Association between thyroid hormones and the components of metabolic syndrome

BACKGROUND: Thyroid hormones are known to have direct and indirect effects on metabolism. Individuals with metabolic syndrome, a disease that is growing in incidence at a rapid rate, are at higher risk for cardiovascular disease, diabetes, and cancer. The aim of this study was to identify whether significant correlations exist between thyroid hormone levels and components of the metabolic syndrome in the general population of Korea. METHODS: The data were collected from the sixth Korea National Health and Nutrition Examination Surveys from 2013 to 2015. A total of 1423 participants were tested for thyroid function. The analysis of variance and multiple linear regression were performed to analyze the relationship between thyroid hormone level and components of the metabolic syndrome. RESULTS: A positive association between free thyroxine and fasting glucose level was observed in patients with high free thyroxine levels (>/=1.70 ng/dL, beta = 15.992, p = < 0.0001), when compared with patients with normal-middle free thyroxine levels. Moreover, a negative association was observed between free thyroxine and triglyceride levels in patients with normal-high free thyroxine levels (beta = - 21.145, p = 0.0054) and those with high free thyroxine levels (beta = - 49.713, p = 0.0404). CONCLUSION: Free thyroxine shows a partially positive association with fasting glucose and a partially negative association with triglycerides in the Korean population. In patients with abnormal thyroid function, follow up tests for glucose levels and lipid profiling during treatment for thyroid dysfunction would be beneficial in terms of overlooking metabolic syndrome and to prevent related diseases.ope

A Case of Sarcoidosis Combined with Massive Ascites

Sarcoidosis is a multi-systemic granulomatous disease of unknown cause, which most commonly involves lung, skin, eye, liver and lymph nodes. Herein, we report a case of sarcoidosis presented with massive ascites. A 47-year-old male patient visited our hospital with symptoms of general weakness and weight loss from past 4 months. Abdomen computed tomography showed multiple lymphadenopathy and hepatosplenomegaly. Lymph node biopsy demonstrated non-caseating granulomas. After biopsy, development of massive uncontrolled ascites was noted. Liver biopsy showed non-cirrhotic hepatic and portal fibrosis and omental biopsy showed submesothelial diffuse fibrosis and focal chronic inflammation, which were suggestive of hepatic and peritoneal involvement in sarcoidosis. Ascites was controlled after subsequent treatment with corticosteroids and methotrexate.ope

Tolerability and Effectiveness of Switching to Dulaglutide in Patients With Type 2 Diabetes Inadequately Controlled With Insulin Therapy

Aims: Glucagon-like peptide 1 (GLP-1) receptor agonists have demonstrated strong glycemic control. However, few studies have investigated the effects of switching from insulin to GLP-1 receptor agonists. We aimed to investigate, using real-world data, whether switching to dulaglutide improves glycemic control in patients with type 2 diabetes mellitus (T2D) inadequately controlled with conventional insulin treatment. Materials and methods: We retrospectively evaluated 138 patients with T2D who were switched from insulin to dulaglutide therapy. We excluded 20 patients who dropped out during the follow-up period. The participants were divided into two groups according to whether they resumed insulin treatment at 6 months after switching to a GLP-1 receptor agonist (group I) or not (group II). A multiple logistic regression analysis was performed to evaluate the parameters associated with the risk of resuming insulin after replacement with dulaglutide. Results: Of 118 patients initiated on the GLP-1 receptor agonist, 62 (53%) resumed insulin treatment (group I), and 53 (47%) continued with GLP-1 receptor agonists or switched to oral anti-hypoglycemic agents (group II). Older age, a higher insulin dose, and lower postprandial glucose levels while switching to the GLP-1 receptor agonist were associated with failure to switch to the GLP-1 receptor agonist from insulin. Conclusions: A considerable proportion of patients with T2D inadequately controlled with insulin treatment successfully switched to the GLP-1 receptor agonist. Younger age, a lower dose of insulin, and a higher baseline postprandial glucose level may be significant predictors of successful switching from insulin to GLP-1 receptor agonist therapy.ope

성장호르몬 분비 뇌하수체 종양의 수술적 완치 후 발견된 지연형 자가면역 당뇨병 1예

Acromegaly is generally caused by a benign growth hormone (GH)-secreting pituitary adenoma. It is characterized by a wide range of complications; cardiovascular, respiratory, bone and joint, and metabolic complications. Among them, impaired glucose tolerance and diabetes mellitus, due to GH-induced insulin resistance, has been reported in approximately 16-46% and 19-56%. They are usually improved following the treatment of acromegaly, surgical or medical therapy. We report a first case of 36-year-old man who was paradoxically diagnosed with GAD antibody positive latent autoimmune diabetes in adults (LADA) after the surgical cure of acromegaly.ope

A 47,X,+t(X;X)(p22.3;p22.3)del(X)(p11.23q11.2),Y Klinefelter Variant with Morbid Obesity

Klinefelter syndrome is the most common type of genetic cause of hypogonadism. This syndrome is characterized by the presence of 1 or more extra X chromosomes. Phenotype manifestations of this syndrome are small testes, fibrosis of the seminiferous tubules, inability to produce sperm, gynecomastia, tall stature, decrease of serum testosterone and increases of luteinizing hormone and follicle stimulating hormone. Most patients with Klinefelter syndrome are tall, with slender body compositions, and reports of obesity are rare. We report the case of a 35-yr-old man with hypogonadism and morbid obesity and diabetes mellitus. He had gynecomastia, small testes and penis, very sparse body hair and his body mass index was 44.85. He did not report experiencing broken voice and was able to have erections. We conducted a chromosome study. His genotype was 47,X,+t(X;X)(p22.3;p22.3)del(X)(p11.23q11.2). In this case, the patient was diagnosed as Klinefelter syndrome. He showed rare phenotypes like morbid obesity and average height and the phenotype may be caused by the karyotype and the excess number of X chromosome. Further studies of the relationship between chromosomes and phenotype are warranted.ope

Duodenal adenocarcinoma following a neuroendocrine tumor in the duodenum

Primary duodenal adenocarcinoma is a rare malignant neoplasm accounting for 0.3% of all gastrointestinal tract carcinomas. We herein present one case of duodenal adenocarcinoma after duodenal neuroendocrine carcinoma. Poorly differentiated duodenal neuroendocrine carcinoma with liver metastasis (TxNxM1) was confirmed, and eight cycles of palliative chemotherapy (5-fluorouracil/etoposide/cisplatin) were administered. The patient was then in a clinically complete response status. About 1 year later, newly developed adenocarcinoma was detected at the same site. It was completely surgically resected, and the patient was cured.ope

體系的 危險의 현실적 접근법과 이를 이용한 성과측정

1980-03企業財務의 目標는 企業의 價値를 最大化함으로써 株主의 富를 極大化시키는 것이다. 그러나 企業이 價値追求를 위하여 投資決定을 할 때는 항상 期待되는 投資收益과 더불어 危險이 따르기 마련이다. 危險이 어떤 意味를 가지고 있느냐 하는 것에 관하여는 다소 見解의 차이는 있으나, 적어도 危險은 未來豫測에 대한 不完全性에서 오는 것으로 不確實性에 기인한다고 볼 수 있다. 投資家의 危險은 未來의 現金흐름이나 가능한 收益의 分散程度(variability of possible return)를 말하며, 未來에 대한 不確實로 인하여 可能한 收益이 平均値에 서 이탈하는 정도를 말한다

(The) effect of nano-sized carbonate apatite on remineralization of artificial caries-like lesions

치의학과/박사[한글] 치아우식증은 무기질 용해와 유기질 파괴로 치아손상이 일어나는 구강영역에서 나타나는 가장 대표적인 질환으로 무기질 교환의 평형을 유지시켜 준다면 탈회를 방지하여 치아우식증을 예방할 수 있으며 치아를 건강하게 유지할 수 있다. 본 연구는 초기 법랑질 우식의 회복과 치아의 재광화를 유도하기 위하여 인공 초기 우식병소를 형성한 법랑질에 nano-sized Carbonate Apatite(n-CAP)의 재광화 효과를 Casein Phosphopeptide Amorphous-Calcium Phosphate(CPP-ACP)와 상호 비교하여 분석하였다. n-CAP의 농도는 0%, 5%, 10%로 구분하였으며 CPP-ACP는 10% 함유되어 시판되고 있는 Tooth MousseTM 를 pH 순환모델을 이용하여 14일간 각각 하루 3회씩 5분간 처리하였으며 처리 전, 후의 표면의 경도 변화를 Vickers Hardness Number (VHN)로 평가하였고 Knoop Hardness number (KHN)로 무기질의 소실정도(vol %)를 ?Z 값으로 측정하여 병소 심부로의 재광화에 미친 영향을 살펴보았다. 또한 초기 법랑질의 재광화 효과를 광학적으로 평가하기 위하여 Quantitative Laser Fluorescence (QLF)를 이용하였다. 건전 치아와 비교해서 초기 법랑질 우식 재광화의 차이를 탐지하기 위해서 시편의 window 부위를 중심으로 QLF를 이용하여 fluorescence loss (?F, %), lesion size (㎜2), ?Q (%×㎜2) 값을 얻었으며 Confocal Laser Scanning Microscopy (CLSM) 관찰을 통하여 fluorescent lesion의 깊이와 intensity 등 병소의 깊이 변화를 관찰하였다. 또한 Scanning Electron Microscope (SEM)을 이용하여 입자의 크기에 따른 결정구조를 살펴보고 재광화 양상을 분석하였으며 다음과 같은 결과를 얻었다. 1. pH 순환 모형을 통한 법랑질 표면의 미세경도 변화를 살펴 본 결과 5% n-CAP군이 ? VHN 값이 23.16±9.99 로 다른 n-CAP군보다 표면 경도가 더 높게 나타났다(p<0.05). 2. 법랑질 표층 하부의 침투율을 심부로의 무기질 소실정도로 측정한 결과에서는 10%의 CPP-ACP 군에서 ?Z 1014.9±342.8(Under Vol 85% area)로 KHN의 평균값이 가장 적게 나타나 10% CPP-ACP에서 병소 심부로 갈수록 무기질의 소실 정도가 낮은 것으로 나타났다(p<0.05). 3. QLF를 이용한 우식병소의 깊이 변화 측정에서는 lesion(mm2)의 mineral loss, 즉 ?Q값이 10%의 n-CAP에서 우식병소의 깊이가 낮은 것(?Q -6.58±7.37)으로 나타났으나 통계적으로 유의하지 않았다(p>0.05). 4. CLSM과 SEM을 이용하여 법랑질 표면의 양상과 우식병소의 무기질 침착 정도를 살펴본 결과 우식병소의 깊이와 표면 경도변화 사이에서 5% n-CAP군이 45.27±9.99 ㎛, 10% n-CAP가 43.35±6.55 ㎛로 10% n-CAP군이 다른 군들에 비해 병소 깊이의 감소를 나타냈지만 유의한 차이 없었다 (p>0.05). 또한 SEM을 이용하여 법랑질 표면의 양상을 살펴본 결과 각 군 간에 특이한 소견은 없었으나 전반적으로 표면에 침착된 양상을 띄었다. 이상의 실험결과를 종합해 볼 때 nano-sized Carbonate Apatite는 법랑질 표면층에서 재광화 효과가 있었으며 CPP-ACP는 법랑질 표면 하층에서 재광화 효과가 있음을 알 수 있었다. 표층과 심부에서의 재광화 양상이 달라진 것은 CPP-ACP의 경우 탈회된 표면에서의 무기질 감소 부위에 칼슘과 인 등의 이온이 용해되었다가 석출되는 과정에서 인 단백질인 Casein phosphopeptide 유기물이 운반체 역할을 하여 칼슘과 인 등의 이온을 병소 심부까지 전달한 것으로 추정되며 n-CAP의 경우는 무기질 침착이 표층 부위에 국한되어 표면층에 침착된 칼슘과 인 등의 이온이 심부로의 침투를 방해하여 심부까지의 완전한 재광화가 일어나지 않았음을 유추할 수 있다. 이에 n-CAP의 재광화 효과를 증진시키기 위한 향후 연구에서는 CPP-ACP의 casein과 같은 활성체 역할을 할 수 있는 유기물질에 대한 고려가 있어야 하리라 여겨진다. [영문] Dental caries are the most common disease leading to tooth damage; they cause this through lysis of minerals and organic substances. When the balance of mineral exchange is maintained, dental caries can be prevented by blocking demineralization. Hence, healthy teeth can be successfully maintained. The aim of this study was to evaluate the remineralization effects of nano-sized carbonate apatite (n-CAP) and to compare it with casein phosphopeptide amorphous-calcium phosphate (CPP-ACP). The concentrations of n-CAP were classified into 0%, 5%, 10%. We use Tooth MousseTM, which is marketed with 10% CPP-ACP. Specimens were prepared from extracted bovine incisal teeth that were free of caries and defects. In this study, we sought to compare the remineralization effects of n-CAP and CPP-ACP on early caries lesions in enamel using a pH-cycling model for 14 days. The enamel specimens were immersed in each solution. Enamel specimens that had Vickers Hardness Numbers (VHN) of 40~80 were selected for artificial demineralization for 48 hours. All specimens were evaluated by measuring the VHN of the enamel surface at each step using the microhardness test (JT, Toshi Inc, Japan). The hardness of the enamel was measured before and after the processing remineralization, and the degree of mineral loss (vol %) was measured as ΔZ using the Knoop Hardness Number (KHN) to determine the effect of lesion depth on remineralization. Likewise, Quantitative Laser Fluorescence (QLF) was used to perform optic quantitative evaluation of early enamel. QLF was focused on a window area to detect the remineralization differences of early enamel caries through comparison with healthy teeth. Fluorescence loss (ΔF,%), lesionsize (㎜2), and ΔQ (%×㎜2) value were determined through this process, and the depth of lesions such as fluorescent lesions was observed using Confocal Laser Scanning Microscopy (CLSM). Lesion intensity was determined, as well. Moreover, we used a Scanning Electron Microscope (SEM) to examine the crystal structure according to the size of the particles and to analyze the features of remineralization. The following are the results of this study: 1. On observing changes in the surface microhardness of the enamel using pH cycling, we noted that the 5% n-CAP group had much higher ΔVHN(23.16±9.99) than did the other n-CAP groups (p<0.05). 2. On measuring the mineral loss of deep enamel lesions, we noted that the 10% CPP-ACP groups exhibited lower mineral loss per the KHN (ΔZ=1014.9±342.8, under vol 85% area) than did the other groups (p<0.05). 3. When measuring the depth changes of caries using QLF, 10% n-CAP showed a greater decrease in lesion depth than did the other groups. However, there was no statistically significant difference among these 4 groups (p>0.05). 4. The features of the enamel surfaces and the degree of mineral deposition in the cavity were observed using CLSM and SEM. Concerning the cavity depth and surface hardness changes, the depth in the 10% n-CAP group was lower than that seen in the other groups, but was not significantly different (p>0.05). Moreover, SEM showed no specific features on examination of the enamel surfaces, but there was a general deposition on the surfaces. Based on that data from this study, it can be concluded that: (1) nano-sized carbonate apatite had the effect of remineralization on the enamel surface layer, and CPP-ACP had the effect of remineralization underneath the enamel surface; (2) differences in remineralization aspects on the surface and in the deep layers are presumed to be secondary to casein phosphopeptide organic material precipitation on areas with mineral reduction during dissolution of ions such as calcium and phosphate. Hence, in future studies dedicated to improving the remineralization effect of n-CAP, organic materials such as casein should be considered proactivators.ope

Effect of ketamine on the isolated uterus of guinea pig

의학과/석사[한글] 산후 자궁출혈은 모체사망의 중요한 원인이 되며 대부분의 강력한 흡입마취제는 자궁수 축의 장애를 일으키므로 문제시 되고있다(Munson, 1970: 任등, 1971: 金, 1972). 임상적으로 ketamine은 자궁수축을 촉진시킨다(Chodoff 및 Stella, 1966: Little등, 1 972; Galbert 및 Gardner, 1973; Corssen 1974)고 보고된바 있으며, Jawalekar 등(1972) 은 쥐의 임신자궁절편에 ketamine을 적용하여 자궁운동의 촉진을 관찰하였다. 金(1975)에 의하면 가토에서 ketamine의 자궁운동 촉진작용은 adrenergic 및 cholinergic receptor 와 관계없이 난소호르몬중 주로 progesterone의 영향을 받으며 자궁근에 대하여 직접적으 로 작용한다고 했다. 이에 저자는 ketamine이 해명(guinea pig)의 자궁에 대해서도 촉진작용을 나타내는지의 여부에 관해 추구함과 동시에 ketamine이 해명에서도 progesterone의 영향을 받는지를 추시했다. 실험동물로는 0.5㎏내외의 비임성숙자성해명(非妊成熟雌性海溟)과 2.0㎏내외의 비임성 숙자성가토(非姙成熟雌性家　)을 사용하였다. 해명과 가토는 각각 양측난소적출 10∼14일 후 estrogen주사군은 estradiol benzoate 2,000 I.U./㎏, progesterone주사군은 progeste rone 5㎎/㎏을 매일 1회 4일간 근육주사했다. 자궁절편(1.5∼2.0㎝ 길이)은 해명 혹은 가토에서 도살하는 즉시 분리 척출(剔出)하여 Locke액 50㎖가 들어있는 이중벽초자제(二重壁硝子製) muscle chamber 저부(底部)에 한골 을 고정하고 다른끝은 lever에 연결하여 그 수축을 kymograph지에 묘사하였다. 이때 musc le chamber내 Locke액은 38℃로 일정하게 유지시키고 산소를 계속 공급했다. 자궁절편의 자발운동이 일정하게 됨을 기다려 ketamine을 적용하고 운동곡선의 변화를 관찰하였던바 다음과 같은 결과를 얻었다. 1) 해명의 자궁운동양상은 가토와는 달리 높은 수축고와 적은 수축빈도를 나타내었다. 2) Estrogen주사 해명자궁절편에 1∼25 γ/㎖의 ketamine을 적용하였던바 자궁운동양상 에 아무런 변화가 없었고 50 γ/㎖이상의 대량을 적용하였을 때는 오히려 자궁수축고의 저하를 나타내었다. 3) Progesterone주사 해명자궁절편에 1∼100 γ/㎖의 ketamine을 적용하였던 아무런 반 응이 없었으나 estrogen투여군의 3배의 양인 150 γ/㎖의 농도에서 역시 자궁수축고의 저 하를 나타냈으며 200 γ/㎖의 농도에서는 현저한 억제를 보여주었다. 4) Estrogen주사 가토자궁절편에 대한 대량의 ketamine의 영향은 20 γ/㎖의 농도에서 는 아무 변화가 없었으나 해명자궁절편에서 수축고의 저하를 보여주는 50 γ/㎖의 농도에 서는 역시 수축고의 저하를 나타내었다. 5) Progesterone주사 가토자궁절편에 대한 대량의 ketamine의 영향을 보았던바 150 γ/ ㎖의 농도에서는 수축고의 항진을 나타냈으나 200 γ/㎖의 농도에서는 역시 수축고의 저 하를 나타냈다. 이상의 결과, ketamine의 자궁수축작용은 가토에 있어서는 progesterone의 영향을 받으 나 해명에 있어서는 progesterone의 영향을 뚜렷이 관찰할 수는 없었다. 즉 종족차이가 있다고 생각할 수 있었다. 그리고 ketamine을 대량 적용하게 되면 자궁수축고의 억제현상 이 나타나는데 그 억제량은 해명 및 가토 모두 estrogen투여군보다 progesterone투여군에 있어서 더 대량이 필요함을 볼 수 있었다. [영문] Postpartum bleeding of the uterus is an important cause of maternal death. It is thought that the inhibitory effect of the majority of potent inhalation anesthetics on uterine contractions is often responsible (Munson, 1970; Lim et al., 1971; Kim, 1972). There have been numerous reports that ketamine stimulates uterine contraction clinically (Chodoff and Stella, 1966; Little et al, 1972; Galbert and Gardner, 1973; Corssen, 1974). Jawalekar and associates (1972) reported that ketamine increased resting tension, contractile amplitude and frequency of the uterine strips of pregnant mice, and Kim (1975) reported research on the effects of ketamine on the isolated uterus of rabbits. According to Kim (1975), ketamine exerted a stimulatory action on the uterus under the influence of progesterone. This progesterone-dependent uterine stimulatory action of ketamine is not concerned with adrenergic and cholinergic mechanisms but appears to have a direct effect on the uterine muscle. The present study was undertaken to determine whether or not ketamine also exerted a stimulatory action on the uterus of the guinea pig and to follow up whether or not stimulatory action of ketamine also depends upon progesterone in the guinea pig. Adult female non-pregnant guinea pigs and rabbits weighing approximately 0.5 kg and 2.0 kg respectively were employed in this experiment. At the end of 10 to 14 days following bilateral oophorectomy, non-pregnant guinea pigs and rabbits were injected intramusculary with estradiol benzoate (2,000 I.U./kg) or progesterone (5 mg/kg) once a day for four consecutive days. A uterine strip, about 1.5-2.0 cm in length, was carefully isolated from the experimental animals and suspended in a muscle chamber containing 50 ml of Locke's solution, maintained at constant temperature of 38℃. It was aerated with 100% oxygen bubbling through the bathing fluid by means of a sintered glass plate at the bottom of the muscle chamber. One end of the uterine strip was attached to the bottom of the muscle chamber and the other end to a lever. Motility and tonus were recorded on kymograph paper. After being washed several times with fresh Locke's solution, the uterine strip attained a constant motility and tonus. Ketamine then was added ion various concentrations to the chamber. The results are as follows: 1. The uterine motility of guinea pig shows a higher amplitude and lower frequency compared with that of rabbit. 2. Effects of ketamine on isolated uterine strips of guinea pig pre-treated with estrogen showed no change using 1-20 γ/ml of ketamine, but with 50 ??/ml or more, the amplitude of uterine contractions was depressed. 3. On isolated uterine strips of guinea pig pre-treated with progesterone, there was no effect with 1-100 γ/ml of ketamine, depressed amplitude of uterine contractions with 150 γ/ml and markedly depressed amplitude of uterine contraction with 200 γ/ml. 4. On isolated uterine strips of rabbit pre-treated with estrogen, there was no effect with 20 γ/ml of ketamine, but depressed amplitude of uterine contraction using 50 γ/ml. 5. On isolated uterine strips of rabbits pre-treated with progesterone, there was an increase in amplitude and frequency of uterine contractions with up to 150 γ/ml of ketamine, but depressed amplitude with 200 γ/ml or more. From the above results it may be concluded that ketamine exerted a stimulatory action on the uterus of rabbit under the influence of progesterone but not on the uterus of guinea pig. The large amount of ketamine depressed the amplitude of uterine contraction in guinea pig and rabbit, and this depressing dose is higher in the animals (guinea pig and rabbit) pre-treated with progesterone than with estrogen.restrictio