• Title/Summary/Keyword: Daily exposure

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The Effect of Corporate SNS Marketing on User Behavior: Focusing on Facebook Fan Page Analytics (기업의 SNS 마케팅 활동이 이용자 행동에 미치는 영향: 페이스북 팬페이지 애널리틱스를 중심으로)

  • Jeon, Hyeong-Jun;Seo, Bong-Goon;Park, Do-Hyung
    • Journal of Intelligence and Information Systems
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    • v.26 no.1
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    • pp.75-95
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    • 2020
  • With the growth of social networks, various forms of SNS have emerged. Based on various motivations for use such as interactivity, information exchange, and entertainment, SNS users are also on the fast-growing trend. Facebook is the main SNS channel, and companies have started using Facebook pages as a public relations channel. To this end, in the early stages of operation, companies began to secure a number of fans, and as a result, the number of corporate Facebook fans has recently increased to as many as millions. from a corporate perspective, Facebook is attracting attention because it makes it easier for you to meet the customers you want. Facebook provides an efficient advertising platform based on the numerous data it has. Advertising targeting can be conducted using their demographic characteristics, behavior, or contact information. It is optimized for advertisements that can expose information to a desired target, so that results can be obtained more effectively. it rethink and communicate corporate brand image to customers through contents. The study was conducted through Facebook advertising data, and could be of great help to business people working in the online advertising industry. For this reason, the independent variables used in the research were selected based on the characteristics of the content that the actual business is concerned with. Recently, the company's Facebook page operation goal is to go beyond securing the number of fan pages, branding to promote its brand, and further aiming to communicate with major customers. the main figures for this assessment are Facebook's 'OK', 'Attachment', 'Share', and 'Number of Click' which are the dependent variables of this study. in order to measure the outcome of the target, the consumer's response is set as a key measurable key performance indicator (KPI), and a strategy is set and executed to achieve this. Here, KPI uses Facebook's ad numbers 'reach', 'exposure', 'like', 'share', 'comment', 'clicks', and 'CPC' depending on the situation. in order to achieve the corresponding figures, the consideration of content production must be prior, and in this study, the independent variables were organized by dividing into three considerations for content production into three. The effects of content material, content structure, and message styles on Facebook's user behavior were analyzed using regression analysis. Content materials are related to the content's difficulty, company relevance, and daily involvement. According to existing research, it was very important how the content would attract users' interest. Content could be divided into informative content and interesting content. Informational content is content related to the brand, and information exchange with users is important. Interesting content is defined as posts that are not related to brands related to interesting movies or anecdotes. Based on this, this study started with the assumption that the difficulty, company relevance, and daily involvement have an effect on the dependent variable. In addition, previous studies have found that content types affect Facebook user activity. I think it depends on the combination of photos and text used in the content. Based on this study, the actual photos were used and the hashtag and independent variables were also examined. Finally, we focused on the advertising message. In the previous studies, the effect of advertising messages on users was different depending on whether they were narrative or non-narrative, and furthermore, the influence on message intimacy was different. In this study, we conducted research on the behavior that Facebook users' behavior would be different depending on the language and formality. For dependent variables, 'OK' and 'Full Click Count' are set by every user's action on the content. In this study, we defined each independent variable in the existing study literature and analyzed the effect on the dependent variable, and found that 'good' factors such as 'self association', 'actual use', and 'hidden' are important. Could. Material difficulties', 'actual participation' and 'large scale * difficulties'. In addition, variables such as 'Self Connect', 'Actual Engagement' and 'Sexual Sexual Attention' have been shown to have a significant impact on 'Full Click'. It is expected that through research results, it is possible to contribute to the operation and production strategy of company Facebook operators and content creators by presenting a content strategy optimized for the purpose of the content. In this study, we defined each independent variable in the existing research literature and analyzed its effect on the dependent variable, and we could see that factors on 'good' were significant such as 'self-association', 'reality use', 'concernal material difficulty', 'real-life involvement' and 'massive*difficulty'. In addition, variables such as 'self-connection', 'real-life involvement' and 'formative*attention' were shown to have significant effects for 'full-click'. Through the research results, it is expected that by presenting an optimized content strategy for content purposes, it can contribute to the operation and production strategy of corporate Facebook operators and content producers.

The Content and Risk Assessment of Heavy Metals in Herbal Pills (유통 환제의 유해 중금속 함량 및 위해도 평가)

  • Lee, Sung-Deuk;Lee, Young-Ki;Kim, Moo-Sang;Park, Seok-Ki;Kim, Yeon-Sun;Chae, Young-Zoo
    • Journal of Food Hygiene and Safety
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    • v.27 no.4
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    • pp.375-387
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    • 2012
  • The objective of this study is investigation of contamination levels and assessment of health risk effects of heavy metals in herbal pills. 31 Items and 93 samples were obtained for this investigation from major herbal medicine producing areas, herbal markets and on-line supermarkets from Jan to Jun in 2010. Inductively coupled plasma mass spectrometer method was conducted for the quantitative analysis of Pb, Cd and As. In addition, the mercury analyzer system was conducted for that of Hg without sample digestion. The average contents of heavy metals in samples were as follows : 0.87 mg/kg for Pb, 0.08 mg/kg for Cd, 2.87 mg/kg for As and 0.16 mg/kg for Hg, respectively. In addition, the average contents of heavy metals in different parts of plants, including cortex, fructus, herba, radix, seed, algae and others were 0.63 mg/kg, 3.94 mg/kg, 1.42 mg/kg, 1.05 mg/kg, 0.16 mg/kg, 22.31 mg/kg and 10.17 mg/kg, respectively. After the estimations of dietary exposure, the acceptable daily intake (ADI), the average daily dose (ADD), the provisional tolerable weekly intake (PTWI) and the relative hazard of heavy metals were evaluated. As the results, the relative hazards compared to PTWI in samples were below the recommended standard of JECFA as Pb 3.1%, Cd 0.9%, Hg 0.5%. Cancer risks through slope factor (SF) by Ministry of Environment Republic Korea and Environmental Protection Agency was $4.24{\times}10^{-7}$ for Pb and $3.38{\times}10^{-4}$ for As (assuming that the total arsenic content was equal to the inorganic arsenic). Based on our results, possible Pb-induced cancer risks in herbal pills according to parts used including cortex, fructus, herba, radix, seed, algae and others were $1.95{\times}10^{-7}$, $1.45{\times}10^{-6}$, $2.14{\times}10^{-7}$, $6.27{\times}10^{-7}$, $1.99{\times}10^{-8}$, $3.61{\times}10^{-7}$ and $9.64{\times}10^{-8}$, respectively. Possible As-induced cancer risks in herbal pills by parts used including cortex, fructus, herba, radix, seed, algae and others were $1.54{\times}10^{-5}$, $7.24{\times}10^{-5}$, $1.23{\times}10^{-4}$, $2.02{\times}10^{-5}$, $3.25{\times}10^{-6}$, $2.18{\times}10^{-3}$ and $5.67{\times}10^{-6}$ respectively. Taken together, these results indicate that the majority of samples except for some samples with relative high contents of heavy metals were safe.

Toxic Impact Analysis by Exposure Duration of Dog Studies for Pesticides using in Korea (국내 사용농약의 노출 기간이 개의 독성반응에 미치는 영향 분석)

  • Lee, Je Bong;Jeong, Mi-Hye;You, Are-Sun;Hong, Soonsung;Paik, Min-Kyoung;Oh, Jin-Ah;Park, Kyung Hun;Ihm, Yang Bin
    • The Korean Journal of Pesticide Science
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    • v.17 no.4
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    • pp.350-358
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    • 2013
  • Both 13-week and 1-year studies in dog were required for pesticide registration in domestic pesticide control authority. It is raising issue up whether to request 1-year dog study of pesticides using non-food crop. So at this investigation, relevant toxicity test to establish acceptable daily intake (ADI), target organs, difference of no-observed adverse-effect levels (NOAELs) in 13-week and 1-year of 166 active ingredients are analyzed. The data were evaluated to determine if the 13-week dog study and the long term studies in two rodent species (mice and rats) without 1-year dog study were sufficient for the identification of NOAELs and lowest observed adverse effect levels (LOAELs) for the derivation of ADI. Toxicity end points and dose response data from 13 week and 1-year studies were compared. The analysis showed that 68 ADIs of the 166 pesticides were established from dog studies. Major target organs of dog studies were liver in 49 cases, body weight change in 21 cases, cholinesterase inhibition in 16 cases, and alteration in hematology in 14 cases. Similarity of target organ in 13-week and 1-year was 73%. 22 of 40 pesticides had similar critical effects regardless of duration and had NOAELs within a difference of 1.5-fold of each other. For the remaining 18 pesticides, 14 items had lower NOAELs in the 1-year study than 13-week study primarily due to dose selection and spacing. In only 10% of the cases were additional toxic effects identified in the 1-year study that were not observed in the 13-week study.

Epidemiological Study of Air Pollution and Its Effects on Health of Urban Population (서울시(市) 대기오염(大氣汚染)이 시민보건(市民保健)에 미치는 영향(影響)에 관(關)한 조사연구(調査硏究))

  • Chung, Kyou-Chull
    • Journal of Preventive Medicine and Public Health
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    • v.2 no.1
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    • pp.5-22
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    • 1969
  • The urban population of our country is rapidly increasing due to many factors of social structure, and sociologists are predicting that the increase rate of the urban population will be over 50% in 1980's. Above all, the population of the capital city of Seoul, is at present more than four millions. Such centring of people in cities, together with the improvement of the standards of living, caused rapid increase in the amount of fuel consumption, and this consumption of fuels became one of the primary sources of the air pollution in cities. Moreover, the heavy traffic, construction of many tall buildings, and the increasing number of new factories due to the industrial development-all these are contributing to make the matter of air pollution worse and worse in the Metropolitan, whose geographical location is quite unfavorable considered from the view point of air pollution. Most homes in Seoul use briquet as fuel, while oils are used in tall buildings. The CO, $SO_2$, and smoke that come from burning of these fuels are a great threat to the health of the urban population. With the purpose of examining the influence of air pollution upon the public health, written inquiries were made upon respiratory diseases, and the carboxyhemoglobin saturation in the blood was measured to determine whether the air pollution may affect the health of the urban population. Method of Health Examination (1) Investigation of Respiratory Diseases Patients' records were examined to figure out the monthly ambulance rate of respiratory patients to the total number of patients treated. On the other hand, by using the questionnaire form approved by the Medical Research Council's Committee on Research into Chronic Bronchitis, investigators interviewed the examinees and inquired into the respiratory symptoms. (2) Measuring of Carboxyhemoglobin Saturation From the ear lobe of the examinees, with the use of the melangeur for the white blood cell counting, blood was taken, and after diluting it ten times with 0.1% $Na{2}CO_{3}$, again diulting it 20 times with 0.5% $Na_{2}\;CO_{3}$, its absorbancy was measured. The following results are obtained from the investigation. (1) It was found out that 7.7% of the total patients under treatment were suffering from upper respiratory infection, acute or chronic bronchitis, bronchial asthma, pulmonary emphysema and bronchiectasis. Of them all, patients with upper respiratory infection numbered the greatest with 4.8% and patients with acute or chronic bronchitis the next with 2.1%, and their monthly ambulance rate was high from December to February during the winter, and from April to May and from September to October during the changeable seasons. (2) The daily ambulance rate of respiratory patients, it was revealed, had a close connection with the concentration of $SO_2$ and CO in the air. (3) It was found out that men were more subject to respiratory disease than women, and both men and women were more liable to the diseases with the advancing of age. (4) People living at Choong-ku with the heavy traffic and in the industrial zones of Yeungdungpo had high frequency of respiratory symptoms. (5) Considered from the view point of occupations, high frequency was found among those without job, with jobs unknown, merchants and intdustrial workers, whose social status was rather low and traffic policemen who were always exposed to the exhaust gas of cars. As for women, the frequency was detected in the order of those from high to low, housewives who were exposed to briquet gas, women with jobs unknown, women without jobs, whose social status was low. (6) Ex-smokers rather than smokers, of both sexes, had higher frequency. As for men, heavy smokers had high frequency, while in women light smokers had rather high frequency which was presumed to be due to their average old age. (7) Men's average of carboxyhemoglobin saturation was 9.48%, while women's was 11.3%, higher than men's. (p<0.05). Age meant no difference in the case of men, but as for women, the saturation was remarkably high between the ages from 20 to 60. (8) No regional difference was detected in the carboxyhemoglobin saturation. (9) The carboxyhemoglobin saturation was found, in the case of men, in the order of office workers, traffic policemen, students, the unemployed, merchants and industrial workers, drivers; and as for women, the order was housewives, office workers, merchants and industrial workers. (10) No significant correlation was found between the carboxyhemoglobin saturation and the concentration of CO detected in kitchens, or between the carhoxyhemoglobin saturation and the passing of time after exposure to briquet gas. No difference of carboxyhemoglobin saturation was detected between smokers and non-smokers, and the degrees of smoking; only, significant negative correlation was found between the passing of time after smoking and the carboxyhemoglobin saturation. It is ture that air pollution causes or aggravates the respiratory diseases, increases the carboxyhemoglobin saturation in the blood, but what seems to be more hazardous to the health is the air polluted by the briquet gas in the kitchens and on-dol rooms rather than the atmospheric air pollution.

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Treatment Outcome of Langerhans Cell Histocytosis (랑게르한스 세포 조직구증의 치료 결과)

  • Chung, So Hak;Kim, Jae Do;Jo, Hyun Ik
    • The Journal of the Korean bone and joint tumor society
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    • v.20 no.1
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    • pp.14-21
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    • 2014
  • Purpose: To analyze the clinical features and treatment outcome of Langerhans' cell histocytosis. Materials and Methods: From August 1996 to June 2013, 28 patients who histologically proven with LCH were analyzed of medical records, radiography, pathologic character retrospectively. Results: A total of 28 cases of LCH including 22 child has been reported. Onset age was 0.6 to 51 years old, occurred in the average age was 14.8 years. Follow-up period was 6 months to 134 months average was 44.6 months. The M:F ratio was 2.5:1. The initial symptoms was pain in 18 cases, 5 cases of pathologic fracture, 3 case of palpable mass, 1 case of discovered by accident in radiography, 1 case of torticollis. In radiological examination osteolysis was seen all cases, 7 cases showed a periosteal reaction, 1 case showed soft tissue extension. Clinical type of all cases were eosinophilic granuloma. 25 cases were classified as unifocal disease and 3 cases were multifocal single systemic diseases. In all cases, incisional biopsy was performed. After histologic confirmed, 14 cases was treated with curettage or surgical excision of the lesion and the other 14 cases were followed up without treatment. There is no death during follow up period. 11 cases has no radiological improvement after 3-6 months observation, intralesional steroid injection was performed. Conclusion: Patients with LCH who has rapid systemic onset is very rare, so if you meet the young children who suspected LCH, you shoulder avoid the examination which cause excessive radiation exposure to the young patient. In order to confirm the diagnosis of disease, biopsy is needed. Close observation after confirmed by histological method will bring the satisfactory results. But the patients who had pathologic fracture or wide bone destruction already may need curettage and bone grafting to lesion or internal fixation. The lesion which has no radiological improvement after 3-6 months observation or appear with pain interferes daily life may need local steroid injection as a good treatment.

Effects of Olanzapine on the Schedule-Induced Polydipsic Rats (Olanzapine이 백서의 Schedule-Induced Polydipsia에 미치는 영향)

  • Lee, Gi-Chul;Lee, Kyung-Kyu;Chang, Hwan-Il;Lee, Jung-Ho;Kim, Hyun-Woo;Ha, Jun-Myung;Jeong, Jae-Hyun;Jeong, Hong-Kyung
    • Korean Journal of Biological Psychiatry
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    • v.6 no.2
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    • pp.240-245
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    • 1999
  • Object : This study was designed to evaluate the effects of olanzapine on the schedule-induced polydipsia(SIP) which is one of animal model of obsessive-compulsive disorder in rats. We administered olanzapine as a serotonin and dopamine blocking agent, fluoxetine as a selective serotonin reuptake inhibitor, and haloperidol for the dopamine antagonist to rats which showed schedule-induced polydipsic behavior. Methods : Spraque-Dawley rats weighing 200-250gm were individually housed and maintained and allowed free access to water. The rats were placed on a restricted diet. To induce polydipsia, rats were placed in the cage where a pellet dispenser automatically dispensed 90mg pellets on a fixed-time 60 seconds(FT-60s) feeding schedule over 150 minute test session per day. Water was available at all times in the cage. After 4 weeks of daily exposure to the FT 60s feeding schedule, experimental rats met a predetermined criterion for polydipsic behavior(greater than 3 times of water per session on average). 5 groups of rats were administered olanzapine(3mg/kg, i.p), olanzapine(10mg/kg, i.p), fluoxetine(5mg/kg, i.p.), haloperidol(0.1mg/kg, i.p.), and vehicle(1cc/kg, i.p.) for 3 weeks. The rats were tested once a week to access schedule induced polydipsic behavior. Water bottles were weighed before and after the 150-minute test session. The chronic effects of administration of experimental drugs on schedule induced polydipsic behavior were analyzed with ANOVA and Scheffe test as a posthoc comparison. In order to measure water consumption in non-polydipsic food-deprived rats, a separate group of rats(N=8) were individually housed and given a single bolus(14.5gm) of food per day which maintained them at their average body weight. Results and Conclusion : The results were as follows ; 1) After 4 weeks of scheduled feeding procedure, the experimental group showed significant differences than the bolus control in the amount of water consumption as compared with their average water intakes for 4 weeks. At the same periods, there were no differences between the experimental group and the bolus control in the body weight. 2) The fluoxetine group showed significant decrease in the amount of water intake over the 3 weeks of drug treatment as compared with their average amount of polydipsic water intakes. The olanzapine 3mg group showed significant decrease in the amount of water intake at 3rd weeks of drug treatment as compared with their average amount of polydipsic water intakes. The olanzapine 10mg group showed significant decrease in the amount of water intake at 2nd and 3rd weeks of drug treatment as compared with their average amount of polydipsic water intakes. However, the haloperidol group and the vehicle control group showed no changes of amounts of water intake for 3 weeks of treatment as compared with their average amount of polydipsic water intakes. 3) The fluoxetine group showed significantly lower amounts of water intake than the haloperidol group at 2nd weeks of drug treatment. And also the fluoxetine group showed significantly lower amounts of water intake than the haloperidol group and the vehicle control at 3rd weeks of drug treatment. The olanzapine 3mg group and the olanzapine 10mg group showed significantly lower amounts of water intake than the haloperidol group and the vehicle control at 3rd weeks of drug treatment. Above findings suggest that the fixed time feeding procedure for schedule-induced polydipsia as an animal model of obsessive compulsive disorder was effective to the evaluation of pharmacological challenge study. The authors assume that the serotonin hypothesis and the serotonin-dopamine interaction hypothesis are preferred to the dopamine hypothesis in the biological etiology of obsessive-compulsive disorder.

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Effect of Vinclozolin Administration on the Gene Expressions in Hypothalamus-Pituitary Axis of Immature Female Rats (미성숙 암컷 흰쥐 시상하부-뇌하수체 축 상의 유전자 발현에 미치는 Vinclozolin 투여 효과)

  • Lee, Woo-Cheol;Lee, Sung-Ho
    • Development and Reproduction
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    • v.12 no.1
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    • pp.97-105
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    • 2008
  • Vinclozolin (VCZ) is a systemic fungicide commonly used in fruits, vegetables and the wine industry. VCZ and its metabolites, butenoic acid (M1) and enanilide (M2) derivatives, act as anti-androgens through actions on the androgen receptor. Although there is growing body of evidence that VCZ's action as an endocrine disrupting chemical (EDC) in male reproductive physiology and pathphysiology, no evidence on the VCZ's EDC action in female is available yet. Previously we found that the prepubertal VCZ exposures could effectively delay the onset of puberty in female rats, suggesting the postponed or weakened activities of hypothalamus-pituitary-ovary (H-P-O) reproductive hormonal axis. The present study was performed to examine whether the VCZ administration affects the transcriptional activities of reproductive hormone-related genes in the same animal model. VCZ (10 mg/kg/day) was administered daily from postnatal day 21 (PND 21) through the day when the first vaginal opening (V.O.) was observed. To determine the transcriptional changes of reproductive hormone-related genes in hypothalamus and pituitary, total RNAs were extracted and applied to the semiquantitative reverse transcription polymerase chain reaction (RT-PCR). As a result, treatment with VCZ significantly lowered the transcriptional activity of nitric oxide synthase-2 (NOS-2) which is known to adjust gonadotropin-releasing hormone (GnRH) secretion in the hypothalamus (p<0.01). Similarly, the mRNA levels of KiSS-1, G protein-coupled receptor 54 (GPR54) and GnRH were significantly decreased in hypothalamus (p<0.01) from VCZ-treated group. As expected, the transcriptional activities of luteinizing hormone-${\beta}$ (LH-${\beta}$) and follicle stimulating hormone-${\beta}$ (FSH-${\beta}$) in the anterior pituitary from VCZ-treated group were also significantly lower than those from the control group. The present study indicates that(i) the inhibitory effect of VCZ exposure on the onset of puberty in immature female rats could be derived from the reduced transcriptional activities of gonadotropin subunits and their upstream modulators such as GnRH and KiSS-1 in hypothalamus-pituitary neuroendocrine axis, and (ii) these inhibitory effects could be mediated by NO signaling pathway.

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Tributyltin Increases Adipogenesis and Apoptosis of Rat Testicular Interstitial Cells (Tributyltin에 의한 흰쥐 정소 내 간질세포의 지방세포 유도와 세포자연사 증가)

  • Song, Yeon-Hwa;Jung, Ji-Eun;Lee, Hyun-A;Hong, Ji-Hee;Yang, Hyun-Won
    • Development and Reproduction
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    • v.14 no.4
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    • pp.297-306
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    • 2010
  • Tributyltin (TBT), an endocrine disrupting chemical, has been reported to decrease testicular function by causing apoptosis in the testis, but this mechanism is not fully understood. Thus, in this study we examined whether TBT induces adipogenesis of the Leydig cells to find out the correlation between adipogenesis and apoptosis in the testis. Three week old SD male rats were orally administrated with sesame oil, 1 mg/kg of TBT, or 10 mg/kg of TBT daily for 1 week and weighed after administration. The testes obtained on day 8 were weighed and stained with BODIPY and TUNEL kit. Using total RNA extracted from the isolated Leydig cells, adipogenesis and apoptosis-related genes were analyzed by real-time PCR. The testicular weights of the rats treated with 10 mg/kg TBT were significantly decreased compared to those in the control rats treated with sesame oil. As a result of BODIPY staining, the number of Leydig cells stained with BODIPY was increased in the rats treated with 10 mg/kg TBT compared with the control rats. Similar to BODIPY staining results, the TUNEL assay showed that the apoptosis of Leydig cells was increased in TBT treated rats. The results of the gene expression analysis in the Leydig cells showed that the expression of adipogenesis-related genes (PPAR${\gamma}$, aP2, Perilipin, CD36) and apoptosis-related genes (TNFRSF1A, TNFSF10) was increased after TBT administration. The present study demonstrates that TBT induces the expression of adipogenesis-related and apoptosis-related genes in the Leydig cells leading to adipogenesis and apoptosis in the testes. These results suggest that the dysfunction of Leydig cells by TBT exposure may cause a loss in testicular function.

Human Risk Assessment of Polybrominated Diphenyl Ethers by Breast Milk Feeding of Infants (영유아의 모유 섭취에 따른 폴리브롬화디페닐에테르의 위해성 평가)

  • We, Sung-Ug;Cho, Bong-Hui;Cho, Yu-Jin;Yoon, Cho-Hee;Choi, Shi-Nai;Min, Byung-Yun
    • Journal of Korean Society of Environmental Engineers
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    • v.34 no.2
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    • pp.109-118
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    • 2012
  • This study achieves results from 22 maternity breast milk samples in total to demonstrate exposure level and risk assessment of PBDEs in Seoul area. PBDEs were detected in all the breast milk samples of the present study, indicating that general population in these Seoul area are widely exposed to these chemicals. Residue levels of total PBDEs (sum PBDEs from tri- to hepta-BDE) ranged of 0.84~13.1 ng/g lipid with an arithmetic mean and median of 3.56 ng/g lipid and 2.6 ng/g lipid, respectively. Global comparison shows that the levels of total PBDEs were relatively similar to those of China, Taiwan and European country (Sweden), and somewhat higher than those in some Asian (Vietnam, Philippines, and Indonesia). In the present study, however, the levels of total PBDEs in human milk are still one to two orders of magnitude lower than those in North America. Contribution rate of each congener appeared to be predominant with BDE-47, followed by BDE-153, BDE-100, BDE-99, BDE-154 and BDE-183. The sum of BDE-47 and BDE-153 accounted for more than 65% of total PBDEs in most samples. From the result of the human risk assessment of infants for total PBDEs and BDE-47 by breast milk feeding, we could find out that the average daily doses and hazard index (95th percentile) were 16.5 ng/kg bw/day and $1.2{\times}10^{-1}$ each other when nursing for 6 months after infants born. However, it was concluded that the infant health hardly had adverse seriously effects under this research condition.

Anticoagulation Management after Mitral Valve Replacement with the St. Jude Medical Prosthesis (승모판치환 환자의 항응혈제 치료)

  • 김종환;김영태
    • Journal of Chest Surgery
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    • v.31 no.12
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    • pp.1172-1182
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    • 1998
  • Background: Primary goal of anticoagulation treatment in patients with mechanical heart valve is the effective prevention of thromboembolism and safe avoidance of bleeding as well. Material and Method: Two-hundred and nine patients with the St. Jude Medical prosthesis operated on between 1984 and 1995, for mitral(MVR 122), aortic(AVR 39) and double mitral and aortic valve replacement(DVR 48) respectively, were studied on the practically achieved levels of anticoagulation and the clinical outcomes. Patients were on Coumadin and followed up by monthly visit to outpatient clinic for examination and prothrombin time measurement to adjust the International Normalized Ratios(INRs) within the low-intensity target range between 1.5 and 2.5. Result: A total anticoagulation follow-up period was 1082.0 patient- years(mean 62.1 months) and INRs of 10,205 measurements were available for evaluation. The accomplished INRs among the replacement groups were not significantly different and only 65% of INRs were within the target range. And, in individual patients, only 37% of patients had INRs included within the target range in more than 70% of tests during follow-up period. The levels of INRs in patients with atrial fibrillation, which was found in 57% of patients, were definitely higher than the ones measured in patients with regular rhythm(p<0.001). Thromboembolisms were experienced by 15 patients with the incidence of 1.265%/patient- year(MVR 1.412%, AVR 0.462% and DVR 1.531%/patient-year) and major bleeding by 4 patients with the incidence of 0.337%/patient-year(MVR 0.424%, AVR none and DVR 0.383%/patient-year). Frequent as well as prolonged missing of prothrombin time tests was the main risk factor strongly associated with the thromboembolic complications(odds ratio 1.99). The proportion of INRs within target range of less than 60% in individual patient was the highly significant risk factor of both thromboembolic and overall embolic and bleeding complications(p<0.004 and p<0.002 respectively). Conclusion: In conclusion, the low-intensity therapeutic target range of INRs was adequate in patients with AVR and in sinus rhythm. However, the patients with replacement of the mitral valve were more likely to require higher target range of INRs, especially in the presence of atrial fibrillation, to achieve the practical levels of anticoagulation enough to prevent thromboembolic complications effectively. For the higher therapeutic target range of INRs between 2.0∼3.0, further accumulation of clinical evidences are required. It is highly desirable to improve the patients' compliance under continuous instructions in visiting outpatient clinic and in taking daily Coumadin without omission and to keep INRs consistently within optimal range with tight control for minimization of chances and of periods of exposure to the risk of complications. And, particularly, patients with high risk of complications and with wide fluctuation of INRs should be better managed with frequent monitoring anticoagulation levels.

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