• Journal of Ginseng Research
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• v.47 no.2
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• pp.218-227
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• 2023

Background: Myocardial fibrosis (MF) is an advanced pathological manifestation of many cardiovascular diseases, which can induce heart failure and malignant arrhythmias. However, the current treatment of MF lacks specific drugs. Ginsenoside Re has anti-MF effect in rat, but its mechanism is still not clear. Therefore, we investigated the anti-MF effect of ginsenoside Re by constructing mouse acute myocardial infarction (AMI) model and AngII induced cardiac fibroblasts (CFs) model. Methods: The anti-MF effect of miR-489 was investigated by transfection of miR-489 mimic and inhibitor in CFs. Effect of ginsenoside Re on MF and its related mechanisms were investigated by ultrasonographic, ELISA, histopathologic staining, transwell test, immunofluorescence, Western blot and qPCR in the mouse model of AMI and the AngII-induced CFs model. Results: MiR-489 decreased the expression of α-SMA, collagenI, collagen III and myd88, and inhibited the phosphorylation of NF-κB p65 in normal CFs and CFs treated with AngII. Ginsenoside Re could improve cardiac function, inhibit collagen deposition and CFs migration, promote the transcription of miR-489, and reduce the expression of myd88 and the phosphorylation of NF-κB p65. Conclusion: MiR-489 can effectively inhibit the pathological process of MF, and the mechanism is at least partly related to the regulation of myd88/NF-κB pathway. Ginsenoside Re can ameliorate AMI and AngII induced MF, and the mechanism is at least partially related to the regulation of miR-489/myd88/NF-κB signaling pathway. Therefore, miR-489 may be a potential target of anti-MF and ginsenoside Re may be an effective drug for the treatment of MF.

• The Korean Journal of Physiology and Pharmacology
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• v.25 no.2
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• pp.147-157
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• 2021

Coronary microembolization (CME) is associated with cardiomyocyte apoptosis and cardiac dysfunction. Puerarin confers protection against multiple cardiovascular diseases, but its effects and specific mechanisms on CME are not fully known. Hence, our study investigated whether puerarin pretreatment could alleviate cardiomyocyte apoptosis and improve cardiac function following CME. The molecular mechanism associated was also explored. A total of 48 Sprague-Dawley rats were randomly divided into CME, CME + Puerarin (CME + Pue), sham, and sham + Puerarin (sham + Pue) groups (with 12 rats per group). A CME model was established in CME and CME + Pue groups by injecting 42 ㎛ microspheres into the left ventricle of rats. Rats in the CME + Pue and sham + Pue groups were intraperitoneally injected with puerarin at 120 mg/kg daily for 7 days before operation. Cardiac function, myocardial histopathology, and cardiomyocyte apoptosis index were determined via cardiac ultrasound, hematoxylin-eosin (H&E) and hematoxylin-basic fuchsin-picric acid (HBFP) stainings, and TdT-mediated dUTP nick-end labeling (TUNEL) staining, respectively. Western blotting was used to measure protein expression related to the phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt)/glycogen synthase kinase-3β (GSK-3β) pathway. We found that, puerarin significantly ameliorated cardiac dysfunction after CME, attenuated myocardial infarct size, and reduced myocardial apoptotic index. Besides, puerarin inhibited cardiomyocyte apoptosis, as revealed by decreased Bax and cleaved caspase-3, and up-regulated Bcl-2 and PI3K/Akt/GSK-3β pathway related proteins. Collectively, puerarin can inhibit cardiomyocyte apoptosis and thus attenuate myocardial injury caused by CME. Mechanistically, these effects may be achieved through activation of the PI3K/Akt/GSK-3β pathway.

• Quality Improvement in Health Care
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• v.18 no.1
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• pp.37-55
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• 2012

Objectives : This study was conducted to evaluate the effect of fixed critical pathway with emr (electronic medical record) on the length of hospital stay, the cost and quality of care provided to gastrectomy patients in a university hospital and to develop flexible critical pathway with emr which can be used excluded or drop-out patients. Methods : Thirty-eight patients with gastrectomy were included as case group and Thirty-four patients included as control group. The comparison between control and case with using fixed critical pathway were done. To develop and to evaluate usefulness of flexible critical pathway with flexible data base, simulation was done for flexible critical pathway with drop-out patients. Result : The major results of this study were as follows: There were no significant differences in patient clinical conditions and no sign of deterioration of quality from critical pathway. The length of hospital stay was 11 days in control group, 8 days in path group(P<0.01). The total costs during the hospital stay were reduced in path group. However the cost per day was significantly increased from reduction of hospital stay(554,352 won in control, 645,669 won in path group). One hundred percentage of drop out patients(60) in the simulation of flexible critical pathway was successful. Conclusion : Computerized critical pathway reduced the length of hospital stay, total hospital costs and resource utilization without harming quality of patient care. The flexible critical pathway program can be used as one of the powerful management tools for reducing the practice variations and increasing the efficiency of care process and decreasing the workload of doctors and nurses in Korean hospital settings.

• Journal of Korean Academy of Nursing
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• v.28 no.1
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• pp.117-131
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• 1998

The purpose of this study was to develop a critical pathway for case management for patients who have received Coronary Artery Bypass Graft (CABG) because of Ischemic Heart Disease(IHD) which is a factor of rising medical expenses. For this study. a conceptual framework was developed through a review of the literature including six critical pathways which are currently being used in USA. In order to identify the overall service contents required by these patients and to draw up a preliminary critical pathway, 30 cases of medical records of patients who had CABG because of IHD between January, 1995 to June. 1996 at the Cardiovascular Center of Yonsei Medical Center in Seoul were analyzed. An expert validity test was done for the preliminary critical pathway and clinical validity test was also done using seven IHD patients with CABG between November 11 and 23, 1996. After these processes. the final critical pathway was developed. The results of this study are summarized as follows : 1. The vertical axis of the critical pathway includes the following eight items : tests, nutrition, medications, consultations, activity, assessments, treatments, education discharge planning and the horizontal axis includes the time from the start of hospitalization to discharge. 2. Analysis of the 30 medical records indicated that the average length of stay was 20.2days with the average length of stay from hospitalization day to operation day being 6.2 days, and the average length of stay from operation day to discharge day was 13. 9 days. Analysis of the service contents showed that the horizontal axis of the preliminary critical pathway was set from hospitalization to the 14th post operation day and the vertical axis was set to include eight items, the contents which ought to have occurred, according to the time frames of the horizontal axis. 3. As a result of the experts validity, it was found that among the total of 571 items. there was over 83% agreement for 482 items, less than 83% for 89 items, which were then deleted and a revision of the critical pathway was done. 4. A clinical validity test was done using seven IHD patients with CABG. During the process, three patients were deleted because they were out of the criteria the investigator set. Finally, four patients were used. The result of study indicated that only one patient was discharged on the tenth post operation day, which was one day later than the expected day. Three patients were discharged later than the expected day from three days to nine days. All the cases progressed on schedule until the operation day and the first post operation day, but from the second post operation days, there were differences between the critical pathway and the actual practice. The differences came from tests, assessments, and treatments. 5. On the basis of the results of the clinical validity test. the following revisions in the final critical pathway were made : the transfer from ICU to step down ward would be the second post operation day, and the transfer to a general ward, the fifth post operation day, for patients who complained of lack of sleep from the fifth post operation day to discharge, a sleeping pill would be prescribed, skin observations would be performed routinely from immediately after the operation until the third post operation day, and would continue if there was a sign of skin injury on the fourth post operation day, and assessment of chest pain would be done from the third post operation day, and the “stairs climbing” item, expected to be done on the ninth post operation day would be deleted. In conclusion, this critical pathway is partially applicable to the care of patients with CABG but there are some parts needed to be further investigated.

• Allergy, Asthma & Immunology Research
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• v.10 no.6
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• pp.628-647
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• 2018

Purpose: Obesity is associated with metabolic dysregulation, but the underlying metabolic signatures involving clinical and inflammatory profiles of obese asthma are largely unexplored. We aimed at identifying the metabolic signatures of obese asthma. Methods: Eligible subjects with obese (n = 11) and lean (n = 22) asthma underwent body composition and clinical assessment, sputum induction, and blood sampling. Sputum supernatant was assessed for interleukin $(IL)-1{\beta}$, -4, -5, -6, -13, and tumor necrosis factor $(TNF)-{\alpha}$, and serum was detected for leptin, adiponectin and C-reactive protein. Untargeted gas chromatography time-of-flight mass spectrometry (GC-TOF-MS)-based metabolic profiles in sputum, serum and peripheral blood monocular cells (PBMCs) were analyzed by orthogonal projections to latent structures-discriminate analysis (OPLS-DA) and pathway topology enrichment analysis. The differential metabolites were further validated by correlation analysis with body composition, and clinical and inflammatory profiles. Results: Body composition, asthma control, and the levels of $IL-1{\beta}$, -4, -13, leptin and adiponectin in obese asthmatics were significantly different from those in lean asthmatics. OPLS-DA analysis revealed 28 differential metabolites that distinguished obese from lean asthmatic subjects. The validation analysis identified 18 potential metabolic signatures (11 in sputum, 4 in serum and 2 in PBMCs) of obese asthmatics. Pathway topology enrichment analysis revealed that cyanoamino acid metabolism, caffeine metabolism, alanine, aspartate and glutamate metabolism, phenylalanine, tyrosine and tryptophan biosynthesis, pentose phosphate pathway in sputum, and glyoxylate and dicarboxylate metabolism, glycerolipid metabolism and pentose phosphate pathway in serum are suggested to be significant pathways related to obese asthma. Conclusions: GC-TOF-MS-based metabolomics indicates obese asthma is characterized by a metabolic profile different from lean asthma. The potential metabolic signatures indicated novel immune-metabolic mechanisms in obese asthma with providing more phenotypic and therapeutic implications, which needs further replication and validation.

• Korea Journal of Hospital Management
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• v.9 no.3
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• pp.128-142
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• 2004

To evaluate the effects of critical pathway on the length of hospital stay, the cost and quality of care provided to gastrectomy patients in a tertiary care academic medical center. The basic research design is a retrospective case-control comparative study. 470 patients of gastrectomy were included in the study; 180 before pathway development (control), 163 right after pathway implementation (path group I) and 127 one year after pathway implementation (path groupII). 476 patients of modified radical mastectomy were also analyzed to examine whether the reduction of the length of hospital stay is from the hospital-wide trend or due to the critical pathway. Death after operation, ICU stay, unplanned re-operation, readmission after discharge, the length of hospital stay and cost were analyzed. 2-test, one-way ANOVA, Bonferroni and Turkey's test were used for statistical analysis. (1) There were no significant differences in patient clinical conditions and no sign of deterioration of quality from critical pathway. (2) The length of hospital stay was 13.0 days in control group, 12.2 days in path group I and 10.0 days (p<0.01) in path groupII. (3) The total costs during the hospital stay were reduced. However the cost per day was significantly increased from reduction of hospital stay (358,488won in control, 366,017won in path group I and 413,220won (p<0.01) in path groupII). Critical pathway reduced the length of hospital stay, total hospital costs and resource utilization without harming quality of patient care.

• Natural Product Sciences
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• v.23 no.3
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• pp.169-174
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• 2017

The aim of this study was to investigate the effect and action mechanism of quercetin on penile corpus cavernosum smooth muscle (PCCSM). PCCSM precontracted with phenylephrine (Phe) was treated with four different concentrations of quercetin ($10^{-7}$, $10^{-6}$, $10^{-5}$ and $10^{-4}M$). PCCSM were preincubated with N-Nitro-L-arginine methyl ester hydrochloride (L-NAME) and 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ) to block nitric oxide synthase and guanylate cyclase, respectively. The changes in PCCSM tension were recorded, and cyclic nucleotides in the perfusate were measured by radioimmunoassay. The interactions of quercetin with phosphodiesterase type 5 inhibitors (PDE5-Is) such as sildenafil, udenafil and mirodenafil, were also evaluated. PCCSM relaxation induced by quercetin occurred in a concentrationdependent manner. The application of quercetin to PCCSM pre-treated with L-NAME and ODQ significantly inhibited the relaxation. Quercetin significantly increased cGMP in the perfusate. Furthermore, quercetin enhanced PDE5-Is-induced relaxation of PCCSM. Quercetin relaxed the PCCSM by activating the NO-cGMP signaling pathway, and it may be a therapeutic candidate or an alternative treatment for patients with erectile dysfunction who do not completely respond to PDE5-Is.

• Journal of Oriental Neuropsychiatry
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• v.33 no.4
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• pp.377-388
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• 2022

Objectives: For diagnosis and evaluation, evaluation tools are needed. Various tools can be used to diagnose and evaluate mental disorders. Among them, psychological tests are widely used. For Korean Standard Classification of Diseases (KCD) diagnosis, psychological tests are also required. Currently developed critical pathway (CP) presented tools for diagnosis and evaluation of mental disorders. The CP suggests the use of tools based on the Clinical Practice Guideline (CPG). Therefore, CPG-based tools should be able to be used in the clinical scene of Korean Medicine for diagnosing and evaluating mental disorders according to CP. Methods: Tools suggested by CPs are summarized. The degree of utilization of tools in CPGs is also summarized. A review was conducted by Korean Medicine neuropsychiatrist experts on tools and user's usage plan. Results: As a result, developed CPs suggested using 19 tools for anxiety disorder, 13 tools for insomnia), 12 tools for Hwabyeong, and 9 tools for dementia. In CPG, 48, 34, 44, and 44 tools were used for anxiety disorder, insomnia, Hwabyeong, and dementia, respectively. Among tools presented in CP, HAM-A, HAM-D, CGI, SAS, and TESS for anxiety disorder, CPG, ISI, and PSQI for insomnia disorder, CPG, STAI, and STAXI for Hwabyeong were frequently used in CPG. For dementia CPG, MoCA, MMSE, HDS, ADL, and ADAS-cog were frequently used. Among them, MoCA, ADL, and ADAS-cog were suggested tools in CP. Conclusions: As a result of analyzing tools suggested and used in the developed CPs and CPGs, it was verified that various tools were used in each study. Most of them were symptom and behavioral evaluation scales. Therefore, symptoms and behavior evaluation scales used more frequently should be able to be used in the clinical scene of Korean Medicine.

• Journal of Oriental Neuropsychiatry
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• v.32 no.4
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• pp.337-343
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• 2021

Objectives: To investigate effectiveness and satisfaction of applying critical pathway (CP) to Hwa-byung outpatients. Methods: Subjects were 32 outpatients who were diagnosed with Hwa-byung between January 1 and 2021 to October 31, 2021. Among these patients, 18 patients were applied with CP and 14 patients received treatment without applying CP. Their medical records and administration records were retrospectively analyzed. Data were analyzed by mean, standard deviation, and t-test using SPSS 26.0 program. Results: Mean total treatment period significantly decreased in the CP group compared with the non-CP group. Medical expenses were classified by treatment period, per visit, and patient charges per type of visit. When analyzed specifically by detailed items, there was a decreasing tendency in total medical expenses, uncovered medical expenses, and patient charges but an increasing tendency in covered medical expenses, although some of these changes were not statistically significant. Satisfaction score increased in the CP group compared with the non-CP group in general, although not all increases were statistically significant. Conclusions: Applying CP may contribute to the reduction of medical expenses and improvement of medical service quality. Further research on the development of CP for various diseases and the application of CP under various circumstances is needed.

• Annals of Clinical Neurophysiology
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• v.12 no.2
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• pp.35-46
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• 2010

Various electrophysiological tests have provided a large body of valuable information on neuronal responses to a presented stimulus. The special and general somatic sensory pathways are main targets of evoked potentials. Two types of evoked potentials, exogenous and endogenous, are commonly used. Exogenous evoked potentials of general and special somatic sensory systems will be reviewed. One of general somatic sensory functional pathways, proprioception, can be evaluated by general somatosensory evoked potentials with electrical stimulation on nerves. The special somatosensory functional pathways, including vision, and audition, can be evaluated by visual evoked potentials and auditory evoked potentials. Also laser-evoked potentials are newly developed for pain pathway, including lateral spinothalamic pathway, and vestibular myogenic evoked potentials for sacculocollic pathways. The evoked potentials of sensory system have maximal clinical utility in evaluating functional deficits along the sensory pathways. They are used for evaluating comatose patients, hysterical patients, premature infants, patients with suspected demyelinating diseases or neoplasms, and research. We discuss the neurophysiologic tests of sensory systems in views of practical points. The organized evaluation of sensory electrophysiologic tests can be helpful in detecting and estimating the abnormalities in neurological diseases.