• The Korean Journal of Emergency Medical Services
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• v.9 no.2
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• pp.111-128
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• 2005

Background: Cardiac arrest is one of the most critical diseases which can likely lead to severe cerebral disability or brain death when the cases can not recover their circulation within 10 minutes. Saving out-of-hospital cardiac arrest cases is a recent concern in Korea. Resuscitation has become an important multidisciplinary branch of medicine, demanding a spectrum of skills and attracting a plethora of specialities and organizations. The best survival can be achieved if all the following links have been optimized : rapid access, and early CPR, defibrillation and ACLS, Since the "Utstein Style" was advocated in 1991, many reports about out-of-hospital cardiac arrest have been published based on this guideline. These differences prevent valid inter-hospital and international comparisons. However, it is not known how effective resuscitation has become to the patients. In other words, there are no guidelines for reviewing, reporting, and conducting research on resuscitation in Korea. This dissertation aims to provide the basic data for a unified reporting guideline of resuscitation in Korea and evaluating the out-of-hospital factors associated with survival discharge of out-of-hospital cardiac arrest. Methods: As for this study, uses the collected data about Out-of-hospital cardiac arrests at 4 area, from January, 2005 to April. 2005. With a retrospective study, 174 cases were analyzed. The data was recorded based on the Out-of-Hospital Utstein Style. Results: Resuscitation was performed on 174 out-of-hospital cardiac arrest cases at the 4 area 14 patients(8.1%) recovered their spontaneous circulation. Overall, the ROSC of the out-of-hospital cardiac arrest patients was 8.1%, which was poorer than that of western countries. Gender distribution was 50 females(28.7%) and 124 males(71.3%), approximately twice as many males as females. ROSC of witnessed arrests was found out to be 97.7%. The ratio of the witnessed arrest groups showed higher results than that of unwitnessed arrest groups in the above-examined cases. Cardiac etiology consisted of cardiac(33.5%), non-cardiac(45.7%), trauma(20.1%), and unknown(6.0%). Cardiac was the best performance. Initial rhythm showed Ventricular Tachycardia/pulseless Ventricular Fibrillation in 8 patients(6.0%), asystole in 100(75.2%) and unknown in 25(18.8%). The results of the Ventricular Tachycardia/pulseless Ventricular Fibrillation showed higher results than the others cases, The proportion of the cardiogenic cause was 33.5%, which was only half of western countries. Ventricular Tachycardia/pulseless Ventricular Fibrillation is relatively rare. These differences were due to the prevalent pattern of Out-of-hospital cardiac arrest as well as prematurity of the EMSS. Bystander CPR was practiced on 13 patients(7.52%). ROSC was shown in 46.2% cases. CPR by EMT was carried out on 167 cases(96.5%). ACLS by EMf was rare. From collapse, 4 cases(2.6%) arrived to ED within 6 minutes. 13 (8.6%) within 10 minutes, and 49(32.5%) over 31 minutes. The sooner the patients arrived, the greater the ratio of ROSC and discharged alive became, and the same with collapse time to ROSC. As the results of the logistic regression analysis, ROSC was found out to be highly influenced by the time of ED arrival from collapse and Ventricular Tachycardia/pulseless Ventricular Fibrillation. Therefore, the ratio of ROSC depends on not any single factor but various intervention factors. Conclusion: This dissertation presents the following suggestions and directions of the study hereafter. First, the first step for a chain of survival should be taken to activate EMSS early with a phone as soon as cardiac arrests are witnessed. Second, it is keenly needed that emergency medical technicians should be increased through emergency education for living. Third, it is necessary to establish the emergency transportation system. Fourth, most of the Koreans have little understanding of EMT and the present operation systems have many problems, which should be fundamentally changed. Fifth, it is required to have an active medical control over Out-of-hospital CPR, And proper psychological supports should be given not only to patients themselves and their family but also individuals who are engaged in emergency situation. Finally, through studies hereafter on nationwide, comprehensive, and standard forms, it is needed to examine into the biological figures of human body, causes and trends of cardiac arrests, and then, to enhance the survival rate of Out-of-hospital cardiac arrests. Korean guidelines for Cardiopulmonary resuscitation need to be made.

• Journal of Chest Surgery
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• v.53 no.5
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• pp.277-284
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• 2020

Background: Cardiac arrest during or after office-based cosmetic surgery is rare, and little is known about its prognosis. We assessed the clinical outcomes of patients who developed cardiac arrest during or after cosmetic surgery at office-based clinics. Methods: Between May 2009 and May 2016, 32 patients who developed cardiac arrest during or after treatment at cosmetic surgery clinics were consecutively enrolled. We compared clinical outcomes, including complications, between survivors (n=19) and non-survivors (n=13) and attempted to determine the prognostic factors of mortality. Results: All 32 of the patients were female, with a mean age of 30.40±11.87 years. Of the 32 patients, 13 (41%) died. Extracorporeal life support (ECLS) was applied in a greater percentage of non-survivors than survivors (92.3% vs. 47.4%, respectively; p=0.009). The mean duration of in-hospital cardiopulmonary resuscitation (CPR) was longer for the non-survivors than the survivors (31.55±33 minutes vs. 7.59±9.07 minutes, respectively; p=0.01). The mean Acute Physiology and Chronic Health Evaluation score was also higher among non-survivors than survivors (23.85±6.68 vs. 16.79±7.44, respectively; p=0.01). No predictor of death was identified in the patients for whom ECLS was applied. Of the 19 survivors, 10 (52.6%) had hypoxic brain damage, and 1 (5.3%) had permanent lower leg ischemia. Logistic regression analyses revealed that the estimated glomerular filtration rate was a predictor of mortality. Conclusion: Patients who developed cardiac arrest during or after cosmetic surgery at office-based clinics experienced poor prognoses, even though ECLS was applied in most cases. The survivors suffered serious complications. Careful monitoring of subjects and active CPR (when necessary) in cosmetic surgery clinics may be essential.

• The Korean Journal of Pharmacology
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• v.9 no.1
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• pp.39-46
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• 1973

It has been reported previously that 2,2-methylene bis(3,4,6-trichlorophenoxy acetic acid) (MTPA) is effective treating for clonorchiasis and less toxic to the hosts. In this studies the absorption, distribution and excretion of MTPA were observed. For this purpose $^{14}C-MTPA$ was synthesised from bis(2-hydroxy-3,5,6-trichlorophenoxyl) methan $^{14}C$ and administerd to the normal rabbit in a single dose of 10mg/kg IV or 20 mg/kg P.O. or to the Clonorchis infected rabbit in dose of 20 mg/kg/day for 6 days. Radioactivity in blood, tissue, bile, urine, feces and tissue of the fluke was measured after the drug was given. The concentration of MTPA in these samples were calcurated from the radioactivity. The result obtained as followes. 1. The increase in concentration of MTPA in blood and urine after oral administration of MTPA was so slow that the absorption of MTPA from the gastrointestinal tract appears very slow. 2. It is presumed that the excretion of MTPA also is slow because the reduction of MTPA concentration in blood after IV injection was very slow. 3. Large amount of MTPA was excreted from the bile. 4. During repeat dose of 20mg/kg/day for 6 days the concentration of MTPA in blood and tissue gradually increased. 5. The highest concentration of MTPA in the kidney and liver, heart, lung, spleen and muscle in decreasing order and the lowest concentration in the brain was noted. 6. During daily dose of 20 mg/kg of MTPA for 6 days of administration the concentration of MTPA gradually increased in urine and feces and the concentration of MTPA in feces was higher than of in urine. It appeares that MTPA take place enterophepatic circulation. 7. It is assumed that accumulation in large amount of MTPA in the liver and tissue of clonorchis, excretion of large amount from the bile is a favorable property of MTPA as a chemotherapeutic agent for clonorchiasis.

• Korean Journal of Digital Imaging in Medicine
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• v.12 no.1
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• pp.27-31
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• 2010

The purpose of this study was to investigated the usefulness of MR perfusion image comparing with SPECT image. A total of pediatric 30 patients(average age : 7.8) with Moyamoya disease were performed MR Perfusion with 32 channel body coil at 3T from March 01, 2010 to June 10, 2010. The MRI sequences and parameters were as followed : gradient Echo-planar imaging(EPI), TR/TE : 2000ms/50ms, FA : $90^{\circ}$, FOV : $240{\times}240$, Matrix : $128{\times}128$, Thickness : 5mm, Gap : 1.5mm. Images were obtained contrast agent administrated at a rate of 1mL/sec after scan start 10s with a total of slice 1000 images(50 phase/1 slice). It was measured with visual color image and digitize data using MRDx software(IDL version 6.2) and also, it was compared of measurement with values of normal and abnormal ratio to analyze hemodynamic change, and a comparison between perfusion MR with technique using Warm Color at SPECT examination. On MR perfusion examination, the color images from abnormal region to the red collar with rCBV(relative cerebral blood volume) and rCBF(relative cerebral blood flow) caused by increase cerebral blood flow with brain vascular occlusion in surrounding collateral circulation advancement, the blood speed relatively was depicted slowly with blue in MTT(Mean Transit Time) and TTP(Time to Peak) images. The region which was visible abnormally from MR perfusion examination visually were detected as comparison with the same SPECT examination region, would be able to confirm the identical results in MMD(Moyamoya disease)judgments. Hymo-dynamic change in MR perfusion examination produced by increase and delay cerebral blood flow. This change with digitize data and being color imaging makes enable to distinguish between normal and abnormal area. Relatively, MR perfusion examination compared with SPECT examination could bring an excellent image with spatial resolution without radiation expose.

• Korean Security Journal
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• no.25
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• pp.109-130
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• 2010

As many countries in the world including the Republic of Korea have used all their national resources in the accelerating economic information warfare, illegal leakage of industrial technologies and information has increased rapidly. The costs required for damage prevention from 2007 to 2008 are estimated at approximately KRW 180 trillion which is expected to increase gradually in future. Because the tricks of leaking key technologies are also getting increasingly systematized, sophisticated and bigger, e.g., simple theft at the individual level or the conspiracy of all the staff taking part in the research activities, we should pay special attention to technology security in addition to technology development. While there are several factors affecting such the brain drain, they usually include personal, social, political and cultural factors, for instance, very heavy educational expenditure of children compared to relatively low pay, the speedy labor market circulation for experienced personnel, or political restrictions on researches. In this context, as part of efforts made to prevent the outflow of core personnel, individual companies and research institutes should establish systematically appropriate core personnel management systems for their own organizational or business goals and principles which are intented to ensure to give better treatment and benefit to core personnel and to exercise closer supervision over them. Furthermore, the conventional personnel management system should be radically and flexibly improved in the manner of encouraging the core personnel returning to the organization to combine their external experiences with practices, instead of penalizing them. At the same time, it is necessary to train and educate core personnel through mutual collaboration and in-house training facilities as well as external academic programs operated jointly at the level of the industry. Finally, as the issues concerning the outflow of core personnel are not just problems of relevant companies and other advanced countries have devoted their best efforts to secure their own key technologies at the national level, it is urgent for the industry and the competent authorities to cooperate closely.

• Journal of Physiology & Pathology in Korean Medicine
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• v.23 no.4
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• pp.779-788
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• 2009

To establish the fundament for EBM of Traditional Korean Medicine, the papers on Samul-tang which was frequently used in medical institutions of Traditional Korean Medicine were analyzed through researching domestic and international literatures. The papers were classified by the registration of domestic or international journals, by the year of publishment, by experimental methods, by laboratory animals used in biological experiment and by the kinds of studies on biological efficacy. Of total 67 papers on Samul-tang, 58 volumes were registered in domestic journals and 9 volumes were in international journals of which 8 volumes were in SCI journals. Since 1978, publishments of papers have continuously increased. The papers on instrumental analyses were 6, biological studies were 58 volumes, clinical studies were 3. Instrumental analyses were preceeded with standard compounds(gallic acid, albiflorin, paeoniflorin, benzoic acid, ferulic acid, 5-HMF). And biological studies showed improvement of cardiovascular function and circulation, antianemia, brain protection, immunoregulation, antistress, radioprotection, antifatigue, antiinflammation and antiallergy, antioxidative effect. Through clinical studies, antifatigue, improvement of insomnia and osteoporosis were reported. Samul-tang could be used to tonify and activate blood. And further study on clinical field need to be conducted in accordance with biological study.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.15 no.3
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• pp.1448-1457
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• 2014

Geriatric illness is increasing with aged population ratio due to a prolonged average life span. Research studies with therapeutic approach using oriental herbs have been attempted, but the very few studies of oriental herbal tea as a healthy drink have done as a health care. This study was performed to identify the effects of oriental herbal tea on the physiological function and behavioral change of elders at geriatric facility. A quasi-experimental design using a nonequivalent control group, pre-post test was used. Total 38 of elderly population (20 of experimental group and 18 of control group) was recruited. 100mL of a type of oriental herbal tea developed for this study was given to each subject 3 times a day for 30 days (from May to June 2013). The health scan analyzer and questionnaire for behavioral change were used to measure dependent variables. The data was analyzed by SPSS/WIN 18.0. After drinking the oriental herbal tea, more significant improvement on blood circulation (t=-4.466, p<.001), liver function (t=-2.855, p=.007), brain function (t=-2.545, p=.015), bone density (t=-6.125, p<.001), blood sugar (t=-4.180, p=<.001) and emotional factor (t=2.389, p=.023) as the sub-variable of behavioral change were found in the experimental group than control group. This study shows that oriental herbal tea can be effective on the physiological function and emotional relief of the elders. Therefore the tea can be utilized as an effective intervention for the health of elders in geriatric facility.

• The Korean Journal of Pharmacology
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• v.23 no.2
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• pp.57-75
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• 1987

Two modalities of gonadotropin secretion, pulsatile gonadotropin and preovulatory gonadotropin surge, have been identified in the mammals. Pulsatile gonadotropin secretion is modulated by the pulsatile pattern of GnRH release and complex ovarian steroid feedback actions. The neural mechansim that regulates the pulsatile release of GnRH in the hypothalamus is called "GnRH pulse generator". Ovarian steroids, estradiol and progesterone, appear to exert thier feedback effects both directly on the pituitary to modulate gonadotropin release and on a hypothalamic site to modulate GnRH release; estradiol primarily affects the amplitude while progesterone decreases the frequency of the pulsatile GnRH. Steroid hormones are known to affect catecholamine transmission in brain. MBH-POA is richly innervated by NE systems and close apposition of NE terminals and GnRH cell bodies occurs in the MBH as well as in the POA. NE normally facilitates pulsatile LH release by acting through ${\alpha}-receptor$ mechanism. However, precise nature of facilitative role of NE transmission in maintaining pulsatile LH has not been clearly understood. Close apposition of DA and GnRH terminals in ME might permit DA to influence GnRH release. Action of DA transmission probably is mediated by axo-axonic contacts between GnRH and DA fibers in the ME. Dopamine transmission does not normally regulate pulsatile LH release, but under certain conditions, increased DA transmission inhibit LH pulse. Endogenous opioid acts to suppress the secretion of GnRH into hypophysial portal circulation, thereby inhibiting gonadotropin secretion. However, an interaction between endogenenous opioid peptides and gonadotropin release is a complex one which involves ovarian hormones as well. LH secretion appears to be most suppressed by endogenenous opioids during the luteal phase, at a time of elevated progesterone secretion. The arcuate nucleus contains not only cell bodies for GnRH and ${\beta}-endorphin$ but also a dense aborization of fibers suggesting that GnRH release is changed by the interactions between GnRH and ${\beta}-endorphin$ cell bodies within the arcuate nucleus. The frequency and amplitude of pulsatile LH release seem to be increased during the preovulatory gonadotropin surge. Estradiol exerts positive feedback action on the hypothalamo-pituitary axis to trigger preovulatory LH surge. GnRH is also crucial hormonal stimulus for preovulatory LH surge. It is unlikely, however, that increased secretion of GnRH during the preovulatory gonadotropin surge represents an obligatory neural signal for generation of the LH discharge in primates including human. Modulation of preovulatory LH surge by catecholamines has been studied almost exclusively in rats. NE and E may be involved in distinct way to accumulate GnRH in the MBH and its release into the hypophysial portal system during the critical period for LH surge on proestrus in rats. However, the mechanisms whereby augmented adrenergic transmission may facilitate the formation and accumulation of GnRH in the ME-ARC nerve terminals before the LH surge have not been clearly understood.

• Journal of Korean Neurosurgical Society
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• v.65 no.6
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• pp.816-824
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• 2022

Objective : Emergency superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis in patients with large vessel occlusion who fails mechanical thrombectomy or does not become an indication due to over the time window can be done as an alternative for blood flow restoration. The authors planned this study to quantitatively measure the degree of improvement in cerebral perfusion flow using perfusion magnetic resonance imaging (MRI) after bypass surgery and to find out what factors are related to the outcome of the bypass surgery. Methods : For a total of 107 patients who underwent emergent STA-MCA bypass surgery with large vessel occlusion, the National Institute of Health stroke scale (NIHSS), modified Rankin score (mRS), infarction volume, and hypoperfusion area volume was calculated, the duration between symptom onset and reperfusion time, occlusion site and infarction type were analyzed. After emergency STA-MCA bypass, hypoperfusion area volume at post-operative 7 days was calculated and analyzed compared with pre-operative hypoperfusion area volume. The factors affecting the improvement of mRS were analyzed. The clinical status of patients who underwent emergency bypass was investigated by mRS and NIHSS before and after surgery, and changes in infarct volume, extent, degree of collateral circulation, and hypoperfusion area volume were measured using MRI and digital subtraction angiography (DSA). Results : The preoperative infarction volume was median 10 mL and the hypoperfusion area volume was median 101 mL. NIHSS was a median of 8 points, and the last normal to operation time was a median of 60.7 hours. STA patency was fair in 97.1% of patients at 6 months follow-up DSA and recanalization of the occluded vessel was confirmed at 26.5% of patients. Infarction volume significantly influenced the improvement of mRS (p=0.010) but preoperative hypoperfusion volume was not significantly influenced (p=0.192), and the infarction type showed marginal significance (p=0.0508). Preoperative NIHSS, initial mRS, occlusion vessel type, and last normal to operation time did not influence the improvement of mRS (p=0.272, 0.941, 0.354, and 0.391). Conclusion : In a patient who had an acute cerebral infarction due to large vessel occlusion with large ischemic penumbra but was unable to perform mechanical thrombectomy, STA-MCA bypass could be performed. By using time-to-peak images of perfusion MRI, it is possible to quickly and easily confirm that the brain tissue at risk is preserved and that the ischemic penumbra is recovered to a normal blood flow state.

• Journal of Korean Neurosurgical Society
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• v.66 no.2
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• pp.144-154
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• 2023

Objective : Stroke caused from large vessel occlusion (LVO) has emerged as the most common stroke subtype worldwide. Intravenous tissue plasminogen activator administration (IV-tPA) and additional intraarterial thrombectomy (IA-Tx) is regarded as standard treatment. In this study, the authors try to find the early recanalization rate of IV-tPA in LVO stroke patients. Methods : Total 300 patients undertook IA-Tx with confirmed anterior circulation LVO, were analyzed retrospectively. Brain computed tomography angiography (CTA) was the initial imaging study and acute stroke magnetic resonance angiography (MRA) followed after finished IV-tPA. Early recanalization rate was evaluated by acute stroke MRA within 2 hours after the IV-tPA. In 167 patients undertook IV-tPA only and 133 non-recanalized patients by IV-tPA, additional IA-Tx tried (IV-tPA + IA-Tx group). And 131 patients, non-recanalized by IV-tPA (IV-tPA group) additional IA-Tx recommend and tried according to the patient condition and compliance. Results : Early recanalization rate of LVO after IV-tPA was 12.0% (36/300). In recanalized patients, favorable outcome (modified Rankin Scale, 0-2) was 69.4% (25/36) while it was 32.1% (42/131, p<0.001) in non-recanalized patients. Among 133 patients, non-recanalized after intravenous recombinant tissue plasminogen activator and undertook additional IA-Tx, the clinical outcome was better than not undertaken additional IA-Tx (favorable outcome was 42.9% vs. 32.1%, p=0.046). Analysis according to the perfusion/diffusion (P/D)-mismatching or not, in patient with IV-tPA with IA-Tx (133 patients), favorable outcome was higher in P/D-mismatching patient (52/104; 50.0%) than P/D-matching patients (5/29; 17.2%; p=0.001). Which treatment tired, P/D-mismatching was favored in clinical outcome (iv-tPA only, p=0.008 and IV-tPA with IA-Tx, p=0.001). Conclusion : The P/D-mismatching influences on the recanalization and clinical outcomes of IV-tPA and IA-Tx. The authors would like to propose that we had better prepare IA-Tx when LVO is diagnosed on initial diagnostic imaging. Furthermore, if the patient shows P/D-mismatching on MRA after IV-tPA, additional IA-Tx improves treatment results and lessen the futile recanalization.