• Journal of Chest Surgery
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• v.57 no.2
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• pp.160-168
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• 2024

Background: Data on perioperative outcomes of emergent versus elective resection in esophageal cancer patients requiring esophagectomy are lacking. We investigated whether emergent resection was associated with increased risks of morbidity and mortality. Methods: Data on patients with esophageal malignancy who underwent esophagectomy from 2005 to 2020 were retrospectively analyzed from the American College of Surgeons National Surgical Quality Improvement Program database. Thirty-day complication and mortality rates were compared between emergent esophagectomy (EE) and non-emergent esophagectomy. Logistic regression assessed factors associated with complications and mortality. Results: Of 10,067 patients with malignancy who underwent esophagectomy, 181 (1.8%) had EE, 64% had preoperative systemic inflammatory response syndrome, sepsis, or septic shock, and 44% had bleeding requiring transfusion. The EE group had higher American Society of Anesthesiologists (ASA) class and functional dependency. More transhiatal esophagectomies and diversions were performed in the EE group. After EE, the rates of 30-day mortality (6.1% vs. 2.8%), overall complications (65.2% vs. 44.2%), bleeding, pneumonia, prolonged intubation, and positive margin (17.7% vs. 7.4%) were higher, while that of anastomotic leak was similar. On adjusted logistic regression, older age, lower albumin, higher ASA class, and fragility were associated with increased complications and mortality. McKeown esophagectomy and esophageal diversion were associated with a higher risk of postoperative complications. EE was associated with 30-day postoperative complications (odds ratio, 2.39; 95% confidence interval, 1.66-3.43; p<0.0001). Conclusion: EE was associated with a more than 2-fold increase in complications compared to elective procedures, but no independent increase in short-term mortality. These findings may help guide data-driven critical decision-making for surgery in select cases of complicated esophageal malignancy.

• Journal of Chest Surgery
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• v.57 no.2
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• pp.128-135
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• 2024

Background: This retrospective study aimed to determine the treatment patterns and the surgical and oncologic outcomes after completion lobectomy (CL) in patients with locoregionally recurrent stage I non-small cell lung cancer (NSCLC) who previously underwent sublobar resection. Methods: Data from 36 patients who initially underwent sublobar resection for clinical, pathological stage IA NSCLC and experienced locoregional recurrence between 2008 and 2016 were analyzed. Results: Thirty-six (3.6%) of 1,003 patients who underwent sublobar resection for NSCLC experienced locoregional recurrence. The patients' median age was 66.5 (range, 44-77) years at the initial operation, and 28 (77.8%) patients were men. Six (16.7%) patients underwent segmentectomy and 30 (83.3%) underwent wedge resection as the initial operation. The median follow-up from the initial operation was 56 (range, 9-150) months. Ten (27.8%) patients underwent CL, 22 (61.1%) underwent non-surgical treatments (chemotherapy, radiation, concurrent chemoradiation therapy), and 4 (11.1%) did not receive treatment or were lost to follow-up after recurrence. Patients who underwent CL experienced no significant complications or deaths. The median follow-up time after CL was 64.5 (range, 19-93) months. The 5-year overall survival (OS) and post-recurrence survival (PRS) were higher in the surgical group than in the non-surgical (p<0.001) and no-treatment groups (p<0.001). Conclusion: CL is a technically demanding but safe procedure for locoregionally recurrent stage I NSCLC after sublobar resection. Patients who underwent CL had better OS and PRS than patients who underwent non-surgical treatments or no treatments; however, a larger cohort study and long-term surveillance are necessary.

• Journal of Chest Surgery
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• v.57 no.3
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• pp.242-251
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• 2024

Background: This study compared the outcomes of surgical aortic valve replacement (AVR) in patients aged 50 to 70 years based on the type of prosthetic valve used. Methods: We compared patients who underwent mechanical AVR to those who underwent bioprosthetic AVR at our institution between January 2000 and March 2019. Competing risk analysis and the inverse probability of treatment weighting (IPTW) method based on propensity score were employed for comparisons. Results: A total of 1,580 patients (984 patients with mechanical AVR; 596 patients with bioprosthetic AVR) were enrolled. There was no significant difference in early mortality between the mechanical AVR and bioprosthetic AVR groups (0.9% vs. 1.7%, p=0.177). After IPTW adjustment, the risk of all-cause mortality was significantly higher in the bioprosthetic AVR group than in the mechanical AVR group (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.07-1.80; p=0.014). Competing risk analysis revealed lower risks of stroke (sub-distributional hazard ratio [sHR], 0.44; 95% CI, 0.28-0.67; p<0.001) and anticoagulation-related bleeding (sHR, 0.35; 95% CI, 0.23-0.53; p<0.001) in the bioprosthetic AVR group. Conversely, the risk of aortic valve (AV) reintervention was higher in the bioprosthetic AVR group (sHR, 6.14; 95% CI, 3.17-11.93; p<0.001). Conclusion: Among patients aged 50 to 70 years who underwent surgical AVR, those receiving mechanical valves showed better survival than those with bioprosthetic valves. The mechanical AVR group exhibited a higher risk of stroke and anticoagulation-related bleeding, while the bioprosthetic AVR group showed a higher risk of AV reintervention.

• Journal of Chest Surgery
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• v.57 no.4
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• pp.371-379
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• 2024

Background: Sutureless valves are widely used in aortic valve replacement surgery, with Perceval valves and Intuity valves being particularly prominent. However, concerns have been raised about postoperative thrombocytopenia with Perceval valves (Corcym, UK). We conducted a comparative analysis with the Intuity valve (Edwards Lifesciences, USA), and assessed how thrombocytopenia affected patient and transfusion outcomes. Methods: Among 595 patients who underwent aortic valve replacement from June 2016 to March 2023, sutureless valves were used in 53 (Perceval: n=23; Intuity: n=30). Platelet counts were monitored during hospitalization and outpatient visits. Daily platelet count changes were compared between groups, and the results from patients who underwent procedures using Carpentier Edwards Perimount Magna valves were used as a reference group. Results: Compared to the Intuity group, the Perceval group showed a significantly higher amount of platelet transfusion (5.48±1.64 packs vs. 0.60±0.44 packs, p=0.008). During the postoperative period, severe thrombocytopenia (<50,000/μL) was significantly more prevalent in the Perceval group (56.5%, n=13) than in the Intuity group (6.7%, n=2). After initial postoperative depletion, daily platelet counts increased, with significant differences observed in the extent of improvement between the Perceval and Intuity groups (p<0.001). However, there was no significant difference in early mortality or the incidence of neurological complications between the 2 groups. Conclusion: The severity of postoperative thrombocytopenia differed significantly between the Perceval and Intuity valves. The Perceval group showed a significantly higher prevalence of severe thrombocytopenia and higher platelet transfusion volumes. However, thrombocytopenia gradually recovered during the postoperative period in both groups, and the early outcomes were similar in both groups.

• Journal of Chest Surgery
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• v.57 no.4
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• pp.351-359
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• 2024

Background: Major pulmonary resection after neoadjuvant concurrent chemoradiation therapy (nCCRT) is associated with a substantial risk of postoperative complications. This study investigated postoperative complications and associated risk factors to facilitate the selection of suitable surgical candidates following nCCRT in stage IIIA-N2 non-small cell lung cancer (NSCLC). Methods: We conducted a retrospective analysis of patients diagnosed with clinical stage IIIA-N2 NSCLC who underwent surgical resection following nCCRT between 1997 and 2013. Perioperative characteristics and clinical factors associated with morbidity and mortality were analyzed using univariable and multivariable logistic regression. Results: A total of 574 patients underwent major lung resection after induction CCRT. Thirty-day and 90-day postoperative mortality occurred in 8 patients (1.4%) and 41 patients (7.1%), respectively. Acute respiratory distress syndrome (n=6, 4.5%) was the primary cause of in-hospital mortality. Morbidity occurred in 199 patients (34.7%). Multivariable analysis identified significant predictors of morbidity, including patient age exceeding 70 years (odds ratio [OR], 1.8; p=0.04), low body mass index (OR, 2.6; p=0.02), and pneumonectomy (OR, 1.8; p=0.03). Patient age over 70 years (OR, 1.8; p=0.02) and pneumonectomy (OR, 3.26; p<0.01) were independent predictors of mortality in the multivariable analysis. Conclusion: In conclusion, the surgical outcomes following nCCRT are less favorable for individuals aged over 70 years or those undergoing pneumonectomy. Special attention is warranted for these patients due to their heightened risks of respiratory complications. In high-risk patients, such as elderly patients with decreased lung function, alternative treatment options like definitive CCRT should be considered instead of surgical resection.

• Journal of Conservation Science
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• v.32 no.2
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• pp.273-291
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• 2016

Some ceramic artifacts representing time-wise from comb pattern pottery in the Neolithic Age to white porcelain in Joseon Dynasty were selected from 7 sites in the north and south area of Charyeong Mountain Range in order to making techniques interpretation and development process of ancient ceramics through physicochemical and mineralogical quantitative analysis. Studied pottery samples in the Prehistoric times showed trace of ring piling in soft-type, and pottery in the Three Kingdoms Period had both soft and hard-type but kettle-ware and storage-ware were made with ring piling, but table-ware was made by wheel spinning. Different from pottery after the Three Kingdom Period when refinement of source clay was high, pottery in the Neolithic Age and in the Bronze Age exhibited highly mineral content in sandy source clay, which showed a lot of larger temper than source clay. Groundmass of celadon and white porcelain almost did not reveal primary minerals but had high content of minerals by high temperature firing. Ceramic samples showed some different in major and minor elements according to sites irrespective of times. Geochemical behaviors are very similar indicating similar basic characteristics of source clay. However, loss-on-ignition showed 0.01 to 12.59wt.% range with a large deviation but it rapidly decreased moving from the Prehistoric times to the Three Kingdom Period. They have correlation with the weight loss due to firings, according to burning degree of source clay and detection of high temperature minerals, estimated firing temperatures are classified into 5 groups. Pottery in the Neolithic Age and in the Bronze Age belongs from 750 to $850^{\circ}C$ group; pottery in the Three Kingdom Period are variously found in 750 to $1,100^{\circ}C$ range of firing temperature; and it is believed celadon and white porcelain were baked in high temperature of 1,150 to $1,250^{\circ}C$. It seems difference between refinement of source clay and firing temperature based on production times resulted from change in raw material supply and firing method pursuant to development of production skill. However, there was difference in production methods even at the same period and it is thought that they were utilized according to use purpose and needs instead of evolved development simply to one direction.

• Journal of Conservation Science
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• v.32 no.2
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• pp.167-178
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• 2016

Despite the size layer is an important part for conserving the artworks in the configuration of oil painting, the conservation scientific approaches of that have not been made yet. Therefore, this study produced standard samples on the basis of the analysis results of oil painting works, and carried out the evaluation of functions of the size layer materials. As a result of literature material, traditionally, animal glue was used for the size layer, whereas synthetic resin have been used in combination with animal glue since the modern age, in particular, it was identified that Polyvinyl Acetate(PVAc) was in general use. As a result of analysis of oil painting works, size layer was detected on the support and it was identified as animal glue. As a result of analysis based on Funaoka canvas for ground, it showed that the lead oxide and the titanium dioxide were the main constituents. On the basis of these results, standard samples were produced. As a result of evaluation on the functions of the size layer materials, in the case of the animal glue, stable result was observed in the shrinkag expansion rate, whereas slight weakness was observed in moisture proofing, color, and tensile strength, and dense cracks were found on surface. As for PVAc(A), moisture proofing, color, and the tensile strength exhibited stable results. Higher shrinkage rate was observed and the cracks with wide gaps were found on surface. As for PVAc(B), tensile strength, shrinkage expansion rate, and surface observation showed stable results, whereas moisture proofing property showed poor results. Different aspects were observed in each experiment, and this phenomena were considered to be due to the density and the adhesion properties between the hydrophilic and hydrophobic molecules in the size layer materials. The results are expected to be used as materials for the oil painting work conservation henceforth.

• Journal of Conservation Science
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• v.30 no.2
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• pp.219-234
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• 2014

Fabrics, natural dyed fabrics, papers, natural dyed papers and paints were examined effects of colors and mechanical properties for materials of museum collections under anoxic treatment. Anoxic conditions using nitrogen and argon were oxygen concentration 0.01%, temperature($20^{\circ}C$, $25^{\circ}C$, $30^{\circ}C$), 50% RH and exposure time 30 days. Examined fabrics were raw silk fabric, UV irradiated raw silk fabric, degummed silk fabric, UV irradiated degummed silk fabric, cotton fabric, and UV irradiated cotton fabric. Natural dyed silk and cotton fabrics were dyed with fresh indigo, indigo, safflower, gromwell, madder sappanwood, amur cork tree, turmeric, gardenia, barberry root, pagoda tree flower, cochineal, lac, alnus japonica, gallnut, chestnut shell, and combination(indigo and safflower, indigo and amur cork tree, indigo and pagoda tree flower, indigo and sappanwood). Papers were Korean papers(mulberry paper, mulberry(70%) and rice straw(30%) mixed paper), Japanese paper(gampi paper), cotton paper, refined linen paper, cotton, linen & manila mixed fibre furnish, copy paper, news print, and alum sized mulberry paper. Natural dyed papers were dyed with indigo, sappanwood, madder, safflower, gardenia, amur cork tree, and pagoda tree flower. Paints were painted on alum-sized papers and silk fabrics using glue and pigments(azurite, malachite, cinnabar, vermilion, orpiment, gamboge, red lead, haematite, iron oxide red, indigo(lake), lac, cochineal, safflower, madder root lake, celadonite, smalt, ultramarine blue, lapis lazuli, prussian blue, kaolin, lead white, oyster-shell white, and clam-shell white). The color differences(${\Delta}E^*$) of all examined materials were below 1.5 or lowered than control samples after anoxic treatment. The variations of tenacity of yarns of fabrics and natural dyed fabrics after anoxic treatment were within that of standard silk and cotton fabrics. Gases(nitrogen and argon) and temperatures of anoxic treatment did not also affected color differences and variations of tenacity of materials.

• Journal of Conservation Science
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• v.30 no.2
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• pp.181-187
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• 2014

AThe studies on ceramic preservation have been conducted widely in various institutions such as national/ public museums and research labs as well as the excavation institutions and university museums. Although there are some differences in preservation methodologies and materials used across the institutions, the variation is minimal. Specifically, epoxy resin is mostly used for ceramic restoration for its high cohesiveness, low contraction and high strength although there are some variations in for Ceramic Preservation. The synthetic resin type used according to the type of damage in the ceramic. However, the yellowing or the change of color across the time after the restoration is the weakness of epoxy resin. In this study, we aim to develop a material which minimizes this yellowing of epoxy resin while enhancing its cohesiveness and strength as well as other physical properties. We made the new material to have similar properties with those used widely for the ceramic restoration, such as EPO-TEK301$^{(R)}$, L30$^{(R)}$, XTR-311$^{(R)}$ through comparative experiments. The cohesiveness of the newly developed resin was improved to 2.51(MPa), which is similar level of XTR-311$^{(R)}$ of the 2.30(MPa) but about 2x higher than the other resins EPO-TEK301$^{(R)}$, L30$^{(R)}$ (1.21 and 1.81 (MPa), respectively). Especially, the experiment on yellowing shows that the existing resins show the range of color change at 10~25(${\Delta}E^*ab$), but the new low yellowing epoxy resin has the color change value at 8.3 (${\Delta}E^*ab$), the value lowering the yellowing effect to 1 to 3 times of the existing epoxy resin, thereby solving the issue of generating sense of differences due to change of color or yellowing.

• Journal of Conservation Science
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• v.30 no.2
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• pp.137-148
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• 2014

Large scale anoxic chamber system(volume $28m^3$) was developed and installed at The National Folk Museum of Korea for the first time in Korea. In order to get optimal anoxic treatment condition, we compared the disinfection of adults, larvae and eggs of cigarette beetles using nitrogen and argon. The time for complete disinfection of cigarette beetles in pine wooden blocks exposed to nitrogen at oxygen concentration 0.01% and 50% in relative humidity were 15 days at $20^{\circ}C$, 10 days at $25^{\circ}C$, and 7 days $30^{\circ}C$. Time were 10 days at $20^{\circ}C$, 7 days at $25^{\circ}C$, and 5 days $30^{\circ}C$ in argon anoxic atmosphere. From the mortality of cigarette beetles, optimal disinfection condition was oxygen concentration 0.01%, $25^{\circ}C$ in temperature, 50% in relative humidity and exposure time 21 days at nitrogen atmosphere. And when large scale anoxic chamber system was supplied nitrogen by nitrogen generator for anoxic treatment of many collections or large collections, it could be operated stably. To verify optimal disinfection condition, museum insects(adults, larvae, pupae and eggs of cigarette beetles in pine wooden blocks, cotton fabrics and Korean paper book, adults and larvae of drugstore beetles in pine wooden blocks, cotton fabrics and Korean paper book, larvae of varied carpet beetles in pine wooden block and silk fabrics, adults and larvae of hide beetles and adults of rice weevils in breeding boxes) which exposed at optimal disinfection condition, were completely killed.