The Committee of Clinical Practice Guidelines of the Korean Diabetes Association (KDA) updated the previous clinical practice guidelines for Korean adults with diabetes and prediabetes and published the seventh edition in May 2021. We performed a comprehensive systematic review of recent clinical trials and evidence that could be applicable in real-world practice and suitable for the Korean population. The guideline is provided for all healthcare providers including physicians, diabetes experts, and certified diabetes educators across the country who manage patients with diabetes or the individuals at the risk of developing diabetes mellitus. The recommendations for screening diabetes and glucose-lowering agents have been revised and updated. New sections for continuous glucose monitoring, insulin pump use, and non-alcoholic fatty liver disease in patients with diabetes mellitus have been added. The KDA recommends active vaccination for coronavirus disease 2019 in patients with diabetes during the pandemic. An abridgement that contains practical information for patient education and systematic management in the clinic was published separately.

The Committee of Clinical Practice Guidelines of the Korean Diabetes Association (KDA) updated the previous clinical practice guidelines for Korean adults with diabetes and prediabetes and published the seventh edition in May 2021. We performed a comprehensive systematic review of recent clinical trials and evidence that could be applicable in real-world practice and suitable for the Korean population. The guideline is provided for all healthcare providers including physicians, diabetes experts, and certified diabetes educators across the country who manage patients with diabetes or the individuals at the risk of developing diabetes mellitus. The recommendations for screening diabetes and glucose-lowering agents have been revised and updated. New sections for continuous glucose monitoring, insulin pump use, and non-alcoholic fatty liver disease in patients with diabetes mellitus have been added. The KDA recommends active vaccination for coronavirus disease 2019 in patients with diabetes during the pandemic. An abridgement that contains practical information for patient education and systematic management in the clinic was published separately.

The publisher wishes to apologize for incorrectly displaying the author (Seok Beom Gwon) name. We correct his name from Seok Beom Gwon to Seok Beom Kwon.

BACKGROUND AND PURPOSE: Charcot-Marie-Tooth disease (CMT) type 1A (CMT1A) is the demyelinating form of CMT that is significantly associated with PMP22 duplication. Some studies have found that the disease-related disabilities of these patients are correlated with their compound muscle action potentials (CMAPs), while others have suggested that they are related to the nerve conduction velocities. In the present study, we investigated the correlations between the disease-related disabilities and the electrophysiological values in a large cohort of Korean CMT1A patients. METHODS: We analyzed 167 CMT1A patients of Korean origin with PMP22 duplication using clinical and electrophysiological assessments, including the CMT neuropathy score and the functional disability scale. RESULTS: Clinical motor disabilities were significantly correlated with the CMAPs but not the motor nerve conduction velocities (MNCVs). Moreover, the observed sensory impairments matched the corresponding reductions in the sensory nerve action potentials (SNAPs) but not with slowing of the sensory nerve conduction velocities (SNCVs). In addition, CMAPs were strongly correlated with the disease duration but not with the age at onset. The terminal latency index did not differ between CMT1A patients and healthy controls. CONCLUSIONS: In CMT1A patients, disease-related disabilities such as muscle wasting and sensory impairment were strongly correlated with CMAPs and SNAPs but not with the MNCVs or SNCVs. Therefore, we suggest that the clinical disabilities of CMT patients are determined by the extent of axonal dysfunction.
Action Potentials ; Axons ; Charcot-Marie-Tooth Disease ; Cohort Studies ; Humans ; Muscles ; Neural Conduction

BACKGROUND: Mutations in mitofusin2 (MFN2) are a major underlying cause of axonal Charcot-Marie-Tooth neuropathy (CMT). It has been reported that patients with an early age of onset (<10 years, EO) show more severe clinical phenotypes than those of patients with a later age at onset (> or =10 years, LO) in CMT2A with MFN2 mutations. There are few studies about CMT patients with MRI studies and we performed leg MRIs for better understanding of CMT2A. METHODS: We identified 19 patients (EO=10; LO=9) with MFN2 mutations. We used functional disability scales and CMT neuropathy scales for the grading of disability. Nerve conduction studies and MRIs of the lower leg were performed in all patients. RESULTS: We confirmed that EO had more severe leg muscle involvement than LO by leg MRI. In 7 out of 9 in LO, there were some degree of asymmetric leg muscle weakness and MRI findings explained the nature of asymmetry, that is, asymmetric cross-sectional areas or fatty infiltration. MRI of EO showed marked fatty infiltration on all three compartments whereas that of LO showed rather selective involvement of the posterior compartment. These results were well correlated with clinical findings that in LO, five patients could not do toe walking whereas only one could not do heel walking. CONCLUSIONS: MRI of the leg may be a useful tool for evaluating axonal CMT neuropathy, and asymmetric leg muscle weakness may be the characteristics of an axonal CMT. In addition, more prominent involvement of the posterior leg in LO is a very interesting phenomenon, which is in contrast to the length-dependent involvement in congenital demyelinating neuropathy.
Age of Onset ; Axons* ; Charcot-Marie-Tooth Disease ; Heel ; Humans ; Leg* ; Magnetic Resonance Imaging* ; Muscle Weakness ; Neural Conduction ; Phenotype ; Toes ; Walking ; Weights and Measures

BACKGROUND: Mitofusin 2 (MFN2) is a membrane protein and is an essential component of mitochondrial fusion machinery. Mitochondrial fusion is essential for various biological functions in mammalian cells. Thus mutations in MFN2 are the underlying cause of Charcot-Marie-Tooth neuropathy type 2A (CMT2A). However, there has been no reports investigating the MFN2 genes in Korean CMT patients. Therefore, we investigated to find the clinical and genetic characteristics in Korean patients with the MFN2 gene mutation. METHODS: We examined the mutations of the MFN2 gene in 137 Korean CMT families. According to criteria from the European CMT consortium, CMT2 was 45 families. Mutations were confirmed by both strands sequencing. Nerve conduction studies were carried out in CMT patients having each mutation. RESULTS: Eight pathogenic mutations were found in 10 families. Six mutations (Leu92Pro, Gly127Asp, His165Arg, Ser263Pro, Arg364Trp, Met376Thr) were determined to be novel, and those were not detected in the 100 healthy controls. A de novo missense mutation was found in three CMT families (30%). The frequency of the MFN2 mutation was 22.2%, which was higher than those found in the Cx32 mutation. In CMT2A, the frequencies with early age at onset (<10 years) and flat feet were 46.2%. CONCLUSIONS: We found MFN2 mutations in patients with sporadic or dominantly inherited CMT. In the majority of cases with CMT type 2, the axonal neuropathy, may be due to MFN2 mutations.
Axons ; Charcot-Marie-Tooth Disease ; Flatfoot ; Humans ; Membrane Proteins ; Mitochondrial Dynamics ; Mutation, Missense ; Neural Conduction

Schwannomas are benign nerve sheath tumors that originate from any anatomical site. Most schwannomas occur in the head, neck or limbs, but rarely occur in the retroperitoneal space. Furthermore, the schwannoma originating from the vagus nerve of retroperitoneal space is much rare. We experienced a case of retroperitoneal schwannoma of the vagus nerve. A 34-year-old male was refered to our hospital for the evaluation of abdominal mass on ultrasonography. Endoscopic examination revealed submucosal tumor-like lesion on high body of the stomach. Computed tomography (CT) revealed that the stomach was compressed by a solid tumor in the retroperitoneum. On exploratory laparotomy, this mass turned out to be a baseball sized mass in the retroperitoneal space. The mass was excised in an encapsulated state. Histological examination with immunohistochemical stains revealed a schwannoma of the vagus nerve.
Adult ; Cranial Nerve Neoplasms/*diagnosis ; English Abstract ; Humans ; Male ; Neurilemmoma/*diagnosis ; Retroperitoneal Space ; *Vagus Nerve ; Vagus Nerve Diseases/*diagnosis

Vancomycin induced agranulocytosis is a rare but life-threatening complication. We here report a case of vancomycin induced agranulocytosis in a patient with chronic renal failure. A 36-year-old woman receiving hemodialysis via jugular cannulation developed staphylococcus sepsis. The catheter was removed and she was started on vancomycin therapy (1.0 g/week). New catheter was inserted for next hemodialysis. Second sepsis of same organism developed 12 days after initial sepsis inspite of vancomycin therapy. We removed this catheter and continued vancomycin therapy. After 19 days of vancomycin treatment, the patient developed a severe agranulocytosis with white blood cell count of 1, 600/ mm3 and the complete absence of neutrophil. Vancomycin was discontinued and teicoplanin was substituted for vancomycin therapy and G-CSF (granulocyte colony stimulating factor) therapy was begun. White blood cell count including neutropil was completely recovered after 13 days of discontinuation of vancomycin.
Adult ; Agranulocytosis* ; Catheterization ; Catheters ; Female ; Granulocyte Colony-Stimulating Factor* ; Humans ; Kidney Failure, Chronic ; Leukocyte Count ; Lupus Nephritis ; Neutrophils ; Renal Dialysis* ; Sepsis ; Staphylococcus ; Teicoplanin ; Vancomycin

PURPOSE:The aim of this study was to compare the early postoperative results and the long-term outcome of restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) in familial adenomatous polyposis (FAP) and ulcerative colitis (UC). METHODS:Thirty patients that underwent IPAA for either FAP (14 patients) or UC (16 patients) at Kyung-Hee University Hospital between January 1987 and December 1999 were studied retrospectively. Either handsewn or stapled anastomosis technique was used in IPAA. Most patients (12 patients in FAP, 16 patients in UC) had a two-stage operation with temporary diverting loop ileostomy and two patients with FAP had a one-stage operation without temporary ileostomy. RESULTS:One patient in the UC group died from sepsis after operation (n=16, 6.25%), but no patients in the FAP group died. Overall operative complications appeared in two patients (14.3%) and four patients (25%) with FAP and UC, respectively. At follow-up (mean, 47.3 months), pouchitis was developed in four patients with UC, but no patients with FAP. The mean daytime stool frequency was 4.5 stools per day in FAP patients and 5.8 stools per day in UC patients (P=0.031), but night-time stool frequency was similar between two groups (1.2 and 1.4 in FAP and UC, respectively; P>0.05). Daytime fecal incontinence was noticed in two patients (14.3%) with FAP and four patients (26.7%) with UC. Night-time fecal incontinence was noticed in three patients (21.4%) with FAP and six patients (40.0%) with UC. CONCLUSIONS:FAP patients tolerated the operation better and had less long-term disability than did UC patients. This suggested that the long-term outcome of IPAA procedure may depend on the primary disease rather than the procedure itself.
Adenomatous Polyposis Coli* ; Colitis, Ulcerative* ; Fecal Incontinence ; Follow-Up Studies ; Humans ; Ileostomy ; Pouchitis ; Proctocolectomy, Restorative* ; Retrospective Studies ; Sepsis ; Ulcer*

PURPOSE: Ischemia-reperfusion is an important pathologic process that leads to impairment of the liver after major surgery. Ischmia-reperfusion injury includes both hypoxia and an inflammatory response associated with reperfusion; the former is caused by the lack of microvascular perfusion and the latter is mediated by cytyokines and oxygen free radicals. In addition to inhibiting thrombin, plasmin, kalikrein, trypsin, and neutrophil elastase, gabexate mesilate also plays an important role in inhibiting cytokines and oxygen free radical production. The purpose of this study was to investigate the effects of gabexate mesilate on ischemia- reperfusion injury in the liver. METHODS: Twenty-four New Zealand white rabbits were divided into three groups. Clamping was not done in group A (n=8), although it was done in group B (n=8) and group C (n=8). Group C received intravenous infusion of gabexate mesilate (10 mg/kg/hr) continuously during the process of clamping. Serum alanine aminotrasferase (ALT) and purine nucleoside phophorylase (PNP) were measured immediately before clamping, following 30-minute ischemia, and after 60-minute reperfusion. Hepatic tissue adenosine triphophate (ATP), xanthine oxidase, and malondialdehyde (MDA) plus 4-hydroxyalcenals (4HA) were measured after reperfusion. RESULTS: Compared with group A, group B and group C demonstrated a significant increase in ALT and PNP levels following ischemia and reperfusion, as well as in xanthine oxidase and MDA plus 4HA levels following reperfusion. However, ATP levels showed no significant differences among the three groups. ALT levels were significantly lower in group C than in group B following reperfusion (P<0.01),although there was no significant differences in PNP levels between them. Xanthine oxidase and MDA plus 4HA levels were significantly lower in group C than in group B (P<0.05). The results suggest that gabexate mesilate inhibits an increase in ALT, xanthine oxidase, and MDA plus 4HA levels. CONCLUSION: Gabexate mesilate inhibits oxygen free radical production of xanthine oxidase, and results in a reduction of hepatic ischemia-reperfusion injury.
Adenosine ; Adenosine Triphosphate ; Alanine ; Anoxia ; Constriction ; Cytokines ; Fibrinolysin ; Free Radicals ; Gabexate* ; Infusions, Intravenous ; Ischemia ; Leukocyte Elastase ; Liver* ; Malondialdehyde ; Oxygen ; Perfusion ; Rabbits ; Reperfusion ; Reperfusion Injury ; Thrombin ; Trypsin ; Xanthine Oxidase