Evaluation of pulmonary venous, mitral and aortic by echocardiography in neonates

Pulmonary vein velocities have recently been estimated in conjunction with mitral flow velocities to increase our understanding of ventricular filling. The advent of transesophageal echocardiography with pulsed Doppler imaging capability has provided a method by which both the mitral valve and pulmonary vein velocities can be easily recorded because of the posterior approach providing unimpeded interrogation of cardiac structures. The purpose of this present study was to evaluate the normal pulmonary venous, mitral and aortic flow pattern by transthoracic echocardiography in neonate according to the postnatal age. The results were as follows. 1. With regard to the aortic flow, the early systolic wave of pulmonary flow peaked after the onset of aortic flow and the late systolic wave occurred consistently before aortic valve closure. 2. The peak velocities of early systolic, late systolic, diastolic and atrial systolic in the pulmonary venous flow were 36.4±13.2cm/s, 45.3±15.3cm/s 48.5±14.1cm/s and 16.6±5.7 cm/s at 1 day old. The difference according to the postnatal age was not significant. 3. The ratio of peak systolic to peak distolic velocity of pulmonary venous flow was 1.0±0.3 at 1 day old, 1.1±0.4 at 1 week old and 1.2±0.3 at 1 month old. The difference between 1 week old and 1 month old was statistically significant (p< 0.05). 4. The peak early diastolic velocity of mitral flow was 51.3±15.2 cm/s at 1 day old, 54.7±13.7 cm/s at 1 week old and 80.7±16.6 cm/s at 1 month old. The difference between 1 week old and 1 month old was statistically significant (p< 0.01). 5. The peak late diastolic velocity of mitral flow was 48.3±14.6 cm/s at 1 day old. 50.1±9.9 cm/s at 1 week ols and 71.8±16.6 cm/s at 1 month old. The difference between 1 week old and 1 month old was statistically significant (p< 0.01). 6. The ratio of peak mitral early diastolic to peak late diastolic velocity was 1.1±0.2 at 1 day old, 1.1±0.3 at 1 week old and 1.2±0.7 at 1 month old. The difference between 1 week old and 1 month old was statistically significant (p< 0.01). 7. The peak aortic valve flow velocity was 62.1±14.2 cm/s at 1 day old, 67.8±1 13.4 cm/s at 1 week old and 76.6±14.1 cm/s at 1 month old. The difference between 1 week old and 1 month old was statistically significant (p< 0.05). In conclusion, improvement of left ventricular diastolic function was noted at 1 month old by echocardiography. These normal data will be useful in comprisons with the data, which obtained in newborn with various congenital heart disease that affects flow dynamics.;Doppler 심에코도를 이용하여 폐정맥혈류 및 승모판혈류를 측정하여 좌심실 확장 기능을 평가하는 방법은 검사조작등으로 인한 혈류장애 없이 비관혈적으로 연구될 수 있다는 장점이 있다. 최근 경식도 도플러 (transesophageal Doppler) 심에코도를 이용하여 성인에서 승모판 혈류와 함께 폐정맥 혈류의 측정이 용이해짐으로써 좌심실 확장기능을 더욱 정확하게 평가할 수 있게 되었다. 이에 저자는 심에코도를 이용하여 정상 신생아에서 생후 1일, 1주 및 1달에 폐정맥, 승모판 및 대동맥판막 혈류의 변화를 측정하여 비정상적인 심확장기 기능을 가진 선천성 심질환과 비교 할 수 있는 기준을 삼고자 본 연구를 시행하여 다음과 같은 결과를 얻었다. 1. 폐정맥 혈류는 대동맥판막혈류가 시작된 후에 폐정맥 초기 수축기 최고속도가 나타났고, 대동맥판막이 닫히기 전에 후기 수축기 최고속도를 나타내었다. 2. 폐정맥 초기 및 후기 수축기, 확장기, 심방수축기 최고혈류속도는 각각 생후 1일에 36.4±13.2 cm/s, 45.3±15.3 cm/s, 48.5±14.1 cm/s, 16.6±5.7 cm/s로 일령에 따른 유의한 차이는 없었다. 3. 폐정맥 확장기 최고속도에 대한 수축기 최고혈류속도의 비는 생후 1일에 1.0±0.3, 생후 1 주에는 1.1±0.4, 생후 1개월에 1.2±0.3으로 생후 1개월에 유의하게 증가하였다 (p<0.05). 4. 승모판 초기 확장기 최고혈류속도는 생후 1일에 51.3±15.2 cm/s. 생후 1주에 54.7±13.7 cm/s, 생후 1개월에 80.7±16.6 cm/s 로서 생후 1개월에 유의하게 증가하였다 (p<0.01). 5. 승모판 후기 확장기 최고혈류속도는 생후 1일에 48.3±14.6 cm/s, 생후 1주에 50.1±9.9 cm/s. 생후 1개월에 71.8±16.6 cm/s 로 생후 1개월에 유의하게 증가하였다 (p<0.01). 6. 승모판 후기 확장기 최고혈류속도에 대한 초기확장기 최고혈류속도의 비는 생후 1일에 1.1±0.2, 생후 1주에 1.1±0.3, 생후 1개월에 1.2±0.7로 생후 1개월에 유의하게 증가하였다 (p<0.01). 7. 대동맥판막 최고혈류속도는 생후 1일에 62.1±14.2 cm/s, 생후 1주에 67.8±13.4 cm/s, 생후 1개월에 76.6±14.1 cm/s 로 생후 1 개월에 유의하게 증가하였다(p<0.05). 본 연구결과를 종합해 볼 때 정상 신생아에서 경흉 심에코도로 측정한 좌심실확장기능은 출생 후 1 개월이 지나면 소아기와 유사하게 증가함을 알 수 있었다. 정상 신생아애서의 폐정맥, 승모판 및 대동맥 혈류의 심에코도 측정은 비정상적인 심기능을 가진 심질환과 비교할 수 있는 좋은 지표로 생각한다.목차 논문개요 = ⅵ Ⅰ. 서론 = 1 Ⅱ. 연구 대상 및 방법 = 3 Ⅲ. 결과 = 6 Ⅳ. 고찰 = 15 Ⅴ. 결론 = 20 참고문헌 = 22 〓Abstract〓 = 2

(A) STRUCTURAL ANALYSIS OF SENTENCES IN THE MIDDLE SCHOOL ENGLISH

The major language acquisition controversy has been that of the linguistic theory based on behaviorism vs. the linguistic theory based on rationalism. The former insists that language is a set of habits and proposes the imitative methods of mimicry and memorization with pattern drills as its language teaching methods. The latter asserts that man is biologically built to learn languages, that he learns the internalized rules of the language he uses, and that the rules generate the infinite new sentences. We can not remember all the sentences we use and this means it is very important to teach the students the finite rules that enable them to make infinite sentences. Well designed text books can furnish the learner with not a simple knowledge but language competence that makes him use the language efficiently. In this sense we estimate the meaningful learning highly. A text book must be systematic. It must be on the basis of meaningful generalization. Considering that a systematic tort book plays an important role in the second language learning, It is desirable to examine the present middle school English text books. Oral Practice and Further Study sections of the text books, in particular, are examined, The analytical criteria employed in the paper are as follows; 1. Whether they present structures from easy ones to more complicated ones; 2. Whether they relate underlying identical structures. In conclusion this paper has found the following points for improvement of teaching English grammar at middle schools in Korea. 1. The present middle school English text books, which adopt the theory of structural grammar as their theoretical foundation, are inefficiently organized in some points and need to be reorganized. 2. For the improvement of teaching English grammar, it is necessary to introduce other grammatical theories into the present grammar study. 3. Considering that the learners reason logically, systematic text books on the basis of meaningful generalization will promote their learning.;언어학습이론의 커다란 두 흐름은 행동주의 심리학을 근거로 하는 이론과 이성주의 심리학을 근거로 하는 이론으로 갈라진다. 전자가 언어행위를 습관으로 보고 모방과 암기를 그 학습방법으로 제안한다면, 후자는 인간의 언어습득 능력이 선천적이며, 후천적인 언어환경에 의해 그 언어에 대한 규칙체계가 내재화되고 이 내재화된 법칙이 무한한 새로운 문장들을 생성케 함을 주장한다. 우리의 언어생활을 생각해 볼 때, 우리가 무한한 문장들을 다 기억할 수 없음을 받아 들인다면, 언어를 교육한다는 문제는 단순한 모방과 암기의 범주를 벗어나 학습자에게 무한한 수의 새로운 문장들을 생성할 수 있는 유한한 수의 규칙체계, 즉 언어능력을 효과적으로 습득케 할 필요가 있다. 효율적인 교육성과를 기대하기 위해서는 외국어 학습에서의 교재의 중요성이 커다란 비중을 차지한다. 잘 정리된 교재의 구성은 곧 학습자로 하여금 단순한 지식으로서의 학습이 아닌, 실제 운용의 언어 능력을 길러 주게 하기 때문이다. 이점에서, 학습에서의 유의적(meaningful)연습이 필요하게 된다. 영문 교재에서 유의적 일반화(meaningful generalization)에 의한 교재의 구조화란 기본적 사상을 토대로 학습하게 될 내용을 선택한 다음, 문장 상호간의 관련성에 따라 편성 나열하는 것이다. 외국어 학습의 효율성이 교재의 구조화에 큰 영향을 받고 있음을 살펴 볼 때, 현재 사용되고 있는 중등 영어 교과서의 그 전개 구성이 바르게 되어 있는지 살펴 보는것은 지극히 바람직하다. 이때 그 검토 기준은 유의적 일반화(meaningful generalization)를 염두에 두어 다음과 같이 살펴본다. 1. 간단하고 쉬운 문장부터, 차츰 복잡하고 어려운 문장구조를 학습할 수 있도록 배열되어 있는가? 2 .동일한 내면구조의 문장을 분리하여 가르치고 있지 않은가? 효과적인 학습 성과를 이루기 위해 현재 사용되고 있는 중학교 영어교재는 다음과 같은 몇 가지 점을 고려해야 될 것이라고 제안해 본다. 1 .구조문법을 바탕으로 표면적 구조에 의거, 문장 구조의 학습단계를 결정하는 방법은 때로 학습과정의 개선점을 요구한다. 2. 이러한 모순을 해결하고 효율적인 학습 결과를 기대하기 위해서는 다양한 문법이론의 도입이 필요하다. 3. 논리적 이성력을 갖추게 되는 시기의 영어 학습 대상자를 고려한다면, 여러 문법이론을 응용한 문형의 유의적 일반화에 의한 교재의 구조화는 학습효과를 높일 수 있다.목차 = ⅲ 논문개요 = ⅴ Ⅰ. 서론 = 1 A. 연구의 목적 = 1 B. 연구의 방법 = 1 Ⅱ. 언어이론과 문법교육 = 3 A. 언어이론과 언어교육 = 3 B. 전통문법이론 = 4 C. 구조문법이론과 구두교수법 = 5 D. 변형문법이론 = 10 Ⅲ. 교재의 구조화 = 17 Ⅳ. 중학교 영어교육 = 22 A. 난이도에 따른 배열 문제 = 22 B. 유기적 상관관계에 따른 배열 문제 = 27 Ⅴ. 결론 = 40 참고문헌 = 42 ABSTRACT = 4

HL-60 세포주의 분화 유도제 처리에 따른 표현형 및 기능 변화에 관한 연구

HL-60 is a promyelocytic cell line which has been investigated as a model not only for leukemic cell biology but also for the myeloid differentiation during hematopoiesis. It is well known that DMSO(dimethyl sulfoxide) or retinoic acid induce granulocytic differentiation of HL-60 cells, while vitamin D or PMA(phorbol 12-myristate 13-acetate) in monocytic linage. It is also known that the expression of CD11b and CD18 on HL-60 cells increase during granulocytic differentiation. Fc receptors and CR3 play an important role in the protective response of granulocytes and monocytes against microbial infection. Fc receptors of IgG fall into three group, FcγRI(CD64), FcγRII(CD32), and FcγRIII(CD16), which opsonize phagocytosis, mediate ADCC and initiate oxidative burst, etc. CR3 (CD11b/CD18 or Mac-1), which binds iC3b, also stimulates phagocytosis. However, FcγRI, FcγRII, FcγRIII as well as CD11b/CD18 have never been measured in a quantitative way during hemopoiesis. Thus we quantified the expression of Fc RI, Fc RII, Fc RIII, and CD11b/CD18 during hematopoietic differentiation using HL-60 cells, which was induced to differentiate by DMSO, all-trans retinoic acid(ATRA), or PMA. In parallel with the phenotypic analysis, functional studies, such as phagocytic activity, respiratory burst and ADCC(antibody-dependent cell-mediated cytotoxicity) were performed. HL-60 cells(ATCC CCL-240), cultured in RPMI 1640 supplemented with 10% FBS, were induced to differentiate by adding 1.0% DMSO, 1μM ATRA or 16nM PMA. On the 4th and 7th day after stimulation as well as before stimulation, the cells were analyzed for phenotypic and functional differentiaton. Phenotypic analysis was performed by flow cytometry after staining the cells with PE-conjugated anti-human CD64, CD32, CD16, CD11b, CD18, and isotype controls, murine IgG_1/rat IgG_2b. And the measured fluorescent intensity was transformed into Molecules of Equivalent Soluble Fluorochromes(MESF). Phagocytic activity was also measured by flow cytometry after incubation of the cells with fluorochrome-conjugated beads. Respiratory burst was measured by chemiluminescence assay of 5x10^5 cells incubated with 250μM luminol after stimulation with 5mM PMA. ADCC was measured by hemoglobin release assay, using Rh+ type O erythrocytes sensitized with anti-D antibody as target cells. The results of phenotypic analysis showed that the expression of CD11b on HL-60 cells increased from 3,257±152MESF before stimulation to 16,613±1,984 on the 4th day and decreased to 9,285±354 on the 7th day by DMSO. ATRA induced similar change in the expression of CD11b. However, PMA did not increase the expression of CD11b. Expression of CD18 was increased from 66,475±2,371MESF to 172,972±19,003MESF on the 4th day after differentiation by DMSO and decreased to 67,140±2,872MESF on the 7th day. ATRA and PMA induced similar change in the expression of CD18. Expression of CD64 was increased to 17,696±2,164MESF on the 4th day and 23,012±2,701MESF on the 7th day by PMA. Expression of CD32 was already induced before differentiation induction and not increased by differentiation-inducing agents. CD16 on HL-60 cells was not expressed in spite of differentiation. The results of phagocytic assay showed that 53±1.9% of HL-60 cells phagocytosed the beads before stimulation. The phagocytic cell fraction did not increase by stimulation of the inducing agents rather decreased about 15-20%. The results of chemiluminescence showed the ATRA increased the respiratory burst of HL-60 cells on the 4th and 7th day by about 20-60 fold. DMSO increased the respiratory burst only about 4 fold, while PMA induced little increase. The results of ADCC showed that ATRA increased % target cell lysis continuously on the 4th and 7th day by about 2 fold. DMSO increased only on the 4th day by about 3 fold, but PMA did not. In summary, the quantitative expression of FcγRI, FcγRII, FcγRIII, and CD11b/CD18 of HL-60 cells was changed during induction of differentiation by DMSO, ATRA or PMA. And high expression of such receptors correlated to their enhanced phagocytic activity, respiratory burst and ADCC. ; 과립구나 단구는 세균이나 기생충 감염에 대한 방어기능을 담당하며, 이 과정에 세포 표면에 발현된 Fc 수용체와 CR3가 중요한 역할을 하게된다. Fc 수용체 중 Fcγ 수용체는 FcγRI(CD64), FcγRII(CD32), FcγRIII(CD16)의 세 종류가 알려져 있다. 이들은 탐식작용, 항체매개성 세포독성(ADCC), 사이토카인 등 매개물의 분비, 산화작용의 개시 및 항체 생산의 조절 등에 관여하는 것으로 알려져 있다. 보체 수용체의 일종인 CR3(CD11b/CD18 또는 Mac-1)는 백혈구와 내피세포의 부착에 관여하는 유착분자로 탐식작용을 항진시킨다. 그런데 현재까지 과립구나 단구의 조혈과정 중에 분화단계에 따른 FcγRI, FcβRII, FcγRIII나 CR3의 발현 정도를 정량적으로 연구한 보고는 없었고, 이들의 발현량과 각 세포의 기능과의 연관성도 알 수 없었다. 따라서 본 연구에서는 전골수세포 단계의 HL-60 세포주를 과립구로 분화시키는 dimethyl sulfoxide(DMSO), all-trans retinoic acid　(ATRA)와 단구로 분화시키는 phorbol 12-myristate 13-acetate(PMA)를 첨가하여 배양하면서 분화에 따른 FcγRI, FcγRII, FcγRIII 및 CD11b/CD18의 발현 정도를 정량적으로 조사하고 아울러 이러한 분화과정 동안에 세포의 기능적 변화를 알아보고자 탐식능, respiratory burst 및 항체매개성 세포독성을 측정하였다. 연구방법은 HL-60(ATCC CCL-240) 세포를 10% 우태아혈청이 함유된 RPMI1640 배지에 5 x 10^5 cells/ml의 농도로 맞추어 각각 1.0% DMSO, 1μM all-trans retinoic acid 및 16nM PMA를 첨가하여 37℃, 5% CO_2 배양기에 배양하면서 분화유도전과 분화유도 후 4일 및 7일째에 세포의 표현형 분석 및 기능 시험을 시행하였다. 세포의 표현형 분석은 phycoerythrin(PE)이 부착된 anti-human CD64, anti-human CD32, anti-human CD16, anti-human CD11b, anti-human CD18 및 isotype control인 murine IgG_1/rat IgG_2b를 사용하여 형광염색을 시행한 후 유세포측정기로 분석하였다. 그리고 측정된 형광강도를 QuickCal Calibration/Compensation kit를 사용하여 Molecules of Equivalent Soluble Fluorochrome(MESF)로 환산하여 정량 측정하였다. 탐식능 분석은 형광물질이 부착된 bead를 첨가하여 세포를 37℃에서 1시간 진탕배양 후 유세포측정기로 탐식 세포의 분획을 조사하였다. Respiratory burst의 분석은 5 x 10^5 세포에 250μM luminol을 첨가한 후 5mM PMA로 자극시 chemiluminescence를 측정하였다. 항체매개성 세포독성은 본 연구 과정에서 고안된 hemoglobin release assay로 측정하였는데 Rh+ O 형 적혈구를 anti-D antibody (RhoGAM)로 감작시킨 표적세포를 실행세포와 반응시킨 후 적혈구의 용혈 정도를 측정하였다. 연구결과는 다음과 같았다. 1. HL-60 세포의 CD11b 발현량은 분화유도전에는 3,257±152 MESF에서 DMSO 처리후 4일째에는 16,613±1,984 MESF로 증가하였다가 7일째에는 9,285±354 MESF로 감소하였다. ATRA를 처리하였을 때에도 그 양상은 일치하였다. 그러나 PMA로 처리하였을 때에는 CD11b의 발현량은 증가하지 않았다. 2. CD18은 분화유도에 관계없이 99%의 세포에서 발현되었고 MESF 값은 DMSO, ATRA 및 PMA 모두에서 4일째 증가되었다가 7일째 감소하였다. 3. FcγRI(CD64)는 4일째 ATRA에 의해 가장 증가되었고, DMSO 및 PMA의 경우는 4일째 보다 7일째에 CD64를 더 많이 발현시켰다. 4. FcγRII(CD32)는 분화유도에 관계없이 90% 이상의 양성세포율을 보였고, 발현량도분화유도제 처리로 증가되지 않았다. 5. FcγRIII(CD16)은 분화유도전과 DMSO, ATRA 및 PMA에 의한 분화유도후 모든세포에서 발현되지 않았다. 6. HL-60 세포의 탐식능 분석의 결과는 분화유도전에는 53±1.9%의 세포가 bead를 탐식하였는데 탐식세포의 분획은 각종 분화유도제 처리에 의해 증가하지 않고 오히려 감소하였다. 7. Respiratory burst 분석을 위한 luminescence 측정의 결과는 ATRA로 분화유도 후 4일에서 7일째에 luminescence가 지속적으로 60배 이상 증가되었다. DMSO로 분화유도시킨 경우는 luminescence가 4배 정도 증가되었고, PMA의 경우는 거의 증가되지 않았다. 8. 항체매개성세포독성의 분석을 위한 Hemoglobin release assay의 결과 DMSO로 분화유도후 4일째 표적세포용해률이 3배 가량 증가되었다가 분화유도 7일째 감소되었고, ATRA의 경우는 분화유도후 7 일째에 2.5배가량 증가되었다. 그러나 PMA의 경우는 항체매개성 세포독성이 증가되지 않았다. 9. DMSO로 분화유도 시킨 경우 CR3 수용체인 CD11b와 CD18 발현이 서로 유의하게 증가하였고(r=0.84) CD11b와 CD18이 발현됨에 따라 항체매개성 세포독성이 증가하였다(r=0.96). 10. ATRA로 분화유도시킨 경우에서도 CD11b와 CD18의 발현이 서로 유의한 상관관계가 있었고(r=0.90), CD64와 CD11b(r=0.96) 및 CD18(r=0.89)의 발현에도 유의한 상관관계가 있었다. CD32의 발현에 따라 탐식능이 증가하였다 (r=0.91). Respiratory burst의 증가에 따라 항체매개성 세포독성도 증가양상을 보였다 (r=0.91). 이와같이 전골수단계의 HL-60 세포주는 분화유도제에 의하여 중성구와 단구로 분화되는 과정에서 각각 특이한 양상으로 Fc 수용체와 보체 수용체의 정량값의 변화를 나타내었으며, 이러한 세포표면 수용체들의 발현에 따라 탐식능, respiratory burst 및 항체매개성 세포독성 등의 기능분화가 이루어짐을 알 수 있었다.논문 개요 ------------------------------------------------------------ ⅷ I. 서 론 ------------------------------------------------------------ 1 II. 연구재료 및 방법 ------------------------------------------------- 4 A. 세포배양 및 분화 유도 -------------------------------------------- 4 B. 유세포측정법(flow cytometry)를 이용한 표현형 분석 ---------------- 4 C. 세포표면 항원의 정량값(MESF) 산정 -------------------------------- 5 D. 탐식능의 분석 ---------------------------------------------------- 6 E. Respiratory burst의 측정 ----------------------------------------- 6 F. 항체매개성 세포독성의 측정 --------------------------------------- 6 G. 통계분석 --------------------------------------------------------- 8 III. 연구결과 -------------------------------------------------------- 9 A. 분화유도제 처리에 따른 HL-60 세포의 표현형 변화 ------------------ 9 1. 유세포측정법에 의한 세포표면항원 양성세포율의 변화 -------------- 9 2. 세포표면 항원의 정량값 변화 ------------------------------------- 10 a. DMSO 처리에 따른 변화 ------------------------------------------ 11 b. ATRA 처리에 따른 변화 ------------------------------------------ 11 c. PMA 처리에 따른 변화 ------------------------------------------- 12 3. 분화유도제에 따른 세포표면 항원의 발현량 변화 ------------------- 12 a. CD11b의 발현 --------------------------------------------------- 12 b. CD18의 발현 ---------------------------------------------------- 12 c. CD64의 발현 ---------------------------------------------------- 12 d. CD32의 발현 ---------------------------------------------------- 13 e. CD16의 발현 ---------------------------------------------------- 13 B. 분화유도제 처리에 따른 HL-60 세포주의 기능 변화 ------------------ 13 1. 탐식능의 변화 --------------------------------------------------- 13 2. Respiratory burst의 변화 ---------------------------------------- 14 3. 항체매개성 세포독성의 변화 -------------------------------------- 14 C. HL-60 세포주의 분화유도제 처리에 따른 표현형 및 기능변화의 상관관계 ---------------------------------------------- 15 1. DMSO 처리에 따른 상관관계 --------------------------------------- 15 2. ATRA 처리에 따른 상관관계 --------------------------------------- 15 3. PMA 처리에 따른 상관관계 ---------------------------------------- 16 IV. 고 찰 ------------------------------------------------------------ 26 V. 결 론 ------------------------------------------------------------- 33 참고 문헌 ------------------------------------------------------------ 35 영문 초록 ------------------------------------------------------------ 4

실린더별 공연비 제어를 위한 배기가스 모델링

학위논문(석사)--서울대학교 대학원 :기계공학과,1998.Maste

Diabetes Fact Sheets in Korea, 2020: An Appraisal of Current Status

Background: This study aimed to investigate the recent prevalence, management, and comorbidities of diabetes among Korean adults aged >= 30 years by analyzing nationally representative data. Methods: This study used data from the Korea National Health and Nutrition Examination Survey from 2016 to 2018, and the percentage and total number of people >= 30 years of age with diabetes and impaired fasting glucose (IFG) were estimated. Results: In 2018, 13.8% of Korean adults aged >= 30 years had diabetes, and adults aged >= 65 years showed a prevalence rate of 28%. The prevalence of IFG was 26.9% in adults aged >= 30 years. From 2016 to 2018, 35% of the subjects with diabetes were not aware of their condition. Regarding comorbidities, 53.2% and 61.3% were obese and hypertensive, respectively, and 72% had hypercholesterolemia as defined by low-density lipoprotein cholesterol (LDL-C) >= 100 mg/dL in people with diabetes. Of the subjects with diabetes, 43.7% had both hypertension and hypercholesterolemia. With regard to glycemic control, only 28.3% reached the target level of <6.5%. Moreover, only 11.5% of subjects with diabetes met all three targets of glycosylated hemoglobin, blood pressure, and LDL-C. The percentage of energy intake from carbohydrates was higher in diabetes patients than in those without diabetes, while that from protein and fat was lower in subjects with diabetes. Conclusion: The high prevalence and low control rate of diabetes and its comorbidities in Korean adults were confirmed. More stringent efforts are needed to improve the comprehensive management of diabetes to reduce diabetes-related morbidity and mortality

Cardiac resynchronization therapy for left ventricular dysfunction induced by chronic right ventricular pacing in a child

Cardiac resynchronization therapy (CRT) has been proven its value in adult patients with congestive heart failure of low ejection fraction and wide QRS duration. Contrast to adult patients, CRT has been rarely applied for young patients. We report on a 9-yr-old boy with progressive left ventricular (LV) dilatation and dysfunction following chronic VVI pacemaker therapy for congenital complete atrioventricular block associated with maternal anti-SSA/ Ro and SSB/La antibody. His LV dysfunction was improved after epicardially established CRT. © 2010 The Korean Academy of Medical Sciences

International Waist Circumference Percentile Cutoffs for Central Obesity in Children and Adolescents Aged 6 to 18 Years

Context: No universal waist circumference (WC) percentile cutoffs used have been proposed for screening central obesity in children and adolescents. Objective: To develop international WC percentile cutoffs for children and adolescents with normal weight based on data from 8 countries in different global regions and to examine the relation with cardiovascular risk. Design and Setting: We used pooled data on WC in 113,453 children and adolescents (males 50.2%) aged 4 to 20 years from 8 countries in different regions (Bulgaria, China, Iran, Korea, Malaysia, Poland, Seychelles, and Switzerland). We calculated WC percentile cutoffs in samples including or excluding children with obesity, overweight, or underweight. WC percentiles were generated using the general additive model for location, scale, and shape (GAMLSS). We also estimated the predictive power of the WC 90th percentile cutoffs to predict cardiovascular risk using receiver operator characteristics curve analysis based on data from 3 countries that had available data (China, Iran, and Korea). We also examined which WC percentiles linked with WC cutoffs for central obesity in adults (at age of 18 years). Main Outcome Measure: WC measured based on recommendation by the World Health Organization. Results: We validated the performance of the age- and sex-specific 90th percentile WC cutoffs calculated in children and adolescents (6-18 years of age) with normal weight (excluding youth with obesity, overweight, or underweight) by linking the percentile with cardiovascular risk (area under the curve [AUC]: 0.69 for boys; 0.63 for girls). In addition, WC percentile among normal weight children linked relatively well with established WC cutoffs for central obesity in adults (eg, AUC in US adolescents: 0.71 for boys; 0.68 for girls). Conclusion: The international WC cutoffs developed in this study could be useful to screen central obesity in children and adolescents aged 6 to 18 years and allow direct comparison of WC distributions between populations and over time

Effects of a 12-week, school-based obesity management program on obese primary school children

Purpose: This study was designed to determine the effects of a school-based obesity-management program on obese primary school children. Methods: A total of 995 children (6-12 years old) in a primary school were screened in March 2008, and of those, 101 obese students (44 boys and 57 girls, body mass index (BMI) ≥95 percentile) were enrolled for a study group. The schoolbased, obesity management program, which includes physical exercise and nutritional education, was conducted as part of an extracurricular program for 12 weeks. The measurement of height, weight, waist circumference, blood pressure (BP), and bioelectrical impedance analysis (BIA) was performed before and after the program. Results: Height and weight increased significantly (P <0.05). The BMI and obesity index decreased significantly (P <0.01). Systolic and diastolic BP decreased significantly (P <0.01). BMI decreased in 61.4% of boys and 66.7% of girls. Protein and basal metabolic rate (BMR) increased significantly on the BIA (P <0.01). Fat decreased significantly (P <0.05). The total body water (TBW) and percent body fat (PBF) decreased significantly (P <0.01). The changes in protein, fat, TBW, PBF, and BMR significantly correlated to the change in BMI (P <0.05). In a multiple logistic regression analysis, BMI change was significantly correlated to the changes in protein and fat content (P <0.01). Conclusion: The school-based obesity management program is a very effective way to manage obesity for obese primary school children

Insulin-like growth factor binding protein-3 induces insulin resistance in adipocytes in vitro and in rats in vivo

Insulin-like growth factor binding protein (IGFBP)-3 binds to IGF and modulates their actions and also possesses intrinsic activities. We investigated its effects on insulin action and found that when IGFBP-3 was added to fully differentiated 3T3-L1 adipocytes in culture, insulin-stimulated glucose transport was significantly inhibited to 60% of control in a time- and dose-dependent manner. Tumor necrosis factor (TNF)-α treatment also inhibited glucose transport to the same degree as IGFBP-3 and, in addition, increased IGFBP-3 levels 3-fold. Co-treatment with TNF-α and IGFBP-3 antisense partially prevented the inhibitory effect of TNF-α on glucose transport, indicating a role for IGFBP-3 in cytokine-induced insulin resistance. Insulin-stimulated phosphorylation of the insulin receptor was markedly decreased by IGFBP-3 treatment. IGFBP-3 treatment suppressed adiponectin expression in 3T3-L1 adipocytes. Infusion of IGFBP-3 to Sprague-Dawley rats for 3 h decreased peripheral glucose uptake by 15% compared with controls as well as inhibiting glycogen synthesis. Systemic administration of IGFBP-3 to rats for 7 d resulted in a dramatic 40% decrease in peripheral glucose utilization and glycogen synthesis. These in vitro and in vivo findings demonstrate that IGFBP-3 has potent insulin-antagonizing capability and suggest a role for IGFBP-3 in cytokine-induced insulin resistance and other mechanisms involved in the development of type-2 diabetes. © International Pediatrics Research Foundation, Inc. 2007. All Rights Reserved

Reference values for serum levels of insulin-like growth factor-I and insulin-like growth factor binding protein-3 in Korean children and adolescents

Objective: Measurements of serum insulin-like growth factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) are utilized in the diagnostic work-up and clinical management of children with growth disorders. We designed this study to establish the reference values of serum IGF-I and IGFBP-3 levels according to age, sex and pubertal stage in Korean children and adolescents. Methods: For the study, 1378 healthy Korean children and adolescents aged 0 to 17. years (722 boys, 656 girls) were randomly selected. Blood samples were collected, and the stored sera were assayed for IGF-I and IGFBP-3 using immunoradiometric assay (IRMA, Immunotech). The R 2.8.1 program (Bell Laboratories) was used to generate reference percentile curves for IGF-I and IGFBP-3 according to age, sex, and pubertal stage. Results: Serum IGFBP-3 level was higher in girls compared to that in boys of the same ages throughout the pubertal period, whereas IGF-I was only higher for girls younger than 13. years of age. Serum levels of IGF-I and IGFBP-3 increased steadily with age in the prepubertal stage, followed by a progressive decline thereafter. Peak levels of serum IGF-I and IGFBP-3 were observed two years earlier in girls compared to those in boys (13 vs. 15. years of age, respectively). Serum IGF-I and IGFBP-3 concentrations were highest at Tanner stage IV in boys and girls, with a subsequent decline. Conclusions: Our reference value model based on age, sex, and pubertal stage can improve the diagnostic utility of IGF-1 and IGFBP-3 levels in the evaluation and management of Korean children and adolescents with growth disorders. © 2011