• Korean Circulation Journal
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• v.54 no.4
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• pp.189-200
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• 2024

Background and Objectives: Concerns remain that early aspirin cessation may be associated with potential harm in subsets at high risk of ischemic events. This study aimed to assess the effects of P2Y12 inhibitor monotherapy after 3-month dual antiplatelet therapy (DAPT) vs. prolonged DAPT (12-month or longer) based on the ischemic risk stratification, the CHADS-P2A2RC, after percutaneous coronary intervention (PCI). Methods: This was a sub-study of the SMART-CHOICE trial. The effect of the randomized antiplatelet strategies was assessed across 3 CHADS-P2A2RC risk score categories. The primary outcome was a major adverse cardiac and cerebral event (MACCE), a composite of all-cause death, myocardial infarction, or stroke. Results: Up to 3 years, the high CHADS-P2A2RC risk score group had the highest incidence of MACCE (105 [12.1%], adjusted hazard ratio [HR], 2.927; 95% confidence interval [CI], 1.358-6.309; p=0.006) followed by moderate-risk (40 [1.4%], adjusted HR, 1.786; 95% CI, 0.868-3.674; p=0.115) and low-risk (9 [0.5%], reference). In secondary analyses, P2Y12 inhibitor monotherapy reduced the Bleeding Academic Research Consortium (BARC) types 2, 3, or 5 bleeding without increasing the risk of MACCE as compared with prolonged DAPT across the 3 CHADS-P2A2RC risk strata without significant interaction term (interaction p for MACCE=0.705 and interaction p for BARC types 2, 3, or 5 bleeding=0.055). Conclusions: The CHADS-P2A2RC risk score is valuable in discriminating high-ischemic-risk patients. Even in such patients with a high risk of ischemic events, P2Y12 inhibitor monotherapy was associated with a lower incidence of bleeding without increased risk of ischemic events compared with prolonged DAPT.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1172-1182
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• 1998

Background: Primary goal of anticoagulation treatment in patients with mechanical heart valve is the effective prevention of thromboembolism and safe avoidance of bleeding as well. Material and Method: Two-hundred and nine patients with the St. Jude Medical prosthesis operated on between 1984 and 1995, for mitral(MVR 122), aortic(AVR 39) and double mitral and aortic valve replacement(DVR 48) respectively, were studied on the practically achieved levels of anticoagulation and the clinical outcomes. Patients were on Coumadin and followed up by monthly visit to outpatient clinic for examination and prothrombin time measurement to adjust the International Normalized Ratios(INRs) within the low-intensity target range between 1.5 and 2.5. Result: A total anticoagulation follow-up period was 1082.0 patient- years(mean 62.1 months) and INRs of 10,205 measurements were available for evaluation. The accomplished INRs among the replacement groups were not significantly different and only 65% of INRs were within the target range. And, in individual patients, only 37% of patients had INRs included within the target range in more than 70% of tests during follow-up period. The levels of INRs in patients with atrial fibrillation, which was found in 57% of patients, were definitely higher than the ones measured in patients with regular rhythm(p<0.001). Thromboembolisms were experienced by 15 patients with the incidence of 1.265%/patient- year(MVR 1.412%, AVR 0.462% and DVR 1.531%/patient-year) and major bleeding by 4 patients with the incidence of 0.337%/patient-year(MVR 0.424%, AVR none and DVR 0.383%/patient-year). Frequent as well as prolonged missing of prothrombin time tests was the main risk factor strongly associated with the thromboembolic complications(odds ratio 1.99). The proportion of INRs within target range of less than 60% in individual patient was the highly significant risk factor of both thromboembolic and overall embolic and bleeding complications(p<0.004 and p<0.002 respectively). Conclusion: In conclusion, the low-intensity therapeutic target range of INRs was adequate in patients with AVR and in sinus rhythm. However, the patients with replacement of the mitral valve were more likely to require higher target range of INRs, especially in the presence of atrial fibrillation, to achieve the practical levels of anticoagulation enough to prevent thromboembolic complications effectively. For the higher therapeutic target range of INRs between 2.0∼3.0, further accumulation of clinical evidences are required. It is highly desirable to improve the patients' compliance under continuous instructions in visiting outpatient clinic and in taking daily Coumadin without omission and to keep INRs consistently within optimal range with tight control for minimization of chances and of periods of exposure to the risk of complications. And, particularly, patients with high risk of complications and with wide fluctuation of INRs should be better managed with frequent monitoring anticoagulation levels.

• Advances in concrete construction
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• v.9 no.3
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• pp.279-287
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• 2020

This paper focuses on the engineering properties of Bentonite-Cement-Sodium silicate (BCS) grout, which was prepared by partially replacing the ordinary Portland cement in Cement-Sodium silicate grout with lithium bentonite (Li-bent) and sodium bentonite (Na-bent), respectively. The effect of different Water-to-Solid ratio (W/S) and various replacement percentages of bentonite on the apparent viscosity, bleeding, setting time, and early compressive strength of BCS grout were investigated. The XRD method was used to detect its hydration products. The results showed that both bentonites played a positive role in the stability of BCS grout, increased its apparent viscosity. Na-bent prolonged the setting time of BCS, while 5% of Li-bent shortened the setting time of BCS. The XRD analysis indicated that the hydration products between the mixture containing Na-bent and Li-bent did not differ much. Using bentonite as supplementary cementitious material (SCM) to replace partial cement is a promising way to cut down on carbon dioxide emissions and to produce low-cost, eco-friendly, non-toxic, and water-resistant grout. In addition, Li-bent was superior to Na-bent in improving the strength and the thickening of BCS grouts.

• Proceedings of the Korea Concrete Institute Conference
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• 2001.05a
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• pp.1005-1010
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• 2001

Recently, polymer-modified mortar has been studied for proposed use on industrial floors as top layers with thin thicknesses, typically 5~ 15mm. The purpose of this study is to evaluate basic properties of self leveling materials using polymer modifier as kinds of SBR, PAE, SUBA. Superplasticizer and thickener have been included in the mixes to reduce bleeding and drying shrinkage as well as in order to facilitate the workability required. The self leveling materials using four types of polymer dispersion are prepared with polymer-cement ratios which respectively range from 50%, 75%, and were tested for basic characteristics such as adhesion in tension, crack resistance test, rebound test after the preparative tests for unit weight, air content, consistency ratio etc. The results show almost as equal quality as existing commercial industrial flooring when mortar is modified by polymer dispersion. Adhesion in tension of polymer modified mortars using each SBR and PAE emulsion was over 10 kgf/$cm^{2}$. Crack or flaw derived from shrinkage is strongly dependent on the type of polymer dispersion because of each different total solid of polymer. It is judged that polymer modified mortar with self-leveling can be very well suited for Floor-finished.

• Journal of the Korean Ceramic Society
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• v.39 no.10
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• pp.970-976
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• 2002

In this paper, the slump flow of the concrete, suspension, pH, corrosion effect, bleeding and the characteristics of coompressive strength were analyzed using antiwashout underwater admixture and antiwashout underwater agent+corrosion inhibitor mixed admixtures(1type). The results showed that there were no rare difference in physical properties but in the results of rapid corrosion tests there were lots of corrosion inhibitor ratio differences between concrete using only antiwashout underwater admixture and the corrosion inhibitor mixed(1type). In the case of only antiwashout underwater admixture 5.4%, the case corrosion inhibitor mixed(1type) 0.07%, the Antiseawater of the concrete which uses the Corrosion Inibitor Mixed(1type) appeared highly.

• Journal of Chest Surgery
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• v.24 no.11
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• pp.1115-1124
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• 1991

Recently the thoracic injuries have been markedly increasing due to the vast increase of traffic accident, industrial disaster, and incidental accident as well as the frequent use of the murderous weapons including gun or rifle. Because the thoracic injuries could involve the heart, lung, and great vessels, and would influence the lives, prompt diagnosis and adequate treatment are essential. Most of thoracic injuries can be managed with the conservative treatment and simple surgical procedure such as closed thoracostomy, but certain cases require open thoracotomy to preserve lives and to return to their normal environment. The authors have analysed the result of 53 cases of open thoracotomy after thoracic injuries mainly according to the patient`s chart review. The mean age was 33.4 years old and male to female ratio was about 5: l. Injury mechanisms that elicited thoracic trauma indicated for open thoracotomy were penetrating[47%] and non-penetrating[53%] injuries. The Most common type of the thoracic lesion was hemothorax with or without pneumothorax and diaphragm rupture was the second. 58\ulcornero of thoracic injuries were accompanied by abdominal injuries and 47% by bone fractures. 34 patients were operated within 24 hours after injury and their average elapsed time was 13.6 hour. The remained patients were operated after 24 hours and their average elapsed time was 7.8 days. 71 cases of operative procedures containing some overlappings were performed: diaphragm repair[28], bleeding control[12], pulmonary and cardiac repair[4 cases] Postoperative complication rate was 32.1% and operative mortality rate was 9.4%[5/53].

• Journal of Chest Surgery
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• v.22 no.4
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• pp.648-654
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• 1989

A clinical study was performed on 363 cases of pulmonary tuberculosis treated surgically resection during the period of 3 years from January, 1986 to December, 1988 in the National Kong-Ju Hospital. The results obtained are follows: 1. The ratio of male to female was 1.6:1 in male predominance, age from 20 to 40 occurred 82.6% of the total cases. 2. The moderately advanced cases was the highest incidence with 53.2 % for extent of disease, duration of illness which 1 to 5 years before operation was 40.8 % of the total cases. 3. Preoperative sputum examination for AFB was 53.2 % in negative but in spite of chemotherapy, persistent positive sputum was 46.7%. 4. Indication for surgery were: total destroyed lung was 35.5 %, destroyed lobe or segment with or without cavity was 30.6%, empyema with or without bronchopleural fistula was 8.5%, according to type and site of surgical procedure, pleuropneumonectomy and pneumonectomy was the highest incidence with 53.4 %, left site was slightly more than right with 55.9 % of the total cases. 5. The incidence of postoperative complication was 10.2 % and then the highest incidence was empyema with or without bronchopleural fistula with 4%, according to type of surgical procedure, postpleuropneumonectomy and postpneumonectomy was 6.1 % of the total cases. 6. Postoperative mortality was 1.4 % of the total cases, according to cause of deaths, hypovolemic shock due to bleeding were 2 cases, respiratory failure were 2 cases and hepatic coma due to hepatic failure was 1 case.

• Journal of Chest Surgery
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• v.3 no.1
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• pp.3-12
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• 1970

During the last 10 years of period, one hundred patients with various pulmonary diseases were pneumonectomized upon at the Department of Chest Surgery of Pusan University Hospital. This paper is concerned with the clnical results of these patients along with the serious postoperative complications such as postoperative intrapleural infection and hemorrhage. The results were obtained as follows. 1.Left pneumonectomy was done in sixty-six of 100 patients [66 %] and the right one was done in the rest thirty-four[34 %]. The ratio between left and right was nearly 2:1. 2.Of all oostoperative complications, the intrapleural infection was most common, and these were 53 % in empyema thoracis and 12.7 % in pulmonary tuberculosis respectively. 3.More postoperative complications could be seen after right pneumonectomy than the left one. 4.It was thought that the postoperative intrapleural infection was closely correlated with the methods of pleural dissection at pneumonectomy,postoperatlve tube drainage, time of operation, massive hemorrhage during operation, prolongation of bleeding time, and dysfunction of the liver. 5.The repeated thoracenteses with infusion of neomycin into the infected thoracic cavity and intravenous administrations of the high units of penicillin were effective in treatment of the postoperative intrapleural infection, however, the refractory cases have to be cured by thoracoplasty with open window. 6.Immediate secondary open thoracotomy appears to be the method of choice in life saving who developed massive intrathoracic hemorrhage after pneumonectomy. 7.The mortality rate was 10 % in our cases and the main causes of death were postoperative respiratory insufficiency, pulmonary edema, hemorrhage and sudden cardiac arrest.

• Journal of Chest Surgery
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• v.25 no.4
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• pp.429-434
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• 1992

We experienced a rare case of traumatic ventricular septal defect by penetrating stab injury The patient was 26-year-old women who got stab wound at the left anterior third intercostal space and left sternal border with a knife. seven hours after admission, the patient was undertaken an emergency thoracotomy due to hypovolemic shock caused by massive bleeding from transected left internal mammary artery, vein, and right ventricular outflow tract. On postoperative second day, the patient was suffered from moderate dyspnea, and arterial blood gas analysis and chest X-ray revealed hypoxemia and pulmonary edema. Right heart cardiac catheterization with Swan-Ganz Cathater showed oxygen step-up between right atrium and main pulmonary artery and a 1.6:1 ratio of pulmonary to systemic blood flow. At operation, harsh systolic thrill was palpable along right ventricular outflow tract. Through small vertical right ventriculotomy, the linear ventricular septal laceration on infundibular septum was noticed, and its size was 1.5cm with sharp margin This defeat was repaired by three interrupted matress sutures using Prolene 4-O with pledget. Her postoperative course was uneventful, and she discharged with good physical condition.

• Journal of Chest Surgery
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• v.23 no.2
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• pp.325-332
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• 1990

Complications of the mediastinal tumors and cysts are malignant change, infection, bleeding, local invasion and mass effect to heart, lung and other mediastinal structures. But early surgical excision and proper treatments bring patients to good clinical course and results. Therefore mediastinal tumors and cysts are surgically interesting diseases We report the analysis of the 58 cases of mediastinal tumors and cysts, experienced in the Department of Cardiothoracic Surgery of the Kosin Medical College from July 1979 to June 1989. The results were as follows ; Sex ratio of male to female to female was 1.3: 1. Range of age was from 11 to 64 years and mean age was 34.3 years. The thymomas were 14 cases[24%], the teratomas were 19 cases[33%o], the neurogenic tumors were 10 cases[17%], the cysts were 9 cases[15%], the carcinomas were 3 cases[5%], the thyroid tumor was 1 case[2%], the Castleman’s disease was 1 case[2%] and unclassified tumor was 1 case[2%]. Malignant tumors were 12 cases [21%] of the 58 cases. Most frequent symptom was chest pain and discomfort and relationship of symptom and malignancy was significant. Complete removal of tumor was performed on the 47 cases[92%] and partial excision was 3 cases[6%]. Inoperable cases were treated with anticancer chemotherapy and radiotherapy. Postoperative complications were wound infection, Homer’s syndrome, phrenic nerve palsy, mediastinal hematoma and pleurisy. There was no case of postoperative mortality and good clinical course in surgically completely resected cases.