• 대한응급의학회지
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• 제29권5호
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• pp.500-508
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• 2018

Objective: The aim of this study was to evaluate the clinical characteristics of heat stroke in a bath facility and investigate predictive factors of multiple major complications in heat stroke patients. Methods: This was a retrospective study on heat stroke patients who visited an urban emergency center from January 2010 to March 2018. We compared clinical characteristics, complication, and outcomes of heat stroke patients in bath and non-bath facilities. Multivariate logistic regression analysis were performed to identify independent predictors of multiple major complications in heat stroke patients. Results: A total of 67 heat stroke patients with heat stroke were enrolled, of which 42 (62.6%) were in a bath facility and 25 (37.3%) were in a non-bath facility. Patients with heat stroke in the bath facility were characterized by old age, past medical history of hypertension and diabetes mellitus, and high incidence of hypotension compared with those in the non-bath facility but also low incidence of acute renal failure, seizure, and multiple major complications. In the multivariate analysis, predictive factors of multiple major complications in heat stroke patients were non-bath facility (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.2-29.9), Glasgow Coma Scale (GCS)${\leq}8$ (OR, 8.2; 95% CI, 1.3-49.4), and mean arterial pressure (MAP), body temperature above $40.5^{\circ}C$ (OR, 8.1; 95% CI, 1.1-58.8) <60 mmHg (OR, 14.8; 95% CI, 1.8-122.9). Conclusion: Heat stroke in the bath facility resulted in less major complications, and high body temperature, GCS ${\leq}8$, and MAP <60 mmHg were independent predictive factors of multiple major complications in heat stroke patients.

• 생물정신의학
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• 제27권2호
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• pp.94-100
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• 2020

Objectives Amyloid β positron emission tomography (Aβ PET) is widely used as a diagnostic tool in patients who have symptoms of cognitive impairment, however, this diagnostic examination is too expensive. Thus, predicting the positivity of Aβ PET before patients undergo the examination is essential. We aimed to analyze clinical predictors of patients who underwent Aβ PET retrospectively, and to develop a predicting model of Aβ PET positivity. Methods 468 patients who underwent Aβ PET with cognitive impairment were recruited and their clinical indicators were analyzed retrospectively. We specified the primary outcome as Aβ PET positivity, and included variables such as age, sex, body mass index, diastolic blood pressure, systolic blood pressure, education, dementia family history, Mini Mental Status Examination (MMSE), Clinical Dementia Rating (CDR), Clinical Dementia Rating-Sum of Box (CDR-SB), hypertension (HTN), diabetes mellitus (DM) and presence of apolipoprotein E (ApoE) E4 as potential predictors. We developed three final models of amyloid positivity prediction for total subjects, mild cognitive impairment (MCI) and Alzheimer's disease (AD) dementia using a multivariate stepwise logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was performed and the area under curve (AUC) value was calculated for the ROC curve. Results Aβ PET negative patients were 49.6% (n = 232), and Aβ PET positive patients were 50.4% (n = 236). In the final model of all subjects, older age, female sex, presence of ApoE E4 and lower MMSE are associated with Aβ PET positivity. The AUC value was 0.296. In the final model of MCI subjects (n = 244), older age and presence of ApoE E4 are associated with Aβ PET positivity. The AUC value was 0.725. In the final model of AD subjects (n = 173), lower MMSE scores, the presence of ApoE E4 and history of HTN are associated with Aβ PET positivity. The AUC value was 0.681. Conclusions The cerebral amyloid positivity model, which was based on commonly available clinical indicators, can be useful for prediction of amyloid PET positivity in MCI or AD patients.

• Journal of Korean Neurosurgical Society
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• 제64권1호
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• pp.78-87
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• 2021

Objective : Intraoperative neurophysiological monitoring (IONM) has been widely used during spine surgery to reduce or prevent neurologic deficits, however, its application to the surgical management for cervical myelopathy remains controversial. This study aimed to assess the success rate of IONM in patients with cervical myelopathy and to investigate the factors associated with successful baseline monitoring and the effect of increasing the stimulation intensity by focusing on motor evoked potentials (MEPs). Methods : The data of 88 patients who underwent surgery for cervical myelopathy with IONM between January 2016 and June 2018 were retrospectively reviewed. The success rate of baseline MEP monitoring at the initial stimulation of 400 V was investigated. In unmonitorable cases, the stimulation intensity was increased to 999 V, and the success rate final MEP monitoring was reinvestigated. In addition, factors related to the success rate of baseline MEP monitoring were investigated using independent t-test, Wilcoxon rank-sum test, chi-squared test, and Fisher's exact probability test for statistical analysis. The factors included age, sex, body mass index, diabetes mellitus, smoking history, symptom duration, Torg-Pavlov ratio, space available for the cord (SAC), cord compression ratio (CCR), intramedullary increased signal intensity (SI) on magnetic resonance imaging, SI length, SI ratio, the Medical Research Council (MRC) grade, the preoperative modified Nurick grade and Japanese Orthopedic Association (JOA) score. Results : The overall success rate for reliable MEP response was 52.3% after increasing the stimulation intensity. No complications were observed to be associated with increased intensity. The factors related to the success rate of final MEP monitoring were found to be SAC (p<0.001), CCR (p<0.001), MRC grade (p<0.001), preoperative modified Nurick grade (p<0.001), and JOA score (p<0.001). The cut-off score for successful MEP monitoring was 5.67 mm for SAC, 47.33% for the CCR, 3 points for MRC grade, 2 points for the modified Nurick grade, and 12 points for the JOA score. Conclusion : Increasing the stimulation intensity could significantly improve the success rate of baseline MEP monitoring for unmonitorable cases at the initial stimulation in cervical myelopathy. In particular, the SAC, CCR, MRC grade, preoperative Nurick grade and JOA score may be considered as the more important related factors associated with the success rate of MEP monitoring. Therefore, the degree of preoperative neurological functional deficits and the presence of spinal cord compression on imaging could be used as new detailed criteria for the application of IONM in patients with cervical myelopathy.

• Nutrition Research and Practice
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• 제15권1호
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• pp.54-65
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• 2021

BACKGROUND/OBJECTIVES: This study aimed to develop healthy, appetizing high-protein snacks with enhanced isolated soy protein for diabetic patients and determine the blood glucose and insulin response after being consumed by these patients. MATERIALS/METHODS: Thirty adult patients aged between 30 and 75 years, with a ≤ 10-year history of type 2 diabetes and hemoglobin A1c of < 7.5%, were enrolled in this study. They made 3 clinical visits at one-week intervals. The control group consumed 50 g carbohydrates (white bread), whereas the test groups consumed high-protein grain (HP_G) or high-protein chocolate (HP_C) after an 8-hrs fast. Blood (2 ㎤) was drawn at 15, 30, 45, 60, 90, and 120 min before and after consumption to analyze the blood glucose and insulin concentrations. RESULTS: Compared to the commercial snacks, the developed high-protein snacks had below-average calorie, carbohydrate, and fat content and a 2.5-fold higher protein content. In diabetic patients who consumed these snacks, the postprandial blood glucose increased between 15 min and 2 h after consumption, which was significantly slower than the time taken for the blood glucose to increase in the patients who consumed the control food product (P < 0.001). Insulin secretion was significantly lower at 45 min after consumption (P < 0.05), showing that the high-protein snacks did not increase the blood glucose levels rapidly. The incremental area under the curve (iAUC), which indicated the degree of blood sugar and insulin elevation after food intake, was higher in the control group than the groups given the 2 developed snacks (P < 0.001), and there was no significant difference in insulin secretion. CONCLUSIONS: The results of the postprandial blood glucose and insulin response suggest that high-protein snacks are potential convenient sources of high-quality protein and serve as a healthier alternative for patients with type 2 diabetes, who may have limited snack product choices. Such snacks may also provide balanced nutrition to pre-diabetic and obese individuals.

• 한방비만학회지
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• 제20권2호
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• pp.69-77
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• 2020

Objectives: In this study, we investigated the antiobesity and antidiabetic effects of polyherbal extract, DM2 consisting of Atractylodis Rhizoma, Anemarrhenae Rhizoma, Cinnamomi Cortex, and Moutan Radicles Cortex in high fat diet-induced obesity mice. Methods: DM2 extract was prepared with a hot water. Six-week-old male C57BL/6N mice were fed a high-fat diet (HFD) for 8 weeks and then administrated with DM2 extract (500 mg/kg, p.o.) for 4 weeks. The changes of physiological markers, body weight (BW), food and water intakes, and the levels of fasting blood glucose (FBG) were measured once a week for 4 weeks in mice. The the serum levels of glucose, insulin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total cholesterol (T-CHO), triglyceride, and low density lipoprotein cholesterol in sera were measured in mice using autometic chemical analyzer and enzyme linked immunosorbant assay. We also observed the histological changes of liver and pancreatic tissues with Hematoxylin & Eosin staining. Results: In physiological change, the increases of BW, calorie intake, and FBG in HFD-induced obese mice were significantly decreased after administration of DM2 extract for 4 weeks. The decrease of water intake was significantly increased in DM2 extract-administrated mice. In serological change, the administration of DM2 extract in obesity mice was significantly decreased the serum levels of glucose, insulin, T-CHO, AST, and ALT levels. We also found that DM2 extract inhibited the increase of lipid droplets in liver and the structural destruction of pancreatic tissues in obesity mice. Conclusion: Our study demonstrated that DM2 extract has antiobesity antidiabetic effects with body weight loss, decrease of glucose and insulin levels, and lipid accumulation on liver tissue.

• 보건행정학회지
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• 제31권1호
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• pp.114-124
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• 2021

Background: In this study, we aimed to investigate the interaction effects of individual socioeconomic status and regional deprivation on the onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients. Methods: Korean National Health Insurance Service National Sample Cohort data from 2002 to 2013 were used. A total of 50,954 patients newly diagnosed with type 2 diabetes from 2004 to 2012 and aged 30 years or above were included. We classified patients into six groups according to individual income level and neighborhood deprivation: 'high in advantaged,' 'high in disadvantaged,' 'middle in advantaged,' 'middle in disadvantaged,' 'low in advantaged,' and 'low in disadvantaged.' We calculated hazard ratios (HR) of onset of diabetes complication and diabetes-related hospitalization using the Cox proportional hazard model, with the reference group as diabetes patients with high income in advantaged regions. Results: In terms of the interaction effects of individual income level and regional socioeconomic level, even with the same low individual income level, the group with a high regional socioeconomic level (low in advantaged) showed low HRs for the onset of diabetes complication (HR, 1.04; 95% confidence interval [CI], 1.00-1.08) compared to the 'low in disadvantaged' group (HR, 1.10; 95% CI, 1.05-1.16). In addition, the 'high in advantaged' group showed slightly higher HRs for the onset of diabetes complication (HR, 1.06; 95% CI, 1.00-1.11) compared to the 'low in advantaged' and it appeared to be associated with slight mitigation of the risk of diabetes complication. For the low-income level, the patients in disadvantaged regions showed the highest HRs for diabetes-related hospitalization (HR, 1.29; 95% CI, 1.19-1.41) compared to the other groups. Conclusion: Although we need to perform further investigations to reveal the mechanisms that led to our results, interaction effects individual socioeconomic status and regional deprivation might be associated with on onset of diabetes complications and diabetes-related hospitalization among type 2 diabetes patients.

• 한국산학기술학회논문지
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• 제21권12호
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• pp.826-835
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• 2020

본 연구는 노인의 구강보건행위가 건강관련 삶의 질(Health-related Quality of Life, HRQOL)에 미치는 영향에서 스트레스의 매개 효과를 분석하기 위하여 국민건강영양조사(2010-2015)를 활용한 이차 자료분석 연구이다. 65세 이상 노인 8,148명을 대상으로 사회 경제상태, 건강 상태, 흡연 및 음주 습관, 스트레스 여부, 그리고 구강보건행위(칫솔질 횟수, 정기적인 치과 검진여부, 치간 세정도구 사용)를 조사하였으며 건강관련 삶의 질 측정을 위해 EuroQol-5 Dimension(EQ-5D) index를 사용하였다. 연구결과, 사회경제학적 수준이 낮거나 고혈압, 당뇨병을 가진 노인들에서 HRQOL이 낮았으며, 칫솔질 횟수가 적거나 정기적인 치과방문을 하지 않거나 치간 세정도구를 사용하지 않는다고 응답한 노인들에서 HRQOL이 낮았다. 그리고 스트레스는 노인의 삶의 질에 부적 상관을 보였으며 구강보건행위와 삶의 질의 관계에서 부분매개효과를 확인하였다. 이러한 결과는 노인의 구강보건행위와 삶의 질의 관계에서 스트레스 매개효과가 있음을 의미한다. 그러므로, 노인의 건강관련 삶의 질 증진을 위해 건강증진프로그램을 수행할 때 스트레스 해소 및 구강건강증진 프로그램을 포함한 융합적인 프로그램이 필요하며, 그러한 정책마련을 위한 기초자료로 제공하고자 한다.

• 대한임상검사과학회지
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• 제54권2호
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• pp.149-156
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• 2022

본 연구는 지질 축적 지수(lipid accumulation product, LAP)는 중심 지질 축적을 반영하는 새로운 지표로서, 심혈관 위험이나 당뇨병의 강력한 위험인자로 알려져 있다. 본 연구의 목적은 대한민국 20 성인에서 비만의 유무에 따른 지질 축적 지수와 인슐린저항성(homeostasis model assessment of insulin resistance, HOMA-IR)의 관련성에 대하여 조사하였다. 본 연구는 2019년도 국민건강영양조사 자료(2019 Korean National Health and Nutrition Examination Survey, KNHANES V-3)를 이용하여 20세 이상의 대한민국 성인 6,090명을 대상으로 실시하였다. 본 연구결과에서 중요한 결과는 다음과 같다. 첫째, 연령, 성별, 음주습관, 흡연습관, 운동습관, 수축기 및 이완기혈압, 혈중 요소 질소 및 크레아티닌을 보정한 후의 결과에서, 전체인구(P<0.001), 비만이 아닌 군(P<0.001) 및 비만군(P<0.001)에서 LAP의 사분위수가 증가함에 따라 HOMA-IR 평균값(M±SE, 95% confidence interval)이 증가하였다. 둘째, 전체인구, 비만이 아닌 군 및 비만군에서, 공복혈당(모든 그룹, P<0.001), 인슐린(모든 그룹, P<0.001) 및 대사증후군 점수(모든 그룹, P<0.001)의 평균값(M±SE, 95% CI)은 LAP의 사분위수가 증가함에 따라 증가하였다. 결론적으로, 대한민국 성인 중 비만군과 비만이 아닌 군 모두에서 지질 축적 지수가 증가함에 따라 인슐린저항성이 증가하였다.

• Journal of Ginseng Research
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• 제46권6호
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• pp.780-789
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• 2022

Background: Incretin impairment, characterized by insufficient secretion of L-cell-derived glucagon-like peptide-1 (GLP-1), is a defining step of type 2 diabetes mellitus (T2DM). Ginsenoside compound K (CK) can stimulate GLP-1 secretion; however, the potential mechanism underlying this effect has not been established. Methods: CK (40 mg/kg) was administered orally to male db/db mice for 4 weeks. The body weight, oral glucose tolerance, GLP-1 secretion, gut microbiota sequencing, bile acid (BA) profiles, and BA synthesis markers of each subject were then analyzed. Moreover, TGR5 expression was evaluated by immunoblotting and immunofluorescence, and L-cell lineage markers involved in L-cell abundance were analyzed. Results: CK ameliorated obesity and impaired glucose tolerance in db/db mice by altering the gut microbiota, especially Ruminococcaceae family, and this changed microbe was positively correlated with secondary BA synthesis. Additionally, CK treatment resulted in the up-regulation of CYP7B1 and CYP27A1 and the down-regulation of CYP8B1, thereby shifting BA biosynthesis from the classical pathway to the alternative pathway. CK altered the BA pool by mainly increasing LCA and DCA. Furthermore, CK induced L-cell number expansion leading to enhanced GLP-1 release through TGR5 activation. These increases were supported by the upregulation of genes governing GLP-1 secretion and L-cell differentiation. Conclusions: The results indicate that CK improves glucose homeostasis by increasing L-cell numbers, which enhances GLP-1 release through a mechanism partially mediated by the gut microbiota-BA-TGR5 pathway. Therefore, that therapeutic attempts with CK might be useful for patients with T2DM.

• 대한본초학회지
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• 제37권1호
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• pp.1-9
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• 2022

Objective : This study was designed to investigate anti-diabetic effects of fermented soy bean extract with herbal medicines (Godjang) in diabetic rat models induced by streptozotocin (STZ) injection. Method : Changes in body weight, drinking water, and food intake were observed for 4 weeks before and after induction of diabetes mellitus in rats. The anti-diabetic capacity of Godjang was analyzed by fasting blood glucose (FBG) every week. Also, after 4 weeks of administration, the oral glucose tolerance test (OGTT) was performed, and then blood levels of insulin were checked. And serum levels of total cholesterol and triglycerides were determined. Histomorphological changes of liver, kidney and pancreatic tissues were also observed in STZ-induced diabetic rats and Godjang administered rats. Result : In Godjang administered group, body weight and water intake were more lower than that of STZ-induced diabetic rats. FBG was decreased in the Godjang administered group than STZ-induced diabetic group. According to OGTT, blood glucose levels at 30 minutes and 60 minutes significantly decreased in Godjang administered group than in STZ-induced diabetic control group. Administration of Godjang extract for 4W significantly decreased levels of serum glucose, total cholesterol (TC), triglycerides (TG) in diabetic rats. In histomorphological analysis of kidney, liver, Godjang administrated groups showed the inhibition of pathological damage. Conclusion : These results suggest that Godjang extract has an anti-diabetic action through decrease in serum glucose, TC, TG levels and recovery of the morphological changes in kidney and liver in STZ-induced diabetic rats.