• Korean Journal of Clinical Pharmacy
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• v.26 no.3
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• pp.201-206
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• 2016

Objective: Direct current cardioversion for atrial fibrillation could be associated with the risk of thromboembolic events. Anticoagulation therapy with warfarin (INR 2.0-3.0) is recommended 3 weeks before and 4 weeks after cardioversion to reduce the risk of thromboembolism. This study evaluated warfarin therapy in pharmacist-managed anticoagulant services (ACS). Methods: This retrospective study was performed in 106 patients with atrial fibrillation from 2012 to 2013. The primary efficacy endpoint was the composite of stroke, transient ischemic attack, myocardial infarction, and cardiovascular death. The primary safety measure was major bleeding. To evaluate the peri-procedural effects of warfarin treatment, we studied whether target INR was maintained, as well as the maintenance period of the therapeutic range. Quality of treatment was measured by time in therapeutic range (TTR) by using the Rosendaal method. Results: There were no thromboembolic events, but TEE examination at time of cardioversion showed a left atrial thrombus in three patients (2.8%). Bleeding complications after cardioversion occurred in 2 patients (1.9%). The average INR value at the time of cardioversion was $2.59{\pm}0.8$, and was within the therapeutic range in 83 patients (78%). Analysis of the patients in whom the value was within the therapeutic range twice consecutively showed that the ratio of TTR was 80% and the therapeutic range was maintained in 67 patients (63%) for an average of 4.90 weeks prior to cardioversion. Similarly, 76 patients (72%) had a stable INR within the therapeutic range for an average of 5.70 weeks and a mean TTR of 83%. Conclusion: Pharmacists significantly contributed to appropriate warfarin treatment with close monitoring during cardioversion. Likewise, active pharmacist monitoring and systemic management should be considered to reduce thromboembolism and bleeding complications in the peri-cardioversion period.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.4
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• pp.340-349
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• 2007

Free flap transplantation with microvascular anastomosis has been successfully performed by development of surgical technique, materials and postoperative monitoring equipments of flap. But success rate of microvascular anastomosis is influenced by various factors, and failure rate is about 5-10%. The most influential factor for success rate is surgical technique and other factors that influence failure of microvascular anastomosis are ischemic time of free flap, thrombus formation of anastomosis region and vascular spasm. In this study, vascular patency and thrombus formation in experimental micro-venous anastomosis, and endothelial repair were observed with histologic analysis, scanning electron microscopy, transmission electron microscopic examination. The results were obtained as follows: 1. In vascular patency test in 30 minute and 7 days after micro-venous anastomosis with heparin irrigation, all of 12 anastomosis site were good vascular patency. 2. In thrombus formation in 2 weeks group(Experimental I), 2 site of 6 cases were observed thrombus, and in 4 weeks group(Experimental II), 1 site of 6 cases were observed thrombus. 3. In histologic examination, normal vein(Control Group) showed continued internal elastic lamina, well formed thick smooth muscle layer and connective tissue. The group of 2 weeks after microvenous anastomosis(Experimental I) showd locally recovered internal lamina, discontinued internal lamina, disorganized smooth muscle cells and granulation tissue around suture silk. In the group of 4 weeks after micro-venous anastomosis(Experimental II), anastomosis site showed almostly continued internal lamina, disorganized smooth muscle cells and cicartrized tissue around suture silk. 4. In scanning electron microscope examination in 2 weeks(Experimental I) after micro-venous anastomosis, mesh fibrin formation showed near to endothelial cells, and in 4 weeks after micro-venous anastomosis(EXperimental II), numerous blood cells and fibrin mesh formation was seen associated with irregular endothelial cell arrangement. 5. In transmission electron microscope examination in 2 weeks after micro-venous anastomosis(Experimental I), irregular arrangement of smooth muscle cells was seen adjacent to collagenized tissue around suture silk. In 4 weeks after micro-venous anastomosis(Experimental II), denuded venous wall composed of relatively well arranged smooth muscle cells was covered by endothelial cells, but fibroblast cells and foreign body giant cells near to suture silk was remained. From the results obtained in this study, results of good vascular patiency and anti-thrombotic effect of heparin were obtained as a local irrigation solution, and repair of venous endothelial cell was observed in 2 weeks after micro-venous anastomosis.

• Journal of Physiology & Pathology in Korean Medicine
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• v.17 no.3
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• pp.719-727
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• 2003

Background and purpose: Hypertension and obesity has been implicated in the most important risk factors for stroke. The original finding that the G-protein beta3 subunit (GNB3) C825T allele associates with essential hypertension and obesity has been confirmed in several different populations. Hence, our objective was to determine whether the GNB3 C825T polymorphism predicts interindividual variation in stroke. Method: We recruited 361 stroke patients (cerebral infarction, n=278; intracerebral hemorrhage (ICH), n=83) and 199 healthy control subjects. Subjects were genotyped for GNB3 C825T mutation and findings were investigated for association with stroke. Result: The GNB3 T/T type was significantly associated with cerebral infarction prevalence (OR, 1.98; 95% Cl, 1.14-3.46; p=0.015). While, ICH was not found to be significantly associated with GNB3 T/T type (OR, 1.63; 95% ICH, 0.74-3.56; p=0.219). Similarly, no significant association was determined between GNB T/C type, and cerebral infarction (OR, 1.09; 95% Cl, 0.68-1.74; p=0.716), and ICH (OR, 1.14; 95% Cl, 0.59-2.21; p=0.697). Conclusion: In clinical characteristics, this study shows no differences among GNB3 genotypes, that are BMI, WH ratio. hypertension rate, and ischemic heart disease rate, total lipid level, triglycerides level, total cholesterol level, HDL cholesterol level, prothrombine time, with the exception of LDL cholesterol concentrations. However, our subjects showed an inverse relationship between LDL cholesterol level and the risk of cerebral infarction. We have shown that the GNB3 T/T genotype is strongly associated with cerebral infarction. (OR, 1.98; 95% Cl, 1.14-3.46; p=0.015).

• Molecules and Cells
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• v.43 no.4
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• pp.408-418
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• 2020

The sinus node (SN) is located at the apex of the cardiac conduction system, and SN dysfunction (SND)-characterized by electrical remodeling-is generally attributed to idiopathic fibrosis or ischemic injuries in the SN. SND is associated with increased risk of cardiovascular disorders, including syncope, heart failure, and atrial arrhythmias, particularly atrial fibrillation. One of the histological SND hallmarks is degenerative atrial remodeling that is associated with conduction abnormalities and increased right atrial refractoriness. Although SND is frequently accompanied by increased fibrosis in the right atrium (RA), its molecular basis still remains elusive. Therefore, we investigated whether SND can induce significant molecular changes that account for the structural remodeling of RA. Towards this, we employed a rabbit model of experimental SND, and then compared the genome-wide RNA expression profiles in RA between SND-induced rabbits and sham-operated controls to identify the differentially expressed transcripts. The accompanying gene enrichment analysis revealed extensive pro-fibrotic changes within 7 days after the SN ablation, including activation of transforming growth factor-β (TGF-β) signaling and alterations in the levels of extracellular matrix components and their regulators. Importantly, our findings suggest that periostin, a matricellular factor that regulates the development of cardiac tissue, might play a key role in mediating TGF-β-signaling-induced aberrant atrial remodeling. In conclusion, the present study provides valuable information regarding the molecular signatures underlying SND-induced atrial remodeling, and indicates that periostin can be potentially used in the diagnosis of fibroproliferative cardiac dysfunctions.

• Archives of Reconstructive Microsurgery
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• v.9 no.1
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• pp.1-5
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• 2000

The microsurgical reconstruction is necessary for elderly patients to treat severe trauma and head and neck tumor. The aim of this study is to analyze the risks of microvascular surgery and whether or not happening of more complication in elderly patients who are older than 60 years old and to suggest the solution of the complication. The retrospective study included 41 elderly patients who underwent treatment of 44 microsurgical reconstructions among total 271 cases of microsurgical reconstruction from July, 1988 to December, 1998. Their ages ranged from 61 years to 79 years. There were 26 males and 15 females. The involved sites were 23 head and necks, 13 upper gastrointestinal tracts, 3 lower extremities, 1 chest and 1 sacral region. The causes of microsurgical reconstruction were 36 head and neck tumors, 2 radionecrosis, 2 traumas and 1 melanoma in lower limb. The used flaps were 14 radial forearm flaps, 13 jejunal flaps, 10 latissimus dorsi muscle flaps, 3 rectus abdominis muscle flaps, 2 lateral arm flaps, 1 scapular flap, and 1 iliac osteocutaneous flap. They had medical problems which were 29 tobacco abuse, 14 hypertensions, 13 alcohol abuse, 10 chronic obstructive pulmonary diseases, 7 diabetes mellituses, 3 ischemic heart diseases. All patients have had successful results without specific complications except 3 cases of free flap failure and 3 perioperative death. The causes of 3 flap failures were 2 flap necrosis due to arterial insufficiency and 1 flap loss due to secondary infection. All of these cases were treated with secondary free flap surgery. However 3 patients died perioperatively due to 2 respiratory arrests and 1 sepsis. It was not related to operate microsurgical reconstruction itself, but was correlated with the complication of postoperative care after head and neck surgery. We conclude that plastic surgeons consider the importance of prevention of expected complication as thorough analysis of operative risk factor and appropriate treatment. We had to select the donor and recipient vessel appropriately to perform successful microsurgery in elderly patients and consider vein graft and end-to-side anastomosis to reduce complication if necessary. In addition, we emphasize the importance of pre, peri and postoperative care in head and neck cancer patients to reduce postoperative complication and morbidity.

• Proceedings of the Korean Journal of Food and Nutrition Conference
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• 2003.07a
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• pp.82-82
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• 2003

오디는 옛부터 보혈자음(補血滋陰), 생진윤조(生津閏操), 현훈이명(眩最耳鳴), 심계실면(心悸失眠), 수발조백(鬚髮早白) 등을 치료하는 효능을 가진다고 알려져 있다. 상심자(桑 子)라 하여 뽕나무 열매로서 한방에서 상심(桑 ), 상실(桑實), 오심(烏 ), 흑심(黑 ) 등으로 지칭되며, 뽕나무과(Moraceae)에 속하는 뽕나무(Morus alba L)의 성숙한 과실로 취화과(聚花果)에 속하며 작은 수과(瘦果)가 많이 모여 이루어진 장원형으로 길이 1 내지 2 cm, 지름 0.5 내지 0.8 cm이며 황갈색, 갈홍색 또는 암자색을 띠고 짧은 줄기가 있다. 작은 수과(瘦果)는 난원형으로 조금 납작한 편이며, 길이는 약 2 mm, 너비는 약 1 mm 이고 육질의 화편(花片) 4개가 둘러싸고 있다. 그러나 아직까지는 오디에 대하여 자연과학적인 연구방법을 이용하여 구체적으로 연구된 바가 많지 않다. 또한 이의 생리활성 성분에 대해서도 그 작용과 연관지어 보고된 바가 많지 않다. 뇌졸중 가운데 뇌조직으로 가는 혈액 공급의 감소 혹은 차단으로 발생되는 허혈성 뇌졸중(ischemic stroke)은 전체 뇌졸중 환자의 약 80%정도를 차지하고 있으나 아직까지 뇌신경세포 손상기전의 복잡성 등으로 뇌졸중으로 발생하는 뇌신경세포의 손상을 보호해 줄 수 있는 물질이 개발되어 있지 못한 실정이다. 한편, 천연물로부터 뇌허혈 보호작용을 가지는 물질의 도출은 주로 한방에서 처방을 중심으로 이루어지고 있으며, 따라서 처방으로부터 신경보호작용을 가지는 물질의 도출은 그 처방에 함유되어 있는 각종 생약이 갖는 다양한 활성으로 인해 어려운 점이 있으며, 비록 효과가 있다고 하더라도 과학적인 입증자료가 매우 미비한 실정이다. 이에 본 연구에서는 위에 언급된 자료를 토대로 오디추출물이 뇌허혈에 효과가 있을 것이라는 가정하에 in vitro system을 이용하여 오디추출물의 신경보호작용기전을 검색하고자 DPPH radical 의 생성억제효과, PC12 cell line을 이용한 산화적 스트레스에 의한 오디추출물의 방어효과, LSP에 의하여 활성화된 BV-2 cell에 미치는 영향 등을 검색하였다. 오디의 DPPH 소거활성은 단일화랍물인 bacicalein과 유사한 효과를 나타냈으며 PC12 cell line을 이용한 산화적 스트레스에 의한 오디의 방어 효과는 LDH activity를 행한 결과 농도 의존적으로 LDH 유리 량을 감소시켰다. 뇌손상시에 오디추출물의 염증방어 효과를 관찰하기 위하여 microglial cell line인 BV2 세포주를 선택하여 배양한 후 LPS로 자극을 준 후 일차적인 염증지표인 NO양을 측정한 결과 BV2 cell에 LPS 100 ng/ml을 처리하는 경우 nitrite량이 유의적으로 증가하였는데 이때 오디추출물을 1, 5, 10 ug/ml의 용량으로 처리하는 경우 역시 저농도에서 NO생성량을 감소시켰다. 정리해보면 뽕나무과 식물인 오디는 신경보호효과가 있는 것으로 사료되는데 이러한 효과는 아마도 오디의 항산화효과에 기인한 것으로 추정된다.

• Archives of Reconstructive Microsurgery
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• v.4 no.1
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• pp.58-64
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• 1995

The radial forearm flap was first designed at the Ba-Ba Chung Hospital of People's Republic of China in 1978. The flap consists of the skin of the volar surface of the forearm, the subcutaneous fat, the underlying fascia, and the intramuscular fascia which includes the radial vessels. It is very useful flap in soft tissue coverage of skin defects of the upper and lower extremities. The authors have reported 13 cases of forearm free flap treated in the Korea University Hospital from January 1991 to Jun 1995 with a review of literature. The results were as follows. 1. We had good results in soft tissue coverage for all patients 2. The average size of flaps was $54cm^2$ and the average ischemic time of flaps was 74minutes. 3. The postoprative complication was occurred in three of 13 cases, two of three cases were arterial thrombosis treated with thrombectomy in postoperative 2 days, and one case was venous thrombosis resulted in superficial necrosis of the flap treated with STSG. 4. Forearm free flap with sensory innervation is a good donor site for reconstruction of weight-bearing areas of heel and sole. 5 The forearm free flap is suitable for soft tissue coverage of the upper and lower extremities, and can be used by skillful microsurgeon with high success rate.

• Archives of Plastic Surgery
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• v.33 no.4
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• pp.407-412
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• 2006

Purpose: Various attempts of reconstruction for pharyngoesophageal defects after ablative surgery have been made to restore the function of the pharyngoesophagus. A fabricated tubed radial forearm free flap or free jejunal free flap was used when the width of remnant pharyngeal wall was less than 50% of the normal width. However there are many disadvantages such as stricture, saliva leakage and fistula formation on tubed radial forearm free flap. The jejunal free flap has the problem such as short pedicle, poor tolerance of ischemic time, wet voice and delayed transit of swallowed food due to the uncoordinated contraction. The authors studied the utility of patch-type radial forearm free flap using the remnant posterior pharyngeal wall of the hypopharynx. Methods: Retrospective reviews in Severance Hospital were made on 25 patients who underwent reconstruction surgery with patched radial forearm free flap because of the hypopharyngeal cancer between 1996 and 2005. The patients of Group I had the narrow posterior pharyngeal wall and its width was less than 3centimeters after the tumor was resected. Those of Group II had the partial pharyngectomy and the width of the remnant pharynx was larger than 3 centimeters. Results: Seven patients belonged to the group I and the flap of this group had 100% survival rate. One case of fistula and no swallowing discomfort due to stricture was reported. The Group II including 18 patients also had the 100% flap survival rate. Neither fistula nor stricture was seen but the lower diet grade was checked. Conclusion: The patch type radial forearm free flap using the remnant pharyngeal wall have the advantage of the radial forearm free flap, and furthermore this flap is the safe reconstructive method even if the width of the remnant pharyngeal wall is less than 30% of that of normal pharynx.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.645-652
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• 2008

Purpose: In skin flap surgery, surgeons often encounter distal ischemia of the flap. If a powerful free radical scavenger is used, it may reduce the formation of free radical and improves the survival of flap. Thus, the present study purposed to examine whether the survival of flap can be enhanced by administering melatonin, which is known to be a powerful free radical scavenger a antioxidant molecule. Methods: We divided 40 Sprague-Dawley rats into 4 groups, 10 in each group. For the control group(n=10), we intraperitoneally injected only carrier solution once 30 minutes before the operation, and once a day for 7 days from the day of operation. Among the experimental groups, a group(n=10) was administered with dimethyl sulfoxide(DMSO), in another group(n=10), melatonin was intraperitoneally injected, and in the other(n=10) melatonin was intraperitoneally injected and applied topically(2 cc of 1% melatonin) to the operation site. Caudally based skin flaps measuring $3{\times}10cm^2$ were elevated on the mid-dorsum of the rats. and then repositioned. On the seventh postoperative day, the survival area of the flap was measured and tissues were examined under the light microscope. Results: The control group, the DMSO group, the melatonin administration group and the melatonin administration and application group showed the mean survival rates of $55.26{\pm}9.2%$, $70.29{\pm}7.47%$, $81.45{\pm}4.14%$ and $86.1{\pm}1.52%$, respectively, for $30cm^2$ of flap. Compared to the control group, the experimental groups showed a significantly high increase in survival area at significance level of 95%. Conclusion: In this study, the survival rate of flap was enhanced through the administration of melatonin after flap surgery. This suggests that melatonin not only functions as a powerful free radical scavenger and oxygen radical scavenger but also stabilizes and protects cells, and by doing so, enhances the survival of moderately injured ischemic sites in the distal end of flap.

• The Journal of Internal Korean Medicine
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• v.21 no.1
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• pp.116-125
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• 2000

Objectives : The aim of this study is to investigate that Sunghyangjeongki-San which has been frequently medicated in the early stage of stroke can protect against ischemic damage in rat brain Methods : Extracellular levels of amino acids(glutamate, aspartate, GABA, glycine, taurine, tyrosine, alanine), organic acids(pyruvate, lactate), and cerebral infarction volume were measured at the striatum of rats subjected to permanant focal cerebral ischemia induced by 2 hours of middle cerebral artery occiusion(MCAO). Rats were orally administered with Sunghyangjeongki-San at 30mins before MCAO and the microdialysate was collected by intracerebral microdialysis three times before MCAO and six times after MCAO at 20mins interval and analyzed by HPLC. After a microdialysis study, the brain was sliced and stained with cresyl violet buffer for the measurement of cerebral infarcted area and volume by image analyzer system Results : The concentrations of glutamate, aspartate, and tyrosine known as excitatory neurotransmitters were significantly decreased in Sunghyangjeongki-San group compared with control group, The concentrations of GABA, glycine, taurine and alanine known as inhibitory neurotransmitters were significantly increased in Sunghyangjeongki-San group compared with control group. The concentrations of pyruvate and lactate showed little significant change in Sunghyangjeongki-San group compared with control group. The measurement of cerebral infarcted area and volume by image analyzer system were significantly decreased in Sunghyangjeongki-San group compared with control group. Conclusions : Sunghyangjeongki-San can affect on protecting against cerebral ischemia by regulating extracellular levels of excitatory and inhibitory amino acid neurotransmitters and improve the conditions of the patients in the early stage of stroke.