• Korean Journal of Radiology
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• 제25권3호
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• pp.289-300
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• 2024

Objective: To prospectively evaluate the outcomes of ultrasound (US)-guided radiofrequency ablation (RFA) in tertiary hyperparathyroidism (THPT). Materials and Methods: Patients with THPT underwent RFA between September 2017 and January 2022. Laboratory parameters, including serum intact parathyroid hormone (iPTH) levels, were monitored for 48 months after RFA and compared with the levels at baseline. Complications related to RFA and changes in hyperparathyroidism-related clinical symptoms were recorded before and after RFA. Results: A total of 42 patients with THPT were recruited for this study. Ultimately, 36 patients with renal failure and 2 patients who underwent successful renal transplantation (male:female, 17:21; median age, 54.5 years) were enrolled. The follow-up time was 21.5 ± 19.0 months in the 36 patients with renal failure. In these 36 patients, iPTH levels were significantly decreased to 261.1 pg/mL at 48 months compared with the baseline value of 1284.9 pg/mL (P = 0.012). Persistent hyperparathyroidism, defined as iPTH levels maintained at > 585.0 pg/mL for 6 months after treatment, occurred in 4.0% of patients (1/25). Recurrent hyperparathyroidism, defined as iPTH levels > 585.0 pg/mL after 6 months, were 4.0% (1/25) and 0.0% (0/9) at 6 months and 4 years after treatment, respectively. In two patients with THPT after successful renal transplantation, iPTH decreased from the baseline value of 242.5 and 115.9 pg/mL to 171.0 and 62.0 pg/mL at 6 months after treatment. All complications resolved within 6 months of ablation without medical intervention, except in 10.5% (4/38) patients with permanent hypocalcemia. The overall symptom recovery rate was 58.8% (10/17). The severity scores for bone pain, arthralgia, and itchy skin associated with hyperparathyroidism improved after treatment (P < 0.05). Conclusion: US-guided RFA is an effective and safe alternative to surgery in the treatment of patients with TPTH and improves hyperparathyroidism-related clinical symptoms.

• 대한지역사회영양학회지
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• 제18권3호
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• pp.213-222
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• 2013

Few studies investigated the effects of nutrition education and exercises in women with osteopenia. This study examined the relationship between changes in dietary intakes and changes in indicators related to bone health in postmenopausal women with osteopenia (-2.5 ${\leq}$ T-score ${\leq}$ 1) after a 12-week intervention. Thirty-one postmenopausal women aged > 50 years residing in Seoul were recruited and participated in nutritional education regarding bone health and general nutrition practices and aerobic exercises (three times a week; 60 min per session). Twenty-five subjects completed the study and were eligible for the analysis. Bone mineral density (BMD) at femoral neck was measured by dual energy x-ray absorptiometry. Serum calcium, osteocalcin, and intact parathyroid hormone (PTH) were also measured. Dietary intake was estimated by using a one-day 24 recall by a clinical dietitian. After 12 weeks, meat consumption increased (P = 0.028) but vegetable intake decreased (P = 0.005). Intakes of animal protein (P = 0.024), vitamin B1 (P = 0.012) and vitamin $B_2$ (P = 0.047) increased, and sodium intake decreased (P = 0.033). Intact PTH (P = 0.002) decreased and osteocalcin (P = 0.000) increased, however, BMD decreased (P = 0.000). Changes in mushroom consumption were positively correlated with femoral neck BMD (r = 0.673, P = 0.003). Changes in animal iron intake were negatively correlated with intact PTH (r = -0.488, P = 0.013) but were positively correlated with osteocalcin (r = 0.541, P = 0.005). These results suggested that the association between animal iron intake and biochemical markers of bone turnover may play an important role in bone metabolism. Further studies are needed to shed light on complicated mechanisms of diet, hormonal levels of bone metabolism, and bone density.

• 핵의학기술
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• 제16권2호
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• pp.139-148
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• 2012

이 실험은 검사를 매일 실행하고, 동결건조된 표준액을 매번 녹여서 사용하는 검사실은 그 안정성에 대하여 고민을 할 필요는 없지만, 검사를 일주일에 한번 또는 두 번 정도 실행하는 검사실에 대한 보고라고 할 수도 있다. 동결 건조한 표준물질은 용해한 후 다시 동결을 할 경우 보통 $-20^{\circ}C$이하에서 유효기간까지 보관하라는 식으로만 표현 되어져 있고, 이는 몇 번을 녹인 후 재사용해도 안정한가에 대해서는 표현된 바가 없기에 이번 실험은 동결건조한 표준용액을 녹임과 동결을 여러 번 번복하였을 때와 냉장보관을 하였을 시에 표준용액의 변화도와 이것이 결과에 미치는 영향을 비교 평가하였다. 시판되고 있는 방사면역측정법을 이용한 체외진단키트 중 동결건조표준용액으로 되어진 부갑상선호르몬(PTH), 부신피지자극호르몬(ACTH), 황체형성호르몬(LH) kit를 같은Lot.NO.로 구성하였다. 이를 D.W.로 각 용량에 맞게 용해한 후 3개의 대조군으로 분리하였다. 제1대조군은 녹임, 동결을 번복하는 방법으로 하였고 제2대조군은 용해한 후 Test tube에 1회 사용할 만큼 분주하여 동결을 하였고 제3대조군은 냉장보관으로 하였다. 표준액과 환자농도값 날짜 별로 비교하였고, pH Test를 하였으며 날짜 별 단순회귀분석 및 결정계수 산출을 하였으며 Excel Paired t-Test (p-value)를 하여서 유의수준관계를 분석하였다. 위에서 실험한 ACTH, PTH, LH의 동결건조 표준액은 반드시 냉동보관을 할 것을 권고한다. 이는 다른 동결건조표준액도 같은 방법으로 보관을 해야 할 것이다.

• Journal of Periodontal and Implant Science
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• 제42권3호
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• pp.95-104
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• 2012

Purpose: The purpose of this study was to determine whether increasing the Ti6Al4V surface oxide negative charge through heat ($600^{\circ}C$) or radiofrequency plasma glow discharge (RFGD) pretreatment, with or without a subsequent coating with fibronectin, stimulated osteoblast gene marker expression in the MC3T3 osteoprogenitor cell line. Methods: Quantitative real-time polymerase chain reaction was used to measure changes over time in the mRNA levels for osteoblast gene markers, including alkaline phosphatase, bone sialoprotein, collagen type I (${\alpha}1$), osteocalcin, osteopontin and parathyroid hormone-related peptide (PTH-rP), and the osteoblast precursor genes Runx2 and osterix. Results: Osteoprogenitors began to differentiate earlier on disks that were pretreated with heat or RFGD. The pretreatments increased gene marker expression in the absence of a fibronectin coating. However, pretreatments increased osteoblast gene expression for fibronectin-coated disks more than uncoated disks, suggesting a surface oxide-mediated specific enhancement of fibronectin's bioactivity. Heat pretreatment had greater effects on the mRNA expression of genes for PTH-rP, alkaline phosphatase and osteocalcin while RFGD pretreatment had greater effects on osteopontin and bone sialoprotein gene expression. Conclusions: The results suggest that heat and RFGD pretreatments of the Ti6Al4V surface oxide stimulated osteoblast differentiation through an enhancement of (a) coated fibronectin's bioactivity and (b) the bioactivities of other serum or matrix proteins. The quantitative differences in the effects of the two pretreatments on osteoblast gene marker expression may have arisen from the unique physico-chemical characteristics of each resultant oxide surface. Therefore, engineering the Ti6Al4V surface oxide to become more negatively charged can be used to accelerate osteoblast differentiation through fibronectin-dependent and independent mechanisms.

• Clinical and Experimental Pediatrics
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• 제57권5호
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• pp.240-244
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• 2014

Pseudohypoparathyroidism type Ia (PHP Ia) is a disorder characterized by multiform hormonal resistance including parathyroid hormone (PTH) resistance and Albright hereditary osteodystrophy (AHO). It is caused by heterozygous inactivating mutations within the Gs alpha-encoding GNAS exons. A 9-year-old boy presented with clinical and laboratory abnormalities including hypocalcemia, hyperphosphatemia, PTH resistance, multihormone resistance and AHO (round face, short stature, obesity, brachydactyly and osteoma cutis) which were typical of PHP Ia. He had a history of repeated convulsive episodes that started from the age of 2 months. A cranial computed tomography scan showed bilateral calcifications in the basal ganglia and his intelligence quotient testing indicated mild mental retardation. Family history revealed that the patient's maternal relatives, including his grandmother and 2 of his mother's siblings, had features suggestive of AHO. Sequencing of the GNAS gene of the patient identified a heterozygous nonsense mutation within exon 11 (c.637 C>T). The C>T transversion results in an amino acid substitution from Gln to stop codon at codon 213 ($p.Gln213^*$). To our knowledge, this is a novel mutation in GNAS.

• Journal of Nutrition and Health
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• 제26권6호
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• pp.728-742
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• 1993

The effects of dietary calcium levels on the blood pressure and calcium metabolism were investigated. Nine normotensive female college students having hypertention family history were participated in 4-week dietary expeiments. They were provided with either high Ca diet (HCa, average 797mg/day) or low Ca diet(LCa, average 225mg/day) during two weeks, each, consecutively. Sodium amounts of the body diets were 3566~4022mg/day, which were ordinary sodium intake levels in Korea. After the HCa, systolic blood pressures(SBR) in both seated and isogrip-seated postitions were decreased by about 2.5mgHg, comparing with those after the LCa(p<.05). Diastoilc blood pressures(DBP) were not changed by dietary calcium levels. Serum total Ca, ionized Ca, Mg and P levels and Ca/Mg ratio were not different between the HCa and the LCa. Serum parathyroid hormone(PTH) levels were similar between two diets, but individually in seven of nine subjects, the slightly lower values of PTH were observed after the HCa than after the LCa. Urinary excretion of Ca(p<.01), Mg(p<.05) and P(p<.1) were increased after the HCa comparing with the LCa, but Ca/Mg ratio were not different between the two diets. SBP was in positive correlations with boty urinary excretion of Ca(supine, r=.7356, p<.05) and urinary Ca/Mg ratio(isogrip-seated, r=.7483, p<.05). SBP was also negatively correlated with serum P level(supine, r=-.6930, p<.05) and DBP was in negative correlation with urinary P excretion(seated, r=-.8586, p<.01). Serum total and ionized Ca, Mg, Ca/Mg ratio were not significantly correlated with blood pressures.

• International Journal of Oral Biology
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• 제33권3호
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• pp.113-116
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• 2008

Cementum is the mineralized tissue of the tooth. It is similar to bone in several aspects but it differs from bone. Human bone marrow stromal cells (BMSC) and human cementum derived cells (HCDC) (10,000 $cells/cm^2$) were plated in 6 well plates as feeder cells. The next day, mouse bone marrow cells (1.5 million $cells/cm^2$) were added. One group of these plates were incubated in serum-free conditioned medium (SFCM) generated from BMSC or HCDC supplemented with 2% FBS, parathyroid hormone (PTH), 1, 25 dihydroxyvitamin $D_3$ (Vit. $D_3$) and dexamethasone, or plain medium with the same supplements. Another group of plates were cocultured with BMSC or HCDC in plain medium supplemented with 2% FBS, PTH, Vit. $D_3$ and dexamethasone. Plates grown without SFCM or coculture were used as controls. After 10 days, the cells were stained for tartrate-resistant acid phosphatase (TRAP). BMSC were found to support osteoclast formation under normal conditions. This was inhibited however by both SFCM generated from HCDC and also by coculture with HCDC. In addition, HCDC themselves did not support osteoclast formation under any conditions. Our results thus indicate that HCDC do not support osteoclast formation in vitro and that soluble factor (s) from HCDC may inhibit this process. In addition, we show that this inhibition also involves an active mechanism that is independent of osteoprotegerin, a feature that may distinguish cementoblasts from other cells present in periodontium.

• 한국임상약학회지
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• 제26권2호
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• pp.97-106
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• 2016

Background: Sevelamer is associated with reduced complications of chronic kidney disease-mineral bone disorder (CKD-MBD) resulted from hyperphosphatemia, which may contribute mortality, in CKD patients with dialysis. So far clinical outcomes of sevelamer on mortality and risk of cardiovascular mortality related to CKD-MBD are debating. Purpose of this study was to evaluate the effectiveness of sevelamer HCl on mortality of secondary hyperparathyroidism (SHPT), risk of cardiovascular mortality and, frequency of osteopathy in end stage renal disease (ESRD) patients with dialysis. Methods: We retrospectively reviewed the electronic medical records of 536 patients with ESRD, who were admitted for moderate to severe SHPT, for 36 months. 75 patients who met inclusion criteria were evaluated for the efficacy of sevelamer (mean serum iPTH = 487.5 pg/mL). Results: Sevelamer intervention was not associated with increased three-year survival time compared with non-sevelamers group [average survival month: 30.4 months in sevelamer group, 26.8 months in non-sevelamer group, p = 0.463]. Sevelamer intervention was not associated with significant mortality benefit and cardiovascular mortality benefit as compared to non-sevelamer group [sevelamer group: non-sevelamer group, all-cause mortality (iPTH > 600 pg/mL): 14.3% (1/34): 20% (1/41) p = 0.962, OR = 0.935, 95% CI, 0.058-14.98, heart disease mortality: 6.67% (2/30): 0% (0/32) p = 0.138]. Sevelamer was not associated with significantly lower cumulative incidence of osteopathy compared to non-sevelamer group (sevelamer group: non-sevelamer group, 5.9% (2/34):9.8% (4/41); p = 0.538; OR = 0.578; 95% CI, 0.099-3.367). Conclusion: Sevelamer was not associated with decreased all-cause mortality and risk of cardiovascular mortality compared to non-sevelamer group in ESRD patients with SHPT.

• Journal of Periodontal and Implant Science
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• 제38권sup2호
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• pp.395-404
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• 2008

Purpose: Osteoprotegerin (OPG) is a secreted glycoprotein and a member of the tumor necrosis factor (TNF) receptor family that inhibits bone resorption by suppressing osteoclastogenesis. Gingival fibroblasts (GF) play a role in periodontal disease progression, and the purpose of this experiment was to evaluate influence of osteotropic factors on the expression of osteoprotegerin mRNA in these cells. Materials and Methods: In this experiment, the influence of osteoclastogenic factors, interleukin-1 beta (IL-$1{\beta}$), TNF-$\alpha$, prostanglandin E2 ($PEG_2$). parathyroid hormone (PTH) and 1$\alpha$, 25-dihydroxyvitamin $D_3$ on the expression of osteoprotegerin mRNA in GF was studied by Northern blot hybridization. Results: As expected, $PEG_2$ tended to inhibit OPG levels and this was most prominent at 24 hours of culture with $10^{-7}M$ of $PEG_2$. TNF-$\alpha$ at 10ng/ml and also at 25ng/ml decreased OPG levels to almost 30% of the control at 24 hours. This contrasts with reports of increased OPG levels from osteoblast/stromal cells and gingival fibroblasts stimulated by TNF-$\alpha$. Decrease of OPG levels with $PEG_2$ and TNF-$\alpha$ suggests a pathway whereby these mediators exert their resorptive effects. However, OPG levels were increased almost 3-fold at 24 hours with IL-1$\beta$(1 to 15ng/ml) and increased 1.4 fold with 24-hour treatment of $10^{-7}M$ PTH. Conclusion: Increase of OPG levels suggests that these 'osteoclastogenic' factors act in more complex ways and may act to inhibit bone resorption in inflammatory periodontitis. This result supports the role of OPG as a negative feedback mechanism in osteoclastic activity.

• Clinical and Experimental Pediatrics
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• 제54권2호
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• pp.51-54
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• 2011

Vitamin D is present in two forms, ergocalciferol (vitamin $D_2$) produced by plants and cholecalciferol (vitamin $D_3$) produced by animal tissues or by the action of ultraviolet light on 7-dehydrocholesterol in human skin. Both forms of vitamin D are biologically inactive pro-hormones that must undergo sequential hydroxylations in the liver and the kidney before they can bind to and activate the vitamin D receptor. The hormonally active form of vitamin D, 1,25-dihydroxyvitamin D3 $[1,25(OH)_2D]$, plays an essential role in calcium and phosphate metabolism, bone growth, and cellular differentiation. Renal synthesis of $1,25(OH)_2D$ from its endogenous precursor, 25-hydroxyvitamin D (25OHD), is the rate-limiting and is catalyzed by the $1{\alpha}$-hydroxylase. Vitamin D dependent rickets type I (VDDR-I), also referred to as vitamin D $1{\alpha}$-hydroxylase deficiency or pseudovitamin D deficiency rickets, is an autosomal recessive disorder characterized clinically by hypotonia, muscle weakness, growth failure, hypocalcemic seizures in early infancy, and radiographic findings of rickets. Characteristic laboratory features are hypocalcemia, increased serum concentrations of parathyroid hormone (PTH), and low or undetectable serum concentrations of $1,25(OH)_2D$ despite normal or increased concentrations of 25OHD. Recent advances have showed in the cloning of the human $1{\alpha}$-hydroxylase and revealed mutations in its gene that cause VDDR-I. This review presents the biology of vitamin D, and $1{\alpha}$-hydroxylase mutations with clinical findings.