Accuracy of cardiac output measurements during off-pump coronary artery bypass grafting: according to the vessel anastomosis sites

Sung Yong Park,Dae Hee Kim,Han Bum Joe,Ji Young Yoo,Jin Soo Kim,Min Kang,Yong Woo Hong 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.62 No.5

Background: During beating heart surgery, the accuracy of cardiac output (CO) measurement techniques may be influenced by several factors. This study was conducted to analyze the clinical agreement among stat CO mode (SCO), continuous CO mode (CCO), arterial pressure waveform-based CO estimation (APCO), and transesophageal Doppler ultrasound technique (UCCO) according to the vessel anastomosis sites. Methods: This study was prospectively performed in 25 patients who would be undergoing elective OPCAB. Hemodynamic variables were recorded at the following time points: during left anterior descending (LAD) anastomosis at 1 min and 5 min; during obtuse marginal (OM) anastomosis at 1 min and 5 min: and during right coronary artery (RCA) anastomosis at 1 min and 5 min. The variables measured including the SCO, CCO, APCO, and UCCO. Results: CO measurement techniques showed different correlations according to vessel anastomosis site. However, the percent error observed was higher than the value of 30% postulated by the criteria of Critchley and Critchley during all study periods for all CO measurement techniques. Conclusions: In the beating heart procedure, SCO, CCO and APCO showed different correlations according to the vessel anastomosis sites and did not agree with UCCO. CO values from the various measurement techniques should be interpreted with caution during OPCAB. Background: During beating heart surgery, the accuracy of cardiac output (CO) measurement techniques may be influenced by several factors. This study was conducted to analyze the clinical agreement among stat CO mode (SCO), continuous CO mode (CCO), arterial pressure waveform-based CO estimation (APCO), and transesophageal Doppler ultrasound technique (UCCO) according to the vessel anastomosis sites. Methods: This study was prospectively performed in 25 patients who would be undergoing elective OPCAB. Hemodynamic variables were recorded at the following time points: during left anterior descending (LAD) anastomosis at 1 min and 5 min; during obtuse marginal (OM) anastomosis at 1 min and 5 min: and during right coronary artery (RCA) anastomosis at 1 min and 5 min. The variables measured including the SCO, CCO, APCO, and UCCO. Results: CO measurement techniques showed different correlations according to vessel anastomosis site. However, the percent error observed was higher than the value of 30% postulated by the criteria of Critchley and Critchley during all study periods for all CO measurement techniques. Conclusions: In the beating heart procedure, SCO, CCO and APCO showed different correlations according to the vessel anastomosis sites and did not agree with UCCO. CO values from the various measurement techniques should be interpreted with caution during OPCAB.

18–30세 사이에 발생하는 뇌경색의 특징, 다기관 레지스트리 연구

장윤경,송태진,김용재,허지회,이경열,김영은,장민욱,조수진,강석윤 이화여자대학교 의과학연구소 2017 EMJ (Ewha medical journal) Vol.40 No.3

Objectives: Although there have been several reports that described characteristics for young age stroke, information regarding very young age (18–30 years old) has been limited. We aimed to analyze demographic factors, stroke subtype, and 3-month outcome in acute ischemic stroke patient who have relatively very young age in multicenter stroke registry. Methods: We evaluated all 122 (7.1%) consecutive acute ischemic stroke (within 7 days after symptom onset) patients aged 18 to 30 from 17,144 patients who registered in multicenter prospective stroke registry, 1997 to 2012. Etiology was classified by Trial of Org 10172 in Acute Stroke Treatment criteria. Stroke severity was defined as National Institutes of Health Stroke Scale (NIHSS) and stroke outcome was defined by modified Rankin scale (mRS) at 3 months after index stroke. Results: The mean age of all included patients was 25.1±3.7 years and 76 patients (62.2%) were male. The median NIHSS at admission was 4. Considering stroke subtype, 37 patients (30.3%) had stroke of other determined etiology (SOD), 37 (30.3%) had undetermined negative evaluation (UN) and 31 (25.4%) had cardioembolism (CE) were frequently noted. After adjusting age, sex and variables which had P<0.1 in univariable analysis (NIHSS and stroke subtype), CE stroke subtype (odds ratio, 4.68; 95% confidence interval, 1.42–15.48; P=0.011) were significantly associated with poor functional outcome (mRS≥3). Conclusion: In very young age ischemic stroke patients, SOD and UN stroke subtype were most common and CE stroke subtype was independently associated with poor discharge outcome.

Sodium Nitroprusside(SNP)를 사용한 유도 저혈압 마취시 Renin 활성치, Aldosterone, Epinephrine, Norepinephrine의 변동

강기택,구영권,우성,조강희,백세민 인제대학교 1991 仁濟醫學 Vol.12 No.3

악안면 성형재건술 환자 10명을 대상으로한 sodium nitroprusside(SNP) 유도 저혈압 마취에서 SNP를 주입한 후에 체내의 renin-angiotensin-aldosterone system과 sympathoadrenal system이 활성화되었음을 관찰할 수 있었다. Sodium Nitroprusside (SNP) is used during induced hypotension to decrease bleeding in operation site by direct relaxation of vascular smooth muscle. It is known that the infusion of SNP increases plasma renin activity and this activation of remain-angiotensin system is one physiologic mechanism opposing the hypotensive action of SNP. The purpose of this study was to determine plasma renin activity and activation of sympathoadrenal system following infusion of SNP for hypotensive anesthesia in 10 patients needed maxillofacial reconstructive surgery. Blood samples for analysis were drawn according the time sequence of SNP infusion ; Stage 1; After the induction and before SNP infusion, Stage 2 ; 30 min after when mean arterial pressure maintained 60-70 torr and within 30 min after SNP infusion, Stage 3;Before slopping of SNP, Stage4; 30 min after stopping of SNP. The results were as followings, 1) The duration of anesthesia and infusion of SNP were 197.7±131.3 Min and 100.2±40.3 min. 2) Total doses of 0.01% SNP solution were 115.2±36.4 ml through hypotensive anesthesia 3) PRA in stage 2,3 and 4 (25.3±7.6, 26.2±7.2 and 24.5±8.2 ng/dl/hr respectively) were significantly increased compared with the value of stage 1 (8.9±7.0ng/dl/hr) and the level of aldosterone in stage 2, 3, 4 (28.4±12.7, 33.6±20.0 and 32.9±18.0 mg/dl respectively) were significantly increased compared with the value of stage 1 (13.4±9.1 ng/dl). The increased values of PRA and aldosterone fowllowing infusion of SNP were continued eyen after the time of stopping SNP. 4) Norepinephrine in stage 2, 3(545±157.5, 347.7±115.0 pg/ml respectively) and epinephrine in stage 2,3 (178.4±58.7, 132±55.7 pg/ml respectively) were significantly increased compared with the values of stage 1(norepinephrine ; 236.2±107.3, epinephrine ; 111.8±73.9 pg/ml) and they were returned to the control value after slopping of SNP infusion 5) Sodium potassium and chloride were not changed significantly during SNP induced hypotensive anesthesia. In summary, the activity of renin-angiotesin-aldostprone system and sympathoadrenal system were increased following infusion of SNP during SNP induced hypotensive anesthesia.

Comparisons of obstetrical outcomes among vaginal, intramuscular progesterone treatment and conservative management for the prevention of preterm birth in twin pregnancies with a short cervix

( Young Li Kim ),( Young Jae Lee ),( Hee Young Cho ),( Eun Ah Kim ),( Min Jung Baek ),( Young Ran Kim ),( Sukho Kang ),( Ji Yeon Lee ) 대한산부인과학회 2016 대한산부인과학회 학술대회 Vol.102 No.-

목적: To determine the differences in pregnancy outcomes among cases treated by vaginal progesterone, intramuscular(IM) progesterone and conservative management in twin pregnancies with a short cervix. 방법: This is a retrospective study of 273 twin pregnancies complicated by a short cervix(<2.5cm) who delivered from 2007 to 2016 in CHA Bundang Medical Center. Women who received cervical cerclage were excluded. Treatment groups included 1) group I; conservative management group without progesterone treatment(n=174), 2) group II; vaginal progesterone suppository group(n=30), 3) group III; IM progesterone injection group(n=69). Primary outcomes were spontaneous birth at <28, 32, 34, or 36 weeks of gestational age(GA). The secondary outcomes included hospitalized for tocolytics or antenatal corticosteroids, small for gestational age and low APGAR score(<7) at 5 min. 결과: Preterm birth before 36 weeks of GA was different among 3 groups(29.3%[51/174] vs.20.0%[6/30] vs.43.5%[30/69], p=0.034). Low APGAR score(<7) at 5min was significantly different among 3 groups(7.8%[27/348] vs.5.0%[3/60] vs.15.2%[21/138], p=0.018). After multivariate analysis, preterm birth(<36 weeks) occurred more frequently in group III than group I(aOR 6.90 95%CI:1.06-45.04, p=0.044). However, there was no significant difference between group II and III. Meanwhile, there were more cases with low APGAR score(<7) at 5 min in group III than group I(aOR 6.58 95%CI:1.43-30.21, p=0.015) and group II(aOR 17.04 95%CI:1.56-185.74, p=0.020) after multivariate analysis. 결론: In twin pregnancies complicated by short cervical length, IM progesterone group showed significantly greater occurrence of preterm birth before 36 weeks of GA in comparison with vaginal progesterone group and conservative management group.

총경동맥 폐쇄시간에 따르는 국소 뇌혈류 변화 : 실험적 연구 An Experimental Cat Model

강준기,성태경,조병일,백민우,김문찬,허춘웅,하영수,송진언 대한신경외과학회 1983 Journal of Korean neurosurgical society Vol.12 No.3

The microvasculature of the brain is also quite susceptible to ischemic insult, and substantial portions of the brain are not reperfused after restoration of the blood supply following overtime of critical ischemic periods. The purpose of this series of experiments was to determine the effects of ischemia on subsequential regional cerebral blood flow measurements and cortical electric activities following reperfusion after ischemia and also to define the proper time of vascular occlusion without irreversible neural damage. Cerebral ischemia was induced in cat by bilateral common carotid occlusions for periods of 10, 30, to 60 minutes, and the blood supply was reperfused for 3 hours after clamp-off. Regional cerebral blood flow(rCBF) was measured by hydrogen clearance technique following ischemia, restoration of blood supply and electroencephalogram recovery could be predicted according to the rCBF. Forty adult cats weighing 2.7 to 4.0㎏ were used in this study. The animals were divided into 4 groups of 10 cats each : normal control, 10 min-clamped, 30 min-clamped, and 60 min-clamped groups. The results obtained were as follows : 1) The mean rCBF was 24.6±7.0㎖/100g/min in control group. 2) Bilateral carotid occlusions resulted in a reduction of the rCBF(12.4±4.1㎖/100g/min) to 50% of control flow on both hemispheres. 3) Sequential changes of the rCBF after reperfusion : (1) There was restored the rCBF(21.3±5.1㎖/100g/min) to control flow in the 10 minutes-clamped group. (2) There was a 85% recovery of control flow in the 30 minutes-clamped group. (3) There was a only 25% recovery of control flow in the 60 minutes-clamped group. 4) A close correlation was found between cortical electrical activity and rCBF suggesting a threshold relationship. (1) The changes of cortical electric activity began to notice at rCBF less than 17.4±4.7㎖/100g/min. (2) The recovery of cortical electric activity noted at rCBF more than 10.2±2.3㎖/100g/min. 5) There was no evidence of ischemic involvement at the cortex, white matter and basal ganglia in the 10 minutes clamped group, but demonstrated a dense wedge shaped infarct at the cortex and uncus herniation in the 60 minutes clamped group. The rCBF and cortical electric activity restored to normal values in reperfusion within 10 minutes after occlusion of both common carotid arteries.

Comparative evaluation of the algorithms for parametric mapping of the novel myocardial PET imaging agent ¹⁸ F-FPTP

Kim, Ji Who,Seo, Seongho,Kim, Hyeon Sik,Kim, Dong-Yeon,Lee, Ho-Young,Kang, Keon Wook,Lee, Dong Soo,Bom, Hee-Seung,Min, Jung-Joon,Lee, Jae Sung Springer Japan 2017 Annals of nuclear medicine Vol.31 No.6

<P><B>Objective</B></P><P>(<SUP>18</SUP>F-fluoropentyl)triphenylphosphonium salt (<SUP>18</SUP>F-FPTP) is a new promising myocardial PET imaging tracer. It shows high accumulation in cardiomyocytes and rapid clearance from liver. We performed compartmental analysis of <SUP>18</SUP>F-FPTP PET images in rat and evaluated two linear analyses: linear least-squares (LLS) and a basis function method (BFM) for generating parametric images. The minimum dynamic scan duration for kinetic analysis was also investigated and computer simulation undertaken.</P><P><B>Methods</B></P><P><SUP>18</SUP>F-FPTP dynamic PET (18 min) and CT images were acquired from rats with myocardial infarction (MI) (<I>n</I> = 12). Regions of interest (ROIs) were on the left ventricle, normal myocardium, and MI region. Two-compartment (<I>K</I><SUB>1</SUB> and <I>k</I><SUB>2</SUB>; 2C2P) and three-compartment (<I>K</I><SUB>1</SUB>–<I>k</I><SUB>3</SUB>; 3C3P) models with irreversible uptake were compared for goodness-of-fit. Partial volume and spillover correction terms (<I>V</I><SUB><I>a</I></SUB> and <I>α</I> = 1 − <I>V</I><SUB><I>a</I></SUB>) were also incorporated. LLS and BFM were applied to ROI- and voxel-based kinetic parameter estimations. Results were compared with the standard ROI-based nonlinear least-squares (NLS) results of the corresponding compartment model. A simulation explored statistical properties of the estimation methods.</P><P><B>Results</B></P><P>The 2C2P model was most suitable for describing <SUP>18</SUP>F-FPTP kinetics. Average <I>K</I><SUB>1</SUB>, <I>k</I><SUB>2</SUB>, and <I>V</I><SUB><I>a</I></SUB> values were, respectively, 6.8 (ml/min/g), 1.1 (min<SUP>−1</SUP>), and 0.44 in normal myocardium and 1.4 (ml/min/g), 1.1 (min<SUP>−1</SUP>), and 0.32, in MI tissue. Ten minutes of data was sufficient for the estimation. LLS and BFM estimations correlated well with NLS values for the ROI level (<I>K</I><SUB>1</SUB>: <I>y</I> = 1.06<I>x</I> + 0.13, <I>r</I><SUP><I>2</I></SUP> = 0.96 and <I>y</I> = 1.13<I>x</I> + 0.08, <I>r</I><SUP><I>2</I></SUP> = 0.97) and voxel level (<I>K</I><SUB>1</SUB>: <I>y</I> = 1.22<I>x</I> − 0.30, <I>r</I><SUP><I>2</I></SUP> = 0.90 and <I>y</I> = 1.26<I>x</I> + 0.00, <I>r</I><SUP><I>2</I></SUP> = 0.92). Regional distribution of kinetic parametric images (<I>αK</I><SUB>1</SUB>, <I>K</I><SUB>1</SUB>, <I>k</I><SUB>2</SUB>, <I>V</I><SUB>a</SUB>) was physiologically relevant. LLS and BFM showed more robust characteristics than NLS in the simulation.</P><P><B>Conclusions</B></P><P>Fast kinetics and highly specific uptake of <SUP>18</SUP>F-FPTP by myocardium enabled quantitative analysis with the 2C2P model using only the initial 10 min of data. LLS and BFM were feasible for estimating voxel-wise parameters. These two methods will be useful for quantitative evaluation of <SUP>18</SUP>F-FPTP distribution in myocardium and in further studies with different conditions, disease models, and species.</P><P><B>Electronic supplementary material</B></P><P>The online version of this article (doi:10.1007/s12149-017-1171-6) contains supplementary material, which is available to authorized users.</P>

Preparation and Properties of Polyurethane Modified with Polyorganosiloxane Sealant

Kang, Doo Whan,Kim, Young Min,Lee, Sang Moon,Han, Mi Sun,Kang, Ho Jong 한국공업화학회 2001 Journal of Industrial and Engineering Chemistry Vol.7 No.4

α, ω-Trimethoxysilyl polyurethane modified with polyorganosiloxane (TUMPS) sealant was prepared by adding additives, such as plasticizer, crosslinking agent, and viscosity increasing agent, to α, ω-trimethoxysilyl polyurethane modified with polyorganosiloxane hybrid elastomer at room temperature under nitrogen atmosphere. The TUMPS hybrid elastomer was crosslinked by the sol-gel reaction of methoxy group of TUMPS with hydroxyl group in the building stone and moisture of the air. It was found that TUMPS sealant exhibited more stable rheological and sealant properties than those of TUMPS hybrid elastomer. The shrinkage rate of TUMPS sealant was 5.82-6.0%, and skin over time was about 40 min. Alkaline resistance showed good characteristics for 15 days, slump was about 4.0-4.3㎜, and oil content, as the diameter soaked oil from wetted filter paper was 1-2㎜ after 7 days.

뇌관류법으로 평가한 디곡신 및 벤질페니실린 등의 유기음이온 약물의 혈액-뇌 관문 투과기전

강영숙,이경민 숙명여자대학교 약학연구소 2002 약학논문집-숙명여자대학교 Vol.18 No.-

Recently multispecific organic anion transporting polypeptides (oatps; oatpl, oatp2, oatp3) have been isolated from rat brain. Although these localizations at brain have been found that oatpl situated at apical plasma membrane of choroid plexus, oatp2 located at basolateral cells pole of choroid plexus and endothelial cells of blood-brain barrier (BBB), there were no in vivo evidences about the localization of oatp2. On the purpose of evaluating in vivo evidences that oatps are located at BBB, an in situ rat brain perfusion technique was performed by time courses 15 sec, 1 min (4 ml/min) and 5 min (1.25 ml/min) with using some organic anions such as [³H]digoxin, [³H]ouabain and [³H]benzylpenicillin, respectively and with efflux inhibitors such as verapamil or taurocholate sodium. In the case of digoxin, brain uptake of [³H]digoxin (brain volume of distribution, V_(D)) was higher than V_(D) of [³H]ouabain (less than 2.0 μl/g) and the effect of adding an efflux inhibitor, verapamil, was remarkable. Also, in the case of benzylpenicillin, the value of V_(D) of [³H]benzylpenicillin when perfused with unlabelled benzylpenicillin (at 1 mM of benzylpenicillin) showed higher (29.1 ± 2.9 μl/g) than V_(D) of [³H]benzylpenicillin alone (21.7 ± 1.7 μl/g) and the BBB permeability-surface area product (PS) of [³H]benzylpenicillin was significantly increased to 1.5 fold when perfused with verapamil or taurocholate sodium, respectively. These results suggest in vivo evidences of the presence of oatps and the efflux/transport relationship at the BBB.

Involvement of serine phosphorylation of spinal cord NR-2B subunit of the N-methyl-D-aspartate receptor following electroacupuncture stimulation

Kang Byeol-Rim,Choi Byung-Tae,Yoon Hyun-Min,Min Young-Kwang,Ahn Chang-Beohm 대한침구의학회 2007 대한침구의학회지 Vol.24 No.2

Objective : This study was to examine the low frequency EA is associated with NMDAR and phosphorylation of NMDAR NR-2B subunits in the spinal cordMethods : We investigated that only those rats without overt signs of spinal cord or root damage such as paralysis or lameness were used for experimentation. The NMDA antagonist, D-2-amino-5-phosphonopentanoic acid dissolved in sterile saline and injected intrathecally. Two stainless-steel needles were inserted in each hind leg at those acupoints corresponding to Zusanli(S36) and Sanyinjiao(Sp6) in man and wereconnected to an electric stimulator The EA wit 2 ㎐ stimulation started immediately after AP-5 injection for 30 min. Results : EA analgesia was slightly reduced by intrathecal injection of NMDAR antagonist AP-5, but analgesic effects of EA still showed at 60 minutes after termination of stimulation in all EA-treated group. In the Western blot analysis, the levels of NMDAR NR-2B and phospho-NR-2B were slightly induced by EA stimulation in the spinal cord. These expressions were significantly inhibited by spinal blockage of AP-5. As for regional reaction of NMDAR NR-2B and phospho-NR-2B, immunoreactions were observed throughout all laminae of the dorsal horn of spinal cord and weaker ones showed in the neck region. The mean IOD of phospho-NR-2B in the superficial laminae and nucleus proprius of EA-treated rats were significantly increased compared with normal ones, these expressions were decreased in EA-treated with AP-5 groupsConclusion : It is concluded that EA stimulation may be involved NMDAR activation through phosphorylation of spinal NMDAR NR-2B subunit. 목적 : 저주파에 해당하는 2 Hz 전침 자극이 척수 N-methyl-D-aspartate receptor (NMDAR)의 NR-2B subunit의 발현 및 인산화에 미치는 영향을 조사하였다. 방법 : Sprague-Dawley계 흰쥐를 Størkson 등의 방법에 의해 척수막의 지주막하강에 catheter를 삽입하는 수술을 행한 후 마비 등의 척수 손상을 나타내지 않는 개체를 대상으로 하였다. N-methyl-D-aspartate (NMDA) antagonist인 D-2-amino-5- phosphonopentanoic acid (AP-5)를 투여한 후 족삼리와 삼음교에 해당하는 부위에 30분간 전침 자극하였다. 무통각 여부는 hot plate test를 시행하였으며 NMDAR NR-2 subunit 발현과 인산화 여부는 Western blot과 면역조직화학적으로 살펴보았다. 결과 : 전침 무통각은 전침 자극 후 180분 후까지 지속되었으며 NMDA antagonist인 AP-5를 투여하였을 때 전침 무통각이 저하되었으나 유의성은 나타내지 않았다. Western blot 분석으로 보아 NMDAR NR-2B 및 인산화 NR-2B의 발현은 전침자극에 의해 미약한 증가를 보이나 AP-5투여에 의해 현저한 저해를 보였다. 면역조직화학에 의한 척수배각 구역별 발현을 보면 NMDAR NR-2B 및 인산화 NR-2B는 전 배각에 걸쳐 관찰되나 경부 (층판 Ⅴ-Ⅵ)에서 약한 반응을 보였다. 전침 자극에 의한 각 군별 NR-2B 발현은 유의한 차이를 보여 주지 않았으나 인산화 NR-2B는 천층 (층판 Ⅰ-Ⅱ)및 고유핵 (층판 Ⅲ-Ⅳ)에서 유의성 있는 증가를 보였다. 전침 자극시 AP-5 투여는 유의성은 보이지 않았으나 인산화 NR-2B발현을 저해하였다. 결론 : 저주파 2 Hz 전침에 의한 무통각은 NMDA antagonist인 AP-5 투여에 의해 저해될 뿐아니라 NMDAR NR-2B subunit의 인산화를 저해하는 것으로 보아 전침 무통각의 과정에 NMDAR 및 NMDAR NR-2B의 인산화가 관여함을 알 수 있다.

Toxicoproteomic analysis of deltamethrin exposure in neuroblastoma cell lines

Min‑Joo Kang,Mi‑Young Lee 대한독성 유전단백체 학회 2020 Molecular & cellular toxicology Vol.16 No.1

Background Deltamethrin, a type II pyrethroid insecticide, has been widely used due to its high efficacy against insects and low toxicity to mammals. However, recently, potential adverse health effects during deltamethrin exposure have been reported. Methods A proteomic analysis using two-dimensional electrophoresis with mass spectrometry was performed, and the proteomic data were validated by western blotting. Antioxidant enzyme activity was also measured by spectrophotometric analysis. Results The 13 differentially expressed proteins, of which 8 were up-regulated and 5 down-regulated, are involved in a variety of cellular functions including protein folding, cytoskeleton regulation, and splicing process. The activities of antioxidant enzymes and acetylcholinesterase were also altered by deltamethrin exposure. Conclusion Differential protein expression caused by deltamethrin exposure in neuroblastoma cell lines could allow us to develop biomarkers for deltamethrin toxicity, and pursue future studies to assess the molecular mechanisms of deltamethrin toxicity.