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Open Heart Surgery after Pulmonary Artery Banding in Children (소아에서 폐동맥밴딩술후의 개심술 치료)

  • 김근직;천종록;이응배;전상훈;장봉현;이종태;김규태
    • Journal of Chest Surgery
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    • v.32 no.9
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    • pp.781-789
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    • 1999
  • Background: Pulmonary artery banding(PAB) accompanies some risks in the aspect of band complications and mortality in the second-stage operation. To assess these risks of the second-stage operation after PAB, we reviewed the surgical results of the second-stage operation in the pediatric patients who had undergone PAB in infancy. Material and Method: From May 1988 to June 1997, a total of 29 patients with preliminary PAB underwent open heart surgery. Ages ranged from 2 to 45 months(mean 20.6$\pm$9.0 months). Preoperative congestive heart failure conditions were improved after PAB(elective operation group) in 27 patients, but early second-stage procedures were required in the remaining 2 patients due to sustaining congestive heart failure(early operation group). Preoperative surgical indications included 2 double outlet right ventricles(DORV group) and 27 ventricular septal defects as the main cardiac anomaly(VSD group). Result: The mean time interval from PAB to the second-stage operation was 15.5$\pm$8.7 months(range 5 days to 45 months). One patient in the DORV group underwent intraventricular tunnel repair and modified Glenn procedure in the other. In the VSD group, the VSD was closed with a Dacron patch in all patients. Concomitant procedures included a right ventricular infundibulectomy in 4 patients and a valvectomy of the dysplastic pulmonary valve in 1 patient. At the second-stage operations, pulmonary angioplasty was required due to the stenotic banding sites in 18 patients. One patient underwent complete ligation of the main pulmonary artery with the modified Glenn procedure. The mortality at the second-stage operation was 17.2%(5 patients). Causes of death were 4 low cardiac output, and 1 autoimmune hemolytic anemia. Diagnosis with DORV and the early operative group were the risk factors for operative death in this series. There was 1 late death. Conclusion: This study revealed the second-stage operation for pulmonary artery debanding and closure of VSD in children was complicated by the correction of the acquired lesions with a significantly high incidence of morbidity and early postoperative deaths. Primary repair is recommended for isolated VSD, if possible.

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Development of the Risk Evaluation Model for Rear End Collision on the Basis of Microscopic Driving Behaviors (미시적 주행행태를 반영한 후미추돌위험 평가모형 개발)

  • Chung, Sung-Bong;Song, Ki-Han;Park, Chang-Ho;Chon, Kyung-Soo;Kho, Seung-Young
    • Journal of Korean Society of Transportation
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    • v.22 no.6
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    • pp.133-144
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    • 2004
  • A model and a measure which can evaluate the risk of rear end collision are developed. Most traffic accidents involve multiple causes such as the human factor, the vehicle factor, and the highway element at any given time. Thus, these factors should be considered in analyzing the risk of an accident and in developing safety models. Although most risky situations and accidents on the roads result from the poor response of a driver to various stimuli, many researchers have modeled the risk or accident by analyzing only the stimuli without considering the response of a driver. Hence, the reliabilities of those models turned out to be low. Thus in developing the model behaviors of a driver, such as reaction time and deceleration rate, are considered. In the past, most studies tried to analyze the relationships between a risk and an accident directly but they, due to the difficulty of finding out the directional relationships between these factors, developed a model by considering these factors, developed a model by considering indirect factors such as volume, speed, etc. However, if the relationships between risk and accidents are looked into in detail, it can be seen that they are linked by the behaviors of a driver, and depending on drivers the risk as it is on the road-vehicle system may be ignored or call drivers' attention. Therefore, an accident depends on how a driver handles risk, so that the more related risk to and accident occurrence is not the risk itself but the risk responded by a driver. Thus, in this study, the behaviors of a driver are considered in the model and to reflect these behaviors three concepts related to accidents are introduced. And safe stopping distance and accident occurrence probability were used for better understanding and for more reliable modeling of the risk. The index which can represent the risk is also developed based on measures used in evaluating noise level, and for the risk comparison between various situations, the equivalent risk level, considering the intensity and duration time, is developed by means of the weighted average. Validation is performed with field surveys on the expressway of Seoul, and the test vehicle was made to collect the traffic flow data, such as deceleration rate, speed and spacing. Based on this data, the risk by section, lane and traffic flow conditions are evaluated and compared with the accident data and traffic conditions. The evaluated risk level corresponds closely to the patterns of actual traffic conditions and counts of accident. The model and the method developed in this study can be applied to various fields, such as safety test of traffic flow, establishment of operation & management strategy for reliable traffic flow, and the safety test for the control algorithm in the advanced safety vehicles and many others.

Risk Ranking Analysis for the City-Gas Pipelines in the Underground Laying Facilities (지하매설물 중 도시가스 지하배관에 대한 위험성 서열화 분석)

  • Ko, Jae-Sun;Kim, Hyo
    • Fire Science and Engineering
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    • v.18 no.1
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    • pp.54-66
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    • 2004
  • In this article, we are to suggest the hazard-assessing method for the underground pipelines, and find out the pipeline-maintenance schemes of high efficiency in cost. Three kinds of methods are applied in order to refer to the approaching methods of listing the hazards for the underground pipelines: the first is RBI(Risk Based Inspection), which firstly assess the effect of the neighboring population, the dimension, thickness of pipe, and working time. It enables us to estimate quantitatively the risk exposure. The second is the scoring system which is based on the environmental factors of the buried pipelines. Last we quantify the frequency of the releases using the present THOMAS' theory. In this work, as a result of assessing the hazard of it using SPC scheme, the hazard score related to how the gas pipelines erodes indicate the numbers from 30 to 70, which means that the assessing criteria define well the relative hazards of actual pipelines. Therefore. even if one pipeline region is relatively low score, it can have the high frequency of leakage due to its longer length. The acceptable limit of the release frequency of pipeline shows 2.50E-2 to 1.00E-l/yr, from which we must take the appropriate actions to have the consequence to be less than the acceptable region. The prediction of total frequency using regression analysis shows the limit operating time of pipeline is the range of 11 to 13 years, which is well consistent with that of the actual pipeline. Concludingly, the hazard-listing scheme suggested in this research will be very effectively applied to maintaining the underground pipelines.

Channel Innovation through Online Transaction processing System in Floral Wholesale Distribution: FLOMARKET Case (화훼도매 온라인 거래처리 시스템을 통한 유통경로 개선방안 연구: (주)플로마켓 사례)

  • Lee, Seungchang;Ahn, Sunghyuck
    • Journal of Distribution Science
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    • v.8 no.1
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    • pp.21-33
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    • 2010
  • The ICT(information & communication technology) led to a dramatic change of floral distribution service, a phase of competition between wholesales and retail stores, and distribution channels in floral industry. It was expected that a role of the intermediaries in this industry would have reduced due to the improvement of transaction process by ICT. However, the ICT made to overcome a regional limit of the floral retail distribution service leading to an increase in sales and enlargement of the stores. And even it made possible to bring out another type of intermediaries such as private associations. This case study focuses on what kinds of efforts the floral wholesale distributors have made to enable a distribution process more smoothly between the wholesale distributors and retail stores through the information system, and what the failure factors in adopting the information system have been. This paper is also to examine how the wholesale distributors have changed themselves to gain dominant positions in distribution channels. As a result of the study, it was found that the intermediaries mostly failed in successfully achieving the distribution channel innovation through the information system because of several main reasons. FLOMARKET Inc. tried to innovate a distribution channel to obtain high quality goods through consolidating a wholesale distribution market in that segregated both floral joint market from free markets. after implementing the information system with consideration of the failure factors, FLOMARKET Inc. was able to minimize goods in stock and make a major purchase of various goods. In addition, it made a possible pre-ordering process and an exact calculation of purchasing goods so they could provide their products with market price in real time, which helped for the company to gain credits from their customers. Also, FLOMARKET Inc. established the information system which well suited to its business stage in order to deal with a rapidly changing distribution environment. It's so obvious that the transaction processing system of FLOMARKET Inc. definitely helped to share information among traders more seamlessly and smoothly in realtime, standardize goods, and make a transaction process clearer. Besides, the transaction information helped the wholesale distributors and retail stores to make more strategic decisions in their business because through the system they enabled to gather the marketing intelligence information more easily and convenient. If we understand that the floral distribution market is characterized by the low IT- based industry, it's worth to examine a case study proving that the information system actually increases the productivity of the transaction process in the floral industry.

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Study of Factors Controlling Exposure Dose and Image Quality of C-arm in Operation Room according to Detector Size of It (Mainly L-Spine AP Study) (수술 중 C-Arm Neutral AP 검사 시 조절인자에 따른 피폭선량 및 화질비교(L-Spine AP검사를 기준으로))

  • CHOI, Sung-Hyun;JO, Hwang-Woo;Dong, Kyung-Rae;Chung, Woon-Kwan;Choi, Eun-Jin;Song, Ha-jin
    • Journal of Radiation Industry
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    • v.9 no.2
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    • pp.85-90
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    • 2015
  • Purpose: Time of operation has been reduced and accuracy of operation has been improved since C-arm, which offer real-time image of patient, was introduced in operation room. However, because of the contamination of patient, C-arm could not be used more appropriately. Therefore, this study is to know factors of controlling exposure dose, image quality and the exposed dose of health professional in operation room. Materials and methods: Height of Wilson frame (bed for operation) was fixed at 130 cm. Then, Model 76-2 Phantom, which was set by assembling manual of Fluke Company, was set on the bed. Head/Spine Fluoroscopy AEC mode was set for exposure condition. According to detector size of C-arm, the absorbed dose per min was measured in the 7 steps OFD (cm) from 10 cm to 40 cm (10, 15, 20, 25, 30, 35, 40 cm). In each step of OFD, the absorbed dose per min of same diameter of collimation was measured. Moreover, using Nero MAX Model 8000, exposure dose per min was measured according to 3 step of distance from detector (20 cm, 60 cm, 100 cm). Finally, resolution was measured by CDRH Disc Phantom and magnification of each OFD was measured by aluminum stick bar. Result: According to detector size of C-arm, difference of absorbed dose shows that the dose of 20 cm OFD is 1.750 times higher than the dose of 40 cm OFD. It means that the C-arm, which has smaller size of detector, shows the bigger difference of absorbed dose per min (p<0.05). In the difference of absorbed dose in the same step of OFD (from 20 cm to 40 cm), the absorbed dose of 9 inch detect or C-arm was 1.370 times higher than 12 inch' s (p<0.05). When OFD was set to 20 cm OFD, the absorbed dose of non-collimation case was approximately 0.816 times lower than the absorbed dose of collimation cases (p<0.05). When the distance was 20 cm from detector, exposed does includes first-ray and scatter-ray. When the distance was 60 cm and 100 cm from detector, exposed does includes just scatter-ray. So, there was the 2.200 times difference of absorbed does. Finally, when OFD was increased, spatial resolution was 4 to 5 step was increased. However, low contrast resolution was not relative. Moreover, there was 1.363 times difference of magnification (p<0.05). Conclusion: When C-Arm is used, avoiding contamination of patient is more important factor than reducing exposed dose of health professional in operation room. Just controlling exposure time is just way to reduce the exposed does of workers. However, in the case, non-probability influence could be occurred. Therefore, this study proved that the exposed dose will be reduced if the factors such as using small detector size of C-arm, setting OFD from 20 cm to 25 cm and non-collimating. Moreover, dose management of C-arm in the non-interesting area will be considered additionally.

DEM Generation over Coastal Area using ALOS PALSAR Data - Focus on Coherence and Height Ambiguity - (ALOS PALSAR 자료를 이용한 연안지역의 DEM 생성 - 긴밀도와 고도 민감도 분석을 중심으로 -)

  • Choi, Jung-Hyun;Lee, Chang-Wook;Won, Joong-Sun
    • Korean Journal of Remote Sensing
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    • v.23 no.6
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    • pp.559-566
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    • 2007
  • The generation of precise digital elevation model (DEM) is very important in coastal area where time series are especially required. Although a LIDAR system is useful in coastal regions, it is not yet popular in Korea mainly because of its high surveying cost and national security reasons. Recently, precise DEM has been made using radar interferometry and waterline methods. One of these methods, spaceborne imaging radar interferometry has been widely used to measure the topography and deformation of the Earth. We acquired ALOS PALSAR FBD mode (Fine Beam Dual) data for evaluating the quality of interferograms and their coherency. We attempted to construct DEM using ALOS PALSAR pairs - One pair is 2007/05/22 and 2007/08/22, another pair is 2007/08/22 and 2007/10/22 with respective perpendicular baseline of 820 m, 312m and respective height sensitivity of 75 m and 185m at southern of Ganghwa tidal flat, Siwha- and Hwaong-lake over west coastal of Korea peninsula. Ganghwa tidal flat has low coherence between 0.3 and 0.5 of 2007/05/22 and 2007/08/22 pair. However, Siwha-lake and Hwaong-lake areas have a higher coherence value (From 0.7 and 0.9) than Ganghwa tidal area. The reason of difference coherence value is tidal condition between tidal flat area (Ganghwa) and reclaimed zone (Siwha-lake and Hwaong-lake). Therefore, DEM was constructed by ALOS PALSAR pair over Siwha-lake and Hwaong-lake. If the temporal baseline is enough short to maintain the coherent phases and height sensitivity is enough small, we will be able to successfully construct a precise DEM over coastal area. From now on, more ALOS PALSAR data will be needed to construct precise DEM of West Coast of Korea peninsular.

Assessment of Compensator Thickness in Proton Therapy (양성자 치료 시 사용되는 Compensator의 Thickness에 대한 적정성 평가)

  • Park, Yong Soo;Jang, Jun Yeong;Cho, Gwang Hyeon;Park, Yong Cheol;Choi, Byeong Ki
    • The Journal of Korean Society for Radiation Therapy
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    • v.30 no.1_2
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    • pp.35-40
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    • 2018
  • Purpose : The range of force differs from the size of proton energy used in our hospital. The compensator enables to change energy size based on distal thickness which also makes changes in dose rate. Therefore, the purpose of this study is to evaluate the effect of changing the thickness of compensator distal on dose range and beam on time. Subject and Methodology : Five low energy patients who have received proton therapy were selected as subjects for this study. Beam on was checked for the selected patients during the existing therapy. After then, the thickness of distal of compensator was increased by 2 cm up to 14 cm through proton therapy plan system(TPS) for comparative analysis. For the evaluation of dose range, the value of the target's conformity index(CI) and the maximum dose of rear side target's organ at risk(OAR) were compared. Furthermore, to evaluate the effect of therapy time, beam on time was compared by making compensator distal in each thickness. Result : The result of homogeneity index and conformity index of the increased compensator distal showed the same level in all patients. The comparison results of OAR of target rear side showed 7 cGy at spine cord of abdomen at maximum, 88 cGy at eyeball's RT lens, 391 cGy at RT lens of nasal cavity 51 cGy at trachea of the mediastinum, and 661 cGy at a small bowl of the pelvis. The comparison results of the beam on time showed a reduction from 126 seconds to 62 seconds for the abdomen, from 105 seconds to 37 seconds for the eyeball, from 187 seconds to 134 seconds for nasal cavity, from 100 seconds to 40 seconds for mediastinum, from 440 seconds to 118 seconds for the pelvis. Conclusion : The research result showed that as the distal thickness of compensator increased, the size of energy increased. In addition, beam on decreased due to the increase of dose rate. It is expected that the result would help reduce the treatment time and increase the convenience of patients if it is applied to liver patients who need respiratorygated therapy and pediatric patients. However, distal penumbra increased as the size energy increased. Therefore, in treating cases where OAR is in the vicinity of the target rear side, the influence of penumbra should be taken into account in adjusting thickness level of the compensator in proton therapy plan.

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Prognostic Value of Day 3 Inhibin-B on Assisted Reproductive Technology Outcome (보조 생식술 결과에 있어서 기저혈중 Inhibin-B의 예후인자로서의 유용성)

  • Bai, Sang-Wook;Kim, Jin-Young;Lee, Kyung-Sool;Won, Jong-Gun;Lee, Yong-Joo;Yi, Ji-Won;Chang, Kyung-Hwan;Lee, Byung-Seok;Park, Ki-Hyun;Cho, Dong-Jae;Song, Chan-Ho
    • Clinical and Experimental Reproductive Medicine
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    • v.24 no.2
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    • pp.217-223
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    • 1997
  • This study was performed to determine if women with day 3 serum inhibin-B concentrations <45pg/ml (conversion factor to SI unit, 1.00) demonstrate a poor response to ovulation induction and assisted reproductive technology outcome to women with inhibin-B${\ge}45pg$/ml, independant of day 3 FSH, E2 and patient age. From Jan 1996 to Dec 1996, 16 volunteers patients who underwent 25 IVF cycles with luteal phase GnRH agonist suppression and HMG stimulation were allocated to the study group. We evaluated day 3 serum inhibin-B, FSH, E2, peak E2, cancellation rate per initiated cycle (%) and clinical pregnancy rate per initiated cycle (%) according to the above two groups and independent of patient age, day 3 FSH, day 3 E2 and all of above combined. Women with day 3 serum inhibin-B${\ge}45pg$/ml demonstrated higher average day 3 inhibin-B level, clinical pregnancy rate per initiated cycle ($20.3{\pm}2.5$ pg/ml vs $80.9{\pm}5.0$ pg/ml, p<0.05; 24.8% vs 8.5%, p<0.05) and lower day 3 FSH level, cancellation rate per initiated cycle ($6.9{\pm}0.3$ mIU/ml vs $8.5{\pm}0.5$ mIU/ml, p<0.05; 1.5% vs 9.0%, p<0.05). Women with day 3 serum inhibin${\ge}45pg$/ml and age<40 year demonstrated higher pregnancy rate per initiated cycle (28.2% vs 7.4%, p<0.05) and lows. day 3 FSH level, cancellation rate per initiated cycle ($6.9{\pm}0.5$ mIU/ml vs $8.2{\pm}0.7$ mIU/ml, p<0.05; 1.0% vs 9.0%, p<0.05). Women with day 3 serum inhibin${\ge}45pg$/ml and day 3 FSH<15mIU/ml demonstrated higher pregnancy rate per initiated cycle (33.5% vs 9.5%, p<0.05) and lower day 3 FSH level, cancellation rate per initiated cycle ($7.7{\pm}0.2$ mIU/ml vs $8.5{\pm}0.5$ mIU/ml, p<0.05; 1.5% vs 10.0%, p<0.05). Women with day 3 serum inhibin${\ge}45pg$/ml and day 3 E2<50pg/ml demonstrated higher pregnancy rate per initiated cycle (30.0% vs 9.5%, p<0.05) and lower cancellation rate per initiated cycle (1.5% vs 9.5%, p<0.05). Women with day 3 serum inhibin${\ge}45pg$/ml, age<40 year, day 3 FSH<15mIU/ml and day 3 E2<50pg/ml demonstrated higher pregnancy rate per initiated cycle (30.0% vs 10.8%, p<0.05) and lower day 3 FSH level, cancellation rate per initiated cycle ($6.8{\pm}0.6$ mIU/ml vs $8.4{\pm}0.9$ mIU/ml, p<0.05; 1.5% vs 7.8%, p<0.05). Therefore women with low day 3 serum inhibin-B concentrations demonstrate a poorer response to ovulation induction and are less likely to conceive a clinical pregnancy though ART relative to women with high day 3 inhibin-B and day 3 serum inhibin-B, in addition to a day 3 FSH, E2 and patient age, appears helpful in prediction in IVF-ET outcome.

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Effect of Physical Control Technology on Aspergillus ochraceus Reduction (물리적 제어기술이 Aspergillus ochraceus 저감화에 미치는 영향)

  • Lee, Eun-Seon;Kim, Jong-Hui;Kim, Bu-Min;Oh, Mi-Hwa
    • Journal of Food Hygiene and Safety
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    • v.36 no.5
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    • pp.447-453
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    • 2021
  • In this study, the effectiveness of physical control technology, a combined light sterilization (LED, UV) and hot water treatment in reducing Aspergillus ochraceus for food production environment was investigated. In brief, 1 mL aliquot of A. ochraceus spore suspension (107-8 spore/mL) was inoculated onto stainless steel chips, which was then dried at 37℃, and each was subjected to different physical treatment. Treatments were performed for 0.5, 1, 2, 5, 8, and 11 hours to reduce the strains using a light-emitting diode, but no significant difference was confirmed among the treatments. However, a significant reduction was observed on the chips treated with UV-C exposure and hot water immersion. After being treated solely with 360 kJ/m2 of UV-C on stainless steel chip, the fungi were significantly reduced to 1.27 log CFU/cm2. Concerning the hot water treatment, the initial inoculum amount of 6.49 log CFU/cm2 was entirely killed by immersion in 83℃ water for 5 minutes. Maintaining a high temperature for 5 minutes at the site is difficult. Thus, considering economic feasibility and usability, we attempted to confirm the appropriate A. ochraceus reduction conditions by combining a relatively low temperature of 60℃ and UV rays. With the combined treatments, even in lukewarm water, A. ochraceus decreased significantly through the increases in the immersion time and the amount of UV-C irradiation, and the yield was below the detection limit. Based on these results, if work tools are immersed in 60℃ lukewarm water for 3 minutes and then placed in a UV sterilization device for more than 10 minutes, the possibility of A. ochraceus cross-contamination during work is expected to be reduced.

An Analysis on the Knowledge Levels, Attitudes, and Factors Affecting the Choices of Those Who Completed the Education of Persons Conducting Clinical Trial Workers (의약품 임상시험 종사자 교육 이수자의 지식 수준, 태도, 교육 선택 요인 분석)

  • Lee, Yoon Jin;Jang, Hye Yun;Lee, Yu-Mi
    • The Journal of KAIRB
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    • v.3 no.2
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    • pp.19-27
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    • 2021
  • Purpose: This study aimed to analyze the knowledge levels, attitudes, and factors affecting the choices on the education of the participants who completed their education of persons conducting clinical trial workers, and to assess the problems of the current education system for clinical trial workers, leading to improvements. Methods: Clinical trial workers (including principal investigators/subinvestigators, members of the Institutional Review Board [IRB], clinical research coordinators) who were affiliated to one of the 4 university hospitals running their own clinical trial center and IRB in Daegu and completed their education of persons conducting clinical trial workers were the subjects of this study. One hundred seven online questionnaires were answered from 2021-04-02 to 2021-04-17. Descriptive statistics and Pearson correlation analysis were used to analyze the acquired data. Independent t-test and 1-way analysis of variance were used to analyze the differences in the knowledge levels and attitudes following the characteristics of the education participants. Results: The baseline characteristics of the 107 participants were as follows: the majority of the participants were female (72.0%), were in their 30s (36.4%), had a nursing major (29.0%), were clinical research coordinators (63.6%), had never experienced a principal investigator (79.4%), had participated 3 or more educations (58.9%), had completed their maintenance course (55.1%), had 5 or more years of clinical trial experiences (34.6%). The fields on which participants had low levels of objective knowledge were "types and preparations on audits of clinical trials," "regulations on clinical trials (Pharmaceutical Affairs Act, Korea Good Clinical Practice)." The difficulties that the participants faced were on "annual educations" and "lack of information regarding the educations." Factors that showed significant differences in objective knowledge were sex (p=0.02), number of educations (p=0.004), the curriculum of 2020 (p=0.001). Age (p=0.004), having experienced a principal investigator (p=0.006), number of educations (p<0.001), the curriculum of 2020 (p<0.001), clinical trial career (p=0.001) were factors that significantly affected subjective knowledge. Attitudes toward the education were positively correlated with objective knowledge (r=0.20, p=0.04) and subjective knowledge (r=0.32, p=0.001). Major sources through which information on educations was acquired were "institutional notices," and major factors affecting the choices on the education were "when the education took place" and "where the education took place." "Within the affiliated institution," "Online classes (recorded)" and "IRB and review processes" were each the most preferred place, mode, and content of the education. Conclusion: Knowledge levels varied largely among participants who completed their education of persons conducting clinical trial workers, depending on their characteristics such as the number of educations. Participants also complained about their lack of information on educations. The quality of education may be improved if clinical trial organizations are designated as education facilities. Education programs must be developed considering the knowledge level and demand of the participants. Furthermore, as offline classes may be impossible due to pandemics such as the coronavirus disease 2019, the development of diverse and sophisticated online classes is looked forward to.

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