Jae-Geun Lee

Changes in Adenosine Deaminase Activity in Patients with Type 2 Diabetes Mellitus and Effect of DPP-4 Inhibitor Treatment on ADA Activity

Background Dipeptidyl peptidase 4 (DPP-4, also known as CD26) binds with adenosine deaminase (ADA) to activate T lymphocytes. Here, we investigated whether ADA activity is specifically affected by treatment with DPP-4 inhibitor (DPP4I) compared with other anti-diabetic agents. Methods Fasting ADA activity, in addition to various metabolic and biochemical parameters, were measured in 262 type 2 diabetes mellitus (T2DM) patients taking various anti-diabetic agents and in 46 non-diabetic control subjects. Results ADA activity was increased in T2DM patients compared with that in non-diabetic control subjects (mean±standard error, 23.1±0.6 U/L vs. 18.6±0.8 U/L; P<0.05). ADA activity was correlated with fasting plasma glucose (r=0.258, P<0.05), HbA1c (r=0.208, P<0.05), aspartate aminotransferase (r=0.325, P<0.05), and alanine aminotransferase (r=0.248, P<0.05). Compared with the well-controlled T2DM patients (HbA1c<7%), the poorly controlled group (HbA1c>9%) showed significantly increased ADA activity (21.1±0.8 U/L vs. 25.4±1.6 U/L; P<0.05). The effect of DPP4I on ADA activity in T2DM patients did not differ from those of other oral anti-diabetic agents or insulin. T2DM patients on metformin monotherapy showed a lower ADA activity (20.9±1.0 U/L vs. 28.1±2.8 U/L; P<0.05) compared with that of those on sulfonylurea monotherapy. Conclusion Our results show that ADA activity is increased in T2DM patients compared to that in non-diabetic patients, is positively correlated with blood glucose level, and that DPP4I has no additional specific effect on ADA activity, except for a glycemic control- or HbA1c-dependent effect.

Characteristics of subjects with very low serum low-density lipoprotein cholesterol and the risk for intracerebral hemorrhage.

Background/Aims The clinical implications of hypocholesterolemia have not been well studied, although some studies have revealed an association between hypocholesterolemia and intracerebral hemorrhage (ICH). We evaluated the clinical characteristics of subjects with very low-density lipoprotein cholesterol (LDL-C) and compared the risk for ICH using various clinical parameters. Methods Using hospital records, we evaluated the clinical characteristics of subjects with LDL-C levels ≤ 40 mg/dL (very low LDL-C group). We also evaluated the risk for ICH in this very low LDL-C group and in subjects with low LDL-C ≤ 70 mg/dL (low LDL-C group). Results Among 34,415 subjects who presented at the laboratory for serum LDL-C measurements, 250 subjects had a very low serum LDL-C level (≤ 40 mg/dL). About half of the subjects were statin users; the very low LDL levels in the other subjects were likely attributable to alcohol consumption or a various chronic illness such as liver disease or end-stage renal disease (ESRD). ICH occurred in three subjects with very low LDL-C, all of whom had no history of statin use. ESRD tended to be associated with ICH in subjects with serum LDL-C ≤ 70 mg/dL. Conclusions About 1% of the subjects whose LDL-C was measured in the hospital had a LDL-C level ≤ 40 mg/dL, and about half of these subjects had no history of hypolipidemic therapy. ICH incidence was not related to LDL-C level or statin use.

A Case of Metastatic Renal Cell Carcinoma to Thyroid Gland

Metastasis to the thyroid gland from distant cancer is rare, and, in some cases, is a diagnostic challenge. Here, we report a case of metastatic renal cell carcinoma of the thyroid gland. A 77-year-old man presented with a neck mass detected about 1 month previously. He had undergone a right nephrectomy owing to renal cell carcinoma 14 years previously. Fine needle aspiration cytology showed a few atypical follicular cells with nuclear atypia. Under a tentative diagnosis of papillary thyroid carcinoma, a total thyroidectomy was performed. The histologic and immunohistochemical studies of the surgical specimens indicated that the thyroid masses were metastatic renal cell carcinoma to the thyroid.

Pseudonormal or Restrictive Filling Pattern of Left Ventricle Predicts Poor Prognosis in Patients with Ischemic Heart Disease Presenting as Acute Heart Failure

BACKGROUND In patients with acute heart failure (AHF), diastolic dysfunction, especially pseudonormal (PN) or restrictive filling pattern (RFP) of left ventricle (LV), is considered to be implicated in a poor prognosis. However, prognostic significance of diastolic dysfunction in patients with ischemic heart disease (IHD) has been rarely investigated in Korea. METHODS We enrolled 138 patients with IHD presenting as AHF and sinus rhythm during echocardiographic study. Diastolic dysfunction of LV was graded as ≥ 2 (group 1) or 1 (group 2) according to usual algorithm using E/A ratio and deceleration time of mitral inflow, E′/A′ ratio of tissue Doppler echocardiography and left atrial size. RESULTS Patients in group 1 showed higher 2-year mortality rate (36.2% ± 6.7%) than those in group 2 (13.6% ± 4.5%; p = 0.008). Two-year mortality rate of patient with LV ejection fraction (LVEF) < 40% (26.8% ± 6.0%) was not different from those with LVEF 40%–49% (28.0% ± 8.0%) or ≥ 50% (13.7% ± 7.4%; p = 0.442). On univariate analysis, PN or RFP of LV, higher stage of chronic kidney disease (CKD) and higher New York Heart Association (NYHA) functional class were poor prognostic factors, but LVEF or older age ≥ 75 years did not predict 2-year mortality. On multivariate analysis, PN or RFP of LV (hazard ratio [HR], 2.52; 95% confidence interval [CI], 1.09–5.84; p = 0.031), higher stage of CKD (HR, 1.57; 95% CI, 1.14–2.17; p = 0.006) and higher NYHA functional class (HR, 1.81; 95% CI, 1.11–2.94; p = 0.017) were still significant prognostic factors for 2-year mortality. CONCLUSIONS PN or RFP of LV was a more useful prognostic factor for long-term mortality than LVEF in patients with IHD presenting as AHF.

Erratum: Psychiatric Characteristics of the Cardiac Outpatients with Chest Pain

[This corrects the article on p. 169 in vol. 46, PMID: 27014347.].

PS 02-68 THE RELATIONSHIP BETWEEN VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND CLIMATE IN JEJU

Objective: In Korea, Jeju Island is a region where monthly mean temperature does not drop below 0 degrees Celsius. The purpose of this study is to find out the relationship between visit-to-visit blood pressure variability (BPV) and the warm climate. Design and Method: From Jan. 2013 to Dec. 2015, 596 patients who take antihypertensive medication were analyzed in our hospital. 70 patients were excluded: 24 paid no visit more than 3 times, 31 had no blood pressure records, and 15 had atrial fibrillation. The measurement of the BPV is standard deviation. The high variability group was defined as the increased medication or the more than 15mmHg of standard deviation (more than 75 percentile) without decreased medication. Results: An inverse correlations were observed between the monthly mean BP, monthly mean temperature (r = −0.847, p < 0.001; Figure1). In high variability group, which were significantly different compared to the normal variability group (130.7 ± 8.5 mmHg vs. 136.1 ± 11.8 mmHg, p < 0.001; 16.5 ± 1.4oC vs.16.2 ± 1.4oC, p = 0.008). In multivariable analysis, higher monthly mean systolic blood pressure (B = 0.058, odds ratio [OR] = 1.06, p < 0.001, 95% CI = 1.04 – 1.08) and lower monthly mean temperature (B = -0.214, odds ratio [OR] = 0.81, p = 0.003, 95% CI = 0.70 – 0.93) were associated with the high variability group. Conclusions: Even in Jeju, a relatively warm region, blood pressure changed according to the temperature. Blood pressure variability in patients who are taking antihypertensive medication had an association with monthly high mean systolic blood pressure and monthly mean temperature.

PS 05-67 GENDER DIFFERENCE IN THE CHANGE OF AUGMENTATION INDEX AFTER TREADMILL EXERCISE

Objective: Although augmentation index (AIx), which measures the arterial stiffness, has been shown to be greater in women than men, height may influence AIx, and women is usually shorter than men. This study aimed to investigate the gender difference of AIx before and after treadmill exercise. Design and Method: Forty-six subjects (22 women and 24 men), who underwent treadmill exercise test for the evaluation of chest pain, were enrolled in this study. The waveform of central aortic pressure was recorded before and after treadmill exercise using SphygmoCor®, and pulse rate-adjusted AIx (AIx@75) was measured. Results: Age (W; 52.6 ± 16.1 vs. M; 51.8 ± 14.8 years), prevalence of hypertension, coronary artery disease, diabetes or hyperlipidemia, and medications were not different, but height was shorter in women (156.5 ± 6.3 vs. 168.4 ± 7.0 cm, p < 0.001). Baseline AIx@75 was greater in women (25.7 ± 13.0 vs. 18.0 ± 11.1%, p = 0.036). Total duration of exercise and maximal METs during treadmill test were not different. After exercise, AIx@75 was also greater in women (29.5 ± 10.7 vs. 19.2 ± 7.9%, p = 0.001), but changes of AIx@75 were not different between genders (W; 3.7 ± 9.5 vs. M; 1.2 ± 8.5%). AIx@75 was significantly correlated with height (baseline; r = −0.540, p < 0.001, after exercise; r = −0.550, p < 0.001). On multivariate logistic regression analysis including height, AIx@75 at baseline or after exercise was not significantly different between genders. Conclusions: Gender difference of AIx before and after treadmill exercise was not observed. Height was the major determining factor of AIx.