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정찬희,이은정,권혜미,장유수,유승호,이원영 대한내분비학회 2020 Endocrinology and metabolism Vol.35 No.1
Background: We evaluated the association of visceral-to-subcutaneous fat ratio (VSR) with nonalcoholic fatty liver disease(NAFLD) and advanced fibrosis degree based on noninvasive serum fibrosis markers in the general population with NAFLD. Methods: This is a cross-sectional study, in 7,465 Korean adults who underwent health screening examinations. NAFLD was defined as fatty liver detected on ultrasonography, and visceral and subcutaneous abdominal fat was measured using computed tomography. We predicted fibrosis based on the fibrosis-4 (FIB-4) score and aspartate aminotransferase-to-platelet ratio index (APRI) andcategorized the risk for advanced fibrosis as low, indeterminate, or high. Results: The multivariable-adjusted prevalence ratios for indeterminate to high risk of advanced fibrosis based on FIB-4, determinedby comparing the second, third, and fourth quartiles with the first quartile of VSR, were 3.38 (95% confidence interval [CI], 0.64 to17.97), 9.41 (95% CI, 1.97 to 45.01), and 19.34 (95% CI, 4.06 to 92.18), respectively. The multivariable-adjusted prevalence ratiosfor intermediate to high degree of fibrosis according to APRI also increased across VSR quartiles (5.04 [95% CI, 2.65 to 9.59], 7.51[95% CI, 3.91 to 14.42], and 19.55 [95% CI, 9.97 to 38.34], respectively). High VSR was more strongly associated with the prevalence of NAFLD in nonobese subjects than in obese subjects, and the associations between VSR and intermediate to high probabilityof advanced fibrosis in NAFLD were stronger in obese subjects than in nonobese subjects. Conclusion: High VSR values predicted increased NAFLD risk and advanced fibrosis risk with NAFLD, and the predictive valueof VSR for indeterminate to high risk of advanced fibrosis was higher in obese subjects than in nonobese subjects.
IIHS 충격해석에 근거한 구간 조합 복합재료 범퍼 빔 개발
정찬희,함석우,김경석,전성식 한국복합재료학회 2018 Composites research Vol.31 No.1
The aim of the current work is to characterise a piecewisely-integrated composite bumper beam based on the IIHS bumper crash protocol. IIHS bumper crash FE analysis for an aluminium type bumper beam was carried out to get the information about the dominant loading types at several regions in the bumper beam during crash. In the meantime, robust stacking sequences against tension and compression have been searched for using FE analysis of a coupon type model. After determining most effective stacking sequences for tension and compression, three-point bending simulation was preliminarily carried out to investigate the combination performance of them. Finally, IIHS bumper crash FE analysis for the piecewisely-integrated composite bumper beam, which consisted of the combination of tension effective stacking sequence and compression efficacious stacking sequence, was conducted and the result was compared with other types of composite bumper beams. It was found that the newly suggested piecewisely integrated composite bumper beam showed superior crashworthy behaviour to those of uni-modal stacking sequence composite bumper beams. 본 연구에서는 IIHS기준 범퍼 충돌해석을 통하여, 구간 조합 복합 범퍼 빔의 특성 분석하였다. 충돌 시 범퍼 빔의 5개 영역에서 지배적인 하중 유형에 대한 정보를 얻기 위해 Al 범퍼 빔에 대한 IIHS 범퍼 충돌 해석이 진행되었다. 또한, 항공우주 분야에서 빈번히 사용되는 5가지 적층순서 중, 인장 및 압축하중에 가장 효과적인 적층순서가 복합재료 쿠폰 해석을 통해 결정되었다. 이와 더불어, 결정된 두가지 복합재료의 적층순서를 적용한 복합재료 빔에 대해 3점 굽힘 해석이 수행되었다. 마지막으로, IIHS 범퍼 충돌 해석을 진행하여 구간 조합으로 이루어진 복합재료 범퍼 빔을 다른 유형의 복합 범퍼 빔과 비교하였다. 제안된 구간조합 복합재료 범퍼 빔은 단일 적층순서로 이루어진 복합재료 범퍼 빔에 비해 우수한 충돌 특성을 나타내었다.
Recent Updates on Vascular Complications in Patients with Type 2 Diabetes Mellitus
정찬희,목지오 대한내분비학회 2020 Endocrinology and metabolism Vol.35 No.2
It is well known that patients with type 2 diabetes mellitus (T2DM) are at an increased risk of morbidity and mortality from atherosclerotic cardiovascular (CV) complications. Previously, the concept that diabetes mellitus (DM) is a “coronary artery disease (CAD)risk equivalent” was widely accepted, implying that all DM patients should receive intensive management. However, considerableevidence exist for wide heterogeneity in the risk of CV events among T2DM patients and the concept of a “CAD risk equivalent”has changed. Recent guidelines recommend further CV risk stratification in T2DM patients, with treatment tailored to the risk level. Although imaging modalities for atherosclerotic cardiovascular disease (ASCVD) have been used to improve risk prediction, thereis currently no evidence that imaging-oriented therapy improves clinical outcomes. Therefore, controversy remains whether weshould screen for CVD in asymptomatic T2DM. The coexistence of T2DM and heart failure (HF) is common. Based on recent CVoutcome trials, sodium glucose cotransporter-2 inhibitors and glucagon like peptide-1 receptor agonists are recommended who haveestablished ASCVD, indicators of high risk, or HF because of their demonstrated benefits for CVD. These circumstances have led toan increasing emphasis on ASCVD and HF in T2DM patients. In this review, we examine the literature published within the last 5years on the risk assessment of CVD in asymptomatic T2DM patients. In particular, we review recent guidelines regarding screeningfor CVD and research focusing on the role of coronary artery calcium, coronary computed tomography angiography, and carotid intima-media thickness in asymptomatic T2DM patients.
정찬희,조윤영,최덕현,김보연,김철희,목지오 대한내분비학회 2020 Endocrinology and metabolism Vol.35 No.3
Background: Few studies have examined the relationship of sarcopenia with the microcirculation. The current study investigatedthe relationship of sarcopenia with microcirculatory function, as assessed by skin perfusion pressure (SPP), in type 2 diabetes mellitus (T2DM) patients. Methods: In total, 102 T2DM patients who underwent SPP measurements and bioelectrical impedance analysis (BIA) were enrolledin this cross-sectional study. SPP was assessed using the laser Doppler technique. Sarcopenia was defined as low height-adjusted appendicular muscle mass (men, <7 kg/m2; women, <5.7 kg/m2) using BIA. We divided the participants into two groups based on SPP(≤50 and >50 mm Hg), and an SPP below 50 mm Hg was considered to reflect impaired microcirculation. Results: Fourteen patients (13.7%) were diagnosed with impaired microcirculatory function of the lower limb based on SPP. Theprevalence of sarcopenia in all subjects was 11.8%, but the percentage of patients with an SPP ≤50 mm Hg who had sarcopenia wasmore than triple that of patients with an SPP >50 mm Hg (28.6% vs. 9.1%, P=0.036). A significant positive correlation was foundbetween SPP and appendicular muscle mass adjusted for height (P=0.041 for right-sided SPP). Multiple logistic regression analysisshowed that patients with sarcopenia had an odds ratio of 4.1 (95% confidence interval, 1.01 to 24.9) for having an SPP ≤50 mm Hgeven after adjustment for confounding factors. Conclusion: These results suggest that sarcopenia may be significantly associated with impaired microcirculation in patients withT2DM. Nonetheless, the small number of patients and wide CI require cautious interpretation of the results.