Evaluation of dietary quality using elderly nutrition quotient depending on the consumption of healthy functional foods / 한국영양학회지

Purpose@#The purpose of this study was to determine whether the dietary quality of food consumed by the elderly is influenced by the consumption of healthy functional foods using Nutrition Quotients for the Elderly (NQ-E). @*Methods@#The study subjects were 250 adults aged ≥ 65 living in Seoul or Gyeonggi-do. Those who had consumed healthy functional food for more than 2 weeks within the previous year were classified as healthy functional food consumers, and the quality of their meals was evaluated using the NQ-E. Statistical analysis was performed using SAS 9.4, and sex and age-associated differences were adjusted before comparing differences based on healthy functional food intake. @*Results@#The average age of the study subjects was 70.8. The scores for each area and the Nutrition Quotient (NQ) score were as follows: balance 43.3 points, moderation 56.7 points, practice 65.7 points, and NQ 52.5 points. When comparing differences according to healthy functional food intake status, healthy functional food consumers had significantly higher balance and NQ scores than non-consumers. When considering each NQ item score, healthy functional food consumers had significantly higher scores than non-consumers for fruit, fish and seafood, eggs, nuts, and whole grain rice, and a higher score for effort to maintain a healthy diet. @*Conclusion@#Dietary quality as assessed by Nutrition Quotients for the Elderly was better for healthy functional food consumers than non-consumers.

Korean vs. Western Exercise Capacity Nomograms for Korean Patients With Cardiovascular Disease

Background@#Exercise capacity is known to be an independent predictor of cardiovascular events and mortality. However, most previous studies were based on Western populations.Further study is warranted for Asian patients according to ethnic or national standards. We aimed to compare prognostic values of Korean and Western nomograms for exercise capacity in Korean patients with cardiovascular disease (CVD). @*Methods@#In this retrospective cohort study, we enrolled 1,178 patients (62 ± 11 years;78% male) between June 2015 and May 2020, who were referred for cardiopulmonary exercise testing in our cardiac rehabilitation program. The median follow-up period was 1.6 years. Exercise capacity was measured in metabolic equivalents by direct gas exchange method during the treadmill test. The nomogram for exercise capacity from healthy Korean individuals and a previous landmark Western study was used to determine the percentage of predicted exercise capacity. The primary endpoint was the composite of major adverse cardiovascular events (MACE; all-cause death, myocardial infarction, repeat revascularization, stroke and hospitalization for heart failure). @*Results@#A multivariate analysis showed that the risk of primary endpoint was more than double (hazard ratio [HR], 2.20; 95% confidence interval [CI], 1.10–4.40) in the patients with lower exercise capacity (< 85% of predicted) by Korean nomogram. The lower exercise capacity was one of the strong independent predictors along with left ventricular ejection fraction, age, and level of hemoglobin. However, the lower exercise capacity by Western nomogram could not predict the primary endpoint (HR, 1.33; 95% CI, 0.85–2.10). @*Conclusion@#Korean patients with CVD with lower exercise capacity have higher risk of MACE.Considering inter-ethnic differences in cardiorespiratory fitness, the Korean nomogram provides more suitable reference values than the Western nomogram to determine lower exercise capacity and predict cardiovascular events in Korean patients with CVD.

Long-term prognosis and the need for histologic assessment of chronic hepatitis B in the serological immune-tolerant phase

Background/Aims@#The histologic status of the immune-tolerant (IT) phase of chronic hepatitis B relative to long-term outcomes is unclear. This study aimed to discover how the serological criteria currently in use correspond to histologic criteria in determining the IT phase and indication for liver biopsy. @*Methods@#Patients in the serological IT phase determined by positive hepatitis B e antigen, hepatitis B virus (HBV) DNA ≥106 IU/mL, and normal or minimally elevated alanine aminotransferase (ALT) ≤60 IU/L, who underwent liver biopsy at three different hospitals were included. The distribution of the histologic IT phase, defined as fibrosis of stage 1 or less and inflammation of grade 1 or less, was compared with that of the serological IT phase. The risk factors for the incidence of liver-related events, such as hepatocellular carcinoma, liver cirrhosis, liver transplantation, and death, were also analyzed. @*Results@#Eighty-two (31.7%) out of 259 clinically suspected IT phase patients belonged to the histologic IT phase. Age over 35, high AST, and low albumin were useful for ruling out the histologic IT phase. Risk factors predicting liver-related events were age and significant fibrosis stage. There was no significant difference in the proportion of histologic IT phase and clinical prognosis between normal ALT and mildly elevated ALT groups. However, even in patients with normal ALT, age was an important factor in predicting the presence of the histologic IT phase. @*Conclusions@#A significant number of patients who belonged to the serological IT phase were not in the histologic IT phase. Patients over 35 years and those with high AST, low albumin, and low HBV DNA levels were more likely to experience poor long-term clinical outcomes. Therefore, additional histologic assessment should be considered.

Efficacy of Limited Dose Modifications for Palbociclib-Related Grade 3 Neutropenia in Hormone Receptor–Positive Metastatic Breast Cancer / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Frequent neutropenia hinders uninterrupted palbociclib treatment in patients with hormone receptor (HR)–positive breast cancer. We compared the efficacy outcomes in multicenter cohorts of patients with metastatic breast cancer (mBC) receiving palbociclib following conventional dose modification or limited modified schemes for afebrile grade 3 neutropenia. @*Materials and Methods@#Patients with HR-positive, human epidermal growth factor receptor 2–negative mBC (n=434) receiving palbociclib with letrozole as first-line therapy were analyzed and classified based on neutropenia grade and afebrile grade 3 neutropenia management as follows: group 1 (maintained palbociclib dose, limited scheme), group 2 (dose delay or reduction, conventional scheme), group 3 (no afebrile grade 3 neutropenia event), and group 4 (grade 4 neutropenia event). The primary and secondary endpoints were progression-free survival (PFS) between groups 1 and 2 and PFS, overall survival, and safety profiles among all groups. @*Results@#During follow-up (median 23.7 months), group 1 (2-year PFS, 67.9%) showed significantly longer PFS than did group 2 (2-year PFS, 55.3%; p=0.036), maintained across all subgroups, and upon adjustment of the factors. Febrile neutropenia occurred in one and two patients of group 1 and group 2, respectively, without mortality. @*Conclusion@#Limited dose modification for palbociclib-related grade 3 neutropenia may lead to longer PFS, without increasing toxicity, than the conventional dose scheme.

Impacts of Subtype on Clinical Feature and Outcome of Male Breast Cancer: Multicenter Study in Korea (KCSG BR16-09) / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#The treatment of male breast cancer (MBC) has been extrapolated from female breast cancer (FBC) because of its rarity despite their different clinicopathologic characteristics. We aimed to investigate the distribution of intrinsic subtypes based on immunohistochemistry, their clinical impact, and treatment pattern in clinical practice through a multicenter study in Korea. @*Materials and Methods@#We retrospectively analyzed clinical data of 248 MBC patients from 18 institutions across the country from January 1995 to July 2016. @*Results@#The median age of MBC patients was 63 years (range, 25 to 102 years). Among 148 intrinsic subtype classified patients, 61 (41.2%), 44 (29.7%), 29 (19.5%), and 14 (9.5%) were luminal A, luminal B, human epidermal growth factor receptor 2, and triple-negative breast cancer, respectively. Luminal A subtype showed trends for superior survival compared to other subtypes. Most hormone receptor-positive patients (166 patients, 82.6%) received adjuvant endocrine treatment. Five-year completion of adjuvant endocrine treatment was associated with superior disease-free survival (DFS) in patients classified with an intrinsic subtype (hazard ratio [HR], 0.15; 95% confidence interval [CI], 0.04 to 0.49; p=0.002) and in all patients (HR, 0.16; 95% CI, 0.05 to 0.54; p=0.003). @*Conclusion@#Distribution of subtypes of MBC was similar to FBC and luminal type A was most common. Overall survival tended to be improved for luminal A subtype, although there was no statistical significance. Completion of adjuvant endocrine treatment was associated with prolonged DFS in intrinsic subtype classified patients. MBC patients tended to receive less treatment. MBC patients should receive standard treatment according to guidelines as FBC patients.

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.

Comparison of Initial Presentation of Pediatric Diabetes Before and During the Coronavirus Disease 2019Pandemic Era

Background@#Hospital visitation has become challenging during the coronavirus disease 2019 pandemic because of quarantine measures and fear of infection. Consequently, newly diagnosed patients may present with more severe diseases during the pandemic. The present study analyzed the differences in the initial clinical presentations of newly diagnosed patients with type 1 diabetes (T1D) and type 2 diabetes (T2D), comparing pre-pandemic and pandemic periods. @*Methods@#Newly diagnosed patients with T1D or T2D and aged < 18 years during 2018–2020 were included in the study. Data were collected retrospectively from four academic centers in Gyeonggi-do, South Korea. Initial clinical data were compared between the pre-pandemic (2018–2019) and pandemic (2020) periods. @*Results@#In the pre-pandemic and pandemic periods, 99 patients (41 T1D and 58 T2D patients) and 84 patients (51 T1D and 33 T2D patients) were identified, respectively. During the pandemic, the proportion of diabetic ketoacidosis (DKA) cases increased compared to the pre-pandemic period (21.2% during 2018–2019 vs. 38.1% in 2020; P = 0.012). In the prepandemic and pandemic periods, initial pH was 7.32 ± 0.14 and 7.27 ± 0.15, respectively (P = 0.040), and HbA1c values were 11.18 ± 2.46% and 12.42 ± 2.87%, respectively (P = 0.002). During the pandemic, there was an increased risk of DKA in patients with T1D (odds ratio, 2.42; 95% confidence interval, 1.04–5.62; P = 0.040). @*Conclusion@#During the pandemic, the proportion of DKA in newly diagnosed patients with T1D increased and clinical parameters showed a deteriorating pattern. Increased awareness of pediatric diabetes, especially DKA, could facilitate visit to the hospital for an early diagnosis; thus, reducing the number of DKA cases during the pandemic era.

Fasting Blood Glucose Variability and Unfavorable Trajectory Patterns Are Associated with the Risk of Colorectal Cancer

Background/Aims@#The relationship between fasting blood glucose (FBG) variability and colorectal cancer (CRC) remains ill-defined. This study aimed to evaluate the association of FBG variability with CRC risk in the healthy population without overt diabetes. @*Methods@#In the data from the Korean National Health Insurance Service-Health Screening Cohort, we included individuals examined by FBG testing at least 3 times between 2002 and 2007. FBG variability was calculated using standard deviation (SD) and coefficient of variation (CV). @*Results@#Regarding FBG variability, an increase in the quintile of SD or CV was independently associated with CRC risk (all p for trend <0.01). When the change in FBG was classified into six trajectory patterns, unfavorable trajectory patterns (high stable and upward) were significantly associated with increased CRC risk (hazard ratio [HR] 2.30, p=0.003; HR 1.19, p=0.007, respectively). In subgroup analyses according to the sex, a significant association between FBG variability (SD or CV) and CRC risk was observed in men but not in women. The high stable and upward pattern were also associated with CRC risk in men (HR 2.47, p=0.002; HR 1.21, p=0.012) but not in women. @*Conclusions@#This study identified that FBG variability and unfavorable trajectory patterns were significantly associated with increased CRC risk in the healthy population without overt diabetes. Our findings suggest that FBG variability as well as FBG itself may be a predictive factor for the development of CRC.

A case of follow-up of a patient with 22q11.2 distal deletion syndrome and a review of the literature

Microdeletions of chromosome 22q11.2 are one of the most common microdeletions occurring in humans, and is known to be associated with a wide range of highly variable features. These deletions occur within a cluster of low copy repeats (LCRs) in 22q11.2, referred to as LCR22 A-H. DiGeorge (DGS)/velocardiofacial syndrome is the most prevalent form of a 22q11.2 deletions, caused by mainly proximal deletions between LCR22 A and D. As deletions of distal portion to the DGS deleted regions has been extensively studied, the recurrent distal 22q11.2 microdeletions distinct from DGS has been suggested as several clinical entities according to the various in size and position of the deletions on LCRs. We report a case of long-term follow-up of a female diagnosed with a 22q11.2 distal deletion syndrome, identified a deletion of 1.9 Mb at 22q11.21q11.23 (chr22: 21,798,906-23,653,963) using single nucleotide polymorphism array. This region was categorized as distal deletion type of 22q11.2, involving LCR22 D-F. She was born as a preterm, low birth weight to healthy non-consanguineous Korean parents. She showed developmental delay, growth retardation, dysmorphic facial features, and mild skeletal deformities. The patient underwent a growth hormone administration due to growth impairment without catch-up growth. While a height gain was noted, she had become overweight and was subsequently diagnosed with pre-diabetes. Our case could help broaden the genetic and clinical spectrum of 22q11.2 distal deletions.

Diagnosis and management of pediatric type 1 diabetes mellitus

In contrast to type 2 diabetes, type 1 diabetes mellitus (T1DM) requires insulin treatment to control blood glucose. As the incidence and prevalence of T1DM have steadily increased; therefore, T1DM is increasingly being diagnosed not only in children and adolescents, but also in adults. Therefore, the importance of accurate diagnosis and optimal management of T1DM is being recognized in clinical practice.Current Concepts: T1DM is caused by insulin deficiency, following the destruction of insulin-producing pancreatic β-cells. Diagnosis of diabetes is based on the following criteria: fasting blood glucose levels ≥126 mg/dL, random blood glucose levels ≥200 mg/dL accompanied by symptoms of hyperglycemia, an abnormal 2-hour oral glucose tolerance test, or glycated hemoglobin ≥6.5%. Accurate diagnosis of T1DM based on patients’ clinical characteristics, serum C-peptide levels, and detection of autoantibodies against β-cell autoantigens is important for optimum care and to avoid complications. A target glycated hemoglobin level is recommended in children, adolescents, and young adults with access to comprehensive care. The availability of insulin analogues and mechanical technologies (insulin pumps and continuous glucose monitors) has improved the management of T1DM, and these are useful for the prevention of microvascular complications. Screening for microvascular complications should commence at puberty or 5 years after diagnosis of T1DM.Discussion and Conclusion: Effective cooperation and coordination between patient, parents, and healthcare providers are necessary to achieve a successful transition from pediatric to adult care in patients with T1DM. Diabetic management for T1DM should be individualized based on patients’ lifestyle, as well as psychosocial, and medical circumstances.

Real-World Clinical Data of Palbociclib in Asian Metastatic Breast Cancer Patients: Experiences from Eight Institutions / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Use of cyclin-dependent kinase 4/6 inhibitors improved survival outcome of hormone receptor (HR) positive metastatic breast cancer (MBC) patients, including Asian population. However, Asian real-world data of palbociclib is limited. We analyzed the real-world clinical practice patterns and outcome in HR-positive, MBC Asian patients treated with palbociclib. @*Materials and Methods@#Between April 2017 to November 2019, 169 HR-positive, human epidermal growth factor-2–negative MBC patients treated with letrozole or fulvestrant plus palbocilib were enrolled from eight institutions. Survival outcome (progression-free survival [PFS]), treatment response and toxicity profiles were analyzed. @*Results@#Median age of letrozole plus palbociclib (145 patients, 85.8%) and fulvestrant plus palbociclib (24 patients, 14.2%) was 58 and 53.5 years, with median follow-up duration of 14.63 months (range 0.2 to 33.9 months). Median PFS (mPFS) of letrozole plus palbociclib and fulvestrant plus palbociclib was 25.6 (95% confidence interval [CI], 19.1 to not reached) and 6.37 months (95% CI, 5.33 to not reached), comparable to previous phase 3 trials. In letrozole plus palbociclib arm, luminal A (hazard ratio, 2.86; 95% CI, 1.20 to 6.80; p=0.017) and patients with good performance (Eastern Cooperative Oncology Group 0-1 [hazard ratio, 3.68; 95% CI, 1.70 to 7.96]) showed better mPFS. In fulvestrant plus palbociclib group, chemotherapy naïve patients showed better mPFS (hazard ratio, 12.51, 95% CI, 1.59 to 99.17; p=0.017). The most common grade 3 or 4 adverse event was neutropenia (letrozole 86.3%, fulvestrant 88.3%). @*Conclusion@#To our knowledge, this is the first real-world data of palbociclib reported in Asia. Palbociclib showed comparable benefit to previous phase 3 trials in Asian patients during daily clinical practice.

Myhre syndrome: the first case in Korea

Myhre syndrome (MS) is a rare autosomal-dominant disorder characterized by short stature, intellectual disability, skeletal anomalies, restricted joint mobility, distinctive facial dysmorphism, and deafness. Early diagnosis of MS is difficult because its features progress and become noticeable at school age. Recently, the SMAD4 gene was identified as the major gene responsible for MS. Herein, we report the first Korean case of MS after identification of a SMAD4 mutation by clinical exome sequencing. The patient was born small for gestational age, and she had the typical clinical features of MS, including short stature, characteristic facial appearance, developmental delay, and selective mutism. She was diagnosed with central precocious puberty. Because of the patient’s precocious puberty and short stature, we administered combined recombinant human growth hormone and gonadotropin-releasing hormone agonist treatments, which resulted in improved height. While there have been 79 cases of MS reported worldwide, to our knowledge, this is the first case of genetically-confirmed MS in Korea.

Clinical Utilities of Continuous Glucose Monitoring and Insulin Pumps in Pediatric Patients with Type 1 Diabetes / 이화의대지

Type 1 diabetes requires lifelong insulin therapy because insulin-secretion capability is diminished. Glycemic control and glucose monitoring are important to prevent type 1 diabetes complications. Diabetes technologies have developed rapidly; continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) are now common and greatly aid glycemic control, especially in children and adolescents. The National Health Insurance Service has provided partial reimbursements for both CGM and CSII devices since 2019 and 2020, respectively; the devices are thus expected to become more popular. CGM reduces the frequency of hypoglycemia and the level of glycated hemoglobin. CSII affords more precise glycemic control than multi-dose insulin therapy. CSII showed reduced frequency of hypoglycemia and improved metabolic outcome without an increase in the body mass index z-score. Technological advancement of combined CGM and CSII will eventually serve as an artificial pancreas. The National Health Insurance Service should fund not only the devices but also education of patients and caregivers. In addition, healthcare providers must be continuously updated on new diabetes technologies.

Diagnosis and management of pediatric type 1 diabetes mellitus

In contrast to type 2 diabetes, type 1 diabetes mellitus (T1DM) requires insulin treatment to control blood glucose. As the incidence and prevalence of T1DM have steadily increased; therefore, T1DM is increasingly being diagnosed not only in children and adolescents, but also in adults. Therefore, the importance of accurate diagnosis and optimal management of T1DM is being recognized in clinical practice.Current Concepts: T1DM is caused by insulin deficiency, following the destruction of insulin-producing pancreatic β-cells. Diagnosis of diabetes is based on the following criteria: fasting blood glucose levels ≥126 mg/dL, random blood glucose levels ≥200 mg/dL accompanied by symptoms of hyperglycemia, an abnormal 2-hour oral glucose tolerance test, or glycated hemoglobin ≥6.5%. Accurate diagnosis of T1DM based on patients’ clinical characteristics, serum C-peptide levels, and detection of autoantibodies against β-cell autoantigens is important for optimum care and to avoid complications. A target glycated hemoglobin level is recommended in children, adolescents, and young adults with access to comprehensive care. The availability of insulin analogues and mechanical technologies (insulin pumps and continuous glucose monitors) has improved the management of T1DM, and these are useful for the prevention of microvascular complications. Screening for microvascular complications should commence at puberty or 5 years after diagnosis of T1DM.Discussion and Conclusion: Effective cooperation and coordination between patient, parents, and healthcare providers are necessary to achieve a successful transition from pediatric to adult care in patients with T1DM. Diabetic management for T1DM should be individualized based on patients’ lifestyle, as well as psychosocial, and medical circumstances.

Real-World Clinical Data of Palbociclib in Asian Metastatic Breast Cancer Patients: Experiences from Eight Institutions / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Use of cyclin-dependent kinase 4/6 inhibitors improved survival outcome of hormone receptor (HR) positive metastatic breast cancer (MBC) patients, including Asian population. However, Asian real-world data of palbociclib is limited. We analyzed the real-world clinical practice patterns and outcome in HR-positive, MBC Asian patients treated with palbociclib. @*Materials and Methods@#Between April 2017 to November 2019, 169 HR-positive, human epidermal growth factor-2–negative MBC patients treated with letrozole or fulvestrant plus palbocilib were enrolled from eight institutions. Survival outcome (progression-free survival [PFS]), treatment response and toxicity profiles were analyzed. @*Results@#Median age of letrozole plus palbociclib (145 patients, 85.8%) and fulvestrant plus palbociclib (24 patients, 14.2%) was 58 and 53.5 years, with median follow-up duration of 14.63 months (range 0.2 to 33.9 months). Median PFS (mPFS) of letrozole plus palbociclib and fulvestrant plus palbociclib was 25.6 (95% confidence interval [CI], 19.1 to not reached) and 6.37 months (95% CI, 5.33 to not reached), comparable to previous phase 3 trials. In letrozole plus palbociclib arm, luminal A (hazard ratio, 2.86; 95% CI, 1.20 to 6.80; p=0.017) and patients with good performance (Eastern Cooperative Oncology Group 0-1 [hazard ratio, 3.68; 95% CI, 1.70 to 7.96]) showed better mPFS. In fulvestrant plus palbociclib group, chemotherapy naïve patients showed better mPFS (hazard ratio, 12.51, 95% CI, 1.59 to 99.17; p=0.017). The most common grade 3 or 4 adverse event was neutropenia (letrozole 86.3%, fulvestrant 88.3%). @*Conclusion@#To our knowledge, this is the first real-world data of palbociclib reported in Asia. Palbociclib showed comparable benefit to previous phase 3 trials in Asian patients during daily clinical practice.

Myhre syndrome: the first case in Korea

Myhre syndrome (MS) is a rare autosomal-dominant disorder characterized by short stature, intellectual disability, skeletal anomalies, restricted joint mobility, distinctive facial dysmorphism, and deafness. Early diagnosis of MS is difficult because its features progress and become noticeable at school age. Recently, the SMAD4 gene was identified as the major gene responsible for MS. Herein, we report the first Korean case of MS after identification of a SMAD4 mutation by clinical exome sequencing. The patient was born small for gestational age, and she had the typical clinical features of MS, including short stature, characteristic facial appearance, developmental delay, and selective mutism. She was diagnosed with central precocious puberty. Because of the patient’s precocious puberty and short stature, we administered combined recombinant human growth hormone and gonadotropin-releasing hormone agonist treatments, which resulted in improved height. While there have been 79 cases of MS reported worldwide, to our knowledge, this is the first case of genetically-confirmed MS in Korea.

Diabetes in Adolescence, Appropriate Transition to Adult Clinic / 임상당뇨병

As the prevalence of diabetes in children and adolescents increases, the transition of diabetes care from childhood to adulthood is increasing. During the transition period, the risks for hypoglycemia and hyperglycemia as well as microvascular and macrovascular complications can increase due to poor glycemic control along with mental health problems and high-risk behaviors. It is necessary to prepare and plan for the transition to the adult care system so that diabetes care is properly implemented, reducing the risk of complications and fostering successful diabetes management. The transition should begin at least 1 year prior to transfer and should focus on patient diabetes self-management skills. Pediatric providers should prepare a summary of the patient's medical records, including current mental health problems and presence of complications. Adult providers should be aware of and take into account the characteristics of emerging adults in management of diabetes, which are different from those of older adults. For successful transition, it is necessary to spend more time, consider mental health problems and high-risk behaviors, and communicate and exchange information with the pediatric provider. To this end, it is necessary for academia to develop a systematic, specific, and practical transition program and protocols and to develop a transition training program for pediatric and adult providers.

Maintenance chemotherapy after 6 cycles of platinum-doublet regimen in anthracycline-and taxane-pretreated metastatic breast cancer

Background/Aims@#Sequential monotherapy is recommended for anthracycline-and taxane-resistant metastatic breast cancer (MBC), but combination chemotherapy is considered in patients with visceral crisis. Cisplatin-doublet chemotherapy is a combination regimen for MBC, but prolonged treatment is challenging because of toxicity. We analyzed the role of single-agent maintenance chemotherapy after cisplatin-doublet chemotherapy for MBC. @*Methods@#From January 2011 to December 2017, 96 anthracycline- and taxane-resistant MBC patients were retrospectively reviewed, and 49 patients with a sustained clinical benefit during the initial 6 cycles of cisplatin-doublet chemotherapy were enrolled for study. Patients were treated with gemcitabine-cisplatin (gemcitabine, 1,250 mg/m2, intravenously [IV], days 1 to 8; cisplatin 60 mg/m2, IV, day 1) or capecitabine-cisplatin (capecitabine 2,500 mg/m2, orally, days 1 to 14; cisplatin 60 mg/m2, IV, day 1) during the induction period. After 6 cycles, 16 patients were switched to single-maintenance treatment (gemcitabine or capecitabine) and the doublet regimen was continued in 24 patients. Survival outcomes (progression-free survival [PFS] and overall survival [OS]) were analyzed. @*Results@#Among the 49 patients who showed a clinical benefit during cisplatin-doublet therapy, 24 were maintained on the doublet regimen, 16 were switched to single-maintenance treatment, and chemotherapy was suspended until disease progression in nine patients. The single-maintenance chemotherapy group showed superior survival than the chemotherapy holiday and doublet regimen groups (median PFS 15.43 months vs. 8.37 and 10.67 months, respectively, p = 0.008; median OS 43.67 months vs. 22.17 and 22.33 months, respectively, p = 0.014). @*Conclusions@#Patients showing a clinical benefit during 6 cisplatin-doublet chemotherapy cycles may have a sustained survival benefit from single-maintenance chemotherapy.

Comparison of the ulnar nerve blockade between intertruncal and corner pocket approaches for supraclavicular block: a randomized controlled trial / 대한마취과학회지

Background@#The corner pocket (CP) approach for supraclavicular block (SCB) prevents ulnar nerve (UN) sparing due to needle proximity to the lower trunk. Improved ultrasound resolution has suggested that the intertruncal (IT) approach is a suitable alternative method. We compared efficiency of these two approaches on the UN blockade. @*Methods@#Sixty patients were randomized to undergo SCB using the ultrasound-guided CP or IT approach. For lower trunk blockade, 10 ml of local anesthetic agents (1 : 1 mixture of 0.75% ropivacaine and 1% lidocaine) were injected in the CP (CP approach) or between the lower and middle trunks (IT approach). Additional 15 ml was injected identically to block the middle and upper trunks in both groups. Sensory and motor blockade was evaluated after intervention. @*Results@#Complete sensory blockade (75.9% [22/29] vs. 43.3% [13/30], P = 0.023) and complete motor blockade (82.8% [24/29] vs. 50.0% [15/30], P = 0.017) of the UN at 15 min after SCB were significantly more frequent in the IT than in the CP group. Sensory block onset time of the UN was significantly shorter in the IT compared to the CP group (15.0 [10.0; 15.0] min vs. 20.0 [15.0; 20.0] min; P = 0.012). @*Conclusions@#The IT approach provided a more rapid onset of UN blockade than the CP approach. These results suggest that the IT approach is a suitable alternative to the CP approach and can provide faster surgical readiness.

Clinical Utilities of Continuous Glucose Monitoring and Insulin Pumps in Pediatric Patients with Type 1 Diabetes / 이화의대지

Type 1 diabetes requires lifelong insulin therapy because insulin-secretion capability is diminished. Glycemic control and glucose monitoring are important to prevent type 1 diabetes complications. Diabetes technologies have developed rapidly; continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) are now common and greatly aid glycemic control, especially in children and adolescents. The National Health Insurance Service has provided partial reimbursements for both CGM and CSII devices since 2019 and 2020, respectively; the devices are thus expected to become more popular. CGM reduces the frequency of hypoglycemia and the level of glycated hemoglobin. CSII affords more precise glycemic control than multi-dose insulin therapy. CSII showed reduced frequency of hypoglycemia and improved metabolic outcome without an increase in the body mass index z-score. Technological advancement of combined CGM and CSII will eventually serve as an artificial pancreas. The National Health Insurance Service should fund not only the devices but also education of patients and caregivers. In addition, healthcare providers must be continuously updated on new diabetes technologies.