Timing for initiation of sequential continuous renal replacement therapy in patients on extracorporeal membrane oxygenation

Paek, Jin Hyuk,Park, Seohyun,Lee, Anna,Park, Seokwoo,Chin, Ho Jun,Na, Ki Young,Lee, Hajeong,Park, Jung Tak,Kim, Sejoong Korean Society of Nephrology 2018 Kidney Research and Clinical Practice Vol.37 No.3

<P><B>Background</B></P><P>Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy used in critically ill patients with severe cardiopulmonary dysfunction. Continuous renal replacement therapy (CRRT) is supplemented to treat fluid overload, acute kidney injury, and electrolyte disturbances during ECMO. However, the best time to initiate CRRT is not well-defined. We performed this study to identify the optimal timing of CRRT for ECMO.</P><P><B>Methods</B></P><P>We conducted a multicenter retrospective cohort study of 296 patients over 12 years. Patients received CRRT during ECMO at Seoul National University Hospital, Seoul National University Bundang Hospital, or Yonsei University Hospital. We assigned patients to an early or late CRRT group depending on the CRRT initiation time. We considered early CRRT to be CRRT instituted within 72 hours of ECMO initiation.</P><P><B>Results</B></P><P>Among 296 patients, 212 patients (71.6%) received early CRRT. After using a propensity score matching method, 47 patients were included in each group. The time from ECMO initiation to CRRT initiation was 1.1 ± 0.9 days in the early CRRT group and 14.6 ± 18.6 days in the late CRRT group. No difference in patients’ mortality (<I>P</I> = 0.834) or hospital stay (<I>P</I> = 0.627) between the early and late CRRT groups was found. After adjusting all covariables, there was no significant difference in mortality between the early and late CRRT groups (hazard ratio, 0.697; 95% confidence interval, 0.410–1.184; <I>P</I> = 0.182).</P><P><B>Conclusion</B></P><P>This study showed that early CRRT may not be superior to late CRRT in ECMO patients. Further clinical trials are warranted.</P>

Renal outcomes of laparoscopic versus open surgery in patients with rectal cancer: a propensity score analysis

( Jin Hyuk Paek ),( Sung Il Kang ),( Jiwon Ryu ),( Sung Yoon Lim ),( Ji Young Ryu ),( Hyung Eun Son ),( Jong Cheol Jeong ),( Ho Jun Chin ),( Ki Young Na ),( Dong-wan Chae ),( Sung-bum Kang ),( Sejoong 대한신장학회 2021 Kidney Research and Clinical Practice Vol.40 No.4

Background: A laparoscopic approach is widely used in abdominal surgery. Although several studies have compared surgical and oncological outcomes between laparoscopic surgery (LS) and open surgery (OS) in rectal cancer patients, there have been few studies on postoperative renal outcomes. Methods: We conducted a retrospective cohort study involving 1,633 patients who underwent rectal cancer surgery between 2003 and 2017. Postoperative acute kidney injury (AKI) was diagnosed according to the serum creatinine criteria of the Kidney Disease: Improving Global Outcomes classification. Results: Among the 1,633 patients, 1,072 (65.6%) underwent LS. After matching propensity scores, 395 patients were included in each group. The incidence of postoperative AKI in the LS group was significantly lower than in the OS group (9.9% vs. 15.9%; p = 0.01). Operation time, estimated blood loss, and incidence of transfusion in the LS group were significantly lower than those in the OS group. Cox proportional hazard models revealed that LS was associated with decreased risk of postoperative AKI (hazard ratio [HR], 0.599; 95% confidence interval [CI], 0.402-0.893; p = 0.01) and postoperative transfusion was associated with increased risk of AKI (HR, 2.495; 95% CI, 1.529-4.072; p < 0.001). In the subgroup analysis, the incidence of postoperative AKI in patients with middle or high rectal cancer who underwent LS was much lower than in those who underwent OS (HR, 0.373; 95% CI, 0.197-0.705; p = 0.002). Conclusion: This study showed that LS may have a favorable effect on the development of postoperative AKI in patients with rectal cancer.

Timing for initiation of sequential continuous renal replacement therapy in patients on extracorporeal membrane oxygenation

( Jin Hyuk Paek ),( Seohyun Park ),( Anna Lee ),( Seokwoo Park ),( Ho Jun Chin ),( Ki Young Na ),( Hajeong Lee ),( Jung Tak Park ),( Sejoong Kim ) 대한신장학회 2018 Kidney Research and Clinical Practice Vol.37 No.3

Background: Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy used in critically ill patients with severe cardiopulmonary dysfunction. Continuous renal replacement therapy (CRRT) is supplemented to treat fluid overload, acute kidney injury, and electrolyte disturbances during ECMO. However, the best time to initiate CRRT is not well-defined. We performed this study to identify the optimal timing of CRRT for ECMO. Methods: We conducted a multicenter retrospective cohort study of 296 patients over 12 years. Patients received CRRT during ECMO at Seoul National University Hospital, Seoul National University Bundang Hospital, or Yonsei University Hospital. We assigned patients to an early or late CRRT group depending on the CRRT initiation time. We considered early CRRT to be CRRT instituted within 72 hours of ECMO initiation. Results: Among 296 patients, 212 patients (71.6%) received early CRRT. After using a propensity score matching method, 47 patients were included in each group. The time from ECMO initiation to CRRT initiation was 1.1 ± 0.9 days in the early CRRT group and 14.6 ± 18.6 days in the late CRRT group. No difference in patients’ mortality (P = 0.834) or hospital stay (P = 0.627) between the early and late CRRT groups was found. After adjusting all covariables, there was no significant difference in mortality between the early and late CRRT groups (hazard ratio, 0.697; 95% confidence interval, 0.410-1.184; P = 0.182). Conclusion: This study showed that early CRRT may not be superior to late CRRT in ECMO patients. Further clinical trials are warranted.

신장 ; IgA 신장병의 장기 추적에 따른 임상 경과 및 예후 인자

백진혁 ( Jin Hyuk Paek ),김예림 ( Yae Rim Kim ),박하연 ( Ha Yeon Park ),황은아 ( Eun Ah Hwang ),한승엽 ( Seung Yeup Han ),박성배 ( Sung Bae Park ) 대한내과학회 2015 대한내과학회지 Vol.88 No.1

목적: IgA 신장병은 전 세계적으로 가장 흔한 일차성 사구체신염으로 임상 경과가 다양하며 25-50%에서 말기 신부전으로 진행하는 것으로 알려져 있다. 국내에서 시행한 연구들은 IgA 신장병의 자연 경과에 비해 추적 관찰 기간이 짧으며 그 대상 환자들 또한 적었다. 이에 IgA 신장병을 진단 받고 10년 이상 추적 관찰했던 환자들을 대상으로 임상 경과및 예후 인자에 대해 연구를 시행하였다. 방법: 1985년 4월부터 2003년 3월까지 계명대학교 동산의료원 신장내과에 입원하여 경피적 신생검을 시행하여 IgA신장병으로 진단된 471명의 환자 중 일차성 IgA 신장병으로진단 받고 10년 이상 추적 관찰이 가능했던 184명을 대상으로 조사하였다. 결과: 총 184명의 환자 중 남자 97명, 여자 87명으로 남녀비는 1.1:1이었다. 평균 연령은 33.7 ± 11.5세(12-35세)였고 평균 추적 관찰 기간은 181.3 ± 46.3개월(120.3-305.6개월)이었다. 추적 관찰 기간 동안 말기 신부전으로 진행한 환자가 73명(39.6%)이었으며 진단 당시로부터 말기 신부전으로의 진행 기간은 평균 98.1 ± 55.9개월(12.9-245.6개월)이었다. 추적관찰 기간 동안 5년, 10년, 15년, 20년 신생존율은 각각 87.5%,74.3%, 59.2%, 49.3%였다. 신생존군과 말기 신부전군 간의단일 변량 분석에서 고혈압, 1.3 mg/dL 이상의 혈청 크레아티닌, 60 mL/min/1.73 m2 미만의 추정 사구체 여과율, 3.5 g/dL미만의 혈청 알부민, 1 g/day 이상의 단백뇨량, 진행된 조직학적 소견 등이 유의한 위험인자로 나타났다. 나이, 성별, 혈청 IgA/C3비, 육안적 혈뇨, 현미경적 혈뇨 등은 유의한 차이를 보이지 않았다. 다변량 분석에서는 진행된 조직학적 소견만이 독립적인 위험인자로 나타났다. 결론: 일차성 IgA 신장병을 평균 15.1년간 장기 추적 관찰한 결과, 진단 당시 진행된 조직학적 소견을 보였던 환자에서 말기 신부전으로의 진행률이 유의하게 높았다. Background/Aims: Immunoglobulin A nephropathy (IgAN) is the most common type of primary glomerulonephritis worldwide. Although several studies have identified IgAN prognostic factors in Korea, the follow-up period was insufficient to evaluate thenatural history of IgAN. Methods: A total of 471 patients were diagnosed with IgAN after percutaneous renal biopsy between April 1985 and March 2003. Patients with secondary IgAN and patients with a follow-up < 10 years since their diagnosis were excluded. Thus, 184 patients wereenrolled. Results: Among the 184 patients, 97 were males (52.7%) and 87 were females (47.3%). The mean age was 33.7 ± 11.5 years, andthe mean follow-up period was 181.3 ± 46.3 months. During the follow up, 73 patients (36.9%) had progressed to end-stage renaldisease (ESRD). The mean duration to ESRD was 98.1 ± 55.9 months. The overall renal survival rate was 60.3%, the 10-years renalsurvival rate was 74.3%, and the 20-years renal survival rate was 49.3%. Univariate analyses indicated that hypertension, serumcreatinine > 1.3 mg/dL, estimated glomerular filtration rate < 60 mL/min/1.73 m2, serum albumin < 3.5 g/dL, proteinuria ≥ 1 g/day,and severe renal pathology by the Haas sub-classification were significantly associated with ESRD. When these factors wereincluded in multivariate Cox regression analyses, only severe renal pathology by the Haas sub-classification was an independentprognostic factor for IgAN. Conclusions: Careful follow-up and treatment is recommended, particularly in patients with IgAN and severe renal pathology bythe Haas sub-classification.

무선 심박측정 시스템에 적용 가능한 저주파 잡음 특성 개선의 RF 전치부 설계 연구

최진규(Jin-Kyu Choi),백현(Hyun Paek),권소현(So-Hyun Kwon),최혁재(Hyuk-Jae Choi),김종호(Jong-Ho Kim),신준영(Jun-Yeong Shin),김형석(Hyeong-Seok Kim) 대한전기학회 2009 대한전기학회 학술대회 논문집 Vol.2009 No.7

This paper presents the design and analysis of RF Front End for Wireless Heartbeat measurement System. In this work LNA , an inductor connected at the gate of the cascode transistor and capacitive cross-coupling are strategically combined to reduce the noise and the nonlinearity influences of the cascode transistors in a differential LNA. The Mixer is implemented by using the Gilbert-type configuration, cross pmos injection technique and the resonating technique for the tail capacitance. The resulting LNA achieves 1.26 ㏈ NF, better than 1.88㏈ NF Typical. Also Mixer resulting achieves 9.8㏈ at 100㎑.

Acute interstitial nephritis with acute kidney injury after COVID-19 vaccination: a case report

Lim Jimin,Paek Jin Hyuk,Shin Hyeong Chan,Park Woo Yeong,Jin Kyubok,Choe Misun,Han Seungyeup,Kim Yaerim 대한백신학회 2024 Clinical and Experimental Vaccine Research Vol.13 No.1

In the context of the massive spread of coronavirus disease 2019 (COVID-19), the development of a COVID-19 vaccine is urgently needed. The Pfizer-BioNTech COVID-19 vaccine has been widely applied across global populations. Herein, we report a case of acute interstitial nephritis with acute kidney injury in a young healthy subject after administration of the COVID-19 vaccine. A 20-year-old man was admitted with abdominal discomfort and nausea. He had received the Pfizer-BioNTech COVID-19 vaccine 6 days before. At 9 days after vaccination, his kidney function was decreased, with serum creatinine levels of 1.8 mg/dL. Even with supportive care with hydration, his kidney function worsened, and he underwent a kidney biopsy. The pathology findings revealed diffuse interstitial infiltration of inflammatory cells, predominantly comprising lymphocytes, with preservation of the glomerulus. No abnormal findings were noted by immunofluorescence or electron microscopy. Based on a diagnosis of drug-related acute interstitial nephritis, we treated the patient with high-dose prednisolone. After administration of prednisolone, kidney function slowly improved. A close linkage between COVID-19 vaccination and acute interstitial nephritis should be considered in the clinic, despite the low incidence.

Lambda/8 선로를 이용한 하이브리드 방향성 결합기의 설계

백현(Hyun Paek),최진규(Jin-Kyu Choi),김군태(Koon-Tae Kim),최혁재(Hyuk-Jae Choi),권소현(So-Hyun Kwon),김형석(Hyeong-seok Kim) 대한전기학회 2009 대한전기학회 학술대회 논문집 Vol.2009 No.7

RFID system had used same frequency for transmit and receive signal. RFID recognize range is restrict, because of receive and transmit signal coupled each other. That cause directional coupler is not ideal isolation characteristic and antenna missmatching. So we proposed lambda/8 section directional coupler and design high isolation to use RFID.

족관절 족배 굴곡 각도의 측정

이우천,박현수,한영길,조정진,장병춘,이재율,엄기혁,라종득 대한스포츠의학회 1998 대한스포츠의학회지 Vol.16 No.1

Clinical measurement of ankle motion includes tarsal and tarsometatarsal as well as tibiotalar motion, and it is affected by knee position and weight-bearing. The purpose of this study is to determine the problem of each method of measurement, the difference in the angles measured by various methods, and to suggest a reference data to assess the tightness of the Achilles tendon. Dorsiflexion range of 80 healthy ankles was measured by 8 different methods. The dorsiflexion range of the Group 1, 2, 3 was measured when the foot was not weight-bearing and the knee was flexed 90° with the foot in inversion, eversion, and neutral position respectively and the means and standard deviation of each group were 13.8±5°, 27.5°±6° and 23.4±5° respectively. The dorsiflexion range of the Group 4, 5, 6 was measured with the foot in inversion, eversion and neutral position when the foot was not bearing weight, and the knee was extended and the means and standard deviations of each group were -6±5°, 10±4° and 7±4° respectively. The dorsiflexion range of the Group 7 and 8 was measured with the knee in flexed or extended position, when the subject was bearing weight and the mean and standard deviation of each group were 44±7° and 38±7° respectively. There were statistically significant differences between each group within the Groups 1·2·3, Groups 4·5·6, Groups 3·6 and Group 7·8(p<0.01). In conclusion, the measurement of dorsiflexion range of ankle motion need to be done with the foot in neutral position to minimize the effect of the shape of the foot or the motion in the foot. Measurement in weight-bearing condition is not recommended, because it might be affected by the degree of weight bearing. The difference in the dorsiflexion range between the Group 3(measured with the knee flexed) and the Group 6(measured with the knee extended) is 15.9±4.9°, and it be used as a reference angle to assess the presence of Achilles tightness.

Preoperative dipstick albuminuria and other urine abnormalities predict acute kidney injury and patient outcomes

Park, Sehoon,Lee, Soojin,Lee, Anna,Paek, Jin Hyuk,Chin, Ho Jun,Na, Ki Young,Chae, Dong-Wan,Kim, Sejoong Elsevier 2018 Surgery Vol.163 No.5

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>It is unclear whether pathologic findings on preoperative urinalysis are associated with the risk of postoperative acute kidney injury (AKI). Therefore, we performed a retrospective review to investigate this association.</P> <P><B>Methods</B></P> <P>We assessed the clinical significance of preoperative dipstick urinalysis in a 10-year surgery cohort from a tertiary hospital in Korea. Patients without available information on perioperative serum creatinine levels or kidney injury prior to surgery were excluded. Preoperative dipstick urinalysis parameters, including albuminuria, hematuria, pyuria, and others were studied. The primary outcome was postoperative acute kidney injury. Secondary outcomes were postoperative 1-year mortality and progression of poor kidney function parameters.</P> <P><B>Results</B></P> <P>We enrolled 40,090 patients. The presence of dipstick albuminuria was associated with an increased risk of postoperative AKI (adjusted odds ratio 1.47 [1.29–1.66], <I>P</I> < .001), and the association showed a dose-response relationship. High specific gravity was significantly associated with increased risk of AKI (adjusted odds ratio 1.30 [1.04–1.63], <I>P</I> = .02). Furthermore, in patients with postoperative AKI, those with baseline albuminuria had a worse prognosis with regard to 1-year mortality (adjusted hazard ratio 2.81 [1.56–5.09], <I>P</I> < .001) and persistent renal function impairment (adjusted odds ratio 2.07 [1.21–3.46], <I>P</I> = .007), independent of estimated glomerular filtration rate values. Patients with baseline hematuria and pyuria also had an inferior postoperative AKI prognosis when compared to those without the urinalysis abnormalities.</P> <P><B>Conclusion</B></P> <P>Baseline dipstick urinalysis may predict postoperative AKI and may be significantly associated with prognosis after surgery. (Surgery 2017;160:XXX-XXX.)</P>

Awareness, incidence and clinical significance of acute kidney injury after non-general anesthesia : A retrospective cohort study

Park, Sehoon,Lee, Soojin,Lee, Anna,Paek, Jin Hyuk,Chin, Ho Jun,Na, Ki Young,Chae, Dong-Wan,Kim, Sejoong Williams & Wilkins Co 2018 Medicine Vol.97 No.35

<▼1><P>Supplemental Digital Content is available in the text</P></▼1><▼2><P><B>Abstract</B></P><P>Postoperative acute kidney injury is associated with high mortality and poor prognosis. Additional investigations into the risk factors for this condition and the outcomes of patients who undergo surgeries under non-general anesthesia (GA) are necessary.</P><P>This retrospective cohort study included data on all surgeries performed in adult patients from January 2006 to December 2015 at a tertiary hospital in Korea. Patients were divided into those undergoing surgeries with non-GA and those undergoing surgeries with GA. We analyzed the nephrological evaluation patterns, the risk factors for acute kidney injury, and prognoses after acute kidney injury by reviewing mortality, progression to end-stage renal disease, and serum creatinine doubling/estimated glomerular filtration rate halving from baseline.</P><P>Of 74,524 patients, 20,332 underwent surgery with non-GA. These patients had baseline (adjusted odds ratio [OR], .68, 95% confidence interval [CI], .63–.72; <I>P</I> < .01] and follow-up serum creatinine levels (adjusted OR, .34; 95% CI, .33–.36; <I>P</I> < .01) less frequently measured than those undergoing GA. However, the incidence of acute kidney injury did not differ significantly between the 2 groups. Moreover, postoperative acute kidney injury after non-GA surgery showed a worse clinical prognosis which was similar with that of GA operations.</P><P>Patients undergoing surgeries under non-GA did not receive sufficient evaluation for their risks of acute kidney injury. As an acute kidney injury in non-GA was associated a worse prognosis as in GA surgeries, more clinical attention should be considered.</P></▼2>