• Clinical and Experimental Pediatrics
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• v.62 no.3
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• pp.95-101
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• 2019

Purpose: Increased apoptosis was recently found in the hypertrophied left ventricle of spontaneously hypertensive rats (SHRs). Although the available evidence suggests that apoptosis can be induced in cardiac cells by various insults including pressure overload, cardiac apoptosis appears to result from an exaggerated local production of angiotensin in adult SHRs. Altered expressions of Bcl associated X (Bax), Bcl-2, chemokine receptor (CCR)-2, monocyte chemoattractant protein (MCP)-1, transforming growth factor $(TGF)-{\beta}1$, phosphorylated extracellular signal-regulated kinases (PERK), and connexin 43 proteins, and kallikrein mRNA were investigated to explore the effects of losartan on the SHR model. Methods: Twelve-week-old male rats were grouped as follows: control (C), SHR (hypertension: H), and losartan (L; SHRs were treated with losartan [10 mg/kg/day] for 5 weeks). Western blot and reverse transcription polymerase chain reaction assays were performed. Results: Expression of Bax, CCR-2, MCP-1, $TGF-{\beta}1$, PERK, and connexin 43 proteins, and kallikrein mRNA was significantly increased in the H group compared to that in the C group at weeks 3 and 5. Expression of Bax, CCR-2, MCP-1, $TGF-{\beta}1$, and connexin 43 proteins and kallikrein mRNA was significantly decreased after losartan treatment at week 5. PERK protein expression was significantly decreased after losartan treatment at weeks 3 and 5. Bcl-2 protein expression was significantly decreased in the H group compared to that in the C group at weeks 3 and 5. Conclusion: Losartan treatment reduced expression of Bax, CCR-2, MCP-1, $TGF-{\beta}1$, PERK, and connexin 43 proteins, and kallikrein mRNA in SHRs, along with decreased inflammation and apoptosis.

• The Journal of the Korea Contents Association
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• v.22 no.6
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• pp.184-193
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• 2022

'Burnout', which has been frequently used recently, is one of the representative expressions representing the psychology of modern people living in fierce competition. In this paper, I approached and analyzed two films, 'Hector and the Search for Happiness' and 'To Each His Own' from the perspective of burnout, which are considered two of the most healing movies for office workers. The symptoms of burnout in the work were lethargy, irritability, anger, insomnia, depression, and suicidal thoughts. In the case of 'Hector and the Search for Happiness' the clash of values from repeated consulting work, and in the case of 'To Each His Own', work overload, performance pressure, and the absence of a community of colleagues were the causes. This burnout state is visually expressed through the dialogues and expressions of the characters, as well as looking down shots of various sizes, low lighting, and placing objects in front of the main character. This intuitively expressed the symptoms of burnout, which is difficult to diagnose. In particular, it was confirmed through the movie that one of the diagnostic criteria for burnout, such as hobbies, physical activity, and the presence or absence of a fellow community, helps to get out of burnout.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1318-1326
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• 1992

Backgroud. To determine the influence of age at operation upon surgical outcome in patients with isolated secundum atrial septal defect, retrospective clinical analysis was done. Material and method. From June, 1976 to December, 1991, 146 patients, 63 male and 83 female patients ranging in age from 13 months to 56 years, were operated on for isolated secundum atrial septal defect. The patients were divided into 3 groups according to their age at operation: Group I [<20 years old], 91 patients[62.3%]; Group II [21 to 40 years old], 44 patients[30.1%]; GroupIII[>41 years old], 11 patients[7.6%]. Significant differences in clinical features, hemodynamic function, early and late results between age groups were speculated. Results. One hundred thirty-one patients[89.6%] were symptomatic at the time of operation, the most common symptoms being dyspnea on exertion, recurrent respiratory infection, palpitation and chest pain. Patients in NYHA class III or IV were 3.3% in group I, 25% in groupIII, and 54.5% in group Ill. Hemodynamic data was available for 138 patients [94.5%]. Significant pulmonary hypertension [MPA systolic pressure $^3$ 40mmHg] was noted in 22 patients [15.9%]. Patients with pulmonary vascular disease [Rp/Rs>1.25] were 2% in group I, 7.3% in group Il, and 9.1% in groupIII. But there were no significant differences between the age groups in the size of the shunt or the ratio of pulmonary to systemic flow. Atrial septal defects were closed with direct suture in 144 patients and patch repair was performed in 2 patients with high defect. Atrial arrhythmia [8.2%] was the most common postoperative complication. The mean [LSD] duration of follow-up in all patients was 16$\pm$22 months [range, 1~96 months]. Functional result was excellent regardless of the age groups. During follow-up period, late cardiovascular events were arrhythmia [7 cases], reoperation for recurrent ASD [2 cases], and premature late death due to bacterial endocarditis [1 case]. Incidence of preoperative and late atrial fibrillation was significantly higher in older age group. Conclusion. Age at operation is one of the most important predictor of early and late surgical outcome with its impact on the following factors : 1] hemodynamic alterations and ventricular dysfunction due to longstanding volume and pressure overload, 2] pulmonary vascular disease, and 3] atrial arrhythmia including atrial fibrillation as a result of atrial dilatation. Therefore, among patients with surgically repaired atrial septal defects, those operated on over the age of 20 require careful supervision on the long-term basis.

• Clinical and Experimental Pediatrics
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• v.55 no.8
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• pp.297-300
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• 2012

Symptomatic pulmonary arterial hypertension (PAH) in patients with isolated atrial septal defect (ASD) is rare during infancy. We report a case of isolated ASD with severe PAH in an infant who developed airway obstruction as cardiomegaly progressed. The patient presented with recurrent severe respiratory insufficiency and failure to thrive before the repair of the ASD. Echocardiography confirmed volume overload on the right side of heart and severe PAH (tricuspid regurgitation [TR] with a peak pressure gradient of 55 to 60 mmHg). The chest radiographs demonstrated severe collapse of both lung fields, and a computed tomography scan showed narrowing of the main bronchus because of an intrinsic cause, as well as a dilated pulmonary artery compressing the main bronchus on the left and the intermediate bronchus on the right. ASD patch closure was performed when the infant was 8 months old. After the repair of the ASD, echocardiography showed improvement of PAH (TR with a peak pressure gradient of 22 to 26 mmHg), and the patient has not developed recurrent respiratory infections while showing successful catch-up growth. In infants with symptomatic isolated ASD, especially in those with respiratory insufficiency associated with severe PAH, extrinsic airway compression should be considered. Correcting any congenital heart diseases in these patients may improve their symptoms.

• Journal of Biosystems Engineering
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• v.6 no.2
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• pp.1-8
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• 1982

The objective of this study was to find out the technical feasibility of ethanol-diesel fuel blends as a diesel engine fuel. Fuel properties essential to the proper operation of a diesel engine were determined for blends containing several concentrations of ethanol in No. 2 diesel fuel. A single-cylinder diesel engine for a power tiller was used for the engine tests, in which load, speed and fuel consumption rate were measured. The fuels used in tests were No. 2 diesel fuel and a blend containing 10-percent ethanol and 90-percent No. 2 diesel fuel. The results of the study are summarized as follows. 1. It was not possible to blend ethanol and No. 2 diesel fuel as a homogeneous solution even though anhydrous ethanol was used. The problem of blending ethanol in No. 2 diesel fuel could be solved by adding butanol about 5% of the amount of ethanol in the blends. 2. Because ethanol had a much lower boiling point ($78.3^{\circ}C$ under atmospheric pressure) than a diesel fuel, it was necessary to store ethanol-diesel fuel blends airtight in order to prevent them from evaporation losses of ethanol. 3. The addition of ethanol to No. 2 diesel fuel lowered the fuel viscosity and the cetane rating, but a blend of 10% ethanol and 90% diesel fuel had a viscosity and a cetane rating well above the KS minimum values for No. 2 diesel fuel. 4. At the rated speed, the specific fuel consumption of No.2 diesel fuel was lower than that of the 10% ethanol blend for the almost entire range of load. However, under the overload condition the specific fuel consumption was lower for the 10% ethanol blend. 5. Under the variable-speed full-load tests, both fuels produced approximately the same torque and power. At the speeds of 1600rpm or below, the specific fuel consumption of No. 2 diesel fuel was lower than that of the 10% ethanol blend. At the speeds of 1600rpm or above, however, the specific fuel consumption was lower for the 10% ethanol blend. 6. At the ambient temperature above $15^{\circ}C$, the use of the 10% ethanol blend in the engine created a vapor lock in the fuel injection pump and stalled the engine. The vapor locking problem was overcome by chilling the surroundings of the fuel injection pump and the cylinder head with water.

• Journal of the Korean Society of Marine Environment & Safety
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• v.22 no.3
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• pp.278-285
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• 2016

The key features of maritime accidents are the change of their attributes by new risks from time to time. To prevent maritime accidents in Korea, the impacts by new risks on domestic safety environments should be identified or predicted. The purpose of this paper is to find the hazard factors by new risks on maritime safety in Korea. The meaning of new risks is the elements of accident hazard which is compiled from new or rare or unprecedented events in the worldwide maritime transportations. The problems of new risks are the lacks of optimum countermeasures to mitigate accident risks. Using the questionnaires with 152 event scenarios classified by 20 accident causes, the hazard identification and risk analysis of new risks was performed based on the Formal Safety Assessment (FSA) by IMO. A total of 22 Influence Diagrams, which is to depict the transit flows between accident causes to consequences, is used in the construction of 152 event scenarios. A total of 20 accidents causes is the same contents as the causation factors represented in Statistical Year Book for Maritime Accidents of Korean Maritime Safety Tribunals. After defining the evaluation equations to the response results of questionnaires by 46 experts, the work for risk analysis is carried out. As results from the analysis of 152 scenarios, it is known that the root cause to affect on maritime safety in Korea is the pressure of business competition and it led to the lacks of well experienced crews, the overload of vessel operations and crew's fatigue. In addition, as results from the analysis of 20 accident causes, the three accident causes are to be candidate as main issues in Korea such as the inadequate preparedness of departure, the neglecting of watch keeping in bridge and the inadequate management of ship operations. All of the results are thought to be as basic hazard factors to safety impediments. It is thus found that the optimum Risk Control Options to remove the hazard factors and to mitigate consequences required are the following two factors: business competition and crewing problems.

• Tuberculosis and Respiratory Diseases
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• v.85 no.3
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• pp.249-255
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• 2022

Background: The main cause of death in pulmonary embolism (PE) is right-heart failure due to acute pressure overload. In this sense, extracorporeal membrane oxygenation (ECMO) might be useful in maintaining hemodynamic stability and improving organ perfusion. Some previous studies have reported ECMO as a bridge to reperfusion therapy of PE. However, little is known about the patients that benefit from ECMO. Methods: Patients who underwent ECMO due to pulmonary thromboembolism at a single university-affiliated hospital between January 2010 and December 2018 were retrospectively reviewed. Results: During the study period, nine patients received ECMO in high-risk PE. The median age of the patients was 60 years (range, 22-76 years), and six (66.7%) were male. All nine patients had cardiac arrests, of which three occurred outside the hospital. All the patients received mechanical support with veno-arterial ECMO, and the median ECMO duration was 1.1 days (range, 0.2-14.0 days). ECMO with anticoagulation alone was performed in six (66.7%), and ECMO with reperfusion therapy was done in three (33.3%). The 30-day mortality rate was 77.8%. The median time taken from the first cardiac arrest to initiation of ECMO was 31 minutes (range, 30-32 minutes) in survivors (n=2) and 65 minutes (range, 33-482 minutes) in non-survivors (n=7). Conclusion: High-risk PE with cardiac arrest has a high mortality rate despite aggressive management with ECMO and reperfusion therapy. Early decision to start ECMO and its rapid initiation might help save those with cardiac arrest in high-risk PE.

• Journal of Chest Surgery
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• v.36 no.3
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• pp.136-141
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• 2003

We assessed the intermediate-term result of tricuspid annuloplasty (TAP) for tricuspid valve regurgitation (TR) associated with congenital heart disease in adults. Risk factors for residual TR were also analysed. Material and Method: From August 1989 to June 2001, seventy three adult patients, 51 females and 22 males, underwent TAP for TR associated with various congenital heart disease. Their age ranged from 46 years to 73 years (mean:43). Associated heart anomalies were atrial septal defect (55), ventricular septal defect (6), partial anomalous pulmonary venous return (4) and others (8). Preoperative and post-operative TR velocities were 3.25 m/sec and 2.56 m/sec respectively, and the types of TAP were De Vega in 43, Kay in 18 and Ring annuloplasty in 12. Postoperative follow-up duration was 2,347 patient-month (mean: 32.6 months), and 134 two-dimensional echocardiographic examinations were done during this period. Residual TR greater than III/IV was considered as TAP failure. Result: TAP failure was observed in 7 patients (9.6%), and one patient among them underwent tricuspid valve replacement. Risk factors for TAP failure were diagnosis other than atrial septal defect (p=0.001), preoperative (p=0.038) and postoperative (p=0.028) high TR velocity. There was no statistical significance in terms of TAP methods. Conclusion: Careful evaluation of valve morphology and aggressive surgical intervention are mandatory for the repair of TR with preoperative or residual RV pressure overload.

• Tuberculosis and Respiratory Diseases
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• v.59 no.6
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• pp.656-663
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• 2005

Background : The B-type natriuretic peptide (BNP) is a cardiac neurohormone that is specifically secreted from the ventricles in response to volume expansion and a pressure overload. Differentiating congestive heart failure from the pulmonary causes of dyspnea is very important for patients presenting with acute dyspnea. Methods : A retrospective study was carried out on 261 patients who were admitted to the emergency department of Hanyang University Hospital due to acute dyspnea from March to July 2004. The serum BNP levels of the patients were measured using the ELISA method. Results : The BNP levels were 382, 111-1140 pg/ml (median, interquartile range) in the heart failure group (n=119) and 29, 7-81 pg/ml in the non-heart failure group (n=142). The BNP levels according to the subgroups of heart failure were 820, 354-1620 pg/ml, 1650, 239-1990 pg/ml, and 378, 106-1120 pg/ml for the chronic obstructive pulmonary disease (COPD) with combined left heart failure (n=5), cor pulmonale (n=3), and left heart failure groups (n=111), respectively. The BNP levels according to the subgroups of non-heart failure were 39, 21-101 pg/ml, 59, 10-129 pg/ml, and 15, 6-47 pg/ml for the COPD (n=20), other pulmonary diseases (n=56), and other causes groups (n=66), respectively. The BNP levels were significantly different according to the underlying etiology (p<0.001), and were significantly higher in the COPD patients with left heart failure than in those without (p=0.002). When the patients with no cardiovascular risk factor such as diabetes mellitus, hypertension, smoking or renal failure were analyzed, the BNP levels were also significantly higher in the patients with heart failure than in those without(p<0.001). When 133 pg/ml was designated as the BNP cut-off level the sensitivity for predicting heart failure was 73 percent and the specificity was 87 percent. Conclusion : BNP measurements are useful for determining the presence of heart failure in the patients presenting with acute dyspnea. The possibility of heart failure must be seriously considered in patients with high BNP levels even when they have a pre-existing pulmonary disease such as COPD or no risk factors for heart failure.

• Tuberculosis and Respiratory Diseases
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• v.54 no.3
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• pp.320-329
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• 2003

Background : The serum B-type natriuretic peptide (BNP) is released from the ventricles as a response to volume or pressure overload of the ventricles. A few studies have reported that the BNP measurements are useful in differentiating between heart failure and pulmonary causes in patients who visited the emergency department with dyspnea as the chief complaint. It is difficult to differentiate a right heart failure from a left heart failure in the emergency room. However, there is no report on the application of a BNP assay to differentiate in right heart failure from left heart failure. In this study, the BNP levels were measured from dyspneic patients in the emergency department to determine whether or not the BNP level would be useful in differentiating the cause of the dyspnea from right ventricular failure and left ventricular failure. Method : 89 patients who visited emergency department of the Bundang Cha Hospital with dyspnea from June 2002 to March 2003 were selected. The 29 patients from the outpatient clinics and inpatients were randomly selected as the control. Results : The BNP levels of patients in the left heart failure group were significantly different from that of the patients in the right heart failure group ($682{\pm}314$ pg/mL vs. $149{\pm}94$ pg/mL, p=0.000). When the BNP cut-off level was designated as 219 pg/mL using the receiver operating characteristic curve, the sensitivity was 94.3%, and specificity was 92.9%. In addition, the positive predictive value was 97% and the negative predictive value was 86.7% in differentiating right heart failure from left heart failure. Conclusion : Measurements of the serum BNP levels is an accurate and rapid method that can aid in distinguishing between right heart failure and left heart failure.