Effects of preoperative spinopelvic compensation states on the patient-reported outcomes of adult spinal deformity surgery: three-dimensional motion analysis results.

PURPOSE: This study aimed to investigate how preoperative motion analysis results affect the postoperative clinical outcomes of patients undergoing surgery for adult spinal deformity (ASD). METHODS: Patients who underwent surgery for ASD and whose motion analysis results were available were included. All patients underwent preoperative three-dimensional gait analysis using a motion analysis system. Univariate and multivariate regression analyses were performed to determine the predictive parameters of the 12-month postoperative Oswestry Disability Index (ODI). According to the mean anterior pelvic tilt (Ant-PT) angle in the motion analysis, the patients were divided into two groups: small and high Ant-PT angle groups. The 12-month postoperative ODI between the two groups was compared. RESULTS: A total of 111 patients who met the inclusion criteria were enrolled in the study. In the multivariate regression analysis, the preoperative sacral slope and mean Ant-PT angle were significant predictors of the 12-month postoperative ODI (p = 0.013 and p = 0.009, respectively). The high Ant-PT angle group showed a poorer 12-month postoperative ODI than did the small Ant-PT angle group, with a mean ODI of 21.9 ± 8.4 and 16.7 ± 8.5, respectively (p = 0.002). Simple linear regression analysis revealed that the Ant-PT angle was positively correlated with the postoperative sagittal vertical axis in all follow-up periods. CONCLUSION: The study highlights that a high preoperative Ant-PT angle in motion analyses is associated with poor clinical outcomes after surgery for ASD. Therefore, it is necessary to observe and consider the dynamic gait pattern related to the compensatory mechanism for sagittal imbalance in the decision-making process for ASD surgery.

Monocyte Chemoattractant Protein (MCP)-1 in Rotavirus-Associated White Matter Injury in Newborns.

Recent reports have suggested an association between rotavirus infection and a distinctive pattern of white matter injury (WMI) in neonates with seizures; however, the connection between the two is not fully understood. To evaluate the underlying mechanism, we profiled and compared eight cytokines (IL [interleukin]-1ß, IL-6, IL-8, IL-10, IFN-γ [interferon-γ ], MCP-1 [monocyte chemoattractant protein-1], MIP-1ß [macrophage inflammatory protein-1ß], and TNF-α [tumor necrosis factor-α]) in the cerebrospinal fluid (CSF) of 33 neonates with seizures who had no other well-known causes of seizures and 13 control patients (rotavirus-induced gastroenteritis but without seizures). Among the 33 neonates with seizures, 9 showed WMI and all were infected with rotavirus (R + W + ). Among the 24 patients without WMI, 11 were infected with rotavirus (R + W - ) and 13 were not (R - W - ).Only MCP-1 and MIP-1ß were different between the groups. MCP-1 was increased in R+ W+ compared with R + W- (p < 0.01), R - W- (p < 0.01), and control (p = 0.03) patients. MIP-1ß was decreased in R + W+ compared with R - W- (p < 0.01) and control (p < 0.01), but not R + W- (p = 0.23) patients. MCP-1 and MIP-1ß are C-C chemokines that recruit immune cells to the site of inflammation. Our pilot study suggests MCP-1-mediated monocyte recruitment may be linked with this complication caused by rotavirus.

Ten-year Nationwide Population-based Survey on the Characteristics of Children with Henoch-SchÓ§nlein Purpura in Korea.

BACKGROUND: Henoch-SchÓ§nlein purpura (HSP) is a common vasculitis of childhood. Though HSP is usually self-limiting, severe complications can occur. The management for this condition has not been established yet. Thus, this nationwide study aimed at investigating epidemiological characteristics of children with HSP in Korea. The patterns of clinical practice with regard to the complications of the condition were also investigated. METHODS: This is a national population-based study that used the National Health Insurance Database. Children below 18 years who were diagnosed with HSP in Korea between 2006 and 2015 were enrolled. Data, such as age, sex, yearly and monthly distribution of HSP, hospitalization, re-hospitalization, comorbidities, and interventions were obtained. The use of steroids was also analyzed. RESULTS: A total of 56,841 children were enrolled. The annual incidence of HSP was 55.9 per 100,000 children. The peak age was 5 years. Spring was the most prevalent season. Sex (male) and young age (< 9 years) were risk factors of hospitalization. Younger children were more likely to be re-hospitalized and suspected with intussusception, arthritis, and nephritis. Only 4 children received laparotomy. In total, 57% were managed with steroids, and mean durations of medication were 4-5 days. Children who were hospitalized and those with comorbidities used steroids more frequently (P < 0.001). CONCLUSION: The annual incidence of HSP is 55.9 per 100,000 children which is higher in Korea than that in other countries. Younger children can have a more severe clinical course. This nationwide survey provides valuable information to understand HSP in children and to inspire further research on HSP.

Detection of Rotavirus Genotypes in Korea 5 Years after the Introduction of Rotavirus Vaccines.

Rotavirus (RV) is one of the most important viral etiologic agents of acute gastroenteritis (AGE) in children. Although effective RV vaccines (RVVs) are now used worldwide, novel genotypes and outbreaks resulting from rare genotype combinations have emerged. This study documented RV genotypes in a Korean population of children with AGE 5 yr after the introduction of RVV and assessed potential genotype differences based on vaccination status or vaccine type. Children less than 5-yr-old diagnosed with AGE between October 2012 and September 2013 admitted to 9 medical institutions from 8 provinces in Korea were prospectively enrolled. Stool samples were tested for RV by enzyme immunoassay and genotyped by multiplex reverse-transcription polymerase chain reaction. In 346 patients, 114 (32.9%) were RV-positive. Among them, 87 (76.3%) patients were infected with RV alone. Eighty-six of 114 RV-positive stool samples were successfully genotyped, and their combinations of genotypes were G1P[8] (36, 41.9%), G2P[4] (12, 14.0%), and G3P[8] (6, 7.0%). RV was detected in 27.8% of patients in the vaccinated group and 39.8% in the unvaccinated group (P=0.035). Vaccination history was available for 67 of 86 cases with successfully genotyped RV-positive stool samples; RotaTeq (20, 29.9%), Rotarix (7, 10.4%), unvaccinated (40, 59.7%). The incidence of RV AGE is lower in the RV-vaccinated group compared to the unvaccinated group with no evidence of substitution with unusual genotype combinations.

Detection of norovirus genogroup IV, klassevirus, and pepper mild mottle virus in sewage samples in South Korea.

Norovirus (NoV) genogroup (G) IV has been infrequently isolated from patients suffering from acute gastroenteritis (AGE), although this virus has not been detected in Korea. Klassevirus, a novel virus belonging to the family Picornaviridae and a possible etiologic agent of AGE, and pepper mild mottle virus (PMMoV), which originates from processed pepper products and is shed in human feces, are suggested to be new indicators of fecal pollution. We aimed to investigate the presence of NoV-GIV, klassevirus, and PMMoV in sewage samples collected in Korea. Between December 2010 and February 2012, influent sewage samples were collected every month from a wastewater treatment plant located in the eastern part of Seoul in Korea. The sewage samples were concentrated by the adsorption elution method using an HA (pore size of 0.45 µm with mixed cellulose ester) electronegative filter with an acid-rinse procedure. RT-PCR was performed using specific primers for the capsid gene of NoV-GII and NoV-GIV, the coat gene of PMMoV, and the VP0/VP1 gene of klassevirus. Among the 14 sewage samples tested, klassevirus was detected in eight (57.1 %), PMMoV in eight (57.1 %), NoV-GII in five (35.7 %), and NoV-GIV in three (21.4 %). NoV-GIV was detected in December 2010 and January and March 2011. PMMoV and klassevirus were frequently detected in winter. Phylogenetic analysis revealed that the NoV-GIV detected in this study belonged to G-IV1 lineage. This is the first study to confirm the presence of NoV-GIV, klassevirus, and PMMoV in sewage samples in Korea.

Detection of Aichi virus in South Korea.

Aichi virus (AiV) is considered to be a possible etiologic agent of acute gastroenteritis (GE). We analyzed 1,568 stool samples collected by the Seoul Metropolitan Health Research Center from patients with GE during outbreaks in Seoul, together with 378 archived common-enteric-virus-negative stool samples from children with GE hospitalized at a tertiary hospital in Seoul. AiV was detected in 1.7 % (27/1,568) of the first group but not found in the second group (0 %, 0/378). Genotypes A and B of AiV were both detected in this study. This is the first study confirming the circulation of AiV in Korea.

Risk factors for neurologic complications of hand, foot and mouth disease in the Republic of Korea, 2009.

In 2009, the first outbreak of hand, foot and mouth disease (HFMD) or herpangina (HP) caused by enterovirus 71 occurred in the Republic of Korea. This study inquired into risk factors associated with complications of HFMD or HP. A retrospective medical records review was conducted on HFMD or HP patients for whom etiologic viruses had been verified in 2009. One hundred sixty-eight patients were examined for this investigation. Eighty patients were without complications while 88 were accompanied by complications, and 2 had expired. Enterovirus 71 subgenotype C4a was the most prevalent in number with 67 cases (54.9%). In the univariate analysis, the disease patterns of HFMD rather than HP, fever longer than 4 days, peak body temperature over 39℃, vomiting, headache, neurologic signs, serum glucose over 100 mg/dL, and having an enterovirus 71 as a causative virus were significant risk factors of the complications. After multiple logistic analysis, headache (Odds ratio [OR], 10.75; P < 0.001) and neurologic signs (OR, 42.76; P < 0.001) were found to be the most significant factors. Early detection and proper management of patients with aforementioned risk factors would be necessary in order to attain a better clinical outcome.

Whole-genome characterization and genotyping of global WU polyomavirus strains.

Exploration of the genetic diversity of WU polyomavirus (WUV) has been limited in terms of the specimen numbers and particularly the sizes of the genomic fragments analyzed. Using whole-genome sequencing of 48 WUV strains collected in four continents over a 5-year period and 16 publicly available whole-genome sequences, we identified three main WUV clades and five subtypes, provisionally termed Ia, Ib, Ic, II, IIIa, and IIIb. Overall nucleotide variation was low (0 to 1.2%). The discriminatory power of the previous VP2 fragment typing method was found to be limited, and a new, larger genotyping region within the VP2/1 interface was proposed.

Emergence of norovirus GII-4/2008 variant and recombinant strains in Seoul, Korea.

Recently, the emergence of a new NoV GII-4 variant strain every 2 or 3 years has been reported. One hundred seventeen NoV GII strains were detected by RT-PCR in children with AGE between August 2008 and February 2010. In phylogenetic analyses, GII-4 and GII-3 were the most frequently detected strains. The detection rate of the 2008 variant was similar to that of the 2006b variant in the winter seasons of 2009 and 2010. This study shows a changing pattern of a predominant GII-4/2006b variant to the 2008 variant, as well as a novel NoV recombinant strain, GII-6/GII-14, in Korea.

Detection of human parechoviruses in children with gastroenteritis in South Korea.

Human parechoviruses (HPeVs) are associated with gastroenteritis (GE), although their etiologic role is uncertain. The purpose of this study was to detect HPeVs in children with GE in Korea. A total of 348 stool samples that were negative for common enteric viruses were screened for HPeV using RT-PCR. Of the 348 stool samples, seven (2.0%) were positive for HPeV. Five Korean strains belonged to HPeV-1, and two strains belonged to HPeV-4. Four Korean HPeV-1 strains clustered with strain 7555312 and the other HPeV-1 strain clustered with the BNI-788St strain. Two HPeV-4 strains showed discordant phylogenic relationships in the 3D gene, suggesting that recombination had occurred. This is the first study reporting the detection of HPeVs in children with GE in Korea.

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.

Detection of GII-4/2006b variant and recombinant noroviruses in children with acute gastroenteritis, South Korea.

Norovirus (NoV), a single-stranded, positive RNA virus, is an important etiologic agent of acute gastroenteritis in children worldwide. In this study, a total of 434 fecal samples collected from 434 children with acute gastroenteritis in Seoul, between September 2007 and July 2008 were tested to determine the molecular epidemiology of NoVs and characterize recombinant strains by using RT-PCR followed by sequencing. Of the 434 specimens, NoV, rotavirus, and adenovirus were detected in 155 (35.8%), 72 (16.6%), and 19 specimens (4.3%), respectively. NoV GI was detected in 7 specimens (1.6%) and GII in 148 (34.1%) specimens. Phylogenetic analysis of capsid sequences in the GII-positive specimens revealed the presence of the following strains: GII-4, 111 (75.0%); GII-3, 35 cases (23.6%); GII-6b, 1 case; and GII-16, 1 case. Most of the GII-4 strains were grouped with the GII-4/2006b variant with 98-100% nucleotide identity. Eleven strains were identified as recombinant (GII-4/GII-3 in 10 cases and GII-b polymerase/GII-16 capsid in 1 case) by sequencing based on the RdRP and capsid genes. The putative recombination point in the recombinant strains was the ORF-1/ORF2 overlap, located at nucleotide 5,046 with reference to Lordsdale. In conclusion, GII-4/2006b variants were detected predominantly and a new recombinant strain (GII-4/GII-3) was found in the Korean children with gastroenteritis. Continuous monitoring of the genetic diversity of NoVs is important to determine the trend of the predominant genotype and new recombinant strain.

Genetic characterization of rotavirus in children in South Korea from 2007 to 2009.

Rotavirus is the most important etiological agent in children with acute gastroenteritis (AGE). The recent implementation of a rotavirus vaccine in Korea requires the monitoring of prevailing rotavirus strains in order to control the infection. One hundred thirty-nine rotavirus strains were detected in children hospitalized with AGE in Seoul, Korea from 2007 to 2009. The most frequent combination of genotypes was G9P[8] (32.1%), followed by G1P[8] (20.7%) and G3P[8] (11.7%). Mixed G-types were detected in 14 samples (10.0%), and mixed P-types were found in six samples (4.3%). G9 genotypes were predominant from 2007 to 2008, whereas G1 and G3 genotypes were predominant from 2008 to 2009. G1 strains clustered mostly in the Id lineage, and some clustered in the Ic, IId, and Ia lineages. G2 strains clustered in the IV and V lineages. G3 and G9 strains clustered in the IIId and Id lineages, respectively. This study shows a rapid change of the prevalent genotype from G9 to G1 and G3 genotypes, suggesting that continuous surveillance of rotavirus strains is important for rotavirus vaccination.

Detection of human rhinovirus C in children with acute lower respiratory tract infections in South Korea.

Recently, HRV-C was identified as a new species of HRV, but its spectrum of clinical disease is still not clear. The purpose of this study was to investigate the molecular epidemiology of HRVs in children with acute lower respiratory tract infections (LRTIs). A total of 54 HRV-positive samples that were negative for other respiratory viruses were sequenced. HRV-A was detected in 33, HRV-B in 4, and HRV-C in 17 of these samples. All HRV-C-positive patients showed favorable clinical outcomes. We confirmed the presence of HRV-C in children with LRTIs, but its association with clinical severity is not clear.

Detection of human bocavirus-2 in children with acute gastroenteritis in South Korea.

Human bocavirus (HBoV)-2, a new parvovirus, has been identified in stool samples and is suggested to be one of the etiologic agents of acute gastroenteritis (GE). The purpose of this study was to investigate the prevalence of HBoV-2 in children with GE. Stool samples were collected from 358 children hospitalized with GE. HBoV-2 was detected in 3.6% of the patients. HBoV-2 was co-detected with other viral agents in 53.8% of the patients. These findings suggest that HBoV-2 may be an etiologic agent in GE, but further studies are needed due to frequent co-detection with other enteric viruses.

Management of Acute Gastroenteritis in Children: A Survey among Members of the Korean Society of Pediatric Gastroenterology, Hepatology, and Nutrition.

PURPOSE: No national survey has yet described the guidelines followed by Korean pediatricians to treat acute gastroenteritis (AGE). An online survey was performed to investigate the management of AGE followed by members of The Korean Society of Pediatric Gastroenterology, Hepatology, and Nutrition, and the results were compared between pediatric gastroenterologists (PG) and general pediatricians (GP). METHODS: Questionnaires were sent to pediatricians between June 2 and 4, 2018 regarding the type of hospital, indications for admission, antiemetic and antidiarrheal drugs and antibiotics prescribed, and dietary changes advised. RESULTS: Among the 400 pediatricians approached, 141 pediatricians (35.3%) responded to the survey. PG comprised 39% of the respondents and 72.7% worked at a tertiary hospital. Both PG and GP considered diarrhea or vomiting to be the primary symptom. The most common indication for hospitalization was severe dehydration (98.8%). Most pediatricians managed dehydration with intravenous fluid infusions (PG 98.2%, GP 92.9%). Antiemetics were prescribed by 87.3% of PG and 96.6% of GP. Probiotics to manage diarrhea were prescribed by 89.1% of PG and 100.0% of GP. Antibiotics were used in children with blood in diarrheal stool or high fever. Dietary changes were more commonly recommended by GP (59.3%) than by PG (27.3%) (p<0.05). Tests to identify etiological agents were performed primarily in hospitalized children. CONCLUSION: This survey assessing the management of pediatric AGE showed that the indications for admission and rehydration were similar between GP and PG. Drug prescriptions for diarrhea and dietary changes were slightly commonly recommended by GP than by PG.

Neonatal seizures and white matter injury: Role of rotavirus infection and probiotics.

BACKGROUND: Recent reports associate rotavirus infection with neonatal seizures of distinctive white matter injury (WMI) pattern, but evidence is lacking. We examined this association prospectively and analyzed factors related to occurrence of seizures and WMI pattern in neonates with rotavirus infection. METHODS: We prospectively included 228 neonates (≥34 gestational weeks) who were admitted to a regional neonatal intensive care unit between February 2015 and April 2016 and underwent rotavirus antigen testing using stool samples. Patients with neonatal seizures of other etiologies were excluded. RESULTS: Seventy-eight (34.2%) neonates were rotavirus-positive. Otherwise-unexplained seizures were more frequently observed among rotavirus-positive than among rotavirus-negative neonates (20.5% vs. 4.0%, p < 0.001). Rotavirus infection increased the risk of seizures (odds ratio [OR], 6.19; p < 0.001), even after adjustment for confounders (OR, 4.46; p = 0.007). After stratification according to probiotic administration immediately after birth, rotavirus infection remained a significant risk factor only in patients without probiotic medication (OR, 4.83; p = 0.01 vs. OR, 2.44; p = 0.49). The WMI pattern was observed in 9 of 22 neonates with seizures, and this subgroup was characterized by rotavirus infection (100% vs. 53.8%, p = 0.004) and seizure onset on days 4-6 of life (66.7% vs. 15.0%; p = 0.02). G9P[8] was the most common genotype in this subgroup but was also commonly detected in neonates without seizures. CONCLUSION: Rotavirus infection is an independent risk factor for neonatal seizures, and associated with the WMI. Immediate administration of probiotics after birth may reduce rotavirus-associated neonatal seizures.

Outbreak of rotavirus variant P[8] in Seoul, South Korea.

An epidemiologic study was performed to determine the genetic variability of rotaviruses in Seoul, South Korea. In 3,174 stool specimens from children with acute diarrhea at five referral hospitals, 571 (18%) possessed the antigen of group A rotavirus detectable by ELISA--10.8% in 2004 and 28.1% in 2005. VP7 genotyping revealed that the G3 type was found in 25.6% of all typed isolates, G4 in 23.8%, G2 in 21.6%, and G1 in 17.6%. VP4 genotyping showed that the P[8] type was detected in 66.7%, P[6] in 15.6%, P[4] in 13.0%, and P[9] in 0.2%. Because the variant P[8] type could not be amplified initially by conventional P typing primers (1T-1), PCR were performed using newly designed 1T-1S primer, which revealed that 307 specimens were the variant P[8] type. Uncommon combinations such as G4P[6] and G2P[8] were also found with relatively high prevalence, 14.6% and 12.8%, respectively. Variant P[8] types were associated with an outbreak of rotavirus in 2005.

Th1 and Th2 cytokine levels in nasopharyngeal aspirates from children with human bocavirus bronchiolitis.

BACKGROUND: Human bocavirus (hBoV) is regarded as one of the possible etiologic agents in lower respiratory tract infection and bronchial asthma exacerbation in children despite frequent co-detection with other respiratory viruses. The immunologic response in children with hBoV infection is still not clear. OBJECTIVES: To investigate the profiles of T helper-1 (Th1)/T helper-2 (Th2) cytokines in children with hBoV-associated bronchiolitis. STUDY DESIGN: This study utilized of 59 nasopharyngeal aspirates from 59 infants aged 24 months or younger, including 29 from children with hBoV-related bronchiolitis and 30 with respiratory syncytial virus (RSV)-related bronchiolitis. Eighteen infants hospitalized for elective surgeries were included as controls. Nasopharyngeal aspirates were tested simultaneously for cytokines interleukin (IL)-2, IL-4, IL-5, IL-10, interferon (IFN)-gamma, and tumor necrosis factor (TNF)-alpha using the Cytometric Bead Array. RESULTS: Significantly higher concentrations of IFN-gamma (p=0.0001), IL-2 (0.006), and IL-4 (p=0.0002) were observed in hBoV positive specimens than in controls. The concentration of IL-10 (p=0.04) and TNF-alpha (p=0.006) in the RSV-positive group was significantly higher than in the hBoV-positive group, while there was no difference in other cytokines concentration between the two groups. CONCLUSIONS: These results showed that both of Th1 and Th2 cytokines were increased in children with hBoV-related bronchiolitis compared to normal controls, but Th2-polarized responses were not observed.

Detection of Pathogenic Viruses in the Ambient Air in Seoul, Korea.

The possible transport of pathogenic microorganisms during Asian dust events could be an important concern for health workers; however, this is still uncertain owing to a lack of supporting evidence. The present study aimed to investigate the presence of pathogenic microorganisms in air samples collected during the Asian and non-Asian dust periods. Between March and September 2016, air samples were collected at three weather observation stations in Seoul using a high-volume air sampler. Multiplex PCR was performed using the Allplex™ respiratory and gastrointestinal panel assay kits to detect 46 microorganisms. RT-PCR was performed for klassevirus, Aichivirus, and human parechovirus (HPeV) detection. In total, 71 air samples were collected during the Asian (8 samples) and non-Asian (63 samples) dust events. During an Asian dust event, only one human rhinovirus (HRV)-positive air sample was collected on April 23. During the non-Asian dust period, HRV, HPeV, norovirus (NoV), enteroaggregative Escherichia coli (EAEC), enterotoxigenic E. coli (ETEC), and Blastocystis hominis were detected in four, two, one, one, one, and one air samples, respectively. Pathogenic viruses were mostly detected in ambient air samples during the non-Asian dust period, which suggests a possible air-borne transmission of viral pathogens; however, the role of Asian dust in epidemics caused by pathogenic viruses is unclear.