• Journal of Chest Surgery
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• v.33 no.6
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• pp.445-468
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• 2000

Background: Retrograde cerebral perfusion(RCP) is currently used for brain protection during aorta surgery, however, for the safety of it, various data published so far are insufficient. We performed RCP using pig and investiaged various parameters of cerebral metabolism and brain injury after RCP under deep hypothermia. Material and Method: We used two experimental groups: in group I(7 pigs, 20 kg), we performed RCP for 120 minutes and in group II (5 pigs, 20 kg), we did it for 90 minutes. Nasopharyngeal temperature, jugular venous oxygen saturation, electroencephalogram were continuously monitored, and we checked the parameters of cerebral metabolism, histological changes and serum levels of neuron-specific enolose(NSE) and lactic dehydrogenase(LDH). Central venous pressure during RCP was mainained in the range of 25 to 30 mmHg. Result: Perfusion flow rates(ml/min) during RCP were 130$\pm$57.7(30 minutes), 108.6$\pm$55.2(60 minutes), 107.1$\pm$58.8(90 minutes), 98.6$\pm$58.7(120 minutes) in group I and 72$\pm$11.0(30 minutes), 72$\pm$11.0(60 minutes), 74$\pm$11.4(90 minutes) in group II. The ratios of drain flow to perfusion flow were 0.18(30 minutes), 0.19(60 minutes), 0.17(90 minutes), 0.16(120 minutes) in group I and 0.21, 0.20, 0.17 in group II. Oxygen consumptions(ml/min) during RCP were 1.80$\pm$1.37(30 minutes), 1.72$\pm$1.23(60 minutes), 1.38$\pm$0.82(90 minutes), 1.18$\pm$0.67(120 minutes) in group I and 1.56$\pm$0.28(30 minutes), 1.25$\pm$0.28(60 minutes), 1.13$\pm$0.26(90 minutes). We could observe an decreasing tendency of oxygen consumption after 90 minutes of RCP in group I. Cerebrovascular resistance(dynes.sec.cm-5) during RCP in group I incrased from 71370.9$\pm$369145.5 to 83920.9$\pm$49949.0 after the time frame of 90 minutes(p<0.05). Lactate(mg/min) appeared after 30 minutes of RCP and the levels were 0.15$\pm$0.07(30 minutes), 0.18$\pm$0.10(60 minutes), 0.19$\pm$0.19(90 minutes), 0.18$\pm$0.10(120 minutes) in group I and 0.13$\pm$0.09(30 minutes), 0.19$\pm$0.03(60 minutes), 0.29$\pm$0.11(90 minutes) in group II. Glucose utilization, exudation of carbon dioxide, differences of cerebral tissue acidosis between perfusion blood and drain blood were maintained constantly during RCP. Oxygen saturation levels(%) in drain blood during RCP were 22.9$\pm$4.4(30 minutes), 19.2$\pm$4.5(60 minutes), 17.7$\pm$2.8(90 minutes), 14.9$\pm$2.8(120 minutes) in group I and 21.3$\pm$8.6(30 minutes), 20.8$\pm$17.6(60 minutes), 21.1$\pm$12.1(90 minutes) in group II. There were no significant changes in cerebral metabolic parameters between two groups. Differences in serum levels of NSE and LDH between perfusion blood and drain blood during RCP showed no statistical significance. Serum levels of NSE and LDH after resuming of cardipulmonary bypass decreased to the level before RCP. Brain water contents were 0.73$\pm$0.03 in group I and 0.69$\pm$0.06 in group II and were higher than those of the controls(p<0.05). The light microscopic findings of cerebral neocortex, basal ganglia, hippocampus(CA1 region) and cerebellum showed no evidence of cerebral injury in two groups and there were no different electron microscopy in both groups(neocortex, basal ganglia and hippocampus), but they were thought to be reversible findings. Conclusion: Although we did not proceed this study after survival of pigs, we could perform the RCP successfully for 120 minutes with minimal cerebral metabolism and no evidence of irreversible brain damage. The results of NSE and LDH during and after RCP should be reevaluated with survival data.

• Journal of Chest Surgery
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• v.31 no.2
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• pp.108-112
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• 1998

Experimental trials of unilateral lung transplantation in dogs have been attempted and satisfactory results were obtained without any noticeable difficulty in surgical techniques. Fourteen dogs with the body weight of around 25 kg were anesthesized by 20~30 mg/kg of intravenous Entobar,; one was sacrificed to make available blood for use during transplantation for the recipient dog. A mid-sternotomy incision was performed and 20 mg/kg of Prostaglandin E1 was infused through the pulmonary artery and Euro-Collin's(E-C) preservation solution, cooled down to 4$^{\circ}C$, was perfused at the rate of 70cc/kg by a pressure of 30 cmH2O. The heart-lung block was then resected out and promptly immersed in the prepared preservation solution at 4$^{\circ}C$. One lung preserved in the EC solution at 4$^{\circ}C$ was anastomosed to the recipient dog in the order of the pulmonary vein, bronchus then pulmomary artery and the thoracotomy incision was closed after the bleeding control and tube thoracostomy. Then the pneumonectomy in the opposite side was perfomed in the same manner and the tailored lung was transplanted in the order of the pulmonary vein, bronchus, then pulmonary artery. We conclude that in the bilateral sequential lung transplantation, the right lung transplantation should precede to better expose the operative field and to prevent reperfusion injury; also, the cardiopulmonary bypass should be consider for certain appropriate cases.

• Journal of Chest Surgery
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• v.43 no.3
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• pp.254-259
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• 2010

Background: Diagnosing chronic pulmonary embolism at an early stage is difficult because of the patient’s nonspecific symptoms. This condition is not prevalent in Korea, and in fact, there have been only a few case reports on this in the Korean medical literature. We analyzed the surgical outcome of performing pulmonary thromboendarterectomy in patients with chronic pulmonary embolism. Material and Method: The study subjects included those patients who underwent surgery for chronic pulmonary embolism from 1996 to 2008. For making the diagnosis, echocardiography, chest CT and a pulmonary perfusion scan were performed on the patients who complained of chronic dyspnea. Result: Pulmonary endarterectomy was performed as follows: by incision via a mid-sternal approach (7 patients); by incision via a left posterolateral approach (1 patient); using the deep hypothermic circulatory arrest technique (4 patients); under ventricular fibrillation (3 patients); and under cardioplegic arrest (1 patient). The postoperative systolic pulmonary artery blood pressure significantly decreased from a preoperative value of $78.9{\pm}14.5\;mmHg$ to $45.6{\pm}17.6\;mmHg$ postoperatively (p=0.000). The degree of tricuspid regurgitation was less than grade II after surgery. Two patients died early on, including one patient who had persistent pulmonary hypertension without improvement and right heart failure. Conclusion: Patients who have chronic pulmonary embolism are known to have a poor prognosis. However, we think that early surgical treatment along with making the proper diagnosis before the aggravation of right heart failure can help improve the quality of a patient's life.

• Journal of Chest Surgery
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• v.42 no.5
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• pp.576-587
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• 2009

Background: The up-regulation of the nitric oxide (NO)-cGMP pathway might be involved in the change of vascular reactivity in rats 3 days after they suffer acute myocardial infarction. However, the underlying mechanism for this has not been clarified. Material and Method: Acute myocardial infarction (AMI) was induced by occluding the left anterior descending coronary artery (LAD) for 30 min (Group AMI), whereas the sham-operated control rats were treated similarly without LAD occlusion (Group SHAM), The concentration-response relationships for phenylephrine (PE), KCl, acetylcholine (Ach) and sodium nitroprusside (SNP) were determined in the endothelium intact E(+) and endothelium denuded E(-) thoracic aortic rings from the rats 3 days after AMI or a SHAM operation. The concentration-response relationships of PE in the E(+) rings from the AMI rats were compared with those relationships in the rings pretreated with nitric oxide synthase (NOS) inhibitor $N{\omega}$-nitro-L-arginine methyl ester (L-NAME) or the cyclooxygenase inhibitor indomethacin. The plasma nitrite/nitrate concentrations were checked via a Griess reaction. The cyclic GMP content in the thoracic aortic rings was measured by radioimmunoassay and the endothelial nitric oxide synthase (eNOS) mRNA expression was assessed by real time PCR. Result: The mean infarct size (%) in the rats with AMI was $21.3{\pm}0.62%$. The heart rate and the systolic and diastolic blood pressure were not significantly changed in the AMI rats. The sensitivity of the contractile response to PE and KCl was significantly decreased in both the E(+) and E(-) aortic rings of the AMI group (p<0.05). L-NAME completely reversed these contractile responses whereas indomethacin did not (p<0.05). Moreover, the sensitivity of the relaxation response to Ach was also significantly decreased in the AMI group (p<0.05). The plasma nitrite and nitrate content (p<0.05), the basal cGMP content (p<0.05) and the eNOS mRNA expression (p=0.056) in the AMI rats were increased as compared with the SHAM group. Conclusion: Our findings indicate that the increased eNOS activity and the up-regulation of the NO-cGMP pathway can be attributed to the decreased contractile or relaxation response in the rat thoracic aorta 3 days after AMI.

• Korean Journal of Social Welfare
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• v.57 no.3
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• pp.5-30
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• 2005

Globalization has conflicting effects on pharmaceutical policies. A change into a 'populist competitive nation' due to globalization strengthens policies to reduce drug manufacturing costs while the WTO's TRIPS Agreement that is affected by multinational pharmaceutical companies increases drug manufacturing costs by bolstering the patent rights on new drugs. Currently, the independency of populist nations' policies to reduce drug manufacturing cost is being compromised because multinational organizations(such as the European Union) which represents the interests of the multinational pharmaceutical companies put restrictions on the pharmaceutical policies of populist nations for purposes of promoting the industrial goals of the multinational companies. Korea is no exception. Up until the late 1990s, the main feature of the pharmaceutical policies in Korea was keeping the drug price at the cost level based on a growth-driven ideology, and this was Korea's unique policy tools as a developing nation. However, the increase in the power of multinational pharmaceutical companies currently infringes on the independency of Korea's pharmaceutical policies. Expensive imported drugs were originally covered by the national health insurance plan, but starting from 1999 such drugs began to be covered by the plan. After separation of medical and pharmaceutical services, the use of expensive drugs was increased, and the Korean government planned to introduce the reference price policy in order to contain the cost of the national health insurance plan. However, due to pressures from the U.S. government as well as multinational pharmaceutical companies, implementation of the policy has been postponed. In addition, due to a pressure from the U.S. government, a working group was created which would affect the health care policy of the Korean government. Discussions so far on globalization was about whether the change into populist competitive nations due to globalization resulted in the reduction of welfare spending. However, this study shows not only the reduction of health care cost through policies to reduce drug manufacturing costs but increase in welfare spending by raising the strengths of multinational pharmaceutical companies that are for-profit providers of welfare service. While focusing on the contradictory effects of globalization on pharmaceutical policies of a nation, this study looked at how these conflicting effects end up promoting the interests of multinational pharmaceutical companies by examining the Korean case.

• Tuberculosis and Respiratory Diseases
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• v.53 no.6
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• pp.619-634
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• 2002

Background : Many inflammatory mediators and collagenases are involved in the pathogenesis of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The increase of matrix metalloproteinase-9 (MMP-9, gelatinase-B) produced mainly by inflammatory cells was reported in many ALI models and connective tissue cells. In this study, the expression of MMP-9 in ventilator-induced lung injury (VILI) model and the effects of matrix metalloproteinase inhibitor (MMPI) on VILI were investigated. Methods : Eighteen Sprague-Dawley rats were divided into three groups: low tidal Volume (LVT, 7mL/Kg tidal volume, 3 $cmH_2O$ PEEP, 40/min), high tidal volume (HVT, 30mL/Kg tidal volume, no PEEP, 40/min) and high tidal volume with MMPI (HVT+MMPI) groups. Mechanical ventilation was performed in room air for 2 hours. The 20 mg/Kg of CMT-3 (chemically modified tetracycline-3, 6-demethyl 6-deoxy 4-dedimethylamino tetracycline) was gavaged as MMPI from three days before mechanical ventilation. The degree of lung injury was measured with wet-to-dry weight ratio and acute lung injury score. Expression of MMP-9 was studied by immunohistochemical stain with a mouse monoclonal anti-rat MMP-9 $IgG_1$. Results : In the LVT, HVT and HVT+MMPI groups, the wet-to-dry weight ratio was $4.70{\pm}0.14$, $6.82{\pm}1.28$ and $4.92{\pm}0.98$, respectively. In the HVT group, the ratio was significantly higher than other groups (p<0.05). Acute lung injury score measured by five-point scale was $3.25{\pm}1.17$, $12.83{\pm}1.17$ and $4.67{\pm}0.52$, respectively. The HVT group was significantly damaged by VILI and MMPI protects injuries by mechanical ventilation (p<0.05). Expression of MMP-9 measured by four-point scale was $3.33{\pm}2.07$, $12.17{\pm}2.79$ and $3.60{\pm}1.95$, respectively, which were significantly higher in the HVT group (p<0.05). Conclusion : VILI increases significantly the expression of MMP-9 and MMPI prevents lung injury induced by mechanical ventilation through the inhibition of MMP-9.

• Journal of Korean Public Health Nursing
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• v.16 no.2
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• pp.354-377
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• 2002

Aging population is a global trend and Korea is no exception. Due to the progress of the medical and scientific sectors, increase in the average lifetime incurred increase in the number of elderly people. Meanwhile, the family function of supporting the elderly has become a major issue in a society due to the changes in the society's structure and increased entry of the women into the workforce. As a means to substitute the protection of the elderly who are not protected at their respective homes and to replace the tending needs, weekly protection centers and short-stay centers for the elderly were established and operated in Seoul since 1992. However, structured and satisfactory services are not yet to be provided, thus this research intends to understand the current situation at the short-stay centers for the elderly, to identify users' characteristics and to conduct study on nursing need for the health reasons so that the results of the research can be utilized as basic data for the development of nursing care program. Towards this end, this research targeted 142 elderly people who were undergoing treatment at the 11 short-stay centers for the elderly out of total of 13 located in Seoul that were willing to cooperate. The research was conducted from April to May 2002, with the measurement tool developed by Rhee, Seon-ja (2001) to measure the level of nursing need. Then data was collected and analyzed using SPSS program. The results are as follows. The general characteristics of users of the short-stay centers for the elderly were: 123 females $(86.6\%)$, 19 males $(13.4\%)$ and 72 elderly were over the age of 80 $(50.7\%)$. Among these, 24$(16.9\%)$ were living by themselves. Among the illnesses that the subjects were inflicted with were: dementia $(54.2\%)$, stroke $(54.1\%)$ and high blood pressure $(50.7\%)$, in the respective order. Despite the fact that they were diagnosed with illnesses, $47.2\%$ responded that they do not undergo special treatment due to financial reasons. When the level of needs for nursing care among the elderly who use the short-stay centers is divided into informational. physical. and emotional need levels and scored between zero to two, the level of emotional need is the highest with 1.80, followed by physical (1.45) and informational (1.44) need levels. As for the realities of services at the centers and improvement areas, restriction on term was cited as the greatest inconvenience with $38.7\%$, followed by lack of budget (24 respondents, $16.9\%$). Wishful services were financial assistance $(46.5\%)$, medical and nursing services $(40.1\%)$, meal provision service $(8.5\%)$ and counseling service $(4.9\%)$, in the respective order. Based on the above mentioned results, the research identified the need to develop nursing program for the patients of dementia that can be applied onto the short-stay centers and the need to develop volunteer service, backed by societal support. Also, placement of specialized cadre of professionals is needed so that medical and nursing service functions can be provided in a complementary manner.

• Journal of agricultural medicine and community health
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• v.28 no.2
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• pp.155-169
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• 2003

Objectives: The purpose of this study is to provide data for the improvement of hypertension management of community health practitioner posts through the study on hypertension management in community health practitioner posts. Methods: A questionnaire was mailed to 700 community health practitioners and 205 of them responded during the period from March 13, 2003 to May 13. The survey results were analyzed using SPSS program, version 11. Results: The results are as follows; 1. There are two major activities in a hypertension prevention project for community: health education and early detection. About 57% of community health care practitioners perform a health education for community people four times a year. The 64.5% of them used the materials for health education provided from a community health center and 22.1% of them performed a post-evaluation. The main method of early detection of hypertension was measurement of blood pressure of person to visit, which was 96.1%. Other methods included home visiting(89.3%), a referral from community hospitals and other resources(49.1%), health promotion events(39.5%), and a review of medical records(35.7%). 2. For the registration and management of patients with hypertension, about 36% of community health centers used a special form and more than 50% of them have registered patients who were managed by other health care institutions in the community. A computerized program was used for the management of patients with hypertension in 68.5% of them. More than 60% of them responded that it was used for report, treatment, and follow-up of patients with hypertension.

• Journal of agricultural medicine and community health
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• v.41 no.4
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• pp.205-216
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• 2016

Objectives: We compared the difference of lipid, insulin resistance and metabolic markers based on HCV RNA in Korean adults.Methods: This was a cross-sectional study of 222 subjects visited the health promotion center of Pusan nationaluniversity hospital from 2004 to 2007. Subjects were anti-HCV antibody positive and were performed RT-PCR for HCV RNA. The HCV RNA (+) group were 85 subjects, HCV RNA (-) control group were 115 subjects, and the HCV RNA (-) but past positive group were 22 subjects. We performed anthropometry, anti-HCV, RT-PCR, plasma concentrations of insulin, total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglyceride.Results: BMI, waist circumference, blood pressure, fasting plasma glucose, triglyceride, HDL cholesterol, insulin resistance such as HOMA-IR and QUICKI were not significantly different between HCV RNA positive and negative groups. The serum total cholesterol and LDL cholesterol level were significantly lower in the HCV RNA positive group than in the negative group ($186.24{\pm}37.63$ vs $197.22{\pm}37.23$ mg/dl, p=0.041, $111.66{\pm}34.06$ vs $121.38{\pm}35.50$ mg/dl, p=0.042). After adjusting age and sex, high total cholesterol (${\geq}200mg/dl$) (adjusted OR=0.51, 95%CI 0.28-0.94, p=0.03) and high LDL cholesterol (${\geq}130mg/dl$) (adjusted OR=0.46, 95%CI 0.24~0.87, p=0.02) were inversely associated with being HCV RNA positive (p<0.05). Conclusion: The serum total cholesterol and LDL-cholesterol level were significantly lower in HCV RNA (+) group than in HCV RNA (-) group, but not in HCV RNA (-) but past positive group. Prospective cohort studies are needed to clarify the relationship between HCV RNA and metabolic markers.

• KDI Journal of Economic Policy
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• v.32 no.4
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• pp.1-34
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• 2010

We conduct a comprehensive risk analysis of household debt in Korea for the first time using the whole sample credit bureau (CB) data of 2.2 million individual debtors. After analysing debt service capacity profiles of debtor groups classified by the borrower characteristics such as income, age, occupation, credit scoring, and the type of creditor business companies, we investigate the impact of interest rate and income changes on debt service-to-income ratios (DTIs) and default rates of respective debtor groups. Empirical results indicate that debt service burdens are relatively high for low income wage earners, high income self-employed, low income capital and card loan holders, and high income mutual savings loan holders. We also find that debtors from multiple financial companies are particularly weak in their debt service capacity. The scenario analysis indicates that financial companies, with the current level of capital buffers, may be able to absorb negative consequences arising from the increase in DTIs and loan default rates if the interest rate and income changes remain modest. However, the negative consequences may fall disproportionately on non-bank financial companies such as capital, credit card, and mutual savings banks, whose debtors' DTIs are already high. We also find that the refinancing risk of household debt is relatively high in Korea as more than half of household mortgage debts are bullet loans. As the DTIs of mortgage loan holders are already high, under the current DTI regulation, mortgage loans may not be readily refinanced especially when the interest rate rises. Disruptions in mortgage loan refinancing may put downward pressure on housing prices, which may in turn magnify refinancing risk under the current loan-to-value (LTV) regulation. Overall our analysis suggests that, for more effective monitoring of household debt risk, it is necessary to combine existing surveillance schemes based on macro aggregate indicators with more comprehensive and detailed risk analyses based on micro individual data.