• Title/Summary/Keyword: Survival Probability

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Mechanical versus Bioprosthetic Aortic Valve Replacement in Patients Aged 50 to 70 Years

  • Youngkwan Song;Ki Tae Kim;Soo Jin Park;Hong Rae Kim;Jae Suk Yoo;Pil Je Kang;Sung-Ho Jung;Cheol Hyun Chung;Joon Bum Kim;Ho Jin Kim
    • Journal of Chest Surgery
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    • v.57 no.3
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    • pp.242-251
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    • 2024
  • Background: This study compared the outcomes of surgical aortic valve replacement (AVR) in patients aged 50 to 70 years based on the type of prosthetic valve used. Methods: We compared patients who underwent mechanical AVR to those who underwent bioprosthetic AVR at our institution between January 2000 and March 2019. Competing risk analysis and the inverse probability of treatment weighting (IPTW) method based on propensity score were employed for comparisons. Results: A total of 1,580 patients (984 patients with mechanical AVR; 596 patients with bioprosthetic AVR) were enrolled. There was no significant difference in early mortality between the mechanical AVR and bioprosthetic AVR groups (0.9% vs. 1.7%, p=0.177). After IPTW adjustment, the risk of all-cause mortality was significantly higher in the bioprosthetic AVR group than in the mechanical AVR group (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.07-1.80; p=0.014). Competing risk analysis revealed lower risks of stroke (sub-distributional hazard ratio [sHR], 0.44; 95% CI, 0.28-0.67; p<0.001) and anticoagulation-related bleeding (sHR, 0.35; 95% CI, 0.23-0.53; p<0.001) in the bioprosthetic AVR group. Conversely, the risk of aortic valve (AV) reintervention was higher in the bioprosthetic AVR group (sHR, 6.14; 95% CI, 3.17-11.93; p<0.001). Conclusion: Among patients aged 50 to 70 years who underwent surgical AVR, those receiving mechanical valves showed better survival than those with bioprosthetic valves. The mechanical AVR group exhibited a higher risk of stroke and anticoagulation-related bleeding, while the bioprosthetic AVR group showed a higher risk of AV reintervention.

Inhibition of Graft Versus Host Disease Using CD4+CD25+ T Cells Induced with Interleukin-2 in Mismatched Allogeneic Murine Hematopoietic Stem Cell Transplantation (주조직적합항원이 불일치하는 마우스 동종 조혈모세포이식에서 IL-2로 유도된 CD4+CD25+ T세포를 이용한 이식편대숙주병의 억제)

  • Hyun, Jae Ho;Jeong, Dae Chul;Chung, Nak Gyun;Park, Soo Jeong;Min, Woo Sung;Kim, Tai Gyu;Choi, Byung Ock;Kim, Won Il;Han, Chi Wha;Kim, Hack Ki
    • IMMUNE NETWORK
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    • v.3 no.4
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    • pp.287-294
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    • 2003
  • Background: In kidney transplantation, donor specific transfusion may induce tolerance as a result of some immune regulatory cells against the graft. In organ transplantation, the immune state arises from a relationship between the immunocompromised graft and the immunocompetent host. However, a reverse immunological situation exists between the graft and the host in hematopoietic stem cell transplantation (HSCT). In addition, early IL-2 injections after an allogeneic murine HSCT have been shown to prevent lethal graft versus host disease (GVHD) due to CD4+ cells. We investigated the induction of the regulatory CD4+CD25+ cells after a transfusion of irradiated recipient cells with IL-2 into a donor. Methods: The splenocytes (SP) were obtained from 6 week-old BALB/c mice ($H-2^d$) and irradiated as a single cell suspension. The donor mice (C3H/He, $H-2^k$) received $5{\times}10^6$ irradiated SP, and 5,000 IU IL-2 injected intraperitoneally on the day prior to HSCT. The CD4+CD25+ cell populations in SP treated C3H/He were analyzed. In order to determine the in vivo effect of CD4+CD25+ cells, the lethally irradiated BALB/c were transplanted with $1{\times}10^7$ donor BM and $5{\times}10^6$ CD4+CD25+ cells. The other recipient mice received either $1{\times}10^7$ donor BM with $5{\times}10^6$ CD4+ CD25- cells or the untreated SP. The survival and GVHD was assessed daily by a clinical scoring system. Results: In the MLR assay, BALB/c SP was used as a stimulator with C3H/He SP, as a responder, with or without treatment. The inhibition of proliferation was $30.0{\pm}13%$ compared to the control. In addition, the MLR with either the CD4+CD25+ or CD4+CD25- cells, which were isolated by MidiMacs, from the C3H/He SP treated with the recipient SP and IL-2 was evaluated. The donor SP treated with the recipient cells and IL-2 contained more CD4+CD25+ cells ($5.4{\pm}1.5%$) than the untreated mice SP ($1.4{\pm}0.3%$)(P<0.01). There was a profound inhibition in the CD4+CD25+ cells ($61.1{\pm}6.1%$), but a marked proliferation in the CD4+CD25- cells ($129.8{\pm}65.2%$). Mice in the CD4+CD25+ group showed low GVHD scores and a slow progression from the post-HSCT day 4 to day 9, but those in the control and CD4+CD25- groups had a high score and rapid progression (P<0.001). The probability of survival was 83.3% in the CD4+CD25+ group until post-HSC day 35 and all mice in the control and CD4+CD25- groups died on post-HSCT day 8 or 9 (P=0.0105). Conclusion: Donor graft engineering with irradiated recipient SP and IL-2 (recipient specific transfusion) can induce abundant regulatory CD4+CD25+ cells to prevent GVHD.

Which of Baby Boom Generation Can Get the Benefit of Extension of the Retirement Age Obligation? (베이비붐세대와 정년연장 혜택의 귀착)

  • Seok, Jae Eun;Yi, Gi Joo
    • Korean Journal of Social Welfare
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    • v.68 no.2
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    • pp.107-130
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    • 2016
  • This study is aimed at the exploratory research on the influence of the obligation of extension of the retirement age on the baby boom generation. The basic question of this study is about which of the baby boom generation can get how much benefit according as the extension of the retirement age becomes compulsory. The extension of the retirement age is the system that can be applied to regular full-time workers. Accordingly, this study is intending to analyze the characteristics of the workers having a high likelihood for benefits from extension of the retirement age by tracing the economic activity state and labor history of the baby boomers. For this purpose, this study looked into the change of the economic activity state by age cohort of the male baby boomers based on the data for the Korea Labor Panel's 4th(2001) & 17th(2014)year. Using Survival analysis, this study also analyzed who will continue to remain as a regular full-time wage earner. As the result of the analysis, it was found that the more the cohort ages of baby boomers increased, the smaller the probability of remaining as a regular full-time wage earner, and the group who can get benefits from extension of the retirement age was predicted to account for only 11.4% level among the baby boomers. In addition, the result showed that there was a high likelihood of getting more benefits from extension of the retirement age when the baby boomers worked for the government-invested institution, corporate bodies, and government organizations rather than working for private enterprises. Thus, it can be safely said that there might appear a generational conflict due to extension of the retirement age in that such jobs coincide with the ones favored by the rising generation.

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Twenty-year Experience of Mitral Valve Replacement with the St. Jude Medical Mechanical Valve Prosthesis (St. Jude 기계 판막을 이용한 승모판막 치환술의 20년 장기성적)

  • Seo Yeon-Ho;Kim Kong-Soo;Jo Jung-Ku
    • Journal of Chest Surgery
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    • v.39 no.7 s.264
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    • pp.527-533
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    • 2006
  • Background: A retrospective study was conducted to analyze the results of St. Jude Medical mitral valve replacement at the Chonbuk National University Hospital since the initial implant in May 1984. Material and Method: Between May of 1984 and December of 1996, 95 patients underwent MVR with the St. Jude Medical mechanical valve prosthesis at Department of Medical Science of Chonbuk National University Hospital and follow-up ended in May of 2004. Result: Age ranged from 19 to 69 years. Follow-up (mean${\pm}$standard deviation) averaged $10.6{\pm}4.2\;year$. Thirty-day operative mortality was 4.2% (4/95). Nine late deaths have occurred and actuarial survival was $90.5{\pm}3.0%,\;87.9{\pm}3.4%\;and\;83.2{\pm}4.6%$ at 5, 10 and 20 years, respectively. Probability of freedom from valve-rotated death was $95.5{\pm}2.1%,\;94.3{\pm}2.4%\;and\;91.0{\pm}3.9%$ at 5, 10 and 20 years, respectively. Seven patients have sustained thromboembolic events (1,05%/patient-year). Fifteen patients had anticoagulation related hemorrhage (3.56%/patient-year). There was no structural valve deterioration. Probability of freedom from all complications was $82.0{\pm}3.9%,\;71.3{\pm}4.8%\;and\;42.4{\pm}10.5%$ at 5, 10 and 20 years, respectively. Conclusion: We confirm the effective and excellent durability of the St. Jude Medical prosthesis in the mitral position with a low event rate at long-term follow-up. It also demonstrates the commonly encountered practical difficulty of adjusting the anti-coagulation protocol in patients with prosthetic mitral valves.

Reproduction Cycle and Litter Size of Red-tongued viper snake (Gloydius ussuriensis) (쇠살모사의 생식주기와 한배의 출산수)

  • Kim, Byoung-Soo;Oh, Hong-Shik
    • Korean Journal of Environment and Ecology
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    • v.28 no.5
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    • pp.531-541
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    • 2014
  • This research investigated the reproduction cycle, litter size, and the effects of factors of red-tongue viper snake inhabiting in Jeju Island, to delve into their life strategy. Field survey was conducted in Jeju Island from May 2006 to November 2008. Reproduction cycle was analyzed through measurements of testis and follicle sizes in laboratory from March 2009 to December 2010. According to the research results, the sizes of red-tongue viper snake's testis and follicle clearly changed seasonally. The number of eggs within the oviduct were greater on the right side ($2.6{\pm}1.0$ eggs, n=16) than on the left side ($1.8{\pm}0.5$ eggs, n=16) (t=-2,721, p<0.05). Average (${\pm}SD$) of survival litter size (SLS) was $4.4{\pm}1.7$ (1~9, range), while total litter size (TLS) was $4.7{\pm}1.5$ (3~9, range), which were not statistically significant. However, their litter sizes were similar to the number of eggs within the oviduct (t=0.039, P>0.05). Relative litter mass (RCM) was $0.42{\pm}0.13$ (0.18~0.79, n=33), and tended to increase, as maternal condition of pre-parturition (MCPPI) was getting better. The sexual ratio of delivered litters showed no significant difference between male and female red-tongue viper snakes (♂:♀ = 1.15:1, n=73 ; ${\chi}^2$=0.342, P>0.5). Average neonate mass showed a weak correlation with maternal mass of pre-parturition (MMPP1) (r=0.387, P<0.05, n=33). Average neonate Snout-vent length (SVL) also demonstrated a weak correlations with maternal SVL (r=0.399, P<0.05, n=33) and MMPP1 (r=0.344, P<0.05, n=33). Average neonate mass and maternal SVL approached significant probability (r=0.323, P=0.067, n=33). This indicates that mother snakes can bear bigger litter due to its larger size. In some cases, litter's weight decreases as mother snakes are bearing more litter; however, the red-tongued viper snake did not show such exchange relationship. From this, it can be conjectured that a red-tongued viper snake has peculiarity of its own species. The research results are predicted to be used as the basis to find a life history of red-tongued viper snake.

Determinants of IPO Failure Risk and Price Response in Kosdaq (코스닥 상장 시 실패위험 결정요인과 주가반응에 관한 연구)

  • Oh, Sung-Bae;Nam, Sam-Hyun;Yi, Hwa-Deuk
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.5 no.4
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    • pp.1-34
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    • 2010
  • Recently, failure rates of Kosdaq IPO firms are increasing and their survival rates tend to be very low, and when these firms do fail, often times backed by a number of governmental financial supports, they may inflict severe financial damage to investors, let alone economy as a whole. To ensure investors' confidence in Kosdaq and foster promising and healthy businesses, it is necessary to precisely assess their intrinsic values and survivability. This study investigates what contributed to the failure of IPO firms and analyzed how these elements are factored into corresponding firms' stock returns. Failure risks are assessed at the time of IPO. This paper considers factors reflecting IPO characteristics, a firm's underwriter prestige, auditor's quality, IPO offer price, firm's age, and IPO proceeds. The study further went on to examine how, if at all, these failure risks involved during IPO led to post-IPO stock prices. Sample firms used in this study include 98 Kosdaq firms that have failed and 569 healthy firms that are classified into the same business categories, and Logit models are used in estimate the probability of failure. Empirical results indicate that auditor's quality, IPO offer price, firm's age, and IPO proceeds shown significant relevance to failure risks at the time of IPO. Of other variables, firm's size and ROA, previously deemed significantly related to failure risks, in fact do not show significant relevance to those risks, whereas financial leverage does. This illustrates the efficacy of a model that appropriately reflects the attributes of IPO firms. Also, even though R&D expenditures were believed to be value relevant by previous studies, this study reveals that R&D is not a significant factor related to failure risks. In examing the relation between failure risks and stock prices, this study finds that failure risks are negatively related to 1 or 2 year size-adjusted abnormal returns after IPO. The results of this study may provide useful knowledge for government regulatory officials in contemplating pertinent policy and for credit analysts in their proper evaluation of a firm's credit standing.

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Evaluation of Scattered Dose to the Contralateral Breast by Separating Effect of Medial Tangential Field and Lateral Tangential Field: A Comparison of Common Primary Breast Irradiation Techniques (유방암 접선조사 치료 방법에 대한 반대쪽 유방에서의 산란선량 평가)

  • Ban, Tae-Joon;Jeon, Soo-Dong;Kwak, Jung-Won;Baek, Geum-Mun
    • The Journal of Korean Society for Radiation Therapy
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    • v.24 no.2
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    • pp.183-188
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    • 2012
  • Purpose: The concern of improving the quality of life and reducing side effects related to cancer treatment has been a subject of interest in recent years with advances in cancer treatment techniques and increasing survival time. This study is an analysis of differing scattered dose to the contralateral breast using common different treatment techniques. Materials and Methods: Eclipse 10.0 (Varian, USA) based $30^{\circ}$ EDW (Enhanced dynamic wedge) plan, $15^{\circ}$ wedge plan, $30^{\circ}$ wedge plan, Open beam plan, FiF (field in field) plan were established using CT image of breast phantom which in our hospital. Each treatment plan were designed to exposure 400 cGy using CL-6EX (VARIAN, USA) and we measured scattered dose at 1 cm, 3 cm, 5 cm, 9 cm away from medial side of the phantom at 1 cm depth using ionization chamber (FC 65G, IBA). We carried out measurement by separating effect of medial tangential field and lateral tangential field and analyze. Results: The evaluation of scattered dose to contralateral breast, $30^{\circ}$ EDW plan, $15^{\circ}$ wedge plan, $30^{\circ}$ wedge plan, Open beam plan, FIF plan showed 6.55%, 4.72%, 2.79%, 2.33%, 1.87% about prescription dose of each treatment plan. The result of scattered dose measurement by separating effect of medial tangential field and lateral tangential field results were 4.94%, 3.33%, 1.55%, 1.17%, 0.77% about prescription dose at medial tangential field and 1.61%, 1.40%, 1.24%, 1.16%, 1.10% at lateral tangential field along with measured distance. Conclusion: In our experiment, FiF treatment technique generates minimum of scattered dose to contralateral breast which come from mainly phantom scatter factor. Whereas $30^{\circ}$ wedge plan generates maximum of scattered doses to contralateral breast and 3.3% of them was scattered from gantry head. The description of treatment planning system showed a loss of precision for a relatively low scatter dose region. Scattered dose out of Treatment radiation field is relatively lower than prescription dose but, in decision of radiation therapy, it cannot be ignored that doses to contralateral breast are related with probability of secondary cancer.

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Coronary Artery Bypass Grafting in Elderly Patients Older Than 75 Years (75세 이상 고령환자의 관상동맥우회로술)

  • Yoo Dong Gon;Kim Chong Wook;Park Chong Bin;Choo Suk Jung;Lee Jae Won;Song Meong Gun;Song Hyun
    • Journal of Chest Surgery
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    • v.38 no.2 s.247
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    • pp.123-131
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    • 2005
  • Background: The number of elderly patients undergoing coronary artery bypass grafting (CABG) is increasing. Elderly patients are at increased risk for a variety of perioperative complications and mortality. We identified determinants of operative complications and mortality in elderly patients undergoing CABG. Material and Method: Between January 1995 and July 2003, 91 patients older than 75 years underwent isolated CABG at Asan Medical Center. There were 67 men and 24 women with mean age of $77.0\pm2.4$ years. Thirty clinical or hemodynamic variables hypothesized as predictors of operative mortality were evaluated. Result: CABG was performed under emergency conditions in 5 patients. The internal thoracic artery was used in 85 patients and 10 patients received both internal thoracic arteries. The mean number of distal anastomosis was 3.7 per patient. Operative mortality was $3.3\%$. Twenty-two patients had at least one major postoperative complication. Low cardiac output syndrome was the most common complication, followed by reoperation for bleeding, pulmonary dysfunction, perioperative myocardial infarction, stroke, acute renal failure, ventricular arrhythmia, upper gastrointestinal bleeding, infection, and delayed sternal closure. None were the predictors of mortality. Renal failure, peripheral vascular disease, emergency operation, recent myocardial infarction, congestive heart failure, New York Heart Association (HYHA) class III or IV, Canadian Cardiovascular Society (CCS) angina scale III or IV, and low left ventricle ejection fraction below $40\%$ were univariate predictors of overall complications. Actuarial probability of survival was $94.9\%,\;89.8\%,\;and\;83.5\%$ at postoperative 1, 3 and 5 years respectively. During the follow-up period $93.3\%$ of patients were in NYHA class I, or II and $91.1\%$ were free from angina. Conclusion: Although operative complication is increased, CABG can be performed with an acceptable operative mortality and excellent late results in patients older than 75 years.

Experimental Transplantation for the Restoration of Seagrass, Zostera marina L. Bed Around Sinyangseopji Beach in Bangdu Bay, Jeju Island (제주 신양섭지해수욕장 주변 방두만 거머리말 군락 복원을 위한 실험적 이식)

  • LEE, HYUNG WOO;KANG, JEONG CHAN;PARK, JUNG-IM;KIM, MYUNG SOOK
    • The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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    • v.26 no.4
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    • pp.343-355
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    • 2021
  • Eelgrass, Zostera marina L., was widely distributed around Sinyangseopji Beach in Bangdu Bay, on the eastern coast of Jeju Island, until breakwater construction in the late 1990s resulted in its complete loss. Six experimental sites were identified for restoration of the Z. marina bed in Bangdu Bay. Using the staple method, 500 Z. marina shoots were transplanted at each site in January 2019 and 2020. The transplants, along with environmental parameters, were monitored for 10 months following transplantation. There were significant differences in underwater irradiance, water temperature, and salinity among the sites, but all were suitable for Z. marina growth. The Ulva species, an opportunistic alga, appeared in spring and accumulated during summer at all sites; however, there was no significant effect of Ulva species on the survival and growth of the eelgrass transplants. Most of the transplanted Z. marina survived, and after 3 months, the density increased by 112.5-300% due to vegetative propagation, with a rapid rate of increase observed during spring and early summer at all sites. For 1-2 months after transplanting, the Z. marina shoots showed signs of transplant shock, after which the shoot density increased at all sites, confirming that all transplants adapted well to the new environment. However, in both 2019 and 2020, during late summer to early fall, the sites experienced heavy damage from typoons (twice in 2019 and three times in 2020) that hit Bangdu Bay. The transplants at two sites located in the center of Bangdu Bay were completely destroyed, but those at three sites located to the west of the bay showed a 192-312% increase in density. Thus, we confirmed that the Bangdu Bay Z. marina bed can be restored, with the highest probability of success for Z. marina restoration on the western side of Bangdu Bay, which is protected from typhoons.