Poster Session : PS 1423 ; Hemato-Oncology(Oncology) : Metastatic Thyroid Gland Tumor Presenting as an Initial Manifestation of Recurred Uterine Cervical Cancer

( So Dam Hong ),( Hye Jeong Cho ),( Jae Kyoung Shin ),( Hee Jin Hong ),( Bo Hye Kim ),( So Young Chong ),( Do Youn Oh ),( Ji Su Oh ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

The incidence of metastases to the thyroid gland demonstrates a 1% in unselected autopsy series to 25% in patients with widespread metastatic lesions. Most recurrent uterine cervical cancer patients have metastatic lesions in intra-pelvis and adjacent lymph node involvement, while a distant metastasis alone is extremely rare. We report a case of a 79-year-old woman with recurrent uterine cervical cancer, presenting thyroid mass without intra-pelvic recurrence four year after initial curative treatment. 4 years ago, the patient was diagnosed uterine cervical cancer (invasive squamous cell carcinoma, non-keratinizing type). She had undergone a course of concurrent chemoradiotherapy to the pelvis. She had lived without any other symptoms and evidence of recurrence for 4 years. Several weeks ago she had noticed foreign body sensation in throat, a palpable mass in the left side of her neck and a swelling in the region of the thyroid gland. Sono-guided biopsy of thyroid mass was performed and revealed metastatic squamous cell carcinoma, clinically from the uterine cervix. She had undergone total thyroidectomy and treated with 4 cycles of chemotherapy and radiotherapy. We conclude that patients who present swelling or palpable nodules in the thyroid side and have a history of a previous malignancy must be considered for metastatic disease although metastasis from the uterine cervical carcinoma to the thyroid gland is even rare.

증 례 : 재발한 자궁경부암에서 전이성 갑상선암

홍소담 ( So Dam Hong ),신재경 ( Jae Kyoung Shin ),홍희진 ( Hee Jin Hong ),허진형 ( Jin Hyung Heo ),정소영 ( So Young Chong ),오도연 ( Do Youn Oh ),오지수 ( Ji Su Oh ) 대한내과학회 2016 대한내과학회지 Vol.90 No.1

비록 자궁경부암이 갑상선으로의 전이는 매우 드물지만, 자궁경부암의 과거력이 있는 경우, 갑상선부위의 부종이나 촉지되는 결절이 발생하면 반드시 전이성 병변을 의심해봐야 한다. 비록 갑상선으로의 전이는 매우 나쁜 예후를 의미 하지만 고식적 치료로 전신항암요법 및 방사선요법이 환자의 삶의 질 개선에 도움을 줄 수 있다. 드물기는 하지만 갑상선으로의 악성전이 보고가 증가하는 추세로, 이에 대해 어떠한 치료가 가장 효과적일지에 대한 연구가 필요하겠다. Most patients with recurrent uterine cervical cancer have intra-pelvis metastasis with adjacent lymph node involvement, while a lone, distant metastasis is extremely rare. We report a 79-year-old woman with recurrent uterine cervical cancer that presented as thyroid mass with no intra-pelvic recurrence. Four years earlier, the patient had been diagnosed with uterine cervical cancer. She had undergone a course of concurrent chemoradiotherapy to the pelvis and had no subsequent evidence of recurrence. Several weeks before presenting, she had noticed a foreign body sensation in her throat and a palpable mass in the left side of her neck. Clinically, this was metastatic squamous cell carcinoma from the uterine cervix. Patients who present with swelling or palpable nodules in the neck with a previously diagnosed malignancy must be evaluated for metastatic disease, although metastasis from uterine cervical carcinoma to the thyroid gland is rare. (Korean J Med 2016;90:68-71)

Minireview: A Need for an Adequate Diet Program for Postmenopausal Women with Obesity in the Republic of Korea

So Hee Park,Bo Dam Kim,Jae Hong Sang,Hae-Hyeog Lee,Tae-Hee Kim 대한폐경학회 2023 대한폐경학회지 Vol.29 No.2

Women undergo various physical changes because of hormonal changes occurring after menopause. Some representative changes caused by the reduction in estrogen levels in these women are dyslipidemia, abnormal lipoprotein levels, obesity, weight gain, and changes in body fat distribution. A characteristic of women approaching menopause is the shift of fat from their hips and thighs to their abdomen. Notably, fat accumulation is common in internal organs, resulting in male-pattern obesity among women approaching menopause; therefore, these women require more exercise therapy than premenopausal women to prevent and treat obesity. To the best of our knowledge, no effective exercise therapy guidelines have been established for postmenopausal women; therefore, I aimed to suggest more effective diet and exercise therapies for postmenopausal women with obesity. For this purpose, I organized the diet and exercise protocol by collaborating with an obstetrician and a researcher specializing in sports medicine; further, this protocol was actually applied to all participants. The results indicated that the protocol is effective in reducing weight; however, joint pain was commonly noted in participants who dropped out of the program. Based on the evaluation of joint pain, this study found that it is necessary to perform exercise therapy by avoiding weight-bearing activities and reinforcing personalized joint strengthening exercises because reduced estrogen level is an important factor exacerbating arthritis in postmenopausal women.

Impact of early diagnosis on functional disability in rheumatoid arthritis

( Dam Kim ),( Chan-Bum Choi ),( Jiyoung Lee ),( Soo-Kyung Cho ),( Soyoung Won ),( So-Young Bang ),( Hoon-Suk Cha ),( Jung-Yoon Choe ),( Won Tae Chung ),( Seung-Jae Hong ),( Jae-Bum Jun ),( Young Ok Ju 대한내과학회 2017 The Korean Journal of Internal Medicine Vol.32 No.4

Background/Aims: To determine whether early diagnosis is beneficial for func-tional status of various disease durations in rheumatoid arthritis (RA) patients. Methods: A total of 4,540 RA patients were enrolled as part of the Korean Obser-vational Study Network for Arthritis (KORONA). We defined early diagnosis as a lag time between symptom onset and RA diagnosis of ≤ 12 months, whereas patients with a longer lag time comprised the delayed diagnosis group. Demo-graphic characteristics and outcomes were compared between early and delayed diagnosis groups. Logistic regression analyses were performed to identify the im-pact of early diagnosis on the development of functional disability in RA patients. Results: A total of 2,597 patients (57.2%) were included in the early diagnosis group. The average Health Assessment Questionnaire-Disability Index (HAQ-DI) score was higher in the delayed diagnosis group (0.64 ± 0.63 vs. 0.70 ± 0.66, p < 0.01), and the proportion of patients with no functional disability (HAQ = 0) was higher in the early diagnosis group (22.9% vs. 20.0%, p = 0.02). In multivariable analyses, early diagnosis was independently associated with no functional disability (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.01 to 1.40). In a subgroup analysis according to disease duration, early diagnosis was associated with no functional disability in patients with disease duration < 5 years (OR, 1.37; 95% CI, 1.09 to 1.72) but not in patients with longer disease duration (for 5 to 10 years: OR, 1.07; 95% CI, 0.75 to 1.52; for ≥ 10 years: OR, 0.92; 95% CI, 0.65 to 1.28). Conclusions: Early diagnosis is associated with no functional disability, especial-ly in patients with shorter disease duration.

한국인 글루코코르티코이드 유발 골다공증 진료지침

( So Young Park ),( Hyun Sik Gong ),( Kyoung Min Kim ),( Dam Kim ),( Hayoung Kim ),( Chan Hong Jeon ),( Ji Hyeon Ju ),( Shin-seok Lee ),( Dong Ah Park ),( Yoon-kyoung Sung ),( Sang Wan Kim ) 대한류마티스학회 2018 대한류마티스학회지 Vol.25 No.4

목적. 한국인의 글루코코르티코이드 유발 골다공증의 예방과 치료를 위한 진료 지침과 권고안을 개발하고자 하였다. 방법. 대한골대사학회와 대한류마티스학회는 한국보건의료연구원에서 작성한 임상진료지침 개발 매뉴얼에 따라 공동으로 진료지침을 개발하였다. 국내 연구 결과가 제한적인 점을 고려하여, 기존에 개발된 근거 중심 진료지침을 수용 개작하였다. 핵심 질문 선정과 진료지침의 체계적 고찰이 수행되었으며 질평가를 통해 선정된 진료지침을 대상으로 핵심 질문에 대한 대답과 권고안이 동료 검토를 통해 도출되었다. 결과. 본 진료지침의 적용 대상은 글루코코르티코이드를 사용하거나 사용할 계획인 19세 이상의 성인이며 소아 및 청소년은 포함하지 않았다. 골절 위험도의 초기 평가는 글루코코르티코이드 사용시작 6개월 내에 이루어져야 하며 장기간 사용시 12개월마다 골절 위험도를 평가해야 한다. 골절위험도는 글루코코르티코 이드의 용량을 보정한 FRAX, 과거 골다공증에 의한 골절력, 골밀도 결과 등으로 평가한다. 매일 프레드니솔론 2.5 mg 을 3개월 이상 복용하는 경우 적절한 칼슘과 비타민 D를 투여할 것을 권고한다. 중등도 이상의 골절 위험이 있는 환자들의 경우 골다공증 약제를 투여해야 한다. 가장 권고 수준이 높은 1차 약제는 경구 비스포스포네이트, 테리파라티드, 데노수맙이다. 가임기 여성은 골다공증 약제 사용에 주의가 필요하다. 글루코코르티코이드을 지속적으로 투여받는 환자들에 대해 매년 골밀도, FRAX를 이용한 골절위험도 평가 및 척추 단순 엑스선 검사를 시행할 것을 권고한다. 결론. 임상의들을 위한 글루코 코르티코이드 유발 골다공증의 예방과 치료에 대한 진료지침이 개발되었다. Objective. To develop guidelines and recommendations to prevent and treat glucocorticoid-induced osteoporosis (GIOP) in Korea. Methods. The Korean Society for Bone and Mineral Research and the Korean College of Rheumatology developed this guideline based on Guidance for the Development of Clinical Practice Guidelines version 1.0 established by the National Evidence-Based Healthcare Collaborating Agency. This guideline was developed by adapting previously-published guidelines, and a systematic review and quality assessment were conducted. Results. This guideline applies to adults aged 19 years or older who are using or plan to use glucocorticoids (GCs), but does not include children and adolescents. An initial assessment of fracture risk should be performed within 6 months of initial GC use. Fracture risk should be estimated using FRAX (Fracture Risk Assessment Tool) with adjustments for GC dose, previous osteoporotic fracture history, and bone mineral density (BMD) results. All patients taking more than 2.5 mg/day prednisolone or equivalent for more than 3 months are recommended to take adequate calcium and vitamin D. Patients at moderate to high fracture risk should be treated with additional osteoporosis medication. All patients continuing GC therapy should receive an annual BMD measurement, vertebral X-ray, and fracture risk assessment using FRAX. When a treatment failure is suspected, switching to another drug should be considered. Conclusion. This guideline is intended to provide guidance for clinicians in prevention and treatment of GIOP. (J Rheum Dis 2018;25:263-295)

Transcriptional Regulation Studies of Tissue-Specific Gene in Chicken Primordial Germ Cells

So Dam Jin(진소담),Hong Jo Lee,Young Sun Hwang,Jong Won Yoon,Jae Yong Han 한국가금학회 2015 한국가금학회 정기총회 및 학술발표회 Vol.2015 No.11

Prevalence and Associated Factors for Non-adherence in Patients with Rheumatoid Arthritis

( Dam Kim ),( Ji-young Choi ),( Soo-Kyung Cho ),( Chan-Bum Choi ),( So-Young Bang ),( Hoon-Suk Cha ),( Jung-Yoon Choe ),( Won Tae Chung ),( Seung-Jae Hong ),( Tae-Hwan Kim ),( Tae-Jong Kim ),( Eunmi K 대한류마티스학회 2018 대한류마티스학회지 Vol.25 No.1

Objective. To estimate the prevalence of non-adherence to rheumatoid arthritis (RA) medication and identify the associated factors for non-adherence in RA patients. Methods. Among the KORean Observational study Network for Arthritis 3,523 patients who completed a questionnaire about the adherence to RA medication were analyzed. The patients were divided into two groups: 1) adherent group, patients who skipped medication ≤5 days within the past 2 months; and 2) non-adherent group, patients who skipped ≥6 days of medication. The baseline characteristics were compared, and multivariable regression analysis was performed to identify the associated factors for non-adherence. Results. The non-adherent group had 339 patients (9.6%). The common causes of non-adherence were forgetfulness (45.8%), absence of RA symptoms (24.7%), and discomfort with RA medication (13.1%). Younger age (odds ratio [OR] 1.02, p<0.01) and higher income (OR 1.70, p<0.01) were associated with an increased risk of non-adherence. Whereas higher functional disability (OR 0.68, p<0.01) and oral corticosteroid use (OR 0.73, p=0.02) were associated with a decreased risk of non-adherence. The associated factors differed according to cause of non-adherence. Having adverse events (OR 2.65, p=0.02) was associated with the risk of non-adherence due to discomfort with RA medication while a higher level of education (OR 2.37, p=0.03) was associated with the risk of non-adherence due to an absence of RA symptoms. Conclusion. The 9.6% of Korean RA patients were non-adherent to RA medication. The associated factors differed according to the cause of non-adherence. Therefore, an individualized approach will be needed to improve the adherence to RA medication. (J Rheum Dis 2018;25:47-57)

Regulatory elements and transcriptional control of chicken <i>vasa</i> homologue ( <i>CVH</i> ) promoter in chicken primordial germ cells

Jin, So Dam,Lee, Bo Ram,Hwang, Young Sun,Lee, Hong Jo,Rim, Jong Seop,Han, Jae Yong BioMed Central 2017 Journal of animal science and biotechnology Vol.8 No.-

<P><B>Background</B></P><P>Primordial germ cells (PGCs), the precursors of functional gametes, have distinct characteristics and exhibit several unique molecular mechanisms to maintain pluripotency and germness in comparison to somatic cells. They express germ cell-specific RNA binding proteins (RBPs) by modulating tissue-specific <I>cis</I>- and <I>trans</I>-regulatory elements. Studies on gene structures of chicken <I>vasa</I> homologue (<I>CVH</I>), a chicken RNA binding protein, involved in temporal and spatial regulation are thus important not only for understanding the molecular mechanisms that regulate germ cell fate, but also for practical applications of primordial germ cells. However, very limited studies are available on regulatory elements that control germ cell-specific expression in chicken. Therefore, we investigated the intricate regulatory mechanism(s) that governs transcriptional control of <I>CVH</I>.</P><P><B>Results</B></P><P>We constructed green fluorescence protein (GFP) or luciferase reporter vectors containing the various 5′ flanking regions of <I>CVH</I> gene. From the 5′ deletion and fragmented assays in chicken PGCs, we have identified a <I>CVH</I> promoter that locates at −316 to +275 base pair fragment with the highest luciferase activity. Additionally, we confirmed for the first time that the 5′ untranslated region (UTR) containing intron 1 is required for promoter activity of the <I>CVH</I> gene in chicken PGCs. Furthermore, using a transcription factor binding prediction, transcriptome analysis and siRNA-mediated knockdown, we have identified that a set of transcription factors play a role in the PGC-specific <I>CVH</I> gene expression.</P><P><B>Conclusions</B></P><P>These results demonstrate that <I>cis</I>-elements and transcription factors localizing in the 5′ flanking region including the 5′ UTR and an intron are important for transcriptional regulation of the <I>CVH</I> gene in chicken PGCs. Finally, this information will contribute to research studies in areas of reproductive biology, constructing of germ cell-specific synthetic promoter for tracing primordial germ cells as well as understanding the transcriptional regulation for maintaining germness in PGCs.</P>

Poster Session : PS 1319 ; Endocrinology : Insulin Allergy Developed during Pregnancy in Patient with Type 2 Diabetes

( Hee Jin Hong ),( So Dam Hong ),( Jae Kyoung Shin ),( Hye Jeong Cho ),( Kyung Soo Kim ),( Soo Kyung Kim ),( Yong Wook Cho ),( Seok Won Park ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Allergy to insulin has significantly decreased since human recombinant insulin was introduced. However, cases with insulin allergy are still present. Here, we report a case of type 2 diabetes patient who developed allergy to human recombinant insulin( Aspart) during pregnancy, successfully controlled by oral hypoglycemic agent. This case is intriguing because usually pregnancy induces immune tolerance in maternal immune system. A 32-year-old pregnant woman came to emergency room for skin eruption and dyspnea. She was having her second baby, and using insulin Aspart-protamine/ Aspart(Novomix 30, Novorapid) for type 2 diabetes. 3 years ago, she was diagnosed as gestational diabetes during first pregnancy. At that time, she received intensive glucose control using human insulin(Novolet-R, Novolet-N). Then she successfully delivered her first baby without any complications. 6 weeks after the first delivery, she was diagnosed as type 2 diabetes by oral glucose tolerance test. She was recommended to use oral hypoglycemic agent, but she did not take any medications. On physical examination, there were whole body skin rashes and skin eruption on her upper abdomen which was insulin injection site. After using intravenous dexamethasone, symptoms were immediately improved. Because her symptoms suggested possibility of insulin allergy, we performed the skin prick test using 1:100 diluted Aspart- protamine/Aspart (Novomix) and the result was positive. Therefore she was con-firmed to have allergy to human recombinant insulin. Of various treatment options, desensitization has been accentuated over time. In this case, however, desensitization could not be used because it was very risky to pregnancy. Switching to other insulins was also risky because we could not exclude the possibility of having allergy to other insulins. Therefore, we choose oral hypoglycemic agent, metformin and glibenclamide, and the glucose level was well controlled. Then she successfully delivered without any complications.

운전시뮬레이터-기반 인지평가와 CPAD의 상관성 : 일반대학생 집단을 중심으로

유소정 ( Yoo So-jung ),유상희 ( Yoo Sang-hee ),이유진 ( Lee Yoo-jin ),김담이 ( Kim Dam-i ),홍승표 ( Hong Seung-pyo ) 대한인지재활학회 2019 대한인지재활학회지 Vol.8 No.1

목적: 본 연구는 일반대학생을 대상으로 운전시뮬레이터-기반 인지평가의 표준화 예비연구를 위해 전산화 운전재활인지평가도구인 CPAD와 상관성을 파악하고자 하였다. 연구방법: 운전시뮬레이터-기반 인지평가에 대한 경험이 없는 학생 20명을 대상으로 운전시뮬레이터-기반 인지평가와 CPAD를 무작위 순서로 평가하였다. 평가에 소요되는 시간은 약 약 50분이었고, 두 평가 사이에는 휴식 시간을 부여하였다. 결과: 운전시뮬레이터-기반 인지평가의 적성평가는 CPAD의 지속적주의력, 분할주의력, 숫자-문자 선잇기와 유의한 상관관계를 보였고. 깊이감평가는 CPAD의 지속적주의력, 스트룹검사, 숫자-문자 선잇기와 청각평가는 숫자-문자 선잇기와 관련성이 있었다(p<0.05). 운전면허 소지여부에 따라 운전시뮬레이터-기반 인지평가의 적성평가와 급제동평가에서 운전면허 소지자 집단의 점수가 유의하게 높았다(p<0.05). 운전시뮬레이터-기반 인지평가의 항목들 간 상관관계에서는 적성평가와 판단력평가가 여러 항목들과 상관관계가 있었다(p<0.05). 결론: 운전시뮬레이터-기반 인지평가는 운전관련 인지기능을 반영하고, 핸들과 페달 조작을 동반한 평가를 수행하기 때문에 운전관련 인지능력을 더 정밀하게 분석한다고 사료된다. Objective: This is to prove the correlation between the driving simulator-based evaluation of cognitive abilities and the CPAD among the college students. Methods: An experiment was conducted on 20 college students in their 20s who had no experience about driving simulator and who fully understood the purpose of the study and agreed to the experiment. Participants were given sufficient time to rest between simulator-based evaluation of cognitive abilities and the CPAD randomly. It took about 50 minutes per participant and two assessment tool training were conducted on the same day. Result: In virtual Driving simulator, aptitude test and judgment evaluation were the highest correlation within the modulator aptitude test, followed by predictive and auditory assessment. In addition, the depth assessment of aptitude tests showed the highest correlation between continuous attention and stroop test. Items of aptitude test and distance assessment showed the highest correlation with depth perception ability and trail making A and B, respectively. Conclusion: The results of this study are suitable for assessing the Driving function as the virtual Driving simulator that includes the various operational performance capabilities required for Driving compared to CPAD, which is biased to the cognitive assessment.