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.

Purpose: We investigated the clinical efficacy of immune checkpoint blocker (ICB) therapy for metastatic or advanced melanoma in Korean patients. As well, we assessed whether the effects of ICBs can be enhanced by combination therapy with palliative radiotherapy (RT). Materials and Methods: We retrospectively reviewed the records of 127 patients with metastatic melanoma who received ICB with or without palliative RT between 2014 and 2018. The melanoma subtypes were classified as follows: chronic sun-damaged (CSD), acral, mucosal, and uveal. The primary endpoint was the objective response rate (ORR). Results: The overall ORR was 15%, with 11 complete and eight partial responses. ORRs for CSD, acral/mucosal, and uveal melanomas were 50%, 16.5%, and 0%, respectively (p=0.009). In addition to the subtype, stage at treatment, total tumor burden at treatment, and ICB type were significantly associated with ORR (all p < 0.05). Palliative RT was administered in 44% of patients during the treatment, and it did not affect ORR. Clinical responders to ICB therapy exhibited significantly higher 1-year progression-free and overall survival rates than nonresponders. Conclusion ORR for ICB monotherapy in Korean patients with melanoma is relatively modest compared with that in Western patients because the non-CSD subtypes are predominant in the Korean population. Our findings regarding combination therapy with ICB provided a rationale for the initiation of our phase II study (NCT04017897).

BACKGROUND: We evaluated the efficacy and safety of acarbose add-on therapy in Korean patients with type 2 diabetes mellitus (T2DM) who are inadequately controlled with metformin and sitagliptin. METHODS: A total of 165 subjects were randomized to metformin and sitagliptin (Met+Sita, n=65), metformin, sitagliptin, and acarbose (Met+Sita+Acarb, n=66) and sitagliptin and acarbose (Sita+Acarb, exploratory assessment, n=34) therapy in five institutions in Korea. After 16 weeks of acarbose add-on or metformin-switch therapy, a triple combination therapy was maintained from week 16 to 24. RESULTS: The add-on of acarbose (Met+Sita+Acarb group) demonstrated a 0.44%±0.08% (P<0.001 vs. baseline) decrease in glycosylated hemoglobin (HbA1c) at week 16, while changes in HbA1c were insignificant in the Met+Sita group (−0.09%±0.10%, P=0.113). After 8 weeks of triple combination therapy, HbA1c levels were comparable between Met+Sita and Met+Sita+Acarb group (7.66%±0.13% vs. 7.47%±0.12%, P=0.321). Acarbose add-on therapy demonstrated suppressed glucagon secretion (area under the curve of glucagon, 4,726.17±415.80 ng·min/L vs. 3,314.38±191.63 ng·min/L, P=0.004) in the absence of excess insulin secretion during the meal tolerance tests at week 16 versus baseline. The incidence of adverse or serious adverse events was similar between two groups. CONCLUSION: In conclusion, a 16-week acarbose add-on therapy to metformin and sitagliptin, effectively lowered HbA1c without significant adverse events. Acarbose might be a good choice as a third-line therapy in addition to metformin and sitagliptin in Korean subjects with T2DM who have predominant postprandial hyperglycemia and a high carbohydrate intake.
Acarbose ; Diabetes Mellitus, Type 2 ; Drug Therapy, Combination ; Glucagon ; Hemoglobin A, Glycosylated ; Humans ; Hyperglycemia ; Incidence ; Insulin ; Korea ; Meals ; Metformin ; Sitagliptin Phosphate

Pancreatic islet transplantation is a physiologically advantageous and minimally invasive procedure for the treatment of type 1 diabetes mellitus. Here, we describe the first reported case of successful allogeneic islet transplantation alone, using single-donor, marginal-dose islets in a Korean patient. A 59-yr-old patient with type 1 diabetes mellitus, who suffered from recurrent severe hypoglycemia, received 4,163 islet equivalents/kg from a single brain-death donor. Isolated islets were infused intraportally without any complications. The immunosuppressive regimen was based on the Edmonton protocol, but the maintenance dosage was reduced because of mucositis and leukopenia. Although insulin independence was not achieved, the patient showed stabilized blood glucose concentration, reduced insulin dosage and reversal of hypoglycemic unawareness, even with marginal dose of islets and reduced immunosuppressant. Islet transplantation may successfully improve endogenous insulin production and glycemic stability in subjects with type 1 diabetes mellitus.
Blood Glucose/analysis ; Diabetes Mellitus, Type 1/*surgery ; Female ; Humans ; Hypoglycemia/*surgery ; Immunosuppression/methods ; Immunosuppressive Agents/therapeutic use ; Islets of Langerhans/physiology/*surgery ; Islets of Langerhans Transplantation/*methods ; Middle Aged ; Republic of Korea ; Tissue Donors

OBJECTIVE: To detect meconium peritonitis for the fetal period is important for prenatal counseling. The aim of this study was to evaluate prenatal ultrasound finding for diagnosing meconium peritonitis and postnatal clinical course and outcomes. METHODS: The prenatal and postnatal medical records of all patients to our institutions with confirmed meconium peritonitis were reviewed, with emphasis on prenatal ultrasound findings, postnatal investigations, operative findings, outcomes of meconium peritonitis. RESULTS: Fourteen fetuses were confirmed to have meconium peritonitis at birth by operation. Eight cases were diagnosed correctly because of prenatal ultrasound showing ascites and calcification/dilated or hyperechoic bowel loops. In the other 6 cases, prenatal ultrasound showed only ascites. One patient was operated on first day of life and its intra-operative finding was malrotation of small bowel, volvulus with strangulation, perforation and jejunal atresia. Most cases were operated on 2nd or 3rd day of life. Intra-operative findings were ileal atresia and perforation in 11 cases and jejunal atresia and perforation in 3 cases. Four patients underwent ileostomy but all patients survived and prospered. CONCLUSION: All patients do not present typical prenatal ultrasound findings of meconium peritonitis. Therefore, even in pregnancies associated with isolated ascites, meconium peritonitis should be taken into consideration. Favorable outcome of intrauterine meconium peritonitis is reassuring in prenatal counselling and stems from multidisplinary team approach.
Ascites ; Counseling ; Fetus ; Humans ; Ileostomy ; Intestinal Atresia ; Intestinal Volvulus ; Meconium ; Medical Records ; Parturition ; Peritonitis ; Pregnancy ; Prenatal Diagnosis

Japanese encephalitis virus (JEV) causes a mosquitoborne viral zoonosis that is becoming increasingly important to public health in east and south Asia. Although JEV is primarily associated with reproductive failure in swine, JEV infection can cause fever and headache in humans and is associated with aseptic meningitis and encephalitis. The exact mode of transmission, including host range and possible source of viral amplification within livestock, is still not completely clear. This study consisted of a serological survey of JEV infection in goats. A total of 804 goat serum samples were collected from 144 farms in Korea between May 2005 and May 2006. The incidence of positive cases was 12.1% (97 out of 804 goats). The seroprevalence of JEV infection in the 144 farms screened was 31.3% (45/144), indicating that JEV infection is frequent in goat farms in Korea. In addition, three districts of Korea (mainly in the southern region) had a higher seroprevalence of JEV compared to other areas. The results suggest that goats could be monitored epidemiologically as a sentinel animal for JEV transmission in Korea.
Age Factors ; Animals ; Antibodies, Viral/blood ; Encephalitis Virus, Japanese/*isolation & purification ; Encephalitis, Japanese/epidemiology/*veterinary/virology ; Goat Diseases/*epidemiology/*virology ; Goats ; Hemagglutination Inhibition Tests/veterinary ; Korea/epidemiology ; Seroepidemiologic Studies

To characterize the genetic diversity of bovine viral diarrhea viruses (BVDV) circulating in Korea, 11 BVDV isolates were obtained from 467 field samples collected during 2005~2006 in Korea. All of the BVDV isolates were identified as non-cytopathic (non-cp) BVDV biotypes. The 5' noncoding region (NCR) genes of the isolates were sequenced and analyzed. In total, ten BVDV isolates were typed as BVDV-1 by comparing the genomic sequences to the 5' NCR. One isolate (05R169) showed 98.6% nucleotide sequence identity with the BVDV-2 reference strain and was therefore typed as BVDV-2. Our results indicate that BVDV-1 is the main genotype circulating in the cattle population of Korea.
Animals ; Base Sequence ; Cattle ; Diarrhea Virus 1, Bovine Viral ; Diarrhea Virus 2, Bovine Viral ; Diarrhea Viruses, Bovine Viral* ; Genetic Variation ; Genotype ; Korea*

Bovine coronavirus (BCoV) is a causative agent of entero-pathogenic diarrhea in young calves and winter dysentery (WD) in adult cattle. In this study, we conducted a nationwide sero-epidemiological survey of BCoV infection in Korea. In total, 3,029 bovine sera collected between October and December 2005 were screened for the presence of antibodies against BCoV using a hemagglutination inhibition (HI) test. Half (50.0%) of individual cattle tested were positive for BCoV. The regional distribution of the seroprevalence of positive HI antibodies was 55.7% (234/420) in Gyeonggi, 53.0% (316/596) in Jeonra, 51.9% (374/720) in Chungcheong, 48.5% (401/827) in Gyeongsang, 43.9% (79/180) in Jeju, and 38.1% (109/286) in Gangwon Province. Analyzing the distribution of HI titer according to the age of the cattle showed the highest BCoV seropositive rate in 5-year-old cattle, and the incidence of cattle with an HI antibody titer of 1:160 or above was 12.1%.
Adult ; Animals ; Antibodies ; Cattle ; Child, Preschool ; Coronavirus, Bovine* ; Diarrhea ; Dysentery ; Gangwon-do ; Gyeonggi-do ; Hemagglutination ; Humans ; Incidence ; Korea* ; Seroepidemiologic Studies

PURPOSE: The aim of this study was to evaluate the CT findings of pulmonary fat embolism syndrome that was induced by triolein and oleic acid, along with its pathologic correlation. MATERIALS AND METHODS: 16 rabbits were included in this study. The rabbits in group I (n=8) were embolized with 0.2 mL triolein and the rabbits of group II (n=8) were embolized with 0.2 mL oleic acid through ear veins. HRCT scans were done prior to embolization and at 0.5, 4, 24, 48 and 72 hours post-embolization. The pathologic correlations were determined at 0.5, 24, 48 and 72 hours. RESULTS: At 24 hours, one group I rabbit showed abnormal CT findings that were composed of several 2-3 mm nodules and multiple ill-defined peripheral ground glass opacities. The pathologic finding of this rabbit at 48 hours was mainly intraarveolar edema. All the group II rabbits (n=8/8) showed ill-defined bilateral and peripheral ground glass opacities with (n=6/8) or without consolidations (n=2/8) on the 0.5 hour CT. All the rabbits (n=7/7) showed that the new ground glass opacities and ground glass opacities noted on the 0.5 hour CT were changed into consolidation. The margins of the ground glass opacities and consolidations were more sharpened on the 24 hours CT. All 6 rabbits (n=6/6) showed consolidations without ground glass opacities and the margins of the consolidations were more sharpened on the 48 hours CT. There was no significant interval change on the 72 hours CT. The pathologic findings of ground glass opacities were interstitial edema or mild intraalveolar edema. The pathologic findings of consolidation were intraalveolar edema, hemorrhage and coagulation necrosis. CONCLUSION: The CT findings after fat embolization using triolein and oleic acid were ill-defined peripheral ground glass opacities with/without consolidations. These findings occurred in only one triolein group with the time lag, but these findings were immediately and extensively seen in all group II rabbits. These CT findings may be important for making a diagnosis of pulmonary fat embolism syndrome.
Diagnosis ; Ear ; Edema ; Embolism, Fat* ; Glass ; Hemorrhage ; Necrosis ; Oleic Acid* ; Pulmonary Embolism ; Rabbits* ; Triolein* ; Veins