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소의 대동맥 내피세포에서 산화저밀도 지단백에 의한 아포프토시스에 백일해 독소 및 콜레라 독소가 미치는 영향
손호영(Ho Young Son),강성구(Sung Ku Kang),강무일(Moo Il Kang),차봉연(Bong Youn Cha),이광우(Kwang Woo Lee),장상아(Sang Ah Chang),최윤희(Yoon Hee Choi),문성대(Sung Dae Moon),안유배(Yoo Bae Ahn),손현식(Hyun Sik Son),윤건호(Kun Ho Yoon) 대한내과학회 1999 대한내과학회지 Vol.56 No.5
N/A Objectives : Oxidized LDL is thought to play a key role in atherogenesis. Among their wide variety of biological properties, oxidized LDL injures the endothelium as an early event of atherogenesis. However, the mechanisms by which oxidized LDL injures endothelial cells are not definitely known. In order to evaluate the involvement of GTP-binding protein on the mechanism of apoptosis, we studied the effects of pertussis and cholera toxin on oxidized LDL-induced apoptosis in bovine aortic endothelial cells(BAECs). Methods : Oxidized LDL elicited apoptosis in cultured BAECs as shown by characteristic morphological and biochemical changes. Chromatin condensation and nucleus fragmentation were visualized by using fluorescence microscopy of intact cells staining by acridine orange/ ethidium bromide. DNA fragmentation was quantified by an ELISA with specific antibody for bromodeoxyuridine- labelled DNA fragments and confirmed with DNA ladder formation. Results : Studies using a combination of bacterial toxins which change the function of GTP-binding protein suggest that oxidized LDL-induced apoptosis was regulated by GTP-binding protein. Oxidized LDL-induced apoptosis was not changed by pretreatment of BAECs with pertussis toxin. In contrast, pretreatment with cholera toxin completely prevented the oxidized LDL- induced apoptosis. Conclusion : These results show that oxidized LDL induces apoptosis of BAECs and suggest that cholera toxin-sensitive G-proteins are involved in signal transduction of oxidized LDL-induced apoptosis of BAEC.
제2형 남자 당뇨병환자에서 비만과 비비만에 따른 아디포넥틴의 혈중 농도와 다중결합체의 차이
장상아 ( Sang Ah Chang ),손호영 ( Ho Young Son ),이정민 ( Jung Min Lee ),손태서 ( Tae Seo Sohn ),권혁상 ( Hyuk Sang Kwon ),손현식 ( Hyun Shik Son ),윤건호 ( Kun Ho Yoon ),김희승 ( Hee Seung Kim ),차봉연 ( Bong Yun Cha ),이광우 ( K 대한당뇨병학회 2007 Diabetes and Metabolism Journal Vol.31 No.3
3, 4, 6번 뇌신경이 동시에 마비된 당뇨병성 다발성 뇌 신경병증 1예
반태현 ( Tae Hyun Ban ),장상아 ( Sang Ah Chang ),이정민 ( Jung Min Lee ),김지현 ( Ji Hyun Kim ),김지혜 ( Ji Hye Kim ),노지웅 ( Ji Woong Roh ),김경훈 ( Kyung Hoon Kim ) 대한내과학회 2014 대한내과학회지 Vol.87 No.1
당뇨병 환자에서 다발성 뇌신경병증은 매우 드문 질환이다. 이는 다른 원인으로 인한 질환을 배제함으로써 당뇨병성 신경병증의 하나로 진단할 수 있다. 저자들은 갑작스런 복시와 어지럼 및 외안근 마비를 보이는 73세의 당뇨병 환자에서 생긴, 다발성 뇌신경병증을 경험하여 문헌고찰과 함께 보고한다. Multiple simultaneous cranial neuropathies occur rarely in diabetes patients. In general, diabetic cranial neuropathy presents in an isolated form and frequently involves oculomotor or facial nerves. We report a 73-year-old man with known type 2 diabetes mellitus who presented with severe dizziness, diplopia and third, fourth and sixth nerve ophthalmoplegia of both eyes. Radiological, laboratory and ophthalmic work-up including magnetic resonance imaging and angiography (MRI and MRA) revealed no specific tumor, aneurysm, or inflammation findings, except for a previous cerebral infarction and atherosclerotic changes in the internal carotid and vertebral arteries. After strict blood glucose control, the multiple cranial nerve palsies spontaneously resolved in 12 weeks. We report the case with a review of the literature. (Korean J Med 2014;87:92-95)
당뇨병 교육이 환자의 혈당 조절과 자가 관리에 미치는 영향
김지현 ( Ji Hyun Kim ),장상아 ( Sang Ah Chang ) 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.6
연구배경: 당뇨병은 지속적인 치료와 자기관리가 필요한 질환으로 이를 위한 효과적인 자가 관리의 강화와 당뇨병 교육이 중요하다. 현재 시행되고 있는 당뇨병 교육이 환자의 혈당 조절과 자가 관리 및 자아 효능감에 미치는 영향을 알아보고자 하였다. 방법: 2007년 1월부터 12월까지 당뇨병을 처음 진단받거나 당뇨병으로 치료하던 중 혈당 조절이 불량하여 당뇨병 교육을 받도록 한 592명의 환자 중에서 2008년 4월부터 7월까지 당뇨병 교육에 대한 설문 조사에 참여하고 임상 검사를 시행한 117명을 대상으로 하였다. 이들은 각각 교육받지 않은 군(비교육군, 23명)과 교육을 1회 이상 받은 군(교육군, 94명)으로 나누어 당뇨병의 자가 관리와 당뇨병에 대한 지식, 자기 효능감을 설문지를 이용하여 조사하였으며 임상적 검사 지표로는 당화혈색소, 혈당, 지질수치를 사용하였다. 결과: 당뇨병 교육군에서 비교육군에 비해 당화혈색소 감소치가 유의하게 높았다(P=0.039). 또한, 당뇨병 교육군에서 비교육군보다 당뇨병 지식 평가 점수가 유의하게 높았으나(P=0.005). 이러한 효과는 자가 관리와 당뇨병 치료에 대한 자아 효능감에는 반영되지 않았다. 결론: 당뇨병 교육군에서 혈당과 지질 수치가 향상되는 빈도와 당뇨병에 대한 지식수준이 높았다. 그러나 당뇨병 교육이 당뇨병의 자가 관리 및 효능감에 미치는 영향은 미미하게 나타났다. 그러므로, 실제 행동으로 실천할 수 있고 자아 효능감을 증진시킬 수 있는 효율적인 교육 방법의 개발이 필요하다. Background: Diabetes mellitus is a chronic disease requiring continuous treatment and vigorous self-management. Reinforcement of effective self management and diabetes education are important factors in successful treatment. The aim of this study was to evaluate the effectiveness of the current diabetes education program on blood glucose control, self-management, and self-efficacy of patients with type 2 diabetes mellitus. Methods: A total of 592 patients with newly diagnosed or uncontrolled type 2 diabetes mellitus were recruited to the diabetes education program from January to December 2007. We surveyed 338 patients from April to July 2008. A total of 117 patients had biochemical examinations and completed a questionnaire about knowledge, self-management and self-efficacy of diabetes treatment (no education group (n=23), education group (n=94)). Results: The total scores from the questionnaires and the results of laboratory data showed no differences between the two groups. However, there were significant reductions in hemoglobin A1c level in the education group, as compared with the no education group (P=0.039). Although the score for knowledge about diabetes mellitus was significantly higher in the education group (P=0.005), greater knowledge was not reflected in the self-management or self-efficacy of the patients. Conclusion: The current diabetes education program had no effect on the self-management or self-efficacy of patients with diabetes, although did show some degree of association with blood glucose control and diabetes knowledge level. We conclude that a more effective diabetes education program needs to be developed and applied to daily practice for the improvement of self-efficacy in patients with diabetes mellitus. (Korean Diabetes J 33:518-525, 2009)
수술적 치료를 받은 갑상선질환의 임상적 고찰 - 1988 년부터 1992 년까지 갑상선 수술의 경향 -
김형근(Hyung Keun Kim),문성대(Sung Dae Moon),장상아(Sang Ah Chang),안유배(Yoo Bae Ahn),송기호(Ki Ho Song),한제호(Je Ho Han),유순집(Soon Jip Yoo),이종민(Jong Min Lee),손현식(Hyun Sik Son),윤건호(Kun Ho Yoon),강무일(Moo Il Kang),차봉연(Bo 대한내과학회 1998 대한내과학회지 Vol.55 No.6
N/A Objectives: The thyroid disease is the common form of endocrine diseases, which often requires surgical management. Recently, fine needle aspiration biopsy is widely used preoperatively. As a result, some studies show that numbers of thyroid operation have decreased significantly. We performed this study to analyze the clinical features of thyroid diseases and the trend of thyroid operation in Korea. Methods: We reviewed medical records of 1787 cases with thyroid diseases who were managed surgically in Catholic Medical Center, Korea from 1988 to 1992. Results: 1) The percentage of thyroid diseases in total cases undergoing operation in Department of General Surgery was 3%, which tended to decrease with time. 2) 72.9% of thyroid diseases was benign. Among them, the frequency of nodular hyperplasia and follicular adenoma were 67.5% and 18.4%, respectively. 3) The percentage of thyroid cancers in thyroid diseases was 27.1%, which tended to increase with time. The frequency of papillary adenocarcinoma was 78.6%, follicular adenocarcinoma 18.2% and medullary carcinoma 1.5%. 4) Thyroid cancers were most commonly found in the forty and sixty decades. Male: female ratio was 1:8.5. 5) 7.6% of thyroid cancers was accompanied by benign thyroid diseases which were mostly nodular hyperplasia and follicular adenoma. 6) The most common type of operation was lobectomy(82.5%) in benign thyroid diseases, and total thyroidectomy(47.1%) and lobectomy(41.1%) in thyroid cancers. 7) Fine needle aspiration biopsy was performed in 51.7% of thyroid nodules, the frequency of which tended to increase with time. The sensitivity, specificity, false negative rate and false positive rate of this test were 78.3%, 89.4%, 13.7% and 17.2%, respectively. Conclusion: With the use of fine needle aspiration biopsy, numbers of thyroid operation decreased and the percentage of thyroid cancers in thyroid operation increased.
제2형 당뇨병환자에서 일회뇨 알부민-크레아티닌 비와 24시간 뇨 알부민 배설량과의 관련성
이지인 ( Jee In Lee ),권혁상 ( Hyuk Sang Kwon ),오수진 ( Su Jin Oh ),이정민 ( Jung Min Lee ),장상아 ( Sang Ah Chang ),차봉연 ( Bong Yun Cha ),손현식 ( Hyun Shik Son ),손태서 ( Tae Seo Sohn ) 대한당뇨병학회 2009 Diabetes and Metabolism Journal Vol.33 No.4
연구배경: 미세알부민뇨는 당뇨병성 신증의 선별검사로 이용될 뿐만 아니라 심혈관질환의 예측인자 중 하나이다. 미세알부민뇨는 24시간 알부민 요배설량(AER)을 측정하거나 일회뇨 알부민-크레아티닌 비(ACR)로 측정할 수 있다. 본 연구에서는 제2형 당뇨병환자를 대상으로 AER과 ACR의 상관관계 및 ACR의 기준치을 알아보고자 하였다. 방법: 가톨릭대학교 의정부성모병원에 2006년 3월부터 2008년 2월까지 입원한 제2형 당뇨병환자를 대상으로 AER과 ACR을 측정하였다. 결과: 전체 대상 환자는 310명 이었고, 미세알부민뇨와 거대알부민뇨의 빈도는 각각 25.4%, 15.8%였다. 전체 대상 환자들에서 AER과 ACR은 상관계수(R)가 0.8인 양의 상관관계에 있었고, 거대알부민뇨보다 미세알부민에서 뚜렷한 상관관계를 보였다. 본 연구에서 AER과 ACR의 회귀방정식과 ROC 곡선에서 나온 가장 적절한 ACR의 기준치는 31.2 μg/mg였다. 결론: ACR과 AER은 뚜렷한 양의 상관관계에 있었고, 특히 미세알부민뇨에서 양의 상관관계를 보였다. 따라서 미세알부민뇨의 선별검사로서 ACR은 AER을 대치할 수 있다. 본 연구에서 제2형 당뇨병환자의 미세알부민뇨의 기준치는 31.2 μg/mg이었으나, 이 수치를 적용하기 위해서는 입원환자 대상이 아닌 외래 환자를 대상으로 한 추가적인 연구가 필요하리라 생각된다. Background: Measuring urine albumin in diabetic patients is an important screening test to identify those individuals at high risk for cardiovascular disease and the progression of kidney disease. Recently, spot urine albumin-to-creatinine ratio (ACR) has replaced 24 hour-collected urine albumin excretion rate (AER) as a screening test for microalbuminuria given its comparative simplicity. The purpose of the current study was to evaluate the degree of correlation between AER and ACR in the normal, microalbuminuric and macroalbuminuric ranges, and to identify the lower limits of ACR for both genders. Methods: A total of 310 type 2 diabetics admitted to one center were enrolled in the present study. Following the collection of a spot urine sample, urine was collected for 24 hours and albumin content was measured in both specimens. Results: Mean patient age was 60.2 years. A total of 25.4% had microalbuminuria and 15.8% had macroalbuminuria. The data revealed a strongly positive correlation between AER and ACR across all ranges of albuminuria (R=0.8). The cut-off value of ACR for 30 mg/day of AER by the regression equation was 24 μg/mg for men, 42 μg/mg for women and 31.2 μg/mg for all patients. The diagnostic performance expressed as the area under the curve (AUC) was 0.938 (95% CI, 0.911-0.965) for ACR. ACR revealed a sensitivity of 84% and specificity of 84%, when a cut-off value of 31.2 μg/mg was employed. Conclusion: ACR was highly correlated with AER, particularly in the range of microalbuminuria. The gender combined cut-off value of ACR in type 2 diabetic patients was determined to be 31.2 μg/mg However, additional studies of large outpatient populations, as opposed to the inpatient population used in the present study, are required to confirm the utility of this value. (Korean Diabetes J 33:299-305, 2009)
증례 : 내분비-대사: 요근농양과 십이지장누공을 동반한 부신결핵에 의한 애디슨병 1예
정형석 ( Hyeong Seok Jeong ),신윤영 ( Yune Young Shin ),김지현 ( Ji Hyun Kim ),이정민 ( Jung Min Lee ),장상아 ( Sang Ah Chang ) 대한내과학회 2016 대한내과학회지 Vol.90 No.4
본 증례에서 80세 남자에서 부신결핵으로 발생한 애디슨병의 1년 동안 경과 및 치료를 보고하였다. 적절한 결핵약과 부신피질 호르몬 보충에도, 부신결핵종이 요근의 농양과 십이지장으로 누공을 형성하였고, 이의 악화에 따른 호르몬 용량 증가도 필요하였다. 급성 부신결핵으로 인한 애디슨병은 빠른 진단과 치료뿐만 아니라, 면밀한 임상증상 관찰과 주기적인 영상 검사를 통하여 결핵종의 변화 및 그에 상응하는 호르몬 치료를 적절히 조정하여야 될 것이다. An 80-year-old male with nausea and poor oral intake was referred for evaluation of hyponatremia. Primary adrenal insufficiency was diagnosed by a rapid adrenocorticotropic hormone (ACTH) stimulation test. The cause of the adrenal insufficiency was revealed to be adrenal tuberculosis presenting as a bilateral adrenal mass on computed tomography imaging. During the first few months of treatment, the size of the tuberculous mass increased and spread to an adjacent area, and further adrenal hormone replacement was needed. In addition, there was a newly developed tuberculous abscess in a nearby psoas muscle with a duodenal fistula. Thus, we report a case of a long-term clinical course of Addison`s disease with changes in hormone replacement as a result of active adrenal tuberculosis, together with a review of the literature. (Korean J Med 2016;90:351-356)