• Journal of the Korean Institute of Traditional Landscape Architecture
• /
• v.39 no.2
• /
• pp.15-28
• /
• 2021

'Cheonunjeongsa (天雲精舍)', designated as Gyeongsangbukdo Folklore Cultural Property No. 76, is a Siksanjeongsa built in 1700 by Manbu Lee Shiksan. In this study, we investigate the life and perspective of Manbu Lee in relation to Siksanjeongsa, and estimate the feng shui location, territoriality, and original landscape by analyzing 「Nuhangnok」 and 「Nuhando」, the results of his political management. The following results were derived by examining the philosophy that the scholar wanted to include in his space. First, Manbu Lee Shiksan was a representative hermit-type confucian scholar in the late Joseon Dynasty. 'Siksan', the name of the government official and the nickname of Manbu Lee, is derived from the mountain behind the village, and he wanted to rest in the four areas of thought(思), body(躬), speech(言), and friendship(交). During the difficult years of King Sukjong, Lee Manbu of a Namin family expressed his will to seclude through the title 'Siksan'. Second, There is a high possibility of restoration close to the original. Manbu Lee recorded the location of Siksanjeongsa, spatial structure, buildings and landscape facilities, trees, surrounding landscape, and usage behaviors in 「Nuhangnok」, and left a book of 《Nuhangdo》. Third, Manbu Lee refers to the feng shui geography view that Oenogok is closed in two when viewed from the outside, but is cozy and deep and can be seen from a far when entering inside. The whole village of Nogok was called Siksanjeongsa, which means through the name. It can be seen that the area was formed and expanded. Fourth, the spatial composition of Siksanjeongsa can be divided into a banquet space, an education space, a support space, a rest space, a vegetable and an herbal garden. The banquet space composed of Dang, Lu, and Yeonji is a personal space where Manbu Lee, who thinks about the unity of the heavenly people, the virtue of the gentleman, and humanity, is a place for lectures and a place to live. Fifth, Yangjeongjae area is an educational space, and Yangjeongjae is a name taken from the main character Monggwa, and it is a name that prayed for young students to grow brightly and academically. Sixth, the support space composed of Ganjijeong, Gobandae, and Sehandan is a place where the forested areas in the innermost part of Siksanjeongsa are cleared and a small pavilion is built using natural standing stones and pine trees as a folding screen. The virtue and grace of stopping. It contains the meaning of leisure and the wisdom of a gentleman. Seventh, outside the wall of Siksanjeongsa, across the eastern stream, an altar was built in a place with many old trees, called Yeonggwisa, and a place of rest was made by piling up an oddly shaped stone and planting flowers. Eighth, Manbu Lee, who knew the effects of vegetables and medicinal herbs in detail like the scholars of the Joseon Dynasty, cultivated a vegetable garden and an herbal garden in Jeongsa. Ninth, it can be seen that Lee Manbu realized the Neo-Confucian utopia in his political life by giving meaning to each space of Siksanjeongsa by naming buildings and landscaping facilities and planting them according to ancient events.

• The Korean Journal of Pharmacology
• /
• v.28 no.2
• /
• pp.115-128
• /
• 1992

The training of male wistar rats for active conditioned response (ACR) was performed by one daily training session of 30 consecutive trials for 10 successive days using a two-way shuttle box, and the rats that showed 10 or more ACRs on the last day were treated for further 10 days with electroconvulsive shock (ECS : 50 mA, 0.5 msec; 100 Hz; 1.5 sec) and the following compounds. On the 20th day, all the rats were tested for the ACR rention. The ECS regimens were one ECS per day for 10 days with one day interval $(5{\times}ECS)$, one ECS at 3 hrs (ECS-3h), and one ECS at 24 hrs (ECS-24h), respectively, before the ACR retention test. And CDP-choline (cc: 250 mg/kg), spermine (SM: 10 mg/kg), ${\alpha}-difluoromethylornithine$ (DO: 250 mg/kg), or aminoguanidine (AG: 100 mg/kg) was administered by one daily i.p. injection for 10 days. The ACR number $(13.7{\pm}1.0)$ obtained on the last training day was increased by 37.23% on the 20th day in the control rats. And the ACR increase was significantly suppressed by 5-ECS, ECS-3h, CC, or SM but was little affected by ECS-24h, DO, or AG. However, the 5-ECS induced impairment of ACR retention was significantly suppressed by AG, SM, and CC in the order of potency but was little affected by DFMO. And the ECS-3h induced impairment was moderately worsened by SM or AG. The acetylcholine (ACh) of the rat hypothalamus (HT), hippocampus (HC), and entorhinal cortex (EC) was markedly increased by CC and moderately increased by SM, but little affected by ECS-3h, ECS-24h, DO, or AG. But $5{\times}ECS$ slightly increased the ACh content. The brain putrescine (Pt) content was significantly increased by AG and little affected by CC, SM, or DO. But the $5{\times}ECS$ markedy decreased the brain Pt content, and the decrease was significantly suppressed by CC, SM, or AG. CC induced the marked increases of the spermidine (Sd) and spermine (Sm) contents of all the areas. SM increased the Sd contents of all the areas and the EC-Sm content. DO decreased the brain Sd and Sm contents. And AG increased the HT-Sd content and the Sm contents of all the brain areas. The $5{\times}ECS$ induced decrease of the HC-Sm content was suppressed by CC, SM and AG. These results suggest that the improving effect of aminoguanidine on the $5{\times}ECS$ induced impairment of ACR retention may be ascribed in part to its activity as a diamine oxidase inhibitor.

• Journal of Preventive Medicine and Public Health
• /
• v.22 no.4 s.28
• /
• pp.555-577
• /
• 1989

This study was conducted to compare the delivery management including laboratory tests, medication and surgical procedures for the delivery in various medical facilities. Two university hospitals, two general hospitals, three hospitals, two private obstetric clinics, and two midwifery clinics in a large city were selected as they permitted the investigators to abstract the required data from the medical and accounting records. The total number of deliveries occurred at these 11 facilities between 15 January and 15 February, 1989 was 789 among which 606(76.8%) were vaginal deliveries and 183 (23.3%) were C-sections. For the normal vaginal deliveries, CBC, Hb/Hct level, blood typing, VDRL, hepatitis B antigen and antibody, and urinalysis were routinely done except the private clinics and midwifery clinics which did not test for hepatitis B and Hb/Hct level at all. In one university hospital ultrasonography was performed in 71.4% of the mothers and in one general hospital liver function test was done in 76.7% of the mothers. For the C-section, chest X-ray, bleeding/clotting time and liver function test were routinely done in addition to the routine tests for the normal vaginal deliveries. Episiotomy was performed in 97.2% of the vaginal deliveries. The type and duration of fluid infused and antibiotics administered showed a wide variation among the medical facilities. In one university hospital antibiotics was not administered after C-section at all while in the general hospitals and hospitals one or two antibiotics were administered for one week on the average. In one private clinic one pint of whole blood was transfused routinely. A wide variation was observed among the medical facilities in the use of vitamin, hemostatics, oxytocics, antipyreptics, analgesics, anti-inflammatory agents. sedatives. digestives. stool softeners. antihistamines. and diuretics. Mean hospital day for the normal vaginal deliveries of primipara was 2.6 days with little variation except one hospital with 3.5 days. Mean hospital day for the C-section of primipara was 7.5 days and that of multipara was 7.6 days and it ranged between 6.5 days and 9.4 days. Average hospital fee for a normal vaginal delivery without the medical insurance coverage was 182,100 Won for the primipara and 167,300 Won for the multipara. In case of the primipara covered by the medical insurance a mother paid 82,400 Won and a multiparous mother paid 75,600 Won. Average hospital fee for a C-section without the medical insurance was 946,500 Won for the primipara and 753,800 Won for the multipara. In case of the primipara covered by the medical insurance a mother paid 256,200 Won and a multiparous mother paid 253,700 Won. Average hospital fee for a normal vaginal delivery in the university hospitals showed a remarkable difference, 268,000 Won vs 350,000 Won, as well as for the C-section. A wide variation in the laboratory tests performed for a normal vaginal delivery and a C-section as well as in the medication and hospital days brought about a big difference in the hospital fee and some hospitals were practicing the case payment system. Thus, standardization of the medical care to a certain level is warranted for the provision of adequate medical care for delivery.

• The Journal of Korean Society for Radiation Therapy
• /
• v.34
• /
• pp.73-82
• /
• 2022

Purpose: The purpose of this study is to evaluate the effectiveness of reducing the absorbed dose to the ovaries and the quality of the CBCT image when using the Halcyon^TM Fast kV CBCT of cervical cancer patients of child-bearing age who performed ovarian transposition Materials and Methods : Contouring of the cervix and ovaries required for measurement was performed on the computed tomography images of the human phantom (Alderson Rando Phantom, USA), and three Optically Stimulated Luminescence Dosimeter(OSLD) were attached to the selected organ cross-section, respectively. In order to measure the absorbed dose to the cervix and ovaries in the Truebeam^TM pelvis mode (Hereinafter referred to as TP), The Halcyon^TM Pelvis mode (Hereinafter referred to as HP) and The Halcyon^TM Pelvis Fast mode (Hereinafter referred to as HPF), An image was taken with a scan range of 17.5 cm and also taken an image that reduced the Scan range to 12.5cm. A total of 10 cumulative doses were summed, It was replaced with a value of 23 Fx, the number of cervical cancer treatments, and compared In additon, uniformity, low contrast visibility, spatial resolution, and geometric distortion were compared and analyzed using Catphan 504 phantom to compare CBCT image quality between equipment. Each factor was repeatedly measured three times, and the average value was obtained by analysing with the Doselab (Mobius Medical Systems, LP. Versions: 6.8) program. Results: As a result of measuring absorbed dose by CBCT with OSLD, TP and HP did not obtain significant results under the same conditions. The mode showing the greatest reduction value was HPF versus TP. In HPF, the absorbed dose was reduced by 39.8% in the cervix and 19.8% in the ovary compared to the TP in the scan range of 17.5 cm. the scan range was reduced to 12.5 cm, absorbed dose was reduced by 34.2% in the cervix and 50.5% in the ovary. In addition, result of evaluating the quality of the image used in the above experiment, it complied with the equipment manufacturer's standards with Geometric Distortion within 1mm (SBRT standard), Uniformity HU, LCV within 2.0%, Spatial Resolution more than 3 lp/mm. Conclusion: According to the results of this experiment, Halcyon^TM can select more various conditions than Truebeam^TM in treatment of fertility woman who have undergone ovarian Transposition , because it is important to reduce the radiation dose by CBCT during radiation therapy. So finally we recommend Halcyon^TM Fast kV CBCT which maintains image quality even at low mAs. However, it is consider that the additional exposure to low doses can be reduced by controlling the imaging range for patients who have undergone ovarian transposition in other treatment machines.

• Journal of Intelligence and Information Systems
• /
• v.28 no.1
• /
• pp.175-196
• /
• 2022

Information and communication and home appliance industries, which were one of South Korea's main industries, are gradually losing their export share as their export competitiveness is weakening. This study objectively analyzed export competitiveness and suggested export-promising countries in order to help South Korea's information communication and home appliance industries improve exports. In this study, network properties, centrality, and structural hole analysis were performed during network analysis to evaluate export competitiveness. In order to select promising export countries, we proposed a new variable that can take into account the characteristics of an already established International Trade Network (ITN), that is, the Global Value Chain (GVC), in addition to the existing economic factors. The conditional log-odds for individual links derived from the Exponential Random Graph Model (ERGM) in the analysis of the cross-border trade network were assumed as a proxy variable that can indicate the export potential. In consideration of the possibility of ERGM linkage, a parametric approach and a non-parametric approach were used to recommend export-promising countries, respectively. In the parametric method, a regression analysis model was developed to predict the export value of the information and communication and home appliance industries in South Korea by additionally considering the link-specific characteristics of the network derived from the ERGM to the existing economic factors. Also, in the non-parametric approach, an abnormality detection algorithm based on the clustering method was used, and a promising export country was proposed as a method of finding outliers that deviate from two peers. According to the research results, the structural characteristic of the export network of the industry was a network with high transferability. Also, according to the centrality analysis result, South Korea's influence on exports was weak compared to its size, and the structural hole analysis result showed that export efficiency was weak. According to the model for recommending promising exporting countries proposed by this study, in parametric analysis, Iran, Ireland, North Macedonia, Angola, and Pakistan were promising exporting countries, and in nonparametric analysis, Qatar, Luxembourg, Ireland, North Macedonia and Pakistan were analyzed as promising exporting countries. There were differences in some countries in the two models. The results of this study revealed that the export competitiveness of South Korea's information and communication and home appliance industries in GVC was not high compared to the size of exports, and thus showed that exports could be further reduced. In addition, this study is meaningful in that it proposed a method to find promising export countries by considering GVC networks with other countries as a way to increase export competitiveness. This study showed that, from a policy point of view, the international trade network of the information communication and home appliance industries has an important mutual relationship, and although transferability is high, it may not be easily expanded to a three-party relationship. In addition, it was confirmed that South Korea's export competitiveness or status was lower than the export size ranking. This paper suggested that in order to improve the low out-degree centrality, it is necessary to increase exports to Italy or Poland, which had significantly higher in-degrees. In addition, we argued that in order to improve the centrality of out-closeness, it is necessary to increase exports to countries with particularly high in-closeness. In particular, it was analyzed that Morocco, UAE, Argentina, Russia, and Canada should pay attention as export countries. This study also provided practical implications for companies expecting to expand exports. The results of this study argue that companies expecting export expansion need to pay attention to countries with a relatively high potential for export expansion compared to the existing export volume by country. In particular, for companies that export daily necessities, countries that should pay attention to the population are presented, and for companies that export high-end or durable products, countries with high GDP, or purchasing power, relatively low exports are presented. Since the process and results of this study can be easily extended and applied to other industries, it is also expected to develop services that utilize the results of this study in the public sector.

• KOREAN JOURNAL OF CROP SCIENCE
• /
• v.53 no.spc
• /
• pp.96-102
• /
• 2008

This study was carried out to examine agronomic characteristics and seed qualities of 827 Korean soybean landraces according to the collecting areas. Agronomic characteristics and seed qualities was examined according to the localities by weather characteristics. Days to flowering was the longest (mean 70.9 days) in the northwest seashore, and the most short in the south inland (mean 63.8 days). Growth days was the longest in the Gyeongbuk inland (mean 136.0 days), and the most short in the mountain-high (mean 132.8 days). The stem height was the most short in the north-west seashore (mean 81.3 cm), and in the south seashore (mean 58.8 cm). The seed weight of 100 seeds was the lightest in the north-west seashore (mean 17.1 g), and the heaviest in the south-west seashore (mean 21.5 g). The crude protein contents was the lowest in the north-west seashore (mean 40.1%), the highest in the south seashore (mean 42.8%), and vice versa in the crude oil. The contents of sucrose and oligo-saccharide was the highest 5.8% and 8.6%, respectively, in the mountain-high, and the lowest 4.8% and 7.6% in the Gyeongbuk inland and south seashore, respectively. Among the iso-flavone contests, the contents of genistein and total was the highest, $635.6\;{\mu}g/g$ and $1258.1\;{\mu}g/g$, respectively, in the mountain inland, and the lowest $319.2\;{\mu}g/g$ and $835.3\;{\mu}g/g$ in the south-west seashore. The contents of glycitein was the highest $124.3\;{\mu}g/g$ in the south seashore.

• Horticultural Science & Technology
• /
• v.34 no.2
• /
• pp.269-281
• /
• 2016

The statistical analyses of coefficient of variation, heritability, and genetic advance were carried out to identify differences in morphological characteristics, such as the stem and inflorescence length, of 10 major commercial cultivars of spray chrysanthemum (Chrysanthemum morifolium). For morphological characteristics, stem lengths ranged from 46.4 cm to 54.9 cm, the maximum diameter of stem was 5.6 to 8.5 mm, the hardness of the stem was 0.17 to $0.70kg{\cdot}m^{-2}$, the fresh weight of stem was 7.5 to 17.5 g, the dry weight of the stem was 1.6 to 3.3 g, the ratio of dry weight/fresh weight of stem was 15.9% to 23.1%. Also, the number of leaves on the stem was 8.4 to 12.2, the stem leaf area was 17.8 to $37.8m^2$, the fresh weight stem leaves was 5.3 to 18.6 g, the dry weight was 0.5 to 1.4 g and the ratio of dry weight /fresh weight of stem leaves was 7.6% to 11.5%. The inflorescence length ranged from 10.1 to 18.6 cm, the fresh weight of inflorescence was 7.3 to 26.7 g, the dry weight of inflorescence was 1.2 to 2.8 g, the ratio of dry weight /fresh weight of inflorescence was 10.4% to 17.1%. For flower, the diameter of the flower center was 8.2 to 13.3 mm, the petal width was 5.7 to 14.0 mm, the petal length was 12.9 to 33.1 mm, and the petal thickness was 157.8 to $354.4{\mu}m$. The mean values of each character in each cultivar were very different, and DMRT and LSD values based on morphological characteristics among 10 cultivars were highly significant. For variability and genetic parameters, the lowest CV (coefficient of variation), PCV (phenotypic coefficient of variation), and GCV (genotypic coefficient of variation) were 4.79% to 5.15% in stem length, and the highest variations were 62.97% to 65.21% in leaf area. ECV (error or environmental coefficient of variation) was the lowest for leaf area (1.71%) and it was the highest for leaf dry weight (19.30%). Heritability also significantly differed among the characteristics, ranging from 68.69% to 99.67%, the lowest value was shown in ratio of dry weight /fresh weight of stem and the highest value was for leaf area of stem. The value for genetic advance was the lowest in hardness of stem at 0.30 and the highest in leaf thickness at 156.65. The lowest genetic advance as percentage of mean of stem hardness was 9.17%, while the highest percentage of stem length was 134.27%. Thus the characters which had the highest values indicated above show the influence of additive gene action and may provide useful resources for selection programs for agronomic improvement.

• Journal of Periodontal and Implant Science
• /
• v.37 no.sup2
• /
• pp.427-445
• /
• 2007

To improve osseointegration at the boneto-implant interface, several studies have been carried out to modify titanium surface. Variations in surface texture or microtopography may affect the cellular response to an implant. Osteoblast-like cells attach more readily to a rougher titanium surface, and synthesis of extracellular matrix and subsequent mineralization were found to be enhanced on rough or porous coated titanium. However, regarding the effect of roughened surface by physical and mechanical methods, most studies carried out on the reactions of cells to micrometric topography, little work has been performed on the reaction of cells to nanotopography. The purpose of this study was to examme the response of osteoblast-like cell cultured on blasted surfaces and alkali treated surfaces, and to evaluate the influence of surface texture or submicro-scaled surface topography on the cell attachment, cell proliferation and the gene expression of osteoblastic phenotype using ROS 17/2.8 cell lines. In scanning electron micrographs, the blasted, alkali treated and machined surfaces demonstrated microscopic differences in the surface topography. The specimens of alkali treatment had a submicro-scaled porous sur-face with pore size about 200 nm. The blasted surfaces showed irregularities in morphology with small(<10 ${\mu}m$) depression and indentation among flatter-appearing areas of various sizes. Based on profilometry, the blasted surfaces was significantly rougher than the machined and the alkali treated surfaces (p$TiO_2$) were observed on alkali treated surfaces, whereas not observed on machined and blasted surfaces. The attachment morphology of cells according to time was observed by the scanning electron microscope. After 1 hour incubation, the cells were in the process of adhesion and spreading on the prepared surfaces. After 3 hours, the cells on all prepared surfaces were further spreaded and flattened, however on the blasted and alkali treated surfaces, the cells exhibited slightly irregular shapes and some gaps or spaces were seen. After 24 hours incubation, most cells of the all groups had a flattened and polygonal shape, but the cells were more spreaded on the machined surfaces than the blasted and alkali treated surfaces. The MTT assay indicated the increase on machined, alkali treated and blasted surfaces according to time, and the alkali treated and blasted surfaces showed significantly increased in optical density comparing with machined surfaces at 1 day (p<0.01). Gene expression study showed that mRNA expression level of ${\alpha}\;1(I)$ collagen, alkaline phosphatase and osteopontin of the osteoblast-like cells showed a tendency to be higher on blasted and alkali treated surfaces than on the machined surfaces, although no siginificant difference in the mRNA expression level of ${\alpha}\;1(I)$ collagen, alkaline phosphatase and osteopontin was observed among all groups. In conclusion, we suggest that submicroscaled surfaces on osteoblast-like cell response do not over-ride the one of the surface with micro-scaled topography produced by blasting method, although the microscaled and submicro-scaled surfaces can accelerate osteogenic cell attachment and function compared with the machined surfaces.

• Korean Journal of Agricultural Science
• /
• v.4 no.1
• /
• pp.94-104
• /
• 1977

In order to investigate the effects of mechanical transplanting on the rice, four rice varieties including Jo-saing Tongil were planted in case nursering bed for three times with 10 days interval beginning from April 16. Fourty days old seedlings were transplanted with rice-transplanter, and growth habits of seedlings in bed and rice plants in main field and yield were examined and summerized as follows: 1. The plant height and number of leaves of the 40 days old seedling in case nursery bed were appeared to be less than those of seedlings grown in ordinary nursery bed. In case nursery, the plant height and number of leaves of seedlings grown in case nursery were apparently higher than those of seedlings grown in upland case nursery. 2. The root of 40 days old seedlings were cut to investigate the rooting ability of seedlings, and the rooting ability of the seedlings grown in the case nursery bed were apparently lower in the rooting ability compared with the seedlings grown in ordinary nursery bed. The rooting ability of the seedlings grown in the lowland case nursery was higher than that of the seedlings grown in the upland case nursery. 3. The tip of leaves of the varieties derived from Indica type were becoming yellow and yellow-red in color 25 to 30 days after planted in the case nursery bed. Those varieties was almost stopped growth. 4. The seedlings transplanted by transplanter had shown more than five to seven days of delay in rooting, compared with the seedlings transplanted by ordinary method. The heading dates was delayed five to seven days when transplanter was used, even though the delay of heading dates was a little different depending on the varieties. 5. The yields of unhulled rice were a little lower than that of Yusin variety which was hand planted. When mechanically transplanted, the yield of Tongil variety was highest in the plot where seedlings were transplanted on May 26. When transplanted on June 15, Milyang#15 was highest in yield, indicating the importance of varietal selection in mechanical transplantation. 6. The rice transplanter could transplant from 73 to 108 seedlings per $3.3m^2$. If the seeds of rice were evenly planted in the bed, the two-row rice transplanter could be used five to six times more effectively with less than one percent of missing plant compared with the hand transplanting. This suggests that rice transplanter could be utilized in the mono cropping area. 7. Since the time of transplantings in the double-cropping area is rather limitted, mechanical transplantation might be possible without reducings yield providing better adapted varieties and improved case-nursery techniques.

• Journal of Chest Surgery
• /
• v.40 no.12
• /
• pp.817-824
• /
• 2007

Background: There are two choices for heart valve replacement-the use of a tissue valve and the use of a mechanical valve. Using a tissue valve, additional surgery will be problematic due to valve degeneration. If the risk of additional surgery could be reduced, the tissue valve could be more widely used. Therefore, we analyzed the risk factors and mortality of patients undergoing repeated heart valve replacement and primary replacement. Material and Method: We analyzed 25 consecutive patients who underwent repeated heart valve replacement and 158 patients who underwent primary heart valve replacement among 239 patients that underwent heart vale replacement in out hospital from January 1995 to December 2004. Result: There were no differences in age, sex, and preoperative ejection fraction between the repeated valve replacement group of patients and the primary valve replacement group of patients. In the repeated valve replacement group, the previously used artificial valves were 3 mechanical valves and 23 tissue valves. One of these cases had simultaneous replacement of the tricuspid and aortic valve with tissue valves. The mean duration after a previous operation was 92 months for the use of a mechanical valve and 160 months for the use of a tissue valve. The mean cardiopulmonary bypass time and aortic cross clamp time were 152 minutes and 108 minutes, respectively, for the repeated valve replacement group of patients and 130 minutes and 89 minutes, respectively, for the primary valve replacement group of patients. These results were statistically significant. The use of an intra aortic balloon pump (IABP) was required for 2 cases (8%) in the repeated valve replacement group of patients and 6 cases (3.8%) in the primary valve replacement group of patients. An operative death occurred in one case (4%) in the repeated valve replacement group of patients and occurred in nine cases (5.1%) in the primary valve replacement group of patients. Among postoperative complications, the need for mechanical ventilation over 48 hours was different between the two groups. The mean follow up period after surgery was $6.5{\pm}3.2$ years. The 5-year survival of patients in the repeated valve replacement group was 74% and the 5-year survival of patients in the primary valve replacement group was 95%. Conclusion: The risk was slightly increased, but there was little difference in mortality between the repeated and primary heart valve replacement group of patients. Therefore, it is necessary to reconsider the issue of avoiding the use of a tissue valve due to the risk of additional surgery, and it is encouraged to use the tissue valve selectively, which has several advantages over the use of a mechanical valve. In the case of a repeated replacement, however, the mortality rate was high for a patient whose preoperative status was not poor. A proper as sessment of cardiac function and patient status is required after the primary valve replacement. Subsequently, a secondary replacement could then be considered.