• Tuberculosis and Respiratory Diseases
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• 제83권3호
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• pp.248-254
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• 2020

Background: Although few studies have reported improved clinical outcomes with the administration of vitamin B1 and C in critically ill patients with septic shock or severe pneumonia, its clinical impact on patients with sepsis-related acute respiratory distress syndrome (ARDS) remains unclear. The purpose of this study was to evaluate the association with vitamin B and C supplementation and clinical outcomes in patients with ARDS. Methods: Patients with ARDS requiring invasive mechanical ventilation, admitted to the medical intensive care unit (ICU) were included in this study. Clinical outcomes were compared between patients administered with vitamin B1 (200 mg/day) and C (2 g/day) June 2018-May 2019 (the supplementation group) and those who did not receive vitamin B1 and C administration June 2017-May 2018 (the control group). Results: Seventy-nine patients were included. Thirty-three patients received vitamin B1 and C whereas 46 patients did not. Steroid administration was more frequent in patients receiving vitamin B1 and C supplementation than in those without it. There were no significant differences in the mortality between the patients who received vitamin B1 and C and those who did not. There were not significant differences in ventilator and ICU-free days between each of the 21 matched patients. Conclusion: Vitamin B1 and C supplementation was not associated with reduced mortality rates, and ventilator and ICU-free days in patients with sepsis-related ARDS requiring invasive mechanical ventilation.

• Journal of Chest Surgery
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• 제29권11호
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• pp.1257-1262
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• 1996

연세대학교 원주의과대학 흉부외과학교실에서는 1989년 1월부터 1996년 2월까지 외상성 횡격막 파열로 진단되어 수술을 시행하였던 환자 50례를 대상으로 하였으며, 남녀 성비는 4:1이였다. 연령 분포는 2세부터 80세까지로 평균 연령은 37세 였다. 외상의 종류로는 둔상이 39례였고 관통상이 11례로서, 둔상인 경우 교통사고가 29례, 추락사고 7례, 경운기 사고가 3례였으며, 관통상인 경우에는 자상 9례, 총상 1례, 유리에 찔린 경우가 1례 였다. 가장 빈번한 증상은 호흡곤란, 흉통 및 복통이었고, 파열 부위는 둔상인 경우 좌측이 30례, 우측이 9례였으며, 관통상인 경우에는 좌측이 8례, 우측이 3례였다. 수술 접근 방법은 18례에서 개흉술을 시행하였고 3례는 개흉 및 개복술을, 29례는 개복술을 시행하였다. 수술후 합병증은 15례로서 둔상인 경우에는 창상 감염이 5례, 호흡 부전이 3례 ,수흉 및 장폐쇄가 각각 2례였으며 농흉, 신부전 및 패혈증이 각각 1례였다. 관통상인 경우는 창상 감염이 2례, 농흉이 1례였다. 사망은 3례로서 사망 원인은 패혈성 쇼크, 뇌손상 및 호흡 부전이 각각 1례였다.

• Journal of Trauma and Injury
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• 제21권2호
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• pp.85-90
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• 2008

Purpose: Supraventricular arrhythmia is a well-known complication of cardiothoracic surgery, and is common in patients wirth underlying cardiovascular disease. Also, it's treatment and prognosis are well known. However the incidence, the contributing factors, and the prognosis for supraventricular arrhythmias in noncardiothoracic surgical patients are less well known. This study was undertaken to investigate the incidence, the clinical presentation, the prognosis, and the factors comtributing to the prognosis for supraventricular arrhythmia in the surgical intensive care unit. Methods: We performed a retrospective study of 34 patients with newly developed or aggravated supraventricular arrhythmias in the surgical intensive care unit between March 2004 and February 2005. The incidence, the risk factors, and the prognosis of supraventricular arrhythmias were analyzed. Results: During a 12month period, the incidence of supraventricular arrhythmia was 1.79% (34/1896). Most patients had pre-existing cardiovascular disease and sepsis. The mortality rate was 29.4%, and the most common cause of death was multiple organ failure due to septic shock. The mean value of the APACHE II score was 20.9, and the surgical intensive care unit and the hospital lengths of stay were 9.9 days and 25.8 days, respectively. The APACHE II score measured when the arrhythmia developed was a significant factor in predicting mortality, Conclusion: Supraventricular arrhythmias result in increased mortality and increased length of stay in both the surgical intensive care unit and the hospital. The arrhythmia itself did not cause death, but a high APACHE II score incicated a poor prognosis. This may reflect the severity of the illness rather than an independent contributor to mortality.

• Childhood Kidney Diseases
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• 제7권2호
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• pp.245-252
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• 2003

Posttransplant lymphoproliferative disease(PTLD)는 이식 후 발생하는 림프증식성 질환으로 이식장기의 거부반응을 억제하기 위한 면역억제제의 사용 및 이에 따른 EBV 감염과 연관이 있다고 알려져 있다. 소아 PTLD의 경우 성인에 비해 EBV의 초감염 또는 재활성이 더 많은 것으로 보고되고 있으며 최근 더 강력한 면역억제제들의 개발 및 사용에 따라 발생이 증가하고 있다. 본 증례는 14세 여아로 신이식 44개월 후에 EBV 감염의 증거 없이 지발성 PTLD가 발생하였으며 골수 검사상 B-세포 급성 림프구성 백혈병으로 진단되어 항암화학요법 치료를 시작하였고, 치료 후 완전 관해는 이루어졌으나 심한 중성구 감소증에 따른 패혈성 쇼크로 입원 77일만에 사망하였다.

• Journal of Microbiology and Biotechnology
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• 제29권1호
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• pp.151-159
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• 2019

Lipoteichoic acid isolated from Lactobacillus plantarum K8 (pLTA) alleviates lipopolysaccharide (LPS)-induced excessive inflammation through inhibition of $TNF-{\alpha}$ and interleukin (IL)-6. In addition, pLTA increases the survival rate of mice in a septic shock model. In the current study, we have found that pLTA contributes to homeostasis through regulation of pro- and anti-inflammatory cytokine production. In detail, pLTA decreased the production of IL-10 by phorbol-12-myristate-13-acetate (PMA)-differentiated THP-1 cells stimulated with prostaglandin E2 (PGE-2) and LPS. However, $TNF-{\alpha}$ production which was inhibited by PGE-2+LPS increased by pLTA treatment. The regulatory effects of IL-10 and $TNF-{\alpha}$ induced by PGE-2 and LPS in PMA-differentiated THP-1 cells were mediated by pLTA, but not by other LTAs isolated from either Staphylococcus aureus (aLTA) or L. sakei (sLTA). Further studies revealed that pLTA-mediated IL-10 inhibition and $TNF-{\alpha}$ induction in PGE-2+LPS-stimulated PMA-differentiated THP-1 cells were mediated by dephosphorylation of p38 and phosphorylation of c-Jun N-terminal kinase (JNK), respectively. Reduction of pLTA-mediated IL-10 inhibited the metastasis of breast cancer cells (MDA-MB-231), which was induced by IL-10 or conditioned media prepared from PGE-2+LPS-stimulated PMA-differentiated THP-1 cells. Taken together, our data suggest that pLTA contributes to inflammatory homeostasis through induction of repressed pro-inflammatory cytokines as well as inhibition of excessive anti-inflammatory cytokines.

• Journal of Ginseng Research
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• 제46권5호
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• pp.675-682
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• 2022

Background: Korean Red Ginseng (KRG) was reported to play an anti-inflammatory role, however, previous studies largely focused on the effects of KRG on priming step, the inflammation-preparing step, and the anti-inflammatory effect of KRG on triggering, the inflammation-activating step has been poorly understood. This study demonstrated anti-inflammatory role of KRG in caspase-11 non-canonical inflammasome activation in macrophages during triggering of inflammatory responses. Methods: Caspase-11 non-canonical inflammasome-activated J774A.1 macrophages were established by priming with Pam3CSK4 and triggering with lipopolysaccharide (LPS). Cell viability and pyroptosis were examined by MTT and lactate dehydrogenase (LDH) assays. Nitric oxide (NO)-inhibitory effect of KRG was assessed using a NO production assay. Expression and proteolytic cleavage of proteins were examined by Western blotting analysis. In vivo anti-inflammatory action of KRG was evaluated with the LPS-injected sepsis model in mice. Results: KRG reduced LPS-stimulated NO production in J774A.1 cells and suppressed pyroptosis and IL-1β secretion in caspase-11 non-canonical inflammasome-activated J774A.1 cells. Mechanistic studies demonstrated that KRG suppressed the direct interaction between LPS and caspase-11 and inhibited proteolytic processing of both caspase-11 and gasdermin D in caspase-11 non-canonical inflammasome-activated J774A.1 cells. Furthermore, KRG significantly ameliorated LPS-mediated lethal septic shock in mice. Conclusion: The results demonstrate a novel mechanism of KRG-mediated anti-inflammatory action that operates through targeting the caspase-11 non-canonical inflammasome at triggering step of macrophage-mediated inflammatory response.

• 대한이식학회지
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• 제31권4호
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• pp.193-199
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• 2017

Background: Although there more than 1,000 liver transplantations (LTs) are performed in Korea annually, their immense cost remains a great hurdle. Hence, in an attempt to reduce the medical costs of LT, a program was initiated at a public hospital affiliated with the Seoul National University Hospital. Methods: A total of 11 LTs have been successfully executed since the first LT performed at Seoul Metropolitan Government Seoul National University Boramae Medical Center in July 2011 through December 2014. Results: Nine patients (81.8%) were male and two (18.2%) were female. The mean age of patients was 53.4±11.4 years. Hepatitis B virus-related liver disease (n=6, 54.5%) was the most common causative disease, followed by alcoholic liver disease (ALD) (n=4, 36.4%). The actuarial 3-year survival rate was 90.9%. The median total medical cost of LTs was US $41,583 (calculated from operation to discharge), but only $11,860 was actually charged for patients with health insurance coverage. One female patient who had undergone deceased donor LT for alcoholic liver cirrhosis died during follow-up. This patient was non-compliant with the medical instructions after discharge, and finally expired due to septic shock at 10 months post-LT. Conclusions: In the public hospital, LT was successfully performed at a much lower cost. However, LT guidelines and peritransplant management protocols for patients with ALD must be established before escalating LT at public hospitals since ALD with poor compliance is one of the most common causes of complications at public hospitals.

• Journal of Trauma and Injury
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• 제36권4호
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• pp.385-392
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• 2023

Purpose: This study investigated the epidemiology, management, outcomes, and postoperative disabilities of degloving soft tissue injuries (DSTIs) treated at a tertiary care center in northern India. Methods: A prospective study of patients with DSTIs was conducted over 15 months. The type of degloving injury, the mechanism of injury, and any associated injuries were analyzed using the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 along with the management, outcomes, and disabilities at a 3-month follow-up. Results: Among 75 patients with DSTIs, the average age was 27.5 years, 80.0% were male, and 76.0% had been injured in traffic accidents. The majority (93.3%) were open degloving injuries. Lower limbs were affected most often (62.7%), followed by upper limbs (32.0%). Fractures were the most commonly associated injuries (72.0%). Most patients required more than two procedures, including secondary debridement (41.3%), split skin grafting (80.0%), flap coverage (12.0%), or vacuum-assisted closure (24.0%), while five patients underwent conservative management for closed degloving injuries. Postoperative complications included surgical site infections (14.7%) and skin necrosis (10.7%). Two patients died due to septic shock and multiple organ dysfunction syndrome. The mean length of hospital stay was 11.5±8.1 days, with injuries affecting the lower limbs and perineum requiring longer hospital stays. The mean WHODAS 2.0 disability score at 3 months was 19. Most patients had mild disabilities. Time away from work depended largely upon the site and severity of the injury. Approximately 75% of patients resumed their previous job or study, 14% changed their job, and 8% stopped working completely due to residual disability. Conclusions: DSTIs are common injuries in trauma and management is challenging. Although open DSTI are clinically evident at secondary survey, closed degloving injuries may be missed in the primary survey, necessitating a high index of suspicion, thorough clinical examination, and protocol-based management. Primary preventive strategies (e.g., road safety protocols, preplacement training, and proper protective equipment in industries) are also needed to reduce the incidence of these injuries.

• 한국의료질향상학회지
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• 제30권1호
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• pp.132-152
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• 2024

Purpose: This study aimed to identify and evaluate interprofessional education (IPE) interventions for healthcare professional students in East Asian countries. Methods: The reporting of this study followed the Preferred Reporting Items of Systematic Reviews and Meta-Analysis guidelines. A literature search was conducted using seven electronic databases: PubMed, EMBASE, CINAHL, Scopus, Web of Science, ERIC, and ProQuest Dissertations & Theses Global. Joanna Briggs Institute Critical Appraisal Checklists were also used to appraise the quality of the included studies. The outcomes of IPE interventions were classified based on a modified Kirkpatrick model. Results: This review included 30 studies predominantly conducted in Singapore, South Korea, and Taiwan. The prevalent research design was a one-group pre-posttest design, and most IPE interventions occurred as single events. Approximately 70% of the studies involved students from two healthcare professions, mainly nursing and medicine. Simulations, group discussions, and lectures have emerged as the most common teaching methodologies, with almost half of the studies leveraging a combination of these techniques. The IPE content primarily focused on interprofessional teamwork, communication, and clinical patient care situations; these included the management of septic shock. The effectiveness of the IPE interventions was mainly evaluated through self-reported measures, indicating improvements in attitudes, perceptions, knowledge, and skills, aligning with Level 2 of the modified Kirkpatrick model. Nonetheless, the reviewed studies did not assess changes in the participants' behavior and patient results. Conclusion: IPE interventions promise to enhance interprofessional collaboration and communication skills among health professional students. Future studies should implement rigorous designs to assess the effectiveness of IPE interventions. Moreover, when designing IPE interventions, researchers and educators should consider the role of cultural characteristics in East Asian countries.

• The Korean Journal of Medicine
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• 제99권4호
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• pp.219-223
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• 2024

Emphysematous prostatitis with an abscess is an extremely rare but lethal infection, characterized by the accumulation of gas and purulent exudates. Due to its rarity, severity, and nonspecific presentation, prompt diagnosis and treatment are crucial to achieve favorable clinical outcomes. This report presents a 43-year-old male with hemodialysis-dependent end-stage kidney disease who reported a 3-day history of fever, urinary incontinence, dysuria, and dyspnea. His condition rapidly deteriorated due to septic shock caused by emphysematous prostatitis with an abscess. Following extensive treatment including long-term parenteral antibiotics, polymyxin B hemoperfusion filter treatment, abscess drainage via transurethral resection of the prostate, and suprapubic cystostomy, the patient successfully recovered.