Relationship between short stature at 3 years old and height, weight, and body mass index changes for 6 years after birth: a retrospective, nationwide, population-based study of children born 2011–2014 in Korea

Purpose@#Height at 3 years of age, when catch-up growth based on birth history is completed, is considered a major prognostic factor for predicting short stature, underweight, and growth faltering. However, too few large-scale studies have followed and analyzed height, weight, and body mass index (BMI) changes in children whose stature was short at 3 years of age. This study followed and compared the growth parameters (height, weight, and BMI) of children with short stature at 3 years of age and children with nonshort stature at 3 years of age for 6 years after birth using nationwide, population-based data. @*Methods@#We retrospectively analyzed physical measurement data from the National Health Screening Program for Infants and Children for people born in 2011–2014 in Korea and followed to 2020. The data were provided by the National Health Insurance Service’s customized data service. Growth parameters were compared using chi-square tests, Student t-tests, analyses of variance, and linear regressions. @*Results@#Among 210,902 enrolled participants, 759 (0.4%) and 210,143 (99.6%) were in the short stature at 3 years group and the nonshort stature at 3 years group, respectively. In both sexes, height, weight, and BMI for 6 years after birth were significantly higher in the nonshort stature at 3 years group than in the short stature at 3 years group (P<0.0001). The BMI rebound was observed later than the standard period in the short stature at 3 years group. @*Conclusion@#Early intervention and close follow-up are necessary to prevent persistent short stature and growth faltering in children with short stature at 3 years of age.

2022 Clinical practice guidelines for central precocious puberty of Korean children and adolescents

The Committee of Central Precocious Puberty of Korean Pediatrics and Adolescents of the Korean Society of Pediatric Endocrinology has newly developed evidence-based 2022 clinical practice guidelines for central precocious puberty in Korean children and adolescents. These guidelines provide the grade of recommendations, which includes both the strength of recommendations and the level of evidence. In the absence of sufficient evidence, recommendations are based on expert opinion. These guidelines have been revised and supplement the previous guidelines "Clinical Guidelines for Precocious Puberty 2011," and are drawn from a comprehensive review of the latest domestic and international research and the grade of recommendation appropriate to the domestic situation. This review summarizes the newly revised guidelines into 8 key questions and 27 recommendations and consists of 4 sections: screening, diagnosis, treatment, and long-term outcome of central precocious puberty.

Analysis of Critical COVID-19 Cases Among Children in Korea

Background@#Coronavirus disease 2019 (COVID-19) is generally asymptomatic or mild in otherwise healthy children, however, severe cases may occur. In this study, we report the clinical characteristics of children classified as critical COVID-19 in Korea to provide further insights into risk factors and management in children. @*Methods@#This study was a retrospective case series of children 97% for infant) and one was overweight (BMI 21.3). All patients had fever, six patients had dyspnea or cough and other accompanied symptoms included sore throat, headache, lethargy and myalgia. Radiologic findings showed pneumonia within 1–8 days after symptom onset. Pneumonia progressed in these children for 2–6 days and was improved within 5–32 days after diagnosis. Among the eight critical cases, remdesivir was administered in six cases.Steroids were provided for all cases. Inotropics were administered in one case. Six cases were treated with noninvasive mechanical ventilator and three required mechanical ventilator. One case required ECMO due to acute respiratory distress syndrome. All cases were admitted to the intensive care unit and admission period ranged from 9–39 days. Among all critical COVID-19 cases < 18 years of age, there were no fatal cases. @*Conclusion@#To develop appropriate policies for children in the COVID-19 pandemic, it is important to monitor and assess the clinical burden in this population.

Prevalence of Type 2 Diabetes Mellitus among Korean Children, Adolescents, and Adults Younger than 30 Years: Changes from 2002 to 2016

Background@#Despite the importance of and social concern regarding prevention of diabetes at younger ages, limited data are available. This study sought to analyze changes in the prevalence of type 2 diabetes mellitus (T2DM) in Koreans younger than 30 years according to sex, age, and level of income. @*Methods@#The dataset analyzed in this study was derived from health insurance claims recorded in the National Health Insurance Service (NHIS) database. Participants’ level of income was categorized as low (quintile 1, <20% of insurance premium) or others (quintile 2–5). @*Results@#In males and females, the prevalence of T2DM per 10,000 people steadily increased from 2.57 in 2002 to 11.41 in 2016, and from 1.96 in 2002 to 8.63 in 2016. The prevalence of T2DM in girls was higher in the age group of 5 to 14 years. Even though the prevalence was higher among those older than 20 years, the increase had started earlier, in the early 2000s, in younger age group. Adolescents aged 10 to 19 years in low-income families showed a remarkable increase in prevalence of T2DM, especially in boys. @*Conclusion@#The prevalence of T2DM in young Koreans increased more than 4.4-fold from 2002 to 2016, and the increase started in the early 2000s in younger age groups and in low-income families. This is the first study to examine the trend in prevalence of T2DM in children, adolescents, and young adults in Korea. Future studies and collaborations with social support systems to prevent T2DM at an early age group should be performed.

Response to vitamin D replacement in overweight and normal weight children with vitamin D deficiency

PURPOSE: It is well known that obesity is related to vitamin D deficiency (VDD). We investigated the response to vitamin D replacement in normal-weight and overweight children. METHODS: This was a prospective study including 62 Korean children with VDD. VDD was defined as a serum 25-hydroxycholecalciferol (25(OH)D) concentration <20 ng/mL. Overweight was defined as a body mass index (BMI)≥the 85th percentile (n=21), and normal weight as a BMI between the 5th and 84th percentiles (n=41). All participants received vitamin D3 supplementation (2,000 IU/day) for 8 weeks. The serum levels of 25(OH)D, PTH and biochemical parameters were measured before and after treatment. RESULTS: The mean age was 10.0±1.4 years in normal-weight children and 10.0±2.1 years in overweight children (P=0.93). After 8 weeks of treatment, 61.9% of normal-weight children and 47.6% of overweight children achieved vitamin D sufficiency (P =0.30). The mean serum 25(OH)D levels after vitamin D replacement were 33.8±7.6 ng/mL and 30.3±6.6 ng/mL in normal-weight and overweight children, respectively (P =0.10). The mean calcium/creatinine ratios after treatment were 0.09±0.07 and 0.08±0.06 in the normal-weight and overweight groups, respectively, and no hypercalciuria was found. In multiple regression analysis, the response to vitamin D replacement was influenced by the BMI (β=-1.0, P=0.03) and sex (β=-4.0, P=0.04). CONCLUSIONS: Eight weeks of vitamin D replacement (2,000 IU/day) is sufficient to overcome vitamin D deficiency in normal-weight and overweight children without any complications.

Morning basal luteinizing hormone, a good screening tool for diagnosing central precocious puberty

PURPOSE: The standard method used to diagnose central precocious puberty (CPP) is the gonadotropin releasing hormone stimulation test (GnRHST). However, this test is inconvenient for children because it is time-consuming and requires multiple samples. This study aimed to determine the reliability of morning unstimulated luteinizing hormone (mLH) level when screening for CPP, with an emphasis on the influence of diurnal variation. METHODS: This study included 160 girls with signs of early puberty (SMR 2) under 8 years of age. They were classified as CPP or non-CPP based on their standard GnRHST. The auxological, biochemical, and hormonal characteristics of subjects were retrospectively evaluated. The prognostic value of single morning unstimulated gonadotropin level was examined for use in CPP screening. RESULTS: Of 160 patients, 121 (75.6%) presented with CPP, and 39 (24.4%) were determined to be prepubertal. The mLH/mFSH (morning unstimulated follicular stimulating hormone) ratio showed significant differences between the 2 groups (P<0.001). The mLH was correlated with GnRHST variables (r=0.532, P<0.001). The mLH cutoff point when screening for CPP was 0.22 IU/L, which had sensitivity and specificity of 69.4% and 82.1%, respectively. In regression analysis, bone age (BA) (odds ratio [OR], 1.018; 95% confidence interval [CI], 0.967–1.071; P=0.506) and body mass index (BMI) (OR, 0.874; 95% CI, 0.583–1.310; P=0.515) were not significant predictors. The mLH≥0.22 IU/L group (OR, 9.596; 95% CI, 3.853–23.900; P<0.001) was highly suggestive of CPP. CONCLUSIONS: In this study, single morning unstimulated luteinizing hormone had clinical efficacy for CPP screening, but BA advanced over chronological age and BMI was not useful for CPP screening.

History of the Korean Anatomical Terminology / 체질인류학회지

In this study, the origin of anatomical terms, the process by which international anatomical terms were made, and the making principles of international anatomical terminology were confirmed. We also describe the process in which the Japanese anatomy terminology (Termonologia Anatomica Japonica), which has been influential in Korea, has developed. Most of the past Korean anatomical terminology used the Japanese term. However, the Korean association of anatomists gradually recognized the necessity of own terminology and decided to refine the terms by forming a terminology committee. The terminology committee first laid down the direction for refining terms and made the basic principles of revising them. Through many meetings, the terms were refined and made into terminology book (Korean anatomical terminology). The Korean anatomical terminology has been revised five times since its first edition in 1979 to the sixth edition in 2014. Here, we illustrate the difference between Japanese terms and Korean terms and the process of refining Korean terms using examples.

Ecthyma Gangrenosum in a Previously Healthy Adolescent / 대한피부과학회지

No abstract available.

Diurnal variation of gonadotropin levels in girls with early stages of puberty

PURPOSE: Pubertal gonadotropin secretion shows circadian pattern and the luteinizing hormone (LH) levels tend to rise in later stages of puberty in girls. We studied the usefulness of basal LH in the evaluation of central precocious puberty with emphasis on the influence of sampling time. METHODS: Medical records of 334 girls that underwent gonadotropin-releasing hormone stimulation test (GnRHST) were reviewed. Auxological and laboratory data were compared between those with early morning (EM, before 10 AM) and late morning/afternoon (LM/A, after 10 AM) basal samples. RESULTS: Among those in sexual maturity rating (SMR) 2, EM samples showed higher basal LH (P=0.004) compare to LM/A samples, whereas those in SMR 3 showed no difference in LH levels between EM and LM/A samples. Among girls with pubertal response, EM group showed higher basal LH (P=0.031) and follicular stimulating hormone (P=0.008) than LM/A group. The EM basal LH was more closely related with the peak stimulated LH than the LM/A basal LH did (rs=0.871 vs. rs=0.524). The optimal basal LH cutoffs to predict a pubertal response to GnRHST were 0.11 IU/L with a sensitivity of 66.7% and a specificity of 78.7% in EM group, and 0.07 IU/L with a sensitivity of 60.0% and a specificity of 78.9% in LM/A group, respectively. CONCLUSION: In girls with early stages of puberty, EM basal LH is a more sensitive screening tool than the LM/A basal LH. Diurnal variation should be considered in evaluating children with precocious puberty.

Waist-to-Height Ratio as an Index for Cardiometabolic Risk in Adolescents: Results from the 1998-2008 KNHANES

PURPOSE: To describe the relationship between the waist-to-height ratio (WHtR) and cardiometabolic risk factors (CMRFs) and to evaluate the validity of WHtR in identifying adolescents with metabolic syndrome. MATERIALS AND METHODS: We analyzed data from a pooled population of 4068 adolescents aged 10-19 years from the Korean National Health and Nutrition Examination Surveys conducted between 1998 and 2008. Overweight individuals were defined by body mass index (BMI) ≥85th percentile. Those with at least 2 CMRFs among hypertension, hyperglycemia, hypertriglyceridemia, and decreased high-density lipoprotein cholesterol (HDL-C) were classified as having multiple CMRFs. RESULTS: WHtR was significantly related to systolic blood pressure, HDL-C, and triglycerides in both non-overweight and overweight adolescents (all p<0.01). Among overweight adolescents, the area under the curve (AUC) for WHtR in identifying multiple CMRFs was significantly greater than that for BMI (p=0.014). Metabolic syndrome was more common in overweight adolescents with a WHtR of ≥0.5 than in those with a WHtR of <0.5 (p<0.001). In non-overweight adolescents, the prevalences of multiple CMRFs (p=0.001) and metabolic syndrome (p<0.001) were higher in those with a WHtR of ≥0.5 than in those with a WHtR of <0.5. Among those without central obesity, the prevalence of multiple CMRFs was higher in those with a WHtR of ≥0.5 than in those with a WHtR of <0.5 (p=0.021). CONCLUSION: WHtR is a simple and valid index for identifying adolescents with increased cardiometabolic risk and is related to CMRFs even in non-overweight adolescents. In adolescents already screened via BMI and waist circumference (WC), WHtR seems to be of additional help in discriminating those at higher cardiometabolic risk.

Vitamin D deficiency in Korean children: prevalence, risk factors, and the relationship with parathyroid hormone levels

PURPOSE: This study was performed to investigate the relationship between serum vitamin D and parathyroid hormone (PTH) levels as well as to describe the prevalence and the risk factors of vitamin D deficiency (VDD) in Korean children. METHODS: Participants were 1,212 children aged 4 to 15 years, who visited Bundang CHA Medical Center (located at 37degreesN) between March 2012 and February 2013. Overweight was defined as body mass index> or =85th percentile. Participants were divided into 4 age groups and 2 seasonal groups. VDD was defined by serum 25-hydroxyvitamin D (25OHD) <20 ng/mL. RESULTS: The level of 25OHD was significantly lower in overweight group than in normal weight group (17.1+/-5.1 ng/mL vs. 19.1+/-6.1 ng/mL, P<0.001). Winter-spring season (odds ratio [OR], 4.46; 95% confidence interval [CI], 3.45-5.77), older age group (OR, 1.60; 95% CI, 1.36-1.88), and overweight (OR, 2.21; 95% CI, 1.62-3.01) were independently related with VDD. The PTH levels were significantly higher in VDD group compared to vitamin D insufficiency and sufficiency group (P<0.001). In normal weight children, 25OHD (beta=-0.007, P<0.001) and ionized calcium (beta=-0.594, P=0.007) were independently related with PTH, however, these associations were not significant in overweight children. CONCLUSION: VDD is very common in Korean children and its prevalence increases in winter-spring season, in overweight children and in older age groups. Further investigation on the vitamin D and PTH metabolism according to adiposity is required.

Dextrocardia and Situs Inversus with Incomplete Inversion: a Case Report / 체질인류학회지

Situs inversus totalis is a very rare anatomical abnormality, which is characterized by dextrocardia and "mirror image" distribution of abdominal organs. Dextrocardia and situs inversus have important surgical implications due to altered anatomy. The aim of this study was to describe the anatomical structures of the situs inversus with dextrocardia in Korean. Presence of situs inversus with dextrocardia was confirmed in a 72-year-old female cadaver during dissection in a gross anatomy course. It was observed by focusing on the positions of the thoracoabdominal structures. In this cadaver, clearly inverted morpholoiges existed in the structures of the thoracoabdomen except the kidneys. The left-sided kidney was located at a slightly higher level than the right-sided kidney although the liver was located on the left side. We reported herein a case of dextrocardia and situs inversus with incomplete inversion, which will provide useful information for accurate diagnosis and relevant surgical procedures.

The Location of the Modiolus in Living Korean / 체질인류학회지

Modiolus is convergence of the facial muscles at the angle of the mouth, and its shape and size varying with individual, age, sex and ethnicity. In the previous study, the modiolus was usually located under the horizontal line at the mouth angle. In most medical schools, the cadavers are of later ages and their facial muscles have lost their elasticity as they got older. The purpose of this study is to identify the location of the modiolus in live young Korean and to compare it with that of Korean cadavers from the previous study. Participants were one hundred students of the catholic medical school with a mean age of 24 years. Experimenter palpated the modiolus of each student with thumb and index finger. The average young live Korean modiolus was located at 14.4 mm lateral to mouth angle and 1.6 mm below the horizontal line of the mouth angle. Commonly, it is located below the mouth angle in 124 sides (62%). There was difference between horizontal distance of female and of male, and vertical distance of right and of left. The location of the modiouls was symmetric in 67%. These results were consistent with the previous study using Korean cadavers. Therefore these results suggest that the location of the modiolus is below to the mouth angle in large number of Koreans.

The inferior epigastric artery arising from the internal iliac artery via a common trunk with the obturator artery / 대한해부학회지

We report a rare case of a left inferior epigastric artery arising from the internal iliac artery via a common trunk with the obturator artery in an 84-year-old female cadaver. A common trunk for the inferior epigastric and obturator arteries firstly originated from the left internal iliac artery, at 3.0 mm below the bifurcation of the left common iliac artery. This trunk ran straight between the left external iliac artery and left external iliac vein, and was finally divided into the left inferior epigastric and left obturator arteries just superior to the inguinal ligament.

Morphometrical Study of Uncinate Processes and Vertebral Body of Cervical Spine

OBJECTIVE: The anatomical knowledge is the most important and has a direct link with success of operation in cervical spine surgery. The authors measured various cervical parameters in cadaveric dry bones and compared with previous reported results. METHODS: We made 255 dry bones age from 19 to 72 years (mean, 42.3 years) that were obtained from 51 subjects in 100 subjects who donated their bodies. All measurements from C3-C7 levels were made using digital vernier calipers, standard goniometer, and self-made fix tool for two different cervical axes (canal and disc setting). We classified into 4 groups (uncinate process, vertebral body, lamina, and pedicle) and measured independently by two neurosurgeons for 28 parameters. RESULTS: We analyzed 23970 measurements by mean value and standard deviations. In comparing with previous literatures, there are some different results. The mean values for uncinate process (UP) width ranged from 5.5 mm at C4 and 5 to 6.3 mm at C3 and C7 in men. Also, in women, the mean values for UP width ranged from 5.5 mm at C5 to 6.3 mm at C7. C7 was widest and C5 was most narrow than other levels. The antero-posterior length of UP tended to increase gradually from C3 to C6. The tip way, tip distance, and base distance of UP also showed increasing pattern from C3 to C7. CONCLUSION: These measurements can provide the spinal surgeons with a starting point to address bony architectures surrounding targeted soft tissues for safeguard against unintended damages during cervical operation.

Perinatal Outcomes of In Vitro Fertilized Twins in Women of Advanced Age

PURPOSE: The purpose of this study is to compare perinatal outcomes between in vitro fertilization (IVF) twins and naturally conceived twins born to women aged 35 years or older and to provide basic information for taking care of IVF twins born to women aged 35 years or older. METHODS: We reviewed the records of perinatal and neonatal outcomes in 288 IVF twins and 220 naturally conceived twins born to women aged 35 years or older between January 2001 and December 2010 at CHA Bundang Medical Center. RESULTS: No difference was observed in the maternal ages of mothers giving birth to IVF twins and those giving birth to naturally conceived twins. Gestational ages and birth weights of IVF twins were not different from those of naturally conceived twins. Various perinatal outcomes, including gestational diabetes mellitus, pregnancy-induced hypertension, placenta previa, premature amniotic membrane rupture, and need for a Cesarean section did not differ between the 2 groups. However, the 1-min and 5-min Apgar scores (P=0.019 and P=0.045, respectively) were different between the 2 groups. The incidence of early-onset sepsis was lower in the IVF twins than in the naturally conceived twins (P=0.02). However, the 2 groups did not show any difference in the incidence of respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, and other congenital anomalies. CONCLUSION: The perinatal outcomes in IVF twins born to women aged 35 years or older were not significantly different from those of naturally conceived twins.

Sex Determination from the Tibia in Korean Population / 체질인류학회지

There are a number of studies in the world that uses tibia for sex determination, however there are no such studie in Korea. Eight variables were used to determinate sex of tibia. The sample consisted of 170 tibiae (from 55 males and 30 females). The ages for these specimens ranged from 18 and 91 years. Vernier caliper (Absolute Digimetric, Mitutoyo Corp, Japan), osteometric table (Osteometric table, GPM Corp, Swiss) and Ruler (Ruler, Peace Corp, Korea) were used to measure these variables and statistical analysis was performed. Result showed that the accuracy of maximum breadth of lateral articular surface of proximal condyle (LAB) was highest to reached 80.5%; on the contrary, circumference the body that the point found nutrient foramen (CNF) was lowest correlation variable to reach only 68.4%. Other variables except for CNF showed higher than 75.0% accuracy. Equation of sex determining function was made by the stepwise logistic regression using maximum breadth between lateral and medial condyle on the superior aspect (PAB) and maximum length of lateral articular surface of proximal condyle (LAL). The accuracy of the equation showed 84.8%. This study showed that certain parameters of the tibia useful for sex determination in the case of fragment of tibia are found.

Anatomic Variations of Ligaments and Muscles Related with the Ulnar Nerve Entrapment Syndrome in the Upper Arm / 대한해부학회지

Compressive neuropathy of the ulnar nerve occurs commonly at the cubital tunnel, but it can also be occurred by the anatomic variations of the structures on the ulnar nerve passage. This study was thus performed to clarify the variations of the ligaments and muscles, which can cause the ulnar nerve entrapment syndrome in the upper arm. One hundred arms of 50 Korean adult cadavers were used. The arcade of Struthers, a musculo-tendinous band from the medial head of the triceps brachii to the medial intermuscular septum, was observed in 34% of the cases. This arcade was mostly in a narrow-band shape, but a broad-band shaped arcade was sometimes observed. The internal brachial ligament was observed in 17% of cases. The epitrochleoanconeus muscle between the medial epicondyle and the olecranon was observed in 3% of cases. The ulnar nerve was wrapped or covered by the medial head of triceps brachii in 5% of cases. This study is expected to further the current understanding of the anatomic variations of ligaments and muscles on the ulnar nerve passage, and to be helpful data for the diagnosis and treatment of the ulnar nerve entrapment syndrome in the upper arm.

Liver Dysfunction due to Hepatic Glycogenosis in a Girl with Type 1 Diabetes / 대한소아내분비학회지

Hepatic glycogenosis is an under-recognized cause of hepatomegaly and elevated serum aminotransferase levels in patients with type 1 diabetes; further, most cases of hepatic glycogenosis are reported to be associated with poor glycemic control. In this report, we describe the case of a 12-year-old girl with hepatic glycogenosis, who presented with elevated liver enzymes. She was diagnosed with type 1 diabetes at the age of 6 years, and her diabetes was very "brittle" with recurrent episodes of hypoglycemic attacks. Her recent hemoglobin A1C (HbA1c) level was 8.4%, and the average HbA1c level during the last 2 years was 8.7%. Her aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were persistently elevated during the last year, up to 700 and 258 U/L, respectively. Her growth rate and pubertal development were normal. Her serum was negative for hepatitis viral markers, and the plasma levels of ceruloplasmin and ferritin were also normal. Ultrasound examination revealed hepatomegaly with increased hepatic echogenicity. Liver biopsy demonstrated irregular glycogen deposition in hepatocytes. Recurrent hypoglycemia was resolved with continuous subcutaneous insulin infusion, and after 3 weeks, her AST and ALT levels decreased to 47 and 33 U/L, respectively. We conclude that hepatic glycogenosis should be suspected as a cause of abnormal liver function tests in patients with poorly controlled or brittle type 1 diabetes. After excluding other causes of hepatic dysfunction, a 1-month trial for achieving improved glycemic control, while avoiding hypoglycemia, is recommended before proceeding with invasive investigation of the patient.

Estimation of Maximum Tibia Length from Fragmentary Condition in Korean Populations / 체질인류학회지

Long limb bones have been used in the derivation of regression equations for stature assessment. Various papers to estimate stature from long limb bones were existed. However fragmentary long bones are found for analyses in forensic cases, it has impossible to derive regression equations for the estimation of stature from the fragments of these bones. In this reason, this study was tried to estimate maximum long bone length specially tibia as measured nine variables. The sample consisted of 170 tibias (55 males and 30 females). The ages for these specimens ranged between 18 and 91 years. Vernier caliper (Mitutoyo, Tokyo, Japan) and osteometric table (GPM, Swiss) were used to measure variable. Statistical analysis was made using SPSS 15.0 for windows to estimate maximum tibia length. The variables, seemed to higher than 0.5 R-square, were circumference the body that the point found nutrient foramen (CNF) in female and maximum breadth between lateral and medial condyle on the superior aspect (PAB), CNF in combined sex. Also, regression equations were made through the stepwise analysis. The R-squares were 0.499 of male, 0.685 of female and 0.617 of combined sex. In the absence of intact long bones, the equations derived from the present study can provide a reliable estimate of maximum tibia length and can estimate stature after all.