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Early Diagnosis and Treatment Strategies of Obesity Hypoventilation Syndrome (비만성 저환기 증후군의 조기 진단 및 치료 전략)

  • Hwan Hee Kim;Sang Haak Lee;Sei Won Kim
    • Sleep Medicine and Psychophysiology
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    • v.29 no.1
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    • pp.4-8
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    • 2022
  • Obesity hypoventilation syndrome (OHS) is defined as the triad of obesity (body mass index, [BMI] ≥ 30 kg/m2), daytime hypercapnia (PaCO2 ≥ 45 mm Hg), and sleep breathing disorder, after excluding other causes for hypoventilation. As the obese population increases worldwide, the prevalence of OHS is also on the rise. Patients with OHS have poor quality of life, high risk of frequent hospitalization and increased cardiopulmonary mortality. However, most patients with OHS remain undiagnosed and untreated. The diagnosis typically occurs during the 5th and 6th decades of life and frequently first diagnosed in emergency rooms as a result of acute-on-chronic hypercapnic respiratory failure. Due to the high mortality rate in patients with OHS who do not receive treatment or have developed respiratory failure, early recognition and effective treatment is essential for improving outcomes. Positive airway pressure (PAP) therapy including continuous PAP (CPAP) or noninvasive ventilation (NIV) is the primary management option for OHS. Changes in lifestyle, rehabilitation program, weight loss and bariatric surgery should be also considered.

Hemodynamic effects of Chunwangbosim-dan - A 3-dimensional radial pulse tonometry device study (3차원 맥영상 검사로 살펴본 천왕보심단이 심혈관계에 미치는 영향)

  • HeeJung KANG;YoungSang KUN;Tae Hun KU;Gyeung Cheul KIM
    • Journal of Convergence Korean Medicine
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    • v.6 no.1
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    • pp.5-20
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    • 2024
  • Objectives: This study was aimed to evaluate the hemodynamic feasibility using pulse parameters as a way to establish safe dose guidelines for Chunwangbosim-dan, and to provide a foundation for developing evidence-based guidelines for clinical use. Methods: Forty-one volunteers were recruited to participate in a study examining the changes in pulse wave characteristics following the ingestion of Chunwangbosim-dan, over a period of 2 weeks, and pulse wave measurements were taken before and after the administration. Pulse wave parameters were measured in this study using a 3-dimensional radial pulse tonometry device(DMP-Lifeplus). In addition, questionnaire, blood pressure, temperature, and body composition were also measured as secondary measures. Results: Fifteen minutes after administration of Chunwangbosim-dan, the non-adverse event group(non-AE) exhibited a statistically significant increase in several power and pressure-related parameters, including h1, h3, h4, h5, SA, PA and PW, while the adverse event group(AE) showed a trend of decreasing stroke volume and increasing Systemic Vascular Resistance Index(SVRI) and applied pressure. After 2 weeks of administration, non-adverse event group(non-AE) exhibited significant changes in standard deviation of pulse rate and HRV_LH ratio. Notably, there are significant differences between AE group and non-AE group in h4/h1, w/t, applied pressure, SV and pulse rate. Conclusion: These findings suggest that pulse parameters may be a useful way to establish safe dosing guidelines for Chunwangbosim-dan. Further research is needed to confirm these results and to develop evidence-based guidelines for clinical use.

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Stiffness of the Central Corpus Cavernosum on Shear-Wave Elastography Is Inversely Correlated with the Penile Rigidity Score in Patients with Erectile Dysfunction

  • Joo Yong Lee;Dae Chul Jung;Seungsoo Lee;Nam Gyu Kang;Young Taik Oh;Kyunghwa Han
    • The World Journal of Men's Health
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    • v.39 no.1
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    • pp.123-130
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    • 2021
  • Purpose: To perform real-time quantitative measurements of penile rigidity for patients with erectile dysfunction (ED) using shear-wave elastography (SWE). Materials and Methods: A total of 92 patients with clinically diagnosed ED filled out an abridged five-item version of the International Index of Erectile Function (IIEF-5) questionnaire and underwent SWE as well as penile color Doppler ultrasound (CDUS) after intracavernosal injection for penile erection. Elasticity measurements were repeated on two sites of the corpus cavernosum (central and peripheral elasticity of corpus cavernosum [ECC]) and the glans penis during the erection phase. Correlations between penile elasticity and rigidity scores or IIEF-5 were evaluated statistically. Penile elasticity was also compared with the ED types based on CDUS. Results: The mean age of all patients was 53.5±13.4 years, and the mean IIEF-5 score was 9.78±5.01. The rigidity score and central ECC value demonstrated a significant correlation (r=-0.272; 95% confidence interval: -0.464 to -0.056; p=0.015). The IIEF-5 score was not significantly correlated with penile elasticity. Vascular ED patients showed significantly higher central ECC values than nonvascular ED patients (p<0.001). At a cut-off value of 8.05 kPa, the central ECC had a specificity of 41.5%, a sensitivity of 84.6%, and an area under the ROC curve of 0.720 with a standard error of 0.059 (p=0.019) for predicting vascular ED. Conclusions: Quantitatively measuring Young's modulus of the corpus cavernosum using SWE could be an objective technique for assessing penile erectile rigidity and the vascular subtype in patients with ED.

Chemical Composition, Functional Constituents, and Antioxidant Activities of Berry Fruits Produced in Korea (국내 재배 베리류의 화학 조성 및 기능성 성분과 항산화 활성)

  • Lee, Yongcheol;Lee, Jib-Ho;Kim, Sung-Dan;Chang, Min-Su;Jo, In-Soon;Kim, Si-Jeong;Hwang, Keum Taek;Jo, Han-Bin;Kim, Jung-Hun
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.44 no.9
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    • pp.1295-1303
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    • 2015
  • Berry fruits are rich in phytochemicals, including polyphenols, anthocyanins, phenolic acids, and organic acids, which are known to have beneficial effects on health. The aim of this study was to investigate chemical composition, functional constituents, and antioxidant activities of mulberry, black raspberry, raspberry, and blueberry cultivated in Korea. Acidity of the four berries ranged from 0.26% to 1.10%, and pH ranged from 3.3 to 5.2. Total mineral contents of the four berries ranged from 92.9 to 256.0 mg/100 g. Among the berries, mulberry contained the most abundant total free sugars, and glucose and fructose were the major sugars in the berries. Mulberry contained more than three times as much ${\gamma}-aminobutyric$ acid as the content of the other berries. Blueberry contained more free phenolic acid than the other berries. Especially, chlorogenic acids were the major free phenolic acids in blueberry. Black raspberry had the highest amount of polyphenols, anthocyanins, and flavonoids among the berries and showed the highest antioxidant activity.

Improvement and Validation of Convective Rainfall Rate Retrieved from Visible and Infrared Image Bands of the COMS Satellite (COMS 위성의 가시 및 적외 영상 채널로부터 복원된 대류운의 강우강도 향상과 검증)

  • Moon, Yun Seob;Lee, Kangyeol
    • Journal of the Korean earth science society
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    • v.37 no.7
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    • pp.420-433
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    • 2016
  • The purpose of this study is to improve the calibration matrixes of 2-D and 3-D convective rainfall rates (CRR) using the brightness temperature of the infrared $10.8{\mu}m$ channel (IR), the difference of brightness temperatures between infrared $10.8{\mu}m$ and vapor $6.7{\mu}m$ channels (IR-WV), and the normalized reflectance of the visible channel (VIS) from the COMS satellite and rainfall rate from the weather radar for the period of 75 rainy days from April 22, 2011 to October 22, 2011 in Korea. Especially, the rainfall rate data of the weather radar are used to validate the new 2-D and 3-DCRR calibration matrixes suitable for the Korean peninsula for the period of 24 rainy days in 2011. The 2D and 3D calibration matrixes provide the basic and maximum CRR values ($mm\;h^{-1}$) by multiplying the rain probability matrix, which is calculated by using the number of rainy and no-rainy pixels with associated 2-D (IR, IR-WV) and 3-D (IR, IR-WV, VIS) matrixes, by the mean and maximum rainfall rate matrixes, respectively, which is calculated by dividing the accumulated rainfall rate by the number of rainy pixels and by the product of the maximum rain rate for the calibration period by the number of rain occurrences. Finally, new 2-D and 3-D CRR calibration matrixes are obtained experimentally from the regression analysis of both basic and maximum rainfall rate matrixes. As a result, an area of rainfall rate more than 10 mm/h is magnified in the new ones as well as CRR is shown in lower class ranges in matrixes between IR brightness temperature and IR-WV brightness temperature difference than the existing ones. Accuracy and categorical statistics are computed for the data of CRR events occurred during the given period. The mean error (ME), mean absolute error (MAE), and root mean squire error (RMSE) in new 2-D and 3-D CRR calibrations led to smaller than in the existing ones, where false alarm ratio had decreased, probability of detection had increased a bit, and critical success index scores had improved. To take into account the strong rainfall rate in the weather events such as thunderstorms and typhoon, a moisture correction factor is corrected. This factor is defined as the product of the total precipitable waterby the relative humidity (PW RH), a mean value between surface and 500 hPa level, obtained from a numerical model or the COMS retrieval data. In this study, when the IR cloud top brightness temperature is lower than 210 K and the relative humidity is greater than 40%, the moisture correction factor is empirically scaled from 1.0 to 2.0 basing on PW RH values. Consequently, in applying to this factor in new 2D and 2D CRR calibrations, the ME, MAE, and RMSE are smaller than the new ones.

Kinetics of the Reaction of Carbon Dioxide with AMP and Piperazine (AMP에 Piperazine을 첨가한 CO2 흡수 동역학)

  • Jang, Sang-Yong;Song, Ju-Seouk;Cho, Sang-Won;Oh, Kwang-Joong
    • Journal of Korean Society of Environmental Engineers
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    • v.22 no.3
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    • pp.485-494
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    • 2000
  • According to the worldwide interest in controlling $CO_2$ which contributes to green house effect. new techniques of reducing $CO_2$ are under development. We have developed new technique for reducing $CO_2$. In low $CO_2$ concentration. the chemical absorption method is useful. In this study. the kinetics of the reaction between $CO_2$ and the sterically hindered amine solution with piperazine. have been investigated from measurements of the rate of absorption of $CO_2$ in the stirred vessel that has a horizontal liquid-gas interface, in the temperature range $30{\sim}70^{\circ}C$. The experiments were carried out in the range 10.130~20.260 kPa of partial pressure of $CO_2$, and in aqueous $2.0kmol/m^3$ AMP solution with $0{\sim}0.4kmol/m^3$ piperazine The experimental results are as follows: 1) The absorption rate of $CO_2$ into aqueous AMP + piperazine solution is gett ng faster than that of aqueous AMP absorbents with temperature. Because the activation energy of piperazine 57.147 kJ/mol is higher than that of AMP 41.7kJ/mol. therefore the effect of piperazine on absorption rate increases with temperature. 2) Compared with aqueous AMP solution. the absorption rate of $CO_2$ into AMP + piperazine solution increases from 6.33% at $30^{\circ}C$ to 12% at $70^{\circ}C$, so AMP + piperazine solution is thought to be a better than AMP solution, 3) The reaction rate constants of piprazine in aqueous AMP solution with $CO_2$ have been determined as 217.21, 420.46, 707.00 and $3162.167m^3/kmol{\cdot}s$ respectively at 30, 40, 50 and $70^{\circ}C$ but these results are higher than those of Xu which were 186.7. 367.32. 693.01. $2207.65m^3/kmol{\cdot}s$ at 30, 40, 55, $70^{\circ}C$in aqueous MDEA solution. So the regression analysis of the data has led to the following equation In $k_p$ =28.324-6934.7/T.

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Efficacy of Low-dose Hydrocortisone Infusion for Patients with Severe Community-acquired Pneumonia Who Invasive Mechanical Ventilation (기계 환기가 요구된 중증 지역사회 획득 폐렴에서 저용량 하이드로코르티손 주입의 효과)

  • Kim, Ho Cheol;Lee, Seung Jun;Ham, Hyoun Seok;Cho, Yu Ji;Jeong, Yi Yeong;Lee, Jong Deok;Hwang, Young Sil
    • Tuberculosis and Respiratory Diseases
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    • v.60 no.4
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    • pp.419-425
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    • 2006
  • Background : Severe community-acquired pneumonia (CAP) can develop into respiratory failure that requires mechanical ventilation (MV), which is associated with a higher rate of mortality. It was recently reported that a hydrocortisone infusion in severe CAP patients was associated with a significant reduction in the length of the hospital stay and mortality. This study evaluated efficacy of a hydrocortisone infusion for patients with severe CAP requiring MV. Methods : From February 2005 to July 2005, 13 patients (M : F = 10 : 3, mean age: $68.6{\pm}14.1years$), who were diagnosed with severe CAP and required MV, were enrolled in this study. Hydrocortisone was administered as an intravenous 200mg loading bolus, which was followed by an infusion at a rate of 10mg/hour for 7 days. The control group was comprised of patients with severe CAP requiring MV but in whom corticosteroid was not used before study period. The clinical and physiologic parameters on or by day 8 and the outcome in the hydrocortisone infusion group were compared with those in the control group. Results : 1) There was no significant difference in age, gender ratio, SAPS II, SOFA score, temperature, leukocyte count, PaO2/FiO2 (P/F) ratio, the number of patients with P/F ratio < 200, chest radiograph score, lung injury score and catecholamine-dependent septic shock between the hydrocortisone infusion group and control group at day 1. 2) At day 8, the proportion of patients with an improvement in the P/F ratio ${\geq}100$ and the chest radiograph score was significantly higher in the hydrocortisone infusion group than in the control group (61.5% vs. 15.4%, 76.9% vs. 23.1%, p< 0.05). However, there was no significant difference in the other clinical and physiologic parameters. 3). There was no significant difference in the duration of the MV, ICU stay, hospital stay and 10th and 30th day mortality between the two groups. Conclusion : Hydrocortisone infusion for patients with severe CAP requiring invasive mechanical ventilation may be effective in improving the level of oxygenation and the chest radiograph score.

Thrombolytic Therapy for Thrombosis of Prosthetic Mitral Valve - A Case Report - (인공 승모판막에 생긴 혈전의 혈전용해 치료 - 1례 보고 -)

  • Kang, Shin-Kwang;Kim, Si-Wook;Won, Tae-Hee;Ku, Kwan-Woo;Na, Myung-Hoon;Yu, Jae-Hyun;Lim, Seung-Pyung;Lee, Young;Jeong, Jin-Ok
    • Journal of Chest Surgery
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    • v.35 no.11
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    • pp.826-830
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    • 2002
  • Prosthetic valve thrombosis(PVT) may be a life-threatening complication requiring prompt intervention. This is a case report of thrombolytic therapy for thrombosis of prosthetic mitral valve. A 47 year-old male admitted to the emergency room for abrupt onset of dyspnea. He had undergone mitral valve replacement(On-Ⅹ valve, 29mm) for mitral stenosis 8 months ago. The patient's international normalized ratio(INR) on admission was 1.09. The mechanical clicks were muffled and rales were heard in both lung fields. A transesophageal echocardiography(TEE) revealed prosthetic valve thrombosis with increased transvalvular pressure gradient(34 mmHg). The patient's condition needed to intubation for mechanical ventilation due to hemodynamic compromise, however his wife and relatives refused the surgical intervention due to financial problems. The patient was transferred to the cardiac care unit and we decided to perform thrombolytic therapy. A bolus of 1,500,000 IU of urokinase was given, followed by a drip of 1,500,000 IU for 1 hour. The patient did not improved hemodynamically; therefore, we gave 100 mg of tissue plasminogen activator(t-PA) for over 2 hours. During that time mechanical clicks were audible and hemodynamics of the patient improved progressively. A TEE showed disappearance of thrombus and decreased pressure gradient(1.7 mmHg) after 6 hours of thrombolytic therapy. The patient was recovered without any neurologic sequale and was discharged with administration of warfarin.

Direct Intratumoral Injection of Ethanol in the Patients with Obstruction of Major Bronchus (주기관지 폐색환자에서 종양내 ETHANOL 주입치료 효과)

  • Lee, Bong-Chun;Yum, Ho-Kee;Choi, Soo-Jeon;Kim, Dong-Soon
    • Tuberculosis and Respiratory Diseases
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    • v.40 no.5
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    • pp.495-500
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    • 1993
  • Background: For the relief of the occlusion of major bronchi, laser therapy, radiation therapy or combined therapy is generally used. But the effect of radiation therapy is very slow and not consistent and laser therapy requires expensive equipments and technical expertise with occasional serious side effects. Direct ethanol injection has been widely used for the control of bleeding in gastrointestinal lesion, esophageal varices or renal cell carcinoma with good results. So we tried direct injection of ethanol into the tumor to relieve the obstruction of major bronchus in 11 patients. Method: All procedures were done under the fiberoptic bronchoscopy with continuous oxygen supplement and aliquoted 0.5-1.0 ml of absolute ethanol directly into the tumor through the endobronchial aspiration needle. The tumor was endoscopically removed with a biopsy forceps immediately after ethanol injection. The whole procedure was repeated 3-4 days interval until the lumen opens. Usually after 2-3 trials of ethanol injection, the lumen opened up. Results: The immediate effect of ethanol injection was whitening of the mucosa and prompt cessation of bleeding. The late effect was necrosis of the tumor. The final results of this procedure were improvement of symptoms and reexpnasion of the lung in all patients. $FEV_{1.0}$ and FVC were improved and $PaO_2$ was increased from $68.1{\pm}9.2$ mmHg to $83.9{\pm}8.1$ mmHg, $SaO_2$: from $94{\pm}8.5%$ to $96.6{\pm}1.1%$, and $AaDO_2$ was reduced from $26.5{\pm}8.5$ mmHg to $10.9{\pm}9.1$ mmHg. Conclusion: Direct ethanol injection into the tumor tissue is a rapid, cheap and relatively safe method of relieving the complete occlusion of major bronchus.

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Establishment of Featal Heart Surgery with an Improvement of the Placental Blood Flow in Cardiopulmonary Bypass Using Fetal Lamb Model (양태아를 이용한 심폐우회술에서의 태반혈류개선을 통한 태아심장수술의 기반기술 확립)

  • 이정렬;박천수;임홍국;배은정;안규리
    • Journal of Chest Surgery
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    • v.37 no.1
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    • pp.11-18
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    • 2004
  • Background: We tested the effect of indomethacine and total spinal anesthesia on the improvement of placental flow during cardiopulmonary bypass on fetal lamb. Material and Method: Twenty fetuses at 120 to 150 days of gestation were subjected to bypass via trans-sternal approach with a 12 G pulmonary arterial cannula and 14 to 18 F venous cannula for 30 minutes. All ewes received general anesthesia with ketamine. In all the fetuses, no anesthetic agents were used except muscle relaxant. Ten served as a control group in which placenta was worked as an oxygenator during bypass (Control group). The remainder worked as an experimental group in which pretreatment with indomethacine and total spinal anesthesia was performed before bypass with the same extracorporeal circulation technique as control group (Experimental group). Observations were made every 10 minutes during a 30-minute bypass and 30-minute post bypass period. Result: Weights of the fetuses ranged from 2.2 to 5.2 kg. In Control group, means of arterial pressure decreased from 44.7 to 14.4 mmHg and means of Pa$CO_2$ increased from 61.9 to 129.6 mmHg at each time points during bypass. Flow rate was suboptimal (74.3 to 97.0 $m\ell$/kg/min) during bypass. All hearts fibrillated immediately after the discontinuation of bypass. On the contrary, in Experimental group, means of arterial pressure reamined higher (45.8 to 30 mmHg) during bypass (p<0.05). Means of Pa$CO_2$ were less ranging from 59.8 to 79.4 mmHg during bypass (P<0.05). Flow rates were higher (78.8 to 120.2 $m\ell$/kg/min) during bypass (p<0.05). There were slower deterioration of cardiac function after cessation of bypass. Conclusion: In this study, we demonstrated that the placental flow was increased during fetal cardiopulmonary bypass in the group pretreated with indomethacine and total spinal anesthesia. However, further studies with modifications of the bypass including a creation of more concise bypass circuit, and a use of axial pump are mandatory for the clinical application.