Yoon Yoo Sang;Park Jeong Jun;Yun Tae Jin;Kim Young Hwue;Ko Jae Kon;Park In Sook;Seo Dong Man
Journal of Chest Surgery
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v.39
no.1
s.258
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pp.18-27
/
2006
Background: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly, but is one of the most common causes of myocardial ischemia which would result in high mortality within the first year of life. This is our early result of the surgical management for these patients. Material and Method: From June 1989 to July 2003, 6 patients with ALCAPA and one patient with ARCAPA (Anomalous origin of the Right coronary artery from the pulmonary artery) underwent surgical repair. We have reviewed the all medical records, electrocardiogram, chest X-ray and echocardiography retrospectively. Result: Three of the patients were boys and four were girls. The median age at the operation was 5.4 months (Range: 3$\∼$33 months). The average body weight of at the operation was 6.7 kg (Range: 3.7$\∼$11.3 kg). A mean follow up period was 18 months. Only 3 patients were initially diagnosed as ALCAPA. And 3 patients had moderate mitral regurgitation. Immediate coronary artery reimplantation on diagnosis with the aim of restoring a two-coronary system circulation was done. The average bypass time was 114$\pm$37 minutes, and the average aortic cross clamping time was 55$\pm$22 minutes. The average stay of intensive care unit was 5$\pm$3 days, the mean mechanical ventilator time was 38$\pm$45 hours and the hospital stay after operation was 12$\pm$5 days. There were significant improvements in electrocardiogram and chest X-ray of the all patients except one late death patient. The ventricular function showed almost normal recovery after operation; the EF (Ejection Fraction) increased from 41.2$\pm$ 10.3$\%$ to 60.5$\pm$ 15.8$\%$ within 1 month and to 59.8$\pm$13.9$\%$ within 1 year after operation, the SF (Shortening Fraction) increased from 23.6$\pm$4.7$\%$ to 38.6$\pm$8.4$\%$ within 1 month and to 37.4$\pm$7.9$\%$ within 1 year after operation, LVEDDI (Left Ventricular End-diastolic Dimension Index) decreased from 100.8$\pm$25.6 mm/$m^{2}$ to 90.3$\pm$ 19.2 mm/$m^{2}$ within f month and to 79.3$\pm$ 15.8 mm/$m^{2}$ within 1 year after operation. Concomitant mitral repair was done in two patients with anterior mitral leaflet prolapse. In every patient, mitral valve showed less than mild regurgitation during follow up. One late death occurred in which patient Dor procedure was applied 10 months after initial operation due to the dilated cardiomyopathy Conclusion: In the management of this rare and could be fatal Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), early suspicion and correct diagnosis is of most important. But, after diagnosis, immediate restoration of 2 coronary systems could result in good outcome.
The vesicle system of DPPC(dipalmitoylphosphaticylcholine)/Chol(Cholesterol) has been modified by incorporating various mole fractions of flourinated surfactant($C_8F_{17}(CH_2)_2OCO-CH_2CH(SO_3Na)COO(CH_2)_2C_8F_{17}$. Sodium bis(1H,1H,2H,2H-heptadecaflurododecyl)-2-sulfosuccinate, FS)/fluorinated fatty acid salt ($C_7F_{15}COONH_4$, ammoniumpentadecaflurooctyrate, FFS), and their physicochemical properties have been investigated in an attempt to enhance the stability of phospholipid vesicle system. The ${\zeta}$-potential measurement by use of Zetamaster sub-micron Particle Electrophoresis Analyzer (Malvern Co.) showed that a charged homogeneous DPPC/Chol/FS vesicle has been formed owing to the incorporated FFS effect on the membrane, playing a role as a cosurfactant in the bilayer between DPPC and FS components. With increase in the concentration of FFS, it was found that the particle size and also surface charge of the DPPC/Chol/FS vesicle decreased. The stability of DPPC/Chol/FS/FFS liposome was found to be enhanced significantly compared to that of DPPC/Chol/FS according to the dispersity change as a function of time. The release rate of dye molecule of Methylene Blue from the DPPC/Chol/FS/FFS vesicle was determined to be slower than that of DPPC/Chol/FS system, and it may be attributed to the increase in microviscosity of the hydrophobic region in the bilayer. The affinfinity of DPPC/Chol/FS/FFS vesicles to albumin was found to be slightly lowered compared to that of DPPC/Chol/FS. Based on these findings, it was confirmed that a more stable and homogeneous vesicle system of DPPC/Chol/FS could be prepared by addition of FFS, acting as a cosurfactant in the aggregate formation.
Rhee, Chin Kook;Joo, Young Bin;Kim, Seok Chan;Park, Sung Hak;Lee, Sook Young;Koh, Yoon Seok;Kim, Young Kyoon
Tuberculosis and Respiratory Diseases
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v.62
no.5
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pp.389-397
/
2007
Background B-type natriuretic peptide (BNP) has been shown to be strong mortality predictors in a wide variety of cardiovascular syndromes. Little is known about BNP in patients with acute respiratory distress syndrome (ARDS). We studied whether BNP can predict mortality in patients with ARDS. Method Echocardiographic study was done to all patients with ARDS, and we excluded patient with low ejection fraction (less than 50%) or showing any features of diastolic dysfunction. 47 patients were enrolled between December, 2003 and February, 2006. Parameters including BNP were obtained within 24h hours at the time of enrollment. Result Mean BNP concentrations and APACHE II scores differed between the survivors and nonsurvivors (BNP, $219.5{\pm}57.7pg/mL$ vs $492.3{\pm}88.8pg/mL$; p=0.013, APACHE II score, $17.4{\pm}1.6$ vs $23.1{\pm}1.3$, p=0.009, respectively). With the use of the threshold value for BNP of 585 pg/mL, the specificity for the prediction of mortality was 94%. The threshold value for APACHE II of 15.5 showed sensitivity of 87%. 'APACHE II + $11{\times}logBNP$' showed sensitivity 63%, and specificity 82%, using threshold value for 46.14. Conclusion BNP concentrations and APCHE II scores were more elevated in nonsurvivors than survivors in patients with ARDS who have normal ejection fraction. BNP can predict mortality. Further study should be done.
Alveolar bone grows with development of tooth germs and roots; bone deposition occurs with tooth eruption. Bone components undergoes processes of resorption and deposition, and when the balance between them is disrupted, decrease in alveolar bone height or excessive bone deposition result. It has been hon that repositioning of teeth through orthodontic treatment can cause alveolar bone resorption which result in decreased alveolar bone height, and there have been many studies to evaluate such effects. X-ray films that could be replicated and standardized were chosen in clinical studies, and among them, bitewing films were used for objective evaluation of changes in alveolar bone level. Twenty subjects, 10 to 13-year- old (average 12.2) children with Cl I molar key, healthy oral condition, no congenital missing, no periodontal disease, and pre-and post-orthodontic bitewing films, were randomly selected for comparison of alveolar bone heights. Amounts of tooth and changes in alveolar bone heights were analyzed. The following results were obtained: 1. Amount of tooth movement in canine, premolar, and molar regions, changes in tooth axis, and changes in alveolar bone heights were measured, and the mean and median values were obtained. 2. When pre-and post-orthodontic alveolar bone levels were compared, larger changes were noticed in maxilla than mandible. 3. When mesio-distally compared, larger changes were observed in the distal sides of 3D3 and 4M3, mesial sides of 4M3 and 4D3, distal sides of 4D3 and 5M3, mesial sides of 5M3 and 5D3, md distal sides of 5D3 and 6M3. 4. When the amounts of tooth movements(TX, TY)and changes in tooth axis(A) were compared,34TX, 34TY, 34A of both sides in maxilla were greater, iud changes in alveolar bone level were greater than any other region.
GRAS probiotics can be used to modulate intestinal microbiota and to alleviate various gastrointestinal disorders. In several recent studies, researchers have explored the potential expansion and usability of probiotics to reduce the risk factors associated with diseases, including obesity, hypercholesterolemia, arterial hypertension, hyperhomocysteinemia, and oxidative stress. In this review, our aim was to clarify the mechanism underlying interactions between hosts (animal or human) and probiotics and the beneficial effects of probiotics on human health.
Today, IT organizations perform projects with vision related to marketing and financial profit. The objective of realizing the vision is to improve the project performing ability in terms of QCD. Organizations have made a lot of efforts to achieve this objective through process improvement. Large companies such as IBM, Ford, and GE have made over $80\%$ of success through business process re-engineering using information technology instead of business improvement effect by computers. It is important to collect, analyze and manage the data on performed projects to achieve the objective, but quantitative measurement is difficult as software is invisible and the effect and efficiency caused by process change are not visibly identified. Therefore, it is not easy to extract the strategy of improvement. This paper measures and analyzes the project performance, focusing on organizations' external effectiveness and internal efficiency (Qualify, Delivery, Cycle time, and Waste). Based on the measured project performance scores, an OT (Opportunity Tree) model was designed for optimizing the project performance. The process of design is as follows. First, meta data are derived from projects and analyzed by quantitative GQM(Goal-Question-Metric) questionnaire. Then, the project performance model is designed with the data obtained from the quantitative GQM questionnaire and organization's performance score for each area is calculated. The value is revised by integrating the measured scores by area vision weights from all stakeholders (CEO, middle-class managers, developer, investor, and custom). Through this, routes for improvement are presented and an optimized improvement method is suggested. Existing methods to improve software process have been highly effective in division of processes' but somewhat unsatisfactory in structural function to develop and systemically manage strategies by applying the processes to Projects. The proposed OT model provides a solution to this problem. The OT model is useful to provide an optimal improvement method in line with organization's goals and can reduce risks which may occur in the course of improving process if it is applied with proposed methods. In addition, satisfaction about the improvement strategy can be improved by obtaining input about vision weight from all stakeholders through the qualitative questionnaire and by reflecting it to the calculation. The OT is also useful to optimize the expansion of market and financial performance by controlling the ability of Quality, Delivery, Cycle time, and Waste.
Background: In cardiac surgery, hypothermia is associated with a number of major disadvantage, including its detrimental effects on enzymatic function, energy generation and cellular integrity. Warm cardioplegia with normothermic cardiopulmonary bypass cause three times more incidence of permanent neurologic deficits than the cold crystalloid cardioplegia with hypothermic cardiopulmonary bypass. Interruptions or inadequate distribution of warm cardioplegia may induce anaerobic metabolism and warm ischemic injury. To avoid these problems, tepid blood cardioplegia was recently introduced. Material and Method: To evaluate whether continuous tepid blood cardioplegia is beneficial in clinical practice during valvular surgery, we studied two groups of patients matched by numbers and clinical characteristics. Warm group(37$^{\circ}C$) consisted of 18 patients who underwent valvular surgery with continuous warm blood cardioplegia. Tepid group(32$^{\circ}C$) consisted of 17 patients who underwent valvular surgery with continuous tepid blood cardioplegia. Result: Heartbeat in 100% of the patients receiving continuous warm blood cardioplegia and 88.2% of the patients receiving continuous tepid blood cardioplegia converted to normal sinus rhythm spontaneously after removal of the aortic cross clamp. There were no differences between these two groups in CPB time, ACC time, the amount of crystalloid cardioplegia used and peak level of potassium. During the operation, the total amount of urine output was more in the warm group than the tepid group(2372${\pm}$243 ml versus 1535${\pm}$130 ml, p<0.01). There were no differences between the two groups in troponin T level measured 1hr and 12hrs after the operation. Conclusion: Continuous tepid blood cardioplegia is as safe and effective as continuous warm blood cardioplegia undergoing cardiac valve surgery in myocardial protection.
The technology of 'Virtual Reality' has placed in advanced tools for human beings' joy and anger together with sorrow and pleasure in our generation. It has recently tried in a variety ways to use as an implication for treatment in the field of Cognitive Psychology. Especially, it widely approaches to human in terms of that a sense of reality in a virtual world through the five senses should reinterpret the meaning of cognition in the real world. Based on this paradigm shift, it allows for new treatment using the technology of virtual reality. A typical example is a field of Therapy in order to overcome panic disorder. It has advantages that in particular development of flexible interaction technologies in a virtual space can lead patients to experience psychological environments rather than physical one. the interaction technology provides environments in which users' five senses can be actively stimulated, it is very useful that information from the experiences in the virtual world allows people to learn through real experiences by renewing potential energies, advantages of Virtual Reality Therapy can be customized treatment by depending on symptoms in patients with panic disorder and are capable of differentiate application for the cure at each stage. It is to treat by leading patients to get accustomed to environments and situations in real world through care process with each symptom and stage. It is helpful that based on A Human-Sensibility Ergonomics, technologies like immersive virtual reality equipment, force-relative feedback and stereophonic sound, and like stimulating the sense of smell make people to induce experiences by stimulating human's five senses. There are many advantages of immersion in virtual world in that the phenomenon such as challenge, interaction, reality, illusion, and cooperation is expanded. As an application for therapy by growing such augmented reality, virtual space and sharing of data through the Internet and also inexpensive its availability have recently expanded the base. There are other benefits of Virtual Reality Therapy offering active interaction environments for cognitive experience which can provide appropriately adjusted environments for patients who are hard to overcome the real situation because of phobia. In addition to that it is safe and economical and patients' confidentiality is assured. Moreover, due to the principles of applying real-time navigation the Virtual Reality Therapy makes modification and supplementation easier and also it can reduce cybersickness because of the supply of Lenticular allowing people to see stereoscopy without eyeglasses, which makes sense of presence clearer. On top of that due to the development of interactive technologies, it is becoming close to sense of reality similar to real world by leading users to navigate by themselves and to operate objects in a virtual space. This paper will therefore examine, although it is of limited, characteristics of application of virtual reality technology based on A Human-Sensibility Ergonomics used for treatment for a disorder. this paper will analyse a range of its application and problems and it will suggest the future possibilities.
Purpose : Urinary lithiasis is uncommon in children, however, it may lead to chronic renal insufficiency and even end stage renal disease. The etiology of stone formation in children is largely unknown; although the most common causes are known to be associated with congenital anomalies of the genito-urinary(G-U) tract, urinary tract infections(UTI), and metabolic diseases. Methods : A total of 73 children(male:female=42:31, mean age $6.6{\pm}5.3$ years) presented with urinary lithiasis between Sep. 1998 and Jul. 2007 at Seoul National University Children's Hospital. The medical records were reviewed retrospectively. Results : The most common presenting symptoms were gross hematuria(28/73, 38%) and flank or abdominal pain(23/73, 32%). The stones were located in the upper urinary tract in 48 patients(66%), in the bladder in 18(24%), and in both the bladder and upper urinary tract in 2 (3%). Congenital anomalies of the G-U tract with/without UTI were detected in 30 children (41%), hypercalciuria with/without hypercalcemia in 15(20%), and other metabolic diseases in 8(11%). In 17 patients(23%), no underlying cause of stone formation was detected. The majority of stones were infected stones(24/36, 67%), which were followed by calcium stones(8/36, 22%), uric acid stones(3/36, 8%). and cystine stones(1/36, 3%). Thirty-four patients(46%) underwent surgical procedures and/or extracorporeal shockwave lithotripsy for stone removal, and 13(18%) passed stones spontaneously with/without medical management. Stones recurred in 6 patients(8%): 4 with neurogenic bladder augmented by ileocystoplasty, 1 with cystinuria, and 1 with unknown etiology. Conclusion : The common causes of urinary lithiasis in children were congenital anomalies of the G-U tract with/without UTI and metabolic disorders including hypercalciuria/hypercalcemia. For the management of stones, minimally invasive procedures should be chosen on the basis of accompanying symptoms and the composition, locations and etiology of stones.
Online-to-offline (O2O) commerce is the new trend that merges online commerce with traditional industries in various fields. The primary purpose of this paper is to find out which factors influence customers' intention to switch from call-based driver-for-hire services to O2O app-based services. This study used variables and factors based on Theory of Switching Intention, and Extended Unified Theory of Acceptance and Use of Technology in order to design research questions. We surveyed 500 users of call-based driver-for-hire services. According to the result of this study, dissatisfaction with the current call-based driver-for-hire services is estimated to be a significant factor that strengthens customers' intention to switch from the call-based driver-for-hire services to the app-based services. Loyalty to the previous call-based driver-for-hire services was not seen as a crucial motivator that causes customers to switch to the new O2O driver service. Switching cost also did not play a key role in explaining the relationship between dissatisfaction with the current call-based service and the intention to use the new app-based service. Performance expectancy, easiness in use, the level of user's knowledge or available assistance in relation to the use of app-based services, and expectancy for reasonable price was found to have meaningful impacts on customers' intention to switch from the call-based driver-for-hire services to the app-based services. Age, gender and user experience on the new service were found incapable of moderating the relationship between aforementioned factors which influence customers' choice of the app-based driver-for-hire service, and customers' intent to switch to the app-based service.
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