Park Il;Kim Kyu Tae;Lee Jong Tae;Chang Bong Hyun;Lee Eung Bae;Cho Joon Yong
Journal of Chest Surgery
/
v.38
no.7
s.252
/
pp.489-495
/
2005
In the surgical treatment of aortic dissection, aortic arch replacement under total circulatory arrest is often performed after careful inspection to determine the severity of disease progression. Under circulatory arrest, antegrade or retrograde cerebral perfusion is required for brain protection. Recently, antegrade cerebral perfusion has been used more, because of the limitation of retrograde cerebral perfusion. This study is to compare these two methods especially in the respect to neurological complications. Material and Method: Forty patients with aortic dissection involving aortic arch from May 2000 to May 2004 were enrolled in this study, and the methods of operation, clinical recovery, and neurological complications were retrospectively reviewed. Result: In the ACP (antegrade cerebral perfusion) group, axillary artery cannulation was performed in 10 out of 15 cases. In the RCP (retrograde cerebral perfusion) group, femoral artery Cannulation was performed in 24 out of 25 cases. The average esophageal and rectal temperature under total circulatory arrest was $17.2^{\circ}C\;and\;22.8^{\circ}C$ in the group A, and $16.0^{\circ}C\;and\;19.7^{\circ}C$ in the group B, respectively. Higher temperature in the ACP group may have brought the shorter operation and cardiopulmonary bypass time. However, the length of period for postoperative clinical recovery and admission duration did not show any statistically significant differences. Eleven out of the total 15 cases in the ACP group and thirteen out of the total 25 cases in the RCP group showed neurological complication but did not show statistically significant difference. In each group, there were 5 cases with permanent neurological complications. All 5 cases in the ACP group showed some improvements that enabled routine exercise. However all 5 cases in RCP group did not show significant improvements. Conclusion: The Antegrade, cerebral perfusion, which maintains orthordromic circulation, brings moderate degree of hypothermia and, therefore, shortens the operation time and cardiopulmonary bypass time. We concluded that Antegrade cerebral perfusion is safe and can be used widely under total circulatory arrest.
Since the first implanted in September 1997, the use of On-X prosthetic heart valve has been increasing around in the world. This study was designed to assess the feasibility, safety, and the postoperative hemodynamics with this new valve in clinical setting. Material and Method: The current study was carried out on 52 patients undergoing aortic valve replacement with this prosthesis between April 1999 to August 2002 at Chonnam National University Hospital to evaluate the surgical results. 52% of the patients were male and the average age at implant was 50$\pm$13 years. The study followed the guidelines of the AATS/STS. Preoperatively, 32(61.5%) patients were in NYHA functional class III or IV and 2 patients had previous aortic valve surgery. Concomitant cardiac surgery was performed in 71.1%. The implanted valve sizes were 19 mm in 13 patients, 21 mm in 26, 23 mm in 10 and 25 mm in 3, respectively. Mean follow-up was 16.6$\pm$10.5 months (1∼39 months). Echocardiographic assessment was performed pre- and immediate postoperatively, as well as 3, 6, 12 months after surgery, evaluating pressure loss and regression of left ventricular hypertrophy. Result: Mean cardiopulmonary bypass time was 191$\pm$94.7 minutes with an aortic cross-clamp time of 142$\pm$51.7 minutes. There was no early and late mortality, Freedom from adverse events at 1 year in the study were as follows: thromboembolism, 95.6$\pm$6%; bleeding events, 90.2$\pm$4%; paravalvular leakage 92.3$\pm$4%; and overall valve-related morbidity at 1 year was 76.6$\pm$3%. There were no cases of valve thrombosis, prosthetic valve endocarditis and structural or non-structural failure. Left ventricular function at 12 months after surgery (EF=62.7$\pm$9.8%) revealed a statistically significant improvement compared to preoperative investigation (EF=55.8$\pm$15.9%, p=0.006). Left ventricular mass index was 247.3$\pm$122.3 g/$m^2$ on preoperative echocardiographic study, but regressed to 155.5$\pm$58.2 g/$m^2$ at postoperative 1 year (p=0.002). Over the follow-up period a further decrease of peak transvalvular gradients was observed in all patients: 62.5$\pm$38.0 mmHg on preoperative assessment, 18.2$\pm$6.8 mmHg at immediate postoperative period (p < 0.0001), 7.6$\pm$5.09 mmHg (p<0.0001) at 6 month, 18.0$\pm$10.8 mmHg (p<0.0001) at 1 year. Conclusion: The On-X prosthetic heart valve performs satisfactorily in the first 1 year period. Clinical outcome by examining NYHA functional classification revealed especially good results. Effective regression of left ventricular hypertrophy and statistically significant decrease of transvalvular gradient were observed over the first year, but longer-term follow-up of this patient group is needed to establish the expected rates for late valve-related events as well as the long-term clinical efficacy of this valve.
The rise of income and introduction of 5 day a week working system give korean people opportunities to enjoy their leisure time. And many korean people have much interest in oceanic sports such as yachting and also oceanic leisure equipments. With the popularization and development of the equipments, the scope of oceanic activities has been expanding in Korea just as in the advanced oceanic countries. However, The current conditions for the sports in Korea are not advanced and even worse than underdeveloped countries. In order to develop the underdeveloped resources of Korean marina, we need to customize the marina models of advanced nations to serve the specific needs and circumstances of Korea As such we have carried out a comparative analysis of how Austrailia, Newzealand, Singapore, japan and Malaysia operate their marina, reaching the following conclusions. Firstly, in marina operations, in order to protect personal property rights and to preserve the environment, we must operate membership and non-membership, profit and non-profit schemes separately, yet without regulating the dress code entering or leaving the club house. Secondly, in order to accumulate greater value added, new sporting events should be hosted each year. There is also the need for an active use of volunteers, the generation of greater interest in yacht tourism, and the simplification of CIQ procedures for foreign yachts as well as the provision of language services. Thirdly, a permanent yacht school should be established, and classes should be taught by qualified instructors. Beginners, intermediary, and advanced learner classes should be managed separately with special emphasis on the dinghy yacht program for children. Fourthly, arrival and departure at the moorings must be regulated autonomically, and there must be systematic measures for the marina to be able, in part, to compensate for loss and damages to equipment, security and surveillance after usage fees have been paid for. Fifthly, marine safety personnel must be formed in accordance with Korea's current circumstances from civilian organizations in order to be used actively in benchmarking, rescue operations, and oceanic searches at times of disaster at sea.
Bioterrorism is becoming more attractive to terrorist groups owing to the dramatic increase in the utility and lethality of biological weapons in line with today's cutting-edge biological science and technology. The Republic of Korea is facing both internal and external terrorist threats, as well as the possible biological warfare by North Korea. Therefore, it is essential to establish an effective bioterrorism response system in the ROK. In order to come up with the adequate response system for the ROK, an in-depth study has been conducted on the current bioterrorism response system of the U.S. whose preparedness is considered relatively adamant. As a result, the following facts have been found: (1)the legislation with regard to bioterrorism has been established or amended according to the current situation in the U.S., (2)the counter terrorism activities have been integrated with the Department of the Homeland Security as the central agency in order to maximize the national CT capacity, (3)Specific procedures and instructions to cope with bioterrorism have been made into manuals so as to enhance the working-level response capabilities. Next, the analysis on the ROK's bioterrorism response system has been performed in various categories, including the legislation system, task role distribution, cooperative relations, and resource application. It turned out that the ROK's legislation basis is relatively weak and it lacks the apparatus to integrate the bioterrorism response activities on the national level. The shortage of the adequate response facilities and resources, as well as the poor management of manpower have also emerged as problems that hinder the effective CT implementations. Through an analytical and comparative study of the U.S. and the ROK systems, this paper presents several ways to ameliorate improve the current system in the ROK as follows: (1)establish the anti-terrorism law, which would be the basic legal basis for the bioterrorism-related matters; and make revisions to the disaster-related legislation, relevant to bioterrorism response activities, (2)establish an integrated body that has a powerful authority to coordinate the relevant CT agencies; and converge the decentralized functions to maximize the overall response capacity, (3)install the laboratories with a high biosafety level and secure enough of the strategic medical stock-pile, (4)enhance the ability of the inexperienced response personnel by providing with a manual that has detailed instructions.
Kim, Chang-Yong;Park, Chi-Hyun;Bae, Gyu-Jin;Hong, Sung-Wan;Oh, Myung-Ryul
Journal of Korean Tunnelling and Underground Space Association
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v.2
no.2
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pp.11-21
/
2000
Tunnelling has been created as a great extent in view of less land space available because the growth of population in metropolitan has been accelerated at a faster pace than the development of the cities. In tunnelling, it is often faced that measures are obliged to be taken without confirmation for such abnormality as diverged movement of surrounding rock mass, growing crack of shotcrete and yielding of rockbolts. In this case, it is usually said that the judgments of experienced engineers for the selection of measure are importance and allowed us to get over the situations in many construction sites. But decrease of such experienced engineers need us to develop the new system to assist the selection of measures for the abnormality without any experiences of similar tunnelling sites. In this study, After a lot of tunnelling reinforcement methods were surveyed and the detail application were studied, an expert system was developed to predict the safety of tunnel and choose proper tunnel reinforcement system using fuzzy quantification theory and fuzzy inference rule based on tunnel information database. The expert system developed in this study have two main parts named pre-module and post-module. Pre-module decides tunnel information imput items based on the tunnel face mapping information which can be easily obtained in-situ site. Then, using fuzzy quantification theory II, fuzzy membership function is composed and tunnel safety level is inferred through this membership function. The comparison result between the predicted reinforcement system level and measured ones was very similar. In-situ data were obtained in three tunnel sites including subway tunnel under Han river. This system will be very helpful to make the most of in-situ data and suggest proper applicability of tunnel reinforcement system developing more resonable tunnel support method from dependance of some experienced experts for the absent of guide.
Purpose : The outbreaks of measles in infants and school children have been reported recently, but there are no specific treatment of these patients except symptomatic therapy. This study was performed to evaluate the effectiveness of intravenous gammaglobulin(IVGG) therapy in acute febrile phase of measles. Methods : The 68 cases in measles were treated with single dose of IVGG(400~500 mg/kg), and 44 cases were treated with only symptomatic treatment during the periods of 14 months from Jan. 2000 to Feb. 2001. They were compared to duration of fever, rash, the levels of CRP and days of admission on both groups after treatment. Results : The results obtained follows. The average of age was $7.9{\pm}3.6$ year old, and male to female was 1.0 : 1.6. The duration of fever after admission was $2.4{\pm}1.2$ days in treated group and $5.7{\pm}2.4$ days in control group. The period of disappearance of systemic erythematous maculopapular rash was $4.5{\pm}1.3$ days in treated group, and $6.9{\pm}2.4$ days in control group. The durations of admission day were also shown significantly shorter duration of period in treated group(P<0.05). The levels of CRP were no significant difference between two groups before treatment. However, treated group was significantly shown by improved within 5 days after IVGG therapy(P<0.05). Conclusions : The single dose of IVGG(400~500 mg/kg) therapy is one of rapid and effective therapy for clinical symptoms and signs in acute high febrile phase of measles.
Background: Currently, the cardiopulmonary machine with non-pulsatile pumps, which are low in internal circuit pressure and cause little damage to blood cells, is widely used. However, a great number of experimental studies shows that pulsatile perfusions are more useful than non-pulsatile counterparts in many areas, such as homodynamic, metabolism, organ functions, and micro-circulation. Yet, many concerns relating to pulsatile cardiopulmonary machines, such as high internal circuit pressure and blood cell damage, have long hindered the development of pulsatile cardiopulmonary machines. Against this backdrop, this study focuses on the safety and effectiveness of the pulsatile cardiopulmonary machines developed by a domestic research lab. Material and Method: The dual-pulsatile cardiopulmonary bypass experiment with total extracorporeal circulation was conducted on six calves, Extracorporeal circulation was provided between superior/inferior vena cava and aorta. The membrane oxygenator, which was placed between the left and right pumps, was used for blood oxygenation. Circulation took four hours. Arterial blood gas analysis and blood tests were also conducted. Plasma hemoglobin levels were calculated, while pulse pressure and internal circuit pressure were carefully observed. Measurement was taken five times; once before the operation of the cardiopulmonary bypass, and after its operation it was taken every hour for four hours. Result: Through the arterial blood gas analysis, PCO2 and pH remained within normal levels. PO2 in arterial blood showed enough oxygenation of over 100 mmHg. The level of plasma hemoglobin, which had total cardiopulmonary circulation, steadily increased to 15.87 $\pm$ 5.63 after four hours passed, but remained below 20 mg/㎗. There was no obvious abnormal findings in blood test. Systolic blood pressure which was at 97.5$\pm$5.7 mmHg during the pre-circulation contraction period, was maintained over 100 mmHg as time passed. Moreover, diastolic blood pressure was 72.2 $\pm$ 7.7 mmHg during the expansion period and well kept at the appropriate level with time passing by. Average blood pressure which was 83$\pm$9.2 mmHg before circulation, increased as time passed, while pump flow was maintained over 3.3 L/min. Blood pressure fluctuation during total extracorporeal circulation showed a similar level of arterial blood pressure of pre-circulation heart. Conclusion: In the experiment mentioned above, pulsatile cardiopulmonary machines using the doual-pulsatile structure provided effective pulsatile blood flow with little damage in blood cells, showing excellence in the aspects of hematology and hemodynamic. Therefore, it is expected that the pulsatile cardiopulmonary machine, if it becomes a standard cardiopulmonary machine in all heart operations, will provide stable blood flow to end-organs.
The current international legal system does not provide a safeguard against the militarization and the weaponization of outer space. Although the term "peaceful use of outer space" in the 1967 Outer Space Treaty(OST) appears in official government statements or in multilateral space treaties, it is still without an authoritative definition in reviewing national practices. The ambiguous ban on weapons in Article IV of the OST allows countries to loophole on the deployment of other weapons other than nuclear weapons. Meanwhile "Draft Treaty on the Prevention of the Placement of Weapon in Outer Space and of the Threat or Use of Force against Outer Space Objects(PPWT)" to Conference on Disarmament (CD) commissioned by the UN General Assembly's Special Session jointly submitted by China and Russia in 2008 and later revised in 2014, attempting to define and prohibit the proliferation of weapons in outer space and provided definitions of prohibited weapons, are opposed by the US on the grounds that currently there is no arms race in outer space. Some experts support a hard law approach in which binding laws aimed at ultimately creating integrated and binding legal instruments in all aspects of the use of outer space should be adopted to regulate the military use of space. However as a temporary measure the soft law guidelines should be developed for the non liquiet, a situation where there is no applicable law. The soft law could be used to create support for the declaration of the treaties and to create international customary law. For example, the 1963 Declaration of Legal Principles Governing the Activities of States in the Exploration and Use of Outer Space that regulates the activities of the state in the exploration and use of the universe, and the 1992 Principles Relevant to the Use of Nuclear Power Sources in Outer Space will illustrated. While substantial portions of the former was codified later in the 1967 OST, the latter which, although written in somewhat mandatory terms, have been consistently complied with by states, have arguably become part of customary international law. On November 12, 1974, the General Assembly reaffirmed that the development of international law may be reflected inter alia, by declarations and resolutions of the General Assembly which may to that extent be taken into consideration by the International Court of Justice.
This study was conducted to evaluate the quality characteristics of low-fat emulsion type sausages containing 0% tomato powder (C), 5.0% ground raw tomato paste (T1) and 0.5% freeze dried tomato powder (T2) during storage at $5{\pm}1^{\circ}C$ for 30 days. The crude protein content of T2 was significantly lower (p<0.05) than that of the other sausage types. Moisture, crude fat and crude ash contents of the sausages during storage were not affected by the addition of tomato. The pH and shear force ($kg/cm^2$) values of C were significantly higher (p<0.05) than those of T1 and T2. There was no significant difference among the different sausages in cooking loss, ranging from $13.00{\sim}14.98%$. The WHC values of T1 and T2 were significantly higher (p<0.05) than that of C. The values of TBARS were significantly (p<0.05) increased for ail sausages following storage. The TBARS value (mg MA/kg) of C was significantly higher (p<0.05) than those of T1 and T2 at 15 days of storage, however T1 was significantly higher (p<0.05) than the other sausages after 30 days of storage. The meat color values tended to decrease with increased storage time. Microorganism analysis revealed that all sausage types did not reach $4.4log_{10}CFU/g$ until 30 days of storage. The texture, brittleness, Hardness, and springiness of each sausage type were not significantly different after 1 day of storage, while the cohesiveness, gumminess and chewiness of T1 and T2 were significantly higher (p<0.05) than that of C. T1 and T2 sausages had a slightly higher score regarding color, aroma, tenderness and overall acceptability, however the sensory evaluation score among the different sausage types was not significantly different (p>0.05). In conclusion, low-fat sausage with added tomato showed higher lipid oxidative stability during storage than sausage to which no tomato was added.
The study, executed with Hallasan National Park, which deserves to be a typical ecotourism destination, aims to provide basic information on park management for early establishment of ecotourism in a national park by assessing its visitors' behavior and satisfaction with a nature trail established as a series of an environmental interpretation program. The questionnaire survey was conducted at Eorimok Square in the weekday and on the weekend for two months of August and September in 2006, and finally 144 valid samples were used for the analysis. As a result of the research, it revealed that the demographic characteristics of the visitors to Hallasan National Park tended to coincide with those of the visitors to other national parks In Korea. On the whole, it showed their low recognition level of nature trails built up in national parks and less experience in using them. However, the visitors' satisfaction level and intention of re-visit, and recommendation to others were comparatively higher after actually using the nature trail at the site of Hallasan National Park, which hints at the possibility of national parks' much weightier role as the ground for ecology education and the functional expansion of the environmental interpretation-related facilities and programs. As for the attributes having effects on users' satisfaction with a nature trail, substantial aspects such as accessibility, safety, uniqueness and interest in environmental interpretation, and educational quality as well as physical facility management were revealed to have equal effects on users' satisfaction level, so there still remain a lot of pending issues over the reality of national parks in the initial stage of ecotourism staying at the level of the introduction and establishment of the facilities for environmental interpretation. This research had surveyed visitors to Hallasan National Park and limited to the nature trail only. For more systematic and practical ecological management of a national park, the in-depth understanding of the attributes affecting satisfaction of ecotourists, including nature trails and other environmental interpretation programs, and more sophisticated measuring tools are needed.
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