Neuroprotective Effects of GV1001 in Animal Stroke Model and Neural Cells Subject to Oxygen-Glucose Deprivation/Reperfusion Injury / 대한뇌졸중학회지

Background@#and Purpose Previous studies have revealed the diverse neuroprotective effects of GV1001. In this study, we investigated the effects of GV1001 on focal cerebral ischemia-reperfusion injury (IRI) in rats and oxygen-glucose deprivation/reoxygenation (OGD/R)-induced injury in neural stem cells (NSCs) and cortical neurons. @*Methods@#Focal cerebral IRI was induced by transient middle cerebral artery occlusion (MCAO). Brain diffusion-weighted imaging (DWI) was performed 2 hours after occlusion, and a total of 37 rats were treated by reperfusion with GV1001 or saline 2 hours after occlusion. Fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging, immunohistochemistry, and neurobehavioral function analyses were performed. Additionally, OGD/R-injured NSCs and cortical neurons were treated with different GV1001 concentrations. Cell viability, proliferation, migration, and oxidative stress were determined by diverse molecular analyses. @*Results@#In the stroke model, GV1001 protected neural cells against IRI. The most effective dose of GV1001 was 60 μM/kg. The infarct volume on FLAIR 48 hours after MCAO compared to lesion volume on DWI showed a significantly smaller ratio in the GV1001-treated group. GV1001-treated rats exhibited better behavioral functions than the saline-treated rats. Treatment with GV1001 increased the viability, proliferation, and migration of the OGD/R-injured NSCs. Free radicals were significantly restored by treatment with GV1001. These neuroprotective effects of GV1001 have also been demonstrated in OGD/R-injured cortical neurons. Conclusions The results suggest that GV1001 has neuroprotective effects against IRI in NSCs, cortical neurons, and the rat brain. These effects are mediated through the induction of cellular proliferation, mitochondrial stabilization, and anti-apoptotic, anti-aging, and antioxidant effects.

Neuroprotective Effects of GV1001 in Animal Stroke Model and Neural Cells Subject to Oxygen-Glucose Deprivation/Reperfusion Injury / 대한뇌졸중학회지

Background@#and Purpose Previous studies have revealed the diverse neuroprotective effects of GV1001. In this study, we investigated the effects of GV1001 on focal cerebral ischemia-reperfusion injury (IRI) in rats and oxygen-glucose deprivation/reoxygenation (OGD/R)-induced injury in neural stem cells (NSCs) and cortical neurons. @*Methods@#Focal cerebral IRI was induced by transient middle cerebral artery occlusion (MCAO). Brain diffusion-weighted imaging (DWI) was performed 2 hours after occlusion, and a total of 37 rats were treated by reperfusion with GV1001 or saline 2 hours after occlusion. Fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging, immunohistochemistry, and neurobehavioral function analyses were performed. Additionally, OGD/R-injured NSCs and cortical neurons were treated with different GV1001 concentrations. Cell viability, proliferation, migration, and oxidative stress were determined by diverse molecular analyses. @*Results@#In the stroke model, GV1001 protected neural cells against IRI. The most effective dose of GV1001 was 60 μM/kg. The infarct volume on FLAIR 48 hours after MCAO compared to lesion volume on DWI showed a significantly smaller ratio in the GV1001-treated group. GV1001-treated rats exhibited better behavioral functions than the saline-treated rats. Treatment with GV1001 increased the viability, proliferation, and migration of the OGD/R-injured NSCs. Free radicals were significantly restored by treatment with GV1001. These neuroprotective effects of GV1001 have also been demonstrated in OGD/R-injured cortical neurons. Conclusions The results suggest that GV1001 has neuroprotective effects against IRI in NSCs, cortical neurons, and the rat brain. These effects are mediated through the induction of cellular proliferation, mitochondrial stabilization, and anti-apoptotic, anti-aging, and antioxidant effects.

LGR5 and Downstream Intracellular Signaling Proteins Play Critical Roles in the Cell Proliferation of Neuroblastoma, Meningioma and Pituitary Adenoma

Leucine-rich repeat-containing G-protein coupled receptor 5 (LGR5) has been reported to play critical roles in the proliferation of various cancer cells. However, the roles of LGR5 in brain tumors and the specific intracellular signaling proteins directly associated with it remain unknown. Expression of LGR5 was first measured in normal brain tissue, meningioma, and pituitary adenoma of humans. To identify the downstream signaling pathways of LGR5, siRNA-mediated knockdown of LGR5 was performed in SH-SY5Y neuroblastoma cells followed by proteomics analysis with 2-dimensional polyacrylamide gel electrophoresis (2D-PAGE). In addition, the expression of LGR5-associated proteins was evaluated in LGR5-inhibited neuroblastoma cells and in human normal brain, meningioma, and pituitary adenoma tissue. Proteomics analysis showed 12 protein spots were significantly different in expression level (more than two-fold change) and subsequently identified by peptide mass fingerprinting. A protein association network was constructed from the 12 identified proteins altered by LGR5 knockdown. Direct and indirect interactions were identified among the 12 proteins. HSP 90-beta was one of the proteins whose expression was altered by LGR5 knockdown. Likewise, we observed decreased expression of proteins in the hnRNP subfamily following LGR5 knockdown. In addition, we have for the first time identified significantly higher hnRNP family expression in meningioma and pituitary adenoma compared to normal brain tissue. Taken together, LGR5 and its downstream signaling play critical roles in neuroblastoma and brain tumors such as meningioma and pituitary adenoma.

Quality Improvement Activities to Facilitate the Filing of Complexity Payment Claims for Patients with Malnutrition

PURPOSE: The grade of complexity in the diagnosis related group (DRG) payment system is influenced by the secondary diagnosis of specific complication and comorbidity level, in which moderate or severe malnutrition is included. This study examined an existing proportion of patients with malnutrition who were supposed to be qualified for the complexity level and devised quality improvement measures to increase the proportion of qualifying complexity payments. METHODS: The goal of the activities was to increase the rate of complexity payment claims for patients with malnutrition (%). Cases ineligible for the DRG payment system and cases with no diagnosis of malnutrition were excluded. We established a collaborative system between the nutrition support team and departments related to each improvement factor (i.e., patient care, medical records, insurance review, and medical information). RESULTS: Before implementing the activities, this study investigated the current level of complexity payment claims for malnutrition patients who were discharged within a specific period (June 1, 2015~August 31, 2015). The results showed that complexity payment claims were filed in 10.00% (2 of the 20 malnutrition cases). After the activities, the rate of complexity payment claims for the patients with malnutrition within the study period (June 1, 2016~August 31, 2016) was 46.43% (26 out of 56), showing an approximately 364% increase from the pre activity rate. This change was statistically significant according to the chi-square test on Microsoft Excel 2010 (P < 0.01). CONCLUSION: Collaborative efforts by the related departments enabled the smooth implementation of each activity. In addition, moderate or severe malnutrition was revealed to be a variable in the complexity-specific payment system. In the future, hospital-wide awareness and effort are crucial to promot the steady practice of these activities and expand their implementation.

Leucine-rich G Protein-coupled Receptor-5 Is Significantly Increased in the Aqueous Humor of Human Eye with Proliferative Diabetic Retinopathy

Leucine-rich G protein-coupled receptor-5 (LGR5) is known to be a stem cell marker in many organs. LGR5 may have important roles in proliferative diabetic retinopathy (PDR) because LGR5 potentiate the Wnt/β-catenin pathway, which plays crucial roles in pathologic neovascularization in the retina. The association between LGR5 and retinal pathologic neovascularization has not yet been reported. In the present study, LGR5 was compared in human aqueous humor (AH) between normal control and patients with PDR to confirm the relationship between LGR5 and PDR. AH was collected from 7 naïve PDR patients and 3 control subjects before intravitreal injection and cataract surgery, respectively. LGR5 and key members of Wnt/β-catenin were assessed by western blotting. In the present study, it was confirmed for the first time that LGR5 is detected in AH and it increases in PDR patients. Key members of Wnt/β-catenin pathway were also increased in AH of PDR patients compared to control. These findings might support the hypothesis that LGR5 has important roles in PDR especially considering the roles of the Wnt/β-catenin pathway, which is activated by LGR5, contributing to retinal pathologic neovascularization.

Differences between the Molecular Mechanisms Underlying Ruptured and Non-Ruptured Carotid Plaques, and the Significance of ABCA1 / 대한뇌졸중학회지

BACKGROUND AND PURPOSE: Carotid plaques are a strong risk factor for ischemic stroke, and plaque rupture poses an even higher risk. Although many studies have investigated the pathogenic mechanisms of carotid plaque formation, few have studied the differences in molecular mechanisms underlying the rupture and non-rupture of carotid plaques. In addition, since early diagnosis and treatment of carotid plaque rupture are critical for the prevention of ischemic stroke, many studies have sought to identify the important target molecules involved in the rupture. However, a target molecule critical in symptomatic ruptured plaques is yet to be identified. METHODS: A total of 79 carotid plaques were consecutively collected, and microscopically divided into ruptured and non-ruptured groups. Quantitative polymerase chain reaction array, proteomics, and immunohistochemistry were performed to compare the differences in molecular mechanisms between ruptured and non-ruptured plaques. Enzyme-linked immunosorbent assay was used to measure the differences in ATP-binding cassette subfamily A member 1 (ABCA1) levels in the serum. RESULTS: The expression of several mRNAs and proteins, including ABCA1, was higher in ruptured plaques than non-ruptured plaques. In contrast, the expression of other proteins, including β-actin, was lower in ruptured plaques than non-ruptured plaques. The increased expression of ABCA1 was consistent across several experiments, ABCA1 was positive only in the serum of patients with symptomatic ruptured plaques. CONCLUSIONS: This study introduces a plausible molecular mechanism underlying carotid plaque rupture, suggesting that ABCA1 plays a role in symptomatic rupture. Further study of ABCA1 is needed to confirm this hypothesis.

Neural Stem Cell Death Mechanisms Induced by Amyloid Beta

BACKGROUND AND PURPOSE: Amyloid beta (Aβ) is the main component of amyloid plaques, which are deposited in the brains of patients with Alzheimer's disease (AD). Biochemical and animal studies support the central role of Aβ in AD pathogenesis. Despite several investigations focused on the pathogenic mechanisms of Aβ, it is still unclear how Aβ accumulates in the central nervous system and subsequently initiates the disease at the cellular level. In this study, we investigated the pathogenic mechanisms of Aβ using proteomics and antibody microarrays. METHODS: To evaluate the effect of Aβ on neural stem cells (NSCs), we treated primary cultured cortical NSCs with several doses of Aβ for 48 h. A 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide assay, trypan blue staining, and bromodeoxyuridine cell proliferation assay were performed. We detected several intracellular proteins that may be associated with Aβ by proteomics and Western blotting analysis. RESULTS: Various viability tests showed that Aβ decreased NSCs viability and cell proliferation in a concentration-dependent manner. Aβ treatment significantly decreased lactate dehydrogenase B, high-mobility group box 1, aldolase C, Ezrin, and survival signals including phosphorylated phosphoinositide 3-kinase, Akt, and glycogen synthase kinase-3β. CONCLUSIONS: These results suggest that several factors determined by proteomics and Western blot hold the clue to Aβ pathogenesis. Further studies are required to investigate the role of these factors.

Time series analysis of patients seeking orthodontic treatment at Seoul National University Dental Hospital over the past decade / 대한치과교정학회지

OBJECTIVE: This paper describes changes in the characteristics of patients seeking orthodontic treatment over the past decade and the treatment they received, to identify any seasonal variations or trends. METHODS: This single-center retrospective cohort study included all patients who presented to Seoul National University Dental Hospital for orthodontic diagnosis and treatment between January 1, 2005 and December 31, 2015. The study analyzed a set of heterogeneous variables grouped into the following categories: demographic (age, gender, and address), clinical (Angle Classification, anomaly, mode of orthodontic treatment, removable appliances for Phase 1 treatment, fixed appliances for Phase 2 treatment, orthognathic surgery, extraction, mini-plate, mini-implant, and patient transfer) and time-related variables (date of first visit and orthodontic treatment time). Time series analysis was applied to each variable. RESULTS: The sample included 14,510 patients with a median age of 19.5 years. The number of patients and their ages demonstrated a clear seasonal variation, which peaked in the summer and winter. Increasing trends were observed for the proportion of male patients, use of non-extraction treatment modality, use of ceramic brackets, patients from provinces outside the Seoul region at large, patients transferred from private practitioners, and patients who underwent orthognathic surgery performed by university surgeons. Decreasing trends included the use of metal brackets and orthodontic treatment time. CONCLUSIONS: Time series analysis revealed a seasonal variation in some characteristics, and several variables showed changing trends over the past decade.

Analysis of Variation in Total Airborne Bacteria Concentration to Assess the Performance of Biological Safety Cabinets in Microbial Laboratories

BACKGROUND: The purpose of this study was to compare the concentration of total airborne bacteria (TAB) in biosafety cabinets (BSCs) at universities and hospital microbial laboratories to assess the performance of BSCs. METHODS: TAB was determined by using the single-stage Anderson sampler (BioStage Viable Cascade Impactor). The samples were obtained three times (with the BSC turned off and the shield open; with the BSC turned off and the shield closed; and with the BSC tuned on and operating) from the areas in front of 11 BSCs. RESULTS: TAB concentrations of accredited and nonaccredited BSCs were determined. No significant differences were observed in the TAB concentrations of the accredited BSCs and the nonaccredited BSCs for the areas outside the BSCs in the laboratories (p > 0.05). TAB concentrations for the BSCs sampled with the shield open and the instrument turned off showed differences based on the sampling site outside the BSC in each laboratory. CONCLUSION: These results imply that TAB concentration is not altered by the performance of the BSCs or TAB itself and/or concentration of TAB outside the BSC is not a good index of BSC performance.

Effect of glycerin on the surface hardness of composites after curing / 대한치과보존학회지

OBJECTIVES: The purpose of this study was to examine the effect of glycerin topical application on the surface hardness of composite after curing. MATERIALS AND METHODS: A composite (Z-250, 3M ESPE) was packed into a disc-shaped brass mold and light cured according to one of the following protocols. Group 1 (control) was exposed to air and light cured for 40 sec, group 2 was covered with a Mylar strip and light cured for 40 sec, group 3 was surface coated with glycerin and light cured for 40 sec, and group 4 was exposed to air and light cured for 20 sec and then surface coated with glycerin and cured for additional 20 sec. Twenty specimens were prepared for each group. The surface hardnesses of specimens were measured with or without polishing. Five days later, the surface hardness of each specimen was measured again. Data were analyzed by three-way ANOVA and Tukey's post hoc tests. RESULTS: The surface hardnesses of the unpolished specimens immediately after curing decreased in the following order: group 2 > 3 > 4 > 1. For the polished specimens, there was no significant difference among the groups. Within the same group, the hardness measured after five days was increased compared to that immediately after curing, and the polished specimens showed greater hardness than did the unpolished specimens. CONCLUSIONS: The most effective way to increase the surface hardness of composite is polishing after curing. The uses of a Mylar strip or glycerin topical application before curing is recommended.

Exposure to Volatile Organic Compounds and Possibility of Exposure to By-product Volatile Organic Compounds in Photolithography Processes in Semiconductor Manufacturing Factories

OBJECTIVES: The purpose of this study was to measure the concentration of volatile organic compound (VOC)s originated from the chemicals used and/or derived from the original parental chemicals in the photolithography processes of semiconductor manufacturing factories. METHODS: A total of four photolithography processes in 4 Fabs at three different semiconductor manufacturing factories in Korea were selected for this study. This study investigated the types of chemicals used and generated during the photolithography process of each Fab, and the concentration levels of VOCs for each Fab. RESULTS: A variety of organic compounds such as ketone, alcohol, and acetate compounds as well as aromatic compounds were used as solvents and developing agents in the processes. Also, the generation of by-products, such as toluene and phenol, was identified through a thermal decomposition experiment performed on a photoresist. The VOC concentration levels in the processes were lower than 5% of the threshold limit value (TLV)s. However, the air contaminated with chemical substances generated during the processes was re-circulated through the ventilation system, thereby affecting the airborne VOC concentrations in the photolithography processes. CONCLUSION: Tens of organic compounds were being used in the photolithography processes, though the types of chemical used varied with the factory. Also, by-products, such as aromatic compounds, could be generated during photoresist patterning by exposure to light. Although the airborne VOC concentrations resulting from the processes were lower than 5% of the TLVs, employees still could be exposed directly or indirectly to various types of VOCs.

The Effects of Prophylactic Metoclopramide and Induction with Propofol on Postoperative Nausea and Vomiting / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) are common problems in patients undergoing a laparoscopic cholecystectomy. This study evaluated the effect of prophylactic metoclopramide (MCP) and induction with propofol on PONV. METHODS: 165 patients undergoing laparoscopic cholecystectomy were randomly divided into four groups. Groups 1 (control group) and 2 were inducted with thiopental sodium. Groups 3 (propofol group) and 4 were inducted with propofol. Prophylactic metoclopramide 10 mg i.v. was administered in Groups 2 (MCP group) and 4 (propofol + MCP group). The incidence of PONV, the need for rescue antiemetics, adverse events, and the nausea severity scores were assessed at 0 to 1 hour and at 1 to 24 hours postoperatively. RESULTS: During the first 24 hours after anesthesia, the incidence of PONV in Groups 1, 2, 3 and 4 was 41.5%, 29.3%, 30.3% and 23.3%, respectively. There was no significant difference between the groups. During the period, 1 hour to 24 hours, after anesthesia, the incidence of PONV in Groups 1, 2, 3 and 4 was 36.6%, 17.4%, 27.5% and 14.4%, respectively. The incidence of PONV in Group 4 was significantly lower than in Group 1 (P < 0.05). CONCLUSIONS: In patients with laparoscopic cholecystectomy, a combination of prophylactic metoclopramide administration and induction with propofol was found to reduce the incidence of PONV by about 22.6% during the period 1 hour to 24 hours after anesthesia.

The Effect of Low-dose Ketamine on the Incidence of Emergence Agitation in Preschool Children Receiving Sevoflurane Anesthesia: Comparison with Ketorolac / 대한마취과학회지

BACKGROUND: Emergence agitation is a common side effect of sevoflurane anesthesia in preschool children. Low-dose ketamine is defined as a bolus dose of less than 1 mg/kg when administered via the intravenous route, and produces potent analgesia without respiratory depression or other side effects. In this study, we examined the effect of low-dose ketamine on the incidence of emergence agitation in preschool children receiving sevoflurane anesthesia and compared this with the effect of ketorolac. METHODS: Sixty eight preschool children receiving sevoflurane anesthesia were randomized to receive either ketorolac 1 mg/kg or ketamine 0.2 mg/kg intravenously before the end of surgery. Emergence agitation was assessed using a 3-point scale (1 = asleep, calm, or mildly agitated but easily consolable; 2 = moderately agitated or restless but inconsolable; and 3 = hysterical, crying inconsolably, or thrashing) during transfer and at 10 minutes after arrival at our postanesthesia care unit. RESULTS: We observed that the incidences of emergence agitation were 30.0%, 45.0% in the ketamine group, and 60.7%, 78.6% in the ketorolac group (P < 0.05) during transfer and at 10 minutes after arrival at the postanesthesia care unit, respectively. No significant difference was observed between the two groups with respect to discharge time from the postanethesia care unit. CONCLUSIONS: Emergence agitation after sevoflurane anesthesia in preschool children was significantly reduced by low-dose ketamine as compared with ketorolac without delaying recovery.

Two Case of Twin Pregnancy with a Single Anomalous Fetus / 대한산부인과학회잡지

Twin pregnancy is at increased risk for congenital anomalies. Although twins were relatively infrequent, they accaunted for a disproportionately large portion of adverse pregnancy outcome, primarily as a consequence of preterm delivery, gestational diabetes, and pregnancy induced hypertension. In case of twin pregnancy with a single anomalous fetus, the clinicians are faced with difficult decision-making processes regarding the route of delivery, when to deliver, how aggressively to attempt to prevent delivery. Twin pregnancy discordant for a fetal abnormality can be managed expectantly or by selective fetocide of abnormal twin. Recently we experienced two cases of twin pregnancy with a single anornalous fetus. We reported cases with concerned literatures.

Clinical Analysis of 1,068 Cases of Mid-trimester Genetic Amniocentesis / 대한산부인과학회잡지

OBJECTIVES: The objective of this study is to analyze 1,068 cases of prenatal genetic amniocentesis and to compare the results with reported studies. METHOD: We analyzed 1,068 cases of midtrimester prenatal genetic amniocenteses from September 1994 to February 1999, and investigated the fetal chromosomal abnormality, obstetric outcomes and complications by the indications of genetic amniocentesis and prophylactic antibiotic use at the Department of Obstetrics and Gynecology, Ajou University School of Medicine. RESULTS: Abnormal maternal serum markers were the most common indication of amniocentesis (57.7%) and the most common age distribution was 25-29 years (39.2%). One case of early amniocentesis (14 gestational weeks) was performed. The overall incidence of chromosomal aberration was 5.2% (56/1,068), of which there were 28 cases (50.0%; 28/56) of numerical aberrations and 28 cases (50.0%; 28/56) of structural aberrations. There were 50 cases (4.7%) of autosomal chromosomal aberrations and 6 cases (0.6%) of sex chromosomal aberrations. The pregnancy outcome was full-term delivery in 86.5%, preterm delivery in 7.6%, termination of pregnancy in 4.0%. There were no cases of serious complications including fetal death except for a case of self-limited amniotic fluid leakage(high leakage) in which the pregnancy was maintained. There were no significant differences between prophylactic antibiotics user group and non-user group in obstetric complications and outcomes. CONCLUSION: We could confirm that the trend in the indication of genetic amniocentesis had changed from advanced maternal age(35 year-old) toward abnormal maternal serum marker(triple test), and we recognized the importance of genetic amniocentesis according to the various antenatal screening tests of maternal serum marker, antenatal ultrasound, past history of fetal anomaly or family history of fetal chromosomal anomaly in the younger age groups(< 35 year-old) that are involved in more than half of the chromosomal anomaly. Further study will be needed to elucidate the efficacy of using prophylactic antibiotics in amniocentesis.

Hemangiopericytoma of the Greater Omentum Mimicking Ovarian Tumor: a Case Report / 대한부인종양콜포스코피학회잡지

The hemangiopericytoma originated from the greater omentum is a very rare vascular tumor and grows to a large mass without symptoms for a long period. The diagnosis can be made on ultrasonogram, CT or MRI and angiogram with the findings of well circumscribed, solitary mass with hypervascularity in the abdominal cavity especially retroperitoneal cavity. The surgical treatment is recommended due to its possibility of malignant potential and metastasis on diagnosis. The evaluation of differential diagnosis to rule out this tumor is obligatory if a large solitary movable mass being palpated in abdomen. We experienced a case of hemangiopericytoma of greater omentum which was diagnosed as a left ovarian tumor preparatively, and we report the case with brief review of the literatures.

Hemangiopericytoma of the Greater Omentum Mimicking Ovarian Tumor: a Case Report / 대한부인종양콜포스코피학회잡지

The hemangiopericytoma originated from the greater omentum is a very rare vascular tumor and grows to a large mass without symptoms for a long period. The diagnosis can be made on ultrasonogram, CT or MRI and angiogram with the findings of well circumscribed, solitary mass with hypervascularity in the abdominal cavity especially retroperitoneal cavity. The surgical treatment is recommended due to its possibility of malignant potential and metastasis on diagnosis. The evaluation of differential diagnosis to rule out this tumor is obligatory if a large solitary movable mass being palpated in abdomen. We experienced a case of hemangiopericytoma of greater omentum which was diagnosed as a left ovarian tumor preparatively, and we report the case with brief review of the literatures.

Monitoring of Activated Coagulation Time with Kaolin vs. Celite Activator in Cardiac Surgical Patients with Aprotinin / 대한흉부외과학회지

BACKGROUND: High-dose aprotinin has been reported to enhance the anticoagulant effects of heparin during cardiopulmonary bypass ; hence, som authors have advocated reducing the dose of heparin in patients treated with aprotinin. MATERIAL AND METHOD: The ACT was measured before, during and after cardiopulmonary bypass, with Hemochron 801 system using two activators of celite (C-ACT) and kaolin (K-ACT) as surface activator. From June, 1996 to February, 1997, 22 adult patients who were scheduled for elective operation were enrolled in this study. RESULT: The ACT without heparin did not differ between C-ACT and K-ACT. At 30 minutes after anticoagulation with heparin and cardiopulmonary bypass, the average C-ACT was 928+/-400 s; K-ACT was 572+/-159s (p<0.05). After administration of protamine, C-ACT was 137+/-26 s; K-ACT was 139+/-28s, which were not statistically significant. CONCLUSION: Our results showed that the significant increase in the ACT during heparin-induced anticoagulation in the presence of aprotinin was due to the use of celite as surface activator, rather than due to enhanced anticoagulation of heparin by aprotinin. We conclude that the ACT measured with kaolin provides better monitoring of cardiac surgical patients treated with high dose aprotinin than does the ACT measured with celite. The patients treated with aprotinin should receive the usual doses of heparin.

Double Valve Replacement via Ministernotomy: A Case Report / 대한흉부외과학회지

Recently, several versatile approaches via limited incision have been developed for minimally invasive cardiac surgery. As the incision is limited, it is often dfficult to get a satisfactory operative field, especially for the manipulation of two separate lesions such as simultaneous mitral and aortic valve disease with a single limited incision. Here, we describe a case of successful double valve replacement via ministernotomy, which was followed by two cases of minimally invasive aortic valve replacement via transsternal approach. The operative field was unexceptionally satisfactory and the postoperative patient's acceptance was high. The methodology is described with a review of the relevant literatures.

Minimally Invasive Aortic Valve Surgery: A Report of Two Cases / 대한흉부외과학회지

Recently, minimally invasive approach via limited incision becomes one of the rapidly developing strategy in cardiac surgery as it gives less surgical trauma and is more satisfactory to the patients in respect to operative scar although the surgical technique is more demanding. Here, we report two cases of aortic valve replacement via limited transsternal incision. The methodology is described with review of the relevant literature.