• Journal of Chest Surgery
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• v.33 no.7
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• pp.531-540
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• 2000

Baclgrpimd; Recent studies have suggested that the cardioprotective effect of ischemic preconditioning(IP) is closely related to glycogen depletion and attenuation of intracellular acidosis. In the present study, the authors tested this hypothesis by perfusion isolated rabbit hearts with glucose(G) is closely related to glycogen depletion and attenuation of intracellular acidosis. In the present study, the authors tested this hypothesis by perfusion isolated rabbit hearts with glucose(G)-free perfusate. Material and Method; Hearts isolated from New Zealand white rabbits(1.5~2.0 kg body weight) were perfused with Tyrode solution by Langendorff technique. After stabilization of baseline hemodynamics, the hearts were subjected to 45 min global ischemia followed by 120 min reperfusion with IP(IP group, n=13) or without IP(ischemic control group, n=10). IP was induced by single episode of 5 min global ischemia and 10 min reperfusion. In the G-free preconditioned group(n=12), G depletion was induced by perfusionwith G-free Tyrode solution for 5 min and then perfused with G-containing Tyrode solution for 10 min; and 45 min ischemia and 120 min reperfusion. Left ventricular functionincluding developed pressure(LVDP), dP/dt, heart rate, left ventricular end-distolic pressure(LVEDP) and coronary flow (CF) were measured. Myocardial cytosolic and membrane PKC activities were measured by 32P-${\gamma}$-ATP incorporation into PKC-specific peptide and PKC isozymes were analyzed by Western blot with monoclonal antibodies. Infarct size was determined by staining with TTC(tetrazolium salt) and planimetry. Data were analyzed by one-way analysis of variance (ANOVA) and Turkey's post-hoc test. Result ; In comparison with the ischemic control group, IP significantly enhanced functional recovery of the left ventricle; in contrast, functional significantly enhanced functional recovery of the left ventricle; in contrast, functional recovery were not significantly different between the G-free preconditioned and the ischemic control groups. However, the infarct size was significantly reduced by IP or G-free preconditioning(39$\pm$2.7% in the ischemic control, 19$\pm$1.2% in the IP, and 15$\pm$3.9% in the G-free preconditioned, p<0.05). Membrane PKC activities were increased significantly after IP (119%), IP and 45 min ischemia(145%), G-free [recpmdotopmomg (150%), and G-free preconditioning and 45 min ischemia(127%); expression of membrane PKC isozymes, $\alpha$ and $\varepsilon$, tended to be increased after IP or G-free preconditioning. Conclusion; These results suggest that in isolated Langendorff-perfused rabbit heart model, G-free preconditioning (induced by single episode of 5 min G depletion and 10 min repletion) colud not improve post-ischemic contractile dysfunction(after 45-minute global ischemia); however, it has an infarct size-limiting effect.

• Proceedings of the Membrane Society of Korea Conference
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• 1996.10a
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• pp.82-83
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• 1996

키토산 막을 이용한 유기혼합물 중의 물을 효율적으로 분리해내는 투과증발공정은 많은 발전을 거듭해 왔으며, 특히 에탄올중의 물을 효율적으로 탈수하는 것에는 탁월한 성능을 보고한 바 있다. 키토산은 주로 게등의 갑각류의 외피에서 얻을 수 있는 키닌을 주원료로 하는 물질로서 친수성이 뛰어난 막재료뿐만 아니라 생체적 합성이 요구되는 생체재료로도 널리 사용이 되고 있는 물질이다. 에틸렌즐리콜은 석유화학공정에서 생성되는 에틸렌 옥시이드를 원료로 하여 제조가 되고 있는 물질이다. 에틸렌글리콜은 PET의 원료로서 사용이 많이 되고 있으며, 겨울철에는 자동차등의 부동액이나 눈이 많이 내리는 지역에서 효율적으로 눈을 제거하기 위하여 공항의 활주로등에서 주로 사용이 되고 있는 물질이다. 에틸렌글리콜의 제조공정중에서 물을 효과적으로 제거하는 방법으로는 증류법이 있을 수 있으나 에틸렌글리콜의 비점이 물보다 현저히 높기 때문에, 공비혼합물을 생성하지 않는 이 혼합물의 특성과는 무관하게, 투과증발법을 이용할 경우 에너지의 절감이 이루어지게 되기 때문에 매우 효용적이고 추천할만할 공정이다. 또한 활주로의 부동액등으로 사용되는 경우 에틸렌글리콜의 재활용이 이루어질 경우 경비의 절감이나 환경적인 문제의 해결등의 장점이 있어서 물의 분리가 요구되고 있다. 이 경우에는 마찬가지로 에틸렌글리콜과 물의 분리는 일반적인 분리에 비해서 투과증발법이 유용하다고 할 수 있다. 본 실험에서는 키토산 막의 효율적인 응용예로서 기존의 알콜의 탈수와 더불어서 에틸렌글리콜의 탈수를 고찰해보고자 하였다.관리가 간편하며, 용존산소량을 줄일수 있다는 점에서 장점이 있으나, 전 ultra pure water의 system이 열적으로 안정해야 하고 경제적인 문제가 수반하는 단점을 가지고 있다. 후자의 경우, 미량의 과산화수소수 (1~10,000 ppm)를 이용해 처리 해주는 방법의 경우 경제적으로 큰 장점이 있고, 처리가 단순하다는 장점이 있으나 과산화수소수 자체에 포함하고 있는 높은 impurit level, 그리고 처리후 장시간의 flushing time을 가져야 한다는 단점등이 존재 하고 있다.요구된다. 몰입이 가능하여 임계치가 저하된 것으로 여겨진다. 또한 광학적 이득의 존재는 이 구조에 의한 극단파장 반도체 레이저다이오드의 실현 가능성을 나타내는 것이다.548 mL에 비해 통계학적으로 의의 있게 적었다(p<0.05). 결론: 관상동맥우회로 조성수술에서 전방온혈심정지액을 사용할 때 희석되지 많은 고농도 포타슘은 fliud overload와 수혈을 피하고 delivery kit를 사용하지 않음으로써 효과적이고 만족할 만한 심근보호 효과를 보였다.를 보였다.4주까지에서는 비교적 폐포는 정상적 구조를 유지하면서 부분적으로 소폐동맥 중막의 비후와 간질에 호산구 침윤의 소견이 특징적으로 관찰되었다. 결론: 분리 폐 관류는 정맥주입 방법에 비해 고농도의 cisplatin 투여로 인한 다른 장기에서의 농도 증가 없이 폐 조직에 약 50배 정도의 고농도 cisplatin을 투여할 수 있었으며, 또한 분리 폐 관류 시 cisplatin에 의한 직접적 폐 독성은 발견되지 않았

• Journal of Life Science
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• v.17 no.4 s.84
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• pp.515-521
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• 2007

Aprotinin, a serine protease inhibitor, has been used to ameliorate the inevitable consequences, including blood component injury after cardiac surgery with cardiopulmonary bypass (CPB). However, there are many arguments on its dosage or usage. We assessed whether administration of low dose of aprotinin in only priming solution has any beneficial effect or reduces its side effects on cardiac surgery. Thirty patients scheduled for elective cardiac surgery were randomly assigned to aprotinin group (n=15) which received aprotinin in priming solution (two million kallikrein inhibitory unit, KIU) and added one million KIU at 1 hour after the beginning of CPB or control group (n=15) which did not receive it. Hematological and biochemical variables, cytokines and cardiac marker levels, and postoperative outcomes were compared between two groups at before, during or after operation. Platelet count in aprotinin group was higher than that of control group at postoperative 24 hr. Activated partial thromboplastin time in aprotinin group was longer than that of control group at intensive care unit (ICU). Troponin-I level and postoperative blood loss volumes in aprotinin group were lower than those of control group at ICU. There were no significant differences between the two groups on the others. These results showed that low dosage of only priming solution during cardiac surgery with CPB reduced platelet destruction and postoperative bleeding, and attenuates myocardial damage. However, further studies need to be carried out with more population or pediatric patients for evaluating various aprotinin usage.

• Journal of Chest Surgery
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• v.25 no.1
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• pp.1-16
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• 1992

The quantitatively measured local myocardial perfusion rates with microspheres are used as an objective indicator of even distribution of cardioplegic solution, and the efficacy of the retrograde right atrial route of cardioplegia is evaluated in hearts with various levels of coronary arterial obstruction. After initial antegrade cardioplegia under the median sternotomy and aortic cannulation, 60 hearts from anesthetized New Zealand white rabbits are divided in random order as normal group [ligated left main coronary artery ; MA, MR] and diagonal group [ligated proximal diagonal artery ; LA, LR]. Half of each group [N=10] are perfused with antegrade cardioplegia[A] under the pressure of 100 cmH2O and the other half with retrograde right atrial route[R] under the pressure of 60 cmH2O[St. Thomas cardioplegic solution mixed with measured amount of microspheres]. The myocardium is subdivided into segments as A[atria], RV[right ventricle]. S[septum], LV[normally perfused left ventricular free wall], ROI[ischemic myocardium of left ventricular free wall]. LV and RQI are further divided into N[subendocardium] and P[subepicardium]. The resulting local myocardial perfusion rates and N /P of each group are compared with Wilcoxon rank sum test. The weight of the hearts is 5.94$\pm$0.66g, and there are no statistically significant dif-ferences[p>0.05, ANOVA] between six compared group. The mean flow rate[F: ml /g / min] of MR group is comparable with MA group[p>0.05], but in N and L group, there are significantly depressed F with right atrial route of cardioplegia, which means elevated perfusion resistance with this route. In spite of no significant differences in delivered doses of microsphere[DEL] between compared groups[p>0.05, ANOVA], there are significantly depressed REC and NF in hearts with right atrial cardioplegia which suggests increased requirement of cardioplegic solution with this route. The interventricular septum shows poor perfusion with right atrial route of cardioplegia without obstruction of supplying coronary arteries. But, with obstruction of coronary artery supplying septum as in M group, the flow rate is superior with right atrial route of infusion. The left ventricular free wall perfusion rates of every RQI with R route are superior to that of A route[p<0.05]. But, in LV segments, there are unfavorable effects of right atrial cardioplegia in L group, although the subendocardial perfusion is well maintained in N group. The LV free wall of left main group shows depressed perfusion rates with antegrade route as compared with RQI segments of diagonal group. But, by contraries, there are increased perfusion rates and superior N /P ratio with retrograde right atrial route. It implies more effective perfusion with right atrial route of cardioplegia in more proximal coronary arterial obstruction[i.e., M group as compared with L group]. As a conclusion, all region of ischemia have superior perfusion rates with right atrial car-dioplegia as compared with antegrade route, and especially excellent results can be obtained in hearts with more proximal obstruction of coronary arteries which would otherwise result in more severe ischemic damage. But, the depressed perfusion rates of the segments with normal coronary artery in hearts with coronary arterial obstruction may be a problem of concern with right atrial cardioplegia and needs solution.

• Journal of Chest Surgery
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• v.25 no.3
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• pp.211-219
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• 1992

Hypothermic cardioplegia is a well established method to optimize myocardial preservation during ischemic arrest, and it has been demonstrated that oxygenation of crystalloid cardioplegic solutions markedly enhances myocardial protection, The addition of a small amount of red blood cells to a crystalloid cardioplegic solutions improves capillary perfusion. Considering these results, we changed our cardioplegic solution from cold oxygenated crystalloid[Group 2] to cold oxygenated diluted blood[Group 1]. In this investigation, we examined the effects of two hypothermic potassium cardioplegic solutions on myocardial preservation in 50 patients[30 of Group 1 and 20 of Group 2] of child age group. Factors considered preoperatively included age, sex, body weight, preoperative diagnosis, and they showed no statistical differences, Intraoperative factors considered included duration of cardiopulmonary bypass, duration of aortic occlusion, operative mortality, which also revealed no statistically significant differences, We measured the serum levels of GOT[glutamate oxaloacetate transaminase] and CPK [creatine phosphokinase] during the first two days postoperatively, which, in both groups, showed significantly higher values until postoperative 1 day, and decreasing tendancy thereafter, however we failed to find any significant difference between two groups regarding the serum levels of those enzymes each day. Time for extubation and use of inotropics also revealed no significant differences. Defibrillation was needed less in Group 1 than in Group 2[p<0.05], and one case of supraventricular tachyarrhythmia occured in Group l. We conclude that cold oxygenated diluted blood cardioplegia provides no less preservation than does an oxygenated crystalloid cardioplegic solution in child age group.

• The Journal of Korean Medicine
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• v.43 no.3
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• pp.164-180
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• 2022

Objectives: The purpose of this study was to evaluate the effects of shenfu injection on myocardial protective effects after mitral valve replacement surgery. Methods: We searched four international databases (PUBMED, Embase, Web of Science and CNKI) and three domestic electronic databases (OASIS, RISS and NDSL) for relevant studies. We used following keywords 'shenfu', 'valve replacement', 'mitral valve' at PUBMED, Embase and Web of Science; '二尖瓣', '参附注射液', '瓣膜' at CNKI and '이첨판', '판막', '삼부' at domestic databases. The search range included randomized controlled trials. When appropriate, meta-analyses were performed. Results: Seven randomized controlled trials were selected. All studies used Shenfu injection after mitral valve replacement surgery. We analyzed myocardial damage, cardiac function, patients' recovery rate, with various evaluation indicators. We also used meta-analysis for CK-MB, cTnI, MDA and voluntary recovery of heartbeat. CK-MB was analyzed in two subgroups: 8 hours and 24 hours after surgery. Std was -2.34(95% CI -4.10, -0.58) for 8 hours and -1.95(95% CI -4.79 to 0.88) for 24 hours. 8 hours showed statistically significant difference. cTnI appeared significant decrease with Std of -2.13(95% CI -2.60, -1.66). MDA showed significant decrease with Std of -0.95(95% CI -1.43 to -0.47). Voluntary recovery of heartbeat significantly increased with the odd ratio of 4.34(95% CI 1.76, 10.70). Conclusions: We suggest that Shenfu injection after Mitral valve replacement surgery may have significant myocardial protective effects in terms of reducing myocardial damages, reactive oxygen species, increasing cardiac function and patients' recovery after surgery. However, the evidence is limited, further research is required.

• Journal of Chest Surgery
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• v.29 no.6
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• pp.593-598
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• 1996

The large number of past investigation on extended myocardial protection clearly indicates that cold potassium cardioplegia and topical cooling have limited capabilities. Accordingly, more recent experimen- tal approaches have focused on the modalities of reperfusion and their implication on postischemic myo- cardial recovery. Oxygen may play a crucial role in the development of ischemic and reperfusion injury. Reactive oxygen radicals may be produced during ischemia or reperfusion after incomplete reduction of molecular oxygen or from other pathway and then induce fatal injury of the heart. The important obser- vation of oxygen-induced myocardial damage during reperfusion has led to the concept of applying oxy- gen free radical scavengers. So, this study is on dietary vitamin C supplementation as antioxidant in rats to determine whether or not they have a higher tolerance against cardiac ischemia-reperf'usion injury under Langendorff system. Male or female Sprague-Dawley rats (190-33Og) were randomly separated into two groups. Group A was not treated(n=10). Group B received vitamin C supplement (n=10). Experiment was performed 24 hours after vitamin C 200mg fed orally as injectable ascorbic acid. There were significant differences in contractile parameters between control and vitamin C-treated group. The RLVP (r te of post/preischemic left ventricular pressure) and Rdp/dt (rate of post/preischemic dp/dt) were significant statistically between two groups (p<0.05). But, RHR (rate of post/preischemic heart rate), time to first beat and sta'utilization were not significant. In conclusion, pretreatment with the antioxidant, ascorbic acid, was found to preserve left ventricular contractile function. But the precise mechanism of action of ascorbic acid has not as yet been determined, so further study will be required.

• Journal of Chest Surgery
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• v.35 no.7
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• pp.523-529
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• 2002

Background: Previous reports present that the early results of coronary artery bypass grafting (CABG) has been improving with the accumulation of surgical experience. We conducted a retrospective analysis of the patients who received CABG to evaluate the recent results of CABG. Material and Method: Between January 1996 and August 2001, 154 patients underwent CABG at Hanyang University Hospital. There were 47 patients(group I) who were operated between 1996 and 1998, and 107 patients(group II) who were operated thereafter. The preoperative diagnosis, operative procedure, mortality, and complications were analyzed retrospectively. Result: There were 35 males and 12 females in group I, and 78 males and 29 females in group II, which shows similar ratio of sexes between the two groups. The average age of patients for group I and group II was $55.9{\pm}6.2$ years and $61.0{\pm}8.0$ years, respectively, showing a significant increase in group II(p<0.05). The average left ventricular ejection fraction(LVEF) for group I and group II was $54.6{\pm}11.8$% and $56.9{\pm}13.0$%, respectively. The number of patients who had previous MI in group I and group II were 13 patients(27.7%) and 14 patients(13.1%), respectively, which shows a significant difference (p<0.05). All procedures were performed using the cardiopulmonary bypass(CPB) and moderate systemic hypothermia. Myocardial protection was achieved using intermittent hypothermic ischemia under ventricular fibrillation state or cold crystalloid cardioplegic solution for most of group I patients, whereas cold blood cardioplegic solution was used for group II patients. The mean CPB times for group I and group II were $149.2{\pm}48.7$ minutes and $113.1{\pm}30.6$ minutes, respectively. The mean aortic cross clamp times for group I and group II were $81.3{\pm}26.5$ minutes $72.2{\pm}23.9$ minutes, respectively. These figures show that CPB and aortic cross clamp times were significantly reduced in group II(p<0.05). The use of the left internal thoracic artery(LITA) was increased from 42%(20/47) for group I to 81% (87/107) for group II. The mean number of grafts also significantly increased from $2.5{\pm}0.6$ for group I to $3.0{\pm}1.1$ for group II(p<0.05). Intra-aortic balloon pump(IABP) was applied in 7 cases in group I and 17 cases in group II. Of these, 28.6%(2/7) and 52.9%(9/17) were broadly applied preoperatively in patients with LVEF<40% or congestive heart failure. The operative mortalities for group I and II were 10.6%(5/47) and 0.9%(1/107), respectively, which shows significant decrease for group II(p.0.05). Conclusion: This report suggest that CABG using CPB can recently be performed more safely in virtue of the accumulation of surgical experience with reduction in CPB and aortic cross clamp times and improved surgical techniques and myocardial protection. And we think that the optimal treatment of patients with left ventricular dysfunction associated with congestive heart failure and the extended application of IABP, especially have contributed to the reduction of operative mortality and morbidity.

• Proceedings of the Mineralogical Society of Korea Conference
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• 2003.05a
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• pp.51-51
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• 2003

임진강대의 변성이질암은 전형적인 바로비안형 변성분대를 보이며, 남쪽으로 갈수록 변성도가 증가하여 석류석$\longrightarrow$십자석$\longrightarrow$남정석 대를 정의한다. 우리는 반상변정의 성장과 여러번에 걸친 광역변형작용의 연관성을 밝히기 위해 광물의 반응관계와 성장순서 그리고 미구조(microstructure)를 -특히 석류석에 대해서- 연구하였다. 임진강대는 크게 세 번에 걸쳐 변형작용을 받은 것으로 해석된다: (1) 지각 두께의 증가에 수반된 압축변형작용 (D$_{n-1}$), (2) 주 엽리(Sn)를 만든 변형작용(Dn), 그리고 (3) 연성전단작용에 수반된 신장변형작용(D$_{n+1}$ ). 석류석대의 석류석 반상변정에서는 약간 휘어진 포유물 궤적(inclusion trail)이 주 엽리면에 대해 연속적이며, 이는 Dn과 동시기에 반상변정이 생성되었음을 지시한다. 이러한 석류석은 녹니석과 백운모로 구성된 주 엽리를 치환하면서 자라기 때문에, 녹니석+백운모+석영=석류석+흑운모+$H_2O$의 반응에 의해 만들어진 것으로 해석된다. 석류석 자형변정(idioblast)이 주 엽리를 자르면서 성장하기도 하는데, 이는 Dn 이후에도 석류석이 후구조(post-tectonic) 광물로 성장했음을 지시한다. 또한, 이러한 석류석은 흑운모를 치환하기 때문에, 동구조(syn-tectonic) 석류석의 생성반응에서와는 달리 흑운모가 반응물임을 알 수 있다. 한편, 십자석대의 석류석은 포유물 궤적에 의해 정의되는 S$_{n-1}$면이 주 엽리면과 사각을 이루며 단속적이기 때문에, D$_{n-1}$과 Dn 사이에 자란 것으로 해석된다. 이와는 대조적으로 십자석은 주 엽리를 치환하면서 자라고 있어서 Dn과 동시기 혹은 Dn 이후에 자랐을 것으로 해석된다..의 환경문제를 발생하지 않으며, 공정액에 첨가제를 투입하지 않으므로 순환형 친환경공정으로 각광받을 수 있다. 본 연구에서는 고온, 고농도의 NaOH 수용액의 처리에 적합한 막소재와 발생될 수 있는 제반 문제점 등을 파악하였고, 장기간의 실험을 거쳐 최적 투과 압력(Trans membrane pressue), 세정 조건 및 주기, 막재질에 있어서 보강하여야 할 Point, 최적 운전 조건들을 토출해 내었고, 향후 실제 Plant에 적용할 계획이다.는 양적으로 다른 두 가지의 유사한 마그마가 수반된 것으로 추정된다. 것으로 추정된다.를 사용하지 않음으로써 효과적이고 만족할 만한 심근보호 효과를 보였다.를 보였다.4주까지에서는 비교적 폐포는 정상적 구조를 유지하면서 부분적으로 소폐동맥 중막의 비후와 간질에 호산구 침윤의 소견이 특징적으로 관찰되었다. 결론: 분리 폐 관류는 정맥주입 방법에 비해 고농도의 cisplatin 투여로 인한 다른 장기에서의 농도 증가 없이 폐 조직에 약 50배 정도의 고농도 cisplatin을 투여할 수 있었으며, 또한 분리 폐 관류 시 cisplatin에 의한 직접적 폐 독성은 발견되지 않았다이 낮았으나 통계학적 의의는 없었다[10.0%(4/40) : 8.2%(20/244), p>0.05]. 결론: 비디오흉강경술에서 재발을 낮추기 위해 수술시 폐야 전체를 관찰하여 존재하는 폐기포를 놓치지 않는 것이 중요하며, 폐기포를 확인하지 못한 경우와 이차성 자연기흉에 대해서는 흉막유착술에 더 세심한 주의가 필요하다는 것을 확인하였다. 비디오흉강경수술은 통증이 적고, 입원기간이 짧고, 사회로의 복귀가 빠르며, 고위험군에 적용할 수 있고, 무엇보다도 미용상의 이점이 크다는 면에서 자연기흉에 대해 유용한 치료방법임에는 틀림이 없으나 개흉술에 비해 재발율이 높고 비용이 비싸다는 문제가 제기되고 있는 만큼 더 세심한 주의와 장기 추적관찰이 필요하리라 사료된다.전 도부타민 심초음파는 관상동맥우회로술 후