• Tuberculosis and Respiratory Diseases
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• 제59권1호
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• pp.53-61
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• 2005

배 경 : cTnI는 심근손상의 특이 표시자로서 급성관상동맥 질환에서 높은 증가는 나쁜 예후와 상관이 있다. cTnI의 증가는 여러 가지 비심장성 중증질환에서도 관찰할 수 있다. 연구자 등은 비순환기계 중환자의 예후인자로서 cTnI의 유용성을 조사하였다. 대상 및 방법 : 2003년 1월부터 2004년 7월까지 경상대학교 병원내과계 중환자실에 급성 관상동맥 증후군 이외의 중증 질환으로 입원한 215명의 환자(남:142명, 여:73명, 평균 나이:$63{\pm}2$세)를 대상으로 하였다. 환자들은 중환자실 입원 24시간 이내에 SAPS II와 SOFA점수를 산출하였고 혈청 cTnI를 측정하였다. cTnI 양성군(${\geq}0.1{\mu}g/L$)과 음성군($<0.1{\mu}g/L$) 환자의 중환자실 제 10병일째와 30병일째 사망률을 비교하였다. cTnI 양성군에서 중환자실 제 10병일째와 30병일째에 혈청 cTnI의 평균수치를 비교하였다. cTnI 양성군에서 혈청 cTnI 수치와 SAPS II와 SOFA점수와의 상관관계를 조사하였다. 결 과 : 1) cTnI양성군 환자는 120명(56%)이었고 음성군환자는 95명(44%)였다. 2) 중환자실 제 10병일째와30병일째의 사망률은 cTnI 양성군(29%, 41%)이 음성군(12%, 21%)보다 유의하게 높았다(p<0.01). 3) cTnI 양성군에서 중환자실제10병일째와 30병일째의 cTnI 평균 수치는 비생존군($4.5{\pm}9.2{\mu}g/L$, $3.5{\pm}7.9{\mu}g/L$)이 생존군($1.8{\pm}3.6{\mu}g/L$, $2.0{\pm}3.9{\mu}g/L$)보다 유의하게 높았다(p<0.05). 4) cTnI 양성군에서 cTnI 수치는 SAPS II 점수(r=0.24, p<0.001)와 SOFA 점수(r=0.30, p<0.001)와 유의한 상관관계가 있었다. 결 론 : 혈청 cTnI는 비순환기계 중환자의 유용한 예후인자가 될 수 있을 것으로 사료된다.

• Journal of Chest Surgery
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• 제51권2호
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• pp.92-99
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• 2018

Background: We evaluated the early clinical outcomes of tricuspid valve annuloplasty (TAP) with the Tri-Ad annuloplasty ring for functional tricuspid regurgitation (TR). Methods: From January 2015 to March 2017, 36 patients underwent TAP with a Tri-Ad ring for functional TR. To evaluate the early clinical outcomes of TAP with the Tri-Ad ring, we conducted a propensity score-matched analysis comparing the Tri-Ad and $MC^3$ tricuspid annuloplasty rings (n=34 in each group). The follow-up duration was $11.0{\pm}7.07$ months. Results: There was 1 case of operative mortality (2.8%) and no cases of late mortality. Postoperative complications occurred in 15 patients (41%), including acute kidney injury in 6 patients (16%), bleeding requiring reoperation in 4 patients (11%), and low cardiac output syndrome in 4 patients (11%). There were no ring-related complications, such as atrioventricular block or ring dehiscence. The TR grade decreased significantly (from $2.03{\pm}1.06$ to $1.18{\pm}0.92$, p<0.01), as did the systolic pulmonary artery pressure (from $43.53{\pm}13.84$ to $38.00{\pm}9.72mm\;Hg$, p=0.03). There were no cases of severe residual TR, but moderate TR was observed in 3 patients, all of whom had severe TR preoperatively. Severe preoperative TR was also associated with moderate in the univariate analysis (p<0.01). In the propensity score-matched analysis comparing the Tri-Ad and $MC^3$ rings, there was no significant difference in early clinical outcomes. Conclusion: TAP with the Tri-Ad ring corrected functional TR effectively and provided good early clinical and echocardiographic results without ring-related complications. However, severe preoperative TR was associated with moderate or severe residual TR in the immediate postoperative period. A follow-up study is necessary to confirm the stability of this procedure.

• Journal of Chest Surgery
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• 제38권10호
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• pp.717-720
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• 2005

심실중격파열 및 좌심실자유벽파열은 급성 심근경색의 주요 합병증들 중의 하나이나 이 치명적인 합병증 둘이 모두 동일 환지에서 발생한 소위 심실이중파열에 대한 외과적 치험예는 거의 보고되고 있지 않고 있다. 저자들은 급성심근경색의 합병증으로 발생한 심실중격파열에 이어 좌심실자유벽이 파열된 환자에서 시행된 외과 치험 1예를 보고하고자 한다. 58세 남자가 급성심근경색으로 전원되었다. 심초음파로 후심실중격파열을 진단 후 대동맥내풍선점프를 넣고 응급수술을 계획하였다. 마취 유도 중 갑자기 환자는 순환허탈에 빠져 심장마사지를 하며 개흉하여 혈심낭에 의한 급성 심장압전과 좌심실 후벽 중간 부위에서 혈액을 분출하고 있는 약 2cm 길이의 세로 방향의 파열을 관찰할 수 있었다. 심폐바이패스를 설치, 혈역학을 안정시킨 후 좌심실 재건술을 시행하였다. 환자의 수술 후 경과는 술 전 심장마비로부터 비롯된 것으로 생각되는 뇌손상으로 지연되었다.

• Journal of Chest Surgery
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• 제30권5호
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• pp.486-492
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• 1997

큰 심실 중격 결손을 가진 조기 영아에서 결손의 일차봉합을 조기에 시행하는 것이 적절한 치료방법이 될 수 있는가를 알기 위해 영아의 심실중격 결손의 수술 결과를 조사 분석하였다. 저자들은 1993년 3월부터 1996년 6월까지 심실 중격 결손증을 가진 63예의 영아들을 수술하고 이를 5개월 미만과 이상의 두 군으로 나누어 수술 결과를 비교 분석하였다. 양군의 심실 중격 결손의 해부학적 위치의 빈도는 비슷하였고, 긴급 수술을 요하는 심한 울혈성 심부전증은 1군의 4예에서 보였다. 수술 조기 사망은 1군에서 3예(9.7%)였고, 2군에서는 없었다(0%). 조기 사망은 2예에서 수술 전 심정지에 의한 심근 및 뇌 손상이 발생하여 일어났고, 1예에서 수술 전부터 기관 연화에 의한 술후 호흡정지로 일어났다. 만기 사망은 없었으며, 심에코 검사상 모든 환자에서 사소한 단락도 없었다. 술후 조기 사망의 원인이 수술 및 술후 처치와 무관함을 고려한다면, 심한 울혈성 심부전을 동반하기에 충분한 크기의 심실 중격 결손을 가진 5개월 미만의 조기 영아에서 일차 폐쇄 봉합술은 적절한 술후 처치와 함께 낮은 사망률과 이병율로 시행될 수 있다고 사료된다.

• 대한한방내과학회지
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• 제21권5호
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• pp.747-763
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• 2000

through a literal study upon Arrhythmia between east and west medicine, the results were as follows 1. Arrhythmia is not only irregular cardiac beat but disorder of cardiac impulse making and conduction disturbance. it means almost irregularity of interval between two beat 2. In the east medicine, arrhythmia is represented various category as palpitation, continuous palpitation, dizziness, consumption which give the first consideration by the accompanied symptoms. A separate way in a diagnostics it become a base of diagnosis of diseases and decision of prognosis by the examination of pulse 3. In the west medicine, Arrhythmia is classified as disorder of heart rate, rhythm, conduction disturbance or tachycardia, bradycardia and it is concomitant with fatigue, palpitation, dyspnoea, syncope, chest discomfort 4. The diagnostic study of pulse condition which represent arrhythmia was started from $\mathbb{<}$Nae-Kyung$\mathbb{>}$ and it was revealed as pulse condition of rapid pulse, slow pulse, swift pulse, running pulse, knotted pulse, intermittent pulse etc. Out of them running pulse, knotted pulse, intermittent pulse which obviously are concomitant with irregularity of interval are clinically meaningful in a conditions of disease and decision of prognosis. and the significance of these pulse condition are transformed through the changes of the times 5. According to cause of disease it is classified by Arrhythmia(running pulse, knotted pulse, intermittent pulse) due to heat, cold, phlegm, deficiency(or insufficiency) and There are three categories of etiological factor that is, endogenous, exogenous and non-exo-endogenous factor. the endogenous factor is insufficiency of the heart Ki, deficiency of both Ki and blood, intemal stagnation of phlegm and fluid, stagnation of seven emotions. the exogenous factor is caused by stagnation of Ki and blood by six exogenous pathogenic factor and the non-exo-endgenous factors are improper diet, overstrain, traumatic injury. A cause of arrhythmia in western medicine are a organic and pathological change of the heart itself and malfunction of the autonomic nervous system.

• 대한약리학회지
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• 제26권1호
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• pp.7-12
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• 1990

흰쥐로 부터 심장을 적출하여 Langendorff 관류장치에 현수하여 Krebs-Hensleit 영양액으로 분당 12ml속도로 30분간 관류시킨 후 관류 속도를 분당 1ml로 줄여(ischemia)60분간 관류시키면, 적출심장의 수축력이 현저히 감소되었고, resting tension이 현저히 증가되었다. 또 적출심장으로부터 유출되는 관류액의 250nm에서의 UV흡광치는 증가되었으며, 좌심실내의 칼슘의 농도는 대조군보다 상당히 증가되었다. 본 실험에서는 흰쥐에서 항염증작용, 혈압강하 및 서맥 작용, 평활근 및 심장근에서 근이완작용을 나타내는 cyclobuxine D의 ischemia에 의해 유도된 심장손상에 대한 보호효과를 관찰하였다. Cyclobuxine D(100ng/ml)는 ischemia에 의해 유발된 적출심장의 수축력 감소와 resting tension의 증가를 유의하게 억제하였으며, 심장으로부터의 ATP metabolites의 유출과 좌심실내의 칼슘 축적을 억제시켰다. 이상의 결과는 Cyclobuxine D가 ischemia에 의해 유발된 손상으로 부터 심장을 보호할 수 있음을 나타내며, 이는 cyclobuxine D의 심장세포내의 칼슘 유입 억제작용에 기인하는 것으로 사려된다.

• The Korean Journal of Physiology and Pharmacology
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• 제20권3호
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• pp.305-314
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• 2016

Inflammatory and fibrotic responses are accelerated during the reperfusion period, and excessive fibrosis and inflammation contribute to cardiac malfunction. NecroX compounds have been shown to protect the liver and heart from ischemia-reperfusion injury. The aim of this study was to further define the role and mechanism of action of NecroX-5 in regulating inflammation and fibrosis responses in a model of hypoxia/reoxygenation (HR). We utilized HR-treated rat hearts and lipopolysaccharide (LPS)-treated H9C2 culture cells in the presence or absence of NecroX-5 ($10{\mu}mol/L$) treatment as experimental models. Addition of NecroX-5 significantly increased decorin (Dcn) expression levels in HR-treated hearts. In contrast, expression of transforming growth factor beta 1 ($TGF{\beta}1$) and Smad2 phosphorylation (pSmad2) was strongly attenuated in NecroX-5-treated hearts. In addition, significantly increased production of tumor necrosis factor alpha ($TNF{\alpha}$), $TGF{\beta}1$, and pSmad2, and markedly decreased Dcn expression levels, were observed in LPS-stimulated H9C2 cells. Interestingly, NecroX-5 supplementation effectively attenuated the increased expression levels of $TNF{\alpha}$, $TGF{\beta}1$, and pSmad2, as well as the decreased expression of Dcn. Thus, our data demonstrate potential antiinflammatory and anti-fibrotic effects of NecroX-5 against cardiac HR injuries via modulation of the $TNF{\alpha}/Dcn/TGF{\beta}1/Smad2$ pathway.

• 대한물리치료과학회지
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• 제8권1호
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• pp.745-758
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• 2001

The purpose of study to phenomenological examine and the mechanism regarding the gene(DNA, RNA, Protein) and sports to studied, analyzed. and evaluated. This review considers the evidence for genetic effects in several determinants of endurance performance and resistance performance, namely: body measurements and physique, body fat pulmonary functions, cardiac and circulatory functions, muscle characteristics. substrate utilization, maximal aerobic power and other. Moreover, the response to aerobic training of indicators aerobic work metabolism and endurance performance is reviewed, with emphasis on the specificity of the response and the individual differences observed in training ability. This study indicate that improvement of 'Enhancer Action' in RNA genes changed by exercise or sports. Moreover exercise was effect on Central Dogma with DNA makes RNA makes Protein. and think that occurred with exercise influence on skeletal muscle into cell have to Myosin Heavy Chain (MHC) changed was after exercise performance, which accompanied into skeletal muscle that were exercise-induces gene-modulation that is, take gene mutations. This study known that existed hormone(epinephrine)-immune system with interaction. Exercise were altered insulin binding and MAP Kinase signaling increased into immune cells. This review suggested that the high rate of glutamine utilization by cells of the immune system serves to maintain a high intra cellular concentration of the intermediates of biosynthetic pathways such that optimal rates of DNA, RNA and protein synthesis can be maintained. In the absence of glutamine, lymphocytes do not proliferate in vitro: proliferation increase greatly as the glutamine concentration increase. Glutamine is synthesized in skeletal muscle. Skeletal muscle and plasma glutamine levels are lowered by sepsis, injury, bums, surgery and endurance exercise and in the overtrained athlete. The study of result show that production of ET-1 is markedly increased tissue specifically in the heart by exercise without appreciable changes in endothelin-converting enzyme and endothelial receptor expressions, suggest that myocardial ET-1 may participate in modulation of cardiac function during exercise. Conclusionally, this study indicate that improvement of 'Enhancer Action' in RNA genes changed by exercise or sports. Moreover exercise was effect on Central Dogma with DNA makes RNA makes Protein. This study is expected to contribute the area of sports science, medicine, hereafter more effort is required to establish the relation between gene alters and exercise amount.

• Journal of Chest Surgery
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• 제53권1호
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• pp.8-15
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• 2020

Background: We aimed to investigate the associations of critical care provided in a cardiac surgical intensive care unit (CSICU) staffed by an attending intensivist with improvements in intensive care unit (ICU) quality and reductions in postoperative complications. Methods: Patients who underwent elective isolated coronary artery bypass grafting (CABG) between January 2007 and December 2012 (the control group) were propensity-matched (1:1) to CABG patients between January 2013 and June 2018 (the intensivist group). Results: Using propensity score matching, 302 patients were extracted from each group. The proportion of patients with at least 1 postoperative complication was significantly lower in the intensivist group than in the control group (17.2% vs. 28.5%, p=0.001). In the intensivist group, the duration of mechanical ventilation (6.4±13.7 hours vs. 13.7±49.3 hours, p=0.013) and length of ICU stay (28.7±33.9 hours vs. 41.7±90.4 hours, p=0.018) were significantly shorter than in the control group. The proportions of patients with prolonged mechanical ventilation (2.3% vs. 7.6%, p=0.006), delirium (1.3% vs. 6.3%, p=0.003) and acute kidney injury (1.3% vs. 5.3%, p=0.012) were significantly lower in the intensivist group than in the control group. Conclusion: A transition from an open ICU model with trainee coverage to a closed ICU model with attending intensivist coverage can be expected to yield improvements in CSICU quality and reductions in postoperative complications.

• Journal of Chest Surgery
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• 제13권3호
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• pp.212-218
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• 1980

A severe crushing injury of the chest produce a very striking syndrome referred to as traumatic asphyxia. This syndrome is characterized by bluish-red discoloration of the skin which is limited to the distribution of the valveless veins of the head and neck. And also if it is characterized by bilateral subconjunctival hemorrhages and neurological manifestations. But these clinical entities faded away progressively in a few weeks. Apporximately 90% of the patients who live for more than a few hours will recover from traumatic asphyxia when it occurs as a single entity. And so, death results from either severe associated injuries of from subsequent infection, rather than from pulmonary or cardiac insufficiency in traumatic asphyxia. We have experienced 4 cases of traumatic asphyxia with severe crushing thoracic injuries at department of the chest surgery, Captial Armed forces General Hospital during about 3 years from April 1977 to Aug. 1980. The 1st 22 year-old male was struct 2$\frac{1}{2}$ ton truck on the road and was transferred to this hospital immediately. He had taken tracheostomy due to severe dyspnea with contusion pneumonia and for removal of a large amount of bronchial secretion. The 2nd case was 23 year-old male who was got buried in a chasm. In this case, the heavy metal post tumbled over him back while at work. The 3rd case was 39 year-old male who leapt out of a window in 5th story while fire broke out in living room by oil stove heating. He had multiple rib fracture with right hemothor x and right colle's fracture and pelvic bone fracture. The last 22 year-old male was run over by a gun carriage. The wheel of this gun carriage passed over his thorax and right chin. He was brought to this hospital by helicopter. when he was first examined at emergency room, he was in semicomatose state and has pneurmomediastinum with multiple rib fracture and severe subcutaneous emphysema. As soon as he arrived, bilateral closed thoracostomy was performed and cardiopulmonary resuscitation was done. In hospital 8th weeks, chest series showed fibrothorax in right side even if chest wall stabilized. All 4 cases had multiple petechiae over their facees and chest and bilateral subconjunctival hemorrhages referred to as traumatic asphyxia. 3 cases except one case who received splenectomy, had been suffered from contusion pneumonia and had been treated with respiratory care. In these 3 cases, they had warning of impending injury before accident, and took a deep breath hold it and braces himself. And also, even if he had not impending fear in remaining one case, he had taken a deep breath and had got valsalva maneuver for pulling off the heavy metal post. Intrathoracic pressure rose suddenly and resulted to traumatic asphyxia in this situation. All these cases were recovered completely without sequelae except one fibrothorax, right.