Variability in the association of smoking status with the prevalence of diabetes mellitus in the Korean population according to different definitions of smoking status: analysis based on the Korea National Health and Nutrition Examination Survey (2014-2020).

We evaluated the association between smoking and diabetes, as well as the effects of gender differences and hidden smoking among females on this association using nationally representative data. Analyzing data from 44,049 individuals aged 19 and older, we utilized multivariable logistic regression to investigate associations, controlling for sociodemographic factors. Subgroup analysis based on smoking status determined factors associated with diabetes. To better our understanding of the smoking-diabetes relationship, we introduced a new variable, survey-cotinine verified smoking status (SCS). This study provides valuable insight by exploring the correlation between smoking and diabetes using different definitions of smoking status. Both male and female smokers showed correlations with diabetes according to cotinine-verified smoking status (OR: 1.22 and 1.48, respectively). According to smoking amount, cotinine-verified heavy smokers correlated with diabetes in males (OR: 1.37), while light smokers exhibited a negative correlation with diabetes in females for both cotinine-verified smoking status (OR: 0.60) and survey-cotinine verified status (OR: 0.58) Smoking was associated with diabetes in the overall population, with gender differences observed. When evaluating this association, we should consider variables of smoking amount, passive and intermittent smoking, and specifically, account for the influence of hidden smoking among females, particularly when utilizing self-reported questionnaires in Korea.

This study examines the association between smoking status and diabetes, focusing on gender-specific patterns, using a nationally representative sample. To increase the accuracy of smoking assessments, a new variable based on cotinine-determined smoking status is used. The study sheds light on the prevalence of under-reporting among female smokers in the Korean population, revealing important insights for future research and public health interventions. These findings underscore the importance of considering hidden smoking among women when investigating the relationship between smoking and diabetes, particularly when using self-reported questionnaires.

Association between serum vitamin D and depressive symptoms in apparently healthy male adults undergoing routine health check-ups at a single centre.

OBJECTIVE: To determine the level of vitamin D and to identify the association between vitamin D and depressive symptoms in apparently healthy Korean male adults. DESIGN: A retrospective study design. Among 43 513 participants between 1 March and 30 November 2018, after eliminating participants with a history of depression or vitamin D deficiency, 9058 were included. To determine the level of vitamin D, serum 25-hydroxyvitamin D [25(OH)D] was measured. To assess the level of depression, the Korean version of the Center for Epidemiologic Studies Depression Scale (CES-D) was used. SETTING: South Korea. PARTICIPANTS: Male adults who underwent routine health check-ups. RESULTS: The average vitamin D level was 22·31 ± 7·09 ng/ml as 25(OH)D, while the number of subjects in the vitamin D insufficiency group with a finding of <20 ng/ml was 3783 (41·8 %). The mean CES-D score in all subjects was 8·31 ± 5·97 points, and the proportion of the depressive symptoms group with a score of ≥16 was 8·71 %. The OR of patients in the depressive symptoms group also being in the insufficiency group was found to be 1·49 (95 % CI 1·12, 2·00). CONCLUSIONS: A total of 41·8 % of apparently healthy male adults had vitamin D levels <20 ng/ml. We identified an association between vitamin D insufficiency and depressive symptoms in apparently healthy Korean male adults.

Factors Associated with Reaching Mid-Parental Height in Patients Diagnosed with Inflammatory Bowel Disease in Childhood and Adolescent Period.

Background/Aims: The recent update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease initiative has added normal growth in children as an intermediate target in Crohn's disease and ulcerative colitis. We aimed to investigate factors associated with reaching mid-parental height (MPH) in patients diagnosed with inflammatory bowel disease in childhood and the adolescent period. Methods: This multicenter retrospective observational study included pediatric patients with inflammatory bowel disease that had reached adult height. Factors associated with reaching MPH were investigated by logistic regression analyses. Results: A total of 166 patients were included in this study (128 Crohn's disease and 38 ulcerative colitis). Among them, 54.2% (90/166) had reached their MPH. Multivariable logistic regression analysis revealed that height Z-score at diagnosis and MPH Z-score were independently associated with reaching MPH (odds ratio [OR], 8.45; 95% confidence interval [CI], 4.44 to 17.90; p<0.001 and OR, 0.11; 95% CI, 0.04 to 0.24; p<0.001, respectively). According to the receiver operating characteristic curve analysis, the optimal cutoff level of "height Z-score at diagnosis minus MPH Z-score" that was associated with reaching MPH was -0.01 with an area under the curve of 0.889 (95% CI [0.835 to 0.944], sensitivity 88.9%, specificity 84.2%, positive predictive value 87.0%, negative predictive value 86.5%, p<0.001). Conclusions: Height Z-score at diagnosis and MPH Z-score were the only factors associated with reaching MPH. Efforts should be made to restore growth in pediatric patients who present with a negative "height Z-score at diagnosis minus MPH Z-score."

Changing Trends in School Absenteeism and Identification of Associated Factors in Adolescents with Atopic Dermatitis.

Atopic dermatitis (AD) has a negative influence on school attendance. We aimed to identify factors associated with school absenteeism in adolescents with AD. We used data from the 3rd to 11th annual Korean Youth Risk Behavior Web-based Survey completed from 2007 to 2015. Survey data were obtained from a stratified, multistage, clustered sample. Participants responded to the question "have you ever been diagnosed with AD?" Factors associated with AD-related school absenteeism (ADSA), which is defined as at least one school absence due to AD, were evaluated. Among the 141,899 subjects, the prevalence of AD increased (17.3% to 24.2%), while that of ADSA decreased (7.3% to 2.6%) from 2007 to 2015. Compared to adolescents without ADSA, those with ADSA were more likely to be male, middle school students, and have negative mental health states, including suicidality. In the multivariate logistic regression model, the association of sleep dissatisfaction and depression with ADSA was high (adjusted odds ratio, 6.12; 95% confidence intervals, 4.61-7.95; and 5.44; 5.23-5.67, respectively). The prevalence of ADSA has decreased despite an increase in the prevalence of AD in Korean adolescents; however, it is important for pediatricians to screen for factors associated with ADSA to improve school attendance in adolescents with AD.

Ensemble deep-learning networks for automated osteoarthritis grading in knee X-ray images.

The Kellgren-Lawrence (KL) grading system is a scoring system for classifying the severity of knee osteoarthritis using X-ray images, and it is the standard X-ray-based grading system for diagnosing knee osteoarthritis. However, KL grading depends on the clinician's subjective assessment. Moreover, the accuracy varies significantly depending on the clinician's experience and can be particularly low. Therefore, in this study, we developed an ensemble network that can predict a consistent and accurate KL grade for knee osteoarthritis severity using a deep learning approach. We trained individual models on knee X-ray datasets using the most suitable image size for each model in an ensemble network rather than using datasets with a single image size. We then built the ensemble network using these models to overcome the instability of single models and further improve accuracy. We conducted various experiments using a dataset of 8260 images from the Osteoarthritis Initiative open dataset. The proposed ensemble network exhibited the best performance, achieving an accuracy of 76.93% and an F1-score of 0.7665. The Grad-CAM visualization technique was used to further evaluate the focus of the model. The results demonstrated that the proposed ensemble network outperforms existing techniques that have performed well in KL grade classification. Moreover, the proposed model focuses on the joint space around the knee to extract the imaging features required for KL grade classification, revealing its high potential for diagnosing knee osteoarthritis.

Association of Sleep Duration and Weekend Catch-Up Sleep with Suicidal Ideation among Adolescents with Atopic Dermatitis.

Atopic dermatitis (AD) is a prevalent allergic disease in children that often causes sleep disturbance and which is associated with diminished quality of life and heightened susceptibility to depression and suicidality. In this study, we investigate the relationship between weekend catch-up sleep (WCUS) and mental health in a sample of 71,434 adolescents with AD and 221,057 without AD using multivariate logistic regression analysis. We hypothesized that adolescents with AD experience shorter total and daytime sleep due to pruritus, with compensatory longer WCUS. We found that the lifetime prevalence of AD was 24.4%, and that adolescents with AD slept less overall, with significantly shorter weekday and weekend sleep durations but longer weekend catch-up sleep (WCUS). Sleep dissatisfaction was markedly higher in the AD group. Interestingly, our results suggest that prolonged WCUS is a protective factor against suicidal ideation in adolescents with AD. The study highlights the importance of addressing sleep patterns in adolescents with AD to enhance mental health. Overall, our findings indicate a need for increased awareness and intervention strategies to ensure sufficient sleep and reduce the risk of suicidal ideation in this population.

Global relationship between parent and child obesity: a systematic review and meta-analysis.

BACKGROUND: The growing prevalence of overweight and/or obese children is an important public health problem in both developed and developing countries. Although the association of obesity between parents and their children is well known, its underlying mechanisms are not well established. PURPOSE: This meta-analysis examined parent-child (PC) relationships in obesity and identified factors such as world region and country income level that may influence this relationship. METHODS: We identified all related studies published between January 1, 2015 and May 31, 2020 by conducting a literature search using the MeSH terms "obesity," "overweight," "body mass index," "parent," "child," "associate," and "relate" in the PubMed database in English. RESULTS: The meta-analysis of 23 studies that reported an odds ratio (OR) for parent and child obesity associations found a significant association between parents and children who were overweight or obese (pooled OR, 1.97; 95% confidence interval, 1.85-2.10). A meta-regression analysis was used to examine the sources of interstudy heterogeneity. The association between parent and child obesity was higher in Asia than in Europe and the Middle East and higher in high-income countries than in middle-or low-income countries. In addition, a higher association between parent and child obesity was found when both parents were obese than when only the father or mother was obese. This study from multiple countries indicates a significant PC relationship in weight status that varies according to PC pair type, parent and child weight statuses, world region, and country income level. CONCLUSION: These results demonstrate that the risk of childhood obesity is greatly influenced by parental weight status and indicate that parents could play an important role in preventing child obesity.

The effect of hidden female smoking on the relationship between smoking and cardiovascular disease.

BACKGROUND: Smoking is a known risk factor for cardiovascular morbidity and mortality, but several Korean studies have shown differing results on the association of current smoking status and the risk of cardiovascular disease (CVD). The aim of the present study was to investigate the association between smoking status and CVD (myocardial infarction and stroke) using national representative populationbased samples. The aim was also to investigate the effects of hidden smokers on the association between CVD and smoking. METHODS: Data were acquired from 28,620 participants (12,875 men and 15,745 women), age 19 years or older, who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) conducted from 2008 to 2016. RESULTS: The multivariable logistic regression analysis showed that ex-smoking status was correlated with CVD when self-reported (odds ratio [OR]: 1.62; 95% confidence interval [CI]: 1.20-2.19) and for survey-cotinine verified-smoking status (OR: 1.57; 95% CI: 1.20-2.19). Interestingly, the present study showed current smoking was not significantly associated with CVD. For the effect of sex on smoking and CVD, self-reported and survey-cotinine-verified ex-smoking status were correlated with CVD in males (OR: 1.45; 95% CI: 1.04-2.04 and OR: 1.43; 95% CI: 1.02-2.02) and in females (OR: 2.74; 95% CI: 1.59-4.71 and OR: 2.92; 95% CI: 1.64-5.18). The ratios of cotinine-verified to self-reported smoking rates were 1.95 for women and 1.08 for men. CONCLUSIONS: In the current study, while ex-smoking status was significantly associated with CVD, current smoking status was not. Female ex-smoking status had a higher adjusted odds ratio for CVD than males compared to non-smoking status. An effect of hidden female smoking was also found on the association between smoking status and CVD in Korean adults.

Case Report: Development of Type 1 Autoimmune Pancreatitis in an Adolescent With Ulcerative Colitis Mimicking Pancreatic Cancer.

Introduction: Autoimmune pancreatitis (AIP) is a rare extraintestinal manifestation of inflammatory bowel disease (IBD) which is typically responsive to corticosteroid treatment. Case Presentation: We report a case of a 17-year-old male diagnosed with ulcerative colitis who subsequently developed acute pancreatitis. Blood tests demonstrated elevated pancreatic enzyme levels of amylase (1319 U/L) and lipase (809 U/L). Abdominal computed tomography revealed peripancreatic fat stranding and the presence of a perisplenic pseudocyst. Azathioprine and mesalazine were stopped as possible causes of drug-induced pancreatitis. However, pancreatic enzymes remained elevated and corticosteroid treatment was started. Despite corticosteroid therapy, amylase and lipase levels continued to increase. Infliximab was started due to a flare in gastrointestinal symptoms of ulcerative colitis. Follow-up abdominal ultrasonography revealed a pancreatic tail mass. Tumor markers, including CA 19-9, were elevated and atypical cells were seen on histological examination of an endoscopic ultrasonography-guided fine needle aspiration biopsy. Surgical pancreaticosplenectomy was performed for suspected pancreatic neoplasm. Surprisingly, histology revealed chronic pancreatitis with storiform fibrosis and infiltration of IgG4-positive cells, compatible with AIP type 1. Thereafter, pancreatic enzymes gradually decreased to normal levels and the patient has been in remission for 9 months on infliximab monotherapy. Conclusion: Pediatric gastroenterologists should keep in mind that AIP may develop during the natural course of pediatric IBD. Moreover, the development of pancreatic fibrosis may be non-responsive to corticosteroid treatment and mimic pancreatic neoplasia.

Nationwide "Pediatric Nutrition Day" survey on the nutritional status of hospitalized children in South Korea.

BACKGROUND/OBJECTIVES: To evaluate the nutritional status and prevalence of malnutrition in hospitalized children at admission and during hospitalization in South Korea. SUBJECTS/METHODS: This first cross-sectional nationwide "Pediatric Nutrition Day (pNday)" survey was conducted among 872 hospitalized children (504 boys, 368 girls; 686 medical, 186 surgical) from 23 hospitals in South Korea. Malnutrition risk was screened using the Pediatric Yorkhill Malnutrition Score (PYMS) and the Screening Tool Risk on Nutritional status and Growth. Nutritional status was assessed by z-scores of weight-for-age for underweight, weight-for-height for wasting, and height-for-age for stunting as well as laboratory tests. RESULTS: At admission, of the 872 hospitalized children, 17.2% were underweight, and the prevalence of wasting and stunting was 20.2% and 17.3%, respectively. During hospitalization till pNday, 10.8% and 19.6% experienced weight loss and decreased oral intake, respectively. During the aforementioned period, fasting was more prevalent in surgical patients (7.5%) than in medical patients (1.6%) (P < 0.001). According to the PYMS, 34.3% and 30% of the children at admission and on pNday, respectively, had a high-risk of malnutrition, requiring consultation with the nutritional support team (NST). However, only 4% were actually referred to the NST during hospitalization. CONCLUSIONS: Malnutrition was prevalent at admission and during hospitalization in pediatric patients, with many children experiencing weight loss and poor oral intake. To improve the nutritional status of hospitalized children, it is important to screen and identify all children at risk of malnutrition and refer malnourished patients to the multidisciplinary NST for proper nutritional interventions.

Lysophosphatidylcholine activates adipocyte glucose uptake and lowers blood glucose levels in murine models of diabetes.

Glucose homeostasis is maintained by the orchestration of peripheral glucose utilization and hepatic glucose production, mainly by insulin. In this study, we found by utilizing a combined parallel chromatography mass profiling approach that lysophosphatidylcholine (LPC) regulates glucose levels. LPC was found to stimulate glucose uptake in 3T3-L1 adipocytes dose- and time-dependently, and this activity was found to be sensitive to variations in acyl chain lengths and to polar head group types in LPC. Treatment with LPC resulted in a significant increase in the level of GLUT4 at the plasma membranes of 3T3-L1 adipocytes. Moreover, LPC did not affect IRS-1 and AKT2 phosphorylations, and LPC-induced glucose uptake was not influenced by pretreatment with the PI 3-kinase inhibitor LY294002. However, glucose uptake stimulation by LPC was abrogated both by rottlerin (a protein kinase Cdelta inhibitor) and by the adenoviral expression of dominant negative protein kinase Cdelta. In line with its determined cellular functions, LPC was found to lower blood glucose levels in normal mice. Furthermore, LPC improved blood glucose levels in mouse models of type 1 and 2 diabetes. These results suggest that an understanding of the mode of action of LPC may provide a new perspective of glucose homeostasis.

Variability in sociodemographic factors and obesity in Korean children: a cross-sectional analysis of Korea National Health and Nutrition Examination survey data (2007-2015).

PURPOSE: Sociodemographic factors are well-known risk factors for childhood obesity, even though the relationship between sociodemographic factors and obesity varies among countries. The objective of this study was to evaluate the relationship between sociodemographic factors and obesity in Korean children. METHODS: This study is an analysis of cross-sectional data from the 2007-2009, 2010-2012, and 2013-2015 Korea National Health and Nutrition Examination Surveys. The sample included 14,482 children aged between 2 and 18 years (7652 boys and 6830 girls) and their parents. Sociodemographic factors were measured as a combination of demographic, economic, and sociological factors, including sex, age, residential area, family income, parent education level, and parent employment status. RESULTS: In 2013-2015, obesity among Korean children was associated with current maternal smoking (P < .001). Obesity categorized according to age group was positively associated with paternal education level/high school graduation (P = .026 for ages 7-12 years), maternal smoking (P = .003 for ages 7-12 years), maternal body mass index (all age groups), paternal body mass index (all age groups), and low monthly family income (P = .017 for ages 2-6 years). CONCLUSIONS: Current maternal smoking habits, paternal education, and low family income are potential risk factors for obesity in Korean children.

Association between cataract and cotinine-verified smoking status in 11 435 Korean adults using Korea National Health and Nutrition Examination Survey data from 2008 to 2016.

PURPOSE: To investigate the association between cataract and cotinine-verified smoking status. SETTING: Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, South Korea. DESIGN: Retrospective study. METHODS: Participants were randomly selected using data collected by the Korea National Health and Nutrition Examination Survey from 2008 to 2016. Participants completed a questionnaire to self-report smoking status and a history of cataract, among other variables. To identify the relationship between cataract and smoking, a new variable was used to define smoking status, survey-cotinine-verified smoking status (SCS)-the combination of self-reported smoking status and cotinine-verified smoking status- and thus identify hidden smokers. RESULTS: In total, 11 435 participants were eligible for final analysis. The study comprised 4925 men and 6510 women; the mean age was 52.86 ± 16.83 years (median: 54 years). Of 2292 SCS smokers, 382 (16.7%) were nonsmokers according to their self-report. Notably, the ratio of the cotinine-verified to self-reported smoking rate of women was greater than that of men, 1.60 and 1.06, respectively. This indicated that female hidden smokers may affect the results of studies based on self-reported questionnaires. Multivariate logistic regression analysis showed that smoking was correlated with cataract (odds ratio [OR], 1.37 [95% CI, 1.07-1.76]; OR, 1.35 [CI, 1.12-1.64]; and OR, 1.36 [CI, 1.10-1.69]) for self-reported, cotinine-verified, and SCS, respectively. No statistically significant sex difference was found. CONCLUSION: Smoking was associated with cataract, but it did not vary by sex. Female hidden smoking must be considered when investigating the association between smoking and cataract based on self-reported questionnaires.

Relationship of shift work with endoscopic gastritis among workers of an electronics company.

Objectives The current study aimed to examine the cross-sectional association between shift work and gastritis using endoscopic evaluation. Methods We collected questionnaire data from 964 non-shift workers and 290 shift workers aged 22-40 years at an electronics company, comprising age, smoking status, alcohol consumption, physical activity, occupational stress, and gastrointestinal symptoms. We performed a gastroendoscopy of participants. Along with describing the gastroendoscopic results, we analyzed the correlations between gastritis and shift work using multiple logistic regression analysis. Results In terms of gastrointestinal symptoms, night shift workers complained more of indigestion than non-shift workers (P<0.01), and the rate of gastritis was higher. The odds of gastritis was significantly higher among shift workers after adjusting for covariates. The odds ratio (OR) for gastritis was 2.24 [95% confidence interval (CI) 1.47-3.43] in shift workers compared with non-shift workers. Among seven subtypes of gastritis, only superficial gastritis was significantly associated with shift work (OR 1.58, 95% CI 1.12-2.24). Conclusions We found that shift workers experience gastritis more than non-shift workers as well as more gastrointestinal symptoms, particularly indigestion. Using endoscopic findings, our study supports that shift work negatively affects the gastrointestinal system.

Korean Children and Adolescents with Crohn's Disease Are More Likely to Present with Perianal Fistulizing Disease at Diagnosis Compared to Their European Counterparts.

PURPOSE: We aimed to investigate the disease phenotype of Korean pediatric Crohn's disease (CD) patients at diagnosis according to the Paris classification by comparison with patients from the European multicenter 5-years recruitment of children with newly developed IBD (EUROKIDS registry). METHODS: Korean children and adolescents who had been newly diagnosed with CD at the age of <18 years during 2013-2016 were included in this multicenter retrospective study. Disease phenotype at diagnosis was classified according to the Paris classification, and compared with the published data from the EUROKIDS study. RESULTS: A total of 255 patients were included. The median diagnosis age was 14.7 years (range, 0.8-17.9 years). No significant difference was observed in male-to-female ratio with EUROKIDS (1.9:1 vs. 1.45:1, p=0.062). The proportion of children aged <10 years was significantly lower in Koreans (7.1% vs. 19.6%, p<0.001). Colonic disease was less prominent (10.0% vs. 27.3%, p<0.001), while upper GI involvement was more prominent in Korean children (59.3% vs. 46.2%, p<0.001). The proportion with perianal fistulizing disease at diagnosis was significantly higher in Korean patients (44.8% vs. 8.2%, p<0.001). A separate analysis of Korean patients revealed that perianal fistulizing disease at diagnosis was positively associated with male sex and body mass index z-score (odds ratio [OR]=2.12, 95% confidence interval [CI]=1.20-3.76, p=0.010; and OR=1.29, 95% CI=1.05-1.58, p=0.015, respectively). CONCLUSION: Approximately half of pediatric CD patients in Korea present with perianal fistulas and/or abscesses at diagnosis, which is a distinct feature of CD in Korean children and adolescents compared to their European counterparts. An underlying genetic difference between ethnicities may play a role in this expression of different phenotypes in pediatric CD.

Direct observation of interfacial C60 cluster formation in polystyrene-C60 nanocomposite films.

Large interfacial C(60) clusters were directly imaged at the supporting film-substrate interface in physically detached polystyrene-C(60) nanocomposite films by atomic force microscopy, confirming the stabilizing mechanism previously hypothesized for thin polymer films. Additionally, we found that the C(60) additive influences basic thermodynamic film properties such as the interfacial energy and the film thermal expansion coefficient.

Infliximab Trough Levels Are Associated With Mucosal Healing During Maintenance Treatment With Infliximab in Paediatric Crohn's Disease.

BACKGROUND AND AIMS: Mucosal healing is an important treatment goal in Crohn's disease. We investigated the association between serum infliximab trough levels and mucosal healing, and the infliximab cut-off levels required for mucosal healing in paediatric patients. METHODS: In this multicentre, retrospective, cross-sectional study, medical records and electronic data of paediatric patients with luminal Crohn's disease, who had received infliximab for ≥1 year, were examined. Ileocolonoscopy was performed on the same day as the infliximab infusion, and serum samples for trough levels were collected immediately before infusion. Mucosal healing was defined as a Simple Endoscopic Score for Crohn's Disease of 0. Univariate, multivariate logistic regression, and receiver operating characteristic curve analyses were performed. RESULTS: Overall, 105 patients [median age 14.8 years] were included, with mucosal healing observed in 48.6%. Median serum infliximab trough levels were higher in patients with mucosal healing [4.5 µg/mL] than without [3.3 µg/mL, p = 0.002]. In the final multivariate model, infliximab trough level ≥4.2 µg/mL [p = 0.002] and ≥1-year duration from diagnosis to infliximab treatment [p = 0.003] were positively and negatively associated with mucosal healing, respectively. The infliximab trough level for achieving mucosal healing with a specificity of 80% was ≥5 µg/mL. CONCLUSIONS: Associations between serum infliximab trough concentrations and mucosal healing were observed in paediatric patients. Identification of the infliximab trough level that positively associates with mucosal healing in most paediatric patients with Crohn's disease [≥5 µg/mL] may guide treatment decisions to optimise therapeutic response in the era of treat-to-target.

Early Infliximab Yields Superior Long-Term Effects on Linear Growth in Pediatric Crohn's Disease Patients.

BACKGROUND/AIMS: Information regarding the efficacy of early infliximab treatment in pediatric patients with Crohn's disease (CD) is limited. We aimed to evaluate the impact of early combined immunosuppression on linear growth in pediatric patients with CD by performing step-up comparisons. METHODS: This retrospective study included pediatric patients with moderate-to-severe CD, who received a combination therapy with infliximab and azathioprine for at least 3 years and sustained corticosteroid-free remission without loss of response. The z-scores of the growth indicators obtained at the time of diagnosis and annually for 3 years thereafter were compared between the two groups. RESULTS: The early combined immunosuppression group displayed significantly increased linear growth 3 years after diagnosis (p=0.026). A significant difference was also observed in the linear growth 3 years after diagnosis between subgroups of Tanner stages 1-2 (p=0.016). CONCLUSIONS: The early introduction of biologics should be considered to improve linear growth in pediatric patients with CD.

Usefulness of the procalcitonin test in young febrile infants between 1 and 3 months of age.

PURPOSE: To study the usefulness of the procalcitonin (PCT) test in young febrile infants between 1 and 3 months of age. METHODS: We evaluated the medical records of 336 febrile infants between 1 and 3 months of age who visited the Emergency Department or outpatient department of Samsung Changwon Hospital from May 2015 to February 2017, and analyzed the clinical characteristics between infants in the serious bacterial infection (SBI) group and non-SBI group. RESULTS: Among the 336 infants, 38 (11.3%) had definitive SBI (bacteremia, n=3; meningitis, n=1; urinary tract infection, n=34). The mean PCT (6.4±11.9 ng/mL) and C-reactive protein (CRP) level (3.8±2.6 mg/dL), and the absolute neutrophil count (ANC) (6,984±4,675) for patients in the SBI group were significantly higher than those for patients in the non-SBI group (PCT, 0.3±1.2 ng/mL; CRP, 1.3±1.6 mg/dL; ANC, 4,888±3,661). PCT had lower sensitivity (43.6%), but higher specificity (92.6%) and accuracy (86.9%) than CRP (92.3%, 25.3%, and 33.0%) for identifying SBI. The area under the receiver operating characteristic curves (AUCs) for definitive SBI were PCT 77.0%, CRP 80.8%, WBC 56.8%, ANC 67.8%, and PLT 48.1%. The AUCs for definitive SBI were PCT+CRP 85.4%, PCT+WBC 77.2%, PCT+ANC 81.3%, CRP+WBC 80.1%, and CRP+ANC 81.6%. CONCLUSION: Our results suggest that the PCT test or a combination of PCT and CRP tests is a more accurate and specific biomarker to detect and rule out SBIs.