Temporal trends and in-hospital outcomes of primary percutaneous coronary intervention in nonagenarians with ST-segment elevation myocardial infarction

( Joon Young Kim ),( Myung Ho Jeong ),( Yong Woo Choi ),( Yong Keun Ahn ),( Shung Chull Chae ),( Seung Ho Hur ),( Taek Jong Hong ),( Young Jo Kim ),( In Whan Seong ),( In Ho Chae ),( Myeong Chan Cho ) 대한내과학회 2015 The Korean Journal of Internal Medicine Vol.30 No.6

Background/Aims: Data regarding the outcomes of primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in nonagenarians are very limited. The aim of the present study was to evaluate the temporal trends and in-hospital outcomes of primary PCI in nonagenarian STEMI patients. Methods: We retrospectively reviewed data from the Korea Acute Myocardial Infarction Registry (KAMIR) from November 2005 to January 2008, and from the Korea Working Group on Myocardial Infarction (KorMI) from February 2008 to May 2010. Results: During this period, the proportion of nonagenarians among STEMI patients more than doubled (0.59% in KAMIR vs. 1.35% in KorMI), and the rate of use of primary PCI also increased (from 62.5% in KAMIR to 81.0% in KorMI). We identified 84 eligible study patients for which the overall in-hospital mortality rate was 21.4% (25.0% in KAMIR vs. 20.3% in KorMI, p = 0.919). Multivariate analysis identified two independent predictors of in-hospital mortality, namely a final Thrombolysis in Myocardial Infarction (TIMI) flow < 3 (odds ratio [OR], 13.7; 95% confidence interval [CI], 3.2 to 59.0; p < 0.001) and cardiogenic shock during hospitalization (OR, 6.7; 95% CI, 1.5 to 30.3; p = 0.013). Conclusions: The number of nonagenarian STEMI patients who have undergone primary PCI has increased. Although a final TIMI flow < 3 and cardiogenic shock are independent predictors of in-hospital mortality, primary PCI can be performed with a high success rate and an acceptable in-hospital mortality rate.

鉛과 銅 同時投與가 白鼠의 毒作用에 미치는 影響 : δ-ALAD活性度, Hb値 및 組織內의 金屬濃度를 中心으로 On δ-ALAD activity, Hemoglobin and Metal Contents in Various Organs

趙仁濟,車喆煥 고려대학교 의과대학 1982 고려대 의대 잡지 Vol.19 No.1

The object of the study was to observe the toxicological effects of lead (Pb) and copper(Cu) in rats when administered simulataneously. A total of 100 Sprague-Dawley rats were divided into 3 groups, viz., the first group was fed with tap water containing Pb alone, the second group with both Pb and Cu and the control with plain water. The results could be summarized as follows : 1. The body weight of the control rats, which was 178.5±8.2 g at the commencement of feeding, increased up to 350.5±10.5 g on the 120th day of observation. Both in the Pb group and the Pb, Cu combined group, the increase in body weight was slghtly hampered after 40 days of observation, and finally stopped after 80 days, thus showing 297.6±4.1 g in the Pb group and 314.5±9.8 g in the Pb and Cu combined. 2. The blood activity of δ-ALAD in the Pb rats after 120 days of feeding decreased to a level of 17.2%, while that of the Pb and Cu rats decreased to 14.34% of the control. 3. After 120 days of feeding, the blood hemoglobin in the Pb rats reached 12.81±0.97 g/dl, while the combined group was 12.06±3.01 g/dl. The Fe contents in the blood and the liver tissues were much higher in the Pb rats as compared to the Pb and Cu combined, which showed the same trend as the level of hemoglobin. 4. The Pb contents in the blood and other organs increased in both groups. However, the Pb contents on the 120th day of feeding were measured higher in the Pb rats than the Pb and Cu combined as shown in the table below : ◁표 삽입▷(원문을 참조하세요) With the results it has been demonstrated that the excessive amount of Cu absorbed in rats which were simultaneously fed with Pb, has an adverse effect on lead poisoning.

중학교 과학 수업에서 협동을 위한 협동학습 모형의 적용 방안 연구

김인환,이승민,차정호 대구대학교 2006 대구대학교 학술논문집 Vol.1 No.2

과학 수업을 더욱 의미 있는 학습 경험으로 구성하기 위해서는 학생들의 능동적인 수업참여와 활발한 토의를 유도할 수 있는 교수-학습 전략이나 학습 환경에 대한 연구가 필요하다. 우리나라에서는 다양한 협동학습 방법이 소개되었으나 과학과에 적용된 수업 모형으로는 STAD, LT, Jigsaw, 등에 국한되어 있는 것으로 나타나고 있다. 따라서 과학과 수업에 적용해 볼 수 있는 좀 더 변화된 수업 모형 적용에 관하여 연구해 볼 필요가 있다. 본 연구에서는 학생들 사이의 협동기술을 증진시킬 수 있는 과학과에서의 새로운 협동학습 모형으로 협동을 위한 협동학습(Co-op Co-op)모형을 선정하여 적용가능성을 탐색해 보고 일선 교육 현장에서 곧바로 활용할 수 있는 교수-학습 자료를 개발하고자 하였다. 이 수업 모형이 중학교 과학과에 적합한지, 중학교 교과 수업에 적합한지, 중학교 교과에 적용시 기대되는 효과는 어떠한 것들이 있는지에 관하여 검토하였으며, 중학교 과학1 교과 '물질의 세가지 상태' 단원을 적용시켜 6차시 분량의 수업지도안과 탐구 활동지를 개발하였다. 협동을 위한 협동학습(Co-op Co-op)모형은 교사들이 교단에서 쉽게 적용할 수 있는 수업 모형으로 적절히 사용한다면 과학 수업에서 결여된 협동성과 사회성이 가미되어 과학과 탐구 실험 활동에서 보다 나은 참여와 효과적인 수업이 될 수 있다고 생각된다. 본 연구에서는 중학교 교과에서 협동을 위한 협동학습(Co-op Co-op)모형의 적용가능성을 검토했지만, 더 나아가 고등학교 교과에 적용 시킬 수 있는 연구도 요구된다. A study is needed on strategies or learning environment to form science classes as meaningful learning experience. In our country, various methods of cooperative learning have been introduced, but learning models applied in the science subject are limited in STAD, LT, Jigsaw, etc. Thus, it is neccessary to study application of more changed learning models for science classes. In this study, Co-op Co-op model was selected as a new cooperative learning model to promote cooperative technique between students in the science subject and its applicability was examined. Based on this process, this study purposed to develop teaching-learning material which can be directly used in the educational field. Accordingly, whether this learning model is suitable to the science subject of middle school was examined. Laying emphasis on whether Co-op Co-op model is fit for the science subject and classes of middle schools, and what effects are expected when it is applied in subjects of middle schools, a study and an analysis were conducted and teaching plan, research activity sheet and assessment sheet of the sixth session were developed by applying it in the unit of "three states of material" of the science subject of middle schools. Co-op Co-op model should be conducted with a class model which is fit for our actual situations and the most suitable to students, and teachers easily apply in the class instead of applying cooperative learning in science classes unconditionally. If this is implemented, cooperation spirit and sociality that science classes lack in are added and it is expected that better participation and effective learning are performed in experimental activity. In this study, applicability of Co-op Co-op model was examined only in subjects of middle schools, alternative plans are demanded to apply it in subjects of high schools.

경피적 경혈관 관상동맥 확장술의 초기결과 및 재협착

성인환 충남대학교 의과대학 지역사회의학연구소 1995 충남의대잡지 Vol.22 No.2

To evaluate the success rate, complication and restenosis rate of percutaneous transluminal coronary angioplasty (PTCA), we analized the result of PTCA for 153 lesions in 109 patients admitted to TaeJeon Eul Ji hospital between March 1993 and December 1994. The results were as follows ; 1) The PTCA was successful in 147 of 153 lesions, the success rate was 96%. The success rate was significantly higher in subgroups with type A (98%) than type B lesion (87%). 2) The PTCA was failed in 6 of 153 lesions (4%). The causes of PTCA failure included guidewire passage failure in 4, balloon passage failure in 1 and acute closure in 1 lesion. 3) The PTCA complications were death in 1 (0.9%), acute myocardial infarction in 1, ventricular tarchycardia in 2, cardiac tamponade in 1 and bleeding in 2 patients. 4) The follow up coronary angiography was performed in 83 of 153 (54%) for a mean follow up duration 7.1 months. The restenosis was observed 37 of 83 lesions, the restenosis rate was 45%. The angiographically restenosis rate was significantly higher in subgroup with over 60 years old (60%), male (50%), diabetes (67%), type B leion (59%), and over 10% residual stenosis (57%). I conclude that the PTCA is an effective and safe revascularization therapy that has a high success rate and low incidence of complications in selected patients with the coronary artery disease. The limitation of PTCA is the restenosis, so I should make a study of reducing the restenosis after PTCA.

Skin Safety of the UV Absorbers by Measurement Cytotoxicity High Functional Product with Water-In-Silicone System

( Kim In-young ),( Kim Min-ho ),( Nam Sang-in ),( Chun Kil Whan ) 대한화장품학회 1997 대한화장품학회지 Vol.23 No.3

Consumers have recently preferred to purchase extensive UV intercepting products, which are waterproof and free from side effects on skin. Testing Cytotoxicity (in-vitro) in SK method, cell survival ratio of UV-B interceptors decreased above 0.08W/V%, and so did that of UV-A interceptors above 0.06W/V%. Also, Patch-test of inorganic UV interceptors resulted in no skin irritation ever below 10.0 and 11.25. UV interceptors in the sunlight showed yellowish discoloration in 5 to 14 days. In absorption curves, UV-B was most suitable for Octyl methoxycinnamate (OMC) and UV-A for Butyl methoxy dibenzoylmethane (BMDM). For this reason, Nylonpoly UVA/UVB the material of OMC and BMDM coated with Nylon & polyethylene, was used as the organic UV interceptor. And zinc oxide (ZnO) and titanium dioxide (TiO,) was used as inorganic UV interceptors. The appropriate mixture ratio of ZnO and TiO, was 6 to 4. 6% of ZnO, 4% of TiO, and 5% of Nylonpoly UVA/UVB were all combined with our sunscreen cream. The SPF value of in-vivo applied to a guinea pig was 34.9 and that of in-vivo was 38.5. Cyclomerhicone and dimethicone were used in water-in-Silicone system. Ceryl dimethi-cone and sorbitan sesquiolente were used as emulsifiers and MgSO, · 7 H₂O, Mg-stearate/Mg-Al-stearate copolymer as emulsification stabilizers. In practical application, each SPF duration of O/’W type and W/S type containing sunscreen cream of the same content showed that W/S type of sunscreen cream was 5 times as durable as the other. This product is fit for using in swimming, climbing or skiing. This research is to minimize skin trouble caused by UV interceptors and to make one with proper softness, skin safety and UV intercepting efficiency.

톡소포자충 감염마우스의 Cytokine 및 Heat shock protein 생산 분석

노형준,최인욱,신대환,이영하 충남대학교 의과대학 의학연구소 2002 충남의대잡지 Vol.29 No.2

T. gondii frequently causes severe congenital defects and life-threatening disease in immunocompromised individuals. Cytokines. nitric oxide (NO) and heat shock proteins (HSP) are important to control the parasite multiplication and host resistance. However. there were only fen reports about HSP70 in toxoplasmosis. Moreover. we do not know the cytokines and HSP70 production in case of NO inhibition. Therefore. this study was performed to analyze the production of NO. HSP70 and cytokines after adminstration of aminoguanidine (AMG. suppressor of NO production) in mice infected with T. gondii. BALB/c and C57BL/6 mice were injected with either 5 brain cysts of Me49 strain of T. gondii or 50㎍ of AMG for 2 weeks every day. and then mice were sacrificed at day 4. 7. 14 and 28. HSP70 production in the brain and spleen of both mice strains mere decreased after treatment with AMG. however Toxoplasma-infected ones were significantly increased. HSP70 production of Infection/AMG-treated group of C57BL/7mice was significantly decreased in comparison to Infection group. Whereas Infection/AMG-treated group of BALB/c mice showed similar HSP70 production compared to Infection group. After T. gondii infection. the IFN-γ and TNF-α mRNA expression in the brain and spleen was significantly increased in BALB/c or C57BL/6 mice. IFN-γ mRNA expression in the brain and spleen of Infection/AMG-treated BALB/c mice were not significant differences compared to those of infected ones. however there were significant differences in the spleen of C57BL/6 mice. TNF-α mRNA expression in the spleen of Infection/AMG-treated BALB/c or C57BL/6 mice were significantly decreased in comparison to those of infected ones. Taken together. HSP70. IFN-γ and TNF-α production were significantly increased in Toxoplasma-infected BALB/c and C57L/6 mice. After treatment with NO inhibitor in infected C57BL/6 mice, the production of HSP70 and IFN-γ were significantly decreased. whereas BALB/c mice were not significant differences of HSP70 and IFN-γ production between Infection and Infection/AMG-treated group.

관상동맥 스텐트 시술 후의 재협착에 관한 연구

김윤철,이정우,김보영,강정아,임대승,이민수,김정희,성보영,최성준,성인환,전은석 충남대학교 의과대학 지역사회의학연구소 2000 충남의대잡지 Vol.27 No.1

Coronary stent implacement is known as an effective treatment in the intimal dissection after percutaneous transluminal coronary angioplasty and the prevention of restenosis. However, In-stent restenosis still remains a major concern in clinical stenting. The stents were placed in 103 patients from July 1996 to March 1999 and performed follow-up coronary angiograms in 59(57.3%) patients. To identify the clinical, angiographic and procedurerelated variables 'which predict late restenosis within the stented artery, 59 patients(58.3±9.9, M:F= 41:18) were studied. The clinical characteristics of the patients were stable angina in 23(39.0%), unstable angina in 14(23.7%), acute myocardial infarction in 21(35.6%) and old myocardial infarction in 1(1.7%). Coronary stenting was performed in 1 patient(1.7%) for primary lesion, 50 patients(84.7%) for suboptimal results after PTCA, 6 patients(10.2%) for bail-out procedure, and 2 patients(3.4%) for restenotic lesions. All patients were treated with aspirin and ticlopidinc. The follow-up angiograms were obtained at 7±4 months. The overall in-stent restenosis rate was 27.1%. The coronary angiographic findings were 32 single vessel(54.2%), 19 two vessel(32.2%) and 8 three vessel disease(13.6%). The angiographic morphological characteristics were type A in 33(55.9%), type B in 14(23.7%), type C in 12(20. 3%) cases. Variables of 16 patients with restenosis were compared with those of 43 patients without restenosis. Previously known predictors for in-stent restenosis were multiple stenting, stenting for restenotic lesions, residual stenosis after stenting, stenting for total occlusion lesions, reference diameter, balloon to vessel ratio, acute gain and minimal luminal diameter after procedure, design and characteristics of stents, ostial lesion of aorta, high pressure method for stenting, lesion length, diabetes mellitus, size of artheroma, saphenous vein grafts, ulcerlating lesions and calcified lesions. In this study, Reference diameter before stenting(2.43±0.54mm vs. 2.88±0.65mm, p=0.016) and balloon-to-artery ratio(1.28±0.26 vs. 1.11±0.18, p=0.006) were predictors for in-stent restenosis. 1) The overall in-stent restenosis rate was 27.1%. 2) In the analysis of predictors for in-stent restenosis, there was no significant differences in clinical, angiographic factors between group with restenosis and without restenosis. But, Only reference diameter before stenting and balloon-toartery ratio were predictors of late in-stent restenosis. In conclusion, stenting is effective revascularisation method for selected patients with ischemic heart disease, and to minimize in-stent restenosis rate, stent implanting is achieved in a large vessel on the basis of an artery-to-stnet ration of 1:1, if possible.

Clinical impact of admission hyperglycemia on in-hospital mortality in acute myocardial infarction patients

Kim, Eun Jung,Jeong, Myung Ho,Kim, Ju Han,Ahn, Tae Hoon,Seung, Ki Bae,Oh, Dong Joo,Kim, Hyo-Soo,Gwon, Hyeon Cheol,Seong, In Whan,Hwang, Kyung Kuk,Chae, Shung Chull,Kim, Kwon-Bae,Kim, Young Jo,Cha, Kwa Elsevier 2017 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.236 No.-

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>Acute hyperglycemia on admission is common in acute myocardial infarction (AMI) patients regardless of diabetic status, and is known as one of prognostic factors. However, the effect of hyperglycemia on non-diabetic patients is still on debate.</P> <P><B>Methods</B></P> <P>A total of 12,625 AMI patients (64.0±12.6years, 26.1% female) who were enrolled in Korea Acute Myocardial Infarction Registry-National Institute of Health between November 2011 and December 2015, were classified into 4367 diabetes (65.4±11.6years, 30.4% female) and 8228 non-diabetes (63.3±13years, 23.9% female). Patients were analyzed for in-hospital clinical outcome according to admission hyperglycemic status.</P> <P><B>Results</B></P> <P>In diabetic patients, independent predictors of in-hospital mortality were old age, high HbA<SUB>1</SUB>C, pre-Thrombolysis In Myocardial Infarction (TIMI) flow 0, left ventricle ejection fraction<40%, cardiogenic shock and ventricular tachycardia. In non-diabetic patients, independent predictors of in-hospital mortality were old age, high admission glucose (≥200mg/dL), pre TIMI flow 0, failed percutaneous coronary intervention, low left ventricle ejection fraction<40%, cardiogenic shock, stent thrombosis and decreased Hb≥5g/dL. In hospital mortality was significantly higher in diabetic patients compared to non-diabetic patients (5.0% vs. 3.4%, <I>p</I> <0.001). However, non-diabetic patients with hyperglycemia have significantly higher mortality compared to diabetic patients (17.4% vs. 7.2%, <I>p</I> <0.001). Comorbidity including cardiogenic shock (<I>p</I> <0.001), cerebral hemorrhage (<I>p</I> =0.012), decreased Hb≥5g/dL (<I>p</I> =0.013), atrioventricular block (<I>p</I> <0.001) and ventricular tachycardia (<I>p</I> =0.007) was higher in non-diabetic with hyperglycemia than in diabetic patients.</P> <P><B>Conclusions</B></P> <P>These findings underscore clinical significance of admission hyperglycemia on in-hospital mortality in non-diabetic AMI patients.</P>

관상동맥 질환에서 SDF-1α의 농도

김보영,박용규,박형서,노상필,정승현,이유선,이정우,이재환,최시완,정진옥,성인환 충남대학교 의과대학 의학연구소 2003 충남의대잡지 Vol.30 No.1

Atherosclerosis is now viewed as an inflammatory disease of the vascular system. Expression of several chemokines, including monocyte chemoattractant protein(MCP)-1, MCP-4, RANTES(regulated on activation normal T-cell expressed and secreted), and interleukin-8(IL-8) are increased in human atherosclerotic plaques compared with normal vessels. They are involved in the pathogenesis of atherosclerosis and plaque rupture by activating and directing leukocytes into the atherosclerotic lesions. However, some are involved in homeostatic functions such as normal leukocyte traffic and growth regulation. SDF-la is a multi-functional cytokine that is involved in myelogenesis, hematopoiesis, angiogenesis and injured gastric mucosal regeneration in the gastric ulcer patient. SDF-la is recently shown to be highly expressed in atherosclerotic plaques and a potent platelet agonist. At least in high concentrations, SDF-la may mediate antiinflammatory and matrix stabilizing effects in unstable angina. Many studies are going on to know the function of SDF-la in coronary artery diseases. I investigated the difference of the plasma level of SDF-la between control group and coronary artery disease group. Total 75 subjects were enrolled. The diagnosis of coronary artery disease was confirmed in all patients by coronary angiography. Control subjects in this study were confirmed normal by coronary angiography. Clinical profile and risk factors were also reviewed. Control subjects in this study were 27 (M=10, F=17). Plasma for the study was collected before the angiography and centrifuged. SDF-la analysis was performed by ELISA. Plasma level of SDF-la is significantly increased in patients with stable angina(n=20) and unstable angina group(n=28) compared with healthy control group(n=27). the risk factors do not influence the plasma level of SDF-la in coronary artery diseases. In this study, plasma level of SDF-la is increased in patients with stable angina and unstable angina groups compared with healthy control group(P<0.05). the risk factors do not influence the plasma level of SDF-la in coronary artery diseases.

In-hospital mortality in patients with STEMI admitted during off hours

( Sung-Soo Kim ),( Myung Ho Jeong ),( Jeong Gwan Cho ),( Young Keun Ahn ),( Jong Hyun Kim ),( Shung Chull Chae ),( Young Jo Kim ),( Seung Ho Hur ),( In Whan Seong ),( Taek Jong Hong ),( Dong-hoon Choi 대한내과학회 2013 대한내과학회 추계학술대회 Vol.2013 No.1

Conflicting results exist on the outcome of off hours PCI in ST elevation myocardial infarction (STEMI). However, there were only a few studies that have focused on the clinical characteristics and outcomes of off hours PCI in STEMI. So, we studied the clinical characteristics and hospital mortality in STEMI patients treated with primary PCI during regular hours (weekdays 9:00 AM to 6:00 PM) versus off hours Weekdays 6:01 PM to 8:59 AM, weekends, and holidays) in Korea Acute Myocardial Infarction Registry. We analyzed in hospital and one year mortality among 5,665 consecutive ST segment elevation myocardial infarction patients treated with primary PCI between November 2005 to January 2008. Total 2,848 (50.2%) patients were treated during off hours. Baseline finding were similar, although regular hours patients were older. Median symptom to balloon time (304 min, IQR 175 to 750 vs. 270 min, IQR 145 to 551, p=0.001) were longer for regular hours primary PCI. Median door to balloon time (71min, IQR: 48 to 132 vs. 59 min, IQR 39 to 110 min, p=0.001) were longer for off hours pPCI. Also, Cardiac enzyme such as Max CK-MB (212.1±299.3 vs 194.7±303.4, p=0.031) and max TnI (72.6±239.5 vs. 58.9±94.4, p=0.013) were increased in off hours pPCI. However, unadjusted in hospital (6.0% off hours vs. 6.0% regular hours, p=0.946) and one year cardiac mortality (11.3% off hours vs. 11.7% regular hours, p=0.661) were comparable. In multivariate analysis, off hours primary PCI did not predict an adverse outcome. In conclusion, when primary PCI was performed within an appropriate reperfusion strategy, the clinical effectiveness of either off hours or regular hours pPCI is comparable.