The association of insulin resistance and carotid atherosclerosis with thigh and calf circumference in patients with type 2 diabetes

BACKGROUND: The relationship between body composition parameters such as thigh and calf circumference and insulin resistance or atherosclerosis in type 2 diabetes is poorly understood. The aim of this study was to investigate the relationship between insulin resistance, atherosclerosis, and thigh and calf circumference in patients with type 2 diabetes. METHODS: A total of 4,427 subjects with type 2 diabetes were enrolled in this study. Insulin sensitivity was assessed according the rate constant for plasma glucose disappearance (Kitt) determined via the short insulin tolerance test. Biochemical and anthropometric profiles were measured according to a standardized protocol. Visceral fat thickness and carotid intima media thickness (IMT) were measured by ultrasonography. RESULTS: Insulin sensitivity index (Kitt) was significantly correlated with weight adjusted thigh and calf circumference. Thigh circumference was inversely associated with IMT in men and women and calf circumference was negatively correlated with IMT in women. Multiple stepwise regression analysis revealed that thigh circumference was independently correlated with insulin sensitivity index (Kitt) and IMT. Furthermore, in multivariate logistic regression analysis, thigh circumference was an independent determinant factor for carotid atherosclerosis in patients with type 2 diabetes even after adjusting for other cardiovascular risk factors. CONCLUSIONS: Thigh and calf circumference were correlated with insulin resistance and carotid atherosclerosis, and thigh circumference was independently associated with insulin resistance and carotid atherosclerosis in patients with type 2 diabetes.ope

A determinant of insulin resistance in patients with schizophrenia

Background/Aims: As compared with the general population, patients with schizophrenia have a higher risk of obesity and glucose metabolism impairment. Moreover, some antipsychotic drugs add to this risk owing to side effects such as weight gain. However, few reports exist regarding the pathophysiology of insulin resistance in drug-naive or drug-free schizophrenic patients. Therefore, the aim of the present study was to investigate the factors that contribute to insulin resistance in antipsychotic drug-naive and drug-free schizophrenic patients. Methods: Nineteen (4 men, 15 women) drug-naive or drug-free subjects with schizophrenia and nineteen age- and sex-matched controls were recruited for participation in this study. We measured weight, height, waist circumference, biochemical profiles, body fat percentage, and calculated body mass indices (BMI) in all patients. Furthermore, we correlated HOMA-IR, a marker for insulin resistance, with anthropometric measures and clinical characteristics. Results: There were no significant differences in BMI, waist circumference, or body fat percentage between the two groups. In addition, there were no differences in blood pressure, glucose, HbA1c, insulin, HOMA-IR, total cholesterol, HDL-cholesterol, or LDL-cholesterol; however, triglyceride levels and 24 hr urine free cortisol levels were higher in schizophrenic patients. There was also a significant correlation between HOMA-IR and both age and waist circumference in the control group. Additionally, HOMA-IR was significantly correlated with 24 hr urine free cortisol levels in schizophrenic patients. Conclusions: The study shows that risk factors for insulin resistance in drug-naive or drug-free schizophrenic patients do not differ from those of the control group; however, the major determinant of insulin resistance in schizophrenia patients was that of increased cortisol levelsope

A Case of Pseudohypoparathyroidism without Albright's Hereditary Osteodystrophy in an Adult

Pseudohypoparathyroidism is a rare disease caused by resistance to parathyroid hormone, and is associated with typical clinical typical symptoms such as tetany and seizures, hypocalcemia, hyperphosphatemia and increased parathyroid hormone levels. Pseudohypoparathyroidism is classified to Type Ia, Ib, Ic and II according to the clinical and biochemical manifestations. Type Ia and Ic have morphological characteristics called Albright’s hereditary osteodystrophy. Type Ib differs from type II for the pathogenesis. Type Ib may~receptors and type II may~ pathway, but the pathophysiology of type II is not clear yet. Administration of parathyroid hormone extract may help to distinguish between the two types. We report a case of a pseudohypoparathyroidism type Ib or II patient who had tetany, hypocalcemia and hyperphosphatemia with normal morphologic featuresope

A Case of Turner`s Syndrome with Transient Hypopituitarism

Turner's syndrome is characterized by short stature and gonadal dysgenesis, and it is often associated with various systemic manifestations, such as cardiovascular, renal, thyroidal, gastrointestinal, and musculoskeletal disorders. Though very rare, it can also be accompanied by hypopituitarism. It is important to give a meticulous medical attention to short females with gonadal dysgenesis so that neither disease is neglected or gets delayed diagnosis. In this case, Turner's syndrome and hypopituitarism were diagnosed almost simultaneously, but hypopiuitarism was transient, and the normal pituitary function was recovered spontaneously without any treatment. Initial sella MRI showed mild congenital hypoplastic hypopituitarism, and combined pituitary function test was compatible with hypopituitarism, but after 5 years, though growth hormone deficiency was still present, otherwise normal pituitary function was noted without any change in MRI. Herein, we are reporting a case of Turner's syndrome with transient idiopathic hypopituitarism with the review of literature.ope

내시경 초음파에서 췌장의 종양성 낭종으로 오인된 췌장 가성낭종 2예

ope

Activation of NF-κB and AP-1 in Peripheral Blood Mononuclear Cells Isolated from Patients with Diabetic Nephropathy

Background We evaluated the role of oxidative stress in diabetic nephropathy by measuring intracellular reactive oxygen species (ROS) and redox-sensitive transcription factors in isolated peripheral mononuclear cells (PBMC). Methods From 66 diabetic patients with or without diabetic nephropathy (Group III and II, respectively) and 49 normal control subjects (Group I), spontaneous and stimulated ROS levels, activities of nuclear factor-kappa B (NF-κB), activator protein-1 (AP-1), and specificity protein1 (Sp1) in PBMC, urinary and PBMC TGF-β1 (transforming growth factor-β1), and 24-hour urinary albumin excretion (UAE) were measured. Results Spontaneous ROS was significantly higher in group III and II than group I (60.7 ± 3.3 vs. 60.0 ± 3.0 vs. 41.1 ± 2.4%, respectively), and stimulated ROS were significantly higher in Group III compared to Group II (Increment of H2O2-induced ROS production: 21.8 ± 2.2 vs. 11.1 ± 2.0%, respectively; increment of PMA-induced ROS production 23.5 ± 4.5 vs. 21.6 ± 2.2%, respectively). The activities of NF-κB and AP-1, but not of Sp1, were significantly higher in Group III than in Group II (2.53 vs. 2.0 vs. 1.43-fold, respectively). Both PBMC- and urinary TGF-β1 levels were higher in Group III than Group II (3.23 ± 0.39 vs. 1.99 ± 0.68 ng/mg in PBMCs, 16.88 ± 6.84 vs. 5.61 ± 1.57 ng/mL in urine, both respectively), and they were significantly correlated with activities of NF-κB and AP-1 and 24-hour UAE. Conclusion Increased intracellular ROS generation in PBMCs of diabetic patients is involved in the pathogenesis of diabetic nephropathy through activation of NF-κB and AP-1, but not Sp1, and increased expression of TGF-β1.ope

Visceral fat thickness predicts fatty liver in Koreans with type 2 diabetes mellitus

Our aim was to study whether visceral adiposity is a predictor of diabetic fatty liver in Korean type 2 diabetes mellitus. In this study, abdominal ultrasonography was used to assess the presence of fatty liver in 1,898 patients with type 2 diabetes. We measured visceral fat thickness by high-resolutional ultrasonography and insulin resistance by Kitt. Half of the cohort had a fatty liver (50.2%). High visceral fat thickness had the highest odds ratio for developing fatty liver in both sexes (odds ratio [S.D]: 3.14 [2.24-4.69], p<0.00 in male, 2.84 [2.04-3.93], p<0.00 in female). In addition, visceral fat thickness of 42.45 and 37.7 mm in men and women, respectively, were chosen as the discriminating value to predict the presence of fatty liver with a sensitivity of 71% and 73% and a specificity of 70% and 70% in men and women, respectively. The area under the receiver-operating characteristics curve was 0.759 in men and 0.764 in women. Therefore we could conclude that the degree of visceral adiposity predicts the presence of fatty liver type 2 diabetes mellitus, whether centrally obese or not, suggesting that hepatic fat accumulation in a diabetic fatty liver may be influenced by visceral fat accumulation regardless of waist circumferenceope

응집-정밀여과를 이용한 정수처리 공정에서 플록의 특성이 막여과 성능에 미치는 영향

Thesis(doctor`s)--서울대학교 대학원 :응용화학부,2005.Docto

Effect of cardiovascular risk markers independently of glycemic control after pioglitazone 15mg therapy

의학과/석사[한글] 연구 배경: thiazolidinedione (TZD) 계통의 피오글리타존은 인슐린 저항성을 개선하여 혈당조절상태를 호전시키는 것 이외에 심혈관계 위험인자들을 개선시킨다고 알려져 왔다. 그러나 국내에서 적용한 연구가 드물며, 기존의 임상 연구들에서 적용된 피오글리타존의 용량은 대부분 30mg 또는 45mg이었는데 반해, 현재 한국에서 사용할 수 있는 용량은 15mg으로 기존 연구의 결과들을 적용하기 무리가 있다. 이에 제 2형 당뇨병 환자에서 피오글리타존 15mg 치료 후 심혈관계 합병증 위험인자에 미치는 영향을 관찰하여 그 효과에 대하여 검증하고 현재 사용되는 용량의 적정성을 알아보고자 하였다.방법: TZD를 투여 받지 않던 제2형 당뇨병 환자들을 두 군으로 나누어 한 군은 기존 약제에 피오글리타존 15mg을 추가 투여하고 다른 군은 기존의 약제로 12주간 치료하였다. 두 군간의 공복혈당, 공복인슐린, 당화혈색소, hsCRP, fibrinogen, HOMA-IR, 지질, 경동맥 내중막 두께의 투여 전후 차이를 비교하였다.결과: 피오글리타존 투여군 48명, 대조군 40명이 참여하였다. 12주 피오글리타존 투여 군에서 투여전보다 경동맥 내중막 두께를 감소시키고, 공복 인슐린, 당화혈색소, HOMA-IR, 중성지방, 저밀도 콜레스테롤, hsCRP의 통계학적으로 유의한 호전을 관찰할 수 있었으며, 공복혈당과 총 콜레스테롤, fibrinogen의 유의한 변화는 없었다. 대조군에서는 LDL 콜레스테롤의 호전만을 관찰할 수 있었다.결론: 피오글리타존 15mg 12주 투여 후 혈당 개선 효과 이외에도 염증 지표의 개선과 이상지혈증의 개선에 효과가 있음을 알 수 있었으며 동맥경화증 지표인 경동맥 내중막 두께를 감소시켜주는 항 동맥경화 효과도 관찰할 수 있었다. [영문] Background: Carotid intima-media thickness (cIMT) is a strong predictor of macrovascular disease. Pioglitazone has been reported to have antiatherogenic effect and anti-inflammatory effect. But the dose of pioglitazone in previous clinical trial was 30mg or 45 mg daily. This study was performed to assess the effect of pioglitazone 15mg, which has been commercially used dose in Korea, to carotid intima-media thickness.Method: A 12 weeks, open-label, prospective, controlled clinical study was done. Patients were randomized to pioglitazone 15mg administerd group or control group. Biochemical and clinical markers was assessed including cIMT, fasting glucose, insulin, lipids, high sensitivity C-reactive protein (hsCRP), fibrinogen, and HbA1c.Result: The study was completed by 98 patients (52 pioglitazone group, 46 control group). There were no difference baseline characteristics between two groups. The average and maximal cIMT were reduced only in the pioglitazone group after 12 weeks. And fasting serum insulin, HOMA-IR, hsCRP levels were improved only in pioglitazone group.Conclusions: There were a regression of cIMT, a decrease of hsCRP and an improvement of HOMA-IR after pioglitazone 15mg therapy. This result implies pioglitazone 15mg has an anti-inflammatory effect and an antiatherogenic effect too.ope

면심입방구조 금속의 소성변형기구 이론

DoctorThe activation of plastic deformation mechanisms determines the mechanical behavior of crystalline materials. For face-centered cubic metals, the stacking fault has been widely used to interpret the intragranular deformation mechanisms, twinning, stacking fault, and full slip. However, the current description of plastic deformation with stacking fault energy is still empirical and weak on the physical basis. The generalized planar fault energy was proposed as an alternative parameter but still the interpretation contains unresolved problem which is not clearly understood. Here, we put forward a transparent theory of plasticity based on the generalized planar fault energy. We demonstrate that grain orientation can drastically alter the deformation mode activity and propose the concept of effective energy barrier to reflect the orientation effect. Finally, a single parameter derived from the intrinsic energy barriers is identified. Based entirely on this parameter, a simple deformation mode diagram is shown to delineate a series of convenient criteria of metals. Additionally, the effect of stress types on deformation mechanism fraction is revealed