Comparisons of efficacy between dapagliflozin and sitagliptin in combination with metformin in type 2 diabetes mellitus patients

최근 개발된 sodium-glucose co-transporter subtype 2(SGLT2) 억제제 계열의dapagliflozin은 혈당강하 효과와 더불어 체중감소 효과가 있는 경구용 혈당강하제로서 사용량이 점차 늘어가는 추세이다. 새로운 작용기전의 dapagliflozin은 기존의 혈당강하제와 마찬가지로 혈당강하 효과가 입증되었고, 기존의 약물요법에 추가되어 당뇨병 환자의 효과적인 혈당조절에 기여할 수 있을 것으로 기대된다. 또한, 제 2형 당뇨병 환자에게 체중조절은 다양한 당뇨 합병증 예방을 위한 필수 사항이므로 dapagliflozin이 가진 체중감소 효과는 그렇지 않은 당뇨병 치료제에 비해 약제 선택에 있어 고려될 장점인 것은 분명하다. 이에, 본 연구에서는 만 18세 이상 제 2형 당뇨병 환자를 대상으로 metformin과 dapagliflozin 병용요법의 혈당강하와 체중감소 효과를 metformin과 sitagliptin병용요법의 경우와 비교하고자 하였다. Sitagliptin은 저혈당, 체중증가의 부작용이 상대적으로 적게 보고된 dipeptidyl peptidase-4(DPP4) 저해제로서 그 계열 약물 중 가장 많이 사용되는 약물이다. 2015년 1월 1일부터 2016년 3월 31일까지 서울 A병원에서 metformin과 dapagliflozin 또는 metformin과 sitagliptin을 처방 받은 제 2형 당뇨병 환자 중 만 18세 이상인 환자의 전자의무기록을 수집하여 후향적으로 분석하였다. 본 연구는 dapagliflozin 하루 한 번 복용, sitagliptin 하루 한 번 복용하는 환자를 대상으로 하였다. Metformin과 dapagliflozin을 처방 받은 군(dapagliflozin군)과 metformin과 sitagliptin을 처방 받은 군(sitagliptin군)의 3개월 간격의 hemoglobin A1c(HbA1c) 수치와 3개월 간격의 체중을 수집하였다. 총 150명의 환자는 stratified randomization 하여 75명의 dapagliflozin 군과 75명의 sitagliptin 군으로 구성되었다. HbA1c 수치는 기본값에서 dapagliflozin 군이 sitagliptin군 보다 유의한 차이로 높았다 (7.5% vs. 6.8%, P<0.001). 3개월, 6개월, 9개월, 12개월 후의 HbA1c 변화량은 3개월 후(-0.75% vs. 0.01%, P<0.001), 6개월 후(-0.36% vs. 0.08%, P=0.029), 9개월 후(-0.53% vs. 0.08%, P=0.046)에는 dapagliflozin 군에서 유의적으로 더 크게 감소되었지만, 12개월 후의 변화량에는 유의적 차이가 없었다(-0.47% vs. 0.33%, P=0.057). HbA1c 변화율은 3개월 후(-0.09 vs. 0.01, P<0.001), 6개월 후(-0.04 vs. 0.01, P=0.031), 9개월 후(-0.07 vs. 0.02, P=0.029), 12개월 후(-0.05 vs. 0.05, P=0.047)에는 모든 기간 dapagliflozin 군에서 유의적으로 더 크게 감소되었다. 체중은 기본값에서 dapagliflozin 군이 유의한 차이로 높았다(79.4kg vs. 70.8kg, P<0.001). 체중변화량은 3개월 후(-2.46kg vs. 0.37kg, P<0.001), 6개월 후(–3.02kg vs. 0.13kg, P<0.001), 9개월 후(-2.27kg vs. 0.50kg, P=0.002), 12개월 후(-3.66kg vs. 0.26kg, P<0.001)로 모든 기간 dapagliflozin 군에서 유의적으로 더 크게 감소 되었다. 체중변화율도 3개월 후(-3.10% vs. 0.52%, P<0.001), 6개월 후(-3.83% vs. 0.21%, P<0.001), 9개월 후(-2.84% vs. 0.79%, P=0.002), 12개월 후(-4.91% vs. 0.44%, P<0.001)로 모든 기간 dapagliflozin 군에서 유의적으로 더 크게 감소 되었다. 본 연구를 통해 dapagliflozin은 제 2형 당뇨병 환자에게서 혈당을 조절함과 동시에 체중 감소에 효과적인 치료제임을 알 수 있었다. 향후 대규모의 전향적, 다기관 연구가 시행되어 제 2형 당뇨병 환자에게 최선의 약물요법이 제공되길 기대한다.;Dapagliflozin, a recently developed sodium-glucose co-transporter subtype 2 (SGLT2) inhibitor, is being used more and more widely as a popular antidiabetic nowadays because of its glycemic effectiveness in conjunction with its effectivenss in bringing about weight loss. Dapaglflozin has been proven for its glycemic effectiveness in comparison to previous antidiabetics, and therefore it is expected to contribute to the effective control of blood glucose levels as an antidiabetic add-on treatment. Also, weight control is essential for type II diabetic patients in order to prevent diabetic complications. Therefore there is no doubt that the weight loss effect of dapagliflozin is beneficial for type II diabetic patients in comparison to other antidiabetics. This study aimed to compare the glycemic effectiveness and weight loss effect of metformin and dapagliflozin combination versus metformin and sitagliptin combination in type II diabetic patients 18 years and over. Sitagliptin is a dipeptidyl peptidase-4 (DPP4) inhibitor used widely because of the comparatively lower reports of its antiglycemic and weight gain adverse effects. This study retrospectively reviewed the medical records, from January 1st 2015 to March 31st 2016, of type II diabetic patients in Seoul A hospital who were more than 18 years and prescribed dapagliflozin or sitagliptin in combination with metformin. This study was based on patients who took dapagliflozin or sitagliptin once daily. Hemoglobin A1c (HbA1c) levels were measured and collected every 3 months in metformin and dapagliflozin group(dapagliflozin group) and metformin and sitagliptin group(sitagliptin group). Baseline weight and final weight within this study were also collected every 3 months. A total of 150 patients were chosen by a stratified random sampling method. They consisted of a group of 75 dapagliflozin patients and another group of 75 sitagliptin patients. Baseline HbA1c level in dapagliflozin group was significantly higher than in the sitagliptin group(7.5% vs. 6.8%, P<0.001). Dapagliflozin group showed greater decrease in HbA1c levels after 3 months(-0.75% vs. 0.01%, P<0.001), 6 months(-0.36% vs. 0.08%, P=0.029)and 9 months(-0.53% vs. 0.08%, P=0.046). However, there was no significant difference after 12 months(-0.47% vs. 0.33%, P=0.057). Dapagliflozin group showed greater significant decrease in the rate of change in HbA1c level after 3 months(-0.09 vs. 0.01, P<0.001), 6 months(-0.04 vs. 0.01, P=0.031), 9 months(-0.07 vs. 0.02, P=0.029)and 12 months(-0.05 vs. 0.05, P=0.047). In terms of weight loss, baseline weight in dapagliflozin group was significantly higher with than in the sitagliptin group(79.4kg vs. 70.8kg, P<0.001). Dapagliflozin group showed greater decrease in amount of weight change after 3 months(-2.46kg vs. 0.37kg, P<0.001), 6 months(–3.02kg vs. 0.13kg, P<0.001), 9 months(-2.27kg vs. 0.50kg, P=0.002), 12 months(-3.66kg vs. 0.26kg, P<0.001). Dapagliflozin group showed greater decreases in rate of change in weight after 3 months(-3.10% vs. 0.52%, P<0.001), 6 months(-3.83% vs. 0.21%, P<0.001), 9 months(-2.84% vs. 0.79%, P=0.002)and 12 months(-4.91% vs. 0.44%, P<0.001). Through this study, we conclusively determined that dapagliflozin is an effective drug for type II diabetic patients because of its glycemic effectiveness in conjunction to its weight loss effect. It is expected that a large number of prospective, multi-center studies will be conducted to definitely promote dapagliflozin as the most effective drugs for type II diabetic patients.Ⅰ. 서론 1 Ⅱ. 연구방법 3 A. 연구 대상 3 B. 자료 수집 3 C. 자료 분석 5 D. Randomization 방법 6 E. 통계 분석 6 F. 연구 대상자의 개인정보 보호에 관한 대책 7 Ⅲ. 연구 결과 8 A. 연구 대상의 특성 8 B. Dapagliflozin군과 sitagliptin 군의 기간별 HbA1c 수치 비교 9 C. Dapagliflozin군과 sitagliptin 군의 기본값으로부터 HbA1c 변화량(amount of change) 및 변화율(rate of change) 비교 9 D. Dapagliflozin군과 sitagliptin 군의 기본값으로부터 체중 변화량(amount of change) 및 변화율(rate of change) 비교 10 Ⅳ. 고찰 21 Ⅴ. 결론 25 References 26 Abstract 3

The Effect of Integrated Art Activities using Picture Books on Young Children‘s Creative Expression : Focusing on '5-year Nuri Curriculum'

유아기는 창의성 발달이 가장 활발하게 이루어질 수 있는 시기이므로 기초적인 사고 능력을 토대로 유연하고 창의적인 사고 능력을 기르는 데 중점을 두어야 한다. 급속히 변화하고 다원화되어 가는 우리 사회의 구성원으로 잘 적응하기 위해서는 새로운 환경이나 문제에 당면했을 때 스스로 노력하여 해결하고자 하는 태도가 요구되며 또한 유아 각자는 독창적이고 독특한 능력을 발휘할 수 있는 창의적인 사람으로 자라게 할 필요가 있다. 이는 주변 세계에 관심을 가지고 자신만의 방법으로 탐색하는 과정을 통해 형성된다(교육과학기술부·보건복지부, 2012). 본 연구는 유치원과 어린이집에서 새로운 공통과정으로 배우게 되는 만 5세 누리과정을 대상으로 생활 속에서 쉽게 접할 수 있는 그림책을 활용한 통합적 미술 교육 방법이 유아의 그림그리기에서 창의적 표현력에 어떻게 영향을 미치는지 분석함으로써 유아교육 현장에서 보다 효과적인 학습방법을 마련하는 데 그 목적을 두었다. 이러한 목적을 달성하기 위해 다음과 같이 연구를 진행하였다. 첫째, 현행 교육과정의 실제를 알아보기 위해 만 5세 누리과정의 예술경험 영역의 내용을 바탕으로 현행 교육과정을 검토하였다. 미술 교육의 도구로서 그림책의 가치와 중요성, 미술 교육적 가치 등을 조사하여 활용 방안을 찾아보고 통합적 미술교육의 의미 및 효과에 대하여 고찰하였다. 또한 만 5세 유아의 발달적 특성을 기반으로 창의적인 표현능력의 의미와 기준, 구성요소에 대하여 고찰하였다. 둘째, 만 5세 누리과정을 기반으로 그림책을 활용하여 통합적으로 접근한 미술 수업지도안을 작성하였다. 셋째, 그림책을 활용한 통합미술활동이 유아의 창의적 표현에 어떠한 효과를 주는지 알아보기 위해 2013년 3월 13일부터 4월 11일까지 서울 성북구 S어린이집 만 5세 유아 40명(실험집단 20명, 통제집단 20명)을 대상으로 사전검사, 실험처치, 사후검사를 진행하였다. 넷째, 그림책을 활용한 통합미술교육 활동이 유아의 창의적 표현에 효과적인지 검증하기 위해 우선 비교집단과 통제집단과의 사전검사를 통해 두 집단이 동질함을 밝히고, 두 집단의 사전/사후의 검사 점수 차이를 SPSS(Statistical Package for Social Science) v.17.0 통계 패키지 프로그램을 활용하여 문항별 분석, 평가요소별 분석, 총점을 분석하여 결론을 도출하였다. 본 연구에서 유아의 창의적 표현력을 평가하기 위해 사용한 검사 도구는 이수경(2011)의 연구에서 사용하였던 창의적 그림 표현력 검사 도구를 참고하여 수정·보완하였다. 본 연구의 결과는 다음과 같다. 그림책을 활용한 통합미술활동 실험집단의 사전, 사후 창의적 표현력에 차이가 나는지 살펴본 결과, 실험집단은 창의적 표현력의 하위영역인 표현태도, 대상, 내용, 방법의 모든 문항에서 사전검사보다 사후 검사의 창의적 표현 능력이 월등하게 높게 나타났다. 반면, 통제집단은 창의적 표현력 검사에서 사전과 사후 결과 사이에 큰 변화가 없었다. 즉, 수업 진행시기에 따른 유아의 학습 효과를 고려하더라도 본 연구에서 적용한 그림책을 활용한 통합적 미술활동이 창의적 표현능력에 매우 긍정적인 영향을 미친 것으로 입증되었다. 따라서 그림책을 활용한 통합적 미술교육 접근법은 유아의 창의적 표현력을 신장하는 바람직한 교수방법이라는 결론을 도출하게 되었다. 그러나 본 연구의 대상 및 실험 기간이 연구결과를 일반화하기에는 한계가 있으므로 후속연구에서는 보다 다양한 유아들을 대상으로 장기간에 걸쳐 분석하는 후속 연구가 필요할 것이다. 본 연구는 통합적 접근법으로 유아미술활동에서 창의적 표현과 더불어 전인적인 발달을 도모할 수 있는 프로그램이라 할 수 있다. 유아기는 창의성 발달이 가장 활발하게 이루어질 수 있는 시기이므로, 그 자체가 창의적 산물인 그림책을 활용하여 전인적 발달을 도울 수 있는 통합적 미술교육 방법은 현장에서 활용되어야 하며 이러한 연구 또한 앞으로 지속적으로 진행되어야 하겠다. 또한 본 연구에서 수업도구로 활용한 그림책은 유아들의 실생활과 밀접하고 미술적 가치가 높은 도구로써, 다양하고 자유로운 통합적 활동으로 발전시키기에 적합한 매체이므로 앞으로도 적극적인 교육 매체로 사용할 수 있도록 지속적인 관심이 필요하다.;The Effect of Integrated Art Activities using Picture Books In educational applications for infants in pre-school stage, it is important to educate infants to successfully deal with the dynamic circumstances of today's society. Infants should be supported by helping nurture their own creative personal abilities or talents, and it can be forged when children observe the world around them with creative curiosity. Therefore, preschool children ought to be trained to make their thoughts as flexible and creative as possible, for infancy is a critical period to develop infants' creativeness(Nuri course for 5-year olds, 2012). The purpose of the research is to suggest a more effective way to teach in a preschool arts education. The paper focuses on how effective an arts education that uses children's picture books, aiming at 5-year-olds who would be applied a new educational system, "Nu-ri course" in nurseries and kindergartens in South Korea. To verify the effectiveness of the teaching method, the paper aims at the demonstration of the practicality and validity of using children's picture books in arts classes, and how they affect children to express their artworks creatively. The thesis contains a four-tier study procedures: Firstly, an investigation on current educational system is followed, based on arts experience in Nuri course for preschoolers age of 5. Suggested ways to practice and utilize picture books in arts education are also demonstrated by considering the educational value of the teaching materials, so that the method successfully fulfill the efficacy on preschoolers arts development. Secondly, the thesis contains a lesson plan that works to apply children's picture books in the classroom for 5 year olds. Thirdly, there is an experiment to materialize the effectiveness of integrative arts education approach with picture books. The study shows how the teaching method assists students to express creatively in their artworks. In the investigation there were experimental and control group, 20 students each, all 5-year olds from "S" nursery in Seong-buk Gu, Seoul, Korea. The experiment is divided into 3 subfields: pretest, experimental development, and posttest. Fourthly, beforehand the conclusion, a pretest demonstrates that there were a little difference between the experimental and control group. To visualize the differentiation between the two, the research applied PSS(Statistical Package for Social Science) v.17.0 statistic package program by analyzing questions, evaluated elements, and scores. The test tools for creativity is referred to the creative arts expression test tool that was used in Soo-kyong Lee(2011). The results of the study are below: The experimental group was taken tests measuring for the creative expressions; expressive attitude, objects, contents and manner. The result demonstrates that the experimental group shows an obvious development in the field of creative expressions from the beginning to the end of the study, proved in pre and post assessments. However, there was a little difference in the estimations that conducted on the control group. Considering the development stage of the infants, the effectiveness of children's picture books in preschool arts classes is well-demonstrated. Thus, the whole-arts educational approach with children's picture books turned out to be desirable teaching method. However, there is a limitation on the research, for it only took limited number of students population. This means a further study should be followed by expanding its experimental scale and the period on this occasion. The study is based on an integrative approach, helping children to develop arts skill by using children's picture books which nurture them with artistic creativity. The pre-school period is a crucial point to develop abundant arts expressions. Hence, the results strongly recommend arts education method with practicing children's picture books. Considering its validity and practicality, further studies for detailed information on the same subject could be a valuable effort. Book materials used in this study are worthy enough for infant education with their familiar contents and artworks. They are appropriate to composite an integrative and flexible arts activities, so it requires to conduct more active and intensified research on utilizing them in arts classrooms.Ⅰ. 서론 1 A. 연구의 목적 1 B. 연구문제 3 C. 연구내용 및 방법 3 D. 선행연구 4 Ⅱ. 이론적 배경 6 A. 만 5세 누리과정 6 B. 그림책과 미술교육 15 C. 통합적 미술교육 19 D. 창의적 표현 24 Ⅲ. 연구방법 31 A. 연구대상 31 B. 연구설계 및 절차 31 C. 연구도구 36 D. 자료 처리 및 분석 45 Ⅳ. 연구결과 및 해석 46 A. 연구결과 46 B. 작품 분석 54 Ⅴ. 결론 및 제언 60 참고문헌 62 부록 67 ABSTRACT 8

SCB (저농도 액비) 처리가 한국 잔디의 생장에 미치는 효과

Thesis(masters) --서울대학교 대학원 :식물생산과학부(원예과학전공),2010.2.Maste

Spontaneous Renal Artery Dissection as a Cause of Acute Renal Infarction: Clinical and MDCT Findings

The purpose of this study was to assess the incidence of spontaneous renal artery dissection (SRAD) as a cause of acute renal infarction, and to evaluate the clinical and multidetector computed tomography (MDCT) findings of SRAD. From November 2011 to January 2014, 35 patients who were diagnosed with acute renal infarction by MDCT were included. We analyzed the 35 MDCT data sets and medical records retrospectively, and compared clinical and imaging features of SRAD with an embolism, using Fisher's exact test and the Mann-Whitney test. The most common cause of acute renal infarction was an embolism, and SRAD was the second most common cause. SRAD patients had new-onset hypertension more frequently than embolic patients. Embolic patients were found to have increased C-reactive protein (CRP) more often than SRAD patients. Laboratory results, including tests for lactate dehydrogenase (LDH) and blood urea nitrogen (BUN), and the BUN/creatinine ratio (BCR) were significantly higher in embolic patients than SRAD patients. Bilateral renal involvement was detected in embolic patients more often than in SRAD patients. MDCT images of SRAD patients showed the stenosis of the true lumen, due to compression by a thrombosed false lumen. None of SRAD patients progressed to an estimated glomerular filtration rate < 60 mL/min/1.73 m(2) or to end-stage renal disease during the follow-up period. SRAD is not a rare cause of acute renal infarction, and it has a benign clinical course. It should be considered in a differential diagnosis of acute renal infarction, particularly in patients with new-onset hypertension, unilateral renal involvement, and normal ranges of CRP, LDH, BUN, and BCR

커뮤니티 스토어의 디자인 특성 연구 - 타운스퀘어 기반 애플 스토어를 중심으로 -

(Background and Purpose) Today, as the IT industry develops, online purchases dominate rather than offline purchases. As a result, Apple is moving from a brand with a minimal corporate philosophy to a community-oriented space design strategy, or town square strategy. Therefore, the purpose of this study is to derive the value of design change pattern of future community store by analyzing the characteristics of community store in brand space and understanding the effect obtained by it. Therefore, the purpose of this study is to analyze the characteristics of the community store in the brand space and to find out the effect obtained thereby, so that the brand space design can be produced in more creative and diverse ways. (Method) Based on qualitative research, this study studies the contents of community store characteristics through the changed Apple retail store, Town Square. First, we define the concept of town square and community store, and derive three keywords experience, regionality, and publicity, and derive detailed characteristics. Based on the analysis, the design characteristics and effects of the community-based Apple Store are derived, and the research contents are summarized and concluded. (Results) In this study, through theoretical considerations, case analysis of the characteristics of community stores, experience, regionality, and publicity as a building element of spatial design, result of exchange of complex space, intrusiveness of non-materialization construction, contextuality of materiality, fluidity of time Four characteristics such as identity and physical relationship were derived. First, the interchangeability of the complex space refers to the psychological and physical interaction between the commercial function and the public function through the space. Second, intrusiveness in the construction of dematerialization refers to the interaction between the boundaries of the inner and outer spaces breaking through physical properties. Third, the contextuality of physical properties eliminates and expands the original physical properties to derive new physical properties, and reinterprets the original physical properties to express identity in a new dimension. Fourth, the fluidity of time is not fixed, such as changes in space and changes in material with time, and changes according to the environment from time to time. (Conclusions) This study found that through the case of Apple Town Square, the characteristics of community store expression in space can be expressed in various ways. As can be seen from Apple's case, the brand space emphasized by the community will be a valuable design as a coexisting space rather than a fragmented sales space. In addition, it is expected that the use of various properties and the use of various contents will coexist with the local community and narrow the emotional relationship with consumers.N

타원곡선위의 페어링과 암호학적 서명기법

학위논문(박사) - 한국과학기술원 : 수학전공, 2005.8, [ vii, 70 p. ]Throughout this thesis, we have focused on developing new pairing formulae and signature schemes using bilinear property that pairings can provide. The former contains three pairings: squared pairings, the qth powered pairing and the zeta pairing. We first investigate the relationship between powers of pairings and plain pairings in ordinary elliptic curves. Along these lines, we show that the squared Weil/Tate pairing for arbitrary chosen point can be transformed into a plain Weil/Tate pairing for the trace zero point which has a special form to compute them more efficiently. This transformation requires only a cost of some Frobenius actions. Similarly, we can derive an explicit formula for the 4th powered Weil pairing represented as the optimized plain Weil pairing. Next, two kinds of pairings are proposed, motivated by the eta pairing approach of Barreto et al.. One is the qth powered Tate pairing that is derived from the property of [q] map in supersingular curves. This has the same efficiency with the eta pairing. approach without any restriction. From this freedom of restriction, it becomes applicable for the reduced Tate pairing whereas the eta pairing approach seems to be only related to the modified Tate pairing since the condition requires a distortion map. As a result, we can also derive new pairing formulae that maintain the above advantage, and moreover improve the efficiency by a factor close to 2. These are not only comparable to the new algorithms by Barreto et al. but also based on more generic view. It is also shown that a rather complicated final powering in our new algorithms as well as Barreto et al.``s can be replaced by a qth Frobenius action. The other pairing that we provide is the zeta pairing. At the first glance, it is inefficient compared with the reduced Tate pairing in supersingular curves. However, it turns out that the simplified final exponentiation of the zeta pairing brings relative efficiency improvement as the security para...한국과학기술원 : 수학전공