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The Epidemiologic and Clinical Study of Pulmonary Tuberculosis - Among Students at One Women's University for Recent 10 Years - (일개 여자대학교 학생의 최근 10년간 폐결핵 동태 및 임상경과에 관한 고찰)

  • Choi, Hee-Jung;Hong, Young-Sun;Oh, Ji-Yong;Cheon, Seon-Hee;Kim, Kyung-Ja;Kim, Man-Ae;Min, Hong-Ki;Choi, Sam-Sub;Lee, Kee-Young
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.4
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    • pp.465-473
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    • 1995
  • Background: The prevalence of pulmonary tuberculosis has decreased progressively after the control of the tuberculosis began as national control. But as diabetes, malignancy, immunodeficiency disease recently tend to be increased, the tuberculosis become to the important national health problem. So, this study was designed to observe the state and the change of the prevalence and the clinical status of pulmonary tuberculosis for recent 10 years at one women's university. Method: We retrospectively investigated the epidemiology and the clinical status of 612 patients who were registered at the Ewha Womans University Health Center by analyzing records from 1983 to 1992. Results: 1) The prevalence rate had been steadily decreased from 0.63% in 1983 to 0.11 % in 1992. The prevalence of freshman and the incidence rate according to the entrance year while in the university significantly decreased since 1989. 2) In classifying by registered source, 45.6% of students were detected by annual periodical health examination, 34.5% by entrance physical examination, 12.0% by hospital, 5.4% by health center clinic, 2.5% by reentrance physical examination, sequentially. 3) The students with past history of tuberculosis were 70(11.4%) and 61(10%) suffered from pulmonary tuberculosis. The patients with family history of tuberculosis were 142(23.3%). 4) There were 530(86.6%) with minimal disease, 79(12.9%) with moderate and only 3(0.5%) with far advanced, when classified by the severity of disease. 5) The initial symptoms were mild breathing difficulty in 30.1%, sweating in 14.9%, fatigue in 14.3%, febrile sense in 11.7%, hemoptysis in 8.2%, sequentially. 6) The duration of treatment was $10.6{\pm}3.6$ months in mild group, $14.9{\pm}5.2$ months in the moderate group(P<0.05). 7) The side reactions of the drug were GI trouble in 7.2%, hepatitis in 1.8%, skin rash in 0.8% and streptomycin side in used patients in 9.1%. Conclusion: The prevalence of pulmonary tuberculosis among the students in one women's university was significantly lower than that of university students and 20-24 year-old age group announced in tuberculosis survey on a national scale, and significantly decreased since 1989. The treatment effect was desirable in student's group managed by university health center.

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Clinical Investigation of Cervical Tuberculous Lymphadenitis (결핵성 경부 임파선염의 임상적 고찰)

  • Park, Mi-Ran;Kim, Chang-Sun;Seo, Jee-Young;Son, Hyung-Dae;Rheu, Nam-Soo;Cho, Dong-Il
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.6
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    • pp.1225-1233
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    • 1997
  • Background : Cervical tuberculous lymphadenitis(CTL) is one of the most common extra-pulmonary tuberculosis. Recently overall incidence of pulmonary tuberculosis has decreased, but the incidence of tuberculous lymphadenitis has not decreased. Its duration of treatment is still controversial and the pathogenesis, prognosis and relationship with other site tuberculous are poorly published. So we did a retrograde study of 120 cases of confirmed CTL about its clinical manifestations. Method : All patients were applied fine needle aspiration(FNA) of palpable enlarged cervical lymph nodes and 114 patients were examined for AFB smear and 34 patients for TB culture with aspirated fluid. 57 patients were examined Mantoux test(5TU with PPD-S). With above methods, a total of 120 patients was diagnosed as having CTL. Results : 1) CTL is most prevalent in young women between the age of 20~30 years and the incidence of CTL in female is 2.5 times higher than that of male. It is located most commonly in the posterior cervical area. The most common presenting symptom is painless palpable enlarged cervical lymph nodes. 2) With FNA of enlarged cervical lymph nodes, the percentage of histopathological positivity is 82.3%. The percentage of AFB smear positivity is 38.6%, and that of TB culture positivity is 17.6%(p<0.001). 3) Pulmonary tuberculosis is noted in 79 cases(65.8%). And 42 cases(53.5%) of them had minimal pulmonary tuberculosis. In 14 cases(11.7%), other extrapulmonary tuberculosis coexsisted and pleural tuberculosis was most Common in the order. 4) CTL was treated with anti-tuberculous medication(first line drug) and median treatment duration was 18.5months. During treatment, the size of involved lymph nodes decreased gradually in 62 cases(75.8%), newly developed lymph nodes were found in 25 cases(30.4%), fluctuation formation in 22 cases(26.8%) and fistula formation in 14 cases(17.0%). Conclusion : CTL is prevalent in women between the age of 20~40 years and it involves posterior cervical area most commonly. CTL is treated with long-term anti-tuberculous chemotherapy. We think it is one manifestation of systemic disease and frequently coexisting with pulmonary tuberculosis. Despite anti-tuberculous chemotherapy, the size of involved lymph nodes was increased, new lymph nodes were developed or fluctuation and fistula formed in involved lymph nodes. After sufficient medication, when the patient felt pressure discomfort from enlarged lymph node or fistula was formed, we recommended total excision of involved lymph nodes.

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Study on IL -8 Expression in Peripheral Blood Monocytes (말초 혈액 단핵구에서 IL-8 발현에 관한 연구)

  • Kim, Jae-Yeol;Lee, Jae-Cheol;Kang, Min-Jong;Park, Jae-Seok;Yoo, Chul-Gyu;Kim, Young-Whan;Han, Sung-Koo;Shim, Young-Soo;Lee, Jae-Ho
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.5
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    • pp.703-712
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    • 1995
  • Background: Peripheral blood monocytes are important immune effector cells that play a fundamental role in cellular immunity. In addition to their antigen-presenting and phagocytic activities, monocytes/macrophage produce a vast array of regulatory and chemotactic cytokines. Interleukin-8(IL-8), a potent neutrophil-activating and chemotactic peptide, is produced in large quantities by mononuclear phagocytes and may be an important mediator of local and systemic inflammation. Overexpression by IL-8 of such inflammation may be an important step of tissue injury frequently seen in inflammatory reaction. So it could be hypothesized that the agents which block the production of IL-8 can decrease the inflammatory reaction and tissue injury. To evaluate this, we described the effect of Dexamethasone, $PGE_2$, Indomethacin and Interferon-$\gamma$(IFN-$\gamma$) on IL-8 mRNA and protein expression from LPS-stimulated human peripheral blood monocytes(PBMC). Method: PBMC was isolated from healthy volunteers. To evaluate the effect of Dexamethasone, $PGE_2$ & Indomethacin, these drug were treated for 1 hour before and after LPS stimulation and IFN-$\gamma$ was only treated I hour before the LPS stimulation. Northern blot analysis for IL-8 mRNA and ELISA for immunoreactive IL-8 protein in culture supernatant were performed. We repeated above experiment three times for Northern blot analysis and two times for ELISA and got the same result. Results: 1) Pre- and post-treatment of Dexamethasone suppressed both the LPS stimulated IL-8 mRNA expression and IL-8 protein release in PBMC. 2) IFN-$\gamma$ pre-treatment suppressed the IL-8 mRNA expression and IL-8 protein release in unstimulated cells. 3) In LPS stimulated cells, IFN-$\gamma$ suppressed the IL-8 mRNA expression but IL-8 protein release suppression was not observed. 4) $PGE_2$ and Indomethacin exert no effect on the LPS-stimulated IL-8 mRNA and protein expression in concentration used in this experiment ($PGE_2;10^{-6}M$, Indomethacin; $10{\mu}M$). Conclusion: One of the mechanism of antiinflammatory action of Dexamethasone can be explained by the suppressing effect of IL-8 production in some extent and by this antiinflammatory effect, dexamethasone can be used to suppress local and systemic inflammation mediated by IL-8.

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Rapid Detection of Rifampicin Resistant M. tuberculosis by PCR-SSCP of rpoB Gene in Clinical Specimens (RpoB 유전자 PCR-SSCP법에 의한 임상검체내 Rifampicin 내성 결핵균의 신속진단)

  • Shim, Tae-Sun;Kim, Young-Whan;Lim, Chae-Man;Lee, Sang-Do;Koh, Youn-Suck;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.6
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    • pp.1245-1255
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    • 1997
  • Background : Rifampicin(RFP) is a key component of the antituberculous short-course chemotherapy and the RFP resistance is a marker of multi-drug resistant(MDR) tuberculosis. RPoB gene encodes the $\beta$-subunit of RNA polymerase of M. tuberculosis which is the target of RFP. And rpoB gene mutations are the cause of RFP resistance of M. tuberculosis. Although several reports showed that PCR-SSCP would be a rapid diagnostic method for identifying the RFP resistance, there were few reports Performed using direct, clinical specimens. So we Performed PCR-SSCP analysis of rpoB gene of M. tuberculosis in direct, clinical specimens. Methods : 75 clinical specimens were collected from patients at Asan Medical Center from June to August 1996. After PCR of IS 6110 fragments, 43 both AFB smear-positive and IS6110 fragment PCR-positive specimens were evaluated. The RFP susceptibility test was referred to the referral laboratory of the Korean Tuberculosis Institute. DNA was extracted by bead beater method. And heminested PCR was done using 0.1ul(1uCi) [$\alpha-^{32}P$]-dCTP. SSCP analysis was done using non-denaturating MDE gel electrophoresis. Results : The results of PCR of IS6110 fragments of M. tuberculosis were positive in 55(73%) cases of 75 AFB smear-positive clinical specimens. Of the 55 specimens, RFP susceptibility was confirmed in only 43 specimens. Of the 43 AFB smear-positive and IS6110 fragment-positive specimens, 29 were RFP susceptible and 14 were RFP resistant. All the RFP susceptible 29 strains showed the same mobility compared with that of RFP sensitive H37Rv in SSCP analysis of ropB gene. And all the other RFP resistant 13 strains showed the different mobility. In other words they showed 100% identical results between PCR-SSCP analysis and traditional susceptibility test. Conclusion : The PCR-sseP analysis of rpoB gene in direct clinical specimens could be used as a rapid diagnostic method for detecting RFP resistant M. tuberculosis.

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Pharmacokinetics of ofloxacin in Patients with Multidrug-Resistant Tuberculosis (다제내성결핵 환자에서 ofloxacin의 약동학적 분석)

  • Park, Seung-Kyu;Yoon, Young-Ran;Lee, Woo-Chul;Jun, Hyung-Min;Shon, Ji-Hong;Kim, Kyoung-Ah;Park, Ji-Young;Shin, Jae-Gook
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.2
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    • pp.128-136
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    • 2002
  • Background: There are few studies that have reported on the pharmacokinetic(PK) disposition of fluoroquinolones in patients with multi-drug resistant tuberculosis(MDR-Tb), even though fluoroquinolones are frequently co-prescribed to those patients. In this study, the PK disposition of ofloxacin, a fluoroquinolone, was evaluated in patients with MD R -Tb. Methods: Twenty patients with MDR-Tb were given 2nd line Tb drugs including ofloxacin (300mg twice a day), prothionamide, cycloserine, para-aminosalicylic acid, kanamycin, and streptomycin. The patients were grouped according to their body mass index(BMI) as an index of emaciation (group A : 18.5$\leq$BMI <23, group B : BMI < 18.5). Blood samples were serially drawn and urine samples were collected upto 24 hours after the last dose of those drugs at steady state (over 1 month). The ofloxacin concentrations were determined using HPLC (High Performance Liquid Chromatography). Results: The AUC of ofloxacin in group B was greater than that in group A ($31.4{\pm}8.9{\mu}g/ml{\cdot}h$ vs. $24.1{\pm}6.2{\mu}g/ml{\cdot}h$)(Check the symbols), (p<0.05). The total clearance(Cl/F) of ofloxacin was $0.16{\pm}0.03$ L/h/kg in group A, and $0.14{\pm}0.03$ L/h/kg in group B. The half-lives of ofloxacin in two groups were similar (group A : $5.3{\pm}0.8$ hours, group B : $5.7{\pm}0.9$ hours). In addition, the other PK parameters in two groups were also similar. Conclusions: The pharmacokinetics of ofloxacin in patients with MDR-Tb appears to be comparable with those of normal subjects, and the extent of emaciation appears to have an influence on the pharmacokinetics of ofloxaicn in chronic debilitated MDR-Tb patients.

The Analysis of Risk Factors of Pulmonary Tuberculosis Patients Failed in Retreatment (재치료실패 폐결핵 환자의 위험인자 분석)

  • Kim, Hyoung-Soo;Lee, Won-Jin;Kong, Seok-Jun;Shon, Mal-Hyun
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.6
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    • pp.684-690
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    • 2000
  • Background : The most common cause of treatment failure of pulmonary tuberculosis is early stoppage of treatment or irregular medication. The most important aspect of a retreatment is regular medication provided over a long period. Inadequate treatment may cause drug resistance and prolong the duration of chemotherapy. This study analyzed the risk factors of pulmonary tuberculosis patients, who failed in retreatment, and to use the results as basic data in the management of intractable tuberculosis patients with improving the rate of retreatment success. Methods : We performed a retroactive study of 62 pulmonary tuberculosis patients in retreatment at National Mokpo Tuberculosis Hospital from Jan. 1994 to Dec. 1995. The patients were separated into two groups: group I was retreatment failure and group II was retreatrnent success. For the analysis of risk factors in retreatment failure, we compared the difference between the two groups and tested the confidence limit about results of the results by independent t-test, ${\chi}^2$ test and Fisher's exact test. Results : The treatment failure rate of retreatment patients was 13(21%), and treatment success 49(79%). No significant difference (p>0.05)in age, sex, number of treatment, irregular rate of treatment, extent of the disease & cavitary lesion on the chest X-ray, number of resistance drugs, number of used drugs to medication, number of sensitive bactericidal drugs to medication, rate of sensitive drugs to medication and resisiance to INH & RFP had not significant difference. was found. However, the number of treatment was $2.4{\pm}0.8$ in group I and $1.6{\pm}0.9$ in group II, and had showing a significant difference(p<0.05) between the two groups. Conclusion : The risk factor of retreatment failure was more irregular previous treatment the irregularity of the previous treatment. For reducing the retreatment failure of pulmonary tuberculosis, greater efforts are needed more need to be done to prevent failure of first treatment.

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Clinical Characteristics of Tuberculosis in Liver or Heart Transplant Recipients (간 또는 심장이식을 시행 받은 환자에서의 결핵의 발생률 및 임상양상)

  • Jung, Hoon;Oh, Yeon-Mok;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Kim, Jae-Joong;Lee, Sung-Gyu;Shim, Tae-Sun
    • Tuberculosis and Respiratory Diseases
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    • v.61 no.5
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    • pp.440-446
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    • 2006
  • Background: Post-transplant tuberculosis (TB) is a serious complication in solid organ transplant recipients worldwide, However there is little or no data on TB in liver or heart transplant recipients in Korea. Methods: The incidence and clinical characteristics of TB of 730 patients who had undergone a liver transplant in a university hospital in Korea between 1992 and 2004, and 110 heart transplant recipients in the same period, were reviewed retrospectively. Results: The incidence of TB was 1.5%(11/730) and 2.7%(3/110) in the liver and heart transplantation, respectively. The median time from the transplant to the development of TB was 8.4 months(1.0-30.8). and the mean time from the symptoms to the diagnosis of TB was $2.1{\pm}3.6$ months(0.3-13.2). Nine patients (65%) had pulmonary TB and five (35%) had extrapulmonary TB. The leukopenia and positive HbeAg at the baseline, post-transplant diabetes mellitus, and chronic rejection were associated with the development of TB in the liver transplant recipients. Ten patients were treated with a 4-drug standard regimen for a mean duration of $7.8{\pm}3.5$ months. One patients died of TB. Conclusion: The incidence of TB in liver or heart transplant recipients was similar to that reported in other countries with a similar TB-burden.

Study on the Anti-oxydative, Anti-tumor effect of Whakijogyungtang (화기조경탕(化氣調經湯)이 항산화 및 항암효과)

  • Yu, Mi-Kyung;Kim, Jong-Han;Park, Su-Yeon;Choi, Jeong-Hwa
    • The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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    • v.20 no.1 s.32
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    • pp.80-98
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    • 2007
  • Objectives : This study was carried out to evaluate anti-oxydative, anti-tumor effect for clinical application of Whakijogyungtang (WJT) Results : 1. DPPH radical scavenging activities of WJT water extracts(Exts) were in proportion as concentration of WJT.(3 ${\mu}g/ml:12.6{\pm}2.3$ %) 2. ABTS+ scavenging activities of WJT water Exts were more effective in high density.(3 ${\mu}g/ml:4.3{\pm}1.6$ %, 10 ${\mu}g/ml$: $11.8{\pm}2.5$ %, 30 ${\mu}g/ml:45.3{\pm}3.2%$ 100 ${\mu}g/ml$: $62.7{\pm}4.8%$) 3. Hydrogen peroxide$(H_2O_2)$ scavenging activities of WJT water Exts were effective.(3 ${\mu}g/ml:4.7{\pm}0.8$ %, 10 ${\mu}g/ml: $8.2{\pm}1.6$ %, 30 ${\mu}g/ml:19.5{\pm}3.2$ % 100 ${\mu}g/ml$: $24.6{\pm}3.8$ %) 4. Anti oxidative effects against linoleic acid were not effective. 5. The generation of $O_2\;^-$ in S-180 cells were according to the concentration of WJT water Exts, specially effective over 100 ${\mu}g/ml$ concentration. 6. The SOD activities in S-180 cells were in proportion as cytotoxicity against S-180 cells of WJT water Exts. 7. The GPx activities in S-180 cells were in proportion as cytotoxicity against S-180 cells of WJT water Exts(more effective on 300 ${\mu}g/ml$ and 1000 ${\mu}g/ml$ concentration), but the catalase activities in S-180 cells were not effective. 8. The results of activites against multi-drug-resistance(MDR) of WJT were as follows. 1) In water Exts from WJT, cytotoxicity against AML-2/D100 with vincristine($IC_{50:}39.78$ ${\mu}g/ml$) was more effective than without vincristine($IC_{50:}$ 183.58 ${\mu}g/ml$), Cross resistance(CR:3.85) was not effective, and anti-MDR activites(RF) was effective.(RF:3.85) 2) In hexane fraction, cytotoxicity against AML-2/D100 with vincristine ($IC_{50:}130.88$ ${\mu}g/ml$) was more effective than without vincristine ($IC_{50:}293.10$ ${\mu}g/ml$) and anti-MDR activites(RF) was effective.(RF:4.61) 3) In chloroform fraction, the cytotoxicity against AML-2/WT and AML-2/D100 was not effective. 4) In ethyl acetate fraction, cytotoxicity against AML-2/D100 with vincristine($IC_{50:}36.43$ ${\mu}g/ml$) was more effective than without vincristine ($IC_{50:}73.07$ ${\mu}g/ml$), Cross resistance(CR:0.53) was not effective, and anti-MDR activites(RF) was effective.(RF:2) 5) In butanol fraction, the cytotoxicity against AML-2/WT and AML-2/D100 was not effective. 6) In $H_2O$ fraction, the cytotoxicity against AML-2/WT and AML-2/D100 was not effective. Conclusion : These result suggest that WJT has antioxidative effects, anti-tumor effects by apoptosis of free radical$(O_2\;^-)$ activity, and anti-MDR activites(especially hexane and ethyl acetate fraction).

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Quality Characteristics of Jochung Containing Various Level of Letinus edodes Powder (표고버섯 가루를 이용한 조청의 품질 특성)

  • Park, Jung-Suk;Na, Hwan-Sik
    • Korean Journal of Food Science and Technology
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    • v.37 no.5
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    • pp.768-775
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    • 2005
  • Lentinus edodes powder was added at 1-3%(w/w) to improve functional properties of jocheong. Content of crude protein, ash, crude lipids, total mineral, free sugar and reducing sugar increased with increasing amount of L. edodes powder, while viscosity and solid and carbohydrate contents decreased. Through amino acid analysis, 17 amino acids were identified and quantified, glutamic acid being the major amino acid. No significant differences were observed in fatty acid composition and pH between control and L. edodes powder-added jocheong. Addition of mushroom powder in jocheong decreased lightness, yellowness and redness in Hunter's color value. Sensor score of jucheong containing 1% of L. edodes powder was similar to that of control. Results showed jocheong containing less than 2% L. edodes powder gave highest scores in quality characteristics and sensory evaluation.

Changes in Microbial Counts, Enzyme Activity and Quality of Foxtail Millet Takju Treated with High Hydrostatic Pressure during Storage (초고압 처리한 좁쌀탁주의 저장 중 미생물수, 효소활성 및 품질변화)

  • Lim, Sang-Bin;Jwa, Mi-Kyung;Mok, Chul-Kyoon;Park, Young-Seo;Woo, Gun-Jo
    • Korean Journal of Food Science and Technology
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    • v.36 no.2
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    • pp.233-238
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    • 2004
  • Foxtail Millet Takju was treated with heat ($65^{\circ}C/30\;min$) (HT) or high hydrostatic pressure ($27^{\circ}C/400\;MPa/10\;min$) (PT), and changes in microbial count, enzyme activity, and quality were determined during 30-day storage at 10 and $25^{\circ}C$. Total viable cellcount remained constant, while lactic acid bacteria and yeast were not detected in HT and PT Takjus. Relative activities of ${\alpha}-amylase$ in PT Takju significantly increased by 169.7% at 3 days storage, then decreased to 137.7 and 68.7% at 10 and $25^{\circ}C$, respectively, at 30 days. Relative activities of glucoamylase in HT Takju showed reversible change, and were 36.5 and 54.3% at $10\;and\;25^{\circ}C$, respectively, at 30 days storage. Activities in PT Takju increased with storage period, 158.2% at 30 days storage at $10^{\circ}C$. Titratable acidity in untreated Takju increased, while those in HT and PT Takjus remained almost constant during 30 days storage. Reducing sugar content in untreated Takju showed no change, while that in HT Takju increased gradually, reaching 2.9% at 30 days, whereas that in PT increased sharply after 3 days, reaching 4.8% at 30 days. Sensory evaluation showed sourness and bitterness were low, and sweetness and overall acceptance were high in PT Takju after 30 days storage at $10^{\circ}C$.