쿠싱증후군 환자에서 당 대사 이상 정도에 따른 인슐린 감수성과 인슐린 저항성의 변화

정인경,김성훈,정재훈,민용기,이명식,이문규,유형준,안규정,노정현,김동준,김광원 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.4

연구배경 당질 코르티코이드는 당 대사에 매우 중요한 호르몬으로 내인성 당질 코르티코이드 과다상태인 쿠싱증후군에서는 말초조직에서 인슐린 저항이 증가하고 이를 보상하고자 인슐린 분비의 증가로 고인슐린혈증이 동반된다고 보고되고 있다. 하지만 생체 내에서와 달리 시험관내에서는 췌도세포에 당질 코르티코이드를 장시간 처리하면, 인슐린 분비 및 생합성이직접적으로 억제됨이 확인된 바 있어 쿠싱증후군 환자에서 당뇨병의 원인으로는 아마도 말초조직에서 증가된 인슐린 저항성 뿐 아니라 이를 충분히 보상하지 못하는 췌장에서의 인슐린 분비 저하가 같이 동반되어있지 않을까 하는 가설을 세우게 되었고, 아직까지 당질코르티코이드가 당대사 이상을 일으키는 기전에 대해 쿠싱증후군을 당대사 정도에 따라 인슐린 감수성과 분비능을 분석한 연구는 없었기에 이를 알아보고자 하였다. 방법: 삼성서울병원에서 쿠싱증후군으로 진단 받은 환자 15명을 대상으로 하였다. 이에 대한 대조군으로는 쿠싱증후군 환자와 같은 성별 그리고 체질량지수를 갖은 15명의 건강한 성인을 대상으로 비교 하였다 쿠싱증후군 환자를 대상으로 경구당부하 검사를 통해 당대사 정도를 정상군, 내당능장애군, 그리고 당뇨병군으로 나눈 후 정맥 당부하 검사를 시행하여 각군의 인슐린 저항성과 인슐린 분비능의 지표를 비교하고, 수술 후 쿠싱증후군이 완치된 상태에서 수술 전후의 당대사 지표의 변화를 조사하였다. 결과: 1) 쿠싱증후군 환자 중 정상인은 20%, 내당능 장애는 27%, 그리고 당뇨병은 53%였다. 체질량지수, 나이, 그리고 발병 기간은 세 군간에 의미 있는 차이가 없었으나, 24시간 소변검사의 코르티솔 농도는 당뇨병군에서 의미있게 높았다. 2) 정맥당부하 검사 결과, 인슐린 감수성 지표인 Sl는쿠싱증추린」서 1.58±0.10[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 대조군의 3.37±0.49[×10^(-4)(min^(-1)(μU/mL)^(-1)]에 비해 의미있게 낮았으나(P=0.024), 쿠싱증후군 환자 중 NGT, IGT, DM 군간에 서로 통계적인 차이는 없었다. 3) SG는 정상 대조군과 쿠싱증후군 환자간에는 의미있는 차이가 없었고, 쿠싱 증후군에 있어서 당대사가 악화될수록 감소하는 경향을 보였으나 의미있는 차이는 없었다. 4) 인슐린 분비능의 지표인 AIRg는 정상인에 비해 전체 쿠싱증후군 환자의 경우 증가하는 경향을 보였으나 의미있는 차이는 없었다. 하지만 쿠싱증후군 환자중에서 당대사 상태에 따라 NGT군은 1299 (1297∼1310)(mu/g/min ×10^(-2))로 정상 대조군(368.9±98.6[mu/g/min ×10^(-2)]) 보다도 의미있게 높았고, DM군{202.2 (91.1~371.4) [mu/g/min ×10^(-2)}은 NGT군에 비해 의미있게 낮았다(P=0.0031). 5) 15명중 현재 완치 상태에 있는 6명에 대해 수술전과 후로 비교하였다. 수술 전 당대사 상태가 1명은정상, 1명은 내당능 장애, 그리고 4명은 당뇨병이었으나 수술 후 시행한 경구 당부하 검사상 모두 정상 당대사 상태를 보였다. 6) 수술 후 완치된 환자 6명에 있어 인슐린 감수성지표인 Sl는 수술전에 중앙값이 1.22[×10^(-4)(min^(-1)(μU/mL)^(-1)]로 대조군에 비해 의미있게 감고』어 있었으나(p.0.05), 수술후 10.95 [×10^(-4)(min^(-1)(μU/mL)^(-1)]로 정상 수준으로 회복되었고(P=0.0022), 인슐린 분비능을 나타내는 AIRg [mu/g/min ×10^(-2)] 값도 정상수준으로 회복되었다. 특히 인슐린 분비능의 회복양상은 혈당농도에 따라 판이하게 나타나서, 정상과 내당능장애 상태에 있던 2명은 수술전에 1201 [mu/g/min ×10^(-2)]로 증가되어 있던 AIRg 값이 수술 후 정상 수준으로 감소하였고, 수술 전에 당뇨병 상태에 있던 4명의 경우 245.9 [mu/g/min ×10^(-2)]로 인슐린 분비능이 감고il어 있었는데 이들은 수술 후 모두 정상 수준으로 증가되었다 (P=0.0286). 결론: 쿠싱증후군 환자에서 당대사 이상은 80%로 높은 유병률을 보였다. 모든 쿠싱증후군환자에서 인슐린 감수성은 정상인에 비해 저하되어 있어 말초조직의 인슐린 저항이 선행됨을 시사하며, 인슐린 분비능은 당대사의 정도에 따라 다르게 나타났는데, 정상 당대사군에서는 인슐린의 저항성을 극복할 만큼 정상 대조군보다 더 많은 양의 인슐린 분비를 하다가 고코르티솔혈증이 심할수록 인슐린 분비능의 감소로 당뇨병으로 진행됨을 확인할 수 있었고, 이런 인슐린 저항성과 인슐린 분비장애는 수술 후 다시 회복되는 가역적인변화를 보였다. Background: Glucocorticoid plays an important role in the control of carbohydrate metabolism. Patients with Cushing's syndrome have been reported to have an increased incidence of carbohydrate intolerance due to peripheral insulin resistance and hyperinsulinemia, although the exact incidence and nature of this disorder have remained unclear. Few results have been published about insulin resistance and insulin secretion according to the level of glucose concentration, or about the reversibility of such defects in patients with Cushing's syndrome. Methods: To assess the effect of glucocorticoid on the insulin sensitivity and insulin secretion in Cushing's syndrome, 15 patients with Cushing's syndrome were classified into 3 groups (normal glucose tolerance: NGT, impaired glucose tolerance: IGT, diabetes: DM) according to the degree of glucose tolerance based on the oral glucose tolerance test (OGTT). Insulin modified, frequently sampled, intravenous glucose tolerance test (FSIGT) was performed before and after curative surgery on these patients and on 15 healthy control subjects. Data were evaluated by non-parametric statistical analysis. Results: 1) Among the 15 patients with Cushing's syndrome, 3 (20%) were NGT, 4 (27%) IGT, and 8 (53%) DM, based on OGTT. Twenty-four hour urinary free cortisol (UFC) was significantly higher in the DM group. 2) Insulin sensitivity index (SI) of Cushing's syndrome was significantly lower than that of the control group p=0.0024), but was not significantly different among the three Cushing's syndrome groups of NGT, IGT and DM. 3) Glucose mediated glucose disposal (SG) (Ed- confirm this abbreviation; it does not seem to match the definition) of Cushing's syndrome was not significantly different from that of the control group. 4) Insulin secretion (AIRg) of Cushing's syndrome tended to be high, but it was not significantly different from that of control. However, according to the level of glucose concentration there was significant difference in AlRg among the three Cushing's syndrome groups p=0.0031); AIRg of DM was significantly lower than that of NGT. 5) After surgical treatment, parameters of insulin sensitivity and insulin secretion were normalized in 6 cured patients; 1 with NGT, 1 with IGT, and 4 with DM, preoperatively. Median SI of all 6 patients was significantly improved up to the normal range postoperatively p=0.0022). Median AIRg of these 6 patients was balanced around that of normal control postoperatively p=0.0286). Conclusion: Eighty percent of patients with Cushing's syndrome had abnormality of carbohydrate metabolism. Insulin sensitivity was significantly decreased in Cushing's syndrome. Insulin secretion was significantly higher only in the NGT and IGT groups of Cushing's syndrome. As the hypercortisolemia is exacerbated, insulin secretion is significantly decreased and causes DM, suggesting that glucocorticoid has a direct or indirect toxic effect on the pancreatic beta cell (J Kor SOC Endocrinol 18:392-403, 2003).

민(MIN) 설계 방법을 이용한 무인기 수평이동제어 알고리즘에 관한 연구

왕현민(Hyun-Min Wang),허경무(Kyung-Moo Huh),우광준(Kwang-Joon Woo) 대한전자공학회 2009 電子工學會論文誌-SC (System and control) Vol.46 No.3

최근 무인기의 형태는 다양한 형태로 개발되고 있으며, 탑재 장비의 고성능 소형화를 바탕으로 무인기는 소형화 되고 있다. 이러한 소형화되고 일반적인 형태가 아닌 무인기 개발에 있어, 기존의 개발방법으로는 이러한 비선형적인 요소로 인하여 정확한 모델링 및 제어기 알고리즘의 정형화하기가 어렵다. 따라서 본 논문에서는 기존이 비행체 개발 방법이 아닌, 하중 제어 개념을 적용한 Min 설계 방법의 첫 번째 단계로, 원통형 무인기에 적용하여, 수평 비행 조건과 특성 그리고 제어기 설계 알고리즘을 찾아보았다. 이러한 Min 설계 방법은 고성능 컴퓨터를 사용한 무인기 개발에 있어 실시간 시뮬레이션을 통한 비용절감과 개발기간을 단축시킬 수 있다. Recently, UAV(unmanned aerial vehicle) has evolved into various figure and become miniaturized. On using existing design method, it is hard to make modelling and standardizing design of flight control system of the figure including cylinder like pipe. These problems are caused by uncorrect express of nonlinearity in controller design. Therefore, it is developed through step of correct modelling and simulation on real time using high efficiency computer in aircraft development of various figure. This is reducing period and expense of aircraft development. For the shake of solving these problems, Min-design method has been devised by H.M. Wang. In this paper, an object of control is cylindrical UAV instead of the general figure of aircraft. It was analyzed flight condition, specification about level flight of the UAV and was presented algorithm to find control value.

대장내시경검사의 전처치로서 항콜린제 사용에 관한 연구 : 전향적, 이중맹검법으로

박경남,한동수,이민호,최호순,박준용,손주현,이오영,함준수,전용철,송승찬,기춘석,윤병철,이종희 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.3

Background: Use of antispasmodic medication prior to colonoscopy is controversial but someone believes antispasmodic may improve visualization of colonic mucosa and ease colonoscope insertion. So, we designed a study to assess the effect of premedication with the antispasmodic, hyoscine-N-butyl bromide(Buscopan') on the performance of colonoscopy. Methods: This study was prospective, double blinded, randomized, controlled study, One hundred three consecutive patients were randomized to receive intravenous buscopan lml(n=52) or placebo(n=51) combined with our standard initial medication(me- peridine 50 mg and midazolam 2 mg). Insertion of colonoscopy was timed, and 100 mm visual analogue scales (VAS) were used for asscssing difficulty of procedure, colonic motility, frequency of positional change, frequency of external compression, difficulty of assistance and degree of discomfort experienced by the patients. Results: There were no significant differences of intubation time between buscopan group(mean time, 7.23 min., range 2~15) and placebo group(7.07 min., range 3-25), (p=0.83) and withdrawal time between buscopan group (6.46 min., range 2-22) and placebo group(6.76 min., range 2 25), (p=0.69). Also, there was no significant differences in intubation time between males and females(buscopan; males 7.00 min., females 7.60 min., p=0.34, placebo; males 7.0~5 min., females 7.08 min., p 0.44). The VAS scores checked by endoscopist(p=0.29), assistant(p=0.32) and patient (p=0.15) were not significantly different in both groups. There were no significant differences in intubation time, VAS scores nf endoscopist, assistant, and patients. Conclusion: Premedication with intravenous bu.opan has no advantage on colonoscopy procedure. Use of antispasmodic medication prior to colonoscopy was not considered as recommendable agent.

총경동맥 폐쇄시간에 따르는 국소 뇌혈류 변화 : 실험적 연구 An Experimental Cat Model

강준기,성태경,조병일,백민우,김문찬,허춘웅,하영수,송진언 대한신경외과학회 1983 Journal of Korean neurosurgical society Vol.12 No.3

The microvasculature of the brain is also quite susceptible to ischemic insult, and substantial portions of the brain are not reperfused after restoration of the blood supply following overtime of critical ischemic periods. The purpose of this series of experiments was to determine the effects of ischemia on subsequential regional cerebral blood flow measurements and cortical electric activities following reperfusion after ischemia and also to define the proper time of vascular occlusion without irreversible neural damage. Cerebral ischemia was induced in cat by bilateral common carotid occlusions for periods of 10, 30, to 60 minutes, and the blood supply was reperfused for 3 hours after clamp-off. Regional cerebral blood flow(rCBF) was measured by hydrogen clearance technique following ischemia, restoration of blood supply and electroencephalogram recovery could be predicted according to the rCBF. Forty adult cats weighing 2.7 to 4.0㎏ were used in this study. The animals were divided into 4 groups of 10 cats each : normal control, 10 min-clamped, 30 min-clamped, and 60 min-clamped groups. The results obtained were as follows : 1) The mean rCBF was 24.6±7.0㎖/100g/min in control group. 2) Bilateral carotid occlusions resulted in a reduction of the rCBF(12.4±4.1㎖/100g/min) to 50% of control flow on both hemispheres. 3) Sequential changes of the rCBF after reperfusion : (1) There was restored the rCBF(21.3±5.1㎖/100g/min) to control flow in the 10 minutes-clamped group. (2) There was a 85% recovery of control flow in the 30 minutes-clamped group. (3) There was a only 25% recovery of control flow in the 60 minutes-clamped group. 4) A close correlation was found between cortical electrical activity and rCBF suggesting a threshold relationship. (1) The changes of cortical electric activity began to notice at rCBF less than 17.4±4.7㎖/100g/min. (2) The recovery of cortical electric activity noted at rCBF more than 10.2±2.3㎖/100g/min. 5) There was no evidence of ischemic involvement at the cortex, white matter and basal ganglia in the 10 minutes clamped group, but demonstrated a dense wedge shaped infarct at the cortex and uncus herniation in the 60 minutes clamped group. The rCBF and cortical electric activity restored to normal values in reperfusion within 10 minutes after occlusion of both common carotid arteries.

A Comparative Experimental Study of the, In-vitro Efficiency of Hypertonic, Saline-Enhanced Hepatic Bipolar and, Monopolar Radiofrequency Ablation

Lee, Jeong Min,Han, Joon Koo,Kim, Se Hyung,Sohn, Kyu Li,Lee, Kyoung Ho,Ah, Su Kyung,Choi, Byung Ihn Korean Radiological Society 2003 Korean Journal of Radiology Vol.4 No.3

Fast Eating Speed Increases the Risk of Endoscopic Erosive Gastritis in Korean Adults

Min-Kyung Kim,Byung Joon Ko,E-Yeon Kim,Byoung-Duck Han,조경환 대한가정의학회 2015 Korean Journal of Family Medicine Vol.36 No.6

Background: Fast eating or overeating can induce gastrointestinal diseases such as gastritis. However, the association between gastritis and speed of eating is unclear. The aim of this study was to determine whether eating speed is associated with increased risk of endoscopic erosive gastritis (EEG). Methods: We carried out a cross-sectional study involving 10,893 adults who underwent a general health checkup between 2007 and 2009. Two groups, EEG patients and EEG-free patients, were compared by using the t-test and the chi-square test. Multiple logistic regression analyses were performed to investigate the association between eating speed and EEG. Results: The group with EEG had a higher proportion of males, average age, body mass index, and percentages of current smokers and risky drinkers than those without EEG. After adjusting for anthropometric, social, and endoscopic parameters, the group with the highest eating speed (<5 min/meal) had 1.7 times higher risk for EEG than the group with the lowest eating speed (≥15 min/meal) (odds ratio, 1.71; 95% confidence interval, 1.20–2.45). Conclusion: High eating speed is an independent risk factor for EEG. Our results indicate the need for further studies to clarify the role of eating speed in gastritis.

간질환환자의 위내용물 배출시간에 관한 연구

함준수(Joon Soo Hahm),이동후(Dong Hoo Lee),박경남(Kyung Nam Park),이민호(Min Ho Lee),이종철(Jong Chul Rhee),기춘석(Choon Suck Kee),유대현(Dae Hyun Yoo) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.2

N/A Gastric emptying time(GET) is influenced by several factors, such as neura), hormonal and composi- tion and physiochemical properties of food. The patients with delayed GET have some upper gastrointestinal symptoms such as recurrent nausea, vomiting, postprandia! Bloating, anorexia, and iveight loss. And also, almost of acute hepatitis and a part of chronic ]iver disease patients have similar symptoms of the patients with delayed GET. Therefore We performed GET measurement in liver disease patients to identify the relationship between nonspecific upper gastrointestinal symp- toms and gastric emptying function. The resu]ts are as followings; 1) Total ]iver disease patients are 28 in number, composed of acute hepatitis 3, chronic hepatitis 18, liver cirrhosis 7. 2) The GET(T1/2) of liver disease patients was delayed significantly than that of the normal volunteers. (Mean+SE;120.8+6.6 vs 89.4+5.9 mins.) 3) The GET of the symptomatic patients (N = 20 ) ivas 128.3+6.8 mins (Mean+SE), and that of the asymptomatic patients (N =8) was 101.8+13.2 mins. The symptomatic patients have delayed GET in 10 patients and asymptomatic patients have delayed GET in 3. 4) The GET of the patients who have elevated serum transaminase level higher than twice of normal is delayed significantly than that of the patients who have serum transaminase level lower than twice of normal. (Mean+SE; 143.4+2.6 vs 110.0+7.4 mins.)

비행 물체의 유도제어 시스템 설계를 위한 하중(중력수) 제어 모델의 성능분석

왕현민(Hyun-Min Wang),우광준(Kwang-Joon Woo),허경무(Kyung-Moo Huh) 대한전자공학회 2009 電子工學會論文誌-SC (System and control) Vol.46 No.1

기존의 방법에서는 비선형 운동 물체의 운동 방정식을 선형화하므로써 비행체의 운동 상태방정식을 구하고, 각 제어 기관에 따라 전달함수를 구하여 안정성 판별과 더불어 제어기를 설계하였다. 이러한 설계 방법으로는 일반적인 비행기와 같은 형태, 비행 환경이 급격하게 변하지 않고 속도가 빠르지 않는 비행체의 유도/제어기 설계에 많이 사용되어 많은 성능을 발휘할 수 있다. 그러나 이러한 설계 방법은 통상적이지 않는 비행체 형태뿐만 아니라 빠른 속도에서 급격한 움직임을 갖는 비행체에서는, 기존의 유도/제어기 설계 방법으로는 이러한 비선형성으로인하여 제어성(경로문제)과 안정성(안정화문제)을 동시에 충족할 만한 성능을 발휘 할 수 없다. 따라서 본 논문에서는 이러한 불확실성이 내포된 비행체 제어 문제에서 제어성과 안정성을 동시에 충족시키기 위한 과정 중 먼저 제어성 문제를 해결하기 위한 비행체 제어성을 분석하고 모델을 제시한다. 또한 본 논문에서 비행체 모델과 동역학 모델에서 제어 요소로서 하중(중력수)을 설정하고 비행 특성에 따른 제어요소 값을 살펴본다. 이것은 Min 설계 방법 1단계이다. In conventional method, flight model is discribed to differential equation by linealization of nonlinear object motion equation. As state equation from differential equation of moving object, the controller is designed by transfer functions of each module under discrimination of stability criteria. But this conventional method is designed under limitation of nonlinearity from object's shape and speed. In other word, The greater part of guidance/navigation system was satisfied with the result of good performance for normal figure of flight object, not sudden changed flight condition, not high speed. But it is not able to give full play to its ability on flight object which has abnormal figure, sudden changeable motion, high speed. Therefore, in this paper was presented performance analysis of load control model for navigation/guidance system on flying object being uncertainty, non-linear like abnormal figure, sudden changeable motion, high speed and is presented method of trajectory control(controllability) ahead of controllability and stability to achieve flight mission. In other word, this paper shows the first step of Min-design method and flight control model.

본태성 고혈압 환자의 적혈구 Na+-Li+ Countertransport 와 적혈구막 지방산 구성에 대한 연구

이영우,고경수,고재준,박경수,김원배,한은경,김성연,조보연,이홍규,고창순,민현기 한국지질학회 1991 韓國脂質學會誌 Vol.1 No.1

Since the changes of Na^+-Li^+ countertransport (SLC) Vmax in essential hypertension have been reported. it has been known that hyperlipidemia could affect SLC independently of blood pressure. To reveal the relation between SLC Vmax and RBC membrane fatty acid conposition in the hypertensive patients, we divided patients into two groups according to their levels of SLC Vmax of erythrocytes(elevated SLC Vmax: n=4, normal SLC Vamx: n=6). The results were as follows: 1) There was no difference in body mate index, waist-hip ratio, blood pressure, serum cholesterol level between two groups. Triglyceride were higher in elevated group (278.0±180.0 ㎎/㎗) than normal group (124.3±60.7 ㎎/㎗) but there was no statistical significance. HDL-cholesterol levels were significantly lower in elevated group (32.0±3.6 vs. 44.8±8.9 ㎎/㎗) and free fatty acid concentrations, intracellular (RBC) Na^+ concentrations were similar between two groups. 2) The results of oral glucose tolerance test showed no differences in the glucose and insulin area, however the incremental insulin areas of elevated group (108.8±31.3, μU. min/㎖×10²) were significantly higher compared with those of normal group (56.3±20.7 μU. min/㎖×10²). 3) In the elevated group, palmitic acid proportions of erythrocytes (22.1±0.7%) were higher than those of normal group (20.1±0.7%) and SLC Vmax showed significant correlation (r=0.81, p$lt;0.01) with palmitic acid proportion. These results suggest that the abnormal lipid metabolism may change the RBC Na^+ transport system through the alterations of RBC membrane fatty acid composition.

Zn-Fe 합금 도금강판의 점용접성에 관한 연구

민준기,신재경,안효영,서수정,서창제 成均館大學校 科學技術硏究所 1992 論文集 Vol.43 No.1

Spot welding is widely used in automobile assembly lines. Electroplating of Zn-Fe on steel sheets is increasingly used in assembly lines, because of its good spot weldability, formability and corrosion resistance. In this study, to evaluate spot weldability, tensile shear strength and cross tensile strength of steel sheets electroplated with Zn and Fe up to 0.7mm thickness were investigated, and these mechanical properties were compared with those of steel sheets electroplated with Zn only. The thickness of electroplated steel sheets was measured with SEM. The following conclusions were obtained. (1) In spot welding, the weldability lobe was getting wider and directed toward low currency direction, in steel sheets electroplated with Zn-Fe compared with those electroplated with Zn only. (2) Electrode force and welding time obviously affected the ultimate welding strength, and the range representing constant ultimate welding strength was observed. (3) When Zn-Fe were electroplated on steel sheets, the ductility ratio was increased in optimal welding condition, indicating that good weldability was obtained. (4) Around 8.5KA where optimal strength existed, by spot welding, the amount of the electroplated layer was observed to be reduced by approximately 15% in thickness.