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: 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

We report here a case of maternal 3-methylcrotonyl-coenzyme A carboxylase (3-MCC) deficiency in a Korean woman. Her 2 infants had elevated 3-hydroxyisovalerylcarnitine (C5-OH) on a neonatal screening test by liquid chromatography-tandem mass spectrometry (LC-MS/MS), but normal results were found on urine organic acid analysis. The patient was subjected to serial testing and we confirmed a maternal 3-MCC deficiency by blood spot and breast milk spot test by LC-MS/MS, serum amino acid analysis, urine organic acid and molecular genetic analysis that found c.838G>T (p.Asp280Tyr) homozygous mutation within exon 9 of the MCCB gene. Especially, we confirmed marked higher levels of C5-OH on breast milk spot by LC-MS/MS, in the case of maternal 3-MCC deficiency vs. controls.
Breast* ; Exons ; Female ; Humans ; Infant ; Infant, Newborn ; Mass Spectrometry ; Milk, Human* ; Molecular Biology ; Neonatal Screening

Bronchial injury due to blunt trauma is often associated with other significant injuries; as a result, making a rapid diagnosis can be difficult. Delay of early diagnosis and surgical treatment can result in a fatal course, including persistent pneumothorax, soft tissue emphysema, lung collapse, recurrent infection, or death. Bronchoscopy remains a reliable diagnostic method; however, it is difficult to perform in the emergency department. In some cases, suspicion of emergency physicians, depending on findings observed on computed tomography scan, can be more helpful than bronchoscopy. In this article, we present two cases of bronchial injury after blunt chest trauma; differences in prognosis were dependent on the time taken to make a decision.
Bronchoscopy ; Early Diagnosis ; Emergencies ; Emphysema ; Pneumothorax ; Prognosis ; Pulmonary Atelectasis ; Rupture ; Thorax

PURPOSE: Syncope in a common condition that is typically benign but is occasionally associated with mortality. We conducted a retrospective validation of the San Francisco Syncope Rule (SFSR) for use in identifying emergency department (ED) syncope patients with short-term serious outcomes. METHODS: We studied 131 syncope patients who were admitted to or visited the out-patient department within 1 month of an ED visit related to syncope from January to December 2010. Patients meeting the inclusion criteria as defined in the SFSR derivation were evaluated for 5 previously derived predictor variables: abnormal electrocardiography (ECG), shortness of breath, hematocrit <30%, triage systolic blood pressure <90 mm Hg, and a history of congestive heart failure. Predetermined outcome measures as defined by the SFSR included death, myocardial infarction, arrhythmia, pulmonary embolism, stroke, subarachnoid hemorrhage, significant hemorrhage, or any condition causing or likely to cause a return ED visit and hospitalization, or related event. RESULTS: The patient group consisted of 63 males and 68 females with an average age of 56 years. 35(26.7%) patients met the predetermined criteria for serious outcome. 10 of 35(28.6%) patients with a serious outcome were not identified as high risk using the rule. The rule performance for predicting serious outcomes included a sensitivity of 71.4% (95% confidence interval (CI), 56% to 86%), specificity of 69.8% (95% confidence interval (CI), 69% to 70%) and positive predictive value of 47.3%. CONCLUSION: In this retrospective validation study in Korea, the SFSR performed with comparable specificity but with significantly lower sensitivity than reported in the original study. Implementing the rule would significantly increase admission rates.
Arrhythmias, Cardiac ; Blood Pressure ; Dyspnea ; Electrocardiography ; Emergencies ; Female ; Heart Failure ; Hematocrit ; Hemorrhage ; Hospitalization ; Humans ; Korea ; Male ; Myocardial Infarction ; Outcome Assessment (Health Care) ; Outpatients ; Pulmonary Embolism ; Retrospective Studies ; San Francisco ; Sensitivity and Specificity ; Stroke ; Subarachnoid Hemorrhage ; Syncope ; Triage

PURPOSE: This study was undertaken in order to identify the influence of wearing a head protective device (helmet) on facial fracture patterns in injured motorcycle riders. METHODS: We retrospectively reviewed the medical records of patients who underwent facial bone computed tomography (CT) resulting from motorcycle riding injuries between May 2009 and July 2011. Data collected included age, gender, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), status of helmet use, alcohol intake, time of accident, seating position of the rider, traumatic head injury (THI) measure and facial fracture patterns. Facial fracture patterns were grouped as fracture of the upper-face (orbits), mid-face (maxilla, zygoma, nose) and lower-face (mandible). We assessed the association between facial fracture patterns and helmet use. RESULTS: Of the 180 patients included in this study, 163 (90.6%) were male, 60 (33.3%) suffered facial fracture, 85 (47.2%) wore a helmet and 30 (16.7%) suffered THI. Their mean age was 28.7+/-14.6 years. Between the helmeted and unhelmeted groups, there was statistically significant difference in age, GCS, RTS and THI. There was no significant association between wearing a helmet and type of facial fracture. Multivariate logistic regression analysis demonstrated that age was the only factor influencing helmet use. CONCLUSION: Wearing a helmet prevented traumatic head injury but did not prevent any particular type of facial fractures in the injured motorcycle riders assessed in this study.
Craniocerebral Trauma ; Facial Bones ; Facial Injuries ; Glasgow Coma Scale ; Head Protective Devices ; Humans ; Logistic Models ; Male ; Medical Records ; Motorcycles ; Retrospective Studies ; Zygoma

PURPOSE: The purpose of this study was to evaluate whether the symptoms of migraine and car sickness coexist or not. In addition, we tried to elucidate whether the car sickness can be a clinical indicator of diagnosing migraine in children. METHODS: A total of 166 children and adolescents who had newly diagnosed migraine and followed up for more than 2 years after the termination of treatment were involved in the study. The co-morbidity or co-existence of symptoms between two conditions in the clinical course was investigated. RESULTS: Sixty three of 124 who had car sickness as well as migraine recovered from migraine. Among these 63 patients, the car sickness disappeared in 44 (69.8%), decreased in 7 (11.1%) and persisted in 12 (19.0%). On the other hand, 23 of those 124 migraineurs continued to have migraine. In these patients, car sickness disappeared in 4 (17.4%), decreased in 5 (21.7%) and persisted in 14 (60.9%). The freedom or alleviation of car sickness is more common in children free from migraine than in children with persistent migraine (P<0.001). CONCLUSION: The results suggest that migraine is closely related to car sickness in children and the clinical course of migraine generally overlaps those of car sickness. We therefore believe that car sickness can be a clinical indicator in the diagnosis of migraine.
Adolescent ; Child ; Freedom ; Hand ; Humans ; Migraine Disorders ; Motion Sickness

PURPOSE: The purpose of this study was to evaluate the clinical course and prognosis of migraines in childhood and adolescence, and the influence of preventive therapy on them. METHODS: We recruited 110 children and adolescents with migraines who had been newly diagnosed and treated. Treatment was composed of observation after consultation, acute symptomatic treatment, and preventive therapy. We prescribed topiramate for preventive therapy. The recipients of preventive therapy were those patients who complained of disturbance in daily life due to severe headache. The clinical course was evaluated on the basis of changes in the frequency of migraine attack and was divided into three groups: complete recovery, partial recovery, and non-recovery. The prognosis of migraine was classified into those free from migraine attack, decreased, and persistant. RESULTS: Forty-six (41.8%) of 110 patients completely recovered, and 70 (63.6%) were free from migraine attack. In those suffering from migraines without aura, 38.3% of the patients completely recovered and 59.6% were free from migraine attack. Regarding migraines with aura, 58.5% of the patients completely recovered and 70.7% were free from migraine attack. With respect to cases of probable migraine, 18.2% completely recovered and 59.6% were free from migraine attack. In those receiving preventive treatment, 80.0% of all patients completely recovered and 85.0% were free from migraine. According to migraine type, 66.7% of patients with migraine without aura completely recovered and 80% were free from migraine. In those with migraine and aura, 88.8% of patients completely recovered and 88.8% were free from migraine attack. CONCLUSION: It was estimated that the clinical course and prognosis of migraine patients who were treated by pediatric neurologists were generally good. The clinical course was better in the preventive therapy group. In particular, the effect of preventive treatment and prognosis were optimal in patients with migraine with aura.
Adolescent ; Child ; Epilepsy ; Fructose ; Headache ; Humans ; Migraine Disorders ; Migraine with Aura ; Migraine without Aura ; Prognosis ; Stress, Psychological