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Lee Sangho,Kim Kyoung-Sun,상보현,Hwang Gyu-Sam 대한마취통증의학회 2022 Anesthesia and pain medicine Vol.17 No.1
Background: Excessive citrate load during therapeutic plasma exchange (TPE) can cause metabolic alkalosis with compensatory hypercarbia and electrolyte disturbances. If TPE is required immediately before ABO-incompatible (ABOi) liver transplant (LT) surgery, metabolic derangement and severe electrolyte disturbance could worsen during LT anesthesia.Case: We report two ABOi LT cases who received TPE on the day of surgery because isoagglutinin titers did not be dropped below 1:8. One case had a surprisingly high metabolic alkalosis with a pH of 7.73 immediately after tracheal intubation because of hyperventilation during mask bagging. The other experienced sudden ventricular tachycardia and blood pressure drop after surgical incision accompanied with severe hypokalemia of 1.8 mmol/L despite supplementation with potassium.Conclusions: Special attention should be paid to patients who just completed TPE the operative day morning as they are vulnerable to severe acid-base disturbances and life-threatening ventricular arrhythmias in ABOi LT.
Cheong Yuseon,Lee Sangho,Lee Do-Kyeong,Kim Kyoung-Sun,상보현,황규삼 대한마취통증의학회 2021 Anesthesia and pain medicine Vol.16 No.4
Background: Generally, lactate levels > 2 mmol/L represent hyperlactatemia, whereas lactic acidosis is often defined as lactate > 4 mmol/L. Although hyperlactatemia is common finding in liver transplant (LT) candidates, association between lactate and organ failures with Acute-on-chronic Liver Failure (ACLF) is poorly studied. We searched the important variables for pre-LT hyperlactatemia and examined the impact of preoperative hyperlactatemia on early mortality after LT. Methods: A total of 2,002 patients from LT registry between January 2008 and February 2019 were analyzed. Six organ failures (liver, kidney, brain, coagulation, circulation, and lung) were defined by criteria of EASL-CLIF ACLF Consortium. Variable importance of preoperative hyperlactatemia was examined by machine learning using random survival forest (RSF). Kaplan-Meier Survival curve analysis was performed to assess 90-day mortality.Results: Median lactate level was 1.9 mmol/L (interquartile range: 1.4, 2.4 mmol/L) and 107 (5.3%) patients showed > 4.0 mmol/L. RSF analysis revealed that the four most important variables for hyperlactatemia were MELD score, circulatory failure, hemoglobin, and respiratory failure. The 30-day and 90-day mortality rates were 2.7% and 5.1%, whereas patients with lactate > 4.0 mmol/L showed increased rate of 15.0% and 19.6%, respectively. Conclusion: About 50% and 5% of LT candidates showed pre-LT hyperlactatemia of > 2.0 mmol/L and > 4.0 mmol/L, respectively. Pre-LT lactate > 4.0 mmol/L was associated with increased early post-LT mortality. Our results suggest that future study of correcting modifiable risk factors may play a role in preventing hyperlactatemia and lowering early mortality after LT.
Kim Kyoung-Sun,Lee Sangho,상보현,Hwang Gyu-Sam 대한마취통증의학회 2022 Anesthesia and pain medicine Vol.17 No.2
Background: We aimed to explore intraoperative lactic acid (LA) level distribution during liver transplantation (LT) and determine the optimal cutoff values to predict post-LT 30-day and 90-day mortality.Methods: Intraoperative LA data from 3,338 patients were collected between 2008 to 2019 and all-cause mortalities within 30 and 90 days were retrospectively reviewed. Of the three LA levels measured during preanhepatic, anhepatic, and neohepatic phase of LT, the peak LA level was selected to explore the distribution and predict early post-LT mortality. To determine the best cutoff values of LA, we used a classification and regression tree algorithm and maximally selected rank statistics with the smallest P value.Results: The median intraoperative LA level was 4.4 mmol/L (range: 0.5–34.7, interquartile range: 3.0–6.2 mmol/L). Of the 3,338 patients, 1,884 (56.4%) had LA levels > 4.0 mmol/L and 188 (5.6%) had LA levels > 10 mmol/L. Patients with LA levels > 16.7 mmol/L and 13.5–16.7 mmol/L showed significantly higher 30-day mortality rates of 58.3% and 21.2%, respectively. For the prediction of the 90-day mortality, 8.4 mmol/L of intraoperative LA was the best cutoff value.Conclusions: Approximately 6% of the LT recipients showed intraoperative hyperlactatemia of > 10 mmol/L during LT, and those with LA > 8.4 mmol/L were associated with significantly higher early post-LT mortality.
이상보 ( Sang Bo Lee ) 택민국학연구원 2011 국학연구론총 Vol.0 No.7
노계는 조선왕시대에 명종·선조·광해군·인조의 4대에 걸쳐 생존했던 사람이다. 그 당시는 당쟁이 격렬하고 국운이 침체해 있던 시기로 임진왜란과 병자호란의 이민족의 침입이 두 차례나 있었다. 노계는 그러한 때에 군인으로 종군하여 국난을 극복하고, 그 사회의 참담한 환경 속에서 애국충정을 한시문과 시조와 가사 등의 문학으로 승화시킨 사대부였다. 그의 출사기(32~50세)에는 수군으로 또는 만호(말단의 군관직)로 진충보국하면서도 국문시가를 지어 항왜문학을 수립하고, 은퇴기(51~82세)에는 고향에서 유유자적하며 성·경·충·효의 네 글자를 좌우명으로 삼아 성리학에 마음을 기울이고 오로지 도학자로서 문학창작에만 정진하였다. 그러기에 그의 문학 특히 가사에는 중국의 고전과 시경을 수용하여 도문일치의 한국 어문학을 생산해 낼 수 있었던 것이다. NoGye was a competent man who was existed in an age of Joseonjo through the for th family lline which were Myeongjong, Seonjo, Kwanghaekun, Injo. At that time, faction was fierced and national destinies was depressed. So there were two an invasion from different nations which has been named them as Imjinwaeran and Byeongjahoran. Under these terrible circumstances, Nogye served in a war as soldier and also wrote a Hansiman, Sijo and Gasa for showing a his loyalty. He is a scholar who was sublimated to literature. He was devoted to his nation as the navy or a minor official in time of his government service. With this effort, he didn``t neglect his studies to write Korean poems. As a result of this, he established a literature which confront with Japan. After retiring, he spent time in his hometown easily. And concenrtrated on his studying abroad with regarding sincerity, respect, fidelity, filial duty as a principle. He only was strived to a literature creation as a moralist. As we see, so he were able to make a Korea Language literature that accords to morality and literature by accepting Sikyeong and chinese old literature in especially his Gasa.