강직성 척추염 환자에서 동반된 복부 및 가슴 대동맥류

양여리,민홍기,강주현,정승민,박성환 대한내과학회 2012 대한내과학회 추계학술발표논문집 Vol.2012 No.1

Reduction of Sulfonylurea with the Initiation of Basal Insulin in Patients with Inadequately Controlled Type 2 Diabetes Mellitus Undergoing Long-Term Sulfonylurea-Based Treatment

양여리,신정아,양혜경,이승환,고승현,안유배,윤건호,조재형 대한당뇨병학회 2016 Diabetes and Metabolism Journal Vol.40 No.6

Background: There were a limited number of studies about β-cell function after insulin initiation in patients exposed to long durations of sulfonylurea treatment. In this study, we aimed to evaluate the recovery of β-cell function and the efficacy of concurrent sulfonylurea use after the start of long-acting insulin. Methods: In this randomized controlled study, patients with type 2 diabetes mellitus (T2DM), receiving sulfonylurea for at least 2 years with glycosylated hemoglobin (HbA1c) >7%, were randomly assigned to two groups: sulfonylurea maintenance (SM) and sulfonylurea reduction (SR). Following a 75-g oral glucose tolerance test (OGTT), we administered long-acting basal insulin to the two groups. After a 6-month follow-up, we repeated the OGTT. Results: Among 69 enrolled patients, 57 completed the study and were analyzed: 31 in the SM and 26 in the SR group. At baseline, there was no significant difference except for the longer duration of diabetes and lower triglycerides in the SR group. After 6 months, the HbA1c was similarly reduced in both groups, but there was little difference in the insulin dose. In addition, insulin secretion during OGTT was significantly increased by 20% to 30% in both groups. A significant weight gain was observed in the SM group only. The insulinogenic index was more significantly improved in the SR group. Conclusion: Long-acting basal insulin replacement could improve the glycemic status and restore β-cell function in the T2DM patients undergoing sulfonylurea-based treatment, irrespective of the sulfonylurea dose reduction. The dose reduction of the concurrent sulfonylurea might be beneficial with regard to weight grain.

Refractory Graves’ Disease Successfully Cured by Adjunctive Cholestyramine and Subsequent Total Thyroidectomy

양여리,황세원,김민지,임예지,김민희,이소희,임동준,강무일,차봉연 대한내분비학회 2015 Endocrinology and metabolism Vol.30 No.4

The three major forms of treatment for Graves thyrotoxicosis are antithyroid drugs, radioactive iodine therapy and thyroidectomy. Surgery is the definitive treatment for Graves thyrotoxicosis that is generally recommended when other treatments have failed or are contraindicated. Generally, thyrotoxic patients should be euthyroid before surgery to minimize potential complications which usually requires preoperative management with thionamides or inorganic iodine. But several cases of refractory Graves’ disease have shown resistance to conventional treatment. Here we report a 40-year-old female patient with Graves’ disease who complained of thyrotoxic symptoms for 7 months. Her thyroid function test and thyroid autoantibody profiles were consistent with Graves’ disease. One kind of thionamides and β-blocker were started to control her disease. However, she was resistant to nearly all conventional medical therapies, including β-blockers, inorganic iodine, and two thionamides. She experienced hepatotoxicity from the thionamides. What was worse is her past history of serious allergic reaction to corticosteroids, which are often used to help control symptoms. A 2-week regimen of high-dose cholestyramine improved her uncontrolled thyrotoxicosis and subsequent thyroidectomy was successfully performed. In conclusion, cholestyramine could be administered as an effective and safe adjunctive agent for preoperative preparation in patients with severe hyperthyroid Graves’ disease that is resistant to conventional therapies.

Cardiovascular Autonomic Neuropathy Predicts Higher HbA1c Variability in Subjects with Type 2 Diabetes Mellitus

양여리,이은영,조재형,박용문,고승현,윤건호,강무일,차봉연,이승환 대한당뇨병학회 2018 Diabetes and Metabolism Journal Vol.42 No.6

Background: This study aimed to investigate the association between the presence and severity of cardiovascular autonomic neuropathy (CAN) and development of long-term glucose fluctuation in subjects with type 2 diabetes mellitus. Methods: In this retrospective cohort study, subjects with type 2 diabetes mellitus who received cardiovascular autonomic reflex tests (CARTs) at baseline and at least 4-year of follow-up with ≥6 measures of glycosylated hemoglobin (HbA1c) were included. The severity of CAN was categorized as normal, early, or severe CAN according to the CARTs score. HbA1c variability was measured as the standard deviation (SD), coefficient of variation, and adjusted SD of serial HbA1c measurements. Results: A total of 681 subjects were analyzed (294 normal, 318 early, and 69 severe CAN). The HbA1c variability index values showed a positive relationship with the severity of CAN. Multivariable logistic regression analysis showed that CAN was significantly associated with the risk of developing higher HbA1c variability (SD) after adjusting for age, sex, body mass index, diabetes duration, mean HbA1c, heart rate, glomerular filtration rate, diabetic retinopathy, coronary artery disease, insulin use, and antihypertensive medication (early CAN: odds ratio [OR], 1.65; 95% confidence interval [CI], 1.12 to 2.43) (severe CAN: OR, 2.86; 95% CI, 1.47 to 5.56). This association was more prominent in subjects who had a longer duration of diabetes (>10 years) and lower mean HbA1c (<7%). Conclusion: CAN is an independent risk factor for future higher HbA1c variability in subjects with type 2 diabetes mellitus. Tailored therapy for stabilizing glucose fluctuation should be emphasized in subjects with CAN.

High-Density Lipoprotein Cholesterol and the Risk of Myocardial Infarction, Stroke, and Cause-Specific Mortality: a Nationwide Cohort Study in Korea

양여리,한경도,박상현,김미경,윤건호,이승환 한국지질동맥경화학회 2021 지질·동맥경화학회지 Vol.10 No.1

Objective: We aimed to investigate the relationship between high-density lipoprotein cholesterol (HDL-C) level and the risk of myocardial infarction (MI), stroke, and cause-specific mortality. Methods: Using the Korean National Health Insurance Service-National Sample Cohort, we identified 343,687 subjects (men, 176,243; women, 167,444) aged ≥20 years who underwent health examinations between 2009 and 2012. HDL-C levels were categorized based on the concentration with 10 mg/dL intervals, starting from levels <30 mg/dL, with levels ≥90 mg/dL considered the highest. The endpoints of the study were newly-diagnosed MI, stroke, or mortality. We used the Cox proportional hazards model with restricted cubic splines. Results: During a median follow-up of 6.0 years, the number of cases of death, MI, and stroke were 6,617, 4,064, and 3,435 in men and 3,677, 2,804, and 2,891 in women, respectively. The risk of all-cause mortality, cancer mortality, other mortality, and stroke was the lowest at HDL-C concentrations of 57–76 mg/dL in the spline curves; inverse associations with increased risk were observed at the lower HDL-C levels. In contrast, the lowest risk of cardiovascular mortality and MI was observed at the extreme high end. In men, there was a significant inverse and graded increase in hazard ratios of all outcomes in the lower HDL-C categories compared to the reference group (50–59 mg/dL). In the higher HDL-C categories, no significant increase in outcomes was observed. Women showed similar trends. Conclusion: The risk of mortality, MI, and stroke was high at low HDL-C levels in the Korean general population. However, extremely high HDL-C levels were not associated with an increased risk of mortality, MI, and stroke.

Higher Weight Variability Could Bring You a Fatty Liver

양여리,조재형 대한내분비학회 2021 Endocrinology and metabolism Vol.36 No.4

노인정 봉사학습이 초등 통합교육 환경의 장애학생과 비장애학생에게 미친 영향

양여경(Yang, Yeo Kyung),박승희(Park, Seunghee) 이화여자대학교 특수교육연구소 2014 특수교육 Vol.13 No.2

본 연구는 초등 통합교육 환경에서 장애학생과 비장애학생의 교육적 요구를 병합한 노인정 봉사학습(service learning) 프로그램을 개발하여 장애학생을 ‘봉사제공자’로서 비장애학생과 동등하게 봉사학습에 참여하게 하고, 장애학생과 비장애학생을 대상으로 그 교육적 효과를 밝히는 것이 목적이다. 노인정 통합적 봉사학습(inclusive service learning)이 학생에게 미친 영향에 대해 인성적 측면에서는 장애학생과 비장애학생의 친사회적 행동, 학업적 측면에서는 장애학생과 비장애학생의 화폐관리 기술, 사회적 측면에서는 장애학생에 대한 비장애학생의 태도를 알아보았다. 본 연구의 참여자는 서울특별시 소재 초등학교 2개교의 3, 4학년 장애학생 8명, 비장애학생 22명이다. 사전-사후검사 통제집단 설계를 사용하여 15명의 실험집단 학생들(장애학생 4명, 비장애학생 11명)에게 노인정 봉사학습 프로그램을 총 17회기 제공하였다. 본 연구의 결과는 첫째, 노인정 봉사학습에 참여한 실험집단의 장애학생들은 통제집단에 비해 친사회적 행동이 더 큰 폭으로 향상되었으며, 실험집단 비장애학생들 또한 친사회적 행동에서 유의한 향상을 보였다. 둘째, 실험집단의 장애학생들은 통제집단의 장애학생들에 비해 화폐관리 기술이 더 큰 폭으로 향상되었으며, 실험집단 비장애학생들 또한 화폐관리 기술에서 유의한 향상을 보였다. 셋째, 실험집단의 비장애학생들은 장애학생에 대한 태도에서 통제집단의 비장애학생들에 비해 통계적으로 유의한 향상을 보였다. 본 연구는 일상적인 봉사활동이 아닌 ‘봉사학습’에 주목하여 초등 통합교육 환경에서 봉사학습의 교육적 효과를 장애학생과 비장애학생을 대상으로 검증하고 긍정적 성과를 양적 자료로 보고하는 첫 번째 예비연구라는 점에서 의의를 가진다. 본 연구의 제한점과 더불어 학교현장에서 봉사학습의 보다 활발한 적용을 위한 제언이 제시되었다. The purpose of this study is to examine the effects of an inclusive service-learning program of visiting senior citizen’s centers on the elementary students’ prosocial behaviors, money management skills and attitudes toward students with disabilities. The participants in this study were 30 students in the 3rd and 4th grades of two inclusive elementary schools. Both experimental and control group consisted of 15 students(4 students with disabilities and 11 students without disabilities) of the School A and B located in Seoul. The program, visiting two senior citizen’s centers located near to the School A, was carried out with 17 sessions on every Saturday. In this study, a pretest-posttest control-group experimental design was used. Prosocial behaviors, money management skills of all participating students, and attitudes toward students with disabilities of students without disabilities were measured before and after the service learning program. The results of this study were as follows: Firstly, the students with disabilities in the experimental group showed higher improvement in the prosocial behaviors than those in the control group. And the students without disabilities in the experimental group showed significantly higher improvement in the prosocial behaviors than those in the control group. Secondly, the students with disabilities in the experimental group showed higher improvement in the money management skills than those in the control group. And the students without disabilities in the experimental group showed significantly higher improvement in the money management than those in the control group. Lastly, the students without disabilities in the experimental group showed significantly higher improvement in their attitudes toward students with disabilities than those in the control group. The results of this study suggest that an inclusive service-learning program is an effective method to improve the students" prosocial behaviors, money management skills, and positive attitudes toward students with disabilities in an inclusive elementary school.

지적장애를 가진 부모를 위한 자녀 양육지원 프로그램의 최선의 실제: 2000-2020년 선행연구 분석

양여경(Yang, Yeo Kyung),박승희(Park, Seung Hee) 한국장애인복지학회 2021 한국장애인복지학 Vol.51 No.51

본 연구의 목적은 ‘지적장애를 가진 부모’(이하 ’지적장애 부모‘)를 위한 자녀 양육지원 프로그램에 관한 국내외 연구동향 및 프로그램 특성을 분석하고, 양질의 양육지원 프로그램의 개발 및 실행을 위한 ‘최선의 실제’(best practices) 요소를 제시하는 것이다. 지적장애 부모를 위한 양육지원 프로그램에 대한 지난 20년간(2000-2020년)의 국내외 선행연구 중 총 18편(국내4편, 국외14편)이 채택되어 전반적인 연구동향과 양육지원 프로그램의 특성이 분석되었으며 이를 통해 지적장애 부모의 자녀 양육지원 프로그램의 최선의 실제 요소 6가지가 다음과 같이 추출되었다: (1)양육에 영향을 미치는 다양한 사회생태학적 요인의 반영; (2)개별가정의 맥락을 고려한 지원의 우선순위 판별; (3)지적장애 부모를 위한 사회적 지원의 중요성 반영; (4)개별가정 중심의 양육지원 프로그램의 실행; (5)효과적인 교수전략 및 자료의 선정 및 수정; (6)비공식적 지원 및 자연적 지원 활성화를 위한 주변인과의 협력. 본 연구결과로 판별된 최선의 실제 6가지 요소가 실행되는 맥락 조성에 기여할 지적장애 부모를 위한 양육지원 활성화 방안을 논의하였다. 본 연구는 지적장애 부모의 자녀양육 관련 긍정적 관심과 연구가 부족한 국내 상황에서 지난 20년간 국내외에서 출판된 양육지원 프로그램에 대한 문헌연구를 기초로 최선의 실제 요소를 판별하였으며 지적장애 부모의 자녀 양육지원에서의 질적 향상과 후속연구 및 정책적 지원을 촉구하며 양육지원 활성화 방안을 제안하였다는 점에서 의의를 지닌다. The purpose of this study was to conduct a systematic review of the articles on parenting support programs for the parents with intellectual disabilities(ID) and to identify the best practices for the parenting support programs. Through analyzing the eighteen studies selected based on the eligibility criteria published during the last 20 years(from 2000 to 2020), six factors of the best practices in parenting support programs for the parents with ID were derived as follows: (1)reflecting the various social-ecological factors that have an effect on parenting; (2)identifying the priority of supports considering the individual family’s contextual fit; (3)reflecting the importance of social supports for the parents with ID; (4)implementing the individual family-based support programs; (5)identifying and adaptation of the effective instructional strategies and materials; (6)collarboration with significant others for providing informal supports and natural supports. Based on these findings, future directions for promoting the parenting supports for the parents with ID were discussed. This study is the first systematic literature review on parenting support programs for the parents with ID and is significant in suggesting the six factors of the best practices and ways to promote the quality parenting supports for the parents with ID in Korea.

아미노기를 도입한 Microcrystalline Cellulose(MCC)를 충전제로 사용한 PU 복합체 제조 및 물성 연구

양여경(Yeokyung Yang),김한나(Hanna Kim),임광희(Kwang-Hee Lim),하기룡(KiRyong Ha) 한국고분자학회 2018 폴리머 Vol.42 No.1

본 연구에서는 생분해성인 미세결정셀룰로오스(MCC) 분말 표면을 3-aminopropyltriethoxysilane(APS)를 사용하여 실란화 반응으로 표면에 -NH2기를 도입하였다. 개질된 MCC(MCC-APS)를 충전제로 사용하여, poly(tetrahydrofuran) (PTHF, Mw= ~1000 g/mol)에 투입하여 분산시킨 후, 4,4"-methylenebis(phenyl isocyanate)(MDI)와 반응시켜 prepolymer를 제조하고, 사슬 연장제인 1,4-butanediol(1,4-BD)와 반응시켜 폴리우레탄(PU) 복합체를 제조하였다. MCC-APS 충전제가 PU의 열적 및 기계적 물성에 미치는 영향은 열 중량 분석기(TGA), 만능재료시험기(UTM) 및 동적기계적분석기(DMA)로 각각 분석하였다. 또한 충전제와 PU 매트릭스 계면에서의 결합 상태는 주사전자현미경(SEM)을 사용하여 측정하였다. MCC-APS 충전제의 함량이 증가함에 따라, PU 복합체의 탄성률은 크게 증가하고, 파단연신율은 크게 감소하였다. 이는 MCC-APS 충전제와 PU 매트릭스 계면에서 강한 우레아 결합 생성 때문으로 판단된다. In this study, the surface of biodegradable microcrystalline cellulose (MCC) powder was modified with 3-aminopropyltriethoxysilane (APS) to introduce -NH2 functional groups on the surface by silanization. After mixing APS modified MCC (MCC-APS) powders in poly(tetrahydrofuran) (PTHF, Mw= ~1000 g/mol), they were reacted with 4,4"-methylenebis(phenyl isocyanate) (MDI) to make prepolymers, and chain-extended with 1,4-butanediol (1,4-BD) to prepare polyurethane (PU) composites. The effect of MCC-APS fillers on various properties of PU composites were studied using thermogravimetric analyzer (TGA), universal testing machine (UTM) and dynamic mechanical analyzer (DMA). The interfacial binding between MCC-APS and PU matrix was characterized by scanning electron microscope (SEM). We observed significant increase in tensile moduli and significant decrease in elasticity with increasing MCC-APS contents in PU composites, due to the strong urea bond formation at the interface between the MCC-APS and the PU matrix.

CO₂ 흡착 충전제 제조를 위한 microcrystalline cellulose (MCC) 입자 표면개질연구

양여경 ( Yeokyung Yang ),박성환 ( Seonghwan Park ),김한나 ( Hanna Kim ),황기섭 ( Ki-seob Hwang ),하기룡 ( Kiryong Ha ) 한국화학공학회 2017 Korean Chemical Engineering Research(HWAHAK KONGHA Vol.55 No.1

In this study, we performed surface modification of biodegradable microcrystalline cellulose (MCC) to use as a filler in polyethylene (PE) composite in food packaging application. We modified MCC surface with (3-trimethoxysilylpropyl) diethylenetriamine (TPDT) silane coupling agent, which has one primary amino group and two secondary amino groups per molecule, to introduce amino groups with a carbon dioxide adsorption capability in MCC. Effects of each of the reaction conditions such as amount of TPDT introduced, swelling time, reaction temperature, and reaction time on surface modification degree of MCC were investigated by changing a variety of above reaction conditions. The amount of TPDT grafted on MCC surface and formation of chemical bonds were confirmed by Fourier transform infrared spectroscopy (FT-IR), elemental analysis (EA), X-ray photoelectron spectroscopy (XPS), thermogravimetric analysis (TGA) and solid state ²⁹Si nuclear magnetic resonance (NMR) spectroscopy. We confirmed increase of grafted amount of TPDT on MCC with increasing reaction time, reaction temperature, and amount of introduced TPDT.