• Journal of Chest Surgery
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• v.32 no.9
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• pp.806-812
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• 1999

Background: Selection of reconstruction route in esophageal cancer surgery is based on the patient's status, characteristics of tumor, surgeon's preference and experience. Of the various routes, it has been documented that subcutaneous or substernal route may prolong operation time and may be vulnerable to postoperative respiratory complications. This study was designed to evaluate whether the selection of reconstruction route affects the surgical outcomes. Material and Method: Of 131 patients who have undergone resection and reconstruction for esophageal cancer, posterior mediastinal route(Group I, n=34), substernal route (Group II, n=31), and subcutaneous route(Group III, n=21) were retrospectively reviewed in 86 patients. Results of early operations and morbidities were compared between the groups. Result: There was a male prevalence(79 of males vs. 7 of females). There were 81 squamous cell cancers and 5 adenocarcinomas. There were no differences between groups in weight, height, age, cancer staging and location, and in the preoperative anesthetic risk evaluation and pulmonary function test(p=NS). Postoperative mechanical ventilation time was longer in Group I(20.6 hours) than in Group II(7.8 hours) or III(3.4 hours)(p=0.005). Duration of stay in the intensive care unit was prolonged in Group III(6.4 days) compared to Group I (3.9 days) or II(3.1 days)(p=0.043). No differences were noted in the duration of hospital stay between the groups(p=NS). Blood transfusion was needed in 30 out of 34 patients in Group I compared to 14/31 in Group II or 15/21 in Group III(p=0.001). The mean amount of transfusion for each patient was also higher in Group I(3,833 mL) than in Group II(1535 mL) or Group III(1419 mL)(p=0.04), but there was no difference in the inreoperation due to bleeding. Ea ly mortality rate was substantially higher in Group I(17.6%) but the differences between the groups were insignificant(p=NS). Although sepsis was a more prevalent cause of death in Group I, it was not related to anastomotic leak. Other morbidities did not differ between the groups(p=NS). Conclusion: In above results show that the reconstruction route does not affect the outcome of esophageal cancer surgery. We believe that the selection of reconstruction route can be based on the surgeon's preference and experience.

• Journal of Chest Surgery
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• v.39 no.4 s.261
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• pp.275-280
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• 2006

Background: Aortopulmonary window (APW) is a very rare congenital heart anomaly, often associated with other cardiac anomalies. It causes a significant systemic to pulmonary artery shunt, which requires early surgical correction. Accurate diagnosis and surgical correction will bring good outcomes. The purpose of this study was to describe our 20-year experience of aortopulmonary window. Material and Method: Between March 1985 and January 2005, 16 patients with APW underwent surgical repair. Mean age at operation was $157.8{\pm}245.3$ ($15.0{\sim}994.0$) days and mean weight was $4.8{\pm}2.5$ ($1.7{\sim}10.7$) kg. Patent ductus arteriosus (8), atrial septal defect (7), interruptedaortic arch (5), ventricular septal defect (4), patent foramen ovate (3), tricuspid valve regurgitation (3), mitral valve regurgitation (2), aortic valve regurgitation (1), coarctation of aorta (1), left superior vena cavae (1), and dextrocardia (1) were associated. Repair methods included 1) division of the APW with primary closure or patch closure of aorta and pulmonary artery primary closure or patch closure (11) and 2) intra-arterial patch closure (3). 3) Division of the window and descending aorta to APW anastomosis (2) in the patients with interrupted aortic arch or coarctation. Result: There was one death. The patient had 2.5 cm long severe tracheal stenosis from carina with tracheal bronchus supplying right upper lobe. The patient died at 5th post operative day due to massive tracheal bleeding. Patients with complex aortopulmonary window had longer intensive care unit and hospital stay and showed more morbidities and higher reoperation rates. 5 patients had reoperations due to left pulmonary artery stenosis (4), right pulmonary artery stenosis (2), and main pulmonary artery stenosis (1). The mean follow-up period was $6.8{\pm}5.6$ (57.0 days$\sim$16.7 years)years and all patients belonged to NYHA class 1. Conclusion: With early and prompt correction of APW, excellent surgical outcome can be expected. However, optimal surgical method needs to be established to decrease the rate of stenosis of pulmonary arteries.

• Journal of Chest Surgery
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• v.38 no.2 s.247
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• pp.110-115
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• 2005

Background: The aims of this paper were to review the mid term clinical results and to analyze the preoperative risk factors of isolated aortic valve replacement (AVR). Material and Method: Between January 1992 and February 2003, 80 patients underwent isolated AVR. 58 were male and 22 were female patients, raging from 12 to 75 years of age (mean :$46.8{\pm}13.0$ years). 74 patients except one early death and 5 follow-up loss were contacted by OPD or by telephone. The mean duration of follow-up was $44.2{\pm}29.7$ months and the total cumulative period was 272.8 patient-year. Result: The complications in hospital occurred in 35 cases : 12 wound problems (11 superficial, 1 deep), 11 arrhythmias (9 temporary, 2 persistent), 3 low cardiac output, and so forth. The late deaths were 4 cases : the heart-related deaths were 2 cases ($0.7\%$ patient-year). Conclusion: The risk factors that influenced the early mortality and morbidity were older age (> 60 years)(p=0.04), poor preoperative NYHA functional class (> 3) (p=0.048), high preoperative serum creatinin level (> 1.2 mg/100 ml)(p=0.031), long operation time (aortic clamping time>90 min)(p=0.042). The same factors influenced the late mortality and morbidity. Freedom from valve-related complication was $86.4{\pm}5.3\%,$ actuarial survival rate were $96.8{\pm}2.3\%$ at 3 years and $90.8{\pm}4.6\%$ at 10 years.

• The Korean Society of Law and Medicine
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• v.13 no.1
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• pp.199-247
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• 2012

According to the review and analysis of medical cases that are assigned to the Supreme Court and all local High Court in 2011 and that are presented in the media, it was found that the following categories were taken seriously, medical and pharmaceutical product liability, the third principle of trust between medical institutions, negligence and causation estimation, responsibility limit, the meaning of medical records and related judgment of disturbed substantiation, Oriental doctors' duties to explain the procedures, IMS events, whether one can claim for each medical care operated by non-physician health care institutions to the nonmedical domain in the National Health Insurance Corporation, and the basis of norms for each claim. In the cases related to medical pharmaceutical product liability, Supreme Court alleviated burden of proof for accidents with medical and pharmaceutical products prior to the practice of Product Liability Law and onset the point of negative prescription as the time of damage strikes to condition feasibility of the specific situation. In the cases related to the 3rd principle of trust between medical institutions, the Supreme Court refused to sentence the doctor who has trusted the judgment of the same third-party doctors the violations of the care duty. With respect to proof of a causal relationship and damages in a medical negligence case, the Supreme Court decided that it is unjust to deny negligence by the materials of causal relationship rejecting the original verdict and clarified that the causal relationship shall not deny the reasons to limit doctors' responsibilities. In order not put burden on patients with disadvantages in which medical records and the description of the practice or the most fundamental and important evidence to prove negligence and causation are being neglected, the Supreme Court admitted in the hospital's responsibility for the case of the neonate death of suffocation without properly listed fetal heart rate and uterine contraction monitor. On the other hand, the Seoul Western District Court has admitted alimony for altering and forging medical records. With respect to doctors' obligations to description, the Supreme Court decided that it is necessary to explain the foreseen risks by the combination of oriental and western medicines emphasizing the right of patient's self-determination. However, questions have arisen whether it is realistically feasible or not. In a case of an unlicensed doctor performing intramuscular stimulation treatment (IMS), the Supreme Court put off its decision if it was an unlicensed medical practice as to put limitation of eastern and western medical practices, but it declared that IMS practice was an acupuncture treatment therefore the plaintiff's conduct being an illegal act. In the future, clear judgment on this matter should be made. With respect to the claim of bills from non-physical health care institutions, the Supreme Court decided to void it for the implementation of the arrangement is contrary to the commitments made in the medical law and therefore, it is invalid to claim. In addition, contrast to the private healthcare professionals, who are subject to redemption according to the National Healthcare Insurance Law, the Seoul High Court explicitly confirmed that the non-professionals who receive the tort operating profit must return the unjust enrichment and have the liability for damages. As mentioned above, a relatively wide range of topics were discussed in medical field of 2011. In Korea's health care environment undergoing complex changes day by day, it is expected to see more diverse and in-depth discussions striding out to the development in the field of health care.

• The Korean Journal of Blood Transfusion
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• v.29 no.3
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• pp.262-272
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• 2018

Background: Massive hemorrhage due to trauma is one of the major causes of death in trauma patients, and the quick supply of appropriate blood products is critical in order to reduce the mortality rate. We introduced a massive transfusion protocol (MTP) for safe and rapid transfusion of trauma patients. Using records collected since its adoption, we compared the characteristics of MTP applied group (MTP group) and MTP not applied group (non-MTP group) to determine whether there is an indicator for predicting patients to be treated with MTP. Methods: We retrospectively reviewed the electronic medical records and laboratory findings of patients who received massive transfusions in the trauma emergency room of a single tertiary hospital from February to August 2018. We analyzed various laboratory test results, the amount and ratio of the transfused blood products, and the time required for blood products to be released for the MTP group and the non-MTP group. Results: Of the 54 trauma patients who received massive transfusions, 31 were in the MTP group and 22 in the non-MTP group. There was no significant difference in initial vital signs (except blood pressure) and laboratory test results. Also there was no difference in the amount and ratio of blood products, but the time required for blood product release was shorter in the MTP group. Conclusion: There was no significant difference in clinical findings such as initial vital signs and laboratory test results between the MTP and non-MTP groups, but required blood products were prepared and released more quickly for the MTP group.

• Journal of Life Science
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• v.28 no.12
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• pp.1406-1415
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• 2018

Based on the antioxidative effects in organic solvent fractions obtained from the main methanolic extract of Houttuynia cordata Thunb, the cytoprotective effects by oxidative-stress were here analyzed. Regarding the antioxidant activity of organic solvent fractions, the electron-donating ability of DPPH increased in a dose-dependent manner, and $ED_{50}$ exhibited the highest concentration at $175{\mu}g/ml$ in the Hc-EtOAc fraction. The cell viability of Hc-EtOAc fractions on $H_2O_2$-induced HaCaT cell death ($IC_{50}$) increased in a concentration-dependent manner and a visible cell survival rate of 74% was observed at a concentration of $100{\mu}g/ml$. Meanwhile, the gene expression patterns in HaCaT cells treated with $100{\mu}g/ml$ of the Hc-EtOAc fraction for 6 and 24 hr were identified with microarray analysis. The genes involved in signal transduction, cell division, antioxidant activity, and epithelial cell proliferation were found to be 2-fold up-regulated genes in HaCaT cells following the Hc-EtOAc fraction treatment. Especially, proinflammatory cytokines (IL1B, TNF, and IL6) were identified as involved in antioxidant activity based on the expression patterns of the HaCaT cells, and pathway analysis indicated that TLR4 might be considered an upstream regulator of these genes. In order to verify the activity of IL1B, TNF, and IL6, qRT-PCR showed that the expression increased more than 2 times in HaCaT cells treated with at least $100{\mu}g/ml$ of the Hc-EtOAc fraction. The activity of the upstream regulator TLR4 protein was also increased by the Hc-EtOAc fraction. As a result, the antioxidative activity of the Hc-EtOAc fraction is predicted to pass from TLR4 through cytokines such as IL1B, TNF, and IL6.

• Journal of the Korean Society of Radiology
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• v.13 no.3
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• pp.359-369
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• 2019

To evaluate the effect of simultaneous use of platelet glycoprotein IIb / IIIa receptor blocker and catheter assisted thrombus aspiration in the treatment of coronary stent thrombosis. 267 patients ($64.6{\pm}12.1years$, 187 men) with stent thrombosis on coronary angiography at Chonnam National University Hospital from July 2008 to July 2017 were enrolled. We devided two groups based on treatment modalities: Group I (N=32, platelet glycoprotein IIb / IIIa receptor blocker and thrombo-aspiration), Group II (N =235, either platelet glycoprotein IIb /IIIa receptor blocker or thrombo-aspiration, or none of both), and the major cardiac events including death, revascularization and stent thrombosis were followed up for 1 year. There were no significant differences in clinical characteristics between the two groups including age (Group I: $60.8{\pm}12.9$ vs. Group II: $65.1{\pm}11.9$, p= 0.603), male (Group I: 75.0% vs. Group II: 69.4%, p=0.681), and left ventricular ejection fraction (Group I: $58.1{\pm}9.0%$ vs. Group II: $59.5{\pm}11.9%$, p= 0.127). The major cardiac events did not differ between the two groups (Group I: 12.5% vs. Group II: 23.8%, p=0.180). The secondary endopoints were as followings: The mortality rate (Group I: 0% vs. 13.2%, Group II: p=0.034), target lesion revascularization (Group I: 9.4% vs Group II: 6.4%, p=0.461) and stent thrombosis (Group I: 3.1% vs. Group II: 4.7%, p=1.000). In conclusion, in the treatment of coronary artery stent thrombosis, simultaneous use of platelet glycoprotein IIb / IIIa receptor blocker and thrombus aspiration was associated with better clinical outcomes regarding 1 year mortality.

• Clean Technology
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• v.28 no.1
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• pp.24-31
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• 2022

Petroleum-based plastics are used for various purposes and pose a significant threat to the earth's environment and ecosystem. Many efforts have been taken globally in different areas to find alternatives. As part of these efforts, this study manufactured alginate-based polyvinyl alcohol (PVA) blended films by casting from an aqueous solution prepared by mixing 10 wt% petroleum-based PVA with biodegradable, marine biomass-derived alginate. Glutaraldehyde was used as a cross-linking agent, and cardanol, an alkyl phenol-based bio-oil extracted from cashew nut shell, was added in the range of 0.1 to 2.0 wt% to grant antibacterial activity to the films. FTIR and TGA were performed to characterize the manufactured blended films, and the tensile strength, degree of swelling, and antibacterial activity were measured. Results obtained from the FTIR, TGA, and tensile strength test showed that alginate, the main component, was well distributed in the PVA by forming a matrix phase. The brittleness of alginate, a known weakness as a single component, and the low thermal durability of PVA were improved by cross-linking and hydrogen bonding of the functional groups between alginate and PVA. Addition of cardanol to the alginate-based PVA blend significantly improved the antibacterial activity against S. aureus and E. coli. The antibacterial performance was excellent with a death rate of 98% or higher for S. aureus and about 70% for E. coli at a contact time of 60 minutes. The optimal antibacterial activity of the alginate-PVA blended films was found with a cardanol content range between 0.1 to 0.5 wt%. These results show that cardanol-containing alginate-PVA blended films are suitable for use as various antibacterial materials, including as food packaging.

• Journal of Korean Tunnelling and Underground Space Association
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• v.23 no.6
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• pp.517-534
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• 2021

Hydrogen fuel is emerging as an new energy source to replace fossil fuels in that it can solve environmental pollution problems and reduce energy imbalance and cost. Since hydrogen is eco-friendly but highly explosive, there is a high concern about fire and explosion accidents of hydrogen fueled vehicles. In particular, in semi-enclosed spaces such as tunnels, the risk is predicted to increase. Therefore, this study was conducted on the applicability of the equivalent TNT model and the numerical analysis method to evaluate the hydrogen explosion pressure in the tunnel. In comparison and review of the explosion pressure of 6 equivalent TNT models and Weyandt's experimental results, the Henrych equation was found to be the closest with a deviation of 13.6%. As a result of examining the effect of hydrogen tank capacity (52, 72, 156 L) and tunnel cross-section (40.5, 54, 72, 95 m²) on the explosion pressure using numerical analysis, the explosion pressure wave in the tunnel initially it propagates in a hemispherical shape as in open space. Furthermore, when it passes the certain distance it is transformed a plane wave and propagates at a very gradual decay rate. The Henrych equation agrees well with the numerical analysis results in the section where the explosion pressure is rapidly decreasing, but it is significantly underestimated after the explosion pressure wave is transformed into a plane wave. In case of same hydrogen tank capacity, an explosion pressure decreases as the tunnel cross-sectional area increases, and in case of the same cross-sectional area, the explosion pressure increases by about 2.5 times if the hydrogen tank capacity increases from 52 L to 156 L. As a result of the evaluation of the limiting distance affecting the human body, when a 52 L hydrogen tank explodes, the limiting distance to death was estimated to be about 3 m, and the limiting distance to serious injury was estimated to be 28.5~35.8 m.

• Journal of Life Science
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• v.32 no.10
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• pp.784-791
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• 2022

This study observed changes in the body composition of Protaetia brevitarsis sinulensis larvae when reared with feed that included noni and nipa palm. Compared to the control group, the death rate and product yield of the treatment group were improved after the larval fasting process. The brightness of the larval powder of the treatment group increased, but the redness decreased. The crude fat content of the treated group was slightly increased according to the assays of the general components, but the mineral content was significantly increased. The total structural amino acids of the treatment group decreased, but the total free amino acids increased. The structural amino acids generally tended to decrease in the treatment group. However, the free amino acids showed no specific differences. Among the free amino acids, tryptophan, phosphoserine, and methylhistidine were highly increased in the treatment group, whereas threonine, methionine, and asparagine showed the opposite results. Among the polyunsaturated fatty acids, eicosapentaenoic acid (C20:5n3) of omega-3 was increased in the treatment group, but the omega-6 series was decreased. Since minerals, total free amino acids, and omega-3 fatty acids in the treatment group were increased compared to the control group, we suggest that noni and nipa palm can potentially be applied to the production of functionally improved substances as additional sources of feed for Protaetia brevitarsis sinulensis larvae.