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Comparative Analysis of $\alpha$-STAT and pH-STAT Strategies During Deep Hypothermic Circulatory Arrest in the Young Pig (초저체온 순환정지시 $\alpha$-STAT와 pH-STAT 조절법의 비교분석 -어린돼지를 이용한 실험모델에서-)

  • Kim, Won-Gon;Lim, Cheong;Moon, Hyun-Jong;Won, Tae-Hee;Kim, Yong-Jin
    • Journal of Chest Surgery
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    • v.31 no.6
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    • pp.553-559
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    • 1998
  • Introduction: The most dramatic application of hypothermia in cardiac surgery is in deep hypothermic circulatory arrest(DHCA). Because man in natural circumstances is never exposed to this extreme hypothermic condition, one of the controversial aspects of clinical hypothermia is appropriate acid-base management($\alpha$-stat versus pH-stat). This study aims to compare $\alpha$-stat with pH-stat for: (1) brain cooling and re-warming speed during hypothermia induction and re-warming by cardiopulmonary bypass (CPB); (2) cerebral perfusion, metabolism, and their coupling; and (3) the extent of development of cerebral edema after circulatory arrest, in young pigs. Materials & Methods: Fourteen young pigs were assigned to one of two strategies of gas manipulation. Cerebral blood flow was measured with a cerebral venous outflow technique. After a median sternotomy, CPB was established. Core cooling was initiated and continued until nasopHaryngeal temperature fell below $20^{\circ}C$. The flow rate was set at 2,500 ml/min. Once their temperatures were below $20^{\circ}C$, the animals were subjected to DHCA for 40 mins. During cooling, acid-base balance was maintained according to either $\alpha$-STAT or pH-STAT strategies. After DHCA, the body was re-warmed to normal body temperature. The animals were then sacrificed, and their brains measured for edema. Cerebral perfusion and metabolism were measured before the onset of CPB, before cooling, before DHCA, 15 mins after re-warming, and upon completion of re-warming. Results & Conclusion: Cooling time was significantly shorter with $\alpha$-stat than with pH-stat strategy, while there were no significant differences in rewarming time between the two groups. Nosignificant differences were found in cerebral blood flow, metabolic rate, or flow/ metabolic rate ratio between two groups. Temperature-related differences were significant in cerebral blood flow, metabolic rate, and flow/metabolic rate ratio within each group. Brain water content showed no significant differences between two groups.

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The Effects of Obstructive Sleep Apnea Syndrome on Periodic Limb Movements in Sleep (폐쇄성 수면무호흡증이 주기성 사지운동증에 미치는 영향)

  • Seo, Cheon-Seok;Youn, Tak;Kim, Eui-Joong;Jeong, Do-Un
    • Sleep Medicine and Psychophysiology
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    • v.7 no.1
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    • pp.34-42
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    • 2000
  • Objectives: Periodic limb movements in sleep(PLMS) is a moderately prevalent disorder, of which pathophysiology remains largely unknown. PLMS has been reported to be common in patients with obstructive sleep apnea syndrome(OSAS), but reports on their relationship have been inconsistent in previous studies. Inconsistency of results may be attributable to insufficient number of the study subjects. We attempted to explore the influence of OSAS on PLMS in a large number of subjects. Methods: Three hundred and twenty subjects(M : F=192:128) with PLMS, as identified by the nocturnal polysomnography, were studied. Sample mean age was 53.1(SD=15.1) years and their mean periodic limb movement index(PLMI) is 25.2/hr (SD=24.8). PLMS subjects were divided into two groups, based on the presence or absence of OSAS. Periodic limb movement indices and sleep parameters between two groups were analyzed to evaluate the effects of OSAS on PLMS. Results: Each of PLMI and PLMI with arousal(PLMAI) correlated positively with age. PLMI of men was larger than that of women (p<0.01). The presence of comorbid OSAS independently had influence on PLMI(t=-2.20, p<0.05), but not PLMAI. There were no significant differences between the two groups in their PLMI, PLMAI and sleep parameters. However, the two groups differed in PLMI-correlated sleep parameters. In PLMS subjects with comorbid OSAS, PLMI was negatively correlated with each of slow wave sleep time and REM sleep time. In subjects without comorbid OSAS, PLMI was negatively correlated with sleep efficiency. Conclusion: PLMS patients with OSAS turned out to have increased PLMI than those without OSAS We suggest that OSAS patients may have subtle autonomic arousals and these arousals could, in part, express themselves as PLM.

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Effects of Nasal Continuous Positive Airway Pressure Application on Sympathetic Activation : Power Spectrum Analysis of Electrocardiogram in Obstructive Sleep Apnea Syndrome (폐쇄성 수면무호흡증에서 지속적 상기도 양압술 시행이 교감신경계 활성도에 끼치는 영향 : 심전도 스펙트럼 분석)

  • Youn, Tak;Park, Hae-Jeong;Kim, Eui-Joong;Jeong, Do-Un
    • Sleep Medicine and Psychophysiology
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    • v.7 no.1
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    • pp.43-50
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    • 2000
  • Objectives: Obstructive sleep apnea syndrome(OSAS) is known to be associated with the changes of autonomic nervous system (ANS). Nasal continuous positive airway pressure(nCPAP) treatment was found to correct abnormal ANS changes in OSAS but it remains to be further clarified. We aimed to assess the effects of nCPAP on ANS manifested on electrocardiogram, using spectrum analysis in the subjects with OSAS. Methods: Digital polysomnography was performed in 18 patients with OSAS(mean age $43.7{\pm}16.6$ years ; 17 males, 1 female ; mean respiratory disturbance index (RDI) $48.6{\pm}20.9$) for one baseline and another CPAP nights. From each night, 300 continuous beats of ECGs without artifact were chosen from both stage 2 sleep and REM sleep and they were used for power spectrum analysis. We compared between baseline and CPAP nights the heart rate variability including VLF(very low frequency power), LF (low frequency power), HF(high frequency power), R-R means, R-R variance, and LF/HF ratio, using Wilcoxon signed ranks test. Results: In all patients, nCPAP proved to be effective in relieving apneas and snoring. During nCPAP night compared with baseline night, decreases in VLF(p<0.05), LF(p<0.01), and R-R variance(p<0.05) were found in stage 2 sleep, and decreased LF(p<0.05) was found in REM sleep. No significant differences in each sleep stage were found in other variables between the two nights. Conclusion: Our findings suggest that OSAS increases the activity of sympathetic nervous system and nCPAP application effectively decreases the activity. And nCPAP does not appear to influence the parasympathetic nervous activity in OSAS.

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Perceived Stressor and Psychopathology during the Menstrual Cycle in High School Girls (여자 고등학생들의 월경주기에 따른 스트레스인자 지각 및 정신병리)

  • Koh, Kyung-Bong;Hyun, Tae-Young;Koo, Min-Seong
    • Korean Journal of Psychosomatic Medicine
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    • v.7 no.2
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    • pp.233-240
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    • 1999
  • The purpose of this study was to make a comparison in perceived stressor and psychopathology among premenstrual, menstrual and postmenstrual phases, in high school girls. Three hundred forty-one high school girls(164 academic school girls, 177 art school girls) participated in this study. Global assessment of recent stress(GARS) scale and symptom checklist-90-revised(SCL-90R) were used to measure perceived stressors and psychopathology. The scores of perceived stressor relevant to change in relationships were significantly higher during the premenstrual and the postmenstrual phases than during the menstrual phase. However, no significant differences were found in psychopathology among three mentstrual phases. Scores of perceived stressor relevant to change or no change in routine were significantly higher in academic school girls than in art school girls. The scores of obsessive-compulsion subscale and positive symptom total were significantly higher in academic school girls than in art school girls. In conclusion, a perceived stressor was higher during the premenstrual and the postmenstrual phases than during the menstrual phase in adolescents, but psychopathology was not related to the menstrual cycle. These results indicated that the psychopathology in adolescent girls might be influenced by other factors than menstrual cycle.

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Cancer Mortality and Morbidity Based on Secondary Data Analysis of Health Among Residents Around Waegwan, Gyeongsangbuk-do, Korea (건강관련 2차 자료에 근거한 왜관 지역주민의 암 발생 현황)

  • Lee, Kwan;Lim, Hyun-Sul;Min, Young-Sun;Lee, Duk-Hee;Ju, Young-Su;Yang, Won-Ho;Cho, Yong-Sung;Kim, Geun-Bae
    • Journal of Environmental Health Sciences
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    • v.39 no.4
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    • pp.335-345
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    • 2013
  • Objectives: As the suspicion was raised that 'Agent Orange' was reclaimed 30 years ago at Camp Carol, located in Waegwan, Gyeongsangbuk-do, the government conducted an investigation of the influence of environmental and health effects around Camp Carol through a public-private joint investigation team. As part of the investigation of population health effects, this study was carried out in order to observe changes and regional differences in diseases, particularly cancer, by year. Methods: We authors conducted an analysis of secondary health data, such as cancer registration data, mortality data, and health insurance data. We drew an age standardized incidence ratio (SIR), death rate (SDR), mortality ratio (SMR), and health care utilization rate using these data. Results: For gastric cancer in women, and other cancers in men, a significant increase in incidence was observed compared to the control area. For biliary tract cancer, gallbladder cancer, and thyroid cancer in women, and prostate cancer in men, a significant decrease in incidence was observed compared to the control area. In the national statistical analysis of data, such as health insurance data and mortality data, we did not observe a significant increase at the Waegwan region compared to other regions. Conclusions: We must consider the limitations of this study. Because thirty years have passed from the time of the estimated landfill of 'Agent Orange', recent national statistical data may not reflect the past real situation. Therefore, the monitoring of secondary data for health effects at the municipal level should be carried out continuously.

Balloon Dilatation of Bronchial Stenosis in Endobronchial Tuberculosis (기관지결핵에 의한 기도협착에서 풍선카테터를 이용한 기도확장요법)

  • Chung, Hee-Soon;Han, Sung-Koo;Shim, Young-Soo;Kim, Keun-Youl;Han, Yong-Chol;Kim, Woo-Sung;Im, Jung-Gi
    • Tuberculosis and Respiratory Diseases
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    • v.38 no.3
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    • pp.236-244
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    • 1991
  • The prevalence rate of pulmonary tuberculosis is 1.8% in 1990, and endobronchial tuberculosis may exist in 10 to 40% of active disease. Endobronchial tuberculosis usually leaves bronchial stenosis as the complication despite of modern chemotherapy, and it is often misdiagnosed as bronchial asthma. When bronchial stenosis involves major airway, its treatment needs such special measures as steroid therapy, surgical intervention and/or laser therapy, but the therapeutic result is often disappointing. To exploit a new treatment modality for bronchial stenosis, balloon dilatation was carried out in 12 patients with endobronchial tuberculosis. Under local anesthesia, 4F-Fogarty balloon was inserted via bronchofiberscope in ten cases and 10F-Gruentzig balloon was introduced under fluoroscopic guide in two others. Endobronchial tuberculoses were subdivided into two(16.7%) with actively caseating type, seven (58.3%) with fibrostenotic type, and three (25.0%) with stenotic type without fibrosis, according to the bronchoscopic findings. In 7 healed cases which were all stenotic with fibrosis, three (42.9%) took favorable turn in clinical status but four (57.1%) were not improved with balloon dilatation. In 5 active cases, all (two with actively-caseating type and three with stenotic type without fibrosis) were improved with this method. $FEV_{1.0}$ or FVC increased 10% or more after procedure in seven (70.0%) of ten and bronchial lumen remained enlarged in eight (66.7%) of twelve, in whom follow-up examination was done after the procedure. Balloon dilatation of bronchial stenosis is more effective, when endobronchial tuberculosis is in active stage than in healed fibrotic stage. It is suggested that bronchial stenosis can be minimized by early diagnosis and early application of balloon dilatation in the course of disease.

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Discharge Assessment Tool in Stroke and Elderly Patients: A Systematic Review (뇌졸중 및 노인 환자의 퇴원 평가도구에 대한 체계적 고찰)

  • Hwang, Na-Kyoung;Yoo, Eun-Young
    • Therapeutic Science for Rehabilitation
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    • v.9 no.3
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    • pp.7-21
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    • 2020
  • Objective : The aim of this systematic review is to analyze the assessment items and tools used for the discharge of stroke and elderly patients and to help select appropriate assessment tools for discharge planning. Methods : The studies included in this review were collected from the PubMed, Medline Complete (EBSCOhost), and Scopus databases from January 2009 to December 2018. A total 22 studies were selected. The research types, the areas and sub-areas of assessment, as well as the assessment tools according to the areas were analyzed. Results : Descriptive research (59.2%) was the most frequent type of research. The 12 main areas of assessment were medical condition, activities of daily living, swallowing function, sensation, mobility, cognition and perception, communication, emotion, home environment, patient knowledge and readiness for discharge, social support, and well-being. Among the assessment tools, the most frequently used tools were Bathel Index; Functional Independence Measure, to assess activities of daily living; Short-Form Health Survey, to assess well-being, and Timed Up and Go test, to assess mobility. Conclusion : This study will help select the assessment areas and tools to be considered at discharge of stroke patients and serve a basis for the development of comprehensive assessment tools for discharge planning.

Community care perceived by medical welfare service providers and residents dwelling in the community (보건의료복지 서비스제공자와 지역주민의 커뮤니티케어에 대한 인식)

  • Son, Miseon;Kim, Hyeongsu;Cho, Jonghee;Ko, Young;Kim, Miye
    • Journal of Convergence for Information Technology
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    • v.10 no.6
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    • pp.200-208
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    • 2020
  • The purpose of this study was to investigate and compare health, medical and welfare service providers' and local residents' perception on community care. The participants were 68 service providers and 95 local residents. The data were analyzed using independent t-test and chi-square test. The results showed that the degree of agreement of service providers on the need for policy, and visiting services were higher. Service providers' ability to link local residents with a need for care to community resources was higher, but in the activation of self-help group in community, local residents agreed more. In add budget of policy to health insurance, local residents agreed less. In perception on priority for community care policy, high priorities were preparation of financial resources and care culture. To effectively operate community care policy, it is necessary to establish a care culture through active exchanges for reducing differences in policy and opinions of recipients.

Association Between VDR Polymorphisms and Breast Cancer: An Updated and Comparative Meta-analysis of Crude and Adjusted Odd Ratios

  • Huang, Qian-Qian;Liao, Yu-Yi;Ye, Xiao-Hua;Fu, Jin-Jian;Chen, Si-Dong
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.2
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    • pp.847-853
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    • 2014
  • There is a lot of debate on the relationship between vitamin D receptor polymorphisms and risk of breast cancer. Herein, we quantitatively analyzed the published case-control studies on this relationship by meta-analysis, performing a bibliographic search from Pubmed and CNKI up to July 31, 2013. The included case-control studies for Fok1, Bsm1, Taq1, Apa1, Cdx2 and Poly-A were 16, 19, 20, 10, 4, 6, respectively. Crude and adjusted odd ratios and 95% confidence intervals were calculated to present and compare the strength of any associations. The results of combined analyses indicated that Fok1, Bsm1, Apa1, Cdx2 and Poly-A were not significantly associated with the risk of breast cancer. In contrast, the tt genotype of Taq1 was a modest risk factor for breast cancer development (tt vs. TT: OR = 1.21, 95% CI: 1.01-1.44). To further confirm the above results, adjusted effects for the six polymorphisms were pooled based on adjusted ORs reported in the original studies. Adjusted ORs of Fok1, Apa1, Cdx2 and Poly-A were similar to the crude ORs. However, Bsm1 and Taq1 showed inconsistent results. For Bsm1, OR for BB vs. bb was 0.85, 95% CI: 0.74-0.98; for Taq1, OR for tt vs. TT was 1.03, 95% CI: 0.92-1.15, and not associated with risk. Subgroup analyses for crude ORs showed some association between Bsm1, Taq1 and breast cancer in Caucasians only, but for adjusted ORs, no associations were found. This meta-analysis suggests that the roles that Fok1, Apa1, Cdx2 and Poly-A polymorphisms play in breast cancer risk are negligible, with Bsm1 and Taq1 as possible exceptions. To be conservative, we still assumed that they may play a modest role in determining breast cancer risk. Further studies are needed to validate our findings.

The Clinical Research of the Effectiveness of Pharmacopuncture Complex Therapy on Peripheral Facial Paralysis - Hominis Placenta Pharmacopuncture Therapy and Sweet Bee Venom Therapy - (말초성 안면신경마비에 대한 약침병행치료 효능의 임상적 고찰 - 자하거 약침과 Sweet Bee Venom을 중심으로 -)

  • Park, Jae-Heung;Jang, Sun-Hee;Lee, Chang-Hwan;Ku, Ji-Young;Jeun, Dae-Seong;Ahn, Chang-Beohm;Kim, Cheol-Hong;Song, Choon-Ho;Yoon, Hyun-Min
    • Journal of Acupuncture Research
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    • v.27 no.2
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    • pp.79-87
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    • 2010
  • Objectives : The aim of this study is to investigate the effect of Hominis Placenta pharmacopuncture therapy and sweet bee venom therapy on peripheral facial paralysis. Methods : Clinical studies were done 36 patients who were treated peripheral facial paralysis to Dept. of Acupuncture and Moxibusition, of Oriental Medicine Dong-Eui University from June 15, 2009 to January 5, 2010. Subjects were randomly divided into 2 groups. : Hominis Placenta Pharmacopuncture treated group (group A, n=18), sweet bee venom treated group (group B, n=18). In group A, we treated patients with dry needle acupuncture and Hominis Placenta pharmacopuncture therapy. In group B, we treated patients with dry needle acupuncture and sweet bee venom therapy. All process of treatment were performed by double blinding method. To investigate the effectiveness of treatment applied for two groups, we used Yanagihara's unweighed grading system at before treatment, after 1week, 2weeks, 3weeks and 4weeks of treatment. Results : The Yanagihara's scores of group B were higher than those of group A, but not statistically significant. The improvement indexs of group A and group B were different, but not statistically significant. Conclusions : There were no significant differences statistically between Hominis Placenta pharmacopuncture therapy and sweet bee venom therapy on peripheral facial paralysis.