110年度秋季會

目

錄

兩會理監事名單 .................................................................................2 網路直播會議連結 ..............................................................................3 節目表 ................................................................................................4 中華民國內分泌暨糖尿病學會理事長致詞 ..........................................6 演講者之簡歷和摘要 ..........................................................................8

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網路直播 課程

社團法人中華民國內分泌暨糖尿病學會理監事名單 社團法人中華民國內分泌學會

第十四屆理監事名單

理 事 長

曾芬郁

常務理事

王佩文、蔡克嵩

理

王治元、李亭儀、施翔蓉、陳思達、陳涵栩 劉鳳炫、歐弘毅、簡銘男

事

常務監事

張慶忠

監

林宏達、林怡君

事

秘 書 長

吳婉禎

副秘書長

王舒儀、周振凱、林志弘、邱偉益、陳思綺 蘇登煌

社團法人中華民國糖尿病學會

第十四屆理監事名單

理 事 長

黃建寧

常務理事

陳榮福、杜思德、蔡世澤、楊偉勛

理

胡啟民、陳清助、李弘元、曾慶孝、裴 馰 林時逸、朱志勳、洪乙仁、蘇景傑、林慶齡

事

常務監事

許惠恒

監

莊立民、何橈通、戴東原、葉振聲

事

秘 書 長

張恬君

副秘書長

李建興、林嘉鴻、楊宜瑱、王俊興、田凱仁 林昆德

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網路直播 課程

社團法人中華民國內分泌暨糖尿病學會 110 年度秋季學術研討會 日期：110 年 9 月 26 日（星期日）09:00-16:30 地點：網路直播課程

大會 Program 時間

主 題

演講者

主持人

08:30-09:00

線上報到

09:00-09:10

內分泌暨糖尿病學會 曾芬郁理事長 黃建寧理事長 致歡迎詞 Interpretation of Common Endocrine

09:10-09:55 Laboratory Tests: Technical Pitfalls,

Mechanisms and Practical Considerations The New Era of Injectable Hypoglycemic 09:55-10:40 Agents

陳瑜忻 醫師 國泰醫院

曾芬郁 教授 東基 / 臺大醫院

朱志勳 主任 高雄榮總

陳榮福 主任 高雄長庚

Coffee Break

10:40-10:50

Debate: Parathyroidectomy or Close 10:50-12:00 Observation? The Dilemma of Normocalcemic Hyperparathyroidism

黃書萱 醫師 成大醫院 鄭凱比 醫師 成大醫院 楊逸亭 醫師 高雄長庚

歐弘毅 主任 成大醫院

12:00-12:45

臨床新知 - 諾華

臨床新知 - 百靈佳殷格翰

臨床新知 - 台田

12:45-13:30

臨床新知 - 台田

臨床新知 - 阿斯特捷利康

臨床新知 - 拜耳

13:30-14:40

Debate: Pros and Cons of Intermittent Fasting on Glycemic and Body Weight Control

14:50-15:35 COVID 19, Diabetic Care and Vaccination

16:20-16:30

莊立民 教授 臺大醫院

楊宜瑱 主任 中山附醫

楊純宜 主任 奇美醫院

施翔蓉 醫師 臺大醫院

王治元 教授 臺大醫院

Break

14:40-14:50

15:35-16:20

溫振宇 醫師 林彥博 醫師 施文蕙 醫師 林冠宇 醫師 臺大醫院

Management of Patients with Anaplastic Thyroid Cancer

內分泌暨糖尿病學會 曾芬郁理事長 黃建寧理事長 致詞

學分：中華民國內分泌暨糖尿病學會 甲類 15 分、台灣內科醫學會 B 類 10 分 ( 上午和下午各至少登入觀看一小時才可給予學分 )

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社團法人中華民國內分泌暨糖尿病學會 110 年度秋季學術研討會 ( 臨床新知 ) 日期：110 年 9 月 26 日（星期日）12:00-13:30 地點：網路直播課程 本時段課程採預錄影片撥放

Program 時間

廠商

演講者

主持人

Beat It Early with Combination Therapy_ Vildagliptin As Metformin Best Partner

曾耀賢 主任 童綜合醫院

杜思德 院長 彰基醫院

百靈佳 殷格翰

DPP4i treatment : Comprehensive Solution for Complicated T2D Journey in Asian Patients

江珠影 醫師 亞東醫院

吳忠澤 主任 雙和醫院

台田

Minimize Risk of Statin Treatment in Asian Patients-Which Is the Optimal Dose

洪逸芷 醫師 中國附醫

陳清助 主任 中國附醫

台田

Timely Treatment with Primary and 杜思德 院長 Secondary Prevention for Renal 彰基醫院 Complication in T2D Patients

許惠恒 院長 臺北榮總

Breakthrough Current State of Prevention and Treatment for CKD in Patients with T2D

田凱仁 醫師 奇美醫院

楊偉勛 醫師 臺大醫院

Precision medicine in Thyroid Cancer: Expanding Targetable NTRK Fusion Treatment Options

蔡慧珍 醫師 成大醫院

諾華

12:00-12:45

12:45-13:30

阿斯特 捷利康

拜耳

主題

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網路直播 課程

社團法人中華民國內分泌學會 理事長致詞

社團法人中華民國內分泌暨糖尿病學會 110 年秋季會由內分泌學會主辦。 原本預定於 9 月 26 日在成大醫院舉行的學術活動及台南輕旅行，因應 COVID 疫情變化，決定改用線上直播方式舉辦。本次活動安排了許多精彩的節目， 四場演講包括國泰醫院陳瑜忻醫師主講的 " Interpretation of Common Endocrine Laboratory Tests: Technical Pitfalls, Mechanisms and Practical Considerations "、高雄 榮總朱志勳主任主講的 " The New Era of Injectable Hypoglycemic Agents "、中山 附醫楊宜瑱主任主講的 " COVID 19, Diabetic Care and Vaccination "、臺大醫院施 翔蓉醫師主講的 " Management of Patients with Anaplastic Thyroid Cancer "。兩場 debate 包括由成大醫院黃書萱醫師、成大醫院鄭凱比醫師、高雄長庚楊逸亭醫師 負 責 的 " Parathyroidectomy or Close Observation? The Dilemma of Normocalcemic Hyperparathyroidism " 以及臺大醫院溫振宇醫師、林彥博醫師、施文蕙醫師、 林 冠 宇 醫 師 負 責 的 " Pros and Cons of Intermittent Fasting on Glycemic and Body Weight Control "。六場臨床新知也都邀請學養豐富的專家主講臨床治療的新發展。 感謝所有的演講者以及高雄長庚陳榮福主任、成大醫院歐弘毅教授、臺大醫院莊 立民教授、奇美醫院楊純宜主任、臺大醫院王治元教授的主持、秘書處同仁的付 出、贊助廠商的協助以及全體會員的支持，讓秋季會順利圓滿。 祝大家身體健康，平安喜樂 !

理事長

敬上

中華民國 110 年 9 月 26 日

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社團法人中華民國糖尿病學會 理事長致詞

各位會員大家好： 今年秋季學術研討會因為新冠肺炎疫情仍未緩解，改為即時線上舉 行，但兩會準備的課程內容仍然豐富精采。特別是兩場 debate，分別針對 Normalcalcemic Hyperparathyroidism 及 intermittent fasting on glycemic and BW control，由幾位會員醫師根據實證進行辯論，非常值得期待。其他有 關內分泌常見檢查的判讀、甲狀腺未分化癌的處理、注射型降血糖藥物的 新紀元、糖尿病病人在 COVID-19 的治療及疫苗注射等，都是大家關注的 熱門話題。 於此疫情混沌之際，祝各位會員們線上學習充實，身心維持健康愉快。

理事長

敬上

中華民國 110 年 9 月 26 日

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網路直播 課程

陳瑜忻 Yu-Hsin Chen 國泰綜合醫院細胞學科主任暨內分泌新陳代謝科主治醫師

學 歷 2007

輔仁大學醫學系

醫學士畢業

經 歷 2007- 2010 2010- 2012 2012-2013 2013-2015 2015-2018 2018-2019 2017- 迄今

國泰醫院內科駐院醫師及總醫師訓練 國泰醫院內分泌新陳代謝專科醫師訓練 國泰醫院一般醫學科 台灣大學附屬醫院檢驗醫學部 臨床檢驗醫學住院醫師訓練 國泰醫院內分泌新陳代謝科 Indiana University Hospital Clinical Pathology & Laboratory Medicine 國泰醫院細胞學科

住院醫師 準主治醫師 主治醫師 住院醫師 主治醫師 交換學者 主任

研究領域 Thyroid cytology

論 文 ( 5 important publications – latest sequence ) 1. Fine-needle aspiration cytology of metastatic spindle cell follicular thyroid carcinoma: A case report; Yu-Hsin Chen, Carmen M Perrino, Liang Cheng, Howard H Wu; Diagnostic Cytopathology: 2019 Jun;47(6):608-611 2. The importance of risk of neoplasm as an outcome in cytologic-histologic correlation studies on thyroid fine needle aspiration; Yu-Hsin Chen, Kristen L Partyka, Rae Dougherty, Harvey M Cramer, Howard H Wu; Diagnostic Cytopathology: 2020 Dec;48(12):1237-1243.

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Interpretation of common endocrine laboratory tests: technical pitfalls, mechanisms and practical considerations 常見內分泌之檢驗：檢驗技術原理、陷阱與臨床考量 陳瑜忻 國泰綜合醫院細胞學科兼內分泌新陳代謝科

The disease of endocrinology is highly dependent on laboratory measurement of hormones or hormone metabolites in serum, plasma, and urine. This measurement is a challenging because concentrations of most hormones are very small ranging from 10-6 to 10-12 mol/L. Early detection of small change of hormone levels can contribute early diagnosis.

Antibody-based methods are suited to achieve sensitivity and wide dynamic ranges.

The technique using antibody-based methods call immunoassay which can be done in automatic or manual. Immunoassays seem to be vulnerable to analytical errors due to the nature of antibody-antigen interactions and the potential for interference from crossreactive species. Although antibodies tend to be high specificity for the antigen, there is endogenous antibodies react with the reagent causing false-positive or false-negative signals.

Immunoassay interferences can originate from exogenous or endogenous sources.

Exogenous is an often-overlooked problem in immunoassays. Endogenous interferences are caused by the patient’s blood. It can be physiological or pathophysiological condition which is difficult to detect and eliminate and may change between patients and from time to time.

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網路直播 課程

朱志勳 Chih-Hsun Chu 高雄榮民總醫院新陳代謝科主任 學 歷 1990 2006

中國醫藥學院醫學系學士 中山大學生物科學研究所 在職專班碩士

經 歷 1 9 9 9 / 0 7 - 2014/9 2020

高雄榮民總醫院新陳代謝科 輔英科技大學

主治醫師 副教授

研究領域 D M 、 T h yroid、 A dipokines

論 文 ( 5 important publications – latest sequence ) 1. Chih-Hsun Chu, Chih-Cheng Hsu, Shih-Yi Lin, Lee-Ming Chuang, Jia-Sin Liu, Shih-Te Tu. Trends in antidiabetic medical treatment from 2005 to 2014 in Taiwan. J Formos Med Assoc 2019, 118:s74-82.

2. Chen HH & Chu CH, Wen SW, Lai CC, Cheng PW and Tseng CJ. Excessive Fructose Intake Impairs Baroreflex Sensitivity and Led to Elevated Blood Pressure in Rats.

Nutrients. Published: 25 October 2019.

3. Chu CH, Lam HC, Lee JK, Lu CC, Sun CC, Cheng HJ, Wang MC, Chuang MJ. Carotid intima-media thickness in Chinese type 2 diabetic subjects with or without microalbuminuria. Journal of Endocrinological Investigation. 2012;35: 254-259.)

4. Chu CH, Lam HC, Lee JK, Lu CC, Sun CC, Cheng HJ, Wang MC, Chuang MJ. Elevated serum retinol-binding protein 4 concentrations are associated with chronic kidney disease but not with the higher carotid intima-media thickness in type 2 diabetic subjects.

Endocrine journal 2011: 58 (10), 841-847).

5. Chu CH , Lee JK, Wang MC , Lu CC , S u C C , C h u an g M J , L am HC . C h an g e o f Visfatin, C-Reactive Protein Concentrations and Insulin Sensitivity in Patients with Hyperthyroidism. Metabolism. 2008;57:1380-1383. )

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The New Era of Injectable Hypoglycemic Agents 注射型降血糖藥的新時代 朱志勳 高雄榮民總醫院新陳代謝科主任

Insulin and GLP-1RA are important treatment options for the management of patients with T2DM. A patient-centered approach should be used to guide the choice of pharmacologic agents. Considerations include effect on cardiovascular and renal comorbidities, efficacy, hypoglycemia risk, impact on weight, cost, risk for side effects, and patient preferences.

The early introduction of insulin should be considered if there is evidence of ongoing catabolism (weight loss), if symptoms of hyperglycemia are present, or when A1C levels or blood glucose levels are very high. Clinicians should be aware of the potential for overbasalization with insulin therapy. Clinical signals that may prompt evaluation of overbasalization include basal dose more than ~ 0.5 IU/kg, high bedtime-morning or post-preprandial glucose differential, hypoglycemia, and high variability. Indication of overbasalization should prompt reevaluation to further individualize therapy.

Among patients with T2DM who have established atherosclerotic cardiovascular disease or indicators of high risk, established kidney disease, or heart failure, GLP-1 RA with demonstrated cardiovascular disease benefit is recommended.

If basal insulin has been titrated to an acceptable fasting blood glucose level and A1C remains above target, consider advancing to combination injectable therapy. This approach can use a GLP-1 RA added to basal insulin or multiple doses of insulin. The combination of basal insulin and GLP-1 RA has potent glucose-lowering actions and less weight gain and hypoglycemia compared with intensified insulin regimens. The once-daily, fixed dual-combination products containing basal insulin plus a GLP-1 RA are available. As people with T2DM get older, it may become necessary to simplify complex regimens because of a decline in self-management ability.

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網路直播 課程

Debate 黃書萱 Shu-Hsuan Huang

成大醫院內分泌暨新陳代謝科總醫師 學 歷 2016/6

高雄醫學大學學士後醫學系醫學學士

經 歷 2017/8/1-2020/7 國立成功大學醫學院附設醫院內科部 住院醫師 2020/8國立成功大學醫學院附設醫院內分泌新陳代謝科 總醫師

鄭凱比 Kai-Pi Cheng

成大醫院內分泌暨新陳代謝科主治醫師 學 歷 2002-2009

國立成功大學醫學系

學士

經 歷 2010-2013 2013-2015 2015- 迄今

成大醫院內科部 住院醫師 成大醫院內分泌暨新陳代謝科 總醫師 成大醫院內分泌暨新陳代謝科 主治醫師

研究領域 糖尿病學 、新陳代謝

楊逸亭 Yi-Ting Yang

高雄長庚紀念醫院新陳代謝內分泌科主治醫師 學 歷 2013

高雄醫學大學醫學系

學士

經 歷 2014/8-2017/6 2017/7-2019/12 2020/1-2021/5 2021/6-

高雄長庚紀念醫院內科 高雄長庚紀念醫院新陳代謝內分泌科 高雄長庚紀念醫院新陳代謝內分泌科 高雄長庚紀念醫院新陳代謝內分泌科

研究領域 Thyroid disease、Diabetes mellitus 12

住院醫師 總醫師 一般級主治醫師 講師級主治醫師

Parathyroidectomy or Close observation?

The Dilemma of Normocalcemic Hyperparathyroidism

副甲狀腺切除還是密切觀察 ? 正常血鈣性副甲狀腺亢進症的困境 鄭凱比 1, 楊逸亭 2 1 2

成大醫院內科部內分泌暨新陳代謝科 高雄長庚紀念醫院新陳代謝內分泌科

Parathyroidectomy

Normocalcemic hyperparathyroidism (NHPT) is a distinct entity of primary hyperparathyroidism, which is defined as persistent normal calcium levels in the presence of high PTH levels after ruling out secondary causes of hyperparathyroidism. Due to the lack of large-scale, well-designed studies, there is no consensus on the best management of NHPT. However, for the following reasons, parathyroidectomy can be considered in some cases. First, over time, some NHPT patients will develop evidence of progressive parathyroid disease, including bone mineral loss and nephrolithiasis, and one-fifth of NHPT patients will develop hypercalcemia. Once it occurs, NHPT patients who meet the surgical criteria for classical primary hyperparathyroidism (PHPT) can undergo parathyroidectomy. Secondly, compared with the normal population, NPHT patients have lower bone mineral density and higher prevalence of osteoporosis. NHPT is considered the cause of skeletal complications. More importantly, some studies have shown that NPHT patients have increased bone density after parathyroidectomy.

Third, limited studies have demonstrated that surgery is beneficial to kidney stones and quality of life in patients with NPHT. In conclusion, NHPT is not a negligible disease, and parathyroidectomy should be considered in some cases because it is beneficial to end organ damage in patients with NPHT.

Close observation

Although studies have shown clear benefits of parathyroidectomy in symptomatic hyperparathyroidism patients, with improvements in bone health, kidney stone risk and cardiovascular outcomes, there has been controversy as to the benefits in mild or asymptomatic disease. When patients with normocalcemic primary hyperparathyroidism have parathyroid surgery, the limited data indicate that there is a similar improvement in bone density as for patients with hypercalcemic disease. Some studies found out that for patient with normocalcemic and eGFR >60 ml/min/1.73 m2, there was no renal benefits after parathyroidectomy. There is not enough evidence yet to attribute any benefit of parathyroidectomy in relieving neuropsychiatric or cardiovascular symptoms for patient with mild hyperparathyroidism.

In addition, surgery for normocalcemic hyperparathyroidism raises different challenges compared with surgery for classical primary hyperparathyroidism. Because localization studies are likely to be negative; the rate of multi-gland disease is higher and there is no clear marker to assess the effectiveness of the operation.

For patient with normocalcemic hyperparathyroidism without obvious end organ damage, close observation wound be reasonable.

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網路直播 課程

Debate 溫振宇 Chen-Yu Wen 臺大醫院代謝內分泌科住院醫師 學 歷 2007-2009 2011-2016

臺灣大學 / 醫學院微生物學研究所 碩士 高雄醫學大學 / 學士後醫學系 醫學士

經 歷 2016-2017 20172020- 迄今

台北榮民總醫院 / 教學部 臺大醫院內科部 臺大醫院代謝內分泌科

不分科住院醫師 住院醫師 住院醫師

林彥博 Yen-Bo Lin 臺大醫院代謝內分泌科住院醫師 學 歷 2007-2014 2015-2016

輔仁大學醫學系 約翰霍普金斯公共衛生學院

學士 碩士

國泰綜合醫院 臺大醫院內科部 臺大醫院代謝內分泌科

不分科住院醫師 住院醫師 住院醫師

經 歷 2016-2017 2017-2020 2020- 迄今

研究領域 糖尿病流行病學分析、甲狀腺相關基因體研究

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施文蕙 Wen-Hui Hsih 臺大醫院代謝內分泌科住院醫師 學 歷 2016

臺大醫學系

學士

臺大醫院內科部 臺大醫院代謝內分泌科

住院醫師 住院醫師

經 歷 2017-2020 2020- 迄今

林冠宇 Kuan-Yu Lin 臺大醫院雲林分院代謝內分泌科主治醫師 學 歷 1997-2014

國立臺灣大學醫學系

學士

臺大醫院內科部

住院醫師

經 歷 2016-2021

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網路直播 課程

Pros and Cons of intermittent fasting on glycemic and body weight control 間歇性斷食的好處與壞處 - 著重於體重和血糖控制的影響 溫振宇 1, 林彥博 1, 施文蕙 1, 林冠宇 2 1

臺大醫院 內分泌新陳代謝科

2

臺大醫院雲林分院 內分泌新陳代謝科

The history of medical fasting could be traced back to Hippocrates, when abstinence from food or drink was recommended for ill patients. Until recently, numerous animal studies explored the benefits of intermittent fasting (IF) at cellular levels. Several different fasting regimens had been developed clinically with the aim to induce weight loss. Alternate day fasting (ADF), intermittent energy restriction (5:2 Method) and timerestricted feeding (TRF) are among the most popular interventions.

Intermittent fasting has been shown to deliver a range of metabolic benefits, including weight loss and improved insulin resistance. Several proposed mechanisms such as metabolic switching (ketogenesis), oxidative stress hypothesis and circadian rhythm have conducted how IF leads to better health outcomes. During the fasting period, fatty acids – instead of glucose – act as the main sources of energy of cells, which result in production of ketone bodies. Ketogenesis would induce mitochondrial biogenesis and improve stress resistance. As type 2 diabetes and/or obesity patients are prone to have increased lipogenesis and hyperinsulinemia, ketogenesis during fasting may decrease adiposity and therefore improve insulin sensitivity. Ketogenesis also induces body weight loss due to reduction of calorie intake. This energy-restriction period not only cuts calories but decreases free radical production to several organs as well. Recently, insulin resistance is known to be affected by circadian rhythm as well; as we synchronize our eating behavior to our rhythm, insulin resistance could be lowered.

Among patients with type 2 DM or insulin resistance, three types of IF methods seemed to have promising results. The earlier study by Ash et al studied 51 DM patients with intensive diet intervention and calorie restrictions including ADF. The result showed an average weight loss of 6% and 1.0% of HbA1c reduction. A study from University of Illinois enrolled 100 obese patients randomized to ADF, daily calorie restriction and control group. Mean weight loss of 6% after 12 months in ADF groups noted. In the secondary analysis involving 43 patients with insulin resistance, 53% reduction in HOMA-IR after 12 months was found in the ADF group. Carter et al studied 137 DM 16

patients and concluded that 5:2 IF was an effective alternative diet strategy to continuous energy restriction (CER), with average 6.8 kilograms and 0.3% HbA1c reduction after 12-month intervention periods. Few studies focused on the efficacy of time restricted feeding (TRF) on weight loss or other metabolic parameters in T2DM patients. Sutton et al. conducted the first supervised controlled feeding trial including 8 prediabetic men.

After 5 weeks of early TRF, insulin sensitivity, blood pressure, and oxidative stress levels improved without losing weight. In one meta-analysis by Borgundvaag and colleagues involving 337 DM patients, IF was associated with greater weight loss in T2DM patients compared with a standard diet.

Although some reports suggested that IF may improve insulin resistance, the impact on glycemic control remained unclear. In the same meta-analysis by Borgundvaag, the pooled analysis of the 6 trials showed no significant decrease of HbA1c in the IF arm compared to the control arm. The reduction in HbA1c was still insignificant after stratifying the studies by baseline HbA1c and study duration. Second, IF may increase the risk of hypoglycemia, especially in patients who are on antidiabetic medications, such as insulin and sulfonylureas. Corley et al found an two-folded increased risk of hypoglycemia events on fasting days despite medication adjustment. This raises a great concern of serious morbidities associated with hypoglycemia, including cardiovascular events, stroke, arrhythmias, and falls. Third, current evidence did not support the superiority of intermittent fasting over continuous energy restriction (CER), with respect to glycemic control, weight reduction, or cardiometabolic biomarkers such as lipid profiles. Higher dropout rate in the IF group compared with the CER group was reported due to dissatisfaction with the diet. Therefore, due to the above reasons, IF has not been recognized as a standard practice in the obese diabetes patients.

In clinical practice, the benefits and side effects of intermittent fasting should be well informed to the patient. A feasible fasting regimen should be individualized, considering the patient’s underlying comorbidities, lifestyles, medications and preferences. Dose reduction of anti-diabetic medication is warranted on fasting days. In conclusion, intermittent fasting promotes moderate weight loss in patients with obesity with or without type 2 diabetes, and the effect is comparable with continuous energy restriction.

The benefits of intermittent fasting on other metabolic profiles including glycemic control, blood pressure or lipid profiles are more controversial. It is a generally safe and tolerable diet intervention in patients with type 2 diabetes in the short-term. The long-term benefits of IF remain unknown, and which fasting regimen or eating-window benefits more requires further investigation.

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網路直播 課程

楊宜瑱 Yi-Sun Yang

中山醫學大學附設醫院內分泌新陳代謝科主任暨 內科部副主任 ( 醫研及教學 )

學 歷 1991/9-1998/6 2005/9-2007/6 2007/9-2014/7 2021/1-

中山醫學大學醫學系 中山醫學大學醫學研究所碩士 中山醫學大學醫學研究所博士 中山醫學大學醫學系副教授

經 歷 1998/7/1-2002/6/31 2002/7/1-2003/6/31 2003/7/1-2003/6/31 2003/7/1-2005/6/31 2006/7/1-2013/6/31 2005/72013/72020/8-

中山醫學大學附設醫院內科部住院醫師 中山醫學大學附設醫院內科部住院總醫師 國立台灣大學醫學院附設醫院內科部 內分泌新陳代謝科 臨床研究醫師 國立台灣大學醫學院附設醫院內科部 老人醫學臨床研究醫師 中山醫學大學附設醫院內科部一般內科 中山醫學大學附設醫院內科部內分泌新陳代謝科主治醫師 中山醫學大學附設醫院內科部內分泌新陳代謝科主任 中山醫學大學附設醫院內科部副主任 ( 醫研及教學 )

專科部分 內科專科、內分泌新陳代謝科專科、老人醫學專科

研究領域 臨床基礎研究 : 糖尿病血管病變 臨床研究 : 糖尿病衛教研究 , 包括團體衛教、血糖監測、衛教工具等

論 文 ( 5 important publications – latest sequence ) 1. Optimal Initial Blood Pressure in Intensive Care Unit Patients with Non-Traumatic Intracranial Hemorrhage.Wei MC, Kornelius E, Chou YH, Yang YS, Huang JY, Huang CN.Int J Environ Res Public Health. 2020 May 14;17(10):3436. doi: 10.3390/ijerph17103436.

2. Association of blood glucose and renal end points in advanced diabetic kidney disease.Kornelius E, Lo SC, Huang CN, Wang YH, Yang YS*.Diabetes Res Clin Pract. 2020 Mar;161:108011. doi: 10.1016/j.diabres.2020.108011. Epub 2020 Jan 25.PMID: 31991151 3. Early cardiovascular risk and all-cause mortality following an incident of severe hypoglycaemia: A population-based cohort study. Lo SC, Yang YS, Kornelius E, Huang JY, Lai YR, Huang CN, Chiou JY. Diabetes Obes Metab. 2019 Aug;21(8):1878-1885. doi: 10.1111/dom.13746. Epub 2019 May 9.PMID: 30972910 4. Variations of the proprotein convertase subtilisin/kexin type 9 gene in coronary artery d i s e a s e . C h i a n g S M , Ya n g Y S * , Ya n g S F, Ts a i C F, U e n g K C . J I n t M e d R e s . 2020 Jan;48(1):300060519839519. doi: 10.1177/0300060519839519. Epub 2019 Apr 5.PMID: 30947598 5. Liraglutide protects against glucolipotoxicity-induced RIN-m5F β-cell apoptosis through restoration of PDX1 expression.Kornelius E, Li HH, Peng CH, Yang YS, Chen WJ, Chang YZ, Bai YC, Liu S, Huang CN, Lin CL.J Cell Mol Med. 2019 Jan;23(1):619-629. doi: 10.1111/ jcmm.13967. Epub 2018 Oct 24.PMID: 30353648

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COVID 19, Diabetic Care and Vaccination 新冠肺炎之糖尿病照護和疫苗接種 楊宜瑱 中山醫學大學附設醫院

The novel coronavirus disease (COVID-19) tends to portend a poor prognosis in patients with diabetes mellitus. Primary prevention remains the mainstay for mitigating the risks associated with COVID-19 in patients with diabetes mellitus. A significant step in primary prevention is timely vaccination. Routine vaccination against pneumococcal pneumonia, influenza, and hepatitis B is recommended in patients with diabetes mellitus with good efficacy and reasonable safety profile. With clinical data supporting a robust neutralizing antibody response in COVID-19 patients with diabetes mellitus, vaccination in individuals with diabetes mellitus is justified. In fact, as the burden of the disease is borne by people with diabetes mellitus, COVID-19 vaccination should be prioritized in individuals with diabetes mellitus. Multiple unresolved issues with regard to preferred vaccine type, vaccine efficacy and durability, frequency of administration, vaccination in children (<18 years) and pregnant/lactating women however remain, and need to be addressed through future research .Patients with type 1 and type 2 diabetes mellitus are at a high risk of poor prognosis with COVID-19 and vaccination should be prioritized in them. However, many unresolved issues with regard to COVID-19 vaccination need to be addressed through future research.

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網路直播 課程

施翔蓉 Shyang-Rong Shih 臺大醫學系副教授兼臺大醫院代謝內分泌科主治醫師

學 歷 1993/7-2000/6 2009/7-2012/1

臺大醫學系 臺大醫工所

學士 博士

臺大醫院代謝內分泌科 臺大醫學系內科

主治醫師 副教授

經 歷 2008/7 至今 2020/8/1 至今

研究領域 甲狀腺癌、甲狀腺眼病變、纖維母細胞生長因子與骨代謝

論 文 ( 5 important publications – latest sequence ) 1 Yang WP, Chang HH, Li HY, Lai YC, Huang TY, Tsai KS, Lin KH, Lin DT, Jou ST, Lu MY, Yang YL, Chou SW, Shih SR. Iron Overload Associated Endocrine Dysfunction Leading to Lower Bone Mineral Density in Thalassemia Major. The Journal of Clinical Endocrinology and Metabolism.

2020 Apr 1;105(4):dgz309. doi: 10.1210/clinem/dgz309.

2 Shih SR, Liao SL, Shih CW, Wei YH, Lu TX, Chou CH, Yen EY, Chang YC, Lin CC, Chi YC, Yang WS, Tsai FC. Fibroblast Growth Factor Receptor Inhibitors Reduce Adipogenesis of Orbital Fibroblasts and Enhance Myofibroblastic Differentiation in Graves' Orbitopathy. Ocular Immunology and Inflammation. 2019 Oct 28:1-10. doi: 10.1080/09273948.2019.1672196 3 Shih SR, Jan IS, Chen KY, Chuang WY, Wang CY, Hsiao YL, Chang TC, Chen A. Computerized Cytological Features for Papillary Thyroid Cancer Diagnosis-Preliminary Report. Cancers (Basel).

2019 Oct 25;11(11). pii: E1645. doi: 10.3390/cancers11111645.

4 Lin CH, Chang CK, Shih CW, Li HY, Chen KY, Yang WS, Tsai KS, Wang CY, Shih SR. Serum fibroblast growth factor 23 and mineral metabolism in patients with euthyroid Graves' diseases: a case-control study. Osteoporosis International. 2019 Nov;30(11):2289-2297. doi: 10.1007/s00198019-05116-1. Epub 2019 Aug 5. PMID: 31384956 5 Lin CH, Chen KH, Chen KY, Shih SR, Lu JY. Immune checkpoint inhibitor therapy-induced hypophysitis a case series of Taiwanese patients. Journal of the Formosan Medical Association.

2019 Jan;118(1 Pt 3):524-529. doi: 10.1016/j.jfma.2018.07.014. Epub 2018 Aug 10. Shih SR and Lu JY are corresponding authors

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Management of Patients with Anaplastic Thyroid Cancer 甲狀腺未分化癌患者的處置 施翔蓉 臺大醫院 代謝內分泌科

Fine needle aspiration cytology is important for initial diagnosis of ATC, but core biopsy may be necessary for definitive diagnosis and molecular interrogation. If the patients receive thyroidectomy, pathology evaluation should focus on definite diagnosis of ATC, extent of disease, presence of any coexisting differentiated thyroid cancer.

Molecular profiling should be performed, especially BRAFV600E mutation, to inform decisions related to the use of targeted therapies. Initial radiological staging should include computed tomography (or MRI) of neck to pelvis with contrast and FDG PET/ CT. Brain MRI should be performed if clinically indicated. Comprehensive diseasespecific multidisciplinary input should be attained and decision should be made with the patients. Palliative care with pain and symptom control should be included in the management. Hospice care is an important option.

For patients with confined ATC in whom R0/R1 resection is anticipated, surgical resection is recommended. Radical resection is generally not recommended given the poor prognosis of ATC. Following R0/R1 resection, radiotherapy with concurrent systemic therapy should be offered in patients in good performance status and without metastatic disease. Patients who have undergone R2 resection or have unresectable disease without metastasis could be offered radiotherapy with systemic disease.

In BRAFV600E mutated ATC, combined BRAF/MEK inhibitors can be considered. In NTRK or RET fusion ATC patients with stage IVC disease, initiation of a TRK inhibitor or RET inhibitor is recommended if available. In IVC ATC patients with high PD-L1 expression, checkpoint inhibitors can be considered as a first-line therapy in the absence of other targetable alterations or as later line therapy. In metastatic ATC patients lacking other therapeutic options including clinical trials, cytotoxic chemotherapy such as taxane, anthracyclin, and carboplatin should be considered.

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