Insulin Fact Sheet in Type 1 and 2 Diabetes Mellitus and Trends of Antidiabetic Medication Use in Insulin Users with Type 2 Diabetes Mellitus: 2002 to 2019

Background@#This study investigated the trends of insulin use among Korean patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Changes in prescription of antidiabetic medications in T2DM patients taking insulin therapy were evaluated. @*Methods@#We analyzed data from the National Health Insurance Service database in Korea to evaluate the prevalence of insulin users and trends of insulin use in T1DM and T2DM patients from January 2002 to December 2019. We also investigated numbers and types of antidiabetic medications in insulin users with T2DM. @*Results@#The overall total number of insulin users increased from 2002 to 2019, reaching 348,254 for T2DM and 20,287 for T1DM in 2019 compared with 109,974 for T2DM and 34,972 for T1DM in 2002. The proportion of patients using basal analogs and short acting analogs have increased and those using human insulin, premixed insulin, or biphasic human insulin have decreased (rapid acting analogs: 71.85% and 24.12% in T1DM and T2DM, respectively, in 2019; basal analogs: 76.75% and 75.09% in T1DM and T2DM, respectively, in 2019). The use of other antidiabetic medication in addition to insulin increased for T2DM, especially in dual therapy, reaching up to 52.35% in 2019 compared with 16.72% in 2002. @*Conclusion@#The proportion of the patients using basal or rapid acting analogs increased among all insulin users in both T1DM and T2DM patients. Among patients with T2DM, the proportion of patients using antidiabetic medications in addition to insulin was significantly increased compared to those who used insulin alone.

Transcutaneous medial fixation sutures for free flap inset after robot-assisted nipple-sparing mastectomy

The application of minimal invasive mastectomy has allowed surgeons to perform nipplesparing mastectomy via a shorter, inconspicuous incision under clear vision and with more precise hemostasis. However, it poses new challenges in microsurgical breast reconstruction, such as vascular anastomosis and flap insetting, which are considerably more difficult to perform through the shorter incision on the lateral breast border. We propose an innovative technique of transcutaneous medial fixation sutures to help in flap insetting and creating and maintaining the medial breast border. The sutures are placed after mastectomy and before flap transfer. Three 4-0 nylon suture loops are placed transcutaneously and into the pocket at the markings of the preferred lower medial border of the reconstructed breast. After microvascular anastomosis and temporary shaping of the flap on top of the mastectomy skin, the three corresponding points for the sutures are identified. The three nylon loops are then sutured to the dermis of the corresponding medial point of the flap. The flap is placed into the pocket by a simultaneous gentle pull on the three sutures and a combined lateral push. The stitches are then tied and buried after completion of flap inset.

The macrophage migration inhibitory factor protein superfamily in obesity and wound repair

The rising number of obese individuals has become a major burden to the healthcare systems worldwide. Obesity includes not only the increase of adipose tissue mass but importantly also the altered cellular functions that collectively lead to a chronic state of adipose tissue inflammation, insulin resistance and impaired wound healing. Adipose tissue undergoing chronic inflammation shows altered cytokine expression and an accumulation of adipose tissue macrophages (ATM). The macrophage migration inhibitory factor (MIF) superfamily consists of MIF and the recently identified homolog D-dopachrome tautomerase (D-DT or MIF-2). MIF and D-DT, which both bind to the CD74/CD44 receptor complex, are differentially expressed in adipose tissue and have distinct roles in adipogenesis. MIF positively correlates with obesity as well as insulin resistance and contributes to adipose tissue inflammation by modulating ATM functions. D-DT, however, is negatively correlated with obesity and reverses glucose intolerance. In this review, their respective roles in adipose tissue homeostasis, adipose tissue inflammation, insulin resistance and impaired wound healing will be reviewed.

The macrophage migration inhibitory factor protein superfamily in obesity and wound repair

The rising number of obese individuals has become a major burden to the healthcare systems worldwide. Obesity includes not only the increase of adipose tissue mass but importantly also the altered cellular functions that collectively lead to a chronic state of adipose tissue inflammation, insulin resistance and impaired wound healing. Adipose tissue undergoing chronic inflammation shows altered cytokine expression and an accumulation of adipose tissue macrophages (ATM). The macrophage migration inhibitory factor (MIF) superfamily consists of MIF and the recently identified homolog D-dopachrome tautomerase (D-DT or MIF-2). MIF and D-DT, which both bind to the CD74/CD44 receptor complex, are differentially expressed in adipose tissue and have distinct roles in adipogenesis. MIF positively correlates with obesity as well as insulin resistance and contributes to adipose tissue inflammation by modulating ATM functions. D-DT, however, is negatively correlated with obesity and reverses glucose intolerance. In this review, their respective roles in adipose tissue homeostasis, adipose tissue inflammation, insulin resistance and impaired wound healing will be reviewed.

Association between cord blood 25-hydroxyvitamin D concentrations and respiratory tract infections in the first 6 months of age in a Korean population: a birth cohort study (COCOA) / 소아과

PURPOSE: Previous studies suggest that the concentration of 25-hydroxyvitamin D [25(OH)D] in cord blood may show an inverse association with respiratory tract infections (RTI) during childhood. The aim of the present study was to examine the influence of 25(OH)D concentrations in cord blood on infant RTI in a Korean birth cohort. METHODS: The levels of 25(OH)D in cord blood obtained from 525 Korean newborns in the prospective COhort for Childhood Origin of Asthma and allergic diseases were examined. The primary outcome variable of interest was the prevalence of RTI at 6-month follow-up, as diagnosed by pediatricians and pediatric allergy and pulmonology specialists. RTI included acute nasopharyngitis, rhinosinusitis, otitis media, croup, tracheobronchitis, bronchiolitis, and pneumonia. RESULTS: The median concentration of 25(OH)D in cord blood was 32.0 nmol/L (interquartile range, 21.4 to 53.2). One hundred and eighty neonates (34.3%) showed 25(OH)D concentrations less than 25.0 nmol/L, 292 (55.6%) showed 25(OH)D concentrations of 25.0-74.9 nmol/L, and 53 (10.1%) showed concentrations of > or =75.0 nmol/L. Adjusting for the season of birth, multivitamin intake during pregnancy, and exposure to passive smoking during pregnancy, 25(OH)D concentrations showed an inverse association with the risk of acquiring acute nasopharyngitis by 6 months of age (P for trend=0.0004). CONCLUSION: The results show that 89.9% of healthy newborns in Korea are born with vitamin D insufficiency or deficiency (55.6% and 34.3%, respectively). Cord blood vitamin D insufficiency or deficiency in healthy neonates is associated with an increased risk of acute nasopharyngitis by 6 months of age. More time spent outdoors and more intensified vitamin D supplementation for pregnant women may be needed to prevent the onset of acute nasopharyngitis in infants.

The difference between the two methods for myocardial performance index in children / 소아과

PURPOSE: The object of this study was to determine the difference between two methods for myocardial performance index(MPI) in children, using the conventional and pulsed Doppler echocardiography. METHODS: A total of 27 children with anatomically normal hearts were enrolled for the study. all were examined by conventional and pulsed Doppler echocardiography at Gangneung Asan Hospital between December, 2005 and February, 2006. First, we measured the time interval(a1) between the mitral inflows from apical 4-chamber view, and the ejection time(ET1) from apical 5-chamber view. And then, we calculated MPI1, isovolumic contraction time(ICT1) and isovolumic relaxation time (IRT1). Secondly, we measured ICT2, ET2 and IRT2 from apical 5-chamber view with a Dopper signal placed at just below junction between mitral and aortic valve at the same cardiac cycle. And then, we calculated MPI2. We compared MPI1 to MPI2. All MPIs were calculated by using the formula, MPI=(ICT+IRT)/ET. RESULTS: The mean age was 5.7+/-2.2 years old(M:F=15:12). The MPI2 was higher than MPI1: 0.277+/-0.083 vs. 0.428+/-0.081(MPI1 vs MPI2, P=0.000). Also, the ICT2 was higher than ICT1: 56+/-15 msec vs 97+/-18 msec(ICT1 vs ICT2, P=0.000) and the IRT2 was higher than IRT1: 42+/-8 msec vs 53+/-9 msec(IRT1 vs IRT2, P=0.000). But, the ET2 was lower than ET1: 260+/-16 msec vs 254+/-14 msec (ET1 vs ET2, P=0.01). There was, as well, positive linear correlation between MPI1 and MPI2. CONCLUSION: This study showed that there is a difference between MPI1 and MPI2 in connection with estimating methods. However, the two MPIs had a positive linear correlation. Judging from our results, the MPI of the new method might be a useful index of venticular global function in children.

The Utilities of Lung Biopsy in Pediatric Lung Disease

PURPOSE: The aim of this study is to evaluate the value of lung biopsies for the management of children with lung disease. METHODS: We retrospectively reviewed 19 lung biopsies done at Asan Medical Center, Seoul between 1993 and 2001. Data gathered included demographic information, underlying conditions, diagnosis before biopsy, final diagnosis, change in therapy, morbidity and mortality. RESULTS: Nineteen patients underwent lung biopsy. Among them, 13 patients were male and six patients were female; the median age was 3.6 years(0.8 to 8.6 years). Twelve patients underwent open lung biopsies and seven patients had thoracoscopic biopsies. The overall diagnosis rate was 95 %. The most common diagnosis was interstitial lung disease(12 patients, 64%) and infection was detected in four patients(21%). The biopsy-proven bronchiolitis obliterance was confirmed in two of seven patients suspected by CT findings. Specific treatment was changed after biopsy in 16 patients (85%). The morbidity & overall mortality rates of the patients were 5%(one patient) and 21%(four patients) respectively. Only one complication was seen: empyema. The causes of death were acute respiratory distress syndrome(one patient), respiratory failure(two patients), and septicemia(one patient). CONCLUSIONS: The lung biopsy is a safe procedure and it contributes to more accurate diagnosis and proper management of pediatric lung diseases. We recommend lung biopsies should be considered more positively in the diagnosis of pediatric lung diseases.

Risk Factors for Recurrence of Febrile Seizure in Children

OBJECTIVE: We researched the factors influencing recurrence, frequency and recurrence interval after first attack of febrile seizure. METHODS: The study was performed in 125 children who visited emergency rooms and was followed up over 24 months after the first febrile seizure. Children were divided into several groups according to fever degree, onset age, sex, seizure duration, serum sodium concentration at first seizure attack. The recurrence rate, frequency, and recurrence interval of each group were then compared. RESULTS: 1) Febrile seizures recurred in 36(28.8%) of 125 children with 2.89 seizure episodes, and recurrence occurred within 6 months in 18(50.0%), within 12 months in 26(72.2%), within 18 months in 33(91.2%) after the first febrile seizures. 2) The recurrence rate was significantly high in children who developed seizures before 12 months of age(P<0.05), and slightly increased in cases with a positive family history and lower degree of fever groups, but statistically no significance was found. 3) Seizure frequencies were also high in younger age group(3.25 episodes), compared to the older age group. 4) Recurrence within 6 months from onset occurred in 72% of the young age group. The younger the age at first occurrence the more likely the recurrence rate. The duration of seizure, sex, and serum sodium concentration did not meaningfully affect recurrent rate and frequency. CONCLUSION: In children who have had a first febrile seizure, recurrence is common. The onset of the first febrile seizure at an early age was associated with an increased risk of more frequent recurrent febrile seizures and a short recurrence interval after first febrile seizure.

Quantification of Age-related Reference Values for Urinary Organic Acids in the Healthy Korean Population

PURPOSE: For the accurate diagnosis of organic acidopathies, quantification of urinary organic acid should be done and we should know the normal ranges of each organic acid excreted in the urine. The amount of organic acids excreted in the urine shows wide variability according to ethnic group, diet and age. We have quantified 82 organic acids to make a Korean reference value. METHODS: Organic acid concentrations were quantified with gas chromatography and the individual acids identified with mass spectrometry in urine specimens from members of the healthy Korean population of ages of one day to more than 12 years, subdivided into four age groups : neonatal period(-2 mon), infantile period(-2 year), childhood period(-12 year) and adolescent and adulthood(over 12 years). For isolation of organic acids from urine, we used solvent extraction method with ethylacetate. Derivatization was done with MSTFA(N-methyl-N-trimethylsilylfluoroacetamide). The library and four points quantification curve for the quantification of each organic acid that we used have been developed by Dr. Giudici of Kayser Permanante Metabolic Laboratory, CA., USA. RESULTS: Quantitative ranges and frequency distribution patterns of urinary organic acid excretion are reported, as a basis on which to compare results obtained for patients whose clinical condition suggests that their excretion values may be abnormal. CONCLUSION: The quantitative values we observed, enable the relative significance of different urinary metabolites to be assessed.

Prevalence of gastroesophageal reflux in infants with recurrent wheezing / 천식및알레르기

Background : Recurrent wheezing in infants is manifested in a number of disease spectrums and gastroesophageal reflux ( GER ) has been known to be associated with apnea, recurrent pneumonia, asthma, chronic cough, and wheezing. The prevalence of GER in infants with recurrent wheezing and the relationship between atopy and GER in infantile asthmatics have not yet been established, but it was hypothesized that microaspiration of food allergen could induce food-induced wheezing. Objective : To evaluate the prevalence of GER in infants with recurrent wheezing episodes, and to determine whether the presence of atopy affects the prevalence of GER in infantile asthmatics. Method : Seventy infants with recurrent wheezing episodes were evaluated for GER using 24 hour continuous esophageal pH monitoring. Patients were classified into five groups, : 12 atopic asthmatics : 20 nonatopic asthmatics : 15 infants with recurrent bronchiolitis : 8 infants with recurrent pneumonia : and 15 infants with chronic lung disease ( CLD ) of prematurity. GER was considered to be prevalent when reflux index was higher than 95 percentile of normal values by Vandenplas, 1991. Result : The prevalence of GER in infants with recurrent wheezing was 21.4%. The prevalence of GER in each group was 25% in atopic asthmatics, 20% in nonatopic asthmatics, 6.7% in infants with recurrent bronchiolitis, 12.5% in infants with recurrent pneumonia, and 40% in infants with CLD of prematurity. There were no significant differences in prevalence of GER between atopic asthmatics and nonatopic asthmatics, between asthmatics with atopic dermatitis and those without, and between asthmatics with family history of allergy and those without. CONCLUSION: The prevalence of GER in infants with recurrent wheezing was high, especially in infantile asthmatics and infants with chronic lung disease of prematurity. The presence of atopy may not affect the prevalence of GER in infantile asthmatics.

A Case of Epidermolysis Bullosa Herpetiformis

Epidermolysis bullosa (EB) is a rare inherited disease characterized by vesiculobullous lesion that arise in response to minimal trauma or shearing force to the skin. Epiderrnolysis bullosa herpetiformis-Dowling Meara, a variant of EB, has its onset at birth and can be a life threatening disease as it was in this case. We report a case of epidermolysis bullosa herpetiformis in a newborn with a generalized intraepidermal blisters noted at birth whose diagnosis was confirmed by electron microscope. A brief review of the literature is included.