• Journal of Chest Surgery
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• v.41 no.1
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• pp.1-11
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• 2008

Background: The Damus-Kaye-Stansel (DKS) procedure is a proximal MPA-ascending aorta anastomosis used to relieve systemic ventricular outflow tract obstructions (SVOTO) and pulmonary hypertension. The purpose of this study was to review the indications and outcomes of the DKS procedure, including the DKS pathway and semilunar valve function. Material and Method: A retrospective review of 28 patients who underwent a DKS procedure between May 1994 and April 2006 was performed. The median age at operation was 5.3 months ($13\;days{\sim}38.1\;months$) and body weight was 5.0 kg ($2.9{\sim}13.5\;kg$). Preoperative pressure gradients were $25.3{\pm}15.7\;mmHg$ ($10{\sim}60\;mmHg$). Eighteen patients underwent a preliminary pulmonary artery banding as an initial palliation. Preoperative main diagnoses were double outlet right ventricle in 9 patients, double inlet left ventricle with ventriculoarterial discordance in 6,. another functional univentricular heart in 5, Criss-cross heart in 4, complete atrioventricular septal defect in 3, and hypoplastic left heart variant in 1. DKS techniques included end-to-side anastomosis with patch augmentation in 14 patients, classical end-to-side anastomosis in 6, Lamberti method (double-barrel) in 3, and others in 5. The bidirectional cavopulmonary shunt and Fontan procedure were concomitantly performed in 6 and 2 patients, respectively. Result: There were 4 hospital deaths (14.3%), and 3 late deaths (12.5%) with a follow-up duration of $62.7{\pm}38.9$ months ($3.3{\sim}128.1$ months). Kaplan-Meier estimated actuarial survival was $71.9%{\pm}9.3%$ at 10 years. Multivariate analysis showed right ventricle type single ventricle (hazard ratio=13.960, p=0.004) and the DKS procedure as initial operation (hazard ratio=6.767, p=0.042) as significant mortality risk factors. Four patients underwent staged biventricular repair and 13 received Fontan completion. No SVOTO was detected after the procedure by either cardiac catheterization or echocardiography except in one patient. There was no semiulnar valve regurgitation (>Gr II) or semilunar valve-related reoperation, but one patient (3.6%) who underwent classical end-to-side anastomosis needed reoperation for pulmonary artery stenosis caused by compression of the enlarged DKS pathway. The freedom from reoperation for the DKS pathway and semilunar valve was 87.5% at 10 years after operation. Conclusion: The DKS procedure can improve the management of SVOTO, and facilitate the selected patients who are high risk for biventricular repair just after birth to undergo successful staged biventricular repair. Preliminary pulmonary artery banding is a safe and effective procedure that improves the likelihood of successful DKS by decreasing pulmonary vascular resistance. The long-term outcome of the DKS procedure for semilunar valve function, DKS pathway, and relief of SVOTO is satisfactory.

• Journal of Chest Surgery
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• v.43 no.2
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• pp.127-132
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• 2010

Background: Femoropopliteal artery bypss grafting is an effective form of treatment for infrainguinal artery occlusive disease in those patients who have either intermittent claudication or resting critical ischemia. The objective of this analysis was to evaluate the long-term patency of a femoropopliteal bypass graft that is classified as an above-the-knee saphenous vein graft or an above-the-knee PTFE (polytetrafluoroethylene) graft. Material and Method:From January 1998 to February 2005, 103 above-the-knee femoro-popliteal bypasses were performed on 87 patients. There were 74 male and 13 female patients with a mean age of $65.7{\pm}9.69$ (range: 31~82). The surgical indications were intermittent claudication in 65 cases (74.7%), foot ulceration in 2 cases (2.3%), foot necrosis in 10 ases (11.5%) and toe necrosis in 10 cases (11.5%). For the bypass graft, a reversed saphenous vein was used in 31 limbs and a polytetrafluoroethylene (PTFE) prosthesis was used in 72 limbs (6 mm: 27 limbs, 8 mm: 45 limbs). The perioperative risk factors were diabetes mellitus in 33 cases (37.9%), hypertension in 47 cases (54.0%), a history of ischemic heart disease in 13 cases (14.9%) and smoking in 72 cases (82.8%). Result:There were three perioperative deaths (3.4%) and seven late deaths (8.3%). Major leg amputation was necessary in 12 patients (13.8%) during the entire course of the study. The primary patency rate at 5 years for the vein grafts, the 8 mm-PTFE grafts and the 6 mm-PTFE grafts were 84.7%, 77.4% and 74.2%, respectively and the overall primary patency rate was 78.7%, and there were no significant statistical differences among the graft groups. By using multivariate analysis, the number of patent tibial arteries was determined to be a significant factor that influenced the primary graft patency rate (p<0.005), but risk factors such as diabetes mellitus, ischemic heart disease, smoking and age had no statistically significant affect on the primary graft patency rates. Conclusion: The great saphenous vein is considered the most durable conduit for infrainguinal revascularization, but the overall results of this study show that saphenous vein and PTFE grafts have comparable patency rates when used above the knee in patients with claudication or critical ischemia. The use of PTFE above the knee is a reasonable alternative for a femoro-poplitael bypass and it is associated with acceptable long term patency rates.

• Journal of Chest Surgery
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• v.29 no.8
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• pp.875-882
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• 1996

Multlvalvular heart surgery was performed In 78 cases, in the Department of Thoracic & Cardiovascu far Surgery of Chonbuk national University Hospital from november 1983 to March 1994. There Where 31 men and 47 women. whose ranged from 14 to 63 years. The causes of the valvular lesions were 57 rheumatic origin, 18 degenerative, 1 previous endocarditls, 1 prosthetic valve mal-function. There were 25 double valve replacement with or wit out tricuspid valve repair, i M VR and aortic valve repair, 18 MVR and tricuspid valve repair, 1 MVR and aortic and tricuspid valve repair, 10 AVR and mi- tral valve repair, 1 AVR and tricuspid valve repair, 8 mitral aortic valve repair, 13 mitral and tricuspid valve repair. They were improved mean New York Heart Association functional cldss, from 2.72% 121 Early deaths were 5 cases(6.4%). The cause of death wet'e low cArdiac output syndrome. veritricular tachycardia, massive bleeding and cerebral thromboembolism. All the survivors belonged to New York Heart Association functional class I or ll at discharge. The patients who had had valve replacement operation were medicated with warfarin to maintain the level of 30∼ 50% of normal prothrombin time. During follow-up(93.6%, mean 49.9 months), 2 late deaths were developed. One was due to intracranial hemorrhage and the other congestive heart failure. The pre-operative New York Heart Association Functional class IV was statistically sig ificant operat- ive risk factors(p< 0.05).

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.6
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• pp.2597-2606
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• 2014

Background: There is a scarcity of information about the proportion of the adult Saudi population that meet the recommended guidelines of physical activity (PA) to reduce cancer risk. Moreover, their awareness about the role of PA in cancer prevention is unclear. Objectives: This cross-sectional study aimed at estimating the proportion of adult Saudis meeting the PA guidelines, specifically those recommended by American Cancer Society (ACS) for cancer prevention, and to assess the public awareness about the role of PA in cancer prevention. Materials and Methods: Using a multistage sampling method, 2,127 adult Saudis of both genders were recruited from 6 urban and 4 rural primary health care centers in Al Hassa, Saudi Arabia. Participants were personally interviewed to gather information about their sociodemographic characteristics, searching activity about PA and cancer, and the time spent in leisure time PA (moderate and vigorous)/week using the Global Physical Activity Questionnaire with show cards. Finally, items about the role of PA in cancer risk reduction were inquired. Results: Of the included participants, 11.6% met the recommendations for cancer prevention (${\geq}45$ minutes of moderate-vigorous PA activity/${\geq}5$ days/week or 225 minutes/week). Multivariate regression showed that being male (AOR=1.49, CI=1.09-2.06), <20 years of age (AOR=3.11, CI=2.03-4.76), and unemployed (AOR=2.22, CI=1.57-3.18) were significant predictors for meeting PA recommendations for cancer prevention. Only 11.4% of the sample indicated correctly the frequency and duration of PA required for an average adult to be physically active and while >70% of them indicated the role of PA in prevention of hypertension, coronary heart disease and lowering elevated blood cholesterol, only 18.6% and 21.7% correctly mentioned the role of PA in reducing colon and breast cancer risk, respectively. Poor knowledge was found among those with less than college education and aged ${\geq}50$ years. The level of knowledge was significantly positively correlated with total leisure time PA of the participants. Conclusions: A minority of adult Saudis in Al Hassa was aware about the role of PA in cancer prevention and engaged in sufficient LTPA for cancer risk reduction benefits, highlighting the need for public health actions to include policies and programs that address factors deterring their participation in LTPA and increasing their awareness with remedies to manage the prevalent misconceptions.

• Journal of Chest Surgery
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• v.35 no.8
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• pp.573-579
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• 2002

Background: In this study, the role and the surgical outcome of the modified Blalock-Taussig shunt in the treatment of the infants with cyanotic complex congenital heart diseases were investigated. Material and Method: Over the last 12 years, 105 modified BT shunts were performed in 100 infants. Postoperative course, shunt patency rate, complications, mortality and its risk factors were reviewed restrospectively. Result: The mean age at operation was 43.0$\pm$36.6 days. Sex ratio was 60:40(M:F). The postoperative oxygen saturations were lowest after mean duration of 11 hours after the shunt procedure. The operative mortality was 8%(8) with 3 late deaths. Causes of operative death included failure of maintenance of minimum oxygenation during the procedure(2), immediate postoperative shunt occlusion(2), respiratory failure(2), low cardiac output due to heart failure and pericardial effusion(2) and sepsis(2). Late deaths resulted from acute cardiac arrest during the follow up cardiac catheterization, hypoxic myocardial failure, and arrhythmia. Year of surgery, shunt size, age at operation, and complexity of the anomalies were not the risk factors for mortality. Six month shunt patency rate was 97% and overall patency rate was 96%. Postoperative complications comprised of shunt occlusion(6), phrenic nerve palsy(3), and wound infection(2). Conclusion: We demonstrated that modified Blalock-Taussig shunt was a useful tool to palliate the infants with complex cyanotic heart disease in whom early complete repair was not feasible with acceptable mortality and patency rate. An adequate postoperative management and a meticulous surgical technique may be key factors for the better results.

• Journal of Nutrition and Health
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• v.37 no.5
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• pp.352-363
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• 2004

Lipid-lowering effects of the inulin have been demonstrated in animal, yet attempts to reproduce similar effects in humans have generated conflicting results. In this study, the lipid-lowering potential of inulin and especially its effect on bile acid and neutral sterol excretion were investigated in Korean postmenopausal women. Nineteen postmenopausal women were randomly divided into two groups in a double-blind parallel design and consumed one of two supplements for 12 weeks; placebo of 8g maltodextrins/sucrose mixture (placebo group) or 8g inulin (inulin group). There were no significant changes in body weight during the supplementation period in either inulin or placebo group. Dietary consumption of animal fat in both group tended to decrease after 12 weeks of experiment. Intake of cholesterol was lower in placebo group, whereas the decrease of cholesterol intake in inulin group did not reach statistical significance after 12 weeks. The levels of serum total cholesterol (TC) and LDL-cholesterol (LDL-C) were significantly decreased in both placebo (p＜0.05) and inulin group (p＜0.01) after supplementation for 12 weeks compared with the baseline. The levels of serum triglyceride (TG) and HDL-cholesterol (HDL-C) were not significantly affected by inulin supplements, but atherogenic index (AI) and LDL-C/HDL-C ratio (LHR) as a predictor for coronary heart disease were improved (p＜0.01) significantly after inulin supplementation. Therefore, inulin supplement may decrease the risk of cardiovascular disease via improving blood cholesterol level. Fecal weight and pH were not changed after 12 weeks of supplementation. There were no statistically significant changes for the fecal short-chain fatty acids (SCFAs). In inulin group, fecal deoxycholic acid (DCA) was significantly lowered compared with the baseline (p＜0.05) whereas other bile acids were not changed. During the 12 weeks of intervention, no differences were found in fecal excretion of neutral sterol in the two groups. In summary, dietary inulin decreases serum TC, LDL-C, AI, LHR and lowers excretion of fecal DCA in the Korean postmenopausal women. These results support the use of inulin for reducing risk factors for hyperlipidemic postmenopausal women. However, the exact mechanism (s) responsible for the blood lipid lowering action of inulin including altered fecal bile acid remain to be elucidated.

• Journal of Chest Surgery
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• v.38 no.2 s.247
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• pp.116-122
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• 2005

Background: Adverse effects of cardiopulmonary bypass can be avoided by 'Off-pump' coronary artery bypass (OPCAB) surgery. Recent studies have reported that OPCAB had the most beneficial impact on patients at highest risk by reducing bypass-related complications. The purpose of this study is to compare the outcome of OPCAB and conventional coronary artery bypass grafting (CCAB) in patients with poor left ventricular (LV) function. Material and Method: From March 1997 to February 2004, seventy five patients with left ventricular ejection fraction (LVEF) of $35\%$ or less underwent isolated coronary artery bypass grafting at our institute. Of these patients, 33 patients underwent OPCAB and 42 underwent CCAB. Preoperative risk factors, operative and postoperative outcomes, including LV functional change, were compared and analysed. Result: Patients undergoing CCAB were more likely to have unstable angina, three vessel disease and acute myocardial infarction among the preoperative factors. OPCAB group had significantly lower mean operation time, less numbers of total distal anastomoses per patient and less numbers of distal anastomoses per patient in the circumflex territory than the CCAB group. There was no difference between the groups in regard to in-hospital mortality $(OPCAB\; 9.1\%\;(n=3)\;Vs.\;CCAB\;9.5\%\;(n=4)),$ intubation time, the length of stay in intensive care unit and in hospital postoperatively. Postoperative complication occurred more in CCAB group but did not show statistical difference. On follow-up echocardiography, OPCAB group showed $9.1\%$ improvement in mean LVEF, 4.3 mm decrease in mean left ventricular end-diastolic dimension (LVEDD) and 4.2 mm decrease in mean left ventricular end-systolic dimension (LVESD). CCAB group showed $11.0\%$ improvement in mean LVEF, 5.1 mm decrease in mean LVEDD and 5.5 mm decrease in mean LVESD. But there was no statistically significant difference between the two groups. Conclusion: This study showed that LV function improves postoperatively in patients with severe ischemic LV dysfunction, but failed to show any difference in the degree of improvement between OPCAB and CCAB. In terms of operative mortality rate and LV functional recovery, the results of OPCAB were as good as those of CCAB in patients with poor LV function. But, OPCAB procedure was advantageous in shortening of operative time and in decrease of complications. We recommend OPCAB as the first surgical option for patients with severe LV dysfunction.

• Journal of Acupuncture Research
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• v.19 no.3
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• pp.126-137
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• 2002

Objective : There is accumulating data that cardiovascular diseases, including hypertension, cerebro-vascular accident, coronary heart disease, relate to atherosclerotic changes. Increased serum levels of lipids could play a role in these circumstances. the SDPTG(the second derivative of photoplethysmogram waveform) is noninvasive methods for evaluating the pulse wave and is correlated with age and other risk factors for atherosclerosis. Methods : To study the effects of serum lipid levels on the SDPTG in the middle-age adults, data on serum lipid levels and the SDPTG were collected in 80 healthy middle age with varying serum lipid concentrations. Biological vascular age was assessed using the SDPTG. the SDPTG consists of an a, b, c, and d wave in systole and an e wave in diastole; an SDPTG aging index(Al) was calculated as (b-c-d-e)/a. Results : Serum triglyceride, total cholesterol, total lipid, phospholipid, HDL cholesterol levels were respectively and significantly correlated with SDPTG Al. Serum lipid levels and blood pressure are age-dependent and the SDPTG is blood pressure-dependent. Restricting analysis to age and blood pressure yield strong positive correlations between serum triglyceride, total lipid levels and SDPTG Al, but no correlations between serum total cholesterol, phospholipid levels and SDPTG Al. Conclusion : The results of this study suggest that preventive acupuncture programs or herbal medications for reducing serum lipid, especially triglyceride, levels in middle-age should include a evaluation of biological vascular aging with the second derivative of photoplethysmogram waveform.

• Korean Journal of Community Nutrition
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• v.4 no.2
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• pp.186-193
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• 1999

Recent epidemiologic and clinical students have shown that plasma cholesterol and triglyceride levels are independent risk factors for coronary heart disease. However, there is not much data on the characteristics of anthropometry and lipid profiles of hypercholesterolemia patients with hypertiglyceridemia. In this study, 112 hypercholesterolemic subjects$(T.C{\ge}240mg/dl)$ were divided into two groups by their plasma triglyceride levels. We compared the anthropometric measurements and lipid profiles of the subjects between the two groups : the simples hypercholesterolemic group(SHC, TG<200mg/dl) and the combined hypercholesterolemic group$(CHC, TG{\ge}250mg/dl)$. The distribution of the subjects into the SHC and CHC groups was 36.6% and 47.3%, respectively. The frequency of the CHC patients decreased with age. The subjects in this group had higher weight, BMI, HWR, cricumferences of mid arm, waist, hip and thigh, and skinfold thicknesses of biceps and triceps than those of the SHC subjects. The difference of plasma total cholesterol level was mainly due to the difference of VLDL-C levels. These differences resulted in the CHC subjects having higher atherogenic indexes and T-C/HDL-C ratios than those of the SHC subjects. Also, the former had higher Apo-B and insulin levels than those the latter. However, blood pressure, fasting blood glucose and HDL-C levels were not significantly different between the two groups. These results suggest that hypercholesterolemic patients with hypertriglyceridemia have riskier lipid profiles for CHD than those of patients with normal triglyceridemia. They also indicate that CHC is closely associated with glucose resistance syndrome(obesity, hyperglycemia, hyperinsulinemia and hypertriglyceridemia), and more prevalent in young people.

• Journal of Biomedical Engineering Research
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• v.38 no.6
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• pp.313-320
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• 2017

Myocardial infarction is a disease caused by stenosis of the coronary arteries. The high risk of sudden cardiac death due to myocardial infarction has triggered related researches that have been actively studied so far. However, these studies focused on the clinical results, which are mainly based on observations of symptoms due to infarction through electrocardiograms. Therefore, in this study, we tried to analyze the behavior of heart according to the position and volume of infarction lesion through the computer simulation study using three dimensional ventricular models. In order to implement infarction, commercial software was used to simulate cell necrosis due to blockage of a specific coronary. In addition, the conduction block due to infarction was mimicked by reducing the electrical conduction in the infarcted area, which was 100 times less than the electrical conduction of the whole ventricular lattice implemented by the finite element analysis method. Thus, this study classified the infarcted cases into the upper, middle, lower, and apex according to lattice data of eight different infraction areas. In other words, we assumed that myocardial infarction would have inherent electro-dynamic characteristics depending on the location and extent, and analyzed the ventricular electromechanical responses for infarction lesions using a three dimensional cardiac physiome model. The results showed that the volume of infarction did not directly affect the cardiac responses, but the location of the infarction lesions could influence the ventricular pumping efficiency. These suggest that the occlusion of specific coronary arteries may have a fatal effect on the decline in ventricular performance. In conclusion, although location of myocardial infarction lesions is considered to be an important variable to be considered clinically rather than lesion size, quantitative predictions should be made more in the future considering physiological factors such as lesion location and direction of myocardial fiber at that location.