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Kim, Nam Hoon,Kim, Tae Joon,Kim, Nan Hee,Choi, Kyung Mook,Baik, Sei Hyun,Choi, Dong Seop,Park, Yousung,Kim, Sin Gon Williams & Wilkins Co 2016 Medicine Vol.95 No.30
<▼1><P>Supplemental Digital Content is available in the text</P></▼1><▼2><P><B>Abstract</B></P><P>Both low socioeconomic status (SES) and diabetes mellitus (DM) are important risk factors for mortality. However, little is known about their combined effects and relative contribution to the mortality risk.</P><P>From a nationwide cohort provided by the National Health Insurance Service in Korea, 153,075 subjects who were over 30 years of age from 2003 to 2004 were followed-up until 2010. The SESs of the subjects in the DM and non-DM (NDM) groups were categorized into 3 groups (highest 30% as S1, middle 40% as S2, and lowest 30% as S3) based on the subjects’ income levels.</P><P>During the 7.9-year follow-up, 3933 deaths occurred. When the subjects were stratified into 6 groups by their socioeconomic and diabetes status, a linearly increasing pattern of the hazard ratio (HR) of mortality from the higher SES without diabetes group (NDM-S1, as a reference) to the lower SES with diabetes group (DM-S3; HR, 2.04, 95% confidence interval (CI), 1.80–2.36) was observed (<I>P</I> for trend < 0.001). Notably, subjects with DM in the highest SES group (DM-S1) had a significantly higher mortality risk than did non-DM subjects in the lowest SES group (NDM-S3). This pattern was maintained in cause-specific mortality but was more prominent in cardiovascular disease (CVD) and less prominent in cancer mortality. The association was not affected by gender; however, in individuals <60 years of age, the combined effects of SES and DM on mortality were more prominent (DM-S3; HR, 3.68, 95% CI, 2.95–4.60) than in those ≥60 years of age.</P><P>Low SES and DM were major determinants of mortality and synergistically increased the risks of all-cause, CVD, and cancer mortality.</P></▼2>
Kim, Nan Hee,Seo, Ji A,Cho, Hyunjoo,Seo, Ji Hye,Yu, Ji Hee,Yoo, Hye Jin,Kim, Sin Gon,Choi, Kyung Mook,Baik, Sei Hyun,Choi, Dong Seop,Shin, Chol,Cho, Nam Han Williams & Wilkins Co 2016 Medicine Vol.95 No.15
<P><B>Abstract</B></P><P>The reported effects of a metabolically healthy obese (MHO) phenotype on diabetes and cardiovascular disease (CVD) risk are contradictory. Within the context of a population-based cohort study, we aimed to investigate the long-term risk of an MHO status for the development of diabetes and CVD, and whether consistency of this phenotype or age affected cardiometabolic outcomes.</P><P>We recruited 7588 subjects without diabetes or CVD, aged 40 to 69 years at baseline examination, from the Korean Genome and Epidemiology Study, and followed-up these subjects for 10 years biennially. Participants were divided into 4 groups based on the body mass index and the presence of metabolic syndrome: metabolically healthy normal weight (MHNW), MHO, metabolically unhealthy normal weight (MUNW), and metabolically unhealthy obese (MUO). We defined persistent phenotypes if subjects maintained the same phenotype at every visit from baseline to their last visit. Incident diabetes and CVD morbidity or mortality were identified during 10 years of follow-up.</P><P>Compared to MHNW controls, MUNW and MUO groups had increased risk for development of diabetes (hazard ratio [HR] 3.0 [95% CI: 2.5–3.6], and 4.0 [3.4–4.7], respectively) and CVD (HR 1.6 [1.3–2.0], and 1.9 [1.5–2.4], respectively). However, the MHO group showed only a marginal increase in risk for diabetes and CVD (HR 1.2 [0.99–1.6], 1.4 [0.99–1.8], respectively). The impact of MHO on the development of diabetes was more prominent in younger individuals (HR 1.9 [1.2–3.1] vs 1.1 [0.8–1.4], <45 years vs ≥45 years at baseline). Only 15.8% of MHO subjects maintained the MHO phenotype at every visit from baseline to the 5th biennial examination (persistent MHO). In subjects with persistent MHO, the risk for diabetes and CVD was significantly higher than those with persistent MHNW (1.9 [1.2–3.1], 2.1 [1.2–3.7], respectively).</P><P>MHO phenotype, even if maintained for a long time, was associated with a significantly higher risk for the development of diabetes and CVD in Korean subjects.</P>
Kim, Jung A,Hwang, Soon Young,Chung, Hye Soo,Kim, Nam Hoon,Seo, Ji A,Kim, Sin Gon,Kim, Nan Hee,Choi, Kyung Mook,Baik, Sei Hyun,Yoo, Hye Jin Korean Diabetes Association 2018 Diabetes and Metabolism Journal Vol.42 No.-
<P><B>Background</B></P><P>Sarcopenic obesity (SO) is a serious public health concern, few studies have examined the clinical implications of SO in newly-diagnosed type 2 diabetes mellitus (T2DM) patients. We evaluated the prevalence of the newly diagnosed, drug-naïve T2DM patients with low muscle mass with abdominal obesity and its association with insulin resistance and other diabetic complications.</P><P><B>Methods</B></P><P>We classified 233 drug-naïve T2DM subjects into four groups according to abdominal obesity (waist circumference ≥90 cm in men and ≥85 cm in women) and low muscle mass status (appendicular skeletal muscle <7.0 kg/m<SUP>2</SUP> for men and <5.4 kg/m<SUP>2</SUP> for women).</P><P><B>Results</B></P><P>The proportion of the subjects with low muscle mass and abdominal obesity among the newly diagnosed, drug-naïve T2DM patients was 8.2%. Homeostasis model assessment of insulin resistance (HOMA-IR) increased linearly according to body composition group from normal to abdominal obesity to both low muscle mass and abdominal obesity. The multiple logistic regression analysis indicated that subjects with low muscle mass and abdominal obesity (odds ratio [OR], 9.39; 95% confidence interval [CI], 2.41 to 36.56) showed a higher risk for insulin resistance, defined as HOMA-IR ≥3, than those with abdominal obesity (OR, 5.36; 95% CI, 2.46 to 11.69), even after adjusting for other covariates. However, there were no differences in lipid profiles, microalbuminuria, or various surrogate markers for atherosclerosis among the four groups.</P><P><B>Conclusion</B></P><P>Subjects with both low muscle mass and abdominal obesity had a higher risk of insulin resistance than those with low muscle mass or abdominal obesity only.</P>
RET 유전자 배선 돌연변이가 확인된 제2형 다발성 내분비선종증 (MEN 2A) 1예
김희영,이지연,김성범,이계원,서지아,오정헌,김신곤,최경묵,백세현,최동섭,김난희 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.5
저자들은 언니가 갑상선 종양으로 절제술을 시행받은 가족력이 있고 당뇨병의 증상으로 내원한 47세 여자 환자가 양측 갑상선 종괴와 양측 부신덩이를 동반한 다발성 내분비선종의 특징을 보여, 생화학적 검사 및 영상학적 검사로 MEN 2A로 잠정적으로 진단한 후 갑상선 전절제술 및 양측 부신제거술로 양측성갑상선수질암과 갈색세포종을 진단하고 유전자 분석에서 RET 원발암유전자의 codon 618의 돌연변이를 확인였기에 문헌 고찰과 함께 보고하는 바이다. Multiple endocrine neoplasia 2A (MEN 2A) is an autosomal dominantly inherited disease, composed of medullary thyroid carcinoma, pheochromocytoma and hyperparathyroidism. The activation of germ-line mutations in the RET proto-oncogene are responsible for MEN 2. The analysis of the RET mutations has replaced the measurement of the calcitonin level in the diagnosis of the MEN carrier state. Specific RET codon mutations correlate with the MEN 2 syndromic variant, the age at onset of the medullary thyroid carcinoma (MTC) and the aggressiveness of the MTC. Herein, our experience of a 47-year-old woman, who had a bilateral pheochromocytoma and MTC, and MEN 2A confirmed by the detection of an RET proto-oncogene mutation at axon 10 on codon 618, is reported. Her sister was found to have the same mutant gene. After a total thyroidectomy and bilateral adrenalectomy, the calcitonin and catecholamine levels were normalized, and the patient discharged without problems. This case is reported, with a review of the literature (J Kor Soc Endocrinol 18:481∼488, 2003).
( Ji Hee Yu ),( Jae Hee Ahn ),( Hye Jin Yoo ),( Ji A Seo ),( Sin Gon Kim ),( Kyung Mook Choi ),( Sei Hyun Baik ),( Dong Seop Choi ),( Chol Shin ),( Nan Hee Kim ) 대한내과학회 2015 The Korean Journal of Internal Medicine Vol.30 No.6
Background/Aims: Obstructive sleep apnea (OSA) is associated with an increased risk of obesity and non-alcoholic fatty liver disease (NAFLD), but it remains unclear whether the risk of NAFLD is independently related to OSA regardless of visceral obesity. Thus, the aim of the present study was to examine whether OSA alone or in combination with excessive daytime sleepiness (EDS) or short sleep duration was associated with NAFLD independent of visceral fat in Korean adults. Methods: A total of 621 participants were selected from the Korean Genome and Epidemiology Study (KoGES). The abdominal visceral fat area (VFA) and hepatic fat components of the participants were assessed using computed tomography scans and they were then categorized into four groups depending on the presence of OSA and EDS. Results: The proportions of NAFLD were 21.1%, 18.5%, 32.4%, and 46.7% in participants without OSA/EDS, with only EDS, with only OSA, and with both OSA and EDS, respectively. A combination of OSA and EDS increased the odds ratio (OR) for developing NAFLD (OR, 2.75; 95% confidence interval [CI], 1.21 to 6.28) compared to those without OSA/EDS, and this association remained significant (OR, 2.38; 95% CI, 1.01 to 5.59) even after adjusting for VFA. In short sleepers (< 5 hours) with OSA, the adjusted OR for NAFLD was 2.50 (95% CI, 1.08 to 5.75) compared to those sleeping longer than 5 hours without OSA. Conclusions: In the present study, OSA was closely associated with NAFLD in Korean adults. This association was particularly strong in those with EDS or short sleep duration regardless of VFA.
Papillary thyroid carcinoma presenting as multiple soft tissue masses and bone metastasis
( Ju Hee Choi ),( Kyeong Jin Kim ),( Sin Gon Kim ),( Dong Seop Choi ),( Hee Young Kim ),( Nam Hoon Kim ),( Jee Hyun An ),( Sun Hwa Kim ),( Kyoung Jin Kim ) 대한내과학회 2015 대한내과학회 추계학술대회 Vol.2015 No.1
Papillary thyroid carcinoma is the most prevalent type of thyroid malignancy and usually metastasizes to lymph nodes and lung. Distant metastasis, especially soft tissue metastasis such as skin or skeletal muscle, is a rare manifestation. There had been a few cases of soft tissue and bone metastasis of PTC, which are more unusual than in follicular thyroid carcinoma. However, we could not find any report of such cases of PTC in Korea. We report a case of PTC presenting as multiple soft tissue and bone metastasis. A 59-year-old male patient, who was diagnosed as non-small cell lung cancer 7 years ago and in stable disease after concurrent chemoradiotherapy, complained of a painless movable mass in left lower back. After biopsy of the lesion, metastatic PTC was confirmed. Thyroid FNA was done in 1.4 × 0.8 cm sized hypoechoic nodule of isthmus, and the result of FNA cytology revealed malignant cells. PET-CT and pelvis MRI showed disseminated metastatic disease including huge soft tissue mass (8.6 × 7.8 cm) involving muscle and subcutaneous layer of left inguinal area and right iliac bone metastasis. Upon this diagnosis, the patient underwent total thyroidectomy and level VI neck dissection. After 1 week, embolization for preoperative devascularization and debulking surgery of left inguinal mass was performed. He also received radioactive iodine treatment but aggravated metastasis in left glottis was noted during 4 months of follow-up. This case of PTC is reported because of its uncommon and aggressive manifestation as multiple soft tissue and bone metastasis.
Clinical Study of Adrenal Incidentaloma in Korea
김희영 ( Hee Young Kim ),( Sin Gon Kim ),( Kye Won Lee ),( Ji A Seo ),( Nan Hee Kim ),( Kyung Mook Choi ),( Sei Hyun Baik ),( Dong Seop Choi ) 대한내과학회 2005 The Korean Journal of Internal Medicine Vol.20 No.4
Background : This study was designed to evaluate the clinical, endocrinological and histological characteristics of adrenal incidentalomas. Methods : Eighty patients (41, males; 38, females; age range 17-80 years) who were diagnosed with adrenal incidentaloma at Korea University Hospital from 1992 to 2003 were studied retrospectively. Results : Endocrinological investigation revealed 16 pheochromocytomas (20%), nine Cushing`s syndromes (11%), eight primary aldosteronism (10%) and 46 non-functioning tumors (58%). Forty-four patients received operations, and biopsies were performed on two patients. Pathologic examination revealed 16 adrenocortical adenomas (20%), five carcinomas (6%), 13 pheochromocytomas (16%), three metastatic cancers (4%), and other tumors (10%). The diameter of the carcinomas (mean: 10.8 cm, range: 5-19 cm) were significantly larger than the diameter of benign adenomas (mean: 2.84 cm, range: 1-6 cm) (p=0.002). According to the receiver operating charactenstic (ROC) curve analysis, the cut-off value of tumor size for discriminate malignant tumor was 4.75 cm (sensitivity 90%, specificity 58%). Twenty-four patients with non-functioning tumors were followed up for a period of 3 to 72 months. During the follow up period, two patients showed an increase in tumor size of more than 1 cm, and one patient developed Cushing`s syndrome. Changes in mass size and function were observed only between 10 and 26 months after the initial diagnosis. Conclusions : These data show that an endocrine evaluation should be performed in all adrenal incidentalomas, and an adrenalectomy is recommended for tumors 5 cm or greater or tumors with adrenocortical hyperfunction. In addition, these tumors should be monitored for changes in mass size and function for a follow up period of approximately 26 months.
Evening Chronotype Is Associated With Metabolic Disorders and Body Composition in Middle-Aged Adults
Yu, Ji Hee,Yun, Chang-Ho,Ahn, Jae Hee,Suh, Sooyeon,Cho, Hyun Joo,Lee, Seung Ku,Yoo, Hye Jin,Seo, Ji A,Kim, Sin Gon,Choi, Kyung Mook,Baik, Sei Hyun,Choi, Dong Seop,Shin, Chol,Kim, Nan Hee Issued for the Endocrine Society by the Williams & 2015 The Journal of clinical endocrinology & metabolism Vol.100 No.4