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Clinical Practice Guideline for Cardiac Rehabilitation in Korea

  • Kim, Chul;Sung, Jidong;Lee, Jong Hwa;Kim, Won-Seok;Lee, Goo Joo;Jee, Sungju;Jung, Il-Young;Rah, Ueon Woo;Kim, Byung Ok;Choi, Kyoung Hyo;Kwon, Bum Sun;Yoo, Seung Don;Bang, Heui Je;Shin, Hyung-Ik;Kim, Yong Wook;Jung, Heeyoune;Kim, Eung Ju;Lee, Jung Hwan;Jung, In Hyun;Jung, Jae-Seung;Lee, Jong-Young;Han, Jae-Young;Han, Eun Young;Won, Yu Hui;Han, Woosik;Baek, Sora;Joa, Kyung-Lim;Lee, Sook Joung;Kim, Ae Ryoung;Lee, So Young;Kim, Jihee;Choi, Hee Eun;Lee, Byeong-Ju;Kim, Soon
    • Journal of Chest Surgery
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    • v.52 no.4
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    • pp.248-329
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    • 2019
  • Background: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. Methods: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. Results: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Conclusion: Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

Reduction of Artifacts in Magnetic Resonance Imaging with Diamagnetic Substance (반자성 물질을 이용한 자기공명영상검사에서의 인공물 감소)

  • Choi, Woo Jeon;Kim, Dong Hyun
    • Journal of the Korean Society of Radiology
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    • v.13 no.4
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    • pp.581-588
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    • 2019
  • MRI is superior when contrasted to help the organization generate artifacts resolution, but also affect the diagnosis and create a image that can not be read. Metal is inserted into the tooth, it is necessary to often be inhibited in imaging by causing the geometric distortion due to the majority and if the difference between the magnetic susceptibility of a ferromagnetic material or paramagnetic reducing them. The purpose of this study is to conduct a metal artefact in accordance with the analysis using a diamagnetic material. The magnetic material include a wire for the orthodontic bracket and a stainless steel was used as a diamagnetic material was used copper, zinc, bismuth. Testing equipment is sequenced using 1.5T, 3T was used was measured using a SE, TSE, GE, EPI. A self-produced phantom material was used for agarose gel (10%) to a uniform signal artifacts causing materials are stainless steel were tested by placing in the center of the phantom and cover inspection of the positive cube diamagnetic material of 10mm each length.After a measurement artefact artifact zone settings area was calculated using the Wand tool After setting the Low Threshold value of 10 in the image obtained by subtracting images, including magnetic material from a pure tool phantom images using Image J. Metal artifacts occur in stainless steel metal artifact reduction was greatest in the image with the bismuth diamagnetic materials of copper and zinc is slightly reduced, but the difference in degree will not greater. The reason for this is thought to be due to hayeotgi offset most of the susceptibility in bismuth diamagnetic susceptibility of most small ferromagnetic. Most came with less artifacts in image of bismuth in both 1.5T and 3T. Sequence-specific artifact reduction was most reduced artifacts from the TSE 1.5T 3T was reduced in the most artifacts from SE. Signal-to-noise ratio was the lowest SNR is low, appears in the implant, the 1.5T was the Implant + Bi Cu and Zn showed similar results to each other. Therefore, the results of artifacts variation of diamagnetic material, magnetic susceptibility (${\chi}$) is the most this shows the reduced aspect lower than the implant artificial metal artifacts criteria in the video using low bismuth susceptibility to low material the more metal artifacts It was found that the decrease. Therefore, based on the study on the increase, the metal artifacts reduction for the whole, as well as dental prosthesis future orthodontic materials in a way that can even reduce the artifact does not appear which has been pointed out as a disadvantage of the solutions of conventional metal artifact It is considered to be material.

Evaluation of Commercial Complementary DNA Synthesis Kits for Detecting Human Papillomavirus (인유두종바이러스 검출을 위한 상용화된 cDNA 합성 키트의 평가)

  • Yu, Kwangmin;Park, Sunyoung;Chang, Yunhee;Hwang, Dasom;Kim, Geehyuk;Kim, Jungho;Kim, Sunghyun;Kim, Eun-Joong;Lee, Dongsup
    • Korean Journal of Clinical Laboratory Science
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    • v.51 no.3
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    • pp.309-315
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    • 2019
  • Cervical cancer is the fourth most common malignant neoplasm in women worldwide. Most cases of cervical cancer are caused by an infection by the human papillomavirus. Molecular diagnostic methods have emerged to detect the HPV for sensitivity, specificity, and objectivity. In particular, real-time PCR has been introduced to acquire a more sensitive target DNA or RNA. RNA extraction and complementary DNA synthesis are proceeded before performing real-time PCR targeting RNA. To identify an adequate and sensitive cDNA synthesis kit, this study evaluated the two commonly used kits for cDNA synthesis. The results show that the $R^2$ and efficiency (%) of the two cDNA synthesis kits were similar in the cervical cancer cell lines. On the other hand, the Takara kit compared to Invitrogen kit showed P<0.001 in the $10^2$ and $10^3$ SiHa cell count. The Takara kit compared to the Invitrogen kit showed P<0.001 in the $10^1$ and $10^2$ HeLa cell count. Furthermore, 8, 4, 2, 1, and 0.5 ml of forty exfoliated cell samples were used to compare the cDNA synthesis kits. The Takara kit compared to the Invitrogen kit showed P<0.01 in 8, 4, and 1 ml and P<0.05 in 0.5 mL. The study was performed to identify the most appropriate cDNA synthesis kit and suggests that a cDNA synthesis kit could affect the real-time PCR results.

The Scope and the Meaning of 'Time of Arrival' in Carriage of Passengers by Air : Focused on the Germanwings GmbH v. Ronny Henning, Case C-452/13 (2014). (항공여객운송에서의 지연보상과 도착시각의 의미 - EU 사법재판소 2014. 9. 14. 판결(ECLI:EU:C:2014:2141)을 중심으로 -)

  • Sur, Ji-Min
    • The Korean Journal of Air & Space Law and Policy
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    • v.33 no.2
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    • pp.267-290
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    • 2018
  • This paper reviews and criticizes the EU Case of C-452/13, Germanwings GmbH v. Ronny Henning. Under this case, Ronny Henning later sued Lufthansa's budget carrier Germanwings after it refused to pay him 250 euros compensation for a delay he said totalled more than three hours. Germanwings, however, maintained his flight had arrived only two hours and 58 minutes behind schedule. In those circumstances, the following question to the European Court of Justice (ECJ) for a preliminary ruling: What time is relevant for the term time of arrival used in Articles 2, 5 and 7 of Regulation [No 261/2004]: (a) the time that the aircraft lands on the runway (touchdown); (b) the time that the aircraft reaches its parking position and the parking brakes are engaged or the chocks have been applied (in-block time); (c) the time that the aircraft door is opened; (d) a time defined by the parties in the context of party autonomy? ECJ says that the situation of passengers on a flight does not change substantially when their aircraft touches down on the runway at the destination airport, when that aircraft reaches its parking position and the parking brakes are engaged or when the chocks are applied, as the passengers continue to be subject, in the enclosed space in which they are sitting, to various constraints. Therefore, it is only when the passengers are permitted to leave the aircraft and the order is given to that effect to open the doors of the aircraft that the passengers may in principle resume their normal activities without being subject to those constraints. ECJ rules that it is apparent that Articles 2, 5 and 7 of Regulation No 261/2004 must be interpreted as meaning that the concept of 'arrival time', which is used to determine the length of the delay to which passengers on a flight have been subject, corresponds to the time at which at least one of the doors of the aircraft is opened, the assumption being that, at that moment, the passengers are permitted to leave the aircraft.

Protective Effect of the Ethyl Acetate-fraction of Methanol Extract of Ophiophogon japonicus on Amyloid beta Peptide-induced Cytotoxicity in PC12 Cells (소엽맥문동-에틸아세테이트 분획물의 아밀로이드 베타단백질-유발 세포독성에 대한 억제 효능)

  • Moon, Ja-Young;Kim, Eun-Sook;Choi, Soo-Jin;Kim, Jin-Ik;Choi, Nack-Shik;Lee, Kyoung;Park, Woo-Jin;Choi, Young-Whan
    • Journal of Life Science
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    • v.29 no.2
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    • pp.173-180
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    • 2019
  • Amyloid ${\beta}$-protein ($A{\beta}$) is the principal component of senile plaques characteristic of Alzheimer's disease (AD) and elicits a toxic effect on neurons in vitro and in vivo. Many environmental factors, including antioxidants and proteoglycans, modify $A{\beta}$ toxicity. It is worthwhile to isolate novel natural compounds that could prove therapeutic for patients with AD without causing detrimental side effects. In this study, we investigated the in vitro neuroprotective effects of the ethyl acetate fraction of methanol extract of Ophiophogon japonicas (OJEA fraction). We used an MTT reduction assay to detect protective effects of the OJEA fraction on $A{\beta}_{25-35}$-induced cytotoxicity to PC12 cells. We also used a cell-based ${\beta}$-secretase assay system to investigate the inhibitory effect of the OJEA fraction on ${\beta}$-secretase activity. In addition, we performed an in vitro lipid peroxidation assay to evaluate the protective effect of the OJEA fraction against oxidative stress induced by $A{\beta}_{25-35}$ in PC12 cells. The OJEA fraction had strong protective effects against $A{\beta}_{25-35}$-induced cytotoxicity to PC12 cells and was strongly inhibitory to ${\beta}$-secretase activity, which resulted in the attenuation of $A{\beta}$ generation. In addition, the OJEA fraction significantly decreased malondialdehyde (MDA) content, which is induced by the exposure of PC12 cells to $A{\beta}_{25-35}$. Our results suggested that the OJEA fraction contained active compounds exhibiting a neuroprotective effect on $A{\beta}$ toxicity.

The Effect of Exercise Intensity on Changes in Neuronal Nitric Oxide Synthase Expression in the Hippocampus and Cerebral Cortex of Obese Mice (고지방식이로 유도된 비만 마우스의 해마 및 대뇌피질에서 운동강도에 따른 nNOS 발현의 변화)

  • Baek, Kyung-Wan
    • Journal of Life Science
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    • v.29 no.1
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    • pp.18-28
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    • 2019
  • Recent studies reported that obesity upregulated the expression of neuronal nitric oxide synthase (nNOS) and regulated particular behavior patterns in animal models. They also reported that ameliorated the increase in nNOS expression and decreased depression and anxiolytic effects. Thus, exercise seems to be an effective strategy for improving brain function by downregulating nNOS. However, the immune response differs greatly, depending on the exercise intensity. The aim of the present study was to investigate differences in brain nNOS expression in obese C57BL/6 mice that performed exercise of different intensities. Obesity was induced in 6-wks-old mice (n=35) by feeding a 60%-fat diet for 6-wks. A control (CON) group (n=14) was fed a normal diet. At the end of the induction 6-wks period of obesity, seven animals in the CON group and obesity-induced group were sacrificed to confirm obesity induction (preliminary experiments and confirmation of visceral fat accumulation). The remaining animals were then used in an 8-wks exercise intervention. Other than the CON (n=7), the obesity-induced animals were divided into the following groups: high-fat diet (HFD, n=7), HFD-low intensity (HFD-LI, n=7, 12 m/min for 75 min), HFD-moderate intensity (HFD-MI, n=7, 15 m/min for 60 min), and HFD-high intensity (HFD-HI, n=7, 18 m/min for 50 min). The exercise was performed on an animal treadmill. The expression of the nNOS protein in the hippocampus was significantly higher in the HFD group as compared with that in the CON group (p<0.01). However, there was no difference in the hippocampal expression of the nNOS protein in the other exercise groups as compared with that in the CON group. In contrast, nNOS expression in the HFD-HI group was significantly lower than that in the HFD-LI group (p<0.05). The expression of phosphorylated Akt (pAkt) was significantly higher in all the exercise groups as compared with that in the CON and HFD groups. There was no difference in the expression of pAkt in the cerebral cortex among groups, and the expression of pAkt in the cerebellum was significantly higher in the HFD-HI group as compared with that in the CON group (p<0.05). There were also no between-group differences in pAkt expression in the cerebellum among the various exercise groups. In conclusion, nNOS seems to be overexpressed in response to obesity, and it appears to be downregulated by exercise. Relatively high-intensity exercise may be effective in improving brain function by downregulating nNOS.

Comparison of shear bond strength according to various surface treatment methods of zirconia and resin cement types (지르코니아의 다양한 표면처리 방법과 레진시멘트 종류에 따른 전단결합강도 비교)

  • Bae, Ji-Hyeon;Bae, Gang-Ho;Park, Taeseok;Huh, Jung-Bo;Choi, Jae-Won
    • The Journal of Korean Academy of Prosthodontics
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    • v.59 no.2
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    • pp.153-163
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    • 2021
  • Purpose: The aim of this study was to evaluate the effects of four surface treatment methods to improve zirconia roughness and three types of resin cement on the shear bond strength (SBS). Materials and methods: A total of 120 zirconia blocks were randomly divided into four surface treatments: non-treatment (Control), airborne-particle abrasion (APA) with 50 ㎛ Al2O3 (APA50), APA with 125 ㎛ Al2O3 (APA125), and ZrO2 slurry (ZA). Three resin cements (Panavia F 2.0, Superbond C&B, and Variolink N) were applied to the surface-treated zirconia specimens. All specimens were subjected to SBS testing using a universal testing machine. The surface of the representative specimens of each group was observed by scanning electron microscope (SEM). SBS data were analyzed with oneway ANOVA, two-way ANOVA test and post-hoc Tukey HSD Test (α=.05). Results: In the surface treatment method, APA125, APA50, ZA, and Control showed high shear bond strength in order, but there was no significant difference between APA125 and APA50 (P>.05). Also, ZA showed significantly higher shear bond strength than Control (P<.05). In the resin cement type, Panavia F 2.0, Superbond C&B, and Variolink N showed significantly higher shear bond strength in order (P<.05). In SEM images, the zirconia surfaces of the APA50 and APA125 showed quite rough and irregular shapes, and the zirconia surface of the ZA was observed small irregular porosity and rough surfaces. Conclusion: APA and ZrO2 slurry were enhanced the surface roughness of zirconia, and Panavia F 2.0 containing MDP showed the highest shear bond strength with zirconia.

Ethanol Extract of Glycyrrhiza uralensis Protects Against Oxidative Stress-induced DNA Damage and Apoptosis in Retinal Pigment Epithelial Cells (망막색소상피세포에서 감초 추출물의 산화적 스트레스에 의한 DNA 손상 및 apoptosis 유발의 차단 효과)

  • Kim, So Young;Kim, Jeong-Hwan;Kim, Sung Ok;Park, Seh-Kwang;Jeong, Ji-Won;Kim, Mi-Young;Lee, Hyesook;Cheong, JaeHun;Choi, Yung Hyun
    • Journal of Life Science
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    • v.29 no.11
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    • pp.1273-1280
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    • 2019
  • Age-related macular degeneration (AMD) is one of the leading causes of blindness in the elderly population, and damage to retinal pigment epithelial (RPE) cells due to oxidative stress contributes to the development of AMD. Glycyrrhiza uralensis Fischer is one of the most widely used herbal medicines for the treatment of various diseases in Asian countries. Although recent studies indicated that treatment with G. uralensis can protect cells from oxidative stress, its mechanisms in RPE cells remain unknown. We evaluated the effect of a G. uralensis ethanol extract (GU) on $H_2O_2$-induced oxidative injury in ARPE-19 RPE cells. The GU pretreatment attenuated reactive oxygen species (ROS) generation induced by $H_2O_2$, which was associated with induced expression of nuclear factor erythroid-derived-2-like 2 (Nrf2) and heme oxygenase-1 (HO-1). GU also suppressed $H_2O_2$-induced DNA damage and mitochondrial dysfunction. The inhibitory effect of GU on $H_2O_2$-induced apoptosis was associated with the protection of caspase-3 activation. Overall, GU appeared to protect RPE cells from oxidative injury by inhibiting DNA damage and reducing apoptosis. Further studies are needed to determine the regulation of Nrf2-mediated HO-1 expression, but our results suggest the possibility of using GU to reduce the risk of AMD.

Determination of Proper Irrigation Scheduling for Automated Irrigation System based on Substrate Capacitance Measurement Device in Tomato Rockwool Hydroponics (토마토 암면재배에서 정전용량 측정장치를 기반으로 한 급액방법 구명)

  • Han, Dongsup;Baek, Jeonghyeon;Park, Juseong;Shin, Wonkyo;Cho, Ilhwan;Choi, Eunyoung
    • Journal of Bio-Environment Control
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    • v.28 no.4
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    • pp.366-375
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    • 2019
  • This experiment aims to determine the proper irrigation scheduling based on a whole-substrate capacitance using a newly developed device (SCMD) by comparing with the integrated solar radiation automated irrigation system (ISR) and sap flow sensor automated irrigation system (SF) for the cultivation of tomato (Solanum lycopersicum L. 'Hoyong' 'Super Doterang') during spring to winter season. For the SCMD system, irrigation was conducted every 10 minutes after the first irrigation was started until the first run-off was occurred, of which the substrate capacitance was considered to be 100%. When the capacitance threshold (CT) was reached to the target point, irrigation was re-conducted. After that, when the target drain volume (TDV) was occurred, the irrigation stopped. The irrigation volume per event for the SCMD was set to 50, 75, or 100 mL at CT 0.9 and TDV 100 mL during the spring to summer cultivation, and the CT was set to 0.65, 0.75, 0.80, or 0.90 in the winter cultivation. When the irrigation volume per event was set to 50, 75, or 100 mL, the irrigation frequency in a day was 39, 29, and 19, respectively, and the drain rate was 3.04, 9.25, and 20.18%, respectively. When the CT was set to 0.65, 0.75, or 0.90 in winter, the irrigation frequency was about 6, 7, 15 times, respectively and the drain rate was 9.9, 10.8, 35.3% respectively. The signal of stem sap flow at the beginning of irrigation starting time did not correspond to that of solar irradiance when the irrigation volume per event was set to 50 or 75 mL, compared to that of 100 mL. In winter cultivation, the stem sap flow rate and substrate volumetric water content at the CT 0.65 treatment were very low, while they were very high at CT 0.90 was high. All the integrated data suggest that the proper range of irrigation volume per event is from 75 to 100 mL under at CT 0.9 and TDV 100 mL during the spring to summer cultivation, and the proper CT seems to be higher than 0.75 and lower than 0.90 under at 75 mL of the irrigation volume per event and TDV 70 mL during the winter cultivation. It is going to be necessary to investigate the relationship between capacitance value and substrate volumetric water content by determining the correction coefficient.

Strategy of Multistage Gamma Knife Radiosurgery for Large Lesions (큰 병변에 대한 다단계 감마나이프 방사선수술의 전략)

  • Hur, Beong Ik
    • Journal of the Korean Society of Radiology
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    • v.13 no.5
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    • pp.801-809
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    • 2019
  • Existing Gamma Knife Radiosurgery(GKRS) for large lesions is often conducted in stages with volume or dose partitions. Often in case of volume division the target used to be divided into sub-volumes which are irradiated under the determined prescription dose in multi-sessions separated by a day or two, 3~6 months. For the entire course of treatment, treatment informations of the previous stages needs to be reflected to subsequent sessions on the newly mounted stereotactic frame through coordinate transformation between sessions. However, it is practically difficult to implement the previous dose distributions with existing Gamma Knife system except in the same stereotactic space. The treatment area is expanding because it is possible to perform the multistage treatment using the latest Gamma Knife Platform(GKP). The purpose of this study is to introduce the image-coregistration based on the stereotactic spaces and the strategy of multistage GKRS such as the determination of prescription dose at each stage using new GKP. Usually in image-coregistration either surgically-embedded fiducials or internal anatomical landmarks are used to determine the transformation relationship. Author compared the accuracy of coordinate transformation between multi-sessions using four or six anatomical landmarks as an example using internal anatomical landmarks. Transformation matrix between two stereotactic spaces was determined using PseudoInverse or Singular Value Decomposition to minimize the discrepancy between measured and calculated coordinates. To evaluate the transformation accuracy, the difference between measured and transformed coordinates, i.e., ${\Delta}r$, was calculated using 10 landmarks. Four or six points among 10 landmarks were used to determine the coordinate transformation, and the rest were used to evaluate the approaching method. Each of the values of ${\Delta}r$ in two approaching methods ranged from 0.6 mm to 2.4 mm, from 0.17 mm to 0.57 mm. In addition, a method of determining the prescription dose to give the same effect as the treatment of the total lesion once in case of lesion splitting was suggested. The strategy of multistage treatment in the same stereotactic space is to design the treatment for the whole lesion first, and the whole treatment design shots are divided into shots of each stage treatment to construct shots of each stage and determine the appropriate prescription dose at each stage. In conclusion, author confirmed the accuracy of prescribing dose determination as a multistage treatment strategy and found that using as many internal landmarks as possible than using small landmarks to determine coordinate transformation between multi-sessions yielded better results. In the future, the proposed multistage treatment strategy will be a great contributor to the frameless fractionated treatment of several Gamma Knife Centers.