotics. Empirical antibiotics were used more frequently when the fever was longer before admission, respiratory symptoms and ill being appearances were present and C-reactive protein was elevated. The rate of readmission was low in the group not used empirical antibiotics. Most of the patients detected by enterovirus PCR in cerebrospinal fluid didn't used empirical antibiotics. The results of respiratory virus multiplex RT-PCR showed no difference in the use of empirical antibiotics. CONCLUSIONS: In our study, empirical antibiotic prescriptions were affected not respiratory virus multiplex RT-PCR but enterovirus PCR. If multiplex RT-PCR were reported more rapid turn around time, it will affect antibiotic use.

Child Rearing Experience of Mothers of School-Age Children with Autism Spectrum Disorders

PURPOSE: The purpose of this study was to describe the child rearing experience of mothers of school-age children with autism spectrum disorders in Korea. METHODS: Seven mothers were interviewed from October 2015 to January 2016. Interviews were transcribed verbatim and analyzed using Giorgi's phenomenological method. RESULTS: The study results showed that the child rearing experience of mothers of school-age children with autism spectrum disorders consists of six major themes: “facing unexpected situations”, “trying to accept children with disabilities”, “having considerably adjusted to the difficulties associated with the children's school life”, “experiencing frustrations”, “maintaining a child-centered life style”, and “being grateful for the present and looking forward to a better future”. CONCLUSION: The findings from this study show the need to provide more practically individualized and holistic services in the community for this population including their children such as lifetime education programs for the children and more financial aid for their therapies. In addition, the results reveal that mothers need physical, emotional, informational, financial, and social support to continue their life with children who have autism spectrum disorders.

Molecular Testing of Lymphoproliferative Disorders: Current Status and Perspectives

Molecular pathologic testing plays an important role for the diagnosis, prognostication and decision of treatment strategy in lymphoproliferative disease. Here, we briefly review the molecular tests currently used for lymphoproliferative disease and those which will be implicated in clinical practice in the near future. Specifically, this guideline addresses the clonality test for B- and T-cell proliferative lesions, molecular cytogenetic tests for malignant lymphoma, determination of cell-of-origin in diffuse large B-cell lymphoma, and molecular genetic alterations incorporated in the 2016 revision of the World Health Organization classification of lymphoid neoplasms. Finally, a new perspective on the next-generation sequencing for diagnostic, prognostic, and therapeutic purpose in malignant lymphoma will be summarized.