• 대한두개안면성형외과학회지
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• 제25권2호
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• pp.71-76
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• 2024

Background: The rising incidence of dialysis-dependent end-stage renal disease (ESRD) has underscored the need for collaboration between plastic surgeons and nephrologists, particularly concerning preoperative and postoperative management for facial reconstruction. This collaboration is essential due to a scarcity of comprehensive information in this domain. Methods: A study initiated in January 2015 involved 10 ESRD cases on dialysis undergoing Mohs micrographic surgery for facial skin cancer, followed by reconstructive surgery under general anesthesia. To ensure surgical safety, rigorous measures were enacted, encompassing laboratory testing, nephrology consultations, and preoperative dialysis admission. Throughout surgery, meticulous control was exercised over vital signs, electrolytes, bleeding risk, and pain management (excluding nonsteroidal anti-inflammatory drugs). Postoperative assessments included monitoring flap integrity, hematoma formation, infection, and cardiovascular risk through plasma creatinine levels. Results: Adherence to the proposed guidelines yielded a notable absence of postoperative wound complications. Postoperative plasma creatinine levels exhibited an average decrease of 1.10 mg/dL compared to preoperative levels, indicating improved renal function. Importantly, no cardiopulmonary complications or 30-day mortality were observed. In ESRD patients, creatinine levels decreased significantly postoperatively compared to the preoperative levels (p< 0.05), indicating favorable outcomes. Conclusion: The consistent application of guidelines for admission, anesthesia, and surgery yielded robust and stable outcomes across all patients. In particular, the findings support the importance of adjusting dialysis schedules. Despite the limited sample size in this study, these findings underscore the effectiveness of a collaborative and meticulous approach for plastic surgeons performing surgery on dialysis-dependent patients, ensuring successful outcomes.

• Journal of Chest Surgery
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• 제57권4호
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• pp.390-398
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• 2024

Background: In this study, we examined the impact of a patient blood management (PBM) program on red blood cell (RBC) transfusion practices in cardiothoracic surgery. Methods: The PBM program had 3 components: monitoring transfusions through an order communication system checklist, educating the medical team about PBM, and providing feedback to ordering physicians on the appropriateness of transfusion. The retrospective analysis examined changes in the hemoglobin levels triggering transfusion and the proportions of appropriate RBC transfusions before, during, and after PBM implementation. Further analysis was focused on patients undergoing cardiac surgery, with outcomes including 30-day mortality, durations of intensive care unit and hospital stays, and rates of pneumonia, sepsis, and wound complications. Results: The study included 2,802 patients admitted for cardiothoracic surgery. After the implementation of PBM, a significant decrease was observed in the hemoglobin threshold for RBC transfusion. This threshold dropped from 8.7 g/dL before PBM to 8.3 g/dL during the PBM education phase and 8.0 g/dL during the PBM feedback period. Additionally, the proportion of appropriate RBC transfusions increased markedly, from 23.9% before PBM to 34.9% and 58.2% during the education and feedback phases, respectively. Among the 381 patients who underwent cardiac surgery, a significant reduction was noted in the length of hospitalization over time (p<0.001). However, other clinical outcomes displayed no significant differences. Conclusion: PBM implementation effectively reduced the hemoglobin threshold for RBC transfusion and increased the rate of appropriate transfusion in cardiothoracic surgery. Although transfusion practices improved, clinical outcomes were comparable to those observed before PBM implementation.

• 한국의료질향상학회지
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• 제4권1호
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• pp.50-63
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• 1997

Background : A pressure sore was defined as any skin lesion caused by unrelieved pressure and resulting in damage to underlying tissue. The health care institutions in the United States were reported the incident rate of pressure sores ranging from 6 to 14 %. Intensive Care Unit needed highest quality of care has been found over 40% incidence rate of pressure sore. Also, Annual expenditures for the care of pressure sores in patients in the United States have been estimated to be $7.5 billion; furthermore, 50 percent more nursing time is required to care for patients with pressure sore in comparison to the time needed to implement preventive measures against pressure sore formation. However, In Korea, there were little reliable reports, or researches, about incidence rates of pressure sore in health care institution including intensive care unit and about the integrated approach like CQI action team for risk assessment, prevention and treatment of pressure ulcers. Therefore, this study was to develop pressure sore risk assessment tool and the protocol for prevention of pressure sore formation through CQI action team activities, to monitor incident rate of pressure sore and the length of sore formation for patients at high risk, and to approximately estimate nursing time for sore dressing during research period as the effect of CQI action team. Method : CQI action team in intensive care unit, launched since early 1996, reviewed the literature for the standardized risk assessment tool, developed the pressure sore assessment tool based on the Braden Scale, tested its validity, compared on statistics including incidence rate of pressure sore for patients at high risk. Throughout these activities, CQI action team was developed the protocol, called as St. Marys hospital Intensive Care Unit Pressure Sore Protocol, shifted the emphasis from wound treatment to wound prevention. After applied the protocol to patients at high risk, the incident rate and the period of prevention against pressure development were tested with those for patients who received care before implementation of protocol by Chi-square and Kaplan-Meier Method of Survival Analysis. Result : The CQI action team found that these was significant difference of in incidence rate of pressure sores between patients at high risk (control group) who received care before implementation of protocol and those (experimental group) who received it after implementation of protocol (p<.05). 25% possibility of pressure sore formation was shown for the patients with 6th hospital day in ICU in control group. In experimental group, the patients with 10th hospital day had 10% possibility of pressure sore. Therefore, there was significant difference(p<.05) in survival rate between two groups. Also, nursing time for dressing on pressure sore in experimental group was decreased as much as 50% of it in control group. Conclusion : The collaborative team effort led to reduced incidence, increased the length of prevention against pressure sore, and declined nursing care times for sore dressing. However, there have had several suggestions for future study. The preventive care system for pressure sore should be applied to patients at moderate, or low risk throughout continuous CQI team activities based on Bed Sore Indicator Fact Sheet. Hospital-wide supports, such as incentives, would be offered to participants for keeping strong commitment to CQI team. Also, Quality Information System monitoring incidents and estimating cost of poor quality, like workload (full time equivalence) or financial loss, regularly in a hospital has to be developed first for supporting CQI team activities as well as empowering hospital-wide QI implementation. Being several limitations, this study would be one of the report cards for the CQI team activities in intensive care unit of an acute hospital and a trial of quality improvement of health care in Korea.

• Archives of Plastic Surgery
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• 제44권6호
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• pp.482-489
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• 2017

Background Polydeoxyribonucleotide (PDRN) is known to have anti-inflammatory and angiogenic effects and to accelerate wound healing. The aim of this study was to investigate whether PDRN could improve peripheral tissue oxygenation and angiogenesis in diabetic foot ulcers. Methods This was a prospective randomized controlled clinical trial. Twenty patients with a non-healing diabetic foot ulcer were randomly distributed into a control group (n=10) and a PDRN group (n=10). Initial surgical debridement and secondary surgical procedures such as a split-thickness skin graft, primary closure, or local flap were performed. Between the initial surgical debridement and secondary surgical procedures, 0.9% normal saline (3 mL) or PDRN was injected for 2 weeks by the intramuscular (1 ampule, 3 mL, 5.625 mg, 5 days per week) and perilesional routes (1 ampule, 3 mL, 5.625 mg, 2 days per week). Transcutaneous oxygen tension ($TcPO_2$) was evaluated using the Periflux System 5000 with $TcPO_2/CO_2$ unit 5040 before the injections and on days 1, 3, 7, 14, and 28 after the start of the injections. A pathologic review (hematoxylin and eosin stain) of the debrided specimens was conducted by a pathologist, and vessel density (average number of vessels per visual field) was calculated. Results Compared with the control group, the PDRN-treated group showed improvements in peripheral tissue oxygenation on day 7 (P<0.01), day 14 (P<0.001), and day 28 (P<0.001). The pathologic review of the specimens from the PDRN group showed increased angiogenesis and improved inflammation compared with the control group. No statistically significant difference was found between the control group and the PDRN group in terms of vessel density (P=0.094). Complete healing was achieved in every patient. Conclusions In this study, PDRN improved peripheral tissue oxygenation. Moreover, PDRN is thought to be effective in improving inflammation and angiogenesis in diabetic foot ulcers.

• The Korean Journal of Physiology and Pharmacology
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• 제27권4호
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• pp.417-426
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• 2023

The TRPM4 gene encodes a Ca²⁺-activated monovalent cation channel called transient receptor potential melastatin 4 (TRPM4) that is expressed in various tissues. Dysregulation or abnormal expression of TRPM4 has been linked to a range of diseases. We introduced the hemagglutinin (HA) tag into the extracellular S6 loop of TRPM4, resulting in an HA-tagged version called TRPM4-HA. This TRPM4-HA was developed to investigate the purification, localization, and function of TRPM4 in different physiological and pathological conditions. TRPM4-HA was successfully expressed in the intact cell membrane and exhibited similar electrophysiological properties, such as the current-voltage relationship, rapid desensitization, and current size, compared to the wild-type TRPM4. The presence of the TRPM4 inhibitor 9-phenanthrol did not affect these properties. Furthermore, a wound-healing assay showed that TRPM4-HA induced cell proliferation and migration, similar to the native TRPM4. Co-expression of protein tyrosine phosphatase, non-receptor type 6 (PTPN6 or SHP1) with TRPM4-HA led to the translocation of TRPM4-HA to the cytosol. To investigate the interaction between PTPN6 and tyrosine residues of TRPM4 in enhancing channel activity, we generated four mutants in which tyrosine (Y) residues were substituted with phenylalanine (F) at the N-terminus of TRPM4. The YF mutants displayed properties and functions similar to TRPM4-HA, except for the Y256F mutant, which showed resistance to 9-phenanthrol, suggesting that Y256 may be involved in the binding site for 9-phenanthrol. Overall, the creation of HA-tagged TRPM4 provides researchers with a valuable tool to study the role of TRPM4 in different conditions and its potential interactions with other proteins, such as PTPN6.

• 미래기술융합논문지
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• 제3권2호
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• pp.25-31
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• 2024

최근 정보통신 기술로 인해 산업화되고 발달됨에 있어, 현대사회의 현대 여성들은 수많은 스트레스로 육체적, 정신적 건강에 노출되어 있다. 대중적으로 발생하는 염증들은 유산균이 감소되거나 잦은 항생제 복용 및 면역력 저하의 원인이 대표적이다. 도움이 되며 반영되는 제품 개발이 필요하다. 현재 시중에 소개되고 있는 이너케어젤은 유익균을 증가시키고 건강한 y존을 유지할수 있다. 이너 젤 속에는 하이드로젤 성분이 함유되어있다. 90%가 물로 이루어져 있고 그 외에 성분은 물을 지지하는 지지체로서의 역할을 수행하며, 고분자 사슬간의 가교결합을 통해 형성된다. HEC(hydroxyethyl cellulose)는 셀룰로오스의 하이드록시에칠에 텔이다. 사용목적은 결합제, 유화안정제, 점도증가제(수성), 피막형성제 역할을 한다. CA (crosslinker)는 가교제이며, 결합시켜주는 역할을 한다. 미용분야의 하이드로젤은 얇은 피막형성으로 피부를 부드럽게 감싸주는 피막형성제 역할을 하고, 다른 원료들이 분리되지 않도록 도움을 주는 유화안정제 역할을 한다. 또한, 화장품에 점성을 높여 점도를 개선시키는 점증제 역할을 한다. 또한, 바이오 분야에서는 포도당 감시, 간호관리, 세포이식 및 상처 치료에도 사용되어지고 있다. 현재로서는 기능성 하이드로젤을 이용한 제품은 나오지 않은 것으로 파악되어 있어 본 연구에서는 기능성 하이드로젤 항균성을 알아보기 위해 Y존 케어 하이드로젤 솔루션 제조를 수행하였으며 새로운 솔루션 개발을 목적으로 한다. 결과적으로 Y존에 적절한 Ph를 맞추었음을 확인하였고, PDB배지에 칸디다 알비칸균 배양 후 Y존 케어 하이드로젤솔루션 세가지 제품 모두 0.5~1.0mm의 항균력 효과를 보았다.

• Archives of Hand and Microsurgery
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• 제23권4호
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• pp.230-238
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• 2018

목적: 중수골 골절에서 시행되는 두 가지 수술 방법; 즉, 폐쇄적 정복술 및 평행핀 외고정술, 개방적 정복술 및 플레이트 내고정술 시행 이후 골절각의 변화를 수술 직후 및 추적 관찰하여 비교 분석하였다. 방법: 2008년 4월부터 2018년 1월까지 수부 단일 중수골 골절에 대해 수술적 처치를 받은 46명의 환자를 대상으로 후향적 연구를 진행하였다. 관절 외 중수골 골절에서 폐쇄적 정복술 및 가로 방향 평행 핀 외고정술(그룹 1) 또는 개방적 정복술 및 플레이트 내고정술(그룹 2)을 진행하고, 수술 전후 및 추시 후 수부 방사선 비스듬영상에서 골절각을 측정하여 분석하였다. 결과: 두 그룹 모두 정복술 진행 후 유의한 골절각 교정 결과를 보였다. 그룹 1의 경우 수술 후 3-4주에 능동적 운동을 시작하였으며, 골절각 재발 소견이 다소 나타났다(그룹 1: 수술 직후 골절각 $20^{\circ}{\pm}7^{\circ}$, 추시 후 골절각 $24^{\circ}{\pm}10^{\circ}$, p<0.05). 반면에 그룹 2는 수술 후 2주에 운동 진행 이후에도 정복된 상태를 지속적으로 유지하였다(그룹 2: 수술직후 골절각 $19^{\circ}{\pm}5^{\circ}$, 추시 후 골절각 $18^{\circ}{\pm}6^{\circ}$). 결론: 관절 외 단일 중수골 골절에서 폐쇄적 정복술 및 평행 핀 외고정술과 개방적 정복술 및 플레이트 내고정술 모두 골절에 의한 각형성을 유의하게 교정할 수 있는 유용한 수술 방법이다. 폐쇄적 정복술 및 평행 핀 외고정술 이후 3-4주에 손 운동을 시작할 경우 골절 부위에 과도한 운동 또는 외부 자극에 의한 저항이 가해지면 유합 진행을 악화시킬 수 있으므로 주의 깊은 경과 관찰을 요하며, 골절 상태에 따라 적절한 수술 방법을 계획해야 한다.