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Relation of Neoaortic Root Dilation and Aortic Insufficiency after Arterial Switch Operation (동맥전환술 후의 신생대동맥근부 확장과 대동맥판막폐쇄부전의 관계)

  • 박한기;김도균;홍유선;이종균;최재영;조범구;박영환
    • Journal of Chest Surgery
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    • v.36 no.12
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    • pp.921-927
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    • 2003
  • Arterial switch operation (ASO) has been the most effective surgical option for transposition of the great arteries. But, the inappropriate dilation of the neoaortic root has been reported and its effect on neoaortic valve function and growth of aorta has not been well documented. Material and Method: Forty-eight patients who underwent cardiac catheterization during follow up after arterial switch operation were included in this study. Arterial switch operation was performed at a median age of 18 days (range 1∼211 days). Preoperative cardiac catheterization was performed in 26 patients and postoperative catheterization was performed in all patients at 15.8$\pm$9.6 months after ASO. Postoperative ratios of the diameters of neoaortic annulus, root and aortic anastomosis against the descending aorta were compared to the size of preoperative pulmonary annular, root and sinotubular junction. Preoperative and operative parameters were analyzed for the risk factors of neoaortic insufficiency. Result: There were two clinically significant neoaortic insufficiencies (grade$\geq$II/IV) during follow up, one of which required aortic valve replacement. Another patient required reoperation due to aortic stenosis on the anastomosis site. Post-operatively, neoaortic annulus/DA ratio increased from 1.33$\pm$0.28 to 1.52$\pm$.033 (p=0.01) and neoaortic root/DA ratio increased form 2.02$\pm$0.40 to 2.56$\pm$0.38 (p<0.0001). However, the aortic anastomosis/DA ratio showed no statistically significant difference (p=0.06). There was no statistically significant correlation between the occurrence of neoaortic insufficiency and neoaortic annulus/DA ratio and neoaortic root/DA ratio. Non-neonatal repair (age>30days) (p=0.02), preopeative native pulmonaic valve stenosis (p=0.01), and bisuspid pulmonic valve (p=0.03) were the risk factors for neoaortic insufficiency in univariate risk factor analysis. Conclusion: After ASO, aortic anastomosis site showed normal growth pattern proportional to the descending aorta, but neoaortic valve annulus and root were disproportionally dilated. Significant neoaortic valve insufficiency rarely developed after ASO and neoaortic annulus and root size do not correlate with the presence of postoperative neoarotic insufficiency. ASO after neonatal period, preoperative native pulmonary valve stenosis, and bicuspid native pulmonic valve are risk factors for the development of neoaortic insufficiency.

The Study on the Contents and Satisfaction of Oriental Medicine Examination Program (한방건강검진 프로그램의 내용과 참가자들의 만족도에 관한 연구)

  • Lee Eun-Kyoung;Jahng Doo-Sub;Song Yung-Sun;Lee Ki-Nam
    • Journal of Society of Preventive Korean Medicine
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    • v.6 no.1
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    • pp.51-95
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    • 2002
  • 1. As a point at issue of occidental medicine examination, followings have been indicated, 1) Occidental medical examination is performed by mainly test and instrument and therefore, role of doctors could be excluded and it could be diagnosed only for target disease and 2) in Korea, it could not be conducted in public medical system and therefore improvement effect of public health promotion could not be made due to increase of total medical expenses and infirmity of post management. These points are substantial limit of paradigm resided in occidental medicine and also problem caused by unique characteristics of medical system of Korea. In Korea, result of occidental medical examination show increased health risk from aged thirties and major diagnosed diseases are circulatory disease or chronic disease such as hepatic, hyperlipemic, hypertensional disease and diabetes, etc. Accounting that those chronic disease make a role as major public health risk, it is difficult that medical examination by only occidental medicine make effect on public health promotion. 2. Characteristics of oriental medicine examination could be summarized as diagnosis (information acquisition based on the facts) and demonstration (speculation based on acquired information) and in addition, quadruple diagnosis, as a medical examination method, include test as well as basic examination. Accounting on oriental medical examination, principally it is performed by independent herbalist and therefore, herbalist could acquire systemic result during first medical examination. Based on the theory of inner-outer examination, oriental medical examination has a principle of universe theory, systemic analysis of quadruple diagnosis, demonstration & reasoning. In addition, root of oriental medical examination could be found in pre-disease theory, a principal theory of oriental medicine. Pre-disease service could prove the advantage of oriental medicine in medical examination activities and therefore, it is needed that content of oriental medical examination should be actualized in current medical system. 3. In this study, oriental medical examination program, comprised of pulse-diagnosis, contrast muscular taking and medical consultation of herbalist is progressed communally with occidental medical examination. As pre-examination, questionary was given of general characteristics, health promoting life style, physical constitution and subjective symptom of musculoskeletal system. In addition, post-examination notification was given to subjects about health promoting control, physical constitution regimen and management of musculoskeletal system. During this study program, verification was conducted for input of acquired information and difference of each information after analysis and in addition, performed was analysis of factor influencing health promoting life style and musculoskeletal subjective symptom and evaluation of relationship of physical constitution and health promoting life study. In addition, it was verified of difference between musculoskeletal subjective symptom and result of muscle contrast picture evaluation. 4. Evaluation of oriental medical examination model is divided into 2 categories of oriental medical examination-consultation and result evaluation -post management. Oriental medical examination-consultation demands establishment of examination system, standardization of examination and establishment of examination form and in addition, it should be admitted as enlarged examination assists systemic quadruple diagnosis of herbalist not a key of oriental medical examination. In addition, information acquisition for research purpose should be performed according to the systemic research plan based on the separation of questionary for examination purpose and research purpose. For evaluation of the result, it was concluded that needed are result evaluation meets oriental medical system and post-notification system, informing health management information, based on examination result. 5. Accounting on satisfaction for oriental medical examination model, affirmative reply was much higher (66%) than negative (8.64%). Satisfaction of each area was in order of consultation of herbalist, systemic muscle contrast taking, pulse examination, post-notification and questionary fill-up and dissatisfaction was in order of post-notification, questionary fill-up, consultation of herbalist, systemic muscle contrast taking and pulse measurement. Satisfaction for collaborative examination of occidental and oriental medicine was over 60% and over 75% hope oriental examination would be included in later medical examination program. Based on this result, collaborative examination including occidental and oriental medicine could increase satisfaction of subjects for medical examination program.

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Two Dimensional Size Effect on the Compressive Strength of Composite Plates Considering Influence of an Anti-buckling Device (좌굴방지장치 영향을 고려한 복합재 적층판의 압축강도에 대한 이차원 크기 효과)

  • ;;C. Soutis
    • Composites Research
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    • v.15 no.4
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    • pp.23-31
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    • 2002
  • The two dimensional size effect of specimen gauge section ($length{\;}{\times}{\;}width$) was investigated on the compressive behavior of a T300/924 $\textrm{[}45/-45/0/90\textrm{]}_{3s}$, carbon fiber-epoxy laminate. A modified ICSTM compression test fixture was used together with an anti-buckling device to test 3mm thick specimens with a $30mm{\;}{\times}{\;}30mm,{\;}50mm{\;}{\times}{\;}50mm,{\;}70mm{\;}{\times}{\;}70mm{\;}and{\;}90mm{\;}{\times}{\;}90mm$ gauge length by width section. In all cases failure was sudden and occurred mainly within the gauge length. Post failure examination suggests that $0^{\circ}$ fiber microbuckling is the critical damage mechanism that causes final failure. This is the matrix dominated failure mode and its triggering depends very much on initial fiber waviness. It is suggested that manufacturing process and quality may play a significant role in determining the compressive strength. When the anti-buckling device was used on specimens, it was showed that the compressive strength with the device was slightly greater than that without the device due to surface friction between the specimen and the device by pretoque in bolts of the device. In the analysis result on influence of the anti-buckling device using the finite element method, it was found that the compressive strength with the anti-buckling device by loaded bolts was about 7% higher than actual compressive strength. Additionally, compressive tests on specimen with an open hole were performed. The local stress concentration arising from the hole dominates the strength of the laminate rather than the stresses in the bulk of the material. It is observed that the remote failure stress decreases with increasing hole size and specimen width but is generally well above the value one might predict from the elastic stress concentration factor. This suggests that the material is not ideally brittle and some stress relief occurs around the hole. X-ray radiography reveals that damage in the form of fiber microbuckling and delamination initiates at the edge of the hole at approximately 80% of the failure load and extends stably under increasing load before becoming unstable at a critical length of 2-3mm (depends on specimen geometry). This damage growth and failure are analysed by a linear cohesive zone model. Using the independently measured laminate parameters of unnotched compressive strength and in-plane fracture toughness the model predicts successfully the notched strength as a function of hole size and width.

A study on the comparison by the methods of estimating the relaxation load of SEM-pile (SEM파일의 이완하중 산정방법별 이완하중량 비교 연구)

  • Kim, Hyeong-Gyu;Park, Eun-Hyung;Cho, Kook-Hwan
    • Journal of Korean Tunnelling and Underground Space Association
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    • v.20 no.3
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    • pp.543-560
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    • 2018
  • With the increased development in downtown underground space facilities that vertically cross under a railway at a shallow depth, the demand for non-open cut method is increasing. However, most construction sites still adopt the pipe roof method, where medium and large diameter steel pipes are pressed in to form a roof, enabling excavation of the inside space. Among the many factors that influence the loosening region and loads that occur while pressing in steel pipes, the size of the pipe has the largest impact, and this factor may correspond to the magnitude of load applied to the underground structure inside the steel pipe roof. The super equilibrium method (SEM) has been developed to minimize ground disturbance and loosening load, and uses small diameter pipes of approximately 114 mm instead of conventional medium and large diameter pipes. This small diameter steel pipe is called an SEM pile. After SEM piles are pressed in and the grouting reinforcement is constructed, a crossing structure is pressed in by using a hydraulic jack without ground subsidence or heaving. The SEM pile, which plays the role of timbering, is a fore-poling pile of approximately 5 m length that prevents ground collapse and supports surface load during excavation of toe part. The loosening region should be adequately calculated to estimate the spacing and construction length of the piles and stiffness of members. In this paper, we conducted a comparative analysis of calculations of loosening load that occurs during the press-in of SEM pile to obtain an optimal design of SEM. We analyzed the influence of factors in main theoretical and empirical formulas applied for calculating loosening regions, and carried out FEM analysis to see an appropriate loosening load to the SEM pile. In order to estimate the soil loosening caused by actual SEM-pile indentation and excavation, a steel pipe indentation reduction model test was conducted. Soil subsidence and soil loosening were investigated quantitatively according to soil/steel pipe (H/D).

Return to Sports Activity After Anterior Cruciate Ligament Reconstruction (전방십자인대 재건술 후 스포츠 활동 복귀)

  • Park, Jong-Hyuk;Lee, Jun-Mo;Bae, Hyun-Kyung;Im, Jong-Han;Lee, Ju-Hong
    • Journal of Korean Orthopaedic Sports Medicine
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    • v.8 no.2
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    • pp.95-101
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    • 2009
  • Purpose: The purpose of this study was to determine how many of our patients who had had anterior cruciate ligament (ACL) reconstruction returned to their previous levels of sports and to identify why not doing so. Material and Methods: We evaluated 43 knees with a minimum of two years follow-up among whom undergoing 109 ACL reconstruction from September 2003. The mean age of patients was 26 years (17 to 45 years) Clinical results was evaluated according to the Lysholm Knee scores, Tegner activity score, subjective IKDC questionnaires, objective IKDC evaluation form and KT-1000 arthrometer. Results: The overall clinical results demonstrated significant improvement at the final follow-up comparing to preoperative data (P<0.05). Among 43 patients, 25 patients (58%) returned to their previous level of sports and 18 patients (42%) did not. Of whom, 11 patients (61%) were not able to return to sports due to fear to re-injury and 7 patients (39%) suffered from instability and pain. The differences in the Lysholm Scores, KT-1000 arthrometer and subjective IKDC in the 3 groups of patients by ANOVA test were found to be statistically significant (P<0.001). Although there is no difference in objective IKDC and KT-1000 arthrometer, the difference was observed in Tegner activities, subjective IKDC obtained by those who returned to sport and those who had fear to reinjury (P<0.001). Conclusion: This study showed that a quater of patients could not return to their previous level of sport after ACL reconstruction because of fear to reinjury. We thought that not only improving the technique of ACL reconstruction and systemic rehabilitation but also considering psychological factor of patients could allow more patients to return to the previous level of sports.

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EEPERF(Experiential Education PERFormance): An Instrument for Measuring Service Quality in Experiential Education (체험형 교육 서비스 품질 측정 항목에 관한 연구: 창의적 체험활동을 중심으로)

  • Park, Ky-Yoon;Kim, Hyun-Sik
    • Journal of Distribution Science
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    • v.10 no.2
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    • pp.43-52
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    • 2012
  • As experiential education services are growing, the need for proper management is increasing. Considering that adequate measures are an essential factor for achieving success in managing something, it is important for managers to use a proper system of metrics to measure the performance of experiential education services. However, in spite of this need, little research has been done to develop a valid and reliable set of metrics for assessing the quality of experiential education services. The current study aims to develop a multi-item instrument for assessing the service quality of experiential education. The specific procedure is as follows. First, we generated a pool of possible metrics based on diverse literature on service quality. We elicited possiblemetric items not only from general service quality metrics such as SERVQUAL and SERVPERF but also from educational service quality metrics such as HEdPERF and PESPERF. Second, specialist teachers in the experiential education area screened the initial metrics to boost face validity. Third, we proceeded with multiple rounds of empirical validation of those metrics. Based on this processes, we refined the metrics to determine the final metrics to be used. Fourth, we examined predictive validity by checking the well-established positive relationship between each dimension of metrics and customer satisfaction. In sum, starting with the initial pool of scale items elicited from the previous literature and purifying them empirically through the surveying method, we developed a four-dimensional systemized scale to measure the superiority of experiential education and named it "Experiential Education PERFormance" (EEPERF). Our findings indicate that students (consumers) perceive the superiority of the experiential education (EE) service in the following four dimensions: EE-empathy, EE-reliability, EE-outcome, and EE-landscape. EE-empathy is a judgment in response to the question, "How empathetically does the experiential educational service provider interact with me?" Principal measures are "How well does the service provider understand my needs?," and "How well does the service provider listen to my voice?" Next, EE-reliability is a judgment in response to the question, "How reliably does the experiential educational service provider interact with me?" Major measures are "How reliable is the schedule here?," and "How credible is the service provider?" EE-outcome is a judgmentin response to the question, "What results could I get from this experiential educational service encounter?" Representative measures are "How good is the information that I will acquire form this service encounter?," and "How useful is this service encounter in helping me develop creativity?" Finally, EE-landscape is a judgment about the physical environment. Essential measures are "How convenient is the access to the service encounter?,"and "How well managed are the facilities?" We showed the reliability and validity of the system of metrics. All four dimensions influence customer satisfaction significantly. Practitioners may use the results in planning experiential educational service programs and evaluating each service encounter. The current study isexpected to act as a stepping-stone for future scale improvement. In this case, researchers may use the experience quality paradigm that has recently arisen.

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A Study on the Selection of the Recommended Safety Distance Between Marine Structures and Ships Based on AIS Data (AIS 기반 해양시설물과 선박간 권고 안전이격거리 선정에 관한 연구)

  • Son, Woo-ju;Lee, Jeong-seok;Lee, Bo-kyeong;Cho, Ik-soon
    • Journal of Navigation and Port Research
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    • v.43 no.6
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    • pp.420-428
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    • 2019
  • Although marine structures are a risk factor interfering with the passage of ships, there are no obvious guidelines on the required safety distance between ships and marine structures under regulations and laws. In this study, the width of the shipping route width was set based on the AIS data to analyze the separation distance between marine structures and ships, and the ships were classified by the length of each ship. By analyzing the distribution at marine structures, this study confirmed that the ships' traffic volume was in the form of normal distribution. To statistically analyze the separation distance between the traffic distribution results and the normal distribution of ships in this study, the traffic pattern analysis around the marine structures was performed. As a result, the traffic pattern was different by length and the recommended safety distance for each length is presented accordingly. Referring to the IMO (International Maritime Organization) the standard turning circle and reference of safety separation distance between ships and offshore wind turbines of the CESMA (Confederation of European Shipmasters' Associations) and P IANC (World Association for Waterborne Transport Infrastructures), the analysis was conducted on ships that did not follow the set distance among the AIS data by setting the distance within the recommended ship safety distance to 5-7 overall length. As a result, the 5.5 length over all of the safety recommendations were selected as appropriate, and based on the above results, the two cases recommending ship safety distance were proposed.

The Relationship with Electronic Trust, Web Site Commitment and Service Transaction Intention in Public Shipping B2B e-marketplace (해운 B2B e-marketplace의 전자적 신뢰, 사이트몰입 및 서비스 거래의도와의 관계성)

  • Kim, Yong-Man;Kim, Seog-Yong;Lee, Jong-Hwan;Shim, Gyu-Yeol
    • Journal of Global Scholars of Marketing Science
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    • v.17 no.4
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    • pp.113-139
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    • 2007
  • This study aims to, looking from a standpoint of network, has investigated the shipping industry's B2B e-marketplace, the characteristics that can earn electronic trust from the users, and characteristics of the web-site. It has examined the mechanism whereby electronic trust be earned and how it affects web-site involvement and service transaction intention. Ultimately, The study attempts to make proposals whereby such trust can lead for a cooperative trading community in the shipping industry's B2B e-marketplace The Covalence structural equation modeling was designed and empirically tested for the shipping industry's B2B e-marketplace. The shipping industry employees were given questionnaires and data were analyzed. Except for perceived security of the three characteristic factors on the web-site, the perceived site quality and characteristics factors in operation only affected co-variables. Transaction Fairness was determined to be the most important factor among exogenous factors increasing electronic trust. With regards to transaction rules, if a transaction is beneficial only to one side, then no long term transaction will not take place. If the concerned parties properly recognize that transaction fairness is crucial to electronic transaction, then it will enormously contribute to successful operations of shipping e-marketplace. Also, Perceived efficiency in transaction also affects electronic trust. This reduces transaction costs and speeds up and simplifies the transaction process. It has reduced greater time and costs than existing off-line transaction, and would positively affect electronic trust. By making an open forum for participants to obtain information for transaction, they can gather useful information, and at the same time, the web-site operator can provide information, which, in turn, will increase electronic trust in electronic transaction. Furthermore, such formation of trust in electronic transaction influences shipping companies in such a way that they will want to continuously participate in the transaction, raising web-site involvement. The result of increased trust is that shipping companies in the future will do business with each other and form a foundation for continuous transactions amongst themselves. Consequently, the formation of trust in electronic transaction greatly influences web-site involvement and service transaction intention. The results of the study have again proved that in order to maintain continuous business relationship with the current clients, electronic trust in virtual space, which operates the shipping industry's B2B e-marketplace, is important for the interested parties.

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Use of Human Adipose Tissue as a Source of Endothelial Cells (혈관내피세포 채취의 원천으로 인간 지방조직의 활용)

  • Park, Bong-Wook;Hah, Young-Sool;Kim, Jin-Hyun;Cho, Hee-Young;Jung, Myeong-Hee;Kim, Deok-Ryong;Kim, Uk-Kyu;Kim, Jong-Ryoul;Jang, Jung-Hui;Byun, June-Ho
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.32 no.4
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    • pp.299-305
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    • 2010
  • Purpose: Adipose tissue is located beneath the skin, around internal organs, and in the bone marrow in humans. Its main role is to store energy in the form of fat, although it also cushions and insulates the body. Adipose tissue also has the ability to dynamically expand and shrink throughout the life of an adult. Recently, it has been shown that adipose tissue contains a population of adult multipotent mesenchymal stem cells and endothelial progenitor cells that, in cell culture conditions, have extensive proliferative capacity and are able to differentiate into several lineages, including, osteogenic, chondrogenic, endothelial cells, and myogenic lineages. Materials and Methods: This study focused on endothelial cell culture from the adipose tissue. Adipose tissues were harvested from buccal fat pad during bilateral sagittal split ramus osteotomy for surgical correction of mandibular prognathism. The tissues were treated with 0.075% type I collagenase. The samples were neutralized with DMEM/and centrifuged for 10 min at 2,400 rpm. The pellet was treated with 3 volume of RBC lysis buffer and filtered through a 100 ${\mu}m$ nylon cell strainer. The filtered cells were centrifuged for 10 min at 2,400 rpm. The cells were further cultured in the endothelial cell culture medium (EGM-2, Cambrex, Walkersville, Md., USA) supplemented with 10% fetal bovine serum, human EGF, human VEGF, human insulin-like growth factor-1, human FGF-$\beta$, heparin, ascorbic acid and hydrocortisone at a density of $1{\times}10^5$ cells/well in a 24-well plate. Low positivity of endothelial cell markers, such as CD31 and CD146, was observed during early passage of cells. Results: Increase of CD146 positivity was observed in passage 5 to 7 adipose tissue-derived cells. However, CD44, representative mesenchymal stem cell marker, was also strongly expressed. CD146 sorted adipose tissue-derived cells was cultured using immuno-magnetic beads. Magnetic labeling with 100 ${\mu}l$ microbeads per 108 cells was performed for 30 minutes at $4^{\circ}C$ a using CD146 direct cell isolation kit. Magnetic separation was carried out and a separator under a biological hood. Aliquous of CD146+ sorted cells were evaluated for purity by flow cytometry. Sorted cells were 96.04% positivity for CD146. And then tube formation was examined. These CD146 sorted adipose tissue-derived cells formed tube-like structures on Matrigel. Conclusion: These results suggest that adipose tissue-derived cells are endothelial cells. With the fabrication of the vascularized scaffold construct, novel approaches could be developed to enhance the engineered scaffold by the addition of adipose tissue-derived endothelial cells and periosteal-derived osteoblastic cells to promote bone growth.

Finding Influential Users in the SNS Using Interaction Concept : Focusing on the Blogosphere with Continuous Referencing Relationships (상호작용성에 의한 SNS 영향유저 선정에 관한 연구 : 연속적인 참조관계가 있는 블로고스피어를 중심으로)

  • Park, Hyunjung;Rho, Sangkyu
    • The Journal of Society for e-Business Studies
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    • v.17 no.4
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    • pp.69-93
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    • 2012
  • Various influence-related relationships in Social Network Services (SNS) among users, posts, and user-and-post, can be expressed using links. The current research evaluates the influence of specific users or posts by analyzing the link structure of relevant social network graphs to identify influential users. We applied the concept of mutual interactions proposed for ranking semantic web resources, rather than the voting notion of Page Rank or HITS, to blogosphere, one of the early SNS. Through many experiments with network models, where the performance and validity of each alternative approach can be analyzed, we showed the applicability and strengths of our approach. The weight tuning processes for the links of these network models enabled us to control the experiment errors form the link weight differences and compare the implementation easiness of alternatives. An additional example of how to enter the content scores of commercial or spam posts into the graph-based method is suggested on a small network model as well. This research, as a starting point of the study on identifying influential users in SNS, is distinctive from the previous researches in the following points. First, various influence-related properties that are deemed important but are disregarded, such as scraping, commenting, subscribing to RSS feeds, and trusting friends, can be considered simultaneously. Second, the framework reflects the general phenomenon where objects interacting with more influential objects increase their influence. Third, regarding the extent to which a bloggers causes other bloggers to act after him or her as the most important factor of influence, we treated sequential referencing relationships with a viewpoint from that of PageRank or HITS (Hypertext Induced Topic Selection).