• Annals of Surgical Treatment and Research
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• 제95권6호
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• pp.324-332
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• 2018

Purpose: We present our experience involving the management of this disease, identifying prognostic factors affecting treatment outcomes. Methods: The patients treated for Fournier gangrene at our institution were retrospectively reviewed. Data collected included demographics, extent of soft tissue necrosis, predisposing factors, etiological factors, laboratory values, and treatment outcomes. The severity index and score were calculated. Multivariate regression analysis was used to determine the association between potential predictors and clinical outcomes. Results: A total of 41 patients (male:female = 33:8) were studied. The mean age was 54.4 years (range, 24-79 years). The most common predisposing factor was diabetes mellitus (n = 19, 46.3%). Sixteen patients (39.0%) were current smokers. Seven patients had chronic kidney disease. The most frequent etiology was urogenital lesion (41.5%). The mortality rate was 22.0% (n = 9). Multivariate regression analyses showed that extension of necrosis beyond perineal/inguinal area and pre-existing chronic kidney disease were significant and independent predictors of mortality. Extension of necrosis beyond perineal/inguinal area was a significant predictor of increased duration in the intensive care unit and hospital stay. In addition, pre-existing chronic kidney disease was a significant predictor of flap reconstruction in the wound. Conclusion: Fournier gangrene with extensive soft tissue necrosis and pre-existing chronic kidney disease was associated with poor prognosis and complexity of patient management. Early recognition of dissemination and premorbid renal function is essential to reduce mortality and establish a management plan for this disease.

• Journal of Animal Science and Technology
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• 제55권5호
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• pp.483-488
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• 2013

본 연구에서는 환경친화적 사축퇴비화 기술을 개발할 목적으로 부자재의 종류별 사축퇴비화 특성을 파악하였다. 부자재로는 사축발생 현장에서 쉽게 구할 수 있는 퇴비, 돈분, 톱밥, 왕겨를 대상으로 실험하였으며 다공성관을 이용한 자연통기형 방법을 고안하여 사용하였다. 실험실 규모의 사축퇴비화 시스템은 100 mm 스티로폼을 이용하여 제작 (W36 ${\times}$ L60 ${\times}$ H26 cm) 하였으며 자연송풍은 바닥을 통해 이루어지도록 고안하였다. 모든 실험은 4처리 (퇴비, 돈분+퇴비, 톱밥, 왕겨) 3반복으로 수행하였으며 퇴비화기간은 40일이었다. 사축퇴비화 과정중의 침출수 발생패턴과 양을 보면 퇴비와 톱밥을 부자재로 사용한 경우에는 침출수가 전혀 발생하지 않았던 반면 돈분+퇴비 및 왕겨를 부자재로 이용한 경우에는 침출수가 발생하였다. 침출수 발생은 퇴비화 초기에 집중되었으며 배출된 침출수의 양은 돈분+퇴비의 경우 18ml/kg-mortality, 왕겨의 경우에는 8.2ml/kg-mortality 이었다. 침출수로 배출되는 오염물질의 양은 왕겨를 부자재로 사용 시 사체 kg당 1.91mg의 $NH_4$-N와 2.22 mg의 TOCs가 발생하였고, 퇴비와 분뇨를 혼합하여 부자재로 사용할 때에는 사체 kg 당 38.65 mg의 $NH_4$-N와 0.70mg의 TOCs가 발생하였다. 고안된 퇴비화 시스템에서의 악취발생 정도를 알기 위해 사축퇴비화 과정 중의 DMDS 발생을 조사한 결과 사축분해 정도와 관계없이 평균적으로 매우 낮은 발생을 보였는데 이는 상층에 위치한 완숙퇴비가 바이오필터의 역할을 담당했기 때문으로 판단되었다. 사축분해율은 퇴비, 돈분+퇴비, 톱밥, 왕겨구에서 각각 25.3, 25.8, 13.5, 14.5% 수준으로 퇴비 및 돈분+퇴비구의 사축분해율이 톱밥이나 왕겨구에 비해 유의적으로 높았다 (p<0.05). 또한 퇴비나 돈분을 혼합하여 부자재로 이용한 처리구에서만 $55^{\circ}C$ 이상으로 충분한 열이 발생하여 1주일 정도 유지된 것으로 나타나 부자재를 단독으로 사용하는 것은 생물학적 안정성측면에서 바람직하지 않은 것으로 판단되었다.

• IMMUNE NETWORK
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• 제8권2호
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• pp.39-45
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• 2008

Background: Down regulation of major histocompatibility complex class II transactivator (CIITA) has been identified as a major factor of immunosuppression in sepsis and the level of CIITA expression inversely correlates with the degree of severity. However, it has not been fully elucidated whether the lower expression of CIITA is a cause of disease process or a just associated sign. Here we determined whether the CIITA deficiency decreased survival rate using murine sepsis model. Methods: Major histocompatibility complex class II (MHC-II) deficient, CIITA deficient and wild type B6 mice were subjected to cecal ligation puncture (CLP) surgery. CIITA and recombination activation gene (RAG)-1 double deficient mice were generated to test the role of lymphocytes in CIITA-associated sepsis progression. Results: Sepsis mortality was enhanced in CIITA deficient mice, not by impaired bacterial clearance resulted from CD4 T cell depletion, but hyper-inflammatory response such as excessive release of a pro-inflammatory cytokine, high-mobility group box 1 (HMGB1). Conclusion: Our results demonstrate that CIITA deficiency affects the course of sepsis via the unexpected function of CIITA, regulation of cytokine release.

• Tuberculosis and Respiratory Diseases
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• 제40권2호
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• pp.91-97
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• 1993

Pulmonary surfactant is a lipoprotein complex composed primarily of phospholipid and lung specific apoproteins that reduces surface tension in the alveolus and maintains alveolar stability at low lung volume. Adult respiratory distress syndrome still carries a very high morbidity and mortality. The surfactant system is vital to the maintenance of proper lung function, any type of surfactant deficiency, whether primary or secondary, will contribute significantly to the development of pulmonary pathophysiology. Various mechanisms in adult respiratory distress syndrome may be responsible for such alterations in the surfactant system. Surfactant replacement is now an established treatment for neonatal respiratory distress syndrome, reducing both incidence of complications and mortality. With the current knowledge of surfactant physiology and the pathophysiology of the adult respiratory distress syndrome exogenous surfactant treatment or stimulation of endogenous surfactant synthesis and secretion will prove to be beneficial in preventing and treating the adult respiratory distress syndrome. The study of clinical surfactant therapy for adult respiratory distress syndrome is just beginnig and this can be viewed as an area with exciting potential. As soon as surfactant preparations become more widely available trials should begin to define the role of surfactant treatment in the adult respiratory distress syndrome as an adjunct to available treatment techniques.

• Tuberculosis and Respiratory Diseases
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• 제73권1호
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• pp.1-10
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• 2012

Care of patients with sepsis has improved over the last decade. However, in the recent two years, there was no significant progress in the development of a new drug for critically ill patients. In January 2011, it was announced that the worldwide phase 3 randomized trial of a novel anti-Toll-like receptor-4 compound, eritoran tetrasodium, had failed to demonstrate an improvement in the mortality of patients with severe sepsis. In October 2011, Xigris (drotrecogin alfa, a recombinant activated protein C) was withdrawn from the market following the failure of its worldwide trial that had attempted to demonstrate improved outcome. These announcements were disappointing. The recent failure of 2 promising drugs to further reduce mortality suggests that new approaches are needed. A study was published showing that sepsis can be associated to a state of immunosuppression and loss of immune function in human. However, the timing, incidence, and nature of the immunosuppression remain poorly characterized, especially in humans. This emphasizes the need for a better understanding of sepsis as well as new therapeutic strategies. Many clinical experiences of the extracorporeal membrane oxygenator (ECMO) treatment for adult acute respiratory distress syndrome (ARDS) patients, which is caused by the H1N1 influenza A virus, were reported. The use of ECMO in severe respiratory failure, particularly in the treatment of adult ARDS, is occurring more commonly.

• Journal of Chest Surgery
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• 제22권5호
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• pp.753-759
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• 1989

Recently, the arterial switch operation has received more interest and increased application for many patients with TGA [Transposition of the Great Arteries]. Not all patients, however, are suitable candidates for this approach, and its success will be measured against the Senning procedure. From June 1982 through June 1989, 48 consecutive patients underwent correction of TGA by a modification of the Senning procedure in our hospital. 34 were males and 14 females, with ages ranging from 3 months to 99 months [mean age 14 months]. The patients were divided into two groups, group I [TGA with intact ventricular septum or without significant pulmonary hypertension] and group II [TGA with significant pulmonary hypertension]. The hospital mortality was 9.5 % in group I and 55.6 % in group lI. 31 patients were discharged from the hospital after a Senning operation and have been followed a mean of 31.2 months. There were 5 late deaths, 3 in group I and 2 in group II. All patients were followed up with EKG, echocardiogram, and in several cases, Holter monitor and cardiac catheterization and angiography were also performed. There have been arrhythmias in 7, superior vena caval obstruction in 5, pulmonary venous obstruction in 2 and tricuspid insufficiency and/or right ventricular dysfunction in 16 patients. The Senning operation for Simple TGA can be performed with a low operative mortality and morbidity, but tricuspid insufficiency and/or depressed right ventricular function can be a problem with prolonged follow up.

• BMB Reports
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• 제55권1호
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• pp.30-38
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• 2022

Cardiovascular disease, especially ischemic heart disease, is a major cause of mortality worldwide. Cardiac repair is one of the most promising strategies to address advanced cardiovascular diseases. Despite moderate improvement in heart function via stem cell therapy, there is no evidence of significant improvement in mortality and morbidity beyond standard therapy. The most salutary effect of stem cell therapy are attributed to the paracrine effects and the stem cell-derived exosomes are known as a major contributor. Hence, exosomes are emerging as a promising therapeutic agent and potent biomarkers of cardiovascular disease. Furthermore, they play a role as cellular cargo and facilitate intercellular communication. However, the clinical use of exosomes is hindered by the absence of a standard operating procedures for exosome isolation and characterization, problems related to yield, and heterogeneity. In addition, the successful clinical application of exosomes requires strategies to optimize cargo, improve targeted delivery, and reduce the elimination of exosomes. In this review, we discuss the basic concept of exosomes and stem cell-derived exosomes in cardiovascular disease, and introduce current efforts to overcome the limitations and maximize the benefit of exosomes including engineered biomimetic exosomes.

• Childhood Kidney Diseases
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• 제23권2호
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• pp.116-120
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• 2019

Bilateral renal obstruction is a rare critical condition, requiring a prompt diagnostic approach and treatment to restore the renal function. The most commonly observed obstructive uropathy in children is congenital malformation, such as posterior urethral valves and bilateral ureteropelvic junction obstruction. Malignant pelvic masses obstructing the ureter are widely reported in adults but are rarely observed in children. The treatment of ureteral obstruction related to pelvic malignancy is a therapeutic challenge with a median survival duration of 3-7 months in adults; however, pediatric patients with pelvic malignancy leading to ureteral obstruction had better outcomes, with a reported 5-year mortality rate of 20%, than the adult patients. Here, we report a rare case of bilateral ureteral obstruction associated with pelvic rhabdomyosarcoma presenting with acute kidney injury treated by ureteral diversion with double J stent, and concommittent emergency hemodialysis, leading to restoration of good renal function. We suggest that bilateral ureteral obstruction should be released as soon as possible using surgical or interventional approach to minimize the obstruction period, and subsequential chemotherapy may contribute to improvement of survival and recovery of renal function.

• 턱관절균형의학회지
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• 제8권1호
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• pp.11-15
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• 2018

Recently, clinical efficacies of the intraoral balancing appliance therapy have been reported by several researchers, and it has been found that there are various kinds of diseases that can be effectively applied. However, studies on cerebrovascular disease, one of the main diseases with a high mortality rate, are still poorly reported, and studies of temporomandibular joint disorder (TMD)-induced changes in brain function suggest that cerebrovascular disease is more appropriate as an adaptive disorder of the temporomandibular joint (TMJ) balancing device. In the developed countries, the importance of research on the structure and function of the brain has been recognized and spurred on the related research. In Korea, the research on brain function and cognitive disorders should have promoted more massively. In order to regain its former reputation in the Korean medicine in the field of cerebrovascular disease, it should be spurred on basic research and clinical case studies. In addition, extensive and in-depth studies including animal studies are needed to establish the basis of underlying mechanisms of the TMJ balancing therapies.

• 정형스포츠물리치료학회지
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• 제14권2호
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• pp.65-72
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• 2018

Purpose: Lifestyle intervention (LSI) provides basic recommendations that improve the quality of life and health of patients with minor disabilities. The LSI intervention strategies are associated with active living, healthy weight, healthy eating, and emotional stability. These intervention strategies can change an unhealthy lifestyle to a healthy lifestyle and provide important health care information. Main issue: This study focused on a new LSI-based knee rehabilitation protocol and proved the effect of exercise prescription on the knee. The clinical significance of this study demonstrated that continuous rehabilitation, effective rehabilitation, and recurrence prevention can be achieved by prescribing the appropriate exercise for patients after discharge. Therefore, practical lifestyle medicine knowledge and information are provided by the home-based rehabilitation self-exercise program with the new LSI-based knee rehabilitation protocol. Conclusions: The LSI-based protocol can improve and maintain health conditions and knee function. With the aim of improving self-care abilities, this program is expected to make significant contributions recurrence prevention, reduced mortality, and improved quality of life, physical function, and fitness.