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).

개의 췌도분리에서 췌장의 팽창과 콜라겐 분해요소

이상훈,김성주,박정환,김종성,오승훈,한진수,정인경,양태영,김동준,김광원,이문규,민용기,이명식,정재훈,함종렬 대한당뇨병학회 2000 Diabetes and Metabolism Journal Vol.24 No.2

Backgrounds: One of the main problems conditioning the outcome of islet transplantation is the ability to separate a sufficient number of viable islets with preserved function. Islet purification is critically affected by all of the isolation stages. Thus, it is necessary to set up the standard isolation method that islets are separate well from acinar without compromising islet yield and viability. Methods: Twenty three adult mongrel dogs were used for the experiment of total pancreatectomy with islet isolation. The islets were properly isolated by a modified Recordi method. The obtained islets were further purified by centrifugation on discontinuous gradients using cell separation system (Model 2991, Cobe, Lakewood Colo). We evaluated islet number (islet equivalent number, 150 um equivalents/kg of recipient body weight, IEq/kg), purity, cell volume, viabilty, recovery rate, and comparison of outcome according to the isolation conditions. Results: 1) The mean of islet numbers before purification were 13543±9431Eq/kg, digestion times were 13.8±2.6 min., digestion temperature was 37.4±0.2℃, purity was 59.7?.0%, viability was 90.0±2.1%, cell volume was 4.7±1.1 mL, islet number after purification were 4064±361 IEq/kg, and recovery rate was 29±2.9%. 2) Isolated islet numbers were different according to the degree of pancreas distension with collagenase, digestion temperature, and digestion time. 3) The best conditions for islet isolation were above 37.5℃ in temperature at recirculation of collagenase, within 12 min in digestion time and well distended pancreas with collagenase. 4) According to multiple regression adjusted by variable factors, the degree of pancreas distension with collagenase and digestion time were independently associated factors for successful islet isolation. Conclusions: In this study, we concluded that the degree of pancreas distension with collagenase and digestion time were independent factors for successful islet isolation and the best conditions for islet isolation were above 37.5℃ in temperature at recirculation of collagenase, within 12 min in digestion time and well distended pancreas with collagenase.

응집공정에 적합한 In-Line 정적혼화기를 이용한 혼화공정의 개선

정철우,강민수,최시환,정수일,손인식,강임석 대한상하수도학회 2003 상하수도학회지 Vol.17 No.3

The rapid mixing process for coagulation is a critical component in a water treatment plant. However, at the present time a detailed understanding of the rapid mixing by in-line mixer or generally accepted criteria for the design of in-line static mixer are not available. The aim of this work is therefore to improve the understanding of how the in-line static mixer works and how to better utilize it in coagulation process in water treatment. To investigate the performance of static mixer, coagulation experiments were conducted to compare the static mixer to the traditional backmixer under several coagulation conditions. Experiments were also performed to compare the coagulation efficiency of different mixing type of static mixer which were made using different flow rates and the number of elements equipped in a pipe. The static mixer performed better than the backmixer for all coagulation and mixing conditions tested. Especially, the static mixer was very effective in the surface charge neutralization, as showing higher reduction of negative charge with increasing mixing intensity. However, little difference was observed in the performance of the static mixer equipped with 2, 3, and 5 elements. Also, in a series of bench-scale studies of rapid mixing, the in-line static mixer performed better than the traditional backmixer for both adsorption and charge neutralization (A/N) mechanism and sweep coagulation mechanisms. Especially, the static mixer was more efficient at producing A/N mechanism conditions as a result of its fast and uniform dispersion of the coagulant.

지리산 세석지역 구상나무 임분의 생태적 특성

조민기(Cho, Min-Gi),정재민(Chung, Jae-Min),김태운(Kim, Tae-Woon),김충열(Kim, Chung-Yeol),노일(Noh, Il),문현식(Moon, Hyun-Shik) 한국기후변화학회 2015 한국기후변화학회지 Vol.6 No.4

복강내 Cisplatin 주입요법에 의한 악성 복수 조절

정진민(Jin Min Chung),문한림(Han Lim Moon),홍영선(Young Seon Hong),박동준(Dong Jun Park),김훈교(Hoon Kyo Kim),이경식(Kyung Shik Lee),김동집(Dong Jip Kim),홍대식(Dae Shik Hong) 대한내과학회 1987 대한내과학회지 Vol.33 No.1

N/A A major problem of cancer chemoterapy is narrow therapeutic index. To overcome this problem, in patients with intraabdominal cancer metastasis, intraperitoneal instillation of cancer chemotherapeutic agent is tried and much higher concentration of chemotherapeutic agent could be exposed to cancer tissue. Sixteen patients with malignant acites with various kinds of cancer, such as stomach caner(9), ovarian cancer(2), hepatocelluar carcinoma(2) and malignacy of unknown origin(4), recieved a total of 23 courses of intraperitoneal cisplatin therapy, After confirmation of normal renal function and adequate hydration, ascites was drained completely. 90 mg/m² B.S.A. of cisplatin suspended in 2 liters of warm saline was in- stilled into the peritoneal cavity. After a single 4-hour dwelling, the solution was again drained as completely as possible. Of 12 evaluable patients, ascites did not recur in 3 patients for 1 month after therapy (complete control). Seven patients showed increased performance status and decreased abdominal girth and body weight (partial control). When ascites recurred, IP therapy was repeated. The toxicities were mild to moderate nausea and vomiting, diarrhea, abdominal pain, high fever and bone marrow suppression. There was no nephrotoxicity and neurotoxicity. We concluded intraperitoneal cisplatin therapy was effective for the control of malignant ascites and tolerable.

지리산 반야봉 아고산 침엽수림의 생태적 특성

조민기(Cho, Min-Gi),정재민(Chung, Jae-Min),임효인(Im, Hyo-In),노일(Noh, Il),김태운(Kim, Tae-Woon),김충열(Kim, Chung-Yeol),문현식(Moon, Hyun-Shik) 한국기후변화학회 2016 한국기후변화학회지 Vol.7 No.4

간흡충감염 마우스에 있어 담관상피세포의 병리조직학적 변화에 대한 Aflatoxin B_1의 영향

정경숙,민홍기,전계식 梨花女子大學校 醫科大學 醫科學硏究所 1987 EMJ (Ewha medical journal) Vol.10 No.2

The present study was carried out to examine the effect of a carcinogen, aflatoxin B_1 on the pathogenesis of the bile duct changes in mice experimentally infected with Clonorchis sinensis metacercariae. A total of 75 male albino mice of the BALB/c strain was used, and divided into 3 group; group Ⅰ, treated with 1.0ppm aflatoxin B_1 in drinking water alone for 12 weeks; group Ⅱ, given 50 Clonorchis sinensis metacercariae alone and group Ⅲ, given 50 metacercariae at the beginning of the 12 week treatment with 1.0ppm aflatoxin B_1 in drinking water. Three mice were served as untreated-uninfected normal control. All mice were fed the standard protein diet which was synthesized and supplied by the Laborarory of Sam-Lip Food Co. Since the 4th week three mice from each group were removed and sacrigiced at 4 week interval up to the 32nd week. The hepatobiliary tissues were extracted and subsequently prepared for light microscopic examination. The tissue specimens were stained with hematoxylin and eosin. Mice in group Ⅰ showed no significant changes except the lower degrees of bile ductular proliferation and inflammatory cell infiltration at the portal regions at an earlier stage. In groups Ⅱ and Ⅲ there were remarkable together with extensive acute and chronic inflammatory cell infiltrations, cellular atypia and periductal fibrosis from earlier stages. However, in group Ⅲ the histopathological changes observed were more prominent than those in group Ⅱ throughout the observation. As the time elapsed, they showed gradual regression with some fluctuations in the degrees. No any evidences of malignant changes of epithelial cells were noted in group Ⅱ, but in group Ⅲ the first tumor was found at the 28th week and the second one was at the 32nd week, respectively. Histologically the tumors observed were well differentiated adenocarcinoma of the bile duct. It was appeared that the tumors were of peripheral origin with a tendency of multifocal growth. They also showed an infiltrative growth pattern, increased mucin droplets, increased nuclear-cytoplasmic ratio and nuclear hyperchromatism. No hepatocellular carcinoma was noticed throughout the observation. In conclusion, it was suggested that Clonorchis sinensis infection promotes carcinogenic action aflatoxin B_1, a carcinogenic agent.

Changes in Antibody Titers of Measles, Mumps, Rubella, and Hepatitis B Virus After Bone Marrow Transplantation in Korea : A Preliminary Report

Chung, Myung Sun,Park, Yoon Hee,Park, Sung Gyoo,Choi, Su Mi,Min, Woo Sung,Shin, Wan Shik,Lee, Seong Hee,Yoo, Jin Hong,Kim, Chun Choo,Choi, Jung Hyun,Kim, Yong Jae,Kim, Dong Jip 대한감염학회 1998 감염 Vol.30 No.6

목 적 : 조혈모세포 이식술 후 환자의 면역기능손상에 따라서 추가 예방접종의 시기와 필요성을 알아보기 위하여 measles, mumps, rubella 및 간염바이러스에 대한 항체가를 측정하였다. 방 법 : 20명의 환자에서 이식전과 이식후 3, 6, 9, 12개월째 혈청을 분리하여 MMR과 간염바이러스 각각의 항체가를 효소면역측정법을 이용하여 정량적으로 추적검사 하였다. 결 과 : Measles, rubella, 그리고 HBV에 대한 항체가는 이식후 일년까지는 통계학적으로 의미 있게 감소하지는 않았으나 mumps에 대한 항체가는 이식 후 6개월 후부터 급속히 감소하여 이식 전에 비해 유의한 차이를 보였다. Measles, mumps, rubella 및 간염바이러스에 대한 항체가는 이식후 감소하는 양상을 보였으나 평균값은 면역력을 가진 것으로 관찰되었다. 결 론 : 조혈모세포 이식후 1년까지는 MMR 및 간염에 대한 추가면역은 불필요한 것으로 사료되며, 필요하다면 환자의 면역상태를 개별적으로 파악하여 실시하는 것이 바람직하다. 추후 더 많은 환자수와 이의 추적기간을 연장하여 국내에서의 조혈모세포이식후 추가면역접종의 필요성 및 시기를 결정하고자 한다. Background : Bone marrow transplantation (BMT) has become a significant treatment modality for hematopoietic adn solid organ malignancy. Recipients of BMTs lose immunity to measles-mumps-rubella (MMR) and hepatitis B infections which are preventable with vaccination. There is no consensus regarding a vaccination schedule after BMT and time of vaccination is variable according to each institution. We analyzed sequential changes in antibody titers of MMR and hepatitis B during the first year after BMT in an attempt to identify the time, dose, and needs for revaccination. Methods : Total 20 patients with hematologic malignancies were studied. Serum levels of IgG antibodies of MMR and hepatitis B virus (HBV) were determined every three months post-BMT by enzyme immunoassay (EIA), chemical luminescence immunoassay (CLIA) and immunofluorescence assay (IFA). Results : IgG antibody levels of measles, rubella, HBV were 1:746, 80±85 IU/mL, 214±343 IU/L before BMT, declined to 1:633, 18±11 IU/mL, 4±6 IU/L one year after BMT, respectively. All the antibody levels were still above cut-off value for positive immunity. Mumps antibody titers were 1:62 before BMT, declined to 1:25 significantly from 6 months after BMT, but the antibody level was still above cut-off value. Conclusion : Antibody titers of MMR and hepatitis B decline during the first year after BMT, but the levels are still above cut-off value. Thus, the timing of revaccination should be after the first year post-transplantation. Long-term studies are needed to determine the optimal time for revaccination.

The pulsating pressure in the intake and exhaust manifold of a single cylinder engine by the various of engine revolutions

Chung, Han-Shik,Choi, Seuk-Cheun,Jong, Hyo-Min,Lee, Chi-Woo,Kim, Chi-Won The Korean Society of Marine Engineering 2004 한국마린엔지니어링학회지 Vol.28 No.1

In this research, a computer analysis has been developed for predicting the Pipe pressure of the intake and exhaust manifold in a small single cylinder engine. To get the boundary conditions for a numerical analysis one dimensional and unsteady gas dynamic calculation is performed by using the MOC(Method Of Characteristics). The main numerical parameters are engine revolutions. to calculate the Pulsating flow which the intake and exhaust valves are working. The distributions of the exhaust pipe pressures were influenced strongly to the cylinder pressures and the shapes of exhaust pressure variation were similar to the Inside of cylinder pressure As the engine revolutions are increased. the intake pressure was lower than ambient pressure. The amplitude of exhaust pressure had increased and the phase of cylinder pressure $P_c$ is delayed and the amplitude of cylinder pressure were increased.

Temperature Characteristics of Cascade Refrigeration System by Pressure Adjustment

Chung Han-Shik,Jeong Hyo-Min,Kim Yeong-Geun,Rahadiyan Lubi The Korean Society of Mechanical Engineers 2005 JOURNAL OF MECHANICAL SCIENCE AND TECHNOLOGY Vol.19 No.12

Super low temperature has many applications nowadays, from the chemical processing, automotives manufacturing, plastic recycling, etc. Considering of its wide application in the present and the future, study of the super-low temperature refrigeration system should be actively carried out. Super low state temperature can be achieved by using multi-stage refrigeration system. This paper present the development and testing of cascade refrigerator system for achieving super-low temperature. On this experiment, two different types of HCFCs refrigerants are utilized, R-22 and R-23 were applied for the high stage and the low-pressure stage respectively. The lowest temperature in the low-pressure evaporator that can be achieved by this cascade refrigeration system is down to $-85^{\circ}C$. This experiment is aimed to study the effect of inlet pressure of the low-pressure stage evaporator and low-pressure stage compressors inlet pressure characteristics to the overall temperature characteristics of cascade refrigeration system.