• Journal of Korean Society for Quality Management
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• v.39 no.3
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• pp.391-399
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• 2011

Our study was carried out to analyze the variation factors of severity-adjusted length of stay(LOS) in coronary artery bypass graft(CABG). The subjects were 932 CABG inpatients of the Korean National Hospital Discharge In-depth Injury Survey from 2004 through 2008. The data were analyzed using $x^2$ test and the severity-adjusted model was developed using data mining technique. The results of the study were as follows: male(71.1%), older than 61 years of age(61.6%), more than 500 beds(92.8%) and admitting via ambulatory care(70.0%) appeared to have higher rate than otherwise. In-hospital mortality of CABG inpatients was 2.8%. In addition, 46.4% of the patients received their care in other residence. The angina pectoris(45.6%) was found to be the highest in principle diagnosis, followed by chronic ischemic heart disease(36.9%) and acute myocardial infarction(12.0%). We developed severity-adjusted LOS model using the variables such as gender, age and comorbidity. Comparison of adjusted values in predicted LOS revealed that there were significant variations in LOS by location of hospital, bed size, and whether patients received the care in their residences. The variations of LOS can be explained as the indirect indicator for quality variation of medical process. It is suggested that the severity-adjusted LOS model developed in this study should be utilized as a useful method for benchmarking in hospital and it is necessary that national standard clinical practice guideline should be developed.

• Journal of Chest Surgery
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• v.30 no.5
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• pp.517-523
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• 1997

The records of 14 patients with traumatic diaphragmatic rupture seen at Dongguk University Hospital from February 1992 through December 1995 were reviewed. Ten patients were male and four were female(M:F=2.5:1). The age distribution ranged from 17 to 73 years with the mean age of 41.7 years. The 14 patients included 12 who had blunt trauma(traffic accident 11, crushing injury 1) and 2 with penetrating diaphragmatic rupture(stab wound 2). Of those 12 blunt trauma, 7 patients(58.3%) were left sided and 5(41.7%) involved the right hemidiaphragm. The diagnosis was made preoperatively in 8 patients (57.1%) and during surgery in 6(42.9%). All right-sided injuries were repaired through a thoracotomy and left-sided defects were corrected through a laparotomy in 6, laparotomy and thoracotomy in 1. There were 2(14.3%) operative deaths that were caused by myocardial infarction and the sequelae of combined injuries.

• Biomolecules & Therapeutics
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• v.23 no.6
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• pp.517-524
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• 2015

Human mesenchymal stem cells (MSCs) have been used in cell-based therapy to promote revascularization after peripheral or myocardial ischemia. High levels of reactive oxygen species (ROS) are involved in the senescence and apoptosis of MSCs, causing defective neovascularization. Here, we examined the effect of the natural antioxidant lycopene on oxidative stress-induced apoptosis in MSCs. Although $H_2O_2$ ($200{\mu}M$) increased intracellular ROS levels in human MSCs, lycopene ($10{\mu}M$) pretreatment suppressed $H_2O_2$-induced ROS generation and increased survival. $H_2O_2$-induced ROS increased the levels of phosphorylated p38 mitogen activated protein kinase (MAPK), Jun-N-terminal kinase (JNK), ataxia telangiectasia mutated (ATM), and p53, which were inhibited by lycopene pretreatment. Furthermore, lycopene pretreatment decreased the expression of cleaved poly (ADP ribose) polymerase-1 (PARP-1) and caspase-3 and increased the expression of B-cell lymphoma 2 (Bcl-2) and Bcl-2-associated X protein (Bax), which were induced by $H_2O_2$ treatment. Moreover, lycopene significantly increased manganese superoxide dismutase (MnSOD) expression and decreased cellular ROS levels via the PI3K-Akt pathway. Our findings show that lycopene pretreatment prevents ischemic injury by suppressing apoptosis-associated signal pathway and enhancing anti-oxidant protein, suggesting that lycopene could be developed as a beneficial broad-spectrum agent for the successful MSC transplantation in ischemic diseases.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.13 no.6
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• pp.2672-2679
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• 2012

The study was done to provide basic data of medical quality evaluation after developing the comorbidity disease mortality measurement modeled on the severity-adjustment method of AMI. This study analyzed 699,701 cases of Hospital Discharge Injury Data of 2005 and 2008, provided by the Korea Centers for Disease Control and Prevention. We used logistic regression to compare the risk-adjustment model of the Charlson Comorbidity Index with the predictability and compatibility of our severity score model that is newly developed for calibration. The models severity method included age, sex, hospitalization path, PCI presence, CABG, and 12 variables of the comorbidity disease. Predictability of the newly developed severity models, which has statistical C level of 0.796(95%CI=0.771-0.821) is higher than Charlson Comorbidity Index. This proves that there are differences of mortality, prevalence rate by method of mortality model calibration. In the future, this study outcome should be utilized more to achieve an improvement of medical quality evaluation, and also models will be developed that are considered for clinical significance and statistical compatibility.

• Journal of Chest Surgery
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• v.50 no.1
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• pp.1-7
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• 2017

Complex lesions of the thoracic aorta are traditionally treated in 2 surgical steps with the elephant trunk technique. A relatively new approach is the frozen elephant trunk (FET) technique, which potentially allows combined lesions of the thoracic aorta to be treated in a 1-stage procedure combining endovascular treatment with conventional surgery using a hybrid prosthesis. These are very complex and time-consuming operations, and good results can be obtained only if appropriate strategies for myocardial, cerebral, and visceral protection are adopted. However, the FET technique is associated with a non-negligible incidence of spinal cord injury, due to the extensive coverage of the descending aorta with the excessive sacrifice of intercostal arteries. The indications for the FET technique include chronic thoracic aortic dissection, acute or chronic type B dissection when endovascular treatment is contraindicated, chronic aneurysm of the thoracic aorta, and chronic aneurysm of the distal arch. The F ET technique is also indicated in acute type A aortic dissection, especially when the tear is localized in the aortic arch; in cases of distal malperfusion; and in young patients. In light of the great interest in the FET technique, the Vascular Domain of the European Association for cardio-thoracic Surgery published a position paper reporting the current knowledge and the state of the art of the FET technique. Herein, we describe the surgical techniques involved in the FET technique and we report our experience with the F ET technique for the treatment of complex aortic disease of the thoracic aorta.

• Journal of Chest Surgery
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• v.25 no.1
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• pp.32-41
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• 1992

From August 1982 to December 1991, 58 consecutive infants with tetralogy of Fallot underwent primary repair. Age ranged from 22 days to twelve months [n=58, 8.7$\pm$2.7 months] and body weight from 3.1 to 13 kilograms [n=58, 7.8$\pm$1.7 kilograms]. Qne infant had absence of the pulmonary valve; one had Ebstein`s anomaly and one had supramitral ring. Thirty-two patients [56%] experienced anoxic spell. Preoperative pulmonary artery indices were measured in 38 cases, ranging 126-552mm2/M2BSA[n=38, 251$\pm$79mm2/M2BSA]. All infants required a right ventricular outflow tract patch; in 41, the patch extended across the pulmonary valve annulus, in 13 of them, monocusps were constructed. All had patch closure of ventricular septal defect. Two infants had REV operation for avoiding injury to the canal branch of the right coronary artery which cross the right ventricular out flow tract. Post repair PRV/LV were measured at operating room in 40 cases, which revealed mean value of 0.49$\pm$0.12 [range: 0.25-0.74]. The hospital mortality was 10.3% [6 patients], and causes of deaths were right heart failure due to sustained right ventricular hypertension[4] and right ventricular outflow tract obstruction, intractablesuraventricular tachyarrhythmia[1], hypoxia[1] due to residual right to left shunt across the atrial septal defect in patient associated with Ebstein`s anomaly. All infants were doing well at follow-up from 1 to 101 months[20.6 months /patient, 1, 072 patient-month] Serial postoperative echocardiograms revealed no residual ventricular septal defects and estimated RVOT gradients between 0 and 40 mmHg except 3 cases [50, 50, 60 mmHg]. There were no late deaths and late ventricular arrhythmias or congestive heart failure. Redo operations were done in 2 cases because of residual right ventricular outflow tract obstruction. This experience with infants with tetralogy of Fallot suggests that, if mortality is tolerable, eletive repair of tetralogy of Fallot could be reasonably undertaken during the first year of life, and even better results could be anticipated along with improvement of methods of myocardial protection and postoperative care.

• The Journal of Korean Medicine
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• v.19 no.2
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• pp.137-152
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• 1998

Acute complications of diabetes mellitus were diminished after Banting and Best discovered insulin. But chronic complications of diabetes mellitus have been increased. The main complications of diabetes mellitus are diabetic retinopathy, diabetic nephropathy, diabetic neuropathy, diabetic foot lesion and macrovascular complication. These complications can result in renal failure, loss of sight, cerebral infarction and myocardial infarction. So it is very difficult to treat the complications of diabetes mellitus. In oriental medicine, the transformations(傳變症) of Sogal(消渴) are edema, carbuncle, loss of sight and so on. The comparative study between the trcmsformations(傳變症) of SogaI(消渴) and the complications of diabetes mellitus has come to the following conclusions. 1. In oriental medicine, diabetic retinopathy was expessed as loss of sight and the treament of diabetic retinopathy should be started at an early stage, to prevent vitreous hemorrhage and traction retinal detachment. 2. In oriental medicine. diabetic nephropathy was expressed as edema and the treatment should be started at an early stage of renal injury when the protein comes from urine.3. Symmetrical distal polyneuropathy is the main part of diabetic neuropathy and it was expressed as weakness of the lower limbs and pain of joints in the symptoms of Haso(下消). In Oriental medicine, acupuncture and herb medicine which effect is SopungHwalHyul can treat polyneuropathy. 4. Chief macrovascular complications are coronary artery disease and cerebrovascular disease, The cause of macrovascular complication is atherosclerosis. So the method of treating atherosclerosis should be studied in oriental medicine. 5. Diabetic foot were expressed as carbuncle and its main causes are decreasing perfusion of fool, diabetic neuropathy and infection. So these causes should be studied in oriental medicine. 6. The complications of diabetes mellitus afe very similar to the transfonnatiuns of Sogal(消渴).The control of blood glucose is indispensable to prevent and delay the complication of diabetes mellitus.

• Journal of Chest Surgery
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• v.52 no.3
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• pp.155-161
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• 2019

Background: Coronary artery bypass grafting (CABG) is being offered increasingly frequently to octogenarians. However, old age is known to be an independent risk factor in CABG. The aim of this study was to compare the outcomes of off-pump coronary artery bypass (OPCAB) between octogenarians and septuagenarians. Methods: We retrospectively reviewed the data of 1,289 consecutive patients aged ${\geq}70years$ who underwent OPCAB at a single institution between 2001 and 2016. We compared the outcomes of 115 octogenarians and 1,174 septuagenarians. Using propensity score matching, based on preoperative clinical characteristics, 114 octogenarians were matched with 338 septuagenarians. Results: Propensity score analysis revealed that the incidence of acute kidney injury (14.9% vs. 7.9%, p=0.028) and respiratory complications (8.8% vs. 4.2%, p=0.040) was significantly higher in octogenarians. The early mortality rate (2.6% vs. 1.0%, p=0.240) and 1-year survival rate (89.5% vs. 94.4%, p=0.097) were not statistically significant between the groups. However, the 5-year survival rate (67.3% vs. 79.9%, p<0.001) was significantly lower in octogenarians. Previous myocardial infarction and a left ventricular ejection fraction ${\leq}35%$ were associated with a poor 1-year survival rate. Conclusion: Early and 1-year outcomes of OPCAB in octogenarians were tolerable when compared with those in septuagenarians. OPCAB could be a suitable option for octogenarians.

• Journal of Ginseng Research
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• v.46 no.2
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• pp.175-182
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• 2022

Coronavirus disease 2019 (COVID-19) not only targets the respiratory system but also triggers a cytokine storm and a series of complications, such as gastrointestinal problems, acute kidney injury, and myocardial ischemia. The use of natural products has been utilized to ease the symptoms of COVID-19, and in some cases, to strengthen the immune system against COVID-19. Natural products are readily available and have been regularly consumed for various health benefits. COVID-19 has been reported to be associated with the risk of thromboembolism and deep vein thrombosis. These thrombotic complications often affects mortality and morbidity. Panax ginseng, which has been widely consumed for its various health benefits has also been reported for its therapeutic effects against cardiovascular disease, thrombosis and platelet aggregation. In this review, we propose that P. ginseng can be consumed as a supplementation against the various associated complications of COVID-19, especially against thrombosis. We utilized the network pharmacology approach to validate the potential therapeutic properties of P. ginseng against COVID-19 mediated thrombosis, the coagulation pathway and platelet aggregation. Additionally, we aimed to investigate the roles of P. ginseng against COVID-19 with the involvement of platelet-leukocyte aggregates in relation to immunity-related responses in COVID-19.

• Journal of The Korean Dental Society of Anesthesiology
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• v.14 no.3
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• pp.157-165
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• 2014

Background: Incisional site of surgical operation become transient ischemic state and then occur reoxygenation due to vasodilatation by inflammatory reaction, the productive reactive oxygen species (ROS) give rise to many physiologic results. Apoptosis have major role on elimination of inflammatory cell and formation of granulation tissue in normal wound healing process. Remifentanil can prevent the inflammatory response and can suppress inducible nitric oxide synthase expression in a septic mouse model. After cardiopulmonary bypass for coronary artery surgery, remifentanil can also inhibit the release of biomarkers of myocardial damage. Here we investigated whether remifentanil pretreatment has cellular protective effect against hypoxia-reoxygenation in HaCaT human keratinocytes, if so, the role of apoptosis and autophagy on this phenomenon. Methods: The HaCaT human keratinocytes were exposed to various concentrations of remifentanil (0.01, 0.05, 0.1, 0.5 and 1 ng/ml) for 2 h before hypoxia (RPC/HR group). These cells were cultured under 1% oxygen tension for 24h at $37^{\circ}C$. After hypoxia, to simulate reoxygenation and recovery, the cells were reoxygenated for 12 h at $37^{\circ}C$. 3-MA/RPC/HR group was treated 3-methyladenine (3-MA), autophagy inhibitor for 1h before remifentanil treatment. Cell viability was measured using a quantitative colorimetric assay with thiazolyl blue tetrazoliumbromide (MTT, amresco), showing the mitochondrial activity of living cells. To investigate whether the occurrence of autophagy and apoptosis, we used fluorescence microscopy and Western blot analysis. Results: The viability against hypoxia-reoxygenation injury in remifentanil preconditioning keratinocytes were increased, and these cells were showed stimulated expression of autophagy 3-MA suppressed the induction of autophagy effectively and the protective effects on apoptosis. Atg5, Beclin-1, LC3-II and p62 were elevated in RPC/HR group. But they were decreased when autophagy was suppressed by 3-MA. Conclusions: Remifentanil preconditioning showed the protective effect in human keratinocytes, and we concluded that autophagy may take the major role in the recovery of wound from hypoxia-reoxygenation injury. We suggest that further research is needed about the cell protective effects of autophagy.