• Journal of Chest Surgery
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• v.31 no.1
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• pp.32-39
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• 1998

High-dose aprotinin(Hammersmith regimen) has been widely used for years to control postoperative bleeding and reduce blood consumption in cardiac surgery but had known to cause some side-effects and had disadvantage in cost-effectiveness. The prospective controlled study of 33 patients undergoing cardiopulmonary bypass was performed to evaluate the efficacy for reducing postoperative bleeding and unfavorable effects of low-dose aprotinin. The level of hemoglobin and platelet in the blood and the amount of postoperative bleeding were assessed preoperatively, and postoperatively for the study of hemostatic function. The level of BUN and serum creatinine in the blood, levels of urine creatinine, total protein, albumin, alpha-1-microglobulin and creatinine clearance were assessed before and after the operation for the study of renal function. The aprotinin group had a significant reduction in chest tube drainage; 243$\pm$ 123 ml versus 406$\pm$303 ml(P=0.037) during 6 hours immediate-postoperatively, 494$\pm$358 ml versus 869$\pm$570 ml(P=0.045) during 24 hours postoperatively. The ratio of alpha-1-microglobulin/creatinine and microalbumin/creatinine in the urine were slightly increased in the aprotinin group postoperatively in comparison with the control group but there were no statistically significant difference(55$\pm$23 versus 24$\pm$10 in the alpha-1-microglobulin/creatinine, 56$\pm$19 versus 38$\pm$25 in the microalbumin/creatinine at post- operative 3rd day). There were no significant difference between two groups in other parameters of renal function, too. This study showed that low-dose aprotinin is an effective means of reducing postoperative bleeding without inducing significant renal dysfunction.

• Journal of Biomedical Engineering Research
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• v.42 no.4
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• pp.150-158
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• 2021

Intracranial hemorrhage (ICH) refers to acute bleeding inside the intracranial vault. Not only does this devastating disease record a very high mortality rate, but it can also cause serious chronic impairment of sensory, motor, and cognitive functions. Therefore, a prompt and professional diagnosis of the disease is highly critical. Noninvasive brain imaging data are essential for clinicians to efficiently diagnose the locus of brain lesion, volume of bleeding, and subsequent cortical damage, and to take clinical interventions. In particular, computed tomography (CT) images are used most often for the diagnosis of ICH. In order to diagnose ICH through CT images, not only medical specialists with a sufficient number of diagnosis experiences are required, but even when this condition is met, there are many cases where bleeding cannot be successfully detected due to factors such as low signal ratio and artifacts of the image itself. In addition, discrepancies between interpretations or even misinterpretations might exist causing critical clinical consequences. To resolve these clinical problems, we developed a diagnostic model predicting intracranial bleeding and its subtypes (intraparenchymal, intraventricular, subarachnoid, subdural, and epidural) by applying deep learning algorithms to CT images. We also constructed a visualization tool highlighting important regions in a CT image for predicting ICH. Specifically, 1) 27,758 CT brain images from RSNA were pre-processed to minimize the computational load. 2) Three different CNN-based models (ResNet, EfficientNet-B2, and EfficientNet-B7) were trained based on a training image data set. 3) Diagnosis performance of each of the three models was evaluated based on an independent test image data set: As a result of the model comparison, EfficientNet-B7's performance (classification accuracy = 91%) was a way greater than the other models. 4) Finally, based on the result of EfficientNet-B7, we visualized the lesions of internal bleeding using the Grad-CAM. Our research suggests that artificial intelligence-based diagnostic systems can help diagnose and treat brain diseases resolving various problems in clinical situations.

• Computers and Concrete
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• v.30 no.6
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• pp.393-407
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• 2022

Due to the enormous cement content, pozzolanic materials, and the use of different aggregates, sustainable controlled low-strength material (CLSM) has a higher material cost than conventional concrete and sustainable construction issues. However, by selecting appropriate materials and formulations, as well as cement and aggregate content, whitethorn costs can be reduced while having a positive environmental impact. This research explores the desire to optimize plastic properties and 28-day unconfined compressive strength (UCS) of CLSM containing powder content from unprocessed-fly ash (u-FA) and recycled fine aggregate (RFA). The mixtures' input parameters consist of water-to-cementitious material ratio (W/CM), fly ash-to-cementitious materials (FA/CM), and paste volume percentage (PV%), while flowability, bleeding, segregation index, and 28-day UCS were the desired responses. The central composite design (CCD) notion was used to produce twenty CLSM mixes and was experimentally validated using MATLAB by an Artificial Neural Network (ANN). Variance analysis (ANOVA) was used for the determination of statistical models. Results revealed that the plastic properties of CLSM improve with the FA/CM rise when the strength declines for 28 days-with an increase in FA/CM, the diameter of the flowability and bleeding decreased. Meanwhile, the u-FA's rise strengthens the CLSM's segregation resistance and raises its strength over 28 days. Using calcareous powder as a substitute for cement has a detrimental effect on bleeding, and 28-day UCS increases segregation resistance. The response surface method (RSM) can establish high correlations between responses and the constituent materials of sustainable CLSM, and the optimal values of variables can be measured to achieve the desired response properties.

• Journal of Chest Surgery
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• v.57 no.1
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• pp.25-35
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• 2024

Background: Prothrombin complex concentrate (PCC) and fresh frozen plasma (FFP) are commonly used to manage bleeding in patients during cardiac surgery. However, the relative efficacy and safety of these 2 strategies remain uncertain. Methods: MEDLINE, Embase, and Cochrane were searched for studies comparing PCC and FFP in patients who underwent cardiac surgery complicated by bleeding. Review Manager (RevMan) ver. 5.4 (Nordic Cochrane Centre, The Cochrane Collaboration) was used for statistical analysis. Binary and continuous outcomes were compared using pooled risk ratios and mean differences, respectively. The meta-analysis protocol was registered in the International Prospective Register of Systematic Reviews under protocol number CRD42022379144. Results: We included 8 studies with 1,500 patients, of whom 613 (40.9%) received PCC. The mean follow-up period ranged from 28 to 90 days. The PCC group had significantly lower chest tube drainage at 24 hours (mean difference [MD], -148.50 mL; 95% CI, -253.02 to -43.99 mL; p=0.005; I² =42%). Fewer units of red blood cells (RBCs) were transfused within the first 24 hours (MD, -1.02 units; 95% CI, -1.81 to -0.24 units; p=0.01; I² =56%), and fewer patients required RBC transfusion within the first 24 hours (risk ratio, 0.85; 95% CI, 0.78-0.93; p<0.007; I² =45%) in the PCC group. There were no statistically significant differences in secondary outcomes. Nonetheless, a subgroup analysis of randomized controlled trials failed to corroborate the results obtained from the main analysis. Conclusion: Our findings suggest that PCC can be effective, without increased adverse events, when compared with FFP in patients undergoing cardiac surgery complicated by bleeding.

• Journal of Chest Surgery
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• v.57 no.2
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• pp.195-204
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• 2024

Background: Extracorporeal membrane oxygenation (ECMO) is an intervention for severe heart and lung failure; however, it poses the risk of complications, including gastrointestinal bleeding (GIB). Comprehensive analyses of GIB in patients undergoing ECMO are limited, and its impact on clinical outcomes remains unclear. Methods: This retrospective study included 484 patients who received venovenous and venoarterial ECMO between January 2015 and December 2022. Data collected included patient characteristics, laboratory results, GIB details, and interventions. Statistical analyses were performed to identify risk factors and assess the outcomes. Results: GIB occurred in 44 of 484 patients (9.1%) who received ECMO. Multivariable analysis revealed that older age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01-1.06; p=0.0130) and need to change the ECMO mode (OR, 3.74; 95% CI, 1.75-7.96; p=0.0006) were significant risk factors for GIB, whereas no association was found with antiplatelet or systemic anticoagulation therapies during ECMO management. Half of the patients with GIB (22/44, 50%) underwent intervention, with endoscopy as the primary modality (19/22, 86.4%). Patients who underwent ECMO and developed GIB had higher rates of mortality (40/44 [90.9%] vs. 262/440 [59.5%]) and ECMO weaning failure (38/44 [86.4%] vs. 208/440 [47.3%]). Conclusion: GIB in patients undergoing ECMO is associated with adverse outcomes, including increased risks of mortality and weaning failure. Even in seemingly uncomplicated cases, it is crucial to avoid underestimating the significance of GIB.

• Transactions of the Korean Society of Mechanical Engineers B
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• v.32 no.4
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• pp.300-306
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• 2008

In the present study, the second order response surface method (RSM) is carried out to get optimum thermal design for enhancing heat transfer in a square channel with bleed flow. The RSM is used as an optimization technique. To calculate the heat transfer, RNG k-epsilon model and enhanced wall function are used. To design optimum rib turbulators, two design variables such as attack angle of rib $({\alpha})$ and rib pitch-to-rib height ratio (p/e) are optimized. In these analyses, the channel inlet Reynolds number was fixed at 10,000 in both non-bleeding and bleeding cases. The response surfaces of two design variables are constructed in cases with and without bleed flow. As a result, the optimum (or highest) heat transfer values are almost the same in ranges of two cases with and without bleed flow. However, the friction losses in the case with bleed flow are lower than those without bleed flow.

• Korean Journal of Pharmacognosy
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• v.18 no.1
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• pp.5-13
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• 1987

Male rats were fed diets containing perilla oil, sardine oil or corn oil for 15 weeks in order to investigate their antithrombotic effects. Rats given perilla oil and sardine oil diets showed significantly longer bleeding time, and lower level of malondialdehyde generation during thrombin-induced aggregation of platelets than rats given corn oil. With regard to the composition of platelet fatty acid, the ratio of eicosapentaenoic acid(EPA) $(20:5{\omega}3)$ to arachidonic acid $(20:4{\omega}6)$ of perilla oil, sardine oil and corn oil treated rats were 0.54, 0.96 and 0.01, respectively, suggesting that linolenic acid $(18:3{\omega}3)$ of perilla oil was metabolized to EPA which is known to have antithrombotic activity.

• Journal of Chest Surgery
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• v.26 no.6
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• pp.483-487
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• 1993

From July 1990 to August 1992,78 Hickman catheters and 22 chemoports were inserted in 98 patients for chemotherapy.We analyzed the clinical data of these patients. The results were as follows: 1]Mean age of patients was 42.8$\pm$1.6[SE] years 2]Male to female ratio was 1.09:1 3]The diseases of the cases were leukemia[66] ,lymphoma[8], stomach cancer[8],uterine cervix cancer[5],ovarian cancer[4],lung cancer[3],aplastic anemia[2],maxillary gland cancer[1],pancreas cancer[1],malignant mesothelioma[1] and multiple myeloma[1] 4]Mean values of preoperative WBC counts,platelet counts,PT and APTT were 31,500$\pm$ 8,132[SE]/mm,104,000$\pm$ 12,200 [SE]/mm,82$\pm$ 1.9[SE]% and 32$\pm$ 0.8[SE] sec,respectively. 5]The average duration of catheter uses was 121.7$\pm$ 17.3[SE]days. 6]The complications were subcutaneous tunnel bleeding or hematoma[2],exit site or subcutaneous tunnel infection[2] and catheter related septicemia[1]. 7]The causes of catheter removal were patient`s death or hopeless discharge[22],completion of treatment[6],subcutaneus hematoma or bleeding[2],exit site or subcutaneous tunnel infection[2] and catheter related septicemia[1].So,we concluded that Hickman catheter and chemoport were useful vascular access for chemotherapy in patients with malignant diseases, with low rate of complication and longterm duration.

• Journal of Chest Surgery
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• v.25 no.5
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• pp.480-493
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• 1992

Between October 1964 and August 1979, 2,537 patients underwent operation for pulmonary disease including tuberculosis at the National Kongju Hospital. Ages at operation ranged from 6.6 to 67.6 years with a mean age of 30.8 years and the male to female ratio was 3.07: l. Indications for operation were, respectively, as follows; destroyed lobe or segment with /without cavity[68.6%], ipsilateral total destroyed lung[14.8%], empyema with/wit-hout fistula[6.0%], atelectasis with bronchostenosis[2.6%], bronchiectasis[2.4%], tuberculoma[1.6%], lung abscess[1.7%], etc. There were 1,416 thoracoplasties[most common], 915 lobectomies, 591 pneumonectomies, etc. 1,073 patients with hemoptysis were found, streaking[23.8%], mild[42.3%], moderate[26.6%], severe[3.4%] and massive[3.9%] as the severity. Tuberculosis was the most common cause of severe and massive hem-optysis. Postoperative complications were developed 16.% of the operated cases, bleeding was the most frequent complication found in these cases. The mortality of operation was 8%, the most common cause of death was bleeding also.

• Journal of Chest Surgery
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• v.28 no.7
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• pp.666-670
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• 1995

A total of and consecutive 87 patients underwent concomitant double mitral and aortic valve replacement with the St. Jude Medical prosthesis between January 1985 and December 1993. They were 44 males and 43 females with the ages ranging from 18 to 59 years[mean$\pm$SD: 40.9$\pm$9.5 years . Fifteen patients[17.2% had a history of previous cardiac valve replacement. There were 2 early deaths[2.3% , and 85 early survivors were followed up for a total of 352.6 patient-years[mean$\pm$SD: 4.1 $\pm$2.6 years . All were anticoagulated with coumadin keeping the target international normalized ratio within the range of 1.5 and 2.5. There was a single late death[late mortality of 0.284%/patient-year . Thromboembolism was the most frequent complication[1.985%/patient-year , and bleeding related to anticoagulation was experienced in one patient [0.284%/patient-year . The incidences of prosthetic valve endocarditis and of paravalvular leak were also low[0.284%/patient-year, respectively . The survival including operative mortality was 96.1%$\pm$2.2% at 10 years. The actuarial probabilities of freedom from thromboembolism and from all events were 77.9%$\pm$11.1% and 72.4%$\pm$10.7%, respectively, at 10 years. There was no structural failure of the prosthesis. Results from a series of clinical studies suggest strongly that the use of lower intensity of anticoagulation therapy lowers the thromboembolic as well as bleeding rates in patients with the ST. Jude Medical prosthesis.