• Title/Summary/Keyword: Current Bleeding

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Hemorrhagic Moyamoya Disease : A Recent Update

  • Fujimura, Miki;Tominaga, Teiji
    • Journal of Korean Neurosurgical Society
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    • v.62 no.2
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    • pp.136-143
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    • 2019
  • Moyamoya disease (MMD) is a progressive cerebrovascular disease with unknown etiology, characterized by bilateral steno-occlusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network formation at the base of the brain. MMD has an intrinsic nature to convert the vascular supply for the brain from internal carotid (IC) system to the external carotid (EC) system, as indicated by Suzuki's angiographic staging. Insufficiency of this 'IC-EC conversion system' could result not only in cerebral ischemia, but also in intracranial hemorrhage from inadequate collateral anastomosis, both of which represent the clinical manifestation of MMD. Surgical revascularization prevents cerebral ischemic attack by improving cerebral blood flow, and recent evidence further suggests that extracranial-intracranial bypass could powerfully reduce the risk of re-bleeding in MMD patients with posterior hemorrhage, who were known to have extremely high re-bleeding risk. Although the exact mechanism underlying the hemorrhagic presentation in MMD is undetermined, most recent angiographic analysis revealed the characteristic angio-architecture related to high re-bleeding risk, such as the extension and dilatation of choroidal collaterals and posterior cerebral artery involvement. We sought to update the current management strategy for hemorrhagic MMD, including the outcome of surgical revascularization for hemorrhagic MMD in our institute. Further investigations will clarify the optimal surgical strategy to prevent hemorrhagic manifestation in patients with MMD.

A 2.3-2.7 GHz Dual-Mode RF Receiver for WLAN and Mobile WiMAX Applications in $0.13{\mu}m$ CMOS (WLAN 및 Mobile WiMAX를 위한 2.3-2.7 GHz 대역 이중모드 CMOS RF 수신기)

  • Lee, Seong-Ku;Kim, Jong-Sik;Kim, Young-Cho;Shin, Hyun-Chol
    • Journal of the Institute of Electronics Engineers of Korea SD
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    • v.47 no.3
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    • pp.51-57
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    • 2010
  • A dual-mode direct conversion receiver is developed in $0.13\;{\mu}m$ RF CMOS process for IEEE 802.11n based wireless LAN and IEEE 802.16e based mobile WiMAX application. The RF receiver covers the frequency band between 2.3 and 2.7 GHz. Three-step gain control is realized in LNA by using current steering technique. Current bleeding technique is applied to the down-conversion mixer in order to lower the flicker noise. A frequency divide-by-2 circuit is included in the receiver for LO I/Q differential signal generation. The receiver consumes 56 mA at 1.4 V supply voltage including all LO buffers. Measured results show a power gain of 32 dB, a noise figure of 4.8 dB, a output $P_{1dB}$ of +6 dBm over the entire band.

NOAC for Patients with AF and ACS (급성관동맥증후군을 동반한 심방세동 환자에서 NOAC 치료)

  • Kim, Dong Hyeok;Choi, Jong-Il
    • International Journal of Arrhythmia
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    • v.17 no.1
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    • pp.41-45
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    • 2016
  • Atrial fibrillation (AF) can occur in acute coronary syndrome (ACS), which is a serious medical condition and may require the use of antiplatelet agents in addition to anticoagulants for stroke prevention. Recently, novel or non-vitamin K antagonist oral anticoagulants (NOACs) have been increasingly used for stroke prevention in patients with AF instead of traditional OACs. The duration of treatment or treatment with a stepwise approach (e.g. triple, double, or monotherapy) is determined depending on the clinical setting and the balance between the risks of ischemic stroke and bleeding. However, some concerns and controversies in the use of NOACs in patients with AF and ACS need to be addressed. Here, the current management for NOAC therapy in patients with ACS and AF will be reviewed based on recently published guidelines.

Multiloculated Hydrocephalus : Open Craniotomy or Endoscopy?

  • Lee, Yun Ho;Kwon, Young Sub;Yang, Kook Hee
    • Journal of Korean Neurosurgical Society
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    • v.60 no.3
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    • pp.301-305
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    • 2017
  • Multiloculated hydrocephalus (MLH) is a condition in which patients have multiple, separate abnormal cerebrospinal fluid collections with no communication between them. Despite technical advancements in pediatric neurosurgery, neurological outcomes are poor in these patients and the approach to this pathology remains problematic especially given individual anatomic complexity and cerebrospinal fluid (CSF) hydrodynamics. A uniform surgical strategy has not yet been developed. Current treatment options for MLH are microsurgical fenestration of separate compartments by open craniotomy or endoscopy, shunt surgery in which multiple catheters are placed in the compartments, and combinations of these modalities. Craniotomy for fenestration allows better visualization of the compartments and membranes, and it can offer easy fenestration or excision of membranes and wide communication of cystic compartments. Hemostasis is more easily achieved. However, because of profound loss of CSF during surgery, open craniotomy is associated with an increased chance of subdural hygroma and/or hematoma collection and shunt malfunction. Endoscopy has advantages such as minimal invasiveness, avoidance of brain retraction, less blood loss, faster operation time, and shorter hospital stay. Disadvantages are also similar to those of open craniotomy. Intraoperative bleeding can usually be easily managed by irrigation or coagulation. However, handling of significant intraoperative bleeding is not as easy. Currently, endoscopic fenestration tends to be performed more often as initial treatment and open craniotomy may be useful in patients requiring repeated endoscopic procedures.

A Case of the Angiofibroma of the Nasal Septum (비중격에 발생한 혈관섬유종 1례)

  • 권혁진;박호선
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1983.05a
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    • pp.17.5-18
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    • 1983
  • Angiofibroma in otorhinolaryngologic field is rare, highly vascular and non-metastatizing benign tumor. It was noted as histologically benign but clinically malignant tumor because of the anatomical site, severe bleeding in surgery and recurrence in incomplete removal. It occurs almostly in nasopharynx of adolescent males. Recently, the authors have experienced a very rare case of angiofibroma which occupied the nasal septum in a 37-years-old-male with complaints of nasal obstruction and frequent nasal bleeding. The tumor mass was removed surgically through intranasal approach under local anesthesia. We report our case with review of current literatures.

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The Role of Genetic Diagnosis in Hemophilia A

  • Lee, Ja Young
    • Journal of Interdisciplinary Genomics
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    • v.4 no.1
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    • pp.15-18
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    • 2022
  • Hemophilia A is a rare X-linked congenital deficiency of clotting factor VIII (FVIII) that is traditionally diagnosed by measuring FVIII activity. Various mutations of the FVIII gene have been reported and they influence on the FVIII protein structure. A deficiency of or reduction in FVIII protein manifests as spontaneous or induced bleeding depending on the disease severity. Mutations of the FVIII gene provide important information on the severity of disease and inhibitor development. FVIII mutations also affect the discrepant activities found using different FVIII assays. FVIII activity is affected differently depending on the mutation site. Long-range PCR is commonly used to detect intron 22 inversion, the most common mutation in severe hemophilia. However, point mutations are also common in patients with hemophilia, and direct Sanger sequencing and copy number variant analysis are being used to screen for full mutations in the FVIII gene. Advances in molecular genetic methods, such as next-generation sequencing, may enable accurate analysis of mutations in the factor VIII gene, which may be useful in the diagnosis of mild to moderate hemophilia. Genetic analysis is also useful in diagnosing carriers and managing bleeding control. This review discusses the current knowledge about mutations in hemophilia and focuses on the clinical aspects associated with these mutations and the importance of genetic analysis.

Evaluation of Corrosion Resistance with Grout Type and Tendon (그라우트 품질을 고려한 텐던의 부식저항성 평가)

  • Ryu, Hwa-Sung;An, Ki-Hong;Koh, Kyung-Taek;Kwon, Seung-Jun
    • Journal of the Korea institute for structural maintenance and inspection
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    • v.22 no.4
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    • pp.76-82
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    • 2018
  • Grout in duct is very effective protection from tendon corrosion in PSC(Prestressed Concrete) structure. In the work, durability and mechanical tests are performed for two types of grout which are conventionally used one and the improved grout with reduced w/c (water to cement) ratio and silica fume. Tendon system with 1000mm height is prepared and various tests including strength, flow, absorption, and bleeding ratio are conducted. ICM(Impressed Current Method) is adopted for corrosion acceleration in tendon with 12.7mm diameter inside grout. For 2 and 4 days, corrosion acceleration is performed for 2 different type of grout and corrosion amount is investigated. The improved grout shows higher compressive strength by 10 MPa and lower absorption ratio by 50% than the conventional one. It also provides an excellent corrosion reduction to 39.8 %~48.2 % for 2~4 days of acceleration period.

A High Linearity Low Noise Amplifier Using Modified Cascode Structure (높은 선형성을 갖는 새로운 구조의 MMIC 저잡음 증폭기)

  • Park, Seung Pyo;Eu, Kyoung Jun;No, Seung Chang;Lee, Moon-Que
    • The Journal of Korean Institute of Electromagnetic Engineering and Science
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    • v.27 no.2
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    • pp.220-223
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    • 2016
  • This letter proposes a low noise amplifier which has low noise figure and high linearity simultaneously using a cascode structure with an additional transistor. The proposed structure minimizes the noise source by using optimizing transistor sizes and also improves linearity from the current bleeding technique. The device was fabricated in a $0.5{\mu}m$ GaAs pHEMT process and has noise figure of 1.1 dB, a voltage gain of 15.0 dB, an $OIP_3$ of 30.8 dBm and an input/output return loss of 11.6 dB/10.4 dB from 1.8 to 2.6 GHz.

Evaluation of Peri-procedural Warfarin Therapy Undergoing Cardioversion in Patients with Atrial fibrillation (심방세동 환자의 심율동전환 시행 전·후 warfarin 치료의 적절성 평가)

  • Moon, Jung-Yeon;Kim, Bo-Ram;Jo, Eun-Jung;Cho, Yoon-Sook;Han, Hyun-Joo;Choi, Eue-Keun
    • Korean Journal of Clinical Pharmacy
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    • v.26 no.3
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    • pp.201-206
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    • 2016
  • Objective: Direct current cardioversion for atrial fibrillation could be associated with the risk of thromboembolic events. Anticoagulation therapy with warfarin (INR 2.0-3.0) is recommended 3 weeks before and 4 weeks after cardioversion to reduce the risk of thromboembolism. This study evaluated warfarin therapy in pharmacist-managed anticoagulant services (ACS). Methods: This retrospective study was performed in 106 patients with atrial fibrillation from 2012 to 2013. The primary efficacy endpoint was the composite of stroke, transient ischemic attack, myocardial infarction, and cardiovascular death. The primary safety measure was major bleeding. To evaluate the peri-procedural effects of warfarin treatment, we studied whether target INR was maintained, as well as the maintenance period of the therapeutic range. Quality of treatment was measured by time in therapeutic range (TTR) by using the Rosendaal method. Results: There were no thromboembolic events, but TEE examination at time of cardioversion showed a left atrial thrombus in three patients (2.8%). Bleeding complications after cardioversion occurred in 2 patients (1.9%). The average INR value at the time of cardioversion was $2.59{\pm}0.8$, and was within the therapeutic range in 83 patients (78%). Analysis of the patients in whom the value was within the therapeutic range twice consecutively showed that the ratio of TTR was 80% and the therapeutic range was maintained in 67 patients (63%) for an average of 4.90 weeks prior to cardioversion. Similarly, 76 patients (72%) had a stable INR within the therapeutic range for an average of 5.70 weeks and a mean TTR of 83%. Conclusion: Pharmacists significantly contributed to appropriate warfarin treatment with close monitoring during cardioversion. Likewise, active pharmacist monitoring and systemic management should be considered to reduce thromboembolism and bleeding complications in the peri-cardioversion period.

Association between soluble forms of the receptor for advanced glycation end products and periodontal disease: a retrospective study

  • Kim, Keun-Suh;Lee, Yun Jong;Ahn, Soyeon;Chang, Yoon-Seok;Choi, Yonghoon;Lee, Hyo-Jung
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.47 no.6
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    • pp.445-453
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    • 2021
  • Objectives: Periodontitis is the most common chronic disease that causes tooth loss and is related to systemic diseases such as cardiovascular disease and diabetes. An objective indicator of the current activity of periodontitis is necessary. Soluble forms of the receptor for advanced glycation end products (sRAGE) are markers that reflect the status of inflammatory diseases. In this study, the relationship between sRAGE and periodontitis was analyzed to determine whether it can be used to diagnose the current state of periodontitis. Patients and Methods: Eighty-four patients without any systemic diseases were diagnosed with periodontitis using three classifications of periodontitis. Demographics and oral examination data such as plaque index (PI), bleeding on probing (BOP) index, and probing pocket depth (PPD) were analyzed according to each classification. In addition, correlation and partial correlation between sRAGE and the values indicating periodontitis were analyzed. Results: In each classification, the level of sRAGE tended to decrease if periodontitis was present or severe, but this change was not statistically significant. sRAGE and periodontitis-related variables exhibited a weak correlation, among which the BOP index showed a relatively strong negative correlation (ρ=-0.20). Based on this, on analyzing the correlation between the BOP index and sRAGE in the group with more severe periodontitis (PPD≥5 mm group, severe group of AAP/CDC [American Academy of Periodontology/Centers for Disease Control and Prevention], periodontitis group of López), the correlation further increased (ρ=-0.23, -0.40, -0.50). Partial correlation analysis of the sRAGE and BOP index showed a stronger negative correlation (ρ=-0.36, -0.55, -0.45). Conclusion: sRAGE demonstrated a tendency to decrease upon increased severity of periodontitis according to the classifications used. Above all, the correlation with the BOP index, which reflects the current state of periodontitis, was higher in the group with severe periodontitis. This indicates that the current status of periodontitis can be diagnosed through sRAGE.