111年度秋季會(台南遠東香格里拉)

1. Yueh-Hsiang Huang, Szu-Tah Chen, Feng-Hsuan Liu, Yi-Hong Wu. The efficacy and safety of concentrated herbal extract granules, YH1, as an add-on medication in poorly controlled type 2 diabetes: A randomized, double-blind, placebo-controlled pilot trial. PLOS ONE 2019, Aug. 15.

2. Feng-Hsuan Liu, Deng-Huang Su, Wei-Yih Chiu, Wan-Chen Wu, Hsuan-Ju Huang, Hsin-Yu Su, Fen-Yu Tseng. Quality of the multiple-choice questions of the written tests for Endocrinology and Metabolism specialist board exams. Journal of Medical Education 2019;23:125-32.

3. Ming-Hsien Wu, Feng-Hsuan Liu, Kun-Ju Lin, Szu-Tah Chen. I-131 NP-59 scintigraphy as a useful diagnostic tool for primary aldosteronism at a medical center in North Taiwan: a retrospective study. Nuclear Medicine Communications 2019;40:568-75.

4. Chiung-Ya Chen, Szu-Tah Chen, Bie-Yu Huang, Jawl-Shan Hwang, Jen-Der Lin, Feng-Hsuan Liu. The effect of suppressive thyroxine therapy in nodular goiter in postmenopausal women and 2 year＇ s bone mineral density change. Endocrine Journal 2018;65:1101-9.

5. Feng-Hsuan Liu, Jawl-Shan Hwang, Chang-Fu Kuo, Yu-Shien Ko, Szu-Tah Chen, Jen-Der Lin. Subclinical hypothyroidism and metabolic risk factors association: a health examination-based study in northern Taiwan. Biomedical Journal 2018; 41:52-8.

論文 (5 important publications – latest sequence)

1. Chou CA, Lin CN, Chiu DTY, Chen IW , Chen ST. Tryptophan as a surrogate prognostic marker for diabetic nephropathy. J Diabetes Investig 2017 doi: 10.1111/jdi.12707

2. Hu S, Chen WC, Hwang GS, Chen ST, Kuo SB, Chen YF, Idova G, Wang SW. Changes in plasma steroids and cytokines levels in betel chewing patients in Taiwan. Steroids 111 (2016) 134–138

3. Li YR, Chen ST, Hseuh C, Chao TC, Ho TY, Lin JD. Risk factors of distant metastasis in the follicular variant of papillary thyroid carcinoma. J Formos Med Assoc. 2015 Jul 31. pii: S0929-6646(15)00239-9. doi: 10.1016/j.jfma.2015.07.002.

4. G.S. Hwang, S. Hu, Y.H. Lin, S.T. Chen, T.K. Tang, P.S. Wang, S.W. Wang. Arecoline inhibits interleukin-2 secretion in jurkat cells by decreasing the expression of alpha7nicotinic acetylcholine receptors and prostaglandin E2. J Physiol & Pharm 2013, 64, 5, 535-543

5. Chung, SY, Huang, WC, Su, CW, Lee, KW, Chi, HS, Lin, CT, Chen, ST, Huang, KM, Tsai, MS, Yu, HP and Chen, SL (2013) FoxO6 and PGC-1α form a regulatory loop in myogenic cells. Biosci. Rep. 33(3), art:e00045.doi:10.1042/BSR20130031

Education：

1982~1989 M.D. Chung-Shan Medical University, Taiwan

1999~2003 Ph.D. National Taiwan University, Taiwan (Physiology)

2005~2007 EMBA Graduate Institute of Business Administration, National Taiwan University

Current Position：

1. Deputy Director, Department of Internal Medicine, National Taiwan University Hospital

2. Professor, Faculty, Department of Internal Medicine, College of Medicine, National Taiwan University, Taiwan

3. Attending Physician, Department of Internal Medicine, National Taiwan University Hospital No. 7, Chung – Shan South. Road, Taipei, Taiwan 100, R.O.C.

Specialty：

1993~ Specialty, Taiwan Society of Internal Medicine, Taiwan

1995~ Specialist, Endocrinology and Metabolism, The Endocrinology Society and Diabetes Association of the Republic of China

2005~ Certified Diabetes Educator, Taiwan Association of Diabetes Education, Taiwan

Public Careers：

1995~1998 Secretary General, The Endocrinology Society of the Republic of China

2005~ present Education Committee, The Society of Ultrasound in Medicine, Taiwan

2007~ present Board of Directors, Endocrine Society, Taiwan

2008~ present Editor, Journal of Medical Ultrasound (West Pacific)

2010~ present Board of Directors, Taiwan Association of Diabetic Educator, Taiwan

2012~ present Executive Editor, Journal of Internal Medicine of Taiwan, Taiwan

2014~ 2020 Secretary General, Taiwan Association of Diabetic Educator, Taiwan

2020~ present President, Taiwan Association of Diabetic Educator, Taiwan

1988-1995

1991-1993 Harvard Medical School

1991-1993 Joslin Diabetes Center 1995- 迄今

2007- 迄今 2015- 迄今 講座教授

2015-2022 臺大醫院內科部代謝內分泌科 科主任 2010-2012)

James Louis Januzzi, Jr., M.D., F.A.C.C., F.E.S.C.

Current Position

Attending physician, Endocrinology and Metabolism, Taipei City Hospital, Zongxiao branch Education

08/1984-05/1988 BA Biology College of the Holy Cross, Worcester, MA

08/1990-05/1994 MD Medicine New York Medical College, Valhalla, NY

Postdoctoral Training

07/1994-06/1995 Intern Medicine Brigham and Women's Hospital, Boston, MA

07/1995-06/1997 Assistant Resident Medicine Brigham and Women's Hospital

07/1997-06/1999 Clinical and Cardiology Massachusetts General Research Fellow Hospital, Boston, MA

07/1999-06/2000 Clinical and Cardiac Massachusetts General Hospital Research Fellow Ultrasound

Faculty Academic Appointments

06/1994-06/1997 Clinical Fellow Medicine Harvard Medical School, Boston, MA

07/1997-06/2000 Clinical and Medicine, Harvard Medical School Research Fellow Cardiology

07/2000-01/2002 Instructor Medicine Harvard Medical School 01/2002-12/2006 Assistant Professor Medicine Harvard Medical School 01/2006-00/2013 Associate Professor Medicine Harvard Medical School 10/2013-Present Hutter Family Professor Medicine Harvard Medical School

Appointments at Hospitals/Affiliated Institutions

07/2000-01/2004 Assistant in Medicine Medicine, Massachusetts General Hospital Cardiology

01/2004-06/2010 Assistant Physician Medicine, Massachusetts General Hospital Cardiology

06/2010-11/2016 Associate Physician Medicine, Massachusetts General Hospital Cardiology

05/2011-12/2015 Roman W. Desanctis Medicine, Massachusetts General Hospital Endowed Distinguished Cardiology Clinical Scholar in Medicine

01/2014-Present Senior Faculty Cardiometabolic Harvard Clinical Research Trials Group Institute 11/2016-Present Physician Medicine, Massachusetts General Hospital Cardiology James Januzzi

吳允升 醫師

Associate Professor of Internal medicine, NTUH Section of Nephrology, Department of Internal Medicine, National Taiwan University Hospital

Major

Vin-Cent conductes the Taiwan Primary Aldosteronism Investigation (TAIPAI) database, which is a registry about primary aldosteronism in Chinese people. This project is to improve the diagnosis of aldosteronism and aldosterone-related cardiovascular, psychosocial morbidity and mortality. I also involved in the analysis of a database of acute kidney injury in the National Taiwan University Study Group on Acute Renal Failure (NSARF) and Consortium for Acute Kidney Injury and Renal Diseases (CAKs) strive to advance high-quality care in acute kidney injury (AKI) and aspires to plunge the worldwide increasing prevalence of chronic kidney disease (CKD) from the perspective of AKI-CKD transition.

Honor / Award

2012 Best oral presentation of the annual meeting, Taiwan Society of Internal Medicine.

2013 Best abstract of EDTA

2014 Travel grand and best abstract of APCH, Korea

2014 Honorary Award of APCN, JAPAN

2015 Travel Award of APCH, Bali 2016 Travel Award of RAAS. Tokyo

2015 Travel grand and best abstract of APCH(Asia Pacific Congress of Hypertension）,

2016 Invited speaker, 2015,1st International Congress of Chinese Nephrologists (ICCN) HK

2016 Great wall Hypertension forum Invited speaker, Xia Jaing

2016 ISH official satellite symposium RAAS 2016 Invited speaker, Tokyo,

2017 The 5th Seoul International Congress of Endocrinology and Metabolism invited speaker, Seoul 2017 Asia-Pacific adrenal bank promotors.

2017 Invited speaker,2nd Invited speaker of ICCN, Taipei.

2018 The top 10% poster of ISN frontier of Tokyo.

2018 The Deputy secretary general of Asian- Pacific AKI-CRRT 2018, Taipei (http://www.apcrrt2018.com/)

Member of KDIGO Controversies Conference on Acute Kidney Injury, ROME

2019 Chairperson of international symposium “Aldosterone and related substances in hypertension 2019 (ISARSH 2019)

2020 invite speaker of SICEM, Korea

Brief Publications [SCI] more than 230 SCI, about aldosteronism , in brief

The hidden face of hypertension- Aldosteronism Lisa 醫師

Primary aldosteronism (PA) is the most common secondary form of arterial hypertension, with a particularly high prevalence among patients with resistant high blood pressure. (Wu. J Hypertens. 2012). I chair the Taiwan Primary Aldosteronism Investigation (TAIPAI) group, which is the largest and comprehensive registry about primary aldosteronism all over the world. Utilizing a physician-focused approach, we designate to furnish up-dated information on the etiology, diagnosis, and the management of PA. (Wu. Ann Med. 2013). Till now, I have cared more than 2,400 PA patients.

Subclinical hypercortisolism is common in clinical aldosterone-producing adenoma patients without KCNJ5 mutation or with a relatively larger adrenal tumor. The presence of serum cortisol levels >1.5 μg/dL after 1 mg DST may be linked to a lower clinical complete success rate. (Peng, Wu, Hypertension. 2020). Aldosterone-producing adenoma patients with KCNJ5 mutations had higher left ventricle mass index (LVMI) and ieLVMI and a greater regression of LVMI and ieLVMI after adrenalectomy than those without mutations. (Chang ,Wu, Hypertension. 2021). There was 51.3% of the unilateral PA patients with classical adenoma harboring co-existent surrounding multiple aldosterone-producing nodules or micronodules (mAPN/mAPM). These patients were more likely to have hypertension-persistence after adrenalectomy. The functional signatures of adenomas showed attenuated HTR2B- mediated PLC/IP3/Ca2+ pathway. (Wu, Hypertension . 2021) Two-thirds of unilateral PA patients had concomitant mAPN/mAPM; 1/3 of uPA patients had concurrent ACS. Steroidogenic HSD3B7/CYP11B1 signaling was associated with uPA adenomas with surrounding multiple aldosterone-producing nodules or micronodules (mAPN/mAPM). (Wu et, al. Endocr Relat Cancer . 2022) PCR-based target enrichment followed by long-read sequencing is an efficient and precise approach to dissecting complex genomic regions, such as those involved in GRA mutations. (Wu, BMC Bioinformatics . 2022) Via combined cNGS and Sanger sequencing aldosterone-driver gene mutations were detected in altogether 186 of our 240 (77.5%) uPA samples in Taiwan. (Wu, Biomedicines, 2021) The ATP2B3 K416_F418delinsN mutation is a functional mutation in APA. (Wu, Cancers ,2021). The KCNJ5-G387R mutation needs to be distinguished from functional KCNJ5 mutations during genomic analysis in APA evaluation because of its functional silence. (Chueh, Wu. J Mol Endocrinol, 2021). We further demonstrated that macrolide antibiotics, roxithromycin, could not interfere the aberrant electrophysiological properties and gain-of-function aldosterone secretion induced by KCNJ5 157-159delITE mutation. (Peng, Wu. Biomedicines , 2021) Adrenalectomy was associated with lower all-cause mortality of unilateral PA patients, compared to that of EH patients. We further documented a more beneficial effect of adrenalectomy over mineralocorticoid receptor antagonist treatment on long-term mortality, major cardiovascular events, and congestive heart failure in unilateral PA patients. (We, Eur J Endocrinol. 2021) These results show the recently achievement of Taiwan Primary Aldosteronism Investigators group.

Blood pressure goal in diabetic patients (<140/90 mmHg)

王威傑 醫師

Hypertension is a common disease in diabetic patients, which also known as a major risk factor for both atherosclerosis cardiovascular disease (ASCVD) and microvascular complications. Several studies have shown that reducing blood pressure (BP) reduces ASCVD events, heart failure and microvascular complications. Although the benefit of BP control has been well documented in diabetic patients, however, the treatment goal of blood pressure is a matter of controversy, whether it should be lowering to <140/90 or <130/80 mmHg. Therefore, in this session, I will review the clinical evidence and benefit of BP lower than 140/90 mmHg.

論 文 (4 important publications – latest sequence)

1. Tung-Yen Lin, Kuan-Yu Lin, Hung-Yang Kuo, Kuo-How Huang, Chih-Yuan Wang, Yu-Lin Lin, Shyang-Rong Shih, Po-Chin Liang. Yttrium-90 Selective Internal Radiation Therapy Plus Cryoablation for Recurrent Adrenocortical Carcinoma With Liver Metastases. J Endocr Soc. 2022;6(8):bvac091

2. Shyang-Rong Shih, Kuan-Hua Chen, Kuan-Yu Lin, Pan-Chyr Yang, KuenYuan Chen, Chun-Wei Wang, Chun-Nan Chen, Chih-Feng Lin, Chia-Chi Lin. Immunotherapy in anaplastic thyroid cancer: Case series. J Formos Med Assoc. 2022 Jun;121(6):1167-1173

3. Kuan-Yu Lin, Wen-Hui Hsih, Yen-Bo Lin, Chen-Yu Wen, Tien-Jyun Chang. Update in the epidemiology, risk factors, screening, and treatment of diabetic retinopathy. J Diabetes Investig. 2021 Aug;12(8):1322-1325

4. Kuan-yu Lin, Shyang-Rong Shih, Jih-Hsiang Lee. SUN-480 An Unusual Clear Cell Carcinoma in the Thyroid. Where Is the Primary? J Endocr Soc. 2020 May 8; 4(Suppl 1): SUN-480

Blood Pressure Goal in Patients with Diabetes (<130/80 mmHg)

林冠宇 醫師

It is previously believed that the J-curve phenomenon exists, which means that cardiovascular risk increases when we treat blood pressure to the target below a certain level. However, the existence of the J curve phenomenon is questionable. Epidemiological studies suggested that SBP can be safely reduced to 100-110 mmHg without increasing cardiovascular diseases. SPRINT trial revealed that intensive treatment to SBP less than 120 mmHg reduced 27% CV endpoints and 25% all-cause death compared to standardized treatment (<140 mmHg). Most prospective RCTs did not observe any J-curve phenomenon.

In the ACCORD trial, there were no statistically significant differences in cardiovascular events between the intensive systolic blood pressure treatment group (< 120 mmHg) versus standard treatment (< 140 mmHg) in patients with type 2 diabetes. However, the result showed favorable trends towards intensive treatment, and the beneficial effects on individual outcomes were similar between the ACCORD trial and SPRINT. The exclusion of advanced age, dyslipidemia and chronic kidney diseases were important limitations to make the result of the ACCORD trial generalizable. The number of participants in the ACCORD trial may just be not enough to reach statistical power.

In a meta-analysis involving 40 large-scale randomized controlled trials, targeted blood pressure to less than 130 mmHg in patients with type 2 diabetes led to lower risk of stroke (28% risk reduction), retinopathy and albuminuria progression. Since Taiwanese population had higher stroke risk than Western population, it is reasonable to set a lower systolic BP target to 130 mmHg in patients with type 2 diabetes. This year, Lancet published an individual participantlevel data meta-analysis including 103,325 patients with type 2 diabetes. A 5 mm Hg reduction of systolic blood pressure decreased 6% risk of major cardiovascular events in patients with type 2 diabetes, irrespective of the baseline systolic blood pressure, even in normal or high-normal blood pressure values. No blood pressure threshold was found to be ineffective or harmful for the use of antihypertensive therapy. The study implies that the degree of blood pressure reduction rather than baseline blood pressure affords cardiovascular risk reduction.

Different guidelines had recommended different targets for blood pressure control in type 2 diabetes patients. In 2017 ACC/AHA guidelines and recently updated 2022 TSOC/THS guidelines, universal blood pressure targets for patients with type 2 diabetes were 130/80 mmHg, based on home BP measurement or standardized office BP. On the other hand, 2022 ADA guideline suggested BP target of 130/80 mmHg in diabetic patients with established cardiovascular diseases or 10year ASCVD risk > 15%. Until further evidence and updated guidelines developed, encouraging patients to have home BP measurement, assessing cardiovascular risk during first visit and then annually, shared decision making with individualized BP targets, and finally ensuring patients tolerability of new BP targets were very important in our clinical practice.

Active surveillance in low risk micropapillary thyroid carcinoma

王舒儀 醫師

There is growing concern for overdiagnosis and overtreatment of small papillary thyroid cancers. Small thyroid cancer can grow slowly or not at all. Risk of thyroid surgery is low, but it is not zero. Including temporary or permanent hoarseness, hypoparathyroidism, hypothyroidism. Active surveillance is a safe alternative to surgery for patients with low risk microPTC. With proper patient selection and strict monitoring, more than 85% of such cases remain indolent no meaningful clinical growth over at least 10 years. Moreover, delayed intervention in patients requiring conversion surgery when needed has not led to unresectable disease or higher risk of complications. Active surveillance of low risk microPTC is a safe management offering favorable outcomes and preserves quality of life at low cost. A proper selection of candidate patients is key for the success of AS. This is based on the characteristics of the patient, tumor and medical team. Further investigation is needed regarding the impact of other factors (i.e., TSH levels, ultrasound, and molecular patterns). Effective communication between physician and patient is an essential tool to improve acceptance.

1. Li, Y. H., Sheu, W. H., Chou, C. C., Lin, C. H., Cheng, Y. S., Wang, C. Y., Wu, C. L., & Lee, I. T. (2021). The Clinical Influence after Implementation of Convolutional Neural Network-Based Software for Diabetic Retinopathy Detection in the Primary Care Setting. Life (Basel, Switzerland), 11(3), 200. https://doi.org/10.3390/ life11030200

2. Li, Y. H., & Lee, I. T. (2020). Hyperthyroidism and vascular cell adhesion molecule-1 are associated with a low ankle-brachial index. Scientific reports, 10(1), 17076. https://doi.org/10.1038/s41598-020-74267-7

3. Li, Y. H., Sheu, W. H., & Lee, I. T. (2020). Use of the ankle-brachial index combined with the percentage of mean arterial pressure at the ankle to improve prediction of all-cause mortality in type 2 diabetes mellitus: an observational study. Cardiovascular diabetology, 19(1), 173. https://doi.org/10.1186/s12933-020-01149-7

李宇璇 醫師

The efficacy of thyroid radiofrequency ablation (RFA) is well-established in benign thyroid goiters. However, thyroid RFA for thyroid cancer is still controversial. Different from thyroid RFA for benign goiters, thyroid RFA for mPTC are treated with curative intention. Ablative margins beyond the nodule are necessary, a factor that is considered during patient selection and procedure planning.

The major contraindications include presence of extrathyroidal extension, presence of cervical adenopathy, genetic basis for thyroid malignancy (eg, Cowden syndrome, familial adenomatous polyposis, Carney complex), and limited visualization by ultrasound. Whether a subcapsular location of the tumor is a contraindication to ablation is debatable and depends on the experience of the operator with hydrodissection techniques. Additional concerns are raised by limited neck mobility, prior surgical scars over the area or prior radiation therapy.

Education Background

2018-2022 Ph.D., Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Taiwan.

2003-2010 M.D., National Taiwan University, Taiwan

Professional Career

2011-2016 Resident, Otolaryngology – Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

2016-Present Attending Physician, Otolaryngology – Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

Field of Research

Thyroid surgery, Intraoperative Neuromonitoring, Head and Neck Ultrasonography, Ultrasound-guided Thyroid Ablation Procedures, Post-thyroidectomy Dysphonia, Remote Thyroid Surgery, Head and Neck Cancer and Surgery

Publications (the latest 5 articles)

1. Kuan-Lin Chiu, Ching-Feng Lien, Chih-Chun Wang, Chien-Chung Wang, Tzer-Zen Hwang, Yu-Chen Shih, Wing-Hei Viola Yu, Che-Wei Wu, Gianlorenzo Dionigi, Tzu-Yen Huang*, Feng-Yu Chiang* (2022). Intraoperative EMG recovery patterns and outcomes after RLN traction-related amplitude decrease during monitored thyroidectomy. Frontiers in endocrinology (accepted).

2. Hsin-Yi Tseng, Tzu-Yen Huang, Jia Joanna Wang, Yi-Chu Lin, I-Cheng Lu, Feng-Yu Chiang, Gianlorenzo Dionigi, Gregory W. Randolph, Che-Wei Wu* (2022). Investigation of the Electrophysiological and Thermographic Safety Parameters of Surgical Energy Devices during Thyroid and Parathyroid Surgery in a Porcine Model. Journal of Visualized Experiments (accepted).

3. Hsiao-Yu Huang, Ching-Feng Lien, Chih-Chun Wang, Chien-Chung Wang, Tzer-Zen Hwang, Yu-Chen Shih, Che-Wei Wu, Gianlorenzo Dionigi, Tzu-Yen Huang*, FengYu Chiang* (2022, Jun). Necessity of Routinely Testing the Proximal and Distal Ends of Exposed Recurrent Laryngeal Nerve During Monitored Thyroidectomy. Frontiers in endocrinology, 13(923804):1-11

4. Hsin-Yi Tseng, Tzu-Yen Huang, Yi-Chu Lin, Jia Joanna Wang, How-Yun Ko, ChengHsun Chuang, I-Cheng Lu, Pi-Ying Chang, Gregory W. Randolph, Gianlorenzo Dionigi, Ning-Chia Chang*, Che-Wei Wu (2022, Jun). Safety Parameters of Quantum Molecular Resonance Devices During Thyroid Surgery: Porcine Model Using Continuous Neuromonitoring. Frontiers in endocrinology, 13(924731):1-8

5. Shih-Wei Wang , Leong-Perng Chan, Ling-Feng Wang, Che-Wei Wu, Sheng-Hsuan Lin, Tzu-Yen Huang*, Ka-Wo Lee* (2022, Feb). Secondary primary malignancy in patients with head and neck squamous cell carcinoma: 27-year experience from the perspective of diagnostic tools. PLoS One, 17(2):e026377

Surgical Treatment of Papillary Thyroid Microcarcinoma – In the Quality-of-Life era

黃子晏 醫師

With the improvement of examination tools and health awareness, an increasing number of thyroid cancers have been diagnosed, and the number of patients who require thyroid cancer surgery has also increased each year. However, because of the favorable prognosis of papillary thyroid microcarcinoma (PTMC) and the high patient expectations for postoperative quality of life, surgeons tend to reduce the extent of surgery (total thyroidectomy and central neck dissection) or choose alternative treatments other than surgery. Because the thyroid gland is close to recurrent laryngeal nerve (RLN), external branch of the superior laryngeal nerve (EBSLN) and parathyroid glands, patients often experience various degrees of postoperative dysphonia and hypocalcemia. When performing surgery is still the most effective treatment to eradicate tumors and free patients from the psychological burden of having possible cancer, surgeons should make the best efforts to reduce the incidence of surgical complications. In this presentation, we summarize standardized intraoperative neuromonitoring (IONM) procedures, nearinfrared autofluorescence (NIRAF) techniques, and remote thyroid surgeries as useful tools to reduce surgical complications for PTMC treatment in the quality-of-life era.

Harnessing Obesity Medicine Principles to Treat Diabetes

Obesity is a risk factor of developing prediabetes and Type 2 DM. In The Diabetes Prevention Program(DPP) and The Da Qing IGtand Study found that a 7% decrease in body weight was associated with a 58% reduction risk of diabetes. The commonalities between patients with obesity and type 2 diabetes could be useful as list individual treatment plan.

BMI increase and visceral adipose tissue increases may induce diabetic development, which lead hyperinsulinemia, reduced insulin sensitivity or increase inflammation.

A weight loss of 5% to 10% improves glycemic control, and a 20% weight loss can potentially reverse T2D. Not only glucose level and Hba1c, but also obesity factor, such like body weight, BMI, waist circumference, were treatment goal during diabetic control. Via anti-diabetic medications that benefit weight control, lower carbohydrate diet and exercise, can have a dual benefit with obesity and diabetes.

1. Lin CH, Lee SY, Zhang CC, Du YF, Hung HC, Wu HT, Ou HY. 2016 Nov. Fenretinide Inhibits Macrophage Inflammatory Mediators and Controls Hypertension in Spontaneously Hypertensive Rats via the Peroxisome Proliferatoractivated Receptor Gamma Pathway. Drug Des Devel Ther. 10:3591-3597.

2. Ou HY, Wu HT, Lin CH, Du YF, Hu CY, Hung HC, Wu P, Li HY, Wang SH, Chang CJ. 2017 Jul. The Hepatic Protection Effects of Hepassocin in Hyperglycemic Crisis. J Clin Endocrinol Metab. 102(7):2407-2415.

3. Lin CH, Lin YC, Yang SB, Chen PC. 2022 May. Carbamazepine Promotes Surface Expression of Mutant Kir6.2-A28V ATP-sensitive Potassium Channels by Modulating Golgi Retention and Autophagy. J Biol Chem. 298(5):101904.

4. Wu HT, Lin CH, Pai HL, Chen YC, Cheng KP, Kuo HY, Li CH, Ou HY. 2022 May. Sucralose, a Non-nutritive Artificial Sweetener Exacerbates High Fat Diet-Induced Hepatic Steatosis Through Taste Receptor Type 1 Member 3. Front Nutr. 9:823723.

Pathophysiology of Insulin Secretion Diseases: Focus on ATPSensitive Potassium Channels

林景翰 醫師

Glucose regulates the secretion of insulin, by augmenting the action of other insulin secretagogues. Beta cells take up glucose via glucose transporters (GLUT2). The subsequent metabolism of glucose increases cellular adenosine triphosphate (ATP) concentrations. Hence, closure of ATP-dependent potassium (KATP) channels in the beta cell membrane, leads to membrane depolarization and influx of calcium by opening voltage-gated calcium channels. The rise in intracellular free calcium promotes margination of the secretory granules, and release of their contents into the extracellular space.

The KATP channel is a functional complex of the sulfonylurea 1 receptor (SUR1) and an inward rectifier potassium channel subunit, Kir6.2. Mutations in either the SUR1 gene or the Kir6.2 gene lead to gain of function or loss of function. Persistent hyperinsulinemic hypoglycemia of infancy is one syndrome due to persistent depolarization of cell, causing calcium influx, and release of insulin. Some proportion of neonatal diabetes have been identified with mutations in the Kir6.2 and, to a smaller extent, SUR1 genes. Insulin sensitivity can be restored under the treatment of sulfonylurea medication.

Lunch symposium

中山醫學大學附設醫院內科部一般內科

2003/07/01 ~ 2005/06/31

2003/07/01 ~ 2005/06/31

2006/07/01 ~ 2013/06/31

2005/07 ~

2013/07 ~ 2022

1. Lin CH, Lee SY, Zhang CC, Du YF, Hung HC, Wu HT, Ou HY. 2016 Nov. Fenretinide Inhibits Macrophage Inflammatory Mediators and Controls Hypertension in Spontaneously Hypertensive Rats via the Peroxisome Proliferatoractivated Receptor Gamma Pathway. Drug Des Devel Ther. 10:3591-3597.

2. Ou HY, Wu HT, Lin CH, Du YF, Hu CY, Hung HC, Wu P, Li HY, Wang SH, Chang CJ. 2017 Jul. The Hepatic Protection Effects of Hepassocin in Hyperglycemic Crisis. J Clin Endocrinol Metab. 102(7):2407-2415.

3. Lin CH, Lin YC, Yang SB, Chen PC. 2022 May. Carbamazepine Promotes Surface Expression of Mutant Kir6.2-A28V ATP-sensitive Potassium Channels by Modulating Golgi Retention and Autophagy. J Biol Chem. 298(5):101904.

4. Wu HT, Lin CH, Pai HL, Chen YC, Cheng KP, Kuo HY, Li CH, Ou HY. 2022 May. Sucralose, a Non-nutritive Artificial Sweetener Exacerbates High Fat Diet-Induced Hepatic Steatosis Through Taste Receptor Type 1 Member 3. Front Nutr. 9:823723.

Pneumococcal Diseases Vaccination and Prevention for Diabetic Patients

林景翰 醫師

Diabetic population have relatively poor immunity toward infection. Higher morbidity and mortality are noted among diabetic patients with pneumonia, either community-acquired or nosocomial. Streptococcus pneumoniae is the most frequently isolated pathogen in cases of community-acquired pneumonia (CAP) worldwide. In adults, pneumococcal disease manifests as pneumonia, meningitis, or bacteremia. Many patients experienced a worsening of existing comorbid conditions following a diagnosis of CAP.

There are currently 2 pneumococcal vaccines available for adults: conjugate vaccine and polysaccharide vaccine. Generating antibody production against most polysaccharideencapsulated bacterial infections with vaccines is a complex challenge. Either one vaccine could provide diabetic patients more protective ability against pneumococcal disease resulting from Streptococcus pneumoniae.

1. CH Wu1, YF Chang2,CH Chen 3,EM Lewiecki4, C Wüster5, I Reid 6, KS Tsai7, T Matsumoto8, LB Mercado-Asis9, DC Chan10, JS Hwang11, CL Cheung12,K Saag13, JK LEE14,ST Tu15,W Xia16,W YU17,YS Chung18,P Ebeling 19, A Mithal20, SL Ferrari21, C Cooper 22, GT Lin23, RS Yang24.Consensus Statement on the Use of Bone Turnover Markers for Short-Term Monitoring of Osteoporosis Treatment in the Asia-Pacific Region. J Clin Densitom. 2019 Mar 20.

2. PC Cheng1,SR Hsu1,JC Li2,CP Chen2, SC Chien2, ST Tu1,YC Cheng3,YH Liu4,JF Kuo1.lasma Low-Density Lipoprotein Cholesterol Correlates With Heart Function in Individuals With Type 2 Diabetes Mellitus: A Cross-Sectional Study. Front Endocrinol (Lausanne). 2019 Apr 11;10:234.

3. CH His, ST Tu, WH Sheu 2019 Diabetes Atlas: Achievements and challenges in diabetes care in Taiwan. J Formos Med Assoc. 2019 Nov(11).130-134

4. CH Chu 1, CC Hsu 2, SY Lin 3, LM Chuang 4,JS Liu 2, ST Tu 5.Trends in antidiabetic medical treatment from 2005 to 2014 in Taiwan. J Formos Med Assoc.2019 Nov;118 Suppl 2:S74-S82.

5. HK Sia1,2, ST Tu1, PY Liao1, KH Lin2, CT Kor3, LL Yeh4 A convenient diagnostic tool for discriminating adult-onset glutamic acid decarboxylase antibody-positive autoimmune diabetes from type 2 diabetes: a retrospective study. PeerJ. 2020 Feb.