• Journal of Obesity & Metabolic Syndrome
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• 제27권4호
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• pp.213-222
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• 2018

Bariatric surgery has evolved from a surgical measure for treating morbid obesity to an epochal remedy for treating metabolic syndrome as a whole, which is represented by type 2 diabetes mellitus. Numerous clinical trials have advocated bariatric or metabolic surgery over nonsurgical interventions because of markedly superior metabolic outcomes in morbidly obese patients who satisfy traditional criteria for bariatric surgery (body mass index [BMI] >$35kg/m^2$) and in less obese or simply overweight patients. Nevertheless, not all diabetes patients achieve the most desirable outcomes; i.e., diabetes remission after metabolic surgery. Thus, candidates for metabolic surgery should be carefully selected based on comprehensive preoperative assessments of the risk-benefit ratio. Predictors for diabetes remission after metabolic surgery may be classified into two groups based on mechanism of action. The first is indices for preserved pancreatic beta-cell function, including younger age, shorter duration of diabetes, and higher C-peptide level. The second is the potential for an insulin resistance reduction, including higher baseline BMI and visceral fat area. Several prediction models for diabetes remission have been suggested by merging these two to guide the joint decision-making process between clinicians and patients. Three such models, DiaRem, ABCD, and individualized metabolic surgery scores, provide an intuitive scoring system and have been validated in an independent external cohort and can be utilized in routine clinical practice. These prediction models need further validation in various ethnicities to ensure universal applicability.

• Nutrition Research and Practice
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• 제15권4호
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• pp.456-467
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• 2021

BACKGROUND/OBJECTIVES: The prevalence of morbid obesity in Korean women has consistently been increasing, while the overall prevalence rate of obesity in Korean women seems to be stable. In addition to bariatric surgery, intragastric balloons (IGBs), as a nonsurgical therapy, have been reported to be effective in weight loss. However, the beneficial effects of IGB in Korean women with obesity have not been fully investigated. The aim of this study was to evaluate the changes in fat mass in Korean women with obesity who had undergone IGB treatment for 6 mon. SUBJECTS/METHODS: Seventy-four women with obesity (body mass index [BMI] ≥ 25.0 kg/m²) were recruited. Clinical data, including general information, comorbidities with obesity, anthropometric data, and changes in the body fat composition before and after IGB treatment, were obtained from the subjects. RESULTS: Most subjects had one or more comorbidities, such as osteoarthropathy and woman's disease, and had poor eating behaviors, including irregular mealtimes, eating quickly, and frequent overeating. Body composition measurements showed that weight, fat mass, and waist-hip circumference ratio decreased significantly at 6 mon after IGB treatment. In particular, women with morbid obesity (BMI ≥ 30 kg/m²) showed 33% excess weight loss. There was no significant difference in skeletal muscle mass and mineral contents after IGB treatment. CONCLUSIONS: This study suggested that 6 mon of IGB treatment can be a beneficial treatment for obesity without muscle mass and bone mineral loss.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제13권1호
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• pp.129-138
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• 2002

목 적：소아청소년 정신과 질환의 가장 대표적이라 할 수 있는 주의력결핍-과잉행동장애(ADHD)의 최적치료모델 개발을 위한 연구의 일환으로, 우선 실제 ADHD로 의심되는 환자가 병원을 방문했을 때 임상의들이 현재 (1) 어떠한 진단 평가적 도구를 사용하여 진단적 접근을 하며, (2) 어떠한 치료적 접근을 시행하고 있는지, (3) 현재 시행하고 있지는 않지만, 어떤 모델을 추구하는지에 대해 구조화된 설문도구를 이용하여 파악하고자 하였다. 방 법：대학병원 및 종합병원 소아정신과 담당 전문가 32명을 대상으로 구조화된 설문조사를 하였고, 여기에 포함되는 조사내용으로는 진단검사도구, 약물치료, 비약물치료 현황파악이었다. 이 자료를 Texas Algorithm Project(TAP)와 비교 검토하였다. 결 과：(1) 모든 ADHD 환아에게 실시해야 할 기본적인 검사는 지능검사, 문장완성검사, 지속적 집중력검사, 코너씨 설문지였고, (2) 전반적 ADHD 투여 약물은 TAP 지침과 차이가 없었고, 다만 약효가 인정된 aderall, bupropion, guanfacin의 국내이용이 요구된다고 하였으며, (3) 틱 장애가 동반된 경우는 임상의들이 정신자극제 사용을 자제하는 경향을 보여 TAP 지침과 분명한 차이를 보였고, (4) 파탄적 행동장애가 동반된경우 임상의들은 다른 약물로 교체하기보다는 MPH 투여에 다른 약물을 추가하는 경향을 보였으며, (5) 과반수 이상의 임상의가 꼭 실시하여야 한다고 보고한 치료로는, 개별적 부모상담, 부모교실, 개인별 행동인지 치료였다. 결 론：본 연구 결과를 통해 알 수 있었던 여러 제한점들을 보완하고 또한 본 연구에서 제기된 논쟁점을 위주로 하여서, 한국적 실정에 맞는 ADHD 최적치료모델 개발을 위한 연구와 더불어 전문가들의 합의가 이루어져야 하겠다.

• BMB Reports
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• 제40권4호
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• pp.467-474
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• 2007

Autosomal recessive polycystic kidney disease (ARPKD) is one of the important genetic disorders in pediatric practice. Mutation of the polycystic kidney and hepatic disease gene 1 (PKHD1) was identified as the cause of ARPKD. The gene encodes a 67-exon transcript for a large protein of 4074 amino acids termed fibrocystin, but its function remains unknown. The neoplastic-like in cystic epithelial proliferation and the epidermal growth factor/epidermal growth factor receptor (EGF/EGFR) axis overactivity are known as the most important characteristics of ARPKD. Since the misregulation of $Ca^{2+}$ signaling may lead to aberrant structure and function of the collecting ducts in kidney of rat with ARPKD, present study aimed to investigate the further mechanisms of abnormal proliferation of cystic cells by inhibition of PKHD1 expression. For this, a stable PKHD1-silenced HEK-293T cell line was established. Then cell proliferation rates, intracellular $Ca^{2+}$ concentration and extracellular signal-regulated kinase 1/2 (ERK1/2) activity were assessed after treatment with EGF, a calcium channel blocker and agonist, verapamil and Bay K8644. It was found that PKHD1-silenced HEK-293T cell lines were hyperproliferative to EGF stimulation. Also PKHD1-silencing lowered the intracellular $Ca^{2+}$ and caused EGF-induced ERK1/2 overactivation in the cells. An increase of intracellular $Ca^{2+}$ in PKHD1-silenced cells repressed the EGF-dependent ERK1/2 activation and the hyperproliferative response to EGF stimulation. Thus, inhibition of PKHD1 can cause EGF-induced excessive proliferation through decreasing intracellular $Ca^{2+}$ resulting in EGF-induced ERK1/2 activation. Our results suggest that the loss of fibrocystin may lead to abnormal proliferation in kidney epithelial cells and cyst formation in ARPKD by modulation of intracellular $Ca^{2+}$.

• 정신신체의학
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• 제31권2호
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• pp.118-124
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• 2023

연구목적 우울장애와 불안장애는 흔히 공존하며 임상전단계에서도 흔히 공존한다. 본 연구는 일반인구 집단에서 우울장애와 불안장애가 공존시의 복합 네트워크를 구성하여 중심 증상과 중개 증상을 밝히고자 했다. 방 법 2022년 아산시 청년 정신건강실태조사 데이터를 활용하여 진행하였다. 일반 인구집단 810명의 성인을 대상으로 PHQ-9과 GAD-7을 이용하여 각각 우울과 불안증상의 정도를 측정하였고, 각 증상에 대해 Isingfit model을 기반으로 네트워크 구조를 도출하였다. 주요 증상 및 중개 증상을 찾기 위해 네트워크 지표 중 강도 중심성과 bridge expected influence를 활용하였다. 결 과 우울한 기분, 안절부절 못함과 초조함이 네트워크에서 가장 높은 강도중심성을 보였으며, 불안증상과 우울증상 간의 높은 중개 역할을 하는 증상은 안절부절 못함과 과민성이었다. 결 론 일반 인구집단에서 우울증상과 불안증상이 공존할 때의 중심증 상과 중개증상을 규명하였고 치료적 중재의 목표가 되면 두 질환의 동반이환율을 감소시키는데 기여할 수 있을 것으로 기대된다.

• 대한불안의학회지
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• 제3권1호
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• pp.32-40
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• 2007

Objectives : To investigate the validity of an abbreviated self-rated Korean version of MINI (Mini International Neuropsychiatric Interview) patient health survey which screening social anxiety disorder, panic disorder, generalized anxiety disorder, and major depressive disorder. Methods : 115 subjects completed MINI and MINI patient health survey. The validity of MINI patient health survey was assessed by whether the results from MINI patient health survey were compatible with the results from MINI or not. The Cohen's kappa value, specificity, sensitivity, positive predictive value, and negative predictive value was calculated for this purpose. Results : The Kappa values of social anxiety disorder (0.60), panic disorder (0.49), generalized anxiety disorder (0.60) and major depressive disorder without other co-morbid disorder (0.59) were at least moderate in strength of agreement. Conclusion : The abbreviated self-rated Korean version of MINI patient health survey has the moderate to good validity in social anxiety disorder, panic disorder, generalized anxiety disorder, and major depressive disorder without other co-morbid disorders. Our result suggests that this instrument might be useful for screening above 4 disorders if it is used under careful supervision of experienced clinicians.

• Journal of Korean Neurosurgical Society
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• 제37권6호
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• pp.410-415
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• 2005

Objective: The aim of our study is to evaluate the effectiveness of unilateral hemilaminectomy for bilateral decompression in elderly patients with degenerative spinal stenosis. For this purpose, we studied the co-morbid condition and clinical outcome of patients who underwent decompressive surgery using the unilateral approach technique. Methods: Thirty-four patients over 65years of age who underwent unilateral partial laminectomy for bilateral decompression from January 2000 to October 2003 were analyzed. These patients were studied for preoperative co-morbid condition and physical status according to the American Society of Anesthesiologists(ASA) classification, postoperative morphometrical change, and clinical outcomes, including visual analogue scale(VAS) score. The mean follow-up was 23months (range 6 - 48months). Results: A patient's physical status was recorded as class I, II, or III by ASA classification, which correlated to 41.2%, 44.1%, and 14.7% of patients, respectively. The cross-sectional area of the pre- and postoperative dural sac at the level of the stenosis was $52.5{\pm}19.9mm^2$ and $110.6{\pm}18.2mm^2$, respectively. The outcome was excellent in 8.8%, good in 58.8%, fair in 23.6%, and poor in 8.8% of the patients. The VAS was changed postoperatively to $3.1{\pm}1.2$. There was no operation-related transfusion yet there was no evidence of postoperative instability at the follow-up examination. Conclusion: Unilateral laminectomy for bilateral decompression, in spite of the limited exposure, can result in satisfactory decompression of the lumbar spinal stenosis and tolerable clinical outcome. This approach is thought to be appropriate for elderly patients who have a greater surgical burden.

• 복식
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• 제45권
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• pp.133-146
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• 1999

Because adolescents are much inflicted with the sense of obsession in endless competition with their feers the costume of the pop singers relieving this agony and anxiety is becoming the object of immitation more than that of any oother entertainer. In this perspective it was thought that it was very necessary to attempt to investigate what relationship sense of mental anxiety the costume singers recently have worn had with adolescents sense of anxiety. The anxiety questionnaire used by Chu Young-sook and Kim Jung-hui and the questionnaire drawn up as the result- of the pilot-test and the pre-test were used and the questionnaires drawn up by a total of 228 middle schoolgirls in seoul were used a sfinal data of annalysis. Of them the anxiety questionnaire was made up of 8 sub-scales such as classic·social·morbid·learning examination·school record·poverty·war and other to anxieties. in order to survey the overall content concerning the costume of the singers preferred by teenagers the other questionnaire presented three vaiables such as musicality fashionability and dance as the distinct characteristics of singers and hiphop style tidy style and sexy style of clothing as the style of clothing preferred of singers' clothing. The importance fashionability and imitability of clothing were investigated as variables in relation to singers' clothing behavior. The SPSS PC+ program was used as the analytic method of data which were tested by the frequency analysis Duncan's multiple anaylsis of variance t-test and so on. As a result of investigation middle schoolgirls having a high level of learning and examinatior anxieties preferred the singers excellent in musicality while middle schoolgirls having a lower level of classic anxiety preferred the singers excellent in fashionability and dance wearing the hiphop style of clothing. And it was shown that middle schoolgirls having a lower level of classic anxiety preferred the singers wearing the clothing of sexy style. In the light of these results it was shown that there was the correlation between anxiety and clothing preference. Accordingly it is thought that the purpose of this study was achieved to some exent.

• 대한한의학원전학회지
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• 제19권2호통권33호
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• pp.115-137
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• 2006

The Diagnosis and Treatment of Jaundice According to the Morbid Pulse in the Chapter 15 of Synopsis of Golden Chamber sets forth the classification, symptom, method of treatment, formula, prognosis of jaundice. The contents of this chapter can be induced by(from) yellowing and jaundice These two disease patterns assume various aspects of disease cause, pathomechanism, symptom, prognosis, and treatment. Jaundice was at first classified into liquor jaundice,dietary irregularly jaundice, black jaundicem abd sextual taxation jaundice, later classified into liquor jaundice, dietary irregularly jaundice, black jaundice, sextual tatation jaundice, and yellow sweat. the disease cause and pathomechanism of jaundice are said to be said to be due to the damp-heat, which is attacked with the evil of wind and dampness to affect the spleen-stomach and the liver. and to the inveterate drinking, damage by food, sextual taxation jaundice, sextual taxation, and vacuity taxation. This chapter mainly refers to jaundice as damp-heat, so that it lays down fundamental principles of clear heat and disinhibit dampness. In the prognosis of jaundice, ingibited urination shows symptoms of jaundice, and neither urination nor damp-heat develops symptoms of jaundice. and jaundice with thirst is difficult to cure, and that the symptoms of the abdominal fullness is also difficult to cure, while jaundice without thirst is ease to cure. Of the 18 days of suffering from jaundice, the symptoms of jaundice get better before and after 10 days. I think, however, that getting worse of its symptoms makes more meaningful clinically.

• The Korean Journal of Pain
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• 제35권3호
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• pp.345-352
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• 2022

Background: Optimal needle depth in transforaminal epidural injection (TFEI) is determined by body measurements and is influenced by the needle entry angle. Physician can choose the appropriate needle length and perform the procedure more effectively if depth is predicted in advance. Methods: This retrospective study included patients with lumbosacral pain from a single university hospital. The skin depth from the target point was measured using magnetic resonance imaging transverse images. The depth was measured bilaterally for L4 and L5 TFEIs at 15°, 20°, and 25° oblique angles from the spinous process. Results: A total of 4,632 measurements of 386 patients were included. The lengths of the left and right TFEI at the same level and oblique angle were assessed, and no statistical differences were identified. Therefore, linear regression analysis was performed for bilateral L4 and L5 TFEIs. The R-squared values of height and weight combined were higher than the height, weight, and body mass index (BMI). The following equation was established: Depth (mm) = a - b (height, cm) + c (weight, kg). Based on the equation, maximal BMI capable with a 23G, 3.5-inch, Quincke-type point spinal needle was presented for three different angles (15°, 20°, and 25°) at lumbar levels L4 and L5. Conclusions: The maximal BMI that derived from the formulated equation is listed on the table, which can help in preparations for morbid obesity. If a patient has bigger BMI than the one in the table, the clinician should prepare longer needle than the usual spinal needle.