Kim, Young-Du;Park, Kuhn;Kang, Chul-Ung;Yoon, Jeong-Seob;Moon, Seok-Whan;Wang, Young-Pil;Jo, Kuhn-Hyun
Journal of Chest Surgery
/
v.40
no.1
s.270
/
pp.32-36
/
2007
Background: Although acute renal failure (ARF) after coronary artery bypass graft (CABG) is relatively rare, but devastating complication with high mortality. Our study aims to evaluate the effectiveness of early application of CRRT in patients with ARF which developed after on-pump CABG. Material and Method: Two hundred and eighty seven patients underwent isolated on-pump CABG between May 2002 and Feb. 2006 at our institution, of whom 15 (5.2%) needed CRRT (11 patients for postoperatively developed ARF and the remaining 4 patients with preexisting dialysis-dependent chronic renal failure (CRF) for postoperative hemodynamic and metabolic control). Criteria for early application of CRRT were as follows; decreased urine output less than 0.5cc/h/kg for 2 consecutive hours and elevated serum creatinine level greater than 2.0 mg/dL. Result: The incidence of ARF requiring CRRT after on-pump CABG was 3.9% (11/283) and the overall hospital mortality of patient with CRRT was 33.3% (5/15). Of 5 deaths, 4 were patients with postoperatively developed ARF, and 1 was a patient with pre-existing dialysis-dependent CRF patient. The mean time between the operation and the initiation of CRRT was $25.8{\pm}5.8$ hours and the mean duration of CRRT was $62.1{\pm}41.2$ hours. Of the 7 survivors who were not on dialysis-dependent preoperatively, 6 patients fully recovered renal function during hospital stay and 1 patient required permanent renal supportive treatment after discharge from hospital. Conclusion: Early application of CRRT could maintain stable postoperative hemodynamic status and make outcomes better than those of previous reports in patients with ARF which developed after on-pump CABG.
Purpose : It has been recognized that interaction of the Fas : Fas ligand plays an important role in radiation-induced apoptosis. The purpose of this study was to investigate the role of Fas mutation in radiation-induced apoptosis in vivo. Materials and Method : Mice with mutations in Fas, $MRL/Mpj-Fas^{Ipr}$, and its normal control, MRL/Mpj, were used in this study. Eight-week old male mice were given whole body radiation. After irradiation, the mice were killed and their spleens were collected at different time intervals. Tissue samples were stained with hematoxylin-eosin and the numbers of apoptotic cells were scored. Regulating molecules of apoptosis including p53, Bcl-2, Bax, $Bcl-X_L,\;and\;Bcl-X_S$ were also analyzed by Western blotting. Results : At 25 Gy irradiation, the level of apoptosis reached the peak value at 8 hr after radiation and recovered to the normal value at 24 hr after radiation in MRL/Mpj mice. In contrast, the peak apoptosis level appeared at 4 hr after radiation in $MRL/Mpj-Fas^{Ipr}$. At 8 hr after radiation, the levels of apoptosis in MRL/Mpj mice and $MRL/Mpj-Fas^{Ipr}$ mice were $52.3{\pm}7.8\%\;and\;8.0{\pm}8.6\%$, respectively (p<0.05). The expression of apoptosis regulating molecules, p53, $Bcl-X_L\;and\;Bcl-X_S$, increased in MRL/Mpj mice in response to radiation; p53 with a peak level of 3-fold at 8 h, $Bcl-X_L$ with a peak level of 3.3-fold at 12 h, and $Bcl-X_S$ with a peak level of 3-fold at 12 h after 25 Gy radiation. Bcl-2 and Bax did not show significant change in MRL/Mpj mice. However in $MRL/Mpj-Fas^{Ipr}$ mice, the expression levels of p53, Bcl-2, Bax, $BCl-X_L\;and\;BCl-X_S$ showed no significant change. Conclusion : The level of radiation-induced apoptosis was lower in Fas mutated mice, Ipr, than in control mice. This seemed to be related to the lack of radiation-induced p53 activation in the Ipr mice. This result suggests that Fas plays an important role in radiation-induced apoptosis in vivo.
A high heat flux test facility using a graphite heating panel was constructed and is presently in operation at Korea Atomic Energy Research Institute, which is called KoHLT-1. Its major purpose is to carry out a thermal cycle test to verify the integrity of a HIP (hot isostatic pressing) bonded Be mockups which were fabricated for developing HIP joining technology to bond different metals, i.e., Be-to-CuCrZr and CuCrZr-to-SS316L, for the ITER (International Thermonuclear Experimental Reactor) first wall. The KoHLT-1 consists of a graphite heating panel, a box-type test chamber with water-cooling jackets, an electrical DC power supply, a water-cooling system, an evacuation system, an He gas system, and some diagnostics, which are equipped in an authorized laboratory with a special ventilation system for the Be treatment. The graphite heater is placed between two mockups, and the gap distance between the heater and the mockup is adjusted to $2{\sim}3\;mm$. We designed and fabricated several graphite heating panels to have various heating areas depending on the tested mockups, and to have the electrical resistances of $0.2{\sim}0.5$ ohms during high temperature operation. The heater is connected to an electrical DC power supply of 100 V/400 A. The heat flux is easily controlled by the pre-programmed control system which consists of a personal computer and a multi function module. The heat fluxes on the two mockups are deduced from the flow rate and the coolant inlet/out temperatures by a calorimetric method. We have carried out the thermal cycle tests of various Be mockups, and the reliability of the KoHLT-1 for long time operation at a high heat flux was verified, and its broad applicability is promising.
Purpose : To evaluate changes in expression of cell cycle related genes during apoptosis induced in HL60 cells by X-irradiation to understand molecular biologic aspects in mechanism of radiation therapy. Material and Methods : HL-60 cell line (promyelocytic leukemia cell line) was grown in culture media and irradiated with 8 Gr by linear accelerator (6 MV X-ray). At various times after irradiation, ranging from 3 to 48 hours were analyzed apoptotic DNA fragmentation assay for apoptosis and by western blot analysis and semi-quantitative RT-PCR for expression of cell cycle related genes (cyclin A, cyclin B, cyclin C, cyclin Dl, cyclin E, cdc2, CDK2, CDK4, $p16^{INK4a}$, $p21^{WAF1}$, $p27^{KIP1}$, E2F, PCNA and Rb). Results : X-irradiation (8 Gy) induced apoptosis in HL-60 cell line. Cycline A protein increased after reaching its peak 48 h after radiation delivery and cyclin E, E2F, CDK2 and RB protein increased then decreased after radiation. Radiation induced up-regulation of the expression of E2F is due to mostly increase of Phosphorylated retinoblastoma proteins (ppRb). Cyclin Dl, PCNA, CDC2, CDK4 and $p16^{INK4a}$ protein underwent no significant change at any times after irradiation. There was not detected $p21^{WAF1}$ and $p27^{KIP1}$ protein. Cyclin A, B, C mRNA decreased immediately after radiation and then increased at 12 h after radiation. Cyclin Dl mRNA increased immediately and then decreased at 48 h after radiation. After radiation, cyclin E mRNA decreased with the lapse of time. CDK2 mRNA decreased at 3h and increased at eh after radiation. CDK4 mRNA rapidly increased at 6 to 12 h after radiation. There was no change of expression of $p16^{INK4a}$ and not detected in expressin of $p21^{WAF1}$ and $p27^{KIP1}$ mRNA. Conclusion : We suggest that entry into S phase may contribute to apoptosis of HL60 cells induced by irradiation. Increase of ppRb and decrease of pRb protein are related with radiation induced auoptosis of HL60 cells and tosis of HL60 cells induced by irradiation. Increase of ppRb and decrease of PRb protein are related with radiation induced apoptosis of HL60 cells and this may be associated with induction of E2F and cyclinE/CDK2. These results support that $p21^{WAF1}$ and $p27^{KIP1}$ are not related with radiation induced-apoptosis.
Kim Won Taek;Ki Yong Kan;Nam Ji Ho;Kim Dong Won;Lee Byung Ju;Wang Su Gun;Kyuon Byung Hyun
Radiation Oncology Journal
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v.22
no.4
/
pp.254-264
/
2004
Purpose: This study was carried out to confirm clinical values and limitations of postoperative radiotherapy for hypopharyngeal carcinoma, to evaluate various prognostic factors which may affect to the treatment results and to use these results as fundamental data for making a new treatment strategy. Methods and Materials:. A retrospective analysis was peformed on 64 previously untreated patients with squamous cell carcinoma of the hypopharynx, seen between 1988 and 1999 at Pusan National University Hospital. Most of patients were treated by laryngopharyngectomy and neck dissection followed by conventional fractionated postoperative radiotherapy on surgical bed and cervical nodal areas. Results: The five-year overall survival rate and cause-specific survival rate were 42.2 percent and 51.6 percent, respectively. Univariate analysis of various clinical and pathologic factors confirmed the overall stage, TN-stage, secondary primary cancers, surgical positive margin, nodal extracapsular extension, total radiation doses as significant prognostic factors of hypopharyngeal carcinomas. But in multivariate analysis, TN-stage, surgical positive margin and extracapsular extesion were only statistically significant. Conclusion: In resectable cases of hypopharyngeal carcinoma, combined surgery and postoperative radio-therapy obtained good treatement results, even though sacrificing the function of larynx and pharynx. But in advanced and unresectable cases, with respect to survivals and qualify of life issues, we were able to confirm some limitations of combined therapy. So we recommend that comparative studies of recent various chemo-radiotherapy methods and advanced radiotherapy techniques with these data should be needed.
Purpose: To evaluate the outcomes and prognostic factors of postoperative radiotherapy (PORT) for patients with pathological stage III non-small-cell lung cancer (NSCLC) at a single institution. Materials and Methods: From 2000 to 2007, 88 patients diagnosed as having pathologic stage III NSCLC after curative resection were treated with PORT. There were 80 patients with pathologic stage IIIA and eight patients with pathologic stage IIIB in the AJCC 6th staging system. The majority of patients (n=83) had pathologic N2 disease, and 56 patients had single station mediastinal LN metastasis. PORT was administered using conventional technique (n=76) or three-dimensional conformal technique (n=12). The median radiation dose was 54 Gy (range, 30.6 to 63 Gy). Thirty-six patients received chemotherapy. Radiation pneumonitis was graded by the Radiation Therapy Oncology Group system, and other treatment-related toxicities were assessed by CTCAE v 3.0. Results: Median survival was 54 months (range, 26 to 77 months). The 5-year overall survival (OS) and disease free survival (DFS) rates were 45% and 38%, respectively. The number of metastatic lymph nodes was associated with overall survival (hazard ratio, 1.037; p-value=0.040). The 5-year locoregional recurrence free survival (LRFS) and distant metastasis free survival (DMFS) rates were 88% and 48%, respectively. Multiple stations of mediastinal lymph node metastasis was associated with decreased DFS and DMFS rates (p-value=0.0014 and 0.0044, respectively). Fifty-one relapses occurred at the following sites: 10 loco-regional, 41 distant metastasis. Grade 2 radiation pneumonitis was seen in three patients, and symptoms were well tolerated with anti-tussive medication. Grade 2 radiation esophagitis was seen in 11 patients. There were no grade 3 or more severe complications associated with PORT. Conclusion: Our retrospective data show that PORT for pathological stage III NSCLC is a safe and feasible treatment and could improve loco-regional control. The number of metastatic lymph nodes and stations of mediastinal lymph node metastasis were analyzed as prognostic factors. Furthermore, efforts are needed to reduce distant metastasis, which is a major failure pattern of advanced stage NSCLC.
Purpose : Lipoprotein(a) is a genetically determined risk factor for atherosclerotic vascular disease and is elevated in patients with renal disease. Especially the patients with nephrotic syndrome exhibit excessively high Lp(a) plasma concentrations. Also the patients with end-stage renal disease have elevated Lp(a) levels. But the mechanism underlying this elevation is unclear. Thus, in this study, by measuring the level of serum Lp(a) in common renal diseases in children, we hoped to see whether there would be a change in Lp(a) in renal diseases other than nephrotic syndrome. Then, we figured out its implications, and looked for the factors that affect the Lp(a) concentrations. Methods : A total of 75 patients(34 patients with hematuria of unknown etiology, 10 with hematuria and hypercalciuria, 8 with IgA nephropathy, 8 with poststreptococcal glomerulone phritis, 3 with $Henoch-Sch\"{o}nlein$ nephritis, 7 with urinary tract infection, and 5 with or- thostatic proteinuria) were studied. The control group included 20 patients without renal and liver disease. Serum Lp(a), total protein, and albumin levels, 24-hour urine protein and calcium excretions, creatinine clearance and the number of RBCs and WBCs in the urinary sediment were evaluated. Data analysis was peformed using the Student t-test and a P-value less than 0.05 was considered to be statistically significant. Results : LP(a) was not correlated with 24-hour urine calcium and creatinine. Lp(a) level had a positive correlation with proteinuria and negative correlation with serum albumin and serum protein. Among the common renal diseases in children, Lp(a) was elevated only in orthostatic proteinuria (P<0.05). Conclusion : Lp(a) is correlated with proteinuria, serum protein, and serum albumin, but not with any kind of specific renal disease. Afterward, Lp(a) needs to be assessed in patients with orthostatic proteinuria and its possible role as a prognostic factor could be confirmed.
Our previous study suggested that n-3 fatty acid deficiency was associated with significantly reduced spatial learning as assessed by Morris water maze test. Here we investigated an effect of n-3 fatty acid deficiency on rat brain, retina and serum fatty acyl compositions at 15 wks age using a first generational artificial rearing technique. Newborn Rat pups were separated on day 2 and assigned to two artificial rearing groups or a dam-reared control group. Pups were hand fed artificial milk via custom-designed nursing bottles containing either 0.02%(n-3 Deficient) or 3.1% (n-3 Adequate) of total fatty acids as a-linolenic acid(LNA). At day 21, rats were weaned to either n-3 deficient or n-3 adequate pelleted diets and fatty acid compositions of brain, retina and liver were analyzed at 15 wks age. Brain docosahexaenoic acid(DHA) was lower(58% and 61%, P<0.05) in n-3 deficient in comparison to n-3 adequate and dam-reared groups, receptively, while brain docosapentaenoic acid(DPAn-6) was increased in the n-3 deficient group. In retina and serum fatty acid compositions, the decreased precentage of DHA and increased precentage of DPAn-6 were observed. These results suggested that artificial rearing method can be used to produce n-3 fatty acid deficiency in the first generation and that adequate brain DHA levels are required for optimal brain function.
To obtain the basic data for commercial 10% salted egg yolk for mayonnaise preparation, 3 types of egg yolks [pasteurized egg yolk (Yolk A)-not salted, pasteurized before salting (Yolk B)-salted, and pasteurized after salting (Yolk C)-salted] were prepared, and the changes in quality characteristics of these egg yolks with frozen storage were tested. The results obtained were as follows; Yolk A gelatinized during frozen storage, thus could not used for mayonnaise preparation. The viscosity of the egg yolk increased $3{\sim}5$ times after salting. Viscosity of the salted egg yolk increased with frozen storage time. Viscosity of Yolk B was higher at $-20^{\circ}C$ than $-15^{\circ}C$. Viscosity of Yolk C, however, was higher at $-15^{\circ}C$ than $-20^{\circ}C$. Frozen storage of pasteurized salted egg yolk showed some effects on the emulsification capacity. The effect, however, was smaller than that of unpasteurized salted egg yolk. Microbes of salted egg yolk were decreased with frozen storage, but there was no difference between Yolk B and Yolk C. It was suggested that commercially pasteurized 10% salted egg yolk for mayonnaise preparation can be successfully stored for 12 months at the temperature of $-15{\sim}-20^{\circ}C$.
Purpose: This study was to test the effects of wholistic hospice nursing intervention program on pain and anxiety for in-patient of hospice palliative care unit. This study's design was one-group pre-post test quasi- experimental research. Methods: The subjects of study were 27 patients who were over 18 years old and admitted in hospice palliative care unit of S hospital in P city with agreement in hospice palliative care in their terminal disease. The experimental group subjects participated in holistic hospice nursing program took 120 minutes per session, a total of 1,200 minutes altogether for 10 sessions. The period of data collection was from April 6, 2004 to April 20, 2005. The collected data were analyzed by Paired t-test with SPSS/WIN 12.0 program. A Wholistic Hospice Nursing Intervention Program (named ‘Rainbow Program’) was used as a experimental tool in this study. This was developed by the authors. It was provided by interdisciplinary hospice team (nurses, medical doctors, social worker, pastors, art therapists, and volunteers). In addition, Korean Version of Brief Pain Inventory (BPI-K) by Young-Ho Yun(1998) was used to test degree of pain in physical aspect. And State-Anxiety Inventory was developed by Spielberger(1975) and translated by Kim, Jung-Tack & Shin, Dong-Gyun(1978) was used to test the degree of state-anxiety in emotional aspect. Results: (1) Hypothesis No. 1 "The experimental group which received Wholistic Hospice Nursing Program will have a lower degree of pain than before" was supported (t=-10.585, P= .000). (2) Hypothesis No. 2 "The experimental group which received Wholistic Hospice Nursing Program will have a lower degree of state-anxiety than before" was supported (t=-8.234, P= .000). Conclusion: Our results testified that this Wholistic Hospice Nursing Intervention Program was effective to decrease pain and state-anxiety of the in-patients of hospice palliative care unit. Therefore it can be used and applied actively in practice as a useful model of interdisciplinary team approach by hospice professionals in hospice palliative care unit.
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