Comparison of Infant Length Measurements Using Tape Measure Versus Length Board.

BACKGROUND: For infants requiring intensive care, infant length is a primary gauge of nutrition and forms the basis for important future treatment decisions. However, existing evidence demonstrates discrepancies in infant length measurements between tape measure and length board. PURPOSE: To compare the accuracy and reliability of infant length measurements using tape measure (standard practice) and length board in a neonatal intensive care unit (NICU) at a public academic medical center. METHODS: Using a single-group, quasi-experimental, repeated-measures design, 108 infants (35.58 ± 3.68 weeks, male 59%, 2124.83 ± 881.69 g) admitted to the NICU were prospectively enrolled. Clinical nurses measured infants weekly per unit-based protocol using tape measures. Study team measured length using length boards within 24 hours of tape measurement. Primary outcome was infant length. Length measurements were converted to sex-specific Fenton or WHO growth percentiles. Linear mixed-effects regression, κ coefficient, intraclass correlation coefficient, and positive predictive value were calculated. FINDINGS/RESULTS: The main effect of measurement conditions and time was significant. Predicted length was 0.38 cm lower for length board than for tape measure over time. Weighted κ coefficient and intraclass correlation coefficient indicated good to excellent agreement. More than 37% of infants shifted to a new percentile category based on both measurements. Positive predictive value of length board at time 1 was 63%. IMPLICATIONS FOR PRACTICE: Length board measurements are reliable for accurate classification of an infant's growth curve to influence diagnosis and future plan of care. IMPLICATIONS FOR RESEARCH: Future research warrants replication using a longitudinal design across multiple sites.

The antidiabetic drug teneligliptin induces vasodilation via activation of PKG, Kv channels, and SERCA pumps in aortic smooth muscle.

Diabetes mellitus (DM) is a metabolic disease closely related to cardiovascular disease. The dipeptidyl peptidase-4 inhibitor teneligliptin is used to treat DM and has recently been shown to have a cardiovascular protective effect against diseases such as hypertension and heart failure. The present study demonstrates the vasodilatory effect of teneligliptin using aortic rings pre-contracted with phenylephrine. Teneligliptin induced a vasodilatory effect in a dose-dependent manner, with and without endothelium. In addition, pretreatment with the nitric oxide synthase inhibitor L-NAME and small-conductance Ca2+-activated K+ channel inhibitor apamin did not alter the teneligliptin-induced vasodilatory effect. Although the adenylyl cyclase inhibitor SQ 22536 and protein kinase A (PKA) inhibitor KT 5720 did not modulate the vasodilatory effect of teneligliptin, the guanylyl cyclase inhibitor ODQ and protein kinase G (PKG) inhibitor KT 5823 effectively reduced the effect of teneligliptin. Similarly, pretreatment with the voltage-dependent K+ (Kv) channel inhibitor 4-aminopyridine (4-AP) also reduced teneligliptin-induced vasodilation. However, pretreatment with the inward rectifier K+ (Kir) channel inhibitor Ba2+, large-conductance Ca2+-activated K+ (BKCa) channel inhibitor paxilline, and ATP-sensitive K+ (KATP) channel inhibitor glibenclamide did not alter the vasodilatory effect of teneligliptin. Our data suggest that Kv7.X, but not Kv1.5 or Kv2.1, is one of the major Kv subtypes involved in teneligliptin-induced vasodilation. Furthermore, pretreatment with the sarcoplasmic/endoplasmic reticulum Ca2+-ATPase (SERCA) pump inhibitor thapsigargin and CPA inhibited the vasodilation induced by teneligliptin. Our results suggest that teneligliptin-induced vasodilation occurs via activation of PKG, SERCA pumps and Kv channels, but not the PKA signaling pathway, other K+ channels, or endothelium.

Signal Detection of Adverse Drug Reactions of Cephalosporins Using Data from a National Pharmacovigilance Database.

This case-non-case study aims to detect signals not currently listed on cephalosporin drug labels. From 2009 to 2018, adverse event (AE) reports concerning antibacterial drugs (anatomical therapeutic chemical (ATC) code J01) in the Korea Adverse Events Reporting System (KAERS) database were examined. For signal detection, three indices of disproportionality, proportional reporting ratio (PRR), reporting odds ratio (ROR), and information component (IC), were calculated. The list of signals was compared with ADRs on the drug labels from the United States, United Kingdom, Japan, and South Korea. A total of 163,800 cephalosporin-AE combinations and 72,265 all other J01-AE combinations were analyzed. This study detected 472 signals and 114 new signals that are not included on the drug labels. Cefatrizine-corneal edema (PRR, 440.64; ROR, 481.67; IC, 3.84) and cefatrizine-corneal ulceration (PRR, 346.22; ROR, 399.70; IC, 4.40) had the highest PRR, ROR, and IC among all signals. Additionally, six serious AEs that were not listed on drug labels such as cefaclor-induced stupor (ten cases) and cefaclor-induced respiratory depression (four cases) were found. Detecting signals using a national pharmacovigilance database is useful for identifying unknown ADRs. This study identified signals of cephalosporins that warrant further investigation.

Analysis of furan and monosaccharides in various coffee beans.

The furan levels in commercial coffee product samples (17 instant coffees, 12 mixed coffee, 8 canned coffee) were 49-2155, 10-201 and 15-209 ng/g, respectively. Since thermal degradation/rearrangement of carbohydrates is the main source of furan, the concentrations of furan and monosaccharides (mannose, rhamnose, glucose, galactose and arabinose) were analysed in 26 green and roasted coffee bean (Coffea arabica) varieties. In coffee beans, furan levels ranged from 4.71 (Bourbon Cerrado, Brazil) to 8.63 mg/kg (San Vicente, Honduras). Galactose was the main monosaccharide in green beans, followed by arabinose, glucose, mannose and rhamnose, on average. Roasting decreased the glucose content by about 81%, and arabinose decreased about 27% in all coffee beans. Glucose decreased the greatest after roasting and is thereby considered the major contributor to the formation of furan.

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy With Mitomycin C Used for Colorectal Peritoneal Carcinomatosis.

PURPOSE: This study aimed to assess the evaluation of clinical outcomes and consequences of complications after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for the peritoneal carcinomatosis (PC) from colorectal cancer. METHODS: A total 26 patients underwent CRS and HIPEC for PC from colorectal cancer between March 2009 and April 2018. All the patients underwent CRS with the purpose of complete or near-complete cytoreduction. Intraoperative HIPEC was performed simultaneously after the CRS. Mitomycin C was used as chemotherapeutic agent for HIPEC. RESULTS: Median disease-free survival was 27.8 months (range, 13.4-42.2 months). Median overall survival was 56.0 months (range, 28.6-83.5 months). The mean peritoneal cancer index (PCI) was 8.73 ± 5.54. The distributions thereof were as follows: PCI <10, 69.23%; PCI 10-19, 23.08%; and PCI ≥20, 7.69%. The completeness of cytoreduction was 96.2% of patients showed CC-0, with 3.8% achieved CC-1. The mean operation time was 8.5 hours, and the mean postoperative hospital stay was 21.6 days. The overall rate of early postoperative complications was 88.5%; the rate of late complications was 34.6%. In the early period, most complications were grades I-II complications (65.4%), compared to grades III-V (23.1%). All late complications, occurring in 7.7% of patients, were grades III-V. There was no treatment-related mortality. CONCLUSION: Although the complication rate was approximately 88%, but the rate of severe complication rate was low. In selective patients with peritoneal recurrence, more aggressive strategies for management, such as CRS with HIPEC, were able to be considered under the acceptable general condition and life-expectancy.

Beneficial effect of nasal saline irrigation in children with allergic rhinitis and asthma: A randomized clinical trial.

BACKGROUND: Asthma and allergic rhinitis (AR) are chronic inflammatory diseases of airway and affect the disease severity each other. OBJECTIVE: We performed this study to examine whether nasal saline irrigation (NSI) improves bronchial hyperresponsiveness and clinical parameters in children with asthma and allergic rhinitis (AR). METHODS: We enrolled 20 children with AR and asthma aged between 6-18 years. Patients were randomized into two groups: irrigation group (8 boys and 2 girls) and control group (8 boys and 2 girls). The irrigation group performed daily NSI. All patients received 12-week treatment with montelukast, levocetirizine, and inhaled glucocorticoids. Provocative concentrations of methacholine causing a 20% decrease in FEV1 (PC20), Asthma Control Test (ACT), the Questionnaire for Quality-of-Life Specific to Allergic Rhinitis in Korean Children (QQOL-ARK) and exhaled nitric oxide (FENO) were compared before and after the study. RESULTS: The PC20 at week 12 was higher than baseline measurements in the irrigation group (P = 0.017), while there was no difference in PC20 before and after treatment in the control group (P = 0.333). ACT score increased after 12 weeks of NSI (P = 0.007), while QQOL-ARK score decreased compared to baseline scores (P = 0.028) in the irrigation group. No differences in ACT and QQOL-ARK were found between weeks 0 and 12 in the control group. No differences were found in the median value of changes in PC20, ACT, QQOL-ARK and FENO between the irrigation and control groups. CONCLUSIONS: Our results suggest that NSI is beneficial for treatment of asthma and AR in children.

Biocompatible, drug-loaded anti-adhesion barrier using visible-light curable furfuryl gelatin derivative.

Recently, many of studies have been attempted to determine how to decrease adhesion. To effectively prevent adhesion, decrease in unnecessary surgical procedures, prevention of contact with other tissue, and drug treatment for inflammation are required. However, current anti-adhesion materials have disadvantages. To solve current problems, we prepared a biocompatible drug-loaded anti-adhesion barrier using a visible-light curable furfuryl gelatin derivative. We used riboflavin as a photo-initiator in the photo-curing process. The biocompatibility of riboflavin was estimated compared with that of Rose Bengal. In addition, the curing ratio was measured to determine whether riboflavin initiated photo-curing. We also evaluated the curing ratio of riboflavin according to the concentration of F-gelatin and the photo-irradiation time. A drug used to decrease inflammation that causes adhesion should not disappear from the surgical site and should also be released consistently. For this, we observed the release profiles of photo-immobilized ibuprofen with different concentrations of F-gelatin. Because an anti-adhesion barrier should protect from bacterial infection we evaluated the protective ability of a barrier formed by F-gelatin. In conclusion, a drug-loaded anti-adhesion barrier was prepared using a visible-light curable furfuryl gelatin derivative, with riboflavin as a photo-initiator. We expect that this drug-loaded anti-adhesion barrier effectively decrease adhesion formation.

Reference Values and Utility of Serum Total Immunoglobulin E for Predicting Atopy and Allergic Diseases in Korean Schoolchildren.

The present study aimed to investigate the distribution of total serum immunoglobulin E (IgE) levels in Korean schoolchildren and to evaluate its utility in the prediction of atopy and allergic diseases. A nationwide, cross-sectional survey was conducted in first grade students from randomly selected elementary and middle schools. Total IgE levels were measured by ImmunoCAP. Skin prick tests were performed for 18 common inhalant allergens to determine the presence of atopy. Children aged 12-13 years and parents of children aged 6-7 years were asked to complete questionnaire assessing allergic diseases. The cut-off levels of total IgE were determined by analyzing receiver operating characteristic curves. The median total IgE level was 86.7 kU/L (range: 1.5-4,523.1) in 3,753 children aged 6-7 years and 94.7 kU/L (range: 1.5-3,000.0) in 3,930 children aged 12-13 years. Total IgE concentrations were higher in children with atopy or allergic diseases than in those without (all P < 0.001). At the cut-off value of 127.7 kU/L, sensitivity, specificity, and positive and negative predictive values (PPV and NPV) were 67.1%, 75.4%, 65.4%, and 76.7%, respectively, in elementary schoolchildren. At the cut-off value of 63.0 kU/L, sensitivity, specificity, PPV, and NPV were 81.9%, 66.6%, 75.0%, and 75.1%, respectively, in middle schoolchildren. PPV and NPV were ≥ 70% when cut-offs of 258.8 kU/L and 38.4 kU/L were used for the diagnosis of atopy in 6-7 year-olds and 12-13 year-olds, respectively. This nationwide population-based study provided the first normal reference ranges of total IgE in Korean schoolchildren.

The association between hypovitaminosis D and pediatric allergic diseases: A Korean nationwide population-based study.

BACKGROUND: There is still considerable disagreement regarding the role of vitamin D in the development or exacerbation of allergic diseases. OBJECTIVE: To investigate the association between serum vitamin D levels and recent symptoms of allergic diseases in elementary schoolchildren. METHODS: A nationwide cross-sectional survey was conducted in children ages 6-7 years from 45 randomly selected elementary schools. The presence of atopic dermatitis (AD) or asthma was defined as medical treatment of children for AD or asthma within 12 months of the survey. The presence of allergic rhinitis (AR) was defined as medical treatment for AR during the past 12 months and a positive skin test response. Current AD was defined as confirmed eczema on physical examination. Serum 25-hydroxyvitamin D (25[OH]D) was measured by chemiluminescent immunoassay. RESULTS: Questionnaire data and blood samples were collected from 3720 children. The overall prevalence rates of vitamin D insufficiency (20-29 ng/mL) and deficiency (<20 ng/mL) were 64.0% and 18.4%, respectively. For a 1 ng/mL decrease in 25(OH)D, the adjusted odds ratio (aOR) for AR was 1.020 (95% confidence interval [CI], 1.002-1.040) and the aOR for current AD was 1.027 (95% CI, 1.006-1.047). For each 1 ng/mL decrease in 25(OH)D, the aOR for positive skin-prick test reactivity was 1.013 (95% CI, 1.000-1.027). No significant association between vitamin D level and the prevalence of asthma was observed. CONCLUSIONS: A high prevalence of vitamin D deficiency and insufficiency was found in Korean elementary schoolchildren, and low vitamin D levels were associated with recent symptoms of AD and AR.

Evaluation of drug provocation tests in Korean children: a single center experience.

BACKGROUND: Drug provocation tests (DPTs) are difficult to perform in clinical practice, even though they are the gold standard for the diagnosis of adverse drug reactions (ADRs). OBJECTIVE: The aims of this study were to evaluate the common causative drugs of type B ADRs and to analyze the relationships between host factors and the results of DPTs in Korean children. METHODS: We retrospectively reviewed the medical records of all children younger than 19 years of age who underwent a DPT between November 1994 and November 2014. Open provocation tests were performed with non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, aminopenicillins, cephalosporins, non-ß-lactam antibiotics, antiepileptic drugs, or other drugs. RESULTS: Overall, 84 DPTs were performed in 56 patients whose median age was 7.5 years (range, 6 months to 18 years). DPTs were positive in 25 (29.8%) of 84 cases, which translated to 18 (32.1%) positive findings in 56 patients. Drugs that provided positive results included NSAIDs (7 cases, 28.0%), aminopenicillins (5 cases, 20.0%), acetaminophen (4 cases, 16.0%), cephalosporins (3 cases, 12.0%), and non-ß-lactams (2 cases, 8.0%). Anaphylaxis was noted in 5 (20.0%) of 25 cases. There were no serious complications of DPTs in any of the subjects. The median age was 10.5 years for children who had a positive result following the DPT and 5.0 years for those with negative results (P value = 0.019). CONCLUSIONS: DPTs can be performed safely in children with suspected ADRs in order to achieve a correct diagnosis.

Association of carbon monoxide levels with allergic diseases in children.

BACKGROUND: Air pollution is regarded as a potential reason for the development or aggravation of allergic diseases. OBJECTIVE: To investigate the relationship between exposure to outdoor air pollution during the first year of life and the development of allergic diseases, and to determine the association between outdoor air pollution near the residence and recent symptoms of allergic diseases in children. METHODS: A nationwide cross-sectional survey was conducted in 6- to 7-year-old children. Among them, subjects who had been born (n = 1828) or lived (n = 1894) within 2 km of the nearest air quality monitoring sites were selected. The prevalence of allergic diseases was assessed by using questionnaires. Each subject was examined by pediatricians to determine the presence of eczema. Publicly available data were used regarding the daily ambient concentrations of sulfur dioxide, nitrogen dioxide, ozone, carbon monoxide (CO), and particulate matter. RESULTS: For a 100 ppb increase in the mean daily CO level during the first year of life, the adjusted odds ratio for lifetime allergic rhinitis was 1.10 (95% confidence interval, 1.03-1.19). For a 1 ppm increase in the annual average CO level during the past 12 months, the adjusted odds ratio for the presence of atopic dermatitis on the day of the survey was 8.11 (95% confidence interval, 1.06-62.12). However, the other air pollutants showed no statistical significance. CONCLUSIONS: Higher exposure to CO during infancy increased the risk of development of allergic rhinitis. The risk of current atopic dermatitis symptoms increased in children who were exposed to higher CO levels during the past 12 months.

Theranostic nanoparticles for enzyme-activatable fluorescence imaging and photodynamic/chemo dual therapy of triple-negative breast cancer.

BACKGROUND: Triple-negative breast cancer (TNBC) is a highly diverse group of cancers characterized by tumors that does not express estrogen and progesterone receptors, as well as human epidermal growth factor receptor 2 (HER2) gene expression. TNBC is associated with poor prognosis due to high rate of recurrence and distance metastasis, lack of response to hormonal or HER2-targeted therapies, and partial response to chemotherapy. Hence, development of new therapeutic strategies to overcome such limitations is of great importance. Here we describe the application of photosensitizer-conjugated and camptothecin (CPT)-encapsulated hyaluronic acid (HA) nanoparticles as enzyme-activatable theranostic nanoparticles (EATNP) for near-infrared (NIR) fluorescence imaging and photodynamic/chemo dual therapy of TNBC. METHODS: For the preparation of EATNPs, chlorin e6 (Ce6), a second generation photosensitizer, was covalently conjugated to a monomethoxy poly(ethylene glycol)-grafted HA backbone. Ce6-conjugated HA (Ce6-HA) formed self-assembled nanoparticles (i.e., Ce6-HA NPs) in an aqueous solution. Subsequently, CPT, a topoisomerase 1 inhibitor with remarkable anticancer efficacy but with low water solubility, was encapsulated inside the hydrophobic core of Ce6-HA NPs thereby forming EATNPs. RESULTS: Fluorescence and singlet oxygen generation (SOG) of EATNPs are quenched in its native state. Treatment of EATNPs with hyaluronidase (HAdase) induces enzyme concentration-dependent activation of NIR fluorescence and SOG. Moreover, HAdase-mediated degradation of the nanoparticles also triggers the release of CPT from the EATNPs. In vitro confocal microscopy and cytotoxicity tests confirmed that EATNPs were efficiently introduced into MDA-MB-231 TNBC cell line, thereby inducing better cytotoxicity than that by free CPT. Additional light irradiation onto the EATNP-treated cells significantly increased therapeutic efficacy in TNBC, which indicates that EATNP plays an important role in enzyme-activated NIR fluorescence imaging and photodynamic/chemo dual therapy of TNBC. CONCLUSIONS: We found that HAdase may switch on NIR fluorescence and SOG of EATNPs. Moreover, CTP release from the nanoparticles is triggered by the enzyme HAdase. In vitro cell study showed potential utility of EATNPs for fluorescence imaging and photodynamic/chemo dual therapy of TNBC.

Diagnostic Decision Points of Specific IgE Concentrations in Korean Children With Egg and Cow's Milk Allergies.

PURPOSE: The purpose of this study was to evaluate the utility of specific IgE (sIgE) concentrations for the diagnosis of immediate-type egg and cow's milk (CM) allergies in Korean children and to determine the optimal cutoff levels. METHODS: In this prospective study, children ≥12 months of age with suspected egg or CM allergy were enrolled. Food allergy was diagnosed by an open oral food challenge (OFC) or through the presence of a convincing history after ingestion of egg or CM. The cutoff levels of sIgE for egg white (EW) and CM were determined by analyzing the receiver operating characteristic curves. RESULTS: Out of 273 children, 52 (19.0%) were confirmed to have egg allergy. CM allergy was found in 52 (23.1%) of 225 children. The EW-sIgE concentration indicating a positive predictive value (PPV) of >90% was 28.1 kU/L in children <24 months of age and 22.9 kU/L in those ≥24 months of age. For CM-sIgE, the concentration of 31.4 kU/L in children <24 months of age and 10.1 kU/L in those ≥24 months of age indicated a >90% PPV. EW-sIgE levels of 3.45 kU/L presented a negative predictive value (NPV) of 93.6% in children <24 months of age, while 1.80 kU/L in those ≥24 months of age presented a NPV of 99.2%. The CM-sIgE levels of 0.59 kU/L in children <24 months of age and 0.94 kU/L in those ≥24 months of age showed NPVs of 100% and 96.9%. CONCLUSIONS: Our results indicate that different diagnostic decision points (DDPs) of sIgE levels should be used for the diagnosis of egg or CM allergy in Korean children. The data also suggest that DDPs with high PPV and high NPV are useful for determining whether OFC is required in children with suspected egg or CM allergy.

Significance of 40-, 45-, and 48-kDa Proteins in the Moderate-to-Severe Clinical Symptoms of Buckwheat Allergy.

PURPOSE: This study was aimed to investigate the relationship between the allergen components and moderate-to-severe allergic reactions in patients with buckwheat allergy. METHODS: Fifteen patients with a history of buckwheat ingestion and a buckwheat specific IgE level≥0.35 kU/L were enrolled. They were divided into 2 groups according to clinical severity scores, with 0-1 being asymptomatic-to-mild and 2-4 being moderate-to-severe symptoms. Immunoblotting was performed to investigate IgE reactivity toward buckwheat allergens and to measure intensity of each component by using a reflective densitometer. RESULTS: The proportions of positive band to the 16 kDa (62.5% vs 0%, P=0.026) and 40-50 kDa (87.5% vs 28.6%, P=0.041) buckwheat allergens in the grade 2-4 group were higher than those in grade 0-1 group. The level of buckwheat specific IgE of grade 2-4 group was higher than that of grade 0-1 group (41.3 kU/L vs 5.5 kU/L, P=0.037). The median optical densities (ODs) of IgE antibody binding to 40-50 kDa protein were higher in the grade 2-4 group, compared with those in the grade 0-1 group (130% OD vs 60.8% OD, P=0.037). CONCLUSIONS: The 40-50 kDa protein is implicated as an important allergen to predict moderate-to-severe clinical symptoms in Korean children with buckwheat allergy.