• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.28 no.2
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• pp.238-247
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• 2024

Backgrounds/Aims: Prolonged use of steroids after liver transplantation (LT) significantly increases the risk of diabetes or cardiovascular disease, which can adversely affect patient outcomes. Our study evaluated the effectiveness and safety of early steroid withdrawal within the first year following LT. Methods: This study was conducted as an open-label, multicenter, randomized controlled trial. Liver transplant recipients were randomly assigned to one of the following two groups: Group 1, in which steroids were withdrawn two weeks posttransplantation, and Group 2, in which steroids were withdrawn three months posttransplantation. This study included participants aged 20 to 70 years who were scheduled to undergo a single-organ liver transplant from a living or deceased donor at one of the four participating centers. Results: Between November 2012 and August 2020, 115 patients were selected and randomized into two groups, with 60 in Group 1 and 55 in Group 2. The incidence of new-onset diabetes after transplantation (NODAT) was notably higher in Group 1 (32.4%) than in Group 2 (10.0%) in the per-protocol set. Although biopsy-proven acute rejection, graft failure, and mortality did not occur, the median tacrolimus trough level/dose/weight in Group 1 exceeded that in Group 2. No significant differences in safety parameters, such as infection and recurrence of hepatocellular carcinoma, were observed between the two groups. Conclusions: The present study did not find a significant reduction in the incidence of NODAT in the early steroid withdrawal group. Our study suggests that steroid withdrawal three months posttransplantation is a standard and safe immunosuppressive strategy for LT patients.

• Anatomy and Cell Biology
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• v.57 no.1
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• pp.31-44
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• 2024

The exocrine part of the pancreas has a duct system called the pancreatic ductal system (PDS). Its mechanism of development is complex, and any reorganization during early embryogenesis can give rise to anatomical variants. The aim of this study is to collect, classify, and analyze published evidence on the importance of anatomical variants of the PDS, addressing gaps in our understanding of such variations. The MEDLINE, Web of Science, Embase, and Google Scholar databases were searched to identify publications relevant to this review. R studio with meta-package was used for data extraction, risk of bias estimation, and statistical analysis. A total of 64 studies out of 1,778 proved suitable for this review and metanalysis. The meta-analysis computed the prevalence of normal variants of the PDS (92% of 10,514 subjects). Type 3 variants and "descending" subtypes of the main pancreatic duct (MPD) predominated in the pooled samples. The mean lengths of the MPD and accessory pancreatic duct (APD) were 16.53 cm and 3.36 cm, respectively. The mean diameters of the MPD at the head and the APD were 3.43 mm and 1.69 mm, respectively. The APD was present in only 41% of samples, and the long type predominated. The pancreatic ductal anatomy is highly variable, and the incorrect identification of variants may be challenging for surgeons during ductal anastomosis with gut, failure to which may often cause ductal obstruction or pseudocysts formation.

• Korean Journal of Clinical Pharmacy
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• v.34 no.3
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• pp.194-201
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• 2024

Background: Asthma is a chronic inflammatory airway disease associated with systemic inflammation and increased prevalence of various comorbid conditions. This study investigates the prevalence of non-respiratory comorbidities among adult asthma patients in South Korea, aiming to elucidate potential correlations and impacts of asthma on overall health, thereby affecting patients' quality of life and healthcare systems. Methods: This retrospective cohort study utilized the National Health Insurance Service data (HIRA-NPS-2020) and included adults diagnosed with asthma. Non-respiratory diseases were identified using the Korean Standard Disease Classification (KCD-8) codes, with exclusions applied for other respiratory conditions. The prevalence of comorbidities was analyzed and compared between asthma and non-asthma patients, adjusting for confounders such as age, gender, and insurance status through inverse probability treatment weighting (IPTW). Results: The analysis revealed that asthma patients exhibit significantly higher rates of cardiovascular diseases, metabolic disorders, gastrointestinal conditions, and mental health issues compared to the control group. Notably, conditions such as heart failure, gastroesophageal reflux disease, and anxiety were more prevalent, with odds ratios (OR) ranging from 1.18 to 3.90. These results demonstrate a substantial burden of comorbidities associated with asthma, indicating a broad impact on health beyond the respiratory system. Conclusion: The findings highlight the systemic nature of asthma and the interconnectedness of inflammatory processes across different organ systems. This comprehensive analysis confirms previous research linking asthma with an increased risk of various non-respiratory diseases, providing insights into the multifaceted impact of asthma on patient health.

• Korean Journal of Community Nutrition
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• v.29 no.4
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• pp.278-287
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• 2024

Objectives: This study investigates the relationship between smartphone usage and eating behavior among elementary school students. Methods: This survey was conducted on 4th- to 6th-grade students at elementary schools in Gangneung from September 6th to September 15th, 2023. Of the 129 copies of the questionnaire that were distributed to 5 schools, 66 copies (51.2%) were returned. Results: Compared to the nationwide statistics, the smartphone ownership rate of elementary school students in Gangneung was lower, but the rate of smartphone overdependence was higher. Smartphone dependence was 21.12 points for study subjects and 26.00 points for the overdependence risk group (Org). Compared to national statistics, the self-control failure factor was higher, so study participants in Gangneung City are thought to have great difficulty with self-control. The Org's weekend smartphone use time of 7.54 hours was significantly more than the general user group (Gug)'s 4.06 hours. The number of days in which the Org consumed late-night snacks per week was 2.92 days, and the Gug had 2.15 days, but the difference was not significant. Eating fast food showed a positive correlation with eating sweet food, eating fatty food, and eating heavily seasoned food. It was found that frequent consumption of fast food is closely correlated with unhealthy eating behavior. Weekend smartphone use time showed a significant positive correlation with smartphone dependence and the number of days late-night snacks consumed per week. Conclusions: Study participants in Gangneung are more dependent on smartphones than national statistics. Smartphone dependence had a negative correlation with healthy eating behavior and a correlation with average unhealthy eating behavior.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.464-472
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• 2009

Background: We analyzed the clinical results and the factors for survival of patients who underwent extracorporeal life support system after adult cardiovascular surgery. Material and Method: We retrospectively reviewed the medical record of 44 patients (1.6% of the total adult cardiovascular surgical cases) who underwent the use of a ventricular assisted device or extracorporeal membrane oxygenation from January 2002 to August 2008. There were 32 (72.7%) males and their mean age was 61.7$\pm$14.9(range: 20$\sim$73) years old. The mean duration of extracorporeal life support system was 5.3$\pm$3.0 (range: 1$\sim$12) days. Result: Of these 44 patients, 24 (54.5%) patients were successfully weaned from the extracorporeal device. Eighteen (40.9%) survivors were able to be discharged from the hospital. Complications were noted in 38 patients (86.4%). An emergency operation, no usage of a concomitant intraaortic balloon pump and major complications during use of the extra corporeal life support system such as bleeding, flow instability and renal failure were identified as significant risk factors for poor survival on univariated analysis. Owing to educational support and a continuous renal replacement therapy system, the clinical outcomes of these patients have improved since 2006. On multivariated analysis, renal failure and bleeding during extracorporeal life support were significant risk factors for poor survival. Conclusion: Although using. extracorporeal life support systems after adult cardiovascular surgery revealed acceptable clinical results, determining the optimal treatment strategy and further well designed larger studies are needed to improve the survival rate of patients who undergo extracorporeal life support after adult cardiovascular surgery.

• Radiation Oncology Journal
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• v.25 no.4
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• pp.213-218
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• 2007

Purpose: To analyze retrospectively the outcome of postoperative radiation therapy with or without concurrent chemotherapy for curatively resected stage II pancreatic cancer with T3 or N1 disease. Materials and Methods: Between January 1996 and December 2005, twenty-eight patients completed adjuvant radiation therapy at Ajou University Hospital. The patients had either pathologic T3 stage or N1 stage. The radiation target volume encompassed the initial tumor bed identified preoperatively, resection margin area and celiac nodal area. In the case of N1 patients, the radiation field extended to the lower margin of the L3 vertebra for covering both para-aortic lymph nodes bearing area. The median total radiation dose was 50 Gy. Ten patients received concurrent chemotherapy. Results: Thirteen patients (46%) showed loco-regional recurrences. The celiac axis nodal area was the most frequent site (4 patients). Five patients showed both loco-regional recurrence and a distant metastasis. Patients with positive lymph nodes had a relatively high probability of a distant metastasis (57.1%). Patients that had a positive resection margin showed a relatively high local failure rate (57.1%). The median disease-free survival period of all patients was 6 months and the 1-and 2-year disease free survival rates were 27.4% and 8.2%, respectively. The median overall survival period was 9 months. The 2-and 3-year overall survival rates were 31.6% and 15.8%, respectively. Conclusion: The pancreatic cancer patients with stage II had a high risk of local failure and a high risk of a distant metastasis. We suggest the concurrent use of an effective radiation-sensitizing chemotherapeutic drug and adjuvant chemotherapy after postoperative radiation therapy for the treatment of patients with stage II pancreatic cancer.

• Journal of Chest Surgery
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• v.38 no.2 s.247
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• pp.132-138
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• 2005

Background: Mitral valve repair (MVP) is the optimal procedure for mitral regurgitation (MR), however, failure and subsequent reoperations are the limitations. The current study assessed the procedure in relation to the primary valve related causes of recurrent MR. Material and Method: MR was treated in 493 patients undergoing MVP from January of 1994 to January of 2002. The causes of MR were degenerative $(n=252,\;51.5\%),$ rheumatic $(n=156,\; 31.6\%),$ and others $(n=85,\; 16.9\%).$ Surgery comprised 446 ring annuloplasties $(90.5\%),$ 227 new chordae formations $(46\%),$ 125 quadriangular resections $(25.3\%),$ 28 chordae transfers $(5.7\%),$ and 8 Alfieri's stitches $(1.6\%).$ The mean follow up was $29.04\pm22.81$ months. Result: There were 5 early $(1.01\%)$, and 5 late deaths $(1.01\%).$ The reoperation rate was $1.42\%$. There were 45 $(9.1\%)$ recurrent MR (grade III or IV). Of these, 24 were procedure related including incomplete repair (n=14), discordant new chordae length (n=8) and others (n=2). In 21 patients, the cause was valve related including rheumatic disease progression (n=10), recurrent chordae elongation or prolapse (n=5) and others (n=6). Severe MR was higher after incomplete repair (p < 0.001), and valve related failure strongly correlated with rheumatic progression (p < 0.05). Conclusion: Since completeness of operation is the prime risk factor that determine the repair durability, intra-operative assessment of the initial repair with trans-esophageal echocardiography is essential.

• Asia-Pacific Journal of Business Venturing and Entrepreneurship
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• v.18 no.1
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• pp.141-158
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• 2023

From the perspective of an entrepreneur, one of the most important factors for understanding the inherent limitations of a startup, reducing the risk of failure, and succeeding is the composition of the talent, that is, the founding team. Therefore, a common concern experienced by entrepreneurs in the pre-entrepreneurship stage or the early stage of startup is the choice between independent startups and co-founding start-up. Nonetheless, in Korea, the share of independent entrepreneurship is significantly higher than that of co-founding start-up. On the other hand, focusing on the fact that many successful global innovative companies are in the form of co-founding start-up, the success factors of co-founding start-up were examined. Most of the related preceding studies are studies that identify the capabilities and characteristics of individual entrepreneurs as factors influencing the survival and success of entrepreneurship, and there is a lack of research on partnerships, that is, co-founding start-up, which are common in the field of entrepreneurship ecosystems. Therefore, this study attempted a multi-case study through in-depth interviews, collection of relevant data, analysis of contextual information, and consideration of previous studies targeting co-founders of domestic startups that succeeded in opportunistic startups. Through this, a model for deriving the phased characteristics and key success factors of co-founding start-up was proposed. As a result of the study, the key element of the preliminary start-up stage was 'opportunity', and the success factors were 'opportunity recognition through entrepreneur's experience' and 'idea development'. The key element in the early stages of start-up is "start-up team," and the success factor is "trust and complement of start-up team," and synergy is shown when "diversity and homogeneity of start-up team" are harmonized. In addition, conflicts between co-founders may occur in the early stages of start-ups, which has a large impact on the survival of start-ups. The conflict between the start-up team could be overcome through constant "mutual understanding and respect through communication" and "clear division of work and role sharing." It was confirmed that the core element of the start-up growth stage was 'resources', and 'securing excellent talent' and 'raising external funds' were important factors for success. These results are expected to overcome the limitations of start-up companies, such as limited resources, lack of experience, and risk of failure, in entrepreneurship studies, and prospective entrepreneurs preparing for a start-up in a situation where the form of co-founding start-up is attracting attention as one of the alternatives to increase the success rate. It has implications for various stakeholders in the entrepreneurial ecosystem.

• Journal of Chest Surgery
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• v.35 no.9
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• pp.643-652
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• 2002

As the prevalence of coronay artery disease is increasing, the surgical treatment has been universalized and operative outcome has been improved. We analyzed the short and mid-term results of 292 CABGs performed in Kangdong Sacred Heart Hospital. Material and Method: From June 1994 to December 2001, 292 patients underwent coronary artery bypass grafting. There were 173 men and 119 women and their ages ranged from 39 to 84 years with a mean of $61.8{\pm}9.1$ years. We analyzed the preoperative risk factors, operative procedures and operative outcome. In addition, we analyzed the recurrence of symptoms, long-term mortality and complications via out-patient follow-up for discharged patients. Result: Preoperative clinical diagnoses were unstable angina in 137(46.9%), stable angina in 34(11.6%), acute myocardial infarction in 40(13.7%), non-Q myocardial infarction in 25(8.6%), postinfarction angina in 22(7.5%), cardiogenic shock in 30(10.3%) and PTCA failure in 4(1.4%) patients. Preoperative angiographic diagnoses were three-vessel disease in 157(53.8%), two-vessel disease in 35 (12.0%), one-vessel disease in 11(3.8%) and left main disease in 89(30.5%) patients. We used saphenous veins in 630, internal thoracic arteries in 257, radial arteries in 50, and right gastoepiploic arteries in 2 distal anastomoses. The mean number of distal anastomoses per patient was $3.2{\pm}1.0$ There were 18 concomitant procedures ; valve replacement in 8(2.7%), left main coronary artery angioplasty in 6(2.1%), patch closure of postinfarction ventricular septal defect(PMI-VSD) in 2(0.7%), replacement of ascending aorta in 1(0.3%) and coronary endarterectomy in 1(0.3%) patient. The mean ACC time was $96.6{\pm}35.3 $ minutes and the mean CPB time was $179.2{\pm}94.6$ minutes. Total early mortality was 8.6%, but it was 3.1% in elective operations. The most common cause of early mortality was low cardiac output syndrome in 6(2.1%) patients. The stastistically significant risk factors for early mortality were hypertension, old age($\geq$ 70 years), poor LV function(EF＜40%), congestive heart failure, preoperative intraaortic balloon pump, emergency operation and chronic renal failure. The most common complication was arrhythmia in 52(17.8%) patients. The mean follow-up period was $39.0{\pm}27.0$ months. Most patients were free of symptoms during follow-up. Fourteen patients(5.8 %) had recurrent symptoms and 7 patients(2.9%) died during follow-up period. Follow-up coronary angiography was performed in 13 patients with recurrent symptoms and they were managed by surgical and medical treatment according to the coronary angiographic result. Conclusion: The operative and late results of CABG in our hospital, was acceptable. However, There should be more refinement in operative technique and postoperative management to improve the results.

• Radiation Oncology Journal
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• v.19 no.4
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• pp.335-344
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• 2001

Purpose : The aim of this study was to clarify the role of VEGF expression as an independent prognostic factor and to identify the patients at high risk for poor prognosis in stage IB cervical cancer. Materials and methods : A total of 118 patients with stage IB cervical cancer who had radical hysterectomy and pelvic lymph node dissection were included in the study. All known high risk factors of the patients were pathologically confirmed from the surgical specimen. Of the 118 patients, n patients were treated with postoperative radiotherapy and/or chemotherapy. VEGF expression was examined using immunohistochemistry in formalin-fixed, paraffin-embedded specimens of post-hysterectomy surgical materials. A semiquantitative analysis was made using a scoring system of 0, +, ++, and +++ for increasing intensity of stain. We classified the patients with scores from 0 to ++ as low VEGF expression and the patients with a score of +++ as high VEGF expression. Results : Of the 118 patients, 35 patients $(29.7\%)$ showed high VEGF expression. Strong correlations were found between the high VEGF expression and both deep stromal invasion (p=0.01) and the positive pelvic node (p=0.03). The 5-year overall and disease-free survival rates for all 118 patients were $95.5\%\;and\;93.8\%$. The 5-year overall (p=0.03) and disease-free survival (p<0.001) rates were $98.5\%\;and\;100%$ for low VEGF expression (0, +, and ++) and $85.5\%\;and\;79.7\%$ for high VEGF expression, respectively. Pelvic and distant failures for low versus high VEGF expression were $1.2\%$ versus $17.1\%$, (p=0.001) and $0\%$ versus $14.3\%$ (p<0.001), respectively. In a Cox multivariate analysis of survival, the high VEGF expression (p=0.02) and the bulky mass (p=0.02) were significant prognostic factors for overall survival. The high VEGF expression (p=0.002), and bulky mass (p=0.01) demonstrated as significant prognostic indicators for disease free survival. Conclusion : These results showed that VEGF expression was a highly significant predictor for pelvic and distant failure and the most significant prognostic factor of overall and disease free survival for the patients with stage IB cervix cancer treated with radical surgery. We strongly suggest that the immune-histochemistry for VEGF expression be performed in a routine clinical setting in order to identify the patients at high risk for poor prognosis in early stage cervical cancer. Furthermore, postoperative and/or chemotherapy did not reduce the pelvic failure and distant metastasis. To improve the cure rate for the patients with high VEGF expression in stage IB cervical cancer, antiangiogenic therapy including anti-VEGF Ab may be new treatment option.