• Journal of Chest Surgery
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• v.32 no.2
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• pp.130-137
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• 1999

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.

• Proceedings of the KSPS conference
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• 1996.10a
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• pp.246-246
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• 1996

Purpose: Some of the properties of the prosodic phrasing and some acoustic and phonological effects of contrastive focus on the tonal pattern of Seoul Korean is explored based on a brief experiment of analyzing the fundamental frequency(=FO) contour of the speech of the author. Data Base and Analysis Procedures: The examples were chosen to contain mostly nasal and liquid consonants, since it is difficult to track down the formants in stops and fricatives during their corresponding consonantal intervals and stops may yield an effect of unwanted increase in the FO value due to their burst into the following vowel. All examples were recorded three times and the spectrum of the most stable repetition was generated, from which the FO contour of each sentence was obtained, the peaks with a value higher than 250Hz being interpreted as a high tone (=H). The result is then discussed within the prosodic hierarchy framework of Selkirk (1986) and compared with the tonal pattern of the Northern Kyungsang dialect of Korean reported in Kenstowicz & Sohn (1996). Prosodic Phrasing: In N.K. Korean, H never appears both on the object and on the verb in a neutral sentence, which indicates the object and the verb form a single Phonological Phrase ($={\phi}$), given that there is only one pitch peak for each $={\phi}$. However, Seoul Korean shows that both the object and the verb have H of their own, indicating that they are not contained in one $={\phi}$. This violates the Optimality constraint of Wrap-XP (=Enclose a lexical head and its arguments in one $={\phi}$), while N.K. Korean obeys the constraint by grouping a VP in a single $={\phi}$. This asymmetry can be resolved through a constraint that favors the separate grouping of each lexical category and is ranked higher than Wrap-XP in Seoul Korean but vice versa in N.K. Korean; $Align-x^{lex}$ (=Align the left edge of a lexical category with that of a $={\phi}$). (1) nuna-ka manll-ll mEk-nIn-ta ('sister-NOM garlic-ACC eat-PRES-DECL') a. (LLH) (LLH) (HLL) ----Seoul Korean b. (LLH) (LLL LHL) ----N.K. Korean Focus and Phrasing: Two major effects of contrastive focus on phonological phrasing are found in Seoul Korean: (a) the peak of an Intonatioanl Phrase (=IP) falls on the focused element; and (b) focus has the effect of deleting all the following prosodic structures. A focused element always attracts the peak of IP, showing an increase of approximately 30Hz compared with the peak of a non-focused IP. When a subject is focused, no H appears either on the object or on the verb and a focused object is never followed by a verb with H. The post-focus deletion of prosodic boundaries is forced through the interaction of StressFocus (=If F is a focus and DF is its semantic domain, the highest prominence in DF will be within F) and Rightmost-IP (=The peak of an IP projects from the rightmost $={\phi}$). First Stress-F requires the peak of IP to fall on the focused element. Then to avoid violating Rightmost-IP, all the boundaries after the focused element should delete, minimizing the number of $={\phi}$'s intervening from the right edge of IP. (2) (omitted) Conclusion: In general, there seems to be no direct alignment constraints between the syntactically focused element and the edge of $={\phi}$ determined in phonology; all the alignment effects come from a single requirement that the peak of IP projects from the rightmost $={\phi}$ as proposed in Truckenbrodt (1995).

• Journal of Chest Surgery
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• v.38 no.5 s.250
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• pp.366-370
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• 2005

Background: In general, cardiac surgery has been performed via median sternotomy. During the past decade, improvements in endoscopic equipment and operative techniques have resulted in development of minimally invasive cardiac operation using small incisions. With the advent of a voice controlled camera-holding robotic arm (AESOP 3000, Automated Endoscope System for Optimal Positioning), cardiac surgery entered the robotic age. Material and Method: Between April 2004 and December 2004, a total of seventy eight patients underwent robotic cardiac surgery, of whom sixty four patients underwent robot-assisted minimally invasive cardiac surgery via 5cm right lateral minithoracotomy using voice controlled robotic arm, femoral vessels cannulation, percutaneous internal jugular cannulation, transthoracic aortic cross clamp. Other fourteen patients underwent MIDCAB via internal mammary artery harvesting using AESOP. Result: Robotic cardiac surgery were mitral valve repair in 37 cases, mitral valve replacement in 10 cases, aortic valve replacement in 1 case, MIDCAB in 14 cases, ASD operation in 9 cases, and isolated Maze procedure in 1 case. In mitral operation, mean CPB time was $165.3\pm43.1$ minutes and mean ACC time was $110.4\pm48.2$ minutes. Median length of hospital stay was 6 days (range 3 to 30) in mitral operation, 4 days (range 2 to 7) in MIDCAB, and 4 days (range 2 to 6) in ASD operation. For complications, 3 patients were required by reoperation for bleeding. There was no hospital mortality. Conclusion: Our experience of robot cardiac surgery suggests that many cardiovascular surgeons will be able to perform minimally invasive cardiac operations through small incisions with robot-assisted video-direction. Well-designed studies and close long-term follow-up will be required to analyze the benefits of robot-assisted operation.

• Journal of Chest Surgery
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• v.35 no.7
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• pp.517-522
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• 2002

Background: Congenital heart surgery may lead to myocardial swelling and hemodynamic instability. Delayed sternal closure may be beneficial in this setting. The purpose of this study was to assess mortality and mediastinal infection rate associated with delayed sternal closure after congenital heart surgery and to evaluate the risk factors which affect mortality and mediastinal infection rate. Material and Method: We retrospectively reviewed 40 patients who underwent delayed sternal closure after repair of congenital heart disease at Yonsei Cardiovascular Hospital, from January 1994 to May 2001. In these patients, we assessed the mortality and mediastinal infection rate, and evaluated their risk factors including operation time, bypass time, aortic cross clamp time, duration to sternal closure and postoperative artificial ventilation time. Mediastinal infection was defined to have positive culture in mediastinum. Result: Hemodynamic instability was the most common indication for delayed sternal closure(n=36) and other indications included postoperative bleeding(n=2) and conduit compression(n=2). The median age at operation was $14.4{\pm}33.4$months old(range, 2days-12years). The patients with postoperative bleeding and conduit compression were much older than the others. The sternum was left open for $4.5{\pm}3.4$ days(range, 1-20days). Overall mortality was 25%(10/40) and mediastinal infection occured in 24.3%(9/37) (3 patients were excluded in mediastinal infection for early death). In risk factor analyses, only aortic cross clamp time had statistical significance for mortality in univariate analyses. However, multivariate analyses revealed that there were no significant predictors for risk of mortality and mediastinal infection. Conclusion: Delayed sternal closure after repair of congenital cardiac disease had relatively high mortality and mediastinal infection rate. But, in patients with hemodynamic instability, postoperative bleeding and conduit compression after repair of congenital cardiac disease, delayed sternal closure may be an effective life saving method.

• Journal of Chest Surgery
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• v.41 no.4
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• pp.430-438
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• 2008

Background: All the patients with mechanical valves require warfarin therapy in order to prevent them from developing thromboembolic complications. According to the ACC/AHA practice guidelines, after AVR with bileaflet mechanical prostheses in patients with no risk factors, warfarin is indicated to achieve an INR of 2.0 to 3.0. After MVR with any mechanical valve, warfarin is indicated to achieve an INR of 2.5 to 3.5. But in our clinical experience, bleeding complications (epistaxis, hematuria, uterine bleeding, intracerebral hemorrhage etc.) frequently developed in patients who maintained their INR within this value. So, we retrospectively reviewed the patients with bileaflet mechanical heart valve prosthesis and we determined the optimal anticoagulation value. Material and Method: From January 1984 to February 2007, 311 patients have been followed up at a national medical center. We classified the AVR patients (n=60) into three groups as follows: an INR from 1.5 to 2.0 in Group I, an INR from 2.0 to 2.5 in Group II and an INR from 2.5 to 3.0 in Group III. We classified the MVR (n=171) and DVR (n=80) patients into four groups as follows: an INR from 1.5 to 2.0 in Group I, an INR from 2.0 to 2.5 in Group II, an INR from 2.5 to 3.0 in Group III and an INR from 3.0 to 3.5 in Group III. We compared the groups for their thromboembolic and bleeding complications by means of the Kaplan Meier method. Result: In the AVR patients, 2 thromboembolic complications and 4 bleeding complications occurred and the log rank test failed to identify any statistical significance between the groups for thethromboembolic complication rate, but groups I and II had lower bleeding complication rates than did group III. Thirteen thromboembolic complication and 15 bleeding complication occurred in the MVR and DVR patients, and the log rank test also failed to identify statistical significance between the groups for the thromboembolic complication rate, but groups I and II had lower bleeding complication rates that did groups III and IV. Conclusion: The thromboembolic complication rate was not statistically different between groups I and II and groups III and IV, but the bleeding complication rates of groups I and II were lower than those of groups III and IV. So this outcome encouraged us to continue using our low intensive anticoagulation regime, that is, an INR of 1.5 to 2.5.

• Journal of the Korean Society of Food Science and Nutrition
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• v.45 no.6
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• pp.789-796
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• 2016

The anti-lipogenic effect of cereal samples on high sucrose diet (HSD)-induced non-alcoholic fatty liver disease (NAFLD) in mice was studied. We divided C57BL/6 mice into various groups based on 8 weeks of treatment with three types of cereal samples (HSD+WR, HSD diet containing 40% white rice; HSD+MCG, HSD diet containing 40% mixed cereal grain; HSD+AO-MCG, HSD diet containing 40% mixed antiobesity-cereal grain). After the experimental period, body weight changes, liver weights, serum lipid profiles, and hepatic fatty acid metabolism-related gene expression levels were determined. We found that HSD+WR, HSD+MCG, and HSD+AO-MCG treatments reduced body weight and liver weight, especially HSD+MCG and HSD+AO-MCG effectively reduced levels of serum triglycerides, total cholesterol, and low-density lipoprotein cholesterol. However, high density lipoprotein cholesterol levels increased compared to the control group. Furthermore, expression of hepatic lipogenic genes such as sterol regulatory element-binding protein-1c, acetyl-coenzyme A carboxylase, fatty acid synthase, stearoyl-coenzyme A desaturase-1, cluster of differentiation, and $PPAR-{\gamma}$ (peroxisome proliferator activated receptor ${\gamma}$) decreased, whereas expression of ${\beta}-oxidation$ genes such as $PPAR-{\alpha}$ and carnitine palmitoyl transferase-1 increased following HSD+MCG and HSD+AO-MCG treatment compared with levels in HSD+WR and control groups. These results suggest that the functional cereal samples, especially HSD+AO-MCG treatment, improved hepatic steatosis triggered by an HSD-induced imbalance in hepatic lipid metabolism.

• Journal of Nutrition and Health
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• v.47 no.1
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• pp.12-22
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• 2014

Purpose: This study was conducted to establish the production conditions through optimization of the production process of beverages using Aspergillus oryzae CF1001, and to analyze volatile compounds and antidiabetic activity. Methods: The optimum condition was selected using the response surface methodology (RSM), through a regression analysis with the following independent variables gelatinization temperature (GT, $X_1$), saccharogenic time (ST, $X_2$), and dependent variable; ${\Delta}E$ value (y). The condition with the lowest ${\Delta}E$ value occurred with combined 45 min ST and $50^{\circ}C$ GT. The volatile compounds were analyzed quantitatively by GC-MS. Results: Assessment of antidiabetic activity of saccharogenic mixed grain beverage (SMGB) was determined by measurement of ${\alpha}$-glucosidase inhibition activity, and glucose uptake activity and glucose metabolic protein expression by reverse transcriptase polymerase chain reaction (RT-PCR) and western blot analysis. Results of volatile compounds analysis, 62 kinds of volatile compounds were detected in SMGB. Palmitic acid (9.534% ratio), benzaldehyde (8.948% ratio), benzyl ethyl ether (8.792% ratio), ethyl alcohol (8.35% ratio), and 2-amyl furan (4.826% ratio) were abundant in SMGB. We confirmed that ${\alpha}$-glucosidase inhibition activity, glucose uptake activity, and glucose-metabolic proteins were upregulated by SMGB treatment with concentration dependent manner. Conclusion: Saccharogenic mixed grain beverage (SMGB) showed potential antidiabetic activity. Further studies will be needed in order to improve the taste and functionality of SMGB.

• Journal of Chest Surgery
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• v.39 no.2 s.259
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• pp.99-105
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• 2006

Background: Interrupted aortic arch is a rare congenital heart anomaly which still shows high surgical mortality. In this study, we investigated the causes of and the risk factors for mortality to improve the surgical outcomes for this difficult disease entity. Material and Method: From 1984 to 2004, 42 patients diagnosed as IAA were reviewed retrospectively. Age, body weight at operation, preoperative diagnosis, preoperative PGE1 requirement, type of interrupted aortic arch, degree of left ventricular outflow stenosis, CPB time, and ACC time were the possible risk factors for mortality. Result: There were .14 hospital deaths. Preoperative use of PGE1, need for circulartory assist and aortic cross clamp time proved to be positive risk factors for mortality on univariate analysis. Preoperative left ventricular outflow stenosis was considered a risk factor for mortality but it did not show statistical significance (p-value=0.61). Causes of death included hypoxia due to pulmonary banding, left ventricular outtract stenosis, infection, mitral valve regurgitation, long cardiopulmonary bypass time and failure of coronary transfer failure in TGA patients. Conclusion: In this study, we demonstrated that surgical mortality is still high due to the risk factors including preoperative status and long operative time. However preoperative subaortic dimension was not related statistically to operative death statistically. Adequate preoperative management and short operation time are mandatory for better survival outcome.

• Journal of Chest Surgery
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• v.40 no.3 s.272
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• pp.200-208
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• 2007

Background: The effect of patient-prosthesis mismatch (PPM) on the clinical outcome following aortic valve replacement (AVR) remains controversial. This study compared the surgical outcomes of AVR between patients with a patient-prosthesis mismatch and those having undergone an aortic annular enlargement. Material and Method: Six hundred and twenty seven adult patients, who underwent AVR with stented bioprosthetic or mechanical valves, between January 1996 and February 2006, were evaluated. PPM was defined as an indexed effective orifice area (iEOA) ${\leq}0.85cm^2/m^2$, and Severe if the iEOA${\leq}0.65cm^2/m^2$ PPM was present in 103 (16.4%, PPM group) patients, and severe in 11 (1.8%, SPPM group). During the period of the study, 21 patients underwent an AVR with annular enlargement (AE group). Result: The mean iEOA of the AE group was larger than that of the PPM group ($0.95\;vs.\;0.76cm^2/m^2,\;p=0.00$). The AE group had longer CPB, ACC and operation times than the PPM group, and showed a tendency toward higher operative mortality (14.3% vs. 2.9%, p=0.06). The SPPM group had higher AV pressure gradients (peak/mean) than the AE group (72/45 mmHg vs. 38/25 mmHg, p=0.02/0.06) and suffered more AV related events (AV reoperation or severe aortic stenosis)(45.5% vs. 9.5%, p=0.03). LV masses were not regressed in the patients who experienced an AV related event. Conclusion: During AVR in patients with a small aortic annulus, annular enlargement should be carefully applied taking into account the high risk of operative mortality due to annular enlargement and co-morbidities of patients. Aortic annular enlargement; however, should be considered as an alternative method in patients expected to have a severe PPM after an AVR.

• Magazine of the Korean Society of Agricultural Engineers
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• v.24 no.4
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• pp.69-79
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• 1982

The objective of this study is to contribute to drainage planning in the most realistic and economical way by establishing the relationship between rice yield reduction and overhead flooding by muddy water of each growth stage of paddy, which is the most important factor in determining optimum drainage facilities. This study was based on the data mainly from the experimental reports of the Office of Rural Development of Korea, Reduction Rate Estimation for Summer Crops, published by Ministry of Agriculture and Forestry of Japan and other related research documenta- tion. The results of this study are summarized as follows 1. Damages by overhead flooding are highest in heading stage and have the tendency of decrease in the order of booting stage, panicle formation stage, tillering stage, and stage just after transplanting. Damages by overhead flooding of each growing stage are as follows: a) It is considered that overhead flooding just after transplanting gives a little influence on plant growth and yield because the paddy has sufficient growth period from floo ding to harvest time. b) Jt is analyzed that according to the equation y=11 12x 0.908 which is derived from this study, damages by overhead flooding during tillering stage for 1, 2, 3 successive days are 11.1 %, 20.9%, and 30.2% respectively. c) Damages by overhead flooding after panicle formation stage are very serious because recovering period is very short after damage and ineffective tillering is much. Acc- ording to the equation y=9. 58x+10. Ol derived from this study, damages by overhead flooding fal 1,2,3,5 successive days are 19.6%, 29.2%, 38.8%, 57.9% respectively. d) Booting stage is the very important period in which young panicle has grown up almost completely and the number of glumous flower is fixed since reduction division takes place in the microspore mother cell and enbryo mother cell. According to the equation y=39. 66x 0.558 derived from this study, damages by overhead floodingfor 0.5, 1, 3, 5 successive days are 26.9%, 39.7%, 72. 2% and 97.4%, respectively. Therefore, damages by overhead flooding is very serious during the hooting stage. e) When ear of paddy emerges, flowering begins on that day or the next day; when paddy flowers, fertilization will be completed 2-3 hours after flowering. Therefore overhead flooding during heading stage impedes flowering and increases sterilizing percentage. From this reason damages of heading stage are larger than that of booting stage. According to the equation y-41 94x 0.589 derived from this study, damages by overhead flooding for 0.5, 1, 3, 5, successive days are 27.9%, 63.1 %, 80.1%, and 100% 2. Considering that temperature of booting stage is higher than that of beading stage and plant height of booting stage is ten centimeters shorter than that of heading stage, booting stage should be taken as a critical period for drainage planning because possi- bility of damage occurrence in booting stage is larger than that of heading stage. There-fore, it is considered that booting stage should be taken as critical period of paddy growth for drainage planning. 3. Overhead flooding depth is different depending on the stage of growth. In case, booting stage is adopted as design stage of growth for drainage planning, it is conside red that the allowable flooding depth for new varieties and general varieties are 70cm and 80cm respectively. 4. Reduction Rate Estimation by Wind and Flood for Rice Planting of the present design criteria for drainage planning shows damage by overhead flooding for 1 to 2, 3 to 4, 5 to 7 consecutive days; damages by overhead flooding varies considerably over several hours and experimental condition of soil, variety of paddy, and climate differs with real situation. From these reasons, damage by flooding could not be estimated properly in the past. This study has derived the equation which shows damages by flooding of each growth stage on an hourly basis. Therefore, it has become possible to compute the exact damages in case duration of overhead flooding is known.