Multicenter validation of a deep-learning-based pediatric early-warning system for prediction of deterioration events

ope

1980–2019년 기간 동안 소아청소년 알레르기질환에서 항원 감작의 변화

Purpose Allergen sensitization is constantly changing, and understanding these changes can help manage and prevent allergic diseases. This research analyzed and compared the changes in allergen sensitization in children diagnosed with allergic diseases using the skin test and the multiple allergen simultaneous test. Methods We retrospectively analyzed the data on children who were diagnosed with allergic diseases and received immunotherapy at Yonsei Medical Center from 1980 to 1998 and they were screened for allergen sensitization at Severance Hospital from 2005 to 2019. Results Between 1980 and 1998, and between 2005 and 2019, data on 3,205 (male, 70.3%; mean age, 7.2±2.9 years) and 15,318 children (male, 62.8%; mean age, 8.8±4.5 years) were analyzed. The sensitized allergens that appeared in the 1980–1998 included Dermatophagoides farinae (91.0%), Dermatophagoides pteronyssinus (76.3%), cockroach (13.5%), and Alternaria (11.5%), in order of frequency; further, the sensitized allergens that appeared in the 2005–2019 included D. farinae (45.0%), D. pteronyssinus (39.6%), cat dander (12.2%), and dog dander (9.1%), in order of frequency. D. farinae and D. pteronyssinus demonstrated the highest sensitization rates, although the rates decreased gradually. The sensitization to cat dander and dog dander showed a growing trend, and sensitization to Humulus japonicus, Candida, and cockroach decreased after 2005. Conclusion Over the past 40 years, the allergen sensitization in Korean children with allergic diseases has increased. These changes reflect lifestyle and environmental changes and influence allergic disease management approaches. Thus, changes in allergic sensitization should be monitored continuously.ope

Gram-negative microbiota is related to acute exacerbation in children with asthma

Background: The upper-airway microbiota may be associated with the pathogenesis of asthma and useful for predicting acute exacerbation. However, the relationship between the lower-airway microbiota and acute exacerbation in children with asthma is not well understood. We evaluated the characteristics of the airway microbiome using induced sputum from children with asthma exacerbation and compared the microbiota-related differences of inflammatory cytokines with those in children with asthma. Methods: We analysed the microbiome using induced sputum during acute exacerbation of asthma in children. We identified microbial candidates that were prominent in children with asthma exacerbation and compared them with those in children with stable asthma using various analytical methods. The microbial candidates were analysed to determine their association with inflammatory cytokines. We also developed a predictive functional profile using PICRUSt. Results: A total of 95 children with allergic sensitisation including 22 with asthma exacerbation, 67 with stable asthma, and 6 controls were evaluated. We selected 26 microbial candidates whose abundances were significantly increased, decreased, or correlated during acute exacerbation in children with asthma. Among the microbial candidates, Campylobacter, Capnocytophaga, Haemophilus, and Porphyromonas were associated with inflammatory cytokines including macrophage inflammatory protein (MIP)-1β, programmed death-ligand 1, and granzyme B. Both Campylobacter and MIP-1β levels were correlated with sputum eosinophils. Increased lipopolysaccharide biosynthesis and decreased glycan degradation were observed in children with asthma exacerbation. Conclusion: Gram-negative microbes in the lower airway were related to acute exacerbation in children with asthma. These microbes and associated cytokines may play a role in exacerbating asthma in children.ope

Genome-wide association study identifies BTNL2 associated with atopic asthma in children

Asthma is a heterogeneous disease characterized by chronic airway inflammation with a genetic predisposition. Butyrophilin-like 2 (BTNL2) is a member of the immunoglobulin superfamily that plays an important role in regulating T cell activation and immune homeostasis. Here, we aimed to investigate the association of the genetic variants of BTNL2 with childhood asthma and asthma-related traits by utilizing extreme asthma phenotypes and employing a genome-wide association study. Our study included 243 children with well-defined moderate to severe atopic asthma and 134 healthy children with no history of allergic diseases and allergic sensitization. DNA from these subjects was genotyped using AxiomTM Genome-Wide Array Plates. Although no single nucleotide polymorphisms (SNPs) reached a genome-wide threshold of significance, 3 SNPs, rs3817971, rs41355746, and rs41441651, at BTNL2 were significantly associated with moderate to severe atopic asthma after performing Bonferroni correction. These SNPs were also associated with the risk of allergic sensitization toward house dust mites and the presence and degree of bronchial hyperresponsiveness. Thus, we identified that BTNL2 was associated with atopic moderate to severe persistent asthma in Korean children, and this may play an important role in disease development and susceptibility.ope

SpO 2/FiO 2 as a predictor of high flow nasal cannula outcomes in children with acute hypoxemic respiratory failure

The high-flow nasal cannula (HFNC) is a useful treatment modality for acute hypoxemic respiratory failure (AHRF) in children. We compared the ability of the oxygen saturation to fraction of inspired oxygen ratio (S/F) and arterial oxygen partial pressure to fraction of inspired oxygen ratio (P/F) to predict HFNC outcomes in children with AHRF. This study included children treated with HFNC due to AHRF from April 2013 to March 2019 at the Severance Children's Hospital. HFNC failure was defined as the need for mechanical ventilation. Trends of S/F and P/F during HFNC were analyzed. To predict HFNC outcomes, a nomogram was constructed based on predictive factors. A total of 139 patients with arterial blood gas data were included in the S/F and P/F analyses. S/F < 230 at initiation showed high prediction accuracy for HFNC failure (area under the receiver operating characteristic curve: 0.751). Univariate analyses identified S/F < 230 at HFNC initiation and < 200 at 2 h (odds ratio [OR] 12.83, 95% CI 5.06-35.84), and hemato-oncologic disease (OR 3.79, 95% CI 1.12-12.78) as significant predictive factors of HFNC failure. The constructed nomogram had a highly predictive performance, with a concordance index of 0.765 and 0.831 for the exploratory and validation groups, respectively. S/F may be used as a predictor of HFNC outcomes. Our nomogram with S/F for HFNC failure within 2 h may prevent delayed intubation in children with AHRF.ope

Development of a Multidisciplinary Aerodigestive Program: An Institutional Experience

We share our experience on the implementation of a multidisciplinary aerodigestive program comprising an aerodigestive team (ADT) so as to evaluate its feasibility. We performed a retrospective chart review of the patients discussed at the monthly ADT meetings and analyzed the data. A total of 98 children were referred to the ADT during the study period. The number of cases increased steadily from 3.5 cases per month in 2019 to 8.5 cases per month in 2020. The median age of patients was 34.5 months, and 55% were male. Among the chronic comorbidities, neurologic disease was the most common (85%), followed by respiratory (36%) and cardiac (13%) disorders. The common reasons for consultation were suspected aspiration (56%), respiratory difficulty (44%), drooling/stertor (30%), regurgitation/vomiting (18%), and feeding/swallowing difficulty (17%). Following discussions, 58 patients received active interventions, including fundoplication, gastrostomy, laryngomicrosurgery, tracheostomy, and primary dilatation of the airway. According to the questionnaire of the caregiver, the majority agreed that the main symptoms and quality of life of patients had improved (88%), reducing the burden on caregivers (77%). Aerodigestive programs may provide comprehensive and multidisciplinary management for children with complex airway and digestive tract disorders.ope

Children with Heiner Syndrome: A Single-Center Experience

Heiner syndrome is a rare cause of pulmonary hemosiderosis in children that is triggered by cow's milk allergy. Herein, we describe our experience with three recent cases of Heiner syndrome with diverse clinical courses. We recommend that clinicians should consider the possibility of Heiner syndrome in children who exhibit characteristics of idiopathic pulmonary hemosiderosis.ope

Multidisciplinary aerodigestive program at a children's hospital: A protocol for a prospective observational study

Background: Children with complex chronic multisystemic diseases frequently require care from multiple pediatric subspecialists. The aerodigestive program is a multidisciplinary program that diagnoses and treats pediatric patients with complex multi-systematic problems affecting airway, breathing, feeding, swallowing, or growth. The aim of this study is to present the protocol of the aerodigestive program of a children's hospital. Methods and design: This study is a prospective study to evaluate and compare the overall improvement of patients' objective and subjective conditions before and after the AeroDigestive Team (ADT) program. Among children from 1 month to 18 years of age, patients with complex problems of the airway, breathing, feeding, swallowing, or growth meeting at least two parameters of the inclusion criteria were enrolled. The overall process included referral based on the inclusion criteria, enrollment of ADT program with informed consents, interview and questionnaire for assessing patients' medical condition, prescheduling appointment, multi-specialists' evaluation, monthly team meetings, wrap-up discussion with the patients and family, therapeutic intervention, and follow-up at 6 months with the assessment of outcome measures. The outcome was evaluated objectively and subjectively. The objective outcome measure was divided into surgical or medical intervention, assessment of changes in medical condition, and follow-up study. Both caregiver interviews and questionnaires using a scoring system were used as subjective outcome measures before and after the ADT program. Children were scheduled to be followed-up at 6 months after the interventions or ADT meeting. Discussion: The aerodigestive program is expected to provide comprehensive and multidisciplinary management of children with complex airway and digestive tract disorders.ope

고등학교 가정과 교육과정 개선에 관한 일연구

A. 硏究의 目的 1. 現在 世界的인 敎育課程 改革運動 및 家政科 敎育課程 趨勢를 考察한다. 2. 現行 高等學校 家政科 敎育課程을 分析하고 이를 世界的 敎育課程 改革運動에 비추어 問題點을 抽出한다. 3. 現行 敎育課程의 改善點과 改善方向을 提示한다. B. 硏究方法 文獻硏究와 質問紙에 의한 調査硏究를 병행하였다. 1. 文獻硏究로서 a) 世界的인 敎育課程 改革運動의 考察과 b) 現行 家政科 敎育課程의 分析的 考察을 통하여 現行 敎育課程의 問題點 및 改善方向에 관한 示唆를 받고 2. 調査硏究로서 a) 一線 家政科 敎師 및 敎育課程 作成에 있어 有用한 人士들의 現行 敎育課程에 관한 意見을 調査하고 b) 그에 따라 改善에 관한 示唆點을 抽出한 다음 c) 文獻硏究에서 얻어진 事實과 比較 檢討하였다. C. 硏究의 結果 1. 敎育課程 改善을 위해서는 學問中心 敎育課程 理論이 考慮되어야 한다. 2. 家政科 敎育課程의 改善點으로서는 a) 敎育目標에 대한 再檢討 b) 技能人을 양성하는 것 같은 內容의 再檢討( 잡다한 내용의 축소 ) c) 專門家를 養成하는 것 같은 內容의 再檢討( 이론적면의 축소 ) d) 家族關係, 禮節 등에 관한 補充이 發見되었고 3. 改善方向으로서는 여러 가지 어려움이 豫想되나, 敎育의 效率性을 위해서는 學問中心 敎育課程을 指向하는 方向으로 되는 것이 바람직할 것으로 보인다. 이 밖에도 家政科 敎育 全般에 관한 다음과 같은 示唆를 얻었다. a) 현재 고등학교 敎育課程의 정상적 운영을 저해하고 있는 要因 중 가장 두드러지는 것은 施設 設備라고 指摘되었으나 그 보다는 敎師들 자신의 解決하려는 努力의 缺如도 큰 몫을 차지한다. b) 現行 家政科 敎育課程의 內容領域은 敎師 準備敎育에서 받은 領域보다 훨씬 광범하여 한 敎師가 家政科 全般을 擔當하는데 많은 無理가 따르고 있다. c) 現行 家政科 敎科用 圖書로서 文敎部의 檢定을 받은 敎科書 간에는 內容의 選定에 있어서의 重要度 基準이나 제시된 統計資料의 相違가 發見되는 바 이것은 現場敎師의 困難點으로 대두되고 있다.Ⅰ. 서언 1 A. 연구의 기능 및 목적 1 B. 연구의 내용, 방법 및 절차 2 C. 연구의 제한점 4 Ⅱ. 교육과정 개혁운동 6 A. 교육과정 개혁운동의 배경 6 B. 학문중심 교육과정의 기본원리 14 C. 개혁에 따르는 몇 가지 문제 21 D. 가정과 교육과정의 변혁 27 Ⅲ. 현행 고등학교 가정과 교육과정의 분석적 고찰 35 A. 고등학교 교육과정의 특성 35 B. 가정과 교육과정의 분석적 고찰 40 C. 현행 교육과정의 문제점 53 Ⅳ. 현행 교육과정에 관한 의견조사 61 A. 조사의 설계 및 실행 61 B. 교사의 의견- 조사결과 및 해석 67 C. 기타 인사의 의견-조사결과 및 해석 92 Ⅴ. 요약 및 결어 104 A. 요약 104 B. 결어 110 참고문헌 115 부록 119 1. 고등학교 가정과 교육과정 개선을 위한 의견조사서(교사용) 119 2. 고등학교 가정과 교육과정 개선을 위한 고견청취자료(각계인사용) 12