Medical POSTGRADUATES Abstracts
Medical POSTGRADUATES No. 3, Vol.35, 2007 Leukocytoclastic Vasculitis with Tuberculosis Fig. 3 Fig. 1 Fig. 2 Table 1 Fig. 3 Fig. 4 Fig. 1. 117
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120 Medical POSTGRADUATES No. 3, Vol.35, 2007 Methods for Appropriate Data Analysis in Case-Control Study (1)
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Fig. 2 Fig. 6 REFERENCES 1. Ki M (2006) : Efficient Methods of Data Description. Medical Postgraduates, 34(1) : 4-7 2. Ki M (2006) : Understanding P Value in Clinics. M e d i c a l P o s t g r a d u a t e s, 34(1) : 126-130 3. Fletcher RW & Fletcher SW (2005) : Clinical Epidemiology 4th edi. Philadelphia, PA. Lippincott Williams & Wilkins 124
125 Medical POSTGRADUATES No. 3, Vol.35, 2007 Morphologic Findings of Burkitt Leukemia Fig. 1 Fig. 2
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REFERENCES 1. Foucar K (2001) : Bone marrow pathology 2nd ed. 2. World Health Organization Classification of Tumors ASCP press, American Society of Clinical Pathology, (2001) : Tumors of Hematopoietic and Lymphoid 462-464 Tissues. IARC press: 181-184 127
Medical POSTGRADUATES No. 3, Vol.35, 2007 Prevention of Type 2 Diabetes Table 1 128
Table 1. Table 2. Table 2 Table 3 129
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Medical POSTGRADUATES No. 3, Vol.35, 2007 Ubiquitous Healthcare in Diabetes A b s t r a c t 132
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REFERENCES 1. Yoon KH, Lee JH, Kim JW, Cho JH, Choi YH, Ko SH, Zimmet P, Son HY (2006) : Epidemic obesity and type 2 diabetes in Asia. L a n c e t, 368 : 1681-1688 2. The Diabetes Control and Complications Trial Research Group (1995) : Effect of intensive diabetes management on macrovascular events and risk factors in the Diabetes Control and Complications Trial. Am J Cardiol, 75 : 894-903 3. Writing Team for the Diabetes Control and Complications Trial/Epid emiology of Diabetes Interventions and Complications Research Group (2002) : Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. J A M A, 287 : 2563-2569 4. UK Prospective Diabetes Study Group (1998) : Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. B M J, 317 : 703-713 5. Ohkubo Y, Kishikawa H, Araki E et al. (1995) : Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract, 28 : 103-117 6. Saydah SH, Fradkin J, Cowie CC (2004) : Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. J A M A, 29 : 335-342 7. Koro CE, Bowlin SJ, Bourgeois N, Fedder DO (2004) : Glycemic control from 1988 to 2000 among U.S. adults diagnosed with type 2 diabetes: a preliminary report. Diabetes Care, 27 : 17-20 8. Ubink-Veltmaat LJ, Bilo HJ, Groenier KH et al. (2003) : Prevalence, incidence and mortality of type 2 diabetes mellitus revisited: a prospective population-based study in The Netherlands (ZODIAC-1). Eur J Epidemiol, 18 : 793-800 9. Gatling W, Budd S, Walters D et al. (1998) : Evidence of an increasing prevalence of diagnosed diabetes mellitus in the Poole area from 1983 to 1996. Diabet Med, 15 : 1015-1021 10. Berger B, Stenstrom G, Sundkvist G (1999) : Incidence, prevalence, and mortality of diabetes in a large population. A report from the Skaraborg Diabetes Registry. Diabetes Care, 22 : 773-778 11. Kwon HS, Cho JH, Kim HS, Lee JH, Song BR, Oh JA, Han JH, Kim HS, Cha BY, Lee KW, Son HY, Kang SK, Lee WC, Yoon KH (2004) : Development of web-based diabetic patient management system using short message service. Diabetes Res Clin Pract, 66(Suppl ): S133-S137 12. Kwon HS, Cho JH, Kim HS, Song BR, Ko SH, Lee JM, Kim SR, Chang SA, Kim HS, Cha BY, Lee KW, Son HY, Lee JH, Lee WC, Yoon KH (2004) : Establishment of blood glucose monitoring system using the internet. Diabetes Care, 27(2) : 478-483 13. Cho JH, Chang SA, Kwon HS, Choi YH, Ko SH, Moon SD, Yoo SJ, Song KH, Son HS, Kim HS, Lee WC, Cha BY, Son HY, Yoon KH (2006) : Long-term effect of the Internet-based glucose monitoring system on HbA1c reduction and glucose stability: a 30-month follow-up study for diabetes management with a ubiquitous medical care system. Diabetes Care, 29 : 2625-2631 138
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Medical POSTGRADUATES No. 3, Vol.35, 2007 Type 1 Diabetes as an Autoimmune Disease Fig. 1 Table 1 141
Fig. 1. Table 1. Antigen Sensitivity(Specificity) Comment Insulin 40-95% (99%) Inversely age of diabetes onset related GAD65 70% (99%) Predominantly age independent IA-2 60% (99%) Islet protein tyrosine phosphatase Phogrin/IA-2 55% (99%) Autoantibodies predominantly subset of ICA512/IA-2 Autoantibodies Carboxypeptidase H 10% (99%) Low sensitivity 142
Fig. 2 143
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Table 2. CD4+CD4RB lo Th3 TGF, IL10 Colitis by CD45Rb hi TGF,+/- EAE, glomeruloneph, IL10, IL4 MG, clone DM TR1 IL10, normal IBD by CD45Rb hi, TGF, no IL4 Respond IL-15 CD4+CD25+ CTLA4 Thymectomy autoimmune Constituitive CTLA4 Other CD4+ IL2, IFN MBP EAE model CD8+ CD4-CD8-TCRFas Gamma/Delta Oral tolerance intestine Skin Allograft Gut, Nasal Insulin NKT IL4, IL10, CD1 Activated IFN, TGF Fig. 3. 147
Table 3. Intervention Route Specific agent Dose and schedule Age at start Reduction in incidence Insulin GAD, Peptide 100ug 4 wk : 90% B 9-23 intranasal 40ug daily : 50% for 3d every 4-5 wk Insulin B chain with alum, IFA or 4 wk 40-100% Peptides DTP, 4 3 Human insulin analog 5 ug daily 12 wk 50% Porcine insulin 1 1 mg 2 5 wk 50% Insulin LCMV transgenics, LCMV- induced 0.1-1 mg, 1 diabetes 50% 1-22, GAD 65/ : 10-50ug 3 wk 100% GAD 67 : 100ug, GAD 67 100ug in IFA, 6 wk 80% GAD 65 in IFA, 4 3 4 wk 40-50% GAD 65 peptides in IFA, 4 3 4 wk Not effective GAD 65 peptides 50 ug, 2-3 wk 60% GAD 67 transgenic plant 5 wk 50% Table 3 148
REFERENCES 1. Eisenbarth GS (1986) : Type I diabetes mellitus. A 2. 3. chronic autoimmune disease. N Engle J Med, 3 1 4 :1360-1368 (1999) : 1 8. Park Y, She J, Wang C et al. (2000) : Common., 23 : 355-363 (2001) : T and B cell Autoantigens in Type 1 Diabetes., 25(3) : 19-37 4. Park YS, Kim TW, Kim WB, Cho BY (2000) : Increased prevalence of autoimmune thyroid disease in patients with type 1 diabetes. Korean J Intern Med, 1 5 ( 3 ) : 202-210 5. Park YS, Ko KW, Yang SW, Kawasaki E, Abiru N, Takino H, Eisenbarth G (2001) : Evaluation of the efficacy of multiple autoantibody screening in Korean patients with IDDM. Acta Diabetologica, 37 : 213-217 6. Park Y, Eisenbarth GS (2001) : Genetic susceptibility factors of type 1 diabetes in Asians and their functional evaluation. Diabetes Metab Res Rev, 17 : 2-11 7. Park Y, Wang C, Ko K et al. (1998) : Combinations of HLA DR and DQ molecules determine the susceptibility to insulin-dependent diabetes mellitus in Koreans. H u m I m m u n o l, 59 : 794-801 susceptibility and transmission pattern of HLA DRB1- DQB1 haplotypes to Korean and Caucasian patients with type 1 diabetes. J Clin Endocrinol Metab, 8 5 : 4538-4542 9. Tang Q, Henriksen KJ, Bi M et al. (2004) : In vitroexpanded antigen-specific regulatory T cells suppress autoimmune diabetes. J Exp Med, 199 : 1455-1465 10. Herold KC, Hagopian W, Auger JA et al. (2002) : Anti- CD3 monoclonal antibody in new-onset type 1 diabetes mellitus. N Engl J Med, 346(22) : 1692-1698 11. Diabetes Prevention Trial-Type 1 Diabetes Study Group (2002) : Effects of insulin in relatives of patients with type 1 diabetes mellitus. N Engl J Med, 346 : 1685-1691 12. Park Y (2006) : Why is type 1 diabetes uncommon in Asia? Ann NY Acad Sci, 1079 : 14-20 149
150 Medical POSTGRADUATES No. 3, Vol.35, 2007 Glucotoxicity
151 Table 1 Table 2Fig. 1
Table 1. Downregulated Expression Transcription Factors PPAR PPAR SREBP-1c Transcription Factor Beta 2 PDX-1 HNF1, HNF3, HNF4 NkX6.1/PaX 6 Upregulated Expression PPAR C/EBP- c-myc Lipid Acyl CoA Oxidase Acetyl CoA Carboxylase Metabolism/Transport Malonyl CoA decarboxylase Fatty Acid Synthase Lactate Production/Transport Mitochondrial Proton Transport/ATP Synthesis ATP-Synthase (NS) ATP-Synthase (NS) mgpdh(mitochondrial glycerol phosphate dehydrogenase) Hormone Sensitive Lipase Carnitine Palmitoyl Transferase-1 Lactate Dehydrogenase(A) Monocarboxylate Transporter-1 Monocarboxylate Transporter-2 Monocarboxylate Transporter-3 Uncoupling protein-2 Islet Hormone/Metabolism Insulin Glucose-6-phosphatase Enzymes Glucagon Fructose-bisphosphatase-1 GLUT2 Glutamate Dehydrogenase Glucokinase Kir6.2(ATP dependent K + channel) Islet amyloid polypeptide(iapp) SERCA3, SERCA2B(Sarcoendoplasmic reticulum Ca ++ - ATPase Voltage-dependent calcium channel a1d Inositol phosphate 3 receptor Fructose-bisphosphatase-2 12-lipoxygenase Cycloxygenase-2 Hexokinase Stress/Apoptosis Genes Bcl-2 Inducible nitric oxide synthase Heme oxygenase-1 Cu/Zn superoxide dismutase Mn superoxide dismutase Fas Antiapoptotic A20 152
Table 2. 1 : Adaptation for insulin resistance -Cell hypertrophy -Cell hyperplasia Shift to the left of glucose dose-response curve Normal or increased glucose-induced insulin secretion Normal gene expression profile 2 : Decompensation: mild hyperglycemia Loss of acute glucose-induced insulin secretion Preservation of responses to nonglucose secretagogues(arginine, etc.) Near-normal insulin stores Early -cell dedifferentiation Decreased gene expression of GLUT2, glucokinase, mgpdh, pyruvate carboxylase, voltage-dependent calcium channel, SERCA3, IP3R-II, and transcription factors(pdx-1, HNFs, Nkx6.1, and Pax6) Increased gene expression of LDH, hexokinase, glucose-6-phosphatase, and the transcription factor c-myc 3 : Decompensation: severe hyperglycemia Loss of glucose-induced insulin secretion Impairment of responses to nonglucose secretagogues(arginine, etc.) Increased ratio of secreted proinsulin to insulin Reduced insulin stores(degranulation) More severe -cell dedifferentiation Decreased expression of insulin, IAPP, glucokinase, Kir6.2, SERCA2B, PPAR-, and transcription factor 2 Increased expression of glucose-6-phosphatase, 12-lipoxygenase, COX-2, PPAR-, uncoupling protein 2, fatty acid synthase, and the transcription factor C/EBP Increased expression of stress genes inducible isoform of nitric oxide synthase, A20, and Heme oxygenase-1 4 : Decompensation with structural damage Apoptosis Amyloid deposits Lipid droplets Glycogen deposits Fibrosis C/EBP, CAAT/enhancer binding protein- ; COX-2, cyclooxygenase-2; IAPP, islet amyloid polypeptide; IP3R-II, inositol phosphate 3 receptor; SERCA, sarcoendoplasmicreticulum Ca 2+ -ATPase. Adopted from article of Gordon C. Weir et al. D i a b e t e s, 50(Suppl. 1) : S154-S159, 2001 153
Fig. 1. Table 3 Table 3. Oxidative Stress Activation of Protein Kinase C (PKC) Increase flux through the Hexosamine Biosynthesis Pathway (HBP) Formation of Advanced Glycation Endproducts (AGEs) Altered Polyol Pathway Flux Changes in gene expression 154
Fig. 2. Adopted from article of Robertson RP et al. Free Radical Biology and Medicine, 41 : 177-184, 2006 Fig. 2 155
Fig. 2 156
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Medical POSTGRADUATES No. 3, Vol.35, 2007 Incretin and Type 2 Diabetes 158
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Medical POSTGRADUATES No. 3, Vol. 35, 2007 Surrogate Cell 164
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170 Medical POSTGRADUATES No. 3, Vol. 35, 2007 Islet Transplantation
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Mother-to-Child Transmission of HIV-1 Infection during Exclusive Breastfeeding in the First 6 Months of Life : an Intervention Cohort Study Prof Hoosen M Coovadia et al. Lancet, 369 : 1107-1116, 2007 Invariant Natural Killer T Cells in Asthma and Chronic Obstructive Pandurangan Vijayanand et al. Pulmonary Disease N Eng J Med, 356 : 1410-1422, 2007 190
Optimal Medical Therapy with or without PCI for Stable Coronary Disease William E Boden et al. N Eng J Med, 356 : 1503-1516, 2007 191
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