98年度年會論文摘要集 by Endo 電子書上傳區

30th Annual Meeting of The Endocrine Society & The Diabetes Association of The Republic of China Program & Abstracts

March 21~22, 2009 NTUH International Convention Center

Contents Board of Directors ······································································································ 1 Opening Remarks ······································································································· 2 Overseas Speakers ······································································································ 4 Supporters ··················································································································· 6 Daily Program Schedule ···························································································· 8 Agenda ························································································································· 10 Abstract: Plenary Lecture ····································································································· 10 March 22, 2009 Sunday (PL1~3) Meet the Professor ··································································································11 March 22, 2009 Sunday (MP1~3) Special Lecture

····································································································· 12

March 22, 2009 Sunday (SL1~2) Symposium 1: Postprandial Plasma Glucose ······················································ 12 March 21, 2009 Saturday (S1-1~3) Symposium 2: Sex Hormones and Aging ····························································· 13 March 21, 2009 Saturday (S2-1~3) Symposium 3: Current Opinions of Insulin Therapy ········································· 14 March 21, 2009 Saturday (S3-1~3) Symposium 4: Current Concepts of Adrenal Disorders ····································· 16 March 21, 2009 Saturday (S4-1~3) Symposium 5: Advances on Renin-Angiotensin System in Diabetes: From Basic to Clinical ································································ 17 March 21, 2009 Saturday (S5-1~3)

Symposium 6: Parathyroid Disorders ··································································18 March 21, 2009 Saturday (S6-1~3) Symposium 7: Translating Islet Biology into Diabetes Therapy ························19 March 21, 2009 Saturday (S7-1~2) Symposium 8: Current Concept of Management for Acromegaly ·····················19 March 22, 2009 Sunday (S8-1~3) Lunch Symposium ··································································································20 March 21, 2009 Saturday (LS1~3) March 22, 2009 Sunday (LS4~6) Satellite Symposium ·······························································································26 March 21, 2009 Saturday (SS1~2) Oral Presentation ····································································································27 March 21, 2009 Saturday (O1-1~9; O2-1~9; O3-1~7) March 22, 2009 Sunday (O4-1~9; O5-1~9) Poster ·······················································································································44 March 21~22, 2009 Saturday~Sunday (DP11-1~5; DP12-1~9; DP22-1~30; EP21-1~17) 2008 Award ··············································································································63 March 21~22, 2009 Saturday~Sunday (AP-1~6)

Author Index (English) ································································································255 Author Index (Chinese) ·······························································································262 Floor Plan of Conference Room ··················································································268

BOARD OF DIRECTORS (2007-2010) The Endocrine Society of the Republic of China President

Ching-Chung Chang

Standing Executive Board

Pei-Wen Wang

Keh-Sung Tsai

Executive Board

Tien-Shang Huang

Wang Chih-Yuan

Ging-Shing Won

Hung-Yu Chang

Chwen-Tzuei Chang

Rue-Tsuan Liu

Kam-Tsun Tang

Shih-Li Su

Standing Control Board

Jen-Der Lin

Control Board

Hong-Da Lin

Secretary General

Fen-Yu Tseng

Deputy Secretary General

Feng-Hsuan Liu

Tien-Chun Chang Shyang-Rong Shih

The Diabetes Association of the Republic of China President

Lee-Ming Chuang

Standing Executive Board

Wayne H-H Sheu

Shyi-Jang Shin

Executive Board

Jung-Fu Chen

Shih-Tzer Tsai

Jyuhn-Huarng Juang

Shih-Te Tu

Tjin-Shing Jap

Ching-Fai Kwok

Ching-Chu Chen

Yu-Yao Huang

Standing Control Board

Low-Tone Ho

Control Board

Tong-Yuan Tai

Secretary General

Yi-Der Jiang

Deputy Secretary General

Chien-Wen Chou Tien-Jyun Chang

－ 1 －

Kun-Wu Tsan Hung-Yuan Li

Opening Remarks 各位會員女士先生、各位來賓：

歡迎大家來台大醫院國際會議中心參加中華民國內分泌暨糖尿病學會第 10 屆第 3 次會員大會暨學術演講會。我們兩會共同於 2008 年 12 月 5 日至 8 日在台北圓山飯店成功地舉辦第五屆華夏內分泌大會。華夏總共出席 911 人：台灣 379 人、大陸 481 人、香港 50 人與新加坡 1 人。感謝全體會員、理監事、及秘書處同仁通力合作，完成促進兩岸三地內分泌及新陳代謝專家之間的相互交流與良性互動的歷史任務。內分泌學會過去一年建置內分泌暨糖尿病學會共同網站，已於 2008 年 8 月 15 日建置完成啟用。本兩學會會刊改版作業以期刊方式編排、並申請 ISSN 編號。學術活動方面： 2008 年 10 月 4 日於假新店耕莘醫院舉行 97 年度繼續教育-腎上腺疾病:由基礎到臨床，共 185 人參加。今年年會演講題目: Plenary Lecture 3 場、Meet the Professor 3 場、Special Lecture 2 場、Lunch Symposium 6 場、Oral Presentation 5 場（43 篇）、Poster 61 篇及 Award 6 篇。邀請外賓 8 位分別來自英國、荷蘭、澳洲、芬蘭、美國與加拿大。涵蓋臨床醫學與基礎醫學研究。相信會員們在學術上必定豐收。今年 2009 年 11 月 1~ 4 日在日本名古屋舉辦第 9 屆 AOTA；明年 2010 年 3 月 26 ~ 30 日在日本京都舉辦第 14 屆國際內分泌大會（ICE2010），我們是會員國，希望會員們踴躍報名參加。最後，感謝協辦單位贊助經費。並祝福各位會員身體健康，本次年會圓滿成功。

中華民國內分泌學會理事長

張慶忠

謹上

民國 98 年 3 月 21 日

－ 2 －

Opening Remarks 各位理事、會員、小姐、先生大家好：歡迎大家一同來參與今年的年度盛事。從去年度開始，已經在籌辦幾項重要事項，包括與中華民國心臟學會共同出版「糖尿病與心血管疾病」指引。另外我們也出版「餐後高血糖治療」指引，各位會員在報到時應該都拿到了。2006 出版的第 2 型糖尿病照護指引，也已經開始進行再版作業，預計明年三月出版。編製這些指引的目的，是希望提供臨床醫師在診療上的參考及依據。從下半年度開始，我們將陸續於全省同步展開推廣研習營。如果您對於指引當中，有任何建議及指教，歡迎將您的意見 e-mail 至糖尿病學會秘書處，我們會收集會員意見後，再召開委員會議提出討論。在每一次的年會當中，我們都邀請了學有專精的學者專家分別就學理、臨床及照護等各方面做全盤的探討，為新陳代謝及內分泌疾病的開拓新的視野，希望全方位的分析、了解、提昇、嘉惠病患的照料。今年的節目安排中，在糖尿病方面特別邀請現任 IDF 主席 Prof. Martin Silink，演講糖尿病人口急速上升的因應之道；此外也邀請了 Jalkanen Sirpa Tuulikki、John S.D Chan 及 Gordon C. Weir 夫婦與國內外多位專家就糖尿病與併發症研究及胰島移植的新進展，共同分享與討論，除此之外，還有會員之口頭報告 43 篇和壁報展示 61 篇以及優秀論文得獎壁報展示。節目豐富，內容精彩，相信與會者定能獲益良多。由於大家的共同努力，時常在許多的國際著名刊物迭有精闢論文發表，可以看到會員在國際性學術界多有突出的報告，這些都是有目共睹的成就。希望大家共同繼續努力，為內分泌及糖尿病學的發展，能夠更進一步的擴展。感謝所有來賓參加學會的年度盛會，希望在熱烈的參與和討論中，每一個人都能滿載而歸。尤其要感謝熱心的工作團隊，能盡心盡力為大家服務，在此表示敬意。最後祝大家身體健康，並祝福大會圓滿成功。

中華民國糖尿病學會理事長

莊立民

民國 98 年 3 月 21 日－ 3 －

Overseas Speakers Brian R. Walker

Email: b.walker@ed.ac.uk University of Edinburgh Endocrinology Unit Centre for Cardiovascular Science Queen's Medical Research Institute 47 Little France Crescent Edinburgh EH16 4TJ Scotland, UK

W.M. Wiersinga

Email: w.m.wiersinga@amc.uva.nl Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, The Netherlands

Martin Silink

Email: martins@chw.edu.au President, International Diabetes Federation Institute of Endocrinology and Diabetes The Children's Hospital at Westmead Locked Bag 4001 WESTMEAD NSW 2145 AUSTRALIA

Jalkanen Sirpa Tuulikki

Email: sirpa.jalkanen@utu.fi Professor of Immunology University of Turku MediCity,Tykistökatu 6 Turku, FIN-20520 Finland － 4 －

Gordan C. Weir

Email: Gordon.Weir@joslin.harvard.edu Joslin Diabetes Center One Joslin Place Boston, MA, 02215

Susan Bonner-Weir

Email: Susan.Bonner-Weir@joslin.harvard.edu Research Division, Room 535 Section of Islet Transplantation and Cell Biology Joslin Diabetes Center 1 Joslin Place Boston, MA 02215

John S.D. Chan

Email: john.chan@umontreal.ca Professor of Medicine and Physiology Chief, Laboratory of Molecular Nephrology and Endocrinology Centre Hospitalier de l'Université de Montréal (CHUM)- Hôtel-Dieu Hôpital Room 8-229, Pavillon Masson 3850 rue Saint-Urbain Montréal, Québec, H2W 1T7

Joseph A. Majzoub

Email: joseph.majzoub@childrens.harvard.edu Chief, Division of Endocrinology, Children's Hospital Boston Karp 4125, 300 Longwood Avenue, Boston MA 02115

－ 5 －

THE ENDOCRINE SOCIETY & DIABETES ASSOCIATION OF THE R.O.C. WOULD LIKE TO RECOGNIZE THE FOLLOWING FOR THEIR SUPPORT OF THE 30TH ANNUAL MEETING AstraZeneca Taiwan Limited

台灣阿斯特捷利康股份有限公司

Abbott Laboratories Services Crop Taiwan Branch

美商亞培股份有限公司

Acrobio Healthcare Inc

昇橋健康事業有限公司

Bayer Taiwan Co., Ltd.

台灣拜耳股份有限公司

Boehringer Ingelheim Taiwan Limited

台灣百靈佳殷格翰股份有限公司

Chen-Ho Pharmaceutical Co., Ltd.

正和製藥股份有限公司

Chunghwa Yuming Healthecare Co.,Ltd.

中化裕民健康事業股份有限公司

Daiichi Sankyo Taiwan Ltd.

台灣第一三共股份有限公司

Eli Lilly and Company (Taiwan), Inc.

台灣禮來股份有限公司

Giddi Pharma Co., Ltd.

吉帝藥品股份有限公司

GlaxoSmithKline Far East B.V. Taiwan Branch

荷商葛蘭素史克藥廠(股)公司台灣分公司

Medtronic International, Ltd., Taiwan Branch

台灣美商美敦力鼎眾股份有限公司

Merck Sharp & Dohme (I.A.) Corp. Taiwan Branch

美商默沙東藥廠(股)公司台灣分公司

－ 6 －

MSD Schering-Plough

美商默沙東藥廠(股)公司台灣分公司先靈葆雅企業（股）公司

Novartis (Taiwan) Co., Ltd.-Sandoz

台灣諾華股份有限公司

Novartis (Taiwan) Co., Ltd.

台灣諾華股份有限公司

Novo Nordisk Pharma (Taiwan) Ltd.

台灣諾和諾德藥品股份有限公司

Ocean Spray Cranderries, Inc.

美商優鮮沛蔓越莓公司

Orient Europharma Co., Ltd.

友華生技醫藥股份有限公司

Pfizer Limited

輝瑞大藥廠股份有限公司

Sanofi-Aventis

賽諾菲安萬特股份有限公司

Solvay Taiwan Co., Ltd

台灣蘇威股份有限公司

Servier(S) Pte. Ltd., Taiwan Branch

新加坡商施維雅(股)公司台灣分公司

Taipoc Technology Crop

泰博科技股份有限公司

Taiwan Biotech Co., Ltd.

信東生技股份有限公司

Taiwan Otsuka Pharmaceutical Co., Ltd.

台灣大塚製藥股份有限公司

Tty Biopharm Company Limited

台灣東洋藥品工業股份有限公司

Takeda Chemical Industries (Taiwan), Ltd.

台灣武田藥品工業股份有限公司

（按字母排序）－ 7 －

30th Annual Meeting of The Endocrine Society and The Diabetes Association of The R.O.C. Program March 21（Saturday） Room Time

Room 301

Room 201

8:40~10:10

Postprandial Plasma Glucose (Sym-1)

10:10~10:30

Coffee Break

10:30~12:00

Room 202

Sex Hormones and Aging (Sym-2)

Current Opinions of Insulin Therapy (Sym-3)

Oral-1

Lunch Sym-1

Lunch Sym-2

Lunch Sym-3

(Novartis)

(Sanofi Aventis)

(Solvay)

Advances on Renin-Angiotensin System in Diabetes: From Basic to Clinical (Sym-5)

Oral-2

12:00~13:20

13:30~15:00

Current Concepts of Adrenal Disorders (Sym-4)

15:00~15:20 15:20~16:20 16:20~16:50

Coffee Break

Parathyroid Disorders Translating Islet Biology into Diabetes Therapy (Sym-6) (Sym-7)

16:50~17:30 18:30~21:00

Satellite Sym-1 (GSK) Oral-3

Satellite Sym-2 & Welcome Dinner (MSD) Grand Formosa Regent Taipei, 3F Ballroom

Registration: March 21 8:00~16:00; March 22 8:00~16:00/NTUH International Convention Center 3F Welcome dinner: Shuttle buses will pick up the participants at the entrance of the NTUH International Convention Center at 17:30

－ 8 －

Program March 22（Sunday） Time

Room

Room 301

8:30~9:10 9:10~9:50

Room 201 Glucocorticoids and Cardiovascular Disease (PL-1) Early Stages of Thyroid Autoimmunity (PL-2)

9:50~10:10

Coffee Break

10:10~10:50

Multifunctional Nature of Vascular Adhesion Protein-1 (VAP-1) in the Development of Diabetes and Its Vascular Complication (SL-1)

Mineralocorticoid Replacement Therapy (MP-1)

Room 202

Geberal Assembly & Fang-wu Chen Award

10:50~12:00 Lunch Sym-4

Lunch Sym-5

Lunch Sym-6

12:00~13:20 (Bayer)

13:30~14:10

14:10~14:50

(Astrazeneca) (MSD Schering-Plough) Mobilising the Resources to Address the Diabetes Epidemic (PL-3) Management of Graves' Diabetic Ketoacidosis Orbitopathy (DKA) –Always a Challenge (MP-2) (MP-3)

14:50~15:10 15:10~16:40

16:40~17:20

Coffee Break

Oral-4

Current Concept of Management for Acromegaly (Sym-8) SIADH and Cerebral Salt Wasting: Pathogenesis, Diagnosis, and Treatment (SL-2)

－ 9 －

Oral-5

March 22, 2009 【Room 201】

Plenary Lecture Moderator：Ching-Chung Chang

8:30~9:10

PL-1

GLUCOCORTICOIDS AND CARDIOVASCULAR DISEASE Brian R Walker Endocrinology Unit, Centre for Cardiovascular Science, University of Edinburgh, UK

Moderator：Tien-Chun Chang 9:10~9:50

PL-2

EARLY STAGES OF THYROID AUTOIMMUNITY Wilmar M. Wiersinga Dept. of Endocrinology & Metabolism, Academic Medical Center, Amsterdam, Netherlands

Moderator：Lee-Ming Chuang 13:30~14:10

PL-3

MOBILISING THE RESOURCES TO ADDRESS THE DIABETES EPIDEMIC Martin Silink University of Sydney President, International Diabetes Federation

－ 10 －

March 22, 2009 【Room 301】

Meet the Professor Moderator：Pei-Wen Wang

10:10~10:50

MP-1

MINERALOCORTICOID REPLACEMENT THERAPY Brian R Walker Endocrinology Unit, Centre for Cardiovascular Science, University of Edinburgh, UK

Moderator：Jen-Der Lin 14:10~14:50

MP-2

MANAGEMENT OF GRAVES’ORBI TOPATHY Wilmar M. Wiersinga Dept. of Endocrinology & Metabolism, Academic Medical Center, Amsterdam, Netherlands

March 22, 2009 【Room 201】 14:10~14:50

MP-3

Moderator：Boniface J Lin

DIABETIC KETOACIDOSIS (DKA) –ALWAYS A CHALLENGE Martin Silink President, International Diabetes Federation; Professor of Paediatric Endocrinology, University of Sydney. Institute of Pa e di a t r i cEndoc r i nol ogy ,Chi l dr e n’ sHos pi t a la tWe s t me a d, Sydney, Australia

－ 11 －

March 22, 2009 【Room 201】

Special Lecture Moderator：Wayne H-H Sheu

10:10~10:50

SL-1

MULTIFUNCTIONAL NATURE OF VASCULAR ADHESION PROTEIN-1 (VAP-1) IN THE DEVELOPMENT OF DIABETES AND ITS VASCULAR COMPLICATION Jalkanen Sirpa Tuulikki University of Turku, Turku, Finland

Moderator：Fu-Sung Lo 16:40~17:20

SL-2

SIADH AND CEREBRAL SALT WASTING: PATHOGENESIS, DIAGNOSIS, AND TREATMENT Joseph A. Majzoub Professor of Pediatrics and Medicine, Harvard Medical School, Boston, MA, USA

March 21, 2009 【Room 201】

Symposium 1: Postprandial Plasma Glucose Moderator：Wayne H-H Sheu

8:40~9:05

S1-1

SIGNIFICANCE OF POSTPRANDIAL GLUCOSE AND RELATION TO CARDIOAVSCULAR DISEASE Chih-Yuan Wang Department of Internal Medicine, Far-Eastern Memorial Hospital

－ 12 －

9:05~9:30

S1-2

HOW TO CONTROL AND MONITOR POSTPRANDIAL GLUCOSE LEVELS Yi-Jen Hung Division of Endocrinology & Metabolism, Tri-Service General Hospital, Taipei, Taiwan

9:30~9:55

S1-3

DIETARY CONTROL OF POSTPRANDIAL GLUCOSE LEVELS Hsiu-Yueh Su Department of Dietetics, Taipei Medical University Hospital

9:55~10:10

Discussion

March 21, 2009 【Room 301】

Symposium 2: Sex Hormones and Aging Moderator：Tien-Chun Chang

10:30~10:55

S2-1

AGING AND ANTI-AGING-OVERVIEW AND THE ROLE OF GROWTH HORMONE REPLACEMENT THERAPY Tien-Chun Chang Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan

10:55~11:20

S2-2

THE IMMUNOLOGICAL IMPACT OF STEROID HORMONE Bor-Ching Sheu Department of Obstetrics and Gynecology, College of Medicine and the Hospital, National Taiwan University, Taipei, Taiwan

－ 13 －

11:20~11:45

S2-3

11:45~12:00

LATE ONSET HYPOGONADISM IN TAIWANESE MEN Shih-Ping Liu Department of Urology, National Taiwan University Hospital Discussion

March 21, 2009 【Room 201】

10:30~10:35

Symposium 3: Current Opinions of Insulin Therapy –Are We Doing Better in Type 2 Diabetes? Opening Boniface J Lin Division of Endocrinology and Metabolism, Department of Internal Medicine, Cardinal Tien Hospital, Xindian

Moderator：Shih-Tzer Tsai 10:35~10:45

Audience Survey

Moderator：Jung-Fu Chen S3-1

INTRODUCTION OF INSULIN THERAPY IN TYPE 2 DIABETES Shih-Te Tu Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital

－ 14 －

Moderator：Neng-Chun Yu 11:00~11:15

S3-2

GLYCEMIC CONTROL AND INSULIN REGIMENS IN TYPE 2 DIABETES PATIENTS: RETROSPECTIVE COHORT ANALYSIS Chieh-Hsiang Lu Division of Endocrinology and Metabolism, Department of Internal Medicine, Chia-Yi Christian Hospital

Moderator：Wayne H-H Sheu 11:15~11:30

S3-3

INITIATION OF BASAL INSULIN VERSUS INTENSIFIED LIFESTYLE MANAGEMENT: A PROSPECTIVE STUDY Chao-Hung Wang Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital

Moderator：Shih-Tzer Tsai 11:30~11:55

Discussion

11:55~12:00

Closing Remark Lee-Ming Chuang Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital

－ 15 －

March 21, 2009 【Room 301】

Symposium 4: Current Concepts of Adrenal Disorders Moderator：Justin G.S. Won, Chwen-Tzuei Chang

13:30~13:55

S4-1

PRIMARY ALDOSTERONISM: DIAGNOSIS AND OUTCOMES, DATA OF TAIPEI Kwan-Dun Wu Department of Internal Medicine, National Taiwan University Hospital

13:55~14:20

S4-2

BRONCHIAL CARCINOID-INDUCED ECTOPIC CUSHI NG’ SSYNDROME( ECS): CASE-BASED STUDY Justin G.S. Won Division of Endocrinology and Metabolism, Department of Medicine, Taipei-Veterans General Hospital

14:20~14:45

S4-3

CONGENITAL ADRENAL HYPERPLASIA DUE TO 21-HYDROXLASE DEFICIENCY Yann-Jinn Lee Departments of Pediatrics and Medical Research, Mackay Memorial Hospital, Taipei Department of Pediatrics, Taipei Medical University, Taipei

14:45~15:00

Discussion

－ 16 －

Symposium 5: Advances on Renin-Angiotensin System in Diabetes: From Basic to Clinical

March 21, 2009 【Room 201】

Moderator：Shyi-Jang Shin 13:30~13:55

S5-1

OXIDATIVE STRESS IN HYPERTENSION AND NEPHROPATHY DEVELOPMENT IN DIABETES John S.D. Chan Professor of Medicine and Physiology Faculty of Medicine University of Montreal Chief, Laboratory of Molecular Nephrology and Endocrinology Research Center CHUM-Hotel Dieu Hospital

13:55~14:20

S5-2

ADVANCES ON RENIN-ANGIOTENSIN BLOCKADE IN DIABETIC MICROVASCULAR COMPLICATIONS Shyi-Jang Shin Division of Endocrinology and Metabolism, Kaohsiung Medical University Chung-Ho Memorial Hospital

14:20~14:45

S5-3

ANGIOTENSIN-CONVERTING ENZYME GENE INSERTION/ DELETION POLYMORPHISM AND DIABETIC NEPHROPATHY 1

Yau-Jiunn Lee, 2Shyi-Jang Shin

Le e ’ sEndoc r i nol og i cCl i ni c ,Pi ng t ung , Ta i wa n; 2Departments

of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan2

－ 17 －

14:45~15:00

Discussion

Symposium 6: Parathyroid Disorders

March 21, 2009 【Room 301】

Moderator：Keh-Sung Tsai 15:20~15:45

S6-1

SURGERY FOR UREMIC SECONDARY HYPERPARATHYROIDISM Shih-Ming Huang National Cheng Kung University Hospital

15:45~16:10

S6-2

MANAGEMENT OF MINERAL BONE DISORDERS IN CHRONIC KIDNEY DISEASE Yung-Ming Chen National Taiwan University Hospital

16:10~16:35

S6-3

GNAS1 MUTATIONS AND PSEUDOYPOPARATHYROIDISM IA W-S Yang, K-M Pan, Y-C Chi, K-S Tsai Graduate Institutes of Clinical Medicine and Molecular Medicine, College of Medicine, National Taiwan University; Departments of Internal Medicine and Laboratory Medicine, NTU Hospital

16:35~16:50

Discussion

－ 18 －

March 21, 2009 【Room 201】

Symposium 7: Translating Islet Biology into Diabetes Therapy Moderator：Jyuhn-Huarng Juang

15:20~16:05

S7-1

CHRONIC GLYCEMIC STRESS IN ISLET FAILURE Gordon C. Weir Joslin Diabetes Center

16:05~16:50

S7-2

DIFFERENTIATION OF PANCREATIC DUCT CELLS TO CELLS Susan Bonner-Weir Joslin Diabetes Center

March 21, 2009 【Room 201】

Symposium 8: Current Concept of Management for Acromegaly Moderator：Tien-Shang Huang, Hong-Da Lin

15:10~15:35

S8-1

ACROMEGALY –OVERVIEW AND MEDICAL TREATMENT Tien-Chun Chang Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan

15:35~16:00

S8-2

LONG TERM FOLLOW UP OF PATIENT WITH ACROMEGALY AFTER SRS Chen-Nen Chang Department of Neurosurgery, Chang Gung Memorial Hospital & Chang Gung University, Taipei, Taiwan － 19 －

16:00~16:25

S8-3

GAMMA KNIFE RADIOSURGERY FOR THE TREATMENT OF PITUITARY ADENOMA WITH ACROMEGALY Hung-Chi Pan Department of Neurosurgery, Taipei Veterans General Hospital

16:25~16:40

Discussion

March 21, 2009 【Room 301】

Lunch Symposium-1: From Now to Future Sponsor by: Novartis

Moderator：Wayne H-H Sheu 12:00~12:05 12:05~12:35

Opening Remarks LS1-1

IMPORTANCE OF POST-PRANDIAL GLYCEMIC CONTROL IN T2DM PATIENTS Shih-Te Tu Department of Internal Medicine, Lugang Branch of Changhua Christian Hospital

12:35~13:05

LS1-2

INHIBITION OF RAAS AT POINT OF ACTIVATION: A NEW THERAPEUTIC OPTION Chih-Yuan Wang Department of Internal Medicine, Far-Eastern Memorial Hospital

13:05~13:15

Discussion

13:15~13:20

Closing Remarks

－ 20 －

March 21, 2009 【Room 201】

Lunch Symposium-2: Update Treatment Therapy in Patients with Type 2 Diabetes: From Evidence to Practice Sponsor by: Sanofi Aventis

Moderator：Tien-Shang Huang 12:00~12:05

Opening

Moderator：Tien-Shang Huang 12:05~12:35

LS2-1

THE NEW ERA OF FIXED DOSE COMBINATION OAD IN T2DM TREATMENT Ming-Chia Hsieh Division of Endocrinology and Metabolism, Department of Internal medicine, Kaohsiung Medical University Hospital

Moderator：Low-Tone Ho 12:35~13:15

LS2-2

OPTIMUM MANAGEMENT OF TYPE 2 DIABETES — TIMELY INITIATION AND INTENSIFICATION OF BASAL INSULIN Roger Chen Adjunct Professor, University of Technology, Sydney, Clinical Senior Lecturer, University of Sydney; Senior Endocrinologist, Concord Repatriation General Hospital, Sydney, Australia; Medical Director, Ryde Hospital Diabetes, Sydney, Australia

Moderator：Low-Tone Ho 13:15~13:20

Discussion & Closing － 21 －

March 21, 2009 【Room 202】

Lunch Symposium-3: Residual Risk Reduction in Atherogenic Dyslipidemia Series Sponsor by: Solvay

Moderator：Ching-Chung Chang 12:00~12:05

Opening

Moderator：Ching-Chung Chang 12:05~12:30

LS3-1

POPULATION STUDY ON HDL CHOLESTEROL AND RELATED DISORDERS IN TAIWAN: RISK BEYOND LDL CHOLESTEROL TA-CHEN SU National Taiwan University Hospital Cardiology Department

Moderator：Lee-Ming Chuang 12:30~13:05

LS3-2

MACRO AND MICROVASCULAR RESIDUAL RISK ON OPTIMAL STATIN THERAPY: CLINICAL IMPLICATIONS AND NEW THERAPEUTIC STATEGIES Alberto Zambon Department of Medical and Surgical Sciences, University of Padua, Italy

Moderator：Lee-Ming Chuang 13:05~13:15

Discussion

－ 22 －

Moderator：Lee-Ming Chuang 13:15~13:20

Closing

March 22, 2009 【Room 301】

Lunch Symposium-4: Management Fluctuation of Blood Sugar and Blood Pressure ~ Control the Double Surges ~ Sponsor by: Bayer

Moderator：Tong-Yuan Tai 12:00~12:05

Opening Remarks

Moderator：Tong-Yuan Tai 12:05~12:40

LS4-1

POSTPRANDIAL HYPERGLYCAEMIA — A COMMON DENOMINATOR IN DIABETES AND CVD Wayne H-H Sheu Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital

Moderator：Ching-Chung Chang 12:40~13:15

LS4-2

MANAGEMENT OF THE CV RISK BY CONTROLING THE BP MORNING SURGE Chen-Huan Chen Department of Medical Research and Education, Taipei Veterans General Hospital; Professor of Medicine National Yang-Ming University School of Medicine

－ 23 －

Moderator：Ching-Chung Chang 13:15~13:20

Panel Discussion & Closing Remark

March 22, 2009 【Room 201】

Lunch Symposium-5: Future Health Inspiration Sponsor by: Astrazeneca

Moderator：Shih-Te Tu 12:00~12:10

Opening

Moderator：Chin-Hsiao Tseng 12:10~12:50

LS-5

INFLAMMATION IN ATHEROSCLEROSIS — IS IT CLINICALLY IMPORTANT? — RESULTS OF RECENT CLINICAL TRIALS Lawrence A. Leiter Head, Division of Endocrinology & Metabolism, St .Mi c ha e l ’ sHos pi t a l Professor of Medicine and Nutritional Sciences, University of Toronto

Moderator：Chin-Hsiao Tseng 12:50~13:10

Panel Discussion

Moderator：Shih-Te Tu 13:10~13:20

Closing

－ 24 －

March 22, 2009 【Room 202】

Lunch Symposium-6: Aggressive Treatment in DM Management Sponsor by: MSD Schering-Plough

Moderator：Tien-Shang Huang 12:00~12:05

Opening Remark

Moderator：Tien-Shang Huang 12:05~12:35

LS6-1

CLINICAL IMPACTS AND UPDATES FROM RECENT GUIDELINE AND TRIALS Chih-Yuan Wang Department of Internal Medicine, Far-Eastern Memorial Hospital

Moderator：Jung-Fu Chen 12:35~13:05

LS6-2

AGGRESSIVE LIPID LOWERING IN COMBINATION WITH EZETIMIBE AND STATINS Morgan Mao-Young Fu Department of Cardiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine

Moderator：Jung-Fu Chen 13:05~13:15

Panel Discussion

Moderator：Jung-Fu Chen 13:15~13:20

Closing Remark － 25 －

March 21, 2009 【Room 202】

Satellite Symposium-1: Pathogenesis and Optimal Approaches in Type 2 DM Management Sponsor by: GSK

Moderator：Wayne H-H Sheu 15:20~15:30 15:30~16:10

Opening Remarks SS1

CURRENT THERAPEUTIC APPROACHES TO THE TREATMENT OF TYPE 2 DIABETES Harold Lebovitz State University of New York, USA

16:10~16:20

Discussion & Closing Remarks

March 21, 2009

Satellite Symposium-2

Grand Formosa Regent Taipei 3F Ballroom

Sponsor by: MSD

Moderator：Low-Tone Ho 18:30~18:35 18:35~19:05

Opening SS2

DPP-4 INHIBITOR BASED THERAPIES IN THE MANAGEMENT OF T2DM Troels Wolthers Regional Director Medical Affairs, Diabetes & Obesity Asia Pacific Merck & Co

19:05~19:15

Closing Remark － 26 －

March 21, 2009 【Room 202】

Oral Prentation-1 Moderator：Tong-Yuan Tai

10:30~10:40

O1-1

IMPLEMENTATION OF THE JOINT ASIA DIABETES EVALUATION (JADE) PROGRAM IN TAIWAN L-T HO, C-F KWOK, H-S CHEN, 1T-L HSU, 2W-C YANG, 2

Y-Y NG, 2W-J TSAI, 3C-P TSAI, 3C-M CHEN, 4S-J H WANG,

T-J CHEN, 4M-H LIN, 5W-Y LEI

Metabolism & Endocrinology Division, 1Cardiology Division, 2

Nephrology Division, 3Neurology Division, and 4Family

Medicine Departments, Taipei Veterans General Hospital; 5

10:40~10:50

O1-2

Merck Sharp & Dohme (I.A.) Corp. Taiwan Branch

SERUM HOMA-IR PREDICTS THE DEVELOPMENT OF IMPAIRED FASTING PLASMA GLUCOSE DURING 2- YEAR FOLLOW-UP IN POSTMENOPAUSAL WOMEN T-Y TAI, 1K-S TSAI, 2S-T TU, 3J-S WU, 4C-I CHANG Taipei Jen-Chi Relief Institution; 1National Taiwan University Hospital; 2Chang-hua Christian Hospital; 3National Cheng-Kung University Hospital; 4Division of Gerontology Research National Health Research Institutes

10:50~11:00

O1-3

THE FIRST AND SECOND PHASE OF INSULIN SECRETION IN NAÏVE TAIWANESE TYPE 2 DIABETES D PEI, 1J-D LIN, T-L HSIA, 2C-Z WU, C-C SU, W-Y MA, 2

A-T HSIEH, B LIN, 2K-Y TSAI

Division of Endocrinology and Metabolism, Department of Medicine, Cardinal Tien Hospital, Xindian, Catholic Fu Jen University; 1Wan Fang Hospital, 2Shuang Ho Hospital, Taipei Medical University － 27 －

11:00~11:10

O1-4

METABOLIC PROFILES IN VEGETARIAN AND NON-VEGETARIAN TAIWANESE WOMEN AND THE EFFECTS OF YEARS OF BEING VEGETARIAN JK CHIANG, 1YC CHI, 1, 2WS YANG Departments of Family and Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chaiyi; 1Graduate of Clinical Medicine, College of Medicine, National Taiwan University; 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Moderator：Kun-Wu Tsan 11:10~11:20

O1-5

EXERCISE ON INSULIN ACTION, INFLAMMATORY CYTOKINE, AND SERUM TARTRATE-RESISTANT ACID PHOSPHATASE 5A IN OBESE TAIWANESE MALE ADOLESCENTS 1 KUANG-CHUNG SHIH, 2TSU-YI CHAO, 3 YU-CHING CHOU, 4CHING-FAI KWOK, 5LOW-TONE HO 1 Division of Endocrinology and Metabolism, Tri-Service General Hospital, 2Division of Hematology/Oncology; 3School of Public Health, National Defense Medical Center; 4Division of Endocrinology and Metabolism, Taipei-Veteran General Hospital; 5Departments of Medical Research and Education

11:20~11:30

O1-6

CHINESE METABOLIC SYNDROME RISK SCORE 1 FONE-CHING HSIAO, 2CHUNG-ZE WU, 1 CHANG-HSUN HSIEH, 1CHIH-TSUENG HE, 1 YI-JEN HUNG, 3DEE PEI 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital; 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Cardinal Tien Hospital, Medical School, Fu Jen Catholic University － 28 －

11:30~11:40

O1-7

ASSOCIATION OF INTRAOCULAR PRESSURE WITH THE METABOLIC SYNDROME AND NOVEL CARDIOMETABOLIC RISK FACTORS 1

YI-CHENG CAHNG, 1JOU-WEI LIN,

LU-CHUN WANG, 3HSIEN-MEI CHEN,

JUEY-JEN HWANG, 4LEE-MING CHUANG

Department of Internal Medicine, National Taiwan University

Hospital Yunlin branch; 2 Department of Ophthalmology, National Taiwan University Hospital Yunlin branch; 3 Health Management Cencer, National Taiwan University Hospital Yunlin branch; 4Department of Internal Medicine, National Taiwan University Hospital 11:40~11:50

O1-8

DIABETIC NEPHROPATHY AND RISK FACTORS FOR PERIPHERAL ARTERY DISEASE IN CHINESE WITH TYPE 2 DIABETES 1

M-C HSIEH, 2K-J TIEN, 1J-Y HSIAO,

Y-H CHANG, 1H-W KUO, 1S-J SHIN, 3S-T TU

Division of Endocrinology and Metabolism, Department of

Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Lukang Branch, Changhua, Taiwan

－ 29 －

11:50~12:00

O1-9

INCREASED RISK OF DIABETES AND POLYCHLORINATED BIPHENYLS AND DIOXINS: A 24-YEAR FOLLOW-UP STUDY OF THE YUCHENG COHORT S-L WANG, 1P-C TSAI, 2C-Y YANG, 3Y LEON GUO Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Taiwan, R.O.C.; 1

Department of Basic Medical Sciences, National Cheng-Kung

University Medical College, Taiwan, R.O.C.; 2Department of Health Business Administration, Hung-Kuang University, Taiwan, R.O.C.; 3Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine, and National Taiwan University Hospital, Taiwan, R.O.C.

March 21, 2009 【Room 202】

Oral Prentation-2 Moderator：Yu-Yao Huang

13:30~13:40

O2-1

THE IL4 GENE AND GRAVES' DISEASE: META-ANALYSIS 1,2,3 1,4 2

YANN-JINN LEE, 1,4CHI-YU HUANG,

WEI-HSIN TING, 1WEN-LING GUO,

WEI-FANG CHEN, 5FU-SUNG LO

Departments of 1Pediatrics and 2Medical Research, Mackay Memorial Hospital; 3Department of Pediatrics, Taipei Medical University; 4Mackay Medicine, Nursing and Management College; 5Department of Pediatrics, Chang Gung Memorial Hospital, Chung Gung University College of Medicine, Taoyuan, Taiwan － 30 －

13:40~13:50

O2-2

ASSOCIATION OF CD40 GENE WITH LATER-ONSET GRAVES’DI SEASEI NTAIWANESE 1

J-Y HSIAO, 1M-C HSIEH, 1S-J SHIN

Division of Endocrinology and Metabolism, Department of

Internal Medicine, Kaohsiung Medical University Hospital, Taiwan, ROC 13:50~14:00

O2-3

IDENTIFICATION OF MIR-146B-REGULATED TARGET GENES ASSOCIATED WITH TUMOR AGGRESSIVENESS IN ADULT PAPILLARY THYROID CARCINOMAS 1

CHEN-KAI CHOU, 2HONG-YO KANG, 2RONG-FU CHEN,

KUENDER D. YANG, 3FONG-FU CHOU, 1YA-FANG LEE,

RUE-TSUAN LIU

Division of Metabolism, 2Department of Medical Research,

Department of Surgery, Chang Gung Memorial

Hospital-Kaohsiung Medical Center, Chang Gung University, Kaohsiung 14:00~14:10

O2-4

EVALUATION OF CORRELATION BETWEEN CIRCULATING THYROTROPIN RECEPTOR ANTIBODIES AND SERUM THYROTROPIN LEVELS IN PATIENTS WITH GRAVES' DISEASE 1

L-S LEE, W-C LO

Division of Endocrinology and Metabolism, Department of Internal Medicine, Ren-ai Branch, Taipei City Hospital, Taiwan, R.O.C.; 1Department of Clinical Pathology, Ren-ai Branch, Taipei City Hospital, Taiwan, R.O.C.

－ 31 －

Moderator：Hung-Yu Chang 14:10~14:20

O2-5

THE RELIABLE PARAMETERS OF COLOR DOPPLER ULTRASONOGRAPHY IN PREDICTING THYROID FUNCTION 1

CHIA-CHE HAN, 2SHYH-CHING CHIOU, 1YUN-SHING

PENG, 3HSU-HUEI WENG, 1CHENG HO, 1PAO-YIN CHEN 1

Division of Endocrinology and Metabolism, Department of

Internal Medicine, Chang Gung Memorial Hospital, Chiayi, and Chang Gung University, Taoyuan, Taiwan ; 2Department of Internal Medicine, Da-Chien General Hospital, Miaoli, Taiwan ; 3

Department of Diagnostic Radiology, Chang Gung Memorial

Hospital, Chia-Yi, Taiwan 14:20~14:30

O2-6

ANALYSIS OF CLINICO-PATHOLOGICAL CHARACTERISTICS AND PROGNOSIS FOR SMALL PAPILLARY THYROID CANCERS YA-LING HSU, JEFFERY C. CHEN, 1AN-CHEN FENG, 2

TSUNG-YEN CHENG, 3DUNG-LUNG YU, GERALD TSAI

Division of Endocrinology and Metabolism, Department of Internal Medicine, Koo Fundation Sun-Yat Sen Cancer Center; 1

Office of Clinical Research, Koo Fundation Sun-Yat Sen

Cancer Center; 2Department of General Surgery, Koo Fundation Sun-Yat Sen Cancer Center; 3Department of Nuclear Medicine,Koo Fundation Sun-Yat Sen Cancer Center

－ 32 －

14:30~14:40

O2-7

INTERACTION OF ENDOTHELIN-1 AND ANGIOTENSIN II ON MITOGENIC EFFECTS OF VASCULAR SMOOTH MUSCLE CELLS 1

Y-J LIN, 2Y-P HSU, 1C-C CHEN, 2C-M CHEN, 1S-Y SHIH,

X-Y LU, 1,2,3,4L-T HO

Institute of Physiology, National Yang-Ming University,

Taiwan, R.O.C.; 2Department of Medical Research and Education, Taipei Veterans General Hospital, Taiwan, R.O.C.; 3

Division of Endocrinology and Metabolism, Department of

Internal Medicine, Taipei Veterans General Hospital, Taiwan, R.O.C.; 4Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C. 14:40~14:50

O2-8

ISOLATED ADENOCORTICOTROPIN HORMONE DEFICIENCY IN ADULT REPORT OF 17 CASES T-Y WANG, C-T CHANG, C-C CHEN, R-H CHEN, W-L HUANG, M-H HSEICH, K-C HUANG Division of Endocrinology and Metabolism, Department of Internal Medicine, China Medical University Hospital, Taiwan, R.O.C

14:50~15:00

O2-9

PHEOCHROMOCYTOMA MIMICKING AN ACUTE CORONARY SYNDROME- A CASE REPORT 1

T-W LEE, 1,2T-I LEE, 3K-H LIN, 1T-J CHANG, 1J-D LIN,

W-H LAO, 1I-H LIAO

Division of Endocrinology and Metabolism, Department of

Internal Medicine, Taipei Medical University-Wan Fang Municipal Hospital, Taiwan, R.O.C.; 2 Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C; 3 Division of Urology, Department of Surgery, Taipei Medical University-Wan Fang Municipal Hospital, Taiwan, R.O.C. － 33 －

March 21, 2009 【Room 202】

Oral Presentation-3 Moderator：Rue-Tsuan Liu

16:20~16:30

O3-1

PITUITARY STALK TRANSECTION AND ECTOPIC POSTERIOR PITUITARY LOBE C-M WU, H-J CHENG, S-J TSAI, H-K TSAI, H-Y TSAI, C-C SUN, C-H CHU, C-C LU, J-K LEE, H-C LAM Division of Endocrinology and Metabolism, Department of Medicine, Veterans General Hospital-Kaohsiung, Taiwan, R.O.C.

16:30~16:40

O3-2

CASE REPORT: A CASE OF PAPILLARY THYROID CARCINOMA COMBINED WITH MULTIPLE ENDOCRINE NEOPLASIA TYPE 1 JIUM-HUEI LIN, CHIEN-WEN CHOU, CHWEN-YI YANG Division of Endocrinology and Metabolism, Department of internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan

16:40~16:50

O3-3

ACUTE SUPPURATIVE THYROIDITIS ASSOCIATED WITH OCCURRENCE OF LIVER ABSCESS - A CASE REPORT L-N TSENG, 1Y-T TSAI, S-Y LIN, W H-H SHEU Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan,R.O.C.; 1Intensive Care Medicine Section,Department of Internal Medicine,Taichung Veterans General Hospital, Taiwan, R.O.C.

－ 34 －

Moderator：Kam-Tsun Tang 16:50~17:00

O3-4

REPORT OF HEMOPHAGOCYTOSIS SYNDROME IN A CASE OF METHIMAZOLE INDUCED AGRANULOCYTOSIS WHO LATER RECEIVED DOUBLE FILTRATION PLASMAPHERESIS BEFORE THYROIDECTOMY 1

W-H LEW, 1,2T-I LEE, 1C-J CHANG, 3Y-K CHEN,

C-Y CHENG, 1J-D LIN, 1C FAN

Division of Endocrinology and Metabolism, Department of

Internal Medicine, Wan Fang Municipal Hospital, Taiwan, R.O.C.; 2 Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C.; 3

Division of Hematology and Oncology, Department of

Internal Medicine, Wan Fang Municipal Hospital, Taiwan, R.O.C.; 4 Division of Nephrology, Department of Internal Medicine, Wan Fang Municipal Hospital, Taiwan, R.O.C. 17:00~17:10

O3-5

SECONDARY HYPERTENSION DUE TO A RENIN-SECRETING JUXTAGLOMERULAR CELL TUMOR - A CASE REPORT R-H CHEN, S-Y LIN, 1W-C CHEN Division of Endocrinology and Metabolism, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taiwan, R.O.C.; 1Department of Urology, China Medical University Hospital, China Medical University, Taiwan, R.O.C.

－ 35 －

17:10~17:20

O3-6

COSTIMULATORY MOLECULES AS GENETIC MARKERS FOR RELAPSE OF GRAVES' DISEASE 1

P-W WANG, 2S-H HANK JUO, 1R-T LIU, 1C-J HSIEH,

I-YA CHEN, 2EDWARD HSI

Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Medical Research, Kaohsiung Medical University Hospital, and Graduate Institute of Medical Genetics, Kaohsiung Medical University, Kaohsiung, Taiwan. 17:20~17:30

O3-7

HYPEROSMOLAR HYPERGLYCEMIC STATE COMPLICATED WITH RHABDOMYOLYSIS: A CASE REPORT K-W LIU, Y-L LIANG, 1S-H HSIAO, H-C HUNG, H-Y OU, T-J WU Division of Endocrinology and Metabolism, Department of Internal Medicine, 1Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C.

－ 36 －

March 22, 2009 【Room 301】

Oral Presentation 4 Moderator：Tjin-Shing Jap

15:10~15:20

O4-1

EFFICACY AND SAFETY OF FIXED-DOSE VERSUS FREE COMBINATION OF GLIMEPIRIDE AND METFORMIN IN TAIWANESE PATIENTS WITH TYPE 2 DIABETES C-H WANG, 1S-T TU, 2J-H JUANG, 3H-D LIN, 4C-C CHANG Mackay Memorial Hospital, Taipei, Taiwan, R.O.C.; 1

Department of Internal Medicine, Lugang Branch of Changhua

Christian Hospital, Changhua, Taiwan, R.O.C.; 2Department of Internal Medicine, Chang Gung Memorial Hospital Linko, Taipei, Taiwan, R.O.C.; 3Department of Internal Medicine, Veterans General Hospital-Taipei, Taipei, Taiwan, R.O.C.; 4

Department of Internal Medicine, National Taiwan University

Hospital, Taipei, Taiwan, R.O.C. 15:20~15:30

O4-2

HEPATITIS B/C DO NOT AFFECT THE PIOGLITAZONE EFFECTS IN TYPE 2 DIABETIC PATIENTS 1,2 1

K-D LIN, 1,2Y-H CHANG, 3S-R HE, 1M-Y LEE, 1,3S-J SHIN

Division of Endocrinology and Metabolism, Department of

Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C; 2

Graduate Institute of Medicine Kaohsiung Medical University ,

Taiwan, R.O.C; 3Graduate Institute of Medical Genetics, Kaohsiung Medical University, Taiwan, R.O.C

－ 37 －

15:30~15:40

O4-3

EFFECTS OF ADDING SITAGLIPTIN TO MAXIMAL DOSE OF ORAL ANTIDIABETIC DRUGS ( OAD ) ON INADEQUATELY CONTROLLED ELDERLY PATIENTS WITH TYPE 2 DIABETES ( T2DM ) IN TAIWAN 1,2

M-N CHIEN, 1C-C LEE, 1W-C CHEN, 1S-C LIU,

C-H LEUNG, 1C-H WANG

Division of Endocrinology and Metabolism, Department of

Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; 2

Mackay Medicine, Nursing and Management College, Taipei,

Taiwan 15:40~15:50

O4-4

APPLICATION OF ADRR FOR EVALUATION OF SMBG IN DIABETES YANG-MING LEE, S-T TU, P-Y LIAO, D-H TSAI, S-L SU, H-K SIA, S-R HSU, S-D LIN, S-Y WANG, P-Y CHENG, Y-N CHANG 1

Division of Endocrinology and Metabolism, Department of

Internal Medicine, Changhua Christian Hospital, Taiwan, R.O.C; 2Department of Internal Medicine, Changhua Christian Hospital, Taiwan, R.O.C; 3TaiDoc Technology Corporation

Moderator：Ching-Fai Kwok 15:50~16:00

O4-5

USING CONTINUOUS GLUCOSE MONITORING SYSTEM TO DETECT FLUCTUATION OF BLOOD GLUCOSE IN PATIENTS WITH DIABETES MELLITUS 1

H-C HUNG, 2C-H CHIANG, 3M-Y TSAI, 1S-C HU,

H-Y OU, 1T-J WU

Department of Internal Medicine, Division of Endocrinology

and Metabolism; 2Institute of Medical Engineer; 3Nursing Department, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan － 38 －

16:00~16:10

O4-6

THE STUDY OF RELATIONSHIP BETWEEN METABOLIC OUTCOME AND DIABETES COGNITIVE BEHAVIORS FOR DIABETES SHARED CARE MODEL OUTPATIENTS - AN EXAMPLE FROM A REGIONAL TEACHING HOSPITAL 1

LYH-JYH HAO, 7MI-CHIA MA, 6HAILUN CHAO,

CHING-JU HONG, 3NAI-WEN CHANG, 7TSUNG-YI SHEN,

FU-SHINE CHOU, 9TA-JEN WU, 4MING-DER SHI,

YU-PING LEE, 5JIN-SHIUNG CHENG,

JIANG-KANG CHAO

Division of Endocrinology and Metabolism, Department of

Internal Medicine,Yong Kang Veterans Hospital, Yong Kang, Taiwan, R.O.C.; 2Department of Psychiatry, Yong Kang Veterans Hospital, Yong Kang, Taiwan, R.O.C.; 3Division of Nutrition,Yong Kang Veterans Hospital, Yong Kang, Taiwan, R.O.C.;4Department of Pathology and Laboratory Medicine, Yong Kang Veterans Hospital, Yong Kang, Taiwan, R.O.C.; 5

Department of Administration, Yong Kang Veterans Hospital,

Yong Kang, Taiwan, R.O.C.; 6Department of Health Care Administration, Chung Hwa University of Medical Technology, Tainan, Taiwan, R.O.C.; 7Department of Statistics, National Cheng Kung University, Tainan, Taiwan, R.O.C.; 8Institute of Information Management, National Cheng Kung University, Tainan, Taiwan, R.O.C.; 9Division of Endocrinology and Metabolism, Department of Medicine, National Cheng Kung University Hospital. 16:10~16:20

O4-7

ASSOCIATION OF INTERLEUKIN-6 WITH METABOLIC SYNDROME IN TAIWANESE ELDERLY Y-H YAN, S-C HUA, H-I YU, T-S TAI, C-H LU Division of Endocrinology and Metabolism, Department of Internal Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan － 39 －

16:20~16:30

O4-8

ANKLE BRACHIAL INDEX IN TYPE 2 DIABETIC FEMALE AND MALE TAIWANESE WITH CHRONIC KIDNEY DISEASE AND ALBUMINURIA 1

M-Y LEE, 1C-L WANG, 1Y-H CHANG, 1K-D LIN,

M-C HSIEH, 1P-J HSIAO, 1S-J SHIN

Division of Endocrinology and Metabolism, Department of

Internal Medicine, Kaohsiung Medical University Chung Ho Memorial Hospital, Taiwan, R.O.C. 16:30~16:40

O4-9

THE STUDY OF INTIMA-MEDIA THICKNESS OF CAROTID ARTERIES IN SENILE MALE VETERANS IN SOUTHERN TAIWAN H-J CHENG, H-C LAM, 1,2Y-K LO, 1,3Y-T LIN, 4K-H LAI Division of Endocrinology and Metabolism, Kaohsiung Veterans General Hospital; 1Division of Neurology, Kaohsiung Veterans General Hospital; 2Geriatric Medicine Center, Kaohsiung Veterans General Hospital; 3Division of Geriatric Medicine, Kaohsiung Veterans General Hospital; 4Division of Gastroenterology, Kaohsiung Veterans General Hospital

－ 40 －

March 22, 2009 【Room 202】

Oral Presentation 5 Moderator：Ching-Chu Chen

15:10~15:20

O5-1

MAGNETIC RESONANCE IMAGING OF TRANSPLANTED MOUSE ISLETS LABETED WITH CHITOSAN-COATED SUPERPARAMAGNETIC IRON OXIDE NANOPARTICLES J-H JUANG, 1,2C-R SHEN, 3J-J WANG, 4C-H KUO, Y-W CHIEN, 2H-Y KUO, 2Z-T TSAI, 2T-C YEN Division of Endocrinology and Metabolism, Chang Gung University and Memorial Hospital; 1Department and Graduate Institute of Medical Biotechnology and Laboratory Science, Chang Gung University; 2Molecular Imaging Center, Chang Gung Memorial Hospital; 3Department of Medical Imaging and Radiological Sciences, Chang Gung University; 4Department of Biological Science and Technology, National Chiao Tung University, Taiwan

15:20~15:30

O5-2

PROINFLAMMATORY CYTOKINE AND LIGANDS DIFFERENTIALLY MODULATE PEROXISOME PROLIFERATOR-ACTIVATED RECEPTORS IN THE CARDIOMYOCYTES 1,3 1

T-I LEE, 1Y-S KAO, 4Y-C CHEN, 1,2Y-J CHEN

Graduate Institute of Clinical Medicine, College of Medicine,

Taipei Medical University, Taipei, Taiwan; 2Division of Cardiovascular Medicine, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan; 3Division of Endocrinology and Metabolism, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan; 4Department of Biomedical Engineering, National Defense Medical Center, Taipei, Taiwan － 41 －

15:30~15:40

O5-3

MITOCHONDRIAL SUPEROXIDE DISMUTASE POLYMORPHISM PRESENTATION IN TYPE 2 DIABETES MELLITUS 1,3

Y-H CHEN, 1,2S-L SU, 3L-S HSU, 4C-S LIU, 4C-L KUO,

C-S HUANG

Laboratory of General, Department of Medical Education and

Research, Changhua Christian Hospital; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital; 3Institute of Bichemistry and Biotechnology, Chung-Shan Medical University; 4Laboratory of Vascular & Genome, Department of Medical Education and Research, Changhua Christian Hospital 15:40~15:50

O5-4

EFFECTS OF RESISTIN ON BLOOD PRESSURE REGULATION IN RATS 1

TUNG-YUEH CHUANG, 2LO-CHUN AU,

1,2

SENG-WONG HUANG, 1,2CHI-CHANG JUAN,

1,2

LOW-TONE HO

Institutes of Physiology, National Yang-Ming University;

Department of Medical Research & Education, Taipei Veterans

General Hospital

Moderator：Shih-Li Su 15:50~16:00

O5-5

ARECOLINE IMPAIRS INSULIN SIGNALING PATHWAY AND LIPOGENESIS IN ADIPOCYTES 1

T-J HSIEH, 2P-C CHOU, 1,2S-J SHIN

Graduate Institute of Medical Genetics, Faculty of Medicine,

Kaohsiung Medical University, Kaohsiung, Taiwan; 2Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan － 42 －

16:00~16:10

O5-6

LOCAL RENIN-ANGIOTENSIN SYSTEM REGULATES ADIPOKINE EXPRESSION IN ADIPOCYTES 1,2

W-W HUNG, 3T-J HSIEH, 2P-C CHOU, 2K-D LIN,

P-J HSIAO, 2,3S-J SHIN

Department of Internal Medicine, Kaohsiung Municipal

Hsiao-Kang Hospital; 2Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital; 3

Graduate Institute of Medical Genetics, Faculty of Medicine,

Kaohsiung Medical University 16:10~16:20

O5-7

GREEN TEA (-)-EPIGALLOCATECHIN GALLATE INHIBITS INSULIN STIMULATION OF 3T3-L1 PREADIPOCYTE MITOGENESIS VIA THE 67-KILODALTON LAMININ RECEPTOR PATHWAY 1

H-C KU, 1H-C LIU, 2Y-W TSUEI, 2H-M CHAO,

C-H HUANG, 3C-L LIN, 1H-H CHANG, 1Y-H KAO

Department of Life Science, National Central University;

Armed Forces Tao-Yuan General Hospital; 3VIP Health

Management Center, Cathay General Hospital 16:20~16:30

O5-8

PLASMA PROTEIN PROFILING IN DIABETIC NEPHROPATHY PATIENTS BASED ON MAGNETIC PARTICLE BEADS SEPARATION AND MALDI-TOF MASS SPECTROMETRY 1

PAO-HSIU LIU, 1CHI-LIANG CHERN,

RAY H. LIU, 1HSIU-CHEN TENG,

SHUENN-JIUN YIIN, 3DAW-MING CHANG

Department of Medical Technology, Fooyin University;

Department of Nursing, Tajen University; 3Endocrine and

metabolism section, internal medicine, Ping-Tung Christian Hospital － 43 －

16:30~16:40

O5-9

ESTROGEN SUPPLEMENT AMELIORATES HIGH FRUCTOSE DIET FRUCTOSE-INDUCED INSULIN RESISTANCE IN OVARIECTOMY FEMALE RATS 1

CHING-HENG TING, 1SENG-WONG HUANG,

1,2 1

CHI-CHANG JUAN, 1,2LOW-TONE HO

Institute of Physiology, School of Medicine, National

Yang-Ming University; 2Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan

March 21~22, 2009 AM8:00~PM17:00 【Room 203】

Poster Presentation

Division of Endocrinology and Metabolism, Department of

Internal Medicine, Luodong Saint Mary's Hospital, Taiwan; 2

Department of pathology, Lotung Poh-Ai Hospital, Taiwan,

R.O.C. DP11-2 FALSE-POSITIVE GALLBLADDER UPTAKE IN BOTH POSTABLATIVE IODINE-131 WHOLE BODY SCAN AND F-18 FDG POSITRON EMISSION TOMOGRAPHY IN A CASE OF PAPILLARY THYROID CARCINOMA 1

S-L CHIU, 1Y-C LU, 1S-Y CHEN, 1H-H CHANG, 1K-T DENG

Division of Endocrinology and Metabolism, Department of

Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan, R.O.C.

－ 44 －

－ 45 －

DP11-6 ADRENAL INCIDENTALOMA IN A PATIENT PRESENTING WITH URINARY SYMPTOMS INITIALLY - ONE CASE REPORT OF CUSHING SYNDROME C LAM, 1C-L TSAI, 2H-L CHEN 1

Division of Endocrinology and Metabolism, Department of

I nt e r na lMe di c i ne , Tung s ’ Ta i c hungMe t r oha r borHos pi t a l , Taiwan, R.O.C; 2Depa r t me ntofUr ol ogy , Tung s ’Ta i c hung Metroharbor Hospital, Taiwan, R.O.C. DP12-1 EFFECTS OF CYTOKINES AND OXIDATIVE STRESS ON LIVER STEATOSIS IN CHRONICALLY HIGH FAT-FED RATS 1

C-C CHEN, 1Y-J LIN, 2Y-P HSU, 1C-Y LIN, 1X-Y LU,

1,2,3,4 1

L-T HO

Institute of Physiology, National Yang-Ming University,

Taiwan, R.O.C.; 2Department of Medical Research and Education; 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, R.O.C; 4Faculty of Medicine, National YangMing University, Taiwan, R.O.C. DP12-2 THE ROLE OF ENDOTHELIN-1 IN REVERSE CHOLESTEROL TRANSPORT IN MACROPHAGE 1

C-Y LIN, 1,4T-S LEE, 1C-C CHEN, 1,2,3,4L-T HO

Institute of Physiology, School of Medicine, National

Yang-Ming University, Taiwan, R.O.C.; 2Department of Medical Research and Education; 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, R.O.C.; 4Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C. － 46 －

DP12-3 EFFECT OF HYPOXIA ON INSULIN SENSITIVITY IN 3T3-L1 ADIPOCYTES 1

YU-HAN HUANG, 1,2CHI-CHANG JUAN,

1,2

LOW-TONE HO

Institute of Physiology, National Yang-Ming University;

Department of Medical Research & Education, Taipei Veterans

General Hospital DP12-4 HEXOSAMINE BIOSYNTHETIC PATHWAY REGULATES THE PRO-APOPTOSIS ACTIVITY OF FOXO1 IN HUMAN RENAL PROXIMAL TUBULAR CELLS 1

T-J HSIEH, 1P-C HSIEH, 1T LIN, 1,2S-J SHIN

Graduate Institute of Medical Genetics, Faculty of Medicine,

Kaohsiung Medical University, Kaohsiung, Taiwan; 2Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan DP12-5 RETINOL-BINDING PROTEIN INCREASE FIBROSIS AND APOPTOSIS IN HEK CELLS 1

C-H CHEN, 1C-S LO, 2P-J HSIAO, 1,2K-D LIN, 1T-J HSIEH,

1,2 1

Y-H CHANG, 1,2S-J SHIN

Graduate Institute of Medicine, Kaohsiung Medical University,

Taiwan; 2Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital,Kaohsiung Medical University, Kaohsiung, Taiwan

－ 47 －

DP12-6 HIGH GLUCOSE INDUCES ANP-SYNTHESIS VIA INTRARENAL RENIN-ANGIOTENSIN SYSTEM IN RENAL TUBULAR CELLS 2

C-S LO, 2C-H CHEN, 3T-J HSIEH, 1P-J HSAIO, 1,2K-D LIN,

1,3

S-J SHIN

Division of Endocrinology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 2Graduate Institute of Medicine, Kaohsiung Medical University, Taiwan; 3Graduate Institute of Medical Genetics, Kaohsiung Medical University, Taiwan DP12-7 THE ASSOCIATION OF TCF7L2 RS290487 WITH ALBUMINURIA IN TYPE 2 DIABETIC PATIENTS. 1,2

W-C CHUNG, 1,3C-L WANG, 1,3H-Y LIN, 1,2S-R HE,

1,3

K-D LIN, 1,3Y-H CHANG, 1P-J HSIAO, 1,2S-J SHIN

Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Taiwan, R.O.C.; 2Graduate Institute of Medical Genetics, Kaohsiung Medical University, Taiwan, R.O.C.; 3Graduate Institute of Medicine, Kaohsiung Medical University, Taiwan, R.O.C. DP12-8 DIABETES AND HOGG1 SER326CYS POLYMORPHISMS ARE INDEPENDENTLY ASSOCIATED WITH MULTI-VESSEL INVOLVEMENT IN CORONARY ARTERY DISEASE 1,3

C-L WANG, 2L-T LIN, 2S-H SHEU, 2W-T LAI, 1P-J HSIAO,

1,3

K-D LIN, 1,3H-Y LIN, 1,3Y-H CHANG, 1S-J SHIN

Division of Endocrinology and Metabolism1, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Taiwan, R.O.C.; 2Division of Cardiology, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Taiwan, R.O.C.; 3Department of Internal Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Taiwan, R.O.C. － 48 －

CHUAN CHUAN HSIAO, 2WEN WEI LIANG

Department of Nursing, DaChien Hospital; 2Department of

Endocrinology and Metabolism, DaChien Hospital DP22-2 THE RELATIONSHIP BETWEEN ANKLE-BRACHIAL INDEX, BRACHIAL-ANKLE PULSE WAVE VELOCITY AND QUANTITATIVE INDICES OF PULSE VOLUME RECORDING (%MAP, UPSTROKE TIME) AND CONVENTIONAL RISK FACTORS OF CARDIOVASCULAR DISEASE IN DIABETICS Y-Y CHEN, S-Y LIN, Y-M SONG, I-T LEE, W-J CHANG, L-N TSENG, Y-W YANG, W-C LIU, WAYNE H-H SHEU Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan, R.O.C. DP22-3 THE EFFECT OF AGE ON SERUM ALBUMIN LEVEL 1

CHIU LIEN HSIEH, 2WEN WEI LIANG

Department of Nursing, Dachien Hospital; 2Department of

Endocrinology and Metabolism, Dachien Hospital

－ 49 －

DP22-4 SEASONAL EFFECT ON PREVALENCE OF IMPAIRED FASTING GLUCOSE AND PREDITIVE POWER FOR FUTURE DIABETES SHU YU XUHU, WEN WEI LIANG 1

Department of Nursing, Dachien Hospital; 2Department of

Endocrinology and Metabolism, Dachien Hospital DP22-5 THE STATE AND CONTROL OF DYSLIPIDEMIA AMONG PERSONS WITH TYPE 2 DIABETES IN A PUBLIC MEDICAL CENTER IN TAIWAN 1

S-Y LIN, 1I-T LEE, 1L-N TSENG, 1Y-M SONG,

1,2 1

W-HH SHEU

Endocrinology and Metabolism, Department of Internal

Medicine, Taichung Veterans General Hospital, Taiwan; 2

Department of Internal Medicine, Taichung Veterans General

Hospital, Taiwan DP22-6 THE RESPONSE OF FIRST AND SECOND PHASE INSULIN SECRETION IN NEWLY DIAGNOSED TYPE 2 DIABETES MELLITUS FOLLOWING INITIAL TREATMENT W-Y MA, T-L HSIA, C-C SU, B-J LIN, 1C-Z WU, 2J-DI LIN, D PEI Division of Endocrinology, Department of Internal Medicine, Cardinal Tien Hospital, Xindian; Medical School, Catholic Fu Jen University, Taipei, Taiwan, R.O.C.; 1Division of Endocrinology and Metabolism, Department of Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; 2

Division of Endocrinology and Metabolism, Department of

Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan － 50 －

T-L HSIA, K-Y TSAI, 1B LIN, 2J-D LIN

Division of Endocrinology and Metabolism, Department of Internal Medicine, Shuang Ho Hospital, 2Wan Fang Hospital, Taipei Medical University; 1Cardinal Tien Hospital, Xindian; Medical School, Catholic Fu Jen University

－ 51 －

Y-H LIAO, 1C-J CHANG, 2Y-C LIN, 3S-C JHOU, 1T-I LEE,

J-D LIN, 1C FAN, 1W-H LEW

Division of Endocrinology and Metabolism, Department of

Internal Medicine, 2Department of Family Medicine, 3

Department of Occupational Medicine, Taipei Medical

University-Wan Fang Hospital, Taiwan, R.O.C. DP22-12 DEVELOPMENT OF A NEW MEASURE TO PREDICT THE ACCEPTANCE OF INITIATING INSULIN TREATMENT IN TYPE 2 DIABETIC PATIENTS 1

SHI-YU CHEN, 2PEI-JU LEE, 2YI-JEN HUNG,

HUI-CHUN HSU, 2SU-YIN FANG, 2CHIEN-HSING

CHIANG, 2JI-MEI LEE, 3SHYI-JANG SHIN, 2

YAU-JIUNN LEE

Tri-Service General Hospital, Taipei, Taiwan; 2Le e ’ s

Endocrinologic Clinic, Pingtung, Taiwan; 3Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

－ 52 －

DP22-13 APPLICATION OF TELECARE SYSTEM SERVICE IN THE DIABETES CARE 1

SHI-YU CHEN, 1SU-CHIUNG LIN,

CHANG-HSUN HSIEH, 1YI-JEN HUNG

Metabolic Syndrome Center, Tri-Service General Hospital,

Taipei, Taiwan DP22-14 EFFECT ON HbA1c WITH GLUCOMET AFTER SWITCHING FROM THE SAME DOSE OF GLYBURIDE CO-ADMINISTERED WITH METFORMIN- AN OBSERVATIONAL STUDY FROM A REGIONAL TEACHING HOSPITAL C-L TSAI, W-C HSU, 1W-S LIN Division of Endocrinology and Metabolism, Department of Internal medicine,1De pa r t me ntofNur s i ng , Tung s ’ Ta i c hung MetroHarbor Hospital, Taiwan DP22-15 SURVEILLANCE OF DETEMIR USE AT OPD IN BUDDHIST DALIN TZU CHI GENERAL HOSPITAL B-F CHEN, 1P-F CHEN Department of Pharmacy, Buddhist Da Lin Tzu Chi General Hospital, Taiwan, R.O.C; 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Buddhist Da Lin Tzu Chi General Hospital, Taiwan, R.O.C. DP22-16 BARRIERS TO ADHERENCE TO METFORMIN THERAPY IN TYPE 2 DIABETES MELLITUS Y-L LIANG, M-C LEE, 1S-H HSIAO, P-Y CHEN, H-C HUNG, H-Y OU, T-J WU Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan, R.O.C.; 1Department of Pharmacy, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan, R.O.C. － 53 －

DP22-17 CLINICALANALYSIS OF HEPATOCELLULAR CARCINOMA COMPLICATED WITH HYPOGLYCEMIA AT A SOUTHERN TAIWAN MEDICAL CENTER H-Y TSAI, C-M WU, H-J CHENG, S-J TSAI, H-K TSAI, C-C SUN, C-H CHU, C-C LU, J-K LEE, H-C LAM Division of Endocrinology and Metabolism, Department of Medicine, Veterans General Hospital-Kaohsiung, Taiwan, R.O.C. DP22-18 THE EFFECT OF PIOGLITAZONE ON METABOLIC CONTROL AND COMPLETE CELL COUNT IN DIABETIC PATIENTS WITH DIFFERENT ALBUMINURIA STAGE Y-H CHANG, K-D LIN, M-Y LEE, M-C HSEIH, P-J HSIAO, S-J SHIN Division of Endocrinology and Metabolism, Kaohsiung Medical University DP22-19 KLEBSIELLA PNEUMONIAE BACTEREMIA IN DIABETIC PATIENTS --- EXPERIENCE FROM A MEDICAL CENTER IN NORTHERN TAIWAN S-S TSAI, C-C WANG, J-H SUN, S-Y HUANG, Y-Y HUANG Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taiwan, R.O.C.

－ 54 －

DP22-20 LUNAR NEW YEAR PERIOD HAS NO EFFECT ON GLYCEMIC CONTROL IN PATIENTS WITH TYPE 1 DIABETES MELLITUS 1

MING-YAN TSAI, 2YI-LIN LIANG, 2HORNG-YIH OU,

HAO-CHANG HUNG, 2SHU-HWA HSIAO,

PEI-YIN CHEN, 2TA-JEN WU

National Cheng Kung University Medical College and Hospital, Tainan, Taiwan, 1Nursing Department 2Division of Endocrinology and Metabolism, Department of Internal Medicine, 3Department of Pharmacy DP22-21 ASYMPTOMATIC PYURIA IN FEMALE PATIENTS WITH TYPE 2 DIABETES MELLITUS 1

P-Y CHEN, 2S-H HSIAO, 1Y-L LIANG, 1H-C HUNG,

H-Y OU, 1T-J WU

Division of Endocrinology and Metabolism, Department of

Internal Medicine, and 2Department of Pharmacy, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan DP22-22 A SURVEY OF IMPAIRED-FASTING GLUCOSE, IMPAIRED GLUCOSE TOLERANCE AND DIABETES IN ELDERLY 1

CHIH-KUAN LIN, 2YI-SUN YANG, 2CHIEN-NING HUANG

Division of Nephrology, 2Division of Endocrinology &

Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan

－ 55 －

YI-SUN YANG, 1CHIEN-NING HUANG,

SHIH-TING TSENG

Division of Endocrinology & Metabolism, Department of

Internal Medicine, Chung Shan Medical University Hospital; 2

Division of Endocrinology and Metabolism, Department of

Internal Medicine, Kuang Tien General Hospital, Shalu, Taichung, Taiwan

－ 56 －

DP22-26 PREVALENCE OF ANEMIA AND CLINICAL FEATURES OF PATIENTS WITH DIABETIC KIDNEY DISEASE 1 TERRY TING-YU CHIOU, 1CHIEN-TE LEE, RUE-TSUAN LIU Devision of Metabolism,1Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Chang Gung University College of Medicine, Taiwan DP22-27 INSULIN TREATMENT SATISFACTION AMONG PATIENT WITH TYPE 2 DIABETES 1 HUI-CHUN HSU, 1PEI-JU LEE, 2SHI-YU CHEN, 2YI-JEN HUNG, 1KUN-CHENG LIN, 1SU-YIN FANG, 1YU-CHIEN LIN, 1YEN-CHUN LIN, 1CHIEN-HSING CHIANG, 1JI-MEI LEE, 3SHYI-JANG SHIN, 1YAU-JIUNN LEE 1 Lee's Endocrinologic Clinic; 2Division of Endocrinology and Metabolism, Dep. of Internal Medicine, Tri-service General Hospital; 3Division of Endocrinology and Metabolism, Dep. of Internal Medicine, Kaohsiung Medical University DP22-28 ASSOCIATION OF INSULIN-LIKE GROWTH FACTOR I WITH METABOLIC SYNDROME IN TAIWANESE ELDERLY Y-H YAN, S-C HUA, H-I YU, T-S TAI, C-H LU Division of Endocrinology and Metabolism, Department of Internal Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan. DP22-29 LUNAR NEW YEAR PERIOD HAS AN EFFECT ON GLYCEMIC CONTROL IN PATIENTS WITH TYPE 2 DIABETES MELLITUS 1 H-Y OU, 1H-C HUNG, 2M-Y TSAI, 3S-H HSIAO, 1 Y-L LIANG, 1P-Y CHEN, 1T-J WU 1 Division of Endocrinology and Metabolism, Department of Internal Medicine and 2Nursing Department; 3Department of Pharmacy, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan

－ 57 －

－ 58 －

EP21-3 HYPOKALEMIC PARALYSIS IN A YOUNG WOMAN WITH THYROTOXICOSIS AND PRIMARY HYPERALDOSTERONISM W-N TSAI, 1S-Y LIN, 1L-N TSENG, 1Y-M SONG, 1I-T LI, 1,2

WAYNE H-H SHEU

Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan, R.O.C.; 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan, R.O.C.; 2 Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan, R.O.C. EP21-4 A CASE OF ALDOSTERONE-PRODUCING ADRENOCORTICAL ADENOMA ASSOCIATED WITH A PROBABLE POST-OPERATIVE ADRENAL GLUCOCORTICOID INSUFFICIENCY P-W CHANG, Y-M SONG, W. H-H SHEU Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan, R.O.C. EP21-5 REVERSIBLE DILATED CARDIOMYOPATHY IN THYROTOXICOSIS-A CASE REPORT Y-L LU, S-Y LIN, W. H-H SHEU Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan, R.O.C.

－ 59 －

Y-H LIAO, 1C-J CHANG, 2J-N CHEN, 1T-I LEE, 1J-D LIN,

C FAN, 1W-H LEW

Division of Endocrinology and Metabolism, Department of

Internal Medicine, 2Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University-Wan Fang Hospital, Taiwan, R.O.C. － 60 －

－ 62 －

EP21-17 COLOR DOPPLER SONOGRAPHY OF NECK IN A PATIENT WITH BILATERAL CAROTID BODY TUMORS: A CASE REPORT 1

H-J CHENG, 1H-K TSAI, 1,2C-H CHU, 1C-C LU,

P-C WANG, 4S-J LIN, 1C-C SUN, 1M-C WANG, 1,5J-K LEE,

M-J CHUANG, 1H-C LAM

Division of Endocrinology and Metabolism, Kaohsiung

Veterans General Hospital; 2Tzuhui Institute of Technology; 3

Department of Radiology, Kaohsiung Veterans General

Hospital; 4Division of Hematology, Kaohsiung Veterans General Hospital; 5Laboratory of Biochemistry, Kaohsiung Veterans General Hospital

March21~22, 2009 AM8:00~PM17:00 【Room 203】

2008 Award Winners Professor Fang-Wu Chen Outstanding Research Award

AP-1

THE EPIDEMIOLOGIC TRANSITION OF TYPE 2 DIABETES MELLITUS IN TAIWAN: IMPLICATIONS FOR A REVERSAL OF FEMALE PREPONDERANCE FROM A NATIONAL COHORT C-H Tseng Department of Internal Medicine, National Taiwan University College of Medicine; Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital; Department of Medical Research and Development, National Taiwan University Hospital Yun-Lin Branch, Taiwan － 63 －

Merck Sharpe & Dohme Award AP-2

EXENDIN-4 TREATMENT EXPANDS GRAFT -CELL MASS IN DIABETIC MICE TRANSPLANTED WITH A MARGINAL NUMBER OF FRESH ISLETS J-H Juang, 1C-H Kuo, C-H Wu, C Juang Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung University and Memorial Hospital, Taoyuan; 1Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, ROC

AP-3

THE NEGATIVE CORRELATION BETWEEN PLASMA ADIPONECTIN AND BLOOD PRESSURE DEPENDS ON OBESITY: A FAMILY-BASED ASSOCIATION STUDY IN SAPPHIRE 1,2 H-Y Li, 3Y-F Chiu, 4C-M Hwu, 5W H-H Sheu, 6Y-J Hung, 7 W Fujimoto, 8T Quertermous, 7J. D Curb, 1T-Y Tai and 1,2,9 L-M Chuang 1 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 2Graduate Institute of Clinical Medicine, Medical College, National Taiwan University, Taipei, Taiwan; 3Division of Biostatistics and Bioinformatics, National Health Research Institutes, Taipei, Taiwan; 4Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan; 5Division of Endocrinology and Metabolism, Taichung Veterans General Hospital, Taichung, Taiwan; 6Department of Medicine, Tri-Service General Hospital, Taiwan; 7Pacific Health Research Institute, Honolulu, HI, USA; 8Stanford University School of Medicine, Stanford, CA, USA; 9Graduate Institute of Preventive Medicine, National Taiwan University School of Public Health, Taipei, Taiwan － 64 －

Pfizer Award AP-4

PPAR-GAMMA TRANSACTIVATION-MEDIATED POTENTIATION OF GLUCOSE UPTAKE BY BAI-HU-TANG 1,2

Ching-Chu Chen, 3Chien-Yun Hsiang, 4An-Na Chiang,

Hsin-Yi Lo, 6Chia-Ing Li

Division of Endocrinology and Metabolism, Department of

Medicine, China Medical University Hospital; 2Department of Endocrinology and Metabolism, College of Chinese Medicine, China Medical University; 3Department of Microbiology, School of Medicine, China Medical University. Taichung, Taiwan; 4Institute of Biochemistry and Molecular Biology, National Yang-Ming University, Taipei, Taiwan; 5Department of Nuclear Medicine and PET Center; 6Department of Medical Research, China Medical University Hospital, Taichung, Taiwan AP-5

BENEFICIAL EFFECTS OF INSULIN ON GLYCEMIC CONTROL AND ß-CELL FUNCTION IN NEWLY DIAGNOSED TYPE 2 DIABETES WITH SEVERE HYPERGLYCEMIA AFTER SHORT-TERM INTENSIVE INSULIN THERAPY 1,3

Harn-Shen Chen, 3Tzu-En Wu, 2,3Tjin-Shing Jap,

Li-Chuan Hsiao, 1Shen-Hung Lee, 1,3Hong-Da Lin

Division of Endocrinology and Metabolism, Department of

Medicine; 2Section of Biochemistry, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital; 3

National Yang-Ming University School of Medicine, Taipei,

Taiwan, R.O.C. － 65 －

Outstanding Article Award AP-6

APPROPRIATE IMPAIRED FASTING GLUCOSE LEVEL IN TAIWAN 1

Yun Ru Chen, 2Wen-Wei Liang

Department of Nursing, DaChien Hospital, Miaoli, Taiwan;

Department of Endocrinology and Metabolism, DaChien

Hospital, Miaoli, Taiwan.

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PL-1 GLUCOCORTICOIDS AND CARDIOVASCULAR DISEASE Brian R Walker Endocrinology Unit, Centre for Cardiovascular Science, University of Edinburgh, UK Similarities between the me t a b o l i cs y nd r o mea n dCu s h i ng ’ ss y nd r o me ,a n dr e v e r s i b i l i t y o ft h ef e a t u r e so fCu s h i n g ’ ss y n d r o me ,s u g g e s tt h a tc o r t i s o lma yc o n t r i b u t et op a t h o p hy s i o l o gy in both conditions and that reducing cortisol action may provide a novel therapeutic approach in metabolic syndrome. There is substantial evidence that circulating cortisol concentrations are higher in people with hypertension and glucose intolerance. The basis for this activation of the hypothalamic-pituitary-adrenal (HPA) axis remains uncertain, but recent data supports de f e c t i vene g a t i vef e e dba c kc ont r ol ,pe r ha psa t t r i but a bl et o‘ pr og r a mmi ng’e f f e c t sofe ve nt s in early life, since it is associated with low birth weight. In people who become obese, intracellular cortisol levels within adipose tissue are further amplified by increased local re-generation of cortisol by the enzyme 11-HSD type 1. Recent evidence highlights the role of nutrition and inflammation in regulating 11HSD1 in rodents and humans. In mice, transgenic manipulations of 11-HSD1 have potent effects on obesity and associated features of the metabolic syndrome. Promising preclinical data suggest that novel 11-HSD1 inhibitors will have a role in lowering intra-cellular cortisol levels as a treatment for metabolic syndrome. In addition to their metabolic effects, glucocorticoids act in the blood vessel wall. Pharmacoepidemiological studies suggest that glucocorticoid excess is an independent risk factor for cardiovascular disease. Recent data in rodents suggest that 11-HSD1 within the blood vessel wall influences vascular remodelling and angiogenesis, for example in the myocardium following coronary artery occlusion. Thus, HPA axis hyperactivity may provide a lifelong susceptibility to metabolic syndrome which is amplified by altered cortisol metabolism in obesity. Glucocorticoid signalling provides a potentially tractable system to influence both risk factors for, and the outcome of, type 2 diabetes and cardiovascular disease.

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PL-2 EARLY STAGES OF THYROID AUTOIMMUNITY Wilmar M. Wiersinga Dept. of Endocrinology & Metabolism, Academic Medical Center, Amsterdam, Netherlands Early stages of thyroid autoimmunity can be identified by thyroid hypoechogenecity and/or thyroid antibodies in serum. To get better insight in these early stages we assembled a large group of women at risk for AITD (all had one or more 1st or 2nd degree relatives with AITD), who were in self-proclaimed good health and followed for 5 yr (the Amsterdam AITD cohort). At study entrance, euthyroid women had reduced CD25 expression on CD4+ T-cells and lower serum sIL-2R, irrespective of the presence of TPO-Ab. The findings suggest an early defect in CD4+CD25+ Treg, which contributes to breaking immunological tolerance. Stress exposure was similar in TPO-Ab positive and negative women.Yersinia enterocolitica antibodies were more prevalent in AITD relatives than in controls, irrespective of thyroid function or antibodies. Current smoking and the ever use of estrogens protected against TPO-Ab at baseline. In the 5-yr follow-up discontinuation of smoking likewise increased the risk of de novo occurrence of TPO-Ab. The cumulative event rate of overt hypo- or hyperthyroidism was 7.5% over 5 yr. Independent risk factors for events were baseline findings for TSH (risk starting already at values >2.0 mU/L), TPO-Ab (>100 kU/L) and family background (having two relatives wi t hHa s hi mot o’ sdi s e a s ewa sa s s oc i a t e dwi t hhi g he rr i s k) .We i g hi ngt he s et hr e er i s k factors proportionately to their relative risks provided the predictive THEA (Thyroid Events Amsterdam) score, which gives a rather accurate estimate of the 5-yr risk on developing overt hypo- or hyperthyroidism in female relatives of AITD patients.

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PL-3 MOBILISING THE RESOURCES TO ADDRESS THE DIABETES EPIDEMIC Martin Silink University of Sydney President, International Diabetes Federation In 2006 the International Diabetes Federation led the campaign which resulted in the United Nations (UN) unanimously adopting the UN Resolution on Diabetes (Resolution 61/225). Diabetes joined AIDS as the only other disease to have its own UN Resolution. For the first time, all Governments recognized that diabetes posed severe risks for the entire world. The Resolution declared the current World Diabetes Day, November 14, a UN World Day and encouraged all Member States to develop national programs for the prevention, care and treatment of diabetes in line with sustainable development of their health-care systems. Type 2 diabetes is projected to affect 380 million people by 2025 with the largest increase in diabetes taking place in developing and middle income countries. It is the fourth leading cause of death by disease globally and is estimated to have caused 3.8 million deaths worldwide in 2007 about the same as HIV/AIDS and malaria combined. In Mexico, diabetes is now the leading cause of death. By 2025, the number of adults with diabetes in China and India is expected to reach 59 and 70 million, respectively. Type 1 diabetes is also increasing at approximately 3% per annum (5-6% in the very young). It presents a particular threat to children in poor countries; a child with type 1 diabetes survives less than 12 months in Mali and 4 years in Mozambique. The devastating human, social and economic effects and the dramatic increases in prevalence underscores the urgent need to address the diabetes epidemic, especially in developing and transitional countries. The increased political momentum following the passage of UNR 61/225, the existence of an increasingly coordinated global diabetes community and the availability of cost-effective interventions create a window of opportunity to mobilize world action against this still largely under-recognized threat to world health.

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MP-1 MINERALOCORTICOID REPLACEMENT THERAPY Brian R Walker Endocrinology Unit, Centre for Cardiovascular Science, University of Edinburgh, UK Mineralocorticoid deficienc yi sr a r e ,us ua l l yoc c ur r i ngi npa t i e nt swi t hAddi s on’ s disease or congenital adrenal hyperplasia. The diagnosis is usually straightforward, involving demonstration of an elevated plasma renin concentration or activity with a low- normal plasma aldosterone .‘ Hy p o r e n i n a e mi ch y p o a l d o s t e r o n i s m’a l s oo c c u r s ,u s u a l l ya sac o mp l i c a t i o n of diabetic nephropathy. Aldosterone resistance syndromes (pseudohypoaldosteronism) are extremely rare. Unlike glucocorticoid deficiency, mineralocorticoid deficiency does not occur in patients with pituitary disease. Mineralocorticoid replacement therapy aims to restore sodium balance. This can be achieved in the short term with intravenous saline and/or oral sodium loading. In the longer term, however, most patients are treated with steroids which activate mineralocorticoid receptors (MR). Although cortisol (or hydrocortisone) and, to a lesser extent, prednisolone do bind to MR, they are usually prevented from doing so because they are inactivated in the distal nephron by the enzyme 11-HSD2. Aldosterone is difficult to manufacture in large quantities and has poor pharmacokinetics. However, fludrocortisone (or 9-fluorohydrocortisone) is protected from metabolism by 11-HSD2 and thereby gains access to MR and has improved pharmacokinetics. Inadequate replacement therapy may result in persisting postural hypotension, hyperkalaemia, and hyponatraemia. Excessive mineralocorticoid replacement results in hypertension, hypokalaemia and oedema and may contribute to the increase in cardiovascular di s e a s ewhi c hoc c ur sa mong s tpa t i e nt swi t hAddi s on’ sdi s e a s e .Fl udr oc or t i s onei sus ua l l y given in doses between 50-200 microg/day as a single daily dose, titrated against plasma renin and clinical indices of sodium balance. Surprisingly, however, normalisation of plasma renin is often associated with evidence of mineralocorticoid excess, so the target renin value is usually just above the upper limit of the normal range. In patients receiving hydrocortisone or cortisone therapy there may be a contribution to MR activation from these steroids as well as from fludrocortisone. Doses may need to be adjusted during sodium loss, for example in the summer in hot climates. Patients with co-existing essential hypertension can be difficult to manage. Some specialists recommend reducing mineralocorticoid replacement therapy while others introduce conventional antihypertensive agents. － 70 －

MP-2 MANAGEMENT OF GRAVES’ORBI TOPATHY Wilmar M. Wiersinga Dept. of Endocrinology & Metabolism, Academic Medical Center, Amsterdam, Netherlands DI AGNOSI SofGr a ve s ’or bi t opa t hy( GO)i sus ua l l ys t r a i g ht f or wa r da smos tpa t i e n t s pr e s e ntwi t hbi l a t e r a ls y mme t r i ce y ec ha ng e si nt hes e t t i ngofGr a ve s ’hy pe r t hy r oi di s m. However, atypical cases occur such as unilateral or euthyroid GO. Diagnosis of GO is thus established along three lines: 1. Are the eye changes compatible with GO? None of the eye changes is specific for GO, and there is a differential diagnosis also for bilateral eye changes. 2. Is there evidence of thyroid autoimmunity? Particularly important in euthyroid GO patients, in whom fortunately TBII in serum is almost always present. 3. Exclusion of an alternative diagnosis by orbital imaging, which is specifically indicated in case of unilateral eye changes, in euthyroid patients, and when dysthyroid optic neuropathy (DON) is suspected. A disease-specific quality-of-life questionnaire, called the GO-QoL, is available in several languages (to be downloaded for free from www.eugogo.com) and can be used as an independent outcome measurement in clinical trials. TREATMENT of GO is best done in combined thyroid-eye clinics in view of the multidisciplinary approach required in most patients. Treatment schematically should be instituted along three lines: 1. To stop smoking. Smoking is associated with more severe GO and less favourable response to immunosuppression. Smokers have a four times higher risk of progression of eye changes after 131I treatment than nonsmokers. 2. To restore and maintain euthyroidism. Restoration of euthyroidism is associated with slight improvement of soft tissue changes and eye muscle motility. Whereas antithyroid drugs and thyroidectomy appear rather neutral with respect to the eye changes, 131I treatment carries a definite risk for developing or worsening of eye changes which can be prevented by co-administration of steroids. Oral prednisone should especially be considered if risk factors are present, which are smoking, severe hyperthyroidism, active GO and high TBII. TBII levels increase after 131I, － 71 －

and remain high for many years. TBII levels have a certain prognostic value for the subsequent course of GO. It has not been demonstrated conclusively that total thyroidectomy/total ablation (in an attempt to get rid of all thyroid antigens) is favourable for the eyes. 3. To treat the eye changes. In any stage of GO, complaints can be relieved by a liberal use of artificial tear drops, sunglasses or prisms. EUGOGO has recently published a consensus statement on the management of GO (European Journal of Endocrinology 2008; 158: 273). Treatment is according to disease severity and disease activity, measured fast and simple by the clinical activity score (CAS). DON is an emergency requiring immediate action. Preferred treatment is with intravenous methylprednisolone pulses; if visual functions do not improve after two weeks, an urgent surgical decompression is required. MILD GO is probably best managed by a wait-and-see policy in view of the tendency to spontaneous improvement in the natural course of the disease. Orbital irradiation can be considered if the patient suffers from double vision. MODERATELY SEVERE GO may call for immunosuppression if the disease is still active. Intravenous methylprednisolone pulses are more effective than oral prednisone, but the cumulative dose of steroids should not exceed 8 gram. Response rate is about 70%, but flare-up of eye changes after discontinuation of steroids is not uncommon. Under these circumstances one may opt to give combination treatment (e.g. 20 mg prednisone daily orally with either cyclosporine or orbital irradiation). Treatment with monoclonal antibodies against cytokines or rituximab is in its infancy. If the disease has become inactive, rehabilitative surgery can be done, in the sequence of first surgical decompression, followed by eye muscle surgery and finally eyelid surgery.

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MP-3 DIABETIC KETOACIDOSIS (DKA) –ALWAYS A CHALLENGE Martin Silink President, International Diabetes Federation; Professor of Paediatric Endocrinology, Universi t yofSy dne y .I ns t i t ut eofPa e di a t r i cEndoc r i nol ogy ,Chi l dr e n’ sHos pi t a la t Westmead, Sydney, Australia Diabetic ketoacidosis remains the most severe acute complication of Type 1 diabetes. In most industrialized countries 15-30% newly diagnosed children present in ketoacidosis whilst in developing countries more than 80% present with DKA with many being misdiagnosed. Public health messages through schools and family practitioners have been shown to be able to reduce the prevalence of DKA at diagnosis to zero. DKA occurs when there is a gross deficiency of insulin action due to insulin deficiency and/or insulin resistance. Under these circumstances, ketone acid production (aceto-acetic and beta-hydroxybutyric) rises to several hundred mmol/ day overwhelming physiological homeostatic systems. Management of DKA includes correction of: shock, dehydration, electrolyte deficits, hyperglycaemia, acidosis and sepsis (if present). Warning signs of possible problems include: Severe dehydration, shock, pH < 7.0, low potassium, hypernatraemia, hyperosmolality, extremely high BGL, hyperlipidaemia, deterioration in consciousness and DKA in very young patients. The principles of treatment include (i) Admission to ICU (ii) Treatment of shock (iii) Rehydration over 24-72 hours, (iv) Normal Saline for rehydration unless calculated sodium indicates hypernatraemia (Na > 150) when N/2 Saline should be used, (v) Avoidance of Bicarbonate unless pH is very low, (vi) Insulin infusion (initial dose 0.1 unit/kg/hour with adjustments to achieve a fall in BGL of 90 mg/dl/hr (5 mmol/hour)), (vi) Potassium, (vii) Treatment of any complications such as cerebral oedema (3% Saline, IV Mannitol, intubation and hyperventilation, fluid restriction, Dexamethasone), (viii) Changeover to subcutaneous insulin when food intake established and acidosis controlled. Illustrative cases will be presented for discussion.

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SL-1 MULTIFUNCTIONAL NATURE OF VASCULAR ADHESION PROTEIN-1 (VAP-1) IN THE DEVELOPMENT OF DIABETES AND ITS VASCULAR COMPLICATION Jalkanen Sirpa Tuulikki University of Turku, Turku, Finland Vascular Adhesion Protein-1 is an inducible adhesion molecule that is translocated onto the endothelial cells upon inflammation. It mediates leukocyte extravasation from the blood into the tissues. Besides being an adhesin, it is also an enzyme catalysing oxidative deamination of a primary amine to an aldehyde while hydrogen peroxide and ammonium are released in the reaction. Aldehydes produce aberrant glycosylation of proteins leading to advanced glycation end (AGE) product formation that causes vascular damage. Hydrogen peroxide, on the other hand, up-regulates other adhesion and signaling molecules as well as certain transcription factors modifying the inflammatory microenvironment. Diabetic patients have increased levels of soluble VAP-1 and the levels correlate positively with macroscopic and microscopic vasculopathies. Using gene-deficient and transgenic animals we have shown that VAP-1 is not a consequence but rather a cause for diabetic complications. It is involved in the trafficking of diabetic lymphocytes into the pancreas at the early phase of the disease and later in the development of vascular complications. Thus, VAP-1 may be a potential drug target to prevent diabetes in a pre-diabetic phase and also its vascular complications later in the disease.

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SL-2 SIADH AND CEREBRAL SALT WASTING: PATHOGENESIS, DIAGNOSIS, AND TREATMENT Joseph A. Majzoub Professor of Pediatrics and Medicine, Harvard Medical School, Boston, MA, USA Plasma osmolality is tightly regulated because of its importance to intracellular and intercellular functions, and because it regulates cell shape. Vasopressin regulates plasma osmolality by increasing the reabsorption of water by the kidney (anti-diuresis). Vasopressin secretion is increased by either osmotic stimuli (hyperosmolality) or by hypovolemia/ hypotension. When hypovolemia, due either to dehydration or to decreased effective blood volume (congestive heart failure, cirrhosis, nephrotic syndrome, etc.) is the sole stimulus and is accompanied by excessive water intake, hyponatremia will result. This is the cause of hyponatremia in >90% of cases. Much less common is the syndrome of inappropriate ADH secretion (SIADH). It is usually caused by neoplasms (small cell lung, pancreas, thymus), and brain hemorrhage. Following traumatic brain injury, cerebral salt wasting (CSW) is postulated to cause hyponatremia due to the release from the brain of natriuretic peptides, which cause renal salt loss, dehydration, elevation of vasopressin, and hyponatremia. The evidence for the existence of CSW is not clear. Most often, the explanation for hyponatremia is either SIADH or dehydration. To correctly diagnose the cause of hyponatremia, volume status, fluid intake and output, and urine sodium should be carefully measured. Low blood volume and low urine sodium suggest dehydration, whereas high blood volume and high urine sodium suggest SIADH, and low blood volume with high urine sodium would suggest CSW. Treatment of hyponatremia depends on the cause: dehydration and CSW are both treated with volume and salt replacement, while SIADH is treated by restricting water intake. In the near future, vasopressin receptor antagonists (vaptans) will be available to treat SIADH.

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S1-1 SIGNIFICANCE OF POSTPRANDIAL GLUCOSE AND RELATION TO CARDIOAVSCULAR DISEASE Chih-Yuan Wang Department of Internal Medicine, Far-Eastern Memorial Hospital In conventional epidemic of Diabetes Mellitus, the therapeutic strategies usually try to treat or prevent chronic complications. The chronic complications could be divided into two entities, one is macrovascular, and the other is microvascular complication. Particularly, cardiovascular disease is the chief cause of morbidity and mortality in diabetic patients. The latent stage of cardiovascular disease may correlate to insulin resistance and postprandial hyperglycemia, which may begin 10 years before the onset of Diabetes Mellitus. Increasing evidence suggests that the fluctuated postprandial hyperglycemia is a contributing factor for development of atherosclerosis. In diabetes, the postprandial hyperglycemia is defined by a rapid increase in blood glucose levels, and the postprandial hyperglycemic fluctuating may be relevant to the onset of cardiovascular complications. Epidemiological studies and preliminary intervention studies have shown that fluctuated postprandial hyperglycemia is a direct and independent risk factor for cardiovascular disease. The majority of cardiovascular risk factors are directly enhanced by an acute increase of glucose. Controlling the postprandial hyperglycemia may become the important therapeutic strategy for the prevention and management of cardiovascular diseases in type 2 diabetes. On the other hand, more epidemiological studies discussed aspects of the link between insulin resistance, abnormal glucose tolerance, and cancer. A number of studies have bolstered the evidence of association of diabetes mellitus/hyperinsulinemia with breast cancer, colorectal cancer, prostate cancer, lung cancer and pancr e a t i cc a nc e r …e t c .For example, normal mammary epithelial cells express insulin receptors, which are increased in breast cancer cells. Overexpression of insulin receptors in normal breast epithelial cells results in a transformed phenotype. Meanwhile, insulin is a well-known mitogen for cultured breast cancer cells, and can act via the IGF-I receptor, insulin receptor, and hybrid receptors, all of which are expressed by breast tumors. Therefore, we may assume that early control of fluctuated glucose level may improve hyperinsulinemia and insulin resistance, and further prevent the possible transformation of various cancer cells. In Taiwan, type 2 diabetes mellitus related complications and cancer are two main entities for disease mortality in general population. Under the results of recent research, we should pay more attention to control fluctuated postprandial glucose for its complications, especially for cardiovascular protection. － 76 －

S1-2 HOW TO CONTROL AND MONITOR POSTPRANDIAL GLUCOSE LEVELS Yi-Jen Hung Division of Endocrinology & Metabolism, Tri-Service General Hospital, Taipei, Taiwan Postmeal hyperglycemia occurs early in the development of diabetes, progressively worsens with deteriorating HbA1c and is often inadequately controlled. It is well known that postmeal hyperglycemia is not only related to the development and progression of diabetic microvascular disease, but also to macrovascular complications. Based on evidence to date, the guideline recommends implementing a comprehensive management program that targets both postmeal and fasting glucose, which should be initiated simultaneously at any HbA1clevels to improve outcome in diabetes. A variety of both non-pharmacological and pharmacological therapies should be considered to target postmeal plasma glucose. Under the postmeal guidelines developed through the direction of the IDF, nutritional interventions, physical activity and weight control remain the cornerstones of effective diabetes management, especially in postmeal hyperglycemia. A number of therapeutic agents that preferentially lower postmeal plasma glucose are currently available. These ther a pi e si nc l udeα-glucosidase inhibitors, glinides (rapid-acting insulin secretagogues), rapid-acting insulin, biphasic (premixed) insulins, inhaled insulin and human regular insulin. In addition, newer classes of therapies have emerged that are also associated with a reduction in postmeal glucose excursions and improvement in HbA1c. These agents include amylin analogues, glucagon-like peptide-1 (GLP-1) derivatives and dipeptidyl peptidase-4 (DPP-4) inhibitors, which address deficiencies in pancreatic and gut hormones that affect insulin and glucagons secretion, satiety and gastric emptying. A 2-h postmeal goal of < 7.8 mmol/l (< 140 mg/dl) is recommended, in line with targets published in guidelines from several associations. Such guidelines define normal glucose tolerance as post-challenge values of < 7.8 mmol/l 2 h after ingestion of a 75-g glucose load, corresponding to postmeal values of healthy individuals after meals. The 2-h time frame for testing is also in agreement with published guidelines and in addition reflects the 2- to 3-h return of postmeal hyperglycaemia to basal levels in individuals with normal glucose tolerance The guideline from IDF encourages performing glucose monitoring as frequently as needed in order to guide therapy to achieve postmeal glucose targets. In particular, the － 77 －

guideline suggests considering self-monitoring of blood glucose (SMBG), as it is the only way to directly assess postmeal glucose. Self-monitoring is performed at least three times daily in individuals treated with insulin and according to treatment regimen and level of glycaemic control in non-insulin treated diabetes. What is more, the use of structured SMBG appears to result in a significant reduction in HbA1c, even in individuals with non-insulin requiring diabetes. These findings support the implementation of SMBG as part of a structured program that may involve the training of clinicians and patients to accurately interpret results and adjust therapy accordingly in a timely manner.

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S1-3 DIETARY CONTROL OF POSTPRANDIAL GLUCOSE LEVELS Hsiu-Yueh Su Department of Dietetics, Taipei Medical University Hospital The worldwide prevalence of type 2 diabetes mellitus is growing rapidly. Although glycated hemoglobin (Hb A1C) is a standard assessment tool to assess glucose control in type 2 diabetes, postprandial glucose (PPG) peaks were implicated as a risk factor for microvascular and macrovascular complications. Endothelial dysfunction and activation of the coagulation are likely to be initial steps involved in producing carotid thickening and atherosclerosis. The ADA does state that an understanding of the relation between CVD events and treatments focused at explicitly lowering PPG is critical to reduce mortality as a consequence of CVD. Large postprandial glucose peaks are associated with increased risk of diabetic complications and cardiovascular disease. Numerous studies indicate that postprandial metabolic derangements, most notably hyperglycemia and hypertriglyceridemia, which increases in direct proportion to the increases in glucose and triglycerides after a meal. Drugs that have been effective in reducing meal related glucose excursions, but lifestyle and dietary factors play a central role in the etiology of post-prandial dysmetabolism. Sedentary behavior worsens insulin resistance and magnifies the post-prandial excursions of glucose and triglycerides. The Mediterranean and Japanese diets, which are rich in minimally processed natural foods that are low in caloric density but high in nutrients density, have been associated with improved CV health and longevity. Improvements in diet exert profound and immediate favorable changes in the post-prandial dysmetabolism. Minimizing carbohydrate at breakfast and shifting it to the lunch meal may provide lower diurnal glucose excursions. Specifically, a diet high in minimally processed, high-fiber, plant-based foods such as vegetables and fruits, whole grains, legumes, and nuts will markedly blunt the post-meal increase in glucose, triglycerides, and inflammation. Additionally, lean protein, vinegar, fish oil, tea, cinnamon, calorie restriction, weight loss, exercise, and low-dose to moderate-dose alcohol each positively impact post-prandial dysmetabolism.

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S2-1 AGING AND ANTI-AGING-OVERVIEW AND THE ROLE OF GROWTH HORMONE REPLACEMENT THERAPY Tien-Chun Chang Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan Aging is the process that converts fit adults into frailer adults with a progressively increased risk of illness, injury, and death. The theory of aging includes various aspects, e.g. shortening of telomere, injury by free radicals, deposition of lipofuscin on the cell membrane, cross-linking between glucose and protein or DNA, and the decrease of hormones. From the above theories of aging, various ways of anti-aging were developed. The reproducible anti-aging method is caloric restriction which results in the decrease of free radicals. Another method is the control of blood glucose to reduce the complications of diabetes mellitus. The value of use of anti-oxidants, e.g. vitamins C and E to prolong life is not well confirmed. Various hormones are decreased with aging, e.g. growth hormone (GH) and insulinlike growth factor-1, dehydroepiandrostenedione (DHEA), testosterone, estrogen and progesterones. Although growth hormone replacement in the normal aging adults is widely used to try decreasing the frailty, it has no effects on muscle strength and cognitive function, but administration leads to frequent adverse events. The risks of GH far outweigh the benefits when used as an anti-aging treatment in healthy older adults. However, treatment with GH in GH-deficient adults due to pituitary disease is beneficial in the quality of life. In males, total body fat drops dramatically, and lean body mass improvement can be sustained while on GH, whereas women do not appreciably change body fat mass.

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S2-2 THE IMMUNOLOGICAL IMPACT OF STEROID HORMONE Bor-Ching Sheu Department of Obstetrics and Gynecology, College of Medicine and the Hospital, National Taiwan University, Taipei, Taiwan Interactions of hormones & immune cells are complicated. The gender differences in the immune modulation have been widely proposed. Generally, both estrogens and androgens have roles in the gender differences in immunity and autoimmunity. The most salient gender difference in the immune system is the markedly increased incidence of autoimmune disease in females, compared with males. Females generally display higher serum Ig levels, develop higher antibody titers to a variety of antigens, reject allografts more rapidly, and display a reduced incidence of certain tumors. The brain-pituitary-reproductive axis and the brain-thymus-lymphoid axis also play major influences in the hormone-immune regulations. However, the mechanisms for the gender differences in the immune system remain elusive. Generally, the brain-pituitaryreproductive axis and the brain-thymus-lymphoid axis are linked by complex arrays of internal communication mechanisms that use similar signals (neurotransmitters, peptides, growth factors, hormones). Cyclic changes in immune responsiveness also have a physiological implication, such as the decrease or suppression in cell-mediated immunity observed in the post-moenpausal phase and in pregnancy. Considering the sex-dimorphic immune responses generally, estrogens are considered to be immuno-stimulatory, whereas androgens are considered to be immuno-suppressive. The steroid hormones play essential roles of immunomodulation, and contribute to the sex-dependent changes in immune responsiveness during the estrous-menstrual cycle as well as pregnancy. The reciprocity of the neuroendocrine-immune signaling systems is supported by the ability of sex steroids to modulate thymus-dependent immune functions. Direct effects on specific target genes involved in the development of sex dimorphism and sex-dimorphic immune responses, including the down-regulation of immune response observed during pregnancy and/or post-menopausal phase. The concept that the steroid hormone may behave as an immunological response modifier within the immune system is corroborated by many biochemical as well as clinical evidences.

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S2-3 LATE ONSET HYPOGONADISM IN TAIWANESE MEN Shih-Ping Liu Department of Urology, National Taiwan University Hospital Aging in humans refers to the accumulated changes of the body over time rgarding the physical, psychological, and social aspects. For men, hormonal changes like alterations in serum levels of testosterone, dehydroepiandrosterone, melatonin and so on can have some consequences on the individual. Late onset hypogonadism (LOH) refers to a biochemical syndrome associated with advancing age and characterized by a deficiency in serum androgen levels with or without a decreased genomic sensitivity to androgens. It may result in significant alterations in the quality of life and adversely affect the function of multiple organ systems. It is estimated that the male total testosterone level falls by approximately 1-2 % per year after the age of 40. Approximately 25% of men over the age of 40 may develop LOH. Symptoms of LOH include diminished sexual desire (libido), erectile dysfunction, changes in mood, fatigue, depressed mood, irritability, sleep disturbances, decrease in lean body mass with associated diminution in muscle volume and strength, increase in body fat, decrease in body hair, skin changes, decreased bone mineral density resulting in osteoporosis and the like. The above symptoms coupled with a blood test showing a low level of testosterone would lead to a diagnosis of LOH. 964 Taiwanese men aged 40 to 80 were enrolled to have serum total testosterone, albumin and sex hormone binding globulin checked. Besides, wrist circumference, serum lipids, blood sugar and blood pressure were measured. Both serum testosterone and calculated bio-available and free testosterone were found to decrease with aging. Men with metabolic syndrome and hyperglycemia were found to have significantly lower serum testosterones. Clinical symptoms together with biochemical evidence of low serum testosterone should exist prior to the initiation of LOH therapy. Androgen (testosterone) replacement therapy (ART) can be administered by several methods, such as injections, depots, oral, patches and gels. ART would usually improve the above mentioned symptoms but must be monitored closely for potential side-effects.

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S3-1 INTRODUCTION OF INSULIN THERAPY IN TYPE 2 DIABETES Shih Te Tu Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital Type 2 diabetes is characterized by defects in insulin secretion and increased insulin resistance. During the course of type 2 diabetes, the -cell function of the pancreas will progressively deteriorate and eventually many patients will need insulin therapy to achieve adequate glycemic control. Impaired -cell function appears to be reversible, particularly in the early stage of the disease. Early intensive insulin therapy could improve insulin resistance possibly by correcting glucotoxicity and lipotoxicity. Furthermore, the reduced strain on the -cell by insulin therapy can potentially preserve its function. Recently, the randomized controlled studies demonstrated that early aggressive insulin therapy in newly diagnosed type 2 diabetic patients could more effectively achieve adequate glycemic control and significantly improve -cell function compared with treatment with oral antidiabetic drugs. Insulin is recognized as a highly effective therapy for achieving glycemic goals in management of hyperglycemia. However, it is estimated that only about one fourth and one sixth of patients with type 2 diabetes was treated with insulin based on the past surveys in US and Taiwan, respectively. Insulin therapy is usually initiated late in type 2 diabetes, when glycemic control can no longer be maintained and become very poor with maximal oral antidiabetic drugs. Clinical inertia in response to inadequate glycemic control and psychological resistance to insulin treatment are often cited as the reason for the delay in the real practice. Developing clinical strategies to overcome the barriers to insulin initiation in type 2 diabetes is crucial for improvement of diabetes care.

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S3-2 GLYCEMIC CONTROL AND INSULIN REGIMENS IN TYPE 2 DIABETES PATIENTS: RETROSPECTIVE COHORT ANALYSIS Chieh-Hsiang Lu Division of Endocrinology and Metabolism, Department of Internal Medicine, Chia-Yi Christian Hospital ADA-EASD consensus statement for type 2 diabetes emphasizes early addition of insulin therapy in patients who do not meet target goals. This study is to understand the glycemic control before and 52 weeks after the initiation of insulin therapy for type 2 diabetes in Taiwan. The study design is based on retrospective data mining and includes 1063 patients with type 2 diabetes from 7 sites who started on insulin therapy during 2005-2006. The average age of the patients was 61±13 years. The sex ratio was men 48% and women 52%. Diabetes had been known about for mean 9.6 years. The mean BMI was 25.4 ± 4.5 kg/m2. The glycemic control before initiating the insulin therapy was poor, 67% of the patients had an HbA1c level >9% with a mean level of 10.2 ± 2.1% and the mean fasting plasma glucose (FPG) level was 231 ± 94 mg/dl. Most of the patients had been treated with 2 or 3 OADs. For insulin regimens at the start, 60%, 33% and 6% of the patients were prescribed basal insulin, premixed insulin and basal-prandial insulin, respectively. After one year of initiation insulin therapy, the percentage of patients with HbA1c level >9% was 36% and 17% had HbA1c level <7%. Both HbA1c and FPG were decreased significantly by 1.5 ± 2.4% (p<0.0001) and 73 ± 109 mg/dl (p<0.0001), respectively. The mean daily dose of insulin after 52 weeks was 36.2 ± 23.0 U (0.56 ± 0.36 U/kg). The majority of patients (79%) remained on the same insulin regimen between initiating insulin and after 52 weeks. The weight gain was significantly 2.3 ± 5.2 kg (p<0.05) after 52 weeks. Hypoglycemic events are not collected because of lack of documentation. In summary, glycemic profiles significantly improved after 52 weeks since initiated insulin therapy in type 2 diabetic patients but HbA1c level in most of the patients were still >7%.

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S3-3 INITIATION OF BASAL INSULIN VERSUS INTENSIFIED LIFESTYLE MANAGEMENT: A PROSPECTIVE STUDY Chao-Hung Wang Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital Type 2 diabetic patients who have poor glycemic control with oral antidiabetic drugs (OADs) alone require insulin therapy. This is a prospective, single center study to compare insulin glargine once daily plus 1 OAD with intensified lifestyle management plus existing OADs in patients with HbA1c >7.5% and on ≥2OADs .Onehundr e da ndf i f t e e npa t i e nt s agreed to accept basal insulin combined with 1 OAD (metformin, sulfonylurea or glitazone). Forty eight patients could not accept insulin therapy and then maintained their existing OADs and enhanced the lifestyle modification. The mean ages for the basal insulin (BI) group and the lifestyle management (LM) group were 57.0 ± 12.6 years and 60.7± 9.6 years, respectively (p < 0.05). The female ratio in BI group and LM group were 63% and 81%, respectively (p < 0.05). There were no significant differences between 2 groups on diabetes duration and body mass index. At baseline, HbA1c was 10.2 ± 1.6% in BI group and 9.9 ± 1.5% in LM group, and FPG was 237 ± 49.9 mg/dl in BI group, and 227 ± 44.0 mg/dl in LM group. After 12 months of treatment, HbA1c was reduced by 1.0 ± 1.9 % and 0.4 ± 1.2 % in BI group and in LM group, respectively (p < 0.01 between groups). FPG was decreased by 102 ± 70.9 mg/dl and 20 ± 48.6 mg/dl in BI group and in LM group, respectively (p < 0.0001 between groups). Twenty five patients experienced symptomatic hypoglycemia in BI group but there were none in LM group. There was no episode of severe hypoglycemia found during the study. The change of body weight was 4.0±3.5 kg and -0.3±1.9 kg, respectively (p < 0.0001 between groups). The mean dose of insulin glargine 3/11/2009 1 after 52 weeks was 40.9 ± 17.4 U/day (0.59 ± 0.22 U/kg/day). In conclusion, the initiation of basal insulin therapy is more effective in lowering HbA1c and FPG than the enhancement of lifestyle.

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S4-1 PRIMARY ALDOSTERONISM: DIAGNOSIS AND OUTCOMES, DATA OF TAIPEI Kwan-Dun Wu Department of Internal Medicine, National Taiwan University Hospital Primary aldosteronism (PA), characterized by an inappropriate production of aldosterone has been identified for more than 50 years. The use of aldosterone-renin ratio (ARR) as screening test has contributed the increased diagnostic rate of this disease, which is also true in Taiwan. A large cohort of PA in NTUH, TAIPAI, examined the diagnostic accuracy, co-morbidities, and outcomes. Usually, the diagnosis is not complicated, but near 20% of the cases needs adrenal venous sampling to make the differential diagnosis of aldosteroneproducing adenoma (APA) from bilateral hyperplasia. Captopril test or losartan test can be used as confirmatory test for PA, with accuracy near 90%. Operation of APA leads to cure of hypertension in two thirds of cases. The renal function before operation is a predictor of residual hypertension after unilateral adrenalectomy. Evidences show that excessive aldosterone is associated with metabolic syndrome and cardiovascular diseases. In spite of unknown pathophysiology of PA, we have explored that dopaminergic system played an important role in the overproduction of aldosterone and cell proliferation of APA. D2 dopamine receptor can inhibit aldosterone synthesis/secretion via PKCµ and intracellular signaling. A pilot study of the effect of bromocriptin on PA showed a decreased aldosterone secretion and improvement of insulin resis t a nc ei n6mont hs ’t r e a t me nt .

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S4-2 BRONCHIAL CARCINOID-INDUCED ECTOPIC CUSHI NG’ S SYNDROME (ECS): CASE-BASED STUDY Justin G.S. Won Division of Endocrinology and Metabolism, Department of Medicine, Taipei-Veterans General Hospital A 61-year-old woman presented with weight gain (>7 kg) in the face and abdomen over 6 months. In 1996, she had been diagnosed as CUSHING’ S DISEASE, as judged by a 51% suppression of serum cortisol (30.4 to 14.9 μg/dl) to 8 mg DEXAMETHASONE SUPPRESSION TEST (DST), and had been received a trans-sphenoiodal hypophysectomy in Kaohsiung VGH. Although no tumor was identified histologically, she did have a remission clinically. Nevertheless, in 1998, she had had a right adrenalectomy due to evidence of a clinical recurrence proven biochemically and the finding of a right adrenal tumor on CT scan, which was reported as cortical adenoma. The patient ‘ cycled out’and became eucortisolemic again. Unfortunately, in 2001, relapse of Cushingoid symptoms was evident and was associated with severe aspergillosis infection of the lung, she was then referred to Taipei VGH. Endocrine function tests revealed very high levels of 24-h urinary excretion of free cortisol (UFC; 4057 & 1427 μg/day; normal range <100 μg/day) and midnight serum cortisol (114 & 38 μg/dl; normal range <5 μg/dl), not suppressed plasma ACTH levels (115 & 130 pg/ml at 11:00 PM), associated with a response to corticotropin-releasing hormone (CRH) (171% increase in serum cortisol, over baseline levels) and DDAVP (281% increase in plasma ACTH), and equivocal response to 8 mg DST. The patient recovered eventually after insertion of chest tubes, treatment with antifungal agent-AmBisome, control of hypercortisolism with adrenal enzyme inhibitoraminoglutethemide (250 mg every 6 h) (she was intolerant to ketoconazole with hepatoxicity), and supplement of hydrocortisone. Subsequently she completed the left adrenalectomy (histologically-slightly enlarged adrenal and 4.5 gm in weight) after another episode of bacterial pneumonia with shock and was placed on long-term replacement with cortisone acetate and florine-F. After admission, physical examination revealed MILD DELIRIUM, mild plethora and moderate facial rounding, dorsocervical and supraclavicular fat, and truncal obesity. She also had difficulty rising from a squat. The skin was thin with many bruises, but no striae were present. The laboratory results confirmed hypercortisolism, with a markedly elevated － 87 －

UFC (1677 & 802 μg/day). She also had increased midnight plasma cortisol (25.5 μg/dl) and non-suppressed plasma ACTH value (581 pg/ml). Re-evaluation for the cause of Cushing’ s syndrome showed that the patient responded to DDAVP (a 213% increase in plasma ACTH), but not to CRH; 8 mg DST was not performed. Image study disclosed an enhancing nodule, 2,4 x 1.2 cm, at right suprarenal region both by CT scan and PET-CT, whereas 111In-Octreotide scan and MRI of sella were negative. An attempt to remove the ectopic adrenal tissue was failed. Due to the severe hypercortisolemia and the resultant altered mental status, etomidate, an imidazole-derived anesthetic agent and a potent adrenal enzyme inhibitor, was instituted, with a dose of 2.6 mg/hr, and its effect was evident within 48 hrs, in addition to the use of mitotane 500 mg daily, which was increased by 250 mg weekly, while she was placed on supplement dose of hydrocortisone. During the ensuring 4 months, the hypercortisolemia was well-controlled and the clinical symptoms and signs got improved progressively. Then metyrapone was started and the dose was titrated, whereas etomidate was withdrawn completely. After convalescence, bilateral inferior petrosal sinus sampling (BIPSS) for ACTH (under metyrapone) showed no step-up in the cavernous sinus, with a central-to-peripheral gradient <2 either before or after CRH administration, implying an ectopic source of ACTH. Chest CT scan disclosed a suspected nodule over LLL, near the aorta and behind the heart. Wedge resection of the tumor was performed and the histology was typical of a carcinoid tumor with metastases to local lymph nodes. Immunostaining for ACTH was positive, as also for CD56, neurophysin, chromogranin A, vasopressin receptor 1b & 2, but not for CRH. The patient became frankly hypoadrenal after surgery, with very low plasma cortisol and ACTH concentrations and undetectable UFC. During 6 months of follow-up, the patient was well, associated with regressive change of both the lung lesion and the ectopic adrenal. In the discussion, we will focus on (1) a brief review of bronchial carcinoid-induced ECS; (2) the differential diagnosis between Cushing’ s disease and bronchial carcinoidinduced ECS, morphology or function; and (3) the indications and rational use of adrenal enzyme inhibitors.

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S4-3 CONGENITAL ADRENAL HYPERPLASIA DUE TO 21-HYDROXLASE DEFICIENCY Yann-Jinn Lee Departments of Pediatrics and Medical Research, Mackay Memorial Hospital, Taipei Department of Pediatrics, Taipei Medical University, Taipei There are classic (salt wasting and simple virilizing) and nonclassic forms according to clinical severity. Both cortisol and aldosterone are deficient in the salt wasting form but aldosterone is marginally adequate in the simple virilizing form. Androgens are elevated in both forms and cause virilization. Patients with nonclassic form have mildly elevated androgens and may only have signs of androgen excess after childhood. Incidence and prevalence Newborn screening for elevated concentrations of blood 17-OHP has yielded an incidence of 1 in 14,000 for classic form and 1 in 60 for heterozygous carriers. About 75% are salt losers. Clinical Manifestation Infants with salt wasting form have progressive weight loss, anorexia, vomiting, dehydration, weakness, hyperkalemia, hyponatremia, hypoglycemia, and hypotension at approximately 2 wk of age. Without treatment, shock, cardiac arrhythmias, and death may occur. Female infants with simple virilizing form have virilized genitalia whereas male ones have precocity in childhood. Those with nonclassic form may have signs of androgen excess during childhood or adolescence. Laboratory Tests Patients with salt wasting form have typical laboratory findings associated with cortisol and aldosterone deficiency, including hyponatremia, hyperkalemia, metabolic acidosis, and often hypoglycemia. 17-hydroxyprogesterone is elevated and nomograms comparing its circulating concentrations before and 60 minutes after exogenous ACTH is useful in differential diagnosis. Mutation of the CYP21 gene Mutations of the CYP21 gene encoding 21- hydroxylase consist of point mutations, splicing errors, gene deletions, and gene conversions. Most patients are compound heterozygotes having a different mutation on each allele. The disease has a wide spectrum of clinical manifestations due to the degree of impairment of enzyme activity caused by － 89 －

different mutations in this gene. The phenotype correlates with the less severely mutated allele, and consequently, with the residual 21-hydroxylase activity. Neonatal screening Affected male infants appear normal at birth. Therefore the diagnosis may not be made until signs of adrenocortical insufficiency develop. Screening is effective in preventing adrenal crisis in affected males. It also results in the diagnosis and treatment of male newborns with simple virilizing form and identification of those with non-classical form. However, similar screening 17-hydroxyprogesterone levels are found in infants with the simple virilizing and nonclassic forms as well as in some normal infants. Therefore genotyping may be needed.

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S5-1 OXIDATIVE STRESS IN HYPERTENSION AND NEPHROPATHY DEVELOPMENT IN DIABETES John S.D. Chan Professor of Medicine and Physiology Faculty of Medicine University of Montreal Chief, Laboratory of Molecular Nephrology and Endocrinology Research Center CHUM-Hotel Dieu Hospital Diabetes mellitus is a disease that affects 5-10% of the world population and its complications are the leading cause of stroke, heart disease, blindness, neurological disorders, birth defects and kidney failure. In Canada alone, it is estimated that the number of individuals with diabetes in the general population will increase approximately 1.4 million patients in 2000 to 2.4 million patients in 2016. The total healthcare costs are projected to increase from $4.66 billion in 2000 to $8.14 billion in 2016. It is also estimated that 40% of patients with diabetes will eventually develop kidney failure or end-stage renal disease (ESRD). ESRD is a major risk factor for cardiovascular diseases, including myocardial infarction and stroke. The annual health care cost for patients with ESRD amounts to more than 1 and 20 billion dollars in Canada and USA, respectively. Hypertension affects 25% of the adult population in North America, and 40% of patients with diabetes have hypertension. Indeed, hypertension and diabetes are the leading causes of ESRD, accounting for 65-75% of all ESRD cases in Canada and USA. While intensive insulin therapy and chronic treatment with renin-angiotensin system (RAS) blockers are effective in retarding the progression of ERSD, they do not cure it. Such findings, however, indicate that hyperglycemia and RAS activation are major risk factors in the initiation and pathogenesis of hypertension and nephropathy in diabetes, leading to ESRD. In addition to systemic RAS, the existence of a local intrarenal RAS has now been well-accepted. All of its components are expressed in renal proximal tubular cells (RPTCs). Angiotensinogen (Agt) is the sole substrate of the RAS and it is expressed predominantly in RPTCs, converts to active angiotensin II (Ang II). Renal Ang II levels and RAS gene expression are elevated in hypertension and diabetes. The physiological role(s) of intrarenal RAS in the development of hypertension and nephropathy in diabetes, however, － 91 －

remain(s) incompletely understood. Glomerular damage is a hallmark of renal injury in diabetes. However, tubular atrophy and interstitial fibrosis are closely associated with loss of renal function, indicating that tubular atrophy is a better predictor of renal disease progression than glomerular pathology. Indeed, 71% of glomeruli from proteinuric type 1 diabetics are attached to atrophic tubules at the glomerulo-tubular junction, including 8-17% atubular glomeruli (glomerulus without tubular attachment). The mechanisms underlying tubular atrophy are not well understood. One possible mechanism is apoptosis, which has been demonstrated to mediate cell death in a variety of renal diseases including diabetes, suggesting that tubular apoptosis precedes tubular atrophy. Our group has reported that high glucose stimulates Agt gene expression and RAS activation via reactive oxygen species (ROS) generation in diabetes, and transgenic (Tg) mice overexpressing Agt in their RPTCs develop hypertension, albuminuria and kidney injury. Furthermore, we reported that Agt overexpression and hyperglycemia act additively to enhance RPTC apoptosis in Tg mice in vivo and treatment with RAS blockers (angiotensin II receptor (AT1R-subtype) antagonist and angiotensin-converting enzyme (ACE) inhibitor) prevent hypertension, albuminuria, tubulointerstitial fibrosis and RPTC apoptosis. We have recently created Tg mice overexpressing rat catalase (CAT) in RPTCs and discovered that hypertension, albuminuria, glomerulosclerosis, RPTC apoptosis, Agt and several pro-apoptotic gene expression are attenuated in STZ-induced diabetic CAT-Tg mice and in db/db CAT-Tg mice, establishing that ROS generation plays a central role in hypertension development and RPTC apoptosis in vivo. To identify the downstream target of pro-apoptotic genes that are regulated by ROS in RPTCs, we employed gene chip microarray analysis. We have found and validated several pro-apoptotic genes that are differentially up-regulated in RPTCs of db/db mice, compared to db/m+ and db/db rCAT-Tg mice. Taken together, our data indicate that ROS generation, RAS activation and proapoptotic gene expression play crucial roles in RPTC apoptosis, leading to ESRD. Treatment with RAS blockers and ROS inhibitors could prevent hypertension and tubular atrophy in diabetes.

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S5-2 ADVANCES ON RENIN-ANGIOTENSIN BLOCKADE IN DIABETIC MICROVASCULAR COMPLICATIONS Shyi-Jang Shin Division of Endocrinology and Metabolism, Kaohsiung Medical University Chung-Ho Memorial Hospital The pathogenesis of diabetic microvascular and macrovascular disorders is multifactorial, and the rennin-angiotensin system (RAS) plays an important role. It is well known that RAS blocking agents, e.g. angiotensin I-converting enzyme (ACE) inhibitor and angiotensin II receptor blocker (ARB), have potent renoprotective and cardioprotective effects, which are mediated by their antihypertensive, anti-inflammatory, anti-oxidative and antiproliferative properties. Several investigations, including large multi-institutional randomized trials with patients at various stages of diabetic nephropathy, have well documented that treatment with RAS blockade can prevent and slow the progression of diabetic nephropathy, and reduce cardiovascular mortality and morbidity. ADA and NKF-KDOQI guidelines already recommend that hypertensive patients with microalbuminuria or macroalbuminuria (CKD stages 1-4) be treated with an ACE inhibitor or an ARB. Other drugs, such as diuretics, calcium channel blockers, and beta-blockers, should be used as an additional therapy to further lower blood pressure, with the target blood pressure below 130/80 mmHg. The benefit of inhibiting RAS in diabetic patients with hypertension or/and albuminuria is now well established. However, studies also show that renal and cardiovascular diseases still occur and progress in many patients despite treatment of ACE inhibitors or ARBs. Therefore, alternative strategies that optimize the inhibition of RAS are being investigated to find a more complete blockade that will lead to a better outcome. Such new strategies have been reported, including dual blockade of the RAS with a combination of ARB with ACE inhibitors or with rennin inhibitor, very high doses of ARBs, early use with ARBs or ACE inhibitors, and aldosterone blockade. In 2008, Parving et al. reported that the addition of 300 mg of aliskiren daily on losartan-treated macroalbuminuric diabetic patients reduced the mean urinary albumin/creatinine by 20% compared to patients treated with placebo. It is also well known that strict control of blood pressure in patients with hypertension substantially reduces the progression of diabetic retinopathy. Recently, DIRECT study group showed a significant regression of mild to moderate retinopathy by the treatment － 93 －

with ARB during a 4 year trial in type 2 diabetes with normal blood pressure and normoalbuminuria, despite a non-significant reduction in progression of retinopathy in type 1 and type 2 diabetes. These advances in large, randomized clinical trials of ARS inhibition on the prevention and protection of diabetic microvascular complications provide valuable information in the combination of ARS blockers and in the selection of patients who will be benefited by ARB blockers.

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S5-3 ANGIOTENSIN-CONVERTING ENZYME GENE INSERTION/ DELETION POLYMORPHISM AND DIABETIC NEPHROPATHY 1

Yau-Jiunn Lee, 2Shyi-Jang Shin 1 Le e ’ sEndoc r i nol og i cCl i ni c ,Pi ng t u ng , Ta i wa n;2Departments of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan2 The renin-angiotensin system (RAS) has long been known to be an important regulator of blood pressure and renal electrolyte homeostasis, and this system has also been implicated in the pathological changes of organ damage through modulation of gene expression, growth, fibrosis, and inflammatory response. It has been found that an insertion/deletion polymorphism of ACE gene affects the serum ACE level, studies also have demonstrated that ACE I/D polymorphism is associated with hypertension, coronary heart disease, diabetic nephropathy, and chronic inflammatory diseases. Type 2 diabetic patients with ACE DD genotype were observed to have a significantly higher prevalence of albuminuria and WHO criteria of metabolic syndrome than those with ID and II genotypes. Diabetic patients with DD genotype were also found to have a higher prevalence of dyslipidemia, and have higher serum triglyceride levels. A meta-analysis of ACE genotypes studies in the development of or association with type 2 diabetic nephropathy was performed using studies identified by the Medline database literature research feature from the publication. 27 articles containing 11,470 Asian or Caucasian subjects searched from Medline for studying the association between the ACE I/D polymorphism and nephropathy of type 2 diabetes were qualified to enter the meta-analysis. A significant positive association was present between the D allele and diabetic nephropathy. When studies were grouped to the ethnics, the statistic significance was found only in Asian populations. When diabetic patients with microalbminuria were treated with ACEI or angiotensin II type 1 receptor antagonist, significantly renoprotective effects was found in diabetic patients with nephropathy. While patients with ACE DD genotype were observed to have the most pronounced antiproteinuric response. The incidence of irritating troublesome cough in diabetic patients receiving ACEI treatment is high (49.2%), our observation also revealed that there was a significant association of ACE II genotype with ACEI-related cough. In conclusion, ACE I/D polymorphism was found to be associated with risk, progression, therapeutic response and side effects to ACE-inhibitor of diabetic nephropathy in a Chinese population. － 95 －

S6-1 SURGERY FOR UREMIC SECONDARY HYPERPARATHYROIDISM Shih-Ming Huang National Cheng Kung University Hospital Although a lot of progress in medicine to control the renal secondary hyperparathyroidism (renal HPT), such as non calcium and non alumni containing phosphate binders, nonhypercalcemic vitamin-D analogues, calcimimetics (stimulating Ca-sensing receptor) have developed recently, parathyroidectomy (PTX) is needed for intractable cases which are about 5% in chronic dialysis patients. The term of tertiary hyperparathyroidism is mostly used for the autonomous hyperparathyroidism after successful renal transplantation. Necessary conditions for surgical indication of renal HPT should be 1) Parathyroid Hormone (PTH) level higher than 10 times of upper normal limit, and 2) the enlarged parathyroid gland visible by modern image study. Symptoms or signs such as 1) osteitis fibrosa cystica, bone pain, severe osteoporosis (2) calciphylaxis (3) soft tissue calcification (4) itching usually rapidly improve after parathyroidectomy. Recently muscle weakness, intractable anemia, sex dysfunction, infertility, insomnia, and depression have been also reported as symptomatic surgical indications. The goal of Ca x P < 55 is strongly recommended for all dialysis patients to reduce cardiovascular and bone disorders. Preoperative isotope sestamibi scan is encouraged to detect the ectopic gland, especially in the mediastenium. The size of parathyroid glands <300mg have only 40% detectable rate by any image studies. Upper thymus is the most common supernumerous or ectopic site of inferior parathyroid. Either total PTX with auto transplantation or subtotal PTX have been widely applied in different institutes or surgeons. Total PTX without autotransplantation is usually performed for those patients who are not indicated for kidney transplantation. Intraoperative quick PTH has been a good guide for complete removal of all the functional parathyroid tissues. Alcohol injection is only performed in very rare cases since high nerve damage rate occurred either during injection or once shifting to surgical approach. Postoperative regular and active control of calcium and phosphors is still highly needed after successful PTX, since 10- year recurrent rate may be up to 20%.

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S6-2 MANAGEMENT OF MINERAL BONE DISORDERS IN CHRONIC KIDNEY DISEASE Yung-Ming Chen National Taiwan University Hospital Taiwan has the highest incidence of treated end-stage renal disease (ESRD) in the world, and has a chronic kidney disease (CKD) population estimating over 2.0 million. Unlike Western countries, CKD patients in Taiwan are more likely to develop ESRD than death from any cause. Hence, during the course of renal progression, a broad spectrum of disturbances secondary to renal failure can arise. Recently, the term CKD-mineral bone disease (CKD-MBD) is adopted to delineate the diverse manifestations of disordered mineral metabolism in CKD, which includes secondary hyperparathyroidism (abnormalities of calcium, phosphorus, PTH, or vitamin D), metabolic bone disease (abnormalities in bone turnover and mineralization), and extraskeletal (vascular or other soft tissue) calcification. Many studies have shown that CKD patients with more severe secondary hyperparathyroidism, hyperphosphatemia, or vascular calcification are associated with poorer patient outcomes. Thus, early identification and timely treatment of CKD-MBD are of paramount importance for patients with CKD before ESRD, particularly stages 4 and 5. The Bone Metabolism and Disease guidelines set forth by the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (U.S.A.) raises the potential to improve outcomes for patients with CKD. Studies in the future may address the possibilities of aggressive therapy with a combination of agents targeting vitamin D deficiency, parathyroid hormone and phosphorus excess, as well as novel agents that modulate circulating promoters and inhibitors of calcification.

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S6-3 GNAS1 MUTATIONS AND PSEUDOYPOPARATHYROIDISM IA W-S Yang, K-M Pan, Y-C Chi, K-S Tsai Graduate Institutes of Clinical Medicine and Molecular Medicine, College of Medicine, National Taiwan University; Departments of Internal Medicine and Laboratory Medicine, NTU Hospital Pseudohypoparathyroidism (PHP) is a complex medical condition also with complicated hereditary patterns and molecular pathogenesis. PHP has several subtypes based on their clinical manifestations. PHPIa is characterized by Albright’ s hereditary osteodystrophy and resistance to PTH and the other hormones, such as TSH. The molecular defect of PHPIa was found to be in the stimulatory subunit (Gs, GNAS1) of the trimeric large G protein. Various mutations in GNAS1 have been reported in humans with PHPIa. Here we present two Taiwanese families with manifestations of PHPIa. Mutations in GNAS1 were identified. One novel mutation caused amino acid change from Ile to Thr at codon 106 (ILE106THR). The other mutation has been reported before. It was a 4-bp deletion in exon 7 (565delCTGA). The ILE106THR is located in a hydrophobic helical domain. Computer molecular modeling suggests that significant conformational changes can be observed in loops V65-E87, L113-P122 and R165-C174. Loop R165-C174 moves a little bit toward the ras-domain and may hinder the accessibility of GTP to its binding cleft. The 565delCTGA led to a framshift premature termination mutation and a truncated protein. The other molecular mechanistic studies are underway.

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S7-1 CHRONIC GLYCEMIC STRESS IN ISLET FAILURE Gordon C. Weir Joslin Diabetes Center Beta cells normally exist seeing narrow concentrations of glucose ranging between 4-6.5 mM. When glucose levels rise, which occurs when beta cell mass falls due to either type 1 diabetes or the deficiency in beta cells that occurs in type 2 diabetes, the beta cells are placed in an abnormal environment of hyperglycemia. It is now clear that glucose levels only in the range seen with impaired glucose tolerance will lead to impressive beta cell dysfunction, most notably a reduction of glucose stimulated insulin secretion (GSIS). We know that this is accompanied by marked changes in gene expression, as has been found in islets from experimental animals and humans. There is great interest in islet transplantation but the lack of durability found with clinical transplants is troublesome. Successful recipients usually must be put back on insulin in less than two years. Some of this is no doubt related to immunosuppressive medications and continuing damage from allo-rejection and autoimmunity. But some of the dysfunction must be from the abnormal environment of the graft as well as the mild hyperglycemia, which is seen in even successful islet transplants. It is known that islet grafts of rodents have very low oxygen tension so transplanted beta cells are probably facing relative hypoxemia. When beta cells in the pancreas are exposed to hyperglycemia or when cells are in a transplant site are faced with hyperglycemia and other adverse factors, there are important questions about beta cell survival. Beta cell turnover, which can occur from replication or neogenesis, will be discussed. The potential roles of glucotoxicity, amyloid formation, ER stress, and oxidative injury will be discussed.

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S7-2 DIFFERENTIATION OF PANCREATIC DUCT CELLS TO CELLS Susan Bonner-Weir Joslin Diabetes Center The regenerative process in the pancreas is of particular interest since diabetes, whether type 1 or type 2, results from an inadequate amount of insulin-producing -cells. Experimental rodent models provide evidence that replication of pre-existing beta cells as well as differentiation of new beta cells from progenitors contribute to the normal, compensatory, and regenerative growth. Regeneration studies in mammals have focused on tissue-specific stem and progenitor cells. The presence of pancreatic stem/progenitor cells has been suggested by the observation of islet neogenesis seen as budding of hormone positive cells from the ductal epithelium. Our data from the regeneration rat model of partial pancreatectomy led us to hypothesize that differentiated pancreatic ductal cells were the pancreatic progenitors after birth, that with replication they regressed to a less differentiated phenotype and then could differentiate to form new acini and islets. To test our dedifferentiation hypothesis, we took a direct approach of genetically marking ductal cells using carbonic anhydrase II (CAII) as a duct cell-specific promoter to drive cre recombinase in Cre-lox lineage tracing experiments. We show that CAII-expressing pancreatic duct cells act as progenitors that give rise to both new islets and acini after birth and after injury. This identification of a differentiated pancreatic cell type as in vivo progenitor for all differentiated pancreatic cell types has implications for a potential in vivo or ex vivo expandable source for new islets for replenishment therapy for diabetes.

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S8-1 ACROMEGALY –OVERVIEW AND MEDICAL TREATMENT Tien-Chun Chang Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan If estimation by the prevalence rate, there are about 900-1300 patients with acromegaly in Taiwan. Most acromegaly is due to growth hormone (GH)-producing pituitary tumor. The excess GH results in acromegalic features and metabolic dysfunction. The tumor expansion also can cause headache, hypopituitarism and even cranial nerve dysfunction. The diagnosis of acromegaly is based on the clinical features and determination of serum GH and IGF-1 levels. Because of pulsatile secretion of GH, serum GH levels can be determined by collection of GH every 30 minutes for 5 times, then calculate the mean value, or checked the GH level after glucose tolerance test. Skull X ray (PA and lateral) is a quick help at OPD to see the frontal sinus and sella turcica. If the diagnosis is made, MRI can be performed to determine the tumor size and extent. If necessary, visual field can be done to elucidate the compression and influence on vision. For small tumor and no invasion to the cavernous sinus, operation is the best way. If the situation is not as mentioned about, primary medical treatment for microadenoma, and primary medical treatment followed by the surgery, then medical treatment or combined with radiotherapy for macroadenoma, is a reasonable way, although primary medical treatment is not allowed by the Health Insurance. The effective medications can be used in Taiwan are Somatuline Autogel and Sandostatin LAR which can be injected every 4 weeks, with same effectiveness. Tumor volume can be reduced with biochemical improvement. GH receptor antagonist (pegvisomant) in not available, which can effective control IGF-1, but not effective in the reduction of GH or tumor volume. Som230 which can cover wider somatostatin receptor subtypes, is in clinical trial.

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S8-2 LONG TERM FOLLOW UP OF PATIENT WITH ACROMEGALY AFTER SRS Chen-Nen Chang Department of Neurosurgery, Chang Gung Memorial Hospital & Chang Gung University, Taipei, Taiwan Treatment of Acromegaly remains a challenge to Neurosurgeons. Due to its functional secretion of HGH, a radical extirpation of the tumor is the goal. Recent advancement of minimal invasive endonasal endoscopic trans-sphenoidal (EETS) operation has provided us a safety excision of tumor. Yet, there are still a significant percentage of residual or recurrent tumors, either in the sella or cavernous sinus. In order to obtain a complete control of tumor mass growing, as well as HGH secretion, radiosurgery plays an important role to treat the residual unresectable tumor in this regard. There had been a little reports discussion about the real final long term outcome of radiosurgical treatment for acromegaly. We reviewed 1114 patients between 1994 and 2004 in our rqdiosurgery data bank and recruited 22 Acromegalic patients who had residual or recurrent tumor which need further LINAC-base radiosurgery. They had all been followed up over 3 years. The residual or recurrent of the tumor were defined persisted high level of growth hormone or insulin-like growth factor-1 (IGF-1). The biochemical remission was defined as basal growth hormone < 5ng/ml with a normal sex-and-age adjusted IGF-1. Among these 22 patients, there were 8 males and 14 females, with mean age of 36.5± 7.89 y/o. The mean follow up after radiosurgery was 94.68 months. The overall mean biochemical remission time was 49.2 months (median 42 months). Nineteen patients (86.4%) achieved the biochemical remission throughout the follow up period. The 3, 5, 8 years biochemical remission rate were 36.4%, 54.5% and 72.7% respectively. The decrease of the percentage of the growth hormone becomes stable in their 7.5th years after radiosurgery. The initial GH at diagnosis and the pre-SRS GH correlated with biochemical remission (p=0.005, < 0.0001). Overall post SRS hormone deficit was in 5 patients (22.7%). In conclusion, LINAC radiosurgery also provided a competent outcome for the treatment of recurrent or residual HGH-secreting pituitary tumor. SRS has maximum effect in the first two years and the effect becomes stable after 7.5th years. Therefore, SRS showed long term biochemical effects and needs longer follow up at least 7.5 years for a higher rate of biochemical remission. － 102 －

S8-3 GAMMA KNIFE RADIOSURGERY FOR THE TREATMENT OF PITUITARY ADENOMA WITH ACROMEGALY Hung-Chi Pan Department of Neurosurgery, Taipei Veterans General Hospital Treatment of pituitary adenomas with acromegaly depends on multidisciplinary approaches including microscopic or endoscopic surgery, drugs (Octreotide, Dopamine agonist and growth hormone (GH) receptor antagonist), and radiation therapy. Gamma Knife radiosurgery (GKS) is a new therapeutic armamentarium indicated for the treatment of recurrent or residual pituitary adenomas after microsurgery. The method involves the use of stereotactically directed high-dose, single fraction of radiation to the tumor with minimal effects on surrounding normal structures. GKS can selectively inhibit tumor growth and hormonal hypersecretion whereas spare the radiation damage to adjacent optic pathway and hypothalamus. Between 1993 and 2008, we have used GKS to treat 267 patients with various types of pituitary adenomas. Of them 121 (45%) were non-secreting adenomas, 69(26%) were prolactimomas, 54(20%) were GH-secreting adenomas and 23(9%) were ACTH-secreting adenomas. In acromegaly cases, radiation dose to the tumor margin ranges from 12 to 25Gy, depending on the tumor size and safety of the optic pathway. High-dose radiation (>20Gy) is necessary for better GH control, but optic nerves can only tolerate low dose radiation less than 10-12Gy at the nerve margin. Our result showed GKS is a safe and effective treatment for pituitary adenomas with acromegaly. In the long-term (range 6-162 months) MRI follow-up of 42 GH-secreting adenomas, 97% showed decreased or stable tumor size, and only 3% showed increased tumor size. Gradual reduction of the serum GH level with improved clinical symptoms was observed in most cases, but it usually needed 1-2 years waiting time to reach a normal GH level. In our 42 acromegaly patients, 21 (50%) has improved to normal level of GH <2ng/ml, 8 (19%) showed GH 2-5ng/ml, another 6 (14%) showed >80% reduction of the GH level. For the IGF-1 evaluation in 22 cases, 7 (32%) reached to normal level, and 3 (14%) showed 50-80% reduction. According to our experience, we suggest GKS should be considered as a treatment of choice for recurrent or residual pituitary adenomas with acromegaly after the microsurgery.

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LS1-1 IMPORTANCE OF POST-PRANDIAL GLYCEMIC CONTROL IN T2DM PATIENTS Shih Te Tu Department of Internal Medicine, Lugang Branch of Changhua Christian Hospital The Importance of postprandial glucose has been shown that glucose intolerance, including IGT and diabetes, was a risk factor for death from cardiovascular disease (Diabetes Care 22: 920-924, 1999). DECODE database showed that a high blood glucose concentrations 2h after load is associated an increased risk of death, independently of fasting blood glucose (Lancet 1999; 354: 617-21). The mechanisms through which increased postprandial glucose levels and lipid concentrations may damage endothelial cells on blood vessel walls appear to be complex (Diabetes Care 25: 1439-1443, 2002) These mechanisms include the activation of protein kinase C, increased expression of adhesion molecules, increased adhesion and uptake of leukocytes, increased production of proliferative substances such as endothelin, increased proliferation of endothelial cells, increased synthesis of collagen IV and fibronectin, decreased production of NO, and increased oxidative stress and inflammation (Endrocr Rev 25; 153-175). A recent study showed that a single dose nateglinide improve post-challenge glucose metabolism and endothelial dysfunction in type 2 diabetic patients (Diabet Med 2004; 983-986). In type 2 type diabetes, post-lunch PG and extended postlunch PG are better predictors for glycemic control than fasting plasma glucose (Diabetes Care 20; 1822-1826, 1997). Postprandial glycemic excursions play a major role in metabolic disequilibrium of patients suffering from mild to moderate hyperglycemia. On the contrary, fasting hyperglycemia appears as a main contributor to the overall diurnal hyperglycemia in poorly controlled diabetic patients, whereas the role of postprandial glucose elevation decrease as patients progress toward poor diabetic control (Diabetes Care 26: 881-885, 2003) Nateglinide is a phenylalanine derivative that blocks K+ channel in pancreatic -cell, facilitating insulin secretion (Clin Pharmacokinet 2004; 43(2): 97-120). The study showed that nateglinide selectively enhanced early insulin release and provided better mealtime glucose control with less total insulin exposure than glyburide (Diabetes Care 24: 983-988, 2001). Nateglinide will stimulate the early and rapid insulin release in the control of prandial and post-meal glycemia and also demonstrate that a short anticipatory busrt of insulin － 104 －

(Diabetes, Obesity and metabolism 3, 2001, 73-83). Nateglinide selectively increased early insulin release, where glyburide increased fasting insulin levels and increase insulin levels persistently throughout the day. Overall insulin exposure was reduced by rapid-onset/ short-duration insulintrpoic agent, nateglinide (Diabetes Care 24; 983-988, 2001). In patients stabilized on high-dose metformin monotherapy, the addition of nateglinide improved glycemic control (Diabetes, Obesity and metabolism 4, 2002, 177-186). Nateglinide also produced a significantly improvement in overall glycemia exposure in patients which with type 2 diabetes inadequately controlled with rosigitazone (Diabetes Care 26; 1685-1690, 2003). Nateglinide has demonstrated that higher selectivity for KATP channel suppression compared with repaglinide (Inter J Pharmacol Exp Ther 1999; 291: 1372-1379). In conclusion, nateglinide is suitable for drug naive T2D patients, early stage of diabetes, mild stage of diabetes including obese patients, elderly T2D patients and moderate or more severe stage diabetes who still have insulin secretion ability to some extent or whose glucose toxicity was reduced by insulin injection.

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LS1-2 INHIBITION OF RAAS AT POINT OF ACTIVATION: A NEW THERAPEUTIC OPTION Chih-Yuan Wang Department of Internal Medicine, Far-Eastern Memorial Hospital The dysfunctional renin-angiotensin-aldosterone system (RAAS) could play a pivotal role in the development of cardiovascular diseases, non-diabetic/diabetic nephropathy. Drugs including angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) provide effective control as primary choices in the past two decades. However, the optimal strategy for RAAS control needs more investigation. Nowadays, a new drug targeting blockade of activating RAAS is available and will open a new era in RAAS system. Aliskiren is a potent, highly specific renin inhibitor with a long plasma half-life making it suitable for once-daily dosing. Unlike the downstream inhibitors, ACEIs and ARBs, aliskiren blocks the RAAS without inducing a compensatory increase in plasma renin activity (PRA), angiotensin I or angiotensin II, which implies a more complete control of the system. Reduced PRA was observed in either monotherapy or combination with other anti-hypertensive drugs. In hypertension trials, Aliskiren shows dose-dependent blood pressure lowering effect , and even superior to the used antihypertensive agents, and it may provide additional blood pressure reduction in combination. The activity of Aliskiren is a long lasting effect with sustained blood pressure reduction. At the same time, this new agent maintains good tolerability profile comparable to placebo. An extensive clinical research program is now addressing the potential of organ protection from Aliskiren. From the data of phase II/III trials up to date, Aliskiren is effective in reducing biomarkers of heart failure and improving left ventricular hypertrophy. Studies have also demonstrated that Aliskiren may provide additional effects in type 2 diabetic proteinuriat. These trials, along with the ongoing large scale outcome studies, will help us define the position of Aliskiren in the management of patients with high cardiovascular and renal risk in the future.

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LS2-1 THE NEW ERA OF FIXED DOSE COMBINATION OAD IN T2DM TREATMENT Ming-Chia Hsieh Division of Endocrinology and Metabolism, Department of Internal medicine, Kaohsiung Medical University Hospital Glycemic control is the cornerstone in management of patients with type 2 diabetes. Metformin, in addition to lifestyle intervention, should be given to newly-diagnosed type 2 diabetic patients with no contraindication. It has been clearly demonstrated that when the therapeutic treatment goals for diabetes are not reached, early progression to combination therapy can maintain adequate control of blood glucose in comparison to that achieved with single-agent therapy. The combination of metformin, which addresses insulin resistance, and sulphonylurea, which addresses b-cell dysfunction, provides an example of a rational, effective, and well-studied anti-diabetic combination. In accordance with the new ADA-EASD consensus algorithm, a sulfonylurea combined with metformin constitutes an attractive option in the clinical practice. This combination can reduce A1C concentration up to 2%. Patients with type 2 diabetes frequently have a range of concomitant medical conditions that require pharmacological therapy, and polypharmacy is common in this population. The use of co-administration of two oral anti-diabetic agents tends to add to the complexity of treatment and may hinder adherence. Retrospective analyses of treatment records of type 2 diabetic patients show that patients adhere significantly better to a regimen consisting of single-tablet treatment, compared with co-prescription of two agents. Furthermore, previous studies showed that pa t i e nt s ’a dhe r e nc ei mpr ove ds i g nificantly after switching from the co-administration of metformin and sulphonylurea to a single-tablet combination. Fixed-dose Sulphonylurea/ Metformin combination therapy might improve drug compliance and reduce the cost in management of diabetic patients.

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LS2-2 OPTIMUM MANAGEMENT OF TYPE 2 DIABETES — TIMELY INITIATION AND INTENSIFICATION OF BASAL INSULIN Roger Chen Adjunct Professor, University of Technology, Sydney, Clinical Senior Lecturer, University of Sydney; Senior Endocrinologist, Concord Repatriation General Hospital, Sydney, Australia; Medical Director, Ryde Hospital Diabetes, Sydney, Australia The initiation of insulin in Type 2 diabetes can result in substantially improved glycaemic control. The task endocrinologists and diabetologists have is to convince patients as well as other stakeholders that insulin is safe, effective and can be administered with ease, using devices which are simple to use. The devices include disposable insulin pens such as the solostar pen. In this lecture, data outlining the efficacy of the basal insulin glargine in Type 2 diabetes will be presented. As compared to NPH, glargine use results in less hypoglycaemia, particularly less nocturnal hypoglycaemia, less weight gain and with less glycaemic variability. The DAWN study has identified these issues as being some of those most feared by patients on insulin. Thus, minimisation of these side effects c a nha veas i g ni f i c a ntf a vour a bl ee f f e c tont hepa t i e nt ’ squa l i t yofl i f e ,whi c hc a nt r a ns l a t e to increased confidence and in the long term, hopefully to long term sustained optimal glycaemic control. Data concerning the flexibility of timing of glargine use will also be presented. Once daily glargine can often be sufficient to achieve HbA1c targets; particularly when HbA1c levels are significantly elevated, where fasting hyperglycaemia is the principal contributor to HbA1c. If HbA1c levels improve but do not reach target; postprandial hyperglycaemia must also be considered. In this scenario, prandial insulin can be initiated; initially once daily with the main meal. The use of basal and prandial i ns ul i nha sbe e nt e r me d“ ba s a lpl us ” . Cl i ni c a lt r i a l sha ves hownt ha tt hi sc a nbenotonl y an effective means of achieving HbA1c targets, but also that this is a simple regimen which allows flexibility in timing of injections. Pharmacokinetic and pharmacodynamic data comparing Glargine with other basal insulins will also be presented, as well as clinical data comparing Glargine and Detemir in both Type 1 and Type 2 diabetes.

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LS3-1 POPULATION STUDY ON HDL CHOLESTEROL AND RELATED DISORDERS IN TAIWAN: RISK BEYOND LDL CHOLESTEROL TA-CHEN SU National Taiwan University Hospital Cardiology Department Dyslipoproteinemia and cardiovascular disease are important health burdens in developed countries. The nationwide population-based prevalence and determinants of dyslipoproteinemia, however, are lacking in Taiwan. Furthermore, the roles of various lipid profiles for future cardiovascular disease events such as stroke and coronary heart disease should be investigated among ethnic Chinese in Taiwan. The Taiwanese Survey on Hypertension, Hyperglycemia, and Hyperlipidemia (TwsHHH) in 2002 revealed that hypercholesterolemia, defined as cholesterol level at or above 240 mg/dL, accounted for 9.9% for men and 10.4% for women; and hypertriglyceridemia, defined as triglyceride level at or above 200 mg/dL, accounted 19.5% for men and 10.8% for women of 15 years-old age population in Taiwan. In addition, the corresponding prevalence of low HDL cholesterol was 23.7% for men (HDL<40 mg/dL) and 27.9% for women (HDL<50mg/dL). The high prevalence of dyslipoproteinemia indicated the urgent need of public health concern and development of strategy in the prevention of the associated cardiovascular complications. Age, diabetes, hypertension, overweight or obesity, and central obesity were the determinants of hypercholesterolemia and hypertriglyceridemia for men and women after multivariate adjustment. Subjects of increased the risk of low-HDL were those prehypertension, hypertension, diabetes, current smoker, overweight, obesity and central obesity for men; while the corresponding determinants for women were hypertension, central obesity and diabetes. Among these lipid profiles, the relationship of dyslipoproteinemia and the risk of cardiovascular events have been demonstrated in ethnic Chinese in Taiwan. We also demonstrated that one variant in the novel gene, APOA5, was significantly associated with low HDL and high triglyceride traits. The management of dyslipoproteinemia beyond LDL, especially low HDL cholesterol and hypertriglyceridemia, should be implemented among ethnic Chinese population.

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LS3-2 MACRO AND MICROVASCULAR RESIDUAL RISK ON OPTIMAL STATIN THERAPY: CLINICAL IMPLICATIONS AND NEW THERAPEUTIC STATEGIES Alberto Zambon Department of Medical and Surgical Sciences, University of Padua, Italy Gains in cardiovascular disease (CVD) prevention over the last 4 decades are now seriously challenged by the impact of global epidemics of obesity, metabolic syndrome and type 2 diabetes (T2DM). Recent data even raise the prospect of a reversal in heart disease mortality rates, especially in younger men and women. These trends will undoubtedly impact on the cost of managing CVD, currently estimated at about $450 billion in the USA, and $300 billion in Europe. Despite current standards of care aimed at achieving targets for low-density lipoprotein cholesterol, blood pressure and glycemia, dyslipidemic patients remain at high residual risk of vascular events. Macrovascular and microvascular complications significantly affect life expectancy as well as quality of life of patients with T2DM. Both macro and microvascular complications are accounted for by a clustering of cardiometabolic risk factors: the presence of a peculiar lipoprotein phenotype with elevated triglycerides and low levels of high-density lipoprotein (HDL) cholesterol, often with elevated apolipoprotein B and non-HDL cholesterol, the atherogenic dyslipidemia, plays a significant contribution to the development/progression of T2DM complications. Extensive evidence shows that elevated TG and low HDL-C are each predictors for CVD, independent of LDL-C. While LDL-C levels are often normal or only modestly elevated in patients with diabetes and/or metabolic syndrome, apolipoprotein B concentration is often increased representing the sum of concentrations of atherogenic particles (VLDL, IDL and LDL). Additionally, there tends to be more LDL particles of small size, highly susceptible to oxidation. In lipid treatment trials, the combination of lipid and lipoprotein abnormalities associated with the metabolic syndrome/T2DM substantially adds to residual CVD risk. Even if LDL-C levels are <70 mg/dL, vascular risk remains up to 40% higher in the presence of low HDL-C (<35 mg/dL) or elevated TG (200 mg/dL)(data from the TNT trial). Atherogenic dyslipidemia is also implicated in the pathogenesis of diabetic

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microvascular disease. Elevated serum total and LDL-C and TG may have causative roles in the development of retinal hard exudates and diabetic maculopathy, and high TG was also linked with increased risk for proliferative diabetic retinopathy. In a report from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC) the severity of retinopathy was positively associated with TG and negatively associated with HDL-C. Elevated levels of TG and TG-rich VLDL appear to be closely involved in driving the progression of albuminuria, a marker of nephropathy. Additional data suggest that higher HDL-C levels may be protective against nephropathy. Early initiation of lifestyle changes and combination lipid-modifying therapy aimed at correction of atherogenic dyslipidemia that characterizes T2DM, in addition to current standards of care, may reduce the residual risk of macrovascular as well as microvascular complications in T2DM. Lifestyle modification is an important first step. Pharmacotherapy is often also required. Statins currently represent the cornerstone of dyslipidaemia management in patients with type 2 diabetes. A meta-analysis based on 14 prospective studies including 18,686 patients with T2DM has shown that statins reduce, after one year, major coronary events by 22% and stroke by 21% per 1 mmol/L (39 mg/dl) reduction in LDL-C. Despite this pharmacological approach, a residual risk of further cardiovascular events remains of about 65%-85%%: low levels of HDL-C and elevated triglycerides, key features of the T2DM lipid phenotype, significantly contribute to this residual CV risk as suggested by several trials where statins fail to abolish the coronary risk associated with a low HDL-C and high TG. Fibrates are effective in addressing all three components of the atherogenic lipid profile that characterizes type 2 diabetes. Data from the Helsinki Heart Study (HHS), the Veterans Affairs HDL-Cholesterol Intervention trial (VA-HIT), and the Bezafibrate Infarction Prevention trial (BIP) have shown that fibrates seem to specifically reduce the risk of CHD death and stroke in type 2 diabetics and in patients with metabolic syndrome. FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) provided important evidence of the benefits of fenofibrate treatment in attenuating microvascular and macrovascular complications, including silent myocardial infarction, and hospitalization for acute coronary syndromes in patients with type 2 diabetes. Moreover, progression of albumin excretion rate, laser treatment for retinopathy and non-traumatic amputations were all decreased in FIELD, indicating protection against diabetic microvascular complications. These microvascular effects were independent of the degree of glycemic and lipid control

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or concomitant medication. Evidence from FIELD also supports the safety of adding fenofibrate, but not gemfibrozil, to a statin therapy to fully normalize the atherogenic lipid profile. Combination of statins and fenofibrate seems therefore a logical approach in high risk diabetics. Adding a fibrate to statin therapy improves achievement of all lipid risk factors. Outcomes studies are evaluating whether these strategies translate to greater clinical benefit than with statin alone. The association of fenofibrate to a statin therapy in presence of a persistently low HDL-C and/or elevated triglycerides is supported by the 2004 update of the ATP III guidelines. Altogether, fenofibrate appears particularly indicated in 1) diabetic patients with residual dyslipidemia (high TG and/or low HDL) on statin therapy to reduce the residual risk of cardiovascular disease and 2) non-diabetic overweight insulin-resistant patients at high risk with hypertriglyceridemia and/or low HDL and chronic inflammation. Finally, in the general diabetic population, the potential of beneficial effects on microvascular complications also needs to be considered.

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LS4-1 POSTPRANDIAL HYPERGLYCAEMIA — A COMMON DENOMINATOR IN DIABETES AND CVD Wayne H-H Sheu Division of Endocrinology and Metabolism, Department of Medicine, Taichung Veterans General Hospital Blood glucose levels have previously been the interest of internists/diabetologists, but accumulating evidence indicates that dysglycemia, especially elevated postprandial glucose (PPG), is widespread among patients with coronary artery disease. In fact, it is more common than normoglycemia in these patients and coexistence of dysglycemia and cardiovascular disease presents significant health risks. Recent studies have shown that that both conditions should be treated early to reduce the development of complications. The cardiovascular toxicity of postprandial hyperglycemia is mediated by oxidant stress, which is directly proportional to the increase in glucose after a meal. This transient increase in free radicals acutely triggers inflammation, endothelial dysfunction, hypercoagulability, sympathetic hyperactivity, and a cascade of other atherogenic changes. Early randomized controlled trials indicate that reducing postprandial hyperglycemia appears to significantly slow atherosclerotic progression and may improve cardiovascular prognosis. Diet, exercise, and various pharmacologic agents can improve postprandial hyperglycemia. Alpha-Glucosidase inhibitors (AGIs), specifically target PPG, have been shown in several randomized controlled trials to be effective in controlling blood glucose, whether they are used as monotherapy or in combination with other antidiabetic medications. Studies have also suggested that acarbose, one of most commonly used AGIs, could decrease the risk of cardiovascular disease, both in IGT and in diabetes. Furthermore, AGIs are very safe and are nontoxic drugs. Their only side effects are gastrointestinal, such as flatulence and diarrhea; however, these can be minimized by the "start low, go slow" approach. The current ongoing “ ACE”trial will provide final answer of treatment of Acarbose on new DM and recurrent cardiovascular events in subjects with IGT and history of myocardial infarction.

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LS4-2 MANAGEMENT OF THE CV RISK BY CONTROLING THE BP MORNING SURGE Chen-Huan Chen Department of Medical Research and Education, Taipei Veterans General Hospital; Professor of Medicine National Yang-Ming University School of Medicine Blood pressure (BP) is highest mid-morning and then falls progressively throughout the remainder of the day. The circadian variation of BP is related to awakening and arising, is mainly driven by the sudden activation of the sympathetic nervous system, and is also mediated by other systems, such as the renin-angiotensin system. In hypertensive patients BP surges in the morning hours by a mean of 29/24 mmHg, or 23/33%, versus night time systolic BP and diastolic BP. The early morning BP surge is associated with markers of target organ damage, such as left ventricular hypertrophy and microalbuminuria, and is associated with higher incidence of cardiovascular events. The early morning BP surge contributes to the morning hypertension, which is defined as high morning BP in the presence of normal evening BP. Morning hypertension in the treated hypertensives may be equivalent to the“ ma s ke dhy pe r t e ns i on” ,i de nt i f i e dbyhi g h home BP in the presence of normal office BP. Masked hypertension might be a good predictor of stroke, particularly among individuals using antihypertensive medication. The early morning BP surge, morning hypertension, and masked hypertension are important therapeutic targets in the control of hypertension and can be managed using an effective controlled release formulation, such as nifedipine-GITS. Nifedipine-GITS has been compared with intrinsically long half-life amlodipine in 41 hypertensive patients for more than 6 weeks each in a randomized open-label crossover study and demonstrated a stronger antihypertensive effect than amlodipine during the critical morning period. Furthermore, based on the principle of chronotherapy, monotherapy of nifedipine-GITS at bedtime has been shown to reduce greater nighttime and morning surge of BP, yield more patients with controlled ambulatory BP after treatment and less patients with nondippers, and cause less incidence of edema, than morning treatment nifedipine-GITS. Good control of the early morning BP surge is expected to improve outcomes of patients with hypertension.

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LS-5 INFLAMMATION IN ATHEROSCLEROSIS — IS IT CLINICALLY IMPORTANT? — RESULTS OF RECENT CLINICAL TRIALS Lawrence A. Leiter Head, Division of Endocrinology & Metabolism, St .Mi c ha e l ’ sHos pi t a l Professor of Medicine and Nutritional Sciences, University of Toronto There is increasing evidence that the traditional view of atherosclerosis being solely a result of passive accumulation of lipid within an artery is obsolete. It is now recognized that the role of inflammation is key. This concept is important not just in terms of a better understanding of the biology of atherosclerosis, but more significantly at the clinical level, for providing improved risk stratification as to who will develop a cardiovascular event. Numerous recent studies have revealed that inflammatory markers can significantly help to better risk stratify patients. Of the various inflammatory markers looked at, hsCRP offers the greatest utility as it is a remarkably stable protein over time with a variability similar to other markers such as cholesterol, has readily available standardized assays, and has a relatively low cost. Many studies have shown that hsCRP adds prognostic information at all levels of LDL-C and at all levels of the Framingham Risk Score. The Reynolds Risk Score, which incorporates hsCRP plus family history of premature coronary artery disease on top of traditional Framingham risk factors, has been shown to result in the reclassification of 20-40% of patients based on Framingham risk factors alone, in men and women, respectively. There is also evidence that inflammation can be used to identify patients who will derive greatest benefit with risk reduction therapies. Post hoc analyses of a number of the large statin trials have revealed that individuals with low LDL-C and high hsCRP, for example, derive much greater benefit than those individuals with low LDL-C and low hsCRP levels. The JUPITER trial included 17,802 apparently healthy men and women with elevated levels of hsCRP who were randomly assigned to either rosuvastatin 20 mg daily or placebo. Entry criteria included men >50 years and women >60 years with no prior history of cardiovascular disease or diabetes, an LDL-C<130 mg/dL, and an hsCRP>2 mg/L. In contrast to previous lipid primary prevention trials which included virtually exclusively － 115 －

Caucasian men, JUPITER included 6801 women and 5118 non-Caucasians. The baseline LDL-C was only 108mg/dl with an hsCRP of 4.2 mg/L. The rosuvastatin therapy was associated with a 50% reduction in LDL-C and a 37% reduction in hsCRP. The study was stopped early by the DSMB after a median follow-up of just 1.9 years because of a 44% reduction in the primary end-point of myocardial infarction, stoke, unstable angina/revascularization and cardiovascular death (p<0.00001). The number needed to treat extrapolated to 5 years was only 25. Importantly all of the individual components of the primary end-point were reduced by a similar degree and similar risk reductions were seen across all sub-groups. There was also a significant 20% reduction in all-cause mortality. In addition, no significant safety concerns were observed despite the fact that the mean on-treatment LDL-C was only 55mg/dl. The results of the JUPITER study will have a major effect on treatment guidelines.

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LS6-1 CLINICAL IMPACTS AND UPDATES FROM RECENT GUIDELINE AND TRIALS Chih-Yuan Wang Department of Internal Medicine, Far-Eastern Memorial Hospital Many large, randomized, controlled trials have proved that cholesterol-lowering therapy with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) reduces the risk of mortality and/or cardiovascular events across a wide and various range of cholesterol levels whether patients have a history of coronary artery disease or not. That means that lipid-lowering therapy with statins reduces the risk of cardiovascular events. However, the optimal level of low-density lipoprotein (LDL) cholesterol is in debate. In previous comparison of two statin regimens of different lipid-lowering intensities for the prevention of cardiovascular events, intensive therapy with high-dose satins resulted in a median LDL cholesterol level of up to 62 mg/dl, as compared with a level of 95 mg/dl for standard-dose statins. The more intensive therapy had resulted in a much lower risk of mortality from any cause or major cardiac events than that did a moderate level of lipid lowering with the use of a standard dose of statins. We always could find more intensive lipid lowering significantly increased this clinical benefit for patients with hyperlipidemia and potentially cardiovascular disease. Previous reports indicated that intensive therapy with statins got a persistent beneficial effect on cardiac events due to lower LDL-cholesterol levels with a significant reduction in the risk of recurrent unstable angina and the need for revascularization. The reduction in clinical cardiac events with the more intensive lipid-lowering therapy was prominent as early as less than one month after the start of lipid-lowering therapy. It is very important to note that the safety and efficacy results were reported and monitored in various study population. We may even suggest that after once acute coronary syndrome in both diabetics and non-diabetics, the target LDL cholesterol level should be lower and concerned.

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LS6-2 AGGRESSIVE LIPID LOWERING IN COMBINATION WITH EZETIMIBE AND STATINS Morgan Mao-Young Fu Department of Cardiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine Objectives: To retrospectively assess the effect and safety of adding ezetimibe to statin or fibrate on low-density lipoprotein cholesterol (LDL-C) reduction and goal attainment of National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) in patients with dyslipidemia in real daily practice. Patient and Methods: This was a multi-center, hospital-based study with a minimum duration of 3 months by retrospective survey of a targeted dyslipidemic cohort. Data were collected from medical charts of patients with dyslipidemia who did not achieve (NCEP ATP III) treatment goals with existing statin or fibrate lipid lowering therapy and had been added on with ezetimibe 10 mg for at least 3 months period between January 1st 2006 and March 31st 2007. Results: A total of 428 subjects were included in this analysis. The mean age was 59.3 + 9.4 years old. 54.2% were female. Their average BMI was 26.1 + 4.0. Ezetimibe 10 mg Qd added to statin or fibrate therapy significantly reduced the LDL-C level from 163.8 +42.3 mg/dl to 118.0 + 42.4 mg/dl ( P<0.0001) with an overall additional 39.9% of treatment goal attainment after treatment for 3 months. Among the four NCEP ATP III risk category subgroups of 1) very high risk: patients with clinical atherosclerosis and diabetes; 2) high risk: patients with clinical atherosclerosis or diabetes; 3) medium risk: patients with 2 risk factors and no clinical atherosclerosis or diabetes; 4) low risk: patients with1 risk factor and no clinical atherosclerosis and diabetes, the goal attainment rates were 15.3%, 40.5%, 52.7% and 72.4% respectively after ezetimibe was added on to their existing lipid lowering regimen for three months. Conclusions: When ezetimibe was co-administered with statin or fibrate in dyslipidemic patients with different population of clinical atherosclerotic diseases or risk factors, it provided significantly additional reduction in LDL-C and increased the treatment goal attainment rate.

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SS1 CURRENT THERAPEUTIC APPROACHES TO THE TREATMENT OF TYPE 2 DIABETES Harold Lebovitz State University of New York, USA The role of glycemic control in the development of macrovascular disease in patients with diabetes has been controversial. Numerous epidemiologic studies have shown: 1.) an association of the magnitude of postprandial or post-glucose challenge plasma glucose level and the development of clinical cardiovascular events in individuals with IGT (impaired glucose tolerance) and 2.) the degree of HbA1C elevation in patients with diabetic correlates with the development of clinical cardiovascular events (1,2). However, attempts to show reductions in clinical cardiovascular events with intensive glucose control in randomized, controlled clinical trials have not been conclusive. In the United Kingdom Prospective Diabetes Study, the intensively treated glucose arm had a 16 % reduction in myocardial infarctions and a 6 % reduction in all cause mortality both of which failed to achieve statistical significance (3). In the Diabetes Control and Complication Trial (DCCT) in type 1 diabetic patients the intensive glycemic control arm had less cardiovascular events but the number of events was too small to achieve statistical significance (4). Three large randomized, controlled clinical trials (ACCORD, ADVANCE and VADT) have been carried out over the last several years to specifically answer this question of whether intensive glycemic control will reduce cardiovascular complications in type 2 diabetic patients (5-7). Table 1 defines the characteristics of the three populations. All three were characterized by a long mean duration of diagnosed diabetes and a high prevalence of both previous cardiovascular events and a high cardiovascular risk profile. The entering baselines mean HbA1C ranged from 7.5 to 9.4 %. The difference in HbA1C between the intensively-treated and the ordinarily-treated cohorts ranged from 0.8 % to 1.9 % and should have been sufficient to show the effect of glycemic control. It is important to initiate intensive glycemic control early in the course of diabetes. Is it important what strategies are employed to achieve intensive glycemic control? The ACCORD and VADT data indicate that intensive treatment with insulin was associated with a great increase in severe hypoglycemia in patients with type 2 diabetes. Those patients who experienced a severe hypoglycemic episode were more likely to develop cardiovascular complications and were more likely to die at some time during the trial. The － 119 －

causal relationship between the previous severe hypoglycemic event and the vascular complication or death is not understood. Additionally, the patients gained very large amounts of weight (the intensively-treated cohort in ACCORD had greater than 10 kg weight gain in 28 % of patients). These observations suggest caution in the use of intensive insulin therapy in type 2 diabetic patients with high cardiovascular risk. Rosiglitazone was used extensively in both ACCORD and VADT to help improve glycemic control. Because of the issue raised by a published meta-analysis implicating rosiglitazone as possibly associated with an increase in ischemic myocardial events (13), both studies examined the relationship between rosiglitazone use and the development of cardiovascular events. Both studies found no relationship between rosiglitazone use and the development of cardiovascular events (14). These two studies confirmed previous randomized, controlled clinical trials (RECORD, ADOPT, and DREAM) which showed no significant effect of rosiglitazone in causing ischemic cardiovascular events.

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SS2 DPP-4 INHIBITOR BASED THERAPIES IN THE MANAGEMENT OF T2DM Troels Wolthers Regional Director Medical Affairs, Merck & Co

Diabetes & Obesity Asia Pacific

The search for new and effective therapies for type 2 diabetes has led to the identification of a novel therapeutic target, the incretin hormones, which play a role in mediating glucose homeostasis via effects on glucagon and insulin secretion from pancreatic islet alpha- and beta-cells, respectively. The incretins' glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide are rapidly inactivated by the enzyme DPP-4. DPP-4 inhibitor agents act by blocking the active site of DPP-4, thereby preventing inactivation of and prolonging the duration of action of incretins, which in turn helps to correct the defective insulin and glucagon secretion that marks type 2 diabetes. Clinical studies to date indicate that DPP-4 inhibitors effectively stimulate insulin secretion, suppress glucagon release, and improve glucose control in patients with type 2 diabetes. These agents are well tolerated and have a low incidence of adverse effects. Compounds under development in this new class of oral antidiabetic drugs may be free of the limitations of current therapies.

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O1-1 IMPLEMENTATION OF THE JOINT ASIA DIABETES EVALUATION (JADE) PROGRAM IN TAIWAN L-T HO, C-F KWOK, H-S CHEN, 1T-L HSU, 2W-C YANG, 2Y-Y NG, 2W-J TSAI, 3 C-P TSAI, 3C-M CHEN, 4S-J H WANG, 4T-J CHEN, 4M-H LIN, 5W-Y LEI Metabolism & Endocrinology Division, 1Cardiology Division, 2Nephrology Division, 3 Neurology Division, and 4Family Medicine Departments, Taipei Veterans General Hospital; 5 Merck Sharp & Dohme (I.A.) Corp. Taiwan Branch Background: The Joint Asia Diabetes Evaluation (JADE) Program is a Diabetes care program which was developed based upon the results of the Diabetes center registry evaluation that was conducted by the Chinese University in Hong Kong (CUHK). The registry was first established in 1995, it now consists of data from more than 8,000 patients with a more than 5-year follow up average. A series of Risk Equations were derived to predict the 5-year probability of major events including death, stroke, heart disease and kidney failure. Together with other risk factors including clinically evident complications, renal function, number of risk factors, patients will be categorized into very high, high, medium and low risk groups, patients are then triaged into different care levels for more targeted and individualized management. Objective: To evaluate the Joint Asia Diabetes Evaluation (JADE) Program implementation in Taiwan through a pilot-run experience of a medical center. Method: Patients with type II diabetes were selected and enrolled through the outpatient department. All patients were evaluated following the Comprehensive Assessment (CA) at the first visit with clinical profiles, biochemical parameters. The JADE portal, a web-based data management platform, generated a detailed risk score and probability of events to enable patients to be categorized into 4 groups: a) Very High Risk (VHR), b) High Risk (HR), c) Medium Risk (MR), d) Low Risk (LR) together with their recommended care level. Patients were advised to follow up according to their assigned care levels, which differ principally by intervals between visits and intensity of monitoring. Result: The JADE pilot-run started in Taipei Veterans General Hospital in August, 2008. As of October, 44 patients have been enrolled from the OPD of metabolism & endocrinology, neurology, nephrology, cardiology and family medicine departments. Based on the Portal outputs, 17 patients were categorized as VHR; 21 patients as HR; and 6 patients as MR. There were 42 CA and 11 follow-up visits performed. － 122 －

Conclusion: JADE could be incorporated into regular diabetes out-patient care. The structured care protocol and individualized risk and care level stratification offered by the program is superior to the existing National Health Insurance's diabetes fixed-care procedure. However, more patient data and a longer follow-up period is yet to be accumulated in order to be able to better evaluate the impact of the JADE program on diabetes control.

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O1-2 SERUM HOMA-IR PREDICTS THE DEVELOPMENT OF IMPAIRED FASTING PLASMA GLUCOSE DURING 2- YEAR FOLLOW-UP IN POSTMENOPAUSAL WOMEN T-Y TAI, 1K-S TSAI, 2S-T TU, 3J-S WU, 4C-I CHANG Taipei Jen-Chi Relief Institution; 1National Taiwan University Hospital; 2Chang-hua Christian Hospital; 3National Cheng-Kung University Hospital; 4Division of Gerontology Research National Health Research Institutes Objective: To determine the risk factors for developing impaired fasting plasma glucose（≧ 100 mg/dL）（IFPG）in postmenopausal women. Methods: The study subjects were culled from the Taiwanese Isoflavone Multicentric Enrollment Study, a 2-year, double-blinded, placebo-controlled study that randomized the postmenopausal women aged 45 to 65 years to the oral administration of 300 mg isoflavone aglycone/day or placebo. Of the 431 subjects, 83 cases were excluded, including 51 with diabetes mellitus or fasting plasma glucose 100 mg/dL or over at baseline and 32 with early termination. The parameters collected during the 2-year follow-up were age, menopausal duration, BMI, systolic and diastolic blood pressure, fasting plasma glucose, serum insulin, HOMA-IR, HbA1c, adiponectin, hsCRP, total cholesterol, triglyceride, HDL-cholesterol, LDL-cholesterol, alkaline phosphatase, daily caloric intake, and physical activity. Results: Among the 348 subjects, 30 were found with IFPG（2 cases with diabetes）; the incidence of IFPG is 41.6 per 1000 person-years during the 2-year follow-up. Compared to those with normal fasting plasma glucose, subjects in the IFPG group reveal statistically significant higher levels of HbA1c, fasting plasma glucose, HOMA-IR, and hsCRP at baseline and during the 2-year follow-up. The IFPG group also reports a lower yet insignificantly level of adiponectin at baseline than their normal counterparts. The 2-year administration of isoflavone fails to influence glucose metabolism; moreover, there is no statistically significant difference of the isoflavone treatment percentage between subjects with different fasting plasma glucose statuses. Fasting plasma glucose, hsCRP and HOMA-IR at baseline are positively correlated with subsequent percentage change in HbA1c. Additionally, systolic blood pressure, diastolic blood pressure, and bone alkaline phosphatase at baseline are positively correlated with subsequent percentage change in fasting plasma glucose.

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Simple logistic regression model shows that the levels of fasting plasma glucose, HbA1c, and HOMA-IR are significantly associated with higher risk of developing IFPG. Multiple logistic regression model shows that higher HOMA-IR is associated with greater risk of developing IFPG（odds ratio 1.392; 95﹪confidence interval 1.067 –1.815; p-value = 0.0147）after adjusting with afore mentioned variables. Conclusion: HOMA-IR is independently and consistently associated with the development of IFPG.

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O1-3 THE FIRST AND SECOND PHASE OF INSULIN SECRETION IN NAÏVE TAIWANESE TYPE 2 DIABETES D PEI, 1J-D LIN, T-L HSIA, 2C-Z WU, C-C SU, W-Y MA, 2A-T HSIEH, B LIN, 2 K-Y TSAI Division of Endocrinology and Metabolism, Department of Medicine, Cardinal Tien Hospital, Xindian, Catholic Fu Jen University; 1Wan Fang Hospital, 2Shuang Ho Hospital, Taipei Medical University Objective: There are two phases of ISEC-the first phase (1st ISEC) and second phase (2nd ISEC). The study aimed to evaluate the two phases ISEC in newly diagnosed type 2 diabetes. Method: Fifty two newly onset type 2 diabetes were given two tests; a modified low dose graded glucose infusion (M-LDGGI) and frequent sample intravenous glucose tolerance test (FSIGT). The M-LDGGI is 2 stages of intravenous infusion of glucose water started from 2 and followed by of 6 mg/kg/min. Each stage was maintained for 80 min and blood samples were collected every 20 min for the measurement of plasma insulin and glucose levels. The results were interpreted as the slope of the changes of plasma insulin levels (y-axis) against the glucose (x-axis). The slope of these curves were regarded as the 2nd ISEC and used as the criteria for grouping-the responders and non-responders. Results: The responders are older and had significantly higher BMI and log HOMA-B, but lower FPG and HbA1c than the non-responders. Significant correlations were noted between the 2nd ISEC and 1st ISEC (r = 0.278, p = 0.046) and between the 2nd ISEC and HOMA-B (r = 0.673, p = 0.000) but not between HOMA-B and 1st ISEC (r = -0.039, p = 0.781). Furthermore, the significant relationships were noted between HbA1c and 2nd ISEC (r = -0.388, p = 0.015) and logHOMA-B (r = -0.357, p = 0.026). Conclusion: Older and overweight type 2 diabetes had better 2nd ISEC. Among all the parameters, 2nd ISEC is the most important factor affecting the degree of glucose levels in naïve Chinese type 2 diabetes. In the same time, the 1st and 2nd ISEC were only modestly correlated with each other which indicated that the deterioration of these two phases were not synchronized. Finally, we also recommend using the M-LDDGI for quantifying 2nd ISEC. This practical method could be done in many centers without difficulty.

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O1-4 METABOLIC PROFILES IN VEGETARIAN AND NON-VEGETARIAN TAIWANESE WOMEN AND THE EFFECTS OF YEARS OF BEING VEGETARIAN JK CHIANG, 1YC CHI, 1, 2WS YANG Departments of Family and Internal Medicine, Buddhist Dalin Tzu Chi General Hospital, Chaiyi; 1Graduate of Clinical Medicine, College of Medicine, National Taiwan University; 2 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Background: Vegetarian lifestyle has showed some benefit to the human health already. Our aim was to investigate the impact of the vegetarian lifestyle on the metabolic profiles. Subjects & Method: A total of 797 healthy female subjects including 397 vegetarians who underwent a general physical examination between May 2007 and April 2008 were enrolled. Demographic data and anthropometric measurements were collected. Written informed consent was obtained. Insulin resistance index by HOMA model was calculated. Result: The vegetarians were found to have lower BMI, smaller waist circumference, lower fasting plasma glucose, lower total cholesterol, lower LDL-C, lower HDL-C, lower triglycerides and lower insulin resistance index. In logistic regression adjusting for the other variables, vegetarian lifestyle was an independent factor associated with lower BMI, smaller waist circumference, lower fasting plasma glucose, and lower insulin resistance index. Moreover, we found that the benefit can be extended to more than 10 years after practicing vegetarian lifestyle. Conclusion: The vegetarian lifestyle is associated with better metabolic profiles and the benefit can be of significant long duration.

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O1-5 EXERCISE ON INSULIN ACTION, INFLAMMATORY CYTOKINE, AND SERUM TARTRATE-RESISTANT ACID PHOSPHATASE 5A IN OBESE TAIWANESE MALE ADOLESCENTS 1

KUANG-CHUNG SHIH, 2TSU-YI CHAO, 3YU-CHING CHOU, 4CHING-FAI KWOK, 5 LOW-TONE HO 1 Division of Endocrinology and Metabolism, Tri-Service General Hospital, 2Division of Hematology/Oncology; 3School of Public Health, National Defense Medical Center; 4 Division of Endocrinology and Metabolism, Taipei-Veteran General Hospital; 5 Departments of Medical Research and Education The benefits of the exercise in glucose metabolism, inflammatory markers, and serum tartrate-resistant acid phosphatase 5a (TRACP 5a) protein levels in Chinese male adolescents has not been extensively studied. In this study, we examine the effects of a 12-week exercise program on weight, adiposity, insulin sensitivity (IS), and markers of inflammation, including the novel macrophage marker, TRACP 5a levels in obese Chinese male adolescents. A total of 106 male adolescents were recruited from Army Academy, Taiwan and classified as lean (mean+SEM: age, 15.8+0.1 years, body mass index, 20.9+0.2 kg/m2) or obese (mean+SEM: age, 15.9+0.1 years, body mass index, 27.7+0.2 kg/m2). The obese group participated in 12-week exercise intervention, the lean group did not. Body composition, IS, and inflammatory markers were measured in both groups and in the obese group after completion of the exercise program. Body weight (P<.001), body mass index (P<.001), waist circumference (P<.001), body fat (P<.001), homeostasis model assessment for insulin resistance (P<.01), fasting plasma glucose (P<.001), fasting serum insulin (P<.01), 2-hour post-challenge plasma glucose concentration (P<.001), interleukin-6 (IL-6) (P<.001), C-reactive protein (CRP) (P<.001) and serum TRACP 5a (P<.001) were significantly higher in the obese group than the lean group. Significant reductions occurred in all anthropometric (P<.001), metabolic (P<.01) and inflammatory indicators (P<.01), except serum TRACP 5a (P>.05), after completion of the exercise program. Obese male adolescents display insulin resistance and elevated inflammation markers including serum TRACP 5a. While obese subjects remained obese, exercise training resulted in significant improvement in IS and attenuation of IL-6 and CRP. TRACP 5a protein was unaffected by exercise training, consistent with our hypothesis that it is a novel marker of macrophage number, associated with increased adipose tissue in obesity.

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O1-6 CHINESE METABOLIC SYNDROME RISK SCORE 1

FONE-CHING HSIAO, 2CHUNG-ZE WU, 1CHANG-HSUN HSIEH, 1 CHIH-TSUENG HE, 1YI-JEN HUNG, 3DEE PEI 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital; 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Cardinal Tien Hospital, Medical School, Fu Jen Catholic University Background: The metabolic syndrome (MetS) was first proposed to predict the occurrence of cardiovascular disease and type 2 diabetes. However, it is difficult to identify subjects with MetS early. No previous studies designed to develop a predictive model for MetS in the Chinese population exists; this study was designed to fill that gap. Methods: A middle-aged Chinese cohort of 198 men and 154 women were followed for two years. The binary logistic regression and receiver operation characteristic (ROC) curve were used to develop a predictive model for the future development of MetS. Results: Over two years of follow up, 30 of the 352 subjects (8.52%) without MetS at baseline subsequently developed MetS. Triglycerides (TG) had the highest area under the curve (AUC), while diastolic blood pressure had the lowest. In order to increase the prediction power, MetS components were arranged in the ROC model according to their AUC. After adding waist circumference (WC) to TG (model 1), the AUC was significantly higher than for TG alone. Adding other components into the model did not increase the AUC significantly. A risk score cutoff (0.078) was selected for the best predictive power of model 1 (sensitivity of 76.7%, specificity of 63.4%, with AUC of 76.8%). Conclusions: These results imply that WC and TG are related to the pathophysiologies of MetS, and model 1 could also be used clinically for screening subjects at high risks for MetS. Appendix: The following is the parameter estimates for model 1 in this study: Pr = 1/(1+e-x), where X= -10.201+ 0.01xTG (mg/dL) + 0.082xWC (cm). In this equation, Pr represents the two-year probability of developing MetS, and represents the risk score.

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O1-7 ASSOCIATION OF INTRAOCULAR PRESSURE WITH THE METABOLIC SYNDROME AND NOVEL CARDIOMETABOLIC RISK FACTORS 1

YI-CHENG CAHNG, 1JOU-WEI LIN, 2LU-CHUN WANG, 3HSIEN-MEI CHEN, 1 JUEY-JEN HWANG, 4LEE-MING CHUANG 1 Department of Internal Medicine, National Taiwan University Hospital Yunlin branch; 2 Department of Ophthalmology, National Taiwan University Hospital Yunlin branch; 3 Health Management Cencer, National Taiwan University Hospital Yunlin branch; 4 Department of Internal Medicine, National Taiwan University Hospital Objective: This study was designed to investigate the association of intraocular pressure (IOP) and primary open-angle glaucoma (POAG) with the metabolic syndrome and emerging cardiometabolic risk factors. Methods: Ophthalmologic examinations including IOP measurement were conducted in 1,112 participants undergoing health check-up in a community hospital. The association of IOP and POAG with the metabolic syndrome and other emerging cardiometabolic risk factors was analyzed. Results: Participants with the metabolic syndrome had significantly higher IOP than those without the metabolic syndrome (mean IOP: 15.72±2.94 vs.14.90±2.90 mmHg, p=2 x10-4). Each additional component of the metabolic syndrome was associated with mean increase in IOP of 0.34 mmHg (95% confidence interval [CI]: 0.12~0.55, p< 0.0001).The adjusted odds ratio of POAG was 2.14 (95% CI: 1.06~4.35, p=0.03) for participants with the metabolic syndrome. IOP was also associated with other insulin resistance-related traits such as hepatic steatosis, proteinuria, increased left ventricular mass and elevated fibrinogen levels (p< 0.0001, p=0.008, 0.002, and 0.02 respectively). However, neither type 2 diabetes nor systemic hypertension was associated with IOP or PAOG. Conclusion: The metabolic syndrome and other insulin resistance-related features are positively associated with elevated IOP and POAG. These findings suggest that insulin resistance play participate in the pathogenesis of elevated IOP.

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O1-8 DIABETIC NEPHROPATHY AND RISK FACTORS FOR PERIPHERAL ARTERY DISEASE IN CHINESE WITH TYPE 2 DIABETES 1

M-C HSIEH, 2K-J TIEN, 1J-Y HSIAO, 1Y-H CHANG, 1H-W KUO, 1S-J SHIN, 3S-T TU 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 3 Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Lukang Branch, Changhua, Taiwan Background: The risk for peripheral arterial disease (PAD) is increased in patients with chronic kidney disease (CKD). We investigated the effects of renal function on PAD in Chinese with type 2 diabetes. Methods: This study enrolled a total of 2983 (1342 males and 1641 females) Chinese adults with diabetes. The mean aged was 63.2±11.9 years. PAD was diagnosed by an ankle-brachial index (ABI) <0.9. Renal function was evaluated by serum creatinine (SCr), estimated glomerular filtration rate (eGFR) and urinary albumin/creatinine ratio (ACR). Risk factors for PAD were evaluated using multiple logistic regression analysis. Results: Age, cholesterol and high density lipoprotein-cholesterol (HDL-c) (inverse association) were significant risk factors in men, whereas age, body mass index (BMI) (inverse association), low density lipoprotein-cholesterol (LDL-c) and HDL-c (inverse association) were significant risk factors for diabetic women. After adjustment for age, BMI, blood pressure, glycosylated hemoglobin, cholesterol, HDL-c, LDL-c and triglycerides levels, we found that SCr levels >1.5 mg/dl, eGFR below 60 ml/min, and urinary ACR above 30 mg/g were independent risk factors for PAD in diabetic men, and SCr levels above 1.4 mg/dl and urinary ACR above 30 mg/g were independently associated with PAD in diabetic women. Conclusion: The risk factors for PAD are somewhat different between men and women with diabetes in Chinese population in Taiwan. Diabetic nephropathy is significantly associated with PAD in this patient population.

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O1-9 INCREASED RISK OF DIABETES AND POLYCHLORINATED BIPHENYLS AND DIOXINS: A 24-YEAR FOLLOW-UP STUDY OF THE YUCHENG COHORT S-L WANG, 1P-C TSAI, 2C-Y YANG, 3Y LEON GUO Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Taiwan, R.O.C.; 1Department of Basic Medical Sciences, National Cheng-Kung University Medical College, Taiwan, R.O.C.; 2Department of Health Business Administration, Hung-Kuang University, Taiwan, R.O.C.; 3Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine, and National Taiwan University Hospital, Taiwan, R.O.C. Objective: Polychlorinated biphenyls (PCBs) and polychlorinated dibenzofurans (PCDFs) are important and persistent organic pollutants (POPs) in humans. Recent cross-sectional studies have detected increased concentrations of serum POPs in diabetic patients. We aimed to examine the association between previous high exposures to PCBs and PCDFs and the cumulative incidence of type 2 diabetes and hypertension. Research Design And Methods: During the late 1970s, the consumption of rice-bran oil laced with PCBs poisoned thousands of Taiwanese. Between 1993 and 2003, we e xa mi ne d1, 054Yuc he ng( “ oi ldi s e a s e ” )vi c t i msa g a i ns tneighborhood reference subjects using a protocol blinded for POP exposure. Here, we report the results derived from 378 Yucheng subjects and 370 matched references. Results: The diabetes risk to members of the Yucheng cohort relative to their reference subjects was significantly increased for women (odds ratio [OR] 2.1 [95% CI 1.1–4.5]) but not for men after considering age, BMI, cigarette smoking, and alcohol intake. Yucheng women diagnosed with chloracne had adjusted ORs of 5.5 (95% CI 2.3–13.4) for diabetes and 3.5 (1.7–7.2) for hypertension compared with those who were chloracne free. Conclusions: Yucheng women, who had endured previous exposure to PCBs and PCDFs, suffered from increased incidences of diabetes, particularly those who had retained significant levels of pollutant as evident from chloracne. When planning treatments against diabetes, the body burden of PCBs and dioxins should be carefully considered, especially for women.

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O2-1 THE IL4 GENE AND GRAVES' DISEASE: META-ANALYSIS 1,2,3

YANN-JINN LEE, 1,4CHI-YU HUANG, 1,4WEI-HSIN TING, 1WEN-LING GUO, 2 WEI-FANG CHEN, 5FU-SUNG LO Departments of 1Pediatrics and 2Medical Research, Mackay Memorial Hospital; 3 Department of Pediatrics, Taipei Medical University; 4Mackay Medicine, Nursing and Management College; 5Department of Pediatrics, Chang Gung Memorial Hospital, Chung Gung University College of Medicine, Taoyuan, Taiwan In the thyroid gland affected by Graves' disease (GD), T helper cells (CD4+) is predominate in dense lymphoid aggregates while cytotoxic T cells (CD8+) predominate in areas of lower cell density. Activated CD4+ T cells produce IL-4 which affects many immunoregulatory pathways. Serum IL-4 levels are significantly higher in patients with GD. IL4 has been tested for its association with GD, however, the results are controversial. A meta-analysis combines data from all published studies and may provide a more accurate estimate of effect sizes and reduced probability of false-negative results. Therefore further study in another populations and a meta-analysis are necessary for clarification. Materials and Methods: Our study in the previous report We have reported our preliminary report on the IL4 gene and GD in children in the previous meeting. We recruited more patients and controls and included them in this meta-analysis. The patients were 203 unrelated children (34 boys, 169 girls) with GD, 11 of whom (2 boys, 9 girls) also had type 1 diabetes. Their age at the diagnosis of GD was 10.2 ± 3.4 years (range 2.7 –20.2 years). GD was diagnosed on the basis of clinical and laboratory evidence (clinical symptoms and signs of thyrotoxicosis, elevated free T4/total T4 and suppressed TSH levels, diffuse goiter, with or without ophthalmopathy, and the presence of autoantibodies to thyroglobulin, microsomes or both and TSH receptor antibody). The controls were 686 subjects (305 males, 381 females) who included hospital personnel and individuals undergoing routine health examinations or minor surgery. None had a history of autoimmune disease. All patients and controls were Taiwanese. Literature search and meta-analysis We searched the PubMed database (http://www.ncbi.nlm.nih.gov/sites/entrez) of the US National Library of Medicine for all genetic association studies on the IL4 gene and GD from 2000, when the association was first reported, till September 2008. The references of － 133 －

all identified publications were also searched for additional studies. According to the MOOSE (Meta-a na l y s i sOfObs e r va t i ona lSt udi e si nEpi de mi ol ogy )g ui de l i ne s ,a ut hor s ’ names, year of publication, ethnicity of the study subjects, region/country where the study subjects resided, numbers of cases/patients and controls, age at diagnosis of GD for patients and at sampling of DNA for controls, manner in which the controls were selected, and number of subjects with each genotype or allele in both cases and controls were extracted. 2 Hardy-We i nbe r ge qui l i br i um wa sa s s e s s e df orc a s e sa ndc ont r ol si ne a c hs t udyus i ngχ goodness of fit test. A meta-analysis was performed using Comprehensive Meta-Analysis Version 2. All P values are two-tailed. Results: On the association between the IL4 gene and GD, literature search showed 7 reports on rs2243250, 2 on rs2070874, and 1 on each of rs2243288, rs2243289 and rs2243290. The frequencies of allele T of rs2243250 was significantly higher in Asians than Caucasians (79.4% vs 12.6%, P = 1.4 10-247). Combining data of the reports and ours, meta-analyses did not reveal any significant association between the T allele of rs2243250 and GD in the whole (OR = 1.002, 95% CI 0.828-1.212)or in each ethnic groups (OR = 1.020, 95% CI 0.840-1.238 for Asians; OR = 0.572, 95% CI 0.191-1.711 for Caucasians). Neither did not other alleles and genotypes of the SNP and those of other SNPs (data not shown). No data on haplotypes were available for analysis. Conclusion: A meta-analysis was unable to detect any association between SNPs (rs2243250, rs2070874, and rs2243289) and GD in the whole data or in the individual ethnic groups (Asians and Caucasians).

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O2-2 ASSOCIATION OF CD40 GENE WITH LATER-ONSETGRAVES’ DISEASE IN TAIWANESE 1

J-Y HSIAO, 1M-C HSIEH, 1S-J SHIN 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan, ROC Objective: Gr a ve s ’d i s e a s e( GD)i sk n own to be associated with CD40 genes. Therefore, we decided to investigate the relationship of age at onset of GD with CD40 and susceptibility in a Taiwanese population. Design & Method: We analyzed the association of CD40 polymorphisms with age at onset of GD in Taiwanese patients. We stratified patients into those with early onset (<40 yr; 30.3±4.8 yr; n=135) and later onset (≥40 yr; 52.3 ± 6.3 yr; n=80) and compared the results with those of 141 normal controls. Results: We found the frequencies of the T allele and TT genotype of the CD40 SNP were found to be significantly increased in GD patients who developed GD aged over 40 2 years than those who developed the disease aged below 40 years (allele: χ =5.299, P = 2 0.021, OR = 1.597 ; genotype: χ= 6.168,P = 0.046). Conclusions: These data suggest that the T/T genotype and T allele in the CD40 gene are more likely to be associated with late-onset GD in Taiwanese patients.

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O2-3 IDENTIFICATION OF MIR-146B-REGULATED TARGET GENES ASSOCIATED WITH TUMOR AGGRESSIVENESS IN ADULT PAPILLARY THYROID CARCINOMAS 1

CHEN-KAI CHOU, 2HONG-YO KANG, 2RONG-FU CHEN, 2KUENDER D. YANG, 3 FONG-FU CHOU, 1YA-FANG LEE, 1RUE-TSUAN LIU 1 Division of Metabolism, 2Department of Medical Research, 3Department of Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, Kaohsiung Objective: MicroRNAs (miRNAs) are small noncoding RNA molecules that function as negative regulators of gene expression by binding to the 3 -untranslated region of target mRNAs and blocking the translation or degradation of the mRNAs, that mediate various pathophysiological processes. In our previous study, we demonstrated that miR-221, miR-222, and miR-146b are associated with tumor aggressiveness in adult papillary thyroid carcinomas (PTCs). In this study, we sought to identify the potential gene targets of miR-146b. Research Design And Methods: We pre-selected four PTC samples for fluorescent cDNA targets microarray (Ambion, Austin, TX, USA) analysis and used the algorithm of the bioinformatic programs miRGen (www.diana.pcbi.upenn.edu/miRGen; Megraw et al. 2007), TargetScan (Lewis et al. 2003), Pictar (Krek et al. 2005), and miRanda (John et al. 2004) to predict human miR-146b gene targets. Two PTCs with extrathyroidal invasion and in the high-risk group have high expression level of miR-146b. The other two without extrathyroidal invasion and in the low-risk group have low expression level of miR-146b. Those genes with differential expression on cDNA microarray and regulated by miR-146b are the potential target genes. Results: Differential expression of four genes (C5orf23, HM box1, EPB41L3 and MAP3K8) predicted as miR-146b gene targets were identified. Their expression levels are significantly lower in tumors with high miR-146b expression compared to tumors with low miR-146b expression. Conclusion: We identified four genes potentially regulated by miR-146b and associated with tumor aggressiveness in adult PTCs. Defining the precise role of these genes is important for future investigation.

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O2-4 EVALUATION OF CORRELATION BETWEEN CIRCULATING THYROTROPIN RECEPTOR ANTIBODIES AND SERUM THYROTROPIN LEVELS IN PATIENTS WITH GRAVES' DISEASE 1

L-S LEE, W-C LO Division of Endocrinology and Metabolism, Department of Internal Medicine, Ren-ai Branch, Taipei City Hospital, Taiwan, R.O.C.; 1Department of Clinical Pathology, Ren-ai Branch, Taipei City Hospital, Taiwan, R.O.C. Objective: To elucidate correlation between activity of thyrotropin (TSH) receptor antibodies and serum TSH level in patients with Graves' disease. Methods: We estimated activity of TSH receptor antibodies by means of thyrotropin binding inhibitory immunoglobulin (TBII) index, TSH and free thyroxine (T4) levels in 32 f e ma l e sa nd8ma l e swi t hGr a ve s ’di s e a s e .Da t awe r ec a t e g or i z e da c c or di ng to their TSH levels for further statistical analysis. Results: Mean TBII indices are 63%, 39%, 27%, 18% in the undetectable, subnormal but detectable, normal and supranormal TSH levels subgroups, respectively (P<0.05 or <0.01). Mean free T4 are 2.72, 1.23, 1.14, 1.07 ng/dl in the four groups, respectively (no significance); a significant negative correlation between TSH level and TBII is noted (P<0.01). Conclusion: Circulating TSH receptor antibodies have a significant negative feedback effect on serum TSHs e c r e t i oni npa t i e nt swi t hGr a ve s ’di s e a s e .

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O2-5 THE RELIABLE PARAMETERS OF COLOR DOPPLER ULTRASONOGRAPHY IN PREDICTING THYROID FUNCTION 1

CHIA-CHE HAN, 2SHYH-CHING CHIOU, 1YUN-SHING PENG, 3HSU-HUEI WENG, 1 CHENG HO, 1PAO-YIN CHEN 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, and Chang Gung University, Taoyuan, Taiwan ; 2 Department of Internal Medicine, Da-Chien General Hospital, Miaoli, Taiwan ; 3 Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chia-Yi, Taiwan Objective: The aim of this study is to compare the parameters of color Doppler ultrasonography (CDU) to analyze which parameter more reliable to predict the thyroid function between euthyroid and hyperthyroid status. Eventually, we evaluated the cut-off value of the most reliable parameter of CDU as a reference for clinical practice. Patients and methods: We retrospectively reviewed data from a total of 262 patients who had undergone CDU to image thyroid disorders December 2003 to April 2008. The female to male distribution of patients was 3.44:1 (203 females and 59 males). Patients who underwent CDU ranged in age from 11 to 81 years old with a mean ± standard deviation of 38.45 ± 14.52 years old. The mean age of female patients was 36.96 ± 14.30 years old and that of males was 43.77 ± 14.17 years old. The parameters evaluated including pulsatility index (PI), resistive index (RI), peak systolic velocity (PSV), blood volume flow (VF), ITA diameter (DIAM), end diastolic velocity (ED), Time-averaged maximum velocity (TAmax), Time-averaged mean velocity (TAmean), acceleration (ACCE). We then evaluated the differences among these parameters between euthyroid and hyperthyroid. The Student t test was used to compare the means of CDU parameters and the significant level was set at p< 0.05. The receiver operating characteristic curve (ROC) was used to determine the optimal cut-off value of the parameters of CDU to predict thyroid functional status between euthyroid and hyperthyroid. Results: Except PI (p= 0.195) and RI (p= 0.544), significant differences (p < 0.001) were noted in all CDU parameters between euthyroid and hyperthyroid status, which included VF, DIAM, PSV, ED, ACCE, TAmax, TAmean. Then, we selected the PSV & VF & TAmax, the most available parameters in clinical practice, to further compare to evaluate which one is the most reliable parameter for prediction of thyroid function. The areas under the ROC curve of the three CDU parameters are: VF: 0.8061; PSV: 0.8210; TAmax: － 138 －

0.8024, and there were no significant difference between the three parameters in predicting thyroid function. According to ROC analysis, the most optimal cut-off values of PSV, VF and TAmax for predicting thyroid function are 25cm/sec, 8ml/min and 17cm/sec respectively. Conclusion: The three CDU parameters (include PSV, VF and TAmax) are useful in predicting thyroid function between euthyroid and hyperthyroid status according to ROC analysis. The cut-off values of these parameters which we provided have powerful predi c t i v ea c c ur a c y ,a ndt he ydon’ tdi f f e rs i g ni f i c a nt l y .Si nc et heme a s ur e me ntofVFwa s e a s i l ya f f e c t e dbydi a me t e rofI TA,t hema i nva r i a bl ef a c t orbyphy s i c i a n’ sope r a t i ona nd individual vascular variation, we propose that PSV or TAmax would be the most reliable parameter used to predict thyroid functional status. Keywords: color Doppler ultrasonography; hyperthyroid; euthyroid; PSV; VF; TAmax

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O2-6 ANALYSIS OF CLINICO-PATHOLOGICAL CHARACTERISTICS AND PROGNOSIS FOR SMALL PAPILLARY THYROID CANCERS YA-LING HSU, JEFFERY C. CHEN, 1AN-CHEN FENG, 2TSUNG-YEN CHENG, 3 DUNG-LUNG YU, GERALD TSAI Division of Endocrinology and Metabolism, Department of Internal Medicine, Koo Fundation Sun-Yat Sen Cancer Center; 1Office of Clinical Research, Koo Fundation Sun-Yat Sen Cancer Center; 2Department of General Surgery, Koo Fundation Sun-Yat Sen Cancer Center; 3Department of Nuclear Medicine,Koo Fundation Sun-Yat Sen Cancer Center Backgrounds/Aims: This study aims to describe clinical behaviors and investigate predictors of relapse for small (<= 1.5cm) papillary thyroid cancers (PTCs). Methods: We have reviewed all pathological reports concerning papillary thyroid cancers in our institute from Jan. 1, 2003 to Dec. 31, 2006, in which totally 120 patients with tumor sizes no larger than 1.5cm were identified. The mean duration of follow-up is 40.1 months (range 7.6 to 142.3 months). The data on their clinicopathological characteristics and clinical courses was collected and analyzed. Results: The study included 120 patients (104 female, 16 male), where the patient age at the initial treatment is ranged from 19 to 78 years with a mean of 42.6 years, and the median tumor size is 1.0cm. 15 patients (12.5%) were found with a malignant tumor incidentally after the surgery originally for benign disease. Near total or total thyroidectomy was performed on 71 patients (59.2%), while lobectomy on the other 49 patients. 9 patients out of the 49 had undergone completion of total thyroidectomy. Radio-iodine (I-131) therapy was performed on 79 patients (65.8%) after near total or total thyroidecomy or completion of total thyroidectomy. The mean accumulated I-131 therapeutic dose was 128.3mCi. At the initial diagnosis, 50 patients (41.7%) were multifocal, 29 patients (24.2%) were bilateral, 29 patients (25.5%) had extrathyroid extension, 20 patients (16.7%) had vascular invasion, and 27 patients (22.5%) had lymph nodes involvement. 17 patients (14.2%) had their surgical margin involved. Four patients were subject to distant metastases in their first post-treatment I-131 whole body scan, in which one was found in lung and three in the mediastinum. There is one patient died due to the disease. Persistent/recurrent disease was observed in 42 patients (35%) during follow-up, － 140 －

where21 patients were identified with increased TSH-stimulated serum thyroglobulin (Tg) or with detectable serum Tg under TSH suppression, 18 patients were identified with locoregional metastases, while 3 patients were identified with distant metastases. In the multivariant analysis, the disease persistency/recurrence was observed to be correlated with bilateral tumors, extrathyroid extension, and lymph nodes involvement. The Tg level at the first postsurgical evaluation after L-T4 withdrawal was observed to have the highest correlation with the disease persistency/recurrence in a group of 64 patients who received total thyroidectomy with negative AbTg antibodies (P=0.002). Discussion/Conclusions: In our study, approximately 1/3 total patients were subject to recurrent or persistent disease. The risk factors to predict recurrence included the higher post-surgical TSH-stimulated Tg level, as well as the presence of bilateral tumors, extrathyroid extension, and lymph nodes involvements. We also observed that the patients identified with these small cancers are subject to a great opportunity of bearing one or more risk factors.

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O2-7 INTERACTION OF ENDOTHELIN-1 AND ANGIOTENSIN II ON MITOGENIC EFFECTS OF VASCULAR SMOOTH MUSCLE CELLS 1

Y-J LIN, 2Y-P HSU, 1C-C CHEN, 2C-M CHEN, 1S-Y SHIH, 1X-Y LU, 1,2,3,4L-T HO 1 Institute of Physiology, National Yang-Ming University, Taiwan, R.O.C.; 2Department of Medical Research and Education, Taipei Veterans General Hospital, Taiwan, R.O.C.; 3 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, R.O.C.; 4Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C. Plenty of studies have indicated that vascular smooth muscle cells (VSMCs) are responsible for the maintenance of normal vascular tone. Consequently, VSMCs are tightly associated with several pathologies of cardiovascular system including impaired vasoconstriction or vasodilation as well as improper VSMCs mitogenic effects which comprise of proliferation, migration, and probably inflammatory responses. In the current study, we performed in vitro experiments to explore the effects of Endothelin-1 (ET-1), Angiotensin II (Ang II) and their possible interference with the regulation of insulinstimulated proliferation and related signaling pathways in A10 VSMCs. Cell proliferation was determined by MTT assay or [3H]-Thymidine incorporation. Protein expressions of mitogenic-activated protein kinases (MAPKs) and insulin signaling cascades in A10 VSMCs were assessed by Western blotting. Our preliminary results showed that ET-1, Ang II, and insulin stimulated A10 VSMCs proliferation and migration in a dose-dependent manner. Moreover, the increased mitogenic effects of ET-1 and Ang II on A10 VSMCs might result from augmented short- or long-term MAPKs activities, especially JNK and ERK phosphorylation. Pre-incubation with ET-1 or Ang II potentiated cell proliferation with or without insulin. Furthermore, effects of ET-1 or Ang II may be potentiated through ET-1 receptors and MAPKs activities on VSMCs. In conclusion, ET-1 and Ang II may interact with specific receptors and increase enhancement of MAPKs protein activities to potentiate mitogenic effects on VSMCs.

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O2-8 ISOLATED ADENOCORTICOTROPIN HORMONE DEFICIENCY IN ADULT REPORT OF 17 CASES T-Y WANG, C-T CHANG, C-C CHEN, R-H CHEN, W-L HUANG, M-H HSEICH, K-C HUANG Division of Endocrinology and Metabolism, Department of Internal Medicine, China Medical University Hospital, Taiwan, R.O.C Background: Isolated adrenocorticotropin hormone (ACTH) deficiency (IAD) is a rare cause of secondary adrenocortical insufficiency, characterized by low cortisol with low or normal plasma ACTH, with other pituitary hormones being normal. IAD was first described in 1954 by Sternberg and colleagues. Similar cases have been increasing detected because of the heightened awareness of this disorder among endocrinologists. However, the report of IAD was limited in Taiwan. We described the clinical and laboratory findings of IAD in our hospital. Patients and Methods: Clinical data of 17 patients with IAD identified in China Medical University Hospital between 1997 to 2008 were collected by reviewed the medical reports. The diagnosis of IAD were is made unequivocally when all the following criteria are met (1) low basal plasma cortisol (2) low or normal basal plasma ACTH (3) preservation of other pituitary hormones and (4) absence of structural pituitary defects. Result: There were 17 patients with male to female ratio 9:8. Their age ranged from 22 to 77 years with the mean age 52.9 ± 19.8 years. 11 patients (65%) presented with malaise, weakness, anorexia, nausea and vomiting, 9 patients (53%) had unintentional weight loss, 5 patients (29 %) presented with fever, 3 patients (18%) presented with neuromuscular symptoms and hypotension was noted in 2 patients (12%). Blood chemistry revealed anemia in 11 patients (65%), hyponatremia in 8 patients (47 %) and hypoglycemia in 4 patients (24%). The cortisol level of the 17 patients ranged form 0.01 to7. 6μg / dlwi t h t heme a n2. 8±2. 2μg / dl( nor ma l4. 4 6- 22. 7μg / dl )a ndt heme a nACTHl e ve l7. 4±5. 9pg / ml (normal 9-52 pg/ml). Magnetic resonance imaging of the hypothalamic-pituitary was performed in 12 patients and no abnormalities were found. 1 patient was associated with Ha s hi mot o’ st hy r oi di t i s .Theme a nda i l ydos eofpr e dni s ol onei nourpa t i e nt swa s6mg .No spontaneous remission for IAD has been observed. Conclusions: IAD is increasingly recognized as a clinical entity. The clinical manifestations of IAD are insidious and variable. Elder patients usually present with asthenia, anorexia, － 143 －

nausea, vomiting, weight loss, hypotension, or fever. Lab data may reveal anemia, hyponatremia, or hypoglycemia. Young adult have different clinical characteristics. Gastrointestinal track symptoms and hyponatremia are less noted. In patients with persistent digestive symptoms, unexplained weight loss, fever, neuropsychiatric symptoms which are associated with anemia, hyponatremia, or spontaneous hypoglycemia. IAD should be considered in the different diagnosis.

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O2-9 PHEOCHROMOCYTOMA MIMICKING AN ACUTE CORONARY SYNDROME- A CASE REPORT 1

T-W LEE, 1,2T-I LEE, 3K-H LIN, 1T-J CHANG, 1J-D LIN, 1W-H LAO, 1I-H LIAO 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University-Wan Fang Municipal Hospital, Taiwan, R.O.C.; 2 Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C; 3 Division of Urology, Department of Surgery, Taipei Medical University-Wan Fang Municipal Hospital, Taiwan, R.O.C. Pheochromocytoma is a rare catecholamine producing neuroendocrine tumor with an incidence of less than 0.5% in patients with hypertension. It manifests a variety of symptoms that mimic other diseases. However, rare presentations such as acute abdomen, septic shock-like syndrome, hyperthermia, pulmonary edema and myocardial ischemia have been reported in literature. Here, we report a case of pheochromocytoma mimicking acute coronary syndrome. A 48-year-old Chinese gentleman, with known hypertension, dyslipidemia and impaired fasting glucose for about 5 years, presented at the Emergency Department (ED) with fever, chest tightness and cold sweating several hours prior to consultation. He had experienced paroxysmal attacks of palpitations associated with diaphoresis and shortness of breath for the last 6 months. At ED, he was noted to be febrile with temperature of 39.9 C and heart rate was 92 beats per minute with a high blood pressure of 157/87 mmHg. The apex beat was not displaced. The first and second heart sounds were normal, without cardiac murmurs. The lungs were clear. There was no focal neurological deficit. His cardiac biomarkers were elevated with creatine kinase (CK) 468 U/L, MB fraction 20 U/L and troponin-I 4.3ng/mL. Electrocardiogram (ECG) showed normal sinus rhythm. Under the working diagnosis of non ST-elevation myocardial infarction (NSTEMI), he received primary percutaneous coronary intervention. However, coronary angiography showed normal blood flow on all the coronary arteries. During hospitalization, an episode of ventricular tachycardia that lasted for 3 minutes and subsided spontaneously was found. He had markedly elevated blood pressure up to 270/141 mmHg when ventricular tachycardia happened. Fluctuation of blood pressure was observed during his hospital course. He was discharged and treated as NSTEMI. Four months later, he had recurrent chest tightness, fever and cold sweating. But, these were accompanied by abdominal fullness, nausea and － 145 －

vomiting. Laboratory tests showed severe leukocytosis of 34,180/L with neutrophil predominance (90%), C-reactive protein was 5.83 mg/dL. BUN 38 mg/dL, creatinine 4.3mg/dL, AST 145 U/L, ALT 110 U/L, alkaline phosphatase 107 U/L. ECG showed diffuse ST depression, and his cardiac biomarkers were elevated as follows: CK 325 U/L, MB fraction 33 U/L, and troponin-I 9.5ng/mL. Abdominal sonogram was arranged due to suspected intra-abdominal infection, and revealed a suspicious mass at the splenic fossa. Computed tomography of abdomen was revealed a large, well defined left adrenal mass of about 6.7 X 6.8 cm. His 24-hour urinary catecholamines were collected and showed markedly elevated: epinephrine 590.2 /day, norepinephrine 755.5 /day, dopamine 821.7/day, and VMA 114.2 /day. Oral alpha-adrenergic blocker was used to control his hypertension. Two months after his last admission, left laparoscopic adrenalectomy was performed, and pathological result confirmed our diagnosis. Two months after surgery, the patient remained asymptomatic, normotensive and normoglycemic without medication. Follow-up collection 24 hour catecholamines were also within the normal range. Acute coronary syndrome is an atypical manifestation of pheochromocytoma. Excess catecholamine secretion causes inflammatory exudates leading to myocardial and endothelial damage. Our case illustrates the need to consider pheochromocytoma as one of the differential diagnosis in a patient presenting with signs and symptoms of myocardial ischemia.

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O3-1 PITUITARY STALK TRANSECTION AND ECTOPIC POSTERIOR PITUITARY LOBE C-M WU, H-J CHENG, S-J TSAI, H-K TSAI, H-Y TSAI, C-C SUN, C-H CHU, C-C LU, J-K LEE, H-C LAM Division of Endocrinology and Metabolism, Department of Medicine, Veterans General Hospital-Kaohsiung, Taiwan, R.O.C. We report an 18-year-old female with pituitary stalk transection and ectopic posterior pituitary lobe. She visited our out-patient clinic due to primary amenorrhea and the laboratory findings showed the presence of central hypocortisolism, hypothyroidism, and hypogonadism, but with normal prolactin level. The magnetic resonance imaging study of sella turcica showed: pituitary stalk transection and ectopic posterior pituitary lobe. We reviewed the literatures and proposed that the absence of pituitary stalk in imaging study are afflicted with a more severe form of adenohypophysis hypoplasia and have multiple anterior pituitary hormone deficiency. Keywords: panhypopituitarism, pituitary stalk transection, ectopic posterior pituitary lobe

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O3-2 CASE REPORT: A CASE OF PAPILLARY THYROID CARCINOMA COMBINED WITH MULTIPLE ENDOCRINE NEOPLASIA TYPE 1 JIUM-HUEI LIN, CHIEN-WEN CHOU, CHWEN-YI YANG Division of Endocrinology and Metabolism, Department of internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan The multiple endocrine neoplasia type 1 (MEN1) is a disease that is transmitted in an autosomal dominant way with the incidence of 0.2 - 2 in 100,000 persons, without sexual preference. The disease is made by the germline mutation of a tumor suppressor gene on chromosome 11 long arm 13 (11q13), which encodes menin protein, a transcriptional protein. The diagnosis of MEN 1 is defined as the presence of hyperplasia and neoplasia in at least two different endocrine tissues (parathyroid adenomas, entero-pancreatic tumours and pituitary tumours) within a single patient. Speaking of the thyroid disease, it can be observed in over 25% of MEN1 patients and it can be detected incidentally during parathyroid surgery in MEN1 patients. But there are fewer case report of papillary thyroid carcinoma combined with multiple endocrine neoplasia type 1 (MEN1) in the world. Hence, we presented this rare case. A 46 years old female who had the history of hyperthyroidism and thyroid papillary carcinoma s/p right subtotal thyroidectomy and left total thyroidectomy & I-131 ablation therapy for more than one year. Abdominal ultrasonography was arranged due to abdominal intermittent pain for weeks and revealed a hypoechoic nodular lesion of pancreatic head. Then abdominal computer tomography was arranged and revealed favor a hypervascular tumor (such as islet cell tumor) at pancreatic head. So she was referred to our endocrinology and metabolism outpatient department and was admitted for further evaluation and management. Biochemical investigation showed insulin (AC):3.2 uIU/ml (0.0-15.6), gastrin:58.8 pg/ml (<108), PTH-Intact:18.44 pg/ml (8-76), Ca :8.6 mg/dl (8.4-10.2), prolactin:35.55 ng/ml(3.8-20.6). Celiac arteriography revealed two small hypervascular tumors at pancreatic head which are compatible to islet cell tumor. Skull X-ray showed mild ballooning enlargement of sella turcica. Sella magnetic resonance imaging showed pituitary microadenoma along right lateral aspect ( 0.3 X 0.6 cm). MEN1 is diagnosed under the presence of pancreatic islet tumor and pituitary microadenoma. Tumors of these endocrine glands in MEN1 patients demonstrate loss of heterozygosity (LOH) at the locus of the MEN1 tumor suppressor gene. To verify whether papillary － 148 －

thyroid cancer is developed as a part of MEN1 disease, one should prove that allelic LOH of 11q13 in thyroid tissue be identical to that of leukocyte DNA. There are two published study examining LOH in a papillary cancer occurring in an MEN1 patient which demonstrated retained heterozygosity at the MEN1 locus in the papillary cancer. The lack of obvious LOH of the MEN1 locus in the papillary carcinoma suggests that deletion of the MEN1 tumor suppression might not be etiologically related to the oncogenesis of the papillary thyroid carcinoma. There is one other published case report in a papillary cancer occurring in an MEN1 patient which suggested three possibilities of the development of thyroid papillary cancer as a component of MEN1. First possibility is the close association between the two genes. But no data exists supporting this hypothesis yet. Second, the possibility of the incidental occurrence of thyroid papillary cancer for it occurs with a high prevalence. Finally, the possibility that it is a new type of familial disease causing two diseases by a genetic abnormality that is not characterized yet.

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O3-3 ACUTE SUPPURATIVE THYROIDITIS ASSOCIATED WITH OCCURRENCE OF LIVER ABSCESS - A CASE REPORT L-N TSENG, 1Y-T TSAI, S-Y LIN, W H-H SHEU Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan,R.O.C.; 1Intensive Care Medicine Section,Department of Internal Medicine,Taichung Veterans General Hospital, Taiwan, R.O.C. Acute suppurative thyroiditis with thyroid abscess is a rare condition. There were only few cases or case series reported on reviewing the literature. The rarity of acute suppurative thyroiditis is a result of the resistance of the thyroid gland to local infection. The everreported causative organisms including bacteria, fungus, mycobacterium and parasite. There were only few cases reported with the association with Klebsiella pneumoniae. Most of these cases were associated with diabetes mellitus or alcoholism. Here we reported a 62-year-old woman who denied histories of systemic illness in the past but with a history of non-functioning thyroid goiter over right lobe for more than a decade without regular follow-up. After suffering from fever, chills accompanied with symptoms of upper respiratory tract infection, pain and swelling of the anterior neck developed. Thyroid ultrasound was done which revealed abscess formation over right thyroid gland, pus was aspirated from the abscess which yielded Klebsiella pneumoniae later. Blood cultures also yielded the same results. Searching the possible primary infection site, an abscess measured about 60 mm in diameter over left lobe of liver found. She was neither a diabetic subject nor an victim of alcoholism. Barium esophagogram disclosed no pyriform sinus fistula found. After completing treatments with antibiotics and repeated aspiration of the thyroid abscess, she then received elective lobectomy of right thyroid gland. During the whole course, she stayed euthyroid and was free from diabetes mellitus till now (6 months later). The follow-up ultrasound of liver performed 3 months after the acute episode of right thyroid gland revealed no residual abscess found indicating the completion of treatment in liver abscess at the same time.

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O3-4 REPORT OF HEMOPHAGOCYTOSIS SYNDROME IN A CASE OF METHIMAZOLE INDUCED AGRANULOCYTOSIS WHO LATER RECEIVED DOUBLE FILTRATION PLASMAPHERESIS BEFORE THYROIDECTOMY 1

W-H LEW, 1,2T-I LEE, 1C-J CHANG, 3Y-K CHEN, 4C-Y CHENG, 1J-D LIN, 1C FAN 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Wan Fang Municipal Hospital, Taiwan, R.O.C.; 2 Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C.; 3 Division of Hematology and Oncology, Department of Internal Medicine, Wan Fang Municipal Hospital, Taiwan, R.O.C.; 4 Division of Nephrology, Department of Internal Medicine, Wan Fang Municipal Hospital, Taiwan, R.O.C. Agranulocytosis is a rare complication of anti-thyroid drugs accounting for about 0.3~0.5% of the cases. The use of granulocyte colony stimulating factor (G-CSF) has been suggested to shorten recovery time and duration of antibiotic use. Here we report a case of prolonged recovery time with G-CSF and was proven by bone marrow biopsy to have hemophagocytosis. Intravenous immunoglobulin (IVIG) was given and proved to be effective in shortening duration of treatment. A 44-year-old female presented to our emergency department with leukopenia and a gr a nul oc y t os i s .Thi spa t i e ntwa sdi a g nos e d wi t hGr a ve s ’di s e a s eonemont hpr i ort o admission and methimazole 10mg TID was prescribed and was taken regularly. One week prior to admission, she started to have fever and sore throat and consultation at family clinic OPD was in vain. On the day of admission, she accidentally cut her right 4th finger, and she visited our surgical clinic due to poor healing and fever. Complete blood count showed incidental finding of agranulocytosis. Upon admission, she received G-CSF and empirical antibiotic. Throat swab and 2 sets of blood cultures prior to antibiotics yielded Pseudomonas Aeruginosa. Surgical debridement was performed for rapid progression of right 4th finger wound with necrosis and extension to the whole arm. Hematologist was consulted due to persistent agranulocytosis despite use of G-CSF. Bone marrow biopsy performed showed hemophagocytosis. IVIG was prescribed and patient recovered dramatically after 1 course of infusion. Hyperthyroidism recurred on the 14th hospital day and dose of inderal was adjusted to 60mg qid and cholestyramine 1g tid was added. Preoperatively, 3 courses of double filtration plasmapheresis were performed and thyroid － 151 －

hormones normalize after the 1st course. The patient underwent near total thyroidectomy without any complications. Agranulocytosis is a rare but fatal complication in patients taking antithyroid drugs. Complete blood count should be checked when fever and sore throat occur. Hemophagocytosis should be considered as one of the differential diagnosis in case of patients without improvement in their clinical course while on G-CSF. Preoperative plasmapheresis is an effective adjunct for patients presenting with severe side effects of antihyroid drugs but need emergent surgical intervention.

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O3-5 SECONDARY HYPERTENSION DUE TO A RENIN-SECRETING JUXTAGLOMERULAR CELL TUMOR - A CASE REPORT R-H CHEN, S-Y LIN, 1W-C CHEN Division of Endocrinology and Metabolism, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taiwan, R.O.C.; 1Department of Urology, China Medical University Hospital, China Medical University, Taiwan, R.O.C. A juxtaglomerular cell tumor (JCT) is a rare, rennin-secreting, tumor of the kidney and can cause hypertension. It is recognized pathologically benign, and resection of the tumor is curative for hypertension. We report a 17-year-old girl who had hypertension and hypokalemia for 1 year. Laboratory studies showed increased basal plasma renin activity (PRA), but normal serum aldosterone level. Abdominal computed tomography disclosed a 2 cm solid mass in the left kidney. However, the results of renal vein sampling and the captopril test were equivocal. Partial nephrectomy was performed and the histologic examination demonstrated typical features of JCT. The hypertension and hypokalemia completely resolved postoperatively. JCT should be considered when investigating hypertensive individuals with high PRA.

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O3-6 COSTIMULATORY MOLECULES AS GENETIC MARKERS FOR RELAPSE OF GRAVES' DISEASE 1

P-W WANG, 2S-H HANK JUO, 1R-T LIU, 1C-J HSIEH, 1I-YA CHEN, 2EDWARD HSI 1 Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Medical Research, Kaohsiung Medical University Hospital, and Graduate Institute of Medical Genetics, Kaohsiung Medical University, Kaohsiung, Taiwan. Gr a ve s ’di s e a s e( GD) ,a nor g a ns pe c i f i ca ut oi mmunedi s e a s e ,r e qui r e st wos i g na l st o activate the T cells. In addition to the specific binding through T cell receptor to the antigenic peptide-MHC complex, an antigen-independent costimulatory pathway is required to generate subsequent cytokines and cell surface molecules. This regulation of T-cell response is a highly organized multi-step program. Since the costimulatory signals serve to regulate the magnitude and duration of an autoimmune disease, this study is to test whether genetic polymorphism within these costimulatory genes will affect disease susceptibility or progression. We hope to provide reliable genetic markers to improve GD management. We studied 262 GD patients from the Endocrine Clinic and 200 healthy controls from the Health Screening Center of Chang Gung Memorial Hospital in Kaohsiung. The GD patients were divided into three groups: recurred within 9 months (n=91), between 10-36 months (n=65), and more than 36 months (n=106). Clinical and laboratory evaluation included: the genotypes of CD28, CTLA-4, ICOS, PD-1and CD40; serum levels of T4, T3 and TSH; goiter size and TSH-receptor antibodies at the beginning and end of treatment. DNA was extracted from peripheral blood leucocytes by DNA extraction kit. The SNPs of the candidate genes were genotyped by PCR-RFLP and TaqMan SNP Genotyping Assays (ABI, Alamada, CA) with proper primers. Linkage disequilibrium between pairs of polymorphisms was estimated by Haploview. Haplotype analyses were performed using the Hap-Clustering program. Statistical analysis was conducted with chi-square, general linear model and Kaplan-Meier plot. A p value <0.01 was considered significant. The results showed (1) Genetic polymorphism within the costimulatory molecules affected the susceptibility (rs1093xxxx, rs1168xxxx, rs188xxxx, rs433xxxx, rs435xxxx, rs452xxxx, rs660xxxx, rs481xxxx, rs376xxxx) and progression (rs23xxxx, rs74xxxx, rs376xxxx) of GD; (2) GD patients carried more risk alleles than the controls; (3) Within the GD group, patients harboring more risk alleles would relapse earlier after drug － 154 －

withdrawal; (4) Number of risk alleles, goiter size and TBII levels at end of treatment were independent predictors of disease relapse; (5) A risk score calculation based on odds ratio of r i s ka l l e l e sc or r e l a t e dwi t hpa t i e nt s ’r e l a ps et i mea f t e rdr ugwi t hdr a wa l

Multiple logistic regression analysis for determinants of treatment outcome Variable Risk alleles LevelⅠ (1~8) LevelⅡ (9~10) LevelⅢ (11~15) TBII at the end of treatment Goiter size at the end of treatment Grade 1 Grade 2 Grade 3

Adjusted OR

95% CI

1 2.020 2.431 2.779

0.964-4.230 1.099-5.377 1.439-5.367

1 2.617 1.980

1.294-5.292 0.837-4.684

We conclude that genetic markers of costimulatory molecules may be helpful in choosing appropriate treatment for patients with GD.

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O3-7 HYPEROSMOLAR HYPERGLYCEMIC STATE COMPLICATED WITH RHABDOMYOLYSIS: A CASE REPORT K-W LIU, Y-L LIANG, 1S-H HSIAO, H-C HUNG, H-Y OU, T-J WU Division of Endocrinology and Metabolism, Department of Internal Medicine, 1Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C. Introduction: Hyperosmolar hyperglycemic state (HHS) is a fatal acute complication of diabetes mellitus (DM). Rhabdomyolysis was seldom recognized in such patients. We report a case of HHS with rhabdomyolysis. Case Report: A 61-year-old male patient with DM and old stroke presented with 2 days of fever and disturbance of consciousness. Initial Lab survey showed that high plasma glucose of 605 mg/dl, negative serum ketone, arterial pH 7.478, bicarbonate 32 mEq/l, and Na 147 mEq/L, and the effective plasma osmolality 327.6 mOsm/kg. Under the impression of HHS, therapy with hydration, insulin infusion, and potassium supplement were given. Serial cardiac enzymes were checked to survey the precipitating factor of HHS. The creatine kinase (CK) elevated dramatically (133260 U/L) with only mild elevation of CK-MB and troponin-T. Urine myoglobin was 110345 ng/ml. Under the impression of rhabdomyolysis, sodium bicarbonate was added to intravenous fluid to achieve alkaline diuresis and CK level decreased after treatment (338 U/L). Conclusion: Rhabdomyolysis may develop in patients with HHS. CK should be checked in those with high risk of rhabdomyolysis.

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O4-1 EFFICACY AND SAFETY OF FIXED-DOSE VERSUS FREE COMBINATION OF GLIMEPIRIDE AND METFORMIN IN TAIWANESE PATIENTS WITH TYPE 2 DIABETES C-H WANG, 1S-T TU, 2J-H JUANG, 3H-D LIN, 4C-C CHANG Mackay Memorial Hospital, Taipei, Taiwan, R.O.C.; 1Department of Internal Medicine, Lugang Branch of Changhua Christian Hospital, Changhua, Taiwan, R.O.C.; 2Department of Internal Medicine, Chang Gung Memorial Hospital Linko, Taipei, Taiwan, R.O.C.; 3 Department of Internal Medicine, Veterans General Hospital-Taipei, Taipei, Taiwan, R.O.C.; 4Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, R.O.C. Sulfonylurea/metformin is the most frequently prescribed combination therapy in the treatment of type 2 diabetes in Taiwan. This study was designed to compare the efficacy and safety of glimepiride and metformin given as the fixed dose combination tablet, Amaryl M (FDC) versus the free combination (G+M) in type 2 diabetic patients with HbA1c between 7% and 10%. In this 16-week, randomized, multicenter, open, parallel-group study, 83 subjects were randomized to receive FDC (n=43) or G+M (n=40). Doses were then titrated every 2 weeks with the intent to achieve fasting blood glucose <140 mg/dL. The primary endpoint was the change of HbA1c level from baseline to week 16. The primary analysis was conducted on the per protocol population which consisted of a total of 76 subjects, 40 from the FDC group and 36 from the G+M group. Baseline Characteristics were similar between the FDC and G+M groups (mean age: 56.8±9.4 vs. 60.3±8.5 years; BMI 25.0±2.9 vs. 24.5±2.9 kg/m2; HbA1c 7.73±0.63 vs. 7.68±0.56% [±SD]). HbA1c levels decreased in both groups over the study period (0.85±0.58 vs. 0.90±0.83%). The difference of the changes in HbA1c between the two groups was 0.05 % and the corresponding two-sided 95% confidence interval was (-0.28%, 0.38%) which existed in pre-defined equivalence range of (-0.5%, +0.5%). Decrease in fasting and 2-hour postprandial blood glucose did not show any significant difference between the FDC and G+M groups (-14.8±29.4 vs. -20.0±38.0 mg/dL, p=0.4925and -18.8±58.6 vs. -1.9±60.1 mg/dL, p=0.2122, respectively). The response rate based on HbA1c <7% was similar (62.5 vs. 61.1%, p=0.9010). The occurrence rates of any hypoglycemia (50.0% vs. 42.2%; p=0.4960) and treatment emergent adverse events (57.1% vs. 55.0%; p=0.8450) were comparable. The mean daily dose at the end of the study was similar between the two groups (glimepiride/metformin, 4.3 mg/1071 mg with FDC vs. 4.7 mg/1173 mg with G+M). The fixed-dose combination of glimepiride and metformin is considered to be equally safe and effective for the treatment of type 2 diabetic patients compared to the free combination therapy of glimepiride and metformin already widely used in current medical practice. － 157 －

O4-2 HEPATITIS B/C DO NOT AFFECT THE PIOGLITAZONE EFFECTS IN TYPE 2 DIABETIC PATIENTS 1,2

K-D LIN, 1,2Y-H CHANG, 3S-R HE, 1M-Y LEE, 1,3S-J SHIN 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, R.O.C; 2 Graduate Institute of Medicine Kaohsiung Medical University , Taiwan, R.O.C; 3Graduate Institute of Medical Genetics, Kaohsiung Medical University, Taiwan, R.O.C Introduction: Chronic hepatitis B/C were relatively popular in Taiwanese. There are many diabetic patients with chronic hepatitis B/C and they also take many kinds of anti-diabetic agents. Troglitazone, which was a PPAR-γa g oni s tus e dt ot r e a tt y pe2di a be t i c patients before and was withdrawn due to fulminant hepatitis worries. Pioglitazone is a new PPAR-γa g oni s ta ndus e dt ot r e a tt y pe2di a be t i cpa t i e nt s .The r ei sl i mi t e dda t aa boutt he treatment effects of pioglitazone on type 2 diabetic patients who have hepatitis B/C. We studied our type 2 diabetic patients who had taken pioglitazone for a period and analyzed the treatment effects with hepatitis conditions. Objective: There are 724 type 2 diabetic patients enrolled in this our study. They were divided into hepatitis B/C group and non-hepatitis group. After collecting the initial data, all of them were received pioglitazone 30 mg/day for treatment for 132 days in average. After the pioglitazone treatment, the following data were collected and analyzed. Results:The pioglitazone effects in patients were consistently with other reports. The HBA1c, ALT, hs-CRP and TG were lowered. In contract, the HDL-c, HOMA-IR, and adiponectin were elevated. Compared with the non-hepatitis group, there was no significant difference about the changes of parameters in our hepatitis B group including the lowering of HBA1c, ALT levels and the elevation of HDL-c group. We excluded acute hepatitis event in our hepatitis group. In the hepatitis C group, there was no further changes of parameters compared with non-hepatitis group. Conclusion: The pioglitazone effects in type 2 diabetic patients were consistently in hepatitis B/C group compared with non-hepatitis group in the lowering of HBA1c, ALT levels. There was no acute hepatitis events in our chronic hepatitis patients treated with pioglitazone.

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O4-3 EFFECTS OF ADDING SITAGLIPTIN TO MAXIMAL DOSE OF ORAL ANTIDIABETIC DRUGS ( OAD ) ON INADEQUATELY CONTROLLED ELDERLY PATIENTS WITH TYPE 2 DIABETES ( T2DM ) IN TAIWAN 1,2

M-N CHIEN, 1C-C LEE, 1W-C CHEN, 1S-C LIU, 1C-H LEUNG, 1C-H WANG 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; 2Mackay Medicine, Nursing and Management College, Taipei, Taiwan Background: The elderly population presents challenges for the treatment of T2DM, a sva r i ou sf a c t or sc a na f f e c tt hea bi l i t yt ol owe rt he s epa t i e nt s ’bl oodg l uc os et ot a r g e t levels. OADs prescribed for the treatment of subjects with T2DM are often associated with weight gain and hypoglycemic episode. Sitagliptin is an oral, potent and selective dipeptidyl peptidase-4 (DPP-4) inhibitor that lowers glucose in a glucose-dependent manner by enhancing a natural body system, called the incretin axis. Based on recent trials, the selected DPP-4 inhibitor has demonstrated effects similar to TZDs as add-on therapy without weight gain during clinical phase III trials in patients with T2DM. Avoidance of hypoglycemia is a primary concern in anti-diabetic treatment, because hypoglycemia can have a profound impact on health and quality of life in elderly patients. Subjects and Methods: Thirty-nine T2DM elderly (age ≧65 years) patients, both genders, aged 72.6±5.6 years, duration of diabetes 16.2±4.9 years, were previously treated with diet and exercise and maximal dose of insulin secretagogues ( sulfonylureas or glinides), metformin, and alpha-glucosidase inhibitors, with baseline HbA1c levels ≧7.5%, fasting plasma glucose levels (FPG) ≧ 180mg/dl. We measured FPG levels, 2-hr postprandial plasma glucose levels (2h-PPG), HbA1c levels, body mass index (BMI), and recorded the hypoglycemic episodes before and after 3 months of adding once-daily dose of sitagliptin 100mg to maximal dose of OADs. A paired-student T-test was used for comparison, while p <0.05 was considered to be significant. Results: After 3 months of adding sitagliptin, a significant decrease was observed among FPG, 2h-PPG and HbA1c levels ( p <0.05, respectively). Only a little BMI increased after sitagliptin addition (+0.2 kg/m2, p >0.05). There was no hypoglycemic episode reported during our trial period. Conclusion: Improved glycemic control, weight loss and reduced risk of hypoglycemia － 159 －

may improve the health-related quality of life in elderly T2DM subjects. Many anti-diabetic treatments introduce increased risk for hypoglycemia in the elderly patients. The new incretin based therapies offer advantages over some of the standard medications by improving glucose-dependent insulin secretion. In our study, the elderly T2DM patients inadequately controlled with maximal dose of OADs were treated with addition of sitagliptin 100mg once-daily. It significantly provided effective glycemic control and was generally well tolerated, without any episode of hypoglycemia and without clinically meaningful change in BMI. Nevertheless, Further extended analyses with larger sample size should be put into practice in patients from different ethnic origins to further verify these effects.

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O4-4 APPLICATION OF ADRR FOR EVALUATION OF SMBG IN DIABETES YANG-MING LEE, S-T TU, P-Y LIAO, D-H TSAI, S-L SU, H-K SIA, S-R HSU, S-D LIN, S-Y WANG, P-Y CHENG, Y-N CHANG 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Taiwan, R.O.C; 2Department of Internal Medicine, Changhua Christian Hospital, Taiwan, R.O.C; 3TaiDoc Technology Corporation Objective: Recent studies show that the ability of patients to tightly control their glycemic variation may become a paramount task of diabetes control. The importance of controlling blood glucose variability in relationship to both reducing hypoglycemia and attenuating the risk for cardiovascular and behavioral complications due to hyperglycemia has been shown, and good prediction performance of the measure for blood glucose variability in diabetes called the average daily risk range (ADRR) has been demonstrated. It is therefore important to evaluate the application of ADRR in predicting the health education performance in blood glucose control of outpatients from routine self-monitoring blood glucose (SMBG) data. Research Design And Methods: 17 patients (10 men, 7 women; 7 Type 1 diabetes, 10 Type 2 diabetes), all of whom were regular visitors of the outpatient of the Changhua Christian Hospital in Taiwan, were entered consecutively into the study. The glycemic levels of patients ranged from 24 to 68 years were measured daily at home as SMBG records for continuous 3 months. Metabolic control values were considered to good or poor according to whether HbA1c levels were ≦7.0 or >8.5%, respectively. When HbA1c percentages were both >7.0 and ≦8.5%, the patients were considered as fair metabolic control. The ADRR is computed using the formulas in table 1 from the continuous 3-months SMBG data for each patient. It is sufficient to have 14 days with 3 readings/day in 1 month. The values were stratified into 3 categories: low risk, ADRR 20; moderate risk, ADRR 20-40; and high risk, ADRR 40. Paired t- test are applied to compare the significant statistic difference. Results: From the 3-months SMBG data, we computed the ADRR by month and measured HbA1c before and after the clinical trial. We found that the average HbA1c was decreased from 8.28% to 7% (p=0.039), and the average ADRR from the 1st month to 3rd month were 23.36, 22.44, and 23.71, respectively. 7 of the 17 patients (41.2%) represented － 161 －

good control in HbA1c level (< 7%) before this trial. However, 2 more patients with good control in HbA1c level were shown (increased to 53%) after the continuous 3-month SMBG durations. Moreover, 6 of the 17 patients shown poor control in HbA1c (> 8.5%) before the trial. 2 of them were improved to good control (8.6%→6.8%, 10.7%→6.3%), and 3 of them were improved to fair control status (8.7%→8.3%, 14%→7.5%, 16.4%→ 7.2%) after 3-month SMBG duration. Conclusions: Our study introduces that ADRR values were used to evaluate blood glucose variability from routine SMBG data collection, could also be computed to evaluate performance in our routine health education. Patients with different control status in HbA1c levels before the 3-month SMBG trial would represent improved consequences after the trial durations if the ADRR values indicated as low risk. This study demonstrated the remarkable efficacy of the SMBG program in our health education could simply exhibit by ADRR, and also determined patients who need more educational resources. The regular feedback of ADRR to patients and their clinicians would result in improvements in glycemic control.

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O4-5 USING CONTINUOUS GLUCOSE MONITORING SYSTEM TO DETECT FLUCTUATION OF BLOOD GLUCOSE IN PATIENTS WITH DIABETES MELLITUS 1

H-C HUNG, 2C-H CHIANG, 3M-Y TSAI, 1S-C HU, 1H-Y OU, 1T-J WU 1 Department of Internal Medicine, Division of Endocrinology and Metabolism; 2Institute of Medical Engineer; 3Nursing Department, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan Background: Hemoglobin A1c is currently used to assess glycemic control. Recently, the stability of glycemia is highly appreciated. Continuous Glucose Monitoring System (CGMS) may play an important role in detecting the variability of blood glucose levels. Methods: We used a CGMS, self-monitored blood glucose, and self-reported hypoglycemic episodes to investigate episodes of hypoglycemia and hyperglycemia during the 3-day study in diabetic patients with insulin therapy who complained of fluctuation in blood glucose levels. We developed a soft ware to analyze the CGMS data and calculate the mean amplitude of glycaemic excursions (MAGE) in the measurement. Results: Totally, 14 patients were enrolled to the study. They had a median of 7% (range 0-32%) likelihood of developing hypoglycemia, a median of 29.5% (range 15-83%) likelihood of developing hyperglycemia, and median MAGE of 152 mg/dl (range 77 to 239). A comparison between 7 of 14 patients with A1C <8 % and the other 7 patients with A1C 8 % showed 7% vs. 7% in likelihood of developing hypoglycemia, 23% vs. 43% in likelihood of developing hyperglycemia, and 155±15.0mg/dl vs. 158±57mg/dl in MAGE. Conclusion: In spite of HbA1c values, the diabetic patients with insulin therapy and unstable blood glucose demonstrate to be with high MAGE values in this study. CGMS is useful in detecting blood glucose variability.

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O4-6 THE STUDY OF RELATIONSHIP BETWEEN METABOLIC OUTCOME AND DIABETES COGNITIVE BEHAVIORS FOR DIABETES SHARED CARE MODEL OUTPATIENTS - AN EXAMPLE FROM A REGIONAL TEACHING HOSPITAL 1

LYH-JYH HAO, 7MI-CHIA MA, 6HAILUN CHAO, 1CHING-JU HONG, 3 NAI-WEN CHANG, 7TSUNG-YI SHEN, 8FU-SHINE CHOU, 9TA-JEN WU, 4 MING-DER SHI, 5YU-PING LEE, 5JIN-SHIUNG CHENG, 2JIANG-KANG CHAO 1 Division of Endocrinology and Metabolism, Department of Internal Medicine,Yong Kang Veterans Hospital, Yong Kang, Taiwan, R.O.C.; 2Department of Psychiatry, Yong Kang Veterans Hospital, Yong Kang, Taiwan, R.O.C.; 3Division of Nutrition,Yong Kang Veterans Hospital, Yong Kang, Taiwan, R.O.C.;4Department of Pathology and Laboratory Medicine, Yong Kang Veterans Hospital, Yong Kang, Taiwan, R.O.C.; 5 Department of Administration, Yong Kang Veterans Hospital, Yong Kang, Taiwan, R.O.C.; 6 Department of Health Care Administration, Chung Hwa University of Medical Technology, Tainan, Taiwan, R.O.C.; 7Department of Statistics, National Cheng Kung University, Tainan, Taiwan, R.O.C.; 8Institute of Information Management, National Cheng Kung University, Tainan, Taiwan, R.O.C.; 9Division of Endocrinology and Metabolism, Department of Medicine, National Cheng Kung University Hospital. Objectives: Long-term control of diabetes depends on a comprehensive education program and a regular screening of diabetes in order to achieve optimal metabolic control goals. This research is directed primarily to those outpatie nt swhoha vej oi ne dt he“ di a be t e s s ha r e dc a r emode l ”t os t udyt hedi f f e r e nc e sa ndr e l a t i ons hi pofba s e l i nec ha r a c t e r i s t i c s among the patients, the improvement of annual metabolic indicators and diabetes cognitive behaviors. We hope to offer the research results and suggestions, to afford community primary hospital the disease management model and to share our experience to achieve the goals of promoting higher care quality, reducing the medical utilization rates, increasing pa t i e nt s ’c og ni t i ona ndbe ha vi orcontrol. Methods: A structured questionnaire about cognitive behaviors had been used to collect the data and was analyzed by using the SPSS 12.0 Chinese edition software. The study methods included reliability analysis, descriptive statistic analysis, paired t test, independent two sample t test, Mann-Whitney U test, ANOVA, Pearson correlation analysis, and multiple regression analysis. Results: Parts of cognitive behaviors have significant differences among the patients － 164 －

of the different baseline characteristics. The improvement of parts of annual metabolic indicators has significant relation on cognitive behaviors. Our outpatient diabetes have low emergency and hospitalization utilization rates and significant improvement in DBP, BW, FPG, A1C levels after one year, and significant improvement in SBP, DBP, BW, total cholesterol, HDL-C and LDL-C levels after three years. Conclusion: The“ di a be t e ss ha r e dc a r emode l ”i swor t hi l ypopul a r i z e d,a nds houl dbe offered as close to the time of diagnosis, and directed towards patients with a low education level and high baseline A1C, SBP, total cholesterol, TG, GPT levels, to strengthen and improve knowledge and self-care attitudes. In order to promote behavior control and encourage the family to join the education together and family support. Keywords: diabetes shared care model, the improvement of annual metabolic indicators, diabetes cognitive behaviors. Running title: The Study of Relationship Between Metabolic Outcome and Diabetes Cognitive Behavior

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O4-7 ASSOCIATION OF INTERLEUKIN-6 WITH METABOLIC SYNDROME IN TAIWANESE ELDERLY Y-H YAN, S-C HUA, H-I YU, T-S TAI, C-H LU Division of Endocrinology and Metabolism, Department of Internal Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan Background: Inflammation is hypothesized to play a role in development of type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS). However, clinical data addressing this issue are limited in Taiwan. Objective: To determine whether elevated levels of the inflammatory markers interleukin 6 (IL-6) is associated with MetS in 1,023 elderly in Taiwan (Age 69.1± 8.7, 57.7% were men) in a cross-sectional random sample (Social Environment and Biomarkers of Aging Study, SEBAS). Methods: Serum concentrations of lipids, glucose, and IL-6 were measured. Body height, weight and blood pressure were assessed. Smoking and alcohol consumption was estimated from self-report. The MetS was defined according to the National Cholesterol Education Program ATP III definition for Asians. Results: The prevalence of MetS was 40.9%. IL-6 level was 1.2±1.1 (pg/mL). Multiple logistic regression analyses showed no effects were found for IL-6 on MetS. Estimates were adjusted for age, gender, smoking, alcohol consumption, and body mass index. Conclusions: IL-6 level was not associated with MetS in Taiwanese elderly. Further studies are needed to investigate the relationship within IL-6, IL-6 receptor (IL6R), C-reactive protein (CRP) and MetS.

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O4-8 ANKLE BRACHIAL INDEX IN TYPE 2 DIABETIC FEMALE AND MALE TAIWANESE WITH CHRONIC KIDNEY DISEASE AND ALBUMINURIA 1

M-Y LEE, 1C-L WANG, 1Y-H CHANG, 1K-D LIN, 1M-C HSIEH, 1P-J HSIAO, 1S-J SHIN 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Chung Ho Memorial Hospital, Taiwan, R.O.C. Objective: Several studies have shown the identified risk factors for peripheral arterial disease ( PAD) but only little information was provided on PAD risk factors in individuals with diabetes , especially in the persons with renal insufficiency and albuminuria induced by long term diabetes . Some previous reports revealed positive relationship between renal insufficiency and peripheral arterial disease and in our study , we would like to determine whether the ankle branchial index are related to the status of the chronic kidney disease and albuminuria in type 2 diabetic patients of both sex. Methods: We included four hundred seventy-eight more than 50 year old type 2 diabetic patients in this study. Among this population , two hundred sixty-six were female and two hundred twelve were male. And Ankle branchial index (ABI) was measured by non invasive ABI analyzer. Results: Deterioration of ankle brachial index is prominent starting in the stage of macroalbuminuria (n=34) with P value of 0.005 (β= -0.06537) in the right, 0.014(β= -0.06164) in the left among female population. However , in male population , deterioration of right and left ankle branchial index were associated with chronic kidney disease stage 4 and 5 (n=9) with P value of 0.001 (β= -0.164) in the right, <0.001(β= -0.217) in the left .Age was also the independent factor for the deterioration of the ankle branchial index in both female and male with β=-0. 005831a ndβ=-0.004389 , respectively with P value of <0.001 in the right andβ=-0.006554a ndβ=-0.004321 , respectively with P value of <0.001 in the left. Conclusion: Elderly diabetic women after 50 years old with macroalbuminuria are at the higher risk for peripheral occlusive disease compared with the elderly diabetic men after 50 years old. However in the male population , with chronic kidney disease stage 4 and 5 are at the higher risk for peripheral occlusive disease compared with the elderly diabetic women after 50 years old. Intensive control of the independent factors that can progress to the stage of macroalbuminuria among the diabetic patients like systolic blood － 167 －

pressure , creatinine level ,GFR , triglycerides and high density lipoprotein cholesterol level , fasting blood glucose and HbA1C may help prevent or delay peripheral occlusive disease. And in chronic kidney disease , intensive control of BMI , diastolic blood pressures, creatinine , fasting plasma glucose and albuminuria may help or prevent peripheral occlusive disease.

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O4-9 THE STUDY OF INTIMA-MEDIA THICKNESS OF CAROTID ARTERIES IN SENILE MALE VETERANS IN SOUTHERN TAIWAN H-J CHENG, H-C LAM, 1,2Y-K LO, 1,3Y-T LIN, 4K-H LAI Division of Endocrinology and Metabolism, Kaohsiung Veterans General Hospital; 1 Division of Neurology, Kaohsiung Veterans General Hospital; 2Geriatric Medicine Center, Kaohsiung Veterans General Hospital; 3Division of Geriatric Medicine, Kaohsiung Veterans General Hospital; 4Division of Gastroenterology, Kaohsiung Veterans General Hospital Background: The extracranial carotid intima-media thickness (CIMT) is regarded as an early sign of atherosclerosis and can be used to predict cerebral, coronary, and peripheral vascular diseases. Su et al. show that CIMT 0.68 mm indicates the presence of atherosclerotic vascular diseases in Taiwanese population. However, up to now, there is few reports on CIMT studies in the senile aged population in Taiwan. Purpose: The aim of our study is to measure the CIMT of male senile veterans aged 65 years and to analyze its relationship to various cardiovascular risk factors. Method: We recruit 142 aged 65 years male veterans from Gang-shan veteran home. Body height, body weight, body mass index, waist circumference, and seated blood pressure were recorded. Blood samples were assayed for glucose, insulin, HbA1c, total cholesterol, triglyceride, HDL-C, LDL-C, and hs-CRP. Spot urine for microalbumin were also measured. The IMT of the posterior (or far) wall of the distal common carotid artery (CCA) were measured using B-mode ultrasonography method. Result: Total 138 aged 65 years male veterans complete the study. The average age is 82-year-old of this group, ranging from 65 to 98-year-old. The average CIMT is 0.77mm, and left CIMT 0.79mm is slightly higher than right side 0.75mm. Plaque formation is found in 21 % patients, less than Su et al. reported 36.9%. Our study found that the occurrence of carotid plaque is associated with increasing CIMT. The prevalence of metabolic syndrome is 44% in this group. The leading risk factor contributing to metabolic syndrome is central obesity (55%), followed by systolic hypertension. Our study found that waist to hip ratio has a high relationship to stroke. Discussion: Analysis risk factors of atherosclerosis for our patients, we still need to work hard for central obesity (55%), systolic hypertension (40%), hypertriglyceridemia (28%), and smoking history (24% not quit). And due to high prevalence of metabolic syndrome in this study group, we should pay more attention on follow up and aggressive treatment.

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O5-1 MAGNETIC RESONANCE IMAGING OF TRANSPLANTED MOUSE ISLETS LABETED WITH CHITOSAN-COATED SUPERPARAMAGNETIC IRON OXIDE NANOPARTICLES J-H JUANG, 1,2C-R SHEN, 3J-J WANG, 4C-H KUO, Y-W CHIEN, 2H-Y KUO, 2Z-T TSAI, 2 T-C YEN Division of Endocrinology and Metabolism, Chang Gung University and Memorial Hospital; 1Department and Graduate Institute of Medical Biotechnology and Laboratory Science, Chang Gung University; 2Molecular Imaging Center, Chang Gung Memorial Hospital; 3Department of Medical Imaging and Radiological Sciences, Chang Gung University; 4Department of Biological Science and Technology, National Chiao Tung University, Taiwan Recently, the Edmonton Protocol has markedly improved the success rate of human islet transplantation. However, long-term function of the transplanted islets has been disappointed; only 10% of patients maintain insulin independence 5 years after transplantation although 80% of patients were C-peptide positive. To better understand the fate of transplanted islets and the relationship between transplanted islet mass, graft function, and overall glucose homeostasis, an accurate and reproducible method of imaging islets in vivo is needed. The aim of this study is using magnetic resonance imaging (MRI.) to visualize transplanted islets labeled with chitosan-coated superparamagnetic iron oxide (CSPIO) nanoparticles. Male inbred C57BL/6 mice, aged 8-12 weeks, were used as transplantation donors and recipients. After being incubated with and without CSPIO (10 mg/ml) for 8 hours, 300 islets were transplanted under left kidney capsule of each mouse. The right kidney was used as a control. After transplantation, serial 3.0 Tesla MR imaging of the recipients were performed at 1, 2, 3, 4, 5, 6 and 8 weeks. The islet graft was removed at 8 weeks for electron microscopic and histology studies with insulin and iron staining. From week 0 to 8, the graft of CSPIO-labeled islets were visualized on MR scans as distinct hypointense spots homogeneously distributed at the upper pole of left kidney. The electron microscopic and histology studies confirmed the location of CSPIO-labeled islets in the renal subcapsular area. There were abundant iron and insulin-positive cells in islet grafts. Moreover, the intracellular organelles were intact. Our results indicate transplanted islets can be labeled with CSPIO nanoparticles and and then visualized by MRI. － 170 －

O5-2 PROINFLAMMATORY CYTOKINE AND LIGANDS DIFFERENTIALLY MODULATE PEROXISOME PROLIFERATOR-ACTIVATED RECEPTORS IN THE CARDIOMYOCYTES 1,3

T-I LEE, 1Y-S KAO, 4Y-C CHEN, 1,2Y-J CHEN 1 Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 2Division of Cardiovascular Medicine, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan; 3Division of Endocrinology and Metabolism, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan; 4Department of Biomedical Engineering, National Defense Medical Center, Taipei, Taiwan Background: Peroxisome proliferator-activated receptors (PPAR) mediate inflammatory processes and alter cardiac function. However, it is not clear whether inflammatory cytokines or PPAR ligands regulate PPARs in the cardiomyocytes to modulate cardiac functions. We investigated the effects of tumour necrosis factor-alpha (TNF-α)a ndPP AR ligands on the expression of PPARs in HL-1 cardiomyocytes. Materials and methods: HL-1 cardiomyocytes were incubated with and without TNF-α (1, 10, 25 and50 ng/mL) or PPAR ligands (rosiglitazone, pioglitazone and fenofibrate) at concentra t i onsof0· 1,1a nd10μM f or24h.Thec e l l sa l s or e c e i ve dSN-50 (NF-κB i nhi bi t or ,50 μg / mL) ,a s c or bi ca c i d( 100 μM)a nd c oe nz y meQ10 ( 10 μM)a l oneor combined with TNF-α. Results: Using reverse transcriptase–polymerase chain reaction and Western blot, we found that incubation of TNF-α( 50ng / mL)f or24hde c r e a s e dPP AR-α,buti nc r e a s e d PPAR-γwi t houta l t e r i ngPP AR-δ .The s ee f f e c t swe r enotc ha ng e dbyc o-administration of SN-50. However, co-administration of ascorbic acid prevented the effect of TNF-αbot h on PPAR-αa ndPP AR-γ .Coe nz y meQ1 0pa r t i a l l ya t t e nua t e dt hee f f e c tofTNF-αonPP AR-γ but did not alter its effect on PPAR-α.Thea dmi ni s t r a t i onofr os i g l i t a z one( 10μM)a nd pi og l i t a z one( 10μM)f or24hi n c r e a s e dPP AR-γmRNA,butdi dnota l t e rPP AR-αor PPAR-δ .Mor e ove r ,f e nof i br a t e( 0· 1,1a nd10μM)i nc r e a s e dPP AR-γwi t houta nye f f e c t s on PPAR-αorPP AR-δ . Conclusions: Oxidative stress causes the regulations of PPAR-αa ndPP AR-γi nt he TNF-α-treated cardiomyocytes. The up-regulation of PPAR-γ by PP AR l igands may contribute to their anti-inflammation effects. － 171 －

O5-3 MITOCHONDRIAL SUPEROXIDE DISMUTASE POLYMORPHISM PRESENTATION IN TYPE 2 DIABETES MELLITUS 1,3

Y-H CHEN, 1,2S-L SU, 3L-S HSU, 4C-S LIU, 4C-L KUO, 4C-S HUANG 1 Laboratory of General, Department of Medical Education and Research, Changhua Christian Hospital; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital; 3Institute of Bichemistry and Biotechnology, Chung-Shan Medical University; 4Laboratory of Vascular & Genome, Department of Medical Education and Research, Changhua Christian Hospital Objective: Diabetes is a disorder of fuel utilities and mitochondria is an organelle for cellular energy production. We try to detect the different clinical manifestations of type 2 diabetes mellitus in mitochondrial superoxide dismutase polymorphism (SOD) . Research Design And Methods: We enrolled 132 type 2 DM outpatients in Changhua Christian hospital. All the patient agree and write informed consent which had been approval by institutional review board. Blood sampling had been performed after at least 8 hours fasting. Hemoglobin A1c, SGOT, SGPT, glucose, total cholesterol, triglyceride, high density lipoprotein- cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and SOD1, SOD2 had been performed. All patients received peripheral arterial examination by Collin 1000. Ankle-brachial index (ABI) and pulse wave velocity (PWV) can be got. Define peripheral arterial disease when ABI less than 0.9. ANOVA test was used to compare data whether mitochondrial SOD1 and SOD2 polymorphism or not. Pearson correlation had been done to find the association between polymorphism and other variables. Chi-square is used for compare categorical data. Results: The polymorphism of SOD1 is same in our population but SOD2 show 3 different groups as CC, CT and TT polymorphism. The CC variant groups had higher fasting glucose, hemoglobin A1c, and LDL-C and lower HDL-C. Although, the difference presented but only LDL-C getting s t a t i s t i cs i g ni f i c a nc e s .TheABIa ndPWVdon’ ts howt he difference between these 3 groups. Conclusions: The mitochondrial SOD2 CC variant may have worse glucose control and pathogenic lipid profiles. Due to low protective lipoprotein concentration, CC variant should be early intention management to avoid diabetes chronic micro- or macrovasular complication. The limiting of this study are small sample sizes and short observation period to get the clinical outcomes.

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O5-4 EFFECTS OF RESISTIN ON BLOOD PRESSURE REGULATION IN RATS 1

TUNG-YUEH CHUANG, 2LO-CHUN AU, 1,2SENG-WONG HUANG, 1,2 CHI-CHANG JUAN, 1,2LOW-TONE HO 1 Institutes of Physiology, National Yang-Ming University; 2Department of Medical Research & Education, Taipei Veterans General Hospital Insulin resistance in vascular system, an imbalance between insulin action on ET-1 and NO predisposes to increase endothelial dysfunction. Resistin has been proposed as a link between obesity and insulin resistance and impaired insulin stimulated eNOS activation in vitro. However, the biological function on cardiovascular system of resistin in blood pressure in vivo is not clear. We hypothesized that resistin may cause imbalance between ET-1 and NO in vivo. The SD rats would be infused with resistin for 3 hours. One hour after resistin infusion, rats would be challenged with bradykinin, SNP or ET-1. The influences of resistin on the insulin-stimulated phosphorylation of IRß and Akt would be measured by western blotting. The serum biological parameter were be detected by commercial kits. Results showed that response of bradykinin on vasorelaxation was not changed in resistininfused group compared with the controls. However, resistin infusion accelerated cardiovascular recovery response to SNP and delayed cardiovascular recovery response to ET-1. The levels of IRß and Akt phosphorylation were significantly decreased in skeletal muscle, adipose tissue and aorta in resistin infused rats compared to controls. After 1h-infusion, plasma glucose, insulin, resistin, and insulin resistance were significantly increased in resistin infused rats compared to controls. In conclusion, acute resistin infusion caused an imbalance on ET-1 and NO actions through interfering cardiovascular recovery and impaired insulin signaling pathway in skeletal muscle, adipose tissue and aorta.

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O5-5 ARECOLINE IMPAIRS INSULIN SIGNALING PATHWAY AND LIPOGENESIS IN ADIPOCYTES 1

T-J HSIEH, 2P-C CHOU, 1,2S-J SHIN 1 Graduate Institute of Medical Genetics, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 2Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan Objective: According to several population-based studies, betel-quid chewing has been reported associated with metabolic syndrome and diabetes in British South Asians and Taiwanese. The habit of chewing areca nut independently contributes to the risk of both hyperglycaemia and Type 2 diabetes in Taiwanese men. However, the underline molecular mechanism is not clarified yet. Arecoline is an alkaloid-type natural product found in betel nuts. The aims of the present study are to clarify: (1) the influence of arecoline on adipocyte glucose transport and insulin signaling, including IRS-1, Akt, and PI3 kinase; (2) the molecular mechanism mediates the effect of arecoline on insulin resistance, such as reactive oxygen species (ROS). Methods: Mouse 3T3-L1 preadipocyte cell line was use to test the effect of arecoline on insulin action. Cells were co-incubated with different dosage of arecoline for different timing, and then insulin was added to activate its signaling pathway. Proteins were extracted for western bolting. Real-time PCR was used to detect the related mRNA expression. Lipid was detected by Oil-Red staining. Results: Our results demonstrate that arecoline decreased IRS-1 expression and impaired insulin signaling in adipocytes. Besides, arecoline lessened lipid accumulation in adipocytes. HO-1 mRNA was up-regulated by arecoline, indicating an increase of oxidative stress. Gene expression of antioxidant enzymes (SOD1 and 2) and DNA repair enzymes (OGG1 and NEIL1) was decreased by arecoline. Conclusion: Arecoline blocks lipogenesis by impair the insulin signaling transduction, especially IRS-1. The molecular mechanism may via obstruct the function of antioxidant and DNA repair enzymes as well as the increase of oxidative stress.

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O5-6 LOCAL RENIN-ANGIOTENSIN SYSTEM REGULATES ADIPOKINE EXPRESSION IN ADIPOCYTES 1,2

W-W HUNG, 3T-J HSIEH, 2P-C CHOU, 2K-D LIN, 2P-J HSIAO, 2,3S-J SHIN 1 Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital; 2Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital; 3Graduate Institute of Medical Genetics, Faculty of Medicine, Kaohsiung Medical University Objective: Obesity has been regarded as a major risk factor for type 2 diabetes. In the adipocytes of obese subjects, pathologic changes lead to insulin resistance and cause diabetes. Many large clinical outcome trials have shown blockade of the rennin-angiotensin system (RAS) with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) reduces the incidence of type 2 diabetes. The aim of our study is to determine the effects of RAS blockers on adipocyte differentiation and adipokine secretion. Methods: The 3T3-L1 preadipocytes were used for cell culture and divided into (a) control group (no induction); (b) induction group; (c) induction plus ACEI (perindopril); (d) induction plus AT1R blocker (losartan); and (e) induction plus AT2R blocker (PD123319). We identified the state of adipocyte differentiation and fat accumulation by Oil-red O staining. Real-time PCR was used to detect RAS and adipokine mRNA expression. ELISA was used to measure adipokine production. Results: We found that as 3T3-L1 adipocytes differentiate, the cells enlarge with fat accumulation. The expressions of adipokine mRNA increased and so did angiotensinogen mRNA. AT1R mRNA was down-regulated. Expressions of ACE1 mRNA and AT2R mRNA reached the peak at day 2 of adipocyte differentiation. Additions of ACEI or AT2R blocker changed the extents of adipocyte differentiation and fat accumulation with down-regulation of adipokine secretions. Conclusion: Our results show that the use of RAS blockers including ACEI and AT2R blocker can decrease fat accumulation and reduce adipokine mRNA expressions during adipocyte differentiation, which implicates the rationale that RAS blockers decrease the incidence of diabetes.

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O5-7 GREEN TEA (-)-EPIGALLOCATECHIN GALLATE INHIBITS INSULIN STIMULATION OF 3T3-L1 PREADIPOCYTE MITOGENESIS VIA THE 67-KILODALTON LAMININ RECEPTOR PATHWAY 1

H-C KU, 1H-C LIU, 2Y-W TSUEI, 2H-M CHAO, 2C-H HUANG, 3C-L LIN, 1H-H CHANG, 1 Y-H KAO 1 Department of Life Science, National Central University; 2Armed Forces Tao-Yuan General Hospital; 3VIP Health Management Center, Cathay General Hospital Insulin and (-)-epigallocatechin gallate (EGCG) have been reported to regulate fat cell mitogenesis and adipogenesis, respectively. This study investigated the pathways involved in EGCG modulation of insulin-stimulated mitogenesis in 3T3-L1 preadipocytes. EGCG inhibited insulin stimulation of preadipocyte proliferation in a dose- and time-dependent manner. EGCG also suppressed insulin-stimulated phosphorylation of the insulin receptorbe t a( I Rβ) ,i ns ul i nr e c e pt ors ubs t r a t e s1a nd2( I RS1a ndI RS2) ,a ndmi t og e n- activated protein kinase pathway proteins, RAF1, MEK1/2, and ERK1/2, but not JNK. Furthermore, EGCG inhibited the association of IR with the IRS1 and IRS2 proteins, but not with the IRS4 protein. These data suggest that EGCG selectively affects particular types of IRS and MAPK family members. Generally, EGCG was more effective than epicatechin, epicatechin gallate, and epigallocatechin in modulating insulin-stimulated mitogenic signaling. We identified the EGCG receptor (also known as the 67-kilodalton laminin receptor; 67LR) in fat cells and found that its expression was sensitive to growth phase, tissue-type, and differentiation state. Pretreatment of preadipocytes with 67LR antiserum prevented the effects of EGCG on insulin-stimulated phosphorylation of IRS2, RAF1, and ERK1/2 and insulin-stimulated preadipocyte proliferation (cell number and bromodeoxyuridine incorporation). Moreover, EGCG tended to increase insulin-stimulated associations between the 67LR and IR, IRS1, IRS2, and IRS4 proteins. These data suggest that EGCG mediates anti-insulin signaling in preadipocyte mitogenesis via the 67LR pathway.

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O5-8 PLASMA PROTEIN PROFILING IN DIABETIC NEPHROPATHY PATIENTS BASED ON MAGNETIC PARTICLE BEADS SEPARATION AND MALDI-TOF MASS SPECTROMETRY 1

PAO-HSIU LIU, 1CHI-LIANG CHERN, 1RAY H. LIU, 1HSIU-CHEN TENG, 2 SHUENN-JIUN YIIN, 3DAW-MING CHANG 1 Department of Medical Technology, Fooyin University; 2Department of Nursing, Tajen University; 3Endocrine and metabolism section, internal medicine, Ping-Tung Christian Hospital Background: Identification of plasma biomarker for the accurate prediction of the clinical course of type 2 diabetics with nephropathy remains a challenge in disease management. We established a bead-based affinity- fractionated proteomic approach to discover novel diabetic nephropathy- related markers in plasma. Method: We used MALDI-TOF mass spectrometry and copper affinity magnetic beads to compare protein profiles from plasma of 4 defined groups: Type 2 diabetes patients without microalbuminuria (normoalbuminuria; n = 30), with microalbuminuria (n = 33), with diabetic nephropathy (n = 25), and health control (n = 30). Spectra were a na l y z e du s i ngCl i nPr ot ™s of t wa r e( Br uke rDa l t oni c s )a ndANCOVA.Asar e s ul t ,pr ot e i ns which were differentially expressed with statistical significance (p < 0.05), and progressively increased or decreased expression according to the degree of clinical severity were selected and subjected to ESI-Q-TOF analysis. Result: Three proteins with m/z 3040, 3868, 4575 were found to be elevated, whereas the proteins with m/z 1748, 1848, 2033 were found to be decreased, in diabetic nephropathy compared to normoalbuminuria patients and health control. The m/z 2033, 3040, and 4575 ma s spe a kswe r ei de nt i f i e da sf i br i n og e nα-chain (amino acid 203–224), f i br i nog e nβ-chain (amino acid 15–42, and 1–42), respectively. Among patients with diabetes, the 3040-Da differed significantly between patients with normoalbuminuria and diabetic nephropathy with the highest sensitivity (46%) and specificity (92%). Conclusions: The study shows that the f i br i noge nβ-chain (amino acid 15–42) may be a useful marker for prediction of clinical progression of normoalbuminuria to diabetic nephropathy.

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O5-9 ESTROGEN SUPPLEMENT AMELIORATES HIGH FRUCTOSE DIET FRUCTOSE-INDUCED INSULIN RESISTANCE IN OVARIECTOMY FEMALE RATS 1

CHING-HENG TING, 1SENG-WONG HUANG, 1,2CHI-CHANG JUAN, 1,2 LOW-TONE HO 1 Institute of Physiology, School of Medicine, National Yang-Ming University; 2Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan Metabolic syndrome is a common disease in development countries, the prevalence is higher in men than in women. However, the incidences of metabolic syndrome and cardiovascular diseases rise sharply after menopause. Female sex hormones may play crucial roles in pathogenesis of metabolic syndrome in women. Our previous studies demonstrated that several metabolic abnormalities including obesity, insulin resistance, and hypertension was successfully induced with fructose-fed male rats. In this study, the effects of estrogen on fructose-induced metabolic changes were measured in ovariectomized (OVX) female rats. OVX rats were divided into three groups: (1) regular diet feeding group served as control; (2) high-fructose diet feeding group (HFR); (3) high-fructose diet feeding group with estrogen supplement (HFR + EB). Metabolic parameters, such as body weight, adiposity index, blood pressure, in vivo insulin sensitivity, cellular insulin signaling molecules were assessed. Hyperinsulinemia and insulin resistance were significantly induced in HFRs. Phosphorylation of insulin signaling molecules, such as Akt and IRβ, were also decreased in adipose tissue and skeletal muscle from HFRs compare with that from controls. Fructose-diet feeding induced insulin resistance and decreased phosphorylation of Akt and IRβ were prevented in HFR + EBs. These results proved that estrogen has protective effects against fructose-diet induced metabolic abnormalities. Estrogen is one of important factors involving the development of metabolic disorders in postmenopause stage of women.

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DP11-1 ASYMPTOMATIC PULMONARY CRYPTOCOCCOSIS IN TYPE 2 DIABETIC PATIENT: A CASE REPORT H-L CHEN, 1P-L CHEN, 2C-T CHEN Division of Endocrinology and Metabolism, Department of Internal Medicine, Lotung Poh-Ai Hospital, Taiwan; 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Luodong Saint Mary's Hospital, Taiwan; 2Department of pathology, Lotung Poh-Ai Hospital, Taiwan, R.O.C. Pulmonary Crypyococcosis is a chest infection caused by the fungus Cryptococcus neoformans, mainly affects immunocompromised patients and rare in immunocompetent patients. We report a case of pulmonary cryptococcosis in a 58-year-old diabetic woman, who presented with generalized weakness, body weight loss of 2kg within 3 months and poor glycemic control. She denied the symptom of cough, chest pain, dyspnea or low grade fever. Chest radiographs revealed rounded consolidation in right upper and middle lung field, and chest computed tomography (CT) revealed multiple nodules in right upper and middle lobes. Transthoracic fine needle biopsy was performed from right middle lung nodule. Histopathological examination of transthoracic biopsy specimen demonstrated cryptococcal organisms and laboratory data showed positive cryptococcus antigen with a titer of 1:16(+), which led to more accurate diagnosis of pulmonary cryptococcosis. Human immunodeficiency virus testing was negative. After 3 months of fluconazole therapy with a daily dose of 200mg orally, follow up chest radiographs noted mildly reduced in size of consolidation of right lung although Cryptococcal antigen titer was still positive. She maintains better glycemic control thereafter and her glycosylated hemoglobin(HbA1c) reduced from 10.3% to 8.3%. In conclusion, cryptococcosis should be considered in the differential diagnosis when diabetic patient with abnormal shadow in chest radiograph. An accurate diagnosis was made after pathologic examination of the biopsy specimen.

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DP11-2 FALSE-POSITIVE GALLBLADDER UPTAKE IN BOTH POSTABLATIVE IODINE-131 WHOLE BODY SCAN AND F-18 FDG POSITRON EMISSION TOMOGRAPHY IN A CASE OF PAPILLARY THYROID CARCINOMA 1

S-L CHIU, 1Y-C LU, 1S-Y CHEN, 1H-H CHANG, 1K-T DENG 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan, R.O.C. Introduction: After surgical treatment for well-differentiated thyroid carcinoma, the whole body scan following high dose iodine-131 therapy provides a sensitive tool for detection of local and distant metastatic tumor. False-positive of iodine-131 whole body scans are not frequent, and that should be differentiated with the metastases. The F-18 FDG PET is a sensitive technique for the identification of malignant tissue, but usually showed increase uptake in the condition of infection, inflammation and granulomatous disease. Case Presentation: We presented a 43-year-old male was a case of papillary thyroid carcinoma with left cervical lymphadenopathies status post total thyroidectomy and left neck dissection. The postablative iodine-131 therapeutic scan revealed functioning thyroid tissue in the neck and persistent uptake in right upper abdomen near hepatic hilum. Blood analysis showed thyroglobulin 4.44 ng/dl and negative of anti-thyroglobulin antibody. The abdomen ultrasound was performed and showed gallbladder stone. We arranged F-18 FDG PET scan and an intense focus uptake in gallbladder was found. The patient received cholecystectomy, the pathology showed acute and chronic inflammation with stone. Disscussion: Although lacking clinical symptoms with our patient, it is very likely that asymptomatic cholecystitis have occurred and resulted in the increased FDG uptake of his gallbladder. The whole body iodine-131 therapeutic scan persistent uptake in gallbladder may be explained by both gallbladder morphology and functional abnormalities such as gallbladder stone with chronic cholecystitis in this case.

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DP11-3 NON-ISLET CELL TUMOR INDUCED HYPOGLYCEMIA IN A CASE OF GASTROINTESTINAL STROMAL TUMOR J-Y JIANG, 1C-K LIN, 2K-H CHEN Division of Endocrinology and Metabolism, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei county, Taiwan, R.O.C.;1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei county, Taiwan, R.O.C.;2Department of General Surgery, Far Eastern Memorial Hospital, Taipei county, Taiwan, R.O.C Tumor induced hypoglycemia is a rare condition. The most well known tumors that cause hypoglycemia included those tumors which increase insulin production by islet-cell tumors or small-cell carcinomas. Very few cases of gastrointestinal stromal tumor (GIST) associated with hypoglycemia have been reported in the past. Here, we report a case of 49-year-old man who underwent resection of a large abdominal mass with diagnosis of GIST five years ago. He lost follow up since then. This time, he suffered from constipation, abdominal fullness, poor appetite and body weight loss of 20 kilograms in recent two months. He was sent to our emergency department where physical examination revealed abdominal distension with palpable mass and ileus was impressed. Abdominal computed tomography (CT) revealed multiple large intra-abdominal mass with heterogeneous appearance. His blood sugar on admission was 20 mg/dL (normal range : 70-110 mg/dL). Therefore, intravenous glucose continuous infusion was administered in order to maintain his blood sugar level around 80-100mg / dL.Hi si ns ul i nl e ve lwa s2. 0μI U/ ml( nor ma l r a ng e:28. 4μI U/ ml ) ,C-peptide <0.10 ng/mL (normal range : 1.0 - 7.6 ng/mL). He then underwent debulking surgery for intrabdominal tumor. The pathology report showed high malignant gastrointestinal stromal tumor of small intestine with metastases found in retroperitoneum, intrapelvic cavity and abdominal subcutis. CD117 stain of the tumor is positive. Blood sugar remained complete normalization after operation. In conclusion, non-islet cell tumor induced hypoglycemia (NICTH) should be considered in patient with GIST associated with hypoglycemia episode. Resection or debulking of the tumor is recommended if feasible for the correction of hypoglycemia episode.

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DP11-4 DIABETIC KETOACIDOSIS IN A PATIENT WITH PANCREATIC ABSCESS AND CHRONIC PANCREATITIS: REPORT OF A CASE T-L TSAI, 1W-H LI, H-Y OU, P-Y CHEN, T-J WU Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Tainan Municipal Hospital, Tainan, Taiwan Background: For young patients with DM, type 2 diabetes mellitus recently become more prevalent than type 1 diabetes mellitus in Taiwan. Hereby, we report a case with newly diagnosed DM which may be caused by pancreatic abscess and chronic pancreatitis Case Report: A 21-year-old lady was admitted with the chief complaint of fever and nausea for 3 days. She denied past history of alcoholism. She suffered from body weight loss of 6 kg in one month. Polyphgia, polydipsia, and polyuria appeared about 4 years ago. Physical examination revealed that BH:165cm and BW:53kg. Lab data revealed PH:7.346, HCO3:10.7, Glu AC:384, Anti-GAD Ab negative, and Amylase:15. Under the impression of diabetic ketoacidosis, insulin therapy and hydration were given. On workup for fever, abdominal CT showed a 2cm-cystic lesion over pancreatic head. Fever subsided after antibiotic therapy. Pancreatioduodenectomy 3 months later revealed abscess and chronic pancreatitis. After operation, she was smoothly treated with insulin therapy for DM.

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DP11-5 END-STAGE RENAL DISEASE COMBINED WITH PERSISTED HYPERINSULINEMIC HYPOGLYCEMIA IN AN ADULT PATIENT—CASE REPORT AND REVIEW OF LITERATURE Y-M PAN, C-W CHOU, C-Y YANG, K-J TIEN, H-F CHANG Division of endocrine and Metabolism, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan, R.O.C This 77 y/o man had a previous history with end-stage renal disease on H/D and brought to our hospital for hypoglycemia (random serum sugar: 24mg/dl & 44 mg/dl). Patient denied DM, alcohol drinking. There is also no any other drug was found. No adrenal insufficiency〔random cortisol: 22.2ug/dl, ACTH: 30pg/ml (normal range <46.0)〕, but hyperinsulinemia with AC sugar: 107mg/dl, insulin: 82.5uIU/ml (range 0~15.6), C-peptide: 32.72ng/ml (range 0.78~1.8) and PC sugar: 76mg/dl, insulin 314.8uIU/ml, C-peptide > 30ng/ml. Insulin autoantibody: 0.05(range <0.06). Abdominal echo and MRI revealed no insulinoma was found. Celiac arterial angiography and splenoportal-venous sampling revealed no evidence of hypervascularity tumor in pancreas, but elevated insulin (37.4uIU/ml and prior one sample: 5.3uIU/ml) was at site (from splenic vein) near to pancreatic head. Because of no insulinoma, autoimmune insulin syndrome, drug (alcohol) or ectopic insulin secrectogenous lesion were found, nesidioblastosis induced hypoglycemia was highly suspected. Nesidioblastosis causing hyperinsulinemic hypoglycemia is rare in adults and the incidence rate is about 0.5% to 7% of adult PHH. It may occur in males and females of any age group, reported mean age is 53.8y/o in one series. Few patients had chronic kidney disease. Search from medline, one autopsy report about one patient with nesidioblastosis, myelodysplasitc syndrome and nodular diabetic glomerulosclerosis (Cr: 1.7mg/dl) in an elderly non-diabetic woman and the other patient with ESRD and insulinoma were reported. Because of it may be combined with insulinoma (0.5%) in adults, nesidioblastosis was also thought to being as pre- malignant condition. It is difficulty to reveal precise location. Aggressive strategies for preoperative localization are including trans-gastric echo, CT, celiac angiography or selective arterial calcium stimulation test. But failure to localize lesion does not contraindicate surgical exploration. The management for nesidioblastosis is distal pancreatectomy. The portion of resection is about 60% to 80% (cure rate is about 50% and 19% need further medication post operation, like diazoxide, verapamil or octreotide) in several series. If more than 90% resection portion, IDDM may occur (40% of patients). － 183 －

DP11-6 ADRENAL INCIDENTALOMA IN A PATIENT PRESENTING WITH URINARY SYMPTOMS INITIALLY - ONE CASE REPORT OF CUSHING SYNDROME C LAM, 1C-L TSAI, 2H-L CHEN 1 Di vi s i onofEndoc r i nol ogya ndMe t a bol i s m,De pa r t me ntofI nt e r na lMe di c i ne , Tung s ’ 2 Taichung Metroharbor Hospital, Taiwan, R.O.C; De pa r t me ntofUr ol ogy , Tung s ’ Ta i c hung Metroharbor Hospital, Taiwan, R.O.C. A 32 –year-old male with chronic hepatitis B presented with urinary frequency and nocturia around 4 times each night since June 29th 2006. Harnalidge (Tamsulosin) was prescribed under the impression of benign prostate hyperplasia and the patient was recommended to have further outpatient follow up. Around six months later, his urinary symptoms still persisted and right side flank pain developed as well. General urine examination showed no significant hematuria or pyuria. Ultrasound disclosed a right side hydronephrosis. Both Intravenous pyelogram and voiding cysto-urethrogram revealed poorly distended urinary bladder under the suspicious mass effect over bilateral urinary bladder wall. Abdominal CT scan showed a 35x24x28 mm unknown mass lesion at left suprarenal space, probably arising from adrenal gland or pancreas. Abdominal MRI identified the unknown mass was probably from the posterior-lateral limb of left adrenal gland. After consultation with endocrinologist, his history was reviewed again and adrenal-related hormones were checked. Patient had increased 2 kilogram over the past 2 years. Physical examination disclosed marked purple striae over lower abdomen, armpit and thigh. The data included serum 17-ketosteroid 15.6 (6-22), cortisol 24.2mg/dL (5-25), plasma renin activity 0.2ng/ml (0.15-2.33), aldosterone 57.8ng/L (37-240). Under the impression of Cushing syndrome, left adrenalectomy was performed on Dec 21st 2006. A 4x3 cm yellowish round adrenal tumor was found over left upper adrenal gland. Pathology r e por tc onf i r me dt hedi a g nos i sofa dr e na lc or t i c a la de noma .Pa t i e nt ’ ss e r um c or t i s ol decreased to 2.59mg/dL and ACTH levels was 4.0pg/ml(10-65) on the next day after operation. With the subsequent out patient follow up, his serum cortisol and ACTH level remained low and prednisolone (5mg) twice a day has been prescribed since then. Ready access to and use of high-resolution radiographic imaging for evaluation of nonspecific symptoms has led to increasing discovery of adrenal incidentaloma. A thorough history and physical examination for any signs and symptoms of adrenal-related hormonal dysfunction should be completed. Further study should be made to determine hormone level and lesion site. － 184 －

DP12-1 EFFECTS OF CYTOKINES AND OXIDATIVE STRESS ON LIVER STEATOSIS IN CHRONICALLY HIGH FAT-FED RATS 1

C-C CHEN, 1Y-J LIN, 2Y-P HSU, 1C-Y LIN, 1X-Y LU, 1,2,3,4L-T HO 1 Institute of Physiology, National Yang-Ming University, Taiwan, R.O.C.; 2Department of Medical Research and Education; 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, R.O.C; 4Faculty of Medicine, National Yang- Ming University, Taiwan, R.O.C. Steatosis is characterized by the accumulation of fat droplets in hepatocytes and has been implied to be an important cofactor in the pathogenesis of non-alcoholic fatty liver disease. During this chronic course, cytokines and generation of reactive oxygen species may induce alterations in lipid metabolism including an increase in hepatic triglyceride and oxidative stress. However, the mechanisms are not entirely understood. The aim of this study was to elucidate what cytokines and nuclear factors are involved in hepatic lipid dysregulation using high-fat feeding rats as an experimental model. Male Sprague Dawley rats were fed with either normal chow diet or high-fat diet for 4 months. Plasma and hepatic triglyceride were determined by colorimetric method. Tumor necrosis factor-(TNF-), sterol regulatory element binding protein-1c (SREBP-1c) and other lipogenic genes mRNA from liver extract were examined by real-time PCR. Expression of hepatic nuclear factors, anti-oxidative protein and mitogen-activated protein kinase (MAPK) protein were determined by Western blot. Our results showed that hepatic triglyceride level was significantly higher in rats with high-fat diet than that of normal chow diet rats, although the plasma triglycerides were not different between the two groups. TNF-, SREBP-1c, acetyl-CoA carboxylase (ACC) and fatty acid synthase (FAS) mRNA were increased in high-fat diet group compared with normal chow diet group, but the acyl-CoA oxidase (ACO) mRNA expression was higher in the control group. On the other hand, hepatic PPAR-and MnSOD were downregulated and p38 MAPK phosphorylation was increased in high-fat diet group. Based on these findings, we speculate that high-fat feeding in rat may stimulate TNF- level, which suppressed the expression of PPAR- . At the same time, overexpression of hepatic triglyceride may reduce MnSOD and result in an increase of oxidative stress.

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DP12-2 THE ROLE OF ENDOTHELIN-1 IN REVERSE CHOLESTEROL TRANSPORT IN MACROPHAGE 1

C-Y LIN, 1,4T-S LEE, 1C-C CHEN, 1,2,3,4L-T HO 1 Institute of Physiology, School of Medicine, National Yang-Ming University, Taiwan, R.O.C.; 2Department of Medical Research and Education; 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, R.O.C.; 4Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C. The reverse cholesterol transport pathway is critical for the transfer of excess cholesterol from peripheral tissues back to the liver. Excessive lipid accumulation in macrophages is a major hallmark in the early stage atherosclerotic lesion. Scavenger receptors (SRs) and ATP-binding cassette (ABC) transporters play important roles in foam cell formation by regulating the flux of cholesterol from cells. Endothelin-1 (ET-1), is a potent vasoconstrictive peptide, is known to promote macrophage-foam cell formation, yet the mechanisms are still unclear. The aim of this study was to investigate the possible mechanism of ET-1 affecting lipid accumulation in macrophages. Rat bone marrow cells were isolated and differentiation was induced with macrophage colony stimulating factor (M-CSF). Our previous data indicated that ET-1 mRNA level in bone-marrow deviated macrophage mediated by oxLDL treatment was significantly elevated in a dose-dependent manner. Moreover, combine treatment with ET-1 and oxLDL significantly increased lipid accumulation in macrophages, compared with oxLDL alone group. To explore the effects of ET-1 on cholesterol efflux, macrophages were treated with ET-1 and cellular lysates were subjected to Western blot and real time-PCR analysis. The results showed that ET-1significantly decreased protein level of ABCG1 through ETA and ETB receptors, but not CD36, SR-B1, SR-A or ABCA1 protein level. Furthermore, ET-1 treatment did not affect ABCG1 mRNA expression. Therefore, we examined whether ET-1 arose degradation of ABCG1 protein. Our data demonstrated that ET-1 enhanced degradation of ABCG1 protein through proteasome-dependent degradation pathway. These findings suggest that ET-1may attenuate the cholesterol efflux and further exacerbate the lipid accumulation in macrophag.

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DP12-3 EFFECT OF HYPOXIA ON INSULIN SENSITIVITY IN 3T3-L1 ADIPOCYTES 1

YU-HAN HUANG, 1,2CHI-CHANG JUAN, 1,2LOW-TONE HO 1 Institute of Physiology, National Yang-Ming University; 2Department of Medical Research & Education, Taipei Veterans General Hospital Obesity is a risk factor of insulin resistance. Previous studies showed that adipose tissue dysfunction might cause insulin resistance in obesity and adipose tissues of obese individuals were in a low oxygen status. Those observations indicated that hypoxia status of adipocyte tissue may associate with the development of insulin resistance. However the pathogenic role of hypoxia in the development of insulin resistance is not clear in adipocytes. The purpose of our study is to explore the regulatory mechanism of hypoxia on insulin sensitivity in 3T3-L1 adipocyte. First, 3T3-L1 adipocytes were cultured under hypoxia for fixed time and then evaluated the changes of insulin signaling cascades, insulin-stimulated translocation of glucose transporter 4 and subsequent glucose uptake. Next, we explored the role of hypoxia inducible factor-1(HIF-1) on hypoxia-regulated insulin signaling by using HIF-1 siRNA. Our preliminary result showed that acute hypoxia treatment increased insulin receptor autophosphorylation and Akt phosphrylation in 3T3-L1. Another land long-term hypoxia treatment impaired insulin signaling and insulin-stimulated glucose uptake in adipocyte. This data suggest that hypoxia plays an important regulatory role in insulin sensitivity of adipocytes.

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DP12-4 HEXOSAMINE BIOSYNTHETIC PATHWAY REGULATES THE PRO-APOPTOSIS ACTIVITY OF FOXO1 IN HUMAN RENAL PROXIMAL TUBULAR CELLS 1

T-J HSIEH, 1P-C HSIEH, 1T LIN, 1,2S-J SHIN 1 Graduate Institute of Medical Genetics, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 2Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan Objective: Tubulointerstitial fibrosis and tubular atrophy/apoptosis are involved in diabetic nephropathy (DN). However, the molecular mechanism is not totally clear yet. Activation of FOXO (Forkhead box, class O) proteins have been mentioned involving in apoptosis. Hexosamine biosynthetic pathway (HBP) generates the sugar nucleotide UDPGlcNAc, which is the donor for O-GlcNAc modification of many nucleocytoplasmic proteins and further regulates cell function as well as cell survival. The aim of this study is to clarify the role of FOXO and its interaction with HBP on the apoptosis of human renal proximal tubular cells. Methods: Slices of human kidney biopsy from normal donors and DN patients were stained with anti-O-GlcNAc or FOXO1 antibodies and apoptosis were detected by TUNEL assay. To further clarify the mechanism, we stimulated human renal proximal tubular cells (HK-2) with high glucose (i.e. 35 mM) for different timings and then apoptosis was analyzed by FACS after staining with Annexin-V-R-phycoerythrin. FOXO1 and O-GlcNAcylated proteins were measured by Western Blotting. Messenger RNA of FOXO1 was measured by real-time PCR. Results: Our results demonstrate increased positive stains of apoptotic cells, O-GlcNAcylated proteins, and FOXO1 in proximal tubules of DN patients. The results also show increased amount of apoptotic cells and O-GlcNAc modified proteins in HK-2 cells with high-glucose stimulation. High-glucose stimulated overexpression of FOXO1 RNA and protein more than 3-fold. However, RNA silencing of GFAT-1 (rate-limited enzyme of HBP) reverses the high-glucose effect on the apoptosis of HK-2 and the overexpression of FOXO1. Conclusion: The results suggest that HBP play a role in regulating the pro-apoptotic activity of FOXO1 in human renal proximal tubular cells.

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DP12-5 RETINOL-BINDING PROTEIN INCREASE FIBROSIS AND APOPTOSIS IN HEK CELLS 1

C-H CHEN, 1C-S LO, 2P-J HSIAO, 1,2K-D LIN, 1T-J HSIEH, 1,2Y-H CHANG, 1,2S-J SHIN 1 Graduate Institute of Medicine, Kaohsiung Medical University, Taiwan; 2Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital,Kaohsiung Medical University, Kaohsiung, Taiwan Serum retinol-binding protein 4 (RBP4), a new adipocytokine, was reported to increase insulin resistance. Our previous study showed that RBP4 was significantly elevated in type 2 diabetic patients with microalbuminuria and macroalbuminuria as compared with normoalbuminuric patients. Some adipocytokines have been found to induce cell injury. Therefore, we investigated whether RBP4 could modulate JNK, p38MAPK, ERK and TGF-beta1 expression in HEK cells by using transfection of p38MAPK and JNK small interfering RNA (siRNA). HEK cells were grown without transfection or with transfection with p38MAPK and JNK small interfering RNA (siRNA) plasmid. Cells were also transfected with control siRNA. HEK cells were stimulated with RBP4 (0, 2.5, 12.5, 25 and 59 microgram/dl) to modulate the expression of TGF-beta1 and phosphorylation of JNK, ERK and p38MAPK. Our results showed that the addition of RBP4 significantly increased phosphorylation of JNK, p38MAPK and ERK, and TGF-beta1 expression in a dose-dependent pattern in untransfected cells. The transfection of p38MAPK and JNK siRNA significantly decreased the expression of p38MAPK and JNK, but also markedly attenuated RBP4-activated expression of TGF-beta1. Additionally, the transfection of p38MAPK and JNK siRNA attenuated RBP4-activated caspase expression and DNA fragmentation in HEK cells. In conclusion, our results demonstrated that RBP4 can increase TGF-β1e xpr e s s i ona ndi nduc ea popt os i st hr oug ht hea c t i va t i onof JNK, p38MAPK and ERK phosphorylation in HEK cells.

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DP12-6 HIGH GLUCOSE INDUCES ANP-SYNTHESIS VIA INTRARENAL RENIN-ANGIOTENSIN SYSTEM IN RENAL TUBULAR CELLS 2

C-S LO, 2C-H CHEN, 3T-J HSIEH, 1P-J HSAIO, 1,2K-D LIN, 1,3S-J SHIN 1 Division of Endocrinology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 2Graduate Institute of Medicine, Kaohsiung Medical University, Taiwan; 3Graduate Institute of Medical Genetics, Kaohsiung Medical University, Taiwan Aims: Atrial natriuretic peptide (ANP) expression has been demonstrated in several extra-atrial tissues like kidneys. However, the regulation of ANP synthesized from the kidney has never been elucidated. Therefore, we investigated whether intrarenal renninangiotensin system could modulate renal ANP synthesis in high glucose-stimulation in NRK-52E cells. Addition of losarton, PD123319 and transfection ANG (angiotensinogen) small interfering RNA (siRNA) to elucidate the regulation between ANP and ANG in high glucose stimulation in renal tubular cells. Methods: NRK-52E cells were transfected with ANG or control siRNA. The levels of c e l l ul a rANP ,ANG a ndβ-actin messenger RNA were determined by RT-PCR. ANP and ANG II protein concentration were detected by ELISA. Results: NRK-52E cells were stimulated with high glucose to up-regulate ANP and ANG mRNA and ANG II protein level. These effects of high glucose were attenuated by angiotensin II receptor antagonist ( losartan or PD123319). ANG siRNA silenced ANG expression, and down-regulate ANP expression in high glucose stimulation in renal tubular cells. Conclusion: Our studies suggest that high glucose induces renal ANP synthesis via intrarenal renin-angiotensin system in renal tubular cells.

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DP12-7 THE ASSOCIATION OF TCF7L2 RS290487 WITH ALBUMINURIA IN TYPE 2 DIABETIC PATIENTS. 1,2

W-C CHUNG, 1,3C-L WANG, 1,3H-Y LIN, 1,2S-R HE, 1,3K-D LIN, 1,3Y-H CHANG, 1 P-J HSIAO, 1,2S-J SHIN 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Taiwan, R.O.C.; 2Graduate Institute of Medical Genetics, Kaohsiung Medical University, Taiwan, R.O.C.; 3Graduate Institute of Medicine, Kaohsiung Medical University, Taiwan, R.O.C. Aim: Several studies have demonstrated that TCF7L2 gene polymorphisms are associated with type 2 diabetes. Recently, TCF7L2 variants are found to be associated with chronic kidney disease. These findings promote us to study the association between TCF7L2 rs290487 gene polymorphism and diabetic nephropathy. Materials and method: In this study, we enrolled 819 type 2 diabetic patients from Taiwanese population. They were divided into two groups (ACR≦ 30μg / mga ndACR> 30μg / mg )a c c or di ngt oa l bumi nu r i cs t a t us( ur i na r ya l bumi n-to-creatinine ratio, ACR). Genotyping of the TCF7L2 rs290487 SNP was carried out using real-time TaqMan PCR method. Genotype distribution and allele frequencies were compared to the Hardy– 2 We i nbe r ge qui l i br i um mode lus i ngt hePe a r s onχ test. The statistical significance of di f f e r e nc e swa sa na l y z e dbyunpa i r e dSt ude nt ’ st test. Result: The frequencies of TT and TC+CC genotypes are 43.9% and 56.1% in patients with ACR≦ 30μg / mg ,37. 1% a nd62. 9% i npa t i e nt swi t hACR>30μg / mg .The frequencies showed a significant difference between two groups (P< 0.05). Conclusion: Our study implicates the link between TCF7L2 gene polymorphism rs290487 and diabetic nephropathy. But the underlying molecular mechanism need to be further investigated.

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DP12-8 DIABETES AND HOGG1 SER326CYS POLYMORPHISMS ARE INDEPENDENTLY ASSOCIATED WITH MULTI-VESSEL INVOLVEMENT IN CORONARY ARTERY DISEASE 1,3

C-L WANG, 2L-T LIN, 2S-H SHEU, 2W-T LAI, 1P-J HSIAO, 1,3K-D LIN, 1,3H-Y LIN, 1,3 Y-H CHANG, 1S-J SHIN 1 Division of Endocrinology and Metabolism1, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Taiwan, R.O.C.; 2Division of Cardiology, Chung-Ho Memorial Hospital, Kaohsiung Medical University, Taiwan, R.O.C.; 3Department of Internal Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Taiwan, R.O.C. Background/ AIM: Insulin resistance (IR) is known to be an important mediator in the aggravation of coronary artery disease (CAD). The previous study indicates that the Ser326Cys polymorphism of human 8-oxoguanine glycosylase 1 (hOGG1) gene is associated with IR. Therefore, we investigated the association between hOGG1 Ser326Cys polymorphism and development and severity of coronary artery disease. Methods: We enrolled 378 subjects with CAD patients who had undergone coronary artery angiography. The patients were divided into single and multi-vessel disease groups on the basis of the severity of CAD. 503 subjects from department of preventive medicine served as control groups. Genotyping of hOGG1 Ser326Cys was performed by using a real-time polymerase chain reaction. Result: Ser/Cys+Cys/Cys genotypes (Cys326 variants) presented high frequency in CAD group compared with control group (87.0% vs. 79.9%, p<0.005). Furthermore, Cys326 variants in CAD patients with multiple vessels showed higher frequency than patients with single-vessels (90.2% vs. 80.3%, p<0.007). In multi-vessel disease has more incidence of diabetes more than single-vessel disease (30% vs. 53.5%, p<0.001). Multiple logistic regression analysis demonstrated diabetes and Cys variants as an independent risk factor for CAD development (odds ratio [OR]: 7.38, 95% CI: 3.199 to 17.024 and OR: 2.28, 95% CI: 1.041 to 4.979, respectively) and CAD severity (OR: 2.77, 95% CI: 1.701~4.522 and OR: 2.56, 95% CI: 1.329 to 4.924, respectively). Conclusion: These preliminary results suggest that diabetes and Cys326 variants are associated with presence and severity of CAD. Most importantly, our results indicate that diabetes and hOGG1 Ser326Cys polymorphism may be an independently significant risk factor for developing and severity CAD.

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DP12-9 REGULATION OF HEPATIC LIPOLYSIS BY PIOGLITAZONE IN A HIGH FAT DIET MODEL P-J HSIAO, 1T-J HSIEH, K-D LIN, W-W HUNG, Y-H CHANG, S-J SHIN Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University, Taiwan, R.O.C.; 1Gaduate Institute of Medical Genetics, Kaohsiung Medical University, Taiwan, R.O.C. Pioglitazone has also been proved to decrease hepatic steatosis, improved hepatic necroinflammation and fibrosis in human study. Lipolysis, hydrolysis of triglyceride and cholesterol ester, is mainly determined by the lysosomal acid lipase (LAL), adipose triglyceride lipase (ATGL) and hormone-sensitive lipase (HSL). It remains unclear how the related genes of fatty acid metabolism regulated by the pioglitazone in vivo. So we tried to explore the lipolysis regulation genes by pioglitazone in a high fat diet model. In this experiment, male C57BL/6J mice were fed with a high fat diet (30%), the same diet with pioglitazone 100 mg/kg/day, or a chow diet as control for 4 and 8 weeks. Serum cholesterol, triglyceride, blood glucose and insulin were measured. Serum NEFA and hepatic TG content were analyzed by colorimetric enzymatic hydrolysis. Histologic and immunohistochemical stain were used to evaluate the grading of steatosis and lipid droplets. Real-time PCR were used to compare the changes of LAL, ATGL, HSL among groups at 4 and 8 wk- time intervals. The liver weight and hepatic lipid content were compared among 3 groups. It showed significantly increased liver weight in group of high fat diet at 4 wks, and pioglitazone treatment decreased the liver weight at 8 wks compared with the other groups. At 4-wk period, only the HSL gene expression was enhanced in group of high fat diet but the pi og l i t a z onet r e a t me ntdi dn’ ts how s i g ni f i c a nti nf l ue nc e .Af t e rt he8- wk treatment of pioglitazone, these genes expression of lipolysis (LAL, ATGL, HSL) all were significantly enhanced compared with groups of chow and high fat diet. In conclusion, the activities of lipolysis genes (LAL, ATGL and HSL) are upregulated in a state of the high fat diet and the pioglitazone treatment increases these gene expressions.

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DP22-1 THE EFFECT OF AGE ON SERUM URIC ACID LEVEL 1

CHUAN CHUAN HSIAO, 2WEN WEI LIANG 1 Department of Nursing, DaChien Hospital; 2Department of Endocrinology and Metabolism, DaChien Hospital Objective: We conducted a cross-sectional study to evaluate the effect of age on the uric acid levels. Study Design: We collected data from subjects who first visited our hospital for health examination between 01/2002 and 07/2008. (n=15339).All subjects are 45 years old or elder. We classified the total study subjects into five groups (45-54, 55-64, 65-74, 75-84, 85 or elder) by 10-year age increments. We calculate the mean level of uric acid and prevalence of hyperuricemia in these groups. Because uric acid level associated with glomerular filtration rate (GFR) and obesity, we use multivariable model to examine whether the age is an independent risk factors or not. Results: The mean age of all subjects is 63.4±10.6. We found that mean uric acid level was 5.8mg/dl in 45-54 age group to 6.5mg/dl in 85 or elder age group. The difference is significant (P<0.001). The prevalence of hyperuricemia also increased from in 45-54 age group to 85 or elder age group.(29.5% to 40.1%) . From the data of multivariable model, the prevalence of hyperuricemia in 65-74 age group, 74-85 age group and 85 or elder age group are lower than in 45-54 age group (Odds Ratio : 0.81, p<0.001; 0.61, p<0.001; 0.49 ,P<0.001, separately ) after exclusion the effect of obesity and GFR. We found that prevalence of hyperuricemia decreased as age increased Conclusion: High uric acid level and high prevalence of hyperuricemia were found in old and very old subjects. The phenomenon is resulted from that old or very old people usually had lower GFR. After exclusion the effect of GFR and obesity, prevalence of hyperuricemia was lower in old and very old subjects than in middle-aged.

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DP22-2 THE RELATIONSHIP BETWEEN ANKLE-BRACHIAL INDEX, BRACHIAL-ANKLE PULSE WAVE VELOCITY AND QUANTITATIVE INDICES OF PULSE VOLUME RECORDING (%MAP, UPSTROKE TIME) AND CONVENTIONAL RISK FACTORS OF CARDIOVASCULAR DISEASE IN DIABETICS Y-Y CHEN, S-Y LIN, Y-M SONG, I-T LEE, W-J CHANG, L-N TSENG, Y-W YANG, W-C LIU, WAYNE H-H SHEU Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan, R.O.C. Objective: The aim of this study was to examine the relationship between some novel parameters: brachial-ankle pulse wave velocity (baPWV) and quantitative indices of pulse volume recording (PVR), e.g., %MAP and upstroke time, and ankle-brachial index (ABI) as well as conventional risk factors of cardiovascular disease in diabetics. Methods: We reviewed the reports of ABI of 98 diabetics performed from Jun. 2007 to Oct. 2008 in a teaching hospital. Their age, sex, body mass index (BMI), glycated hemoglobin, fasting total cholesterol, and serum creatinine levels were recorded. The measurements of ABI were performed with a device, VP-1000 (Colin, Komaki, Japan), which can measure brachial and ankle systolic blood pressure (SBP), baPWV, and quantitative indices of PVR (%MAP and upstroke time). Using linear regression analyses, we examined the relationship between baPWV, an indicator of arteriosclerosis, and above-mentioned conventional risk factors of cardiovascular disease. Similarly, the relationship between these risk factors, with %MAP and upstroke time included, and ABI, an indicator of atherosclerosis, was examined. Results: Of the 98 diabetics in this study, the mean age was 66.9 ± 12.6 years (mean ± SD), with 53 men and 45 women, and 56 (57.1%) had a history of hypertension. The mean total cholesterol level was 178.1 ± 37.9 mg/dL (mean ± SD), with 42 (42.9%) receiving lipid-lowering agents. Chronic kidney disease, defined as a serum creatinine level higher than 1.4 mg/dL, was identified in 26 (26.5%). Overall, 17 (17.3%) patients had an ABI (either left or right) less than 0.9 and therefore a diagnosis of peripheral arterial disease (PAD). Compared with those did not, the patients who had PAD had higher age, brachial SBP, baPWV, upstroke time and %MAP. By univariate linear regression analysis, we

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determined significantly correlated factors of ABI: age, brachial SBP, %MAP and upstroke time; baPWV: age, BMI, brachial SBP and %MAP; upstroke time: age, brachial SBP and ABI; %MAP: age, brachial SBP, baPWV and ABI. Using multivariate linear regression analysis, the significantly correlated factors of ABI were %MAP and upstroke time; for baPWV: age, BMI and brachial SBP; for upstroke time: age, brachial SBP and ABI; for %MAP: age and ABI. Conclusions: Our results were consistent with the hypothesis that baPWV correlated with systemic arteriosclerosis, whereas %MAP and upstroke time correlate with ABI, an indicator of atherosclerosis. These findings imply the potential clinical use of these novel parameters in cardiovascular risk assessment in diabetics.

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DP22-3 THE EFFECT OF AGE ON SERUM ALBUMIN LEVEL 1

CHIU LIEN HSIEH, 2WEN WEI LIANG 1 Department of Nursing, Dachien Hospital; 2Department of Endocrinology and Metabolism, Dachien Hospital Objective: We conducted a cross-sectional study to evaluate the effect of age on the serum albumin levels. Study Design: We collected data from subjects who first visited our hospital for health examination between 01/2002 and 07/2008. (n=15339). All subjects are 45 years old or elder. We classified the total study subjects into five groups (45-54, 55-64, 65-74, 75-84, 85 or elder) by 10-year age increments. We calculate the mean level of serum albumin and prevalence of hypoalbuminemia in these groups. Because serum albumin level associated with proteinuria, low body weight, liver function and inflammation, we use multivariable model to examine whether the age is independent risk factors or not. Results: The mean age of all subjects is 63.4±10.6. We found that mean serum albumin level was 4.5mg/dl in 45-54 age group to 4.1mg/dl in 85 or elder age group. The difference is significant (P<0.001). The prevalence of hypoalbuminemia also increased from in 45-54 age group to 85 or elder age group (0.6% to 10.7%). From the data of multivariable model, the prevalence of hypoalbuminemia in 65-74 age group, 74-85 age group and 85 or elder age group are higher than in 45-54 age group (Odds Ratio : 1.80, p<0.001; 2.73, p<0.001 ;9.61 ,P<0.001, separately) after exclusion the effect of proteinuria, low body weight, liver function and inflammation. We found that prevalence of hypoalbuminemia increase as age increase. Conclusion: Low serum albumin level and high prevalence of hypoalbuminemia were found in old and very old subjects. After exclusion the effect of the effect of proteinuria, low body weight, liver function and inflammation, prevalence of hypoalbuminemia was lower in old and very old subjects than in middle-aged.

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DP22-4 SEASONAL EFFECT ON PREVALENCE OF IMPAIRED FASTING GLUCOSE AND PREDITIVE POWER FOR FUTURE DIABETES SHU YU XUHU, WEN WEI LIANG 1 Department of Nursing, Dachien Hospital; 2Department of Endocrinology and Metabolism, Dachien Hospital Background: The seasonal pattern was found in the onset of type 1 diabetes and type 2 diabetes, glycemic control and insulin sensitivity. We designed cross-sectional study to evaluate the seasonal effect on the IFG (impaired fasting glucose) prevalence and IFG predictive power for future diabetes. Method: We collected data from subjects who visited our hospital for health examination at least two times between 06/2002 and 07/2008. (n=3722). We categorized total subjects into four groups (spring, summer, fall and winter) by the season which subjects received first examination. Subjects with diabetes mellitus before the first examination were excluded. We calculated prevalence of IFG and incidence rate of new-onset diabetes from the subjects with IFG by each group. Results: The prevalence of IFG is 12.7%. The incidence of new-onset diabetes between two examinations of IFG subjects is 27.06%. We calculate the prevalence of IFG of total subjects in each season group. We found IFG prevalence to be 11.5% in summer and 18.6% in winter. The IFG prevalence is highest in winter and dip in summer. (p<0.001) We calculate incidence of new-onset diabetes in subjects with IFG in each group. The incidence of new-onset diabetes is highest in summer (33.3%) and dip in winter (11.6%). (p<0.001). Conclusions: We described seasonal variations in IFG prevalence and predictive power of IFG for future diabetes. Prevalence of prevalence is highest in winter and lowest in summer. Incidence of new-onset diabetes in subjects with IFG is lowest in winter and highest in summer.

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DP22-5 THE STATE AND CONTROL OF DYSLIPIDEMIA AMONG PERSONS WITH TYPE 2 DIABETES IN A PUBLIC MEDICAL CENTER IN TAIWAN 1

S-Y LIN, 1I-T LEE, 1L-N TSENG, 1Y-M SONG, 1,2W-HH SHEU 1 Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan; 2Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan The prevalence, treatment, and extent of control of lipids, including low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), and triglyceride levels, were examined in 855 type 2 diabetes patients (48.2% male; aged 65.113.2 years, mean S.D.), who were routinely followed by endocrinologists from January 1, 2007 to December 31, 2007 at a medical center in central Taiwan. The treatment goal of lipids was according to the American Diabetes Association guidelines. The mean total cholesterol was 189.142.1mg/dL, LDL-C 106.536.7 mg/dL, HDL-C 51.115.2mg/dL, and triglyceride 155.9116.8 mg/dL. Overall, 45.3% of men and 43.9% of women with diabetes achieved the treatment target for LDL-C <100mg/dl, and 30.3% of men with HDL-C <40mg/dL, 40% of women had HDL-C <50mg/dL, and 34.6% of men and 32.5 % of women with triglyceride levels<150mg/dL. 21.4% of all the subjects were controlled to the treatment goals of all lipids. In the 38 % of diabetic patients, who were on lipid-lowering treatment (80.4% with statin and 19.6% with fibrates), 48.2%, 64.6%, and 21.1 % of subjects achieved the LDL-C, HDL-C, and triglyceride goals, respectively. In comparison to those not receiving any lipid-lowering therapy, the control rate of HDL-C and triglyceride except LDL-C did not differ. The logistic regression analysis found that LDL-C <100mg/dl was associated with glycated hemoglobin (A1C), and TG<150mg/dl associated with body weight, and antihyperlipidemic therapy. The HDL<40 mg/dl in men or <50mg/dl in women was associated with age, body weight, and insulin injection. In conclusion, this study observed that many persons with diabetes remained under-treatment for dyslipidemia. More intensified efforts were needed to overcome the potential barriers for a successful implementation of the treatment guidelines.

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DP22-6 THE RESPONSE OF FIRST AND SECOND PHASE INSULIN SECRETION IN NEWLY DIAGNOSED TYPE 2 DIABETES MELLITUS FOLLOWING INITIAL TREATMENT W-Y MA, T-L HSIA, C-C SU, B-J LIN, 1C-Z WU, 2J-DI LIN, D PEI Division of Endocrinology, Department of Internal Medicine, Cardinal Tien Hospital, Xindian; Medical School, Catholic Fu Jen University, Taipei, Taiwan, R.O.C.; 1Division of Endocrinology and Metabolism, Department of Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; 2Division of Endocrinology and Metabolism, Department of Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan Objective: This study is conducted to evaluate the first and second phase insulin secretion (1st ISEC, 2nd ISEC, respectively) in newly diagnosed type 2 diabetes before and after treatment. Method: Modified low dose graded glucose infusion test (M-LDGGI) and frequent sample intravenous glucose tolerance test (FSIGT) were performed in newly diagnosed type 2 diabetic subjects before and after treatment with insulin secretagogues for 7±4 months. Acute insulin response to the glucose load (AIRg), regarded as 1st ISEC, was obtaine dbyBe r g ma n’ sMi ni ma lmode lf r om FSI GT.2nd ISEC was represented by the slope of insulin over glucose curve during M-LDGGI test. The changes of insulin secretion and insulin sensitivity were compared before and after treatment after the adjustment of age and gender. The correlations of the change of insulin/glucose slopes (2nd ISEC) with other variables were also analyzed. Study subjects were further divided into two groups arbitrarily according changes of 2nd ISEC before and after treatment. Those with improvement were defined as responders and less improvement as non-responders, accordingly. Results: Totally 27 patients with mean age of 51.2±9.3 were enrolled. After treatment, there were significantly reduction of fasting plasma glucose (p=0.0107) and hemoglobin A1C (p=0.0005) and increased body mass index (BMI) (p=0.012), hip circumference (p=0.0022), high-density lipoprotein cholesterol (HDL-C) (p=0.0001), diastolic blood pressure (p=0.0276), homeostasis model assessment for β -cell function (HOMA-B, p=0.0388) and the 2nd ISEC (0.0436). The AIRg (1st ISEC) had no significant change (p=0.088). The changes of slope of insulin/glucose curve (2nd ISEC) were correlated with age (r=-0.5963, p=0.001), gender (r=-0.5015, p=0.009), BMI (r=-0.4045, p=0.045), waist circumferences (r=-0.4385, p=0.028), serum triglyceride (r=0.5494, p=0.004) initial － 200 －

HbA1C (r=0.5288, p=0.008), the extent of A1C reduction (r=-0.4967, p=0.043) and the slope before treatment (r=-0.4040, p=0.045). Comparing those with the responders and non-responders, the responders were younger, with lower BMI, higher fasting glucose, higher A1C and poorer 2nd ISEC before treatment. The AIRg, insulin sensitivity, homeostasis model assessment for insulin resistance (HOMA-IR) were no statistically difference between these two groups. Conclusion: In treatment naïve type 2 diabetes patients, a greater glycemic control helps insulin secretion, predominantly in second phase. Those with lower BMI, more hyperglycemia, and younger age tended to have better response.

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DP22-7 THE OUTCOME OF STANDARD WARD-BASED PROCEDURES TO PREVENT HOSPITAL HYPOGLYCEMIA YUN-JU LAI, I-TE LEE, WAYNE H-H SHEU, SHIH-YI LIN, HSIU-CHEN LIU, WEN-JANE LEE Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan, R.O.C. Background: Hospital hypoglycemia will result in subsequent morbidity or mortality. It is warranted to establish a ward-wide policy for prevention of hospital hypoglycemia. Methods: A hypoglycemia prevention strategy was proposed by the endocrinologists in Taichung Veterans General Hospital. The multi-disciplinary training for the strategy was addressed to our physicians and nursing staff in the general medicine ward. The occurrence of hypoglycemia events in the patients with diabetes was recorded before and after the administration of the hypoglycemia prevention strategy. In the same period, the hypoglycemia incidence in the metabolism-endocrinoloical ward was also recorded and compared. Results: 39 hospitalized subjects with known diabetes in the general medicine ward were enrolled, 8 subjects experienced at least an episode of hypoglycemia. After administrating the hypoglycemia prevention strategy, of 46 subjects admitted in the general medicine ward, 9 subjects had experienced hypoglycemia while hospitalization. There was no significant difference on occurrence of hypoglycemia in the general medicine ward by the intervention of hypoglycemia prevention pathway. (P = 0.913). In comparison with the general medicine ward, 6 hypoglycemic events were experienced in the 45 study subjects in the metabolism-endocrinoloical ward. There was no significant difference in the hypoglycemia risks between the general medicine and metabolism-endocrinoloical wards. (P = 0.423). Conclusion: The standard ward-ba s e dpr oc e dur e sdi dn’ ta t t e nua t et hehy pog l y c e mi a occurence in the general medicine ward, where the hypoglycemia risk is similar to that in the metabolism-endocrinoloical ward.

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DP22-8 THE ASSOCIATED FACTORS OF QUALITY OF LIFE IN DIABETIC PATIENTS LIVING IN A RURAL AREA H-J CHUANG, 1Y-S YANG, 1C-N HUNG Department of Management, Chung Shan Medical University Hospital Taichung, Taiwan; 1 Division of Endocrinology & Metabolism1, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan The purpose of this study was to describe the risk factors related to quality of life for patients with type 2 Diabetes Mellitus. Method: This is a cross-sectional study, the patients were recruited from the outpatient department of Miaoli County Chronic Disease Control Institution. Each participant was interviewed with WHOQOL BREF Taiwan Version questionnaire to assess the health-related quality of life (HRQOL). The demographic and clinical characteristics were collected simultaneously. Data were coded and analyzed using SPSS for Windows 12.0 edition software by t-test, one-way ANOVA, Pearson correlation and stepwise multiple regression. Result: One hundred and one type 2 diabetic patients completed the questionnaire during April 2008. There were 46 males and 55 females; mean age of 64.8 ± 10.0 years. The value of fasting blood glucose was 136 ± 3.7mg/dl, with 82.2% of patients had average value of blood glucose above 70-110 mg/dl. The average of HbA1c was 7.6 ± 0.12%, with 63.4 % of patients had HbA1c above 7%. The mean period of known diabetes duration was 7.3 ± 0.54 years. The mean score for the total quality of life was 99.90 ± 13.03 points (range from 28-140). The quality of life was divided into four domains: physical, psychological, social, and environmental. The social relationships was the highest score domain (14.73 ± 2.06), and the physical domain was the lowest score (14.05 ± 2.43). Using stepwise multiple regression analysis, the known diabetes treatment time and economic status of an average income more than hundred thousand year were the pr e di c t or sofdi a be t i cpa t i e nt ’ squa l i t yofl i f e( at ot a lva r i a nc eof1 1. 4%) . Thes hor t e r diabetes treatment time, the better quality of life. Discussion: Diabetic patients living in the rural area exhibits a better social relationships quality of life. In contrast, the physical status revealed the lowest score of QOL. The predictors of a better quality of life in this group of diabetic patients were treatment time of diabetes and economic status. Treatment time of diabetes is an important factor for QOL.

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DP22-9 ASSESSMENT OF INSULIN RESISTANCE WITH COMPONENTS OF METABOLIC SYNDROME AND ORAL GLUCOSE TOLERANCE TEST IN DIFFERENT GLUCOSE TOLERANCE C-Z WU, 1D PEI, 1W-Y MA, A-T HSIEH, 1C-C SU, 1T-L HSIA, K-Y TSAI, 1B LIN, 2 J-D LIN Division of Endocrinology and Metabolism, Department of Internal Medicine, Shuang Ho Hospital, 2Wan Fang Hospital, Taipei Medical University; 1Cardinal Tien Hospital, Xindian; Medical School, Catholic Fu Jen University Backgrounds: Insulin resistance (IR) is a major pathophsiology of type 2 diabetes and related to cardiovascular disease. We tried to develop predictive equations, derived from components of metabolic syndrome (MetS) and oral glucose tolerance test (OGTT), for quantifying IR in subjects with different glucose tolerance. Methods: There were 347 subjects enrolled. An OGTT were done and they were divided to normal glucose tolerance (NGT) and abnormal glucose tolerance (AGT) according to the results. On separated day, insulin suppression test (IST) was performed. By using multiple linear regression, components of MetS, insulin and glucose concentrations during OGTT were used as independent variable and steady state plasma glucose (SSPG) was used as dependent variable. Several models were built. Model 1: components of metabolic syndrome; Model 2: plasma glucose and insulin concentrations at 0 and 120 minutes during OGTT; Model 3: all plasma glucose and insulin concentrations in OGTT; Model 4: Model 1 + Model 3. Predictive equations were developed from each model. Moreover, the combination of forward and backward method in multiple regression was used for getting another equations with fewest variables and high relation. Then, by using these equations, the predicted SSPG (p-SSPG) were obtained. All p-SSPG were compared wi t hSSPGbyPe a r s on’ sc or r e l a t i on. Results: p-SSPG in NGT and AGT groups were highly correlated to SSPG in each model (Model 1: r=0.42, 0.55; Model 2: r=0.5, 0.67; Model 3: r=0.56, 0.7; Model 4: r=0.694, 0.768 respectively; all p<0.001). On the other hand, p-SSPG from predictive equations with fewest variables were still highly related to SSPG in both groups (r=0.633, 0.695; p<0.001 respectively). Conclusions: Components of MetS, plasma glucose and insulin concentrations obtaining from OGTT can predict SSPG precisely in both NGT and AGT groups with the r values around 0.7. The predictive equations may be applied in large-scale screen and epidemiologic study. － 204 －

DP22-10 METABOLIC SYNDROME EXACERBATING ANKLE-BRACHIAL INDEX IN TAIWANESE WITH TYPE 2 DIABETES I-T LEE, W-HH SHEU, S-Y LIN, 1W-J LEE Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.; 1Department of Medical Education and Research, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C. Background: Metabolic syndrome is associated with atherosclerosis, which is also one of the chronic complications of Type 2 diabetes. The relationship between metabolic syndrome and macrovascular disease partially resulted from high prevalence of MS in diabetic population. Increase risks of both myocardial infarction and stroke by metabolic syndrome has been demonstrated in the subjects either with or without Type 2 diabetes, but the effects of metabolic syndrome on peripheral artery disease is not established between subjects with and without diabetes, especially in Asian. Methods: Subjects with type 2 diabetes or without diabetes were enrolled in this cross-sectional study. The components of metabolic syndrome, lipid profiles and ankle brachial-index (ABI) were assessed in the study. All study subjects were divided into with or without MS. Results: A total 441 participants enrolled in the study, and the ABI was significantly higher in subjects without metabolic syndrome than those with metabolic syndrome (1.12 + 0.01 vs. 1.09 + 0.01, P = 0.015). For dissecting the effect of diabetes, all subjects in these two groups were further categorized according to either non-diabetes or diabetes. ABI was highest in subjects with neither metabolic syndrome nor diabetes, and lowest in those with both metabolic syndrome and diabetes (P value for trend less than 0.001). Metabolic syndrome is also an independent risk factor for low ABI in subjects with diabetes after adjustment for confounding factors (P = 0.018). Conclusion: Metabolic syndrome associated with lower ABI, especially in subjects with Type 2 diabetes.

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DP22-11 DETERMINATION OF THE CUT-POINT FOR DIAGNOSIS OF HYPERALPHALIPOPROTEINEMIA 1

Y-H LIAO, 1C-J CHANG, 2Y-C LIN, 3S-C JHOU, 1T-I LEE, 1J-D LIN, 1C FAN, 1 W-H LEW 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, 2 Department of Family Medicine, 3Department of Occupational Medicine, Taipei Medical University-Wan Fang Hospital, Taiwan, R.O.C. Background: Low serum level of high-density-lipoprotein cholesterol (HDL-C) is a well known risk factor of astherosclerotic cardiovascular disease. However the clinical relevance of very high level HDL-C (hyperalphalipoproteinemia) has not been well clarified. The first step to understand this condition is to define the level above which hyperalphalipoproteinemia can be diagnosed. Materials and methods: 3128 persons of the northern Taiwan branches of a single company attended physical check up at Wang-Fang hospital in 2006/10 to 2006/11. They received thorough physical examination, history taking and laboratory tests. The 3128 persons included both white collar and blue collar workers. 66.4 % were male. We excluded those subjects with age younger than 18-year-old or older than 50-year-old, subjects having a history of hypertension, liver disease, malignancy, diabetes mellitus, dyslipidemia, seizure, autoimmune disease, thyroid disease or post oophorectomy. Subjects with a history of hypertension were excluded because they might be taking any anti-hypertensive drug that might affect the serum lipid profile. Subjects with a habit of alcohol drinking were also excluded. We also exclude, from the database, subjects having a serum Cr greater or equal to 1.5 mg/dl, GOT or GPT greater or equal to 2 times of upper normal limit, fasting blood glucose greater or equal to 126 mg/dl, abnormal ALP or GGT level, albumin level lower than 3 g/dl, a BMI greater or equal to 27 kg/m2 or lower than 18 kg/m2, positive HBsAg or anti-HCV, a urine protein greater or equal to 1+, CRP level greater or equal to 0.5mg/dl, abnormal tumor markers (AFP, CA-125, CA-153, CA-199, PSA, CEA, beta HCG). HDL-C level was determined in the serum drawn after at least fasting for 8 hours. The laboratory uses Beckman Coulter UniCel DxC-800 Synchron Clinical System. It takes a direct method without any pre-treatment or ultracentrifugation, and applies a detergent to expose the cholesterol contained in HDL to react with the cholesterol esterase and oxidase for a color product in the presence of chromogens. The same detergent and a polyanion － 206 －

work to select the HDL for the reaction by adsorbing and complexing the VLDL, LDL and chylomicrons. Timed-endpoint method is used to measure the cholesterol concentration by change in absorbance at 560 nanometers, with a working range of 5-135mg/dl.. . Results: Of the 3128 physical check-up attendees, 2330 subjects were excluded by the study criteria mentioned above (1106 subjects were excluded by age older than 50-year-old). HDL-C level of 798 subjects (497 male, 301 female) were analyzed. The distribution of HDL-C is right-skewed for both male and female subjects. For male subjects, the mean is 47.5 mg/dl, median 46 mg/dl and mode 44 mg/dl. For female subjects, the mean is 59.95 mg/dl, median 58 mg/dl and mode 51mg/dl. The 90th percentile level of HDL-C is 63.4 mg/dl for male subjects and 78 mg/dl for female subjects. Conclusion: The distribution of HDL-C in normal adults is right skewed. We propose that 63.4 mg/dl be the cut-point above which a male subject is to be diagnosed hyperalphalipoproteinemia and 78 mg/dl for a female subject, if the 90th percentile level is to be used as the criteria.

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DP22-12 DEVELOPMENT OF A NEW MEASURE TO PREDICT THE ACCEPTANCE OF INITIATING INSULIN TREATMENT IN TYPE 2 DIABETIC PATIENTS 1

SHI-YU CHEN, 2PEI-JU LEE, 2YI-JEN HUNG, 2HUI-CHUN HSU, 2 SU-YIN FANG, 2CHIEN-HSING CHIANG, 2JI-MEI LEE, 3SHYI-JANG SHIN, 2 YAU-JIUNN LEE 1 Tri-Service General Hospital, Taipei, Taiwan 2 Le e ’ sEnd o c r i nol og i cCl i ni c ,Pi ng t ung , Ta i wa n 3 Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan Development of a New Measure to Predict the Acceptance of Initiating Insulin Treatment in Type 2 Diabetic Patients. Objective: Psychological resistance for insulin was reported to interfere with the acceptance of insulin injection, and lead to delay the beginning of insulin treatment in type 2 diabetic patients. Therefore, this study was designed to develop a simple approach to determine the barriers for insulin therapy among type 2 diabetic patients. Research Design And Methods: A questionnaire was designed for finding the barriers and evaluating the acceptance of insulin therapy in type 2 diabetic patients. After principal components analysis and cross-sectional study, it was reduced to 13 questions in 3 dimensions with insulin cognition, attitude, and behavior. According the correctness of the answers, we converted all the answers into scores and thus analyzed by logistic regression of each group. And the questions with better odds ratio (OR) were composed into a model and evaluated by ROC curve for accuracy. The database was analyzed by the SPSS. Results: There were 500 type 2 diabetic patients who had never received insulin therapy were recruited from a medical center (n=250) and a community clinic (n=250) in Taiwan. Their genders were almost equally distributed, but their ages were concentrated in 40-64 and above 65. There were 61.0% of subjects would accept insulin therapy, if they had worse blood glucose (BG) controlling. After analyzing by the logistic regression of each dimension, 5 questions, K1 (Insulin is an effective medicine for BG controlling), K2 (Insulin injection would cause malfunction and dialysis of kidneys), A8 (Because of my poor memory, I could not perform the complex insulin injection procedures), A10 (Insulin injection is inconvenient and time and energy consuming) and P12 (I worry that insulin treatment would increase my family's load), had better OR values and were combined into a － 208 －

prediction model. The reliability of this questionnaire and the assumptive model is 70.3% and 72.8% respectively. This model is evaluated by ROC curve with 0.781 of accuracy, 0.661 of sensitivity, and 0.789 of specificity. Conclusions: In this study, we conclude a simple prediction tool, which is a 5-questions approach, to test the acceptance of insulin therapy in type 2 DM patients. If the healthcare professionals can easily determine the acceptance barriers by a simple and quick measurement tool, DM patients can be treated properly and thus receive better outcome.

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DP22-13 APPLICATION OF TELECARE SYSTEM SERVICE IN THE DIABETES CARE 1

SHI-YU CHEN, 1SU-CHIUNG LIN, 1CHANG-HSUN HSIEH, 1YI-JEN HUNG 1 Metabolic Syndrome Center, Tri-Service General Hospital, Taipei, Taiwan Objective: Self-Monitoring of Blood Glucose (SMBG) for diabetic patient has been carried out for many years and has very good effects on cooperative patients. But some older or busy-life patients might forget to measure or to write the glucose values on their recording books, and thus may need some other vigorous services from diabetes center. Telecare might help diabetes educators and patients have bi-directional communications and extra health educations. In this study, we evaluate the combinative effect of telecare and SMBG in diabetes care. Research Design And Methods: Physicians recruited proper outpatients for this telecare trial program. Diabetes educators must teach patients or families to use blood glucose meter and telecare system platform. After registration, diabetes educators followedup, monitored and analyzed patients uploaded measuring data, and arranged outpatient returning. Patients received calls periodically and obtained proper and prompt education from diabetes educators were the most important action for enhancing interactions between patients and health care professionals. Blood biochemistry was tested every 3 months, final satisfaction questionnaire was filled and all the collected information was analyzed by EXCEL. Results: A total of 60 diabetic patients, 25 males and 35 females with median age at 57 (interquartile range 43-65), were enrolled in this study. There were 45 (75%) type 2 diabetic patients and 15 (25%) type 1 diabetic patients. Among them, 5 insulin pump users and 34 insulin injection patients, including 15 beginners, need intensive care and blood glucose monitoring. In general, patients had good HbA1c responds and satisfied with this telecare service after 6 months. HbA1c level was dropped from baseline 9.31  1.96% (mean standard deviation) to 8.38 1.24% (p=0.002) and to 8.51 1.30% (p=0.006) at each 3-month follow-up. According to the analyzed results of satisfaction questionnaire, most patients agree diabetes educators played important role in this telecare service system by phone calls. Conclusions: From our study data, mean value of HbA1c has decreased significantly and good feedback of satisfaction questionnaires has confirmed the excellent utility of telecare service. We therefore suggest that telecare system helps the overall glycemic control of diabetic patients and educators by continuous SMBG, bidirectional communication, and outpatient returning on schedule. － 210 －

DP22-14 EFFECT ON HbA1c WITH GLUCOMET AFTER SWITCHING FROM THE SAME DOSE OF GLYBURIDE CO-ADMINISTERED WITH METFORMIN- AN OBSERVATIONAL STUDY FROM A REGIONAL TEACHING HOSPITAL C-L TSAI, W-C HSU, 1W-S LIN Division of Endocrinology and Metabolism, Department of Internal medicine,1Department of Nurs i ng , Tung s ’ Ta i c hungMe t r oHa r borHos pi t a l , Ta i wa n Background: Poor drug compliance is one of the leading problems encountered in managing T2DM. Combination therapy of sulfonylurea and metformin for T2DM were up to 60-80%. It seems using of fixed dose combination (Glucomet) can improve compliance. The effect on HbA1c with Glucomet after switching from the same dose of glyburide co-administered with metformin would be evaluated. Methods: A total of 32 subjects with glyburide and metformin therapy but without insulin were included. The regimen of glyburide and metformin were switched to the same dose and same frequency of fixed dose combination (Glucomet). Other oral anti-diabetic agents were kept as usual. Their baseline characteristics, Hba1c level before and 3 months after the switching were analyzed. Results: Their age were 59±11 years. 27 patients (84.4%) were in the group of glyburide 10mg and metformin 1000mg twice daily. The HbA1c was changed from 9.2±1.5 % to 8.7±1.5 %(p=0.004). 20 patients (62.5%) had less HbA1c after switching, while 9(28.1%) had worse HbA1c. Discussion/Conclusion: Polypharmacy is a big problem in managing T2DM, especially for elder patients. To simply the regimen could improve compliance and possibly outcome. The glyburide contained in glyburide/metformin tablets (Glucomet) has a unique pharmacokinetic profile. The smaller glyburide particles dissolve quicker and are absorbed rapidly, while larger particles take more time to dissolve and are absorbed more slowly. Our short term study supports the benefit of Glucomet. But not every patient can tolerate and respond well to fixed dose combination of glyburide/metformin. Some studies have concerned the safety of glyburide. Both the limitation and long term benefit of Glucomet should be evaluated in large studies.

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DP22-15 SURVEILLANCE OF DETEMIR USE AT OPD IN BUDDHIST DALIN TZU CHI GENERAL HOSPITAL B-F CHEN, 1P-F CHEN Department of Pharmacy, Buddhist Da Lin Tzu Chi General Hospital, Taiwan, R.O.C; 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Buddhist Da Lin Tzu Chi General Hospital, Taiwan, R.O.C. Objective: Long-acting bed-time insulin is convenient for type 2 diabetic patients with 2nd failure to start insulin injection. The frequency of Detemir ( Levemir® ) injection is once daily and could be at any time of the day. Discrepancy of injection time, in the morning or in the evening/ bed-time, existed in our hospital. This study is to evaluate the real practice and effect of Levemir® at OPD in a local teaching hospital. Materials and Methods: Retrospective data were reviewed from Jan 1, 2008 to Sep 30, 2008 and there were 208 patients who received 2 kinds of oral anti-diabetic drugs and Levemir® once daily. These patients were divided into two groups. Group A enrolls 124 patients using Levemir® in the morning and Group B has 84 patients using Levemir® in the evening or bed-time. After excluding patents with Levemir® use less than 3 months and not having HbA1c before or after Levemir® use. As a result, only 33 patients in Group A and 32 patients in Group B fit with above criteria for analyses. There were 3 patients in Group A and 2 patients in Group B did not record Glu-AC before or after using Levemir®. Results: The Age, duration, body weight, daily dose per kilogram (IU/kg) were no significant difference between Group A and Group B respectively (61±12 vs 59±11 year-old, 5.1±2.1 vs 5.8±2.5 months, 63.7±14.5 vs 67.0±13.0kg and 0.34±0.2 vs 0.3±0.2 IU/kg). Initial HbA1C was 9.0±2.0% and 9.0±1.9% in Group A and Group B with no significant difference (p=0.894). Initial fasting glucose level was 173.3±70.9 and 157.3±53.6 mg/dl (p=0.907). Than we compared the effects of Levemir® use in both groups. HbA1C and fasting glucose level significantly decreased 0.9±0.3% (p=0.002) and 34.2±15.7 mg/dl (p=0.037) in Group A , compared with 0.1±0.2% and 13.6±11.3 mg/dl in Group B. Conclusion: To start Levemir® injection at OPD in our hospital, the early withdraw rate is about 68.8 % and the average dose after 6-month titration is about 0.3-0.34 U/kg. Interestingly, At this dose level, Levemir® use in the morning seems more effect in HbA1C and fasting glucose level reduction. More patient data are needed to determine if Levemir or Lantus® used at this dose are preferred injection in the morning. － 212 －

DP22-16 BARRIERS TO ADHERENCE TO METFORMIN THERAPY IN TYPE 2 DIABETES MELLITUS Y-L LIANG, M-C LEE, 1S-H HSIAO, P-Y CHEN, H-C HUNG, H-Y OU, T-J WU Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan, R.O.C.; 1 Department of Pharmacy, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan, R.O.C. Background: Adherence to metformin therapy in patients with type 2 DM was reported to have an effect on glycemic control. Many patients are found with many residual metformin pills in our daily practice. In this study, we evaluate the barriers to adherence to metformin therapy in patients with type 2 DM and its effect on glycemic control. Methods: The study design is an observational study. Between January 2008 and Mar 2008, we consequently enrolled about 265 type 2 DM patients who were currently treated with metformin and could estimate the amount of pills taken in the recent one month at our outpatient clinic. Adherence was measured by the percentage of pills taken in the recent one month. Clinical data on the current visit were recorded for study. Clinical data including genders, age, body weight, duration of diabetes mellitus, glucose levels, HbA1c, concurrent medications, regimen of metformin, and both compliance and adverse effects of metformin were recorded. Results: Of the 265patients with metformin therapy were enrolled to the study, 250 patients were qualified for analysis. Thirty five patients were with poor adherence to metformin therapy. The poor adherence group is younger in age and shorter in DM duration. In poor adherence group, there is a higher HbA1c value and higher proportion with 2-combined therapy (26/35, 74.3%), tid regimen (18/35, 51%), and with GI upset (17/35, 49%). Conclusion: Poor adherence to metformin therapy is associated with worse glycemic control. Barriers to adherence to metformin therapy included TID regimen, adverse drug effect of GI upset, and forgetting to take medicine.

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DP22-17 CLINICALANALYSIS OF HEPATOCELLULAR CARCINOMA COMPLICATED WITH HYPOGLYCEMIA AT A SOUTHERN TAIWAN MEDICAL CENTER H-Y TSAI, C-M WU, H-J CHENG, S-J TSAI, H-K TSAI, C-C SUN, C-H CHU, C-C LU, J-K LEE, H-C LAM Division of Endocrinology and Metabolism, Department of Medicine, Veterans General Hospital-Kaohsiung, Taiwan, R.O.C. Hepatocellular carcinoma (HCC) complicated with hypoglycemia was one of the paraneoplastic syndrome. According to the western report, primary hepatocellular carcinoma combined with hypoglycemic syndrome is around 10 to 30 percent. The aim of the present study was to compare the clinical characteristics of patients suffering from hepatocellular carcinoma with a low plasma glucose level (< 54 mg/dl) with that of patients having a plasma glucose level ≧ 54 mg/dl. Patients admitted to a medical center in southern Taiwan from January 1990 to August 2007 were reviewed and analyzed.

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DP22-18 THE EFFECT OF PIOGLITAZONE ON METABOLIC CONTROL AND COMPLETE CELL COUNT IN DIABETIC PATIENTS WITH DIFFERENT ALBUMINURIA STAGE Y-H CHANG, K-D LIN, M-Y LEE, M-C HSEIH, P-J HSIAO, S-J SHIN Division of Endocrinology and Metabolism, Kaohsiung Medical University Objective: pioglitazone has been largely used in treating type 2 diabetic patients to improve blood glucose control. However, the comparison of pioglitazone effect in three different albuminuric groups is lacking. Our aim is to evaluate the pioglitazone effect in glucose control, lipid profile, and inflammatory status and complete blood cell count in these three groups of different albuminuric stage. Methods: A total of 441 type 2 diabetic patients were selected from outpatients at KMUH and divided into three groups according to their albumin-to-creatinine ratio: patients with normoalbuminuria (n =153), patients with microalbuminuria (n =102), patients with macroalbuminuria (n = 50). Basic physical record and result of blood exam were collected when enrolled into this study and then pioglitazone was prescribed. Without alternation of other medications, second physical record and result of blood exam were collected after at least six-week usage of pioglitazone. Urine albumin concentration was assayed by RIA. Results: Although there were significant improvement in fasting plasma glucose, HbA1C, insulin resistance (HOMA-IR), hsCRP, high density lipoprotein cholesterol and triglycerides in these three groups after pioglitazone treatment, we found the microalbuminuric or macroalbuminuric group had better improvement in HbA1C, fasting plasma glucose, insulin resistance and degree of albuminuria when compared with normoalbuminuric group. After pioglitazone treatment, we found there were significant decrease in white blood cell count, hemoglobin, hematocrit, platelet and neutrophil count; on the contrary, mean corpuscular volume, lymphocyte count and monocyte count were increased. Conclusion: Our results indicated that pioglitazone was effective in improving glucose control, dyslipidemia and inflammatory status in type 2 diabetic patients. Patients with microalbuminuria or macroalbuminuria might benefit more. We also found significant change in complete cell count and this might hint other possible etiology to this result.

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DP22-19 KLEBSIELLA PNEUMONIAE BACTEREMIA IN DIABETIC PATIENTS --- EXPERIENCE FROM A MEDICAL CENTER IN NORTHERN TAIWAN S-S TSAI, C-C WANG, J-H SUN, S-Y HUANG, Y-Y HUANG Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taiwan, R.O.C. Background: Diabetes mellitus is one of major risk factors of Klebsiella pneumoniae bacteremia and Klebsiella pneumoniae bacteremia also carry significant morbidity and mortality for diabetic patients. This study is a retrospective review of diabetic patients with Klebsiella pneumoniae bacteremia in our hospital. Methods: During 2005 to 2006, one hundred and nineteen three diabetic patients with positive serum culture for Klebsiella pneumonia were enrolled. The clinical data were reviewed and student t- test was introduced for statistic analysis. Results: In 193 total cases, one hundred and forty seven (76.2%) persons with Klebsiella pneumoniae bacteremia is defined by community-acquired. The rest patients (23.8%) had Klebsiella pneumoniae bacteremia by nosocomial infections. Subjects with nosocomial Klebsiella Pneumoniae bacteremia have higher chance of hepatobiliary structural abnormality (66.7% VS. 50.9%) and malignancy (50.0% VS. 19.0%) when compared to that of community-acquired. Nosocomial Klebsiella Pneumoniae bacteremia also carry longer hospital stay days (48.9 VS. 22.6 days), severer drugs-resistance (45.7% VS. 4.1%) and higher mortality (41.3% VS. 18.4%). Those diabetic patients with nosocomial Klebsiella Pneumoniae bacteremia has lower HbA1C level (8.1% VS. 9.5%, p=0.009) than that of community-acquired. Twenty percent of community-acquired and 15% of nosocomial cases were found to have new diagnosed diabetes. Among 147 patients with community-acquired Klebsiella Pneumoniae bacteremia, pneumonia is the major infectious site for mortality (11of 22 cases). The initial presentation of leukopenia(white count<3500) and elevated creatinine (>1.4mg/dL) predicts higher mortality rate (37.5% and 26.8%, respectively). Conclusion: We found significant difference Between diabetic patients with Community-Acquired and Nosocomial Klebsiella Pneumoniae bacteremia. Factors indicating poor prognosis in community-acquired Klebsiella Pneumoniae bacteremia include pneumonia as associated infection, leukopenia, and elevated creatinine as initial presentation. － 216 －

DP22-20 LUNAR NEW YEAR PERIOD HAS NO EFFECT ON GLYCEMIC CONTROL IN PATIENTS WITH TYPE 1 DIABETES MELLITUS 1

MING-YAN TSAI, 2YI-LIN LIANG, 2HORNG-YIH OU, 2HAO-CHANG HUNG, 2 SHU-HWA HSIAO, 2PEI-YIN CHEN, 2TA-JEN WU National Cheng Kung University Medical College and Hospital, Tainan, Taiwan, 1Nursing Department 2Division of Endocrinology and Metabolism, Department of Internal Medicine, 3 Department of Pharmacy Background: Many high calories diets are offered during Lunar New Year Holiday Period in the societies with Chinese culture. Although the detrimental effect of this Holiday on glycemic control was reported in patients with type 2 diabetes mellitus, the effect in patients with type 1 diabetes mellitus is rarely reported. Study design: Retrospective observational cohort study. Methods: The Lunar New Year Holiday Period was from January to February in 2008 in this study. Using the data between Jen 2008 till Feb 2008 as baseline, we also recorded the data 2 months before and the data 2months and 4 months later. The patients with type 1 diabetes mellitus who were regularly treated with insulin at the clinic were evaluated. Results: Totally, 48 patients with type 1 diabetes mellitus were enrolled to the study. The mean HbA1c were 8.38 2.31 (n=46) 2 months before Holiday period, 8.49 1.89 (n=48) during Lunar New Year Holiday Period, 8.36 1.82 (n=45) at 2 months later, and 8.281.82 (n= 46) 4 months later respectively. The mean fasting plasma glucose were 17178 (n=44), 18587 (n=46), 168108 (n=40), and 17583(n=43) respectively. No significant changes in HbA1c and fasting plasma glucose during the observation were noted. Conclusion: Although Lunar New Year Period has a detrimental effect on glycemic control in patients with type 2 diabetes mellitus, no significant changes in HbA1c and fasting plasma glucose occurred in patients with type 1 diabetes mellitus after the Lunar New Year Period in Southern Taiwan.

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DP22-21 ASYMPTOMATIC PYURIA IN FEMALE PATIENTS WITH TYPE 2 DIABETES MELLITUS 1

P-Y CHEN, 2S-H HSIAO, 1Y-L LIANG, 1H-C HUNG, 1H-Y OU, 1T-J WU 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, and 2 Department of Pharmacy, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan Background: Asymptomatic pyuria is a common disorder in female patients with diabetes mellitus. The relationship between pyuria and glycemic control is rarely reported. Study design: case control cohort study Methods: We enrolled 112 female patients with a new episode of asymptomatic pyuria from a population of type 2 diabetes mellitus at the endocrine clinic and 112 female patients without pyuria as control group. We compared the glycemic control between 2 groups. Results: The mean HbA1c and fasting plasma glucose levels of female patients with a new episode of asymptomatic pyuria significantly increased to 8.62 1.92% (p<0.05) and 176 66 mg/dl (p<0.05) respectively from the values of 8.30 1.79% and 162 60 mg/dl at 2 month earlier when they were without pyuria. Conclusion: The pyuria in women with type 2 diabetes mellitus are associated with worsening of glycemic control. Routine urinalysis at each clinic visit is recommended

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DP22-22 A SURVEY OF IMPAIRED-FASTING GLUCOSE, IMPAIRED GLUCOSE TOLERANCE AND DIABETES IN ELDERLY 1

CHIH-KUAN LIN, 2YI-SUN YANG, 2CHIEN-NING HUANG 1 Division of Nephrology, 2Division of Endocrinology & Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan Objective: This is a hospital-based study of a survey of impaired fating glucose, impaired glucose tolerance, and diabetes in the elderly. Methods: Subjects aged more than 65 years were recruited from outpatient clinic for this survey. Body height, body weight, waist circumference, boy mass index (BMI), and blood pressure were recorded. A blood sample was obtained after 8 hours of fasting, checked for fasting plasma glucose (FPG), triglyceride (TG), total cholesterol (T-chol), high-density cholesterol (HDL-C), and low-density cholesterol (LDL-C), and uric acid. For the subjects with impaired fasting glucose (IFG), FPG 100-125 mg/dl, were asked for a 75 g oral glucose tolerance test for the diagnoses of impaired glucose tolerance (IGT and diabetes mellitus (DM). Results: Of the 300 subjects, 145 (48%) were IFG. There were no differenced between male and female. Of the 145 IFG subjects, 97 did the 75 g OGTT, and 63 (59%) had IGT, 15 (15%) had DM. (table 1). The correlation test revealed positive for age, and the components of metabolic syndrome except HDL-C (BMI, waist circumference, TG, and blood pressure). In addition, was correlated to uric acid level. Conclusions: Forty-six percent have IFG in this survey. About 50% of IFG also have IGT and 15% have diabetes mellitus. Besides of the components of metabolic syndrome, elevated plasma creatinine and uric acid level were found to be associated with IFG. As we know, only fasting plasma glucose was not good enough for diabetes, especially those with mild elevated plasma creatinine in the elderly.

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DP22-23 THE CLINICAL FEATURES OF TYPE 2 DIABETIC PATIENTS WITH DIABETIC DERMOPATHY H-W KUO, P-J HSIAO, M-C HSIEH, K-D LIN, Y-H CHANG, M-Y LEE, C-L WANG, Y-J LAI, S-J SHIN Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Background: Diabetic dermopathy (DD) is very common cutaneous manifestation of diabetic patients. Its clinical features have been demonstrated in several studies. In the present study, we aimed to investigate the association of DD with metabolic control and vascular complications in Taiwanese type 2 diabetic patients. Methods: The study enrolled 721 Taiwanese type 2 diabetic patients with mean age of 62.5 years at Outpatient department of KMUH. DD was defined as more than 4 pigmented areas on bilateral lower legs. The association of DD with glycemic, lipid, hs-CRP, eGFR, ACR, and demographic data was analyzed. Results: Prevalence of DD is 7% (53 cases) in this study. These DD patients showed higher fasting blood glucose, HbA1c, higher frequency of urine albuminuria/creatinine ratio, retinopathy and hs-CRP levels, but showed no difference in the lipid profile and ankle-brachial index as compared to patients without DD. Higher frequency of smoking and insulin administration was also found in DD patients. Conclusion: DD diabetic patients showed poorly glycemic control, higher frequency of microvascuar complications, but no difference in lipid control and peripheral vascular disease in Southern Taiwan.

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DP22-24 SELF-REPORTED DIABETES FAMILY HISTORY IS ASSOCIATED WITH WORSE METABOLIC PROFILES IN SCHIZOPHRENIA AND THE INTERACTIONS WITH ANTI-PSYCHOTICS BY CHEN, 1CL CHEN, 1, 2WS YANG Department of Psychiatry, Taipei Municipal Hospital, Sung-The Region; 1Graduate of Clinical Medicine, College of Medicine, National Taiwan University; 2Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Objective: Obesity and diabetes mellitus are common side effects during antipsychotics treatment. Family history was demonstrated as an important risk factor for metabolic diseases in general population. However, whether family history us also important for antipsychotics related metabolic disease is still an unresolved question. Subjects and Methods: Volunteer schizophrenic patients were recruited during a disease screening activity, sponsored by Taipei Public Health Bureau. Schizophrenic who live in community and half-way houses were invited. Personal interview for clinical information were performed. All patients received anthropometric measurements and fasting blood sampling to evaluate metabolic disease status. Results: Totally 307 patients were included in this study. Our analysis revealed prevalence in these patients were 60% for overweight, 30% for obese, 33.01% for metabolic syndrome, 33.66% for hypertension, 10.46% for diabetes mellitus and 9.48% in hypercholesterolemia. Most of these prevalence rates were higher than general population. Males tend to have hypertension. Females were found to have more diabetes and central obesity. The metabolic effects among different antipsychotics were not apparent. Family history of DM increased the risk to 2.35 in overweight, 2.01 in obesity, 2.07 in central obesity and 3.31 in DM. In addition, family history of DM increased body mass index by 2.11kg/m2. The other metabolic disease family histories did not show significant correlation with the metabolic outcomes in schizophrenic patients receiving antipsychotics. In subjects with DM family, the use of antipsychotics is more prominently associated with central obesity without obvious pattern among different anti-psychotics. IN those without DM family history, typical and second-generation antipsychotics were associated with more prominent risk for central obesity. Conclusion: Family history of DM could be a predictor for overweight, obesity, central obesity and DM in patient taking antipsychotics. Also, our study found interaction between antipsychotics and family history of DM. The prevalence of metabolic diseases for schizophrenic patients in community was higher than the general population. － 221 －

DP22-25 THE EFFECT OF FIXED-DOSE ROSIGLITAZONE/ METFORMIN COMBINATION THERAPY ON PLASMA VISFATIN LEVELS IN PATIENTS WITH DRUG NA Ï VE TYPE 2 DIABETES MELLITUS 1

YI-SUN YANG, 1CHIEN-NING HUANG, 2SHIH-TING TSENG 1 Division of Endocrinology & Metabolism, Department of Internal Medicine, Chung Shan Medical University Hospital; 2Division of Endocrinology and Metabolism, Department of Internal Medicine, Kuang Tien General Hospital, Shalu, Taichung, Taiwan Objective: Plasma visfatin was found to be elevated in type 2 diabetic patients. However, its importance is not clear yet. There are limited and conflicting reports regarding the effect of hypoglycemic treatment on visfatin levels. It is still remains unclear whether the glycemic control may have effect on visfatin level or not. We evaluated the effects on plasma visfatin concentrations in patients with drug-naive type 2 diabetic patients, by using a fixed-dose Rosiglitazone/Metformin combination therapy. Methods: Sixty eight patients with type 2 diabetes mellitus (T2DM) were recruited from the outpatient clinic. The patients received Avandamet (4/1000 mg/day or 8/1500 mg/day), and for the group of 4/1000 mg/day could be up-titrated to 8/1500 mg/day according to target of glycemic control. Demographic and clinical characteristics were recorded during the follow-up period of 24 weeks. Plasma visfatin was obtained at baseline, 12 and 24 weeks. Results: Thirty-five (51.0%) patients were given 4/1000 mg/day initially and 14 (40%) of them had up-titrated, and 33 (48%) patients were given 8/1500 mg/day initially. After 6 months of treatment, the HbA1c levels reduced from 7.9% to 6.7% (p < 0.05) in the 4/1000 mg/day group, and from 10.0% to 6.9% in the 8/1500 mg/day group (p < 0.05). The plasma visfatin level was decreased significantly in the group given 8/1500 mg/day initially after 24 weeks (baseline mean 23.4, 24 weeks 15.7, mean difference 13.2, p < 0.01) Conclusion: We evaluated the effects on plasma visfatin concentrations in patients with newly diagnosed and previously untreated T2DM, by using a fixed-dose Rosiglitazone/ Metformin combination therapy, two different insulin sensitizers. The glycemic control was similar in the 4/1000 mg/day and 8/1500 mg/day. However, the visfatin was only significantly decreased in the 8/1500 mg/day group. A possible explanation is an improvement in insulin sensitivity may modulates circulating visfatin levels.

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DP22-26 PREVALENCE OF ANEMIA AND CLINICAL FEATURES OF PATIENTS WITH DIABETIC KIDNEY DISEASE 1

TERRY TING-YU CHIOU, 1CHIEN-TE LEE, RUE-TSUAN LIU Devision of Metabolism,1Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Chang Gung University College of Medicine, Taiwan Introduction and Aims: Anemia appears early in the course of diabetic chronic kidney disease (CKD). There is little data about the prevalence of anemia in diabetic Taiwanese population. The aim of this study is to assess the prevalence of anemia, by stage of CKD, at our medical center in southern Taiwan and determine factors contributing to anemia. Methods: We s c r e e ne d pa t i e nt swho we r er e g ul a r l yf ol l owe di n ourhos pi t a l ’ s Endocrinology outpatient clinic between May 1, 2008 and November 30, 2008. All patients were over age 18 years old, diagnosed with Type II diabetes and had complete blood count (CBC), serum creatinine, and urinary albumin-to-creatinine ratio during the 6-month period. Exclusion criteria included clinical history of recent blood loss, current history of malignancy (within 5 years), abnormal white blood cell count and MCV on CBC. We define anemia as hemoglobin level below 12 mg/dl. Results: In the 877 diabetic patients we enrolled, 23.7% had anemia. Their mean age was 62 years old, duration of diabetes 9.9 years, hemoglobin 13.3mg/dl, estimated glomerular filtration rate (eGFR) 55.65ml/min, hemoglobin A1C 7.4%. The prevalence of anemia increased with increasing CKD stage (I and II: 9.7%, III 29.2%, IV 66.7%, V 90.0%). Hemoglobin level is correlated positively with eGFR (r=0.482, p<0.001), and negatively with age (r=-0.268, p<0.001), urinary albumin-to-creatinine ratio (r=-0.135, p<0.001), hs-CRP (r=-0.087, p=0.022), and duration of diabetes (r=-0.168, p<0.001). Multivariate analysis indicated that eGFR, hs-CRP, and waist circumference were the significant factors contributing to hemoglobin levels. Conclusions: This study demonstrates that anemia occurs commonly in Taiwanese diabetic patients, and its prevalence increases with progressive CKD stages. Screening for anemia in diabetic patients should be advised. Keywords: Anemia, Diabetes, Chronic kidney disease

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DP22-27 INSULIN TREATMENT SATISFACTION AMONG PATIENT WITH TYPE 2 DIABETES 1

HUI-CHUN HSU, 1PEI-JU LEE, 2SHI-YU CHEN, 2YI-JEN HUNG, 1KUN-CHENG LIN, 1 SU-YIN FANG, 1YU-CHIEN LIN, 1YEN-CHUN LIN, 1CHIEN-HSING CHIANG, 1 JI-MEI LEE, 3SHYI-JANG SHIN, 1YAU-JIUNN LEE 1 Lee's Endocrinologic Clinic; 2Division of Endocrinology and Metabolism, Dep. of Internal Medicine, Tri-service General Hospital; 3Division of Endocrinology and Metabolism, Dep. of Internal Medicine, Kaohsiung Medical University Introduction: Insulin is the most reliable and powerful regimen in treatment of diabetes mellitus. While, daily insulin treatment has been viewed as burdensome to patient, for many patients with type 2 diabetes, insulin therapy is associated with numerous negative connotations. Tr e a t me nts a t i s f a c t i oni sar e c i pi e nt ’ sr a t i ngoft hes a l i e nta s pe c t sof the process and results of the treatment. Purpose: The purpose of study is to investigate treatment satisfaction and its relation to metabolic control in type 2 diabetes received insulin treatment for at least 3 months. Methods: The Insulin Treatment Satisfaction Questionnaire (ITSQ) was developed by Anderson, RT, and the Taiwan Chinese version questionnaire was authorized by Mapi Research Trust. Analysis: Analysis was conducted by SPSS for Window 10.0 version. Result: Fifty-eight patients with type 2 diabetes who receiving insulin injection in a diabetic clinic for at least 3 months were studied. There are 26 (44.8%) subjects were male, mean age is 58.810.4 years, duration of diabetes is 11.77.4 years, and the mean of current HbA1C is 8.8±1.4%. The reliability of the ITSQ internal consistency (using Cronbach coefficient) of the subscales ranged from 0.84~0.91, the Cognition questionnaire reliability is 0.78, the Ability questionnaire reliability is 0.82, and the Psychometric questionnaire reliability is 0.90. The ITSQ were significantly correlated with Cognition (r=-.263, p=.046), Ability (r=.572, p<.001), Psychometric (r=.75, p<.001), and educational level (r=-.26, p=.049). Patients with regular insulin injection were observed to have higher ITSQ values that those patients who did not inject insulin on schedule. Conclusion: ITSQ scores showed moderate to high correlation with related measures of treatment burden and applicable to a wide range of insulin therapies.

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DP22-28 ASSOCIATION OF INSULIN-LIKE GROWTH FACTOR I WITH METABOLIC SYNDROME IN TAIWANESE ELDERLY Y-H YAN, S-C HUA, H-I YU, T-S TAI, C-H LU Division of Endocrinology and Metabolism, Department of Internal Medicine, Chia-Yi Christian Hospital, Chiayi, Taiwan. Background: The metabolic syndrome (MetS) is a cluster of cardiovascular risk factors which include central obesity, dyslipidemia, glucose intolerance and hypertension. These risk factors are common in patients with growth hormone (GH) deficiency, suggesting a role for the somatotropic axis in the development of MetS. Objective: To investigate the relationships linking serum levels of insulin-like growth factor I (IGF-I) to MetS in 1,023 elderly (Age 69.1± 8.7, 57.7% were men) in a crosssectional random sample in Taiwan (Social Environment and Biomarkers of Aging Study, SEBAS). Methods: Serum concentrations of lipids, glucose, and IGF-I were measured. Body height, weight and blood pressure were assessed. Smoking and alcohol consumption was estimated from self-report. The MetS was defined according to the National Cholesterol Education Program ATP III definition for Asians. Results: The prevalence of MetS was 40.9 %. IGF-I level was 104.9± 48.0 (ng/mL). Multiple logistic regression analyses showed no effect was found for IGF-I on MetS. Estimates were adjusted for age, gender, smoking, alcohol consumption, and body mass index. Conclusions: IGF-I level was not associated with MetS in Taiwanese elderly. Further studies are needed to investigate the relationship between the somatotropic axis and the MetS.

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DP22-29 LUNAR NEW YEAR PERIOD HAS AN EFFECT ON GLYCEMIC CONTROL IN PATIENTS WITH TYPE 2 DIABETES MELLITUS 1

H-Y OU, 1H-C HUNG, 2M-Y TSAI, 3S-H HSIAO, 1Y-L LIANG, 1P-Y CHEN, 1T-J WU 1 Division of Endocrinology and Metabolism, Department of Internal Medicine and 2 Nursing Department; 3Department of Pharmacy, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan Background: Many high calories diets are offered during Lunar New Year Period in the societies with Chinese culture. It was considered to have a detrimental effect on glycemic control in patients with diabetes mellitus. Study Design: Retrospective observational cohort study. Methods: The Lunar New Year Period was from January to February in 2008 in this study. Using the data between Jan 2008 till Feb 2008 as baseline, we recorded the data 2 months before and the data 2months and 4 months later. The patients with type 2 diabetes mellitus who were regularly treated with at least one hypoglycemic agent in the clinic were evaluated. Results: Totally, 326diabetic patients were enrolled to the study. The mean HbA1c increased from 8.10 1.31 (n=326)) during this period to 8.26 1.41 (n=326, p<0.001) at 2 months later, and 8.23 1.39 (n= 304) 4 months later. Conclusion: A highly significant increase in HbA1c occurred in patients with type 2 diabetes mellitus after the Lunar New Year Period in Southern Taiwan.

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DP22-30 THE DIPEPTIDYL PEPTIDASE-4 INHIBITOR SITAGLIPTIN IMPROVES BETA-CELL FUNCTION IN SUBJECTS WITH TYPE 2 DIABETES-AN INTERIM ANALYSIS SHENG-CHI SU Division of Endocrinology and Metabolism, Department of Internal Medicine, Antai Tian-Sheng Memorial Hospital, Taiwan, R.O.C Objective: To evaluate the effect of treatment with the dipeptidyl peptidase (DPP)-4 inhibitor sitagliptin on glycemic control, insulin sensitivity and beta-cell function in subjects with type 2 Diabetes Research Design And Methods: We conducted a retrospective study of 58 subjects with type 2 diabetes ( 21 female and 37 male, mean±SD age 55.0±12.3 years, DM duration 8.5±7.3 years, BW 71.9±14.9 kg) treated with oral anti-diabetic agent(s) and/or insulin were given with 50~100 mg sitagliptin once daily from 2008/09/09 to 2009/03/10. Data, i nc l udi ng t hes ubj e c t s ’ba s e l i nec ha r a c t e r i s t i c sa nd bi oc he mi c a ll a bor a t or y da t a ,we r e collected. Differences between before and after sitagliptin were compared by using SPSS 13.0 version statistic software (paired-samples T test). Results: 14 subjects were already collected two times data before and after taking sitagliptin (11 subjects take 100 mg, 3 subjects take 50 mg) at least one month (Duration 62.4±22.4 days) until 2008/12/25. Their body weight mildly increases (65.5±8.3 vs 66.1±8.9 kg, p=0.218). The glycemic control is mild improved (8.1±1.5 vs 7.6±1.3 %, p=0.034). The insulin resistance (HOMA-IR) mildly increases (4.8±6.2 vs 5.9±5.4, p=0.529) and beta-cell function mildly increases (51.5±34.2 vs 83.8±69.3, p=0.072). Conclusions: The DPP-4 inhibitor sitagliptin improves beta-cell function and glycemic control even though body weight gains or insulin resistance worsen.

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EP21-1 ECTOPIC PARATHYROID ADENOMA PRESENTED WITH RECURRENT KIDNEY STONE AND HYPERCALCEMIA M-T SUN, 1M-L SHIH, 2K-C SHIH Department of Internal Medicine, Hualien Armed Forces General Hospital, Taiwan, R.O.C.; 1 Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taiwan, R.O.C.; 2Division of Metabolism, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan, R.O.C. Ectopic parathyroid adenoma is challenging to diagnose and treat. We present two patients with ectopic parathyroid adenomas located in the thymus. Both patients had recurrent kidney stones and life threatening hypercalcemia. Their parathyroid adenomas were localized by pre-operative Tc-99m sestamibi scan and successfully resected by unilateral neck exploration. Primary hyperparathyroidism can be overlooked in patients with recurrent kidney stone or refractory cardiovascular diseases. Preoperative image studies, such as Tc-99m sestamibi scan, can localize ectopic parathyroid adenoma and facilitate a successful minimally invasive parathyroidectomy.

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EP21-2 SEVERE HYPONATREMIA AS THE PRESENTING FEATURE OF A PITUITARY ADENOMA Y-L LIN Division of Endocrinology and Metabolism, Department of Internal Medicine, Fong-Yuan Hospital, Department of Health executive Yuan, Taiwan, R.O.C Hyponatremia is one of the most common electrolyte imbalance during admission and can result from a wide range of causes. We report a case of pituitary adenoma presenting with acute gastroenteritis-like symptom and severe hyponatremia. A 48 y/o male presenting with nausea, vomiting and watery diarrhea for 5 days. Lab study reported severe hyponatremia (Na: 105 mmol/L) and the hormone studies displayed hypopituitarism (involving the thyroid, adrenal, and gonadal axis). MRI of the brain revealed a 2 cm macroadenoma within pituitary gland. Hyponatremia returned to 139 mmol/L after supportive treatment and cortisone/eltroxin supply. Non-functional pituitary adenoma complicated /c pan-hypopituitarism is a rare cause of hyponatremia and should be considered in the differential diagnosis of hyponatremia.

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EP21-3 HYPOKALEMIC PARALYSIS IN A YOUNG WOMAN WITH THYROTOXICOSIS AND PRIMARY HYPERALDOSTERONISM W-N TSAI, 1S-Y LIN, 1L-N TSENG, 1Y-M SONG, 1I-T LI, 1,2WAYNE H-H SHEU Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan, R.O.C.; 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan, R.O.C.; 2 Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan, R.O.C. Although thyrotoxicosic periodic paralysis (TPP) is the most common acquired form of periodic paralysis, particularly in young Asian males, some patients with primary hyperaldosteronism may exhibit episodic weakness. We describe a hyperthyroid 27-year-old woman with hypokalemic paralysis and an aldosterone-producing adenoma (APA). The patient had suffered form episodic muscle weakness and palpitation for two months before admission. On physical examination, the patient had a pulse rate of 101/min, blood pressure 163/111 mmHg, body mass index 22.3 kg/m2 and a diffuse enlarged thyroid gland. Neurological examination revealed decreased muscle strength in the proximal part of four limbs and diminished response of the deep tendon reflexes. Laboratory investigation indicated severe hypokalemia (1.7 mEg/l) and primary hyperthyroidism ( TSH <0.004 uIU/ml, free T4 = 48.7 pg/ml). The patient was initially treated with propranolol 20mg tid, Procil 100mg tid, and potassium chloride supplement. The thyroid function substantially improved (free T4 20.4 pg/ml and TSH 0.004 uIU/ml) after antithyroid treatment. However, persistent hypokalemia with proximal muscle weakness was noted. Further endocrinological examinations demonstrated that 24 hour urine potassium excretion was 102 mEq/day with a high transtubular potassium gradient (TTKG) of 8.63, indicating a profound urinary potassium loss. The plasma renin concentration was 1.7 pg/ml (reference range: 3 - 16 pg/ml) and plasma aldosteronism concentration was more than 1450 pg/ml (reference range: 10-160 pg/ml). Abdominal computerized tomography revealed a poor enhanced nodule about 32mm in size at left adrenal gland. The left adrenectomy was performed under the impression of APA. The pathology proved an adrenal cortical adenoma. Postoperatively, her serum potassium level returned to normal level with no recurrence of muscle weakness. It is suggested that other causes for hypokalemic paralysis in addition to TPP should be considered in thyrotoxic patients with muscle weakness, particularly in association with persistent hypokalemia, hypertension, and abnormal high potassium renal excretion. － 230 －

EP21-4 A CASE OF ALDOSTERONE-PRODUCING ADRENOCORTICAL ADENOMA ASSOCIATED WITH A PROBABLE POST-OPERATIVE ADRENAL GLUCOCORTICOID INSUFFICIENCY P-W CHANG, Y-M SONG, W. H-H SHEU Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan, R.O.C. We present a case of aldosterone-producing adrenocortical adenoma associated with a probable post-operative adrenal glucocorticoid insufficiency, possibly due to subtle autonomous cortisol secretion of the tumor. This 63-year-old woman has a history of diabetes mellitus and stage 2 hypertension in spite of the use of multiple anti-hypertensive agents. Clinically no cushingoid appearance was noted. The laboratory examinations revealed hypokalemia( serum potassium: 2.2 mEq/L ), elevated aldosterone level( plasma aldosterone : 551 pg/mL, reference normal range : standing 40-310 pg/mL ), suppressed renin level (plasma renin : 3.04 pg/mL , reference normal range: standing 3-33 pg/mL ) and normal morning cortisol and ACTH levels. The abdominal CT revealed a mass, 2.8 cm in diameter of right adrenal gland. Aldosterone-producing adrenocortical adenoma was diagnosed, and the patient received right adrenalectomy .The histopathological study proved to be adrenocortical adenoma with proliferation of zona glomerulosa cell. Two weeks after the adrenalectomy, the patient suffered from fatigue , weakness, poor appetite, and symptoms of hypoglycemia with a plasma glucose level of 27 mg/dL . Simultaneous plasma cortisol, ACTH and serum potassium levels were 7.9 μ g/dL ( reference normal range: AM 5-25μg/dL), 35.5 pg/mL(reference normal range : ND-46 pg/mL), and 5.5 mEq/L , respectively. The plasma renin concentration was 3.42 pg/mL, and aldosterone concentration was 71.2 pg/mL. After a short term replacement of glucocorticoid, the follow- up plasma cortisol and ACTH levels progressively rose to 12.7μg/dL and 104 pg/mL, respectively, 3 months after operation . According to above findings, it is hypothesized that the aldosterone-producing adrenocortical adenoma in our patient probably also had subtle autonomous cortisol secretion, which had suppressed the hypothalamo-pituitary-adrenal axis and caused the post-operative adrenal glucorcoticoid insufficiency.

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EP21-5 REVERSIBLE DILATED CARDIOMYOPATHY IN THYROTOXICOSIS-A CASE REPORT Y-L LU, S-Y LIN, W. H-H SHEU Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan, R.O.C. Thyrotoxicosis is known as a cause of high cardiac output heart failure. Low cardiac output heart failure is an uncommon manifestation of thyrotoxicosis in patients without heart disease. A full or partial recovery of myocardial dysfunction may be observed when an euthyroid state is achieved. We report a 48-year-ol dma nwi t hGr a ve s ’t hy r ot oxicosis and low cardiac output heart failure presenting with shortness of breath, palpitation, body weight loss, and heat intolerance. On physical examination, his body weight was 62 Kg and body height was 172 cm. Blood pressure was 110/80 mmHg, heart rate was 140 beats/min, and respiratory rate was 25/min. The thyroid gland was diffusely enlarged with the audible bruit. The skin was warm and moist. Results of thyroid function tests were as follows: thyroid stimulating hormone (TSH): <0.01 uIU/ml (Normal range: 0.4 - 4.0 uIU/ml); free thyroxine (free T4): 43.6 (Normal range: 7.0-19.0 pg/ml). Chest X-ray showed cardiomegaly and mild pulmonary edema. Echocardiography showed moderate mitral regurgitation, moderate tricuspid regurgitation, and chamber dilatation of left atrium, left ventricle, and right atrium. Left ventricular ejection fraction (LVEF) was 23%. Electrocardiography showed atrial fibrillation with rapid ventricular rate. Cardiac catheterization revealed no coronary artery disease. Endocardium biopsy showed hypertrophy of myocardium, mild fibrosis, and mild fatty infiltration. His condition was categorized as New York Heart Association (NYHA) functional class III. After successful treatment of the thyrotoxicosis (Free T4: 14.9 pg/ml; TSH: 2.00 uIU/ml), the cardiac function got partial improve. The follow-up echocardiography showed disappearance of mitral regurgitation and chamber dilatation. LVEF was 42%. His status was NYHA function class I. It is hypothesized the actions of the thyroid hormone may induce structural and functional changes of the heart and result in dilated cardiomyopathy, which is reversible with treatment for thyrotoxicosis.

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EP21-6 SEVERE HYPOCALCEMIA DUE TO HYPOPARATHYROIDISM AND HUNGRY BONE SYNDROME AFTER THYROIDECTOMY FOR THYROTOXICOSIS - A CASE REPORT J-S WANG, S-Y LIN, I-T LEE, L-N TSENG, Y-M SONG, H-H SHEU Division of Endocrinology and Metabolism, Taichung Veterans General Hospital It has been reported that rapidly reversal of thyrotoxicosis resulted in skeletal uptake of calcium which leads to hypocalcemia. This condition could exacerbate surgical hypoparathyroidism and resulted in profound hypocalcemia. We reported a 35 year old man wi t hGr a v e s ’d i s e a s ewh os u f f e r e df r o ms e v e r ehy p o c a l c e mi ai mme d i a t e l ya f t e rt hy r o i d e c t o my at regional hospital. The serum calcium level was around 6.0 mg/dl despite intraveouns and oral supplement of calcium for 2 weeks and he was transferred to our hospital for further management. Physical examination revealed surgical scar of neck, regular heart beats, positive Chvostek's sign and Trousseau's sign, and normal muscle power. Laboratory results revealed normal thyroid function (TSH: 0.624μIU/ml, free T4: 10.2 pg/ml), hypocalcemia (5.4 mg/dl), hyperphosphatemia (7.2 mg/dl) with low levels of parathyroid hormone (<3.0 pg/ml), and 24 hours urine calcium excretion was 82.8 mg. In our hospital, he was treated with calcium supplement around 3600 mg daily and vitamin D for 1 week. His symptoms improved but the serum calcium level was only around 7.0 mg/dl. Because he had elevated serum levels of alkaline phosphatase, a marker of osteoblast activity and bone formation, it was speculated that unapposed bone formation with decreased bone resorptive activity might contributed to the development of severe hypocalcemia in addition to surgical hypoparathyroidism after thyroidectomy. In conclusion, we reported a thyrotoxic patient after subtotal thyroidectomy suffered from severe hypocalcemia and elevated serum levels of alkaline phosphatase in spite of a large amount of calcium supplement. Hungry bone syndrome, in addition to hypoparathyroidism, may be the important contributory factor leading to hypocalcemia after thyroidectomy.

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EP21-7 ANOREXIA NERVOSA WITH MULTIPLE HEMATOLOGICAL AND ENDOCRINE DYSFUNCTIONS: A CASE REPORT C-Y YANG, C-W CHOU, K-Z TIEN Division of Endocrine and Metabolism, Department of Internal Medicine, Department of Internal Medicine, Chi-Mei Medical Center, Tainan Anorexia nervosa: is an eating disorder, characterized by low body weight and body image distortion, with an obsessive fear of gaining weight. Individuals with anorexia are known to control body weight commonly through the means of voluntary starvation, purging, excessive exercise or other weight control measures, While the condition primarily affects adolescent females, approximately 10% of people with the diagnosis are male. Anorexia nervosa, involving neurobiological, psychological, and sociological components, is a complex condition that can lead to death in severe cases. Here, we reported a case of anorexia nervosa with multiple endocrine dysfunctions. A 15-years-old male was present with general malaise with dramatically body weight loss 15 kilogram within half a year. He also had symptoms of fear of obesity, depressive mood, insomnia, tension, poor concentration/ memory, poor appetite, dysphoria, over-exercise etc. Physical examination revealed thin figure with body height 168cm, body weight 35 kilogram, BMI of 12.5. Multiple petechiae was noted over his anterior chest and multiple ecchymosed spots over EKG performed skin areas. Hematological data showed mild anemia of Hb, 12.6 g/dl (normal 13.7-17), prolonged Prothrombin time, 28.9 sec (normal 10-13.2); prolonged APTT, 44.6 sec (normal 24.4-34.0); low protein S, 25.9% (normal 70-140); low factor IX assay, 63.3% (normal 70-140). Biochemistry data showed elevated level of liver function with SGOT, 126 IU/L (normal 10-50); SGPT, 214 IU/L (normal 10-50). Endocrine data showed sick euthyroid syndrome with T3, 22.23 ng/dl (normal 60-190); T4, 2.91 ug/dl (normal 4.5-12.5); FT4, 0.47 ng/dl (normal 0.68-1.4); TSH, 2.97 uIU/ml (normal 0.25-4.0).Low level of serum Testosterone, 0.35 ng/ml (normal 1.75-7.8); FSH, <0.2 mIU/ml (normal 1.27-19); LH, <0.2 (normal 1.24-8.6); E2, 13 pg/ml (normal 20-75). High level of serum cortisol (8AM), 24.42 ug/dl (normal 4.75-23.0).; serum cortisol(4PM), 19.57 ug/dl (normal 2.21-15.0); ACTH, 22.0 pg/ml (normal <46.0). Serological data showed normal immunoglobin G, 762 mg/dl (normal 700-1600); ANA, 40x (-); anti-mitochondrial Ab, 20x(-); anti-smooth muscle Ab, 20x(-); EBV-CA IgM, 0.22 (normal Ratio<1.0); CMV IgM, <0.1 (normal Index <0.5); CA-125, 7.2 U/ml (normal <35); a-fetoprotein, 1.6 ng/ml (normal <20); Anti-HBs Ab, － 234 －

negative; Anti-HCV Ab, negative; Anti-HAV IgM, negative; Anti-HDV, negative. EKG revealed sinus bradycardia. Abdominal sonogram showed chronic renal disease. Patient received psychological assessment, nutritional support, IV fluid supplement and medications (Zoloft 50 mg everyday, Anafranil 25 mg at night time, silymarin 70 mg, three times a day, Hematonic F.C 1 tablet everyday, and Zinc 14 mg everyday). His body weight gained 4 kilogram within 3 weeks treatment. Long term follow up is mandatory.

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EP21-8 HASHI MOTO’ STHYROI DI TIS WITH NODULAR GOITER --- 2 CASES REPORT Y-Y HUANG, 1R-J PEI, 2D-A WU Division of Endocrinology and Metabolism, Buddhish Tzu Chi General Hospital Taichung Branch; 1Department of Pathology, Jan-Ai Hospital; 2Division of Endocrinology and Metabolism, Medicine, Hualien Tzu Chi Medical Center Ha s hi mot o’ st hy r oi di t i s( HT)i same di c a ldi s e a s et ha ta f f e c t sa bout5% oft h e population. HT coexisted with nodular lesion is not uncommon, The incidence rates of thyroid neoplasm and nodular goiter coexistient with HT were 15% and 3.5%, respectively The sensitivity of cytology in the diagnosis of papillary carcinoma in HT was 92%. But the cytological finding of HT may present with hyperplastic follicular cells with nuclear pleomorphism, overlapping with carcinoma and nodular goiter. We report 2 cases of HT with nodular lesion in which cytological finding reveals the presence of follicular-cell pleomorphism and some papilliform cell clusters. Under the impression of HT with papillary carcinoma, thyroidectomy was performed. The intra- and post–operative pathological findings are nodular goiter. Ca s e1.A 47y / of e ma l e ,ha sR’ tnodul a rg oi t e r( 1. 2c mi nl e ng t h)a nd di f f us e hypoechoic gland noted in thyroid echo. T4:7.1 (4.5-12. 5μg / dl ) ,T3: 89( 70-170 ng/dl), TSH:0.93 (0.4-4. 0μI U/ ml ) ,ATA6400 X,a ndAMA1600X.FNAc y t ol ogyr e ve a l e ddi f f us e l y mphoc y t e si nf i l t r a t i ng wi t hc e nt r obl a s tc e l l s ,whi c hi sc ompa t i bl ewi t h Ha s hi mot o’ s thyroiditis, but cell clusters are noted aspirated from nodular lesion. Ca s e2 .A 29 y / of e ma l e ,ha sL’ thy poe c hoi cnodul e( 1. 0 x 0. 68 c m) .T4 8. 2 (4.5-12. 5μg / dl ) ,T378( 70-170 ng/dl), TSH 2.21 (0.4-4. 0μI U/ ml )wi t hAMA 1600X,a nd ATA 1280X, FNA was performed and the cytology revealed diffuse lymphocytes infiltrating, mu l t i n u c l e a rg i a n tc e l l sa n ds o med e b r i sc e l l s , wh i c hc o mpa t i b l ewi t hHa s h i mo t o ’ st hy r o i d i t i s . But some anisonucleotic follicular cell clusters with pleomorphism were noted in nodular lesion. Under the impression of HT with papillary carcinoma, thyroidectomy was performed and follicular adenoma was diagnosed after frozen pathology. The final diagnosis of pathology was nodular goiter.

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EP21-9 EPSTEIN-BARR VIRUS INFECTI ONANDGRAVES’DISEASE; ANY RELATIONSHIP? 1

Y-H LIAO, 1C-J CHANG, 2J-N CHEN, 1T-I LEE, 1J-D LIN, 1C FAN, 1W-H LEW 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, 2Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University-Wan Fang Hospital, Taiwan, R.O.C. Several infections may play a role in the development of autoimmune thyroid disease through molecular mimicry or other mechanisms. And molecular mimicry has been demonstrated between EBV proteins and human self antigens. Here we present a patient whowa sdi a g nos e dGr a ve s ’di s e a s ea ndEps t e i n-Barr virus infection simultaneously. This 25-year-old woman without major medical history presented to our hospital with fever, general malaise, URI symptoms, palpitation and a body weight loss 3 kg in one month. Initial blood tests showed mild leukopenia with increased monocyte percentage (white cell count 4.49 x10^3/ul, monocyte 18%, neutrophils 1796/ul), serum GOT 56 U/l, GPT 84 U/l and thyrotoxicosis (free T4 4.65 ng/dl, TSH < 0.005 uIU/ml). The TSH r e c e pt orAbTBI It e s twa s66. 3%.Pa t i e nt ’ smot he rha sahi s t or yofg oi t e ra ndr e c e i ve d partial thyroidectomy more than 10 years ago. On physical examination, the patient had bilateral eye inflammation, a grade 2 diffuse goiter with elastic texture. For treatment of her Gr a ve s ’di s e a s e ,t heMe t hi ma z ol eand Propranolol were used after patient declined surgical treatment and I-131 therapy. Three weeks after initial presentation, patient found a palpable lymph node over left posterior upper neck. On palpation, the lymph node was soft with mild tenderness. A Nasopharyngeal fiberscopy showed no evidence of nasopharyngeal tumor. Blood tests demonstrated leukopenia with increased monocyte percentage again (white cell count 3.80 x10^3/ul, monocyte 17%, neutrophils 1710/ul). The palpable lymph node later shrunk and disappeared spontaneously. During follow up, a blood test at 43 days after initiation of anti-thyroid drug revealed further decrease in white cell count (3.26 x10^3/ul, neutrophils 2184/ul) and increase in serum GPT level. The concurrent free T4 wa s1. 41ng / dl .Pa t i e ntdi dn’ tha vea nys y mpt om oft hy r ot oxi c os i sa tt hes a met i me . Therefore the anti-thyroid drug was discontinued. After the anti-thyroid drug had been discontinued and her thyrotoxicosis subsided, the serial follow up liver function test showed inexplicably progressive elevation from GPT 98 U/l to a peak level: 487 U/l at 42 days after discontinuation of anti-thyroid drug. The viral hepatitis markers showed negative － 237 －

HBsAg, anti-HCV, anti-HAV IgM, CMV IgM Ab but a positive EBV-VCA IgM. An abdominal echo showed no remarkable finding. After conservative treatment with silymarin, her liver function returned to normal 2 months after the peak. During this clinic course after discontinuation of methi ma z ol e ,pa t i e nt ’ sf r e eT4l e ve lwa squi t es t a bl eb e t we e n1. 12a nd 1.82 ng/dl. A follow up TSH receptor Ab (TBII) at one year after initial presentation was 34.5%. In summary, this 25-year-ol dwoma ns uf f e r e df r om Gr a ve s ’di s e a s ewhi l epr e s e nt i ng acute EBV infection. She had typical presentation of EBV infection with fever, general malaise and neck lymphadenopathy and also a course of hepatitis. The positive serology test of EBV-VCA I gM pr ove dpa t i e n t ’ sa c ut eEBV i nf e c t i on.TheGr a ve ’ sdi s e a s ewa s diagnosedbypa t i e nt ’ sdi f f us e ,gr a de2g oi t e r ,t hy r ot oxi c os i s ,e y ema ni f e s t a t i ona ndpos i t i ve TSH receptor antibody test. The development of autoimmune thyroid disease in this patient may arise from abnormal activation of immune response induced by EBV infection.

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EP21-10 PITUITARY MACROADENOMA IN A FEMALE PRESENTING WITH HYPERTENSION, BLURRED VISION AND IRREGULAR MENSTRUATION- ONE CASE REPORT OF CUSHING DISEASE M-Y TSAI, 1W-C HSU, 1C-L TSAI, 2H-C CHEN Department of Internal Medicine, 1Division of Endocrinology and Metabolism, 2Division of Neuro-Sur ge on, Tung s ’ Ta i c hungMe t r oHa r borHos pi t a l , Ta i wa n This 34 y/o woman was admitted via neurosurgeon OPD due to a pituitary mass found at other hospital. Before admission, she had intermittent dizziness, headache, high blood pressure, irregular menstruation for one year. Blurred vision was noted for several years. She did not pay attention to these conditions before. Amenorrhea was noted since 96/09, and she went to CGMH for evaluation. The brain MRI there showed a pituitary mass. No further management was done there and she visited our neurosurgeon OPD for help 3 months later. Then she was admitted to our hospital on 96/12/27 for further evaluation and treatment. Central obesity, neck hump, peripheral muscle wasting with bilateral lower legs weakness were found. Her body mass index is high (Body Weight: 72.5Kg; Height: 153cm; BMI: 32 (kg/m2)). Elevated blood pressure was noted (182/125mmHg). The visual field analysis showed right visual field hemianopsia and left visual field 3/4 quadrianopsia. Her visual acuity was poor, with od 0.03 and os HM/10cm. The fundoscopic exam disclosed arterial attenuation. Compressive optic neuropathy os>od was impressed. The blood biochemistry detected hypokalemia, with [K]: 2.9 mM/L (normal 3.5-5.3mM/L), hypercortisolism (8AM cortisol: 31.3ug/dL, normal 3-30ug/dL) with high serum ACTH level (325 uU/mL, normal 0-46uU/mL). Normal serum prolactin, TSH, free T4, growth hormone, FSH and LH level were noted. The brain MRI showed a 21x26x35mm strong enhancing mass at the sellar turcica, with erosion of sellar floor, encroachment of the pituitary stalk and optic chiasm. A pituitary macro-adenoma was impressed. She received the operation of craniotomy and partial tumor removal on 97/01/05. The pathology showed ACTH secreting adenoma. After operation her blood pressure had obvious normalization (average 136/96mmHg), her [K] level returned to normal value (4.1mM/L 97/01/11 ). Her serum cortisol level was 24ug/dL, ACTH level was 147uU/mL on 97/1/28. She underwent radiotherapy at OPD after operation. So far, she still had regular follow up at neurosurgeon OPD.

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EP21-11 HYPOTHYROIDISM IN A PATIENT WITH LARYNGEAL CANCERONE CASE REPORT OF SUSPICIOUS IRRADIATION INDUCED PRIMARY HYPOTHYROIDISM C-L TSAI, 1G-H CHANG Division of Endocrinology and Metabolism, Department of Internal Medicine, 1Division of He ma t ol ogya ndOnc ol ogy , Tung s ’ Ta i c hungMe t r oHa r borHos pi t a l , Ta i wa n A 74-year-old man with history of coronary artery disease and congestive heart failure visited our cardiovascular clinic due to dizziness and dyspnea. He was found to have low blood pressure (88/52mmHg), slow heart beat (56/min), low voltage of ECG and anemia with leukopenia. He was soon referred to hematology and oncology clinic. His history also included laryngeal cancer with radiotherapy at other teaching hospital 7 years ago. His appetite was poor and often felt malaise, cold and fullness of abdomen. Thyroid function test revealed Free T4 <0.30(0.89-1.8 ng/dl), T3<0.4 (0.7-1.7 ng/ml) and TSH 71.2(0.4-4μ IU/ml). Then he was referred to endocrine clinic. He denied any thyroid disorder history. Physical examination also showed puffy face, eyelid edema, dry cold skin, and leg edema, but no goiter, no operation scar over neck. Sonography revealed small thyroid gland and anti-TPO antibody was 728(<35 IU/ml). Eltroxine replacement was started with low dose and titrated gradually. He felt better spirit and reduced body weight 8.2 kg after 2 months of eltroxine therapy. His hemoglobin and LDL level changed from 10.6g/dL to 11.3g/dL, 165mg/dL to 83mg/dL respectively. Wi t ho utt hepa t i e nt ’ se xa c thi s t o r ya nds t udybe f or ei r r a di a t i onf orl a r y ng e a lc a nc e r , the diagnosis of iatrogenic hypothyroidism can not be made definitely. From paper review, hypothyroidism has been a known consequence of external beam radiotherapy to the neck encompassing part or whole of the thyroid gland for over 40 years. But thyroid function tests are still not a part of routine follow up of head - neck cancer patients treated with radiotherapy with or without surgery. Some authors suggested that serum TSH should be checked every 6 months for the first 5 years and yearly thereafter. Thyroid hormone replacement should be initiated in any patient with a TSH of more than 4.5 mIU/L.

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EP21-12 POSTOPERATIVE HYPERKALEMIA IN A PATIENT WITH ALDOSTERONE-PRODUCING ADENOMA: REPORT OF A CASE 1

YUEH-HUA CHUNG, 1,2TA-JEN WU 1 Department of Internal Medicine, Chiali Hospital, Tainan, Taiwan 2Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan Background: Some patients with primary aldosteronism show postoperative hyperkalemia, which may result form transient hypoaldosteronism, due to chronic suppression of the residual adrenal gland. Case Report: A 63-year-old woman with refractory hypertension and hypokalemia was diagnosed as primary aldosteronism after confirmatory tests. Both abdominal MRI and NP-59 scan showed a lesion at the right side of adrenal gland. She underwent laparoscopic right adrenalectomy and the pathological diagnosis was cortical adenoma of adrenal. After operation, hyperkalemia (6.2 mEq/L) developed. In spite of withdrawal of ACEI, hyperkalemia persisted. Hydrochlorothiazide and calcium channel blocker were added to control hypertension and hyperkalemia, her blood pressure and serum potassium returned to normal levels. Conclusion: Hyperkalemia may be a sequala of operation for APA. Serum potassium should be closely followed up for such patients.

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EP21-13 ARTIFACTUAL HYPERCALCEMIA IN A PATIENT WITH HYPERLIPIDEMIA: CASE REPORT S-J TSAI, C-C LU, C-C SUN, H-HY TSAI, H-K TSAI, H-J CHENG, C-M WU, M-J CHUANG, M-C WANG, C-H CHU, J-K LEE, H-C LAM Division of Endocrinology and Metabolism, Department of Internal Medicine, KaohSiung Veterans General Hospital, Taiwan, R.O.C. Introduction: Hypercalcemia (serum calcium normal range: 9-10.5 mg/dL ) is a disorder that most commonly results from malignancy or primary hyperparathyroidism. Other causes of elevated calcium are less common and usually are not considered until malignancy and parathyroid disease are ruled out. Therefore, a diagnosis should be undertaken if it persists. However, hypercalcemia is occasionally detected coincidentally in a patient with no obvious illness. In such cases, we must confirm the presence of true hypercalcemia, not a falsepositive result of a laboratory test. As we know, some causes induced pseudohypercalcemia, such as hyperalbuminemia, increased circulating levels of an abnormal calcium-binding immunoglobulin, and pronounced thrombocytosis. Herein, we report a case of artifactual hypercalcemia (serum calcium measured by photometric method) with hyperlipidemia. Case present: A 42 years old man with a history of diabetes mellitus and chronic hypertriglyceridemia for years received regular medical treatment in the past. He has no history about Vit.D intoxication, malignancy or thyroid disease. He has no symptom such as gastrointestinal upset, lethargy, weakness, arthralgia, myalgia, polyuria, or psychotic problems such as depression, and so on. Physical examination revealed no specific finding including skin changes (xanthomas), abdominal tenderness, muscle weakness, hyper-reflexia, tongue fasciculations. However, laboratory findings showed hyperlipidemia ( TG 7014 mg/dL, Total cholesterol 595 mg/dL, HDL-C 61 mg/dL, LDL-C 426 mg/dL), hypercalcemia ( Total Ca 11.2 mg/dL ). Therefore, we furthermore checked other tests and the results disclosed free serum calcium 4.4 mg/dL( normal : 4.5~5.3 mg/dL ), IP 5.2 mg/dL( normal 2~4.7 mg/dL ), HS-TSH 0.93 uIU/mL, T3 118 ng/dL, T4 7.99 ug/dl, Intact PTH 20.51 pg/mL( normal 15~80 pg/mL ). After one week of low fat diet and Fenofibrate 200mg 1 tablet # QD therapy, the serum triglyceride level decreased ( TG 4248 mg/dL ) , and the serum calcium concentration also returned to normal level ( Total Ca 10.5 mg/dL ). Conclusion: Misleading hypercalcemia due to hyperlipidemia is a method-dependent error. Therefore, patients with hyperlipidemia and hypercalcemia, ionized calcium measurement is very important and useful. － 242 －

EP21-14 CHOLESTASIS AND ACUTE CHOLECYSTITIS IN THYROTOXICOSIS TRAT WITH METHIMAZOLE: A CASE REPORT W-C CHEN, S-C LIU, C-H WANG, M-N CHIEN, C-C LEE, C-H LEUNG Division of Endocrinology and Metabolism, Department of Internal Medicine, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Taipei, Taiwan, R.O.C Cholestasis was a rare adverse effect exclusively from methimazole and carbimazole. We reported an elderly male patient with thyrotoxicosis who presented with cholestasis after treatment with methimazole. A 69 years old male, a farmer, had the history of thyrotoxicosis and received subtotal thyroidectomy about 30 years ago. No recurrence of thyrotoxicosis was noted after the management. Loss of body weight, poor appetite, nausea, dyspnea on exertion, hand tremor, poor sleep, loose stool, heat intolerance and weakness were also presented. No other symptoms were noted. He denied the history of recent medication, chronic viral hepatitis, alcohol consumption, blood transfusion, recent travel or animal contact. Thy r ot oxi c os i sa sGr a ve s ’di s e a s ewa sdi a g nos e d.I nt heout pa t i e ntde pa r t me ntvi s i t i ng , methimazole 30mg daily in divided dose were given. 4 days later, he had fever and fatigue and visited our emergency. Laboratory data revealed leukocytosis and the elevated concentration of serum GOT, GPT and total bilirubin. Abdominal echo found contracted gallbladder with gallbladder wall thickening. No the dilatation of common bile duct was found. With the impression of acute cholecystitis, he was admitted. With antibiotic therapy, his fever and leukocytosis improved. No black stool or tarry stool was kept. But the elevated concentration of serum GOT, GPT and total bilirubin were still presented. Cholestasis and acute cholecystitng related to methimazole were suspected. Then subtotal thyroidectomy was performed. Three days after the surgery, the concentration of serum total bilirubin, GOT and GPT were depressed. Conclusion: Jaundice can be noted in the patient with thyrotoxicosis with or without medication therapy. Attention on the cholestasis from antithyroid agent is in need.

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EP21-15 HYPOTHALAMIC TUMOR WITH PANHYPOPITUITARISM ASSOCIATED WITH HASHI TOMO’ STHYROI DI TI S:CASE REPORT K-T DENQ, 1Y-C LU, S-Y CHEN, H-H CHANG, S-L CHIU Division of Endocrinology and Metabolism, Department of Internal Medicine , E-DA Hospital , Kaohsiung , Taiwan, R.O.C.; 1Department of Medical Nutrition, I-Shou University, Kaohsiung , Taiwan, R.O.C. Introduction: Hypothalamic tumor is a rare cause of panhypopituitarism. And its a s s oc i a t i onwi t hHa s hi mot o’ st hy r oi di t i si se ve nmor er a r e .Wede s c r i bea nunus ua lc a s eof hy pot ha l a mi ct umor wi t hs e c onda r y hy popi t ui t a r i s m a s s oc i a t e d wi t h Ha s hi t omo’ s thyroiditis. Case Report: A thirty eight year-old obese female presented with diffuse goiter, di a be t e si ns i pi dusa nda me nor r he aa f t e rhe rf i r s tde l i ve r y .Ha s hi mot o’ st hy r oi di t i swa s diagnosed from typical thyroid sonography findings and elevated antimicrosomal antibody titer. Hypothalamic tumor was found from sella magnetic resonance imaging (MRI). There was neither trauma history nor postpartum hemorrhage history. Baseline and dynamic pituitary function tests all indicated multiple pituitary function deficiencies and possible hypothalamic origin. Hormone replacement including cortisone acetate, eltroxine, and desmopressin were presscribed. And then she underwent Gamma knife surgery. The size of the hypothalamic tumor and goiter all showed regressive changes after she received hormonal replacement therapy and Gamma knife surgery. Disscussion: The association among hypothalamic tumor, panhypopituitarism and autoimmune thyroiditis will be discussed.

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EP21-16 SEVERE HEART FAILURE AND PULMONARY HYPERTENSION IN A PATIENT WITH RELAPSING THYROTOXICOSIS W-H HSU, 1C KUO, 2T-J WU Division of Endocrinology and Metabolism and 1Division of Cardiovascular, Department of Internal Medicine, Taiwan Christian Presbyterian Sin-Lau Hospital, 2 Division of Endocrinology and Metabolism, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C. Background: Right heart failure with pulmonary hypertension in patients with thyrotoxicosis was rarely reported. As thyrotoxicosis is a treatable entity and such worsening cardiac failure may be completely reversible after treatment, hyperthyroidism should be considered an important cause of secondary pulmonary hypertension. Case Report: A 30-year-old female, who had thyrotoxicosis with anti-thyroid medication for a long time, discontinued anti-thyroid drugs to prepare pregnancy. Several months later, she visited ER with the chief complaint of dyspnea and general edema for one week. Physical examination revealed clear consciousness, icteric sclera, exophthalmos, and a grade III diffuse goiter, irregular heart beat, rales on bilateral lung areas, and marked bilateral leg edema. CXR showed bilateral hilar enlargement and pleural effusion. EKG revealed atrial fibrillation with rapid ventricular response. Laboratory data showed T3: 3.50 ng/ml (N:0.84-1.72), T4: 15.5 ug/dl (N:4.5-12.5), FT4:4.12 ng/dl (N:0.78-1.95), TSH: 0.01 uIU/ml (N:0.4-4). TSH receptor antibody: 93% (N:<15%), Antimicrosomal antibody: 1: 25600, anti-thyroblobulin antibody: <1:100 (-). Thyroid echo showed a huge diffuse goiter. Cardiac echo showed cardiomegaly with Left ventricle wall motion preserved, LVEF= 60%, valvular heart disease with moderate to severe TR, pulmonary hypertension, right ventricle systolic pressure (RVSP):49 mmHg, moderate MR and mild AR. After furosemide, digoxin, heparin, and water restriction for heart failure and procil and propranolol for thyrotoxicosis, her symptom improved. She was discharged smoothly and followed up at OPD. Conclusion: Hyperthyroidism without adequate therapy may lead to severe heart disorders including atrial fibrillation, pulmonary hypertension, and heart failure.

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EP21-17 COLOR DOPPLER SONOGRAPHY OF NECK IN A PATIENT WITH BILATERAL CAROTID BODY TUMORS: A CASE REPORT 1

H-J CHENG, 1H-K TSAI, 1,2C-H CHU, 1C-C LU, 3P-C WANG, 4S-J LIN, 1C-C SUN, 1 M-C WANG, 1,5J-K LEE, 1M-J CHUANG, 1H-C LAM 1 Division of Endocrinology and Metabolism, Kaohsiung Veterans General Hospital; 2 Tzuhui Institute of Technology; 3Department of Radiology, Kaohsiung Veterans General Hospital; 4Division of Hematology, Kaohsiung Veterans General Hospital; 5Laboratory of Biochemistry, Kaohsiung Veterans General Hospital Paragangliomas are rare cases. Carotid body tumor (CBT) is the most common paraganglioma of the head and neck. Embryologically derived from neural crest cells, paraganglioma and pheochromocytoma are similar in histology. But unlike pheochromocytoma, almost all paragangliomas are nonfunctional. Duplex sonography is reported to be the first noninvasive diagnostic tool for neck mass. However, for more detail of soft tissue nearby, magnetic resonance image and computed tomography with 3D reconstruction are preferred. Herein we report a patient having bilateral CBT concomitant with bilateral pheochromocytomas. We put a focus on the images of the CBT. Duplex sonography clearly demonstrates the tumor and surrounded carotid arteries. Compared with computed tomography, duplex sonography is a more rapid, convenient, safe, and non-expensive measurement for the first diagnostic step.

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AP-1 THE EPIDEMIOLOGIC TRANSITION OF TYPE 2 DIABETES MELLITUS IN TAIWAN: IMPLICATIONS FOR A REVERSAL OF FEMALE PREPONDERANCE FROM A NATIONAL COHORT C-H Tseng Department of Internal Medicine, National Taiwan University College of Medicine; Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital; Department of Medical Research and Development, National Taiwan University Hospital Yun-Lin Branch, Taiwan01 The prevalence of diabetes mellitus is increasing with female preponderance in Taiwan. Whether a gender difference in mortality and/or incidence of diabetes can attribute to these epidemiologic phenomena is interesting and important. The National Health Insurance (NHI) is a very unique health care system in Taiwan which covered more than 96% of the total population at its initial implementation. To answer a series of epidemiologic questions on diabetes in Taiwan, a national cohort of 256,036 diabetic patients (cohort I) using the NHI was established during the year 1995 to 1998. Among them 93,484 cases (cohort II) were successfully interviewed by telephone from a subsample of cohort I. A further subsample of 16,994 cases (cohort III) was used for prospective long-term follow-up and a total of 1441 cases (cohort IV) participated in an extensive health examination with the collection of detailed personal information, biospecimens of urine and blood and complete laboratory examinations for diabetic chronic complications. The prospective follow-up for the mortality of cohort I showed that the diabetic men consistently had a higher mortality rate than women in all age groups in Taiwan. This finding gives part of the explanation to the female preponderance in diabetes prevalence. The incidence trends of type 2 diabetes from 1992 to 1996 for the different age groups in men and women calculated from cohort II disclosed an increasing trend of incidence, which is much more remarkable in the younger generation, especially in the male sex. Obesity could explain this increasing trend of diabetes incidence in the younger men in Taiwan. Therefore a possibility of reversal trend of sex preponderance in diabetes prevalence is expected in the years to come, which was evidenced from the recent national survey in 2002 showing male preponderance in diabetes prevalence in the population aged below 60 years in contrast to a female preponderance in the older population. － 247 －

Analyzing the prevalence of lower extremity amputation (cohort II), stroke (cohort III) and coronary heart disease (cohort III) in the diabetic patients suggests significant age and sex differences in macrovascular complications with male preponderance. The analysis of incidence of hypertension in cohort II also revealed a higher risk in the diabetic men than the diabetic women. Because mortality in the diabetic patients is closely associated with the macrovascular complications, for which hypertension is the most important risk factor, the higher risk of hypertension and the higher prevalence of macrovascular complications in the diabetic men than women in our population gives good explanation for the higher mortality in the diabetic men. In conclusions, increasing prevalence of diabetes with female preponderance had been observed for decades in Taiwan, which can be explained partly by the higher risk of morbidity and mortality in the diabetic men and an overall higher incidence in women of all ages. However, obesity-related diabetes has been increasing over the past decade, which is especially remarkable in the younger generation of the male sex. Therefore the sex preponderance in diabetes is expected to change from women to men in Taiwan rolling from the past decades to the future.

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AP-2 EXENDIN-4 TREATMENT EXPANDS GRAFT -CELL MASS IN DIABETIC MICE TRANSPLANTED WITH A MARGINAL NUMBER OF FRESH ISLETS J-H Juang, 1C-H Kuo, C-H Wu, C Juang Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung University and Memorial Hospital, Taoyuan; 1Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, ROC Background. Exendin-4 stimulates insulin secretion, suppress glucagons secretion, increase -cell replication and neogenesis and reduce -cell apoptosis. However, it has been shown that posttransplant exendin-4 treatment did not improve glucose homeostasis in diabetic mice transplanted with a large number of freshly isolated islets. The aim of this study was to test if exendin-4 is beneficial for hyperglycemic recipients with a marginal number of fresh islets. Methods. We transplanted 150 C57BL/6 mouse islets under the kidney capsule of inbred streptozotocin-diabetic mice, and then treated the recipients with and without exendin-4 for 6 weeks. Before and after transplantation, recipients’blood glucose, body weight and intraperitoneal glucose tolerance test were measured. At 6 weeks, the grafts were removed to determine -cell mass. Results. Blood glucose levels in both groups decreased progressively after transplantation, and the exendin-4-treated group had had lower blood glucose than controls since day 3. By 6 weeks, euglycemia was achieved more in mice treated with exendin-4 than in controls (100% vs. 62.5%, p=0.018). The time to obtain normoglycemia was shorter in the exendin-4-treated group than in controls (128 vs. 2913 days, p<0.001). Blood glucose at 6 weeks was 12318 and 17062 mg/dl in the exendin-4-treated group and controls, respectively (p=0.008). Additionally, the exendin-4 treated group had better glucose tolerance than controls at 2 and 4 weeks (p<0.02). However, both groups exhibited increased body weight over time, and weight changes did not significantly differ between the two groups throughout the study period. At 6 weeks after transplantation, grafts in the exendin-4-treated group were more prominent and contained more insulin-stained cells than those of controls. It had 2.3-fold -cell mass of the graft as controls (0.300.11 vs. 0.130.03 mg, p=0.012). Conclusions. These results indicate posttransplant exendin-4 treatment in the diabetic recipient with a marginal number of fresh islets expands graft -cell mass and improves transplantation outcome.

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AP-3 THE NEGATIVE CORRELATION BETWEEN PLASMA ADIPONECTIN AND BLOOD PRESSURE DEPENDS ON OBESITY: A FAMILY-BASED ASSOCIATION STUDY IN SAPPHIRE 1,2

H-Y Li, 3Y-F Chiu, 4C-M Hwu, 5W H-H Sheu, 6Y-J Hung, 7W Fujimoto, 8T Quertermous, 7 J. D Curb, 1T-Y Tai and 1,2,9L-M Chuang 1 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 2 Graduate Institute of Clinical Medicine, Medical College, National Taiwan University, Taipei, Taiwan; 3Division of Biostatistics and Bioinformatics, National Health Research Institutes, Taipei, Taiwan; 4Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan; 5Division of Endocrinology and Metabolism, Taichung Veterans General Hospital, Taichung, Taiwan; 6Department of Medicine, Tri-Service General Hospital, Taiwan; 7Pacific Health Research Institute, Honolulu, HI, USA; 8Stanford University School of Medicine, Stanford, CA, USA; 9 Graduate Institute of Preventive Medicine, National Taiwan University School of Public Health, Taipei, Taiwan Background: The association between plasma adiponectin level and blood pressure remains inconclusive. Because obese subjects may have different mechanisms to regulate blood pressure, we hypothesized that obesity may be an important modifier. In order to minimize confounding effects from unidentified factors, a family-based design was employed to explore the relationship. Methods: A total of 1,048 subjects from 478 Chinese or Japanese families with a mean age of 50.4 ± 9.0 years were included (the SAPPHIRe (Stanford-Asian Pacific Program in Hypertension and Insulin Resistance) cohort). Blood pressure was recorded automatically and the average of the last two out of three consecutive readings was used in t hea na l y s i s .A s ubj e c twi t h“ hy pe r t e ns i on”wa sde f i ne da sonewith a systolic blood pr e s s ur e( SBP)≥140mm Hg ,oradi a s t ol i cbl oodpr e s s ur e( DBP)≥90mm Hg ,orwhowa s already on medication for hypertension. Obesity was defined as having a body mass index (BMI) ≥25kg / m2.Theupda t e dhome os t a s i smode la s s e s s me ntwa sused for calculating the indices of insulin sensitivity (HOMA2 %S). Fasting plasma adiponectin was determined using radioimmunoassay. Results: Subjects with hypertension had significantly lower plasma adiponectin levels than those without hypertension (5.99 ± 3. 64μg / mlvs .6. 65±3. 86μg / ml ,P < 0.01). Plasma adiponectin level correlated negatively with hypertension after adjusting for age, － 250 －

sex, and HOMA2%S (odds ratio (OR) 0.94, 95% confidence interval (CI) 0.90–0.98). In subjects without hypertension (n = 349), the plasma adiponectin level correlated negatively with SBP in those who were obese, after adjustment for age, sex, BMI, and HOMA2 %S (β =−0. 58,P = 0.03). The association was not significant in those without obesity. Conclusions: Plasma adiponectin level correlates negatively with hypertension. In subjects without hypertension, the relationship between plasma adiponectin level and SBP depends on the presence of obesity.

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AP-4 PPAR-GAMMA TRANSACTIVATION-MEDIATED POTENTIATION OF GLUCOSE UPTAKE BY BAI-HU-TANG 1,2

Ching-Chu Chen, 3Chien-Yun Hsiang, 4An-Na Chiang, 5Hsin-Yi Lo, 6Chia-Ing Li 1 Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital; 2Department of Endocrinology and Metabolism, College of Chinese Medicine, China Medical University; 3Department of Microbiology, School of Medicine, China Medical University. Taichung, Taiwan; 4Institute of Biochemistry and Molecular Biology, National Yang-Ming University, Taipei, Taiwan; 5Department of Nuclear Medicine and PET Center; 6Department of Medical Research, China Medical University Hospital, Taichung, Taiwan Background and Aim: Plant derivatives have been used to reduce hyperglycemia in folk medicine around the world for centuries. We performed a 3T3-L1 adipocyte-based glucose uptake screening assay to measure the glucose uptake effects of herbal medicines that can be potentially used to treat patients with type 2 diabetes mellitus. We found that Bai-Hu-Tang (BHT), a traditional Chinese formula, composed of anemarrhena, gypsum, licorice and rice, was able to stimulate glucose uptake in 3T3-L1 adipocytes. The aims of this study were to explore the glucose uptake effect as well as its mechanism(s) of action of BHT. Material and Method: Differentiated 3T3-L1 adipocytes were treated with vehicle, insulin or insulin plus different concentrations of BHT. The 2-deoxy-[3H] glucose uptake assay was performed to measure the amount of glucose uptake. To explore the mechanism(s) of glucose uptake of BHT, we used PI3 kinase inhibitor and CAP inhibitor to test if the glucose uptake effect was mediated by the insulin signaling pathway. We then used Western blot analysis to re-confirm the result of the insulin signaling inhibition assay. Finally, reporter chimera assay of HuH-7 cell swa sus e dt ome a s ur et hePP ARγa c t i vation by BHT. Results: We found that BHT potentiated insulin-stimulated glucose uptake in 3T3-L1 adipocytes. The effect of BHT-stimulated glucose uptake was neither inhibited by ALLN, a CAP inhibitor, nor by LY 294002, a PI3 kinase inhibitor. From the result of Western blot analysis, the proteins in PI3 kinase did not change after BHTs t i mul a t i on.PP ARγa c t i vation was elevated by 67.7 ± 32% (p < 0.01) in HuH-7 cells treated wi t h0. 8pg / μl of BHT. Conclusions: BHT stimulated glucose uptake in 3T3-L1 adipocytes. This effect was via PP ARγa c t i vation rather than via the insulin signaling pathway. － 252 －

AP-5 BENEFICIAL EFFECTS OF INSULIN ON GLYCEMIC CONTROL AND ß-CELL FUNCTION IN NEWLY DIAGNOSED TYPE 2 DIABETES WITH SEVERE HYPERGLYCEMIA AFTER SHORT-TERM INTENSIVE INSULIN THERAPY 1,3

Harn-Shen Chen, 3Tzu-En Wu, 2,3Tjin-Shing Jap, 1Li-Chuan Hsiao, 1Shen-Hung Lee, 1,3 Hong-Da Lin 1 Division of Endocrinology and Metabolism, Department of Medicine; 2Section of Biochemistry, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital; 3National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C. Objective: To evaluate whether treatment with insulin is advantageous compared with oral anti-diabetic agents in newly diagnosed type 2 diabetes with severe hyperglycemia after short-term intensive insulin therapy. Research Design and Methods: Newly diagnosed type 2 diabetic patients with severe hyperglycemia were hospitalized and treated with intensive insulin injections for 10-14 days. The oral glucose tolerance test (OGTT) was performed after intensive insulin treatment. After discharge, the patients were randomized to receive either insulin injections or oral anti-diabetic drugs (OAD) for further management. The OGTT was repeated 6 months later, and the – cell function and insulin sensitivity were evaluated again. These subjects were continually followed-up for another 6 months to evaluate their long-term glycemic control. Results: At the 6th month of the study, the A1C level was significantly lower in the insulin group than in the OAD group (6.330.70% vs. 7.501.50%, p=0.002). During the follow-up visit, the A1C level was still better in the insulin group (6.781.21% vs. 7.841.74%, p=0.009). All parameters regarding -cell function measured in the OGTT were improved significantly in both groups after 6 months of treatment. Compared with the OAD group, the HOMA-beta index, insulin AUC and insulinogenic index were better in the insulin group. Conclusions: A 6-month course of insulin therapy, compared with OAD treatment, could more effectively achieve adequate glycemic control and significant improvement of -cell function in new-onset type 2 diabetic patients with severe hyperglycemia.

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AP-6 APPROPRIATE IMPAIRED FASTING GLUCOSE LEVEL IN TAIWAN 1

Yun Ru Chen, 2Wen-Wei Liang 1 Department of Nursing, DaChien Hospital, Miaoli, Taiwan; 2Department of Endocrinology and Metabolism, DaChien Hospital, Miaoli, Taiwan. Background: Impaired fasting glucose (IFG) is defined as fasting plasma glucose (FPG) 100 mg/dl to 125 mg/dl which was set by American Diabetes Association (ADA). However, there is no suitable data to confirm IFG levels in Taiwan or Asian people. In the study, we attempt to define suitable cutoff points for IFG in Taiwanese. Method: We collected data from the people who visited our hospital for health examinations at least twice between 01/2002 and 07/2007. We excluded the people with a history of diabetes mellitus or the people with FPG ≧126 mg/dl at first examination. There are 3330 subjects in the study. The criteria for the diagnosis of diabetes in the study are the people with a diagnosis of diabetes mellitus before second examination or FPG≧ 126 mg/dl at second examination. We use the receiver operating characteristic (ROC) curve to calculate the cutoff point in IFG. Results: The mean duration between two health examinations are 930.68 ± 430.08 days. According to the data of the ROC curve, the FPG cutoff point is 90 mg/dl. The area under ROC curve are 0.777±0.068. The sensitivity and specificity for the prediction of diabetes in the cutoff points are 0.691 and 0.733. Conclusion: The cutoff point of IFG is lower in Taiwan than the recommended value set by ADA. We suggest that the cutoff point for IFG should be reduced from 100 mg/dl to 90 mg/dl and that IFG should be redefined as fasting plasma glucose 90 to 125 mg/dl in Taiwan.

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Author Index (English) Name

Page

Name

Page

Alberto Zambon

110

C-H LU

166, 225

AN-CHEN FENG

140

C-H Tseng

247

An-Na Chiang

252

C-H WANG

157, 159, 243

A-T HSIEH

126, 204

C-H Wu

249

A-T HSIEH

204

Chang-Hsun Hsieh

129, 210

B-J LIN

126, 200, 204

Chao-Hung Wang

B-F CHEN

212

CHENG HO

138

Bor-Ching Sheu

Chen-Huan Chen

114

Brian R Walker

67, 70

CHEN-KAI CHOU

136

BY CHEN

221

Chen-Nen Chang

102

C FAN

151, 206, 237

CHIA-CHE HAN

138

C Juang

249

Chia-Ing Li

252

C KUO

245

CHI-CHANG

173, 178, 187

C LAM

184

JUAN

C-C CHANG

157

Chieh-Hsiang Lu

C-C CHEN

142, 143, 185, 186

Chien-Hsing Chiang

208, 224

C-C LEE

159, 243

Chien-Ning Huang

219, 222

C-C LU

147, 214, 242, 246

CHIEN-TE LEE

223

C-C SU

126, 200, 204

Chien-Wen Chou

148

C-C SUN

147, 214, 242, 246

Chien-Yun Hsiang

252

C-C WANG

216

CHIH-KUAN LIN

219

C-F KWOK

122

CHIH-TSUENG HE

129

C-H CHEN

189, 190

Chih-Yuan Wang

76, 106, 117

C-H CHIANG

163

Chi-Liang Chern

177

C-H CHU

147, 214, 242, 246

Ching-Chu Chen

252

C-H HUANG

176

Ching-Fai Kwok

128

C-H KUO

170, 249

Ching-Heng Ting

178

C-H LEUNG

159, 243

CHING-JU HONG

164

－ 255 －

Name

Page

Name

Page

CHIU LIEN HSIEH

197

D-A WU

236

CHI-YU HUANG

133

Daw-Ming Chang

177

Chuan Chuan Hsiao

194

D-H TSAI

161

CHUNG-ZE WU

129

DUNG-LUNG YU

140

CHWEN-YI YANG

148

EDWARD HSI

154

C-I CHANG

124, 151, 206, 237

Fone-Ching Hsiao

129

C-J HSIEH

154

FONG-FU CHOU

136

C-K LIN

181

FU-SHINE CHOU

164

CL CHEN

221

FU-SUNG LO

133

C-L KUO

172

GERALD TSAI

140

C-L LIN

176

G-H CHANG

240

C-L TSAI

184, 211, 239, 240

Gordon C. Weir

C-L WANG

167, 191, 192, 220

HAILUN CHAO

164

C-M CHEN

122, 142

Hao-Chang Hung

217

C-M Hwu

250

Harn-Shen Chen

253

C-M WU

147, 214, 242

Harold Lebovitz

119

C-N HUNG

203

H-C CHEN

239

C-P TSAI

122

H-C HUNG

156, 163, 213, 218,

C-R SHEN

170

C-S HUANG

172

H-C KU

176

C-S LIU

172

H-C LAM

147, 169, 214, 242,

C-S LO

189, 190

C-T CHANG

143

H-C LIU

176

C-T CHEN

179

H-D LIN

157

C-W CHOU

183, 234

H-F CHANG

183

C-Y CHENG

151

H-H CHANG

176, 180, 244

C-Y LIN

185, 186

H-H SHEU

233

C-Y YANG

132, 183, 234

H-HY TSAI

242

C-Z WU

126, 200, 204

H-I YU

166, 225

D PEI

126, 129, 200, 204

H-J CHENG

147, 169, 214, 242,

226

246

－ 256 －

Name

Page

Name

Page

246 H-J CHUANG

203

H-J CHUANG

203

H-K SIA

161

H-K SIA

161

H-K TSAI

147, 214, 242, 246

H-K TSAI

147, 214, 242, 246

H-L CHEN

179, 184

H-L CHEN

179, 184

H-M CHAO

176

H-M CHAO

176

Hong-Da Lin

253

Hong-Da Lin

253

HONG-YO KANG

136

HONG-YO KANG

136

HORNG-YIH OU

217

HORNG-YIH OU

217

H-S CHEN

122

H-S CHEN

122

HSIEN-MEI CHEN

130

HSIEN-MEI CHEN

130

Hsin-Yi Lo

252

Hsin-Yi Lo

252

HSIU-CHEN LIU

202

HSIU-CHEN LIU

202

HSIU-CHEN TENG

177

HSIU-CHEN TENG

177

Hsiu-Yueh Su

HSU-HUEI WENG

138

HSU-HUEI WENG

138

HUI-CHUN HSU

208, 224

HUI-CHUN HSU

208, 224

Hung-Chi Pan

103

Hung-Chi Pan

103

H-W KUO

131, 220

H-W KUO

131, 220

H-Y KUO

170

H-Y KUO

170

H-Y Li

250

H-Y Li

250

H-Y LIN

191, 192

H-Y LIN

191, 192

H-Y OU

156, 163, 182, 213,

H-Y OU

156, 163, 182, 213,

218, 226

H-Y TSAI

147, 214

H-Y TSAI

147, 214

I-H LIAO

145

I-H LIAO

145

I-T LEE

195, 199, 205, 233

I-T LEE

195, 199, 205, 233

I-T LI

230

I-T LI

230

I-TE LEE

202

I-TE LEE

202

I-YA CHEN

154

I-YA CHEN

154

－ 257 －

Name

Page

Name

Page

J. D Curb

250

K-H CHEN

181

Jalkanen S T

K-H LAI

169

J-D LIN

126, 145, 151, 204,

K-H LIN

145

206, 237

K-J TIEN

131, 183

J-DI LIN

200

K-M Pan

JEFFERY C. CHEN

140

K-S Tsai

98, 124

J-H JUANG

157, 170, 249

K-T DENG

180

J-H SUN

216

K-T DENQ

244

Jiang-Kang Chao

164

Kuang-Chung Shih

128

JI-MEI LEE

208, 224

Kuender D. Yang

136

Jin-Shiung Cheng

164

KUN-CHENG LIN

224

JIUM-HUEI LIN

148

K-W LIU

156

J-J WANG

170

Kwan-Dun Wu

JK CHIANG

127

K-Y TSAI

126, 204

J-K LEE

147, 214, 242, 246

K-Z TIEN

234

J-N CHEN

237

Lawrence A. Leiter

115

John S.D. Chan

Li-Chuan Hsiao

253

Joseph A. Majzoub

L-M Chuang

130, 250

JOU-WEI LIN

130

L-N TSENG

150, 195, 199, 230,

J-S WANG

233

J-S WU

124

LO-CHUN AU

173

Juey-Jen Hwang

130

L-S HSU

172

Justin G.S. Won

L-S LEE

137

J-Y HSIAO

131, 135

L-T HO

122, 128, 142, 173,

J-Y JIANG

181

K-C HUANG

143

L-T LIN

192

K-C SHIH

228

LU-CHUN WANG

130

K-D LIN

158, 167, 175, 189,

LYH-JYH HAO

164

190, 191, 192, 193,

Martin Silink

69, 73

215, 220

M-C HSEIH

131, 135, 167, 215,

233

178, 185, 186, 187

－ 258 －

Name

Page

Name

Page

220 M-C LEE

213

M-C LEE

213

M-C WANG

242, 246

M-C WANG

242, 246

M-H HSEICH

143

M-H HSEICH

143

M-H LIN

122

M-H LIN

122

MI-CHIA MA

164

MI-CHIA MA

164

Ming-Chia Hsieh

107

Ming-Chia Hsieh

107

MING-DER SHI

164

MING-DER SHI

164

MING-YAN TSAI

217

MING-YAN TSAI

217

M-J CHUANG

242, 246

M-J CHUANG

242, 246

M-L SHIH

228

M-L SHIH

228

M-N CHIEN

159, 243

M-N CHIEN

159, 243

M M-Y Fu

118

M M-Y Fu

118

M-T SUN

228

M-T SUN

228

M-Y LEE

158, 167, 215, 220

M-Y LEE

158, 167, 215, 220

M-Y TSAI

163, 226, 239

M-Y TSAI

163, 226, 239

NAI-WEN CHANG

164

NAI-WEN CHANG

164

PAO-HSIU LIU

177

PAO-HSIU LIU

177

PAO-YIN CHEN

138

PAO-YIN CHEN

138

P-C CHOU

174, 175

P-C CHOU

174, 175

P-C HSIEH

188

P-C HSIEH

188

P-C TSAI

132

P-C TSAI

132

P-C WANG

246

P-C WANG

246

PEI-JU LEE

208, 224

PEI-JU LEE

208, 224

PEI-YIN CHEN

217

PEI-YIN CHEN

217

P-F CHEN

212

P-F CHEN

212

P-J HSIAO

167, 175, 189, 190,

P-J HSIAO

167, 175, 189, 190,

P-L CHEN

191, 192, 193, 215,

220

179

P-L CHEN － 259 －

179

Name

Page

Name

Page

P-W CHANG

231

SHU-HWA HSIAO

217

P-W WANG

154

Shyh-Ching Chiou

138

P-Y CHEN

182, 213, 218, 226

S-J H WANG

122

P-Y CHENG

161

S-J LIN

246

P-Y LIAO

161

S-J SHIN

RAY H. LIU

177

R-H CHEN

143, 153

R-J PEI

236

Roger Chen

108

93, 95, 131, 135, 158, 167, 174, 175, 188, 189, 190, 191, 192, 193, 208, 215, 220, 224

RONG-FU CHEN

136

S-J TSAI

147, 214, 242

R-T LIU

154

S-L CHIU

180, 244

RUE-TSUAN LIU

136, 223

S-L SU

161, 172

S-C HU

163

S-L WANG

132

S-C HUA

166, 225

S-R HE

158, 191

S-C JHOU

206

S-R HSU

161

S-C LIU

159, 243

S-S TSAI

216

S-D LIN

161

S-T TU

83, 104, 124, 131, 157, 161

Seng-Wong Huang

173, 178

SU-CHIUNG LIN

210

S-H HANK JUO

154

Susan Bonner-Weir

100

S-H HSIAO

156, 213, 218, 226

SU-YIN FANG

208, 224

S-H SHEU

192

S-Y CHEN

180, 244

SHENG-CHI SU

227

S-Y HUANG

216

Shen-Hung Lee

253

S-Y LIN

Shih-Ming Huang

150, 153, 195, 199, 205, 230, 232, 233

Shih-Ping Liu

S-Y SHIH

142

Shih-Ting Tseng

222

S-Y WANG

161

SHIH-YI LIN

202

T LIN

188

SHI-YU CHEN

208, 210, 224

T Quertermous

250

SHU YU XUHU

198

TA-CHEN SU

109

Shuenn-Jiun Yiin

177

T-C YEN

170

－ 260 －

Name

Page

Terry Ting-Yu Chiou

223

T-I LEE

145, 151, 171, 206,

W-C CHEN

153, 159, 243

237

W-C CHUNG

191

Tien-Chun Chang

80, 101

W-C HSU

211, 239

T-J CHANG

145

W-C LIU

195

T-J CHEN

122

W-C LO

137

T-J HSIEH

174, 175, 188, 189,

W-C YANG

122

190, 193

WEI-FANG CHEN

133

156, 163, 164, 182,

WEI-HSIN TING

133

213, 217, 218, 226,

WEN WEI LIANG

194, 197, 198, 254

WEN-JANE LEE

202

WEN-LING GUO

133

W-H HSU

245

W-H LAO

145

W-H LEW

151, 206, 237

W-H LI

182

Wilmar M. Wiersinga

68, 71

W-J CHANG

195

W-J LEE

205

W-J TSAI

122

W-L HUANG

143

T-J WU

Name

Page 232, 250

241, 245 Tjin-Shing Jap

253

T-L HSIA

126, 200, 204

T-L HSU

122

T-L TSAI

182

Troels Wolthers

121

T-S LEE

186

T-S TAI

166

T-S TAI

225

Tsung-Yen Cheng

140

TSUNG-YI SHEN

164

TSU-YI CHAO

128

Tung-Yueh Chuang

173

W-N TSAI

230

T-W LEE

145

W-S LIN

211

T-Y TAI

124

WS YANG

98, 127, 221

T-Y Tai

250

W-T LAI

192

T-Y WANG

143

W-W HUNG

175, 193

Tzu-En Wu

253

W-Y LEI

122

W Fujimoto

250

W-Y MA

126, 200, 204

W H-H SHEU

113, 150, 195, 199,

X-Y LU

142, 185

202, 205, 230, 231,

Y LEON GUO

132

－ 261 －

Name

Page

Name

Page

YA-FANG LEE

136

Y-L LU

232

YA-LING HSU

140

Y-M PAN

183

YANG-MING LEE

161

Y-M SONG

195, 199, 230, 231,

Yann-Jinn Lee

89, 95, 133, 208, 224

Y-C CHEN

171

Y-N CHANG

161

Y-C Chi

98, 127

Y-P HSU

142, 185

Y-C LIN

206

Y-S KAO

171

Y-C LU

180, 244

Y-S YANG

203

YEN-CHUN LIN

224

Y-T LIN

169

Y-F Chiu

250

Y-T TSAI

150

Y-H CHANG

131, 158, 167, 189,

YU-CHIEN LIN

224

191, 192, 193, 215,

YU-CHING CHOU

128

220

Yueh-Hua Chung

241

Y-H CHEN

172

YU-HAN HUANG

187

Y-H KAO

176

Yun Ru Chen

254

Y-H LIAO

206, 237

Yung-Ming Chen

Y-H YAN

166, 225

YUN-JU LAI

202

Yi-Cheng Cahng

130

YUN-SHING

138

Yi-Jen Hung

PENG

YI-JEN HUNG

129, 208, 210, 224

YU-PING LEE

164

YI-LIN LIANG

217

Y-W CHIEN

170

YI-SUN YANG

219, 222

Y-W TSUEI

176

Y-J CHEN

171

Y-W YANG

195

Y-J Hung

250

Y-Y CHEN

195

Y-J LAI

220

Y-Y HUANG

216, 236

Y-J LIN

142, 185

Y-Y NG

122

Y-K CHEN

151

Z-T TSAI

170

Y-K LO

169

Y-L LIANG

156, 213, 218, 226

Y-L LIN

229

233

－ 262 －

※Underline Indicate First author

－ 263 －

Author Index (Chinese) 姓名

頁數

姓名

頁數

丁靖恆

178

何橈通

丁瑋信

133

尹順君

177

何馨如

158, 191

方淑音

208, 224

吳忠擇

126, 129, 200, 204

王子源

143

吳俊興

249

王巧伶

167, 191, 192, 220

吳晉祥

124

王佩文

154

吳崇敏

147, 214, 242

王治元

76, 106, 117

吳慈恩

253

王玫君

242, 246

吳義勇

122

王俊杰

170

吳達仁

156, 163, 164, 182, 213, 217,

王俊興

233

王律均

130

吳寬墩

王柏欽

246

吳篤安

236

王淑麗

132

呂志成

147, 214, 242, 246

王朝弘

85, 157, 159, 243

呂曉昀

142, 185

王舒儀

161

宋育民

195, 199, 230, 231, 233

王誌慶

216

李元彬

164

古惠珍

176

李文宏

182

田凱仁

131, 183, 234

李文珍

202, 205

石光中

128, 228

李弘元

250

石欣盈

142

李仰民

161

朱志勳

147, 214, 242, 246

李佳雵

252

江建興

208, 224

李佩儒

208, 224

江珠影

181

李宗玄

186

江瑞坤

127

李明招

213

何

正

138

李亭儀

145, 151, 171, 206, 237

何志聰

129

李亭衛

145

李奕德

195, 199, 202, 205, 230, 233

122, 128, 142, 173, 178, 185, 186, 187

218, 226, 241, 245

－ 264 －

姓名

頁數

姓名

頁數

李建德

223

林妤倩

224

李洮俊

95, 208, 224

林宏達

157, 253

李美月

158, 167, 215, 220

林育玲

229

李淳權

159, 243

林育德

169

李雅芳

136

林宗憲

192

李集美

208, 224

林幸宜

191, 192

李聖葒

253

林昆正

224

李燕晉

89, 133

林昆德

158, 167, 175, 189, 190, 191,

李龍雄

137

李鎮堃

214, 147, 242, 246

林明憲

122

杜思德

83, 104, 124, 131, 157, 161

林玟秀

211

沈宗毅

164

林

188

沈家瑞

170

林俊佃

126, 151, 200, 204, 206, 237

辛錫璋

93, 95, 131, 135, 158, 167,

林俊甸

145

174, 175, 188, 189, 190, 191,

林政寬

181

192, 193, 208, 215, 220, 224

林春月

185, 186

阮琪昌

173, 178, 187

林昭維

130

卓夙航

154

林英欽

206

周芃君

174, 175

林峻輝

148

周雨青

128

林振強

184

周振凱

136

林時逸

150, 195, 199, 202, 205, 230,

周逢復

136

周碩渠

206

林晏頡

142, 185

周福星

164

林素瓊

210

周劍文

148, 183, 234

林智廣

219

季語喬

127

林瑞祥

126, 200, 204

林世哲

246

林詩怡

153

林世鐸

161

林慶齡

176

林克勳

145

林興中

147, 169, 214, 242, 246

林妍君

224

花士哲

166, 225

192, 193, 215, 220

芷

232, 233

－ 265 －

姓名

頁數

姓名

頁數

邱士欽

138

高玉勳

171

邱松林

180, 244

崔以威

176

邱鼎育

223

康弘佑

136

邱燕楓

250

張乃文

164

姜安娜

252

張天鈞

80, 101

封安珍

140

張以承

130

施銘朗

228

張承能

102

洪乙仁

77, 129, 208, 210, 224, 250

張欣蕙

176

洪靜如

164

張俊仁

145, 151, 206, 237

洪薇雯

175, 193

張根湖

240

洪晧彰

156, 163, 213, 217, 218, 226

張婉珍

195

紀語喬

張淳堆

143

胡啟民

250

張涵軒

180, 244

胡淑珺

163

張毓泓

131, 158, 167, 189, 191, 192,

范

琦

151, 206, 237

夏德霖

126, 200, 204

張道明

177

奚明德

164

張維君

191

孫瑞鴻

216

張慶忠

157

孫群欽

147, 214, 242, 246

張燕妮

161

孫銘聰

228

張蕙芳

183

徐永佩

142, 185

張靜怡

124

徐粹烈

122

張寶文

231

徐維信

245

梁文偉

194, 197, 198, 254

徐慧君

208, 224

梁怡鈴

156, 213, 217, 218, 226

翁旭惠

138

梁清香

159, 243

翁錦興

莊立民

130, 250

郝立智

164

莊明儒

242, 246

馬文雅

126, 200, 204

莊東岳

173

馬瀰嘉

164

莊峻鍠

157, 170, 249

高永旭

176

莊茗琇

249

193, 215, 220

－ 266 －

姓名

頁數

姓名

頁數

莊嫺儒

203

陳俊男

237

許上人

161

陳品汎

212

許立松

172

陳思羽

208, 210, 224

許紋誠

211, 239

陳柏帆

212

許淑瑜

198

陳柏妤

221

許勝雄

192

陳盈佑

195

許博欽

陳祈玲

221

許惠恒

113, 150, 195, 199, 202, 205,

陳哲雄

140

230, 231, 232, 233, 250

陳素榆

180, 244

許雅玲

140

陳偉哲

159, 243

郭小芸

170

陳國鋅

181

郭育良

132

陳清助

143, 252

郭珍菱

172

陳涵栩

122, 253

郭紋伶

133

陳祥來

184

郭軒彣

131, 220

陳曾基

122

郭健葒

170, 249

陳欽昶

142, 185, 186

郭清輝

122, 128

陳雅慧

172

郭

傑

245

陳瑋芳

133

陳之敏

142

陳榮富

136

陳尹愷

151

陳榮興

143, 153

陳仙媚

130

陳肇閎

189, 190

陳永銘

陳震寰

114

陳白蓮

179

陳曉蓮

179

陳亦仁

171

陳鴻鑫

239

陳朱德

179

陳韻如

254

陳志良

177

陳寶印

138

陳沛吟

182, 213, 217, 218, 226

陳耀昌

171

陳汶吉

153

眭致遠

154

陳怡雅

154

傅懋洋

118

陳昌明

122

彭雲杏

138

－ 267 －

姓名

頁數

姓名

曾士婷

222

廖瑜皇

145, 206, 237

曾立年

150, 195, 199, 230, 233

裴仁正

236

曾慶孝

247

裴

126, 129, 200, 204

游冬齡

140

趙宏明

176

游慧宜

166, 225

趙建剛

164

程宗彥

140

趙海倫

164

項千芸

252

趙祖怡

128

黃士銘

劉秀珍

202

黃生旺

173, 178

劉松臻

159, 243

黃怡瓔

236

劉青山

172

黃信彰

122

劉保秀

177

黃俊雄

176

劉咸君

176

黃建寧

203, 219, 222

劉偉翰

145, 151, 206, 237

黃禹堯

216

劉貴文

156

黃郁涵

187

劉瑞川

136, 154, 223

黃偉倫

143

劉瑞厚

177

黃國欽

143

劉詩彬

黃淑鈺

216, 133

劉慧娟

195

黃瑞仁

130

歐弘毅

156, 163, 182, 213, 217, 218,

黃靜珊

172

楊五常

122

歐樂君

173

楊宜瑱

203, 219, 222

潘宏基

103

楊昆德

136

潘國美

楊秋月

132

潘逸民

183

楊純宜

148, 183, 234

蔣宗恆

163

楊偉勛

98, 127, 221

蔡克嵩

98, 124

楊雅雯

195

蔡佩倩

132

葉振聲

253

蔡宗霖

182

雷薇玉

122

蔡易婷

150

廖培湧

161

蔡昆原

126, 204

馰

頁數

226

－ 268 －

姓名

頁數

姓名

頁數

蔡明燕

163, 217, 226

賴文德

192

蔡東華

161

賴盈如

220

蔡松昇

216

賴韻如

202

蔡松容

147, 214, 242

閻紫宸

170

蔡信裕

147, 214, 242

戴在松

166, 225

蔡政麟

184, 211, 239, 240

戴東原

124, 250

蔡哲雄

140

謝安慈

126, 204

蔡婉妮

230

謝沛宸

188

蔡清標

122

謝昌勳

129, 210

蔡涵凱

147, 214, 242, 246

謝明家

107, 131, 135, 167, 215, 220

蔡瑞燦

170

謝芳傑

161

蔡維禛

122

謝旻晃

143

蔡銘洋

239

謝秋蓮

197

鄭仲益

151

謝翠娟

174, 175, 188, 189, 190, 193

鄭佩瑜

161

謝靜蓉

154

鄭欣如

147, 169, 214, 242, 246

鍾岳樺

241

鄭錦翔

164

韓嘉哲

138

鄧秀珍

177

簡鈺文

170

鄧凱太

180, 244

簡銘男

159, 243

黎國洪

169

羅兆盛

189, 190

盧介祥

84, 166, 225

羅欣宜

252

盧永川

180, 244

羅偉誠

137

盧玉強

169

羅福松

133

盧英立

232

嚴元鴻

166, 225

蕭政岳

131, 135

蘇大成

109

蕭娟娟

194

蘇矢立

161, 172

蕭峰青

129

蘇秀悅

蕭淑華

156, 213, 217, 218, 226

蘇景傑

126, 200, 204

蕭壁容

167, 175, 189, 190, 191, 192,

蘇聖棋

227

193, 215, 220 蕭麗娟

253

※：頁數下劃底線，表示第一作者。－ 269 －

2F Conference Room

3F Conference Room

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MEMO _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ － 271 －