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Clinical Comparison of Low-dose and High-dose Steroid in Pediatric Cardiac Surgery with Cardiopulmonary Bypass

  • Choi Seok-Cheol;Kim Song-Myung;Kim Yang-Weon
    • Biomedical Science Letters
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    • v.12 no.3
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    • pp.289-301
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    • 2006
  • Cardiopulmonary bypass (CPB) for cardiac surgery triggers the production and release of numerous chemotactic substances and cytokines, ensuing systemic inflammatory response that leads to postoperative major organ dysfunction. Traditionally, corticosteroids (steroid) have been administered to patients undergoing cardiac surgery to ward off these detrimental physiologic alterations. However, the majority of the studies have been performed on adult patients with high-dose steroid. We carried out a randomized, prospective, double-blind study to compare the efficacy of low-dose steroid with that of high-dose steroid and to determine the adequate dose of pretreated-steroid for prophylactic effects in pediatric cardiac surgery. Thirty pediatric patients scheduled for elective cardiac surgery were randomly assigned to two groups; fifteen patients received low-dose methylprednisolone (10mg/kg intravenously, n=15, low-dose group) and the others received high-dose methylprednisolone (30mg/kg intravenously, n=15, high-dose group) 1 hour prior to CPB. Arterial blood samples were taken before CPB (Pre-CPB), 10 minutes after start of CPB (CPB-10), and immediately after CPB-end (CPB-OFF) for measuring total leukocyte counts (T-WBC) and diff-counts, platelet counts, interleukin-6 (IL-6), myeloperoxidase (MPO), total antioxidant (TAO), neuron-specific enolase (NSE), troponin I (TNI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and blood urea nitrogen (BUN) levels. Other parameters such as volumes of urine output, pulmonary index $(PI,\;PaO_2/FiO_2)$, mechanical ventilating period, intensive care unit (ICU)-staying period, postoperative complications (fever, wound problem), postoperative 24 hrs and total volumes in blood loss, and hospitalized days were also assessed. All parameters were compared between two groups. There were no significant differences in T-WBC counts, monocyte fraction, platelet counts, TA levels, NSE levels, creatinine levels, BUN levels, the volumes of total urine output, PI, the incidences of fever and wound problem, postoperative 24hrs- and total-blood loss volumes and ICU-staying period between two groups (P>0.05). At CPB-OFF, neutrophil fraction, MPO level, TNI level, and AST level were higher in the high-dose group than in the low-dose group (P<0.05). IL-6 level at CPB-10 was higher in the high dose-group than in the low-dose group (P<0.05). Furthermore, mechanical ventilating periods and hospitalized days of the high-dose group were significantly longer than those of low-dose group (P<0.05). The high-dose group had significantly low lymphocyte fi-action at CPB-OFF compared with the low-dose group (P<0.001). These findings suggest that pretreatment of high-dose steroid is not superior to that of low-dose steroid regrading its potential benefits in pediatric cardiac surgery. Therefore, the conventional strategy of steroid treatment, high-dose pretreatment, should be modified in the cardiac surgery with CPB. However, further studies must be performed on the larger number of patients in as much as small number of patients in this study.

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Comparison Study of Dose Rate and Physical Parameters in Low and High Dose Rate Intracavitary Radiation Systems for Carcinoma of the Uterne Cervix. (자궁경부암 강내 방사선조사에 있어서 고 및 저 선량율방법에 의한 선량율 비교 고찰)

  • Yang, Chil-Yong
    • The Journal of Korean Society for Radiation Therapy
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    • v.1 no.1
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    • pp.70-78
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    • 1985
  • The intrauterine irradiation is essential to achieve adequate tumor dose to centeral tumor mass in radio therapy for uterine malignancy. The complications of pelvic organ are known to be directly related to radiation dose and physical parameters. The comparison study of currently using 2 systems was undertaken. The simulation films and medical records of 135 patients who was treated with intrauterine irradiation at one of general hospitals in Busan and Seoul between Jan. 1983 and June 1983, were critically analized and physical parameters of low dose rate system and remote controlled high dose rate system were measured. The physical parameters include distances between lateral walls of vaginal fornices, longitudinal and lateral angles of tandem to the body axis, the distance from the external os of uterine cervix to the central axis of ovoids, the radiation dose ratio to rectum and bladder to reference point A. Followings were summary of study results: 1. In distances between lateral walls of vaginal fornices the low dose rate system showed wide distribution and relatively larger distances. In low dose rate system 5.0-5.9 cm was $55.89\%$ 6.0-6.9 cm: $23.53\%$, 4.0-4.9cm: $10.29\%$, 3.0-3.9cm: $10.29\%$, and in high dose rate system 5.0-5.9cm was $80.59\%$, 4.0-4.9cm: $17.91\%$, $6.0\~6.9\;cm:\;1.5\%$. 2. In lateral angulation of tandem to body axis, the low does system revealed mid position (the position along body axis) $64.7\%$, Lt. deviation $19.13\%$ and Rt. deviation $16.17\%$. However the high dose rate system revealed mid position $49.26\%$ Lt. deviation $40.29\%$ and Rt. deviation $10.45\%$. 3. In longitudinal angulation of tandem to body axis the mid position was $11.77\%$ and anterior angulation $88.23\%$ in low dose rate system but in high dose rate system the mid position was $1.56\%$ and anterior angulation $98.44\%$. 4. Down ward displacement of ovoids below external os was only $2.94\%$ in low dose rate system and $67.69\%$ in high dose rate system. 5. The radiation dose ration to rectum to reference point A was $102.70\%$ in high dose rate system and $70.09\%$ in low dose rate system. The dose ratio to bladder to reference point A was $78.14\%$ in high dose rate system and $75.32\%$ in low dose rate system.

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A Comparison between Effects of Anorexia Induced by Consecutive Low-Dose Cisplatin and High-Dose Cisplatin on Hindlimb Muscles of Rats (시스플라틴에 의해 유발된 식욕부진이 쥐의 뒷다리근에 미치는 영향: 저용량 연속투여요법과 고용량 투여요법 간의 비교)

  • Kim, Jin-Il;Choe, Myoung-Ae
    • Journal of Korean Biological Nursing Science
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    • v.14 no.1
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    • pp.49-56
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    • 2012
  • Purpose: The purpose of this study was to compare the effects of anorexia induced by consecutive low-dose and high-dose of cisplatin (CDDP) on the hindlimb muscles of rats. Methods: Male Sprague-Dawley rats were assigned to three groups: Control group (C) received a saline (the same dose and duration as the low CDDP group), the high-dose cisplatin (High CDDP) group received a single 5 mg/kg dose of cisplatin, the consecutive low-dose cisplatin (Low CDDP) group had 1 mg/kg of cisplatin administered for five consecutive days. On the 8th day the soleus and gastrocnemius muscles were dissected. Body weight, food intake, activity, muscle weight, Type I, II fiber cross-sectional area (CSA) of the dissected muscles were measured. Results: Body weight, food intake, muscle weight and Type I, II fiber CSA of the High CDDP and Low CDDP groups were significantly less than the C group. The High CDDP group showed significant decreases, compared to the Low CDDP group, in body weight, food intake, activity score, muscle weight and Type I, II fiber CSA. Conclusion: Hindlimb muscle atrophy occurs due to anorexia induced by both consecutive low-dose and high-dose cisplatin. The muscle atrophy induced by consecutive low-dose cisplatin is less apparent than high-dose cisplatin.

FTIR study of gamma and electron irradiated high-density polyethylene for high dose measurements

  • Al-Ghamdi, Hanan;Farah, Khaled;Almuqrin, Aljawharah;Hosni, Faouzi
    • Nuclear Engineering and Technology
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    • v.54 no.1
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    • pp.255-261
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    • 2022
  • A reliable and well-characterized dosimetry system which is traceable to the international measurement system, is the key element to quality assurance in radiation processing with cobalt-60 gamma rays, X-rays, and electron beam. This is specifically the case for health-regulated processes, such as the radiation sterilization of single use medical devices and food irradiation for preservation and disinfestation. Polyethylene is considered to possess a lot of interesting dosimetric characteristics. In this work, a detailed study has been performed to determine the dosimetric characteristics of a commercialized high-density polyethylene (HDPE) film using Fourier transformed infrared spectrometry (FTIR). Correlations have been established between the absorbed dose and radiation induced infrared absorption in polyethylene having a maximum at 965 cm-1 (transvinylene band) and 1716 cm-1 (ketone-carbonyl band). We have found that polyethylene dose-response is linear with dose for both bands up to1000 kGy. For transvinylene band, the dose-response is more sensitive if irradiations are made in helium. While, for ketone-carbonyl band, the dose-response is more sensitive when irradiations are carried out in air. The dose-rate effect has been found to be negligible when polyethylene samples are irradiated with electron beam high dose rates. The irradiated polyethylene is relatively stable for several weeks after irradiation.

Dose Distribution of Rectum and Bladder in Intracavitary Irradiation (자궁경부암 강내 방사선 조사장치에 의한 직장 및 방광의 피폭선량 평가)

  • Chu S. S.;Oh W. Y.;Suh C. O.;Kim G. E.
    • Radiation Oncology Journal
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    • v.2 no.2
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    • pp.261-270
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    • 1984
  • The intrauterine irradiation is essential to achieve adequate tumor dose to central tumor mass of uterine malignancy in radiotherapy. The complications of pelvic organ are known to be directly related to radiation dose and physical parameters. The simulation radiation and medical records of 203 patients who were treated with intrauterine irradiation from Feb. 1983 to Oct. 1983, were critically analized. The physical parameters to include distances between lateral walls of vaginal fornices, longitudinal and lateral angles of tandem applicator to the body axis, the distance from the external os of uterine cervix to the central axis of ovoids were measured for low dose rate irradiation system and high dose rate remote control afterloading system. The radiation doses and dose distributions within cervical area including interesting points and bladder, rectum, according to sources arrangement and location of applicator, were estimated with personal computer. Followings were summary of study results ; 1. In distances between lateral walls of vaginal fornices, the low dose rate system showed as $4\~7cm$ width and high dose rate system showed as $5\~6cm$. 2. In horizontal angulation of tandem to body axis, the low dose rate system revealed mid position$64.6\%$, left deviation $19.2\%$and right deviation $16.2\%$. 3. In longitudinal angulation of tandem to body axis, the mid position was $11.8\%$ and anterior angulation $88.2\%$ in low dose rate system but in high dose rate system, anterior angulation was $98.5\%$. 4. Down ward displacement of ovoids below external os was only $3\%$ in low dose rate system and $66.7\%$ in high dose rate system. 5. In radiation source arrangement, the most activities of tandem and ovoid were 35 by 30 in low dose rate system but 50 by 40 in high dose rate system. 6. In low and high dose rate system, the total doses an4 TDF were 50, 70 Gy and 141, 123, including 40 Gy external irradiation. 7. The doses and TDF in interesting points Co, B, were 93, 47 Gy and 230, 73 in high dose rate system but in low doss rate system, 123, 52 Gy and 262, 75 respectively. 8. Doses and TDF in bladder and rectum were 70, 68 Gy and 124, 120 in low dose rate system, but in high dose rate system, 58, 64 Gy 98, 110 respectively, and then grades of injuries in bladder and rectum were 25, $30\%$ and 18, $23\%$ respectively.

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Therapeutic Advantages of Treatment of High-Dose Curcumin in the Ovariectomized Rat

  • Cho, Dae-Chul;Jung, Hyun-Sik;Kim, Kyoung-Tae;Jeon, Younghoon;Sung, Joo-Kyung;Hwang, Jeong-Hyun
    • Journal of Korean Neurosurgical Society
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    • v.54 no.6
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    • pp.461-466
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    • 2013
  • Objective : Although curcumin has a protective effect on bone remodeling, appropriate therapeutic concentrations of curcumin are not well known as therapeutic drugs for osteoporosis. The purpose of this study was to compare the bone sparing effect of treatment of low-dose and high-dose curcumin after ovariectomy in rats. Methods : Forty female Sprague-Dawley rats underwent either a sham operation (the sham group) or bilateral ovariectomy (OVX). The ovariectomized animals were randomly distributed among three groups; untreated OVX group, low-dose (10 mg/kg) curcumin administered group, and high-dose (50 mg/kg) curcumin group. At 4 and 8 weeks after surgery, serum biochemical markers of bone turnover were analyzed. Bone histomorphometric parameters of the 4th lumbar vertebrae were determined by micro-computed tomography (CT). In addition, mechanical strength was determined by a three-point bending test. Results : High-dose curcumin group showed significantly lower osteocalcin, alkaline phosphatase, and the telopeptide fragment of type I collagen C-terminus concentration at 4 and 8 weeks compared with the untreated OVX group as well as low-dose curcumin group. In the analyses of micro-CT scans of 4th lumbar vertebrae, the high-dose curcumin treated group showed a significant increase in bone mineral densities (p=0.028) and cortical bone mineral densities (p=0.036) compared with the low-dose curcumin treated group. Only high-dose curcumin treated group had a significant increase of mechanical strength compared with the untreated OVX group (p=0.015). Conclusion : The present study results demonstrat that a high-dose curcumin has therapeutic advantages over a low-dose curcumin of an antiresorptive effect on bone remodeling and improving bone mechanical strength.

Efficacy of Low Dose Barbiturate Coma Therapy for the Patients with Intractable Intracranial Hypertension Using the $Bispectral^{TM}$ Index Monitoring

  • An, Hung-Shik;Cho, Byung-Moon;Kang, Jeong-Han;Kim, Moon-Kyu;Oh, Sae-Moon;Park, Se-Hyuck
    • Journal of Korean Neurosurgical Society
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    • v.47 no.4
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    • pp.252-257
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    • 2010
  • Objective : Barbiturate coma therapy (BCT) is a useful method to control increased intracranial pressure (IICP) patients. However, the complications such as hypotension and hypokalemia have caused conditions that stopped BCT early. The complications of low dose BCT with $Bispectral^{TM}$ index (BIS) monitoring and those of high dose BCT without BIS monitoring have been compared to evaluate the efficacy of low dose BCT with BIS monitoring. Methods : We analyzed 39 patients with high dose BCT group (21 patients) and low dose BCT group (18 patients). Because BIS value of 40-60 is general anesthesia score, we have adjusted the target dose of thiopental to maintain the BIS score of 40-60. Therefore, dose of thiopental was kept 1.3 to 2.6 mg/kg/hour during low dose BCT. However, high dose BCT consisted of 5 mg/kg/hour without BIS monitoing. Results : The protocol of BCT was successful in 72.2% and 38.1% of low dose and high dose BCT groups, respectively. The complications such as QT prolongation, hypotension and cardiac arrest have caused conditions that stopped BCT early. Hypokalemia showed the highest incidence rate in complications of both BCT. The descent in potassium level were $0.63{\pm}0.26$ in low dose group, and $1.31{\pm}0.48$ in high dose group. The treatment durations were $4.89{\pm}1.68$ days and $3.38{\pm}1.24$ days in low dose BCT and high dose BCT, respectively. Conclusion : It was proved that low dose BCT showed less severe complications than high dose BCT. Low dose BCT with BIS monitoring provided enough duration of BCT possible to control ICP.

Development of Diode Based High Energy X-ray Spatial Dose Distribution Measuring Device

  • Lee, Jeonghee;Kim, Ikhyun;Park, Jong-Won;Lim, Yong-Kon;Moon, Myungkook;Lee, Sangheon;Lim, Chang Hwy
    • Journal of Radiation Protection and Research
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    • v.43 no.3
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    • pp.97-106
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    • 2018
  • Background: A cargo container scanner using a high-energy X-ray generates a fan beam X-ray to acquire a transmitted image. Because the generated X-rays by LINAC may affect the image quality and radiation protection of the system, it is necessary to acquire accurate information about the generated X-ray beam distribution. In this paper, a diode-based multi-channel spatial dose measuring device for measuring the X-ray dose distribution developed for measuring the high energy X-ray beam distribution of the container scanner is described. Materials and Methods: The developed high-energy X-ray spatial dose distribution measuring device can measure the spatial distribution of X-rays using 128 diode-based X-ray sensors. And precise measurement of the beam distribution is possible through automatic positioning in the vertical and horizontal directions. The response characteristics of the measurement system were evaluated by comparing the signal gain difference of each pixel, response linearity according to X-ray incident dose change, evaluation of resolution, and measurement of two-dimensional spatial beam distribution. Results and Discussion: As a result, it was found that the difference between the maximum value and the minimum value of the response signal according to the incident position showed a difference of about 10%, and the response signal was linearly increased. And it has been confirmed that high-resolution and two-dimensional measurements are possible. Conclusion: The developed X-ray spatial dose measuring device was evaluated as suitable for dose measurement of high energy X-ray through confirmation of linearity of response signal, spatial uniformity, high resolution measuring ability and ability to measure spatial dose. We will perform precise measurement of the X-ray beamline in the container scanning system using the X-ray spatial dose distribution measuring device developed through this research.

DOSE AND DOSE RATE EFFECTS OF IRRADIATION ON BLOOD COUNT AND CYTOKINE LEVEL IN BALB/c MICE

  • Son, Yeonghoon;Jung, Dong Hyuk;Kim, Sung Dae;Lee, Chang Geun;Yang, Kwangmo;Kim, Joong Sun
    • Journal of Radiation Protection and Research
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    • v.38 no.4
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    • pp.179-184
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    • 2013
  • The biological effects of radiation are dependent on the dose rate and dose of radiation. In this study, effects of dose and dose rate using whole body radiation on plasma cytokines and blood count from male BALB/c mice were evaluated. We examined the blood and cytokine changes in mice exposed to a low (3.49m Gy $h^{-1}$) and high (2.6 Gy $min^{-1}$) dose rate of radiation at a total dose of 0.5 and 2 Gy, respectively. Blood from mice exposed to radiation were evaluated using cytokine assays and complete blood count. Peripheral lymphocytes and neutrophils decreased in a dose dependent manner following high dose rate radiation. The peripheral lymphocytes population remained unchanged following low dose rate radiation; however, the neutrophils population increased after radiation. The sera from these mice exhibited elevated levels of flt3 ligand and granulocyte-colony-stimulating factor (G-CSF), after high/low dose rate radiation. These results suggest that low-dose-rate radiation does not induce blood damage, which was unlike high-dose-rate radiation treatment; low-dose-rate radiation exposure activated the hematopoiesis through the increase of flt3 ligand and G-CSF.

Measurement of the Space Radiation Dose for the Flight Aircrew at High-Altitude

  • Lee, Jaewon;Park, Inchun;Kim, Junsik;Lee, Jaejin;Hwang, Junga;Kim, Young-Chul
    • Journal of Astronomy and Space Sciences
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    • v.31 no.1
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    • pp.33-39
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    • 2014
  • This paper describes an experimental approach to evaluate the effective doses of space radiations at high-altitude by combining the measured data from the Liulin-6K spectrometer loaded onto the air-borne RC-800 cockpit and the calculated data from CARI-6M code developed by FAA. In this paper, 15 exposed dose experiments for the flight missions at a high-altitude above 10 km and 3 experiments at a normal altitude below 4 km were executed over the Korean Peninsula in 2012. The results from the high-altitude flight measurements show a dramatic change in the exposed doses as the altitude increases. The effective dose levels (an average of $15.27{\mu}Sv$) of aircrew at the high-altitude are an order of magnitude larger than those (an average of $0.30{\mu}Sv$) of the normal altitude flight. The comparison was made between the measure dose levels and the calculated dose levels and those were similar each other. It indicates that the annual dose levels of the aircrew boarding RC-800 could be above 1 mSv. These results suggest that a proper procedure to manage the exposed dose of aircrew is required for ROK Air Force.