Comparing hemostatic resuscitation management of intraoperative massive bleeding with traumatic massive bleeding: a computer simulation

Lee Young Sun,Kim Kyu Nam,Lee Min Kyu,Sun Jung Eun,Hyun Jin Lim,전종헌 대한마취통증의학회 2020 Anesthesia and pain medicine Vol.15 No.4

Background: Appropriate blood component transfusion might differ between intraoperative massive bleeding and traumatic massive bleeding in the emergency department because trauma patients initially bleed undiluted blood and replacement typically lags behind blood loss. We compared these two blood loss scenarios, intraoperative and traumatic, using a computer simulation. Methods: We modified the multi-compartment dynamic model developed by Hirshberg and implemented it using STELLA 9.0. In this model, blood pressure changes as blood volume fluctuates as bleeding rate and transcapillary refill rate are controlled by blood pressure. Using this simulation, we compared the intraoperative bleeding scenario with the traumatic bleeding scenario. In both scenarios, patients started to bleed at a rate of 50 ml/min. In the intraoperative bleeding scenario, fluid was administered to maintain isovolemic status; however, in the traumatic bleeding scenario, no fluid was supplied for up to 30 min and no blood was supplied for up to 50 min. Each unit of packed red blood cells (PRBC) was given when the hematocrit decreased to 27%, fresh frozen plasma (FFP) was transfused when plasma was diluted to 30%, and platelet concentrate (PC) was transfused when platelet count became 50,000/ml. Results: In both scenarios, the appropriate ratio of PRBC:FFP was 1:0.47 before PC transfusion, and the ratio of PRBC:FFP:platelets was 1:0.35:0.39 after initiation of PC transfusion. Conclusion: The ratio of transfused blood component did not differ between the intraoperative bleeding and traumatic bleeding scenarios.

Comparison of Melanoma Subtypes among Korean Patients by Morphologic Features and Ultraviolet Exposure

( Hong Sun Jang ),( Jee Hung Kim ),( Kyu Hyun Park ),( Jae Seok Lee ),( Jung Min Bae ),( Byung Ho Oh ),( Sun Young Rha ),( Mi Ryung Roh ),( Kee Yang Chung ) 대한피부과학회 2014 Annals of Dermatology Vol.26 No.4

Background: Genetic alterations have been identified in melanomas according to different levels of sun exposure. Whereas the conventional morphology-based classification provides a clue for tumor growth and prognosis, the new classification by genetic alterations offers a basis for targeted therapy. Objective: The purpose of this study is to demonstrate the biological behavior of melanoma subtypes and compare the two classifications in the Korean population. Methods: A retrospective chart review was performed on patients found to have malignant melanoma in Severance Hospital from 2005 to 2012. Age, sex, location of the tumor, histologic subtype, tumor depth, ulceration, lymph node invasion, visceral organ metastasis, and overall survival were evaluated. Results: Of the 206 cases, the most common type was acral melanoma (n=94, 45.6%), followed by nonchronic sun damage-induced melanoma (n=43, 20.9%), and mucosal melanoma (n=40, 19.4%). Twenty-one patients (10.2%) had the chronic sun-damaged type, whereas eight patients (3.9%) had tumors of unknown primary origin. Lentigo maligna melanoma was newly classified as the chronic sun-damaged type, and acral lentiginous melanoma as the acral type. More than half of the superficial spreading melanomas were newly grouped as nonchronic sun-damaged melanomas, whereas nodular melanoma was rather evenly distributed. Conclusion: The distribution of melanomas was largely similar in both the morphology-based and sun exposure-based classifications, and in both classifications, mucosal melanoma had the worst 5-year survival owing to its tumor thickness and advanced stage at the time of diagnosis. (Ann Dermatol 26(4) 485~490, 2014)

온풍 조건에서 수분 탈락 정도에 따른 피부 분류 및 개선 방안에 대한 연구

권오선 ( Oh Sun Kwon ),강현종 ( Hyun Jong Kang ),한승민 ( Seung Min Han ),윤지선 ( Ji S Eon Yoon ),조웅희 ( Woong Hee Cho ),오주영 ( Joo Young Oh ),임준만 ( Jun Man Lim ),송영숙 ( Young Sook Song ),박선규 ( Sun Gyoo Park ) 대한화장품학회 2020 대한화장품학회지 Vol.46 No.2

피부를 탄력있고 부드럽게 하는 역할은 각질층에 존재하는 수분량에 의해 좌우된다. 피부 수분량은 냉온풍, 건조환경 등 다양한 환경 변화에 의해 영향을 받음이 알려져 있으나, 개인 피부 차이에 따른 피부수분량 변화와 회복 정도에 대해서는 많은 연구가 이루어 지지 않은 실정이다. 본 연구에서는 온풍 조건하에서 피시험자들의 피부 수분 탈락 및 회복 정도를 비교 평가하여 새로운 피부 타입을 제시하고, 온풍 조건에서 저하되는 피부 수분량을 개선 시켜주는 효능 물질을 개발하고자 하였다. 온풍 환경 조성을 위해, 건강한 피험자(남: 10 명, 여: 39 명, 25 세 - 63 세)의 전완부에 온풍(30 cm, 40 ℃, 6 m/s)을 30 min 간 피부에 노출시켜, 피부 수분량의 변화를 평가하였다. 26명(남: 4 명, 여: 22 명, 평균 연령: 42.7 ± 9.4)이 온풍 노출전에 비하여 온풍 노출 후 수분량이 유의하게 감소하며, 노출 후 30 min이 지나도 회복이 되지 않았다. 온풍노출 후 수분량이 떨어지는 피험자(여: 10 명)를 대상으로 보수력이 높은 크림을 3 주간 전완부에 적용한 이후 동일 온풍 조건하에서 피부 수분량을 측정한 결과, 노출 30 min 후 피부 수분량이 온풍 노출 전 수준으로 회복됨을 확인하였다. 본 연구를 통하여 피부는 건조 조건에서 쉽게 수분을 잃어버리는 피부(탈수형 피부)가 존재하는 것을 확인하였다. 이는 앞으로 화장품 개발을 보습 기능뿐만 아니라, 이러한 환경변화에 따른 피부수분이 쉽게 빠져나가는 피부(탈수형 피부)의 특성에 맞는 제품의 효능 개발이 필요함을 보여준다. Elasticity and softness of the skin depend on the level of moisture present in the stratum corneum, which is known to be affected by various environmental changes, such as cold and hot winds and dry environments. However, not many studies have been conducted on changes in skin moisture and the degree of recovery due to individual skin differences. In the present study, we aimed to investigate the effect of warm air heating on skin hydration levels and develop moisturizing formulas to improve lowered skin hydration levels. In order to deliver warm air heating condition, heating dryer (40 ℃, 6 m/s, 30 cm apart from forearm) was applied into inner forearm of healthy subjects (male: 10, female: 39, age: 25 - 63) Among 49 subjects, 26 subjects showed significantly lowered skin hydration levels until 30 min after warm air heating exposure (lowered group). In addition, moisturizing cream with high water holding capacity was applied to forearm of 10 subjects in lowered group for 3 weeks and skin hydration levels after warm air heating were significantly improved at the levels of before application of warm air heating. From this study, we found out that there is a skin type that skin hydration levels are significantly decreased under warm air heating condition (dehydrated skin) and this dehydrated skin can be improved by moisturizing formulas with high water holding capacity.

열처리에 의한 Morganella morganii와 Photobacterium phosphoreum 유래 Histidine Decarboxylase의 불활성화

박원민(Won-Min Pak),김꽃봉우리(Koth-Bong-Woo-Ri Kim),김민지(Min-Ji Kim),박지혜(Ji-Hye Park),배난영(Nan-Young Bae),박선희(Sun-Hee Park),안동현(Dong-Hyun Ahn) 한국식품영양과학회 2016 한국식품영양과학회지 Vol.45 No.3

Histamine을 생성하는 Morganella morganii와 Photobacterium phosphoreum으로부터 crude histidine decarboxylase(HDC)를 추출하여 65~121°C로 열처리한 다음 균의 생육 및 효소 활성 변화에 대해 살펴보았다. 그 결과 M. morganii와 P. phosphoreum은 모든 열처리 조건에서 비 가열 처리구와 비교 시 균의 생육이 저해됨을 확인하였다. M. morganii와 P. phosphoreum 유래 HDC의 효소 활성은 65°C에서 90% 이상의 효소 활성이 저해됨을 확인하였고, 온도가 증가함에 따라 유의적으로 활성이 억제되는 것으로 나타났다. SDS-PAGE 결과에서는 65~100°C 범위에서 비가열 처리구와 비교 시 조효소액의 단백질 패턴의 변화가 크지 않았으나, 121°C에서 단백질 band의 강도가 크게 약해졌다. Native-PAGE에서는 65°C 처리 조건에서부터 단백질 패턴의 변화가 크게 나타났다. 따라서 가열처리(65~121°C)는 histamine 생성균인 M. morganii와 P. phosphoreum의 생육을 억제할 뿐만 아니라 HDC의 효소 활성도가 저해됨을 확인하여, 식품산업에서 적용되고 있는 열처리 조건에서 histamine 생성 억제에 큰 효과가 있는 것으로 생각한다. This study was performed to investigate the effects of various thermal treatments on the growth of Morganella morganii and Photobacterium phosphoreum and activity of crude histidine decarboxylase (HDC) obtained from M. morganii and P. phosphoreum. Crude HDC and the two strains were treated at 65°C/30 min, 80°C/10 min, 100°C/10 min, and 121°C/10 min. Activity of crude HDC decreased with increasing temperature. Viable cells counts of M. morganii and P. phosphoreum were not detected in any heated samples. SDS-PAGE patterns of heated HDC did not show significant differences up to 100°C. However, at 121°C, protein band intensity was weakened. In native-PAGE, there was a major change in the pattern of HDC at 65°C. These results suggest that thermal treatment can help to reduce histamine production by reducing HDC activity and growth of M. morganii and P. phosphoreum.

젊은 성인에서 흡연에 의한 상완동맥 내피기능의 부전에 관한 연구

이상철,권영주,방덕원,이선해,이보영,김지욱,김영훈,온영근,현민수,김성구 순천향의학연구소 2002 Journal of Soonchunhyang Medical Science Vol.8 No.1

Background and Objectives : Cigarette smoking is a major factor and the most modifiable risk factor for atherosclerosis. Endothelial dysfunction is an early event in atherosclerosis, before the structural change of the systemic arteries. We hypothesized that endothelial dysfunction might be present in the systemic arteries of young adult smokers and that this might be dose-dependent phenomenon. Therefore, we try to certify that smoking is associated with endothelial dysfunction in healthy young adults without other risk factor of atherosclerosis. Subjects and Methods : we studied noninvasively 29 subjects aged 3 to 4 decades without other risk factor of atherosclerosis, they were composed of the two groups, current smokers(n=15) and nonsmokers(n=14). Smoking history varied from 3 to 20 pack years. Using high-resolution ultrasound, vessel diameter and mean flow rate were measured at rest, during reactive hyperemia(with flow-mediated endothelium-dependent dilation), and after sublingual nitroglycerin(NG-induced endothelium-independent vasodilation). Result : Flow mediated endothelium dependent dilation was observed in the control subjects (9.4±3.44%) but was impaired in the smokers(5.8±2.51%)(p=0.004). NG-induced endothelium independent dilation is no difference in all subjects. Conclusion : Cigarette smoking is associated with endothelial dysfunction in healthy young adults.

Effects of Chungkookjang Extract on Growth Hormone Secretion from GH3 Mouse Pituitary Cell and Growth Hormone Receptor Signaling Pathway

Sun Il Choi(최선일),Ji Eun Kim(김지은),In Sik Hwang(황인식),Hye Ryun Lee(이혜련),Young Ju Lee(이영주),Hong Joo Son(손홍주),Dong Seob Kim(김동섭),Kyu Min Park(박규민),Dae Youn Hwang(황대연) 한국생명과학회 2012 생명과학회지 Vol.22 No.9

뇌하수체 전엽에서 성장호르몬의 생산과 분비는 세포의 분열과 분화 그리고 이동을 조절하는 몇 가지 천연물질에 의해 유도된다. 따라서 발효과정을 통해 제조된 청국장이 성장호르몬의 대사에 미치는 영향을 평가하기 위하여 성장호르몬 분비능과 반응성을 뇌하수체 세포와 성장호르몬 표적세포에서 관찰하였다. 6가지 종류의 콩 품종으로 제조된 청국장 추출물 중에서, 대원, 대풍, 태광의 3종류 청국장 추출물은 5 mg/ml 농도에서 GH3 세포로부터 성장호르몬의 분비를 촉진하였다. 비록 세포 생존능은 이러한 추출물에 의해 유의적인 변화가 유도되지 않았으나, 성장호르몬의 분비량은 청국장 추출물의 농도에 의존적으로 증가하였다. 또한 성장호르몬의 표적 기관으로부터 유래된 MG63과 HepG2 세포는 GH3로부터 수집된 조건적 배양액에 의해 유의적으로 활성화되었다. 또한 이러한 세포에서 STAT5 발현은 대원 청국장 추출물을 처리 후, 15분 혹은 30분부터 세포질에서 유의적으로 증가하였으며, p-STAT5는 핵에서 30분 혹은 60분부터 증가하였다. 따라서 이러한 결과는 3가지 종류의 청국장 추출물은 성장호르몬의 분비를 촉진시키며, 청국장의 조건적 배양액은 성장호르몬 표적세포에서 신호전달을 유도함을 제시하고 있다. The production and secretion of growth hormone (GH) in the anterior pituitary gland can be induced by several natural products to control cell proliferation, differentiation, and migration. To investigate whether Chungkookjang (CKJ) produced by the fermentation process affects GH-related metabolism, the secretion and the response of GH were observed in pituitary cells and GH target cells. Among six CKJs manufactured by different strains of glycine max, only three CKJs, including Daewon (DW), Daepung (DP), and Taegwang (TG), induced GH secretion from GH3 cells at 5.0 mg/ml concentration. There were no significant changes detected in the viability of any of the cells treated with these CKJs. In addition, the increase in GH secretion from the GH3 cells was dependent on the concentration of the three types of CKJs. The proliferation of cell lines, including MG63 and HepG2 cells, that originated from those derived from the GH target organs was significantly activated by treatment with the GH-containing conditional medium (GCM) harvested from the three CKJ-treated GH3 cells, although their induction rate was different from each other. In these cells, p-STAT5 was maximally translocated into the nucleus of MG63 cells 30 min after DW treatment, while it was translocated in HepG2 cells at 60 min. These results suggest that these three types of CKJ could enhance the secretion of GH, as well as the GCM-derived response, in the two target organs.

Biliary Self-Expandable Metal Stent Could Be Recommended as a First Treatment Modality for Immediate Refractory Post-Endoscopic Retrograde Cholangiopancreatography Bleeding

Sun Young Moon,Jun Heo,Min Kyu Jung,Chang Min Cho 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.1

Background/Aims: Recent reports suggest that the biliary self-expandable metallic stent (SEMS) is highly effective for maintaininghemostasis when endoscopic hemostasis fails in endoscopic retrograde cholangiopancreatography (ERCP)-related bleeding. Wecompared whether temporary SEMS offers better efficacy than angioembolization for refractory immediate ERCP-related bleeding. Methods: Patients who underwent SEMS placement or underwent angioembolization for bleeding control in refractory immediateERCP-related bleeding were included in the retrospective analysis. We evaluated the hemostasis success rate, severity of bleeding,change in hemoglobin levels, amount of transfusion, and delay to the start of hemostasis. Results: A total of 27 patients with SEMS and 13 patients who underwent angioembolization were enrolled. More transfusionswere needed in the angioembolization group (1.0±1.4 units vs. 2.5±2.0 units; p=0.034). SEMS failure was successfully rescued byangioembolization. The partially covered SEMS (n=23, 85.1%) was generally used, and the median stent-indwelling time was 4 days. The mean delay to the start of angioembolization was 95.2±142.9 (range, 9–491) min. Conclusions: Temporary SEMS had similar results to those of angioembolization (96.3% vs. 92.3%; p=0.588). Immediate SEMSinsertion is considered a bridge treatment modality for immediate refractory ERCP-related bleeding. Angioembolization still has arole as rescue therapy when SEMS does not work effectively.

흡연이 Gastric Emptying Time에 미치는 영향

조민구(Min Koo Cho),정순영(Sun Young chung),김소연(So Yon Kim),문희승(Mun Hee Seung),김진석(Jin Suk Kim),이석호(Suk Ho Lee),이권전(Gwon Jun Lee) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.2

The effect of cigarette smoking on gastric emptying was examined in 25 healthy volunteers by means of Tc-sulfur colloid labeled-solid meal. The volunteers underwent GET measurement two times: before smoking and after smoking two cigarettes. Before smoking, the each average of GET T25% T50%, T75%, was 18 +- 5.2, 40 +- 6.7, 90 +- 18.4 min and after cigarette smoking the each average of GET T25%, T50%, 75% was 30 +- 8.3, 64 +- 12.6, 114 +- 7.0 min. We concluded that cigarette smoking significantly delayed gastric emptying of a solid meal (p< 0.05).

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

Improved Properties of Nanocrystalline Cellulose Isolated from Kraft Pulp by Electron Beam Irradiation

Kim, Sun-Young,Lee, Byoung-Min,Lee, Yeong-Ju,Kim, Du-Yeong,Jeun, Joon-Pyo,Kang, Phil-Hyun American Scientific Publishers 2016 Journal of Nanoscience and Nanotechnology Vol.16 No.10

<P>In this study, we investigated an improvement to the properties of nanocrystalline cellulose (NCC) from kraft pulp using electron beam irradiation (EBI). The EBI of the kraft pulp was performed at various doses (25, 50, and 75 kGy) and then hydrolyzed with 55% sulfuric acid at 50 degrees C (preheated) for 20 min. The hydrolysate of kraft pulp was characterized using X-ray diffraction (XRD), particle size distribution, thermogravimetric analysis (TGA), and transmission electron microscopy (TEM). The NCC of pristine kraft pulp was obtained with a broad size distribution (0-700 nm), an average particle size of 220 nm, and a 75.5% crystallinity index after 20 min of acid-hydrolysisat 50 degrees C. However, isolated NCC from 75 kGy irradiated kraft pulp was obtained with a narrow size distribution (0-530 nm), an average particle size of 160 nm, and 83.2% crystallinity after 20 min of acidhydrolysisat 50 degrees C. These results indicate that the size and crystallinity of NCC were easily controlled by adjusting the EBI dose.</P>