Background/Aims: The protective effects of vitamin D and calcium on colorectal neoplasms are known. Bone mineral density (BMD) may be a reliable biomarker that reflects the long-term anticancer effect of vitamin D and calcium. This study aimed to evaluate the association between BMD and colorectal adenomas including high-risk adenoma. Methods: A multicenter, cross-sectional, case-control study was conducted among participants with average risk of colorectal cancer who underwent BMD and screening colonoscopy between 2015 and 2019. The main outcome was the detection of colorectal neoplasms. The variable under consideration was low BMD (osteopenia/osteoporosis). The logistic regression model included baseline demographics, components of metabolic syndrome, fatty liver disease status, and aspirin and multivitamin use. Results: A total of 2,109 subjects were enrolled. The mean age was 52.1±10.8 years and 42.6% were male. The adenoma detection rate was 43%. Colorectal adenoma and high-risk adenoma were both more prevalent in subjects with low BMD than those with normal BMD (48.2% vs 38.8% and 12.1% vs 9.1%). In the univariate analysis, old age, male sex, smoking, metabolic components, fatty liver, and osteoporosis were significantly associated with the risk of adenoma and high-risk adenoma. In the multivariate analysis, osteoporosis was independently associated with risk of colorectal adenoma (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.11 to 2.46; p=0.014) and high-risk adenoma (OR, 1.94; 95% CI, 1.14 to 3.29; p=0.014). Conclusions Osteoporosis is an independent risk factor of colorectal adenoma and high-risk adenoma

The accuracy and convenience of continuous glucose monitoring (CGM), which efficiently evaluates glycemic variability and hypoglycemia, are improving. There are two types of CGM: professional CGM and personal CGM. Personal CGM is subdivided into real-time CGM (rt-CGM) and intermittently scanned CGM (isCGM). CGM is being emphasized in both domestic and foreign diabetes management guidelines. Regardless of age or type of diabetes, CGM is useful for diabetic patients undergoing multiple insulin injection therapy or using an insulin pump. rt-CGM is recommended for all adults with type 1 diabetes (T1D), and can also be used in type 2 diabetes (T2D) treatments using multiple insulin injections. In some cases, short-term or intermittent use of CGM may be helpful for patients with T2D who use insulin therapy other than multiple insulin injections and/or oral hypoglycemic agents. CGM can help to achieve A1C targets in diabetes patients during pregnancy. CGM is a safe and cost-effective alternative to self-monitoring blood glucose in T1D and some T2D patients. CGM used in diabetes management works optimally with proper education, training, and follow up. To achieve the activation of CGM and its associated benefits, it is necessary to secure sufficient repetitive training and time for data analysis, management, and education. Various supports such as compensation, insurance coverage expansion, and reimbursement are required to increase the effectiveness of CGM while considering the scale of benefit recipients, policy priorities, and financial requirements.

PURPOSE: With the emergence of next-generation sequencing (NGS) technology, profiling a wide range of genomic alterations has become a possibility resulting in improved implementation of targeted cancer therapy. In Asian populations, the prevalence and spectrum of clinically actionable genetic alterations has not yet been determined because of a lack of studies examining high-throughput cancer genomic data. MATERIALS AND METHODS: To address this issue, 1,071 tumor samples were collected from five major cancer institutes in Korea and analyzed using targeted NGS at a centralized laboratory. Samples were either fresh frozen or formalin-fixed, paraffin embedded (FFPE) and the quality and yield of extracted genomic DNA was assessed. In order to estimate the effect of sample condition on the quality of sequencing results, tissue preparation method, specimen type (resected or biopsied) and tissue storage time were compared. RESULTS: We detected 7,360 non-synonymous point mutations, 1,164 small insertions and deletions, 3,173 copy number alterations, and 462 structural variants. Fifty-four percent of tumors had one or more clinically relevant genetic mutation. The distribution of actionable variants was variable among different genes. Fresh frozen tissues, surgically resected specimens, and recently obtained specimens generated superior sequencing results over FFPE tissues, biopsied specimens, and tissues with long storage duration. CONCLUSION: In order to overcome, challenges involved in bringing NGS testing into routine clinical use, a centralized laboratory model was designed that could improve the NGS workflows, provide appropriate turnaround times and control costs with goal of enabling precision medicine.
Academies and Institutes ; Asian Continental Ancestry Group ; DNA ; Humans ; Korea ; Methods ; Paraffin ; Point Mutation ; Precision Medicine ; Prevalence

BACKGROUND: Iodine is an intrinsic element of thyroid hormone, which is essential for childhood growth and development. The Ideal Breast Milk (IBM) cohort study aims to evaluate the effects of maternal iodine status during pregnancy and lactation on maternal thyroid function, offspring growth and development, and offspring thyroid function. METHODS: The IBM cohort study recruited pregnant women from Seoul National University Hospital between June 2016 and August 2017, followed by enrollment of their offspring after delivery. For the maternal participants, iodine status is evaluated by urinary iodine concentration (UIC) and dietary records in the third trimester and at 3 to 4 weeks and 12 to 15 months postpartum. For the child participants, cord blood sampling and UIC measurements are performed at birth. At 3 to 4 weeks of age, UIC and breastmilk iodine concentrations are measured. At 12 to 15 months of age, growth and development are assessed and measurements of UIC, a thyroid function test, and ultrasonography are performed. RESULTS: A total of 198 pregnant women in their third trimester were recruited. Their mean age was 35.1±3.5 years, and 78 (39.4%) of them were pregnant with twins. Thirty-three (16.7%) of them had a previous history of thyroid disease. CONCLUSION: Korea is an iodine-replete area. In particular, lactating women in Korea are commonly exposed to excess iodine due to the traditional practice of consuming brown seaweed soup postpartum. The study of the IBM cohort is expected to contribute to developing guidelines for optimal iodine nutrition in pregnant or lactating women.
Breast* ; Child ; Cohort Studies* ; Cordocentesis ; Diet Records ; Female ; Growth and Development* ; Humans ; Infant ; Iodine* ; Korea ; Lactation* ; Milk, Human* ; Parturition ; Postpartum Period ; Pregnancy Trimester, Third ; Pregnancy* ; Pregnant Women ; Prospective Studies* ; Seaweed ; Seoul ; Thyroid Diseases ; Thyroid Function Tests ; Thyroid Gland* ; Twins ; Ultrasonography

PURPOSE: A distal tibiofibular syndesmosis injury with an ankle fracture is usually fixed with syndesmotic screws. Knotless Tightrope® has been used as an alternative procedure because of the fewer reported complications. Therefore, this study compared the two surgeries. MATERIALS AND METHODS: Forty-two patients, who underwent syndesmotic screw fixation, and 34 patients, who underwent Knotless Tightrope® fixation for distal tibiofibular syndesmosis injury from February 2014 to February 2016, were analyzed retrospectively. The visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, range of motion of ankle at 1 year after surgery, tibiofibular clear space, and tibiofibular interval at preoperative, postoperative and 1 year after surgery were investigated. RESULTS: The VAS score, AOFAS score and radiographs were similar in the two groups. Knotless Tightrope® showed better results in complications and plantarflexion. CONCLUSION: Knotless Tightrope® fixation is a useful treatment that does not show a difference in fixation strength and clinical outcome. Knotless Tightrope® fixation also has an advantage in the range of motion and complications.
Ankle Fractures* ; Ankle Injuries ; Ankle Joint* ; Ankle* ; Bone Screws ; Foot ; Humans ; Range of Motion, Articular ; Retrospective Studies ; Suture Anchors

STUDY DESIGN: Retrospective case-control study. OBJECTIVES: To compare the clinical and radiographic outcomes of a hybrid construct (HC) of cervical artificial disc replacement (CADR) combined with anterior cervical discectomy and fusion (ACDF) (group I) with 2-level ACDF (group II) in patients with 2-level cervical disc disease. SUMMARY OF LITERATURE REVIEW: ACDF is reported to potentially promote degenerative changes in the adjacent segment. CADR has been expected to reduce the risk of adjacent segment degeneration. However, its clinical course has yet to be sufficiently clarified. MATERIALS AND METHODS: Twenty-six patients underwent 2-level cervical disc surgery. Single-level CADR combined with ACDF was performed in 14 patients. Twelve patients underwent 2-level ACDF. Clinical profiles were assessed using the neck disability index (NDI) and visual analogue scale scores of arm and neck pain. Dynamic lateral cervical radiographs were obtained preoperatively and at 1, 6, 12, and 18 months postoperatively. The range of motion (ROM) of the overall cervical spine (C2-7) and the adjacent segments was measured. RESULTS: Group I showed superior NDI 18 months postoperatively (p < 0.05). The mean C2-7 ROM of both groups recovered to the preoperative ROM. At 18 months postoperatively, the C2-7 ROM of group I was higher than that of group II (p < 0.05). The superior adjacent segment ROM was higher in group II (p < 0.05), starting at 6 months. The inferior adjacent segment ROM showed no significant difference between the groups (p>0.05). CONCLUSIONS: The HC group showed comparable clinical and radiographic outcomes to those of the 2-level ACDF group. HC can be used selectively in the treatment of patients with 2-level cervical disc disease.
Arm ; Case-Control Studies ; Cervical Vertebrae ; Diskectomy* ; Female ; Humans ; Neck ; Neck Pain ; Range of Motion, Articular ; Retrospective Studies ; Spinal Fusion ; Spine ; Total Disc Replacement*

PURPOSE: Paroxysmal kinesigenic dyskinesia (PKD) is a rare paroxysmal movement disorder characterized by recurrent and brief dyskinesia attacks triggered by sudden voluntary movement. The diagnosis of PKD is based on clinical findings, and mutations in the proline-rich transmembrane protein 2 (PRRT2) gene have been identified as the cause of PKD. Two Korean cohorts have been reported on PRRT2 mutation analysis in PKD patients. The purpose of this study was to determine the mutation spectrum of the PRRT2 gene and to examine the clinical characteristics associated with PRRT2 mutations. METHODS: We studied 23 members of four families with familial PKD and two families with sporadic PKD which included 9 patients and 2 patients, respectively. Mutation analysis of the PRRT2 gene was performed using Sanger sequencing. Clinical features of PKD were compared between patients with a PRRT2 mutation and those with no detectable PRRT2 mutation. RESULTS: PRRT2 mutations were detected in three of four PKD families (75%), and in none of the two sporadic cases (0%). All detected PRRT2 mutations were c.649dupC (p.Arg217Profs*8). Subjects with detected PRRT2 mutations had earlier age at onset and longer duration of attacks. CONCLUSION: As previously reported in Korean PKD patients, our results confirmed that PRRT2 is a major causative gene for familial PKD, and the c.649dupC is the most frequent mutation. PRRT2 mutation analysis is required for the molecular diagnosis of familial PKD and for evaluating the clinical manifestations of PKD.
Age of Onset ; Cohort Studies ; Diagnosis ; Dyskinesias* ; Dystonia ; Humans ; Movement Disorders

Intrathoracic metastasis of ovarian cancer has poor prognosis regardless of treatment modality. Recent development of surgical techniques and the new concept of direct infusion of chemotherapeutic agents with hyperthermia could help with the treatment of disseminated diseases in ovarian cancer. Using video-assisted thoracoscopic surgery and intracavitary chemotherapy with hyperthermia, we tried hyperthermic intrathoracic chemotherapy for a case of stage IV high-grade serous ovarian cancer with pleural metastasis. There was no high-grade complication related to the procedure. The patient is alive without disease at 32 months after initial treatment.
Cisplatin* ; Drug Therapy* ; Fever ; Humans ; Neoplasm Metastasis* ; Ovarian Neoplasms* ; Prognosis ; Thoracic Surgery, Video-Assisted

OBJECTIVE: To evaluate retrospectively the clinical effectiveness of FlightPlan for Liver (FPFL), an automated tumor-feeding artery detection software in cone-beam CT angiography (CBCTA), in identifying tumor-feeding arteries for the treatment of hepatocellular carcinoma (HCC) using three different segmentation sensitivities. MATERIALS AND METHODS: The study included 50 patients with 80 HCC nodules who received transarterial chemoembolization. Standard digital subtracted angiography (DSA) and CBCTA were systematically performed and analyzed. Three settings of the FPFL software for vascular tree segmentation were tested for each tumor: the default, Group D; adjusting the proportion of segmented tumor area between 30 to 50%, Group L; and between 50 to 80%, Group H. RESULTS: In total, 109 feeder vessels supplying 80 HCC nodules were identified. The negative predictive value of DSA, FPFL in groups D, L, and H was 56.8%, 87.7%, 94.2%, 98.5%, respectively. The accuracy of DSA, FPFL in groups D, L, and H was 62.6%, 86.8%, 93.4%, 95.6%, respectively. The sensitivity, negative predictive value (NPV), and accuracy of FPFL were higher in Group H than in Group D (p = 0.041, 0.034, 0.005). All three segmentation sensitivity groups showed higher specificity, positive predictive value, NPV, and accuracy of FPFL, as compared to DSA. CONCLUSION: FlightPlan for Liver is a valuable tool for increasing detection of HCC tumor feeding vessels, as compared to standard DSA analysis, particularly in small HCC. Manual adjustment of segmentation sensitivity improves the accuracy of FPFL.
Angiography ; Arteries ; Carcinoma, Hepatocellular* ; Cone-Beam Computed Tomography ; Humans ; Liver ; Retrospective Studies ; Sensitivity and Specificity ; Treatment Outcome ; Trees

BACKGROUND/AIMS: The aim of this study was to evaluate the prevalence of colorectal neoplasia in subjects with fundic gland polyps (FGPs) and the relationship between FGPs and colorectal neoplasia in Korea. METHODS: We analyzed 128 consecutive patients with FPGs who underwent colonoscopy between January 2009 and December 2013. For each case, age- (±5 years) and sex-matched controls were identified from among patients with hyperplastic polyps, gastric neoplasms, and healthy controls. Clinical characteristics were reviewed from medical records, colonoscopic findings, pathologic findings, and computed tomography images. The outcome was evaluated by comparison of advanced colonic neoplasia detection rates. RESULTS: Of the 128 patients, seven (5.1%) had colon cancers and seven (5.1%) had advanced adenomas. A case-control study revealed that the odds of detecting a colorectal cancer was 3.8 times greater in patients with FGPs than in the age- and sex-matched healthy controls (odds ratio [OR], 3.80; 95% confidence interval [CI], 1.09-13.24; P =0.04) and 4.1 times greater in patients with FGPs than in healthy controls over 50 years of age (OR, 4.10; 95% CI, 1.16-14.45; P =0.04). Among patients with FGPs over 50 years old, male sex (OR, 4.83; 95% CI, 1.23-18.94; P =0.02), and age (OR, 9.90; 95% CI, 1.21-81.08; P =0.03) were associated with an increased prevalence of advanced colorectal neoplasms. CONCLUSIONS: The yield of colonoscopy in colorectal cancer patients with FGPs was substantially higher than that in average-risk subjects. Colonoscopy verification is warranted in patients with FGPs, especially in those 50 years of age or older.
Adenoma ; Case-Control Studies ; Colon ; Colonic Neoplasms ; Colonoscopy* ; Colorectal Neoplasms ; Humans ; Korea ; Male ; Medical Records ; Polyps* ; Prevalence ; Risk Factors ; Stomach Neoplasms