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원규장,윤지성 대한당뇨병학회 2008 Diabetes and Metabolism Journal Vol.32 No.3
The adverse effects of prolonged exposure of pancreatic islets to supraphysiologic glucose concentrations(i.e. glucose toxicity) is mediated at least in part by glucose oxidation and the subsequent generation of reactive oxygen species(ROS) that can impair insulin gene expression and β cell function. Multiple biochemical pathways and mechanisms of action for glucose toxicity have been suggested. These include glucose autoxidation, protein kinase C activation, methylglyoxal formation and glycation, hexosamine metabolism, sorbitol formation, and oxidative phosphorylation. There are many potential mechanisms whereby excess glucose metabolites traveling along these pathways might cause β cell damage. However, all these pathways have in common the formation of reactive oxygen species that, in excess and over time, cause chronic oxidative stress, which in turn causes defective insulin gene expression and insulin secretion as well as increased apoptosis. The intracellular peroxide levels of the pancreatic islets(INS-1 cells, rat islets) by flow cytometry were increased in the high glucose media compared to 5.6 mM glucose media. The insulin, MafA, PDX-1 mRNA levels and glucose stimulated insulin secretion(GSIS) were decreased in high glucose media compared to 5.6 mM glucose media. The HO-1 seems to mediate the protective response of pancreatic islets against the oxidative stress that is due to high glucose conditions. Also, we observed decreased glutathione level, γ-GCS expression and increased oxidized LDL, malondialdehyde level at leukocytes and mesothelial cells from patients with Korean Type 2 Diabetes(esp, poorly controlled patients). In conclusion, this pathophysiologic sequence sets the scene for considering antioxidant therapy as an adjunct in the management of diabetes, especially type 2 Diabetes.(KOREAN DIABETES J 32:175-181, 2008)
원규장,Won, Gyu-Jang 사단법인 한국당뇨협회 2008 당뇨 Vol.220 No.-
당뇨병은 혈액 내 포도당 농도가 증가되어, 여러 장기에 합병증을 초래하여 사망률과 이환율을 증가시키고 삶의 질을 저하시키는 만성 대사 질환이다. 당뇨병과 간기능의 효소 수치를 높이는 질환들인 비알코올성 간질환, B형 및 C형 간염, 알코올성 간질환 등은 종종 병존하는 것으로 알려지고 있으나, 원인 및 임상적 의의에 대한 연구는 많지 않다.
당뇨병을 동반한 고혈압 환자의 치료에서 ACEI, ARB의 필요성
원규장 CMPMedica Korea 2004 Diabetes Research Digest Vol.1 No.3
당뇨병과 동반된 고혈압과 당뇨의 나쁜 예후와는 강한 역학적 상관관계가 있으며, 약물 및 비약물 치료로 적극적인 혈압조절(<130/80MMhG)이 필요하다. 미세 알부민뇨증이 있는 또는 임상적 신병증이 있는 환자에게서는 ACEI와 AII수용체 차단제가 병의 진행을 예방하고 치료하는데 'renoprotective'효과가 있으며, 일부 보고이지만 AII수용체 차단제도 당뇨병 환자의 심혈관 질환의 예방에도 효과가 있다는 보고가 나오고 있다. 결론적으로 당뇨병 환자의 고혈압 치료에서 AII 수용체 차단제는 현재 ACEI 만큼의 임상적 증거는 충분하지 않으나 1차진료제(first line drug)및 혈관 합병증의 1차 및 2차 예방에 효과적일 것으로 생각된다.
급성심근경색증 환자에서 응급으로 시행한 Tc - 99m Sestamibi 심근관류 SPECT와 심전도의 비교
원규장(Kyu Chang Won),이형우(Hyoung Woo Lee),심봉섭(Bong Sup Shim),이현우(Hyun Woo Lee),조인호(Ihn Ho Cho),박종선(Jong Sun Park),도준영(Jun Young Do),신동구(Dong Gu Sin),윤경우(Kyung Woo Yoon),김영조(Young Jo Kim) 대한핵의학회 1996 핵의학 분자영상 Vol.30 No.1
N/A We did Tc-99m sestamibi myocardial perfusion SPECT in 36 patients with acute myocardial infarction when they arrived at the emergency room. And we compared myocardial perfusion images with ECG findings. Then we obtained the follows. The myocardial infarction by the obstruction of left coronary descending artery and right coronary artery showed a good concordance in the diagnosis and infarction site between myocardial perfusion images and ECG findings. The 7 patients with myocardial infarction by a left circumflex coronary artery showed a perfusion defect in the lateral wall in myocardial perfusion SPECT images. But 4 patients of them showed ST segment elevation, 2 patients showed ST depression and 1 patient showed normal ECG findings. The diagnostic sensitivity of Tc-99m sestamibi myocardial perfusion SPECT was 100% by a qualified analysis. The perfusion defect site in the myocardial perfusion SPECT were con-responded with the infarct related coronary artery in 31 patients which was diagnosed by coronary angiograpy. The size of perfusion defect in the polar map was 31±18%(M±SD), in the myocardial infarction with left anterior descending coronary arery obstruction, 31±13% (M±SD) in the myocardial infarction with right coronary artery obstruction and 25±5.9%(M±SD) in the myocardial infarction on with left circumflex coronary artery obstruction. We concluded that emergency myocardial perfusion SPECT images are useful in the diagnose of myocardial infarction and it's very useful when we are difficult to diagnose with ECG like as lateral wall infarction or left bundle branch block.