• Journal of Chest Surgery
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• v.31 no.7
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• pp.660-667
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• 1998

Background: This study is to evaluate the effectiveness and application of Lecompte procedure as a treatment for various complex cardiac anomalies with pulmonary outflow tract obstruction. Methods: Between July 1988 and December 1997, 44 patients underwent Lecompte procedure in Seoul National University Children's Hospital. The male to female ratio was 24 to 20 and the mean age was 29.2 months(range, 3 to 83). Of these patients, 28(63.6%) had transposition of great arteries with ventricular septal defect and pulmonary stenosis(or pulmonary atresia), 14(31.8%) had double outlet right ventricle with pulmonary stenosis(or pulmonary atresia), and so on. The principles of the technique are 1) extension of the ventricular septal defect or conal resection, 2) construction of a intracardiac tunnel connecting the left ventricle to the aorta, and 3) direct connection, without a prosthetic conduit, of the pulmonary trunk to the right ventricle. Results: There were 3 in-hospital deaths and their causes were sustained hypoxia, myocardial failure, and sepsis, respectively. There was 1 late death due to sepsis. Reoperations were performed in 6 patients who had pulmonary outflow tract obstructions(4 cases), residual muscular ventricular septal defect(1 case), and recurrent septic vegetation(1 case). The cumulative survival rates by the Kaplan-Meier method were 92.7%, 92.7%, and 92.7% at 1, 2, and over 4 years. The reoperation free survival rates were 92.7%, 92.7%, and 70.2% at 1, 3, and over 5 years. Among the risk factors for the operative death, aortic cross clamping time had statistical significance(p<0.05) and all the risk factors for the recurrent pulmonary stenosis such as age, pulmonary artery index, and materials used for the pulmonary outflow tract reconstruction had no statistical significance(p>0.05). Conclusions: Our review suggests that Lecompte procedure is an effective treatment modality for various complex cardiac anomalies with pulmonary outflow tract obstruction. Repair in early age is possible and the rates of mortality and morbidity are also acceptable.

• Journal of Chest Surgery
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• v.32 no.4
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• pp.368-372
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• 1999

Background: Although there have been few reports about minimal skin incision for the repair of congenital heart lesions, minimizing an unsightly scar is a particularly important factor in growing children. We have adopted a technique that permits standard full sternotomy, conventional open chest cardiopulmonary bypass, aortic cross-clamping, left atrial vent, and antegrade cardioplegia with minimal surgical scar. Material and Method: With minimal skin incision and full sternotomy, 40 patients with congenital heart disease underwent open heart surgery from April 1997 through September 1997. Defects repaired included 30 ventricular septal defects, 4 atrial septal defects, and 1 sinus Valsalva aneurysm in 35 children(M:F=17: 18), and 3 Atrial septal defects, 1 ventricular septal defect, and 1 partial atrioventricular septal defect in 5 adults(M:F=1:4). Midline skin incision was performed from the second intercostal space to 1 or 2 cm above the xiphoid process. For full sternotomy, we used the ordinary sternal saw in sternal body, and a special saw in manubrium under the skin flap. During sternal retraction, surgical field was obtained by using two retractors in a crossed direction. Result: The proportion of the skin incision length to the sternal length was 63.1${\pm}$3.9%(5.2∼11cm, mean 7.3cm) in children, and 55.0${\pm}$3.5%(10∼13.5cm, mean 12cm) in adults. In every case, the aortic and venous cannulations could be done through the sternal incision without additional femoral cannulation. There was no hospital death, wound infection, skin necrosis, hematoma formation, or bleeding complication. Conclusion: We conclude that minimal skin incision with full sternotomy can be a safe and effective alternative method for the repair of congenital heart diseases in children and adults.

• Journal of Chest Surgery
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• v.35 no.7
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• pp.501-510
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• 2002

Background: The various pathogeneses of acute respiratory distress syndrome have been suggested but not established yet. In the present study, the role of group II phospholipase $A_2$($PLA_2$) in the pathogenesis of gut ischemia-reperfusion(I/R) induced acute lung injury (ALI), especially in the pulmonary oxidative stress with infiltration of neutrophils was investigated. Material and Method: To induce ALI, reperfusion of mesentery was done for 120 min after clamping of superior mesenteric artery for 60 min in Sprague-Dawley rats that weighed about 300g. To exmaine the role of group II $PLA_2$ in ALI, especially endothelial injury associated with the action of neutrophils, lung myeloperoxidase activity, lung leak index, bronchoalveolar lavage fluid protein were measured, and pulmonary $PLA_2$ activity changes in gut I/R were also measured. The role of group II $PLA_2$in the neutrophilic generation of free radicals was assessed by inhibiting group II $PLA_2$ with rutin, manoalide and scalaradial. Furthermore, to verify the oxidative stress in the lung, histologic and free radical detecting cytochemical electron microscopy were done. Result: After reperfusion, ALI was developed with accumulation of neutrophils in the lung, which was confirmed by the increase of myeloperoxidase activity, lung leak index and bronchoalveolar lavage protein (p<0.001). The pulmonary and intestinal group II $PLA_2$ activities significantly increased after gut I/R which were reversed by rutin(p<0.001). In vitro, cytochrome-c reduction assay denoted the inhibitory effects of rutin, scalaradial and manoalide on the production of free radicals from isolated human neutrophils. Histologically, neutrophilic accumulation and pericapillary edema in the lung after gut I/R was detected by light microscopy which was suppressed by rutin. In $CeCl_3$ cytochemical electron microscopy, the increased production of hydrogen peroxide in the lung after gut I/R was confirmed and also the production of hydrogen peroxide was decreased by rutin. Conclusion: On the basis of these experimental results, the inhibition of group II $PLA_2$ seemed to mitigate gut I/R-induced ALI by suppressing the production of free radicals from the infiltrated neutrophils. Collectively, group II $PLA_2$ seems to play a crucial role in gut I/R-induced ALI by neutrophilic oxidative stress.

• Journal of Chest Surgery
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• v.43 no.2
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• pp.139-143
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• 2010

Background: Thoracic empyema remains a serious problem despite the availability of modern diagnostic methods and appropriate antibiotics. The condition presents in many different forms and stages that require different therapeutic options. Video-assisted thoracic surgery (VATS) has become increasingly popular for use in the treatment of empyema. Material and Method: From January 2005 to May 2009, VATS was performed in 36 patients with pleural empyema and for whom chest-tube drainage and antibiotic therapy had failed or the CT scan showed multiseptate disease. The perioperative clinical factors were analyzed for all the study patients. Result: All the patients underwent VATS, but it was necessary to convert to thoracotomy in one patient. The mean operation time was $90{\pm}38.5\;min$. For the operative evaluation, 11 patients were compatible with ATS stage III. The duration of chesttube insertion was $11.9{\pm}5.8$ (3~24) days. One patient did not improve and therefore this patient underwent additional open drainage. At discharge, costophrenic angle blunting was observed in 22 patients, pleural thickening was noted in 20 patients, both were noted in 17 patients and neither was noted in 11 patients. However, at follow-up, each of these changes was observed in 9, 7, 4 and 24 patients, respectively. All except one patient showed radiographic improvement. Conclusion: VATS is suitable for the treatment of early and fibrinopurulent thoracic empyema, and even in selected patients with stage III disease.

• Journal of the Korea Concrete Institute
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• v.25 no.5
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• pp.485-496
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• 2013

In recent years, frequent terror or military attacks by explosion or impact accidents have occurred. Examplary case of these attacks were World Trade Center collapse and US Department of Defense Pentagon attack on Sept. 11 of 2001. These attacks of the civil infrastructure have induced numerous casualties and property damage, which raised public concerns and anxiety of potential terrorist attacks. However, a existing design procedure for civil infrastructures do not consider a protective design for extreme loading scenario. Also, the extreme loading researches of prestressed concrete (PSC) member, which widely used for nuclear containment vessel, gas tank, bridges, and tunnel, are insufficient due to experimental limitations of loading characteristics. To protect concrete structures against extreme loading such as explosion and impact with high strain rate, understanding of the effect, characteristic, and propagation mechanism of extreme loadings on structures is needed. Therefore, in this paper, to evaluate the impact resistance capacity and its protective performance of bi-directional unbonded prestressed concrete member, impact tests were carried out on $1400mm{\times}1000mm{\times}300mm$ for reinforced concrete (RC), prestressed concrete without rebar (PS), prestressed concrete with rebar (PSR, general PSC) specimens. According to test site conditions, impact tests were performed with 14 kN impactor with drop height of 10 m, 5 m, 4 m for preliminary tests and 3.5 m for main tests. Also, in this study, the procedure, layout, and measurement system of impact tests were established. The impact resistance capacity was measured using crack patterns, damage rates, measuring value such as displacement, acceleration, and residual structural strength. The results can be used as basic research references for related research areas, which include protective design and impact numerical simulation under impact loading.

• Journal of the Korean earth science society
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• v.28 no.2
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• pp.169-178
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• 2007

In this research we diagnosed the actual status of the 7th National science elective curriculum and suggested a way to select and organize the content of the new science elective curriculum. The first science education reform was grounded in the structuralism where the structure of discipline was valued above everything else. On the other hand, the second science education reform suggested alternative interpretations of students' opportunity to learn, putting a brake on the structuralist thinking. According to the survey result, the majority of the science elective courses are in need for revision because the contents are overcrowded, too difficult in light of students' learning readiness, failed to draw students' interest in science, and are overlapped and repeated among the 10th grade science, high school science I and II. In particular, Earth Science II and physics II are the most unfavorable courses among students. Thus, we recommended a fundamental change be made in the new curriculum in addition to the optimization of the content. In this paper, we suggested 'topic-centered content organization' for the science elective course I, i.e., Physics I, Chemistry I, Biology I and Earth Science I that is designed for both science track and non-science track students. Since curriculum provides students with an 'opportunity to learn', a curriculum study should focus on what the 'opportunity to learn' is that students ought to be offered. Based on the result of this study, we recommended one way to select and organize the content of high school elective curriculum.

• Journal of the korean academy of Pediatric Dentistry
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• v.29 no.4
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• pp.509-518
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• 2002

The purpose of this study was to evaluate the bonding of compomer to deciduous dentin which is known to have been developed to improve the weak properties of glass ionomer cement and composite resin. 120 sound primary molars were used for the shear bond strength test and another 24 for the scanning electron microscopic evaluation. Each material was ailed into polyethylene mold attached to exposed dentinal surface($3{\times}4mm$ in diameter) of sample blocks. Shearbond strength was measured using Universal testing machine and data were analyzed statistically with Oneway-ANOVA and Scheffe test. Scanning electron microscopic observation was performed in order to evaluate the pattern of distribution and penetration of resin tags and hybrid layer. Compomer groups(II-V) showed significantly higher bond strength values than glass ionomer group(I)(p<.05). Etching-compomer groups(III, V) showed the significantly higher bond strength than non-etching compomer groups(II, IV)(p<.05), but slightly lower values than composite resin group(VI) with no statistically significant difference(p>.05). No significantly different bond strength was found between compomer groups of different bonding system(p>.05). Scanning electron micrographs showed more irregular distribution of short and thin resin tags in non-etching compomer groups(II, IV) whereas the more regular and intimate distribution of long and thick tags in etching compomer groups(III, V) and composite resin group(VI). The evaluation of hybrid layer also showed more regular formation of thicker layer in etching compomer groups(III, V). Based on the results of present study, the use of compomer as an esthetic restorative material for primary molars might be justified.

• Journal of the korean academy of Pediatric Dentistry
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• v.27 no.2
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• pp.351-360
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• 2000

The purpose of this study was to evaluate the microleakage of class V compomers according to acid etching treatment and treatment times. Extracted 180 sound human molar teeth were selected then prepared physiologic pulpal pressure far this experiment. In this study class V cavities were prepared on buccal surface with gingival margin located in 1mm superior to CEJ under simulate physiological conditions. These specimens were randomly divided into 6 groups of 30 each and restored following methods : A: Dyract AP + Prime&Bond 2.1 Group 1 : No acid etching, according to manufacturer's instruction. Group 2 : 15 seconds acid etching and same method with Group 1. Group 3 : 30 seconds acid etching and same method with Group 1. B: F2000 groups + Single Bond adhesive Group 1 : No acid etching, according to manufacturer's instruction. Group 2 : 15 seconds acid etching and same method with Group 1 Group 3 : 30 seconds acid etching and same method with Group 1. After 500 thermocycling between $5^{\circ}C\;and\;55^{\circ}C$, the specimens were sealed with glass ionomer and nail varnish then placed in 5% methylene blue dye for 5 hours and rinsed with tab water. The specimens were embedded in orthodontic clear resin, then sectioned buccolingually through the center of restoration with a low speed diamond saw. The dye penetration on each of the specimens were then observed with a stereomicroscope at $\times20$ magnification. The results of this study were statistically analyzed using the indepedent sample t-test and analysis of variance. Results were as follows, 1. In occlusal walls, microleakage were significantly reduced in acid etched group restored with Dyract AP but no statistically significance in F2000 groups. 2. In gingival walls, microleakage were significantly reduced in group 2 restored with Dyract AP, and group 2 and group 3 in F2000 groups. 3. All groups, except group 3 in Dyract AP, showed significantly less microleakage in occlusal wall than gingival wall. 4. No statistical significance were showed between group 2 and group 3 in both materials.

• Journal of the korean academy of Pediatric Dentistry
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• v.30 no.2
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• pp.308-319
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• 2003

Mechanical forces are known to have an effect on bone formation, maintenance and remodeling, and there is evidence that the development of the mandibular condyle in the rat or mouse is influenced by altered functional force. However, studies are lacking in molecular-biologic mechanism such as the identification of differentiation factor induced from functional force. Here a mouse model was used to investigate the functional stress-responsive gene or factors which is related to the altered force by comparing the expression genes of functional state and hypo-functional state of the mouse mandible. ICR mice were provisioned with either a soft, mushy diet (soft-diet group) or hard rat pellets (hard-diet group) beginning at weaning for the alteration of functional force and subsequently sacrificed at 89 days of age. Incisor of mice in group 1 were trimmed twice a week to reduce occlusal forces. After killing the animals, mandibular bone including condyle were collected for RNA extraction, subtractive hybridization, northern blot analysis and mRNA in-situ hybridization. The results as follows; 1. A total of 39 clones were sequenced, and 11 individual sequence types were subsequently identified by subtractive hybridization, as 28 clones were represented twice in the analyzed sets. 2. Consequently four candidate clones, FS-s (functional stress-specific)2, -5, -18, and -22 were identified and characterized by homolgy search and northern analysis. Four of these clones, FS-s2, -5, -18, and -22, were shown to be expressed differentially in the hard-diet group. 3. Histologic sections showed that osteoblastic activity along the bone trabeculae and active bone remodeling were significantly lower in soft than in hard diet animals. A soft diet seems to enable a longer period of endochondral ossification in the mandibular condyle. 4. Although the mRNAs of FS-s2, -5, -18, and -22 were expressed rarely by cells of the soft-diet group, highest expression was detected in the cells of the hard-diet group. Together with the above results, it is suggested that FS-s2, -5, -18, and -22 could act as an important factors controlling the tissue changes in response to functional stress. The exact functional significance of these findings remains to be established.

• Journal of Dental Rehabilitation and Applied Science
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• v.25 no.4
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• pp.375-390
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• 2009

Statement of problem: Implant supported overdenture is accepted widely as a way to restore edentulous ridge providing better retention and support of dentures. Various types of attachment for overdenture have been developed. Purpose: The purpose of this study was to investigate the influence of attachment type in implant overdentures on the biomechanical stress distribution in the surrounding bone, prosthesis and interface between implant and bone. Material and methods: Finite element analysis method was used. Average CT image of mandibular body(Digital $Korea^{(R)}$, KISTI, Korea) was used to produce a mandibular model. Overdentures were placed instead of mandibular teeth and 2mm of mucosa was inserted between the overdenture and mandible. Two implants($USII^{(R)}$, Osstem, Korea) were placed at both cuspid area and 4 types of overdenture were fabricated ; ball and socket, Locator, magnet and bar type. Load was applied on the from second premolar to second molar tooth area. 6 times of finite element analyses were performed according to the direction of the force $90^{\circ}$, $45^{\circ}$, $0^{\circ}$ and unilateral or bilateral force applied. The stress at interface between implants and bone, and prosthesis and the bone around implants ware compared using von Mises stress. The results were explained with color coded graphs based on the equivalent stress to distinguish the force distribution pattern and the site of maximum stress concentration. Results: Unilateral loading showed that connection area between implant fixture and bar generated maximum stress in bar type overdentures. Bar type produced 100 Mpa which means the most among 4 types of attachments. Bilateral loading, however, showed that bar type was more stable than other implants(magnet, ball and socket). 26 Mpa of bar type was about a half of other types on overdenture under $90^{\circ}$ bilateral loading. Conclusions: In any directions of stress, bar type was proved to be the most vulnerable type in both implants and overdentures. Interface stress did not show any significant difference in stress distribution pattern.