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      • 골다공증 환자에서 Alendronate (Marvil)의 1년간 치료효과

        김효정,박지원,이수진,이관우,김현만,정윤석 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.1

        연구배경: Alendronate는 골흡수 억제작용을 가진 비스포스포네이트 제재 중 하나로 골다공증의 치료와 예방에 사용되고 있으며 골밀도를 증가시키고 골다공증으로 인한 골절의 빈도를 감소시킨다고 보고되고 있다. 방법: 본 연구는 alendronate(Marvil??)가 골다공증의 치료에 미치는 효과를 검증하기 위하여 138명의 골다공증 진단을 받은 환자를 대상으로 시작하였고 1년 후 50명에서 골대사지표와 골밀도를 추적관찰하였다. 결과: Alendronate를 1년간 투여하였을 때 혈청 ALP는 38.3% 감소하였고 요중 DPD는 40.5% 감소하였다. Alendronate를 1년간 투여하였을 때 L2-4의 평균 골밀도는 6.7% 증가하였고 대퇴골의 평균 골밀도는 20.% 증가하였다. 4명(8%)에서 1년 이내에 새로운 골절이 발생하였고 이 중 3명은 척추골절, 1명은 대퇴골절이었다. 부작용으로 투약을 중단한 환자는 8명(5.8%)이었고 이 중 7명(5.1%)이 소화기증상을 호소하였다. 결론: 이상의 결과로 골다공증 환자에서 alendronate(Marvil??)의 1년간 투여가 골밀도를 증가시킴을 알 수 있었다. Background: To evaluate the effects of alendronate in preventing bone loss at the spine and hip in Korean cases of primary osteoporosis, we treated 138 patients with 10㎎ of alendronate daily. Of the 138 patients treated, 50 were treated for one complete year, and at their final visit, measurements were taken to assess the completed outcome of reatment, and the results from this small group were compared with those of the rest. The way this has been written causes ambiguity concerning exactly who was being studied. Check that my rewrite of this section conveys correctly the group that was studied, and how. Methods: The serum levels of calcium(Ca) and phosphorous(P), total alkaline phosphatase(ALP), the urine calcium creatinine ratio(Uca/cr) and urine deoxypyridinoline(DPD) were measured before, during, and after the 1 year treatment period. The bone mineral densities(BMDs) at the spine and hip were also measured before and after the treatment period. New clinical fractures and side effects, were evaluated during the treatment period. Results: The total serum ALP and urine DPD were decreased significantly, after the treatment period, by 38.3 and 40.5% respectively. The bone mineral density at the spine and hip were significantly increase after 1 year, by 6.7 and 2.0%, respectively. Of the 50 subjects who had completed a full year of treatment, only 4(8%) had developed new clinical fractures. Of the 138 patients who had been treated, 8(5.7%) discontinued the medication due to side effects. Of these, 7 had gastrointestinal symptoms, and 1 had skin eruption. Conclusion: Alendronate significantly decreased the total serum ALP and urine DPD and significantly increase spine and hip bone mineral density. Alendronate 10㎎ was effective in preventing bone loss in Korean cases of primary osteoporosis (J Kor Soc Endocrinol 18:56∼62, 2003)

      • 한국인 제2형 당뇨병 환자의 골격근에서 인슐린 신호전달체계의 결함

        최준혁,이관우,김효정,이동훈,이종우,김정은,엄현채,김경미,최성이,정윤석,김현만 대한내분비학회 2002 Endocrinology and metabolism Vol.17 No.5

        연구배경: 제2형 당뇨병에서 나타나는 인슐린 저항성은 간, 지방, 근육 같은 말초조직에서 인슐린의 작용이 떨어지는 것을 말한다. 제2형 당뇨병의 발생기전에 인슐린 저항성과 인슐린 분비능 저하가 같이 관여함은 잘 알려진 사실이다. 인슐린의 세포내에서의 저항성을 규명하기 위한 인슐린의 세포내 신호전달체계에 대한 연구가 활발히 진행되고 있으며 몇몇 연구에서 인슐린 저항성을 가진 골격근육에서 IRS와 관련된 PI3-kinase의 활성감소와 Akt kinase의 활성감소를 보고하고 있으나 아직까지 명확하게 그 기작이 설명되어지지 않고 있다. 본 연구에서는 정상성인, 제2형 당뇨병 환자를 대상으로 경구당부하검사 및 인슐린 클램프검사를 시행하고 인슐린 클램프 검사시 대상인의 근육을 채취하여 인슐린 신호전달 체계(IR-β, IRS, Akt(PKB, Rac) kinase, GSK-3)를 연구하였다. 방법: 연구대상자는 한국인으로서 경구당부하검사상 정상인 및 당뇨병 환자 각각 11명, 9명을 대상으로 하였으며, 정상인은 건강인으로 과거력상 당대사에 영향을 줄 질환이 없고, 현재 당대사에 영향을 줄 약물 복용 및 다른 소견이 없는 경구당부하검사상 정성 내당능을 보이는 대상자로 하였다. 당뇨병환자는 모두 제2형 당뇨병 환자로 이환기간이 만 5년 이내인 경우로 하고, 인슐린으로 치료하는 대상자는 제외하도록 하였다. 대상자의 연령, 체질량지수, 체지방량, 공복시 총콜레스테롤, 중성지방, 고밀도지단백 콜레스테롤 및 HbA1c, 인슐린, C-peptide를 측정하였고, "HOMA model"을 이용하여 베타세포의 기능와 인슐린저항성 정도를 평가하였다. 정상혈당클램프 검사(euhlycemic hyperinsulinemic clamp test)를 시행하고 인슐린 투입 전과 인슐린 투입 30분후, 두차례에 걸쳐 대퇴부 근육생검을 실시한후 western 법으로 IR-β, IRS, Akt kinase, GSK-3의 인산화량을 측정하였다. 결과: 정상인 11명과 당뇨병 환자 9명을 대상으로 하였으며 대상자의 평균 연령, 평균 체질량지수, 체지방량, 허리/엉덩이 둘레의 비(waist hip ratio; WHR)는 두 군간에 차이가 없었다. 평균 공복혈당은 정상군 98.0±0.3㎎/dL, 당뇨병군 208.1±16.5㎎/dL(p<0.05), HbA1c는 정상군 5.4±0.5%, 당뇨병군 9.2±0.6%(p<0.05)였다. "HOMA model"을 이용한 베타세포의 기능과 인슐린저항성은 정상군 56.4±8.5%, 1.4±0.2, 당뇨병군 72.2±52.3%(p<0.01), 10.2±6.3(p<0.01)였으며 정상혈당클램프 검사상 포도당 이용률은 정상군 8.2±0.6㎎/㎏/min, 당뇨병군 3.7±1.1㎎/㎏/min(p<0.01)로 정상군과 당뇨병군간에 유의한 차이를 나타내었다. Western blot법으로 IR-β, IRS, Akt kinase, GSK-3의 인산화량을 인슐린 투입전과 인슐린 투입 30분후 측정하였을 때 IR-β에서는 정상군이 103.9±2.3에서 241.3±18.6, 당뇨군이 108.9±2.2에서 198.7±6.3으로 증가하였다(p=NS). 이는 인슐린 투입후 당뇨병군이 정상군과 비교하여 인산화량의 증가정도가 통계적인 차이가 없었다. IRS에서는 정상군이 111.6±7.3에서 295.6±17.2, 당뇨군이 114.5±6.1에서 222.0±23.2로 증가하였으며(p<0.05), 인슐린 투입후 당뇨병군이 정상군과 비교하여 인산화량의 증가정도가 약 24% 감소하였다. Akt kinase에서는 103.4±6.0에서 416.8±29.5로 증가하였으며(p<0.01), 인슐린 투입후 당뇨병군이 정상군과 비교하여 인산화량의 증가정도가 약 43% 감소하였다. GSK-3에서는 정상군이 107.7±6.7에서 595.7±28.1, 당뇨군이 104.3±4.8에서 443.3±12.9로 증가하였으며(p<0.01), 인슐린 투입후 당뇨병군이 정상군과 비교하여 인산화량의 증가정도가 약 25% 감소하였다. 결론: 제2형 당뇨병 환자에서 정상인과 비교하여 인슐린 자극후 IR-β는 인산화량의 증가정도가 큰 차이가 없었으나, IRS, Akt kinase, GSK-3에서는 인산화량의 증가 정도가 감소되는 것으로 보아 상위 인슐린 신호전단체계부터 결함이 있는 것으로 생각된다. Background: The glucose uptake rate is the limiting step in glucose utilization and storage. The failure of insulin to stimulate glucose uptake in muscle appears to be a primary defect of insulin resistance. This study was undertaken to examine the effect of physiological hyperinsulinemia on the phosphorylation of the insulin receptor (IR-β), insulin receptor substrate (IRS), Akt kinase and GSK-3 in isolated skeletal muscle, in people with type 2 diabetes(n=9) and control subjects(n=11). Methods: 75g OGTT and euglycemic hyperinsulinemic clamp test were done. And vastus lateralis muscle was obtained before and 30 min into the euglycemic clamp. Western blots were performed for tyrosine phosphroylation of insulin receptor substrate (IRS) and phosphorylation of the insulin receptor(IR-β), Akt and GSK-3. Result: There were no statistical differences in the mean age, BMI and body fat between the control subjects and diabetic patients. The fasting blood sugar and HbA_1c in controls and diabetic patients were 98.0±0.3 and 208.1±16.5ng/dl, and 5.4±0.5 and 9.2±0.6%, and 1.4±0.2 in the control subjects, and 72.2±52.3%(p<0.01) and 10.2±6.3(p<0.01) in the diabetic patients, respectively. The insulin resistance from the euglycemic hyperinsulinemic clamp test were 8.2±0.6㎎/㎏/min and 3.7±1.1ng/㎏/min in the control subjects and in the diabetic patients, respectively(p<0.01). Compared with the normal controls, insulin-stimulated IR phosphorylation was no different to that in the diabetic patients. However, insulin-stimulated IRS phosphorylation, insulin-stimulated Akt phosphorylation and insulin-stimulated GSK-3 phosphorylation were reduced in the diabetic patients compared with the normal controls by 24, 43 and 25%, respectively(p<0.05). Conclusion: In Korean type 2 diabetic patients, the insulin resistance may be due to the impairment of the upstream insulin signal molecular network. Further studies will focus on determining whether these signaling defects are the cause of the development of insulin resistance, or secondary to the altered metabolic state, associated with type 2 diabetes mellitus (J Kor Soc Endocrinol 17:685∼697, 2002).

      • KCI등재

        The Proximal Optimization Technique Improves Clinical Outcomes When Treated without Kissing Ballooning in Patients with a Bifurcation Lesion

        Jeong Hoon Yang,Joo Myung Lee,Taek Kyu Park,Young Bin Song,Joo-Yong Hahn,Jin-Ho Choi,Seung-Hyuk Choi,Cheol Woong Yu,Woo Jung Chun,Ju Hyeon Oh,Bon-Kwon Koo,Jin-Ok Jeong,Hyo-Soo Kim,Hyeon-Cheol Gwon 대한심장학회 2019 Korean Circulation Journal Vol.49 No.6

        Background and ObjectivesThere are limited data regarding the clinical efficacy of the proximal optimization technique (POT) in the treatment of coronary bifurcation lesions. We investigated the influence of POT on the clinical outcomes of patients with coronary bifurcation lesions. MethodsWe enrolled a total of 1,191 patients with a bifurcation lesion with a side branch (SB) diameter ≥2.5 mm treated with a drug-eluting stent from 18 centers between January 2003 and December 2009. The primary outcome was major adverse cardiac events (MACEs: cardiac death, myocardial infarction or target lesion revascularization [TLR]). We performed one-to-many (1:N) propensity score matching with non-fixed matching ratio. ResultsPOT was performed in 252 patients. During follow-up (median 37 months), the incidence of MACE was lower in the POT group than it was in the non-POT group (adjusted hazard ratio, 0.43; 95% confidence interval [CI], 0.24–0.79; p=0.006). After propensity score matching, these were 0.34; 95% CI, 0.17–0.69; p=0.003 for MACE and 0.37; 95% CI, 0.17–0.78; p=0.01 for TLR. The use of POT was associated with significantly lower TLR in patients treated without kissing ballooning, but was not in those who underwent kissing ballooning (p for interaction=0.03). ConclusionsIn coronary bifurcation lesions with a large SB, POT may be beneficial to improve long-term clinical outcome, particularly in patients treated without kissing ballooning during the procedure. Trial RegistrationClinicalTrials.gov Identifier: NCT01642992

      • SCOPUSKCI등재

        조기위암의 근치적 치료로서 내시경적 점막절제술의 유용성

        현동효 ( Hyeon Dong Hyo ),정석 ( Jeong Seog ),이진우 ( Lee Jin U ),정봉주 ( Jeong Bong Ju ),류성태 ( Lyu Seong Tae ),이창근 ( Lee Chang Geun ),김명식 ( Kim Myeong Sig ),권계숙 ( Kwon Gye Sug ),이돈행 ( Lee Don Haeng ),김범수 ( Ki 대한소화기학회 2003 대한소화기학회지 Vol.42 No.6

        Background/Aims: Endoscopic mucosal resection (EMR) has been widely accepted as a curative treatment of early gastric cancer (EGC). The aim of this study was to determine the usefulness and limitations of EMR for treatment of EGC by analyzing our own experience. Methods: We retrospectively evaluated 51 EGC lesions (45 mucosal and 6 submucosal cancers) from 49 patients who had undergone EMR between Oct. 1997 and Aug. 2002 at Inha Universtiy Hospital. Results: Among 45 lesions of mucosal cancer, enbloc resection was performed in 13 lesions and piecemeal resection in 32 lesions. Complete resection rates of enbloc and piecemeal resection were 84.6% and 43.8%, respectively (p=0.012). Complete resection rate of the lesions smaller than 1 cm in size was 71.4%, 1 to 2 cm in size 52%, and greazter than 2 cm in size 37.5%. Complete resection rates of well, moderately, and poorly differentiated EGC were 59.4%, 71.4%, and 16.7%, respectively (p=0.048). Thirty-three patients underwent a follow-up endoscopy at I month after EMR and two were found to have residual cancers. One patient who had a piecemeal EMR showed cerical and abdominal lymph node metastasis 10 months after EMR. Conclusions: In selected patients with EGC, EMR can be a curative treatment modality. However, complete resection rate is low in large sized and poorly differentiated EGCs and when piecemeal resection is performed. (Korean J Gastroenterol 2003;42:453-460)

      • KCI등재

        가스배관의 재질등급 및 충격에너지에 따른 연속연성파괴 거동분석

        정효태(Hyo-Tae Jeong),최병학(Byung-Hak Choe),이영진(Young-Jin Lee),이정화(Jeong-Hwa Lee),홍기용(Key-Yong Hong),백종현(Jong-Hyeon Baek),김우식(Woo-Sik Kim) 한국가스학회 2012 한국가스학회지 Vol.16 No.5

        가스배관 종류 및 사용 환경에 따른 거시적 파괴거동 평가해석을 위하여 1) 가스배관의 특성 및 환경에 따른 파괴거동 변화의 컴퓨터해석과 2) Battelle Two-Curve Method를 이용한 연속연성파괴거동 평가해석을 수행하였다. 새로운 사용환경의 가스와 오일의 배관계획이 진행되면서, 개선된 성능, 신뢰성, 그리고 경제성을 위한 재료가 요구되고 있다. 여기서 제시되는 연속연성파괴 해석은 높은 배관압력, 큰 배관직경과 같은 배관특성의 변화와 천연가스와 같이 다양한 성분을 함유하는 가스, 수소가스, 액화 이산화탄소 등과 같이 다양한 수송매체의 변화를 수용하기 위한 배관시스템에서 고려하여야 할 중요한 기술요소이다. To analyze the macroscopic fracture behavior as functions of the gas pipeline grade and the working environments, following analyses have been accomplished. Computer analysis of changes in fracture behaviors according to the working conditions of pipelines and Analysis of dynamic ductile fracture behaviors using the Battelle Two Curve Method. Recently, an economic and reliable pipe materials with improved performance has been needed for the severe pipeline working condition and new transporting materials. As the grade of pipe materials became higher, the possibility of dynamic ductile fracture could be increased. Therefore, the understanding of the technology to control and arrest the dynamic ductile fracture is important.

      • SCOPUSKCI등재

        육종양 병합형 간세포-담관암

        정봉주 ( Jeong Bong Ju ),현동효 ( Hyeon Dong Hyo ),이경욱 ( Lee Gyeong Ug ),류성태 ( Lyu Seong Tae ),이진우 ( Lee Jin U ),이정일 ( Lee Jeong Il ),정석 ( Jeong Seog ),이돈행 ( Lee Don Haeng ),김범수 ( Kim Beom Su ),김형길 ( Kim Hy 대한소화기학회 2004 대한소화기학회지 Vol.43 No.1

        Combined hepatocellular-cholangiocarcinoma (HCC-CC) with sarcomatoid features is an extremely rare primary liver cancer, of which only four cases have been reported. We report a case of sarcomatoid combined HCC-CC in a 60-year-old woman who complained of right upper quadrant pain and presented with a 7 cm mass in the S4 region of the liver in abdominal CT. Ultrasonography-guided needle biopsy diagnosed it as HCC, and left lobectomy of the liver followed. Microscopically, the tumor consisted of two portions: HCC portion showing trabecular pattern, which had partially sarcomatous area with spindle-shaped tumor cells, and CC portion with glandular pattern. Immunohistochemically, HCC portion reacted positively with α-fetoprotein while CC portion demonstrated positive reactivity with carcinoembryonic antigen and mucicarmine. Sarcomatoid cells reacted positively for cytokeratin. She died of tumor recurrence and hepatic failure 12 months after the operation. Combined HCC-CC has poor prognosis, and sarcomatoid HCC has high metastatic potential and poor prognosis compared with ordinary HCC. (Korean J Gastroenterol 2004;43:56-60)

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