Insights from a Prospective Follow-up of Thyroid Function and Autoimmunity among COVID-19 Survivors

Background@#The occurrence of Graves’ disease and Hashimoto thyroiditis after coronavirus disease 2019 (COVID-19) raised concerns that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger thyroid autoimmunity. We aimed to address the current uncertainties regarding incident thyroid dysfunction and autoimmunity among COVID-19 survivors. @*Methods@#We included consecutive adult COVID-19 patients without known thyroid disorders, who were admitted to Queen Mary Hospital from July 21 to September 21, 2020 and had serum levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine (fT3), and anti-thyroid antibodies measured both on admission and at 3 months. @*Results@#In total, 122 patients were included. Among 20 patients with abnormal thyroid function tests (TFTs) on admission (mostly low fT3), 15 recovered. Among 102 patients with initial normal TFTs, two had new-onset abnormalities that could represent different phases of thyroiditis. Among 104 patients whose anti-thyroid antibody titers were reassessed, we observed increases in anti-thyroid peroxidase (TPO) (P12 U, and four became anti-TPO-positive. Worse baseline clinical severity (P=0.018), elevated C-reactive protein during hospitalization (P=0.033), and higher baseline anti-TPO titer (P=0.005) were associated with a significant increase in anti-TPO titer. @*Conclusion@#Most patients with thyroid dysfunction on admission recovered during convalescence. Abnormal TFTs suggestive of thyroiditis occurred during convalescence, but infrequently. Importantly, our novel observation of an increase in anti-thyroid antibody titers post-COVID-19 warrants further follow-up for incident thyroid dysfunction among COVID-19 survivors.

Insights from a Prospective Follow-up of Thyroid Function and Autoimmunity among COVID-19 Survivors

Background@#The occurrence of Graves’ disease and Hashimoto thyroiditis after coronavirus disease 2019 (COVID-19) raised concerns that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger thyroid autoimmunity. We aimed to address the current uncertainties regarding incident thyroid dysfunction and autoimmunity among COVID-19 survivors. @*Methods@#We included consecutive adult COVID-19 patients without known thyroid disorders, who were admitted to Queen Mary Hospital from July 21 to September 21, 2020 and had serum levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine (fT3), and anti-thyroid antibodies measured both on admission and at 3 months. @*Results@#In total, 122 patients were included. Among 20 patients with abnormal thyroid function tests (TFTs) on admission (mostly low fT3), 15 recovered. Among 102 patients with initial normal TFTs, two had new-onset abnormalities that could represent different phases of thyroiditis. Among 104 patients whose anti-thyroid antibody titers were reassessed, we observed increases in anti-thyroid peroxidase (TPO) (P12 U, and four became anti-TPO-positive. Worse baseline clinical severity (P=0.018), elevated C-reactive protein during hospitalization (P=0.033), and higher baseline anti-TPO titer (P=0.005) were associated with a significant increase in anti-TPO titer. @*Conclusion@#Most patients with thyroid dysfunction on admission recovered during convalescence. Abnormal TFTs suggestive of thyroiditis occurred during convalescence, but infrequently. Importantly, our novel observation of an increase in anti-thyroid antibody titers post-COVID-19 warrants further follow-up for incident thyroid dysfunction among COVID-19 survivors.

Development of a Non-Invasive Liver Fibrosis Score Based on Transient Elastography for Risk Stratification in Patients with Type 2 Diabetes

Background@#In non-alcoholic fatty liver disease (NAFLD), transient elastography (TE) is an accurate non-invasive method to identify patients at risk of advanced fibrosis (AF). We developed a diabetes-specific, non-invasive liver fibrosis score based on TE to facilitate AF risk stratification, especially for use in diabetes clinics where TE is not readily available. @*Methods@#Seven hundred sixty-six adults with type 2 diabetes and NAFLD were recruited and randomly divided into a training set (n=534) for the development of diabetes fibrosis score (DFS), and a testing set (n=232) for internal validation. DFS identified patients with AF on TE, defined as liver stiffness (LS) ≥9.6 kPa, based on a clinical model comprising significant determinants of LS with the lowest Akaike information criteria. The performance of DFS was compared with conventional liver fibrosis scores (NFS, FIB-4, and APRI), using area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive and negative predictive values (NPV). @*Results@#DFS comprised body mass index, platelet, aspartate aminotransferase, high-density lipoprotein cholesterol, and albuminuria, five routine measurements in standard diabetes care. Derived low and high DFS cut-offs were 0.1 and 0.3, with 90% sensitivity and 90% specificity, respectively. Both cut-offs provided better NPVs of >90% than conventional fibrosis scores. The AUROC of DFS for AF on TE was also higher (P<0.01) than the conventional fibrosis scores, being 0.85 and 0.81 in the training and testing sets, respectively. @*Conclusion@#Compared to conventional fibrosis scores, DFS, with a high NPV, more accurately identified diabetes patients at-risk of AF, who need further evaluation by hepatologists.

Influence of Family Support on Depressive Symptom among High School Students in Jeju Island, Korea / 대한정신약물학회지

OBJECTIVE: We investigated the prevalence of depressive symptom and effect of family support on depressive symptom among high school students in Jeju Island, Korea. METHODS: The study subjects were 711 high school students consisting of 403 males and 308 females of three high schools in urban Jeju Island and the data was gathered using self-reporting questionnaires consisting of BDI, sociodemographic factors, health behavior and family support, etc. RESULTS: The prevalence of depressive symptom in high school students in Jeju Island is 17.7% in total, 17.1% in male, 18.5% in female. Multiple logistic regression analysis revealed that the family support had significantly effect on depression after controlling other confounding variables including age, sex, socioeconomic state, parent's marital statue, body image satisfaction, academic achievement, time spend with parents to build a relationship, and mother's education year. CONCLUSION: Family support was found to be a significant correlate of depressive symptom high school students in Jeju Island. Variety of supports to enhance family cohesion and family relation including sociocultural and political policies and program would be needed to reduce the risk of having depressive symptom and suicide ideation among high school students in Jeju Island.

Delayed diagnosis of 22q11.2 deletion syndrome in an adult Chinese lady / 中华医学杂志(英文版)

We report a 32 year-old Chinese lady with history of tetralogy of Fallot, presented to us with chest pain due to hypocalcemia secondary to hypoparathyroidism. With her dysmorphic facial features and intellectual disability 22q11.2 deletion was suspected and confirmed by genetic study. Clinicians should consider the diagnosis of DiGeorge syndrome in adult patient with past medical history of congenital heart disease, facial dysmorphism, intellectual disability and primary hypoparathyroidism.

Isolation and Expression Profile of the Ca(2+)-Activated Chloride Channel-like Membrane Protein 6 Gene in Xenopus laevis / 한국실험동물학회지

To clone the first anion channel from Xenopus laevis (X. laevis), we isolated a calcium-activated chloride channel (CLCA)-like membrane protein 6 gene (CMP6) in X. laevis. As a first step in gene isolation, an expressed sequence tags database was screened to find the partial cDNA fragment. A putative partial cDNA sequence was obtained by comparison with rat CLCAs identified in our laboratory. First stranded cDNA was synthesized by reverse transcription polymerase-chain reaction (RT-PCR) using a specific primer designed for the target cDNA. Repeating the 5' and 3' rapid amplification of cDNA ends, full-length cDNA was constructed from the cDNA pool. The full-length CMP6 cDNA completed via 5'- and 3'-RACE was 2,940 bp long and had an open reading frame (ORF) of 940 amino acids. The predicted 940 polypeptides have four major transmembrane domains and showed about 50% identity with that of rat brain CLCAs in our previously published data. Semi-quantification analysis revealed that CMP6 was most abundantly expressed in small intestine, colon and liver. However, all tissues except small intestine, colon and liver had undetectable levels. This result became more credible after we did real-time PCR quantification for the target gene. In view of all CLCA studies focused on human or murine channels, this finding suggests a hypothetical protein as an ion channel, an X. laevis CLCA.

Minimal-incision Tenorrhaphy in Flexor Tendon Injury

PURPOSE: To retrieve the retracted flexor tendon, additional incision and wide dissection are conventionally required. We introduce minimal-incision tenorrhaphy using 1cm-long incision and minimal dissection. METHODS: Transverse incision about 1cm in length is made over the level of retracted tendon. Nelaton's catheter is advanced into tendon sheath from distal primary laceration wound to emerge proximally through the incisional wound. A catheter is sutured to proximal tendon in end-to- end fashion. By gently pulling the catheter, retracted tendon is delivered to distal wound. Tenorrhaphy with core suture and epitendinous suture is then carried out. RESULTS: This retrieving technique provides minimal incision, minimal dissection, minimal bleeding, minimal injury to tendon end, and shorter operation time with preservation of vincula tendinum and pulley system. CONCLUSION: In case of flexor tendon rupture with retraction, this operative method is believed to allow reliable and effective tenorrhaphy and excellent postoperative outcomes.

Reattachment of Amputated Auricle using Postauricular Subcutaneous Pocket

PURPOSE: There are several modalities to reattach the amputated auricle. Although microvascular replantation can achieve the best outcome, it is technically difficult. Conventional composite graft is technically easy, but uniformly unsuccessful. Our successful experience of reattachment using postauricular subcutaneous pocket is presented. METHODS: The amputated tissue was placed in its anatomical position with buried sutures. The amputated part is dermabraded to remove the epidermis and outer layer of dermis(Fig. 1, Center, left). Postauricular skin flap was then raised and the reattached dermabraded ear was buried beneath the flap(Fig. 1, Center, right). Two weeks after the original surgery, the buried ear was removed from its pocket(Fig. 1, Below, left). RESULTS: The ear was reepithelialized spontaneously in 7 days. In 3 months, the reattached ear shows satisfactory appearance without contour deformity(Fig. 1, Below, right). CONCLUSION: This technique provides increase in contact surface between the amputated segment and the surrounding tissues which supply blood, serum, oxygen and nutrients, maximizing the probability of "take". Minimally injured dermis can be healed from spontaneous reepithelialization and provides minimal contour deformity. We have used this non-microsurgical technique with very satisfying outcome.

Tester to Measure the Hardness of the Nasal Tip: A New Device

The nasal tip occupies important position in Asian rhinoplasty because Asian has a nasal tip featuring of round or bulbous shape, lower height and wider base compared with that of Caucasian. The hardness of the nasal tip may be increased during the course of a routine rhinoplasty by maneuvers such as incision or excision of the lower lateral cartilage, suturing, and grafting of the cartilages. Changes of the hardness may be a component of postoperative dissatisfaction. However there is no device to measure the hardness of the nasal tip. We developed a "nasal tip durometer" using Teclock Durometer GS series 701 G. The spring rate of Teclock Durometer was converted from 0.223 kgf/mm to 0.036 kgf/mm to apply to the human body. After the remote air switch was fixed to apply with the same speed in a patient's nose, we manufactured the frame attachable to the surgical operation table. The reliability, validity, and responsiveness to clinical change of our durometer were evaluated in a clinical study of 20 patients. Our durometer was highly reliable (Spearman correlation coefficient, r=0.95), valid (Spearman correlation coefficient, r= 0.85), and responsible (effect size=11.37). We concluded that nasal tip durometer was useful to measure the hardness of the nasal tip objectively.

Changes in Carpal Tunnel Pressure Following Increments of the Carpal Tunnel Release

Complete division of transverse carpal ligament (TCL) is accepted as a standard procedure for carpal tunnel syndrome (CTS). In some cases however, after complete release of TCL, the loss of grip and pinch power occurs frequently. Previous study revealed that normal intracanal pressure is 25-30mmHg, therefore There were the possibility that complete division of TCL is an over-correction for CTS. The purpose of this experiment was to measure the carpal tunnel pressure during the incremental division of TCL. Twenty patients who were confirmed as CTS were selected from September 2002 to February 2003. By step-wise division of TCL, the pressure was obtained for 3 times serially. Comparative pressure changes between the pre-division and post-division were analyzed by SRM (standard responsiveness mean) and ES (effect size). In Carpal tunnel syndrome, the mean intracanal pressure was 215.5mmHg. After partial release of the portion which was revealed as most severely compressed area on inching test, the carpal pressure decreased to 70.6 mmHg. Releasing the remaining portion of TCL resulted in another 30% decompression. Effect size of partial release was 2.86, and after release of the remaining portion of TCL the effect size was 1.19. Comparing the effect size, as much effect as 70% of the total release (4.15) can be obtained by partial release.

The Reverse Digital Artery Island Flap: Follow Up

In 1998, we reported on 120 fingers in 110 consecutive patients who were treated with reverse digital artery island flaps for fingertip reconstructions. The purpose of this follow-up study is to emphasize a couple of changes in our procedures since the original study. First, we do not employ sensate flaps any more. Second, digital artery is separated more distal than the original report, to the level of distal interphalangeal joint in some cases. Lastly, flap design in a stellate shape is recommended to avoid scar contracture. Twenty-eight additional patients(fingers) during the period from September of 1999 to August of 2002 were added in this study and long-term follow up was performed in 11 cases for 1 to 2 years after operation with insensate and stellate shaped flaps. Extensive digital artery dissections were performed in 9 fingers. Survival of the flaps and postoperative sensory recovery was successful in all 28 fingers. The static two-point discrimination ranged from 8mm to 4mm, with an average of 6.6mm. No patient showed severe discomfort for their sensory perception and, was required an additional operation for further improvement of the finger shape. We still think that the reverse digital artery island flap is an excellent choice for coverage of fingertip defects and are convinced that a couple of technical changes in this study contribute to the improvement of the procedure and its final outcome.

An Anthropometric Study of Medial and Middle Crus of Alar Cartilages

The lack of information germane to alar cartilages in Asians led us to conduct a morphologic and anthropometric study. The purpose of this prospective study was to define the shape of the medial crus of alar cartilage and measure their size. Measurements of 42 medial crura of alar cartilages in 21 Koreans were obtained during 21 consecutive primary open approach rhinoplasties between September of 1999 and February of 2000 in the Korea University Guro Hospital. Eight were male and thirteen were female. Measurements parameters of medial crus included shape, length, width, and thickness. In addition, symmetry of the medial crura and length of the middle crus were also investigated. In the male patients(n = 16), the most common shape was the straight shape(n = 9), followed by the simple flared shape(n = 5), complex flared shape(n = 2). The length of the columellar segment ranged from 8-12 mm, the average being 10.0 mm. That of the footplate segment averaged 7.8 mm, ranging from 6-9 mm. The average width and thickness were 4.3 mm and 0.58 mm. Seven patients showed symmetric shape, but one patient did not. The average length of the middle crus was 4.90 mm. In the female patients(n = 26), the most common shape was the straight shape(n = 12), followed by the simple flared shape (n = 11), complex flared shape(n = 3). The length of the columellar segment ranged from 7-9 mm, the average being 8.0 mm. That of the footplate segment averaged 6.3 mm, ranging from 4-9 mm. The average width and thickness were 4.4 mm and 0.56 mm. Ten patients showed symmetric shape, but three patients did not. The average length of the middle crus was 4.9 mm. In conclusion, the most common shape of the medial crus was straight and the average length of footplate segment was 7.0 mm, which is actually greater than that of Caucasian.

An Anthropometric Study of Lateral Crus of Alar Cartilages in Koreans

The lack of information about alar cartilages in Orientals led us to conduct a morphologic and anthropometric study. Measurements of 52 lateral crura of alar cartilages in 26 Koreans were obtained during the 26 consecutive primary open approach rhinoplasties between September 1999 and February 2000 in the Korea University Guro Hospital. Ten were male and sixteen were female patients. Measurement parameters of lateral crus included shape, length, width, thickness, and distance of caudal border from nostril rim. In addition, symmetry of the cartilages and length of the middle crus were also investigated. In case of male patients (n=20), the most common shape was the concave shape (40%), followed by the concave-convex shape (30%). The average length, width, and thickness were 19.7, 10.5 and 0.54 mm. The distance from the nostril rim was 5.7 mm anteriorly, 7.3 mm middle, and 12.3 mm posteriorly. Eight patients showed symmetric shape. The length of the middle crus was 5.0 mm. In the female patients(n=32), the most common shape was the concave shape(50%), followed by the convex(25%) and convex-concave shape(25%). The average length, width, and thickness were 16.8, 9.8 and 0.54 mm. The distance from the nostril rim was 5.8 mm anteriorly, 6.5 mm middle, and 11.5 mm posteriorly. All 16 patients showed symmetric shape and the length of the middle crus was 4.9 mm. In conclusion, we could find that the lateral crus of alar cartilage in Koreans, contrary to popular myth, may not be significantly smaller than that of Caucasian.