1
|
Park YM, Noh EM, Lee HY, Shin DY, Lee YH, Kang YG, Na EJ, Kim JH, Yang HJ, Kim MJ, Kim KS, Bae JS, Lee YR. Anti-diabetic effects of Protaetia brevitarsis in pancreatic islets and a murine diabetic model. Eur Rev Med Pharmacol Sci 2021; 25:7508-7515. [PMID: 34919253 DOI: 10.26355/eurrev_202112_27450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE In this study, the antidiabetic efficacy of Protaetia brevitarsis in alloxan-treated pancreatic islets and db/db mice was investigated. P. brevitarsis was tested for alloxan-mediated cytotoxicity and nitric oxide production in mice pancreatic islets. MATERIALS AND METHODS The anti-diabetic effect of P. brevitarsis was also evaluated in db/db mice after 4 weeks of administration. Biochemical analysis, oral glucose tolerance test (OGTT), and pancreatic histological analysis were performed. RESULTS P. brevitarsis displayed hypoglycemic activity in alloxan-treated mice pancreatic islets. Our results showed that P. brevitarsis protects pancreatic islets from cytotoxicity. Moreover, daily oral supplementation with P. brevitarsis for 4 weeks reduced plasma glucose levels without affecting body weight and food intake, elevated glucose tolerance in OGTT, improved blood lipid parameters, inhibited fat accumulation, and restored islet structure of db/db mice. CONCLUSIONS The present study provided evidence for the anti‑diabetic effect of P. brevitarsis in alloxan-treated pancreatic islets and db/db mice. These results suggest that P. brevitarsis may be used as an adjunctive anti-diabetic agent or as a functional food.
Collapse
Affiliation(s)
- Y M Park
- INVIVO Co. Ltd., Iksan, Jeonbuk, Korea.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Seong H, Lee SK, Cheon JH, Yong DE, Koh H, Kang YG, Lee WJ, Kim JH, Choi H, Ahn JY, Ku NS, Jeong SJ, Yeom JS, Choi JY. 2584. Effects of Fecal Microbiota Transplantation for Decolonizing Multidrug-Resistant Organism. Open Forum Infect Dis 2019. [PMCID: PMC6809924 DOI: 10.1093/ofid/ofz360.2262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Increasing prevalence of multidrug-resistant microorganisms (MDRO) results in poor clinical outcomes, longer hospitalizations and higher healthcare costs. It is likely that MDRO colonization can lead infections to vulnerable patients. Currently, however, MDRO decolonization strategies are lacking. The purpose of this study was to prove the efficacy of FMT on decolonization of carbapenemase-producing Enterobacteriaceae (CPE) and vancomycin-resistant enterococci (VRE) carriers. Methods This study was a prospective, open-label, uncontrolled, single-center pilot study of FMT for digestive tract colonized CPE, VRE, or CPE/VRE patients between March 2018 and February 2019. Fecal solution obtained from healthy unrelated donors was infused to recipient’s gut. Fecal samples of recipients were collected before and after FMT until 1year.We compared characteristics of subjects succeed in decolonization during study period (responders) with subjects who failed to decolonize MDRO by FMT (non-responders). Furthermore, microbiome analyses were performed to investigate the influence of microbial characteristics of recipients on the outcome of FMT. Results Decolonization was achieved in 12/23 (52.2%) during study period. Hemoglobin (11.0 vs. 10.0, P = 0.018), low-density lipoprotein cholesterol (102.0 vs. 89.0, P = 0.049), and albumin (3.4 vs. 3.2, P = 0.006) levels were higher in responders. Antibiotic treatment(ATB) within 1 week after FMT were less common in responders (41.7% vs. 90.9%, P = 0.027). Patients with no ATB approached frequent decolonization at 1(75.0% vs. 26.7%; P = 0.037) and 3 months (87.5% vs. 33.3%; P = 0.027). The rates of decolonization were significantly different between CPE, VRE and CPE/VRE colonizer (75.0% vs. 38.5% vs. 66.7%; P = 0.018). Gut microbiome of responders showed a higher richness and diversity than non-responders before(294 vs. 274 by Ace; 2.6 vs. 1.8 by Shannon) and after (345 vs. 260 by Ace; 2.9 vs. 2.1 by Shannon) FMT. The microbiota composition analysis revealed increasing abundance of Bacteroidetes and decreasing abundance of Proteobacteria at 1 month after FMT in responders. However, those changes of microbial composition did not occur in non-responders. Conclusion FMT is an effective way to decolonize CPE and VRE by restoration of the gut microbiome. ![]()
![]()
![]()
![]()
Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
- Hye Seong
- Yonsei University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Sang kil Lee
- Yonsei University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Jae hee Cheon
- Yonsei University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Dong eun Yong
- Yonsei University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Hong Koh
- Yonsei University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Yoon gu Kang
- Yonsei University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Woon Ji Lee
- Yonsei University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Jung Ho Kim
- Yonsei University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Heun Choi
- Yonsei University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Jin young Ahn
- Yonsei University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Nam su Ku
- Yonsei University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Su Jin Jeong
- Yonsei University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Joon-Sup Yeom
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Jun yong Choi
- Yonsei University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| |
Collapse
|
3
|
Yang HJ, Kim MJ, Kang HJ, Lee HY, Park YM, Lee YH, Kang YG, Hwa GP, Kang YS, Jung YM, Lee NK, Park KH. Immunomodulating Properties of Polygonum multiflorum Extracts on Cyclophosphamide-induced Immunosuppression Model. Indian J Pharm Sci 2018. [DOI: 10.4172/pharmaceutical-sciences.1000416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
4
|
Yoo JH, Kang YG, Chang CB, Seong SC, Kim TK. The relationship of the medially-offset stem of the tibial component to the medial tibial cortex in total knee replacements in Korean patients. ACTA ACUST UNITED AC 2008; 90:31-6. [PMID: 18160496 DOI: 10.1302/0301-620x.90b1.19605] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We examined the placement of the stem in relation to the medial tibial cortex when using total knee replacements (TKRs) with medially-offset tibial stems in Korean patients. Measurements were performed on the pre- and post-operative radiographs of 246 osteoarthritic knees replaced between January 2005 and May 2006 using the Genesis II or E-motion TKR with a medially-offset stem. Pre-operatively, we measured the distance between the mechanical axis and that of the tibial shaft and post-operatively, that between the midline of the tibial stem and the axis of the shaft. Knees were identified in which there was radiological contact between the tip of the stem and the medial tibial cortex. The mechanical axis was located medial to the axis of the shaft in 203 knees (82.5%). Post-operatively, the midline of the tibial stem was located medial to the tibial shaft axis in 196 knees (79.7%). In 16 knees (6.5%) there was radiological contact between the tibial stem or cement mantle and the medial tibial cortex. Our study has shown that the medially-offset stem in the tibial component may not be a good option for knees undergoing replacement for advanced osteoarthritis in some Korean patients.
Collapse
Affiliation(s)
- J H Yoo
- Department of Orthopaedic Surgery, National Police Hospital, 58 Garak-dong Street, Songpa-gu, Seoul 138-708, Korea
| | | | | | | | | |
Collapse
|
5
|
Park KK, Chang CB, Kang YG, Seong SC, Kim TK. Correlation of maximum flexion with clinical outcome after total knee replacement in Asian patients. ACTA ACUST UNITED AC 2007; 89:604-8. [PMID: 17540744 DOI: 10.1302/0301-620x.89b5.18117] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study aimed to determine the correlation between the amount of maximum flexion and the clinical outcome in 207 Koreans (333 knees) undergoing total knee replacement. The association of maximum flexion with clinical outcome was evaluated one year postoperatively using three scoring systems; the American Knee Society score, Western Ontario McMaster Universities Osteoarthritis index and the Short Form-36. The mean maximum flexion decreased post-operatively at 12 months from 140.1 degrees (60 degrees to 160 degrees ) to 133.0 degrees (105 degrees to 150 degrees ). Only the social function score of the Short Form-36 correlated significantly with maximum flexion (correlation coefficient = 0.180, p = 0.039). In comparative analyses of subgroups divided by a maximum flexion of 120 degrees , we found no significant differences in any parameters except the social function score of the Short Form-36 (41.9 vs 47.3, p = 0.031). Knees with a maximum flexion of more than 135 degrees had a better functional Western Ontario McMasters Universities Osteoarthritis index score than knees with maximum flexion of 135 degrees or less (17.5 vs 14.3, p = 0.031). We found only weak correlation between the postoperative maximum flexion and the clinical parameters for pain relief, function and quality of life, even in Korean patients. Efforts to increase post-operative maximum flexion should be exercised with caution until concerns relating to high-flexion activities are sufficiently resolved.
Collapse
Affiliation(s)
- K K Park
- Joint Reconstruction Center, Seoul National University, Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do (463-707), Seoul, Korea
| | | | | | | | | |
Collapse
|
6
|
Kang YG, Bae CY, Kim S, Kim MJ, Lee YJ, Seo J, Kim YC. Age-related change in serum concentrations of testosterone in middle-aged Korean men. Aging Male 2003; 6:8-12. [PMID: 12809075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
The objective of this study was to determine whether testosterone and sex hormone binding globulin (SHBG) levels are different between healthy men and men with chronic illness, and to evaluate the age-related changes of testosterone and SHBG in healthy men in Korea. enrollment took place between January 2000 and December 2001 at Pundang CHA General Hospital in Korea. All men who came for male climacteric and geriatric health screening examinations were eligible. Of the 762 men recruited, 136 men had at least one present or previous medical illness and 626 men were healthy. Higher serum concentrations of total testosterone (5.31 +/- 1.88 ng/ml vs. 4.96 +/- 1.43 ng/ml; p < 0.05), free androgen index (16.60 +/- 7.36 vs. 14.57 +/- 5.55; p < 0.01) and calculated bioavailable testosterone (8.88 +/- 3.52 nmol/l vs. 7.91 +/- 2.52 nmol/l; p < 0.01) were demonstrated in the healthy compared with the disease group. Total testosterone declined at a rate of 0.2% per year, SHBG increased by 1.74% per year, calculated bioavailable testosterone declined by 0.8% per year, and free androgen index declined by 1.15% per year in healthy subjects aged between 40 and 70. The above results seem to be consistent with previous Western studies, showing higher concentrations of testosterone in healthy men, that decline with increasing age.
Collapse
Affiliation(s)
- Y G Kang
- Department of Family Medicine, College of Medicine, Pochon CHA University, 351 Yatap-dong, Pundang-gu, Sungnam, Kyonggi-do, 463-712 Korea
| | | | | | | | | | | | | |
Collapse
|
7
|
Kang YG, Nishihara K, Nishimura H, Takabe H, Sunahara A, Norimatsu T, Nagai K, Kim H, Nakatsuka M, Kong HJ, Zabusky NJ. Blast-wave-sphere interaction using a laser-produced plasma: an experiment motivated by supernova 1987A. Phys Rev E Stat Nonlin Soft Matter Phys 2001; 64:047402. [PMID: 11690182 DOI: 10.1103/physreve.64.047402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2001] [Indexed: 05/23/2023]
Abstract
We present x-ray shadowgraphs from a high Mach number ( approximately 20) laboratory environment that simulate outward flowing ejecta matter from supernovae that interact with ambient cloud matter. Using a laser-plastic foil interaction, we generate a "complex" blast wave (a supersonic flow containing forward and reverse shock waves and a contact discontinuity between them) that interacts with a high-density (100 times ambient) sphere. The experimental results, including vorticity localization, compare favorably with two-dimensional axisymmetric hydrodynamic simulations.
Collapse
Affiliation(s)
- Y G Kang
- Institute of Laser Engineering, Osaka University, 2-6 Yamada-Oka, Suita, Osaka 565-0871, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
To develop a prolonged and sustained release preparation, we prepared an albumin microsphere-in-oil-in-water emulsion (S/O/W) and examined sustained release from it in comparison with other control preparations such as water-in-oil (W/O) emulsions and microspheres in vitro and in vivo, respectively. Tegafur was used as a model drug. A microsphere-in-oil emulsion was prepared by adding albumin microspheres to soybean oil containing 20% Span 80. To prepare an S/O/W emulsion, the microsphere-in-oil emulsion was added into an aqueous solution of hydroxypropyl methylcellulose containing Pluronic F68. The mean particle size of the albumin microspheres was 3 microns, and the ratio of entrapment of tegafur into albumin microspheres was about 25%. In an in vitro release test, the t75 of the S/O/W emulsion was fourfold greater and in an in vivo release test the mean residence time of tegafur from the S/O/W emulsion was more than twofold that from a W/O emulsion or microsphere system. The mean residence time of 5-fluorouracil (5-FU) from an S/O/W emulsion was also greater than with other dosage forms. These results suggest the possible usefulness of an S/O/W emulsion for the sustained and prolonged release of tegafur.
Collapse
Affiliation(s)
- I Oh
- College of Pharmacy, Chonnam National University, Kwangju, Korea
| | | | | | | | | |
Collapse
|
9
|
Chung JH, Kang YG, Kim HJ. Effect of 0.1% dexamethasone on epithelial healing in experimental corneal alkali wounds: morphological changes during the repair process. Graefes Arch Clin Exp Ophthalmol 1998; 236:537-45. [PMID: 9672801 DOI: 10.1007/s004170050118] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The effect of 0.1% dexamethasone on epithelial healing was evaluated in corneal alkali wounds. METHODS Epithelial wounds were induced by a 60-s application of a round filter paper (5.5 mm) soaked in 1 N NaOH onto the central cornea of the rabbit. Animals were treated with 0.1% dexamethasone 4 times each day for 8 weeks in one subgroup and only for the 1st week in the other subgroup. The control eyes were treated with a balanced salt solution. The repair processes of epithelium and its basement membrane were evaluated morphologically and morphometrically. RESULTS Treatment with 0.1% dexamethasone was found to retard the repair process of epithelial healing compared with the control eyes. Morphologically, the basement membrane in the control cornea was damaged focally at 2 days, maximally disrupted at 4 weeks, and regained the normal integrity at 8 weeks after the initial alkali damage. In 0.1% dexamethasone-treated corneas, regardless of the application period, the basement membrane structure was visible up to 4 weeks but disappeared at 8 weeks after the initial alkali wounds. The eyes treated with 0.1% dexamethasone for 8 weeks showed an intense infiltration of inflammatory cells in the superficial stroma 4 weeks after treatment. CONCLUSION A topical application of 0.1% dexamethasone retarded the corneal epithelial healing. The cornea treated with 0.1% dexamethasone only for the 1st week maintained a well-preserved basement membrane for as long as 4 weeks after initial damage without enhancement of the inflammatory cell infiltration. However, further study is needed to prevent late disintegration of the basement membrane.
Collapse
Affiliation(s)
- J H Chung
- Department of Ophthalmology, Mokdong Hospital, Medical Research Center, College of Medicine, Ewha Women's University, Seoul, Korea
| | | | | |
Collapse
|
10
|
Porte RJ, Bontempo FA, Knot EA, Lewis JH, Kang YG, Starzl TE. Tissue-type-plasminogen-activator-associated fibrinolysis in orthotopic liver transplantation. Transplant Proc 1989; 21:3542. [PMID: 2500761 PMCID: PMC2903867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- R J Porte
- Department of Internal Medicine II, University Hospital Dijikzigt, Rotterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
11
|
Porte RJ, Bontempo FA, Knot EA, Lewis JH, Kang YG, Starzl TE. Systemic effects of tissue plasminogen activator-associated fibrinolysis and its relation to thrombin generation in orthotopic liver transplantation. Transplantation 1989; 47:978-84. [PMID: 2499962 PMCID: PMC3184640 DOI: 10.1097/00007890-198906000-00012] [Citation(s) in RCA: 131] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Orthotopic liver transplantation is frequently associated with hyperfibrinolysis, the origin and clinical relevance of which is largely unknown. In 20 orthotopic liver transplantations, we studied the occurrence and systemic effects of hyperfibrinolysis. Severe fibrinolysis was defined to be present when the euglobulin-clot lysis time and the whole-blood-clot lysis time, as measured by thrombelastography, were shorter than 60 and 90 min, respectively, at some time during the operation. Based on these criteria, 7 patients had minimal fibrinolysis (group I), and 13 patients had severe fibrinolysis (group II). In group II a gradual increase of tissue-type plasminogen activator (t-PA) activity was seen during the anhepatic stage, followed by an "explosive" increase immediately after graft reperfusion (P = 0.0004, compared with group I), and a reduction of plasminogen activator inhibitor (PAI) activity. Plasma degradation products of fibrinogen and fibrin increased parallel to t-PA activity, and levels were significantly higher at 45 min after graft reperfusion in group II compared with group I (P less than 0.04). Thrombin-antithrombin III complexes showed an identical steady increase in both groups, indicating that increased t-PA activity was not related to thrombin formation. A combination of increased endothelial release and reduced hepatic clearance may have caused the increased t-PA activity. The t-PA-associated destruction of fibrinogen and fibrin after graft reperfusion is consistent with the clinical signs of severe oozing often seen in this period. These observations may have important clinical implications for the treatment of bleeding in patients undergoing orthotopic liver transplantation.
Collapse
Affiliation(s)
- R J Porte
- Department of Medicine, University of Pittsburgh, Pennsylvania
| | | | | | | | | | | |
Collapse
|
12
|
Kang YG, Freeman JA, Aggarwal S, DeWolf AM. Hemodynamic instability during liver transplantation. Transplant Proc 1989; 21:3489-92. [PMID: 2662496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Y G Kang
- Department of Anesthesiology, University of Pittsburgh School of Medicine, PA 15261
| | | | | | | |
Collapse
|
13
|
Seifert RD, Kang YG, Begliomini B, Miller SR. Baseline cardiac index does not predict hemodynamic instability during orthotopic liver transplantation. Transplant Proc 1989; 21:3523-4. [PMID: 2662508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- R D Seifert
- Department of Anesthesiology, University of Pittsburgh School of Medicine, PA 15261
| | | | | | | |
Collapse
|
14
|
Mallett S, Virji MA, DeWolf AM, Kang YG, Aggarwal S, Freeman JA, Seifert R. Hormonal control of glucose metabolism during liver transplantation. Transplant Proc 1989; 21:3529. [PMID: 2662512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- S Mallett
- Department of Anesthesiology, University of Pittsburgh School of Medicine, PA 15261
| | | | | | | | | | | | | |
Collapse
|
15
|
Lewis JH, Bontempo FA, Awad SA, Kang YG, Kiss JE, Ragni MV, Spero JA, Starzl TE. Liver transplantation: intraoperative changes in coagulation factors in 100 first transplants. Hepatology 1989; 9:710-4. [PMID: 2651269 PMCID: PMC3032392 DOI: 10.1002/hep.1840090509] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Six intraoperative blood samples were obtained at intervals from each of 100 individuals undergoing their first liver transplants. The patients fell into the following diagnostic categories: postnecrotic cirrhosis 28, primary biliary cirrhosis 20, sclerosing cholangitis 19, miscellaneous diseases 14, carcinoma/neoplasia 12 and fulminant hepatitis 7. Coagulation factor values in the initial (baseline) blood samples varied by patient diagnosis. In general, all factor levels were reduced except factor VIII:C, which was increased to almost twice normal. The slight intraoperative changes in factors II, VII, IX, X, XI and XII suggested that a steady-state relationship existed between depletion (consumption/bleeding) and repletion (transfusion, transit from extra- to intravascular space), even in the anhepatic state. In contrast, there were rapid and very significant falls in factor VIII and fibrinogen and a less pronounced decrease in factor V, all reaching their nadirs in early to mid-Stage III. The cause of these coagulation changes appears to be activation of the fibrinolytic system.
Collapse
Affiliation(s)
- J H Lewis
- Department of Medicine, University of Pittsburgh, Pennsylvania
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Weber T, Marino IR, Kang YG, Esquivel CD, Starzl TE, Duquesnoy RJ. Intraoperative blood transfusions in highly alloimmunized patients undergoing orthotopic liver transplantation. Transplantation 1989; 47:797-801. [PMID: 2655216 PMCID: PMC3005203 DOI: 10.1097/00007890-198905000-00010] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Intraoperative blood requirements were analyzed in patients undergoing primary orthotopic liver transplantation and divided into two groups on the basis of panel reactive antibody of pretransplant serum measured by lymphocytotoxicity testing. One group of highly sensitized patients (n = 25) had PRA values of over 70% and the second group of patients (n = 26) had 0% PRA values and were considered nonsensitized. During the transplant procedure, the 70% PRA group received considerably greater quantities of blood products than the 0% PRA group--namely, red blood cells: 21.1 +/- 3.7 vs. 9.8 +/- 0.8 units (P = 0.002), and platelets: 17.7 +/- 3.2 vs. 7.5 +/- 1.5 units (P = 0.003). Similar differences were observed for fresh frozen plasma and cryoprecipitate. Despite the larger infusion of platelets, the blood platelet counts in the 70% PRA group were lower postoperatively than preoperatively. Twenty patients in the 70% PRA group received platelet transfusions, and their mean platelet count dropped from 95,050 +/- 11,537 preoperatively to 67,750 +/- 8,228 postoperatively (P = 0.028). In contrast, nearly identical preoperative (84,058 +/- 17,297) and postoperative (85,647 +/- 12,445) platelet counts were observed in the 17 0% PRA patients who were transfused intraoperatively with platelets. Prothrombin time, activated partial thromboplastin time, and fibrinogen levels showed no significant differences between both groups. These data demonstrate that lymphocytotoxic antibody screening of liver transplant candidates is useful in identifying patients with increased risk of bleeding problems and who will require large quantities of blood during the transplant operation.
Collapse
Affiliation(s)
- T Weber
- Department of Surgery, University of Pittsburgh, Pennsylvania 15213
| | | | | | | | | | | |
Collapse
|
17
|
Marino IR, Weber T, Kang YG, Esquivel CO, Starzl TE, Duquesnoy R. HLA alloimmunization and blood requirements in orthotopic liver transplantation. Transplant Proc 1989; 21:789-91. [PMID: 2650271 PMCID: PMC2967352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- I R Marino
- University Health Center of Pittsburgh, Pennsylvania
| | | | | | | | | | | |
Collapse
|
18
|
Marino IR, Weber T, Esquivel CO, Kang YG, Starzl TE, Duquesnoy RJ. Intraoperative blood transfusion requirements and deficient hemostasis in highly alloimmunized patients undergoing liver transplantation. Transplant Proc 1988; 20:1087-9. [PMID: 3059590 PMCID: PMC3033038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- I R Marino
- Department of Surgery, University Health Center, University of Pittsburgh
| | | | | | | | | | | |
Collapse
|
19
|
DeWolf AM, Marquez JM, Nemoto EM, Kang YG, Pinsky MR. Cardiovascular responses to acute loading with nifedipine alone and nifedipine plus propranolol during inhalation anesthesia in monkeys. Anesth Analg 1987; 66:1096-103. [PMID: 3662054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The cardiovascular effects of the administration of nifedipine and nifedipine combined with propranolol were examined in 15 monkeys during 0.75 and 1.25 MAC of anesthesia with isoflurane, enflurane, or halothane. Hemodynamic variables measured included heart rate (HR), mean arterial pressure (MAP), left ventricular end-diastolic pressure (LVEDP), maximum rate of increase of the Left ventricular pressure (max LV dP/dt), and thermodilution cardiac output (CO). The infusion of nifedipine at a rate adequate to produce therapeutic blood levels during 0.75 MAC with each anesthetic decreased MAP and SVR, but had no effect on cardiac index (CI), max LV dP/dt, or HR. Increasing the anesthetic concentration from 0.75 to 1.25 MAC during nifedipine administration decreased HR and MAP in all groups and decreased CI with halothane and enflurane, but not with isoflurane. Addition of propranolol by infusion in amounts adequate to produce 75% beta-adrenergic blockade caused a further depression of CI, max LV dP/dt, HR, and MAP. However, the hemodynamic depression was significantly greater with halothane and enflurane than with isoflurane. Intravenous administration of calcium chloride (10 mg/kg) after calcium channel and beta-adrenergic blockade only partially reversed the hemodynamic depression that occurred with all three anesthetics. It was concluded that acute loading with nifedipine with and without propranolol exerts a greater cardiovascular depressant effect during enflurane or halothane anesthesia than during isoflurane anesthesia. The myocardial depressant effects of nifedipine and propranolol myocardial depressant effects of nifedipine and propranolol may be synergistic with the depressant effects of potent inhalation anesthetics.
Collapse
Affiliation(s)
- A M DeWolf
- Department of Anesthesiology and Critical Care Medicine, Presbyterian-University Hospital, University Health Center of Pittsburgh, Pennsylvania 15213
| | | | | | | | | |
Collapse
|
20
|
Nemoto EM, DeWolf AM, Lin MR, Evans RW, Kang YG, Bleyaert AL, Winter PM. Liver free fatty acid accumulation as an indicator of ischemic injury during simple, cold, ischemic preservation and the effects of oxygen. Transplant Proc 1987; 19:146-9. [PMID: 3113017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
21
|
Kang YG, Nemoto EM, Bleyaert AL, Winter PM, Eidelman BH, Taylor FH. Mechanisms of cerebrovascular dilation by ether in monkeys. J Cereb Blood Flow Metab 1987; 7:230-6. [PMID: 3558503 DOI: 10.1038/jcbfm.1987.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We hypothesized that when the depth of ether anesthesia is increased from 2 to 5%, cerebral vessels dilate secondary to circulating catecholamine stimulation of cerebral metabolism. Cerebral blood flow (CBF) by 133Xe clearance and cerebral metabolic rate for oxygen (CMRO2) were measured on 2% and then 5% ether in air in two groups of seven monkeys each during mechanical ventilation. Propranolol, 0.5 mg/kg i.v., was infused over 5 min in one group, and the other received saline. All measurements were repeated on 5% and 2% ether. Cerebrovascular resistance (CVR) fell by 30%, from 2.28 +/- 0.61 (mean +/- SD) to 1.51 +/- 0.28 mm Hg ml-1 100 g-1 min-1 (p less than 0.01), with the increase in ether from 2 to 5%. CBF and CMRO2 were unaltered from values of about 45 ml 100 g-1 min-1 and 2.3 ml 100 g-1 min-1, respectively. During 5% ether anesthesia, propranolol had no effect on CBF, CMRO2, or CVR. On 2% ether, it increased CVR twofold, from 1.5 +/- 0.30 to 3.0 +/- 1.0 mm Hg ml-1 100 g-1 min-1, and decreased CBF by 33%, from 48 +/- 8 to 32 +/- 10 ml 100 g-1 min-1. Plasma epinephrine was two-fold higher on 2% compared to 5% ether, both before and after saline or propranolol infusion. In monkeys, cerebrovascular dilation by ether at 5% compared to 2% is not secondary to catecholamine stimulation of CMRO2. It may result from a direct effect of either plasma catecholamines or ether on the cerebrovasculature.
Collapse
|
22
|
DeWolf AM, Kang YG, Todo S, Kam I, Francavilla AJ, Polimeno L, Lynch S, Starzl TE. Glucose metabolism during liver transplantation in dogs. Anesth Analg 1987; 66:76-80. [PMID: 3099601 PMCID: PMC2955426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Arterial and hepatic venous blood levels of glucose were studied in 12 dogs during orthotopic liver transplantation performed under ketamine anesthesia without exogenous glucose administration. During the early part of surgery, arterial blood glucose levels were stable: 161 +/- 12 mg/dl (mean +/- SEM) after laparotomy and 183 +/- 16 mg/dl 5 min before the anhepatic stage. During the anhepatic stage, arterial blood glucose levels decreased progressively to 135 +/- 9 and 88 +/- 8 mg/dl, 5 min in the anhepatic stage and 5 min before reperfusion of the graft liver, respectively (P less than 0.05). Reperfusion of the graft liver resulted in an increase in arterial glucose levels to 206 +/- 17 and 240 +/- 24 mg/dl, 5 and 30 min after reperfusion, respectively (P less than 0.05). Hepatic venous blood glucose levels increased after reperfusion (405 +/- 37 and 346 +/- 41 mg/dl, 5 and 30 min after reperfusion, respectively) and were significantly higher than in arterial blood (P less than 0.05). Arterial plasma insulin, measured in five animals, did not change significantly during the procedure, whereas plasma glucagon levels, stable during the preanhepatic and anhepatic stages, increased steadily after reperfusion of the graft liver, from 66.1 +/- 14.2 to 108.4 +/- 38.1 pg/ml (P less than 0.05). This study shows that in dogs with ketamine anesthesia mild hypoglycemia occurs during the anhepatic stage of liver transplantation without exogenous glucose administration followed by hyperglycemia on reperfusion of the graft liver, possibly secondary to the release of glucose from the donor liver.
Collapse
|
23
|
Marquez J, Martin D, Virji MA, Kang YG, Warty VS, Shaw B, Sassano JJ, Waterman P, Winter PM, Pinsky MR. Cardiovascular depression secondary to ionic hypocalcemia during hepatic transplantation in humans. Anesthesiology 1986; 65:457-61. [PMID: 3535571 DOI: 10.1097/00000542-198611000-00001] [Citation(s) in RCA: 92] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cardiovascular function, serum ionized calcium (Ca+2), and serum citrate were measured intraoperatively in patients (n = 9) undergoing orthotopic hepatic homotransplantation. Serum citrate increased 20-fold (P less than 0.0006) following transfusion of citrated blood products in the absence of a functional liver. Serum ionized calcium decreased (P less than 0.003) with concomitant decreases in cardiac index (P less than 0.005), stroke index (P less than 0.004), and left ventricular stroke work index (P less than 0.001). Hemodynamic depression and ionic hypocalcemia were reversed following the administration of CaCl2. In contrast to patients with normal hepatic function, who may tolerate large amounts of citrated blood, patients with end-stage liver disease demonstrate acute ionic hypocalcemia with concomitant hemodynamic depression when receiving citrated blood products during the course of hepatic transplantation.
Collapse
|
24
|
Shaw BW, Martin DJ, Marquez JM, Kang YG, Bugbee AC, Iwatsuki S, Griffith BP, Hardesty RL, Bahnson HT, Starzl TE. Advantages of venous bypass during orthotopic transplantation of the liver. Semin Liver Dis 1985; 5:344-8. [PMID: 3909428 PMCID: PMC3008817 DOI: 10.1055/s-2008-1040631] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Venous bypass restores normal hemodynamic physiology during the critical anhepatic phase of orthotopic transplantation of the liver. Its routine use in adults undergoing transplantation in Pittsburgh has resulted in lower operative blood losses, a lower frequency of postoperative renal failure, and a greater probability of survival for all but the highest risk patients. Because it allows for a longer anhepatic phase, the surgeon has the option of tailoring the native hepatectomy to the needs of the individual case, even to the point, in difficult cases, of obtaining most of the hemostasis after removal of the native liver, but before sewing in the donor organ. Selective use of bypass in children may offer similar advantages.
Collapse
|
25
|
Kang YG, Martin DJ, Marquez J, Lewis JH, Bontempo FA, Shaw BW, Starzl TE, Winter PM. Intraoperative changes in blood coagulation and thrombelastographic monitoring in liver transplantation. Anesth Analg 1985. [PMID: 3896028 DOI: 10.1213/00000539-198509000-00008] [Citation(s) in RCA: 360] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The blood coagulation system of 66 consecutive patients undergoing consecutive liver transplantations was monitored by thrombelastograph and analytic coagulation profile. A poor preoperative coagulation state, decrease in levels of coagulation factors, progressive fibrinolysis, and whole blood clot lysis were observed during the preanhepatic and anhepatic stages of surgery. A further general decrease in coagulation factors and platelets, activation of fibrinolysis, and abrupt decrease in levels of factors V and VIII occurred before and with reperfusion of the homograft. Recovery of blood coagulability began 30-60 min after reperfusion of the graft liver, and coagulability had returned toward baseline values 2 hr after reperfusion. A positive correlation was shown between the variables of thrombelastography and those of the coagulation profile. Thrombelastography was shown to be a reliable and rapid monitoring system. Its use was associated with a 33% reduction of blood and fluid infusion volume, whereas blood coagulability was maintained without an increase in the number of blood product donors.
Collapse
|
26
|
Kang YG, Martin DJ, Marquez J, Lewis JH, Bontempo FA, Shaw BW, Starzl TE, Winter PM. Intraoperative changes in blood coagulation and thrombelastographic monitoring in liver transplantation. Anesth Analg 1985; 64:888-96. [PMID: 3896028 PMCID: PMC2979326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The blood coagulation system of 66 consecutive patients undergoing consecutive liver transplantations was monitored by thrombelastograph and analytic coagulation profile. A poor preoperative coagulation state, decrease in levels of coagulation factors, progressive fibrinolysis, and whole blood clot lysis were observed during the preanhepatic and anhepatic stages of surgery. A further general decrease in coagulation factors and platelets, activation of fibrinolysis, and abrupt decrease in levels of factors V and VIII occurred before and with reperfusion of the homograft. Recovery of blood coagulability began 30-60 min after reperfusion of the graft liver, and coagulability had returned toward baseline values 2 hr after reperfusion. A positive correlation was shown between the variables of thrombelastography and those of the coagulation profile. Thrombelastography was shown to be a reliable and rapid monitoring system. Its use was associated with a 33% reduction of blood and fluid infusion volume, whereas blood coagulability was maintained without an increase in the number of blood product donors.
Collapse
|
27
|
|
28
|
Shaw BW, Martin DJ, Marquez JM, Kang YG, Bugbee AC, Iwatsuki S, Griffith BP, Hardesty RL, Bahnson HT, Starzl TE. Venous bypass in clinical liver transplantation. Ann Surg 1984; 200:524-34. [PMID: 6385876 PMCID: PMC1250523 DOI: 10.1097/00000658-198410000-00013] [Citation(s) in RCA: 414] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A venous bypass technique (BP) that does not require the use of systemic anticoagulation is used routinely at our institution in all adult patients during the anhepatic phase of liver transplantation (LT). Complete cardiopulmonary profiles were obtained in a subset of 28 consecutive cases. During the anhepatic phase while on bypass, mean arterial pressure, central venous pressure, and pulmonary arterial wedge pressure were maintained at prehepatectomy levels. Oxygen consumption fell secondary to a decrease in temperature and the removal of the liver. Consequently, cardiac index fell without an increase in arterial-venous O2 content difference, reflecting adequate tissue oxygenation. Compared with 63 patients in a previous series given LT without bypass (NBP), the 57 total BP patients experienced better postoperative renal function (p less than 0.001), required less blood use during surgery (p less than 0.01), and had better survival 30 days after LT. The equivalency of 90-day survival in these groups results from the lack of effect of BP on the long-term survival of patients considered at high risk for metabolic reasons. BP patients at high risk for technical considerations, however, survived LT whereas NBP patients did not. BP offers other advantages important in establishing LT as a service-oriented procedure.
Collapse
|
29
|
Kang YG, Abouleish E, Caritis S. Prophylactic intravenous ephedrine infusion during spinal anesthesia for cesarean section. Anesth Analg 1982; 61:839-42. [PMID: 7125249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Ephedrine sulfate was administered to 44 healthy parturients undergoing elective repeat cesarean section under spinal anesthesia. Twenty patients received ephedrine infusion (0.01% solution, beginning with approximately 5 mg/min) immediately after induction of spinal anesthesia to maintain maternal systolic blood pressure between 90% and 100% of the base line systolic blood pressure (mean dose of ephedrine 31.6 mg). Twenty-four patients (control group) received 20 mg of ephedrine as an intravenous bolus, and additional 10-mg increments, if necessary when systolic blood pressure decreased to 80% of the base line systolic blood pressure (mean dose of ephedrine 26.8 mg). In patients given the infusion, systolic blood pressure did not change significantly from the base line systolic blood pressure following spinal anesthesia (p greater than 0.1) and reactive hypertension did not occur. Nausea and/or vomiting occurred in nine women in the control group and one patient in the infusion group (p less than 0.01). Apgar scores, fetal blood gas tensions, and time for onset of respiration were comparable in the two groups. The results suggest that prophylactic ephedrine infusion is safe and desirable in healthy parturients undergoing cesarean section under spinal anesthesia.
Collapse
|