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Compilation of 104 Experimental Theses on the Antitumor and Immuno-activating therapies of Oriental Medicine (한의학의 항종양 면역치료에 관한 연구 -1990년 이후 발표된 실험논문을 중심으로-)

  • Kang Yeon Yee;Kim Tai Im;Park Jong Ho;Kim Sung Hoon;Park Jong Dai;Kim Dong Hee
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.17 no.1
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    • pp.1-24
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    • 2003
  • This study was done to compile 104 experimental theses which are related to the antitumor and immuno-activating therapies between February 1990 through February 2002. Master's and doctoral theses were dassified by schools, degrees, materials, effects, experimental methods of antitumor and immunoactivity, and results. The following results were obtained from this study : 1. Classifying the theses by the school, 34.6% were presented by Daejeon University, 29.8% by Kyung-hee University and 11.5% by Won-kwang University. Of all theses, 51.0% were aimed for the doctoral degree and 43.3% were for the master's degree. All of three universities have their own cancer centers. 2. Classifying the theses by herb materials, complex prescription accounted for 60.3%, single herb accounted for 24.8% and herbal acupuncture accounted for 14.2%. Considering the key principles of the traditional medicine, complex prescription was much more thoroughly studied than single herb prescription. The results showed that the complex prescription had both antitumor activity and immuno-activating activity, which might reflects on multi-activation mechanisms by complex components. 3. Classifying the theses by the efficacy of herbs examined, in single herb, invigorating spleen and supplementing was 35.5%, expelling toxin and cooling was 29.0%, activating blood flow and removing blood stasis was 12.9%. In herbal acupuncture, invigorating spleen and supplementing was 52.9%, expelling toxin and cooling was 29.4%. In complex prescription, pathogen-free status was 41.9%, strengthening healthy qi to eliminate pathogen was 35.5%, strengthening healthy qi was 22.6%. It is presumed that the antitumor and immunoactivating therapy based on syndrome differentiation is the best way to develop oriental oncology. 4. Classifying the theses by antitumor experiments, cytotoxic effect was 48.1 %, survival time was 48.1 % and change of tumor size was 42.3%. Survival rate was not necessarily correlated with cytotoxicity. These data reflect the characteristic, wholistic nature of the oriental medicine which is based on BRM (biological response modifier). 5. Classifying the theses by immunoactivating experiments, hemolysin titer was 51.0%, hemagglutinin titer was 46.2% and NK cell's activity was 44.2%. In the future studies, an effort to elucidate specific molecular and cellular mechanisms of cytokine production in the body would be crucial. 6. Classifying the theses according to the data in terms of antitumor activity, 50% was evaluated good, 24.0% was excellent, and 15.5% have no effect. In an evaluation of immuno-activating activity, 35.9% was excellent and 18.0% showed a little effect. The index point, as described here, may helps to use experimental data for clinical trials. Changes in index points by varying dosage implicate the importance of oriental medical theory for prescription. 7. In 167 materials, IIP (immunoactivating index point, mean : 3.12±0.07) was significantly higher than AIP(antitumor index point, mean : 2.83±0.07). These data demonstrate that the effect of herb medicine on tumor activity depends more on immunoactivating activity than antitumor activity. This further implies that the development of herbal antitumor drugs must be preceded by the mechanistic understanding of immunoactivating effect. 8. After medline-searching tumor and herb-related articles from NCBI web site, we conclude that most of the studies are primarily focused on biomolecular mechanisms and/or pathways. Henceforth, we need to define the biomolecular mechanisms and/or pathways affected by herbs or complicated prescriptions. 9. Therefore, the most important point of oriental medical oncology is to conned between experimental results and clinical trials. For the public application of herbal therapy to cancer, it is critical to present the data to mass media. 10. To develop the relationship of experimental results and clinical trials, university's cancer clinic must have a long-range plan related to the university laboratories and, at the same time, a regular consortium for this relationship is imperative. 11. After all these efforts, a new type herbal medicine for cancer therapy which is to take care of the long-term administering and safety problem must be developed. Then, it would be expected that anti-tumor herbal acupuncture can improve clinical symptoms and quality of life (QOL) for cancer patients. 12. Finally, oriental medical cancer center must be constructed in NCC (National Cancer Center) or government agency for the development of oriental medical oncology which has international competitive power.

Residual Characteristics of Insecticide Acetamiprid in Asparagus under Greenhouse Condition (시설재배 아스파라거스 중 살충제 acetamiprid의 잔류특성)

  • Kim, Jiwon;Lee, Jungmin;Lee, Doseung;Kang, Seungtae;Kim, Dae-Woon;Lee, Dong-Sun;Riu, Key-Zung;Boo, Kyung Hwan
    • The Korean Journal of Pesticide Science
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    • v.19 no.3
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    • pp.204-209
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    • 2015
  • This study was carried out to investigate residual characteristics of insecticide acetamiprid in asparagus under greenhouse condition from July to August and consequentially to obtain basic data for guideline on safe use of this pesticide in asparagus. Residues of acetamiprid in young stem of asparagus before and after removing foliage were analyzed from samples harvested at 0, 1, 3, 5 and 7 days after single application before harvest. As a result, residues of acetamiprid in young stem of asparagus before and after removing foliage at 0 day were 0.27 mg/kg and 0.14 mg/kg, respectively, which were higher than tentative limit (0.1 mg/kg). However, 3 days later residues of acetamiprid were lower than the tentative limit, representing 0.08 mg/kg and 0.03 mg/kg in the asparagus before and after removing foliage, respectively. Acetamiprid was undetectable in both samples at 5 days since the concentrations were less than detection limit (0.02 mg/kg) in this study. In summary, the half-life of acetamiprid in asparagus regardless of removing foliage was quite short under greenhouse condition from July to August, in the range of 1-3 days, and single application of acetamiprid water dispersible granule in/on asparagus at 7 days before harvest would have no problem on safety issues about pesticide residue. This result might be basic information to construct guideline for safe use of acetamiprid in asparagus.

A Study on Replay Experiments and Thermal Analysis for Autoignition Phenomenon of Shredded Waste Tires (폐타이어 분쇄물의 자연발화현상에 대한 재연실험 및 열분석에 관한 연구)

  • Koh, Jae Sun;Jang, Man Joon
    • Fire Science and Engineering
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    • v.26 no.6
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    • pp.99-108
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    • 2012
  • These days, spontaneous ignition phenomena by oxidizing heat frequently occur in the circumstances of processing and storing waste tires. Therefore, to examine the phenomena, in this work, this researcher conducted the tests of fires of fragmented waste tires (shredded tire), closely investigated components of the fire residual materials collected in the processing and storing place, and analyzed the temperature of the starting of the ignition, weight loss, and heat of reaction. For the study, this researcher conducted fire tests with fragmented waste tires in the range of 2.5 mm to 15 mm, whose heat could be easily accumulated, and performed heat analysis through DSC and TGA, DTA, DTG, and GC/MS to give scientific probability to the possibility of spontaneous ignition. According to the tests, at the 48-hour storage, rapid increase in temperature ($178^{\circ}C$), Graphite phenomenon, smoking were observed. And the result from the DTA and DTG analysis showed that at $166.15^{\circ}C$, the minimum weight loss occurred. And, the result from the test on the waste tire analysis material 1 (Unburnt) through DSC and TGA analysis revealed that at $180^{\circ}C$ or so, thermal decomposition started. As a result, the starting temperature of ignition was considered to be $160^{\circ}C$ to $180^{\circ}C$. And, at $305^{\circ}C$, 10 % of the initial weight of the material reduced, and at $416.12^{\circ}C$, 50 % of the intial weight of the material decreased. The result from the test on oxidation and self-reaction through GC/MS and DSC analysis presented that oxidized components like 1,3 cyclopentnadiene were detected a lot. But according to the result from the heat analysis test on standard materials and fragmented waste tires, their heat value was lower than the basis value so that self-reaction was not found. Therefore, to prevent spontaneous ignition by oxidizing heat of waste tires, it is necessary to convert the conventional process into Cryogenic Process that has no or few heat accumulation at the time of fragmentation. And the current storing method in which broken and fragmented materials are stored into large burlap bags (500 kg) should be changed to the method in which they are stored into small burlap bags in order to prevent heat accumulation.

The Risk Factors Influencing the Postoperative Mortality of the Patients with an Abdominal Aortic Aneurysm (복부대동맥류 환자에서의 수술 후 사망의 위험인자 분석)

  • Lee, Seong-Kwang;Jun, Hee-Jae;Park, Kyung-Taek;Yoon, Young-Chul;Han, IL-Yong;Lee, Yang-Haeng;Cho, Kwang-Hyun
    • Journal of Chest Surgery
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    • v.43 no.6
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    • pp.655-662
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    • 2010
  • Background: Despite the rapid expansion of percutaneous endovascular repair, open surgical repair is still recognized as an option to achieve a cure. We retrospectively analyzed over a 6 year period the surgical outcomes, the complications and the mortality-related factors for patients with abdominal aortic aneurysms. Material and Method: We analyzed 36 patients who underwent surgery for abdominal aortic aneurysms between May 2001 and June 2005, and between April 2007 and November 2009. The indications for surgery were rupture, a maximal aortic diameter > 50 mm, and medically intractable hypertension or pain. Result: The mean patient age was $69.67{\pm}6.97$ years (range: 57 to 84 years). Thirty two patients (88.9%) were males and 4 patients (11.1%) were females. Extension to the iliac artery existed in 28 patients (77.8%). Thirteen patients (36.1%) had ruptured aortic aneurysms. The mean maximal diameter of the aorta was $73.7{\pm}13.3$ mm (60 to 100 mm). Surgery was performed by a midline laparotomy and 10 patients (27.8%) underwent emergency surgery. The mortality rate was 8.3%; the mortality rate for the patients with ruptured aneurysms was 23.1 % and the mortality rate for patients with unruptured aneurysms was 0%. The postoperative complications included wound infection (3 cases), sepsis (2 cases), renal failure (2 cases) and pneumonia (1 case). Unstable vital signs, pre-operative transfusion, ruptured aneurysm, emergency surgery, comorbidity (DM and syncope) and complications (sepsis and renal failure) were the statistically significant mortality-related factors (p < 0.05). Conclusion: Emergency surgery for ruptured aortic aneurysms continues to have high mortality, but the unruptured cases are repaired with relative safety. Even though endovascular aortic repair is the trend for abdominal aortic aneurysms, an elective operation of the unruptured aneurysms could decrease the procedure's morbidity and the inconvenient for repeat evaluation with good surgical results.

A Study on Integrated Logistic Support (통합병참지원에 관한 연구)

  • 나명환;김종걸;이낙영;권영일;홍연웅;전영록
    • Proceedings of the Korean Reliability Society Conference
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    • 2001.06a
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    • pp.277-278
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    • 2001
  • The successful operation of a product In service depends upon the effective provision of logistic support in order to achieve and maintain the required levels of performance and customer satisfaction. Logistic support encompasses the activities and facilities required to maintain a product (hardware and software) in service. Logistic support covers maintenance, manpower and personnel, training, spares, technical documentation and packaging handling, storage and transportation and support facilities.The cost of logistic support is often a major contributor to the Life Cycle Cost (LCC) of a product and increasingly customers are making purchase decisions based on lifecycle cost rather than initial purchase price alone. Logistic support considerations can therefore have a major impact on product sales by ensuring that the product can be easily maintained at a reasonable cost and that all the necessary facilities have been provided to fully support the product in the field so that it meets the required availability. Quantification of support costs allows the manufacturer to estimate the support cost elements and evaluate possible warranty costs. This reduces risk and allows support costs to be set at competitive rates.Integrated Logistic Support (ILS) is a management method by which all the logistic support services required by a customer can be brought together in a structured way and In harmony with a product. In essence the application of ILS:- causes logistic support considerations to be integrated into product design;- develops logistic support arrangements that are consistently related to the design and to each other;- provides the necessary logistic support at the beginning and during customer use at optimum cost.The method by which ILS achieves much of the above is through the application of Logistic Support Analysis (LSA). This is a series of support analysis tasks that are performed throughout the design process in order to ensure that the product can be supported efficiently In accordance with the requirements of the customer.The successful application of ILS will result in a number of customer and supplier benefits. These should include some or all of the following:- greater product uptime;- fewer product modifications due to supportability deficiencies and hence less supplier rework;- better adherence to production schedules in process plants through reduced maintenance, better support;- lower supplier product costs;- Bower customer support costs;- better visibility of support costs;- reduced product LCC;- a better and more saleable product;- Improved safety;- increased overall customer satisfaction;- increased product purchases;- potential for purchase or upgrade of the product sooner through customer savings on support of current product.ILS should be an integral part of the total management process with an on-going improvement activity using monitoring of achieved performance to tailor existing support and influence future design activities. For many years, ILS was predominantly applied to military procurement, primarily using standards generated by the US Government Department of Defense (DoD). The military standards refer to specialized government infrastructures and are too complex for commercial application. The methods and benefits of ILS, however, have potential for much wider application in commercial and civilian use. The concept of ILS is simple and depends on a structured procedure that assures that logistic aspects are fully considered throughout the design and development phases of a product, in close cooperation with the designers. The ability to effectively support the product is given equal weight to performance and is fully considered in relation to its cost.The application of ILS provides improvements in availability, maintenance support and longterm 3ogistic cost savings. Logistic costs are significant through the life of a system and can often amount to many times the initial purchase cost of the system.This study provides guidance on the minimum activities necessary to Implement effective ILS for a wide range of commercial suppliers. The guide supplements IEC60106-4, Guide on maintainability of equipment Part 4: Section Eight maintenance and maintenance support planning, which emphasizes the maintenance aspects of the support requirements and refers to other existing standards where appropriate. The use of Reliability and Maintainability studies is also mentioned in this study, as R&M is an important interface area to ILS.

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Effects of Polyclonal Antibodies to Abdominal and Subcutaneous Adipocytes on Ruminal Fermentation Patterns and Blood Metabolites in Korean Native Steers (한우 복강 및 피하지방 감소 다클론 항체가 반추위 발효패턴 및 혈액 대사물질에 미치는 영향)

  • Choi, Chang-Weon;Baek, Kyung-Hoon;Kim, Sung-Jin;Oh, Young-Kyoon;Hong, Seong-Koo;Kwon, Eung-Gi;Song, Man-Kang;Choi, Chang-Bon
    • Journal of Animal Science and Technology
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    • v.51 no.3
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    • pp.231-240
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    • 2009
  • Sixteen ruminally cannulated Korean native steers (Hanwoo; $626.2\pm47.72$ kg) were used to investigate the effects of polyclonal antibodies against abdominal (AAb) and subcutaneous adipocyte membrane proteins (SAb) on ruminal fermentation patterns and blood metabolites. The body weight (BW) of Hanwoo was decreased 2-weeks after AAb and SAb injection, BW reduction was also observed in control and non-immunized serum groups, indicating that stress induced by other factors (e.g. blood sampling etc.) rather than antibodies injection may affect the BW reduction. Antibodies treatment did not affect (P > 0.05) rumen pH, volatile fatty acids and ammonia-N concentration. The ranges were similar with typical ranges of those in Hanwoo. Compared with control, blood urea N concentration was decreased in AAb group and increased (P < 0.05) in SAb group before antibodies treatment. However, none of the groups were significantly (P > 0.05) affected at 2- or 4-weeks after the treatment. Concentration of plasma glucose in the non-immunized serum group was significantly higher (P < 0.05) than the other groups at 0-week after treatment. However, antibodies treatment did not affect the concentration of plasma glucose. Concentration of plasma triglyceride showed no difference (P > 0.05) between the groups and ranged from 11.4 to 19.9 mg/dl, which is the perfect range of plasma triglyceride of Hanwoo fed concentrate based diets. In conclusion, these results may indicate that the present AAb and SAb have safety in nutritional physiological metabolism in Hanwoo. Further study on in vivo fat reduction of the antibodies against abdominal and subcutaneous adipocytes PMPs of Hanwoo is required for inedible fat-reduced high quality beef production.

Compositions and Contents of Thinner and Reliability of MSDS sold in Busan and Gyeongnam Province (부산,경남에서 판매되는 시너(Thinner)의 구성 성분 중 벤젠 등 일부 독성물질의 함량과 물질안전보건자료에 관한 연구)

  • Kim, Yu Young;Yang, Seung Hyuk;Lee, Jung Sil;Lee, Hyoung Sook;Jang, Kong Hwa;Jin, Koo Won;Lee, Yong Il;Joo, Woo Hong;Paik, Do-Hyeon;Kang, Dae-Ook;Moon, Ja-Young;Cho, Yong-Kweon;Park, Dong Uk;Yoon, Chung Sik;Ha, Kwon Chul
    • Journal of Korean Society of Occupational and Environmental Hygiene
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    • v.16 no.4
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    • pp.314-323
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    • 2006
  • This study was conducted to identify ingredients of thinners and to confirm reliability of material safety data sheets (MSDS) of thinners for public and workers' health. The 41 thinner products were collected from paint shops located in Busan and Gyeongnam province. The 12 thinner products among them were identified using product MSDS. GC-MSD was used to analyze 41 kinds of thinners qualitatively and quantitatively. The 12 products MSDS were compared with thinner's component through qualitative analysis to confirm MSDS. Chemical ingredients, such as Benzene, Toluene, and Xylene etc., of thinners were analysed in quantity. The 41 thinner products contained 17 disclosed specific, trade name, or generically described chemical solvent ingredients. These 17 ingredients came under 6 classes: alcohols, aromatic hydrocarbons, esters, glycol ethers, ketones, and mixtures. These 17 ingredients were important in the view of industrial hygiene and had occupational exposure limit in the ambient, such as toluene, xylene, acetone, nonane, EGEE, heptane, cumene, MIBK, indene, tri-methyl benzene, etc, were found in 41 kinds of thinners. Aromatic hydrocarbons were the most identified ingredient in thinners. Especially, the benzene, which induces leukemia, was found in 4 kinds of thinners. The content rates of benzene in thinners were 0.25~1.18%. The benzene in enamel thinner, which were 0.39~0.72%, was highest from chemical classification. The contents of toluene, which was found from 27 kinds of thinners, were 5.35~64.16%, which were highest in sobu thinner as 58.80%. Xylene was found from 22 kinds of thinners and contents of xylene were 4.61~72.42%. Acrylic thinner's contents of xylene were 12.06~51.05%, which was most high. It was found that contents of benzene were increased and frequency of detection was decreased through comparison with other study. The MSDS possession rate of paint shops was low as 29.27%. So it did not provide information with public or workers. Mean of agreement rate between MSDS and components of thinners through qualitative analysis was 42.01% and it has wide range from 8.3% to 75%. There are many deficiencies in MSDS about component of thinners. In some case of sample, expecially, despite containing benzene, information was not written it on MSDS.

Aspect of the chief of state guard EMP (Electro Magnetic Pulse) protection system for the consideration (국가원수 경호적 측면에서의 EMP(Electro Magnetic Pulse) 방호 시스템에 대한 고찰)

  • Jung, Joo-Sub
    • Korean Security Journal
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    • no.41
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    • pp.37-66
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    • 2014
  • In recent years, with the development of computers and electronics, electronics and communication technology in a growing and each part is dependent on the cross-referencing makes all electronic equipment is obsolete due to direct or indirect damage EMP. Korea and the impending standoff North Korea has a considerable level of technologies related to the EMP, EMP weapons you already have or in a few years, the development of EMP weapons will complete. North Korea launched a long-range missile and conducted a nuclear test on several occasions immediately after, when I saw the high-altitude nuclear blackmail has been strengthening the outright offensive nuclear EMP attacks at any time and practical significance for the EMP will need offensive skills would improve. At this point you can predict the damage situation of Korea's security reality that satisfy the need, more than anything else to build a protective system of the EMP. The scale of the damage that unforeseen but significant military damage and socio-economic damage and fatalities when I looked into the situation which started out as a satellite communications systems and equipment to attack military and security systems and transportation, finance, national emergency system, such as the damage elsewhere. In General, there is no direct casualties reported, but EMP medical devices that rely on lethal damage to people who can show up. In addition, the State power system failure due to a power supply interruption would not have thought the damage would bring State highly dependent on domestic power generation of nuclear plants is a serious nuclear power plant accident in the event of a blackout phenomenon can lead to the plant's internal problems should see a forecast. First of all, a special expert Committee of the EMP, the demand for protective facilities and equipment and conduct an investigation, he takes fits into your budget is under strict criteria by configuring the contractors should be sifting through. He then created the Agency for verification of performance EMP protection after you have verified the performance of maintenance, maintenance, safety and security management, design and construction company organized and systematic process Guard facilities or secret communications equipment and perfect for the EMP, such as protective equipment maneuver system should take.

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Early Clinical Experience in Valve Replacement Using On-X Prosthetic Heart Valve (On-X 기계판막을 이용한 판막치환술의 단기성적분석)

  • 김인섭;김우식;신용철;유환국;김병열;정성철
    • Journal of Chest Surgery
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    • v.37 no.9
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    • pp.742-748
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    • 2004
  • The On-X valve was recently introduced. It was the aim of this study to assess the safety and feasibility from the data derived from 28 patients who underwent aortic and/or mitral valve replacement with this prosthesis in National Medical Center. Material and Method: From May 1999 and May 2003, a series of 28 consecutive patients who had been implanted with 32 On-X prosthesis were reviewed, The operative procedure comprised of 12 MVR, 10 AVR and 6 DVR. The study followed the guidelines of AATS/STS. Mean follow-up was 27 months (total 04 patient-years). Result: Early ($\leq$30 days) mortality was 7.44% (2/28) and no late mortality occurred in the study. Total actuarial freedom from mortality at 2 years was 92.86$\pm$4.87% for all cases, 100% for MVR, 90$\pm$9.49% for AVR, and 83.3$\pm$1.52% for DVR. Thromboembolic event occurred in 2 MVR patients and that was the only complication; therefore, the linearized incidence of valve related complications was 3.17%/ patient-years for all cases and 6.5%/patient-years for MVR and the actuarial freedom from valve related complications at 2 years was 84.85$\pm$10.75%. Preoperatively, 24 (85.71%) patients were in NYHA functional class III or IV but postoperatively, 25 (89,29%) patients were in NYHA functional class I or II. The levels of hemoglobin, hematocrit, serum LDH, reticulocyte rate and indirect bilirubin were all within normal range at postoperative 3 month. In mitral position, the peak gradient was 6.1$\pm$1.8 mmHg and the mean gradient was 3.0$\pm$0.6 mmHg and EOA were 2.54$\pm$0.56 $m^2$, 2.39$\pm$0.73 $m^2$, 2.34$\pm$0.55 $m^2$, 2.40$\pm$0.63 $m^2$ at 27 mm, 29 mm, 31 mm, 33 mm respectively. In aortic postion, the peak gradient was 21.1 $\pm$14.12 mmHg and the mean gradient was 12.3$\pm$6.52 mmHg. Conclusion: Since there was no significant difference in the postoperative mortality, valve related complications and echocardiographic hemodynamic data compared to standard bileaflet design and since there was an improvement in the NYHA functional class and normal values of hemolytic indicators, it can be assumed that On-X valve is safe and feasible. However, accumulation of cases and long-term follow-up of this patient group is needed to establish this result.

Sinus Node Function after Extended Transseptal Approach for Mitral Valve Surgery: 164 Clinical Cases (경중격 절개방식을 좌심방 상부까지 연장시킨 방법을 통한 승모판막 수술 후 동방 결절 기능부전에 대한 164예 임상분석)

  • Ryu Se Min;Kim Hyun Koo;Cho Yang Hyun;Sim Jae Hoon;Sohn Young-sang;Choi Young Ho;Kim Hark Jei
    • Journal of Chest Surgery
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    • v.38 no.3 s.248
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    • pp.214-220
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    • 2005
  • Extended transseptal approach can provide an excellent view of the mitral valve but the safety of this approach is controversial because this incision requires transaction of the sinus node artery, which in most cases and can result postoperative arrhythmia. The purpose of this study was to evaluate perioperative and longterm conduction disturbances and the cardiac rhythms of patients who underwent an extended transseptal approach for mitral valve surgery. Material and Method: Postoperative cardiac rhythms were analyzed in the 164 consecutive patients who received mitral valve replacements with a extended transseptal approach between March 1992 and July 2003. Result: Of the 84 patients in normal sinus rhythm, 34 ($39\%$) had developed transient junctional rhythm and atrial fibrillation after operation, lasting less than 72 hours in most of cases. No intractable arrhythmias occurred. Most of these arrhythmia were not detected at the time of discharge and only 8 patients ($9\%$) had atrial fibrillation at discharge. Postoperative PR intervals increased for 1 week, then decreased within 2 weeks postoperatively, and returned to normal range by 6 months postoperatively. During the postoperative period, 4 of the 78 patients with preoperative atrial fibrillation developed normal sinus thythm. Conclusion: The post-operative arrhythmias were temporary and showed no significant complications after extended transseptal approach for the mitral valve surgery.