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).

A study of ^99mTc-sestamibi labeling condition using radio-chromatography

Moon, Sung-Hyun,Lee, Yun-Sang,Lee, Dong Soo,Chung, June-Key,Jeong, Jae Min Korean Society of Radiopharmaceuticals and Molecul 2017 Journal of radiopharmaceuticals and molecular prob Vol.3 No.1

Tc-99m labeled sestamibi ($^{99m}Tc$-MIBI) is one of most widely used radiopharmaceuticals for myocardial SPECT imaging. Radiolabeling of $^{99m}Tc$-MIBI is recommended by heating in $100^{\circ}C$ water bath for 15 min. However, the water bath might be a source of contamination. Thus, if radiolabeling of $^{99m}Tc$-sestamibi can be performed at room temperature, then it would be more convenient to use in clinical application. In this study, we performed the radiolabeling of $^{99m}Tc$-MIBI in different temperature conditions or using different instruments to find out the efficient labeling condition. We studied the $^{99m}Tc$-MIBI labeling at room temperature or $100^{\circ}C$ heating block, and checked the labelling yields every 1 min for 10 min using radio-TLC with 2 different eluents-saline and acetone. From the experiment, we confirmed that the $^{99m}Tc$-MIBI can be labeled over 90% yield but not completed at room temperature. However, the $^{99m}Tc$-MIBI labeling was completed when it was performed in the $100^{\circ}C$ heating block. Finally, we proved that heating is essential for complete $^{99m}Tc$-MIBI labelling, furthermore using heating block is also possible instead of water bath.

응급실에 내원한 환자에서 어지럼증의 원인과 임상양상의 분석

문원식,정경운,위준선,문정미,전병조,김용권,소정일,류진호,허탁,민용일 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3

Background: Recently, The number of patients who have been complaining of the vertigo or dizziness has been increasing due to rapid growth of elderly population and senile disease. The differentiation of dizzy patients is not familiar to most emergency physicians. This study was designed to differentiate true vertigo and to investigate the clinical difference among central vertigo, peripheral vertigo, and other causes of dizziness. Methods: The authors analyzed the cases of 237 dizzy patients who visited the emergency department of Chonnam University Hospital during the recent 2 years. For the base of dizziness, associated past illnesses, severity, nystagmus type, and the causes of central and peripheral vertigo. Results: Female patients were 142(59.9%) and male patients were 95(40.1%). The most common age group was the 6th decade. The origin of dizziness was classified as peripheral cause(25.3%), central cause(32.9%), and others(41.8%). As to nature of the dizziness, the rotatory sense was dominant in peripheral vertigo and the floating sense and blurred vision in central vertigo. Peripheral vertigo was triggered by position change of head and body, and central vertigo by the eye movement. Audiograms I showed that most patients with central vertigo had normal hearing, but 46.7% of thoswith peripheral vertigo had an abnormal hearing disturbance. Nystagmus was more prevalent in peripheral vertigo Conclusion: History taking and physical examination played an important role in the diagnosis of dizzy patients. An important part of the diagnosis of a dizzy patient could be to evaluate the peripheral origin, the central origin and others causes. Because central vertigo may be associated with a significant neurological pathology, spectral radiological studies, including MRI and CT, are mandatory to rule out a devastating brain lesion.

치과용 임플란트 적용을 위한 RBM과 MAO 표면처리 기법을 이용한 티타니아-하이드록시아파타이트 복합코팅

문승균(Seung-Kyun Moon),강민경(Min-Kyoung Kang),조유정(Yu-Jeong Cho),박정종(Jeong-Jong Park),김광만(Kwang-Mahn Kim),김경남(Kyoung-Nam Kim) 대한치과재료학회 2010 대한치과재료학회지 Vol.37 No.2

This study was performed to examine the effect of a composite coating of resorbable blast media (RBM) and micro arc oxidation (MAO) on the bioactivity and cell compatibility. The RBM treatment was performed by grit blasting with 45 micron-sized hydroxyapatite (HA) powder, and micro arc oxidation (MAO) was performed by the electrolyte solution of β-glycerophosphate and calcium acetate on the condition of various applied voltages (100 V - 250 V) for 3 min. After RBM treatment, the modified surface were analyzed by FE-SEM, EDS and FT-IR. After anodic oxidation at 150 V and 200 V, the surface treated by composite coating included HA and TiO₂, but TiO₂ was only found after micro arc oxidation at 250 V. Overall, a composite coating containing HA and porous TiO₂ can be prepared by using RBM treatment and MAO.

원산지별 감초추출물의 항산화활성 증가를 위한 효율적인 추출조건 탐색

하지훈 ( Ji Hoon Ha ),이혜미 ( Hye Mi Lee ),권순식 ( Soon Sik Kwon ),김해수 ( Hae Soo Kim ),김문진 ( Moon Jin Kim ),전소하 ( So Ha Jeon ),정유민 ( Yoo Min Jeong ),황준필 ( Jun Pil Hwang ),박종호 ( Jong-ho Park ),최영기 ( Yung-key 대한화장품학회 2013 대한화장품학회지 Vol.39 No.4

본 연구에서는 한국 및 중국산 감초(Glycyrrhiza uralensis), 그리고 우즈베키스탄산 감초(Glycyrrhiza glabra)를 대상으로 추출용매, 추출온도, 추출시간 등 추출조건별 추출물을 제조하고 이들 추출물들의 추출 수율과 항산화 활성을 비교하여 최적의 추출조건을 선정하였다. 항산화 활성 중 자유 라디칼(1,1-phenyl-2-pic-rylhydrazyl, DPPH) 소거활성은 85% 에탄올로 60 ℃에서 6 h 동안 추출한 조건에서 한국 감초로부터 얻은 추출물이 가장 높은 활성(46.05%)을 나타내었다. 루미놀 발광법을 이용한 추출물들의 총 항산화능 측정 실험과 피부 광노화에 중요한 ¹O₂으로 유도된 세포막 손상에 대한 추출물들의 세포 보호 효과를 측정한 실험 모두에서도 위의 조건에서 가장 높은 항산화 활성을 나타내었다. 특히, 한국 감초는 τ₅₀이 116.4 min으로 비교 물질인(+)-α-tocopherol (28.5 min)보다 약 4 배나 높은 세포 보호 효과를 나타내었으며, 추출 수율은 18.75%로 우즈베키스탄 및 중국 감초보다 각각 1.2 배 및 2.5 배의 추출 수율을 나타내었다. 따라서, 본 연구 결과는 항산화 소재로 화장품에 응용하기 위하여 감초로부터 추출물을 얻기 위한 최적의 조건은 85% 에탄올로 60 ℃에서 6시간 동안 추출하는 것임을 보여주었다. In this work, licorice extracts were prepared using various extraction conditions such as extraction solvent, temperature, and time from Glycyrrhiza uralensis (G. uralensis) produced in Korea and China and Glycyrrhiza glabra (G. glabra) in Uzbekistan. The optimum extraction condition was selected from the extraction yields and antioxidative activities of extracts. Korea licorice extracts showed the highest free radical (1,1-diphenyl-2-picrylhydrazyl, DPPH) scav-enging activity (46.05%) under the extraction condition of 85% ethanol at 60 ℃ for 6 hours. The prominent ROS (reactive oxygen species) scavenging activity using luminol-dependent chemiluminescence assay and the cellular protective effect against ¹O₂ induced cellular membrane damage were also shown from the extracts obtained from the same condition. Especially, Korea G. uralensis extracts exhibited the higher prominent protective effect (τ₅₀ = 116.4 min) than (+)-α-tocopherol (τ₅₀ = 28.5 min) and the extraction yield of Korea licorice extract was 18.75%, which is 1.2 times and 2.5 times higher than that of Uzbekistan and China, respectively. These results indicate that the extraction condition of 85% ethanol at 60 ℃ for 6 hours is optimal to prepare licorice extracts, which can be applicable as antioxidative cosmetic materials.

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.

외상 후 뇌 지방색전증 1예

문정미,소정일,김용권,류진호,허탁,서정진,민용일 대한응급의학회 2001 대한응급의학회지 Vol.12 No.2

Post-traumatic fat embolism was first reported by Zenker in 1862, Von Bergmann reported the first clinical diagnosis of the fat embolism syndrome in 1873. Fat embolism has been associated with traumatic or non-traumatic disorders. Fat embolization after long bone trauma is probably common as a subclinical event. The diagnosis of fat embolism syndrome is based on the patient's history, is supported by clinical signs of pulmonary, cerebral, and cutaneous dysfunction, and is confirmed by the demonstration of arterial hypoxemia in the abscence of other disorders. Two different mechanisms cause fat to embolize: direct entry of deposit fat into the blood stream and agglutination of endogenous or exogenous plasma fat. MRI can detect a cerebral fat embolism with a higher sensitivity than cerebral CT. We report a case of post-traumatic cerebral fat embolism without pulmonary involvement, and we present a review of the literature. A 16-year girl had a traffic accident and pelvic bone fracture. Forty eight hours later severe trauma become stuporous without a focal neurological deficit. The patient received supportive therapy, and her condition improved throughout her hospital course. She was discharged with good condition after a 30-day hospital stay.

항치매성 acetylcholineaterase 함유 검은 비늘버섯 추출물의 PC12 신경세포사 저해 효과

문정수, 한상민, 이종수 배재대학교 자연과학연구소 2021 自然科學論文集 Vol.32 No.1

본 연구에서는 부분 정제된 acetylcholinesterase 저해물질을 함유한 검은비늘버섯 추출물의 신경세포 PC12에 대한 세포독성을 조사하고 PC12 신경세포 저해효과를 조사하였다. 검은 비늘버섯 추출물은 세포 생존에 영향을 미치지 않았고 무처리군의 85.6%에 비해 19.3%로 세포사 저해효과가 우수하였다. Dementia disease has been increased because of the significant increase in life expectancy over sixty-five years of age in Korea. This studies were carried out to develop new anti-dementia compounds such as acetylcholinesterase(AChE) inhibitor from edible mushrooms.. AChE inhibitor from water extract of finally selected Pholiota adiposa were partially purified by Sephadex G-50 gel permeation chromatography and RP-HPLC. The partial purified acetylcholinesterase inhibitor-containing Pholiota adiposa extracts showed high cell viability and also showed apoptotic inhibitory effects against PC12 neuron-like cells.

젊은 성인에서 신체 만족도에 따른 문제해결양식, 대인관계문제와 우울증상과 자살사고와의 관련성

차승민,김태성,강문희,권명진,김정란,왕성근,지익성 대한생물치료정신의학회 2011 생물치료정신의학 Vol.17 No.2

Objectives:The aim of this study was to evaluate that problem solving styles, interpersonal problems, depression and suicidal ideation according to body image satisfaction. Methods:One hundred and nineteen young healthy normal subjects filled out administered the Body Dysmorphic Disorder Examination-Self Report (Korean version of BDDE-SR K-BDDE-SR), Problem Solving Style Scale(Korean version PSS), Korean Inventory of Interpersonal Problem(KIIP), Korean version of the Depression Anxiety Stress Scale(KDASS-21), Korean version of Beck Scale for Suicidal Ideation(Korean version SSI) and Korean version of Reynolds Suicidal Ideation Questionnaire(Korean version SIQ) for a month. Results:Out of the 119 subjects, 39%(N=46) was male and 61%(N=73) was female. In high K-BDDE-SR group (higher than 67), helplessness was significantly higher than low K-BDDE-SR group(lower than 67), and problem-solving confidence, creative style, approach style were significantly lower than low K-BDDE-SR group. Also, Higher level of all KIIP factors in High K-BDDE-SR group was significantly differ than low K-BDDE-SR group. In High K-BDDE-SR group, K-DASS-21, SSI, and SIQ were significantly higher than low K-BDDE-SR group. Using multiple regression analysis contributing variance toward the total factor score of K-BDDE-SR of participants were K-DASS-21 and SIQ. Conclusion:Our results indicates that high tendency of dissatisfied body images have differences in helplessness, problem-solving confidence, approach style, interpersonal problems, depression and suicidal ideation compared to low tendency of dissatisfied body images. It is necessary to study body dysmorphic disorder patients group in the future.

Use of Electroacupuncture at ST36 to Inhibit Anaphylactic and Inflammatory Reaction in Mice

Moon, Phil-Dong,Jeong, Hyun-Ja,Kim, Su-Jin,An, Hyo-Jin,Lee, Hye-Jung,Yang, Woong Mo,Park, Seong Kyu,Hong, Seung-Heon,Kim, Hyung-Min,Um, Jae-Young S. Karger AG 2007 Neuroimmunomodulation Vol.14 No.1

<P><I>Objective:</I> Electroacupuncture (EA) has been used to treat myalgia, allergy and gastroenteropathy in Korea. To determine whether EA can treat anaphylactic and inflammatory reactions, the effect of EA was investigated in a murine model. <I>Methods:</I> EA stimulation of the ST36 acupoint was performed for 10 min. Using a passive cutaneous anaphylaxis (PCA) model, the antianaphylactic effects of EA were examined. Interleukin-6 and tumor necrosis factor-α were measured using the ELISA method. The level of nuclear factor (NF)-κB/RelA protein and NF-κB DNA-binding activity was determined using the Western blot analysis and the transcription factor enzyme-linked immunoassay method. <I>Results:</I> EA inhibits PCA and β-hexosaminidase release, IL-6 secretion on the PCA, and in addition, EA reduces NF-κB DNA-binding activity. <I>Conclusion:</I> These results indicate that EA may possess antianaphylactic and antiinflammatory properties.</P><P>Copyright © 2007 S. Karger AG, Basel</P>