Clinical Characteristics of Atopic Dermatitis in Korean School-Aged Children and Adolescents According to Onset Age and Severity

Background@#Atopic dermatitis (AD) is a heterogeneous disease with different age of onset, disease course, clinical symptoms, severity, and risk of comorbidity. The characteristics of children with AD also vary by age or country. However, little is known about the clinical characteristics of AD in Korean school-aged children and adolescents. Furthermore, there are few studies on phenotypic differences according to onset age. This study aimed to explore the clinical characteristics and phenotypes according to onset age and severity of AD in children and adolescents in Korea. @*Methods@#AD patients aged 6–18 years who presented to 18 hospitals nationwide were surveyed.The patients were examined for disease severity by pediatric allergy specialists, and data on history of other allergic diseases, familial allergy history, onset age, trigger factors, lesion sites,treatment history and quality of life were collected. The results of the patient’s allergy test were also analyzed. The patients were classified into infancy-onset (< 2 years of age), preschoolonset (2–5 years of age), and childhood-onset (≥ 6 years of age) groups. Study population was analyzed for clinical features according to onset-age groups and severity groups. @*Results@#A total of 258 patients with a mean age of 10.62 ± 3.18 years were included in the study. Infancy-onset group accounted for about 60% of all patients and presented significantly more other allergic diseases, such as allergic rhinitis and asthma (P = 0.002 and P = 0.001, respectively). Food allergy symptoms and diagnoses were highly relevant to both earlier onset and more severe group. Inhalant allergen sensitization was significantly associated with both infancy-onset group and severe group (P = 0.012 and P = 0.024, respectively). A family history of food allergies was significantly associated with infancyonset group (P = 0.036). Severe group was significantly associated with a family history of AD, especially a paternal history of AD (P = 0.048 and P = 0.004, respectively). Facial (periorbital, ear, and cheek) lesions, periauricular fissures, hand/foot eczema, and xerosis were associated with infancy-onset group. The earlier the onset of AD, the poorer the quality of life (P = 0.038). Systemic immunosuppressants were used in only 9.6% of the patients in the severe group. @*Conclusion@#This study analyzed the clinical features of AD in Korean children and adolescents through a multicenter nationwide study and demonstrated the phenotypic differences according to onset age and severity. Considering the findings that the early-onset group is more severe and accompanied by more systemic allergic diseases, early management should be emphasized in young children and infants.

Nursing Students' Peer Feedback Types and Emotional Response, Quality of Feedback, and Self-efficacy for Learning from Peer Feedback in Skill Training / 한국간호교육학회지

PURPOSE: This study was conducted to identify types of peer feedback in nursing skills performance training and to investigate emotional response, perceived quality of feedback and self-efficacy for learning from peer feedback. METHODS: A total of 110 second-year nursing students attending fundamentals of nursing classes at a university participated in 2017. Participants received peer feedback from one selected colleague who observed their skills performance, and completed a questionnaire. Contents of peer feedback video recordings were transcribed and classified into seven types of feedback. Data were analyzed using an independent t-test, ANOVA and Pearson correlation. RESULTS: Participants mostly received feedback of ‘correcting’ and ‘providing information.’ Positive emotional responses from peer feedback were above medium, and negative emotional responses were low. The perceived quality of peer feedback was moderate and self-efficacy for learning was high. Quality of feedback correlated with negative emotional response (r=−.24, p=.014), and self-efficacy for learning (r=.35, p<.001). Self-efficacy for learning correlated with intimacy with peers (r=.24, p=.011) and positive emotional response (r=.21, p=.028). CONCLUSION: The results suggest that peer feedback in skill training could be used in terms of emotional response and self-efficacy for learning.

Head Nurses' Experiences in Clinical Practice Education of Nursing Students: A Qualitative Research / 한국간호교육학회지

PURPOSE: The aim of this study was to understand and describe difficulties and needs experienced by head nurses in the clinical practice education of nursing students. METHODS: A qualitative descriptive method was employed. A convenience sampling method was used to recruit participants from four hospitals in South Korea. Twenty-one head nurses participated in the first interview and 17 of them participated in the second interview. Data were collected through two in-depth interviews and field notes were written. Qualitative content analysis method was utilized for data analysis using ATLAS.ti 6.2 software. RESULTS: Thirty-one codes and twelve categories were identified. Four themes emerged from data analysis, which included ‘too many tasks’, ‘limitations of student education’, ‘many differences’, and ‘lack of support and resources.’ CONCLUSION: This qualitative study described head nurses' many difficulties and needs in the clinical practice education of nursing students. The results of this study provide valuable understanding and knowledge of head nurses' experiences in students' clinical education, which leads to improvement of the quality of clinical education for nursing students.

Etiology and clinical feature of oral allergy syndrome in children

PURPOSE: Oral allergy syndrome (OAS) is a unique allergic reaction to fresh fruits or vegetables, which is caused by cross-reactivity between foods and pollens. This study was conducted to investigate the clinical feature of OAS and relevant pollen allergens as well as the association between them in Korean children. METHODS: This single-center study included 290 children who were sensitized to pollens at Severance Hospital, and the clinical characteristics of children with and without OAS were compared. A multicenter study included 97 children who were diagnosed with OAS at 3 hospitals between January 2008 and June 2014. The details of clinical features were collected by retrospective medical record reviews using a standardized case report form. The relevant pollen allergens were identified by skin prick tests and/or serum specific IgE levels. RESULTS: The most commonly sensitized allergen was Japanese hop in pollen-sensitized children. Children with OAS were most commonly sensitized to birch and oak, and 12.4% of the pollen-sensitized children had OAS in the single center. The number of children who were newly diagnosed with OAS has increased over the past 7 years. The most common causative food of OAS was apple. More than 60% of patients with OAS had oral allergic reactions to multiple foods. CONCLUSION: OAS may be relatively common in pollen-sensitized children. OAS should be considered in children with allergic disease and sensitization to pollens.

Bibliographic Analysis of Articles Published in Journal of Korean Clinical Nursing Research from 2009 to 2015 / 임상간호연구

PURPOSE: The aimof this study was to identify bibliographic characteristics and research trends of articles published in the Journal of Korean Clinical Nursing Research from2009 to 2015. METHODS: Descriptive statistics were used to analyze 268 articles. Bibliographic characteristics, appropriateness ofmethods for quantitative and qualitative studies, and key concepts of articles were analyzed. RESULTS: A clinical nurse was the first author for 184 (66.7%) articles. The number of collaborative works between hospital and university was 184 (68.7%). Study participants were patients (120, 38.1%), nurses (115, 36.5%) and others. IRB approval was given for 156 articles (58.2%). Written informed consent was obtained in 125 articles (46.7%). Quantitative research accounted for 98.6% of the articles but qualitative studies only 4 (1.4%). Types of interventions in the experimental studies were nursing skills (43, 42.6%) and health education (32, 31.7%). Major keywords were nurses, pain, knowledge, intensive care unit, anxiety, depression, fatigue, and stress. CONCLUSION: Articles in this journal deal with topics and concepts confronted in nursing practice so experimental studies on applicability of nursing interventions were frequently published. Findings in this study indicate that the authors published in the journal contribute to the development of nursing with characteristics distinctive from other nursing journals published in Korea.

Clinical implication of exhaled breath temperature measurement in pediatric asthma

PURPOSE: Exhaled breath temperature (EBT) has been suggested as a noninvasive marker of airway inflammation in asthma. The aim of this study was to determine its clinical implication in children with asthma. METHODS: A total of 233 children were enrolled in this study. Among them, 116 were asthmatic children and 117 were healthy children. Spirometry, bronchodilator response (BDR) test, methacholine challenge test, and skin prick test were performed. EBT, fractional exhaled nitric oxide (FeNO), blood eosinophils, and total IgE levels were measured. EBT was measured by using X-halo. RESULTS: EBT was significantly higher in the asthma group than in the control group (median [interquartile range], 32.1℃ [30.0℃–33.9℃] vs. 29.7℃ [29.0℃–31.3℃], P<0.001). EBT was significantly higher in poorly or partly controlled asthmatic children than well-controlled asthmatic children (33.5℃ [31.0℃–34.4℃] vs. 30.3℃ [29.3℃–32.9℃], P<0.0001). Among total subjects, EBT was significantly higher in the atopic group than in the nonatopic group (32.4℃ [30.3℃–34.0℃] vs. 29.8℃ [29.0℃–30.3℃], P<0.001). There were neither significant associations between EBT and BDR (r=0.109, P=0.241) nor between EBT and PC20 (provocation concentration causing a 20% fall in FEV1) in total subjects (r=0.127, P=0.316). EBT did not show any association with FeNO (r=0.353, P=0.071). CONCLUSION: Our study suggests that EBT might play a role as an ancillary marker for allergic airway inflammation and the degree of control in pediatric asthma patients. Additional studies are required to explore the value of EBT in detail.

Association between the serum 25-hydroxyvitamin D level and allergic rhinitis in Korean children

PURPOSE: Vitamin D is known to play an important role in the regulation of the immune system and in the prevention of allergic disease. Herein, we examined the association between vitamin D and allergic rhinitis (AR) in children. METHODS: A total of 72 aeroallergen-proven AR and 57 healthy control subjects who visited Severance Children's Hospital between 2012 and 2014 were evaluated. The mean serum 25-hydroxyvitamin D (25(OH)D) level was measured in all subjects to evaluate their vitamin D status. RESULTS: The mean serum 25(OH)D levels was significantly lower in patients with AR than in controls (19.5±6.4 ng/mL vs. 22.3±5.8 ng/mL, P=0.013). The incidence of AR is higher in the 25(OH)D-insufficient group (15–20 ng/mL) and in the 25(OH)D-deficient group (≤15 ng/mL) compared with the 25(OH)D-sufficient group (>20 ng/mL) (40.3% vs. 84.4% vs. 22.2%, P<0.001). There was no significant difference in the serum 25(OH)D level between subgroups with mild and moderate-to-severe AR symptoms (19.8±6.5 vs. 19.0±6.3, P=0.596). After adjusting for confounding factors, the lower serum vitamin D level groups had increased odds of AR compared with the 25(OH)D-sufficient group (odds ration [95% confidence interval]; 3.67 [1.29–10.38] in the 25(OH)D-insufficient group; P=0.014 and 6.04 [1.49–24.51] in the 25(OH)D-deficient group; P=0.012). CONCLUSION: The serum vitamin D levels were significantly lower in children with AR compared with healthy controls. Therefore, lower serum level of 25(OH)D may be associated with the development of AR.

Heterogeneity of asthma according to systemic inflammatory pattern in children

PURPOSE: Asthma is a chronic airway inflammation. We evaluated whether systemic inflammatory patterns could reflect the nature of airway inflammation. We assessed characteristics of asthma according to systemic inflammatory patterns. METHODS: A total of 413 children with asthma were enrolled in the study. Four systemic inflammatory patterns were classified according to eosinophil and neutrophil counts in peripheral blood. Children with neutrophil count> or =5,000/microL were defined as the NEU(hi) group, those with neutrophil count or =650/microL were defined as the EOS(hi) group, those with eosinophil count<240/microL as the EOS(lo) group. The remaining patients were excluded from the study. The characteristics of asthma include pulmonary function test results, bronchodilator response, airway hyperresponsiveness, and atopy. RESULTS: The EOS(hi) group had a lower PC20 (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 second [FEV1]), a lower FEV1, and a higher immunoglobulin E level rather than the EOS(lo) groups, although there were no significant differences between the NEU(hi) and NEU(lo) groups. The eosinophil percentages of the induced sputum samples were higher in the EOS(hi) group than the EOS(lo) group and correlated with blood eosinophil counts. CONCLUSION: Eosinophilic inflammation was related to characteristics of asthma and sputum eosinophils. However, neutrophilic inflammation reflected neither asthma features, sputum neutrophils, nor eosinophilic inflammation. Further studies on blood neutrophils involving asthma phenotypes in terms of more specific characteristics of asthma should be needed in children.

Tentative Proposal of Optimal Timing of Kasai Operation for Biliary Atresia Based on Fibroscan Results / 대한소아소화기영양학회지

PURPOSE: Based on previous research findings, it is well-known that the timing of surgery is generally considered the most important prognostic factor for a Kasai portoenterostomy, the primary treatment for biliary atresia. This research aimed to identify the optimal timing of a Kasai portoenterostomy and to verify if the proposed optimal timing corresponds to previous studies. All patients were classified by the timing of surgery, and pre- and post-operative fibrotic changes of the liver were measured with the elasticity value from fibroscans. METHODS: The stiffness scores of the pre- and post-operative fibroscans in 34 patients who were treated by Kasai portoenterostomy from October 2007 to September 2010 in Severance children's hospital were reviewed. RESULTS: The earlier the patients were treated by Kasai portoenterostomy, the lower the fibroscan scores. When the patients were treated prior to the 8th week, the post-operative scores of the fibroscans were significantly better than those patients who were treated after the 8th week, and some even recovered partially. Moreover, when operated before the 8th week, the differences between each pre- and post-operative fibroscan score also showed statistical relevance (p=0.0002). CONCLUSION: The earlier the patient was treated by Kasai portoenterostomy, the less liver fibrosis that developed, the lower the level of post-operative fibrosis, and the less the degree of fibrotic progress before and after the operation. Thus, this research proposal reconfirms once more that the 8th week is the optimal timing for a Kasai portoenterostomy.

Clinical outcome of transcatheter closure of patent ductus arteriosus in small children weighing 10 kg or less / 소아과

PURPOSE: Transcatheter closure has become an effective therapy in most patients with patent ductus arteriosus (PDA). However, there are difficulties in transcatheter closure of PDA in small children. We reviewed clinical outcomes of transcatheter closure of PDA in children weighing less than 10 kg in a single center. METHODS: Between January 2003 and December 2009, 314 patients with PDA underwent transcatheter closure in our institute. Among them, 115 weighed less than 10 kg. All of these patients underwent transcatheter closure of PDA using either COOK Detachable Coil(R), PFM Nit-Occlud(R), or Amplatzer duct occluder(R). A retrospective review of the treatment results and complications was performed. RESULTS: The mean age of patients was 9.1+/-5.9 months (median, 8 months), and mean weight was 7.6+/-1.8 kg (median, 7.8 kg). The mean diameter of PDA was 3.2+/-1.4 mm (median, 3 mm). Complete occlusion occurred in 113 patients (98%). One patient was sent to surgery because of a failed attempt at device closure, and another patient had a small residual shunt after device placement. The average mean length of hospital stay was 3.0+/-3.3 days, and mean follow-up duration was 21.0+/-19.6 months. There were no major complications in any of the patients. CONCLUSION: Transcatheter closure of PDA is considered safe and efficacious in infants weighing less than 10 kg. With sufficient experience and further effort, transcatheter closure of PDA can be accepted as the gold standard of treatment for this group of patients.

A Case of Congenital Disseminated Malignant Rhabdoid Tumor of the Soft Tissue in Neonate / 대한주산의학회잡지

Malignant rhabdoid tumor (MRT) was first described as a "rhabdomyosarcomatoid" variant of Wilms tumor, but was later identified as a distinct entity. MRTs are extremely rare and highly aggressive neoplasm with poor outcome, occurring mostly in kidneys and central nervous system, less frequently in extrarenal sites. MRTs are referred to as "congenital" when it is diagnosed at or immediately after birth. There are few reports about congenital disseminated MRT at birth. We report a case of congenital malignant rhabdoid tumor presenting as a soft tissue mass in the right arm at birth although the autopsy revealed the systemic disseminated tumors through the whole body with typical microscopic findings.

A Case of Congenital Disseminated Malignant Rhabdoid Tumor of the Soft Tissue in Neonate / 대한주산의학회잡지

Malignant rhabdoid tumor (MRT) was first described as a "rhabdomyosarcomatoid" variant of Wilms tumor, but was later identified as a distinct entity. MRTs are extremely rare and highly aggressive neoplasm with poor outcome, occurring mostly in kidneys and central nervous system, less frequently in extrarenal sites. MRTs are referred to as "congenital" when it is diagnosed at or immediately after birth. There are few reports about congenital disseminated MRT at birth. We report a case of congenital malignant rhabdoid tumor presenting as a soft tissue mass in the right arm at birth although the autopsy revealed the systemic disseminated tumors through the whole body with typical microscopic findings.

Esophageal Thermal Injury by Hot Adlay Tea

Reversible thermal injury to the esophagus as the result of drinking hot liquids has been reported to generate alternating white and red linear mucosal bands, somewhat reminiscent of a candy cane. This phenomenon is associated with chest pain, dysphagia, odynophagia, and epigastric pain. Here, we report a case of thermal injury to the esophageal and oral cavity due to the drinking of hot tea, including odynophagia and dysphagia. A 69-year-old man was referred due to a difficulty in swallowing which had begun a week prior to referral. The patient, at the time of admission, was unable to swallow even liquids. He had recently suffered from hiccups, and had consumed five cups of hot adlay tea one week prior to admission, as a folk remedy for the hiccups. Upon physical examination, the patient's oral cavity evidenced mucosal erosion, hyperemia, and mucosa covered by a whitish pseudomembrane. Nonspecific findings were detected on the laboratory and radiological exams. Upper endoscopy revealed diffuse hyperemia, and erosions with thick and whitish pseudomembraneous mucosa on the entire esophagus. The stomach and duodenum appeared normal. We diagnosed the patient with thermal esophageal injury inflicted by the hot tea. He was treated with pantoprazole, 40 mg/day, for 14 days, and evidenced significant clinical and endoscopic improvement.

A Case of Choledochal Cyst (Type IVa) and Anomalous Pancreaticobiliary Ductal Union Combined with Pancreatic Duct Stone / 대한소화기내시경학회지

Pancreatic duct stones are commonly associated with recurrent pancreatitis. They are believed to develop as a result of the calcification of an intraductal protein plug. A choledochal cyst is a relatively rare anomaly usually presenting with abdominal pain, jaundice and palpable mass. APBDU (anomalous pancreaticobiliary ductal union) is frequently associated with various pancreatobiliary diseases, including choledochal cyst, biliary tumor, pancreatitis and pancreas divisum. We report a 48-year-old woman who presented with right upper quadrant pain with a pancreatic duct stone, a choledochal cyst and APBDU. She underwent endoscopic pancreatic sphincterotomy, a surgical choledochal cyst excision and Roux-en-Y choledochojejunostomy.

How is the Clinical Efficacy of Extracorporeal Extraction Treatment Especially, Focused on the Hemodiafiltration, for Removal of Paraquat? / 대한신장학회잡지

PURPOSE: We tried to estimate the clinical efficacy of hemodiafiltration in the paraquat poisoning, as compared with that of other various extracorporeal extraction treatment. METHODS: We prepared the fresh frozen plasma mixed with paraquat concentrated up to 30 mg/L. The experiment was designed to remove paraquat by use of various extracorporeal treatment, such as hemodialysis (HD), hemoperfusion (HP), hemofiltration (HF), hemodia-filtration (HDF), hemodiafiltration & hemoperfusion (HDFP), respectively. The efficacy was analyzed on the basis of counting extraction ratio, observing the decreasing concentration of paraquat with the lapse of time. Four pigs (Yorkshire) were prepared and poisoned by paraquat (40 mg/kg) intramuscularly. Two poisoned animals were assigned for hemoperfusion and hemodiafiltration respectively and other two were assigned for the control. We observed extraction ratio, decreasing concentration of paraquat in blood, remained amount of paraquat in major organs, in addition to pathologic change of major organs after sacrifying the animals. RESULTS: The mean of extraction ratio is 0.84+/-0.27 in case of HP, 0.81+/-0.21 in HD, 0.74+/-0.40 in HDFP, 0.53+/-0.24 in HDF, 0.5+/-0.14 in HF. The extraction ratio of HP & HD & HDFP was significantly higher than that of HDF & HF (p<0.01). The extraction ratio was counted as the difference between the paraquat concentration of inlet and outlet was divided by the concentration of inlet. The slope of paraquat concentration undergoing extracorporeal treatment was the most acutely decreased in the case of HDFP, the less decreased in HP, and sequentially in HD, HDF and HF (the least) in the order of the decrease. The more decreased paraquat concentration in plasma was observed, the higher flow rate of dialysate of HDF was conducted. The mean of extraction ratio in animal study was 0.61 in HP and 0.36 in HDF. The blood concentration of paraquat was observed to be much lower in case of HP & HDF, as compared with the control animals. The remained concentration of paraquat in major organs, 7 hours later after being poisoned, was observed to be higher in the vascular structure like kidney and heart. However, it was observed to be lower in kidney, lung & muscle, when either of HDF and HP was conducted, than control. Especially, it was much lower in HP and much less pathologic change in HP. HDF is the less effective measure than HP, but is effective as a continuous treatment to make paraquat concentration to be lower as much as it possible. CONCLUSION: The HDF is the effective measure to keep the blood paraquat level low, even though it is behind the HP in effectiveness.

How is the Clinical Efficacy of Extracorporeal Extraction Treatment Especially, Focused on the Hemodiafiltration, for Removal of Paraquat? / 대한신장학회잡지

PURPOSE: We tried to estimate the clinical efficacy of hemodiafiltration in the paraquat poisoning, as compared with that of other various extracorporeal extraction treatment. METHODS: We prepared the fresh frozen plasma mixed with paraquat concentrated up to 30 mg/L. The experiment was designed to remove paraquat by use of various extracorporeal treatment, such as hemodialysis (HD), hemoperfusion (HP), hemofiltration (HF), hemodia-filtration (HDF), hemodiafiltration & hemoperfusion (HDFP), respectively. The efficacy was analyzed on the basis of counting extraction ratio, observing the decreasing concentration of paraquat with the lapse of time. Four pigs (Yorkshire) were prepared and poisoned by paraquat (40 mg/kg) intramuscularly. Two poisoned animals were assigned for hemoperfusion and hemodiafiltration respectively and other two were assigned for the control. We observed extraction ratio, decreasing concentration of paraquat in blood, remained amount of paraquat in major organs, in addition to pathologic change of major organs after sacrifying the animals. RESULTS: The mean of extraction ratio is 0.84+/-0.27 in case of HP, 0.81+/-0.21 in HD, 0.74+/-0.40 in HDFP, 0.53+/-0.24 in HDF, 0.5+/-0.14 in HF. The extraction ratio of HP & HD & HDFP was significantly higher than that of HDF & HF (p<0.01). The extraction ratio was counted as the difference between the paraquat concentration of inlet and outlet was divided by the concentration of inlet. The slope of paraquat concentration undergoing extracorporeal treatment was the most acutely decreased in the case of HDFP, the less decreased in HP, and sequentially in HD, HDF and HF (the least) in the order of the decrease. The more decreased paraquat concentration in plasma was observed, the higher flow rate of dialysate of HDF was conducted. The mean of extraction ratio in animal study was 0.61 in HP and 0.36 in HDF. The blood concentration of paraquat was observed to be much lower in case of HP & HDF, as compared with the control animals. The remained concentration of paraquat in major organs, 7 hours later after being poisoned, was observed to be higher in the vascular structure like kidney and heart. However, it was observed to be lower in kidney, lung & muscle, when either of HDF and HP was conducted, than control. Especially, it was much lower in HP and much less pathologic change in HP. HDF is the less effective measure than HP, but is effective as a continuous treatment to make paraquat concentration to be lower as much as it possible. CONCLUSION: The HDF is the effective measure to keep the blood paraquat level low, even though it is behind the HP in effectiveness.