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Kim B.H.,Biomedical Research Institute | Kim S.-J.,Biomedical Research Institute | Kim S.-J.,Pusan National University | Kim H.,Pusan National University | And 3 more authors.
Nuclear Medicine Communications | Year: 2013

BACKGROUND: The objective of the study was to investigate whether metabolic tumor volume (MTV) measured by fluorine-18 fluorodeoxyglucose ( 18F-FDG) PET/computed tomography (PET/CT) after stratification of serum thyroid stimulating hormone (TSH) levels could predict malignancy in patients with thyroid 18F-FDG incidentaloma. MATERIALS AND METHODS: A total 262 patients with focal thyroid 18F-FDG incidentaloma undergoing cancer evaluation for nonthyroid cancer or a health checkup were enrolled in this study. We retrospectively evaluated the relationship of the maximum standardized uptake value (SUVmax) and MTV in the prediction of malignant thyroid 18F-FDG incidentaloma. RESULTS: The prevalence of malignancy was 20.9% (37/177). Malignant thyroid incidentaloma had a statistically significant higher value of SUVmax (malignant: median 4.6, range 1.9-34.9; benign: median 4.1, range 0-28; P=0.030). The value of MTV4 in malignant thyroid incidentaloma was significantly higher than that of benign thyroid incidentaloma (malignant: median 0.16, range 0.02-1.19; benign: median 0.10, range 0-0.65; P=0.032). However, the values of MTV3.5, MTV3, and MTV2.5 did not differ significantly between the groups. After stratification of serum TSH levels (an SUVmax>5 was used as the cutoff point) the sensitivity and specificity for prediction of malignancy were found to be 61.1% [95% confidence interval (CI): 35.7-82.7%] and 68.7% (95% CI: 56.2-79.4%), respectively. The area under the curve (AUC) was 0.655 (95% CI: 0.545-0.755; P=0.0239). When MTV4 greater than 0.07 cm3 was used as the cutoff point, the sensitivity and specificity for prediction of malignancy were 81.2% (95% CI: 54.4-96.0%) and 50.0% (95% CI: 37.0-63.0%), respectively. The AUC was 0.650 (95% CI: 0.534-0.755; P=0.0451). On comparison receiver operating characteristic curve analysis, no significant difference was found between SUVmax and MTV4 in the prediction of thyroid carcinoma (P=0.4346). However, a combination of SUVmax and MTV4 resulted in an AUC of 0.669 (95% CI: 0.554-0.772; P=0.0183). CONCLUSION: The SUVmax and MTV4 measured by 18F-FDG PET/CT after stratification of serum TSH levels could predict thyroid cancer in patients with thyroid 18F-FDG incidentaloma. A combination of SUVmax and MTV4 may be more useful for the differentiation of malignant from benign thyroid incidentaloma. © 2013 Wolters Kluwer Health | Lippincott Williams &Wilkins. Source


Kim S.S.,Pusan National University | Song S.H.,Pusan National University | Kim I.J.,Pusan National University | Yang J.Y.,Pusan National University | And 3 more authors.
Diabetes Research and Clinical Practice | Year: 2012

Aim: The aim of this study was to evaluate the association of urinary tubular markers, interleukin-18 (IL-18) and angiotensinogen with albuminuria in early nephropathy of type 2 diabetics. Methods: Urine levels of tubular markers (kidney injury molecule [KIM]-1, neutrophil gelatinase-associated lipocalin [NGAL] and liver-type fatty acid-binding protein [L-FABP]), proinflammatory marker (IL-18), and a marker of intrarenal renin-angiotensin system (RAS) status (angiotensinogen) were determined in 118 patients with type 2 diabetes mellitus and 25 non-diabetic controls with estimated glomerular filtration rate (eGFR) ≥60mL/min/1.73m2. Results: Urinary levels of KIM-1, NGAL, IL-18 and angiotensinogen were significantly higher in macroalbuminuria group compared with control and normo- and microalbuminuria groups but not significantly different between control and normoalbuminuria group. Urinary tubular markers were positively correlated with urinary IL-18 and angiotensinogen, respectively. The urinary albuminuria was correlated with all investigated urinary markers in univariate analysis. After adjusting for several clinical parameters, urinary KIM-1, NGAL and angiotensinogen were significantly associated with albuminuria. Conclusions: The results of this study suggest that urinary tubular markers may be independently associated with albuminuria in the early stage of nephropathy in type 2 diabetics (eGFR ≥60mL/min/1.73m2) and may reflect inflammatory processing and the activation of the intrarenal RAS. © 2012 Elsevier Ireland Ltd. Source


Lee J.H.,Haedong Hospital | Kim S.S.,Pusan National University | Kim I.J.,Pusan National University | Song S.H.,Pusan National University | And 5 more authors.
Journal of Diabetes and its Complications | Year: 2012

Objective: Chronic inflammation has emerged as being a key pathophysiology in the early stages of diabetic nephropathy. YKL-40 has been established as an inflammatory marker in chronic inflammation. The aim of this study was to evaluate the association of plasma and urine YKL-40 with albuminuria in the early stage of type 2 diabetic nephropathy. Design and methods: A total of 75 type 2 diabetic patients and 22 nondiabetic controls with estimated glomerular filtration (eGFR) ≥ 60 ml/min/1.73 m2 were enrolled. Plasma and urine concentrations of YKL-40 were analyzed by ELISA kit. Results: The plasma levels of YKL-40 were significantly higher in the normoalbuminuric group with diabetes than in the control group, and increased with increasing severity of albuminuria among diabetes. However, urine YKL-40 was only increased in macroalbuminuric state. Plasma YKL-40 was positively correlated with urine YKL-40 (r = 0.291, P = 0.011). Urinary albumin significantly correlated with both plasma and urine YKL-40 in a univariate analysis. After adjusting for several confounding factors, plasma YKL-40 was significantly correlated with albuminuria (r = 0.359; P = 0.001), whereas urine YKL-40 did not show significant correlation with albuminuria (r = 0.128, P = 0.241). Conclusions: Although urine YKL-40 has a limited role, plasma YKL-40, as an proinflammatory marker, was an independent factor associated with albuminuria in early stage of nephropathy in type 2 diabetes and might have an useful role as a noninvasive marker for the early diabetic nephropathy detection. © 2012 Elsevier Inc. All rights reserved. Source


Kim S.S.,Pusan National University | Kim S.-J.,Pusan National University | Kim I.J.,Pusan National University | Kim B.H.,Pusan National University | And 2 more authors.
Clinical Nuclear Medicine | Year: 2012

Objective: The aim of the present study was to evaluate differences between children and young adult patients in presentation, clinical course, and outcome of well-differentiated thyroid carcinoma (DTC). Methods: We retrospectively reviewed the medical records of 61 children and young adults (50 female and 11 male; aged <25 years) with DTC who were treated with radioiodine (RI) and followed up between June 2002 and May 2010. All patients had undergone total thyroidectomy with lymph node dissection if enlarged lymph nodes were present and had been referred for initial radioiodine ablation. Recurrence-free survival was evaluated with the Kaplan-Meier method. Results: At diagnosis, extrathyroidal extension of DTC was more prevalent and mean tumor size was bigger in children than in young adults (P = 0.045 and P = 0.002, respectively). However, there was no significant difference between the 2 groups with regard to the presence of lymph node or distant metastases (P = 0.885 and P = 1.000, respectively). During follow-up, the recurrence in the thyroid bed or cervical lymph nodes occurred in 6 children (20.7%) and in 3 young adults (9.4%; P = 0.323). The recurrence-free survival rate was similar in children and in young adults (log-rank test, χ1 = 2.424, P = 0.120). Conclusions: Our result shows that, although the presentation of DTC at the time of diagnosis was more aggressive in children, intensive management elicited a similar clinical outcome in children and in young adults. © 2012 by Lippincott Williams & Wilkins. Source


Kim S.S.,Pusan National University | Song S.H.,Pusan National University | Kim I.J.,Pusan National University | Jeon Y.K.,Pusan National University | And 4 more authors.
Diabetes Care | Year: 2013

OBJECTIVEdThe aim of this study was to evaluate the association of urinary cystatin C, a tubular damage marker, with the progression of type 2 diabetic nephropathy. RESERCHDESIGNANDMETHODSdThe baseline values of serumand urinary cystatin C were measured as primary parameters and those of urinary nonalbumin protein (NAP) were measured as secondary parameters. In this prospective observational study, a total of 237 type 2 diabetic patients were followed up for 29 months (13-44 months). RESULTSdBoth the urinary cystatin C-to-creatinine ratio (CCR) and NAP-to-creatinine ratio (NAPCR) were significantly different according to the degree of albuminuria. Both markers had strongly positive correlations at baseline. After adjusting for several clinical factors, both urinary CCR and NAPCR had significant associations with the decline of the estimated glomerular filtration rate (eGFR) (r = 0.160, P = 0.021; r = 0.412, P < 0.001, respectively). Urinary CCR had positive correlations with the decline of eGFR in the subpopulation of patients with eGFR ≥60 mL/min/1.73 m2. In patients with eGFR ≥60 mL/min/1.73 m2 and normoalbuminuria, only urinary NAPCR showed a significant association with the decline of eGFR; urinary CCR did not. Inmultivariate regression analysis, the number of patients who progressed to chronic kidney disease stage 3 or greater was higher in those in the upper tertiles of both the urinary levels of cystatin C and NAP than in those in the lower tertiles. CONCLUSIONSdThe results of this study suggest that urinary cystatin C and NAP may be predictors of the progression of type 2 diabetic nephropathy. Copyright © 2013 by the American Diabetes Association. Source

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