Publications by authors named "Sowon Park"

23 Publications

  • Page 1 of 1

Development of a Multidisciplinary Aerodigestive Program: An Institutional Experience.

Children (Basel) 2021 Jun 23;8(7). Epub 2021 Jun 23.

Department of Pediatrics, Severance Hospital, Institute of Allergy, Institute for Immunology and Immunological Diseases, Severance Biomedical Science Institute, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul 03722, Korea.

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.
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http://dx.doi.org/10.3390/children8070535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8307318PMC
June 2021

Robust Formation of an Epithelial Layer of Human Intestinal Organoids in a Polydimethylsiloxane-Based Gut-on-a-Chip Microdevice.

Front Med Technol 2020 Aug 7;2. Epub 2020 Aug 7.

Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, United States.

Polydimethylsiloxane (PDMS) is a silicone polymer that has been predominantly used in a human organ-on-a-chip microphysiological system. The hydrophobic surface of a microfluidic channel made of PDMS often results in poor adhesion of the extracellular matrix (ECM) as well as cell attachment. The surface modification by plasma or UV/ozone treatment in a PDMS-based device produces a hydrophilic surface that allows robust ECM coating and the reproducible attachment of human intestinal immortalized cell lines. However, these surface-activating methods have not been successful in forming a monolayer of the biopsy-derived primary organoid epithelium. Several existing protocols to grow human intestinal organoid cells in a PDMS microchannel are not always reproducibly operative due to the limited information. Here, we report an optimized methodology that enables robust and reproducible attachment of the intestinal organoid epithelium in a PDMS-based gut-on-a-chip. Among several reported protocols, we optimized a method by performing polyethyleneimine-based surface functionalization followed by the glutaraldehyde cross linking to activate the PDMS surface. Moreover, we discovered that the post-functionalization step contributes to provide uniform ECM deposition that allows to produce a robust attachment of the dissociated intestinal organoid epithelium in a PDMS-based microdevice. We envision that our optimized protocol may disseminate an enabling methodology to advance the integration of human organotypic cultures in a human organ-on-a-chip for patient-specific disease modeling.
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http://dx.doi.org/10.3389/fmedt.2020.00002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849371PMC
August 2020

Association between Dietary Patterns and Handgrip Strength: Analysis of the Korean National Health and Nutrition Examination Survey Data Between 2014 and 2017.

Nutrients 2020 Oct 5;12(10). Epub 2020 Oct 5.

Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul 03722, Korea.

Non-invasive anthropometric measurement methods such as those for measuring height and weight are crucial in pediatric patients. However, research focusing on the association between the type of dietary pattern and handgrip strength and handgrip-to-weight ratio in adolescents has not been carried out yet. This cross-sectional analysis of the 2014-2017 Korean National Health and Nutrition Examination Survey assessed 2327 adolescents (aged 10-18 years) who had their handgrip strength measured and analyzed its association with dietary pattern. The clusters were examined for nutritional values, and the , and clusters were ultimately generated. Overall, 85.6% of the participants were assigned to a dietary pattern, 9.3% to a dietary pattern, and 5.1% to a dietary pattern. Compared with the participants following a dietary pattern, those following a dietary pattern were shown to have a significantly lower handgrip strength and handgrip-to-weight ratio. Decreased handgrip strength and handgrip-to-weight ratio values in participants following dietary patterns indicate a diffuse problem in adolescents' health and possibly imply an association between reduced muscle quality and dietary pattern. Therefore, the overall environmental factors potentially inducing such unhealthy dietary preferences should be investigated, and appropriate lifestyle changes in Korean adolescents should be encouraged.
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http://dx.doi.org/10.3390/nu12103048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601920PMC
October 2020

Three-Dimensional Regeneration of Patient-Derived Intestinal Organoid Epithelium in a Physiodynamic Mucosal Interface-on-a-Chip.

Micromachines (Basel) 2020 Jul 7;11(7). Epub 2020 Jul 7.

Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX 78712, USA.

The regeneration of the mucosal interface of the human intestine is critical in the host-gut microbiome crosstalk associated with gastrointestinal diseases. The biopsy-derived intestinal organoids provide genetic information of patients with physiological cytodifferentiation. However, the enclosed lumen and static culture condition substantially limit the utility of patient-derived organoids for microbiome-associated disease modeling. Here, we report a patient-specific three-dimensional (3D) physiodynamic mucosal interface-on-a-chip (PMI Chip) that provides a microphysiological intestinal milieu under defined biomechanics. The real-time imaging and computational simulation of the PMI Chip verified the recapitulation of non-linear luminal and microvascular flow that simulates the hydrodynamics in a living human gut. The multiaxial deformations in a convoluted microchannel not only induced dynamic cell strains but also enhanced particle mixing in the lumen microchannel. Under this physiodynamic condition, an organoid-derived epithelium obtained from the patients diagnosed with Crohn's disease, ulcerative colitis, or colorectal cancer independently formed 3D epithelial layers with disease-specific differentiations. Moreover, co-culture with the human fecal microbiome in an anoxic-oxic interface resulted in the formation of stochastic microcolonies without a loss of epithelial barrier function. We envision that the patient-specific PMI Chip that conveys genetic, epigenetic, and environmental factors of individual patients will potentially demonstrate the pathophysiological dynamics and complex host-microbiome crosstalk to target a patient-specific disease modeling.
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http://dx.doi.org/10.3390/mi11070663DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408321PMC
July 2020

Trends in measures of handgrip strength from 2014 to 2017 among Korean adolescents using the Korean National Health and Nutrition Examination Survey Data.

BMC Res Notes 2020 Jun 30;13(1):307. Epub 2020 Jun 30.

Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.

Object: Measuring handgrip strength is a useful method to evaluate sarcopenia. No study has shown the trends of handgrip strength to weight ratio among Korean adolescents by year. This study aimed to determine the trends of handgrip strength among Korean adolescents using data from the Korea National Health and Nutrition Examination Survey (KNHANES). Data of 2304 adolescents who participated in the KNHANES between 2014 and 2017 were obtained. The handgrip-to-weight ratios were categorized by age, sex, and year.

Results: Handgrip strength in adolescents decreased from 28.67 kg in 2014 to 27 kg in 2017 (P for trend < 0.05). The handgrip-to-weight ratio also decreased from 51.48 in 2014 to 48.18 in 2017 (P for trend < 0.05). The handgrip strength and handgrip-to-weight ratio also decreased among boys and girls over the years 2014-2017 (P for trend < 0.05). The results of the present study indicate that the handgrip-to-weight ratio decreased in Korean adolescents from the years 2014 to 2017, and a declining overall ratio indicates a decrease in the health status among Korean adolescents. Hence, there is a need to review the health status of Korean adolescents.
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http://dx.doi.org/10.1186/s13104-020-05112-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7329499PMC
June 2020

Draft Genome Sequences of Two Strains of Bifidobacterium dentium Isolated from a Crude Fecal Extract Used for Fecal Microbiota Transplantation in the Republic of Korea.

Microbiol Resour Announc 2020 Jun 4;9(23). Epub 2020 Jun 4.

Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA

We present the draft genome sequences of two strains isolated from a fecal extract for fecal microbiota transplantation at a hospital in the Republic of Korea. Phylogenetic and functional analyses were performed to understand the physiological characteristics and functions of spp. in the human intestine.
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http://dx.doi.org/10.1128/MRA.00197-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272543PMC
June 2020

Validating the BAVENO VI criteria to identify low risk biliary atresia patients without endoscopy for esophageal varix.

Clin Res Hepatol Gastroenterol 2021 Jan 13;45(1):101437. Epub 2020 May 13.

Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Severance Pediatric Liver Disease Research Group, Seoul, Republic of Korea. Electronic address:

Background And Aims: Portoenterostomy is the initial surgical treatment for biliary atresia (BA); however, no curative therapy exists for BA. Varix bleeding is a major complication of end-stage liver disease and must be determined in patients with BA, necessitating routine surveillance using esophagogastroduodenoscopy (EGD). We attempted to validate criteria to identify BA patients requiring EGD.

Methods: From January 2007 to December 2017, we selected BA patients who underwent Kasai surgery, transient elastography (TE), and EGD at Severance hospital. In total, 190 cases were included; laboratory tests and EGDs were carried out from 3 months before TE to 3 months after TE.

Results: Based on the cut-off value (<10) of the liver stiffness measurement (LSM), 35 (81.4%) patients with low-risk varix (LRV) and 8 (18.6%) with high-risk varix (HRV) were identified. Based on platelet counts (>150,000), 87 (77.68%) patients with LRV and 25 (22.32%) with HRV were identified. Based on this, the BAVENO VI criteria, which identify patients who can safely avoid screening EGD, missed 9/68 (13.24%) of HRV patients. The expanded BAVENO VI criteria missed 21/68 (30.88%) of HRV patients. However, the criteria using LSM <10 and platelet count >150,000 missed identifying only 4/68 (5.88%) HRV patients.

Conclusions: The BAVENO criteria may be as useful in children with BA as in adults with liver cirrhosis. Regular laboratory tests, imaging studies, and EGD may avoid missing diagnoses of varices in BA patients. However, LSM<10 and platelet count>150,000 may provide more accurate criteria and help identify patients who does not need endoscopy.
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http://dx.doi.org/10.1016/j.clinre.2020.04.007DOI Listing
January 2021

Antimicrobial resistance and novel mutations detected in the gyrA and parC genes of Pseudomonas aeruginosa strains isolated from companion dogs.

BMC Vet Res 2020 Apr 15;16(1):111. Epub 2020 Apr 15.

Department of Veterinary Internal Medicine, Konkuk University College of Veterinary Medicine, Seoul, South Korea.

Background: Fluoroquinolone agents, such as enrofloxacin and marbofloxacin, are commonly used for pseudomonal infection in veterinary medicine. However, the rate of resistance to fluoroquinolones is rapidly increasing, according to multiple studies in various countries. Point mutations in the quinolone resistance-determining region (QRDR) are closely related to the increased fluoroquinolone resistance of Pseudomonas aeruginosa. The aim of this study was to investigate current antimicrobial susceptibility and fluoroquinolone resistance in P. aeruginosa strains isolated from dogs. The presence of point mutations in the QRDR was confirmed by gyrA and parC polymerase chain reaction and nucleotide sequencing analysis.

Results: A total of 84 nonduplicated P. aeruginosa strains were obtained from 228 healthy dogs (healthy group) and 260 dogs with clinical signs (infected group). Among these isolates, 38 strains from the healthy group were detected in several sample types, whereas 46 strains from the infected group were obtained mostly from dogs' ears with otitis externa (41/260, 15.8%). All strains were resistant to nalidixic acid, while some were also resistant to enrofloxacin (23/84, 27.4%), marbofloxacin (17/84, 20.2%), levofloxacin (12/84, 14.3%), or ciprofloxacin (11/84, 13.1%). Enrofloxacin resistance was significantly higher in strains from the infected group than in those from the healthy group (p < 0.05). Among the 23 fluoroquinolone-resistant strains, 8 and 4 different mutations were detected in the gyrA and parC genes, respectively. Mutations in gyrA were significantly common in the infected group (p < 0.05). Hotspots for the gyrA and parC mutations were Thr83 (34.8%, 8/23) and Pro116 (91.3%, 21/23), respectively. Double and triple mutations were also found in 5 of the strains.

Conclusion: Novel mutations in the gyrA and parC genes were first found in P. aeruginosa isolated from companion dogs in South Korea. These findings suggest that it is important to encourage prudent use of fluoroquinolone antibiotics in canine pseudomonal infection treatment.
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http://dx.doi.org/10.1186/s12917-020-02328-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158017PMC
April 2020

In Situ Profiling of the Three Dominant Phyla Within the Human Gut Using TaqMan PCR for Pre-Hospital Diagnosis of Gut Dysbiosis.

Int J Mol Sci 2020 Mar 11;21(6). Epub 2020 Mar 11.

School of Applied Biosciences, College of Agriculture and Life Sciences, Kyungpook National University, Daegu 41566, Korea.

A microbial imbalance called dysbiosis leads to inflammatory bowel disease (IBD), which can include ulcerative colitis (UC). Fecal microbiota transplantation (FMT), a novel therapy, has recently been successful in treating gut dysbiosis in UC patients. For the FMT technique to be successful, the gut microbiota of both the healthy donors and UC patients must be characterized. For decades, next-generation sequencing (NGS) has been used to analyze gut microbiota. Despite the popularity of NGS, the cost and time constraints make it difficult to use in emergency services and activities related to the periodic monitoring of microbiota profile alterations. Hence, in this study, we developed a multiplex TaqMan qPCR assay (MTq-PCR) with novel probes to simultaneously determine the relative proportions of the three dominant microbial phyla in the human gut: Bacteroidetes, Firmicutes, and Proteobacteria. The relative proportions of the three phyla in fecal samples of either healthy volunteers or UC patients were similar when assessed NGS and the MTq-PCR. Thus, our MTq-PCR assay could be a practical microbiota profiling alternative for diagnosing and monitoring gut dysbiosis in UC patients during emergency situations, and it could have a role in screening stool from potential FMT donors.
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http://dx.doi.org/10.3390/ijms21061916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139488PMC
March 2020

Increasing incidence of inflammatory bowel disease in children and adolescents: significance of environmental factors.

Clin Exp Pediatr 2020 Sep 6;63(9):337-344. Epub 2019 Dec 6.

Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Pediatric IBD Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.

Inflammatory bowel disease (IBD) is a chronic relapsing immune-mediated disease of the intestinal tract. Although its prevalence is reportedly lower in Asia than in Western countries, the rapid increase in the incidence of IBD has drawn attention to its etiology, including genetic susceptibility and environmental factors. Specifically, recent studies concerning dietary treatments and intestinal microbiota suggest that these factors may interact with the immune system, and the imbalance of this relationship may lead to immune dysregulation in IBD. Changes in diet or alterations in the composition of the intestinal microbiota may be associated with the increasing incidence of IBD in Asia. Here, we aim to review recent studies on the role of diet and intestinal microbiota in IBD pathogenesis and the results of the investigations performed to modulate these factors.
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http://dx.doi.org/10.3345/cep.2019.00500DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462828PMC
September 2020

Combining faecal calprotectin and sigmoidoscopy can predict mucosal healing in paediatric ulcerative colitis.

Eur J Gastroenterol Hepatol 2020 01;32(1):17-21

Pediatric Gastroenterology, Hepatology and Nutrition, Yonsei University College of Medicine, Severance Pediatric IBD Research Group, Severance Children's Hospital, Seoul.

Objectives: Mucosal healing is the endoscopic treatment target in inflammatory bowel disease. The treat-to-target strategy, emphasizing proactive assessment and optimizing treatment, is commonly applied in the clinical setting. Although colonoscopies are essential for this strategy to be successful, bowel preparation and sedative drugs are required for paediatric patients. We attempted to verify the usefulness of sigmoidoscopy, which is less invasive than colonoscopy, combined with faecal calprotectin, to assess mucosal healing.

Methods: A total of 58 paediatric patients diagnosed with ulcerative colitis and followed up at Severance Children's Hospital from March 2015 to May 2018 were enrolled. Clinical data and laboratory findings (including faecal calprotectin and endoscopic data) were collected from medical records. The predictive power of mucosal healing of sigmoid colon and rectum (s-MH) combined with faecal calprotectin to predict mucosal healing throughout the colon was analysed.

Results: Among 58 patients (mean age 16.13 ± 2.88 years), 18 (31.0%) were in mucosal healing status. The median faecal calprotectin level was 486.5 μg/g. The faecal calprotectin cutoff value for predicting mucosal healing, identified using receiver-operating characteristic analyses, was 148 μg/g (area under the curve, 0.81). Sensitivity, specificity, positive predictive value, and negative predictive value of s-MH in predicting mucosal healing were 1.0, 0.82, 0.72, and 1.0, respectively. When we combined s-MH with faecal calprotectin less than the cutoff value, the sensitivity, specificity, positive predictive value, and negative predictive value were 0.56, 1.0, 1.0, and 0.83, respectively.

Conclusion: For patients with a low faecal calprotectin level, sigmoidoscopy might be sufficient to assess mucosal healing.
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http://dx.doi.org/10.1097/MEG.0000000000001550DOI Listing
January 2020

Predicting variceal bleeding in patients with biliary atresia.

Scand J Gastroenterol 2019 Nov 24;54(11):1385-1390. Epub 2019 Oct 24.

Pediatric Gastroenterology, Hepatology and Nutrition, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Korea.

Variceal bleeding is the main cause of morbidity and mortality in children with portal hypertension and biliary atresia. The aim of this study is to predict high-risk varices by analyzing various clinical factors, thus improve prognosis of patients with biliary atresia. A total of 157 patients with biliary atresia who underwent Kasai portoentrostomy were enrolled in a single center. Clinical data including laboratory values, endoscopic findings and values of transient elastography (FibroScan) were analyzed retrospectively. The bleeding group and the non-bleeding group showed statistically significant differences in several variables; The FibroScan value (HR 1.05, 95% CI (1.03-1.07),   <  .01) was higher in the bleeding group. The bleeding group had values of lower albumin after 3 months of operation (HR 0.28, 95% CI (0.11-0.73),   =  .01), higher bilirubin after 3 months of operation (total bilirubin: HR 1.18, 95% CI (1.04-1.33),   =  .01), (direct bilirubin: HR 1.21, 95% CI (1.05-1.41),   =  .01). Gastric varix (HR 4.10, 95% CI (1.62-10.36),   <  .01) was more frequent in the bleeding group. And the presence of red sign was also predictive of bleeding. The FibroScan cut-off value with the predictive power of bleeding was 31.5 kPa (HR 7.7, 95% CI (3.36-17.73),   <  .01). Several clinical factors including high value of transient elastography (FibroScan), gastric varix or red sign of endoscopy, and low albumin or high bilirubin values after 3 months of Kasai operation can be useful in predicting variceal bleeding in patients with biliary atresia.
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http://dx.doi.org/10.1080/00365521.2019.1683225DOI Listing
November 2019

Association of Vitamin D with Inflammatory Bowel Disease Activity in Pediatric Patients.

J Korean Med Sci 2019 Aug 19;34(32):e204. Epub 2019 Aug 19.

Pediatric Gastroenterology, Hepatology and Nutrition, Severance Pediatric IBD Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.

Background: It has been known that vitamin D level (serum 25[OH]D) has correlation with inflammatory bowel disease (IBD). The purpose of this study is to investigate changes of serum 25[OH]D in pediatric IBD patients according to the disease activity.

Methods: A total of 96 children and adolescent with IBD were enrolled in this retrospective study. Serologic inflammatory markers and clinical disease activity scores of the patients were collected, and their correlations with serum 25[OH]D were analyzed. Seasonal variations of serum 25[OH]D were also investigated both in active disease state and remission state.

Results: Of the 96 patients, 41 (43%) were women and patients with a vitamin D deficiency (< 20 ng/mL) at diagnosis were 77 (80.2%). There was no significant difference between Crohn's disease and ulcerative colitis for serum 25[OH]D. Serum 25[OH]D was higher in remission group than in active disease group (12.4 [8.8-29] ng/mL vs. 17.9 [12.3-34.4] ng/mL; < 0.001) and the difference was more significant than other micronutrients. There was no significant difference in serum 25[OH]D concentration between patients with ileal involvement and patients without ileal involvement. There were seasonal variations in the active phase, but there was no significant difference by season in the remission phase.

Conclusion: Serum 25[OH]D is inversely correlated with disease activity in IBD. Monitoring and supplementation is required especially for active disease status and in winter and spring season.
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http://dx.doi.org/10.3346/jkms.2019.34.e204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698452PMC
August 2019

Micronutrients Are Not Deficient in Children with Nonorganic Failure to Thrive.

Pediatr Gastroenterol Hepatol Nutr 2019 Mar 4;22(2):181-188. Epub 2019 Mar 4.

Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Pediatric IBD Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.

Purpose: Inadequate calorie intake is one of the most important causes of nonorganic failure to thrive (NOFTT) and is thought to lead to multiple micronutrient deficiencies. However, there have been few studies on NOFTT and micronutrients. The aim of this study was to evaluate the micronutrient status of children with NOFTT.

Methods: We conducted a retrospective cohort study in 161 children (106 with NOFTT and 55 health controls) at a single institution. Data on weight for age, height for age, body mass index, and biochemical parameters, indicating the children's nutritional and micronutrient status were reviewed via electronic medical records, and the two groups were compared.

Results: Except inorganic phosphate levels, no statistically significant differences were seen in the laboratory findings indicating the children's nutritional and micronutrient status; notably, the inorganic phosphate levels were within the normal range in both groups. We then compared the severe NOFTT (weight for age below the first percentile) and control groups; however, no statistically significant differences were seen for any of the measured parameters.

Conclusion: Most children with NOFTT in this study had normal micronutrient levels and other laboratory findings. Therefore, element deficiencies should not be considered a natural consequence of NOFTT or in healthy children. Close monitoring and additional evaluations are needed.
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http://dx.doi.org/10.5223/pghn.2019.22.2.181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6416380PMC
March 2019

Therapeutic Efficacy of Exclusive Enteral Nutrition with Specific Polymeric Diet in Pediatric Crohn's Disease.

Pediatr Gastroenterol Hepatol Nutr 2019 Jan 10;22(1):72-79. Epub 2019 Jan 10.

Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.

Purpose: The efficacy of exclusive enteral nutrition (EEN) with a polymeric diet has not been confirmed in Korean pediatric patients with Crohn's disease (CD). This study aimed to compare the effectiveness of EEN with a specific polymeric diet (Encover®) and corticosteroids (CSs) for the induction of remission in Korean pediatric CD patients.

Methods: We retrospectively compared data from 51 pediatric CD patients who underwent induction therapy with EEN (n=19) or CSs (n=32) at Severance Children's Hospital or Incheon St. Mary's Hospital in Korea. The primary endpoint of this study was the rate of clinical remission, defined as a Pediatric Crohn's Disease Activity Index (PCDAI) score <10, after 8 weeks of induction treatment. Clinical, laboratory, and growth data at post-induction as well as their changes from baseline were also compared between groups.

Results: After 8 weeks of induction therapy, clinical remission rates were 78.9% (15/19) and 65.6% (21/32) in the EEN and CS groups, respectively (=0.313). No significant differences in PCDAI scores, laboratory variables, and growth parameters were noted between the two groups at post-induction. However, significant changes in albumin levels at post-induction were observed in the EEN group compared to the CS group (=0.038).

Conclusion: Our results suggest that the effectiveness of EEN with a polymeric diet and CSs for induction therapy did not differ in Korean pediatric CD patients. EEN with a polymeric diet is a good first-line treatment option for the induction of remission in these patients.
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http://dx.doi.org/10.5223/pghn.2019.22.1.72DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6333584PMC
January 2019

Handgrip Strength Among Korean Adolescents With Metabolic Syndrome in 2014-2015.

J Clin Densitom 2020 Apr - Jun;23(2):271-277. Epub 2018 Sep 8.

Pediatric Gastroenterology, Hepatology and Nutrition, Yonsei University College of Medicine, Severance Pediatric Liver Disease Research Group, Severance Children's Hospital, Seoul, Republic of Korea. Electronic address:

The prevalence of metabolic syndrome is increasing worldwide in adolescents. Metabolic syndrome is a systemic disease that is likely to be associated with other diseases. Studies have shown a relationship between muscle strength, muscle quality, and metabolic syndrome. Handgrip strength is known as a simple tool to measure muscle strength. Therefore, we aimed to investigate the relationship between handgrip strength and metabolic syndrome and each metabolic syndrome features in adolescents. Data were obtained from 1050 adolescents (574 boys, 476 girls; age 10-18 years) who participated in the Korea National Health and Nutrition Examination Survey. We used the International Diabetes Federation metabolic syndrome guideline and National Cholesterol Education Program Adult Treatment Panel III guideline for children to define metabolic syndrome. The highest handgrip strength for both hands was recorded. Handgrip strength was also divided by the participants' own weight (handgrip-to-weight ratio). Adolescents with metabolic syndrome defined by each guideline have higher handgrip strength (p < 0.05). When handgrip strength was divided with participants' own body weight (handgrip-to-weight ratio), values were decreased in participants with metabolic syndrome (p < 0.05). The male participants tend to have higher handgrip-to-weight ratio than female. However, the handgrip-to-weight ratio was found to be decreased regardless of gender when the metabolic syndrome feature was present. This study shows that handgrip strength is associated with metabolic syndrome in adolescents. This is the first study to compare handgrip strength and metabolic syndrome in Korean adolescents. Given that handgrip strength is associated with metabolic syndrome in adolescents, it can be a diagnostic modality to easily identify the patients' current state in the clinic.
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http://dx.doi.org/10.1016/j.jocd.2018.09.002DOI Listing
July 2021

Can We Estimate Quality of Life in Pediatric Inflammatory Bowel Disease Patients? An Asian Multicenter Study.

J Pediatr Gastroenterol Nutr 2019 01;68(1):45-49

Pediatric Gastroenterology, Hepatology and Nutrition, Yonsei University College of Medicine, Severance Pediatric IBD Research Group, Severance Children's Hospital, Seoul.

Objectives: Inflammatory bowel disease (IBD) is a chronic lifelong condition and is related to poor quality of life (QoL). The aim of this study was to evaluate the QoL of Asian pediatric patients with IBD and to determine the clinical factors that can influence QoL.

Methods: Children and adolescents aged 9 to 18 years diagnosed with IBD were enrolled from 7 hospitals. The patients completed the IMPACT-III questionnaire, and clinical data were collected. The results of the questionnaire and the correlation with clinical data were analyzed.

Results: A total of 208 patients (Crohn disease: n = 166; ulcerative colitis: n = 42) were enrolled. There was no definite QoL difference according to the Paris classification. Female sex (-5.92 ± 2.97, P = 0.0347) and active disease status (-10.79 ± 3.11, P = 0.0006) were significantly associated with poor QoL. Extreme body weight z score and older age at diagnosis were also associated with worse QoL.

Conclusions: Various clinical factors may affect the QoL in patients with IBD, but determining the overall QoL of patients using only these clinical factors is difficult. Therefore, regular direct measurements of QoL are necessary to better understand patients with IBD.
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http://dx.doi.org/10.1097/MPG.0000000000002119DOI Listing
January 2019

Medical staff tend to underestimate the quality of life in children and adolescents with inflammatory bowel disease.

Acta Paediatr 2019 01 7;108(1):138-142. Epub 2018 Aug 7.

Pediatric Gastroenterology, Hepatology and Nutrition, Severance Pediatric IBD Research Group, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.

Aim: We evaluated how well medical staff or parents understood patients with inflammatory bowel disease (IBD) by comparing their evaluation of the patients' quality of life (QoL) with the patients' self-reported QoL.

Methods: This study was carried out at Severance Children's Hospital in Seoul, Korea, in 2017. The children with IBD were recruited from August 2017 to December 2017, and they had a mean age of 16.4 (range 9.3-18.9) years. We asked the 64 children (38 boys), 58 mothers, 16 fathers, three physicians and one IBD nurse to answer the IMPACT-III questionnaire, which measures QoL, and compared the scores.

Results: The intraclass correlation coefficient of the total IMPACT-III score was highest for the patient and their father (0.824) and then for the patient and their mother (0.689), physician (0.625) and IBD nurse (0.499). Parents and medical staff thought the patients' QoL was lower than the patients themselves. The differences in the IMPACT-III scores of the patients were -10.09 ± 17.86 for physicians, -9.87 ± 15.80 for mothers, -5.72 ± 17.04 for nurses and -3.81 ± 11.82 for fathers.

Conclusion: Parents and medical staff showed some correlation with the QoL documented by adolescent IBD patients, but tended to underestimate the levels.
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http://dx.doi.org/10.1111/apa.14498DOI Listing
January 2019

Normal serum alanine aminotransferase and non-alcoholic fatty liver disease among Korean adolescents: a cross-sectional study using data from KNHANES 2010-2015.

BMC Pediatr 2018 07 5;18(1):215. Epub 2018 Jul 5.

Department of Pediatrics, Severance Children's Hospital, Severance Pediatric Liver Disease Research Group, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.

Background: Non-alcoholic fatty liver disease (NAFLD) is complicated disease and increasing worldwide. Previously, many studies of NALFD prevalences have used alanine aminotransferase (ALT) of > 40 U/L to define NAFLD, although that is too high to be reliable among adolescents. This study aimed to define the upper normal limit of ALT among Korean adolescents, and use it to estimate the prevalence of NAFLD, based on data from the Korea National Health and Nutrition Examination Survey (KNHANES).

Methods: Data were obtained from 1785 healthy adolescents (916 boys and 869 girls, 10-18 years old) who participated in the KNHANES during 2010-2015. The International Diabetes Federation metabolic syndrome criteria for adolescents were used to exclude participants with metabolic syndrome components. Furthermore, participants who previously had diseases related to low HDL levels, high TG levels, diabetes, or very low/high body mass index and hepatitis B were excluded. The 95th percentiles level of ALT from healthy participants were evaluated. The definition of NAFLD was overweight status (≥85th percentile of body mass index) plus elevated ALT levels (95th percentile).

Results: The upper normal ALT were 24.1 U/L for boys and 17.7 U/L for girls. Based on these values, the estimated prevalences of NAFLD in 2015 were 8.9% among adolescents.

Conclusion: Defining the upper normal limit of ALT can be adjusted for each sex and ethnics in the general population. ALT laboratory thresholds used for children should be re-examined. The physicians should be aware not to underdiagnose NAFLD patient even ALT level is < 40 U/L.
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http://dx.doi.org/10.1186/s12887-018-1202-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6034238PMC
July 2018

Estimated Prevalence of Adolescents with Nonalcoholic Fatty Liver Disease in Korea.

J Korean Med Sci 2018 Apr 2;33(14):e109. Epub 2018 Apr 2.

Department of Pediatrics, Severance Children's Hospital, Severance Pediatric Liver Research Group, Yonsei University College of Medicine, Seoul, Korea.

Background: Nonalcoholic fatty liver disease (NAFLD) has become prevalent worldwide in the last decade. However, the recent prevalence of NAFLD in adolescents has not yet been investigated in Korea.

Methods: Data were obtained from 1,416 participants aged 10-18 years from the Korea National Health and Nutrition Examination Survey conducted in 2010 and 2015. Systolic blood pressure (SBP), diastolic blood pressure (DBP), height, weight, waist circumference (WC), body mass index (BMI), fasting glucose, total cholesterol, high-density lipoprotein (HDL), aspartate aminotransferase (AST), alanine aminotransferase (ALT) level, waist-to-height ratio (WHtR), and pediatric NAFLD fibrosis index (PNFI) were analyzed.

Results: SBP, weight, WC, BMI, WHtR, and total cholesterol level were significantly higher in 2015 than in 2010. Prevalence of NAFLD (BMI ≥ 85th percentile plus ALT > 30 U/L for boys and ALT > 19 U/L for girls) were 4.7% in 2010 and 5.9% in 2015 (P = 0.360). Using various cutoffs for the ALT level (> 40, > 30, > 25.8 U/L for boys and >22.1 U/L for girls) NAFLD prevalence rates were 3.0%, 4.1%, and 5.5% in 2010; 2.9%, 5.0%, and 7.1% in 2015, respectively (P = 0.899, 0.469, and 0.289). Boys had a higher SBP, DBP, height, weight, WC, BMI, WHtR, fasting glucose, total cholesterol, ALT, and lower HDL level than girls. The probability of liver fibrosis using the PNFI varies between 21.3% and 24.5% among NAFLD participants (P < 0.001).

Conclusion: The Korean society needs to quickly control the increasing prevalence of NAFLD in adolescents and reduce its complications.
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http://dx.doi.org/10.3346/jkms.2018.33.e109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5879040PMC
April 2018

Alpers-Huttenlocher Syndrome First Presented with Hepatic Failure: Can Liver Transplantation Be Considered as Treatment Option?

Pediatr Gastroenterol Hepatol Nutr 2017 Dec 22;20(4):259-262. Epub 2017 Dec 22.

Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.

Mitochondria play essential role in eukaryotic cells including in the oxidative phosphorylation and generation of adenosine triphosphate via the electron-transport chain. Therefore, defects in mitochondrial DNA (mtDNA) can result in mitochondrial dysfunction which leads to various mitochondrial disorders that may present with various neurologic and non-neurologic manifestations. Mutations in the nuclear gene polymerase gamma () are associated with mtDNA depletions, and Alpers-Huttenlocher syndrome is one of the most severe manifestations of mutation characterized by the clinical triad of intractable seizures, psychomotor regression, and liver failure. The hepatic manifestation usually occurs late in the disease's course, but in some references, hepatitis was reportedly the first manifestation. Liver transplantation was considered contraindicated in Alpers-Huttenlocher syndrome due to its poor prognosis. We acknowledged a patient with the first manifestation of the disease being hepatic failure who eventually underwent liver transplantation, and whose neurological outcome improved after cocktail therapy.
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http://dx.doi.org/10.5223/pghn.2017.20.4.259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750381PMC
December 2017

The inhibitory effects of antimuscarinic autoantibodies in the sera of primary Sjogren syndrome patients on the gastrointestinal motility.

Mol Immunol 2013 Dec 1;56(4):583-7. Epub 2013 Aug 1.

Department of Physiology, School of Dentistry, Seoul National University and Dental Research Institute, Seoul, Republic of Korea. Electronic address:

Impairment of gastrointestinal tract (GI) function, including delayed gastric emptying and colonic dysmotility, are common features of primary Sjögren's syndrome (SS). However, the pathogenesis remains largely unknown. The aim of the current study was to investigate the role of functional autoantibodies to the muscarinic receptor in mediating GI dysfunction associated with primary SS. The effect of SS or normal immunoglobulin G (IgG) on smooth muscle (SM) motility was assessed by comparing the amplitude of carbachol (CCh) or electrical field stimulation (EFS) - induced muscle contraction before and after IgG application. Muscarinic receptor type 3 (M3R) played a dominant role in both colon and gastric SM contraction, while M2R was partly involved in gastric smooth muscle contraction. Preincubation for 1h of the colon and gastric SM strips with 1mg/ml purified IgG from the sera of four primary SS patients (SS IgG) significantly inhibited carbachol-induced smooth muscle contraction (CISC) over a range of CCh concentrations, whereas IgG from healthy controls had little effect. Incubation of the colon SM strips with SS IgG also inhibited EFS-induced colon muscle contraction, which was mimicked by the M3R-selective blocker, 4-DAMP. SR1403330, an NK1 antagonist, had little effect on EFS-mediated colonic SM contraction. The results suggest that autoantibodies isolated from primary SS patients' sera inhibit muscarinic receptor-mediated cholinergic neurotransmission in mouse colon and stomach, which may provide clues for explaining the GI dysfunction seen in patients with primary SS.
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http://dx.doi.org/10.1016/j.molimm.2013.06.004DOI Listing
December 2013
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