• 한국음향학회지
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• 제26권4호
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• pp.144-152
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• 2007

기존의 심음분류를 위한 연구들은 인공신경망을 이용하여 주로 이루어졌다. 그러나 심음신호의 통계적 특성을 분석 한 결과 HMM의 의한 신호모델링이 적합한 것으로 나타났다. 본 연구에서는 다양한 질병을 나타내는 심음신호를 HMM을 이용하여 모델링 하고 인식성능이 심음신호의 클러스터링에 따라서 많이 좌우되는 것을 알 수 있었다. 또한 실제 환경에서의 심음신호는 그 시작과 끝나는 시점이 정해지지 않은 연속신호이다. 따라서 HMM을 이용한 심음분류를 위해서는 연속적인 심음신호로부터 한 사이클의 분할된 심음을 추출할 필요성이 있다. 일반적으로 수동분할은 분할오류를 발생시키며 실시간 심음인식에 적합하지 않으므로 분할과정이 필요치 않는 ergodic형 HMM을 변형하여 사용할 것을 제안하였다. 그리고 제안된 HMM은 연속심음을 이용한 분류실험에서 매우 높은 성능을 보임을 알 수 있었다.

• Applied Microscopy
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• 제33권4호
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• pp.325-333
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• 2003

왕거미과 산왕거미(Araneus ventricosus)의 심관과 심근세포의 미세구조적 특성을 주사형 및 투과형 전자현미경으로 관찰하였다. 거미의 심관은 복부마디의 등쪽에 분포되어 있고, 심외막과 심근층으로 구성되어 있었다. 심근층의 근섬유들은 종축을 중심으로 나선상의 배열을 이루고 있었고, 내막이 없이 혈림프에 직접 노출되는 구조를 이루고 있었다. 심관의 외부 표면에서는 3쌍의 심문이 형성되어 있었고, 내강에서는 원형질혈구와 과립혈구, 그리고 편도혈구 등 다양한 유형의 혈구들이 관찰되었다. 특히 심관의 내강을 향해 돌출된 심근돌기 주위에서는 편도혈구들이 대부분을 차지하고 있었다. 편도혈구의 세포질에는 유리 리보조옴이 산재되어 있었고 핵에는 이질염색질과 인이 발달되어 있었으나, 심근층 조직과의 특이한 연접은 관찰되지 않았다. 심근층에는 횡문이 형성되어 있었고, Z-line을 중심으로 근절의 구조를 이룬 근원섬유의 주위에서는 미토콘드리아와 근소포체가 풍부하게 함유되어 있었다. 심관의 배면을 따라 뻗은 신경절의 축삭들이 심근세포와 신경근육간 연접부를 형성하고 있음이 관찰되었다.

• BMB Reports
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• 제52권8호
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• pp.526-531
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• 2019

The vertebrate body plan is accomplished by left-right asymmetric organ development and the heart is a representative asymmetric internal organ which jogs to the left-side. Kupffer's vesicle (KV) is a spherical left-right organizer during zebrafish embryogenesis and is derived from a cluster of dorsal forerunner cells (DFCs). Cadherin1 is required for collective migration of a DFC cluster and failure of DFC collective migration by Cadherin1 decrement causes KV malformation which results in defective heart laterality. Recently, loss of function mutation of A-kinase anchoring protein 12 (AKAP12) is reported as a high-risk gene in congenital heart disease patients. In this study, we demonstrated the role of $akap12{\beta}$ in asymmetric heart development. The $akap12{\beta}$, one of the akap12 isoforms, was expressed in DFCs which give rise to KV and $akap12{\beta}$-deficient zebrafish embryos showed defective heart laterality due to the fragmentation of DFC clusters which resulted in KV malformation. DFC-specific loss of $akap12{\beta}$ also led to defective heart laterality as a consequence of the failure of collective migration by cadherin1 reduction. Exogenous $akap12{\beta}$ mRNA not only restored the defective heart laterality but also increased cadherin1 expression in $akap12{\beta}$ morphant zebrafish embryos. Taken together, these findings provide the first experimental evidence that $akap12{\beta}$ regulates heart laterality via cadherin1.

• 중환자간호학회지
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• 제6권2호
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• pp.51-64
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• 2013

Purpose: This study was to analyze adherence to self-care behaviors and identify factors affecting the adherence behaviors among inpatients with heart failure. Methods: A total 94 hospitalized inpatients from three hospitals participated in a survey. Data were collected using structured self-reported questionnaire from November 28, 2011 to March 31, 2013 and analyzed using frequency, t-test, ANOVA, Pearson's correlation coefficients and stepwise multiple regression. Results: The score of adherence to self-care behaviors among inpatients with heart failure was $26.02({\pm}8.84)$. Factors related to the adherence to self-care behaviors were living with spouse (t=-2.47, p=.019), functional state (t=2.18, p=.034), heart failure knowledge (r=-.49, p<.001), social support (r=-.35, p<.001), self-control (r=-.25, p=.016), and self-care confidence (r=-.24, p=.019). The factors affecting adherence to self-care behaviors were heart failure knowledge, self-care confidence, and social support. These factors explained 32% of the variance in adherence to self-care behaviors. Conclusion: The adherence to self-care behaviors with heart failure can be improved if heart failure knowledge, self-care confidence, and social support are improved. Therefore, developing a nursing intervention program for patient with heart failure that is considered these factors leads to improve quality of life and prevent readmission.

• 한국기계가공학회지
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• 제12권4호
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• pp.22-28
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• 2013

It is important to begin left ventricular assist device (LVAD) treatment at appropriate time for heart failure patients who expect cardiac recovery after the therapy. In order to predict the optimal timing of LVAD implantation, we predicted pumping efficacy of LVAD according to the severity of heart failure theoretically. We used LVAD-implanted cardiovascular system model which consist of 8 Windkessel compartments for the simulation study. The time-varying compliance theory was used to simulate ventricular pumping function in the model. The ventricular systolic dysfunction was implemented by increasing the end-systolic ventricular compliance. Using the mathematical model, we predicted cardiac responses such as left ventricular peak pressure, cardiac output, ejection fraction, and stroke work according to the severity of ventricular systolic dysfunction under the treatments of continuous and pulsatile LVAD. Left ventricular peak pressure, which indicates the ventricular loading condition, decreased maximally at the 1st level heart-failure under pulsatile LVAD therapy and 2nd level heart-failure under continuous LVAD therapy. We conclude that optimal timing for pulsatile LVAD treatment is 1st level heart-failure and for continuous LVAD treatment is 2nd level heart-failure when considering LVAD treatment as "bridge to recovery".

• Child Health Nursing Research
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• 제25권3호
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• pp.262-272
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• 2019

Purpose: We aimed to identify factors influencing physical activity in adolescents with complex congenital heart disease. Methods: We recruited 92 adolescents with complex congenital heart disease from a tertiary medical center in Seoul, measured their levels of physical activity, and identified factors that influenced their physical activity levels using the Global Physical Activity Questionnaire, the New York Heart Association classification, congenital heart disease complexity, the Self-Efficacy Scale, and the Parental Bonding Instrument scale. Stepwise multiple linear regression was used to determine factors influencing physical activity. Results: Total physical activity was higher in males than in females (t=4.46, p<.001). Adolescents who participated in school physical education classes engaged in more physical activity than those who did not (t=6.77, p<.001). Higher self-efficacy (${\beta}=.41$, p<.001), male gender (${\beta}=.37$, p<.001) and participation in school physical education classes (${\beta}=.19$, p=.042) were associated with a higher likelihood of engagement in physical activity. Conclusion: It is necessary to develop nursing interventions that enhance self-efficacy in order to promote physical activity in adolescents with complex congenital heart disease. Physical activity should also be promoted in an individualized manner, taking into account gender, disease severity, and parental attitude.

• BMB Reports
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• 제43권6호
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• pp.432-437
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• 2010

LBH is a transcription factor as a candidate gene for CHD associated with partial trisomy 2p syndrome. To identify potential LBH-interacting partners, a yeast two-hybrid screen using LBH as a bait was performed with a human heart cDNA library. One of the clones identified encodes ${\alpha}B$-crystallin. Co-immunoprecipitation and GST pull-down assays showed that LBH interacts with ${\alpha}B$-crystallin, which is further confirmed by mammalian two-hybrid assays. Co-localization analysis showed that in COS-7 cells, ${\alpha}B$-crystallin that is cytoplasmic alone, accumulates partialy in the nucleus when co-transfected with LBH. Transient transfection assays indicated that overexpression of LBH or ${\alpha}B$-crystallin reduced the transcriptional activities of p53 and p21, respectively, Overexpression of both ${\alpha}B$-crystallin and LBH together resulted in a stronger repression of the transcriptional activities of p21 and p53. These results showed that the interaction of LBH and ${\alpha}B$-crystallin may inhibit synergistically the transcriptional regulation of p53 and p21.

• Korean Circulation Journal
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• 제53권7호
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• pp.425-451
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• 2023

Most patients with heart failure (HF) have multiple comorbidities, which impact their quality of life, aggravate HF, and increase mortality. Cardiovascular comorbidities include systemic and pulmonary hypertension, ischemic and valvular heart diseases, and atrial fibrillation. Non-cardiovascular comorbidities include diabetes mellitus (DM), chronic kidney and pulmonary diseases, iron deficiency and anemia, and sleep apnea. In patients with HF with hypertension and left ventricular hypertrophy, renin-angiotensin system inhibitors combined with calcium channel blockers and/or diuretics is an effective treatment regimen. Measurement of pulmonary vascular resistance via right heart catheterization is recommended for patients with HF considered suitable for implantation of mechanical circulatory support devices or as heart transplantation candidates. Coronary angiography remains the gold standard for the diagnosis and reperfusion in patients with HF and angina pectoris refractory to antianginal medications. In patients with HF and atrial fibrillation, longterm anticoagulants are recommended according to the CHA₂DS₂-VASc scores. Valvular heart diseases should be treated medically and/or surgically. In patients with HF and DM, metformin is relatively safer; thiazolidinediones cause fluid retention and should be avoided in patients with HF and dyspnea. In renal insufficiency, both volume status and cardiac performance are important for therapy guidance. In patients with HF and pulmonary disease, beta-blockers are underused, which may be related to increased mortality. In patients with HF and anemia, iron supplementation can help improve symptoms. In obstructive sleep apnea, continuous positive airway pressure therapy helps avoid severe nocturnal hypoxia. Appropriate management of comorbidities is important for improving clinical outcomes in patients with HF.

• Current Optics and Photonics
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• 제3권1호
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• pp.1-7
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• 2019

Optical stimulation provides a promising alternative to electrical stimulation to selectively modulate tissue. However, developing noninvasive techniques to directly stimulate excitable tissue without introducing genetic modifications and minimizing cellular stress remains an ongoing challenge. Infrared (IR) light has been used to achieve optical pacing for electrophysiological studies in embryonic quail and mammalian hearts. Here, we demonstrate optical stimulation and pacing of the embryonic chicken heart using a pulsed infrared thulium laser with a wavelength of 1927 nm. By recording stereomicroscope outputs and quantifying heart rates and movements through video processing, we found that heart rate increases instantly following irradiation with a large spot size and high radiant exposure. Targeting the atrium using a smaller spot size and lower radiant exposure achieved pacing, as the heart rate synchronized with the laser to 2 Hz. This study demonstrates the viability of using the 1927 nm thulium laser for cardiac stimulation and optical pacing, expanding the optical parameters and IR lasers that can be used to modulate cardiac dynamics.

• Korean Circulation Journal
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• 제53권9호
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• pp.635-644
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• 2023

Background and Objectives: The History, Electrocardiography, Age, Risk factors, and Troponin (HEART) pathway was developed to identify patients at low risk of a major adverse cardiac event (MACE) among patients presenting with chest pain to the emergency department. Methods: We modified the HEART pathway by replacing the Korean cut-off of 25 kg/m² with the conventional threshold of 30 kg/m² in the definition of obesity among risk factors. The primary outcome was a MACE within 30 days, which included acute myocardial infarction, primary coronary intervention, coronary artery bypass grafting, and all-cause death. Results: Of the 1,304 patients prospectively enrolled, MACE occurred in 320 (24.5%). The modified HEART pathway identified 37.3% of patients as low-risk compared with 38.3% using the HEART pathway. Of the 500 patients classified as low-risk with HEART pathway, 8 (1.6%) experienced MACE, and of the 486 low-risk patients with modified HEART pathway, 4 (0.8%) experienced MACE. The modified HEART pathway had a sensitivity of 98.8%, a negative predictive value (NPV) of 99.2%, a specificity of 49.0%, and a positive predictive value (PPV) of 38.6%, compared with the original HEART pathway, with a sensitivity of 97.5%, a NPV of 98.4%, a specificity of 50.0%, and a PPV of 38.8%. Conclusions: When applied to Korean population, modified HEART pathway could identify patients safe for early discharge more accurately by using body mass index cut-off levels suggested for Koreans.