[Show abstract][Hide abstract] ABSTRACT: Purpose:
Incomplete Kawasaki disease (KD) is frequently associated with delayed diagnosis and treatment. Delayed diagnosis leads to increasing risk of coronary artery aneurysm. Anterior uveitis is an important ocular sign of KD. The purpose of this study was to assess differences in laboratory findings, including echocardiographic measurements, clinical characteristics such as fever duration and treatment responses between KD patients with and those without uveitis.
We conducted a prospective study with 110 KD patients from January 2008 to June 2013. The study group (n=32, KD with uveitis) was compared with the control group (n=78, KD without uveitis). Laboratory data were obtained from each patient including complete blood count (CBC), erythrocyte sedimentation rate (ESR), platelet count, and level of alanine aminotransferase, aspartate aminotransferase, serum total protein, albumin, C-reactive protein (CRP), and N-terminal probrain natriuretic peptide (NT-pro BNP). Echocardiographic measurements and intravenous immunoglobulin responses were compared between the two groups.
The incidence of uveitis was 29.0%. Neutrophil counts and patient age were higher in the uveitis group than in the control group. ESR and CRP level were slightly increased in the uveitis group compared with the control group, but the difference between the two groups was not significant. No significant differences in coronary arterial complication and treatment responses were observed between the two groups.
Uveitis is an important ocular sign in the diagnosis of incomplete KD. It is significantly associated with patient age and neutrophil count.
Korean Journal of Pediatrics 10/2015; 58(10):374-379. DOI:10.3345/kjp.2015.58.10.374
[Show abstract][Hide abstract] ABSTRACT: The present study was performed to investigate whether breast-feeding is associated with early pubertal development among children 7-9 years old in Korea.
Children were divided into those who did and did not receive breast-feeding for 6 months or longer in accordance with the recommendations of the WHO. Pubertal status was determined by clinical examination using Tanner staging.
Prospective observational study.
We conducted a follow-up study of children aged 7-9 years in 2011 who had taken part in the Ewha Birth & Growth Cohort study.
Fifty (22·8 %) of the total of 219 children were in early puberty, with the proportion being slightly higher for girls (24·1 %) than boys (21·4 %). Children who had entered early puberty were taller, weighed more and had a higher concentration of insulin-like growth factor 1. Moreover, the change in weight Z-score from birth to follow-up was significantly lower in children who were breast-fed than in those who were not (weight Z-score change: 0·32 (sd 1·59) v. 0·77 (sd 1·61), respectively, P=0·04). Comparison of breast-feeding by puberty status indicated a preventive association with early puberty in children who were breast-fed for 6 months or longer (OR=0·37; 95 % CI 0·18, 0·74). This association remained significant after adjustment for relevant covariates.
These results demonstrate a beneficial association between breast-feeding and early pubertal development, especially in those breast-fed for 6 months or longer. The study suggests that interventions would need to start early in life to prevent early pubertal development.
Public Health Nutrition 03/2015; DOI:10.1017/S1368980015000518 · 2.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose
The incidence of Kawasaki disease (KD) is rare in young infants (less than 3 months of age), who present with only a few symptoms that fulfill the clinical diagnostic criteria. The diagnosis for KD can therefore be delayed, leading to a high risk of cardiac complications. We examined the clinical characteristics and measured the serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels of these patients for assessing its value in the early detection of KD.
We retrospectively reviewed the data of young infants diagnosed with KD from 2004 to 2012. The control group included 20 hospitalized febrile patients. Laboratory data, including NT-proBNP were obtained for each patient in both groups.
Incomplete KD was observed in 21/24 patients (87.5%). The mean fever duration on admission was 1.36±1.0 days in the KD group. Common symptoms included erythema at the site of Bacille Calmette-Guerin inoculation (70.8%), skin rash (50.0%), changes of oropharyngeal mucosa (29.1%), and cervical lymphadenopathy (20.8%). The mean number of major diagnostic criteria fulfilled was 2.8±1.4. Five KD patients (20.8%) had only one symptom matching these criteria. The incidence of coronary artery complications was 12.5%. The mean serum NT-proBNP level in the acute phase, in the KD and control groups, were 4,159±3,714 pg/mL and 957±902 pg/mL, respectively, which decreased significantly in the convalescent phase.
Incomplete KD was observed in 87.5% patients. Serum NT-proBNP might be a valuable biomarker for the early detection of KD in febrile infants aged <3 months.
Korean Journal of Pediatrics 08/2014; 57(8):357-62. DOI:10.3345/kjp.2014.57.8.357
[Show abstract][Hide abstract] ABSTRACT: Objective:
Obesity in adolescence is associated with increased cardiovascular risk. The patterns of obesity and body composition differ between boys and girls. It is uncertain how body composition correlates with the cardiovascular system and whether such correlations differ by sex in adolescents.
Body composition (fat-free mass (FFM), adipose mass, waist circumference (WC)) and cardiovascular parameters and functions were studied in 676 healthy Korean adolescents aged 12-16 years. Partial correlation and path analyses were done.
WC correlated with stroke volume (SV) and cardiac output (CO), systolic blood pressure (SBP) and pulse pressure (PP), cardiac diastolic function (ratio of early to late filling velocity (E/A ratio)), and vascular function (pulse wave velocity (PWV)) in boys. Adipose mass was related to SV, CO, SBP, PP, left ventricular mass (LVM), and PWV in girls - and to E/A ratio in both sexes. FFM affected SV, CO, SBP, and PP in both sexes and LVM in boys. Cardiac systolic functions had no relation with any body composition variable in either sex.
In adolescence, the interdependence of the cardiovascular system and the body composition differs between sexes. Understanding of those relations is required to control adolescent obesity and prevent adult cardiovascular disease.
[Show abstract][Hide abstract] ABSTRACT: To assess the effect of urinary bisphenol A (BPA) on repeated measurements of androgenic hormones and metabolic indices, we used multivariate analysis of variance (MANOVA) adjusted for potential confounders at baseline. During July to August 2011, 80 preadolescent girls enrolled in the Ewha Birth & Growth Cohort study participated in a follow-up study and then forty-eight of them (60.0%) came back one year later. Baseline levels of estradiol and androstenedione were higher in the BPA group than in the non-BPA group. One year later, girls in the high BPA exposure group showed higher levels of androstenedione, testosterone, estradiol, and insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) index, than those in the other groups (p < 0.05). In MANOVA, estradiol and androstenedione showed significant differences among groups, while dehydroepiandrosterone, insulin, and HOMA-IR showed marginally significant differences. Exposure to BPA may affect endocrine metabolism in preadolescents. However, further investigation is required to elucidate the mechanisms linking BPA with regulation of androgenic hormones.
International Journal of Environmental Research and Public Health 11/2013; 10(11):5737-49. DOI:10.3390/ijerph10115737 · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose
To examine the relationship between menarcheal age and anthropometric indices and menstrual irregularity in late adolescent girls in Seoul.
We surveyed 4,218 fertile adolescent girls between the ages of 16 and 18 years to determine their anthropometric indices and menarcheal age. Measurements were taken from June 2008 to October 2009 at seven girl's high schools in Seoul, Korea. Participants were offered self-report questionnaire as a survey tool that included questions on anthropometric indices (height, weight, waist circumference), menarcheal age, menstrual pattern, frequency of menstruation per year.
The participants were categorized into three groups based on menarcheal age: early menarche group (younger than 2 standard deviations [SD]), mid menarche group (within ±2 SD), late menarche group (older than 2 SD). The mean age of early menarche group was 9.9±0.2 years, mid menarche group 12.5±0.9 years, late menarche group 15.1±0.3 years (P < 0.001). Heights were recorded as 160.4±5.2 cm, 161.8±4.9 cm, 162.3±4.7 cm in early, mid, and late menarche group, respectively (P = 0.001). Body mass index (BMI) and waist circumference significantly were lager in early menarche group than mid and late menarche ones (P < 0.001). The menarcheal age had a positive correlation with height and negative correlations with weight, BMI, waist circumference (P < 0.001). The prevalence of oligomenorrhea was more frequent in late menarche group than early and mid menarche group.
The menarcheal age have positive relationship with height and inverse relationship with BMI and waist circumference in late adolescent girls in Seoul. Late menarcheal girls are disposed to have menstrual irregularity compared to early menarcheal girls.
[Show abstract][Hide abstract] ABSTRACT: Background
We used Mendelian randomization analysis to investigate the causal relationship between maternal homocysteine level, as represented by maternal methylenetetrahydrofolate reductase (MTHFR) C677T genotype, with the birth weight of offspring.
We recruited women at 24 to 28 weeks’ gestation who visited Ewha Womans University Hospital for prenatal care during the period from August 2001 to December 2003. A total of 473 newborns with a gestational age of at least 37 weeks were analyzed in this study. We excluded twin births and children of women with a history of gestational diabetes, gestational hypertension, or chronic renal disease. The association of maternal homocysteine concentration with the birth weight of infants was analyzed using 2-stage regression.
MTHFR C677T genotype showed a dose–response association with homocysteine concentration for each additional T allele (Ptrend < 0.01). Birth weight decreased from 120 to 130 grams as maternal homocysteine level increased, while controlling for confounding factors; however, the association was of marginal significance (P = 0.06).
Our results suggest an adverse relationship between maternal homocysteine level and birth weight. A reduction in homocysteine levels might positively affect birth outcomes.
Journal of Epidemiology 07/2013; 23(5). DOI:10.2188/jea.JE20120219 · 3.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background and objective:
We aimed to investigate the association between serum 25-hydroxyvitamin D (25(OH)D) and anthropometric indicators of adiposity among Korean preadolescent children aged 7-9 years.
Subjects and methods:
Children aged 7 to 9 from the Ewha Birth & Growth Cohort were followed up from July to August 2011. Serum 25(OH)D concentration was measured using radio immunoassay. We assessed the magnitude of cross-sectional association with vitamin D concentrations and indicators of adiposity [body mass index (BMI), waist circumference (WC), mid-arm circumference (MAC), body fat mass (BFM), percent body fat (PBF), and triceps skinfold thickness (TSF)] using multiple linear and logistic regression analyses adjusted for sex, age, birth order, maternal education, and fruit/fruit juice intake.
Thirty-two (16%) out of a total of 205 children showed an optimal level of serum 25(OH)D, but most children did not reach a sufficient level (<30 ng/mL) even in summer. The level of 25(OH)D was inversely associated with BMI (β=-0.10, p<0.01), WC (β=-0.28, p<0.01), and BFM (β=-0.12, p=0.02) after adjusting for confounding factors and showed marginal boundary with PBF (β=-0.20, p=0.06) and TSF (β=-0.11, p=0.08). Regarding the risk of overweight, a 13% protective effect per 1 ng/mL increase of 25(OH)D was shown even after adjusting for relevant confounding factors (adjusted odds ratio=0.87, 95% confidence interval 0.78-0.98).
We found that the 25(OH)D concentrations were inversely associated with adiposity indices in preadolescent children. This study suggests that adequate vitamin D intake in growing children is crucial to maintain an optimal vitamin D level to prevent obesity and obesity-related health problems later in life.
[Show abstract][Hide abstract] ABSTRACT: Tumor necrosis factor (TNF)-α is thought to contribute to pulmonary hypertension. We aimed to investigate the effect of infliximab (TNF-α antagonist) treatment on pathologic findings and gene expression in a monocrotaline-induced pulmonary hypertension rat model.
Six-week-old male Sprague-Dawley rats were allocated to 3 groups: control (C), single subcutaneous injection of normal saline (0.1 mL/kg); monocrotaline (M), single subcutaneous injection of monocrotaline (60 mg/kg); and monocrotaline + infliximab (M+I), single subcutaneous injection of monocrotaline plus single subcutaneous injection of infliximab (5 mg/kg). The rats were sacrificed after 1, 5, 7, 14, or 28 days. We examined changes in pathology and gene expression levels of TNF-α, endothelin-1 (ET-1), endothelin receptor A (ERA), endothelial nitric oxide synthase (eNOS), matrix metalloproteinase (MMP)2, and tissue inhibitor of matrix metalloproteinase (TIMP).
The increase in medial wall thickness of the pulmonary arteriole in the M+I group was significantly lower than that in the M group on day 7 after infliximab treatment (P<0.05). The number of intra-acinar muscular arteries in the M+I group was lower than that in the M group on days 14 and 28 (P<0.05). Expression levels of TNF-α, ET-1, ERA, and MMP2 were significantly lower in the M+I group than in the M group on day 5, whereas eNOS and TIMP expressions were late in the M group (day 28).
Infliximab administration induced early changes in pathological findings and expression levels of TNF-α, and MMP2 in a monocrotaline-induced pulmonary hypertension rat model.
Korean Journal of Pediatrics 03/2013; 56(3):116-24. DOI:10.3345/kjp.2013.56.3.116
[Show abstract][Hide abstract] ABSTRACT: The etiology for Kawasaki disease (KD) remains unknown, but several studies have suggested the involvement of immune dysregulation and genetic factors. The purpose of this study is to compare gene expressions before and after an infusion of intravenous immunoglobulin (IVIG) in KD patients.
[Show abstract][Hide abstract] ABSTRACT: Dyslipidemia is one of the important modifiable risk factors for cardiovascular disease. Thus, to know the prevalence of dyslipidemia is the 1(st) step to make guidelines of screening and management plan. Although, American Academy of Pediatrics updated the guidelines for lipid in childhood, Asian study is rare.
The authors aimed to make a reference of each serum lipid level of Korean children and adolescents (2,363 subjects aged 10 to 18 years) from the data of Korea National Health and Nutrition Examination Survey IV (2007-2009).
The mean serum concentrations for total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) were 158 mg/dL, 90 mg/dL, 90 mg/dL, and 49 mg/dL, respectively. The 95th percentile values for TC, LDL-C, and TG were 203 mg/dL, 129 mg/dL, and 185 mg/dL, respectively. The 5th percentile value for HDL-C was 36 mg/dL. The prevalence of hypercholesterolemia, high LDL-C, high TG, and low HDL-C was 6.5%, 4.7%, 10.1%, and 7.1%, respectively. Considering the risk factors such as obesity, hypertension, smoking, and diabetes, approximately 0.41% of the subjects were potentially eligible for pharmacological treatment.
This information may be useful in not only Korean but also Asian planning programs for the prevention of cardiovascular disease through lipid control from childhood.
PLoS ONE 12/2012; 7(12):e49253. DOI:10.1371/journal.pone.0049253 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In Korea, there hasn't been any previous literature that describes auscultatory blood pressure (BP) normative tables for adolescents. Using BP data, from the Korean National Health and Nutrition Examination Survey (KNHANES), we created normative auscultatory BP percentile tables for Korean adolescents.
A total of 3508 adolescents (boys 1852, girls 1656), aged 10-17 in 2001, 2005 and 2007 from the KNHANES database years, were included. Auscultatory BP measurement was performed, using a Baumanometer Mercury Gravity Sphygmomanometer.
The mean systolic BP of boys was higher than that of girls in adolescents older than 13 years of age, and the mean diastolic BP of boys was higher than that of girls in those older than 15 years. Systolic and diastolic BP was correlated with weight, height and age. Age-specific normative auscultatory systolic and diastolic BP percentiles for boys and girls were completed. The graph that showed age-specific prehypertensive and hypertensive systolic and diastolic BP for boys and girls was presented. For adolescents, the height-specific auscultatory BP percentiles for boys and girls were completed. A graph that shows the height-specific prehypertensive and hypertensive BP for boys and girls was also made.
The auscultatory age-and height-specific BP percentiles for Korean adolescents are established. These can be useful in screening the prehypertension and hypertension of Korean adolescents in a clinical setting.
Korean Circulation Journal 12/2012; 42(12):809-15. DOI:10.4070/kcj.2012.42.12.809 · 0.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Chromosome 22q11.2 deletion syndrome is the most common interstitial deletion syndrome. Major clinical manifestation includes hypocalcemia secondary to hypoparathyroidim. At least 10% of the patients with this syndrome had hypocalcemic seizures which are generally improved over the first year of life because of the increase of parathyroid gland hypertrophy and dietary calcium intake. We present two cases of this syndrome diagnosed in 12-year-old boys with new onset hypocalcemic seizures. This case report hopes to call attention to this syndrome as a potential cause of hypocalcemic seizures even after the neonatal period. Furthermore, our first patient showed inheritance from a paternal deletion which is not as common as maternal deletions. This is the first case report of hypocalcemic seizure with a paternally inherited 22q11.2 deletion in Korea.
[Show abstract][Hide abstract] ABSTRACT: Obesity has reached epidemic proportions globally and affects people of all ages. Recent studies have shown that visceral adipose tissue measured by magnetic resonance imaging and/or computed tomography correlates positively with epicardial adipose tissue. Epicardial fat, which is correlated to several metabolic parameters, can be assessed by echocardiography. The aim of this study was to evaluate epicardial fat thickness and other metabolic parameters in obese adolescents and investigate the correlation between epicardial fat thickness and other metabolic parameters in obese adolescents.
We selected 99 subjects, between ages 15-17 years of age, to be enrolled in this study. Sixty five obese adolescents with a body mass index (BMI) >95 percentile and 34 control subjects were included in this study. Echocardiographic measurements including epicardial fat thickness as well as anthropometric and blood pressure (BP) measurements were performed. The following parameters were estimated: blood glucose, total cholesterol, triglyceride, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, aspartate aminotransferase, alanine aminotransferase, free fatty acid, interleukin-6, tumor necrosis factor-α, leptin, adiponectin and high sensitive C reactive protein.
The obese group showed a statistically significant correlation with echocardiographic epicardial fat thickness and, BMI, waist circumference, obesity index, fat percentage, systolic BP, insulin level, leptin and adiponectin. Multivariate linear regression analysis showed epicardial fat thickness as the most significant independent parameter to correlate with obese adolescents.
These data suggest that epicardial fat thickness measured by echocardiography is a practical and accurate parameter for predicting visceral obesity.
Korean Circulation Journal 07/2012; 42(7):471-8. DOI:10.4070/kcj.2012.42.7.471 · 0.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The growth assessment of bone age (BA) is an essential feature in diagnosing various diseases in children. In the clinic, the Tanner and Whitehouse (TW3) method and the Greulich-Pyle (GP) method are used to estimate bone age. Because those methods were developed for foreign children, it is necessary to evaluate the applicability of those methods to Koreans.
This study was designed (1) to compare the skeletal maturity score (SMS) in Koreans to the SMS in foreign children, and (2) to establish a correlation between the BA and chronological age (CA) on the basis of gender and age in normal Korean children.
We estimated the SMS and BA for 378 healthy children (141 boys and 237 girls) who visited the pediatrics clinic in Ewha Womans University Mokdong Hospital (Seoul, Korea) from 2000 to 2009. The SMS and BA were estimated using the TW3 and GP methods.
The SMS in Koreans was higher than in foreign children, and on average, the BA measured by both methods was higher than the CA. The correlation between the BA and CA were different according to gender and age.
We suggest that there are differences between the SMS in Korean and foreign children and between the BA and CA. Therefore, the results can be used in evaluating the skeletal maturity of Koreans, and a correlation between the BA and CA would be a useful reference in diagnosis.
[Show abstract][Hide abstract] ABSTRACT: Steroidogenic acute regulatory (STAR) protein plays a crucial role in steroidogenesis, and mutations in the STAR gene cause congenital lipoid adrenal hyperplasia (CLAH). This study investigated the STAR mutation spectrum and functionally analyzed a novel STAR mutation in Korean patients with CLAH.
Mutation analysis of STAR was carried out in 25 unrelated Korean CLAH patients. A region of STAR comprising exons 4-7 was cloned from human genomic DNA into an expression vector, followed by site-directed mutagenesis and transient expression in COS7 cells. The splicing pattern was analyzed by in vitro transcription, and each transcript was functionally characterized by measuring pregnenolone production in COS7 cells cotransfected with the cholesterol side chain cleavage system.
Mutation p.Q258X was identified in 46 of 50 alleles (92%); mutation c.653C>T was detected in two alleles (4%); and mutations p.R182H and c.745-6_810del were found in one allele (2%). Reverse transcriptase-PCR products amplified from a patient heterozygous for compound c.653C>T and c.745-6_810del mutation revealed multiple alternatively spliced mRNAs. In vitro expression analysis of a minigene consisting of exons 4-7 containing the c.653C>T yielded two transcripts in which exon 6 or exons 5 and 6 were skipped. The encoded proteins exhibited defective pregnenolone-producing ability. The c.745-6_810del mutation led to full and partial intron retention.
p.Q258X is the most common STAR mutation in Korea. A previously reported c.653C>T variant was found to cause aberrant splicing at the mRNA level, resulting in perturbation of STAR function. The c.745-6_810del mutation also resulted in aberrant splicing.
European Journal of Endocrinology 08/2011; 165(5):771-8. DOI:10.1530/EJE-11-0597 · 4.07 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Our study aimed to evaluated sex differences in clinical features of obese high school students.
One hundred three obese high school students (body mass index [BMI]≥85th percentile) and 51 control students (BMI<85th percentile) were enrolled in this study. Anthropometric measurements were performed. Fasting serum glucose, insulin, aspartate aminotransferase, alanine aminotransferase, total cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and high-sensitive C-reactive protein were measured. Abdominal fat thickness, degree of fatty liver, and carotid intima-media thickness were measured by ultrasound.
In control and obese groups, waist circumference was significantly longer in boys but body fat mass was significantly higher in girls. In the control group, total cholesterol and LDL-C were higher in girls. In the obese group, however, aspartate aminotransferase, alanine aminotransferase and triglyceride were higher and HDL-C was lower in boys. Preperitoneal fat thickness was significantly higher in obese girls. In obese group, the degree of fatty liver was significantly higher in boys. Carotid intima-media thickness was not significantly different between boys and girls.
Obese adolescents had distinguishable sex differences in body measurements, metabolic abnormalities, abdominal fat thickness and fatty liver. We can infer that these characteristics may extend into adult obesity.
Korean Journal of Pediatrics 07/2011; 54(7):292-7. DOI:10.3345/kjp.2011.54.7.292
[Show abstract][Hide abstract] ABSTRACT: Kawasaki disease (KD) is the main cause of acquired heart disease in children. In addition to cardiovascular involvement, many complications have been recognized in KD. However, respiratory complications have been rarely reported. We investigated the differences in clinical characteristics, laboratory findings, radiography findings, and echocardiography findings of Mycoplasma pneumoniae infection and other types of pneumonia in KD patients.
Among 358 patients with KD, 54 developed concurrent pneumonia. Among the 54 patients, 12 (22.2%) with high titers of anti-M. pneumoniae antibody (AMA) (>1:640) were grouped in the M. pneumoniae group and 42 were included in the control group. Serum AMA was measured in each patient. Clinical laboratory findings and total duration of fever were analyzed.
The duration of fever, serum hemoglobin, white blood cell count, platelet count, erythrocyte sedimentation rate, C-reactive protein level, albumin level, and the incidence of coronary arterial lesions showed no statistical difference in the 2 groups. Neutrophil count was significantly higher in the M. pneumoniae group than in the control group. Among various radiography findings observed in pneumonia, consolidation and pleural effusion were more frequent in the M. pneumoniae group than in the control group. On the other hand, parahilar peribronchial opacification, diffuse interstitial lesion, and normal findings prevailed in the control group.
KD patients can have concurrent infections, especially pulmonary symptoms. The cause of KD is likely to be associated with M. pneumoniae infection. Thus, immediate treatment of M. pneumoniae infection in KD patients is very important.
Korean Journal of Pediatrics 03/2011; 54(3):123-7. DOI:10.3345/kjp.2011.54.3.123