• Journal of Chest Surgery
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• v.56 no.1
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• pp.6-13
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• 2023

Background: Coronavirus disease 2019 (COVID-19) has been found to cause life-threatening respiratory failure, which can progress to irreversible lung damage. Lung transplantation can be a life-saving treatment in patients with terminal lung disease (e.g., acute respiratory distress syndrome caused by infection). This study aimed to present the clinical course and results after initial lung transplantation in patients with severe COVID-19 who did not recover even with optimal medical care. Methods: From August 2019 to February 2022, this study enrolled 10 patients with COVID-19 (5 men; median age, 55.7 years) who underwent lung transplantation at a single center in Korea. All patients' characteristics, clinical pathway, overall survival, complications, and operative data were collected and analyzed. Results: Veno-venous extracorporeal membrane oxygenation or an oxygenator in a right ventricular assist device circuit was applied to 90% of the patients, and the median length of extracorporeal life support before operation was 48.5 days. There were no cases of mortality after a median follow-up of 372.8 days (interquartile range, 262.25-489 days). The major complications included the requirement for postoperative extracorporeal membrane oxygenation support in 2 cases (20%), re-transplantation in 1 case (10%), and re-exploration due to bleeding in 2 cases (20%). During the follow-up period, 3 out of 10 patients died. Conclusion: Excellent early outcomes were observed for patients who underwent lung transplantation. Thus, lung transplantation can be an effective and feasible treatment for patients with end-stage lung disease caused by COVID-19.

• Journal of Chest Surgery
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• v.47 no.4
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• pp.398-401
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• 2014

Severe tricuspid regurgitation resulting from a flail leaflet is a rare cause of neonatal cyanosis. We report a neonate with profound cyanosis and severe tricuspid regurgitation caused by a rupture of the papillary muscle supporting the anterior leaflet, without other structural heart defects. Ductal patency could not be established. The repair of the tricuspid valve was performed after initial stabilization by using extracorporeal membrane oxygenation.

• Advances in pediatric surgery
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• v.17 no.2
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• pp.133-138
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• 2011

Extracorporeal membrane oxygenation (ECMO) has been utilized in congenital diaphragmatic hernia (CDH) patients with severe respiratory failure unresponsive to conventional medical treatment. We retrospectively reviewed 12 CDH patients who were treated using ECMO in our center between April 2008 and February 2011. The pre ECMO and on ECMO variables analyzed included gestational age, sex, birth weight, age at the time of ECMO cannulation, arterial blood gas analysis results, CDH location, timing of CDH repair operation, complications and survival. There were 9 boys and 3 girls. All patients were prenatally diagnosed. Mean gestational age was $38.8{\pm}1.7$ weeks and mean birth weight was $3031{\pm}499$ gram. Mean age at the time of ECMO cannulation was $29.9{\pm}28.9$ hours. There were 4 patients who survived. Survivors showed higher 5 min Apgar scores ($8.25{\pm}0.96$ vs. $7.00{\pm}1.20$, p=0.109), higher pre ECMO mean pH ($7.258 {\pm}0.830$ vs. $7.159{\pm}0.986$, p=0.073) and lower pre ECMO $PaCO_2$ ($48.2{\pm}7.9$ vs. $64.8{\pm}16.1$, p=0.109) without statistical significance. The hernia was located on the left side in 10 patients and the right side in 2 patients. The time interval from ECMO placement to operative repair was about 3~4 days in 5 early cases and around 24 in the remaining cases. There were 3 cases of post operative bleeding requiring re operation and 2 cases of abdominal compartment syndrome requiring abdominal fascia reopening. ECMO catheter reposition was required in 4 cases. Three cases of arterial or venous thrombosis were detected and improved with follow up. Our data suggests that ECMO therapy could save the lives of some neonates with CDH who can not be maintained on other treatment modalities. Protocolized management and accumulation of case experience might be valuable in improving outcomes for neonates with CDH treated with ECMO.

• Archives of Plastic Surgery
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• v.32 no.3
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• pp.347-356
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• 2005

The wound healing process in fetus is quite different form that of adult. Regeneration plays an important role and scarless wound healing is possible in early gestational fetal period. Recently, the various effects of the hypoxia and reoxygenation in the wound healing process have been investigated by many researchers. The hypoxic state is known to alter protein synthesis and gene expression of TGF-${\beta}$, VEGF. The authors hypothesize there may be differences between fetal and adult fibroblast and this difference may play a possible role in the mechanism of scarless fetal wound healing. In this study, we investigated the growth of fibroblast, the amount of collagen deposition, the amount of protein synthesis and gene expression in TGF-${\beta}$(transforming growth factor-${\beta}$), VEGF(vascular endothelial growth factor) under the various hypoxic and reoxygenation conditions. Through these processes, we tried to determine the relationships between scarless fetal wound healing and hypoxic condition. In control group, fetal and adult fibroblasts were cultured under normoxic condition. The experimental groups were allocated into four different groups. The differences in TGF-beta, VEGF under 24, 48, 72 hours were statistically investigated. Compared to adult fibroblast group, there was a statistically significant increase (p<0.01) in the rates of protein synthesis in TGF-beta and VEGF of fetal fibroblast. In this study, these results may reflect the possibility that fetal fibroblast are more susceptible to change in oxygen and has a superior rate of angiogenesis through increased VEGF expression. The possible superiority of angiogenesis in fetal fibroblast may play an important role in scarless wound healing.

• Archives of Plastic Surgery
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• v.46 no.2
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• pp.108-113
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• 2019

Background The aim of this study was to assess the safety of one-per-mil tumescent injections into viable skin flaps that had survived an ischemic insult, in order to assess the potential suitability of one-per-mil tumescent injections in future secondary reconstructive procedures such as flap revision and refinements after replantation. Methods Forty groin flaps harvested from 20 healthy Wistar rats weighing 220 to 270 g were subjected to acute ischemia by clamping the pedicle for 15 minutes. All flaps showing total survival on the 7th postoperative day were randomly divided into group A (one-per-mil tumescent infiltration; n=14), group B (normal saline infiltration; n=13), and group C (control, with no infiltration; n=13) before being re-elevated. Transcutaneous oxygen tension ($TcPO_2$) was measured before and after infiltration, and changes in $TcPO_2$ were statistically analyzed using analysis of variance, the paired t-test, and the independent t-test. The viability of flaps was also assessed using the Analyzing Digital Images software at 7 days after the second elevation. Results Thirty-nine flaps survived to the final assessment, with the sole exception of a flap from group A that did not survive the first elevation. $TcPO_2$ readings showed significant decreases (P<0.05) following both one-per-mil tumescent ($99.9{\pm}5.7mmHg$ vs. $37.2{\pm}6.3mmHg$) and normal saline ($103{\pm}8.5mmHg$ vs. $48.7{\pm}5.9mmHg$) infiltration. Moreover, all groin flaps survived with no signs of tissue necrosis. Conclusions One-per-mil tumescent infiltration into groin flap tissue that had survived ischemia did not result in tissue necrosis, although the flaps experienced a significant decrease of cutaneous oxygenation.

• Proceedings of the Plant Resources Society of Korea Conference
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• 2021.04a
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• pp.57-57
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• 2021

Oxygen glucose deprivation/re-oxygenation (OGD/R) induces neuronal injury via mechanisms that are believed to mimic the pathways associated with brain ischemia. Stachys sieboldii Miq. (Chinese artichoke), which has been extensively used in oriental traditional medicine to treat of ischemic stroke; however, the role of S. sieboldii Miq. (SSM) in OGD/R induced neuronal injury is not yet fully understood. The present research is aimed to investigate the protective effect and possible mechanisms of SSM extract treatment in an in vitro model of OGD/R to simulate ischemia/reperfusion Injury. Pretreatment of these cells with SSM significantly attenuated OGD/R-induced production of reactive oxygen species (ROS) by increasing GPx, SOD, and decreasing MDA. SSM decreased mitochondrial damage caused by OGD/R injury and inhibited the release of cyt-c from mitochondrion to cytoplasm in SH-SY5Y cells. Furthermore, neuronal cell apoptosis caused by OGD/R injury was inhibited by SSM, and SSM could decrease apoptosis by increasing ratio of Bcl-2/Bax and inhibiting caspase signaling pathway in SH-SY5Y cells. SSM demonstrated a neuroprotective effect on the simulated cerebral ischemia in vitro model, and this effect was the inhibition of mitochondria-mediated apoptosis pathway by scavenging of ROS generation. Therefore, SSM may be a promising neuroprotective strategy against ischemic stroke.