Pusan National University Research Articles

Genetic Aspects of Small for Gestational Age Infants Using Targeted-Exome Sequencing and Whole-Exome Sequencing: A Single Center Study.

Background: The etiology of small for gestational age (SGA) is multifactorial and includes maternal/uterine-placental factors, fetal epigenetics, and genetic abnormalities. We evaluated the genetic causes and diagnostic effectiveness of targeted-panel sequencing (TES) or whole-exome sequencing (WES) in SGA infants without a known cause. Methods: A prospective study was conducted on newborn infants born with a birth weight of less than the 10th percentile for gestational age between January 2019 and December 2020 at the Pusan National University Hospital. We excluded infants with known causes of SGA, including maternal causes or major congenital anomalies or infections. SGA infants without a known etiology underwent genetic evaluation, including karyotyping, chromosomal microarray (CMA), and TES/WES. Results: During the study period, 82 SGA infants were born at our hospital. Among them, 61 patients were excluded. A total of 21 patients underwent karyotyping and chromosomal CMA, and aberrations were detected in two patients, including one chromosomal anomaly and one copy number variation. Nineteen patients with normal karyotype and CMA findings underwent TES or WES, which identified three pathogenic or likely pathogenic single-gene mutations, namely LHX3, TLK2, and MED13L. Conclusions: In SGA infants without known risk factors, the prevalence of genetic causes was 22% (5/21). The diagnostic yield of TES or WES in SGA infants with normal karyotype and CMA was 15.7% (3/19). TES or WES was quite helpful in identifying the etiology in SGA infants without a known cause.

Representation of the wintertime Arctic Oscillation in a multi‐model ensemble

AbstractThe Arctic Oscillation (AO) is a well‐known mode that affects climate variability in the Northern Hemisphere. The equal‐weighed multi‐model ensemble (MME) of six state‐of‐the‐art models from the Copernicus Climate Change Service (C3S) and Pusan National University (PNU) was analysed to understand the wintertime AO performance for the hindcast period December–February 1993/1994–2016/2017. The hindcasts were chosen with lead times of 1 and 4 months with respect to the initialization date (August and November, respectively). The spread of the AO prediction skills of the individual models was significant. In general, the MME demonstrates superior skill compared to the average of single‐model skills in representing the AO pattern at lead times of 1 and 4 months. The AO‐related vertical structure predicted by MME is similar to the observation, but the upper‐level structure is relatively poor compared to the structure of the hindcasted lower‐ or mid‐level atmosphere. Both observation and MME indicate that since the mid‐1990s, the relationship between the AO and East Asian winter monsoon (EAWM) has been weak compared to the connection between the AO and El Niño–Southern Oscillation (ENSO). Simultaneously, the North Pacific centre of the AO moved eastward during the observational period. The MME showed an AO pattern similar to that observed. The eastward shift of the North Pacific centre of the AO may contribute to deepening the Aleutian low and its effect on the tight AO–ENSO relation demonstrated in observations and MME. Strong AO–ENSO relations and weak AO–EAWM connections are found in both observations and MME model. The observation and MME represent the wave activity flux from 60°N to the equator in the troposphere; consequently, the wave activity flux may contribute to the AO and ENSO connection in both observation and MME.

The feasibility of granzyme B levels using an amperometric immunosensor for lung cancer detection.

BackgroundLow-dose computed tomography (LDCT) has improved the early detection of lung cancer. However, LDCT scans present several disadvantages, including the abundance of false-positive results, which lead to a high socioeconomic cost, psychological burden, and repeated exposure to radiation. Therefore, the identification of complementary biomarkers is needed to select high-risk individuals for LDCT. Here, we showed that granzyme B testing with the novel immunosensor has diagnostic value for identifying patients with lung cancer.MethodsWe enrolled 44 patients with lung cancer and 51 health controls at Pusan National University Yangsan Hospital in Korea between March 2018 and September 2019. The immunosensor analyzed serum granzyme B levels, and their association with lung cancer detection was evaluated with machine learning models.ResultsSerum granzyme B levels were assessed in samples from patients with lung cancer and healthy individuals. Granzyme B testing showed 100% sensitivity, 80% specificity, and an area under the curve of 0.938 for lung cancer detection. After combining granzyme B testing with clinical predictors such as age, smoking status, or pack-years, results from the five-fold cross-validation with random forest model improved diagnostic accuracy of 92.1%, with a sensitivity, specificity, and area under the curve of 92.0%, 92.1%, and 0.977, respectively.ConclusionsThis feasibility study suggested that granzyme B may be utilized to detect lung cancer.

Is BMD (Bone Mineral Density) a prognostic factor for luminal A breast cancer in postmenopausal women?

e12542 Background: There are some studies concerned about the relationship of BMD (Bone Mineral Density) and breast cancer risks in menopausal women. However, most studies have limitations in that they did not distinguish the subtypes of breast cancer. Therefore, we assessed the BMD as a risk factor of recurrences, metastases, or occurrences of contralateral breast cancer in the luminal A breast cancer patients with menopause. Methods: In this retrospective study, the data of 348 luminal A type breast cancer patients, who underwent treatment at the Pusan National University Yangsan Hospital from 2012 to 2016, were analyzed. BMD of the lumbar spine, total femur, and femoral neck was measured by Dual Energy X-ray Absorptiometry (DXA). According to the measured BMD and WHO criteria, the group with T scores ≥ -1.0 was defined as normal, the group with T scores < -1.0 and > -2.5 was defined as osteopenia, and the group with T scores < -2.5 was defined as osteoporosis. The patients were divided into two groups: those with normal BMD and those with low BMD including osteopenia or osteoporosis in preoperative examination. We also divided patients as three groups: one group with no change of BMD, the other group with improvement of BMD and the other with deterioration of BMD during treatment. We used Chi-squared tests, Kaplan-Meier method and Cox-regression model to analyze the relationship between BMD and breast cancer risk. Results: Among the 348 patients, normal BMD was confirmed by preoperative examination in 129 patients and low BMD was identified in 219 patients. There was no change in BMD during the treatment in 243 patients. The improvement in BMD was identified in 37 patients, and the deterioration of BMD was confirmed in 68 patients. Younger patients were distributed in normal BMD compared to low BMD (55.7±6.9 vs 61.8±8.0, p<0.05). There were only 14 patients (4.0%) with recurrences, distant metastases or occurrences of contralateral breast cancer during a median follow-up period of 78 months. Among the 219 patients with low BMD, disease-free survival at 5 years was 98.2% compared to 95.0% for 129 patients with normal BMD ( p=0.326). In addition, disease-free survival at 5-years was 97.0% in no change of BMD during treatment, 94.6% in improvement of BMD, and 98.4% in deterioration of BMD ( p=0.785). Conclusions: In this study, BMD did not have statistically significance in the recurrences, metastases, or occurrences of contralateral breast cancer in luminal A breast cancer patients with menopause. In addition, there was no statistically importance in relationship between BMD change during treatment and recurrences, metastases, or occurrences of contralateral breast cancer. Therefore, we should perform treatments to breast cancer patients preventing decreased BMD.

Anti-inflammatory Effects of Gallotannin in Combination With Lactobacillus plantarum in a DSS-Induced Colitis Mouse Model

ObjectivesTo establish the synergistic effects of the pre/probiotics on intestinal inflammation and to elucidate the underlying mechanisms, we investigated the anti-inflammatory effects of Gallotannin (TA) and Lactobacillus plantarum (LP) in LPS-treated cells and DSS-treated mice. We hypothesized that simultaneous intake of TA and LP may modulate the intestinal microbiota and increase the conversion rate of TA into its metabolites, which have potent anti-inflammatory properties due to their regulation of the AMPK/mTOR axis in colitis. MethodsMice were given two cycles of DSS (2.5% for 7 days) to induce chronic colitis with oral gavage of gallotannin (0.8 mg/mouse) every other day for 4 weeks. At the end of each DSS cycle, L. plantarum (108 CFU/100 μL; OD600 = 0.6) was fed for 3 days. Body weight, colon length, and histopathological assessment were all assessed on the final day, and blood, feces, and colon samples were taken. ResultsIn LPS-treated macrophage RAW 264.7, TA metabolized by LP significantly decreased the levels of IL-6 and TNF-α. In an experimental murine model of UC, we found that the combination of LP and TA improved weight gain, gut length, enlarged spleen, and histological scores while lowering the levels of TNF-α, lipocalin-2, MPO, IFN-γ, IL-17, and IL-6 in DSS-treated mice. Furthermore, colonic mRNA expression levels of Pik3r1, Akt1, and mTor were reduced in the groups that received both LP and TA. The expression of Prkaa1 (AMPKa1) and Map1lc3a (LC3) mRNA increased considerably after the co-administration of LP and TA, compared to the DSS control group. Additionally, LP and TA decreased the ratio of p-mTOR/mTOR protein expression while increasing the p-AMPK/AMPK ratio in DSS-treated mice. Mouse feces were used to measure compositional changes in the gut microbiota. Compared to the DSS control, the combination of LP and TA increased the levels of probiotics, such as Lactobacillus spp., Lactobacillus reuteri, and Lactococcus lactis in DSS-treated mice. ConclusionsSimultaneous intake of LP and TA showed a synergistic effect in attenuating mucosal damage and decreasing inflammatory cytokines by modulating the AMPK/mTOR axis and restoring intestinal microbiota imbalance. Funding SourcesNational Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (No. 2020R1G1A1099851) and Pusan National University Research Grant, 2020.

Developing a best practice framework for clinical competency education in the traditional East-Asian medicine curriculum

BackgroundWhile clinical competency is crucial for traditional East-Asian medical education, available studies on the educational system for fostering clinical performance are scarce. This study aimed to review the educational system, curriculum, facilities, and management of current traditional East-Asian medicine in a well-established university of Korea and develop a Best Practice Framework (BPF) of clinical competency education.MethodsThe clinical competency education system in Pusan National University School of Korean Medicine was systematically described through 5 steps of governance of the educational system, competency of the graduates, educational resources, assessment strategies and tools, and gaps in the curriculum. We also reviewed the experiences in education and the points to be improved.ResultsThe Office of Traditional Korean Medicine Education governs the development, implementation, and evaluation of the educational curriculum for cultivating students’ clinical competency. Medical students have undertaken 39 modules of clinical biomedicine and 21 of traditional medicine during the clinical clerkship courses in an affiliated hospital, Clinical Skill Practice Center, clinical research center, practice lab for medical herb, and other locations. After training, 15 modules of simulated clinical training using standardized patients, students’ clinical competency are evaluated by a Clinical Performance Test using a Clinical Performance Examination (CPX) and an Objective Structured Clinical Examination (OSCE) for biomedical and traditional medical skills.ConclusionsA clinical competency framework is required for a qualified physician of traditional East-Asian medicine. This study reviewed the current well-organized educational system of Korean traditional medicine in detail, which can be used for the BPF of competency-based clinical education. We expect the current study to be a representative reference for establishing an educational system of traditional medicine such as acupuncture and medical herbs in other countries.

Seroprevalence of Helicobacter pylori in human immunodeficiency virus-infected patients in a tertiary care hospital in Busan, South Korea

IntroductionHuman immunodeficiency virus (HIV) infection management has recently become more successful. While the life expectancy of HIV-infected patients increased, the prevalence of non-acquired immunodeficiency syndrome-defining cancers, such as gastric cancer, also increased. Helicobacter pylori is associated with gastric cancer, the most common cancer and the fourth leading cause of cancer-related deaths in South Korea, which has the highest incidence of chronic gastric mucosa inflammation. Here, the seroprevalence and risk factors of H. pylori infection in Korean HIV-infected patients were evaluated. MethodsThree hundred HIV-infected patients attending the Outpatient Department of Pusan National University Hospital were prospectively enrolled from October 2018 to February 2019. Socio-demographic information was evaluated using questionnaires, and the serological status of H. pylori infection was analyzed for anti-H. pylori IgG antibodies. ResultsThe overall seropositivity of H. pylori was 32.7%, and 254 patients (84.7%) were male. The risk factors significantly associated with H. pylori seropositivity were: age of 40–49 years (odds ratio [OR] = 5.00; 95% confidence interval [CI] 1.30–19.17), age of 50–59 years (OR = 3.93; 95% CI 1.05–14.73), CD4 cell counts of 350–500/μL (OR = 4.23; 95% CI 1.53–11.65), CD4 cell counts ≥500/μL (OR = 2.78; 95% CI 1.15–6.72), and a weekly average alcohol consumption of at least one alcoholic beverage (OR = 1.78; 95% CI 1.05–2.99). ConclusionsThe seroprevalence of H. pylori is significantly associated with alcohol consumption, high CD4 cell count, and the age group of 40–59 years.

Incidence of congenital hypothyroidism by gestational age: a retrospective observational study.

Congenital hypothyroidism (CH) is the leading cause of preventable physical and intellectual disabilities. This study aimed to assess the incidence and clinical characteristics of CH in newborns. We retrospectively reviewed the medical records of all newborns delivered at the Pusan National University Hospital between January 2011 and March 2021. The incidence of CH was compared according to gestational age, birth weight, and small for gestational age (SGA). The patients aged ≥3 years who could not maintain normal thyroid function and required levothyroxine treatment were diagnosed with permanent CH. Logistic regression analysis was performed to compare CH risks. Of 3,722 newborns, 40 were diagnosed with CH (1.07%). Gestational age and birth weight were significantly associated with CH incidence. The odds ratios (ORs) of CH in infants delivered at 32-37, 28-31, and <28 weeks were 2.568 (95% confidence interval [CI], 1.141-5.778), 5.917 (95% CI, 2.264-15.464), and 7.441 (95% CI, 2.617-21.159) times higher, respectively, than those delivered at term. The ORs of CH in infants weighing 1,500-2,499 g, 1,000-1,499 g, and <1,000 g were 4.664 (95% CI, 1.928-11.279), 11.076 (95% CI, 4.089-29.999), and 12.544 (95% CI, 4.350-36.176) times greater, respectively, than those in infants weighing ≥2,500 g. The OR of CH was 6.795 (95% CI, 3.553-13.692) times greater in SGA than in non-SGA infants. The CH incidence in South Korea has increased significantly compared with that in the past. Gestational age, birth weight, and SGA were significantly associated with CH incidence.

Chinese Language and Literature Education Planning in the Era of Convergence, Pandemic, and Sinophobia : Focusing on the Chinese Language and Literature Capstone Design Class at Pusan National University

Chinese Language and Literature Education Planning in the Era of Convergence, Pandemic, and Sinophobia : Focusing on the Chinese Language and Literature Capstone Design Class at Pusan National University

Significance of Polyspikes on Electroencephalography in Children with Focal Epilepsy

Purpose: Epilepsy is one of the most common neurological disorders in both adults and children. After detailed history-taking, electroencephalography (EEG) is the most important investigation in the evaluation of epilepsy patients. Polyspikes, defined as a sequence of two or more spikes, are among the findings that can be seen on EEGs of epilepsy patients, but the literature on their significance in focal epilepsy patients is scarce. Therefore, in the current study, we investigated the significance of polyspikes on EEG in childhood focal epilepsy. Methods: A retrospective analysis was conducted of data from children who were diagnosed with focal epilepsy and received anti-seizure medications at Pusan National University Children’s Hospital. Results: Among the 1,125 children included in this study, 468 (41.6%) showed interictal polyspikes on their EEGs. In the multivariate analysis, only the presence of brain magnetic resonance imaging (MRI) abnormalities was significantly associated with the presence of interictal polyspikes on EEGs. Among patients with brain MRI abnormalities, localized polyspikes were significantly associated with focal cortical dysplasia, while multifocal polyspikes were significantly associated with perinatal insults (hypoxic-ischemic encephalopathy and destructive encephalomalacia). Conclusion: Focal epilepsy patients with interictal polyspikes were more likely to have a structural etiology. Furthermore, patients with localized polyspikes were more likely to have focal cortical dysplasia as the structural etiology, while patients with multifocal polyspikes were more likely to have perinatal insults as the structural etiology. This study demonstrates that focal polyspikes can be used as markers of the possible presence of a structural etiology in routine practice.

Correlation of ovarian volume and clinical and laboratory parameters of PCOS in Korean patients

Background: The aim of this study is to analyze the correlation of ovarian volume and clinical and laboratory parameters of polycystic ovary syndrome (PCOS) in Korean women. Methods: Two hundred and thirty-three patients aged between 20 and 40 years with PCOS diagnosis between January 2014 and June 2020 at Pusan National University Hospital, Busan, Republic of Korea, were included to this retrospective observational study using previously recorded patient medical charts. PCOS was diagnosed according to the revised 2003 Rotterdam criteria. Laboratory tests including anti-mullerian hormone (AMH), prolactin, thyroid stimulating hormone (TSH), follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, free and total testosterone, dehydroepiandrosterone-sulfate (DHEA-S), 17-alpha-hydroxyprogesterone (17-OHP), HbA1C and insulin were conducted. Results: The correlation analysis showed that free testosterone (p = 0.006, r = 0.215), total testosterone (p &lt; 0.001, r = 0.305), 17-OHP (p = 0.008, r = 0.203) and height (p = 0.008, r = 0.173) were statistically correlated with the total ovarian volume in overall PCOS patients. In these patients, serum AMH level was positively correlated with LH but negatively with body weight and body mass index (BMI). Conclusions: According to the results, the ovarian volume, quantified by ultrasonographic measurements, was significantly related to the increasing serum levels of free testosterone, total testosterone and 17-OHP in Korean PCOS patients.

Changes and Remodeling of Intersegmental Interferences following Bilateral Sagittal Split Ramus Osteotomy in Patients with Mandibular Prognathism

Purpose: This study aimed to measure the amount of change in the mandibular angle, intergonial width, and ramus angulation due to intersegmental interference and changes in condyle position after mandibular bilateral sagittal split ramus osteotomy (BSSRO) in patients with mandibular prognathism and to evaluate the correlation between them. Materials and Methods: A total of 32 patients who underwent mandibular setback using the BSSRO of the mandible to manage skeletal prognathism during the years 2018 to 2020 at the Department of Oral and Maxillofacial Surgery, Pusan National University were followed both clinically and with cone beam computed tomography (CBCT) for at least one year. Those who were also treated with genioplasty or other orthognathic surgery were excluded from the study. The mandibular angle (gonial angle: Ar–Go–Me), intergonial width (Go–Go), and total angle (sum of left and right proximal segmental angle) were recorded. Changes in the ramus were compared and analyzed before surgery (T1), immediately after surgery (T2), and one year following surgery (T3). Results: The mandibular angle increased by an average of 0.14 degrees immediately after surgery (T2–T1) and increased by 0.97 degrees at 12 months postoperatively (T3–T2). No correlation was observed with the amount of change in each group relative to the amount of mandibular setback. The mandibular width decreased by 0.01 mm on average immediately after surgery (T2–T1), and by 4.2 mm on average at 12 months after surgery (T3–T2). The angle of the mesial fragment of the mandible increased by 1.04 degrees immediately after surgery (T2–T1), compared to the preoperative state. It decreased by 0.86 degrees at 12 months postoperatively (T3–T2). Conclusion: The increase in the mandibular angle from immediately after surgery to 12 months after BSSRO reflects the counterclockwise rotational tendency to prevent opening restriction when intentionally selecting the condylar position. The decrease in the intergonial width immediately after surgery is thought to be due to the effect of internal trimming to minimize the bone interference between the outer surface of the distal bone fragment and the inner surface of the mesial fragment, and the decrease 1 year after surgery can be considered to be due to bone remodeling. Interosseous interference during mandibular setback osteotomy does not necessarily cause an increase in the width of the mandibular angle after surgery.

Management of Mandibular Subcondylar Fracture Through an Intraoral Approach Using a Trans-Buccal Trocar With Ramus Buccal Decortication

The aim of this study was to review retrospectively the functional recoveries of subcondylar fracture patients that underwent open reduction surgery using an extraoral approach or an intraoral approach using a trans-buccal trocar and involving ramus buccal decortication. Of 47 patients with mandibular condyle fracture who visited Pusan National University Dental Hospital Department of Oral and Maxillofacial Surgery between May 2015 and November 2020, 38 patients underwent open reduction and were classified according to the surgical method used. Preauricular, submandibular, and retro-mandibular approaches were all classified as extraoral approaches condyle fractures were classified as described by Spiessl and Schroll (1972). Distances between bone fragments on panorama radiographs before and after surgery were measured. Thirty-eight patients were included in this study, 9 patients received subcondylar fracture surgery. Open reduction surgery using an extraoral approach had a greater mean operation time than the intraoral approach using a trocar. Of the 17 patients treated with an intraoral approach, the average distance between bone fragments right after surgery was 1.27 ± 1.41 mm, which was significantly greater than that of the extraoral approach (0.72 ± 0.35 mm). Favorable results can be obtained by mandibular condylar fracture surgery through an intraoral approach using a trans-buccal trocar with ramus buccal decortication. This technique minimizes scarring, secures accessibility using a trocar, and sufficiently secures the field of view through buccal cortical bone reduction.

Complications According to the Handling of the Pterygoid Plate During Bimaxillary Surgery.

During bimaxillary surgery, manipulation of the pterygoid plate is required to facilitate movement of the maxilla. This study examined the complications that occurred after handling the pterygoid plate during a Le Fort I osteotomy. This study compared and analyzed complications according to the pterygoid plate handling method in 80 patients who underwent bimaxillary surgery at Pusan National University Dental Hospital from December 2015 to July 2020. The pterygoid plate was fractured or removed intentionally only if it interfered with the maxilla. Otherwise, it was not treated. The complications during surgery and the follow-up period were investigated. Fourteen patients experienced complications, of which excessive bleeding, hearing problems, and nonunion were encountered in 10, 2, and 2 patients, respectively. Of the 10 patients with excessive bleeding patients, the pterygoid plate was manipulated in 8 patients, which was controlled during surgery. Two patients complained of hearing loss with ear congestion immediately after surgery; both patients improved spontaneously within 1 month. Two nonunion patients underwent plate refixation at least 6 months postoperatively, and normal healing was achieved afterward. Fracture and removal of the pterygoid plate during orthognathic surgery did not significantly affect the occurrence of complications during and after surgery.

Usefulness of Cycloplegic Refraction with Atropine in Patients with Partially Accommodative Esotropia

Purpose: To investigate the usefulness of atropine (Isopto atropine 1% eye drops®; Alcon, Fort Worth, TX, USA) for cycloplegic refraction in patients with partially accommodative esotropia.Methods: We retrospectively analyzed the medical records of patients with partially accommodative esotropia who underwent cycloplegic refraction using both cyclopentolate and atropine at Pusan National University Hospital between November 2017 and December 2020. Patients who replaced their glasses after cycloplegic refraction with atropine were included in group 1 and all other patients were included in group 2. Clinical features and the angle of ocular deviation were compared between the two groups.Results: This study included 23 patients with a mean age of 58.2 ± 22.3 months and mean interval between the two examinations of 5.2 ± 4.1 months. Spherical equivalent was larger after cycloplegic refraction using atropine compared to cyclopentolate (+3.04 ± 1.70 and +2.31 ± 1.75 diopters, respectively; p = 0.001). Groups 1 and 2 included 19 (83%) and 4 (17%) patients, respectively. Clinical characteristics did not significantly differ between the two groups. In group 1, the angle of ocular deviation at near fixation significantly decreased from 28.7 ± 14.0 to 20.7 ± 11.6 prism diopters (p = 0.002) after correction of the refractive error.Conclusions: Cycloplegic refraction with atropine may be useful for detecting latent hyperopia and managing strabismus in patients with partially accommodative esotropia.

Kawasaki disease with intestinal pseudo obstruction and neurogenic bladder.

Pediatrics InternationalVolume 64, Issue 1 e15038 Clinical Notes Kawasaki disease with intestinal pseudo obstruction and neurogenic bladder Hoon Ko, Hoon Ko orcid.org/0000-0002-5834-0900 Department of Pediatric Cardiology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, KoreaSearch for more papers by this authorJoung-Hee Byun, Corresponding Author Joung-Hee Byun africa3217@naver.com Department of Pediatric Cardiology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea Correspondence: Joung-Hee Byun, MD, Division of Pediatric Cardiology, Department of Pediatrics, Pusan National University Yangsan Hospital, Geumo-ro 20, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do 626-770, Korea. Email: africa3217@naver.comSearch for more papers by this authorGeena Kim, Geena Kim orcid.org/0000-0002-6837-7475 Department of Pediatrics, Chungnam National University Sejong Hospital, Sejong-si, KoreaSearch for more papers by this authorHyoung Doo Lee, Hyoung Doo Lee Department of Pediatric Cardiology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, KoreaSearch for more papers by this authorTae Hong Kim, Tae Hong Kim Department of Pediatric Cardiology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, KoreaSearch for more papers by this author Hoon Ko, Hoon Ko orcid.org/0000-0002-5834-0900 Department of Pediatric Cardiology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, KoreaSearch for more papers by this authorJoung-Hee Byun, Corresponding Author Joung-Hee Byun africa3217@naver.com Department of Pediatric Cardiology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Korea Correspondence: Joung-Hee Byun, MD, Division of Pediatric Cardiology, Department of Pediatrics, Pusan National University Yangsan Hospital, Geumo-ro 20, Beomeo-ri, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do 626-770, Korea. Email: africa3217@naver.comSearch for more papers by this authorGeena Kim, Geena Kim orcid.org/0000-0002-6837-7475 Department of Pediatrics, Chungnam National University Sejong Hospital, Sejong-si, KoreaSearch for more papers by this authorHyoung Doo Lee, Hyoung Doo Lee Department of Pediatric Cardiology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, KoreaSearch for more papers by this authorTae Hong Kim, Tae Hong Kim Department of Pediatric Cardiology, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, KoreaSearch for more papers by this author First published: 28 April 2022 https://doi.org/10.1111/ped.15038Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume64, Issue1January/December 2022e15038 RelatedInformation

Clinical characteristics of drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis: A single-center study.

BackgroundStevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe adverse cutaneous reactions, most commonly triggered by medications, characterized by extensive necrosis and detachment of the epidermis.ObjectiveWe investigated the differences in clinical characteristics of drug-induced SJS/TEN depending on the type of drug in a single center.MethodsThe relevance of sex, age, culprit drugs, clinical features, courses, treatment options, and follow-up results were retrospectively evaluated in patients diagnosed with drug-induced SJS/TEN at Pusan National University Hospital between 2008 and 2019.ResultsNinety-two patients with a mean age of 58.7 ± 20.2 years (range, 10–93 years) were included in the study. Those aged 60–80 years accounted for the largest number of patients (42.4%). Patients with drug-induced SJS/TEN comprised 40 women (43.5%) and 52 men (56.5%). We categorized drug-induced SJS/TEN cases by culprit drugs into 6 groups: antibiotics, allopurinol, antiepileptic (AED), nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and other drugs. The rate of NSAID-induced disease significantly increased from SJS to TEN (p = 0.016). Among the patients in the NSAID group, the proportion of TEN (40%) was higher than that in the other groups (p = 0.021). The mean body surface area was significantly lower in the AED group than in the non-AED groups (7.1 ± 9.8 vs. 23.1 ± 27.3, p = 0.020) and higher in the NSAID group than in the non-NSAID groups (47.5 ± 39.5 vs. 15.7 ± 20.0, p = 0.010).ConclusionThis study showed that the clinical characteristics of each causative drug group may be different in drug-induced SJS/TEN. Our findings may help clinicians better understand drug-induced SJS/TEN.

Retrospective analysis of the effects of non-communicable diseases on periodontitis treatment outcomes.

PurposeWe retrospectively analysed patients’ dental and periodontal status according to the presence of non-communicable diseases (NCDs) and the effects of NCDs on periodontal treatment outcomes. Factors influencing disease recurrence were investigated using decision tree analysis.MethodsWe analysed the records of patients who visited the Department of Periodontology, Pusan National University Dental Hospital from June 2014 to October 2019. As baseline subjects, 1,362 patients with periodontitis and who underwent full-mouth periodontal examinations before periodontal treatment were selected. Among them, 321 patients who underwent periodontal examinations after the completion of periodontal treatment and 143 who continued to participate in regular maintenance were followed-up.ResultsForty-three percent of patients had a NCD. Patients without NCDs had more residual teeth and lower sum of the number of total decayed, missing, filled teeths (DMFT) scores. There was no difference in periodontal status according to NCD status. Patients with a NCD showed significant changes in the plaque index after periodontal treatment. The decision tree model analysis demonstrated that osteoporosis affected the recurrence of periodontitis.ConclusionsThe number of residual teeth and DMFT index differed according to the presence of NCDs. Patients with osteoporosis require particular attention to prevent periodontitis recurrence.

Venous Insufficiency is a Clear Provoker of Pigmented Purpuric Dermatosis.

BackgroundPigmented purpuric dermatosis (PPD) is a chronic disorder characterized by distinct petechial hemorrhage and brownish pigmentation. The cause of PPD is unclear, but several underlying conditions are associated with it. Previous reports suggest that venous insufficiency (VI) might be related to PPD; however, a clear correlation remains unelucidated.ObjectiveTo elucidate the causal relationship between PPD and VI.MethodsA total 118 patients diagnosed with PPD in the Department of Dermatology, Pusan National University Hospital from November 2006 to July 2019 were retrospectively reviewed. Doppler ultrasonography of the lower extremities was performed in 56 PPD patients, who were then divided into two groups: PPD with and without VI. We compared the clinical features between the two groups. In the PPD with VI group, we assessed the correspondence ratios between PPD and VI lateralities, and between the PPD distribution and the veins involved.ResultsVI was detected in 35 of the 56 patients (62.5%). The PPD with VI group was significantly associated with wider distribution, darker coloration and longer disease duration. There was a positive correlation of laterality between PPD and VI, and between PPD distribution and the vein involved.ConclusionThis findings suggest that VI is a clear provoker of PPD.

Are the Outcomes of Breast Conservation Surgery Inferior to Those of Mastectomy in Patients with Stage II-IIIA Triple-Negative Breast Cancer?

Purpose: Breast conserving surgery (BCS) is generally not considered for breast cancer because of concerns about the poor prognosis of triple negative breast cancer (TNBC). We assessed the outcomes of BCS and mastectomy for patients with stage II-IIIA TNBC.Methods: The data of 172 breast cancer patients diagnosed with stage II-IIIA TNBC who underwent treatment at Pusan National University Hospital and Pusan National University Yangsan Hospital from 2010 to 2014 were retrospectively analyzed. The patients were divided into the following two groups: patients who underwent BCS (n=101) and those who underwent mastectomy (n=71). The Cox regression model was used to examine the outcomes of both treatments. The median follow-up period was 71 months in the BCS group, and 67 months in the mastectomy group.Results: The median age of the 172 patients was 51 years (range, 22-82 years). In the BCS group, radiation therapy and chemotherapy (p&lt;0.001 and p=0.007, respectively) were performed more frequently. The BCS group had more patients with a high Ki-67 index (p=0.006), while the mastectomy group included more patients with a higher pathologic T (pT) stage (p=0.005). The 5-year loco-regional recurrence-free, disease-free, and overall survival rates of the BCS group versus the mastectomy group were 93.8% versus 95.3%, 89.8% versus 90.7%, and 90.8% versus 86.3%, respectively, but the differences were not statistically significant. Lymphovascular invasion was a risk factor for disease-free survival and advanced stage was an important risk factor for overall survival.Conclusion: In stage II-IIIA TNBC, BCS was not inferior to mastectomy in locoregional recurrence rates, disease-free survival rates, or overall survival rates.