Prognostic Implication of Platelet Reactivity According to Left Ventricular Systolic Dysfunction Status in Patients Treated With Drug-Eluting Stent Implantation:Analysis of the PTRG-DES Consortium

Background@#Coronary artery disease patients undergoing percutaneous coronary intervention (PCI) often exhibit reduced left ventricular ejection fraction (LVEF). However, the impact of LV dysfunction status in conjunction with platelet reactivity on clinical outcomes has not been previously investigated. @*Methods@#From the multicenter PTRG-DES (Platelet function and genoType-Related long-term prognosis in DES-treated patients) consortium, the patients were classified as preserved-EF (PEF: LVEF ≥ 50%) and reduced-EF (REF: LVEF< 5 0%) group by echocardiography. Platelet reactivity was measured using VerifyNow P2Y 12 assay and high platelet reactivity (HPR) was defined as PRU ≥ 252. The major adverse cardiac and cerebrovascular events (MACCEs) were a composite of death, myocardial infarction, stent thrombosis and stroke at 5 years after PCI. Major bleeding was defined as Bleeding Academic Research Consortium bleeding types 3–5. @*Results@#A total of 13,160 patients from PTRG-DES, 9,319 (79.6%) patients with the results of both PRU and LVEF were analyzed. The incidence of MACCE and major bleeding was higher in REF group as compared with PEF group (MACCEs: hazard ratio [HR] 2.17, P < 0.001, 95% confidence interval [CI] 1.85–2.55; major bleeding: HR 1.78, P < 0.001, 95% CI 1.39–2.78).The highest rate of MACCEs was found in patients with REF and HPR, and the difference between the groups was statistically significant (HR 3.14 in REF(+)/HPR(+) vs. PEF(+)/HPR(-) group,P <0.01, 95% CI 2.51–3.91). The frequency of major bleeding was not associated with the HPR in either group. @*Conclusion@#LV dysfunction was associated with an increased incidence of MACCEs and major bleeding in patients who underwent PCI. The HPR status further exhibited significant increase of MACCEs in patients with LV dysfunction in a large, real-world registry.Trial Registration: ClinicalTrials.gov Identifier: NCT04734028

Performance of a Novel CT-Derived Fractional Flow Reserve Measurement to Detect Hemodynamically Significant Coronary Stenosis

Background@#Fractional flow reserve (FFR) based on computed tomography (CT) has been shown to better identify ischemia-causing coronary stenosis. However, this current technology requires high computational power, which inhibits its widespread implementation in clinical practice. This prospective, multicenter study aimed at validating the diagnostic performance of a novel simple CT based fractional flow reserve (CT-FFR) calculation method in patients with coronary artery disease. @*Methods@#Patients who underwent coronary CT angiography (CCTA) within 90 days and invasive coronary angiography (ICA) were prospectively enrolled. A hemodynamically significant lesion was defined as an FFR ≤ 0.80, and the area under the receiver operating characteristic curve (AUC) was the primary measure. After the planned analysis for the initial algorithm A, we performed another set of exploratory analyses for an improved algorithm B. @*Results@#Of 184 patients who agreed to participate in the study, 151 were finally analyzed.Hemodynamically significant lesions were observed in 79 patients (52.3%). The AUC was 0.71 (95% confidence interval [CI], 0.63–0.80) for CCTA, 0.65 (95% CI, 0.56–0.74) for CT-FFR algorithm A (P = 0.866), and 0.78 (95% CI, 0.70–0.86) for algorithm B (P = 0.112). Diagnostic accuracy was 0.63 (0.55–0.71) for CCTA alone, 0.66 (0.58–0.74) for algorithm A, and 0.76 (0.68–0.82) for algorithm B. @*Conclusion@#This study suggests the feasibility of automated CT-FFR, which can be performed on-site within several hours. However, the diagnostic performance of the current algorithm does not meet the a priori criteria for superiority. Future research is required to improve the accuracy.

Nucleocapsid and Spike Proteins of SARS-CoV-2 Drive Neutrophil Extracellular Trap Formation

Patients with severe coronavirus disease 2019 (COVID-19) demonstrate dysregulated immune responses including exacerbated neutrophil functions. Massive neutrophil infiltrations accompanying neutrophil extracellular trap (NET) formations are also observed in patients with severe COVID-19. However, the mechanism underlying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced NET formation has not yet been elucidated.Here we show that 2 viral proteins encoded by SARS-CoV-2, the nucleocapsid protein and the whole spike protein, induce NET formation from neutrophils. NET formation was ROSindependent and was completely inhibited by the spleen tyrosine kinase inhibition. The inhibition of p38 MAPK, protein kinase C, and JNK signaling pathways also inhibited viral protein-induced NET formation. Our findings demonstrate one method by which SARSCoV-2 evades innate immunity and provide a potential target for therapeutics to treat patients with severe COVID-19.

Characteristics and Practice of Parenteral Nutrition in Hospitalized Adult Cancer Patients in Korea

Purpose@#There have been no clinical studies on the characteristics of parenteral nutrition (PN) for adult cancer inpatients in South Korea. The published evidence describing modern PN practices in these patients is also extremely limited. Therefore in this retrospective multicenter cross-sectional study, we aimed to investigate the PN support practice in hospitalized adult cancer patients. @*Methods@#The study included adult cancer patients hospitalized in nine hospitals in South Korea and received PN, during the period from August 1st, 2017 to October 30th, 2017. We evaluated the relevant hospital-based PN practices in this group. @*Results@#Among the 11,580 inpatient admissions during this period, 759 cancer patients received PN (6.6%). The majority of enrolled patients (97.2%) used commercially available PN and 71.2% of these used peripheral PN formulations. The average in-hospital PN duration was 16.1±19.9 days. Patients received only 65.4±25.4% calories of the recommended target calories.The in-hospital mortality of enrolled patients was 26.1%. @*Conclusion@#We conclude that commercial PN is the most common form of PN administered to hospitalized adult cancer patients and the overall in-hospital mortality in the patients using PN is higher in South Korea compared to other countries.

A deep learning model to predict recurrence of atrial fibrillation after pulmonary vein isolation

Background and Objectives@#The efficacy of radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) is well established. The standard approach to RFCA in AF is pulmonary vein isolation (PVI). However, a large proportion of patients experiences recurrence of atrial tachyarrhythmia. The purpose of this study is to find out whether the AI model can assess AF recurrence in patients who underwent PVI. @*Materials and methods@#This study was a retrospective cohort study that enrolled consecutive patients who under‑ went catheter ablation for symptomatic, drug-refractory AF and PVI. We developed an AI algorithm to predict recur‑ rence of AF after PVI using patient demographics and three-dimensional (3D) reconstructed left atrium (LA) images. @*Results@#We included 527 consecutive patients in the study. The overall mean LA diameter was 42.0 ± 6.8 mm, and the mean LA volume calculated using 3D reconstructed images was 151.1 ± 46.7 ml. During the follow-up period, atrial tachyarrhythmia recurred in 158 patients. The area under the curve (AUC) of the AI model based on a convolu‑ tional neural network (including 3D reconstruction images) was 0.61 (95% confidence interval [CI] 0.53–0.74) using the test dataset. The total test accuracy was 66.3% (57.0–75.6), and the sensitivity was 53.3% (34.8–71.9). The specificity was 73.2% (51.8–75.0), and the F1 score was 52.5% 34.5–66.7). @*Conclusion@#In this study, we developed an AI algorithm to predict recurrence of AF after catheter ablation of PVI using individual reconstructed LA images. This AI model was unable to predict recurrence of AF overwhelmingly;therefore, further large-scale study is needed.

Characteristics and Practice of Parenteral Nutrition in Hospitalized Adult Cancer Patients in Korea

Purpose@#There have been no clinical studies on the characteristics of parenteral nutrition (PN) for adult cancer inpatients in South Korea. The published evidence describing modern PN practices in these patients is also extremely limited. Therefore in this retrospective multicenter cross-sectional study, we aimed to investigate the PN support practice in hospitalized adult cancer patients. @*Methods@#The study included adult cancer patients hospitalized in nine hospitals in South Korea and received PN, during the period from August 1st, 2017 to October 30th, 2017. We evaluated the relevant hospital-based PN practices in this group. @*Results@#Among the 11,580 inpatient admissions during this period, 759 cancer patients received PN (6.6%). The majority of enrolled patients (97.2%) used commercially available PN and 71.2% of these used peripheral PN formulations. The average in-hospital PN duration was 16.1±19.9 days. Patients received only 65.4±25.4% calories of the recommended target calories.The in-hospital mortality of enrolled patients was 26.1%. @*Conclusion@#We conclude that commercial PN is the most common form of PN administered to hospitalized adult cancer patients and the overall in-hospital mortality in the patients using PN is higher in South Korea compared to other countries.

A deep learning model to predict recurrence of atrial fibrillation after pulmonary vein isolation

Background and Objectives@#The efficacy of radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) is well established. The standard approach to RFCA in AF is pulmonary vein isolation (PVI). However, a large proportion of patients experiences recurrence of atrial tachyarrhythmia. The purpose of this study is to find out whether the AI model can assess AF recurrence in patients who underwent PVI. @*Materials and methods@#This study was a retrospective cohort study that enrolled consecutive patients who under‑ went catheter ablation for symptomatic, drug-refractory AF and PVI. We developed an AI algorithm to predict recur‑ rence of AF after PVI using patient demographics and three-dimensional (3D) reconstructed left atrium (LA) images. @*Results@#We included 527 consecutive patients in the study. The overall mean LA diameter was 42.0 ± 6.8 mm, and the mean LA volume calculated using 3D reconstructed images was 151.1 ± 46.7 ml. During the follow-up period, atrial tachyarrhythmia recurred in 158 patients. The area under the curve (AUC) of the AI model based on a convolu‑ tional neural network (including 3D reconstruction images) was 0.61 (95% confidence interval [CI] 0.53–0.74) using the test dataset. The total test accuracy was 66.3% (57.0–75.6), and the sensitivity was 53.3% (34.8–71.9). The specificity was 73.2% (51.8–75.0), and the F1 score was 52.5% 34.5–66.7). @*Conclusion@#In this study, we developed an AI algorithm to predict recurrence of AF after catheter ablation of PVI using individual reconstructed LA images. This AI model was unable to predict recurrence of AF overwhelmingly;therefore, further large-scale study is needed.

Comparison of Continuous ECG Monitoring by Wearable Patch Device and Conventional Telemonitoring Device

Background@#Detection of arrhythmias is crucial for the treatment of cardiovascular diseases.However, conventional devices do not provide sufficient diagnostic accuracy while patients should suffer from bothersome diagnostic process. We sought to evaluate diagnostic capability and safety of the new adhesive electrocardiogram (ECG) monitoring device in patients who need ECG monitoring during admission. @*Methods@#We enrolled 10 patients who admitted to Seoul National University Bundang Hospital and required continuous ECG monitoring between October 31, 2019 and December 18, 2019. New adhesive ECG monitoring device and conventional ECG monitoring device were simultaneously applied to the patients and maintained for 48 hours. From each patient, 48 pairs of ECG signal were collected and analyzed by two cardiologists independently.Discrepancy of diagnosis and frequency of noise or signal loss were compared between the two devices. @*Results@#From analyzable ECG data, discrepancy of arrhythmia diagnosis was not observed between the two devices. Noise rate was higher in conventional ECG monitoring device (2.5% vs. 17.3%, P < 0.001) and signal loss was not observed in new adhesive device while there was 9.4% of signal losses in conventional Holter recorder group. The new device was well-tolerated among 48 hours of monitoring period and no adverse event was observed. @*Conclusion@#A newer adhesive ECG monitoring device demonstrated similar diagnostic accuracy compared to conventional ECG monitoring device.

Intravascular imaging analysis of a drug-eluting balloon followed by a bare metal stent compared to a drug-eluting stent for treatment of de novo lesions

BACKGROUND/AIMS@#After a study comparing drug-eluting stents (DESs) to sequential treatment with drug-eluting balloons (DEBs) and bare metal stents (BMSs), we retrospectively analysed strut malapposition and neointimal hyperplasia in de novo coronary lesions using optical coherence tomography (OCT) or intravascular ultrasonography (IVUS).@*METHODS@#We obtained OCT data from 16 patients (eight per group) and IVUS data from 40 patients (20 per group). OCT or IVUS was performed after the index procedure and after 9 months. Parameters including obstruction volume due to neointimal hyperplasia (neointimal hyperplasia volume/stent volume, %), strut malapposition (% of malapposed struts), and intra-individual inhomogeneity of in-stent restenosis were compared.@*RESULTS@#Although obstruction volume due to neointimal hyperplasia was significantly higher in the DEB-BMS group (14.90 ± 15.36 vs. DES 7.03 ± 11.39, p = 0.025), there was no difference in strut malapposition between the two groups (DEB-BMS 1.99 ± 5.37 vs. DES 0.88 ± 2.22, p = 0.856). The DEB-BMS group showed greater intra-individual inhomogeneity of in-stent restenosis pattern than the DES group.@*CONCLUSIONS@#Treatment with DEB followed by BMS failed to improve strut malapposition despite higher in-stent neointimal growth, probably because of the inhomogeneous inhibition of in-stent neointimal hyperplasia by DEB. DEB technology should be improved to obtain even drug delivery to the vessel wall and homogeneous prevention of neointimal growth comparable to contemporary DES.

Factors Influencing HPV Vaccination Intention in Mothers with Elementary School Daughters / 여성건강간호학회지

PURPOSE: The purpose of this study was to identify the impacts of human papillomavirus (HPV) vaccination-related health belief, attitudes toward HPV vaccination, and subjective norms on HPV vaccination intent targeting mothers of elementary school daughters. METHODS: The study use a correlative survey design. The subjects of the study were 121 mothers of elementary school daughters located in metropolitan city B. All subjects agreed to participate in the study. The data were collected from September 1 to October 18, 2018, and were analyzed using descriptive statistics, Independent t-test, ANOVA with a post hoc Scheffé test, Pearson's correlation coefficients, and stepwise multiple regression. RESULTS: Attitude toward HPV vaccination, subjective norms, vaccination plans for their children, and mother's vaccination status were significant factors influencing HPV vaccination intention. These factors accounted for 72% of the HPV vaccination intention. CONCLUSIONS: This study showed that factors affecting the intention of mothers of elementary school daughters to vaccinate against HPV were HPV vaccination attitudes, subjective norms, vaccination plans for their children, and mother's vaccination status. The biggest influencing factor was HPV vaccination attitudes. Therefore, in order to encourage mothers of elementary school daughters to vaccinate against HPVs, national-level policies should be implemented to create a social atmosphere of positive attitudes toward HPV vaccinations that also emphasizes how easy it is to get vaccinated against HPV. Based on this, mothers of elementary school daughters should be encouraged to have them vaccinated against HPV, thus contributing to improving the HPV vaccination rates of elementary school girls.

Effect of Hyperglycemia on Myocardial Perfusion in Diabetic Porcine Models and Humans

BACKGROUND: Diabetes mellitus (DM) causes macro- and microvasculopathy, but data on cardiac microvascular changes in large animals are scarce. We sought to determine the effect of DM on macro- and microvascular changes in diabetic pigs and humans. METHODS: Eight domestic pigs (4 with type I diabetes and 4 controls) underwent coronary angiography with optical coherence tomography (OCT; at baseline and 1 and 2 months), coronary computed tomography angiography, cardiac magnet resonance (CMR) imaging, and histologic examination. RESULTS: The diabetic pigs had more irregular capillaries with acellular capillaries and a smaller capillary diameter (11.7 ± 0.33 μm vs. 13.5 ± 0.53 μm; P < 0.001) than those of the control pigs. The OCT showed no significant epicardial stenosis in either group; however diabetic pigs had a greater intima-media thickness. CMR results showed that diabetic pigs had a lower relative upslope at rest (31.3 ± 5.9 vs. 37.9 ± 8.1; P = 0.011) and during stress (18.0 ± 3.0 vs. 21.6 ± 2.8; P = 0.007) than the control pigs, implying decreased myocardial perfusion. Among the 79 patients with ST elevation myocardial infarction, 25 had diabetes and they had lower myocardial perfusion on CMR as well. CONCLUSION: DM causes microvascular remodeling and a decrease in myocardial perfusion in large animals at a very early stage of the disease course. Early and effective interventions are necessary to interrupt the progression of vascular complications in diabetic patients.

A case of ruptured hepatic angiomyolipoma in a young male

A 31-year-old male visited a local hospital due to sudden-onset severe abdominal pain. Abdominal computed tomography revealed a solid cystic mass with a size of approximately 12 cm and exhibiting both hemorrhage and fluid collection in the pelvic cavity. Emergency angiography and embolization were performed, and a large hepatic tumor was subsequently surgically resected. The tumor cells stained positive for human melanoma black-45 and smooth-muscle actin, and the pathologic diagnosis was hepatic angiomyolipoma. This case report also discusses the spontaneous rupture of a hepatic angiomyolipoma.

Cardiac Resynchronization Therapy Device Implantation in a Patient with Cardiogenic Shock under Percutaneous Mechanical Circulatory Support

65-year-old woman was admitted to our hospital with acute decompensated heart failure with reduced left ventricular ejection fraction and severe mitral regurgitation. Electrocardiography revealed a typical left bundle branch block and atrial fibrillation. Her condition deteriorated despite administering high-doses of inotropes and vasopressors. Pending a decision to therapy, venoarterial extracorporeal membrane oxygenation (ECMO) was performed when the patient underwent a cardiogenic shock. Although the hemodynamic status stabilized with ECMO support, weaning the patient from ECMO was not possible. Thus, we decided to perform cardiac resynchronization with defibrillator implantation as a “rescue” therapy. Five days post-implantation, the patient was successfully weaned from ECMO.

Factors Influencing HPV-related Infection Preventive Behavioral Intention among Female University Students

PURPOSE: The purpose of this study was to identify impacts of HPV-related knowledge, attitude to HPV vaccination, and health beliefs on infection preventive behavioral intention targeting female university students. METHODS: With correlational survey design, subjects of this study were 120 female students at universities located in B metropolitan city and G city. A total sample agreed to participate in the study. Data were analyzed using descriptive statistics, t-test, ANOVA, correlation, and stepwise multiple regression. RESULTS: Attitude to HPV vaccination, experience of smoking, and HPV-related health beliefs were significant factors influencing the HPV-related infection preventive behavioral intention. These factors accounted for 19.0% of the HPV-related infection preventive behavioral intention. CONCLUSION: The most significant factor for HPV infection prevention was the attitude to HPV vaccination. These findings may be useful to develop strategies to improve the HPV infection preventive behavioral intention of the female university students who have a high risk of the HPV infection.

Survey of Preferences in Patients Scheduled for Carpal Tunnel Release Using Conjoint Analysis

BACKGROUND: This study aimed to investigate the preferences of patients scheduled for carpal tunnel release using conjoint analysis and also introduce an example of how to apply a conjoint analysis to the medical field. The use of conjoint analysis in this study is new to the field of orthopedic surgery. METHODS: A total of 97 patients scheduled for carpal tunnel release completed the survey. The following four attributes were predefined: board certification status, distance from the patient's residency, medical costs, and waiting time for surgery. Two plausible levels for each attribute were assigned. Based on these attributes and levels, 16 scenarios were generated (2 × 2 × 2 × 2). We employed 8 scenarios using a fractional factorial design (orthogonal plan). Preferences for scenarios were then evaluated by ranking: patients were asked to list the 8 scenarios in their order of preference. Outcomes consisted of two results: the average importance of each attribute and the utility score. RESULTS: The most important attribute was the physician's board certificate, followed by distance from the patient's residency to the hospital, waiting time, and costs. Utility estimate findings revealed that patients had a greater preference for a hand specialist than a general orthopedic surgeon. CONCLUSIONS: Patients considered the physician's expertise as the most important factor when choosing a hospital for carpal tunnel release. This suggests that patients are increasingly seeking safety without complications as interest in medical malpractice has increased.

The Mycobiota of Air Inside and Outside the Meju Fermentation Room and the Origin of Meju Fungi

The fungi on Meju are known to play an important role as degrader of macromolecule of soybeans. In order to elucidate the origin of fungi on traditional Meju, mycobiota of the air both inside and outside traditional Meju fermentation rooms was examined. From 11 samples of air collected from inside and outside of 7 Meju fermentation rooms, 37 genera and 90 species of fungi were identified. In outside air of the fermentation room, Cladosporium sp. and Cladosporium cladosporioides were the dominant species, followed by Cladosporium tenuissimum, Eurotium sp., Phoma sp., Sistotrema brinkmannii, Alternaria sp., Aspergillus fumigatus, Schizophyllum commune, and Penicillium glabrum. In inside air of the fermentation room, Cladosporium sp., Aspergillus oryzae, Penicillium chrysogenum, Asp. nidulans, Aspergillus sp., Cla. cladosporioides, Eurotium sp., Penicillium sp., Cla. tenuissimum, Asp. niger, Eur. herbariorum, Asp. sydowii, and Eur. repens were collected with high frequency. The concentrations of the genera Aspergillus, Eurotium, and Penicillium were significantly higher in inside air than outside air. From this result and those of previous reports, the origin of fungi present on Meju was inferred. Of the dominant fungal species present on Meju, Lichtheimia ramosa, Mucor circinelloides, Mucor racemosus, and Scopulariopsis brevicaulis are thought to be originated from outside air, because these species are not or are rarely isolated from rice straw and soybean; however, they were detected outside air of fermentation room and are species commonly found in indoor environments. However, Asp. oryzae, Pen. polonicum, Eur. repens, Pen. solitum, and Eur. chevalieri, which are frequently found on Meju, are common in rice straw and could be transferred from rice straw to Meju. The fungi grow and produce abundant spores during Meju fermentation, and after the spores accumulate in the air of fermentation room, they could influence mycobiota of Meju fermentation in the following year. This could explain why concentrations of the genera Aspergillus, Eurotium, and Penicillium are much higher inside than outside of the fermentation rooms.

A Rare Manifestation of Hypothyroid Myopathy: Hoffmann's Syndrome

Hypothyroid myopathy is observed frequently and the resolution of the clinical manifestations of myopathy following thyroid hormone replacement is well known. However, a specific subtype of hypothyroid myopathy, Hoffmann's syndrome, characterized by increased muscular mass (pseudohypertrophy), proximal muscle weakness, muscle stiffness and cramps, is rarely reported. Herein, we describe a 34-year-old male who presented with proximal muscle weakness and non-pitting edema of the lower extremities. He initially visited the neurology department where he was suspected of having polymyositis. Additional laboratory evaluation revealed profound autoimmune hypothyroidism and elevated muscle enzymes including creatine kinase. The patient was started on levothyroxine treatment and, subsequently, clinical symptoms and biochemical parameters resolved with the treatment. The present case highlights that hypothyroidism should be considered in the differential diagnosis of musculoskeletal symptoms even in the absence of overt manifestations of hypothyroidism. To our knowledge, this is the first case reported in Korea.

Primary Hyperparathyroidism with Extensive Brown Tumors and Multiple Fractures in a 20-Year-Old Woman

A brown tumor is a benign fibrotic, erosive bony lesion caused by localized, rapid osteoclastic turnover, resulting from hyperparathyroidism. Although brown tumors are one of the most pathognomonic signs of primary hyperparathyroidism, they are rarely seen in clinical practice. In this report, we present a case of 20-year-old woman with recurrent fractures and bone pain. Plain digital radiographs of the affected bones revealed multiple erosive bone tumors, which were finally diagnosed as brown tumors associated with primary hyperparathyroidism due to a parathyroid adenoma. This case shows that multiple, and clinically severe form of brown tumors can even occur in young patients.

Changes in the clinical manifestations of primary aldosteronism

BACKGROUND/AIMS: Primary aldosteronism (PA) is now widely recognized to have a higher prevalence than was once thought. In view of its increasing prevalence, we compared chronological changes in clinical manifestations of PA according to different times of diagnosis. METHODS: In total, 85 patients diagnosed with PA from January 1986 through March 2012 were reviewed retrospectively, based on their medical records. During two periods-1986 to 2005 and 2006 to 2012-41 and 44 patients, respectively, were diagnosed with PA. We compared the clinical and biological characteristics of PA between these periods. RESULTS: The results demonstrate an increasing trend in the prevalence of idiopathic hyperaldosteronism (IHA; p = 0.19). In the 2006 to 2012 period, patients with PA presented with higher serum potassium levels at the time of diagnosis than in the 1986 to 2005 period (p < 0.0002). Adrenal vein sampling (AVS) was performed mostly in the latter period (82.3%) and the diagnostic accuracy of adrenal computed tomography, compared with AVS, was only 56.2%. About 78.0% versus 86.3% of patients had at least one target organ damage (TOD) in the 1986 to 2005 and 2006 to 2012 periods, respectively (p = 0.39). However, patients with TOD were older and had longer durations of hypertension than patients without, in both periods. CONCLUSIONS: PA is becoming more prevalent. There was an increasing tendency for IHA, and more PA patients presented with normokalemia than in the earlier period. Early and accurate diagnosis of PA with AVS and proper treatment should have substantial prognostic value.

Anaplastic Thyroid Carcinoma Following Radioactive Iodine Therapy for Graves' Disease

Radioactive iodine (RAI) therapy has been used as a treatment option for Graves' disease, and it has been widely accepted to be safe. On the other hand, some evidence suggests that RAI therapy is possibly associated with a small increased risk of thyroid cancer. Herein, we report a rare case of anaplastic thyroid carcinoma (ATC) associated with Graves' disease, following RAI treatment. A 42-year-old woman had been diagnosed with Graves' disease and although she was treated with an antithyroid drug, she remained in a hyperthyroid state, which led to two RAI treatments. More than 10 years later, the patient revisited our clinic due to hoarseness, dysphagia, and dyspnea, which had lasted for 2 months. Neck computed tomography suggested thyroid carcinoma and a lymph node biopsy showed metastatic papillary carcinoma. The patient underwent total thyroidectomy and was finally diagnosed as having an ATC. It is not clear if the occurrence of ATC reported here was influenced by the RAI therapy or alternatively, it may only represent the delayed recognition of a rare change in the natural history of Graves' disease. Nevertheless, this report is worthwhile since it presents a very rare case of ATC that occurred eleven years after the RAI therapy for Graves' disease.