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Clinical Analysis of Repeated Heart Valve Replacement (심장판막치환술 후 재치환술에 관한 임상연구)

  • Kim, Hyuck;Nam, Seung-Hyuk;Kang, Jeong-Ho;Kim, Young-Hak;Lee, Chul-Burm;Chon, Soon-Ho;Shinn, Sung-Ho;Chung, Won-Sang
    • Journal of Chest Surgery
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    • v.40 no.12
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    • pp.817-824
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    • 2007
  • Background: There are two choices for heart valve replacement-the use of a tissue valve and the use of a mechanical valve. Using a tissue valve, additional surgery will be problematic due to valve degeneration. If the risk of additional surgery could be reduced, the tissue valve could be more widely used. Therefore, we analyzed the risk factors and mortality of patients undergoing repeated heart valve replacement and primary replacement. Material and Method: We analyzed 25 consecutive patients who underwent repeated heart valve replacement and 158 patients who underwent primary heart valve replacement among 239 patients that underwent heart vale replacement in out hospital from January 1995 to December 2004. Result: There were no differences in age, sex, and preoperative ejection fraction between the repeated valve replacement group of patients and the primary valve replacement group of patients. In the repeated valve replacement group, the previously used artificial valves were 3 mechanical valves and 23 tissue valves. One of these cases had simultaneous replacement of the tricuspid and aortic valve with tissue valves. The mean duration after a previous operation was 92 months for the use of a mechanical valve and 160 months for the use of a tissue valve. The mean cardiopulmonary bypass time and aortic cross clamp time were 152 minutes and 108 minutes, respectively, for the repeated valve replacement group of patients and 130 minutes and 89 minutes, respectively, for the primary valve replacement group of patients. These results were statistically significant. The use of an intra aortic balloon pump (IABP) was required for 2 cases (8%) in the repeated valve replacement group of patients and 6 cases (3.8%) in the primary valve replacement group of patients. An operative death occurred in one case (4%) in the repeated valve replacement group of patients and occurred in nine cases (5.1%) in the primary valve replacement group of patients. Among postoperative complications, the need for mechanical ventilation over 48 hours was different between the two groups. The mean follow up period after surgery was $6.5{\pm}3.2$ years. The 5-year survival of patients in the repeated valve replacement group was 74% and the 5-year survival of patients in the primary valve replacement group was 95%. Conclusion: The risk was slightly increased, but there was little difference in mortality between the repeated and primary heart valve replacement group of patients. Therefore, it is necessary to reconsider the issue of avoiding the use of a tissue valve due to the risk of additional surgery, and it is encouraged to use the tissue valve selectively, which has several advantages over the use of a mechanical valve. In the case of a repeated replacement, however, the mortality rate was high for a patient whose preoperative status was not poor. A proper as sessment of cardiac function and patient status is required after the primary valve replacement. Subsequently, a secondary replacement could then be considered.

Comparison of marginal fit before and after porcelain build-up of two kinds of CAD/CAM zirconia all-ceramic restorations (두 종류의 CAD/CAM 지르코니아 전부도재관의 도재 축성 전후의 변연적합도 비교)

  • Shin, Ho-Sik;Kim, Seok-Gyu
    • The Journal of Korean Academy of Prosthodontics
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    • v.46 no.5
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    • pp.528-534
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    • 2008
  • Purpose: Marginal fit is one of the important components for the successful prosthodontic restoration. Poor fitting margin of the restoration causes hypersensitivity, secondary caries, and plaque accumulation, which later result in prosthodontic failure. CAD/CAM zirconia all-ceramic restorations, such as $LAVA^{(R)}$ (3M ESPE, St.Paul, MN) and $EVEREST^{(R)}$ (KaVo Dental GmbH, Biberach, Germany) systems were recently introduced in Korea. It is clinically meaningful to evaluate the changes of the marginal fit of the CAD/CAM zirconia systems before and after build-up. The purposes of this study are to compare the marginal fit of the two CAD/CAM all-ceramic systems with that of the ceramometal restoration, before and after porcelain build-up Material and methods: A maxillary first premolar dentiform tooth was prepared with 2.0 mm occlusal reduction, 1.0 mm axial reduction, chamfer margin, and 6 degree taperness in the axial wall. The prepared dentiform die was duplicated into the metal abutment die. The metal die was placed in the dental study model, and the full arch impressions of the model were made. Twenty four copings of 3 groups which were $LAVA^{(R)}$, $EVEREST^{(R)}$, and ceramometal restorations were fabricated. Each coping was cemented on the metal die with color-mixed Fit-checker $II^{(R)}$ (GC Cor., Tokyo, Japan). The marginal opening of each coping was measured with $Microhiscope^{(R)}$ system (HIROX KH-1000 ING-Plus, Seoul, Korea. X300 magnification). After porcelain build-up, the marginal openings of $LAVA^{(R)}$, $EVEREST^{(R)}$,and ceramometal restorations were also evaluated in the same method. Statistical analysis was done with paired t-test and one-way ANOVA test. Results: In coping states, the mean marginal opening for $EVEREST^{(R)}$ restorations was $52.00{\pm}11.94\;{\mu}m$ for $LAVA^{(R)}$ restorations $56.97{\pm}10.00\;{\mu}m$, and for ceramometal restorations $97.38{\pm}18.54\;{\mu}m$. After porcelain build-up, the mean marginal opening for $EVEREST^{(R)}$ restorations was $61.69{\pm}19.33\;{\mu}m$, for $LAVA^{(R)}$ restorations $70.81{\pm}12.99\;{\mu}m$, and for ceramometal restorations $1115.25{\pm}23.86\;{\mu}m$. Conclusion: 1. $LAVA^{(R)}$ and $EVEREST^{(R)}$ restorations in comparison with ceramometal restorations showed better marginal fit, which had significant differences (P < 0.05) in coping state and also after porcelain build-up . 2. The mean marginal opening values between $LAVA^{(R)}$ and $EVEREST^{(R)}$ restorations did not showed significant differences after porcelain build-up as well as in coping state (P > .05). 3. $EVEREST^{(R)}$, $LAVA^{(R)}$ and ceramometal restorations showed a little increased marginal opening after porcelain build-up, but did not show any statistical significance (P > .05).

Comparative Analysis of Price Sensitivity for Using Environmental-Friendly Agricultural Products in University Foodservices Between Jeonnam and Gyeongnam Areas in Korea (대학급식의 친환경 농산물 이용에 대한 전남.경남지역 대학생의 가격민감성 비교)

  • Lee, So-Jung;Kim, Hyun-Ah
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.39 no.8
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    • pp.1220-1230
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    • 2010
  • The purposes of this study were to compare price sensitivity analysis for using environmental-friendly agricultural products in university foodservice between Jeonnam and Gyeongnam areas in Korea and to suggest the optimum guideline for price increase. The questionnaires were distributed to 600 university students respectively in Jeonnam and Gyeongnam area from July 15 to July 25, 2008; among them, 570 students from Jeonnam area and 490 students from Gyeongnam area responded. The results of this study were as follows. First, Indifference price (IDP) were 890 won (Jeonnam area) and 1,050 won (Gyeongnam area); Optimum price point (OPP) were 1,030 won (Jeonnam area) and 1450 won (Gyeongnam area). Price stress range were 140 won (890~1030 won) in Jeonnam area and 400 won (1050~1450 won) in Gyeongnam area. Second, point of marginal cheapness (PMC) were 500 won (Jeonnam area) and 790 won (Gyeongnam area) whereas point of marginal expensiveness (PME) were 1,170 won (Jeonnam area) and 1820 won (Gyeongnam area). Range of acceptable price (RAP) were 670 won (500~1170 won) in Jeonnam area and 1030 won (790~1820 won) in Gyeongnam area. Third, on the basis of IDP percentage and RAP, students in Jeonnam area were more sensitive to meal price increase than students in Gyeongnam area. In contrast, on the basis of Price Stress, students in Gyeongnam area were more sensitive to meal price increase than students in Jeonnam area. Hence, when using environmental-friendly agricultural products in university foodservice, in Jeonnam area, meal price increase should be recommended to be in RAP (500~1170 won), and in Gyeongnam area, meal price increase should be recommended to be in RAP (790~1820 won).

Study the Analysis of Comparison with AROI and MROI Mode in Gated Cardiac Blood Pool Scan (게이트심장혈액풀 스캔에서 자동 관심영역 설정과 수동 관심영역 설정 모드의 비교 분석에 관한 고찰)

  • Kim, Jung-Yul;Kang, Chun-Koo;Kim, Yung-Jae;Park, Hoon-Hee;Kim, Jae-Sam;Lee, Chang-Ho
    • The Korean Journal of Nuclear Medicine Technology
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    • v.12 no.3
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    • pp.222-228
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    • 2008
  • Purpose: The objectives of this study were to compare the left ventricle ejection fraction (LVEF) from gated cardiac blood pool scan (GCBP) for analysis auto-drawing region of interest mode (AROI) and manual-drawing region of interest mode (MROI), respectively. To evaluation the relationships between values produced by both ROI modes. Materials and Methods: Gated cardiac blood pool scan using in vivo method Tc-99m Red Blood Cell were performed for 33 patients (mean age: $53.2{\pm}13.2\;y$) with objective of chemotherapy using single head gamma camera (ADAC Laboratories, Milpitas, CA). Left ventricular ejection fraction was automatically and manually measured, respectively. Results: There was significant difference statistically between AROI and MROI ($LVEF^{AROI}$: $71.4{\pm}12.4%$ vs. $LVEF^{MROI}$: $65.8{\pm}5.9%$, p=0.003). Intra-observer agreements in AROI was higher than MROI ($\gamma^{AROI}=0.964$, Cronbach's $\alpha^{AROI}=0.986$ vs. $\gamma^{MROI}=0.793$, Cronbach's $\alpha^{MROI}=0.911$), either. Additionally, there was no significant difference statistically at best septal view (${\Delta}LVEF^{BSV}=0.7{\pm}2.3%$, p=0.233), however statistically significant difference was found at badly separated septal view (${\Delta}LVEF=10.9{\pm}11.4%$, p=0.001). Moreover, Intra-observer agreements in best septal view was higher than badly separated septal view ($\gamma^{BSV}=0.939$, Cronbach's $\alpha^{BSV}=0.978$; $\gamma=0.948$, Cronbach's $\alpha=0.981$ at AROI, $\gamma^{BSV}=0.836$, Cronbach's $\alpha^{BSV}=0.936$; $\gamma=0.748$, Cronbach's $\alpha=0.888$ at MROI). Conclusion: When best septal view was acquired, LVEF by AROI and MROI indicated not different. Comparing Intra-observer agreements with AROI and MROI, the AROI tended to show higher. Therefore, it is considered that the AROI than MROI is valuable in reproducibility and objective when ROI analysis by acquire left ventricular of best septal view.

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Studies on the Flowering and Maturity in Sesame (Sesamum indicum L.) IV. Effects of Foliage Clipping on the Seed Maturity (참깨의 개화.등숙에 관한 연구 IV. 적엽처리가 참깨의 등숙에 미치는 영향)

  • Lee, Jung-Il;Kang, Chul-Whan;Son, Eung-Ryong
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.30 no.2
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    • pp.165-173
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    • 1985
  • The objectives of the study were to investigate the effects of foliage clipping on photosynthesis and grain filling for branch and non branch types under the polyethylene film mulch and non mulch conditions in mono cropping and second cropping after barley in sesame (Sesamum indicum L.), and to improve poor grain filling at later flowering time utilizing these data. One thousand grain weight was more decreased in branch type than in non branch type, in polyethylene film mulch condition than in non mulch condition, and in second cropping after barley than in mono cropping by clipping lower part foliage. Twentyfive percent clipping of lower part foliage showed a little increase than no clipping. Matured grain rate also showed same tendency between branch and non branch type and between mono cropping and second cropping after barley as well as 1,000 grain weight except for polyethylene film mulch. Matured grain rate of 25% foliage clipping at 30 days after flowering in non branch type presented a little increase but decreased in branch type. Clipping of higher part leaves were so serious decrease of matured grain rate that higher part leaves at late maturing time have a major role in photosynthesis. Matured grain rate of foliage clipping at 10 days after flowering was decreased in all treatments. Chlorophyll content of higher part leaves at 50% lower part foliage clipping presented 39% increase compared to same positioned leaves of non treatment, and 66% increase by 50% higher part foliage clipping in lower part leaves. Photosynthetic activity was 58% more increased in 50% lower part foliage clipping than no clipping, but seriously decreased in 50% higher part foliage clipping. Therfore, photosynthates of remained lower part leaves could not only support their own demands, but also any contribution to translocation of photosynthates from source to sink at late maturing time. Harvest index was 28% increased in 25% lower part foliage clipping and 13% decreased in 50% higher part foliage clipping compared to no clipping. Leaf area was 48% increased in 50% lower part foliage clipping compared to the same positioned leaves of no clipping, and only 5% increased in higher part foliage clipping. Productivity by foliage clipping compared to non treatment, was highly decreased in branch type than in non branch type, in second cropping after barley than in mono cropping. Little difference was detected between polyethylene film mulch and non mulch conditions. Twenty five percentage of lower part foliage clipping on mono cropping of non branch type appeared 5% and 8% yield increase in each of polyethylene film mulch and non mulch conditions compared to no clipping, and all decreased in other treatments. Mean loss of productivity by foliage clipping at 10 days after flowering was serious than clipping at 30 days after flowering. As the result, contribution to photosynthesis of source at 10 days after flowering are larger than that at 30 days after flowering in sesame. Fifty percent lower part foliage clipping at 10 days after flowering showed so the most serious yield decrease that lower part leaves at that time were considered as the main role leaves for photosynthesis.

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Growth and Yield Characteristics by Tillering Sequence in Coix lachryma-jobi L. var. mayuen Stapf (율무의 분얼순서에 따른 생육 및 수량 기여도)

  • Yi, Eun-Sub;Yoon, Seong-Tak;Park, Kyeong-Yeol
    • Korean Journal of Medicinal Crop Science
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    • v.12 no.3
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    • pp.219-225
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    • 2004
  • This study was conducted to evaluate growth and yield characteristics and the contribution to the yield according to the emergent sequence of tiller under two planting density $(60{\times}15\;cm,\;60{\times}25\;cm)$ in Coix lachryma-jobi L. var. mayuen Stapf. The average culm length and number of rachillas of $60{\times}25\;cm$ planting density were 20 cm shorter and 4.7 higher, respectively, whereas seed setting position of $60{\times}25\;cm$ planting density was 1.7 nodes lower compared with $60{\times}15\;cm$ planting density. Culm length and culm diameter of each tiller became shorter and thinner as the tiller emerged later. Length of rachillas was longer, number of grains was higher and ripening rate was also higher in $60{\times}25\;cm$ planting density than those of $60{\times}15\;cm$ planting density, whereas 100 grain weight in $60{\times}25\;cm$ planting density was lower by 0.5 g compared with $60{\times}15\;cm$ planting density. Length of rachillas and number of grains according to the emergent sequence of tiller were shown shorter and lower as the tiller emerged later. The highest number of bract was obtained from the main culm in both planting densities. 100 grain weight according to the emergent sequence of tiller became lower as the tiller emerged later in $60{\times}15\;cm$ planting density, but there was no clear tendency in $60{\times}25\;cm$ planting density. Among 8 tillers, 5th tiller and 4th tiller of main culm contributed 84.4% to the yield in $60{\times}15\;cm$ planting density, while it was 84.1% in $60{\times}25\;cm$ planting density. Analysis of path coefficient to grain yield showed that direct effect was the highest in the number of grain per tiller followed by in the 100 grain weight and in ripening rate.

Evaluation of friction of ceramic brackets in various bracket-wire combinations (브라켓 각도 변화에 따른 세라믹 브라켓의 마찰력 측정)

  • Cha, Jung-Yul;Kim, Kyung-Suk;Kim, Dong-Choon;Hwang, Chung-Ju
    • The korean journal of orthodontics
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    • v.36 no.2 s.115
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    • pp.125-135
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    • 2006
  • The purpose of this study was to measure and compare the level of frictional resistance generated from three currently used ceramic brackets; 1, Crystaline $V^{(R)}$, Tomy International Inc., Tokyo, Japan; 2, $Clarity^{(R)}$, 3M Unitek, Monrovia, CA, USA; 3, $Inspire^{(R)}$, Ormco, Orange, CA, USA; with composite resin brackets, Spirit, Ormco, Orange, CA, USA; and conventional stainless steel brackets, Kosaka, Tomy International Inc., Tokyo, Japan used as controls. In this experiment, the resistance to sliding was studied as a function of four angulations $(0^{\circ},\;5^{\circ},\;10^{\circ}\;and\;15^{\circ})$ using 2 different orthodontic wire alloys: stainless steel (stainless steel, SDS Ormco, Orange, CA, USA), and beta-titanium (TMA, SDS Ormco, Orange, CA, USA). After mounting the 22 mil brackets to the fixture and $.019{\times}.025$ wires ligated with elastic ligatures, the arch wires were slid through the brackets at 5mm/min in the dry state at $34^{\circ}C$. Silica-insert ceramic brackets generated a significantly lower frictional force than did other ceramic brackets, similar to that of stainless steel brackets. Beta-titanium archwires had higher frictional resistance than did stainless steel, and all the brackets showed higher static and kinetic frictional force as the angulation increased. When the angulation exceeded $5^{\circ}$, the active configuration emerged and frictional force quickly increased by 2.5 to 4.5-fold. The order of frictional force of the different wire-bracket couples transposed as the angle increased. The silica-insert ceramic bracket is a valuable alternative to conventional stainless steel brackets for patients with esthetic demands.

Determination of Appropriate Sampling Frequency and Time of Multiple Blood Sampling Dual Exponential Method with $^{99m}Tc$-DTPA for Calculating GFR (사구체여과율 계산을 위한 $^{99m}Tc$-DTPA를 이용한 다중 채혈 이중지수법의 적정 채혈 횟수 및 시간의 선정)

  • Kim, Chung-Ho;O, Joo-Hyun;Chung, Yong-An;Yoo, Ie-Ryung;Sohn, Hyung-Sun;Kim, Sung-Hoon;Chung, Soo-Kyo;Lee, Hyoung-Koo
    • Nuclear Medicine and Molecular Imaging
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    • v.40 no.1
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    • pp.33-39
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    • 2006
  • Purpose: To determine appropriate sampling frequency and time of multiple blood sampling dual exponential method with $^{99m}Tc$-DTPA for calculating glomerular filtration rate (GFR). Materials & Methods: Thirty four patients were included in this study. Three mCi of $^{99m}Tc$-DTPA was intravenously injected and blood sampling at 9 different times, 5ml each, were done. Using the radioactivity of serum, measured by gamma counter, the GFR was calculated using dual exponential method and corrected with the body surface area. Using spontaneously chosen 2 data points of serum radioactivity, 15 collections of 2-sample GFR were calculated. And 10 collections of 3-sample GFR and 12 collections of 4-sample GFR were also calculated. Using the 9-sample GFR as a reference value, degree of agreement was analyzed with Kendall's $\tau$ correlation coefficients, mean difference and standard deviation. Results: Although some of the 2-sample GFR showed high correlation coefficient, over or underestimation had evolved as the renal function change. The 10-120-240 min 3-sample GFR showed a high correlation coefficient (${\tau}=0.93$), minimal difference ($Mean{\pm}SD=-1.784{\pm}3.972$), and no over or underestimation as the renal function changed. The 4-sample GFR showed no better accuracy than the 3-sample GFR. Conclusions: In the wide spectrum of renal function, the 10-120-240 min 3-sample GFC could be the best choice for estimating the patients' renal function.

Effect of Sorbitol on the Texture and the Survival of Lactic Acid Bacteria of Frozen Yoghurt (Sorbitol첨가가 Frozen Yoghurt중 유산균의 생존율과 조직에 미치는 영향)

  • Kim, Eung-Ryul;Kim, Yu-Seong;Lee, Yeong-Geon;Ju, Ji-Seon;Lee, Gang-Ik;Baick, Seung-Cheon;Lee, Jong-Ik;Yu, Je-Hyeon
    • Journal of Dairy Science and Biotechnology
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    • v.14 no.1
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    • pp.71-84
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    • 1996
  • This study was conducted to examine the usability of sorbitol for the manufacture as low-calory ingredient and cryoprotectant against frost damage. When frozen yoghrt was made of replacing sucrose by sorbitol at yoghurt mix, the change of physicochemical and lactic acid bacteria, such as Str. thermophilus, L. bulgaricus, and mixed culture of Str. thermophilus, and L. bulgaricus(1:1), was studied during the frozen storage(-20$^{\circ}$C). During the incubation of yoghurt mix, the rapid growth of lactic acid bacteria in all sample was observed as the increase of sorbitol addition, but sample A and D were almost similar. This results suggested that sucrose could play role of effecting the growth stimulator, otherwise, sorbitol could inhibit the death of microorganism, following the genus. At the survival rate between lactic acid bacteria during freezing of -5$^{\circ}$C by ice cream freezer Str. thermophilus showed 26.19 to 34.76%, L. bulgaricus 3.97 to 5.20%, and mixed culture 17.16 to 40.87% respectively. L. bulgaricus showed the greater lethal rate than other genus. Sample C which mixed sucrose with sorbitol (1:2 ratio) was showed the lowest lethal rate. Therefore, it suggested that the use of this ration could be used for better anti-frost damage. During the storage of -20$^{\circ}$C, the number of lactic acid bacteria generally decreased in the stand point of genus and frozen storage period. The survival of lactic acid bacteria might be the addition of sorbitol which could have the effect of anti-forst damage. In all treatment, lactase activity showed the rapid decrease after freezing. During the period of frozen storage, it was shown the slow decreasing trend. In spite· of decreasing, the result during yoghurt mix incubation -5$^{\circ}$C freezing, and -20$^{\circ}$C frozen storage was different at the level. After 80 days of storage, the lactase activity was similar among all genus and sample. Despite differenting viscosity followed by genus, combination of mix, and pH, the ratio of 1 to 2(sucrose : sorbitol) showed the greatest viscosity. The water holding capacity of frozen yoghurt mix was closely related to viscosity. As increasing sorbitol amounts, hardness and cohesiveness were increased, but elastisity was decreased. The significant differences between sample was inoculated with Str. thermophilus. However, there were not significant difference from the sample inoculated with L. bulgaricus and mixed culture.

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Characteristics of Physico-chemical Water Quality Characteristics in Taehwa-River Watershed and Stream Ecosystem Health Assessments by a Multimetric Fish Model and Community Analysis (태화강 수계의 다변수 어류평가 모델 및 군집분석에 의한 이화학적 수질 특성 및 하천 생태건강도 평가)

  • Kim, Yu-Pyo;An, Kwang-Guk
    • Korean Journal of Ecology and Environment
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    • v.43 no.3
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    • pp.428-436
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    • 2010
  • This study was to evaluate water quality characteristics and ecological health using a mulimetric fish model in Taehwa-River watershed during May~September 2009. The ecological health assessments were based on the Index of Biological Integrity (IBI) using fish community and the multimetric model of Qualitative Habitat Evaluation Index (QHEI). For the study, the models of IBI and QHEI were modified as 8 and 11 metric attributes, respectively. We also analyzed spatial patterns of chemical water quality over the period of 2000~2009, using the water chemistry dataset, obtained from the Ministry of Environment, Korea. Values of BOD and COD averaged $1.7\;mg\;L^{-1}$ (scope: $0.1{\sim}31.8\;mg\;L^{-1}$) and $3.6\;mg\;L^{-1}$ (scope: $0.4{\sim}33\;mg\;L^{-1}$), respectively during the study. Total nitrogen (TN) and total phosphorus (TP) averaged $2.8\;mg\;L^{-1}$ and $96.8\;{\mu}g\;L^{-1}$, respectively, indicating an eutrophic-hypertrophic state. Also, TN and TP showed longitudinal increases toward the downriver reach. In the watershed, QHEI values varied from 67.5 (fair condition) to 164.5 (good condition) by the criteria of US EPA (1993). There was a abruptly decreasing tendency from T9 site in the QHEI values. According to 1st and 2nd surveys of Taewha River, multimetric model values of IBI was averaged 26.1 (n=14) with "good" condition (B) and the spatial variation was evident. Our results suggest that the mainstream sites was getting worse health condition along the river gradient due to inputs of the point and non-point sources from the urban (Ulsan city). Overall, dataset of IBI, QHEI, and water chemistry indicated that the ecological river health showed a downriver decline and the pattern was closely associated with habitat degradations and chemical pollutions as the waters pass through the urban region.