Associations Between Phthalate, Eosinophil, and Aeroallergen Sensitization in Schoolchildren

Background@#Phthalates and bisphenol A (BPA) are endocrine-disrupting chemicals and may cause immunological disorders in children. Therefore, according to the region, we investigated urinary phthalates and BPA levels and the relationship between urinary phthalate, aeroallergen sensitization, and eosinophil count during the coronavirus disease 2019 pandemic. @*Methods@#In total, 203 schoolchildren (134 residential and 69 industrial) aged 7–10 years were enrolled between July 2021 and July 2022. The BPA, metabolites of four high-molecularweight phthalates (Σ4HMWP) and three low-molecular-weight phthalates (Σ3LMWP), were measured in the urine samples. Total eosinophil count and transepidermal water loss (TEWL) were also measured along with the skin prick test. @*Results@#The two groups had no differences in terms of BPA. The industrial group had significantly more plastic container usage, and there was a difference in the Σ3LMWP (P < 0.001) between the two groups but no difference in the Σ4HMWP (P = 0.234). The quartiles of urinary Σ4HMWP and Σ3LMWP (P < were not associated with the total eosinophil count, vitamin D level, or TEWL. After adjusting for cofactors, the quartiles of urinary Σ4HMWP and Σ3LMWP were significantly associated with total eosinophil count (P < 0.001) but not with aeroallergen sensitization or vitamin D. @*Conclusion@#Exposure to phthalates was significantly associated with eosinophil count but not with aeroallergen sensitization or vitamin D. Therefore, reducing the use of plastic containers may effectively prevent exposure to phthalates and reduce Th2 cell-mediated inflammation in children.

Consumption of an Excessive Amount of Ionic Beverage Can Trigger Adrenal Adenoma - Induced Severe Hypokalemic Rhabdomyolysis / 대한내과학회지

Rhabdomyolysis results from acute damage to skeletal muscles caused by various conditions, of which hypokalemia is a recognized but rare example. Although primary aldosteronism may cause severe hypokalemia leading to rhabdomyolysis, the potassium level of such patients can be within the normal range. Hypokalemia is most frequently triggered when these patients are exposed to an additional insult, such as diuretic stress. Similarly, overzealous consumption of ionic beverages with osmotic diuretic effects can cause hypokalemia. Here, we describe a patient with an aldosterone-secreting adrenal adenoma, who presented with acute rhabdomyolysis secondary to severe hypokalemia triggered by consumption of a large volume of ionic beverage for 3 weeks.

A Case of Bilateral Renal Infarction of Unknown Cause in a Previously Healthy Young Male

We report a rare case of bilateral renal infarction resulting in acute renal failure in a previously healthy 26-year-old soldier. The patient presented with an abdominal pain and bilateral costovertebral angle tenderness. Laboratory studies showed elevated serum creatinine, mild leukocytosis, and increased lactate dehydrogenase. Contrast-enhanced computed tomography showed multiple perfusion defects in both kidneys with wedge-shaped infarction in right kidney. Kidney biopsy performed in the left kidney revealed microinfarction. Comprehensive work-up did not reveal any specific causes or risk factors except smoking, and the infarction was considered to be idiopathic. He emphasized that he received extremely strenuous military training several days before he came to the hospital. He was treated with low molecular weight heparin with significant improvement in renal function. Further studies are needed for the characterization of idiopathic renal infarction in previously healthy individuals and evaluating the mechanisms including strenuous physical activity on the renal blood flow.

Effects of Nutrition Education Using Food Exchange System: Changes in Elementary Students' Nutrition Knowledge, Dietary Attitude and Nutrients Intake / 대한지역사회영양학회지

The purpose of this study was to investigate the effects of nutrition education using Food Exchange System on elementary students' nutrition knowledge, dietary attitude and nutrients intake. Nutrition education lessons (40 min /lesson, 4 times), '5 major nutrients and functions', '6 food groups and sources of 6 food groups', 'good choice of snacks and eating out' as class lesson, 'daily needed energy and food exchange units' as individual lesson, were provided to 70 elementary students (4th grade 33 students, 5th grade 37 students) in Jeonbuk Province. We assessed the changes in nutrition knowledge, dietary attitude, food habit using a questionnaire and nutrient intake using 24 hr recall method by nutrition education. In nutrition knowledge, there were significant increases in scores of 'functions of carbohydrate', 'functions of protein', 'functions of lipid', 'foods of carbohydrate', and 'foods of lipid'. In dietary attitude, there were significant increases in scores of 'taking a meal with joy', 'taking a meal at ease', 'taking a meal with sufficient protein intake' and 'taking a meal without spicy foods' by nutrition education. There were significant changes in the type of breakfast and in the frequency of snacks. After education, in type of breakfast, it showed higher number of students ate rice oriented meal than they did before education. and in frequency of snacks, it showed lower number of students ate snacks 'over 3 times' than they did before education. In Carbohydrate : Protein : Fat (CPF) ratio (%), it was significantly changed from 55.8 : 17.7 : 26.6 to 63.6 : 15.3 : 21.1. In evaluation of nutrient intake by Dietary Reference Intakes for Koreans (KDRIs), vitamin A, thiamin, niacin, vitamin B6, calcium, phosphate, iron and zinc showed positive changes in distribution of number of children by intake level. That is, there were significant improvements in intakes of vitamin A, thiamin, niacin, vitamin B6, calcium, phosphate, iron and zinc. These results showed that nutrition education using Food Exchange System for elementary students improved nutrition knowledge, dietary attitude and nutrients intake. It suggest that nutrition education using Food Exchange System may improve dietary behaviors and reduce an incidence of obesity in elementary students.

Clinical Significance of Low-colony Count Scotochromogen Nontuberculous Mycobacteria / 결핵및호흡기질환

BACKGROUND: Even though it has been suggested that low-colony, scotochromogen nontuberculous mycobacteria (NTM) are usually contaminants and not true pathogens, evidence for this hypothesis has not been provided. This study investigated the colony characteristics, organism identification, and clinical significance of low-colony scotochromogen. METHODS: The laboratory cultured 6,898 respiratory clinical specimens for an examination of mycobacteria over a three-month period. A low-colony count was arbitrarily defined as < or = 20 colonies. This study analyzed the recovery rate of the mycobacteria, the number of colonies and their gross characteristics, and their clinical significance. PCR- restriction fragment length polymorphism analysis was carried out to identify the NTM species. NTM pulmonary disease was defined according to the American Thoracic Society. RESULTS: A total of 6,898 respiratory specimens for mycobacterium were cultured. Of these, 263 (3.8%) grew NTM, and 382 (5.5%) grew M. tuberculosis. Of the 263 cultured NTM specimens, 124 (47.1%) were scotochromogens. The smear-positive rate was significantly lower in these scotochromogens (4.8%) than in the non-scotochromogens (23.7%) (p<0.05). The most common isolates were M. gordonae (83/102, 81.4%) in the scotochromogens, and MAC (52/121, 43.0%) in the non-scotochromogens. Even though three out of 113 patients with a low-colony scotochromogen has been diagnosed with NTM pulmonary disease, the isolated scotochromogen was not considered to be the cause of the NTM disease but was just a contaminant. CONCLUSION: In this study, the most common isolate of a low-colony count scotochromogen was M. gordonae, which appeared to be contaminants and not true pathogens. Greater efforts in the quality control of a mycobacterium laboratory are needed in cases where there is a high recovery rate of low-colony count scotochromogen.

Effect of Tuberculin Skin Test on Ex-vivo Interferon-gamma Assay for Latent Tuberculosis Infection / 결핵및호흡기질환

BACKGROUND: Recently, two commercialized whole-blood assays, QuantiFERON(R)-TB Gold (QFT) and T SPOT-TB(R)(SPOT), which measure the IFN-gamma released in the whole blood after being incubation with mycobacterial antigens, were approved for the diagnosis of a latent tuberculosis infection (LTBI). However, there is data on whether or not the previously used PPD skin tests (TST) have any influence on the diagnostic ability of these ex-vivo IFN-gamma assays. METHOD: Forty-six 15 year-old students who did not appear to be infected with Mycobacterium tuberculosis were enrolled in this study. The peripheral blood was collected and used for two IFN-gamma assays. The IFN-gamma assays and TST were performed at the baseline (1st). The TST was repeated two months later (2nd), and the IFN-gamma assays were repeated two (2nd) and four months (3rd) later only in those subjects who had negative results at the baseline in both the IFN-gamma assays and TST. An induration size > 10 mm was considered to be positive in the TST. RESULTS: The mean TST value was 3.1 +/- 5.4 mm (range: 0-20). Of the 46 subjects examined, 13 subjects (28.3%) showed positive results in the two-step TST. Nine (19.6%) were SPOT-positive and only one (2.2%) was QFT-positive. The 2nd and 3rd QFT were carried out in 23 and 25 all-negative subjects, respectively, and all showed negative results. The 2nd SPOT was performed in 23 subjects and only one (4.3%) showed a weak-positive result. CONCLUSION: Even though there were some discrepancies in the results of the two ex-vivo IFN-gamma assays, it appears that their results were not influenced by a previous TST carried out in two or four months earlier.

Recovery Rate and Characteristics of Nontuberculous Mycobacterial Isolates in a University Hospital in Korea / 결핵및호흡기질환

BACKGROUND: The incidence of nontuberculous mycobacterium (NTM) infections in Korea is increasing. This retrospective study was performed to examine the recovery rate of NTM from respiratory specimens as well as the isolated NTM colony characteristics, and to assess the clinical significance of a NTM isolation. METHODS: The results of the respiratory specimens requested for an acid-fast bacilli (AFB) examination during 2002 at Asan Medical Center, along with the patients clinical characteristics were analyzed. RESULTS: A total 26,820 respiratory specimens were requested for the acid-fast bacilli (AFB) smear and culture during the study period. The proportion of M. tuberculosis and NTM isolation was 5.7% and 2.2%, respectively. Among the AFB smear and culture positive specimens, 12.2% were found to be NTM. The scotochromogen showing a low colony count < 20, which appeared to be contaminants, were isolated in 31.8% of the 584 NTM isolates. Excluding the low-colony scotochromogens, the M. avium-intracellulare complex was the most common NTM isolates (42.1%), and was also the most common causative organism for NTM pulmonary diseases. 8.4% (23/275) and 17.8% (49/275) of patients with NTM isolates met the American and British Thoracic Society diagnostic criteria for NTM pulmonary disease, respectively. CONCLUSION: In case of a positive AFB-smear or culture result, the possibility of NTM being a causative organism should always be considered, even in Korea, which has an intermediate incidence of tuberculosis.

Metalloproteinase Plays a Role in Mucin Secretion / 결핵

BACKGROUND: Mucus hypersecretion in the patients with airway diseases represents poor prognosis as well as discomfort. However, there is no known therapy for its effective control. One important component of mucus is mucin, a glycosylated protein, which endows mucus with viscosity. We studied whether a proteinase has a role in mucin secretion and if so, which. METHODS: (1) Inhibition of mucin secretion Group-specific proteinase inhibitors were tested to evaluate whether a proteinase belonging to a group of proteinases plays a role in mucin secretion. Phenylmethylsulfonyl fluoride(PMSF, a serine proteinase inhibitor), E-64(a cysteine proteinase inhibitor), Pepstatin(an aspartic proteinase inhibitor) and 1, 10-Phenanthroline(a metalloproteinase inhibitor) were treated into the Calu-3 cell line for 24 hours. The enzyme linked immunoabsorbant assay(ELISA) for MUC5AC was performed to evaluate the amount of mucin secretion and to compare with a control. (2) Stimulation of mucin secretion Matrix metalloproteinase-9(MMP-9), MMP-12 and TACE(TNF-alpha converting enzyme), which are known to be related with airway diseases, were used to be treated into Calu-3 for 24 hours. ELISA for MUC5AC was performed to evaluate the amount of mucin secretion and to compare with the controls. RESULTS: (1) PMSF(10(-4)M), E-64(10(-4)M), Pepstatin(10(-6)M) and 1, 10-Phenanthroline(10(-4)M) reduced the MUC5AC secretion by 1 +/- 4.9%(mean +/- standard deviation; P=1.0 compared with the control), -6 +/- 3.9%(P=0.34), -13 +/- 9.7%(P=0.34) and 41 +/- 8.2%(P=0.03), respectively. (2) The amounts of MUC5AC secretion stimulated by MMP-9(250ng/ml), MMP-12(100ng/ml) and TACE(200ng/ml) were 103 +/- 6%(P=0.39), 102 +/- 8%(P=1.0) and 107 +/- 13%(P=0.39), respectively, compared with the controls. CONCLUSION: Metalloproteinase(s) is (are) suggested to play a role in mucin secretion. It appears that metalloproteinases, other than MMP-9, MMP-12 or TACE, affect the mucin secretion in this in vitro model.

A Case of Hepatic Carcinoid Tumor Regression with Octreotide / 대한간학회지

Somatostatin analogue octreotide is commonly used for the treatment of carcinoid syndrome. Octreotide also has an antiproliferative effect in neuroendocrine tumors and has demonstrated tumor reduction in patients having advanced carcinoid tumor. This is a case report of a patient who had metastatic liver carcinoid tumor and showed marked regression of liver metastasis after octreotide therapy.

Interpretation of Bronchodilator Response inPatients with Obstructive Airway Disease / 결핵

BACKGROUND: Measurement of bronchodilator response is necessary to establish reversibility of airflow obstruction that was helpful to estimate the diagnosis, treatment, and prognosis in obstructive airway disease. An useful index should be able to detect the bronchodilator response more sensitively not related with degree of airflow obstruction and also be independent of initial FEV1. METHOD: Sensitivities of bronchodilator response in each group classified by degree of airflow obstruction in FEV1, FVC, FEF25~75%, Isovolume FEF25~75%, sGaw were studied and correlation coefficients were calculated between initial FEV1 and reversibilities expressed as absolute, %initial, %predicted, %possible in FEV1. RESULT: Sensitivities of bronchodilator response were 61.5% in FVC, Isovolume FEF25~75% and sGaw, in severe group, and 56.3% in Isovolume FEF25~75% and sGaw, in moderate group, and 62.5% in FEV1 and sGaw and 50.0% in FVC and Isovolume FEF25~75%, in mild group, and 60.0% in sGaw and 58.0% in Isovolume FEF25~75% in total patients. Correlation coefficients between initial FEV1(L) and absolute, % initial, % predicted, % possible were 0.15, -0.22(p<0.05), 0.02, 0.24(p<0.05) and correlation coefficients between initial FEV1(% predicted) and absolute, % initial, % predicted, %possible were 0.06, -0.28(p<0.05), 0.08, 0.39(p <0.05). CONCLUSION: Volume related parameters were more sensitive index not related with degree of airway obstruction and the change in FEV1 expressed as % predicted was the least dependent on initial FEV1 and reversibilities, expressed as % initial or as % possible(predicted minus initial FEV1)were correlated with initial FEV1.

Isolation of Acid-fast bacilli from Tissues of Extrapulmonay Tuberculosis / 영남의대학술지

To evaluate the isolation rate of acid-fast bacilli on Ziehl-Neelsen stain from biopsy specimens of extrapulmonary tuberculosis proven by chronic granulomatous inflammation, 286 cases of extrapulmonary tuberculosis were reviewed and the results are as follows : 1) Mean age was 27.3 years old and lymphatic tuberculosis was more prevalent in the female but others were more common in the male. 2) The most common site of extrapulmonary tuberculosis was pleura (103 cases ; 36%) followed by lymph nodes (87 cases ; 30.4%), gastrointestinal tract (27 cases ; 9.4%), skin and soft tissue (23 cases ; 8.0%), bone (19 cases ; 6.6%), urinary tract (14 cases ; 4.6%), larynx (9 cases ; 3.2%) and breast (5 cases ; 1.8%) in order of frequencies. 3) Of 286 cases, 30.4%, (87 cases) of the biopsy specimens showed acid fast bacilli on microscopy. The isolation rate according to the sites was slightly higher in breast and lymph nodes as 3 of 5 cases (60.0%) and 35 of 87 cases (40.2%) respectively, and followed by 3 of 9 cases (33.3%) in the larynx, 4 of 13 cases (30.8%) in the urinary tract, 5 of 19 cases (26.3%) in the bone, 7 of 27 cases (25.9%) in the gastrointestinal tract, 26 of 103 cases (25.2%) in the pleura, and 4 of 23 cases (17.4%) in the skin and soft tissue, in order of frequencies. 4) The prevalence of extrapulmonary tuberculosis associated with pulmonary tuberculosis on chest X-ray was 85 of 286 cases (29.7%).

A Case of Double Chambered Right Ventricle with Congenital Right Ventricular True Diverticulum

Congenital diverticula of the cardiac ventricle have been reported as arising either from the left ventricule or, rarely from both ventricules. A diverticulum arising from the right ventricle alone is very rare. Double chambered right ventricle(DCRV) was first described in 1962 by Lucas et al, and account for 1.5% of congenital heart disease. Right ventricular diverticulum are associated with right ventricle outlet obstructive disease, tetralogy of fallot, double outlet right ventricle, pulmonic stenosis, ventricular septal defect, left ventricule-right atrium communication, persistant truncus arteriosus. DCRV are freqently associated with ventricular septal defect(80%), pulmonic stenosis(33%), renal anormaly(43%). Treatment consist of suture of diverticulum and resection of septum. We report a case of double chambered right ventricle with congenital right ventricular true diverticulum in 62 years of female patients admitted due to anterior chest pain and mild exertional dyspnea.