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Clinical and pharmacological application of multiscale multiphysics heart simulator, UT-Heart

  • Okada, Jun-ichi;Washio, Takumi;Sugiura, Seiryo;Hisada, Toshiaki
    • The Korean Journal of Physiology and Pharmacology
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    • v.23 no.5
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    • pp.295-303
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    • 2019
  • A heart simulator, UT-Heart, is a finite element model of the human heart that can reproduce all the fundamental activities of the working heart, including propagation of excitation, contraction, and relaxation and generation of blood pressure and blood flow, based on the molecular aspects of the cardiac electrophysiology and excitation-contraction coupling. In this paper, we present a brief review of the practical use of UT-Heart. As an example, we focus on its application for predicting the effect of cardiac resynchronization therapy (CRT) and evaluating the proarrhythmic risk of drugs. Patient-specific, multiscale heart simulation successfully predicted the response to CRT by reproducing the complex pathophysiology of the heart. A proarrhythmic risk assessment system combining in vitro channel assays and in silico simulation of cardiac electrophysiology using UT-Heart successfully predicted drug-induced arrhythmogenic risk. The assessment system was found to be reliable and efficient. We also developed a comprehensive hazard map on the various combinations of ion channel inhibitors. This in silico electrocardiogram database (now freely available at http://ut-heart.com/) can facilitate proarrhythmic risk assessment without the need to perform computationally expensive heart simulation. Based on these results, we conclude that the heart simulator, UT-Heart, could be a useful tool in clinical medicine and drug discovery.

Study on Mechanistic Pattern Identification of Disease for NaeGyungPyen of DongEuiBoGam ("동의보감(東醫寶鑑)" 내경편(內景編)에 나타난 질병(疾病)의 병기론적(病機論的) 변증(辨證)화 연구 - 정신기혈(精神氣血)을 중심으로 -)

  • Kim, Yeong-Mok
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.24 no.2
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    • pp.177-186
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    • 2010
  • This study is about researching DongEuiBoGam by analysing with pattern identification of modern Traditional Korean medical patholgy as more logical, systematic and standardized theory. Disease pattern mechanisms of essence, spirit, qi and blood in NaeGyungPyeb of DongEuiBoGam are these. In Essence, this explain mechanism of disease patterns those are seminal emission, dream emission, spermatorrhea, white ooze. These disease pattern's mechanisms are kidney yang deficiency, kidney yin deficiency, heart yang deficiency, heart yin deficiency, heart qi deficiency, spleen qi deficiency and so on. On viewpoints of viscera and bowels they are related with heart, kidney, spleen. And most of them are deficiency from deficiency-excess Pattern Identification. Classifying disease pattern of qi is about upward, downward movement and more concentrated deficiency than excess pattern. Fright palpitations can be classified heart deficiency with timidity, heart blood and qi deficiency, heart qi deficiency, heart blood deficiency, heart qi movement stagnation, water qi intimidating the heart, phlegm-fire harassing the heart, phlegm clouding the pericardium, and so on. Palpitations can be classified heart blood deficiency, heart yin deficiency, heart deficiency with timidity, heart spleen blood deficiency, spleen qi deficiency, phlegm-fire harassing the heart, intense heart fire, and so on. Forgetfulness can be classified heart spleen blood deficiency, heart spleen qi deficiency, kidney essence deficiency, heart qi deficiency, non-interaction between the heart and kidney, etc. for deficiency pattern, phlegm clouding the pericardium for excess pattern. In Blood just say inside bleeding pattern's category, there are nose bleeding, flopping syncope, qi counterflow, blood vomiting, hemoptysis, spitting of blood, bloody stool, hematuria, and so on. Like these, this study identify pattern of disease in DongEuiBoGam by mechanism of disease theory.

Right-sided heart failure in congenital heart diseases (선천성 심질환에서 우심부전)

  • Jung, Jo Won
    • Clinical and Experimental Pediatrics
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    • v.50 no.11
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    • pp.1055-1060
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    • 2007
  • Right-sided heart failure is a major problem among patients with congenital heart diseases, due to the prevalence of congenital heart defects and the association of pulmonary hypertension. More attention is focused on the structure of the right heart particularly in association with congenital heart defects and chronic lung disease. The right ventricle (RV) may support the pulmonary circulation, and sometimes the systemic circulation (systemic RV) in congenital heart defects. Despite major progress being made, assessing the RV remains challenging, often requiring a multi-imaging approach and expertise (echocardiography, magnetic resonance imaging, nuclear and cineangiography). Evidence is accumulating that RV dysfunction develops in many of these patients and leads to considerable morbidity and mortality. While there is extensive literature on the pathophysiology and treatment of left heart failure, the data for right-sided heart failure is scarce. Therefore RV function in certain groups of congenital heart disease patients needs close surveillance and timely and appropriate intervention to optimise outcomes. An understanding of RV physiology and hemodynamics will lead to a better understanding of current and future treatment strategies for right heart failure. This will review right-sided heart failure with the implications of volume and pressure loading of the RV in congenital heart diseases.

The Clinical Study of 1500 Cases in Open Heart Surgery (개심술1,500례의 임상적 고찰)

  • 김주홍
    • Journal of Chest Surgery
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    • v.27 no.11
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    • pp.914-921
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    • 1994
  • From May 1977 to November 1993, 1, 500 cases of open heart surgery were performed under the cardiopulmonary bypass. In 1500 cases of open heart surgery 975 cases[65%] were congenital heart disease and 525 cases[35%] were acquired heart disease. In 975 cases of congenital heart disease, there were 812 cases[83%] of acyanotic congenital heart anomaly and 163 cases of cyanotic congenital anomaly. In 525 cases of acquired heart disease, most cases were valvular heart disease in which 557 valves were implanted. The each operative mortality of congenital and acquired disease was 7.7% and 7.4% respectively and then overall mortality rate was 7.6%. There has been increasing incidence of open heart surgery in infants in recent years. After 1990, 28 cases of infant open heart surgery below the 12month were performed. Most lowest weight was 2, 200g[15 days]. Operative mortality of open heart surgery in infant with weight below the 10kg was very high as a 25.7%.

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Comparison of 29 Diagrams of Heart originated from MingTangZangFuTu(明堂臟腑圖) (명당장부도(明堂臟腑圖)에서 기원한 심장도(心臟圖) 29종의 비교)

  • Jo, Hak-jun
    • Journal of Korean Medical classics
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    • v.30 no.3
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    • pp.55-76
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    • 2017
  • Objectives : The transition of the 29 diagrams of Heart originated from MingTangZangFuTu will be used to understand the shape of heart and the changes of people's understanding of heart. Methods : The 29 diagrams of Heart originated from MingTangZangFuTu are divided according to their shape elements (Heart itself, internal curvatures, structures above heart, wuzangxi, and excursus). Then its transitions are analyzed, and each shape element is compared to modern anatomy and its textual basis is searched. Results : The lengthy cylinderical organ situated above the heart is composed of upper part consisting with joints and the lower part void of joints. The upper part is Pyewan (such as the lungs) and fall into trachea. The lower part is Xinxi or Feixi which are either relative vein (or aorta) or left bronchus that passes behind the heart. This depiction of the structures around the heart can be considered to have composed by actual observance of a physical heart, a method that is similar to anatomy. However, the shape of the heart itself is described as a lotus flower that has not been bloomed, a depiction which finds its origin from Zhongguangbuzhu huangdineijing suwen (762). The three short curvatures inside the heart is described as Pericardium, influenced by Shisijingfahui (1341) in its depiction, or as sammo, influenced by Nanjing. Structures that are connected directly from the heart to spleen, kidney, and uterus are not found in modern anatomy. The saying in Excursus "All cords of five internal organs belong to heart" is based on Huatuoxuanmenneizhaotu, and this is changed to the saying cords of four internal organs belong to heart in Leijingtuyi for the first time. Conclusions : The authors of medical scriptures at the time did not have a method of direct observance when they were copying heart diagrams. Therefore, they made changes to the source material's diagram and excursus while being influenced by Nanjing, Huatuoxuanmenneizhaotu, and Shisijingfahui. Then the doctors' understandings with regards to the shape and function of heart were reflected during that process.

Analysis of Heart Sound Using the Wavelet Transform (Wavelet Transform을 이용한 Heart Sound Analysis)

  • 위지영;김중규
    • Proceedings of the IEEK Conference
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    • pp.959-962
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    • 2000
  • A heart sound algorithm, which separates the heart sound signal into four parts; the first heart sound, the systolic period, the second heart sound, and the diastolic period has been developed. The algorithm uses discrete intensity envelopes of approximations of the wavelet transform analysis method to the phonocard-iogram(PCG)signal. Heart sound a highly nonstation-ary signal, so in the analysis of heart sound, it is important to study the frequency and time information. Further more, Wavelet Transform provides more features and characteristics of the PCG signal that will help physician to obtain qualitative and quantitative measurements of the heart sound.

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Study on the Relationship of Brain and Heart Based on Oriental Medicine (뇌(腦)와 심(心)의 한의학적 상관성에 대한 연구)

  • Jo Hak-Jun
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.19 no.6
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    • pp.1496-1503
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    • 2005
  • This study aims to define the relationship between brain and heart through several literatures about oriental medicine and the conclusions are as follows. Heart in oriental medicine is called as Sinmyeongjishim(神明之心) which has a close connection with Mind, Consciousness, Emotion, and Physiological instinct of Drain in modern medicine. According to Oriental medicine, Brain stores Wonsin(元神) as Heart stores mind(神). Heart is where mind rests whereas Brain is where mind reveals. The external evidences that prove the relationship of Heart and Mind are as follows: First, with ears, eyes, mouth, and nose the subject of cognition is recognized as Sinmyeongjishim(神明之心). Second, Bulin(不仁), which means decreased movement power and sensibility of limbs, proves that Sinmyeongjishim(神明之心) is involved with movement power and sensibility of limbs. The physiological evidences that prove the relationship of Heart and Mind are as follows; First, Heart as the operation of Sinmyeongjishim(神明之心) manages language. Second, Heart is related with Tongue. Third, Heart is linked to Ears through the ear hole. Fourth, Heart is a store of Mind. Fifth, the five viscera control emotional and psychological activities. The pathological evidence of the relationship of Heart and Mind is that the symptoms of heart disease which are related to Sinmyeongjishim(神明之心) are also related to the functions of Brain. Though Brain has a close connection with Heart in oriental medicine, it is recognized that there are distinctive symptoms of disease of Brain and Hyeolyookjishim(血肉之心) respectively. The relationship of Heart and Brain has been researched in this study, even though there are not enough written materials about oriental medicine. But the fact that the majority of Heart operation is deeply connected with Brain activities cannot be denied. Therefore the research of Heart should be done as well as Brain in the clinical study of Brain.

Pediatric Mechanical Circulatory Support

  • Wilmot, Ivan;Lorts, Angela;Morales, David
    • Journal of Chest Surgery
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    • v.46 no.6
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    • pp.391-401
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    • 2013
  • Mechanical circulatory support (MCS) in the pediatric heart failure population has a limited history especially for infants, and neonates. It has been increasingly recognized that there is a rapidly expanding population of children diagnosed and living with heart failure. This expanding population has resulted in increasing numbers of children with medically resistant end-stage heart failure. The traditional therapy for these children has been heart transplantation. However, children with heart failure unlike adults do not have symptoms until they present with end-stage heart failure and therefore, cannot safely wait for transplantation. Many of these children were bridged to heart transplantation utilizing extracorporeal membranous oxygenation as a bridge to transplant which has yielded poor results. As such, industry, clinicians, and the government have refocused interest in developing increasing numbers of MCS options for children living with heart failure as a bridge to transplantation and as a chronic therapy. In this review, we discuss MCS options for short and long-term support that are currently available for infants and children with end-stage heart failure.

Clinical Analysis of 622 Cases of Open Heart Surgery (1986 년 개심술 622례에 대한 임상적 고찰)

  • 박표원
    • Journal of Chest Surgery
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    • v.20 no.3
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    • pp.489-497
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    • 1987
  • Six hundred and twenty two cases of open heart surgery were performed at Sejong General Hospital in 1986. And also, 117 cases of non open heart cardiac surgery had been performed during same period. Among the 622 open heart cases, 548 were congenital cardiac diseases and 74 were acquired heart diseases. In congenital heart patients, 422 were acyanotic and 126 were cyanotic. There were 52 cases of infant open heart Surgery below 12 months. Acyanotic group were consisted of 314 VSD, 66 ASD, 13 AVSD, 9 PDA, 8 ASD + PS, 4 AS, and 8 other rare cardiac cases. And cyanotic group were consisted of 84 TOF, 15 DORV, 5 Trilogy, 4 Ebstein`s anomaly, 3 PS + TR, 3 TGA, 3 TAPVR, 3 Pulmonary atresia and 6 other rare cardiac diseases. Majority of the acquired heart cases were valvular heart diseases. And there were also 4 cardiac myxoma and one endomyocardial fibrosis in acquired heart disease group. The operative results were as follows: Overall operative mortality, 5.3%: acyanotic 2.4%: cyanotic 15.8% and acquired heart disease, 8.5%.

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