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Preoperative Risk Factors for the Prognosis of Mitral Regurgitation in Patients with Coronary Artery Stenosis and Mitral Regurgitation Who Underwent Coronary Artery Bypass Surgery Alone (승모판폐쇄부전증을 동반한 관상동맥협착증 환자에서 시행한 단독 관상동맥우회술 후 승모판폐쇄부전증의 예후에 영향을 미치는 수술 전 요인)

  • Jin, Ung;Park, Chan-Beom;Choi, Si-Young;Kim, Chi-Kyung
    • Journal of Chest Surgery
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    • v.37 no.5
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    • pp.410-415
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    • 2004
  • Background: In the operation for coronary artery stenosis, the procedures for mitral regurgitation are restricted to cases of more than moderate mitral regurgitation or for the lesions in leaflets. This is based on the belief that the less than mild regurgitation are a form of reversible change results from ischemia with coronary artery stenosis. We studied the changes and prognostic factors of mitral regurgitation in patients with coronary artery stenosis and mitral regurgitation who underwent coronary artery bypass surgery alone. Material and Method: We reviewed the medical records of 90 patients with coronary artery stenosis and mitral regurgitation who underwent coronary artery bypass surgery alone by a single surgeon from Jan. 1995 to Dec. 2002, We grouped the patients according to the postoperative changes of mitral regurgitation, and then we statistically compared the findings of echocardiogram between preoperative and last follow up. Result: There were 24 cases with progression of mitral regurgitation, 12 cases without changes, 54 cases with improvements of mitral regurgitation in total 90 patients. The bypass to LAD was proven as the significant prognostic factor of mitral regurgitation. The preoperative end diastolic left ventricular volume index were higher in aggravated group with 105.38$\pm$38.89 $m\ell$ compared to 71.75$\pm$28,45 $m\ell$ in improvement group, and 84.00$\pm$11.66 $m\ell$ in no change group. The grade of preoperative mitral regurgitation did not show significant differences among the groups. Conclusion: The mitral regurgitation in patient with coronary artery stenosis can be improved after the coronary artery bypass surgery alone. However, the expectation of improvements based on the degree of preparative mitral regurgitation can not be justified, therefore, the procedures for mitral regurgitation should be aggressively considered even in the cases of mild mitral regurgitation. Also, further study should be performed to identify the exact prognostic factors of mitral regurgitation including the left ventricular volume index, and whether the left anterior descending artery has been bypassed.

Acute Renal Failure after On-pump Coronary Artery Bypass Surgery (체외순환하 시행한 관상동맥우회술 후 발생한 급성신부전증)

  • Jin, Ung;Jo, Min-Seop;Park, Chan-Beom;Sa, Young-Jo;Kim, Chi-Kyung
    • Journal of Chest Surgery
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    • v.37 no.5
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    • pp.416-422
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    • 2004
  • Acute renal failure (ARF) is a common postoperative complication after the cardiac surgery. Postoperative ARF have various causes, and are combined with other complications rather than being the only a complication. It deteriorates the general condition of the patient, and makes it difficult to manage the combined complications by disturbing the adequate medication and fluid therapy. We have planned this study to evaluate the effects of postoperative ARF after the on-pump coronary artery bypass surgery (CABG) on the recovery of patients and identify the risk factors. Method and Material: We reviewed the medical records of patients who underwent CABG with cardiopulmonary bypass by a single surgeon from Jan. 2000 to Dec. 2002, We checked the preoperative factors; sex, age, history of previous serum creationism over 2.0 mg/㎗, preoperatively last checked serum creatinine, diabetes, hypertension, left ventricular ejection fraction, intraoperative factors; whether the operation is an emergent case or not, cardiopulmonary bypass time, aortic cross clamp time, the number of distal anastomosis, postoperative factors: IABP. Then we have studied the relations of these factors and the cases of postoperative peak serum creatinine over 2.0 mg/㎗. Result: There were 19 cases with postoperative peak serum creatinine over 2.0 mg/㎗ in a total 97 cases. Dialysis were done in 3 cases for ARF with pulmonary edema and severely reduced urine output. There were 8 cases (42.1%) with combined complications among the 19 patients. This finding showed a significant difference from the 5 cases (6,4%) in the patients whose creatinine level have not increased over 2.0 mg/㎗. The mortalities are different as 1.3% to 10.5%. The risk factors that are related with postoperative serum creatinine increment over 2.0 mg/㎗ are diabetes, the history of previous serum creatinine over 2.0 mg/㎗ and left ventricular ejection fraction. Conclusion: Postoperative ARF after the on-pump CABG is related with preoperative diabetes, the history of previous serum creatinine over 2,0 mg/㎗ and left ventricular ejection fraction. Postoperative ARF could De the reason for increased rate of complications and mortality after on-pump CABG. Therefore, in the patients with these risk factors, the efforts to prevent postoperative ARF like off-pump CABG should be considered.

Comparison of the Mid-term Changes at the Remnant Distal Aorta after Aortic Arch Replacement or Ascending Aortic Replacement for Treating Type A Aortic Dissection (A형 급성대동맥박리증에서 대동맥궁치환술과 상행대동맥치환술 후 잔존 원위부 대동맥의 변화에 대한 중기 관찰 비교)

  • Cho, Kwang-Jo;Woo, Jong-Su;Bang, Jung-Hee;Choi, Pill-Jo
    • Journal of Chest Surgery
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    • v.40 no.6 s.275
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    • pp.414-419
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    • 2007
  • Background: Replacing the ascending aorta is a standard surgical option for treating acute type A aortic dissection. But replacing the aortic arch has recently been reported as an acceptable procedure for this disease. We compared the effects of aortic arch replacement for treating acute type A aortic dissection with the effects of ascending aortic replacement. Material and Method: From 2002 to 2006, 25 patients undewent surgical treatment for acute type A aortic dissection, 12 patients undewent ascending aortic replacement and 13 patients underwent aortic arch replacement. Among the aortic arch group, an additional distal stent-graft was inserted during the operation in 5 patients. 19 patients (11 arch replaced patients and 8 ascending aortic replaced patients) were followed up at the out patient clinic for an average of $756{\pm}373$ days. All the patients undewent CT scanning and we analyzed their distal aortic segments. Result: 4 patients who underwent ascending aortic replacement died, so the overall mortality rate was 16%. Among the 11 long term followed-up arch replacement patients, 2 patients (18.1 %) developed distal aortic dilatation and one of them underwent thoracoabdominal aortic replacement later on. However, among the 8 the ascending aortic replaced patients, 5 patients (62.5%) developed distal aortic dilatation. Conclusion: Aortic arch replacement is one of the safe options for treating acute type A aortic dissection. Aortic arch replacement for treating acute type A aortic dissection could contribute to a reduced distal aortic dilatation rate and fewer secondary aortic procedures.

Surgical Results for Treating Postpneumonectomy Empyema with BPF by Using an Omental Pedicled Flap and Thoracoplasty (전폐절제술 후 기관지 흉막루를 동반한 농흉에서 유경성 대망 이식편과 흉곽성형술을 이용한 수술적 치료에 대한 임상 고찰)

  • Jeong, Seong-Cheol;Kim, Mi-Jung;Song, Chang-Min;Kim, Woo-Shik;Shin, Yong-Chul;Kim, Byung-Yul
    • Journal of Chest Surgery
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    • v.40 no.6 s.275
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    • pp.420-427
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    • 2007
  • Background: Postpneumonectomy empyema (PPE) due to bronchopleural fistula (BPF) can be a surgical challenge for surgeons. We analyzed the follow-up outcomes after performing omentopexy and thoracoplasty for the treatment of PPE with BPF after pneumonectomy. Material and Mehod: Between December 1991 and January 2006, 9 patients underwent BPF closure using an omental pedicled flap for the treatment of PPE with BPF after pneumonectomy. There were 7 males and 2 females (mean age: $45.9{\pm}9$ years). The patients were followed up for a mean of 58 months (median: 28 months, range: $6{\sim}169$). When we performed omentopexy, the surgical procedures for empyema were thoracoplasy for 8 patients and the Clagett procedure for 1 patient. Thoracoplasty was performed for the latter patient due to recurrence of empyema, Result: For the 8 patients who were treated by omentopexy and thoracoplasty, there was 1 operation-related death due to sepsis. During follow up, 1 patient, who was treated by omentopexy and a Clagett procedure, died of acute hepatitis 40 months postoperatively. The early mortality was 11.1% (8/9). Of the 8 patients, including the 1 late death patient, successful closure of the BPF were achieved in all patients (8/9) and the empyema was cured in 7 patients (7/8). Conclusion: The BPF closure using an omental pedicled flap was an effective method for treating PPE with BPF due to 75-destroyed lung, and thoracoplasty with simultaneous omentopexy was effective and safe for removing dead space if the patient was young and in a good general condition.

Repeated Pulmonary Metastasectomy in Patients with Osteosarcoma (골육종 환자의 반복적 폐전이 절제술)

  • Lee, Jin-Gu;Shin, Kyoo-Ho;Park, In-Kyu;Chung, Kyung-Young;Song, Seung-Jun;Kim, Dae-Joon
    • Journal of Chest Surgery
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    • v.40 no.9
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    • pp.607-612
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    • 2007
  • Background: Surgical resection is a standard treatment for pulmonary metastases in patients with osteosarcoma, but the role of performing repeated resections is not clear. This study was designed to clarify the feasibility of performing a repeated pulmonary metastasectomy and the prognostic factors for pulmonary metastases in patients with osteosarcoma. Material and Method: Between January 1990 and July 2005, 62 patients with osteosarcoma were diagnosed with pulmonary metastases and 36 patients underwent pulmonary resection. We reviewed the patients retrospectively. Result: The total number of pulmonary metastasectomies was 62 in 30 patients. Among 36 patients, 18 had a second metastasectomy, 7 had a third metastasectomy, and one patient had a fourth metastasectomy. There was no distinctive difference between the first and second metastatectomy in terms of median survival time, and the 3-year and 5-year survival rate (first resection: 20.5 months, 32.0% and 29,4%; second resection: 11.3 months, 34.9% and 34.%). However, the median survival time (7.1 months) was shorter in patients with a third metastatectomy than in patients with one metastatectomy (p=0.01). In long-term survivors, the number of female patients, patients with a disease free time longer than 12 months, patients with a single metastasis and patients with anatomic resection was larger when compared to non-long term survivors, but showed no statistical significance. Conclusion: Repeated pulmonary metastasectomy is expected to prolong survival time in patients with osteosarcoma, and is expected to increase long-term survival in selected cases. Further studies with a large number of patients are necessary.

In Vivo Preperation of Standard Reference Materials of Lead in Blood (생체내 혈중 납 표준물질의 제조)

  • Chung, Kyou-Chull;Choi, Ho-Chun
    • Journal of Preventive Medicine and Public Health
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    • v.28 no.4 s.51
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    • pp.863-873
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    • 1995
  • This report describes a preperation and characterization of canine blood lead(Pb) standard reference material(SRM). Three adult beagle dogs(A, B, and C)were orally dosed with gelatin capsules containing $Pb(NO_3)_2$, equivalent to $10\sim80mg$ Pb/kg body weight. Blood was drawn 24 hours after the dose from the cephalic vein into lead free 500ml Pyrex beaker in which EDTA.K was contained as an anticoagulant. The amount of lead given to individual dog was varied arbitrarily. Three month later, 3 canine animals were orally dosed with lead secondarily to make mixed SRM(D1) which was mixed different concentrations of lead in bloods with A1, B1, and C1 in vitro. The SRMs for A, B, C, A1, B1, C1, and D1 were distributed 2ml each into more than 300 lead free bottles, and were stored in refregerator at $4^{\circ}C$. The amount of lead in canine whole blood samples were determined using a Varian 30A atomic absorption spectrophotometer(AAS) with a model GTA-96 graphite tube atomizer with D2 background correction and a Hitachi Z-8100 AAS with Zeeman background correction. The sensitivity and detection limits for lead determination of Varian 30A were $0.46{\mu}g/L,\;0.34{\mu}g/L,\;and\;0.56{\mu}g/L,\;0.14{\mu}g/L$ of Hitachi Z-8100, respectively. Day to day variations in determination of blood lead concentration in a certain sample were $31.11{\pm}1.36{\mu}g/100ml$ by Varian 30A, and $33.08{\pm}0.82{\mu}g/100ml$ by Hitachi Z-8100, showing the difference of 3% between the two results. At the blood lead concentrations of $56.31{\pm}1.98{\mu}g/100ml(A),\;40.89{\pm}0.80{\mu}g/100ml(B),\;59.01{\pm}1.38{\mu}g/100ml(C)$, the precisions of replicated measurements by AAS were 3.52%, 1.96%, and 2.34%, respectively. Coefficient variation(CV) of SRMs(A, B, and C) within a standard sample were ranged from 0.92% to 7.50%, and those between 5 standard samples were 1.21%, 2.64%, and 1.11%, respectively, showing inter-vial variation of $1{\mu}g/100ml$. Lead levels in SRMs during one month storage were unchanged. The overall recoveries were $89.6\sim100.4%,\;91.6\sim101.9%,\;90.3\sim100.0%$ for A, B, and C SRMs, means were $56.46{\pm}2.69{\mu}g/100ml,\;39.35{\pm}1.89{\mu}g/100ml,\;57.40{\pm}2.31{\mu}g/100ml$, and measurement ranges were$52.88{\pm}59.26{\mu}g/100ml,\;37.47{\pm}41.68{\mu}g/100ml,\;54.80{\pm}60.69{\mu}g/100ml$, respectively. Those results were laid within confidence limits values. The lead concentrations in the mixed sample(D1) stored over one month period were ranged from $32.76{\mu}g/100ml\;to\;33.54{\mu}g/100ml$, with CV ranging from 1.2% to 2.7%. The results were similiar to each of single samples(A1, B1, and C1) in respect of homogeneity and stability. Results of the mixed blood sample analysed after 1 month storage at $4^{\circ}C$ by four other laboratories(L1, L2, L3, L4) were similar with those of our laboratory($L5;31.18{\pm}0.24{\mu}g/100ml$, acceptable range by $CDC;25.18\sim37.18{\mu}g/100ml$), showing the concentrations of $25.91{\pm}1.19{\mu}g/100ml(L1),\;34.16{\pm}0.22{\mu}g/100ml(L2),\;35.68{\pm}0.85{\mu}g/100ml(L3),\;30.95{\pm}0.46{\mu}g/100ml(L4)$ in a each samples.

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Synthesis and Characterization of Thermally Cross-linkable Hole Transporting Material Based on Poly(p-phenylenevinylene) Derivative (열경화가 가능한 poly(p-phenylenevinylene)계 정공전달 물질의 합성 및 특성)

  • Choi, Jiyoung;Lee, Bong;Kim, Joo Hyun
    • Applied Chemistry for Engineering
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    • v.19 no.3
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    • pp.299-303
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    • 2008
  • A thermally cross-linkable polymer, poly[(2,5-dimethoxy-1,4-phenylenevinylene)-alt-(1,4-phenylenevinylene)] (Cross-PPV), was synthesized by the Heck coupling reaction. In order for the polymer to be cross-linkable, 20 mol% excess divinylbenzene was added. The chemical structure of Cross-PPV and thermally crosslinked Cross-PPV were confirmed by FT-IR spectroscopy. From the FT-IR, UV-Vis, and PL spectral data, thermally crosslinked Cross-PPV was insoluble in common organic solvents. The HOMO and LUMO energy level of thermally cross-linked Cross-PPV were estimated -5.11 and -2.56 eV, respectively, which were determined by the cyclic voltammetry and UV-Vis spectroscopy. From the energy level data, one can easily notice that thermally crosslinked Cross-PPV can be used for hole injection layer effectively. Bilayer structured device (ITO/crosslinked Cross-PPV/PM-PPV/Al) was fabricated using poly(1,4-phenylenevinylene-(4-dicyanomethylene-4H-pyran)-2,6-vinylene-1,4-phenylenevinylene-2,5-bis(dodecyloxy)-1,4-phenylenevinylene (PM-PPV) as the emitting layer, which have HOMO and LUMO energy levels of -5.44 eV and -3.48 eV, respectively. The bilayered device had much enhanced the maximum efficiency (0.024 cd/A) and luminescence ($45cd/m^2$) than those of a single layer device (ITO/PM-PPV/Al, 0.003 cd/A, $3cd/m^2$). The enhanced performance originated from that fact that cross-linked Cross-PPV facilitatse the hole injection to the emissive layer and the injected hole and electron from ITO and Al are recombined in emitting layer (PM-PPV) effectively.

The effect of cleaning methods on bond strength of zirconia after saliva contamination (타액으로 오염된 지르코니아 수복물의 접착강도에 세척 방법들이 미치는 영향)

  • Shim, Young-Bo;Choi, An-Na;Son, Sung-Ae;Jung, Kyoung-Hwa;Kwon, Yong Hoon;Park, Jeong-Kil
    • Korean Journal of Dental Materials
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    • v.44 no.1
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    • pp.61-68
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    • 2017
  • This study evaluated the effects of various cleaning methods on the shear bond strength of zirconia ceramics after saliva contamination. Eighty zirconia disk specimens were divided into 8 groups. All groups were treated with one coat of MDP primer. All specimens (except the negative control) were contaminated with human saliva on the zirconia surface. The positive control went through the bonding procedure immediately after contamination without any cleaning procedure. With the exception of control groups, the remaining six groups were rinsed with water and either applied with MDP recoating (WATER+MDP) or without MDP recoating (WATER). While some were cleaned with a Ivoclean with MDP recoating (IVOCLEAN+MDP) or not applied with MDP recoating(IVOCLEAN), others were cleaned with a 1% NaOCl solution with MDP recoating (NaOCl+MDP) or without MDP recoating (NaOCl). The shear bond strength of all specimens were measured after being stored in distilled water at $37^{\circ}C$ for 24 hours. The data was analyzed statistically by an analysis of ANOVA, Tukey's post hoc test and Student's t-test was used to compare the shear bond strength according to the re-coating of MDP after the cleaning procedure. The positive control group showed the lowest shear bond strength value, and the WATER group and NaOCl group showed no significant difference when compared to the positive control group. The IVOCLEAN group showed significantly higher shear bond strength when compared to Water group and NaOCl group but not with the group of negative control. After rinsing with water or the NaOCl solution, the comparison of the single coating of MDP and re-coating of MDP showed different shear bond strengths but there was no significant difference to the negative control. After rinsing with Ivoclean, there was no significant difference to the negative control regardless of the recoating of MDP. In conclusion, the shear bond strength was affected by the cleansing procedure and Ivoclean was found to be effective regardless of the re-coating of MDP. When water or the NaOCl solution is used to remove surface contaminants, the re-coating of MDP provides a positive effect on cementation.

A Study on Development of Mammo Pad and Analysis of Factors Affecting Compression Pain for Mammography (유방 방사선 검사를 위한 압박 패드의 제작 및 유방 압박 통증에 영향을 주는 요인 분석)

  • Kim, Do-Hee;Yi, Ann;Kwon, Bo-Ra;Ku, Hong-Uk;Bang, Yong-Sik;Cho, Myeong-Ju
    • Journal of the Korean Society of Radiology
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    • v.15 no.5
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    • pp.629-636
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    • 2021
  • The purpose of this study was to identify the effects of mammo pad made of different kinds of materials on the reduced inconvenience and compression pains of patients to examine plausible interchangeability of existing pads made of single kind of material, and to examine the changes in pains of patients taking mammography and various factors therein. The high-hardness and highly-elastic mammo pressure pads, capable of replacing existing mammo pad of "H" company, were manufactured, and the display quality of mammography obtained from respective mammo pad were compared to each other to appraise the availability of manufactured mammo pad. In addition, 200 patients, who came to a general hospital in Seoul, were selected as subjects for the survey employing a questionnaire which was distributed to the subjects from December 2018 to March 2020 to identify the factors involved with the mammo pad of patients while taking mammography. The results of mammography obtained from both of the existing and newly manufactured mammo pad revealed appropriate display qualities fell within the range of clinical criteria. Besides, the factors associated with changing compression pains of patients taking mammography were analyzed wherefrom the general factors in the following order of age, height, and BMI index appeared, while the experiential and female factors appeared as in the following order: presence of menstruation, experience of child-birth, experience of breast feeding, menopause, grade of breast, shape of breast, and experience of mammography. In conclusion, the following factors comprising the age, experience of breast feeding, experience of mammography, and menopause rendered approximately 54% of power of explaining the degree of changing pains during mammography. Regarding the changes in compression pains while taking mammography, the increasing experience of mammography of patients rendered approximately 0.26 times more at the intermediate range of compression pains and approximately 0.14 times more at the range of severe pains.

Experimental Study on the Performance Improvement of Velcro Reinforcement through Internal Filling (내부충진을 통한 벨크로 보강재의 성능향상에 대한 실험적 연구)

  • Jeong, Yeong-Seok;Kwon, Minho;Kim, Jin-Sup;Nam, Gwang-Sik
    • KSCE Journal of Civil and Environmental Engineering Research
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    • v.41 no.4
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    • pp.347-355
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    • 2021
  • During the earthquake, for multi-story structure, if the first floor is soft, the deformation will concentrate on that floor causing a serious damage to the column members which might leads to the collapse of the whole structure like Piloti structure during the Pohang earthquake in Korea. According to the 2016 National Disaster Management Research Institute's "Investigation of Seismic Reinforcement and Cost Analysis of Domestic Non-seismic Buildings", the rate of seismic resistance of private reinforced concrete buildings was 38.3 %. Among them, it was reported that the seismic-resistance ratio of the two to five-story structures was less than 50 %. Accordingly, the government is trying to improve the seismic rate through support projects, but the conventional seismic reinforcement methods are still expensive, and emergency construction is difficult. Therefore, in this study, the field applicability was evaluated by improving the reinforcement method using Velcro, which was developed through the research project of the Ministry of Land, Transport and Maritime Affairs in 2014. In order to improve the performance of the Velcro reinforcement method, introducing the initial tension of Velcro using high foaming rigid urethane filling between the Velcro and concrete of the columns was applied. Additionally, an experiment was conducted to evaluate the ductility of Velcro specimen from the concrete confinement effect. As a result, the ductility of the Velcro specimen was improved compare to Normal specimen. However, the energy dissipation capacity of VELCRO2 is better than VELCRO1, yet the maximum ductility of those two specimens did not show a significant difference. Therefore, the improvement of the internal filler material is still needed to have a better maximum ductility.