기능적 단심실 환자들의 심방 및 폐 동맥 압력 측정 시 최적의 변환기 위치

학위논문 (석사)-- 서울대학교 대학원 : 임상의과학과 임상의과학전공, 2016. 2. 김진태.ABSTRACT Introduction: Obtaining accurate hemodynamic data is the first step in making a correct decision for the hemodynamic management of patients with congenital heart disease. This study was conducted to investigate the optimal transducer position for atrial and pulmonary arterial pressure monitoring in the supine and sitting position in patients with functional single ventricle. Methods: Contrast enhanced chest computed tomographic data of 108 patients who underwent either bicaval pulmonary shunt (BCPS) placement or the Fontan procedure were retrospectively reviewed. From the transverse-section images, vertical distances between the skin of the back and the uppermost fluid levels of the single atrium and pulmonary artery, and their ratios to the largest anteroposterior (AP) diameter of the thoracic cage were calculated for the supine position. For the sitting position, distances between the mid-sternoclavicular joint and the most cephalad fluid levels of the atrium and the pulmonary artery and their ratios to the sternal length were calculated. Each level was determined with regard to the corresponding rib or intercostal space. Results: The ratios of the uppermost blood level of the atrium and pulmonary artery to the largest AP diameter of the thorax in the patient who underwent BCPS placement in the supine position were 76.0 ± 8.1%, and 56.3 ± 5.5 %, respectively. These values were 79.3 ± 10.0% and 58.3 ± 5.8% respectively, in the patients who underwent the Fontan procedure. In the sitting position, the ratios of the most cephalad blood level of the atrium and pulmonary artery to the sternal length in the patients who underwent BCPS placement were 51.4±11.2%, and 42.2±8.1% respectively, whereas those in the patients who underwent the Fontan procedure was 52.7 ± 8.6% and 41.4 ± 7.1% respectively. The external land mark corresponding to the most cephalad atrium and pulmonary artery was the second intercostal space for both the patients who underwent BCPS placement and those who underwent the Fontan procedure. Conclusions: Taken together, the optimal transducer levels for measuring atrial and pulmonary arterial pressures in the supine position were at 75-80% and 55-60% of the AP diameter of the thorax respectively for patients with functional single ventricle. For the sitting position, the optimal transducer level for measuring atrial and pulmonary arterial pressures was approximately the second intercostal space.   ------------------------------------ Keywords: Central venous pressuresupine positionsitting positioncongenital heart diseaseIntroduction 1 Material and Methods 3 Results 7 Discussion 38 References 41 Abstract in Korean 43Maste

Clinical and Lifestyle Determinants of Continuous Glucose Monitoring Metrics in Insulin-Treated Patients with Type 2 Diabetes Mellitus

Background There was limited evidence to evaluate the association between lifestyle habits and continuous glucose monitoring (CGM) metrics. Thus, we aimed to depict the behavioral and metabolic determinants of CGM metrics in insulin-treated patients with type 2 diabetes mellitus (T2DM). Methods This is a prospective observational study. We analyzed data from 122 insulin-treated patients with T2DM. Participants wore Dexcom G6 and Fitbit, and diet information was identified for 10 days. Multivariate-adjusted logistic regression analysis was performed for the simultaneous achievement of CGM-based targets, defined by the percentage of time in terms of hyper, hypoglycemia and glycemic variability (GV). Intake of macronutrients and fiber, step counts, sleep, postprandial C-peptide-to-glucose ratio (PCGR), information about glucose lowering medications and metabolic factors were added to the analyses. Additionally, we evaluated the impact of the distribution of energy and macronutrient during a day, and snack consumption on CGM metrics. Results Logistic regression analysis revealed that female, participants with high PCGR, low glycosylated hemoglobin (HbA1c) and daytime step count had a higher probability of achieving all targets based on CGM (odds ratios [95% confidence intervals] which were 0.24 [0.09 to 0.65], 1.34 [1.03 to 1.25], 0.95 [0.9 to 0.99], and 1.15 [1.03 to 1.29], respectively). And participants who ate snacks showed a shorter period of hyperglycemia and less GV compared to those without. Conclusion We confirmed that residual insulin secretion, daytime step count, HbA1c, and women were the most relevant determinants of adequate glycemic control in insulin-treated patients with T2DM. In addition, individuals with snack consumption were exposed to lower times of hyperglycemia and GV

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Identical thermal stress coupled with different temperature and humidity combinations affects nutrient digestibility and gut metabolites of laying hens

ABSTRACT The present study investigated whether the same temperature-humidity index (THI) values under different conditions of air temperature and relative humidity (RH) would affect the thermoregulatory, nutritional, and behavioral responses of laying hens. One hundred twenty Hy-Line Brown laying hens (60-weeks-old) were divided equally in two environmental chambers: 26 °C with 70% RH (hRH75) and 30 °C with 30% RH (hT75) for 28 days. The two ambient environments (hRH75 and hT75) had an identical THI value of 75, calculated using an empirical formula for laying hens. Neither hRH75 nor hT75 affected rectal and body-surface temperatures and heart and respiratory rates. The concentration of volatile fatty acids in fecal excreta were altered by the thermal treatments. hT75 vs. hRH75 decreased the proportion of acetate and increased the proportion of propionate in fecal samples. hT75 vs. hRH75 lowered the digestibility of dry matter, crude protein, and neutral detergent fiber at 14 days. Thermal treatments did not affect heat stress-associated behavioral responses including feeding, drinking, panting, and wing elevation at any stage. Laying hens exposed to the same THI at different temperatures and RH exhibit equal physiological responses including rectal and body-surface temperatures, heart and respiratory rates, and behavioral responses. Nonetheless, high-temperature treatment (hT75; 30 °C and 30% RH) vs. low temperature treatment (hRH75; 26 °C and 70% RH) affects nutrient digestibility and gut metabolites, suggesting that there are negligible but discernable responses to temperature in the gut physiology

Relationship Between Handgrip Strength and Pulmonary Function in Apparently Healthy Older Women

Objectives To investigate the relationship between handgrip strength and pulmonary function. Design Cross‐sectional study of a representative sample of older Korean women. Setting The Korean National Health and Nutrition Examination Survey. Participants Community‐dwelling women aged 65 and older without chronic diseases or pulmonary disease (N=605). Measurements Handgrip strength was measured using a digital hand dynamometer, and pulmonary function was tested according to guidelines of the American Thoracic Society/European Respiratory Society using a spirometry system. Impaired pulmonary function was defined as a lower limit of normal (LLN) or less of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1). Odds ratios (ORs) and 95% confidence intervals (CIs) for impaired pulmonary function according to handgrip strength quartile were calculated using multiple logistic regression analysis. Results Mean FVC and FEV1 gradually increased in accordance with handgrip strength quartiles (all P \u3c.001). After adjusting for age, body mass index, smoking status, alcohol ingestion, aerobic physical activity, resistance exercise, household income, and education level the odds of impaired pulmonary function were greater for participants in the first quartile of handgrip strength (≤19.25 kg) than for those in the fourth quartile (25.31–37.30 kg) (FVC LLN: OR=3.46, 95 % CI=1.52–7.88; FEV1 LLN: OR=2.62, 95 % CI=1.12–6.15). Conclusion Handgrip strength was positively associated with pulmonary function in a dose‐dependent manner. Given the health implications of pulmonary function, timely detection of weaker handgrip strength in older people may be useful in assessing potential pulmonary function impairment

Increased resistance to hydrogen embrittlement in high-strength steels composed of granular bainite

This paper presents two high-strength steels composed of granular bainite microstructure that have higher extrinsic resistance to hydrogen embrittlement (HE) than conventional tempered-martensite steel, because the granular bainite steel traps less hydrogen than tempered-martensite steel. However, the granular bainite steels had lower intrinsic HE resistance than tempered-martensite steel because hydrogen in granular bainite steels becomes concentrated at microstructures composed of martensite islands and retained austenite. The granular bainite steels with less sulfur showed better HE properties, because S degrades grain-boundary strength. Since the extrinsic properties correspond to the HE resistance that is relevant in industry, granular bainite steels are suitable for applications in hydrogen environment.115sciescopu

Hederagenin Supplementation Alleviates the Pro-Inflammatory and Apoptotic Response to Alcohol in Rats

In this study, we determined the effects of hederagenin isolated from Akebia quinata fruit on alcohol-induced hepatotoxicity in rats. Specifically, we investigated the hepatoprotective, anti-inflammatory, and anti-apoptotic effects of hederagenin, as well as the role of AKT and mitogen-activated protein kinase (MAPK) signaling pathways in ethanol-induced liver injury. Experimental animals were randomly divided into three groups: normal (sham), 25% ethanol, and 25% ethanol + hederagenin (50 mg/kg/day). Each group was orally administered the respective treatments once per day for 21 days. Acetaldehyde dehydrogenase-2 mRNA expression was higher and alcohol dehydrogenase mRNA expression was lower in the ethanol + hederagenin group than those in the ethanol group. Pro-inflammatory cytokines, including TNF-α, IL-6, and cyclooxygenase-2, significantly increased in the ethanol group, but these increases were attenuated by hederagenin. Moreover, Western blot analysis showed increased expression of the apoptosis-associated protein, Bcl-2, and decreased expression of Bax and p53 after treatment with hederagenin. Hederagenin treatment attenuated ethanol-induced increases in activated p38 MAPK and increased the levels of phosphorylated AKT and ERK. Hederagenin alleviated ethanol-induced liver damage through anti-inflammatory and anti-apoptotic activities. These results suggest that hederagenin is a potential candidate for preventing alcoholic liver injury

Comprehensive Analysis of the Safety Profile of a Single-Stranded RNA Nano-Structure Adjuvant

Adjuvants enhance the efficacy of vaccines by stimulating immune response-related gene expression and pathways. Although some adjuvants have been approved for commercial use in human vaccines (e.g., Alum, MF59, and AS03), they might elicit adverse side effects, such as autoimmune diseases. Recently, we developed a novel single-stranded RNA (ssRNA) nano-structure adjuvant, which can stimulate both Th1 and Th2 responses. In this study, we evaluated the safety and toxicological profiles of this ssRNA nano-structure adjuvant in vitro and in vivo. Mice were intramuscularly immunized with the ssRNA nano-structure adjuvant three times, once every 2 weeks. The results indicate no significant differences in hematological and serum biochemistry parameters between the ssRNA-treated groups and the control group. From a histopathological perspective, no evidence of tissue damage was found in any group. The levels of IgE and anti-nuclear antibodies, which are markers of autoimmune disease, were not different between the ssRNA-treated groups and the control group. The findings of this study suggest that the ssRNA nano-structure can be used as a safe adjuvant to increase vaccine efficacies

Effects of Dietary Organic and Inorganic Sulfur on Laying Performance, Egg Quality, Ileal Morphology, and Antioxidant Capacity in Laying Hens

The present study was conducted to investigate the comparative effects of organic and inorganic forms of sulfur, methyl sulfonyl methane (MSM) and sodium sulfate (SS), on laying performance, egg quality, ileal morphology, ileal volatile fatty acids, and antioxidant and stress markers in various biological samples in aged laying hens. A total of 144, 73-week-old Lohman Brown-Lite laying hens were randomly assigned to one of three experimental diets: basal diet (CONT), CONT + 0.2% MSM (MSM), and CONT + 0.3% SS (SS). The trial lasted for 12 weeks. MSM and SS diets contained 0.07% of sulfur, either organic or inorganic. Dietary MSM did not affect egg production or feed conversion ratio at 12 weeks compared with the CONT group. Dietary sulfur did not affect egg quality except for the Haugh unit at 4 weeks, which was lowered (p < 0.05) in the SS group. Compared with the CONT group, a higher (p < 0.05) villus height to crypt depth ratio was observed in the SS group. Dietary sulfur did not affect the percentages of short-chain fatty acids in the ileum. Total antioxidant capacity of the liver increased (p < 0.05) in laying hens fed MSM- and SS-added diets compared with the CONT group. The MSM and SS groups were found to have lowered (p < 0.05) malondialdehyde (MDA) concentration in serum samples compared with CONT. Finally, dietary MSM had the lowest (p < 0.05) MDA concentrations in yolk samples. Taken together, our study showed that dietary organic and inorganic sulfur have positive effects on ileal morphology and antioxidant capacity in laying hens. However, SS-mediated inhibition in laying performance needs to be clarified

Effects of dietary protein levels on performance, nitrogen excretion, and odor emission of growing pullets and laying hens

ABSTRACT: The objective of this study was to determine the effects of dietary crude protein (CP) levels on production performance, nitrogen balance, and odor emission of excreta in growing pullets and laying hens from 13 to 32 wk of age. Two hundred and forty pullets (Hy-Line Brown) were randomly assigned to 1 of 4 dietary groups with 10 replicates per group, and 6 birds per replicate. Experimental diets were formulated to contain 4 graded CP levels in the diets of pullets ranging from 180, 160, 140, and 120 g/kg of diet during 13 to 18 wk (phase 1) and in the diets of laying hens from 190, 170, 150, and 130 g/kg of diet during 19 to 32 wk (phase 2). The limiting amino acids including lysine, methionine, and threonine were supplemented to maintain constant equal amino acid concentrations in all experiment diets. In phase 1, decreasing dietary CP levels did not affect growth performance but increased (linear and quadratic effect, P < 0.05) the relative abdominal fat contents and triglyceride concentration in serum samples. High-density lipoprotein cholesterol in serum samples decreased as the CP levels decreased in the diets of pullets. Dietary CP levels quadratically increased (P < 0.05) the villus height and the villus height to crypt depth ratio but did not affect tibia traits and relative organ weights in pullets at 18 wk. Apparent digestibility of dry matter and ether extract increased with decreasing dietary CP levels in pullets. Graded CP levels linearly increased the digestibility of dry matter, CP, and ether extracts but lowered that of crude ash in laying hens. Nitrogen excretion was linearly decreased (P < 0.05) as the dietary CP levels decreased in both pullets and laying hens. Dietary CP levels only affected carbon dioxide emission in pullets. In phase 2, dietary CP levels did not affect growth performance and the ages at first egg laying and to reach 50% egg production in laying hens. However, egg weights were decreased (linear and quadratic effect, P < 0.05) as the dietary CP level decreased in laying hens. Increasing dietary CP levels increased Haugh unit at 26 wk but lowered corticosterone concentrations in yolk samples at 22 wk. Collectively, this study shows that dietary CP levels could be decreased to reduce nitrogen excretion without adverse effects on performance and egg quality of growing pullets and laying hens