• Journal of Chest Surgery
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• v.55 no.3
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• pp.197-205
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• 2022

Background: The integrated design of the HeartMate 3 (Abbott Laboratories, Chicago, IL, USA) affords flexibility to place the pump within the pericardium or thoracic cavity. We sought to determine whether the presence of a left ventricular assist device (LVAD) in either location has a meaningful impact on overall patient outcomes. Methods: A retrospective cohort study was conducted of all 165 patients who received a HeartMate 3 LVAD via a median sternotomy from November 2014 to August 2019 at our center. Based on operative reports and imaging, patients were divided into intrapleural (n=81) and intrapericardial (n=84) cohorts. The primary outcome of interest was in-hospital mortality, while secondary outcomes included postoperative complications, cumulative readmission incidence, and 3-year survival. Results: There were no significant between-group differences in baseline demographics, risk factors, or preoperative hemodynamics. The overall in-hospital mortality rate was 6%, with no significant difference between the cohorts (9% vs. 4%, p=0.20). There were no significant differences in the postoperative rates of right ventricular failure, kidney failure requiring hemodialysis, stroke, tracheostomy, or arrhythmias. Over 3 years, despite similar mortality rates, intrapleural patients had significantly more readmissions (n=180 vs. n=117, p<0.01) with the most common reason being infection (n=68/165), predominantly unrelated to the device. Intrapleural patients had significantly more infection-related readmissions, predominantly driven by non-ventricular assist device-related infections (p=0.02), with 41% of these due to respiratory infections compared with 28% of intrapericardial patients. Conclusion: Compared with intrapericardial placement, insertion of an intrapleural HM3 may be associated with a higher incidence of readmission, especially due to respiratory infection.

• Journal of Trauma and Injury
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• v.35 no.2
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• pp.123-127
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• 2022

Iatrogenic vascular injury (IVI) can occur with any technique or type of surgery performed around a blood vessel. Patients with severe trauma are at risk of IVI. In this study, we describe our experiences of IVI in the trauma field. We reviewed five patients who were diagnosed with an IVI and received either surgical or endovascular treatment. Of the five patients, one had an arterial injury, three had venous injuries, and one had an arteriovenous fistula, a form of combined arterial and venous injuries. Of the five patients, four had undergone orthopedic surgery. The IVIs of three patients were immediately identified in the operating room and simultaneous vascular repair was performed. The remaining one patient underwent additional surgery for occlusion related to entrapment of the superficial femoral artery by a surgical wire used during orthopedic surgery. Complications presumably related to the IVI were identified in two patients. IVI in trauma patients can be successfully managed, but significant morbidity can occur. If an IVI is suspected, immediate evaluation and management are required.

• Korean Circulation Journal
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• v.53 no.6
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• pp.406-417
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• 2023

Background and Objectives: Pathophysiological changes of right ventricle (RV) after repair of tetralogy of Fallot (TOF) are coupled with a highly compliant low-pressure pulmonary artery (PA) system. This study aimed to determine whether pulmonary vascular function was associated with RV parameters and exercise capacity, and its impact on RV remodeling after pulmonary valve replacement. Methods: In a total of 48 patients over 18 years of age with repaired TOF, pulmonary arterial elastance (Ea), RV volume data, and RV-PA coupling ratio were calculated and analyzed in relation to exercise capacity. Results: Patients with a low Ea showed a more severe pulmonary regurgitation volume index, greater RV end-diastolic volume index, and greater effective RV stroke volume (p=0.039, p=0.013, and p=0.011, respectively). Patients with a high Ea had lower exercise capacity than those with a low Ea (peak oxygen consumption [peak VO₂] rate: 25.8±7.7 vs. 34.3±5.5 mL/kg/min, respectively, p=0.003), while peak VO₂ was inversely correlated with Ea and mean PA pressure (p=0.004 and p=0.004, respectively). In the univariate analysis, a higher preoperative RV end-diastolic volume index and RV end-systolic volume index, left ventricular end-systolic volume index, and higher RV-PA coupling ratio were risk factors for suboptimal outcomes. Preoperative RV volume and RV-PA coupling ratio reflecting the adaptive PA system response are important factors in optimal postoperative results. Conclusions: We found that PA vascular dysfunction, presenting as elevated Ea in TOF, may contribute to exercise intolerance. However, Ea was inversely correlated with pulmonary regurgitation (PR) severity, which may prevent PR, RV dilatation, and left ventricular dilatation in the absence of significant pulmonary stenosis.

• Korean Journal of Community Nutrition
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• v.6 no.1
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• pp.51-68
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• 2001

This investigation studied the relationship between Body Mass Index(BMI) and dietary intake, levels of serum lipid, lipoprotein(a) and plasminogen activator inhibitor-1(PAI-1) of 28.449 Korean adults(16.937 men, 11.542 women) from 1995 to 1999. The dietary assessment was conducted using 24-hour dietary records and food frequency questionnaires. During this five year study, the BMI normal-weight group, as a percentage of the annual test population, decreased from 68.0% to 60.2%, while the BMI overweight and obese groups collectively increased from 25.0% to 29.7%. The levels of serum total cholesterol (TC), LDL-cholesterol(LDL-C), Triacylglycerol(TG) and PAI-1 increased as the values of BMI increased, while the levels of HDL-cholesterol(HDL-C) and lipoprotein(a)(men only) appeared to decrease as values of BMI increased. The levels of daily energy intake also increased as values of BMI increased in both men and women. The obese group had significantly higher levels of carbohydrate, protein, fat(men only), and cholesterol intake than those of the normal-weight, underweight, and overweight groups. In men, BMI positively correlated with the levels of macronutrients and cholesterol intake(p＜0.001), % energy of protein, fat, and alcohol intake(p＜0.001), and the levels of serum TC, LDL-C, TG and PAI-1(p＜0.001), while BMI negatively correlated with % energy of carbohydrate intake, and the levels of Lp(a) and HDL-C(p＜0.001). In women, BMI negatively correlated with level of cholesterol(p＜0.01), fat(p＜0.001), alcohol intake(p＜0.05),% energy of fat (p＜0.001), % energy of alcohol intake and level of and HDL-C(p＜0.001). Subjects who had serum TC, LDL-C, HDL-C, and TG levels greater than the standard reference values(TC＞240mg/㎗, LDL-C＞130mg/㎗, HDL-C＞35, TG＞200mg/㎗) exhibited a higher intake of the three macronutrients, iron, calcium, meat, milk and fatty foods than those subjects who had serum lipid concentrations less-than-or-equal-to the standard reference values. Overall, there was positive correlation between the high risk factors of vascular disease variables, dietary intake, and BMI. Prevalence of hypertension and high blood sugar were increased as BMI increased, but the prevalence of hypertension is decreased as the year goes by. These findings showed that dietary intake, level of serum lipids and other vascular disease risk factors increased as BIM increased. Therefore, middle or upper class Korean adults who have high BMI should improve their eating habits. This involve reducing alcohol, animal fat, high carbohydrate foods, and overall food intake, and balancing intake in order to lower vascular disease risk factors, including obesity.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.4
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• pp.1413-1418
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• 2012

Background: Previous studies generally indicate that synchronous bilateral breast cancers (SBBC) have an equivalent or moderately poorer survival compared with unilateral cases. The prognostic characteristics of SBBC would be relevant when planning adjuvant therapies and follow-up medical surveillance. The frequency of SBBC among early breast cancers in clinical settings in Australia and New Zealand was investigated, plus their prognostic significance, using the Breast Cancer Audit Database of the Society of Breast Surgeons of Australia and New Zealand, which covered an estimated 60% of early invasive lesions in those countries. Design: Rate ratios (95% confidence limits) of SBBC were investigated among 35,370 female breast cancer cases by age of woman, histology type, grade, tumour diameter, nodal status, lymphatic/vascular invasion and oestrogen receptor status. Univariate and multivariable disease-specific survival analyses were undertaken. Results: 2.3% of cases were found to be SBBC (i.e., diagnoses occurring within 3 months). The figure increased from 1.4% in women less than 40 years to 4.1% in those aged 80 years or more. Disease-specific survivals did not vary by SBBC status (p=0.206). After adjusting for age, histology type, diameter, grade, nodal status, lymphatic/vascular invasion, and oestrogen receptor status, the relative risk of breast cancer death for SBBC was 1.17 (95% CL: 0.91, 1.51). After adjusting for favourable prognostic factors more common in SBBC cases (i.e., histology type, grade, lymphatic/vascular invasion, and oestrogen receptor status), the relative risk of breast cancer death for SBBC was 1.42 (95% CL: 1.10, 1.82). After adjusting for unfavourable prognostic factors more common in SBBC cases (i.e., older age and large tumour diameter), the relative risk of breast cancer death for SBBC was 0.98 (95% CL: 0.76, 1.26). Conclusions: Results confirm previous findings of an equivalent or moderately poorer survival for SBBC but indicate that SBBC status is likely to be an important prognostic indicator for some cases.

• Journal of Korean Academy of Nursing
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• v.30 no.3
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• pp.741-749
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• 2000

This study was performed to investigate the relationship between reversed circadian blood pressure and risk factors of peripheral vascular disease in non-insulin-dependent diabetes mellitus (NIDDM) subjects. The subjects in this study were 18 NIDDM patients who were hospitalized in a medical unit of an university medical center located in Incheon, Korea, between November, 1998 and March, 1999. Blood pressure was measured with a mercury sphygmomanometer by 2 trained examiners every 2 hours during 24 hours. NIDDM subjects were divided into a dipper group and non-dipper group. Dippers are defined as those who show a mean nighttime blood pressure(BP) drop of more than 10% compared with daytime BP. Non-dippers are defined as those who show a mean nighttime BP drop of less than 10%, or an elevation in BP compared with daytime BP. Daytime BP included values obtained between 6 a.m. and 10 p.m. Night time BP included values obtained between 10 p.m. and 6 a.m. Data was analyzed by SPSS/PC package. Chi-square( $^2$) test was used for the comparison of sex between The dipper group and non-dipper group. Mann-Whitney test was used for comparisons of values of the risk factors of peripheral vascular disease and the frequency of complications of diabetes between the dipper group and non-dipper group. The results are as follows. There were no significant differences in daytime systolic, diastolic, and mean blood pressures between the dipper group and non-dipper group. However, night time systolic, diastolic, and mean blood pressures in the non-dipper group were significantly nigher than those in the dipper group (p=.021). There were no differences in sex, age, body, weight, duration of diabetes, serum lipid levels, BUN and HbA1c between the two groups. On the contrary, 87.5% of non-dipper group subjects showed having hypertension, 30% of dipper group subjects showed having hypertension and this difference was statistically significant (p=.018). All of the non-dipper group subjects (N=8) showed having at least one diabetic complication. However, 40% of the dipper group subjects (N=10) showed having no diabetic complication at all and this difference was also statistically significant (p=.049). There were no significant differences in frequency of nephropathy, neuropathy and retinopathy between the dipper group and non-dipper group.

• Journal of the Korean Society of Radiology
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• v.13 no.6
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• pp.873-878
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• 2019

Cerebrovascular disease is one of the three major causes of death in Korea. Since these diseases are associated with atherosclerosis, the diagnosis of atherosclerotic factors should be presented. In this study, we evaluated the relationship between brachial-ankle arterial pulse wave velocity, cerebral artery vascular stenosis, blood pressure, obesity, and abdominal obesity by age group. The significance of cerebral artery stenosis and age group. The risk factors of atherosclerosis, such as blood pressure, obesity, and abdominal obesity, were significant in all age groups. When the pulse wave velocity of the brachial-ankle artery was increased, the cerebral artery stenosis was distributed in 57.3% of the total test subjects. If the arterial stiffness is suspected during the measurement of the pulse wave velocity of the brachial ankle artery, We recommend suspected vascular stenosis and perform a cerebral artery angiography. It is suggested that the data will be used as a baseline data for similar studies after evaluating the significance of blood pressure, obesity, and abdominal obesity as risk factors of atherosclerosis.

• The Journal of Internal Korean Medicine
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• v.28 no.4
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• pp.850-862
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• 2007

Background : Cerebrovascular disease is a major cause of death and disability in adults. Silent cerebral infarction (SCI) portends more severe cerebral infarction or may lead to insidious progressive brain damage resulting in vascular dementia. Known cardiovascular risk factors, such as arterial hypertension, diabetes mellitus, smoking, hyperlipidemia and ischemic heart disease may increase the risk of SCI. This study was designed to evaluate the risk factors of SCI in an apparently normal adult population. Methods : We divided 340 neurologically normal adults (mean age=59.90$\pm$8.30, men:women = 146:194) who underwent brain computed tomography (CT) or magnetic resonance imaging (MRI) at the Stroke Medical Center in Daejeon University Oriental Medicine Hospital in two groups, Silent inf. and Controls,and analyzed risk factors of SCI by interview, physical examination and blood test. Risk factors of SCI were assessed by interview, physical examination and blood test. We performed Pearson's chi-square test and two-sample t-test for univariate analysis and multiple logistic regressions for multivariate analysis to evaluate risk factors of SCI. Results : Old age, diabetes mellitus, and high lactate dehydrogenase (LDH) levels were associated with SCI on univariate analysis. Diabetes mellitus was demonstrated to be an independent risk factor for SCI on multivariate analysis. Conclusions : Advanced age, diabetes mellitus, and LDH levels are associated with SCI.

• Korean Journal of Adult Nursing
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• v.21 no.5
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• pp.477-488
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• 2009

Purpose: This study was conducted to identify the clinical characteristics and risk factors on the occurrence of variant angina, and to examine the predicting factors on the vascular endothelial dysfunction of the patients with variant angina. Methods: A total of 134 patients diagnosed with variant angina were recruited from 2006 to 2008. The degrees of endothelial dysfunction were measured and recorded by the researcher using the values of flow-mediated vasodilation of their brachial arteries and Nitroglycerine-mediated dilation. Subjects' demographic data and risk factors were gathered after obtaining informed consent, and their electronic medical records were reviewed to collect laboratory data. Results: The mean age was $54.2{\pm}9.6$ years and 52% was male patients. More than 50% of the male patients were cigarette smokers and had hypercholesterolemia. 84% of the male patients and 70% of the female patients had more than one risk factor of cardiovascular disease. A stepwise multiple regression analysis showed that smoking and hypercholesterolemia predicted the decrease of flow-mediated vasodilation (Adjusted $R^2$ = .204, p < .001). Conclusion: Tailored educational interventions for smoking cessation and cholesterol management are needed to prevent recurrence of angina attack for patients with variant angina and to prevent cardiovascular disease for middle-aged workers.

• Journal of Preventive Medicine and Public Health
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• v.53 no.1
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• pp.56-63
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• 2020

Objectives: The objective of this study was to determine the effect of atrial fibrillation (AF) on the risk of dementia in the Korean elderly. Methods: A 10-year retrospective cohort study was conducted using the National Health Insurance Service-Senior Cohort database. We excluded those who were under 65 years of age as of January 2006 (n=46 113), those who were diagnosed with dementia between 2002 and 2005 (n=9086), and those with a history of stroke prior to AF diagnosis (n=8392). We used a Cox proportional hazards model with a time-varying covariate to determine whether AF is associated with the risk of dementia after adjusting for potential confounders. Results: In univariable Cox regression, the hazard ratio (HR) of dementia according to AF status was 1.28 (95% confidence interval [CI], 1.23 to 1.33). After adjusting for potential confounders, AF was found to increase the risk of dementia (HR, 1.12; 95% CI, 1.07 to 1.17), Alzheimer dementia (HR, 1.12; 95% CI, 1.07 to 1.17), and vascular dementia (HR, 1.10; 95% CI, 1.03 to 1.18). In patients diagnosed with AF, the incidence of dementia was lower (HR, 0.50; 95% CI, 0.47 to 0.52) in patients who were treated with oral anticoagulants. Conclusions: Investigating the potential risk factors of dementia in an aged society is important. We found a slightly higher risk of dementia in those with AF than in those without AF, and we therefore concluded that AF is a potential risk factor for dementia.