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).

열공형과 비열공형 피질하 혈관성 치매에서 위험인자의 차이에 관한 비교 연구

배희준,정지향,유경호,나덕렬,김상윤,최경규,양동원,손의주,이상도,김재우,박경원,김응규,이재홍,박미영,한일우,함동석,최문성,하충건,최성혜,이애영,이병철,한설희 대한치매학회 2003 Dementia and Neurocognitive Disorders Vol.2 No.2

Backgrounds and Objectives: Vascular dementia is a group of dementing disoders arising from various stroke syndrome. Among these. subcortical ischemic vascular dementia (SIVD) is regarded as a relatively distinct clinical entity. However, MRI patterns of SIVD are not homogenous. In some patients, lacunes are dominant, and in others, subcortical white matter changes are. This study was designed to compare risk factor profiles between SIVD with and without multiple lacunes. Methods: We divided 47 subjects (22 males, mean age. 68 years) recruited from VADAPET (Multicenter Trial For Evaluation Of The Changes In the PET Images Of Subcortical Vascular Dementia Patient) study into two groups one with more than 5 lacunes in deep gray matter (lacune group) and the other with 5 or less(non-lacune group) Clinical characteristics and laboratory findings of two groups were compared. Results: Nineteen of 47 patients (40%) belonged to the lacune group. The lacune and non-lacune groups d d not differ in the following variables: age, hypertension, diabetes mellitus, hyperlipidemia heart disease, history of stroke or TIA, history of trauma or major surgery, family history of hypertension stroke, or dementia, age at diagnosis of dementia, body mass index, white blood cell count, ESR, CRP, fibrinogen, hemoglobin A1C, total cholesterol. LDL cholesterol creatinine, proteinuria, glucosuria, and microhematuria. However, male sex, smoking alcohol. hemoglobin, and HDL cholesterol were possibly associated more with lacune group SIVD than with non-lacune group (p<0 1) Multivariate analyses revealed that smoking, hemoglobin, and HDL cholesterol were independent predictors of SIVD with multiple lacunes Conclusion: Our study suggests that SIVD with multiple lacunes may be significantly different in smoking habits hemoglobin, and HDL cholesterol from SIVD without multiple lacunes.

Kinematic Evaluation of Gait Variables in Developmental Studies

이경옥,김미애 이화여자대학교 동작과학연구소 2004 이화체육논집 Vol.7 No.-

본 연구의 목적은 유아 보행 발달 과정과 변화를 통한 발달 전이를 설명하기 위해 사용되는 몇가지 운동학적 변인들을 중심으로 각각의 변인들이 유아 보행의 발달 과정과 변화, 그리고 전이를 어떻게 설명하는지를 평가하는 것이다. 본 연구를 위한 실험은 부천 재활 공학 센터 보행 실험실에 설치된 Oxford Metrics 사의 Vicon 370 시스템(Oxford England)을 사용하였다. 이시스템의 자동 추적 방식은 신체 표시(mark)의 위치를 토대로 신체 내부에 가상 좌표계를 계산해 내고, 이를 기준으로 관절의 움직임을 측정하는 카단 앵글(cardan angle)방법을 채용하고있다.대상은 보행이 관성되는 시기라고 알려져 있는 1세~5세까지의 아동 총 24명이다. 시간 및 거리 보행 인자(분속수:steps/min, 보행장 : step length, 보행속도: speed:m/sec, 단하지 지지기 시간: single supprot:%), 보행 주기 동안의 전체 평균 각도, 보행 구간별 평균각, 보행 구간을 구분하기 위한 순간(event)에서의 각도, 최대값, 동적운동법위(dycamic range of motion),연령에 따른 각도, 연령에 따른 각속도를 변인으로 설정하였다. 보행인자를 통해서 보폭 , 보행 속도, 양하지 지지기가 증가하는 이유 즉, 어느 하지분절이, 어느 방향의 운동이 기여하여 그러한 결과가 나온 것인지에 대한 설명은 할 수 없다. 보행 주기 동안 하지 관절별, 운동면별, 구간별 평균값, 시점에서의 평균값 사이에는 차이가 있다. 최고 평균값과 최대 동적 범위의 연령별, 하지 관절별, 운동면별, 구간에 대한 정보를 통해 유아 보행시 하지 분절의 발달 순서와 분절간 보상을 알수 있다. 연령별 각도 그래프를 통해 연령에 따라 각 관절의 변화를 알 수 있고. 관절별 각도 그래프를 통해 관절 간, 내협웅을 알수 있다. 그러나 움직임이란 변화율이 이므로 각도 곡선 보다는 각속도 곡선이 설명력이 높다고 할 수 있다. 이렇듯 유아 보행 발달 변인들은 각각의 변인에 따라 설명할 수 있는 범위와 내용이 다르다. 그러므로 변인을 설정할 때 자신의 연구 문제를 잘 설명할 수 있는 변인으로 선택해야 한다.

방사선사진에서의 골질과 임상적으로 평가한 골질 분류의 상관관계

김현우,허경회,박관수,김정화,이원진,허민석,이삼선,최순철 대한구강악안면방사선학회 2006 Imaging Science in Dentistry Vol.37 No.1

Purpose : To investigate the validity of digital image processing on panoramic radiographs in estimating bone quality before endosseous dental implant installation by correlating bone quality in radiographic images with clinical bone quality classification. Materials and Methods : An experienced surgeon assessed and classified bone quality for implant sites with tactile sensation at the time of implant placement. Including fractal dimension eighteen morphologic features of trabecular pattern were examined in each anatomical sites on panoramic radiographs. Finally bone quality of 67 implant sites were evaluated in 42 patients. Results : Pearson correlation analysis showed that three morphologic parameters had weak linear negative correlation with clinical bone quality classification showing correlation coefficients of -0.276, -0.280, and -0.289, respectively (p<0.05). And other three morphologic parameters had obvious linear negative correlation with clinical bone quality classification showing correlation coefficients of -0.346, -0.488, and -0.343 respectively (p<0.05). Fractal dimension also had a linear correlation with clinical bone quality classification with correlation coefficients -0.506 significantly (p<0.05). Conclusion : This study suggests that fractal and morphometric analysis using digital panoramic radiographs can be used to evaluate bone quality for implant recipient sites. (Korean J Oral Maxillofac Radiol 2006; 36 : 25-32)

신경망을 이용한 오래된 필름에서의 스크래치 검출

김경태,김은이 건국대학교 산업기술연구원 2005 건국기술연구논문지 Vol.30 No.-

Line scratches are common degradations in old films. To support a demand of high quality of multimedia service, these scratches should be detected and restored. However, although many restoration algorithms have been researched, little have done in automatic scratch detection. This paper presents a texture-based object detection method for scratch detection. We use a multi-layer perceptron(MLP) to automatically make a texture classifier that discriminates between scratch regions and non-scratch ones in various environments. Multiresolution used to reduce influence of resolution. To assess the validity of the proposed method, it has been tested with all kinds of scratches, that is, principal/secondary scratches, alone/not-alone ones, and moving/static ones, and then experimental results shows that the proposed approach leads to not only robust but also efficient scratch detection

디지털 및 일반 측방두부규격방사선사진에서 측정 방법에 따른 계측치의 비교

김미자,허경회,이원진,허민석,이삼선,이진구,안병근,최순철 대한구강악안면방사선학회 2005 Imaging Science in Dentistry Vol.35 No.1

Purpose : To compare cephalometric measurement between measuring methods in digital and conventional lateral cephalometric radiograph. Materials and Methods : Twenty digital and conventional lateral cephalometric radiographs were selected. In digital group, cephalometric measurements were performed manually using hardcopies and automatically using VCeph^(TM) program on the monitor. In conventional group, the same measurements were performed manually on conventional films, and for automatic measurement conventional films were digitized by scanner. All measurements were performed twice by 4 observers, and 24 cephalometric variables were calculated and the time spent for each measurement was recorded. The differences in measurements data and the time spent for each measurement were compared within each group. Intra-observer and inter-observer comparisons were performed. Results : In both groups, no statistically significant difference between manual and automatic measurements was observed and most of the variables didn’t show statistically significant differences between methods. The observer with less experience tended to show statistically significant differences of measurements between methods, and differences from other observers. The differences of measurements between methods in digital group were lesser than those of conventional group with statistical significance in 8 variables out of 24. With automatic method and in digital group, the spent time was shorter. Conclusion : With direct digital radiograph, automatic method using manually idenitified landmarks can be preferable in cephalometric analysis.

병원 간호사들의 이직 결정 과정

이명선,김원옥,김덕희,고문희,이경숙,김증임 성인간호학회 2003 성인간호학회지 Vol.15 No.4

Purpose: The purpose of the study was to explore how hospital nurses decide to quit working as professional nurses using the grounded theory method. Method: The data was collected by individual in-depth interviews with 12 hospital nurses who recently resigned from work and it was analyzed using 'constant comparative analysis.' Result: The core category that emerged was "in search of new balance with self, work, and family". Three stages were identified: 1) "unconditionally accepting the working situation of itself," 2) "weighing advantages and disadvantages of working as a hospital nurse", and 3) "redesigning a future". Each stage contains three major strategies. The major strategies of the first stage are "maintaining a learning attitude", "enduring physical burnout," and "enduring unfair interpersonal relationships". The second stage contains "identifying advantages of working", "identifying disadvan- tages of working, and "comparing the advantages with the disadvantages". Lastly, the third stage includes "reassessing the aim of life", "beginning to construct an alternative life", and "deciding to quit working at a certain point". Conclusion: The results of the study will help nursing administrators in designing and implementing an effective turnover prevention program for nurses by understanding more deeply the process of turnover phenomenon among hospital nurses.

다결정 실리콘 태양전지의 상부 전극용 금속 박막 적용

김상수,임동건,이준신,심경석,김홍우,이만근 성균관대학교 1997 학술회의지원논문목록집 Vol.1997 No.-

We investigated grain boundary effect for terrestrial applications of solar cells with low cost, large area, and high efficiency. Grain boundaries are known as potential barriers and recombination centers for the photo generated charge carriers, which make it difficult to achieve a high efficiency cell. To reduce these effects of grain boundarues, we investigated various influencing factors such as thermal treatments various grid patterns selective wet etchings for grain boundarues, buried contact metallizations along grain boundaries, and use of metallic thin films. From the various grid patterns we learned that the series resistance of solar cell reduced open circuit voltage and consequently decreased the cell efficiency. This paper describes the effect of various grid patterns and the employment of metallic thin films for a top electrode.

조깅시 착지 유형과 시간에 따른 수직 충격 분석

이경옥,김미예 한국유산소운동과학회 2003 한국유산소운동과학회지 Vol.7 No.1

The purpose of this study was to evaluate how impact force changed according to both time and striking patterns while jogging. Subjects for this study were four university students in their early twenties. The women were normal and healthy, without any chronic injuries or foot problems. Independent variables for this study were jogging time and striking pattern. Jogging time was divided into six stages over the duration of one hour. Striking patterns were divided into two types: heel-strike, and toe-strike. Dependent variables were impact force, loading rate of impact force, number of impact peaks, interval time between first heel (or toe) strike to first passive peak. This study utilized the Kistler type 9281B to measure dependent variables. Toe-strikers possessed lower impact force and fewer impact peaks than heel-strikers. In this aspect, jogging with a toe-strike pattern is more effective in reducing impact force, which can cause pain and injuries. For both groups, interval time between first heel (toe)-strike and first passive peak decreased progressively throughout the duration of the test. These results demonstrated not only a negative correlation between test time and interval time, but also alluded to the effects of fatigue as well. In the case of toe-strikers, impact force did not appear until after thirty minutes. As a result, people who possess a toe-striking jogging pattern can jog for less than thirty minutes in order to minimize the detrimental effects of impact force on the body. After thirty minutes toe-strikers can reduce their exercise intensity level in order to reduce the effects of impact force. Once the effects of fatigue are eliminated at a lower intensity level, toe-strikers can increase their intensity levels back to n o d . Heel-strikers displayed impact force from the beginning of the test duration until the end. Furthermore impact force increased steadily with time. Therefore, it is especially important for heel-strikers to have adequately cushioned shoes, socks, and jogging surface.

의원성 사고로 발생한 타액선염 : 증례보고

김현우,허경회,이원진,허민석,이삼선,최순철 대한구강악안면방사선학회 2004 Imaging Science in Dentistry Vol.34 No.2

A case of sialadenitis is presented in a patient with painful swelling of the right mouth floor. The condition was caused by trauma on the right mouth floor during dental treatment, which had happened 15 days before admission. On aspiration, mucous secretion was found and ultrasonography showed obstruction of duct. Histopathological studies and surgical investigation established a definite diagnosis of obstructive sialadenitis caused by ductal laceration. As surgical treatment sialodochoplasty was selected. The case and relevant considerations are discussed.