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Clinical Comparison of Low-dose and High-dose Steroid in Pediatric Cardiac Surgery with Cardiopulmonary Bypass

  • Choi Seok-Cheol;Kim Song-Myung;Kim Yang-Weon
    • Biomedical Science Letters
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    • v.12 no.3
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    • pp.289-301
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    • 2006
  • Cardiopulmonary bypass (CPB) for cardiac surgery triggers the production and release of numerous chemotactic substances and cytokines, ensuing systemic inflammatory response that leads to postoperative major organ dysfunction. Traditionally, corticosteroids (steroid) have been administered to patients undergoing cardiac surgery to ward off these detrimental physiologic alterations. However, the majority of the studies have been performed on adult patients with high-dose steroid. We carried out a randomized, prospective, double-blind study to compare the efficacy of low-dose steroid with that of high-dose steroid and to determine the adequate dose of pretreated-steroid for prophylactic effects in pediatric cardiac surgery. Thirty pediatric patients scheduled for elective cardiac surgery were randomly assigned to two groups; fifteen patients received low-dose methylprednisolone (10mg/kg intravenously, n=15, low-dose group) and the others received high-dose methylprednisolone (30mg/kg intravenously, n=15, high-dose group) 1 hour prior to CPB. Arterial blood samples were taken before CPB (Pre-CPB), 10 minutes after start of CPB (CPB-10), and immediately after CPB-end (CPB-OFF) for measuring total leukocyte counts (T-WBC) and diff-counts, platelet counts, interleukin-6 (IL-6), myeloperoxidase (MPO), total antioxidant (TAO), neuron-specific enolase (NSE), troponin I (TNI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and blood urea nitrogen (BUN) levels. Other parameters such as volumes of urine output, pulmonary index $(PI,\;PaO_2/FiO_2)$, mechanical ventilating period, intensive care unit (ICU)-staying period, postoperative complications (fever, wound problem), postoperative 24 hrs and total volumes in blood loss, and hospitalized days were also assessed. All parameters were compared between two groups. There were no significant differences in T-WBC counts, monocyte fraction, platelet counts, TA levels, NSE levels, creatinine levels, BUN levels, the volumes of total urine output, PI, the incidences of fever and wound problem, postoperative 24hrs- and total-blood loss volumes and ICU-staying period between two groups (P>0.05). At CPB-OFF, neutrophil fraction, MPO level, TNI level, and AST level were higher in the high-dose group than in the low-dose group (P<0.05). IL-6 level at CPB-10 was higher in the high dose-group than in the low-dose group (P<0.05). Furthermore, mechanical ventilating periods and hospitalized days of the high-dose group were significantly longer than those of low-dose group (P<0.05). The high-dose group had significantly low lymphocyte fi-action at CPB-OFF compared with the low-dose group (P<0.001). These findings suggest that pretreatment of high-dose steroid is not superior to that of low-dose steroid regrading its potential benefits in pediatric cardiac surgery. Therefore, the conventional strategy of steroid treatment, high-dose pretreatment, should be modified in the cardiac surgery with CPB. However, further studies must be performed on the larger number of patients in as much as small number of patients in this study.

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Changes in plant hydraulic conductivity in response to water deficit

  • Kim, Yangmin X.;Sung, Jwakyung;Lee, Yejin;Lee, Seulbi;Lee, Deogbae
    • Proceedings of the Korean Society of Crop Science Conference
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    • 2017.06a
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    • pp.35-35
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    • 2017
  • How do plants take up water from soils especially when water is scarce in soils? Plants have a strategy to respond to water deficit to manage water necessary for their survival and growth. Plants regulate water transport inside them. Water flows inside the plant via (i) apoplastic pathway including xylem vessel and cell wall and (ii) cell-to-cell pathway including water channels sitting in cell membrane (aquaporins). Water transport across the root and leaf is explained by a composite transport model including those pathways. Modification of the components in those pathways to change their hydraulic conductivity can regulate water uptake and management. Apoplastic barrier is modified by producing Casparian band and suberin lamellae. These structures contain suberin known to be hydrophobic. Barley roots with more suberin content from the apoplast showed lower root hydraulic conductivity. Root hydraulic conductivity was measured by a root pressure probe. Plant root builds apoplastic barrier to prevent water loss into dry soil. Water transport in plant is also regulated in the cell-to-cell pathway via aquaporin, which has received a great attention after its discovery in early 1990s. Aquaporins in plants are known to open or close to regulate water transport in response to biotic and/or abiotic stresses including water deficit. Aquaporins in a corn leaf were opened by illumination in the beginning, however, closed in response to the following leaf water potential decrease. The evidence was provided by cell hydraulic conductivity measurement using a cell pressure probe. Changing the hydraulic conductivity of plant organ such as root and leaf has an impact not only on the speed of water transport across the plant but also on the water potential inside the plant, which means plant water uptake pattern from soil could be differentiated. This was demonstrated by a computer simulation with 3-D root structure having root hydraulic conductivity information and soil. The model study indicated that the root hydraulic conductivity plays an important role to determine the water uptake from soil with suboptimal water, although soil hydraulic conductivity also interplayed.

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The Second Animal Tests of Artificial Heart Valves (인공심장판막의 개발과 동물실험 -인공심장판막의 2차 동물실험-)

  • 김형묵
    • Journal of Chest Surgery
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    • v.23 no.4
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    • pp.617-621
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    • 1990
  • A heart supplies blood of about 15, 000 liters to each human organ in a day. A normal function of heart valves is necessary to accomplish these enormous work of heart. The disease of heart valve develops to a narrowness of a closure, resulting in an abnormal circulation of blood. In an attempt to eliminate the affliction of heart valves, the operative method to replace with artificial heart valves has developed and saved numerous patients over past 30 years. This replacement operation has been performed since early 1960`s in Korea, but all the artificial heart valves used are imported from abroad with very high costs until recent years. New artificial heart valves have been developed in Korea Advanced Institute of Science and Technology since early 1980`s. The first developed valve was designed with a free-floating pyrolytic carbon disk that is suspended in a titanium cage. The design of the valve was tested in vitro, and in animals in 1987. The results from this study was that the eccentrically placed struts creates a major and minor orifice when the disc opens and stagnation of flow in the area of the minor orifice has led to valve thrombosis. In this work, the design of the valve was changed from a single - leaflet valve to double - leaflet one in order to resolve the problems observed in the first - year tests. Morphological and hemodynamic studies were made for the newly designed valves through the in vitro and in vivo tests. The design and partial materials of the artificial heart valve was improved comparing with first - year`s model. The disc in the valve was modified from single - leaflet to bi - leaflet, and the material of the cage was changed from titanium metal to silicon - alloyed pyrolytic carbon. A test was made for the valve in order to examine its mechanical performance and stability. Morphological and hemodynamic studies were made for the valve that had been implanted in tricuspid position of mongrel dogs. All the test animals were observed just before the deaths. A new artificial heart valve was designed and fabricated in order to resolve the problems observed in the old model. The new valve was verified to have good stability and high resistance to wear through the performance tests. The hemodynamic properties of the valve after implantation were also estimated to be good in animal tests. Therefore, the results suggest that the newly designed valve in this work has a good quality in view of the biocompatibility. However, valve thrombosis on valve leaflets and annulus were found. This morphological findings were in accordance with results of surface polishing status studies, indicating that a technique of fine polishing of the surface is necessary to develop a valve with higher quality and performance.

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External Morphology of the American Leafminer, Liriomyza trifolii (Diptera: Agromyzidae), on Tomato with Scanning Electron Microscope (주사전자현미경을 이용한 토마토에 발생하는 아메리카잎굴파리(Liriomyza trifolii)의 외부형태적 특징)

  • Youn, Young-Nam;Kim, Ki-Duck;Park, Su-Jin;Kim, Nam-Sung;Seo, Mi-Ja;Chae, Soon-Yong
    • Korean Journal of Agricultural Science
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    • v.27 no.1
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    • pp.13-19
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    • 2000
  • The external morphology of male and female of Liriomyza trifolii (Burgess) was studied using the scanning electron microscopy (SEM). Three types of sensilla were identified on the funicle of antennae. The trichoid sensilla were most conspicious and distributed with a characteristic sharp structure at the apical end. Basiconic sensilla were showed distal curvature about $13{\mu}m$ long and $1.2{\mu}m$ to $1.4{\mu}m$ in diameter. Grooved sensilla were showed a finger-like projections at the peg apex. The function of these sensilla likely to be olfactory. The mouthparts were adapted for sucking food, and formed a elongate rostrum which was incorporated with labrum. The labrum was a small and flap-like shape. The slender and paired maxillary palp seemed to combine with each other lengthwise to long tube. The tarsus typically consisted of 5 segments, which might be variously modified, principally by thickening or flattening. The segment beared a pair of claws. Beneath the claws, there was a pair of pad-like pulvillia and a bristle-like median empodium. L. trifolii might secreted on the pulvillus and empodium an adhesive substance that enable them to cling to smooth surfaces. Male terminalia was complicated. The name 'aedeagus' seemed the best available general term for the copulatory organ, otherwise, female terminalia was usually relatively simple. This structure was reduced and formed a telescopic, eversible, and tubular ovipositor.

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Ganoderma Lucidum Pharmacopuncture for Teating Ethanol-induced Chronic Gastric Ulcers in Rats

  • Park, Jae-Heung;Jang, Kyung-Jun;Kim, Cheol-Hong;Kim, Jung-Hee;Kim, Young-Kyun;Yoon, Hyun-Min
    • Journal of Pharmacopuncture
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    • v.18 no.1
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    • pp.72-78
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    • 2015
  • Objectives: The stomach is a sensitive digestive organ that is susceptible to exogenous pathogens from the diet. In response to such pathogens, the stomach induces oxidative stress, which might be related to the development of both gastric organic disorders such as gastritis, gastric ulcers, and gastric cancer, and functional disorders such as functional dyspepsia. This study was accomplished to investigate the effect of Ganoderma lucidum pharmacopuncture (GLP) on chronic gastric ulcers in rats. Methods: The rats were divided into 4 groups of 8 animals each: the normal, the control, the normal saline (NP) and the GLP groups. In this study, the modified ethanol gastritis model was used. The rats were administrated 56% ethanol orally every other day. The dose of ethanol was 8 g/kg body weight. The normal group received the same amount of normal saline instead of ethanol. The NP and the GLP groups were treated with injection of saline and GLP respectively. The control group received no treatment. Two local acupoints CV12 (中脘) and ST36 (足三里) were used. All laboratory rats underwent treatment for 15 days. On last day, the rats were sacrificed and their stomachs were immediately excised. Results: Ulcers of the gastric mucosa appeared as elongated bands of hemorrhagic lesions parallel to the long axis of the stomach. In the NP and GLP groups, the injuries to the gastric mucosal injuries were not as severe as they were in the control group. Wound healings of the chronic gastric ulcers was promoted by using GLP and significant alterations of the indices in the gastric mucosa were observed. Such protection was demonstrated by gross appearance, histology and immunehistochemistry staining for Bcl-2-associated X (BAX), B-cell lymphoma 2 (Bcl-2) and Transforming growth factor-beta 1 (TGF-${\beta}1$). Conclusion: These results suggest that GLP at CV12 and ST36 can provide significant protection to the gastric mucosa against an ethanol induced chronic gastric ulcer.

Operation of Ascending Aorta and/or Aortic Arch (상행대동맥 및 대동맥궁의 수술)

  • 구본원;허동명;전상훈;장봉현;이종태;김규태;이응배
    • Journal of Chest Surgery
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    • v.29 no.11
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    • pp.1212-1217
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    • 1996
  • From Dec. 1993 to May 1995, 9 male and 5 female patients ranging in age from 25 to 65 years, were operated on for ascending aorta and/or aortic arch diseases. Six patients had acute aortic dissection, type A(ruptured in 4 cases); four had ruptured ascending aortic aneurysm; three had annuloaortic ectasia(ruptured in 1 cases); one had aortic arch aneurysm. The diagnostic procedures were echo cardiography and dynamic CT scan in all patients having acute dissection or rupture. The aortic angiography was performed in two cases. Indications for operations were rupture in five cases, acute aortic dissection in five cases, severe congestive heart failure in two cases, progressive aortic insufficiency in one case and impending rupture in one case. The emergent repair was performed in ten cases(71%). The surgical treatment consisted of 6 Cabrol operations, a Cabrol operation combined with arch replacement, a modified Bentall operation, 4 replacement of ascending aorta, a replacement of aortic arch, and a replacement of ascending aorta and aortic arch. Complications were a hypoxic encephalopathy, two atrial fibrillations, a sternal deheiscence, and a mediastinitis. Two early mortality(14%) were due to intractable bleeding and multiple organ failure, and one late mortality(7%) was due to ventricular arrhythmia. In eleven survivors, follow-up period was from 2 months to 12 months and the course was uneventful.

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The Role of Postoperative Pelvic Radiation Therapy in Rectal Cancer (직장암에 있어서 수술후 방사선치료의 역할)

  • Ahn, Yong-Chan;Kim, Jae-Sung;Yun, Hyong-Geun;Ha, Sung-Whan;Park, Charn-Il
    • Radiation Oncology Journal
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    • v.9 no.1
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    • pp.93-102
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    • 1991
  • To evaluate the role of postoperative pelvic radiation therapy in rectal cancer, a retrospective analysis was done on 189 patients with modified Astler-Coiler stages B2+3, Cl , and C2+3 who were treated from February 1979 to June 1980. Forty-seven patients were staged as B2+3,17 as Cl, and 125 as C2+3. As a curative resection,41 received low anterior resection,143 received abdomino-perineal resection, and five received pelvic exenteration. The survival and disease-free survival rates of the total patients at five year were $45.3\%\;and\;44.1\%$, respectively. The stage was an important prognostic factor for survival and disease-free survival: the survival rates at five year were $63.4\%$ in stage B2+3, $62.4\%$ in C1, and $37.2\%$ in C2+3 (p<0.005): the disease-free survival rates at five year were $55.7\%$ in B2+3, $65.7\%$ in C1, and $30.4\%$ in C2+3, respectively (p<0.01). The liver was the most frequently involved organ of recurrence followed by the lung and the perineum. The patients who received low anterior resection achieved better disease-free survival but were more prone to late radiation bowel morbidities than those who received abdominoperineal resection. Postperative Pelvic radiation therapy Proved to be effective in locoregional disease control but did not prevent the appearance of distant metastasis, which was of major concern in advanced stages. Patterns of treatment failure, and factros relating to radiation morbidity are discussed, and therapeutic options for better results are proposed.

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Effect of Recovery of Pulmonarv Function in Hypothermic Lung Preservation (폐의 저량보존법이 폐기능 회복에 미치는 영향)

  • Lee, Man-Bok;Kim, U-Jong;Gang, Chang-Hui;Lee, Gil-No
    • Journal of Chest Surgery
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    • v.30 no.3
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    • pp.253.1-262
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    • 1997
  • Hypothermia during lung preservation decreases metabolic processes. After the rabbit lung was flushed with modified Euro-Collins solution, heart-lung block was harvested and the left lung was assessed after ligation of the right pulmonary artery and right main-stem bronchus. Heart-lung block was immersed in the same solution for 6 hours. The modified Euro-Collins solution and storage temperature of group 1(10 cases) was 4t, roup 2(10 cases) was l$0^{\circ}C$. On completion of the storage period, the left lung was ventilated and reperfused with blood u:high used a cross-circulating paracorporeal rabbit as a "biologic deoxygenator" for 60 minutes. Pulmonary artery pressure, airway pressure, difference in oxygen tension between mow and outflow perfusate and degree of pulmonary edema were assessed at 10-minute intervals while the left lung was ventilated at 0.8 of the inspired oxygen fraction. The mean pulmonary venous oxygen tensions at 10 and 60 minutes after reperfusion were 209.52$\pm$42.46 and 103.48$\pm$ 15.96 mmHg in group I versus 247.78$\pm$36.19 and 147.91 $\pm$ 11.07 mmHg in group II(p=0.049, (0.0001). The mean alveolar-arterial oxygen differences at 20 and 60 minutes after reperfusion were 357. 95$\pm$ 12.84 and 437.31 14.26 mmHg in group I versus 310.88$\pm$3).47 and )90.93$\pm$ 15.86 mmHg in group II (p=0.0092, (0.0001). The mean pulmonary arterial pressures at 10 and 60 minutes after reperfusion were 40.56$\pm$ 18.66 and 87. 2$\pm$ 17.22 mmHg in group I versus 31.22$\pm$6.84 and 65.78$\pm$ 11.02 mmHg in group rl (p : 0.048, 0.0062). The mean pulmonary vascular resistances at 10 and 60 minutes after reperfusion were 2.69$\pm$0.85 and 4.36$\pm$0.86 mmHg/ml/min in group I versus 1.99$\pm$0.39 and 3.29$\pm$0.55 mmHg/ml/min in group II(p : 0.0323, 0.0062). There were no difference between groups in peak airway pressure, lung compliance and degree of pulmonary edema. In conclusion that preservation of lung at l$0^{\circ}C$ was superior to preservation at 4$^{\circ}C$.}C$.

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The Experimental Study for Myocardial Preservation Effect of Ischemic Preconditioning (허혈성 전조건화 유발이 심근보호에 미치는 영향에 관한 실험적 연구)

  • 이종국;박일환;이상헌
    • Journal of Chest Surgery
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    • v.37 no.2
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    • pp.119-130
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    • 2004
  • Decrease in cardiac function after open heart surgery is due to an ischemia induced myocardial damage during surgery, and ischemic preconditioning, a condition in which the myocardial damage does not accumulate after repeated episodes of ischemia but protects itself from damage after prolonged ischemia due to myocytes tolerating the ischemia, is known to diminish myocardial damage, which also helps the recovery of myocardium after reperfusion, and decreases incidences of arrythmia. Our study is performed to display the ischemic preconditioning and show the myocardial protective effect by applying cardioplegic solution to the heart removed from rat. Material and Method: Sprague-Dawley male rats were used, They were fixed on a modified isolated working heart model after cannulation. The reperfusion process was according to non-working and working heart methods and the working method was executed for 20 minutes in which the heart rate, aortic pressure, aortic flow and coronary flow were measured and recorded. The control group is the group which the extracted heart was fixed on the isolated working heart model, recovered by reperfusion 60 minutes after infusion and preserved in the cardioplegic solution 20 minutes after the working heart perfusion and aortic cross clamp, The thesis groups were divided into group I, which ischemic hearts that were hypoxia induced were perfused by cardioplegic solution and preserved for 60 minutes; group II, the cardioplegic solution was infused 45 seconds (II-1), 1 minutes (II-2), 3 minutes (II-3), after the ischemia induction, 20 minutes after working heart perfusion and aortic cross clamp; and group III, hearts were executed on working heart perfusion for 20 minutes and aortic cross clamp was performed for 45 seconds (III-1), 1minute (III-2), 3 minutes (III-3), reperfused for 2 minutes to recover the heart, and then aortic cross clamping was repeated for reperfusion, all the groups were compared based on hemodynamic performance after reperfusion of the heart after preservation for 60 minutes. Result: The recovery time until spontaneous heart beat was longer in groups I, II-3, III-2 and III-3 to control group (p<0.01). Group III-1 (p<0.05) had better results in terms of recovery in number of heart rates compared to control group, and recovered better compared to II-1 (p<0.05). The recovery of aortic blood pressure favored group III-1 (p<0.05) and had better outcomes compared with II-1 (p<0.01). Group III-1 also showed best results in terms of cardiac output (p<0.05) and group III-2 was better compared to II-2 (p<0.05). Group I (p<0.01) and II-3 (p<0.05) showed more cardiac edema than control group. Conclusion: When the effects of other organs are dismissed, protecting the heart by infusion of cardioplegic solution after enforcing ischemia for a short period of time before the onset of abnormal heart beats for preconditioning has a better recovery effect in the cardioplegic group with preconditioning compared to the cardioplegic solution itself. we believe that further study is needed to find a more effective method of preconditioning.

Effects of Allium Vegetable Intake on Levels of Plasma Glucose, Lipid and Minerals in Streptozotocin Induced Diabetic Rats (Allium속 식용식물의 섭취가 Streptozotocin 유발 당뇨 흰쥐의 혈당, 지질 및 무기질 수준에 미치는 영향)

  • Ahn, Young-Mi;Lim, Sook-Ja;Han, Hye-Kyoung;Choi, Sung-Sook
    • Journal of Nutrition and Health
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    • v.39 no.5
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    • pp.433-443
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    • 2006
  • The effects of Allium vegetables on blood glucose levels and lipid metabolism in streptozotocin (S12) induced diabetic rats were investigated. Diabetes mellitus was induced by S1'2 injection (45 mg/kg 5.w.) into the tail vein. Sprague-Dawley rats weighing $220\;{\pm}\;10\;g$ were randomly assigned to 7 groups: normal, S1'2-control and five Allium groups (Allium cepa, Allium fistulosum, Allium sativum, Allium tuberosum and Allium victorialisL Normal and S12control groups were fed an AIN-93 diet and five Allium groups were fed a modified diet containing. 10% Allium powder each for 4 weeks. Body weight, diet intake, food efficiency ratio (FER) and organ weights- were monitored. Activities of aspartate aminotransferase (AST) & alanine aminotransferase (ALT) were observed: Plasma lev~ls of glucose, free fatty acid, triglyceride and HDL-cholesterol were analyzed. Levels of glycogen, cholesterol and triglyceride in liver were determined. Levels of malondialdehyde (MDA) in liver, lung, kidney, and pancreas were assayed. The hepatic contents of chromium (Cr) , iron (Fe), zinc (Zn) and manganese (Mu) were measured. The Allium sativum group had weight gain and suppressed a hypertrophy of the kidney significantly. The activity of ALT was significantly lowered in the diabetic groups except Allium sativum group compared to STZ-control group. The Allium sativum and Allium tuberosum groups showed the hypoglycemic effects at 4 weeks. There were no significant differences between the control and all the other diabetic groups in the plasma levels of cholesterol, HDL-cholesterol, triglycerides and free fatty acids. Most of the Allium groups except Allium fistulosum were observed significantly lowered level of MDA in the lung compared to STZ-control group. The diabetic rats fed the Allium cepa and Allium sativum have shown significantly lowered hepatic Zn contents. The results suggested that the intake of the Allium vegetables may be effective in the antihyperglycemia by lowering blood glucose levels.