Methimazole-Induced Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis in the Peripheral Nerves

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis has been reported in Graves' disease patients treated with antithyroid drugs (ATDs), especially propylthiouracil. ATD-induced ANCA-associated vasculitis usually involved the kidneys followed by the respiratory organs and skin. The treatment of ANCA-associated vasculitis induced by ATDs is to stop ATD therapy immediately, which often leads to an overall good prognosis. We report a case of ANCA-associated vasculitis in the peripheral nerves of the lower extremities in a 66-year-old woman who was treated with methimazole (MMI) for Graves' disease. To our knowledge, this is the third case of peripheral nervous system (PNS) involvement of ATD-induced vasculitis and the first case of PNS vasculitis associated with MMI.

Sweet's Syndrome Associated with Graves' Disease

Sweet's syndrome, or acute febrile neutrophilic dermatosis, occurs in association with autoimmune diseases such as Hashimoto's thyroiditis but is rare in Graves' disease, in which all cases are induced by propylthiouracil (PTU). We report a case of Sweet's syndrome in a patient with Graves' disease treated with methimazole (MMI) during three weeks. A 34-year-old man presented with the acute onset of high fever, skin rashes on the whole body, arthralgia, and acroparesthesia. Laboratory results showed leukocytosis and elevated C-reactive protein. MMI first stopped and antibiotics and antihistamine therapy started, but his symptoms dramatically improved after oral prednisolone. Graves' disease has again been treated by MMI because of his aggravated ophthalmopathy. After one year of retreatment with MMI, there has been no recurrence of Sweet's syndrome, supporting that Sweet's syndrome in this case was not related to MMI exposure. To our knowledge, this is the first report of Sweet's syndrome associated with Graves' disease per se but not PTU or MMI use.

Anaplastic Transformation of Follicular Thyroid Cancer in the Lung, Liver, Bone, and Adrenal Gland

Anaplastic transformation of differentiated thyroid cancer at distant metastatic sites is extremely rare and has a poor prognosis. It usually occurs in the thyroid gland or cervical lymph nodes. Here we report a case of anaplastic transformation arising at multiple distant metastatic sites including the lung, liver, adrenal gland, bone, and lymph nodes in a patient 3 years after total thyroidectomy for follicular thyroid cancer.

Dietary total sugar intake of Koreans: Based on the Korea National Health and Nutrition Examination Survey (KNHANES), 2008-2011 / 한국영양학회지

PURPOSE: The aim of this study is to estimate total sugar intake and identify major food sources of total sugar intake in the diet of the Korean population. METHODS: Dietary intake data of 33,745 subjects aged one year and over from the KNHANES 2008-2011 were used in the analysis. Information on dietary intake was obtained by one day 24-hour recall method in KNHANES. A database for total sugar content of foods reported in the KNHANES was established using Release 25 of the U.S. Department of Agriculture National Nutrient Database for Standard Reference, a total sugar database from the Ministry of Food and Drug Safety, and information from nutrition labeling of processed foods. With this database, total sugar intake of each subject was estimated from dietary intake data using SAS. RESULTS: Mean total sugar intake of Koreans was 61.4 g/person/day, corresponding to 12.8% of total daily energy intake. More than half of this amount (35.0 g/day, 7.1% of daily energy intake) was from processed foods. The top five processed food sources of total sugar intake for Koreans were granulated sugar, carbonated beverages, coffee, breads, and fruit and vegetable drinks. Compared to other age groups, total sugar intake of adolescents and young adults was much higher (12 to 18 yrs, 69.6 g/day and 19 to 29 yrs, 68.4 g/day) with higher beverage intake that beverage-driven sugar amounted up to 25% of total sugar intake. CONCLUSION: This study revealed that more elaborated and customized measures are needed for control of sugar intake of different subpopulation groups, even though current total sugar intake of Koreans was within the range (10-20% of daily energy intake) recommended by Dietary Reference Intakes for Koreans. In addition, development of a more reliable database on total sugar and added sugar content of foods commonly consumed by Koreans is warranted.

Breast-feeding and Obesity in Early Childhood: Based on the KNHANES 2008 through 2011 / 대한지역사회영양학회지

Although there has been a significant increase in breast-feeding (BF) rate in Korea, it is plateaued since 2008 and still low compared with that of other countries. Because BF has been related to lower obesity prevalence in many studies and the increase in childhood obesity became evident in Korea, we wondered if a relatively lower BF rate has anything to do with this increase. Therefore, we looked into the relationship between mode & duration of BF during infancy and weight status of toddlers using the data from Korea National Health and Nutrition Examination Survey 2008 through 2011. Number of 2-3 year old toddlers with complete information on BF, anthropometry and normal birth weight was 674. While 87% of them were ever-breastfed, 6.2% each of them were either obese or overweight based on the Standard Growth Chart for Korean Children. Not only the obesity prevalence was different among groups of different mode of feeding, but also the mean duration of BF was significantly longer in normal weight group (9.2 mo.) compared with obese group (5.5 mo.). Accordingly, overweight and obesity prevalence of the toddlers breast-fed for 12 months or longer was significantly lower than that of the toddlers breast-fed for less than 12 months (OR 0.53, 95% CI 0.32-0.87). This study revealed that both BF and duration of BF affect the childhood obesity and, BF for 12 months or longer should be encouraged more aggressively as one of the main strategies to prevent and/or decrease childhood obesity in Korea.

Measures for a closer-to-real estimate of dietary exposure to total mercury and lead in total diet study for Koreans

Previous Korean total diet studies (KTDSs) have estimated dietary exposure to toxic chemicals based on 110-120 representative foods selected from over 500 foods appeared in the Korea National Health & Nutrition Examination Surveys (KNHANES), which would result in a possible underestimation. In order to find measures for a closer-to-real estimate of dietary exposure to heavy metals, this study examined the feasibility of mapping foods to the representative foods in the KTDS by comparing estimates. In mapping, those foods not analyzed in the 2009 KTDS (443 out of 559 foods appeared in the 2007 KNHANES) were mapped to the 114 representative foods used in the 2009 KTDS based on the closeness in regards to biological systematics and morphological similarity. Dietary exposures to total mercury and lead were re-estimated using the content of total mercury and lead in 114 foods analyzed in the 2009 KTDS, food intake, and individual's own body weight for respondents in the 2007 KNHANES instead of mean body weight of Koreans used in the 2009 KTDS. The re-estimates of exposure with mapping were approximately 50% higher than the original estimates reported in the 2009 KTDS. In addition, mapping enabled the comparison of percentile distribution of the exposure among populations of different age groups. In conclusion, estimates via mapping resulted in a more comprehensive estimation of dietary exposure to heavy metals present in foods that Koreans consume.

Major Sources of Sodium Intake of the Korean Population at Prepared Dish Level: Based on the KNHANES 2008 & 2009 / 대한지역사회영양학회지

We attempted to define the sources of sodium intake for the Korean population at prepared dish level to provide a basis for developing sustainable nutrition policies and feasible programs for sodium intake reduction. Dietary intake data from 2008 and 2009 Korea National Health and Nutrition Examination Survey was used in the analysis for sodium intake sources. Sodium intake from individual dish consumed by each subject was calculated and used in delineating major sodium sources at dish and dish group level for sub-populations of different sex and age. Also, sodium intake was compared between eaters and non-eaters of some specific dish groups with considerable contribution to total sodium intake. The number of subjects included in the analysis was 18,022 and mean sodium intake was 4,600 mg/capita/day. Major sources of sodium intake at dish group level were in the following order: kimchi (1125 mg, 24.5%), noodles (572 mg, 12.4%), soups (488 mg, 10.6%), stews (399 mg, 8.7%), and cooked rice (284 mg, 6.2%). The magnitude of contribution to total sodium intake by soups and stews was different by age group. Sodium intake difference between eaters and non-eaters was much larger for kimchi group (2,343 mg for male, 1,452 mg for female) than for soups or stews. Interaction between consumption of aforementioned specific dish groups and age was highly significant (p < 0.0005) for both sexes. This study revealed an importance of having not only the control over sodium content of foods/dishes, but also the customized approach for different groups of population to accomplish an appreciable reduction in sodium intake.

Reversible Heart Failure and Rhabdomyolysis Caused by Primary Hypoparathyroidism during Lactation

Hypocalcemia can be complicated, on rare occasions, by congestive heart failure and may also be associated with labor and lactation in some cases. Herein, we report a 30-year-old woman with hypocalcemia-induced heart failure secondary to primary idiopathic hypoparathyroidism precipitated by lactation. The patient presented with chest pain and paresthesia in both arms and legs during breast-feeding after her second delivery. She had severe hypocalcemia and low parathyroid hormone levels. Hypocalcemia-induced rhabdomyolysis further aggravated her hypocalcemia symptoms. The echocardiogram showed global hypokinesia with an ejection fraction of 47%. After calcium and vitamin D replacement, her symptoms and ventricular function improved. Hypocalcemia needs to be considered in patients with heart failure, because it is readily reversible. To the best of our knowledge, this is the first report of a patient with heart failure and rhabdomyolysis induced by primary hypoparathyroidism during lactation.

Influencing Factors on the Dietary supplements Consumption among Children in Korea / 대한지역사회영양학회지

With a recent increase in dietary supplements (DS) consumption among children in Korea, this study was performed to examine the influencing factors on children's DS consumption. A nationwide survey was conducted employing 3 representative samples of children for summer & fall of 2008 and spring of 2009 by stratified multistage sampling of 120 survey sites per season based on the 2005 census population. Approximately 30 households from each survey site were screened for residing children of 0-19 years and about 1,700 households remained as eligible samples per season. Trained dietitians visited households to perform face-to-face interview to children and/or parents regarding DS consumption including health functional foods (HFF), vitamins/minerals (V/M) supplements and other food supplements during 1 month prior to interview. Out of 5,328 children responded, 18.7% reported DS consumption. Consumption rate was higher in boys (19.9% vs. 17.3% in girls, P < 0.05) and youngsters (22.8% compared to 15.0% in adolescents, P < 0.001). Children from higher income family (P < 0.001), those living in apartments (P < 0.001), those residing in metropolitan area (P < 0.001), and those of mothers with higher education (P < 0.001) were more likely to take DS. Also, mother's employment status and occupation were significantly associated with children's DS consumption. The most popular DS was HFF (72.1%), which was consumed more in children of higher income family. It is revealed that socioeconomic factors affect children's DS consumption significantly. Also it is necessary to estimate children's V/M intake from DS and foods together especially because there are tolerable upper limits set for V/M for safety purposes.

Response: Comparison of the Efficacy of Octreotide Long-acting Repeatable and Lanreotide Autogel in Acromegalic Patients (J Korean Endocr Soc 25:37-45, 2010)

No abstract available.

An Association between 609 C --> T Polymorphism in NAD(P)H: Quinone Oxidoreductase 1 (NQO1) Gene and Blood Glucose Levels in Korean Population / 당뇨병

BACKGROUND: NAD(P)H: quinone oxidoreductase 1 (NQO1), which is an obligate two-electron reductase that utilizes NAD(P)H as an electron donor and is involved in the protection against oxidative stress, is likely involved in beta-cell destruction. We evaluated the frequency of the NQO1 polymorphism and its association with blood glucose levels. METHODS: Genotypes were determined using a polymerase chain reaction restriction fragment length polymorphism-based assay in 56 patients and 48 healthy subjects. Fasting blood glucose, insulin, and lipid profiles were measured and homeostasis model assessment (HOMA)-insulin resistance (IR) was calculated from fasting glucose and insulin levels in the healthy subjects. RESULTS: The genotype frequencies of NQO1 polymorphism were C/C (56.7%), C/T (42.3%), and T/T (1.0%). There were no associations between the NQO1 polymorphism and body mass index, blood pressure, lipid profile, HbA1c, postprandial glucose, and HOMA-IR. However, NQO1 mutants (C/T and T/T) showed weak but significantly higher fasting blood glucose levels compared with wild type (C/C). CONCLUSION: Our data suggest that NQO1 609 C --> T polymorphism may be associated with glucose metabolism.

Early Detection Of Asymptomatic Coronary Artery Disease In Patients With Type 2 Diabetes Mellitus

BACKGROUND/AIMS: In type 2 diabetic patients, coronary artery disease (CAD) is usually detected at an advanced stage due to a lack of symptoms. The aim of this study was to define which clinical parameters or non-invasive tests predict CAD in asymptomatic type 2 diabetic patients. METHODS: One hundred fourteen asymptomatic type 2 diabetic patients were divided into two groups based on the number of cardiovascular disease (CVD) risk factors (group A > or =2, group B or =10 years (OR=3.28; 95% CI, 1.29-8.84) were independent CAD risk factors in asymptomatic patients. CONCLUSIONS: We recommend a routine screening for CAD in type 2 diabetic patients who have a longer (> or =10 years) diabetic duration or a family history of CAD, even if they are asymptomatic for CAD.

Retrovirus Mediated Gene Transfer of RANK-Fc Ameliorates Bone Loss in a Mouse Ovariectomy Model of Osteoporosis / 대한내분비학회지

BACKGROUND: Interactions between the receptor activator of the NF-kappaB ligand (RANKL) and its receptor, RANK, are important in the terminal differentiation and activation of osteoclasts. In the current investigation, we examine the feasibility of using genetically modified mesenchymal stem cells (MSCs), C3H10T1/2 cells as a platform for the sustained systemic delivery of therapeutic proteins into the circulation in an osteoporosis model, and investigate retroviral-mediated gene therapy of RANK-Fc as a means of ameliorating ovariectomy (OVX)-induced bone resorption. METHODS: C3H10T1/2 cells were transduced with a MSCV-based retroviral vector containing cDNA of a fusion protein combining the extracellular domain of murine RANK with the human immunoglobulin constant domain (MSCV-RANK-Fc-eGFP). Young adult female mice were subjected to OVX or sham surgery, followed by treatment with transduced cells or PBS 4 weeks later. The expression of RANK-Fc by these cells was assessed, both in vitro and in vivo. Total bone mineral density (BMD) was measured and GFP expression was examined. RESULTS: Transduced cells produced biologically active RANK-Fc in vitro and in vivo. Mice that were subjected to OVX followed by treatment with cells transduced with MSCV-RANK-Fc-eGFP 4 weeks later contained no significant but higher total BMD than either the control vector or PBS-treated mice after 8 weeks. Higher GFP expression was attained in the liver, spleen, and intra-abdominal fat of mice treated with MSCV-RANK-Fc-eGFP. CONCLUSION: The data collectively indicate that C3H10T1/2 cells are effectively transduced with a MSCV-based retrovirus, and are capable of secreting biologically active RANK-Fc in vitro and in vivo. Moreover, gene therapy facilitating the sustained delivery of RANK-Fc may be an effective method to reverse OVX-induced osteoporosis.