Original Articles : Risk Factors Associated with Left Ventricular Diastolic Dysfunction in Type 2 Diabetic Patients without Hypertension

( Jung Hyun Noh ),( Joon Hyung Doh ),( Sung Yun Lee ),( Tae Nyun Kim ),( Hyuk Lee ),( Hwa Young Song ),( Jeong Hyung Park ),( Kyung Soo Ko ),( Byoung Doo Rhee ),( Dong Jun Kim ) 대한당뇨병학회 2010 Diabetes and Metabolism Journal Vol.34 No.1

Background: Hypertension and age are recognized as important risk factors for left ventricular (LV) diastolic dysfunction. Some studies have shown that diabetes itself may also be an independent risk factor for LV diastolic dysfunction, although this is controversial. The aim of this study was to determine the factors associated with LV diastolic dysfunction in patients with type 2 diabetes in the absence of hypertension or ischemic heart disease (IHD). Methods: Participants in this study consisted of 65 type 2 diabetes patients (M: F = 45: 20; mean age 51 [26 to 76] years; mean body mass index [BMI] 25.0 ± 2.5 kg/m2) without hypertension, heart disease, or renal disease. Individuals with ischemic electrocardiographic changes were excluded. LV diastolic function was evaluated by Doppler echocardiographic studies. Results: Fifteen patients (23.1%) showed LV diastolic dysfunction on Doppler echocardiographic studies. Patients with LV diastolic dysfunction were older than those without diastolic dysfunction (60.0 ± 2.5 vs. 50.5 ± 1.9 years; P < 0.01). After adjusting for age and sex, BMI was higher (26.6 ± 0.7 vs. 24.6 ± 0.3 kg/m2; P < 0.01) and diabetes duration was longer (9.65 ± 1.48 vs. 4.71 ± 0.78 years; P < 0.01) in patients with LV diastolic dysfunction than in those without diastolic dysfunction. There were no differences in sex, smoking, blood pressure, lipid profiles, hemoglobin A1C, fasting glucose, fasting insulin, or diabetic microvascular complications between the LV diastolic dysfunction group and the normal diastolic function group. After adjusting for age, sex, and BMI, diabetes duration was found to be independently associated with LV diastolic dysfunction (odds ratio 1.38; confidence interval 1.12 to 1.72; P = 0.003). Conclusion: These results suggest that diabetes duration may be a risk factor for LV diastolic dysfunction in type 2 diabetic patients without hypertension or IHD.

자율신경실조증 한의표준임상진료지침 개발을 위한 한의임상 실태조사

박희영,송금주,이현우,박찬,윤석인,박정환,정선용,김종우 대한한방신경정신과학회 2023 동의신경정신과학회지 Vol.34 No.4

Objectives: The study aimed to understand the current treatment patterns in Korean medicine to develop clinical practice guidelines for autonomic dysfunction in Korean medicine. Methods: This study sent an online survey vai text message to 25,900 Korean medicine doctors whose contact information was registered with the Association of Korean Medicine. A total of 1,410 Korean medical doctors completed the online survey. Results: When autonomic treating dysfunction clinically, 77% of the cases included only a description without entering a diagnosis code. The most commonly used information to diagnose o autonomic dysfunction was history-taking and symptoms (79%), and the main symptoms of autonomic dysfunction were palpitations, dizziness, sleeping difficulties, anxiety/nervousness, and depression/lethargy. The most frequently mentioned cause of autonomic dysfunction was mental problems (54%). The most commonly used Korean medicine treatment method for autonomic dysfunction was herbal medicine (70%), and Soyo-san/Gamisoyo-san is the most frequently used herbal medicine preparation. Liver qi depression used to indicate the most often mentioned Korean medicine pattern identification used to indicate autonomic dysfunction (31%). When asked whether cardiac neurosis in Chinese medicine can be considered autonomic dysfunction, opinions for and against it are determined almost equally. Conclusions: Our results serve are a foundation for developing clinical practice guidelines for autonomic dysfunction in Korean medicine and are expected to catalyst promoting future clinical research on autonomic dysfunction.

Relationship between local ventilation distribution and weaning failure in patient with diaphragmatic dysfunction on electrical impedance tomography

( Do Sik Moon ),( Chae-man Lim ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Backgrounds: Diaphragmatic dysfunction is one of the main etiologies of difficult weaning. Electrical impedance tomography (EIT) is a tool to monitor regional ventilation distribution on mechanical ventilation. The objective of this study was to assess the regional ventilation distribution of diaphragm dysfunction patients during spontaneous breathing trial. Methods: Single center, prospective observation study. To determine diaphragmatic dysfunction diagnosed by M-mode ultrasonography (vertical excursion <10 mm). And EIT was applied to identify diaphragm dysfunction during Spontaneous breathing trial to assess the influence of diaphragm dysfunction. EIT were performed at three time points: baseline (PSV) (t0), during a T-piece trial 20min (t1), and after extubation or resumption of PSV who failed SBT (t2). Calculation of EIT parameters was performed, the tidal variation of impedance (TIV), the changes in end-expiratory lung impedance (ΔEELI), and inspiration peak time difference. Data values were changed to relative values based on the baseline. Results: Forty-one patients were examined. 39%(n=16) patients have diaphragmatic dysfunction and 19.5%(n=8) patients failed primary weaning. But there are no significant differences of SBT fail, Ventilation days between diaphragm dysfunction and normal. TIV are decreased at t1 compare with t0. (p=0.03) And there was a significant decrease of TIV in diaphragm dysfunction patients. (82.8±16.4 vs 65.6±11.6, p=0.01). ΔEELI also was decreased at t1 significantly (-0.69±0.94 VS -1.51±1.4, p=0.034). The inspiration peak time difference which means a regional ventilation delay, significantly different at t1 between SBT success and failed. (0.06±1.0 vs 0.19±1.5, p=0.01). Conclusion: EIT showed a decrease of TIV and ΔEELI in diaphragmatic dysfunction patients during spontaneous breathing trial by a T-piece. And inspiration peak time delay is increased in patients who failed SBT and shows spatial heterogeneity within the lung. Therefore, the EIT could be a tool to support monitoring and predicts weaning failure of diaphragm dysfunction patient during SBT.

발기 부전에서 골반저 근육 운동의 역할

김광래 한국운동생리학회 2024 운동과학 Vol.33 No.2

PURPOSE: This study aimed to determine the role or applicability of pelvic floor muscle exercise for erectile dysfunction. METHODS: This narrative review was conducted by searching terms such as “erectile dysfunction”, “erection dysfunction”, “sexual dysfunction”, and “pelvic floor muscle training”, “pelvic floor muscle exercise”, “pelvic floor exercise”, “randomized controlled trials”, “randomized clinical trials” in PubMed, Google Scholar, Scopus, and Web of Science. RESULTS: Seven articles met the inclusion criteria. Six studies applied pelvic floor muscle exercise, electrical stimulation, and biofeedback treatment to patients with erectile dysfunction after radical prostatectomy. Only three studies showed that treatment in the intervention group had a significant effect on erectile function. Considering these results, the study subjects who applied the three treatment methods presented above were mainly patients with erectile dysfunction caused by prostate cancer surgery. CONCLUSIONS: Seven randomized controlled trials showed no significant effect of pelvic floor muscle exercise on erectile dysfunction. However, they are thought to have applicability as a method for treating erectile dysfunction. In studies of erectile dysfunction caused by radical prostatectomy, homogeneity in the age, duration of erectile dysfunction, and nerve-sparing surgery should be ensured between the intervention and control groups. First, future clinical research is required to determine whether existing methods and concurrent treatment with drugs, such as sildenafil (Viagra) and tadalafil (Cialis) can shorten the recovery period of erectile function. Second, clinical research is needed to analyze the differences in changes in erectile function between those performing aerobic exercise and pelvic floor muscle exercise combined and those performing only pelvic floor muscle exercise.

당뇨병성 심근병증과 미토콘드리아 기능 이상

안지현,김재택 대한당뇨병학회 2008 Diabetes and Metabolism Journal Vol.32 No.6

Metabolic syndrome and diabetes are associated with increased risk of cardiac dysfunction independently of underlying coronary artery disease. The underlying pathogenesis is partially understood but accumulating evidence suggests that alterations of cardiac energy metabolism might contribute to the development of contractile dysfunction. Recent findings suggest that myocardial mitochondrial dysfunction may play an important role in the pathogenesis of cardiac contractile dysfunction in type 2 diabetes. This review is focused on evaluating mechanisms for the mitochondrial abnormalities that may be involved in the development and progression of cardiac dysfunction in diabetes. (KOREAN DIABETES J 32:467-473, 2008) Metabolic syndrome and diabetes are associated with increased risk of cardiac dysfunction independently of underlying coronary artery disease. The underlying pathogenesis is partially understood but accumulating evidence suggests that alterations of cardiac energy metabolism might contribute to the development of contractile dysfunction. Recent findings suggest that myocardial mitochondrial dysfunction may play an important role in the pathogenesis of cardiac contractile dysfunction in type 2 diabetes. This review is focused on evaluating mechanisms for the mitochondrial abnormalities that may be involved in the development and progression of cardiac dysfunction in diabetes. (KOREAN DIABETES J 32:467-473, 2008)

The Effects of the Vestibular Rehabilitation on the Benign Paroxysmal Positional Vertigo Recurrence Rate in Patients with Otolith Dysfunction

Reza Hoseinabadi,Akram Pourbakht,Nasrin Yazdani,Ali Kouhi,Mohammad Kamali,Farzaneh Zamiri Abdollahi,Sadegh Jafarzadeh 대한청각학회 2018 Journal of Audiology & Otology Vol.22 No.4

Background and Objectives: Although repositioning maneuvers have shown remarkable success rate in treatments of benign paroxysmal positional vertigo (BPPV), the high recurrence rate of BPPV has been an important issue. The aims of present study were to examine the effects of otolith dysfunction on BPPV recurrence rate and to describe the effect of vestibular rehabilitation exercises on BPPV recurrence in BPPV patients with concomitant otolith dysfunction. Subjects and Methods: Forty-five BPPV patients included in this study (three groups). Patients in group 1 had no otolith dysfunction and patients in groups 2 and 3 had concomitant otolith dysfunction. Otolith dysfunction was determined with ocular/cervical vestibular evoked myogenic potential (oVEMP and cVEMP) abnormalities. Epley’s maneuver was performed for the patients in all groups but patients in group 3 also received a 2-month vestibular rehabilitation program (habituation and otolith exercises). Results: This study showed that BPPV recurrent rate was significantly higher in patients with otolith dysfunction in comparison to the group 1 (p<0.05). Vestibular rehabilitation resulted in BPPV recurrence rate reduction. Utricular dysfunction showed significant correlation with BPPV recurrence rate. Conclusions:Otolith dysfunction can increase BPPV recurrence rate. Utricular dysfunction in comparison to saccular dysfunction leads to more BPPV recurrence rate. Vestibular rehabilitation program including habituation and otolith exercises may reduce the chance of BPPV recurrence.

노인 남성의 성기능장애 진단과 치료

박현준 대한의사협회 2019 대한의사협회지 Vol.62 No.6

Male sexual dysfunction refers to a phenomenon in which a man experiences difficulty at any stage during the process of sexual intercourse. In general, erectile dysfunction is regarded as the most representative form of sexual dysfunction, but various other diseases can also be categorized as male sexual dysfunction, including sexual arousal disorder, decreased libido, ejaculation disorder, and Peyronie’s disease. Causes of sexual dysfunction include chronic diseases, such as diabetes, hypertension, dyslipidemia, and obesity. In addition, some medications, surgical procedures, and traumas can cause sexual dysfunction. However, aging is the most important cause of male sexual dysfunction. To diagnose and treat elderly patients who complain of male sexual dysfunction, it is first necessary to become familiar with the characteristics of sexual dysfunction in elderly men. The prevalence rates of metabolic syndrome, hypertension, diabetes, dyslipidemia, coronary artery disease, stroke, and depression are higher among elderly men than among younger men; furthermore, the elderly are at a higher risk for the development of kidney, hepatic, spinal cord, and neurological diseases. Notably, anti-hypertensive agents can affect erectile function in elderly men: sexual dysfunction may be severe or the response to treatment may be poor. For satisfactory treatment, spousal factors should also be considered.

항정신약물을 복용 중인 조현병 환자에서 성기능 장애의 유병률 조사

정선화,강시현,박동연,윤해주,박은경,이종일 대한조현병학회 2016 대한조현병학회지 Vol.19 No.2

Objectives : Sexual dysfunction is said to affect the compliance of drug and quality of life. This study is a research to investigate the prevalence of sexual dysfunction and affecting factors that can occur when schizophrenic and schizoaffective patients have taken drugs. Methods : Subjects were 300 patients who have been taken inpatient or outpatient treatment in national seoul hospital. We used UKU-S, ASEX scale for evaluating the prevalence of sexual dysfunction and CGI-S, PANSS negative scale and CES-D for investigating the influence of psychopathology and depressive symptoms on sexual dysfunction. Results : It was reported sexual dysfunction 82.7% in male and 92.2% in female with 7 items of UKU-S. The prevalence of sexual dysfunction with criteria of ASEX was 47.72% in male and 65.05% in female. Sexual dysfunction was more prevalent in patients taking prolactin-elevation drugs. In the factor analysis for the sexual dysfunction it was investigated that age, onset time, CGI-S, PANSS negative scale, and CES-D can affect the sexual dysfunction in both male and female. Conclusion : This study reported that many patients complained of sexual dysfunction. On considering the influence of sexual dysfunction to compliance and quality of life, clinicians evaluate sexual side effects more actively because patients are more likely not spontaneously tell the sexual side effects in comparison to others.

응급실에서 진단된 패혈성 쇽 환자의 심기능 저하에 대한 평가방법으로 Troponin I (Tn I)와 B-type natriuretic peptide (BNP)의 유용성

이정현,유승목,손창환,서동우,오범진,임경수,김원영 대한응급의학회 2013 大韓應急醫學會誌 Vol.24 No.4

Purpose: Acute cardiac dysfunction is a well recognized manifestation of organ failure in severe sepsis and septic shock. Although echocardiography is the golden standard for the evaluation of cardiac dysfunction, it is difficult to use in the emergency department (ED). The purpose of this study was to determine the availability of cardiac biomarkers for the estimation of cardiac dysfunction in septic shock patients. Methods: All study subjects included consecutive patients with septic shock diagnosed in the ED and treated with an algorithm of early goal-directed therapy between January 2011 and June 2012. We enrolled patients measured for cardiac biomarkers and performed echocardiography within 24 hours. We divided patients into two groups based on the occurrence of left ventricular dysfunction (defined as an ejection fraction≤40%) and compared serum levels of troponin-I (TnI) and B-type natriuretic peptide (BNP) between the two groups. The area under the receiver operating characteristic (ROC) curve was used to compare the diagnostic ability of TnI and BNP. Results: A total of 127 patients with septic shock and evaluated for cardiac dysfunction were enrolled in this study. TnI and BNP were significantly higher in the left ventricular dysfunction group group (4.2±9.0 vs. 0.6±1.8 ng/mL,respectively, p<0.05) compared with the non-dysfunction group (1087.6±680.1 vs. 633.2±859.1 pg/mL, respectively,p<0.05). However, in the ROC curve for predicting left ventricular dysfunction, the area under the curves of TnI and BNP, respectively, were 0.631(95% CI 0.473-0.788,p=0.103) and 0.704 (95% CI 0.552-0.856, p=0.011). TnI and BNP showed a 84.6% negative predictive value. Conclusion: Although TnI and BNP were significantly higher in septic shock patients with cardiac dysfunction but demonstrated limited accuracy compared to echocardiography. However, TnI and BNP have high negative predictive value in septic shock patients for the evaluation of cardiac dysfunction. Therefore they could serve as a valuable supplement for the detection of cardiac dysfunction.

Correlation of Androgen Deprivation Therapy with Cognitive Dysfunction in Patients with Prostate Cancer: A Nationwide Population-Based Study Using the National Health Insurance Service Database

태범식,전병조,신승훈,최훈,배재현,박재영 대한암학회 2019 Cancer Research and Treatment Vol.51 No.2

Purpose The purpose of this study was to evaluate the association of androgen deprivation therapy (ADT) with cognitive dysfunction. Materials and Methods Using the National Health Insurance Service database of the entire Korean adult prostate cancer population (n=236,391), data on ADT and cognitive dysfunction between 2008 and 2015 were analyzed. We excluded patients previously diagnosed with cognitive dysfunction, dementia, or a cerebral event history. We tested the effect of ADT on the risk of cognitive dysfunction using propensity score–matched Cox proportional hazards regression models and Kaplan-Meier survival analysis. Our final cohort comprised of 35,401 individuals with prostate cancer, including 24,567 men (70.6%) who underwent ADT. Results During a mean follow-up period of 4.1 years, 4,741 patients were newly diagnosed with cognitive dysfunction. A statistically significant association was found between ADT and the risk of cognitive dysfunction (hazard ratio, 1.169; p=0.002). Meanwhile, age ( 70 years), diabetes, hypertension, cardiovascular history, and peripheral vascular disease were identified as factors that contribute to the increased risk of cognitive dysfunction. In contrast, the use of statins and aspirin was associated with a lower risk of cognitive dysfunction. Kaplan-Meier analysis demonstrated that patients aged 70 years or older who underwent ADT had the lowest cumulative probability of remaining cognitive dysfunction-free (log-rank p < 0.001). Conclusion Our results revealed an association between the use of ADT for the treatment of prostate cancer and an increased risk of cognitive dysfunction in a nationwide population-based study. This finding should be further evaluated in prospective studies.