The Prevalence and Clinical Characteristics of Borderline Personality Disorder in South Korea Using National Health Insurance Service Customized Database.

PURPOSE: The purpose of the present study was to identify the prevalence and clinical characteristics of borderline personality disorder (BPD) in South Korea using the Korean National Health Insurance database (DB). MATERIALS AND METHODS: We used the National Health Insurance Service (NHIS)'s research DB (NHIS-2021-1-790) from January 1, 2010 to December 31, 2019, to make customized DB including sociodemographic information and absence or presence of BPD and other psychiatric disorders. The prevalence and the age of onset of BPD was estimated. To compare medical service utilization between the BPD group and the control group, a 1:1:1 propensity score matching was employed, and the regression analysis was conducted. RESULTS: The prevalence of BPD per 10000 people was 0.96 in 2010 and 1.06 in 2019. The prevalence ratio of males to females was 1:1.38 in 2010 and 1:1.65 in 2019, showing that BPD was more prevalent in females. The patients' overall average age of onset was 33.19±14.6 years, with the highest prevalence shown in 8503 people in their 20s. By administrative district, the highest prevalence of BPD per 10000 people was shown in Seoul with 8.71 and the lowest in Jeollanam-do with 2.35. The BPD patients showed a pattern of extensive use of general and mental healthcare services. CONCLUSION: This study identified the prevalence of BPD on a national DB set in South Korea. Although the prevalence of BPD in South Korea was relatively low compared to other countries, there was a steady increase in the number of BPD patients over a decade, which may be possibly due to an increased awareness of mental health and campaigns among healthcare providers and users in the country.

Factors affecting revisit intention for medical services at dental clinics.

Recent changes in the medical paradigm highlight the importance of patient-centered communication. However, because of the lack of awareness of dental clinics and competency of medical personnel, the quality of medical services in terms of the communication between doctors and patients has not improved. This study analyzed the impact of health communication and medical service quality, service value, and patient satisfaction on the intention to revisit dental clinics. The study participants were outpatients treated at 10 dental clinics in Seoul. The research data were collected using a questionnaire during visits to these dental clinics from December 1 to December 30, 2016. A total of 600 questionnaires were distributed (60 copies to each clinics) and 570 valid questionnaires were used for the analysis. The influence of the factors was determined using structural equation modeling. The factors influencing service value were reliability (ß = 0.364, p < 0.001), expertise (ß = 0.319, p < 0.001), communication by doctors (ß = 0.224, p < 0.001), and tangibility (ß = 0.136, p < 0.05). In addition, the factors influencing patient satisfaction were reliability (ß = 0.258, p < 0.001), tangibility (ß = 0.192, p < 0.001), communication by doctors (ß = 0.163, p < 0.001), and expertise (ß = 0.122, p < 0.01). Further, service value (ß = 0.438, p < 0.001) raised patient satisfaction, which was found to influence the intention to revisit dental clinics (ß = 0.383, p < 0.001). Providing accurate medical services to inpatients based on smooth communication between doctors and patients improves patient satisfaction. In addition, doctors can build long-term relations with patients by increasing patients' intention to revisit through patient-oriented communication.

Effects of Meridian Acupressure on Stress, Fatigue, Anxiety, and Self-Efficacy of Shiftwork Nurses in South Korea.

Shiftwork nurses experience physical and psychological health problems related to shift work. This study aimed to examine the effects of Meridian acupressure on stress, fatigue, anxiety, and self-efficacy of shiftwork nurses in South Korea. A quasi-experimental pretest-posttest control group design was employed. Study participants were a total of 59 shiftwork nurses (intervention group: n = 29, control group: n = 30) in S hospital, Seoul, South Korea. The study was conducted at nurse stations in S hospital. Meridian acupressure as intervention was conducted for a total of 15 min on six Meridian acupressure points (GV 20, GB 12, GB 21, LI 11, SI 3, KI 1), 2 min 30 s (10 times for 15 s at a time) on each Meridian point. Measures were the stress scale, fatigue scale, State Anxiety Inventory, and self-efficacy scale, in Korean. Data were collected from July to August 2018. There were significant differences in the degrees of stress, fatigue, and anxiety of shiftwork nurses between the two groups. Meridian acupressure significantly decreased stress, fatigue, and anxiety of shiftwork nurses. This study provides preliminary evidence that Meridian acupressure was an effective intervention. Meridian acupressure could be applied to shiftwork nurses in various clinical situations.

Increased sensitization rates to tree pollens in allergic children and adolescents and a change in the pollen season in the metropolitan area of Seoul, Korea.

INTRODUCTION: Children with allergies are at greater risk of becoming sensitized to allergenic pollens in response to environmental changes. This study investigated the relationship between changes in pollination associated with meteorologic changes and the sensitization rates of children to tree pollen allergens in the metropolitan area of Seoul, Korea. METHODS: The study population consisted of 8,295 children who visited the pediatric allergy clinics at Hanyang University Seoul and Guri Hospital for allergy symptoms between January 1, 1998, and December 31, 2019. Pollen was collected at the two hospitals during the study using a Burkard 7-day sampler. Meteorologic data were obtained from the National Weather Service. RESULTS: Among the major tree pollens, the largest increase in allergic sensitization was to oak, hazel, and alder pollens (0.28% annually). The pollen-sensitization rates increased annually within younger age groups. The duration of the pollen season was 98 days in 1998 and 140 days in 2019. Positive correlations were determined between the duration of the pollen season and the rates of sensitization to tree pollens, as well as between the pollen-sensitization rates and increasing temperature. CONCLUSIONS: This study demonstrated the correlation between weather changes and the resulting changes in the pollen season with sensitization rates to allergenic pollens in children living in the Seoul metropolitan area. An annual increase in sensitization rates in younger children was determined. This pattern is expected to continue due to continuing climate change.

The increased amount of coffee consumption lowers the incidence of fatty liver disease in Korean men.

BACKGROUND AND AIMS: Coffee is known to have a beneficial effect on various liver diseases. The aim of this retrospective longitudinal study was to investigate an association between the amount of coffee consumption and the incidence of fatty liver disease in Korean adults. METHODS AND RESULTS: Data from a total of 91,436 male and female subjects with the mean follow-up period of 2.8 years were analyzed. The incidence of fatty liver was not associated with the amount of coffee consumption at baseline, but it was associated with the change in the amount of coffee consumption at the follow-up period. Multiple linear regression analyses showed that hazard ratios for incidence of fatty liver disease were significantly low in "increase" group comparing with "no change" group in fully adjusted model. When a subgroup analysis by gender was conducted, similar significant results were observed in male subjects, but not in females. CONCLUSIONS: The increment in the amount of coffee consumption is associated with the lower incidence of fatty liver in Korean men and suggests that increasing the coffee consumption may have a protective effect on fatty liver.

Comparison of High-Dose Rosuvastatin Versus Low-Dose Rosuvastatin Plus Ezetimibe on Carotid Atherosclerotic Plaque Inflammation in Patients with Acute Coronary Syndrome.

We compared the effects of ezetimibe/rosuvastatin 10/5 mg versus rosuvastatin 20 mg on carotid atherosclerotic plaque inflammation measured by 18FDG PET/CT. Fifty patients with acute coronary syndrome (ACS) were randomly assigned to the ezetimibe/rosuvastatin 10/5 mg and rosuvastatin 20 mg groups. The primary outcome was the percent change in the target-to-background ratio (TBR) of the index vessel in the most diseased segment (MDS), as assessed by 18FDG PET/CT at baseline and at 6 months. Forty-eight patients completed follow-up PET/CT. MDS TBR was - 6.2 ± 13.9% for patients in the ezetimibe/rosuvastatin group and - 10.8 ± 17.7% for those in the rosuvastatin group (difference, 4.6 percentage points; upper limitation of one-sided confidence interval = 13.8; p = 0.60 for noninferiority). In conclusion, combination therapy with ezetimibe 10 mg and rosuvastatin 5 mg compared with rosuvastatin 20 mg did not meet the criterion for non-inferiority for primary outcome, and the present study was not conclusive on whether the former was non-inferior to the latter. Graphical Abstract.

Impacts of serum vitamin D levels on sleep and daytime sleepiness according to working conditions.

STUDY OBJECTIVES: Low serum vitamin D levels are known to be associated with working conditions and poor sleep, but precedent studies on this issue were limited by the absence of objective sleep measurements or clear distinction between daytime and night shift work. Hence, we aimed to examine serum vitamin D levels and sleep in daytime and night-shift workers using actigraphy. METHODS: A total of 412 night-shift and 432 daytime workers at Seoul National University Bundang Hospital was recruited. All participants completed questionnaires regarding demographic and clinical characteristics. They underwent blood tests for serum vitamin D levels. Objective sleep data were obtained from 150 night-shift workers and 203 daytime workers using actigraphy. RESULTS: There was no significant difference in serum vitamin D levels between night-shift and daytime workers after controlling for possible confounders. In daytime workers, vitamin D deficiency was closely related to shorter duration of total sleep time (odds ratio [OR]: 3.07, 95% confidence interval [CI]: 1.51-6.26, P = .002) and higher risk of excessive daytime sleepiness (OR: 2.20, 95% CI: 1.30-3.74, P = .003). Deficient vitamin D was also associated with life quality impairment regarding psychological health (OR: 1.83, 95% CI: 1.07-3.29, P = .028) and social relationship (OR: 1.78, 95% CI: 1.10-2.88, P = .020). However, in night-shift workers, no significant association was observed between serum vitamin D level and sleep parameters, depressive/anxiety symptoms, or quality of life. CONCLUSIONS: The modest adverse impact of poor vitamin D status on sleep could be attenuated by substantial shift work-related sleep disturbances in night-shift workers. Further studies might be needed to clarify the beneficial effect of vitamin D supplementation for improving sleep and daytime sleepiness in workers with various working conditions.

Effects of Aromatherapy Combined with Music Therapy on Anxiety, Stress, and Fundamental Nursing Skills in Nursing Students: A Randomized Controlled Trial.

PURPOSE: Nursing students often experience anxiety and stress when taking exams that test their fundamental nursing skills. Complementary alternative methods, such as aromatherapy and music therapy, have effectively alleviated such negative emotions among nursing students. However, few studies have examined the effects of combined therapy interventions or compared the effects of different interventions. This study identified the individual and combined effects of aromatherapy and music therapy on test anxiety, state anxiety, stress, and fundamental nursing skills among nursing students in Korea. METHODS: A double-blinded, randomized, controlled trial design was used. The study was conducted at the nursing college at Sungshin Women's University, Seoul, Republic of Korea. Ninety-eight sophomore female nursing students participated in the study. Subjects were randomly categorized under three groups: aromatherapy (n = 32), music therapy (n = 32), and aromatherapy combined with music therapy (n = 34). Aromatherapy was carried out through the inhalation method using an aroma lamp and three drops of Origanum majorana and Citrus sinensis. Music therapy was carried out using Beethoven's Moonlight Sonata. Twenty-minute interventions were performed in separate rooms before an exam was administered. Data were collected through self-report questionnaires, including demographics, test anxiety, state anxiety, and stress. Participants' Foley catheterization skill was likewise evaluated. RESULTS: Aromatherapy combined with music therapy had a significant effect on test anxiety (F = 4.29, p = 0.016), state anxiety (F = 4.77, p = 0.011), stress (F = 4.62, p = 0.012), and performance of fundamental nursing skills (F = 8.04, p = 0.001) compared with aromatherapy and music therapy as separate interventions. CONCLUSIONS: The results suggest that nursing education that includes aromatherapy combined with music therapy may be effective for improving the performance of fundamental nursing skills and reducing anxiety and stress among nursing students.

The effectiveness and safety of Kami Guibi-tang for mild cognitive impairment: study protocol of a pilot, randomized, placebo-controlled, double-blind trial.

BACKGROUND: Mild cognitive impairment (MCI) is an intermediate phase between normal aging and dementia. Since a majority of amnestic MCI (aMCI) cases progress to Alzheimer's disease (AD), it is considered the prodromal stage of AD and, therefore, a treatment target for the prevention of further cognitive decline. However, there is no approved treatment for MCI at present. Kami Guibi-tang (KGT) is a herbal drug used in Korean medicine to treat amnesia, insomnia, loss of appetite, and depression. We will explore the effectiveness and safety of KGT in amnestic MCI in this trial. METHODS/DESIGN: The study will be a single-center, randomized, placebo-controlled, double-blind trial. Eligible participants diagnosed with amnestic MCI will be randomly allocated to a treatment or control group. Participants will take KGT or placebo granules, three times a day, for 24 weeks. The primary outcomes will be changes in Seoul Neuropsychological Screening Battery (SNSB) scores, and magnetic resonance imaging (MRI) measurements including those of brain metabolites, neurotransmitters, and cerebral blood flow. The secondary outcomes will include the safety assessment, measured by changes in blood chemistry, changes in blood protein and cholesterol levels related to AD pathology, and a comparison of MRI changes between the two groups, using age and genotype as covariates. DISCUSSION: This study will be the first clinical trial to identify the therapeutic potential of Kami Guibi-tang for amnestic MCI. The findings will provide insight into the feasibility of large-scale trials to gather evidence for KGT as a treatment for MCI. TRIAL REGISTRATION: Korean Clinical Trial Registry, ID: KCT0002407 . Registered on 30 March 2017.

Efficacy of Polygonatum sibiricum on Mild Insomnia: A Randomized Placebo-Controlled Trial.

Polygonatum sibiricum (PS) rhizome, which contains glyceryl-1-monolinoleate as its primary active component, has been shown to improve insomnia in animal models. Based on these findings, we aimed to investigate the safety and efficacy of PS rhizome extract in improving sleep quality in individuals with mild insomnia. Eighty individuals with mild insomnia were enrolled in a four-week, randomized, double-blind, placebo-controlled trial of PS rhizome extract (500 mg/day, n = 40, PS group) or placebo (n = 40, placebo group). The primary outcome measure was change in total score on the Athens Insomnia Scale (AIS) to indicate sleep quality. The secondary outcome measures included change in actigraphy data and perfusion levels in the brain regions within the default mode network (DMN), which is known to play a key role in insomnia. The PS group showed greater improvement in the total AIS score with a significant increase in total sleep time, relative to the placebo group. In addition, significant group-by-visit interactions were observed in the perfusion level of the medial prefrontal cortex within the DMN. Findings of the current study provide first evidence that PS rhizome extract could be an effective natural ingredient for improving sleep in mild insomnia using a human model.

Increasing prevalence of antimicrobial resistance in urinary tract infections of neurological patients, Seoul, South Korea, 2007-2016.

OBJECTIVES: Urinary tract infection (UTI) is a common medical complication experienced by patients with neurologic diseases. In this study, we established the microbial etiologies of UTI, and resistances to antibiotics in UTI as well as determining which appropriate empirical antibiotics should be used to treat UTI in neurological patients. DESIGNS AND METHODS: We retrospectively reviewed microbial etiologies and antimicrobial resistance among patients experiencing UTI events in the neurology ward of Seoul National University Hospital from 2007 to 2016. RESULTS: The total number of UTI events observed was 301, and Klebsiella pneumoniae was the most common pathogen observed in UTIs. But in catheter-associated UTI (CAUTI), Enterococcus species were the most prevalent pathogens. Susceptibility to commonly-prescribed antibiotics decreased over 10 years, indicating increased antibiotic resistance in pathogens associated with UTI. ESBL-producing K. pneumoniae increased significantly, while increases of MDR K. pneumoniae, ESBL-producing E. coli, and VRE were not observed. CONCLUSIONS: The worldwide trend of increasing drug-resistant pathogens should be considered, and further studies on antibiotics resistance in UTI are needed. These data will greatly assist physicians when they select antibiotics to treat UTIs in neurological patients.

Prevalent Low Thiamine Status Among Adults Living in Seoul Metropolitan Area (South Korea).

The thiamine status of South Korean people has not been recently reported. Therefore, the aim of this study was to determine thiamine intake and status of Korean adults based on a biochemical index. Three consecutive 24-h food recalls and morning first-urine samples were obtained from 143 healthy adults (65 men and 78 women), aged 20-64 years, living in Seoul metropolitan area, Korea. Daily dietary thiamine intake of men and women was 1.42 ± 0.37 mg and 1.18 ± 0.24 mg, respectively. Only 9.1% of the subjects consumed less total thiamine (dietary plus supplemental thiamine) than the estimated average requirement for Koreans. The top 10 major dietary thiamine sources were pork, polished rice, ramyeon (Korean instant noodles), baechukimchi (Chinese cabbage), mandarin oranges, chicken, cow's milk, bread, beef, and potatoes. Those top 10 foods provided 57.85% of the subjects' dietary thiamine intake and the top 30 food sources provided 77.23% of their dietary thiamine intake. Urinary thiamine excretions for men and women were 37.20 ± 26.54 and 39.09 ± 28.80 µg/g creatinine, respectively. Urinary thiamine excretion was positively correlated with total thiamine intake (r = 0.3349, p < 0.0001). Approximately 40% of the subjects had urinary thiamine excretion < 27 µg/g creatinine, indicating thiamine deficiency. In conclusion, thiamine intake among Korean adults in this study was generally adequate, but there was a high prevalence of a low thiamine status. Further study is required to explain the incongruity of adequate intake and low thiamine status thiamine in the South Korean population.

Efficacy of parenteral glutamine supplementation in adult hematopoietic stem cell transplantation patients

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) patients need parenteral nutrition because of nausea, vomiting, and mucositis caused by conditioning regimens. The demand for glutamine increases during the HSCT period. We evaluated the effects of glutamine-containing parenteral nutrition on the clinical outcomes of HSCT patients. METHODS: In this retrospective analysis, we reviewed HSCT patients from Seoul National University from August 2013 to July 2017. Depending on their glutamine supplementation status, 91 patients were divided into 2 groups: glutamine group (N=44) and non-glutamine group (N=47). We analyzed the rate of weight change, infection (clinically/microbiologically documented), complications (duration of mucositis and neutropenia, acute graft versus host disease), and 100-days mortality in each group. RESULTS: Regarding the clinical characteristics of the patients, there were no significant differences between the 2 groups except that there was a larger proportion of myeloablative conditioning regimen in the glutamine group (P=0.005). In the glutamine group, the average number of days of glutamine use, parenteral nutrition, and mucositis was 7.6±1.4, 14.6±9.9, and 13.3±9.5, respectively. Furthermore, multivariate analysis revealed odds ratios of 0.37 (95% CI, 0.14–0.96; P=0.042) and 0.08 (95% CI, 0.01–0.98; P=0.048) for clinically documented infection and 100-days mortality, respectively, in the glutamine group. CONCLUSION: Results showed that the glutamine group had less clinically documented infection and 100-days mortality than the non-glutamine group, but the other outcomes did not show significant differences. The extended duration of glutamine supplementation according to the period of total parenteral nutrition and mucositis should be considered.

Risk factors for food allergy among children in Seoul: focusing on dietary habits and environmental factors / 한국영양학회지

PURPOSE: This study examined the prevalence of food allergies and allergenic factors in a selected sample of children living in Seoul, Korea, along with their dietary habits, environmental factors, and diseases as risk factors for food allergy. The results of this study will provide basic data for addressing food allergies.METHODS: We selected 3,004 pre-school and school-age children, aged 0 ~ 12, in the 25 districts of Seoul as the study sample. Structured self-report questionnaires were administered over a two-month period in July-August 2018, and the children's parents recorded the answers on their children's behalf. The research tools in this study included the Korean version of the questionnaire from the International Study of Asthma and Allergies in Childhood (ISAAC).RESULTS: The physician-diagnosed prevalence rate of food allergies was 14.2%, while 20.4% of the children experienced allergic symptoms at least once and 17.4% reported symptoms within the previous 12 months. The children's symptoms included skin problems (88.1%), gastrointestinal issues (19.2%), oral issues (16.7%), respiratory issues (12.7%), and systemic issues (1.3%). The causes of allergies included eggs, peaches, milk, peanuts, and shrimps. The factors influencing the experience of food allergies were the consumption of cereal (aOR, 1.52; 95% CI, 1.09 ~ 2.10; p = 0.013), potatoes (aOR, 1.88; 95% CI, 1.33 ~ 2.65; p < 0.001), and fast food (aOR, 1.73; 95% CI, 1.10 ~ 2.72; p = 0.017). Having food allergy symptoms was associated with a higher risk of experiencing asthma (aOR, 4.22 95% CI, 3.10 ~ 5.76; p < 0.001), allergic rhinitis (aOR, 2.53; 95% CI, 2.03 ~ 3.15; p < 0.001), and atopic dermatitis symptoms (aOR, 3.56; 95% CI, 2.88 ~ 4.40; p < 0.001).CONCLUSION: Episodes of food allergies warrant examining regular food consumption and placing dietary restrictions through early diagnosis as these episodes may imply the presence of other allergies. Our findings offer basic insights into the patterns, prevalence and symptoms of children's food allergies in Seoul, and our findings will contribute to identifying effective interventions for food allergies.

Cognition enhancing effect of panax ginseng in Korean volunteers with mild cognitive impairment: a randomized, double-blind, placebo-controlled clinical trial

This study aimed to investigate the cognition-enhancing effect of Panax ginseng. A randomized, double-blind, placebo-controlled clinical trial was conducted to address the cognition-enhancing effects of Panax ginseng. A total of 90 Korean volunteers with mild cognitive impairment participated in this study. All subjects were allocated randomly into ‘Ginseng’ group or ‘Placebo’ group. All subjects were administered 3g of Panax ginseng powder or starch (placebo) for 6 months. The Korean version of the Mini-Mental Status Examination (K-MMSE), Korean version of Instrumental Activities of Daily Living (K-IADL), and Seoul Neuropsychological Screening Battery (SNSB) were used to assess the changes in cognitive function at the end of the 6 month study period. The subjects of the ‘Ginseng’ group improved significantly on the Rey Complex Figure Test (RCFT) immediate recall (P = 0.0405 and P = 0.0342 in per-protocol (PP) and intention-to-treat (ITT) analysis, respectively) and on the RCFT 20-min delayed recall (P = 0.0396 and P = 0.0355 in PP and ITT analysis, respectively) compared with ‘placebo’ group throughout the 6 months of Panax ginseng administration. There were no serious adverse events. These results suggest that Panax ginseng has a cognition-enhancing effect.

A study on the correlation between outbreak of allergic rhinitis and airborne pollen in September

PURPOSE: Various studies have investigated factors related to the prevalence of allergic rhinitis (AR). We studied the correlation between the outbreaks of AR and airborne pollen in September. METHODS: According to data from the National Health Insurance Service, the number of AR cases was increased from 2012 to 2016. During the same period, the number of patients with upper respiratory tract infection, respiratory virus detection rate, air pollutants, and concentration of airborne pollen were correlated with the occurrence of AR in correlation analysis. RESULTS: The number of patients with AR showed increasing biphasic patters in the spring and fall with the peak reached in September (278,487±12,894), while April marked the fifth-highest figure with 241,570±132,677. The concentration of airborne pollen was highest at 4,450 grains/m³ in May, followed by 3,597 grains/m³ in April, marking its peak in the spring. September marked the third-highest level at 1,619 grains/m³. According to the monthly correlation between the number of patients with AR and pollen, Seoul and Daejeon showed correlations of ρ=0.929 (P=0.022) and ρ=0.955 (P=0.011), respectively, in September. There were no significant correlations among AR, air pollutants, and respiratory virus detection rate. CONCLUSION: Based on this study, the monthly number of patients with AR was the highest in September. In September, we found the correlation between allergic rhinitis and pollen, although there are regional limitations, regarding outbreaks in the number of patients with AR. Further research and attention are needed to prepare measures against airborne weed pollen during the fall.

Recent changing pattern of aeroallergen sensitization in children with allergic diseases: A single center study

PURPOSE: Allergic diseases have been increasing worldwide over the past few decades. Allergic sensitization is a pivotal risk factor for the development of allergic diseases. The purpose of this study was to examine changes in allergic sensitization patterns of aeroallergens over the last 10 years in children with respiratory allergic diseases. METHODS: We retrospectively reviewed the medical records of 12,848 children under the age of 18 years who received skin prick tests (n=3,852) or serum specific IgE tests (n=8,996) to evaluate sensitization from 2007 to 2016 in a single center, Seoul, Korea. RESULTS: Sensitization rate to house dust mite (Dermatophagoides farinae and Dermatophagoides pteronyssinus) reached a plateau in preschool (28.3%–32.8%) and schoolchildren (45.8%–47.2%). Sensitization rate to animal dander (cat and dog) was increasing from 8.4% to 12.5% in preschool children and from 10.3% to 18.6% in schoolchildren (trend P<0.001 each). In preschool children, tree (birch, oak, and alder; from 3.5% to 6.4%), grass (timothy; from 0.8% to 6.5%), weed (ragweed and mugwort; from 2.8% to 6.9%) pollens and mold (Alternaria; from 2.5% to 6.0%) were also in similar increasing pattern (trend P=0.001, P<0.001, P=0.003, and P<0.001, respectively). Additionally, tree (from 9.0% to 15.2%), grass (from 2.6% to 5.2%) pollens were also in increasing pattern in schoolchildren (trend P<0.001 and P=0.024, respectively). CONCLUSION: Over the past 10 years, sensitization patterns of aeroallergen have been changing in Korean children with allergic diseases. We should pay attention to the changing patterns of allergic sensitization to educate and prevent the allergic disease.

Nutritional Management of a Patient with a High-Output Stoma after Extensive Small Bowel Resection to Treat Crohn's Disease

For patients with short bowel syndrome who undergo ileostomy, nutritional management is essential to prevent complications associated with a high-output stoma (HOS). We report a practical example of ostomic, medical nutrition therapy provided by an intensive nutritional support team (NST). A 42-year-old male with a history of Crohn's disease visited Seoul National University Hospital for treatment of mechanical ileus. He underwent loop ileostomy after extensive small bowel resection. As his remaining small bowel was only 160 cm in length, the stomal output was about 3,000 mL/day and his body weight fell from 52.4 to 40.3 kg. Given his clinical condition, continuous tube feeding for 24 h was used to promote adaptation of the remnant bowel. Thereafter, an oral diet was initiated and multiple, nutritional educational sessions were offered by dietitians. Constant infusion therapy was prescribed and included in the discharge plan. Two months after discharge, his body weight had increased to 46.6 kg and his hydration status was appropriately maintained. This case suggests that the critical features of medical nutritional therapy for ostomy management are frequent assessments of fluid balance, weight history, and laboratory data and after nutritional interventions.

Effects of Early Phosphorus Intake on Respiratory Distress in Extremely Low-Birth-Weight Infants

PURPOSE: This study was aimed to investigate the effect of early phosphorus intake on respiratory distress in extremely low-birth-weight infants (ELBWIs) with a high incidence of hypophosphatemia. METHODS: We performed a retrospective study to target 164 ELBWIs admitted to the neonatal intensive care unit in Seoul National University Children's Hospital. Birth characteristics, nutritional intake, and electrolyte levels during the first week were investigated as predictors that would affect the clinical outcomes. The correlations among invasive ventilation at postnatal age of 2 weeks, moderate-to-severe bronchopulmonary dysplasia (BPD), and phosphorous intake were analyzed. RESULTS: Hypophosphatemia (phosphorus level <4 mg/dL) was observed in 72.0% of the subjects. The rates of invasive ventilation (P=0.001) and moderate-to-severe BPD (P=0.005) were significantly lower in the high phosphorus intake group (≥0.7 mM/kg/day) than in the low phosphorus intake group (<0.7 mM/kg/day). Phosphorus intake during the first week was a significant factor affecting invasive ventilation at 2 weeks of age (adjusted odds ratio [OR], 8.212; 95% confidence interval [CI], 2.256 to 28.896; P=0.001) and moderate-to-severe BPD (adjusted OR, 3.402; 95% CI, 1.274 to 9.084; P=0.015). CONCLUSION: Early insufficient phosphorus intake confers a significantly higher risk with invasive ventilation at 2 weeks of age and moderate-to-severe BPD. Therefore, early sufficient phosphorus supply may improve respiratory outcomes in ELBWIs.

Use of Anti-TNF Alpha Blockers Can Reduce Operation Rate and Lead to Growth Gain in Pediatric Crohn's Disease / 대한소아소화기영양학회지

PURPOSE: Pediatric Crohn's disease (CD) is directly related to growth and has a high probability of requiring surgical intervention(s); therefore, more active treatment for CD is required for children. This study investigated the impact of biologics on growth and disease course associated with surgery. METHODS: This was a retrospective cohort study involving patients diagnosed with CD at the Seoul National University Children's Hospital (Seoul, Korea) between January 2006 and October 2017. The aim was to determine the characteristics of pediatric patients with CD and whether biologics affected growth and the surgical disease course. RESULTS: Among patients who underwent surgery for CD, the mean number of operations per patient was 1.89. The mean time from initial diagnosis to surgery was 19.3 months. The most common procedure was fistulectomy (34%), followed by incision and drainage (25%). In all patients, the use of biologics increased the height (p=0.002) and body mass index (BMI) (p=0.005). Among patients who underwent surgery, height (p=0.004) and BMI (p=0.048) were increased in the group using biologics. Patients who used biologics exhibited a low operation rate only within 2 years after diagnosis, with no differences thereafter (p=0.027). CONCLUSION: Although biologics could not mitigate the operation rate in pediatric patients who underwent surgery for CD, biological therapy delayed disease progression within 2 years of disease onset. Additionally, biologics conferred growth and BMI benefits in this window period. Therefore, it may be helpful to use biologics for optimal growth in pediatric patients with a high probability of undergoing future surgery.