• Clinical and Experimental Pediatrics
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• 제65권5호
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• pp.254-261
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• 2022

Background: The use of systemic steroids for 6+ weeks in children is associated with decreased bone mineral content (BMC) and density (BMD). However, the effects of a shorter duration of use on BMD are unknown. Purpose: To determine the effect of the use of systemic steroids for 2-6 weeks on BMD and BMC in pediatric patients. Methods: Twenty-five pediatric patients (21 with tuberculosis, 2 with systemic juvenile idiopathic arthritis, 1 with inflammatory bowel disease, 1 with autoimmune hemolytic anemia) who received systemic steroids for 2-6 weeks and 25 age- and sex-matched controls were enrolled. BMC, BMD, and z scores of the whole body (WB), lumbar spine (LS), nondominant distal radius (DR), and total body less the head (TBLH) were determined by dual-energy x-ray absorptiometry at baseline, the end of steroid therapy or 6 weeks (whichever was earlier; first follow-up), and at the end of 3 months from baseline (second follow-up) in patients and at baseline in controls. The values were adjusted for confounding variables. Continuous and categorical variables were compared using Student t test and the chi-square test or Fisher exact test, respectively. Pairwise comparisons employed Bonferroni correction. Results: Statistically significant decreases in BMC, BMD, and all z scores were observed. BMC declined by 5.37%, 2.08%, 1.82%, and 2.27%, and 11.42%, 3.75%, 3.34%, and 4.17% for WB, LS, DR, and TBLH, respectively, at the first and second follow-ups, respectively. Similarly, BMD declined by 2.01%, 2.31%, 2.18%, and 1.70% and 4.59%, 3.76%, 3.14%, and 3.50% for the WB, LS, DR, and TBLH, respectively, at the first and second follow-ups, respectively. A significant negative correlation was found among bone densitometric parameters, duration, and cumulative dose. Conclusion: The use of systemic steroids for 2-6 weeks in pediatric patients decreased the BMD and BMC of trabecular and cortical bones, an effect that persisted after discontinuation.

• The Korean Journal of Pain
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• 제36권2호
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• pp.184-194
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• 2023

Background: Degenerative lumbar spondylolisthesis (DLS) is frequently associated with lumbar spinal stenosis (LSS) and conservative treatments such as epidural steroid injection do not have long-term benefits in LSS patients with DLS. This study evaluated the effectiveness of percutaneous epidural neuroplasty using a balloon catheter in patients with LSS and DLS. Methods: Patients' sex, age, body mass index, diabetes, hypertension, stenosis grading, pain duration, location, pain intensity, and medications were retrieved from electronic medical records. At 1, 3, and 6 months following the procedure, data on pain severity, medication usage, and physical functional status were analyzed. A generalized estimating equations model was used at the six-month follow-up. Patients were divided into those with DLS (the spondylolisthesis group) and those without DLS (the no spondylolisthesis group) to evaluate whether the effects of percutaneous epidural neuroplasty using a balloon catheter were different. Results: A total of 826 patients were included (spondylolisthesis: 433 patients, 52.4%; no spondylolisthesis: 393 patients, 47.6%). Age, body mass index, hypertension, pain location, and stenosis grading were statistically different between the two groups. The generalized estimating equations analyses with unadjusted and adjusted estimation revealed a significant improvement in the estimated mean numerical rating scale of pain intensities compared to that at baseline in both groups (P < 0.001). Any adverse events that occurred were minor and temporary. Conclusions: Percutaneous epidural neuroplasty using a balloon catheter may be an alternative treatment option for patients with chronic LSS, regardless of accompanying DLS, who have had failed conservative management.

• 한국간담췌외과학회지
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• 제28권2호
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• pp.155-160
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• 2024

Backgrounds/Aims: No reports to compare incisional hernia (IH) incidence between laparoscopic and open colorectal liver metastases (CRLM) resections have previously been made. This is the first comparative study. Methods: Single-center retrospective review of patients who underwent CRLM surgery between January 2011 and December 2018. IH relating to liver surgery was confirmed by computed tomography. Patients were divided into laparoscopic liver resection (LLR) and open liver resection (OLR) groups. Data collection included age, sex, presence of diabetes mellitus, steroid intake, history of previous hernia or liver resection, subcutaneous and peri-renal fat thickness, preoperative creatinine and albumin, American Society of Anesthesiologists (ASA) score, major liver resection, surgical site infection, synchronous presentation, and preoperative chemotherapy. Results: Two hundred and forty-seven patients were included with a mean follow-up period of 41 ± 29 months (mean ± standard deviation). Eighty seven (35%) patients had LLR and 160 patients had OLR. No significant difference in the incidence of IH between LLR and OLR was found at 1 and 3 years, respectively ([10%, 19%] vs. [10%, 19%], p = 0.95). On multivariate analysis, previous hernia history (hazard ratio [HR], 2.22; 95% confidence interval [CI], 1.56-4.86) and subcutaneous fat thickness (HR, 2.22; 95% CI, 1.19-4.13) were independent risk factors. Length of hospital stay was shorter in LLR (6 ± 4 days vs. 10 ± 8 days, p < 0.001), in comparison to OLR. Conclusions: In CRLM, no difference in the incidence of IH between LLR and OLR was found. Previous hernia and subcutaneous fat thickness were risk factors. Further studies are needed to assess modifiable risk factors to develop IH in LLR.

• International Journal of Heart Failure
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• 제6권2호
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• pp.84-90
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• 2024

Background and Objectives: Vitamin D, as a steroid hormone, has multiple effects on human body and its deficiency has been associated with an increased risk of heart failure (HF) and unfavorable outcomes. The present study investigated the prevalence of vitamin D deficiency (VDD) and its relationship with cardiometabolic parameters in patients hospitalized for HF living in the city of Recife (latitude 8° South). Methods: Analytical cross-sectional study, with men and women aged 40-64 years. The HF group was recruited during hospitalization due to decompensation. A matched control group was recruited from the general endocrine clinics. Vitamin D status was assessed by measuring serum 25-hydroxyvitamin D (25OHD), considering deficiency when 25OHD <20 ng/mL (<50 nmol/L). Results: A total of 243 patients were evaluated (HF group: 161, control group: 82). Lower serum 25OHD levels were observed in the HF group (25.2±9.4 vs. 30.0±7.7ng/mL; p<0.001), as well as a higher prevalence of VDD (27.3% vs. 9.8%; prevalence ratio, 2.80; 95% confidence interval, 1.38-5.67; p=0.002). In patients with HF, VDD was associated with diabetes mellitus (65.9% vs. 41.0%; p=0.005) and female sex (65.9% vs. 44.4%; p=0.015). In the subgroup with VDD, higher values of hemoglobin A1c (7.9% [6.0-8.9] vs. 6.2% [5.7-7.9]; p=0.006) and dyslipidemia were also observed. Conclusions: We found higher rates of VDD in patients hospitalized for HF and this was associated with deleterious laboratory metabolic parameters.

• 한국수산과학회지
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• 제32권5호
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• pp.624-628
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• 1999

범가자미의 인위적인 번식제어를 목적으로 생식소 활성에 따른 혈중 vitellogenin (난황단백전구체)과 성 스테로이드 호르몬의 계절적 농도 변화를 조사하였다. 암컷에 있어서 혈중 vitellogenin의 농도는 난황축적이 활발한 11 월에 연중 최고치를 나타내다가 산란이 시작되는 12월에 감소하기 시작하면서 estradiol의 농도는 이 시기에 연중 최고치를 나타내었다(2.7ng/ml). 산란이 활발히 진행중인 1월에 혈중 estradiol 농도는 급격히 감소하여 5월까지 연중 매우 낮은 농도(0.2ng/ml)로 유지되었다. Testosterone도 estradiol과 유사한 경향을 보였다. 17$\alpha$-hydroxyprogesterone은 난소가 활성화되어 성장되는 시기를 제외하고는 뚜렷한 경향을 보이지 않았다. 수컷의 경우 testosterone과 11-ketotestosterone의 혈중농도는 12월에 최고치를 나타내었으며, 이 시기에 정자변태가 가장 활발하게 이루어지고 있음을 관찰하였다. 이후 완숙 및 방정기 (1월)에 이르러 이들의 농도는 급격히 감소하였다.

• Experimental and Molecular Medicine
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• 제50권12호
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• pp.12.1-12.14
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• 2018

Osteoporosis develops with high prevalence in both postmenopausal women and hypogonadal men. Osteoporosis results in significant morbidity, but no cure has been established. Mesenchymal stem cells (MSCs) critically contribute to bone homeostasis and possess potent immunomodulatory/anti-inflammatory capability. Here, we investigated the therapeutic efficacy of using an infusion of MSCs to treat sex hormone-deficient bone loss and its underlying mechanisms. In particular, we compared the impacts of MSC cytotherapy in the two genders with the aim of examining potential gender differences. Using the gonadectomy (GNX) model, we confirmed that the osteoporotic phenotypes were substantially consistent between female and male mice. Importantly, systemic MSC transplantation (MSCT) not only rescued trabecular bone loss in GNX mice but also restored cortical bone mass and bone quality. Unexpectedly, no differences were detected between the genders. Furthermore, MSCT demonstrated an equal efficiency in rectifying the bone remodeling balance in both genders of GNX animals, as proven by the comparable recovery of bone formation and parallel normalization of bone resorption. Mechanistically, using green fluorescent protein (GFP)-based cell-tracing, we demonstrated rapid engraftment but poor inhabitation of donor MSCs in the GNX recipient bone marrow of each gender. Alternatively, MSCT uniformly reduced the $CD3^+T$-cell population and suppressed the serum levels of inflammatory cytokines in reversing female and male GNX osteoporosis, which was attributed to the ability of the MSC to induce T-cell apoptosis. Immunosuppression in the microenvironment eventually led to functional recovery of endogenous MSCs, which resulted in restored osteogenesis and normalized behavior to modulate osteoclastogenesis. Collectively, these data revealed recipient sexually monomorphic responses to MSC therapy in gonadal steroid deficiency-induced osteoporosis via immunosuppression/anti-inflammation and resident stem cell recovery.

• 한국발생생물학회지:발생과생식
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• 제6권2호
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• pp.117-122
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• 2002

포유동물에서 뇌와 부신에서 합성ㆍ분비되는 카테콜아민(Catecholamine, CA)계 신경전달물질인 dopamine(DA), norepinephrine(NE), epinephrine(E)은 체내 각종 생리현상의 조절에 필수적이며, 생식과 관련된 기능으로는 시상하부와 뇌하수체 사이의 GnRH-gonadotropin 호르몬 축의 활성을 조절함 외에도 번식과 연관된 여러 행동양식을 조절함이 잘 알려져 있다. 본 연구는 카테콜아민 생합성 효소인 tyrosine hydroxylase(TH), dopamine $\beta$ -hydroxylase(DBH), phenylethaolamine-N-methyl transferase(PNMT)의 유전자 발현에 영향을 미치는 sex steroid의 영향을 조사하였다. 성숙한 암컷 흰쥐의 난소를 제거(ovariectomy, OVX)하고 1주 경과 후 실험군과 대조군에 각각 17$\beta$-estradiol(E$_2$; 500$\mu\textrm{g}$/m1)이 들어 있는 silastic capsule과 sesame oil이 들어 있는 silastic capsule을 이식시키고 48시간 후에 희생시켰다. 채취된 조직에서 mRNA를 추출한 후 semi-quantitative reverse transcription-polymerase chain reaction(RT-PCR)을 시행하였다. 그 결과로 (i) TH의 발현 정도는 OVX＋Oil군에서는 시상하부 > Substantia nigra(SNc) > 부신 순으로, OVX＋E$_2$군에서는 SNc ) 시상하부 > 부신 순으로 나타났다. TH발현에 미치는 estradiol의 효과로 SNc와 부신에서는 유의한 증가를 보인데 비해 시상하부에서는 유의한 감소를 관찰하였다. (ⅱ) DBH 발현 정도는 OVX＋Oil군과 OVXi＋E$_2$군에서 모두 부신 > SNc > 시상하부 순으로 나타났다. DBH 발현에 미치는 estradiol의 효과로 SNc에서는 유의한 감소를, 부신에서는 유의한 증가를, 그리고 시상하부에서는 감소하였으나 통계적 유의성이 없었다. (ⅲ) PNMT의 발현의 경우 SNc와 시상하부에서는 이미 알려진 바와 같이 alternative splicing에 의해 110bp 차이의 크고 작은 두 형태의 cDNA(PNMT과 PNMTSs가 증폭되었으나 부신에서는 작은 cDNA(PNMTs)만이 관찰되었다. PNMT1의 발현은 SNc가 시상하부보다 다소 높은 경향이었으나 유의성이 없었고, PNMTs의 발현정도는 OVX＋Oil군과 OVX＋E$_2$군 모두에서 부신 > SNC >시상하부 순으로 나타났다. PNMTs 발현에 미치는 estradiol의 효과로 SNc에서는 유의한 감소를, 부신에서는 유의한 증가를, 그리고 시상하부에서는 통계적 유의성은 없으나 증가하는 경향을 보였다. 본 연구에서는 카테콜아민 생합성 효소들의 유전자 발현의 조절에 미치는 estrogen의 영향이 세포기원이 neural crest cell인 부신 수질은 물론 뇌의 상이한 지역간에서도 조직특이적임을 관찰하였다. 이러한 결과는 각 조직에서의 estrogen 수용체 유형의 차이, 작용 모드와 각 효소 유전자 발현 사이에 중요한 상관관계가 있음을 시사한다.

• Clinical and Experimental Reproductive Medicine
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• 제27권2호
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• pp.117-131
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• 2000

Objectives: To develop a new immunohistochemical marker system for supplementation of the Noyes histological classification of the endometrium in women of child bearing age with regular menstrual cycles, and to employ this system to evaluate pathologic factors involved in endometriosis, and thus to ascertain if it is useful in diagnosis. Materials and Methods: Endometrial biopsies were sampled from the posterior fundus of 41 (24 proliferative phases, 17 secretory phases) women with regular menstrual cycles (28-32 days), and each sample was immunohistochemically stained according to Noyes et al (1975) for determination of expression for estrogen receptor (ER), progesterone receptor (PR), integrin ${\alpha}_1$, ${\alpha}_4$, ${\beta}_3$, COX-1 and COX-2. Then, the PR, integrin ${\beta}_3$ and COX-2 which were clearly expressed in the luteal phase was with endometrial samples were obtained from 20 cases of normal patients (group 1) and 25 cases with endometriosis (group 2) after confirming the day of ovulation by sex steroid level measurements 7-8 days after ovulation Results: In the regular menstruation group the expression of ER showed a tendency to be increased in the proliferative phase and decreased in the secretory phase, and was the highest in the proliferative phase. However, PR in the stromal cells showed no change in the entire menstrual cycle while in the epithelial cells, PR reached a peak in the late proliferative phase and was almost absent in the secretory phase. Integrin (${\alpha}_1$, ${\alpha}_4$, and ${\beta}_3$ expression in the epithelial cells was absent in the proliferative phase but ${\alpha}_1$ was strongly expressed starting from the early secretory phase into the entire secretory phase. ${\alpha}_4$ was expressed strongly in the early and mid secretory phases and disappeared in the late proliferative phase, while ${\beta}_3$ appeared after the mid secretory phase and continued to be expressed until the late secretory phase. Expression in the stromal cells was weak overall and did not show any cyclic pattern. COX-1 expression was shown as a cyclic pattern in the stromal and epithelial cells and was particularly strongly expressed in the mid secretory phase of epithelial cells, and in the mid secretory and menstruation phase of stromal cells. In the endometrial epithelial cells there was strong expression during the entire cycle with stronger expression in the secretory phase compared to the prolferative phase. COX-2 was clearly expressed in the late proliferative, early and mid secretory phases in the stromal cells. No expression was observed in the proliferative phase of the epithelial cells, but which began to appear in the early secretory phase reaching a significant pattern from the mid secretory phase onwards. There was almost no expression in the stromal cells. In the cases with endometriosis showing normal endometrial maturation according to the Noyes classification, PR expression was increased while Integrin-${\beta}_3$의 expression was significantly decreased compared to the normal group. Also, COX-2 expression was slightly decreased in the stromal cells of patients with endometriosis while it was significantly increased in the stromal cells. Conclusion: Immunohistochemical markers can supplement the original Noyes classification of histological endometrial dating and therefore ascertain existing pathologic conditions. Particularly for patients with endometriosis with normally mature endometrial cells, changes in COX-2 and integrin expression patterns may assist in elucidating pathophysiologic mechanisms and therefore aid in the diagnosis of abnormal implantation conditions, and consequently determine a treatment modality.

• 한국축산식품학회지
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• 제30권5호
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• pp.842-850
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• 2010

성호르몬은 근육의 발달(아나볼릭 효과)에 관여하는 것으로 잘 알려져 왔으며 인체의 치료제로 넓게 사용되고 있다. 돼지고기에는 주로 성선(정소와 난소)에서 생산되어 고기에 축적된 다양한 아나볼릭 효과를 나타내는 성호르몬이 많이 존재하는 것으로 알려져 있다. 따라서 본 연구는 돼지고기에 존재하는 아나볼릭 스테로이드를 추출하여 근육세포의 증식과 분화에 미치는 영향을 파악하고자 실시하였다. 본 연구에서 돼지의 각 조직으로부터 아나볼릭 스테로이드를 추출하는 3가지 방법(M1, M2, M3)을 개발하였다. 3가지 모든 추출방법에서 아나볼릭 스테로이드가 추출되었으며 특히 M3에서 조직 1g당 가장 많은 양을 획득할 수 있었다. M3를 이용하여 아나볼릭 스테로이드를 추출했을 때 돼지고기의 근육과 지방에서는 스테로이드 호르몬 양이 수컷에서 가장 높았고, 혈청에서는 nandrolone 과 testosterone의 양은 수컷에서 가장 높았으며, estrone와 $17{\beta}$-estradiol의 양은 비슷하였다. 근육세포 증식은 돼지 아나볼릭 스테로이드의 농도 의존적으로 촉진되었으며, M3에서 가장 빠르게 증식되었다. 근육세포의 분화는 추출된 아나볼릭 스테로이드 처리구가 대조구보다 더 효과적으로 분화가 잘 되는 것을 세포 모양과 유전자(AR, myoD, desmin, myogenin)를 통하여 확인할 수 있었다. 특히 M3에서 추출된 아나볼릭 스테로이드에서 myogenin과 AR 유전자가 유의적으로 높게 발현되었다(p<0.001). 전체적으로 돼지의 아나볼릭 스테로이드는 근육세포의 성장과 분화를 촉진하였다. 따라서 돼지고기에 있는 아나볼릭 스테로이드의 섭취를 통해 인체 근육의 성장과 발달에 긍정적 효과를 나타낼 수 있을 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제44권3호
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• pp.559-573
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• 1997

연구배경 : 기관지 천식은 장기간 증세의 호전과 악화를 반복하는 질환으로 질병의 치료 경과와 예후 인자에 대한 연구는 미흡한 실정이다. 관해(remission)에 대한 연구에 있어서도 아직 정확한 기준이 없는 실정이다. 방 법 : 연구자는 1992년 3월부터 1994년 3월까지 연세대학교 의과대학 세브란스병원 알레르기 크리닉에 등록된 403명의 환자중 2년이상 경과 관찰중인 기관지 천식환자 97명(남자 47명, 여자 50명)을 대상으로 천식의 치료 경과와 예후인자에 관하여 조사하였다. 환자들은 임상 양상에 따라 5군으로 분류하여, 1군(비 조절군), 2군(고 단계 치료 조절군), 3군(단기 조절군), 4군(중기 조절군), 그리고 5군(장기 조절군)으로 하였다. 치료 기간중 NHLBI/WHO 기준에 따른 1, 2단계의 치료로 천식조절상태가 1년 이상이고 methacholine 검사가 음성화되었고 객담에 호산구가 검출되지 않는 환자를 methacholine 음성화군으로 정하였다. 이들에 대하여 병력, 천식의 유형, 알레르기 피부반응 검사와 아토피 점수, 혈청 총 IgE, 특이 IgE, methacholine 천식 유발 검사, 말초 호산구수, 객담 호산구 도말검사, 폐기능 검사와 임상적 상태를 조사하였다. 결 과 : 대상환자중 1군은 20례(20.6%), 2군은 26례(26.9%), 3군은 23례(23.7%), 4군은 15례(15.5%), 5군은 13례(13.4%)였다. 각 군간에 성별, 천식의 가족력, 흡연력, 말레르기성 비염, 아스피린 알레르기의 유무에는 차이가 없었다. 장기 조절군 일수록 발병 당시 나이가 젊었으며 유병기간이 짧고 내원 당시의 폐기능이 좋았다. 내원시 천식의 약물 치료 단계는 낮았으며 치료 시작후 처음 3개월 동안의 스테로이드 투여양과 발작수가 적었다. 그리고 내원후 처음 증상이 조절되기까지의 기간이 짧았다. 내원 당시에 피부반응검사, 객담 호산구와 말초 혈중 호산구수, 혈청 총 IgE, 비특이적 기관지 반응성 각 군간에 상관성이 없었다. 치료 기간중 methacholine검사가 음성화되고, 객담내 호산구수가 발견되지 않는 례는 7명이었으며 평균 증상 조절 기간은 $20.3{\pm}9.7$개월 이었으며 재발이 없었다. 결 론 : 이상의 결과를 종합하면 성인 기관지 천식 환자중 발령 연령이 어리며 유병 기간이 짧으며 폐기능이 좋고, 약물 치료 단계가 낮으며 치료 초기에 스테로이드 요구량이 적으며, 발작의 빈도가 적고, 그리고 치료 시작후 증상 조절시까지 기간이 짧은 환자가 장기 조절군에 많음을 알 수 있었다.