• Tuberculosis and Respiratory Diseases
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• v.62 no.5
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• pp.382-388
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• 2007

Background: The cognitive function is impaired in patients with hypoxemic chronic obstructive pulmonary disease (COPD). However, there are conflicting results regarding the cognitive function in patients with non-hypoxemic COPD. COPD patients also have sleep disorders. This study examined the cognitive function in non-hypoxemic COPD patients, and nocturnal sleep was assessed in COPD patients with a cognitive dysfunction. Methods: Twenty-eight COPD patients (mean age, 70.7 years) with an oxygen saturation > 90%, and 33 healthy control subjects (mean age, 69.5 years) who had visited for a routine check-up were selected. The neurocognitive tests were performed using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) Neuropsychological Battery. Results: The scores of the word list recall test (p=0.03) and the word list recognition test (p=0.006) in the COPD group were significantly lower than those in the control group. Nine patients showed a significantly impaired cognitive function. Seven of these underwent polysomnography, which revealed apnea-hypopnea indices ${\geq}$ five per hour in five patients. The median oxygen desaturation index and median limb movement index were 3.6/h and 38.6/h, respectively. Conclusion: These results suggest that the verbal memory function is impaired in non-hypoxemic COPD patients. Six out of seven COPD patients with an impaired cognitive function had sleep disorders of sleep apnea and/or periodic limb movements during sleep.

• 아동간호학회:학술대회논문집
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• 1997.11a
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• pp.61-74
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• 1997

Endotracheal suctioning is a routine procedure used for clearing secretions from the airway of the intubated infant. This procedure is not without complications. Endotracheal suctioning has been associated with decreases in $PaO_2$, decreases in systemic venous oxygenation, alterations in mean arterial Pressure, disturbances in cardiac rhythm and development of nosocomial pneumonia. So several endotracheal suctioning techniques have been developed to prevent these blown complications. Another method of Endotracheal suctioning eliminates the risk associated with disconnecting the infant from the ventilatior to perform the suctioning procedure. Studies examining closed endotracheal suctioning methods reported that the closed method results in less arterial oxygen saturation, and less systemic venous oxygen desaturation. However those studies have focused on adult patients, and there have been no published studies for newborn infants. The specific purpose of this study is to investigate the two methods and to make a comparison in terms of (1)variations in $SaO_2$, heart rate, and respiration rate appeared before and after the endotracheal suctioning; (2)difference in occurrence of nosocomial infection; (3)difference in recovery time to arrive at pre-suction baseline after suctioning and in nursing time taken for the suctioning. The present study is based on the data obtained from two groups of newborn infants : one group comprises 8 infants with closed suctioning (a total of 304 suctions) among 17 infants treated with ventilator and the other group 9 infants with open method (a total of 629 suctions). The data were analyzed using the SPSS statistical program package. As the distribution test on dependent variables with the Skewnesser Shapiro Wilk test showed an asymmetric distribution, the Wilcoxon Matched-pairs Singled- Ranks test was used for the test of variations in $SaO_2$, heart rate, and respiration rate appeared before and after the endotracheal suctioning. The difference in $SaO_2$ recovery time and nursing time was analyzed with the Mann-Whitney U-Test. The difference in physiologic consequences and occurrence of nosocomial infection between the two groups was analyzed with the Fisher's Exact Test. The results of the study are summarized as follows. For the hypothesis 1 (There would be a difference in $SaO_2$, heart rate, and respiration rate before and after suctioning between the two suctioning methods), the difference in $SaO_2$ turns out to be statistically significant (P=0.015), but heart rate and respiration rate do not procedure a notable difference (P=0.630). The hypothesis 2 (There would be a difference in rates at which a complication arises after suctioning between the two groups) does not prove to be statistically valid (P=0.246). For the hypothesis 3(There would be a difference in $SaO_2$ recovery time and nursing time between the two groups), the average $SaO_2$ recovery time after suctioning turned out to have somewhat significant difference (P=0.064), however the difference in nursing time taken for the suctioning was not statistically significant (P=0.610). The analyses indicate that the closed endotracheal suctioning is more efficient as compared with the open method, in maintaining pre-suction baseline $SaO_2$ and a rapid recovery of newborn infants. Based on these results we suggust to apply the closed method to newborn infants in the ventilation treatment. We also suggest to extend the investigation to include the comparison of suction cost taking into account the case in which a complication arises after endotracheal suctioning between the two groups.

• Journal of the Korean Society of Marine Environment & Safety
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• v.18 no.2
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• pp.95-100
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• 2012

This study was determined to analysis marine environmental and phytoplankton monitoring in Wando coastal waters in August during the period of 2009-2010 and provided the basic environmental data against Southwest Sea of Korea. In August, 2009, the distribution of water temperature and salinity showed an unique characteristics for all of stations, which was associated with a long duration of rainfall after July, 2009 and a lack of sunshine. In the lower of August, 2010, the stratification of water temperature and salinity was shown, which was caused by an intensive sunshine after the middle of August, 2010. Gangjin Bay and Gogeundo waters showed a highly different water temperature and transparency. It is thought that two regions have a distinct water mass and characteristics. In dissolved oxygen and oxygen saturation were higher according to higher water depth regardless of stations. In August, 2009, different dominant species occurred that Gangjin Bay showed a higher cell density of diatom, but Gonyaulax polygramma played an important role in dominant species in Gogeundo waters. It is associated with the introduction red tide water of G. polygramma occurring to southern coastal water in August, 2009. In August, 2010, diatom was extremely higher cell density compared with that of dinoflagellate that regarded as adaptive microrganism against higher quantity of suspended solid in Wando waters. Although Wando has a record of Cochlodinium red tide, this species may be difficult to grow and persist. Dominant species, diatom, play an important role in food organism for shellfish and forming a ecological lineage.

• Tuberculosis and Respiratory Diseases
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• v.42 no.2
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• pp.206-217
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• 1995

Background: In patients with obstructive sleep apnea syndrome(OSAS), there are several factors increasing upper airway resistance and there is a predisposition to compromised respiratory function during waking and sleep related to constitutional factors including a tendency to obesity. Several recent studies have suggested a possible relationship between sleep apnea(SA) and systemic hypertension. But the possible pathophysiologic link between SA and hypertension is still unclear. In this study, we have examined the relationship among age, body mass index(BMI), pulmonary function parameters and polysomnographic data in patients with OSAS. And also we tried to know the difference among these parameters between hypertensive OSAS and normotensive OSAS patients. Methods: Patients underwent a full night of polysomnography and measured pulmonary function during waking. OSAS was diagnosed if patients had more than 5 apneas per hour(apnea index, AI). A careful history of previously known or present hypertension was obtained from each patient, and patients with systolic blood pressure $\geq$ 160mmHg and/or diastolic blood pressure $\geq$ 95mmHg were classified as hypertensives. Results: The noctural nadir of arterial oxygen saturation($SaO_2$ nadir) was negatively related to AI and respiratory disturbance index(RDI), and the degree of noctural oxygen desaturation(DOD) was positively related to AI and RDI. BMI contributed to AI, RDI, $SaO_2$ nadir and DOD values. And also BMI contributed to $FEV_1,\;FEV_1/FVC$ and DLco values. There was a correlation between airway resistance(Raw) and AI, and there was a inverse correlation between DLco and DOD. But there was no difference among these parameters between hypertensive OSAS and normotensive OSAS patients. Conclusion: The obesity contributed to the compromised respiratory function and the severity of OSAS. AI and RDI were important factors in the severity of hypoxia during sleep. The measurement of pulmonary function parameters including Raw and DLco may be helpful in the prediction and assessment of OSAS patients. But we could not find clear difference between hypertensive and normotensive OSAS patients.

• Journal of the Korean Society of Groundwater Environment
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• v.7 no.3
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• pp.103-115
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• 2000

The formation of brown-colored precipitates is one of the serious problems frequently encountered in the development and supply of groundwater in Korea, because by it the water exceeds the drinking water standard in terms of color. taste. turbidity and dissolved iron concentration and of often results in scaling problem within the water supplying system. In groundwaters from the Pajoo area, brown precipitates are typically formed in a few hours after pumping-out. In this paper we examine the process of the brown precipitates' formation using the equilibrium thermodynamic and kinetic approaches, in order to understand the origin and geochemical pathway of the generation of turbidity in groundwater. The results of this study are used to suggest not only the proper pumping technique to minimize the formation of precipitates but also the optimal design of water treatment methods to improve the water quality. The bed-rock groundwater in the Pajoo area belongs to the Ca-$HCO_3$type that was evolved through water/rock (gneiss) interaction. Based on SEM-EDS and XRD analyses, the precipitates are identified as an amorphous, Fe-bearing oxides or hydroxides. By the use of multi-step filtration with pore sizes of 6, 4, 1, 0.45 and 0.2 $\mu\textrm{m}$, the precipitates mostly fall in the colloidal size (1 to 0.45 $\mu\textrm{m}$) but are concentrated (about 81%) in the range of 1 to 6 $\mu\textrm{m}$in teams of mass (weight) distribution. Large amounts of dissolved iron were possibly originated from dissolution of clinochlore in cataclasite which contains high amounts of Fe (up to 3 wt.%). The calculation of saturation index (using a computer code PHREEQC), as well as the examination of pH-Eh stability relations, also indicate that the final precipitates are Fe-oxy-hydroxide that is formed by the change of water chemistry (mainly, oxidation) due to the exposure to oxygen during the pumping-out of Fe(II)-bearing, reduced groundwater. After pumping-out, the groundwater shows the progressive decreases of pH, DO and alkalinity with elapsed time. However, turbidity increases and then decreases with time. The decrease of dissolved Fe concentration as a function of elapsed time after pumping-out is expressed as a regression equation Fe(II)=10.l exp(-0.0009t). The oxidation reaction due to the influx of free oxygen during the pumping and storage of groundwater results in the formation of brown precipitates, which is dependent on time, $Po_2$and pH. In order to obtain drinkable water quality, therefore, the precipitates should be removed by filtering after the stepwise storage and aeration in tanks with sufficient volume for sufficient time. Particle size distribution data also suggest that step-wise filtration would be cost-effective. To minimize the scaling within wells, the continued (if possible) pumping within the optimum pumping rate is recommended because this technique will be most effective for minimizing the mixing between deep Fe(II)-rich water and shallow $O_2$-rich water. The simultaneous pumping of shallow $O_2$-rich water in different wells is also recommended.

• Journal of Chest Surgery
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• v.38 no.4 s.249
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• pp.277-283
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• 2005

Arterial oxygen saturation $(SaO_2)$ instability frequently takes place after systemic-pulmonary shunt without shunt occlusion. We analyzed actual incidence and risk factors for $SaO_2$ instability after shunt operations, and possible mechanisms were speculated on. Material and Method: Ninety three patients, who underwent modified Blalock-Taussig shunt from January 1996 to December 2000, were enrolled in this study. Adequacy of shunt was verified in all patients, either by ensuing one ventricle or biventricular repair later on or by appropriate pulmonary artery growth on postoperative angiogram. Age, body weight, hemoglobin level at operation were 3 day to 36 years (median: 1.8 months), 2.5kg to 51kg (median: 4.1kg) and $10.7\~24.3$ gm/dL (median: 15.2 gm/dL) respectively. Preoperative diagnoses were functional single ventricle with pulmonary stenosis or atresia in 39, tetralogy of Fallot in 38 and pulmonary atresia with intact ventricular septum in 16. Pulmonary blood flow (PBF) was maintained pre-operatively by patent ductus or previous shunt in 64 and by forward flow through stenotic right ventricular outflow tract (RVOT) in 29. $SaO_2$ instability was defined as $SaO_2$ less than $50\%$ for more than 1 hour with neither anatomic obstruction of shunt nor respiratory problem. Result: 10 patients $(10.7\%)$ showed $SaO_2$ instability after shunt operation. After shunt occlusion was ruled out by echocardiogram, they received measures to lower pulmonary vascular resistance (PVR), which worked within a few hours in all patients. Risk factors for $SaO_2$ instability included older age at operation (p=0.039), lower preoperative $SaO_2$ (p=0.0001) and emergency operation (p=0.001). PBF through stenotic RVOT showed marginal statistical significance (p=0.065). Conclusion: $SaO_2$ instability occurs frequently after shunt operation, especially in patients with severe hypoxia pre-operatively or unstable clinical condition necessitating emergency operation. Temporary elevation of pulmonary vascular resistance is a possible mechanism in this specific clinical setting.

• Journal of Chest Surgery
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• v.38 no.4 s.249
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• pp.271-276
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• 2005

We analysed differences in operative methods and postoperative outcome according to the severity of preoperative cyanosis in adult ToF (Tetralogy of Fallot) patients. Material and Method: From August 1989 to June 2001, thirty three adult patients, 18 females and 15 males, underwent total correction for ToF. Their age ranged from 15 years to 54 years (median: 34). Patients were divided into 2 groups by preoperative $SaO_2$ (arterial oxygen saturation): group I$(n=cyanotic,\;SaO_2\;\geq94\%)$ and group II $(acyanotic,\; SaO_2\geq95%)$. Preoperative median hemoglobin level was higher in group I compared to group II (17.5 g/dl vs 15 g/dl). Postoperative follow-up duration ranged from 1 to 94 months (670 patient-month, median: 14 months), and 63 two-dimensional echocardiographic examinations were done during this period. Result: There were no early or late mortality. With regard to RVOT (right ventricular outflow tract) reconstruction, trans-annular patch and RV-PA extracardiac conduit were used in 7 and 3 patients respectively, and all of them belonged to group I. In group I, cardiopulmonary bypass time, aortic cross-clamping time, ICU day, hospital day were significantly longer than in group II, and postoperative inotropic support was significantly greater than in group II. There was no ventricular arrhythmia in both groups, and one patient in group I suffered from atrial arrhythmia, which was resolved spontaneously after tricuspid and pulmonary valve replacement. During follow-up periods, functional class, residual RVOT stenosis and pulmonary regurgitation, tricuspid regurgitation, occurrence of ventricular and atrial arrhythmias were comparable between two groups. Conclusion: In adult ToF patients with severe preoperative cyanosis, more aggressive RVOT reconstruction and careful postoperative care are mandatory. However intermediate-term outcome of this group of patients is comparable to the patients with minimal or no preoperative cyanosis.

• Clinical and Experimental Pediatrics
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• v.49 no.5
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• pp.523-528
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• 2006

Purpose : The purpose of this study was to investigate the relationship between depression and resilience in adolescents with congenital heart disease(CHD) and to identify the variables associated with depression. Methods : The Resilience Scale(cronbach's ${\alpha}=0.92$), Children's Depression Inventory(cronbach's ${\alpha}=0.72$) and Maternal Behavior Research Instrument(cronbach's ${\alpha}=0.88$) were applied and analyzed to assess depression and resilience among 231 adolescents after surgery for CHD from three major cardiac centers in Korea. This group consist of 114 males and 117 females. The mean age was 15.8 years(range : 13-18 years). The clinical severity of illness was rated by CHD functional index and NYHA functional class. Results : The mean score for depression and resilience was 16.74(range : 0-49) and 115.84(range : 70-132) respectively. Depression was significantly related to age(r=0.25, P<0.001) and NYHA functional class(r=0.35, P<0.001), as well as being negatively correlated with oxygen saturation(r=-0.39, P<0.001), academic achievement(r=-0.41, P<0.001), parental attitude(r=-0.49, P<0.001) and resilience (r=-0.59, P<0.001). The results of multiple regression analysis showed that parental attitude(${\beta}=-0.48$, P<0.01) and resilience(${\beta}=-0.62$, P<0.01) were related to depression. Conclusion : This study demonstrated that adolescents with CHD had a higher resilience and were less depressed with an affectionate parent. With respect to medical and nursing intervention programs, it is essential to identify strengths of adolescents with CHD in order to increase their resilience. Additionally, it is also important that parenting and counseling programs be implemented for the parents of adolescents with CHD.

• Journal of Chest Surgery
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• v.31 no.8
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• pp.749-755
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• 1998

Background: Twelve patients with acyanotic tetralogy of Fallot(TOF), characterized by the combination of a malaligned ventricular septal defect(VSD) and infundibular pulmonic stenosis with the clinical finding of acyanosis at rest, underwent surgical correction between January 1988 and July 1997. Materials and methods: 9.92% of patients with the diagnosis of TOF were acyanotic TOF in the same period. Ages ranged from 12 to 42 months(mean 25.2 months). 2D-echocardiographic studies, cardiac catheterization, and angiocardiograms were performed in all patients before operation. The preoperative mean systemic arterial oxygen saturation was 93.5%. According to the 2D-echocardiographic analysis, there was Lt-to-Rt shunt through VSD in 4 patients, bidirectional shunt in 2 patients, and no shunt in 6 patients. Results: The preoperative mean right ventricle to pulmonary artery(RV-PA) pressure gradients were 52.3 mmHg on 2D- echocardiogram and 48.4 mmHg on cardiac catheterization. The repair of ventricular septal defect was performed through a right atrial approach and the hypertrophic infundibular muscle bundles were resected by the transatrial and transpulmonary approach. Six patients(50%) received a transannular patch. The mean cardiopulmonary bypass time was 135.0 minutes, and the aortic crossclamp time was 87.8 minutes. Postoperative complications included bleeding necessitating reentry in one and chylothorax in one. No patient died after operation and there were no late deaths. Postoperative 2D-echocardiograms revealed tiny patch dehiscence in 5 cases and a moderate RV-PA pressure gradients(mean 15.3 mmHg). All patients were in New York Heart Association functional class 1 after operation. Conclusions: acyanotic TOF is the uncommon form of TOF, and acyanotic TOF can be repaired with a good outcome.

• Sleep Medicine and Psychophysiology
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• v.19 no.1
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• pp.22-26
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• 2012

Objectives: The percentage of positional sleep apnea in obstructive sleep apnea (OSA) varies in different reports from 9% to 60%. If there is a positional dependency in patients with OSA, positional therapy alone could be successful in treating about 50% of all OSA cases. The aim of this report is to compare anthropomorphic and polysomnographic data between the positional sleep apnea group and non-positional sleep apnea group with OSA whose conditions were diagnosed in our sleep clinic. Methods: This is a retrospective study of anthropomorphic and polysomnographic data of patients with OSA who was performed a nocturnal polysomnography. Positional sleep apnea was defined as having a supine apnea-hypopnea index (AHI) of twice or more compared to the AHI in the non-supine position. The patients were divided in the positional sleep apnea group and the non-positional sleep apnea group. Results: In 101 patients with OSA, 81 were male, and the mean age was $49.2{\pm}11.9$ years. Seventy-six (75.2%) were diagnosed as the positional sleep apnea. Waist to hip ratio and body mass index (BMI) were significantly higher in non-positional sleep apnea group. The frequency of severe OSA was significantly higher in this group. In the positional sleep apnea group, nocturnal sleep quality was better preserved, and consequently these patients were less sleepy during daytime. AHI was significantly lower and minimal arterial oxygen saturation during sleep was significantly higher in this group. Conclusion: The percentage of positional sleep apnea in OSA was 75.2%. AHI, BMI, and waist to hip ratio were lower in the positional sleep apnea group. These patients have less severe breathing abnormalities than the non-positional sleep apnea group in polysomnography.