• Pediatric Infection and Vaccine
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• v.30 no.2
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• pp.73-83
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• 2023

Purpose: This study aimed to investigate the viral load dynamics in children with underlying malignancies diagnosed with symptomatic coronavirus disease 2019 (COVID-19). Methods: This was a retrospective longitudinal cohort study of patients <19 years old with underlying hemato-oncologic malignancies that were diagnosed with their first symptomatic severe acute respiratory syndrome coronavirus 2 polymerase chain reaction (PCR)-confirmed COVID-19 infection during March 1 to August 30, 2022. Review of electronic medical records and telephone surveys were undertaken to assess the clinical presentations and transmission route of the patients. Thresholds of negligible likelihood of infectious virus was defined as E gene reverse transcription (RT)-PCR cycle threshold (Ct) value ≥25. Results: During the 6-month study period, a total of 43 children with 44 episodes of COVID-19 were included. Of the 44 episodes, the median age of the patients included was 8 years old (interquartile range [IQR], 4.9-10.5), and the most common underlying disease was acute lymphoid leukemia (n=30, 68.2%), followed by patients post-hematopoietic stem cell transplantation (n=8, 18.2%). Majority of the patients had mild COVID-19 (n=32, 72.7%), and three patients (7.0%) had severe/critical COVID-19. Furthermore, 2.3% (n=1) died of COVID-19 associated acute respiratory distress syndrome. The largest percentage of the patients showed E gene RT-PCR Ct value ≥25 between 15-21 days (n=13, 39.4%), followed by 22-28 days (n=10, 30.3%). In 15.2% (n=5), E gene RT-PCR Ct value remained <25 beyond 28 days after initial positive PCR. Refractory malignancy status (β, 67.0; 95% confidence interval, 7.0-17.0; P=0.030) was significantly associated with prolonged duration of E gene RT-PCR <25. A patient with prolonged duration of E gene RT-PCR Ct value <25 was suspected to have infectivity shown by the transmission of the virus to his mother at day 86 after his initial positive test. Conclusions: Children that acquire symptomatic COVID-19 during refractory malignancy state are at a high risk for prolonged shedding warranting PCR-based transmission precautions in this cohort of patients.

• Journal of the Korean Society of Radiology
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• v.81 no.1
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• pp.147-156
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• 2020

Purpose The objective of this study was to evaluate the diagnostic value and threshold levels of cytokeratin fragment 21-1 (CYFRA 21-1) in fine-needle aspiration (FNA) washouts for detection of lymph node (LN) recurrence in postoperative breast cancer patients. Materials and Methods FNA cytological assessments and CYFRA 21-1 measurement in FNA washouts were performed for 64 axillary LNs suspicious for recurrence in 64 post-operative breast cancer patients. Final diagnosis was made on the basis of FNA cytology and follow-up data over at least 2 years. The concentration of CYFRA 21-1 was compared between recurrent LNs and benign LNs. Diagnostic performance and cut-off value were evaluated using a receiver operating characteristic curve. Results Regardless of the non-diagnostic results, the median concentration of CYFRA 21-1 in recurrent LNs was significantly higher than that in benign LNs (p < 0.001). The optimal diagnostic cut-off value was 1.6 ng/mL. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CYFRA 21-1 for LN recurrence were 90.9%, 100%, 100%, 98.1%, and 98.4%, respectively. Conclusion Measurement of CYFRA 21-1 concentration from ultrasound-guided FNA biopsy aspirates showed excellent diagnostic performance with a cut-off value of 1.6 ng/mL. These results indicate that measurement of CYFRA 21-1 concentration in FNA washouts is useful for the diagnosis of axillary LN recurrence in post-operative breast cancer patients.

• Radiation Oncology Journal
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• v.17 no.2
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• pp.100-107
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• 1999

Purpose: This is to evaluate the acute complication, resection rate, and tumor down-staging after pre-operative concurrent chemoradiotherapy for stage IIIA (N2) non-small cell lung cancer. Materials and Methods Fifteen patients with non-small cell lung cancer were enrolled in this study from May 1997 to June 1998 in Samsung Medical Center. The median age of the patients was 61 (range, 45~67) years and male to female ratio was 12:3. Pathologic types were squamous cell carcinoma (11) and adenocarcinoma (4). Pre-operative clinical tumor stages were cT1 in 2 patients, cT2 in T2, and cT3 in 1 and all were N2. Ten patients were proved to be N2 with mediastinoscopic biopsy and five had clinically evident mediastinal Iymph node metastases on the chest CT scans. Pre-operative radiation therapy field included the primary tumor, the ipsilateral hilum, and the mediastinum. Total radiation dose was 45 Gy over 5 weeks with daily dose of 1.8 Gy. Pre-operative concurrent chemotherapy consisted of two cycles of intravenous cis-Platin (100 mg/m$^{2}$) on day 1 and oral Etoposide (50 mg/m$^{2}$/day) on days 1 through 14 with 4 weeks' interval. Surgery was followed after the pre-operative re-evaluation including chest CT scan in 3 weeks of the completion of the concurrent chemoradiotherapy if there was no evidence of disease progression. Results : Full dose radiation therapy was administered to all the 15 patients. Planned two cycles of chemotherapy was completed in 11 patients and one cycle was given to four. One treatment related death of acute respiratory distress syndrome occurred In 15 days of surgery. Hospital admission was required in three patients including one with radiation pneumonitis and two with neutropenic fever. Hematologic complications and other acute complications including esophagitis were tolerable. Resection rate was 92.3% (12/l3) in 13 patients excluding two patients who refused surgery. Pleural seeding was found in one patient after thoracotomy and tumor resection was not feasible. Post-operative tumor stagings were pT0 in 3 patients, pTl in 6, and pT2 in 3. Lymph node status findings were pN0 in 8 patients, pN1 in 1, and pN2 in 3. Pathologic tumor down-staging was 61.5% (8/13) including complete response in three patients ($23.7%). Tumor stage was unchanged in four patients (30.8%) and progression was in one (7.7%). Conclusions : Pre-operative concurrent chemoradiotherapy for Stage IIIA (N2) non-small cell lung cancer demonstrated satisfactory results with no increased severe acute complications. This treatment shceme deserves more patinet accrual with long-term follow-up.

• Radiation Oncology Journal
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• v.22 no.2
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• pp.115-123
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• 2004

Purpose : This retrospective study was conducted to compare early preliminary results of breast conservation therapy (BCT) with mastectomy In early breast cancer. Materials and Methods : We evaluated 171 women with AJCC stage I and II breast cancer who had been treated at Kangnam St. Mary's Hospital from March 1989 to August 1996. Eighty-eight patients underwent mastectomy and 85 patients did conservative surgery with breast irradiation. in the BCT group, all patients received whole breast irradiation to a total dose of 45$\~$50 Gy/5$\~$6 wks, followed by a boost to the original tumor site at least 60 Gy. Chemotherapy was administered to 29 (34.1$\%$) patients in BCT and 40 (45.5$\%$) in mastectomy, with various sequencing of surgery and/or radiation. We compared survival rate, patterns of failure in each treatment group and the prognostic factors that had a significant effect on treatment failure. The median follow-up time was 63 months (19$\~$111 months). Log rank test was used to estimate the prognostic factors for treatment failure. Results : Overall survival, disease free survival, locoregional recurrence and distant metastasis rates were not significantly different between the two treatment groups. During the follow-up period, 11 patients (12.5$\%$)in the mastectomy group and 10 patients (11.8%$\%$ in the BCT group were failed. Six local recurrences occurred after mastectomy and 5 after BCT Five patients fatted at distant site in mastectomy and 4 in BCT. Of the local recurrence cases, five of 6 mastectomy patients and 3 of S BCT patients were alive with no evidence of disease after salvage surgery and/or chemoirradiation. Our results indicated that the major influence on survival was distant metastasis. Unfortunately, control of distant metastasisis was not frequently achieved. Even with salvage systemic therapy or radiotherapy, most of distant metastasis patients died or had uncontrolled disease in both treatment groups: only one of 4 BCT patients and none of mastectomy patients were alive without disease. There was no apparent difference in the incidence rate of contralateral breast cancer and non-breast 2$^{nd}$ primary tumor between the two treatment groups. Univariate Log-rank test identified the N stage and the involved axillary LN number as distinct prognostic factors that were highly predictive of treatment failure in both treatment groups. Additionally, marginal status in BCT and histologic nuclear grade In the mastectomy group were risk factors for treatment fallure (p < 0.05). Concousion : Although further careful follow-up is necessary to confirm the trends evident In this serles, it would appear that patterns of failure and survival rate following conservative surgery and radiotherapy in early breast cancer are similar to those following mastectomy. The great majority of patients with local recurrence had an exellent salvage rate in both treatment groups. Therefore, these preliminary short term results support BCT as an equally effective management for early breast cancer as an alternative to mastectomy.

• Radiation Oncology Journal
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• v.19 no.2
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• pp.113-117
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• 2001

Purpose : To evaluate effect of postoperative radiotherapy on survival and local control for patients with non-small cell lung cancer (NSCLC). Materials and Methods : Ninety two NSCLC patients with N1or N2 involvement who were treated with postoperative radiotherapy following surgery with curative intent from May 1987 to October 1999 were retrospectively analyzed. Age of the patients was ranged from 32 to 78 years. According to TNM Stage, 35 patients had Stage II and 57 had Stage III disease. There were 49 patients with N1 involvement and 43 patients with N2 involvement. Fifty six patients were noted to have $T1\~2$ tumors and 36 patients to have $T3\~4$ tumors. Delivered total dose was ranged from 40 to 60 Gy. Majority of patients received 50 Gy or 50.4 Gy. Follow-up period was ranged from 9 month to 7 years with median follow-up of 26 months. Results : Overall survival rates at 3 and 5 years for entire group of patients were $46\%\;and\;38\%$, respectively. Corresponding disease free survival rates were $44\%\;and\;36\%$. There was significant difference in survival between patients with Stage II and Stage III disease ($50\%\;vs\;28\%$ at 5-year). Five year survival rates for N1 and N2 patients were $52\%\;and\;20\%$, respectively (p<0.05). These were $40\%\;and\;34\%$ for patients with $T1\~2$ tumors and $T3\~4$ tumors. There were documented local relapses in $13\%$ of the patients. For patients with N1 and N2 Stage, local relapse rates were $8\%\;and\;18\%$, respectively. Conclusion : Our study confirms that postoperative radiotherapy for patients with non-small cell lung cancer improves local control. However, influence of postoperative radiotherapy on long-term survival is less clear. More effective systemic treatment to prevent distant metastasis should be investigated in future study to improve long-term survival.

• The korean journal of orthodontics
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• v.27 no.3 s.62
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• pp.421-430
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• 1997

Alveolar bone grows with development of tooth germs and roots; bone deposition occurs with tooth eruption. Bone components undergoes processes of resorption and deposition, and when the balance between them is disrupted, decrease in alveolar bone height or excessive bone deposition result. It has been hon that repositioning of teeth through orthodontic treatment can cause alveolar bone resorption which result in decreased alveolar bone height, and there have been many studies to evaluate such effects. X-ray films that could be replicated and standardized were chosen in clinical studies, and among them, bitewing films were used for objective evaluation of changes in alveolar bone level. Twenty subjects, 10 to 13-year- old (average 12.2) children with Cl I molar key, healthy oral condition, no congenital missing, no periodontal disease, and pre-and post-orthodontic bitewing films, were randomly selected for comparison of alveolar bone heights. Amounts of tooth and changes in alveolar bone heights were analyzed. The following results were obtained: 1. Amount of tooth movement in canine, premolar, and molar regions, changes in tooth axis, and changes in alveolar bone heights were measured, and the mean and median values were obtained. 2. When pre-and post-orthodontic alveolar bone levels were compared, larger changes were noticed in maxilla than mandible. 3. When mesio-distally compared, larger changes were observed in the distal sides of 3D3 and 4M3, mesial sides of 4M3 and 4D3, distal sides of 4D3 and 5M3, mesial sides of 5M3 and 5D3, md distal sides of 5D3 and 6M3. 4. When the amounts of tooth movements(TX, TY)and changes in tooth axis(A) were compared,34TX, 34TY, 34A of both sides in maxilla were greater, iud changes in alveolar bone level were greater than any other region.

• Radiation Oncology Journal
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• v.10 no.1
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• pp.35-41
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• 1992

Forty eight patients with adenoid cystic carcinoma (ACC) in the head and neck treated between 1979 and 1990 were reviewed according to treatment modalities and clinical courses. The common site of origin was minor salivary gland ($69\%$), mostly hard palate and maxillary sinus. 11 patients received radiation therapy (RT) alone and 37 patients received combined surgery and radiation therapy. The follow-up period of the survivors ranged from 4 to 118 months (median 49.5 months). The 5 year local control rate was $69.3\%$, $67.3\%$ and 83.9$\%$ in RT alone, conservative operation (OP)+RT and radical OP+RT group, respectively (p>0.05). The control of local disease was best achieved with radical OP+RT. In postoperative RT, high dose ($\ge$60 Gy) and generous field size($\ge$64 cm$^2$) yielded a better local control rate. Actuarial overall survival rate was $79.0\%$, at 5 years and $19.2\%$ at 10 years. Distant metastases (DM) developed in $40\%$ of patients, mostly in the lung. Disease-free (NED) survival rate was $45.8\%$ at 5 years and significant differences did not exist according to primary sites and treatment options. Survival rate after the onset of DM was $19.5\%$ at 5 years. Occurrence of DM tends to lower survival significantly. In an effort to find the role of RT in the treatment of ACC, our data suggest that a well-planned postoperative RT employing a high dose and generous field size can produce high local control rate and remaining urgent problem of distant metastasis demands more effective chemotherapy for the purpose of improving survival of ACC patients.

• Journal of Chest Surgery
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• v.36 no.12
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• pp.911-920
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• 2003

In this study, we analyzed the long-term surgical outcome of partial atrioventricular septal defects during the past 17 years at Seoul National University Hospital. Material and Method: A retrospective analysis on mortality, survival, and reoperation and their risk factors was done in 93 patients who underwent surgical correction of partial atrioventricular septal defects between April 1986 and December 2002. 32 patients were male and 61 were female with a median age of 68 months (3∼818 months) and a mean follow-up period of 108 months (1∼200 months). Result: There were 4 operative deaths (4.3%) and one mortality during the follow-up period. 3, 5, 10, and 15 year actuarial survival rates were 95.7%, 94.3%, 94,3%, and 94.3%, respectively. After the surgical correction, left atrioventricular valve Incompetence was improved in 61patients (67.7%), remained same as the preoperative status in 14 patients (15.1%), and was aggravated in 12 patients (12.9%). Reoperation was performed in 8 patients (9.0%) after a mean interval of 38.6 months (3∼136 months). Freedom from reoperation rates at 3, 5, 10, and 15 years after surgical correction were 94.0%, 91.4%, 91.4%, and 88,2%, respectively Reasons for reoperation were 7 left atrioventricular valve incompetence, 2 left ventricular outflow tract obstruction, a residual atrial septal defect, a left atrioventricular valve stenosis, and a right ventricular failure. Left ventricular outflow tract obstruction was the only statistically significant factor. In ten patients, significant arrhythmia was developed and three of them were supraventricular arrhythmia. Complete atrioventricular block occurred in 7 patients and permanent pacemakers were implanted in six of them. Conclusion: Surgical corrections of partial atrioventricular septal defects were performed with low operative mortality. Since left atrioventricular valve incompetence was the most common cause of reoperation and left ventricular outflow tract obstruction was the only risk factor for reoperation, a precise estimation of the left atrioventricular valve morphology and the structure of left ventricular outflow tract are needed. Although left ventricular outflow tract obstruction rarely developed, reoperation was frequently required and resection of subaortic tissue could be peformed but the possibility of recurrence was high, so modified Konno operation could be performed with satisfactory results. Complete atrioventricular block developed frequently in early periods, but was overcome with a precise anatomical understanding of conduction system and experience.

• Korean Journal of Fisheries and Aquatic Sciences
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• v.28 no.1
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• pp.87-97
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• 1995

Acute and chronic toxicity of phenol on the mortality, long-term survival and respiration rates of the mysid, Archaeomysis kokuboi adult and juvenile were examined. This experiment was condurted by static bioassay procedure with the different salinity at $25^{\circ}C$ In lethal test, the test animals were exposed to 6 different phenol concentrations to determine $LC_{50}$ and I$LT_{50}$ (median lethal concentration and time) values. The $LC_{50}$ values with the exposure time for the mysid adult ranged from 31.31ppm to 1.49ppm phenol and for the mysid juvenile ranged from 6.90ppm to 0.26ppm in all experimental groups. Mortality was increased with the decrease of salinity, The $96hr-LC_{50}$ values at 16, 24 and $32\%o$ salinity for the mysid adult were 1.49, 2.71 and 4.53ppm phenol, white the values for the mysid juvenile were 0.26, 0.56 and 0.71ppm, respectively. The ratios of $96hr-LC_{50}$ values for the mysid adult to those for the mysid juvenile at 16, 24 and $32\%p$ salinity were 5.73, 4.84 and 6.38, respectively. The mysid juveniles were more sensitive to phenol than the mysid adults. Compared $LT_{50}$ values for the mysid adult with those for the mysid juvenile, the $LT_{50}$ values for the mysid adult ranged from 384.7 to 29.0 hours at 1.7-127ppm phenol concentrations and for the mysid juvenile ranged from 132.2 to 18.7 hours at 0.5~6.Oppm phenol concentrations. The lowest $LT_{50}$ values for the mysid adult and juvenile were showed at the combination of the highest experimental concentration of phenol and the lowest experimental salinity. The mysid juveniles showed lower $LT_{50}$ values than those of adults. The chronic effects of phenol on the mysid at the sublethal effective concentration of phenol were lower in the $32\%o$ salinitr group than 16 or $24\%o$ salinity groups. Oxygen consumption rates of the mysid adult were decreased with the increase of phenol concentration and exposure time, and decreased significantly in lower salinity at the same concentration or phenol.

• Clinical and Experimental Pediatrics
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• v.56 no.10
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• pp.439-445
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• 2013

Purpose: Previous studies suggest that the concentration of 25-hydroxyvitamin D [25(OH)D] in cord blood may show an inverse association with respiratory tract infections (RTI) during childhood. The aim of the present study was to examine the influence of 25(OH)D concentrations in cord blood on infant RTI in a Korean birth cohort. Methods: The levels of 25(OH)D in cord blood obtained from 525 Korean newborns in the prospective COhort for Childhood Origin of Asthma and allergic diseases were examined. The primary outcome variable of interest was the prevalence of RTI at 6-month follow-up, as diagnosed by pediatricians and pediatric allergy and pulmonology specialists. RTI included acute nasopharyngitis, rhinosinusitis, otitis media, croup, tracheobronchitis, bronchiolitis, and pneumonia. Results: The median concentration of 25(OH)D in cord blood was 32.0 nmol/L (interquartile range, 21.4 to 53.2). One hundred and eighty neonates (34.3%) showed 25(OH)D concentrations less than 25.0 nmol/L, 292 (55.6%) showed 25(OH)D concentrations of 25.0-74.9 nmol/L, and 53 (10.1%) showed concentrations of ${\geq}75.0$ nmol/L. Adjusting for the season of birth, multivitamin intake during pregnancy, and exposure to passive smoking during pregnancy, 25(OH)D concentrations showed an inverse association with the risk of acquiring acute nasopharyngitis by 6 months of age (P for trend=0.0004). Conclusion: The results show that 89.9% of healthy newborns in Korea are born with vitamin D insufficiency or deficiency (55.6% and 34.3%, respectively). Cord blood vitamin D insufficiency or deficiency in healthy neonates is associated with an increased risk of acute nasopharyngitis by 6 months of age. More time spent outdoors and more intensified vitamin D supplementation for pregnant women may be needed to prevent the onset of acute nasopharyngitis in infants.