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Lipoprotein and Lipid Abnormalities in Uremic Children with Maintenance Dialysis (투석 치료중인 만성 신부전 소아에서의 지질 및 지질단백 이상)

  • Kim Jung-Sue;Song Jung-Han;Park Hye-Won;Cheong Hae-Il;Kim Jin-Q;Choi Yong;Ko Kwang-Wook
    • Childhood Kidney Diseases
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    • v.1 no.2
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    • pp.109-116
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    • 1997
  • Purpose : Chronic renal failure is often accompanied by severe dyslipidemia, a known risk factor for cardiovascular disease. Lipoprotein(a) [Lp(a)] has recently been characterized as a risk factor for atherosclerosis and thrombosis. Cardiovascular disease is the leading cause of death in adult patients on dialysis. However, there are only limited data available concerning risk factors for atherosclerosis in uremic children. We have measured serum levels of lipids, lipoproteins, apolipoproteins and Lp(a) in uremic children with maintenance dialysis. Methods : Ten uremic children with hemodialysis (HD) and 14 with peritoneal dialysis (PD) in our dialysis unit were included in this study. The mean age of HD patients was $162{\pm}59$ months and the male to female ratio was 7:3. The mean age and sex ratio of PD patients were $123{\pm}63$ months and 6:8, respectively. The levels of cholesterol, triglyceride, lipoproteins, apolipoproteins and Lp(a) were measured from serum sampled after 14 hours of fasting. The normal control levels were cited from 2 articles presenting the normal blood lipid and lipoprotein levels of primary school and middle school children in Korea. Results : There was no difference in age, sex ratio, body mass index and duration of dialysis between the HD and the PD group. The serum concentration of the cholesterol, triglyceride and apolipoprotein B were significantly elevated in dialysis patients compared with normal subjects. The serum level of Lp(a) was significantly elevated in only PD group. The serum Lp(a) level was below 30 mg/dl in 13 and above 30 mg/dl in 11 patients. The serum albumin level was significantly decreased in high Lp(a) group than in low Lp(a) group. Conclusion : The uremic children receiving dialysis reveal abnormal serum lipid and lipoprotein profiles. These results suggest that they have a higher risk for coronary heart disease, although there has been no clinical evidence of coronary heart disease at present. A long-term follow-up study of these children to clarify the suggestion should be started now.

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Technical Efficiency of Medical Resource Supply and Demand (의료자원 공급, 수요의 성과 효율성에 대한 실증분석)

  • Chang, Insu;Ahn, Hyeong Seok;Kim, Brian H.S.
    • Journal of the Korean Regional Science Association
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    • v.34 no.2
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    • pp.3-19
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    • 2018
  • The objective of this study is to observe the efficiency of clinical performance on the supply and demand of medical resources in Korea. For the empirical analysis, we constructed the dataset on age standardized mortality rate, the number of physician, specialist, surgery, medical institution, ratio of general hospitals of 16 provinces in Korea from 2006 to 2013. The panel probability frontier model is employed as an analysis method and considered heteroscedasticity and autocorrelation of the error in panel data. In addition, the demographic and socioeconomic characteristics of the 16 provinces, unemployment rate, elderly population ratio, GRDP per capita, and ratio of hospitals in comparison to the general hospitals are used to find the effect on the technical efficiency of clinical performance on supply and demand of medical resources. The results are as follows. First, for the clinical performance, the supply side of human resources such as doctors and specialists and the demand side factors such as chronic illness clinic per unit population have a significant influence, respectively. Second, the technical efficiency of clinical performance on the supply and demand of medical resources of each input component was 59-70% in terms of clinical efficiency in each region. Third. estimates of technical efficiency of inputs that affect clinical performance showed a slight increase in all regions during the analysis period, but the increase trend decreased slightly. Fourth, the ratio of the elderly population and GRDP per capita have a positive influence on the technical efficiency of clinical performance on the supply and demand of medical resources. The difference of each efficiency by region is due to the regional differences of the input medical resources and the combination of them and the demographic and socioeconomic characteristics of the region. It is understood that the differences in technological efficiency due to the complexity of supply and demand of medical resources, demographic structure and economic difference affecting clinical performance by region are different.

Guideline in the Management of Antenatally Diagnosed Unilateral Hydronephrosis (산전 초음파로 발견된 수신증의 치료 방침)

  • Hahn Hye-Won;Jun Nu-Lee;Kim Kun-Seok;Moon Dae-Hyuk;Yoon Chong-Hyun;Park Young-Seo
    • Childhood Kidney Diseases
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    • v.7 no.1
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    • pp.60-66
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    • 2003
  • Purpose : Neonatal hydronephrosis has been detected with increasing frequency with the widespread use of prenatal ultrasonography, but the consensus about its postnatal management has not yet been reached, especially about surgical intervention. We attempted to determine the guideline of follow-up study and surgical intervention of hydronephrosis by analyzing clinical outcomes of neonates with hydronephrosis. Materials and Methods : Between 1994 and 2000, 128 hydronephrotic kidneys were postnatally confirmed. Cases associated with other urologic anomalies were excluded and 90 unilateral hydronephrotic kidneys with a minimum follow-up of 12 months were enrolled in this study. We classified the patients into 6 groups according to the anterior posterior pelvic diameter(APPD) at initial ultrasonography(USG) within 1 month after birth. Renal USG and $Tc^{99m}-mercaptoacetyl$ triglycerine(MAG3) scan were done according to a set protocol, and pyeloplasty was performed when indicated according to our protocol. Results : Most cases whose APPD were below 10 mm improved or resolved. Only few cases with APPD above 20 mm showed spontaneous improvement and most(88%) had undergone operation. Those with initial APPD within 10-19 mm showed variable outcomes. When the risk factors for irreversible renal functional deterioration were analyzed, the age at pyeloplasty and pre-operative functional deficit were significant. Conclusion : We concluded that in infants with initial APPD below 10 mm, consideration of surgery is not needed, and in those with initial APPD above 20 mm, early operation is recommended. Our set protocol based on initial USG is useful, but the cut-off value of relative renal function(RRF) for operation might be increased to 40% to improve post operative RRF.

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Predictors of Failed Closure of Patent Ductus Arteriosus with the First Course of Indomethacin in Preterm Infants (미숙아 동맥관 개존에서 인도메타신 1차 투여 후 폐쇄 실패의 예측 인자)

  • Lee, Mong-Young;Lim, Dong-Hee;Park, Kyu-Hee;Ha, Gi-Su;Lee, Jang-Hoon;Choi, Byung-Min;Hong, Young-Sook;Yoo, Kee-Hwan;Lee, Joo-Won
    • Neonatal Medicine
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    • v.17 no.1
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    • pp.75-83
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    • 2010
  • Purpose : This study was performed to determine the predictors of failed closure of a patent ductus arteriosus (PDA) following the first course of indomethacin in symptomatic preterm infants. Methods : Forty three of 43 preterm infants, admitted to the neonatal intensive care unit diagnosed with PDA and treated with indomethacin at the Korea University Medical Center between January 1990 and October 2007, ware studied. The perinatal risk factors affecting the failed closure of PDA were retrospectively assessed. Results : The failed PDA closure group included 16 (37%) out of 43 infants three of whom underwent surgery. The closure group included 27 (63%) out of 43 infants. In the failed closure group, the Apgar scores (1 min, 5 min) were significantly higher (P<0.05) and antenatal steroid administration was significantly lower (P<0.05). In addition, dopamine administration was significantly lower (P<0.05) and the mean postnatal age at diagnosis was significantly lower (P<0.05). Multiple logistic regression for the prediction of failed PDA closure found only antenatal steroid administration (OR 0.092, CI 0,010-0.826, P=0.0331) as an associated factor. Conclusion : In patients with antenatal steroid administration the failed PDA closure rate was significantly lower. Therefore, antenatal steroid administration can be considered as an important factor for the closure of PDA in preterm pregnancies.

The Evvalution of Different Factors Influencing the Quality of Silage (Silago 품질에 영향을 미치는 각종요인의 평가)

  • 한정대;윤익석
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.1 no.1
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    • pp.18-28
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    • 1978
  • To study about the effect of harvested stage and physical treatment such as wilting or chopping of plant material on the quality of silage, Italian ryegrass(Lolium multiflorum) harvested at pre-headed or heading stage and Seombadi(Dystaenia takesimana Nakai) harvested at pre-flowering stage, were used for the purpose. The materials were treated in four different ways which were a) non-treated, b) one day-wilted, c) chopped with 1 to 2cm length and d) wilted and chopped, and those were ensiled in plastic containers and stored at room temperature for three months. After three months of storage, it was investigated and obtained the following results. 1) Having 6.31 of NFE/CP ratio and low content of crude fiber, Seombadi contained more suitable constituents for silage than Italian ryegrass. 2) Under the non-treated or chopped condition, the loss of NFE was higher, and lower with wilted material. 3) Wilting or chopping improved DM digestibility. 4) Compared with Italian ryegrass harvested at pre-headed stage, the storage amount per unit volume of heading stage-Italian ryegrass and Seombadi were higher 8% and 69% respectively, and wilting and/or chopping increased the storage amount 41 to 134%. 5) The majority of weight loss during storage was observed at 1st week after ensiling, it continued slightly until 4th week. The highest loss in 8th week were 3.76% of nontreated material. 6) One day wilting increased DM content of silage 23 to 131%. Wilting and chopping increased pH and lactic acid improved the quality considerably. 7) The correlation between $NH_3$ and butyric acid, and between lactic acid and DM were r=0.782**, r=0.634** respectively. The regression equation were y=12.853X+4.908 (X=butyric acid), y=0.016X+1.309(X=DM content), respectively. 8. The above results indicate that it is necessary to wilt or chop material to make good quality silage from Italian ryegrass, and such treatment can improve the quality of silage with Seombadi also.

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The Effect of Hen Age on Egg Quality in Commercial Layer (실용산란계의 산란연령이 계란의 품질에 미치는 영향)

  • Lee, Min Hee;Cho, Eun Jung;Choi, Eun Sik;Bang, Min Hee;Sohn, Sea Hwan
    • Korean Journal of Poultry Science
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    • v.43 no.4
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    • pp.253-261
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    • 2016
  • Egg quality is a very important factor for both consumers and producers. Factors affecting egg quality include strain and age of hens; egg storage temperature, time, and humidity; laying season; and feeding. This study aimed to determine the effect of hen age and egg storage time on egg quality. A total of 700 eggs obtained from Hyline Brown commercial layers were used for this experiment, and they were separated into two hen age groups (30 vs. 60 weeks) with eight treatments and four storage times (day 0, 10, 20, and 30). The egg weight; shell color, thickness, and density; albumen height; Haugh unit (HU); yolk color; and the yolk and albumen pH and viscosity were measured for the egg quality assessment. The results showed that the age of the hen and egg storage time significantly affected almost all parameters of the internal and external egg quality. The shell thickness, albumen height, HU, yolk color, pH of yolk and albumen, and yolk viscosity significantly decreased with increasing hen age. The egg shell color was significantly lighter in eggs from 60-week-old hens than in those from 30 weeks-old hens. The egg weight; shell weight, thickness, and density; albumen height, HU; and albumen viscosity significantly decreased, but the yolk color and pH of the yolk and albumen increased with increasing egg storage time. The interaction effects between the storage time and hen age were significant in shell thickness, albumen height, yolk color, and yolk and albumen pH and viscosity. The eggs obtained from 60-week-old hens showed significantly lower shell thickness, albumen height, and HU values, which are considered typical egg quality measurements, than values of eggs from 30-week-old hens. Therefore, increasing hen age and egg storage time caused the deterioration of egg quality. In conclusion, this study demonstrated that hen age is the major factor affecting the quality of fresh eggs, whereas the storage time is the determinant factor affecting the quality of stored eggs.

Functional Components and Radical Scavenging Activity of Germinated Brown Rice according to Variety (품종별 발아현미의 기능성분 및 라디칼 소거 활성)

  • Lee, Kyung ha;Ham, Hyeonmi;Kim, Hyun-Joo;Park, Hye Young;Sim, Eun-Yeong;Oh, Sea Kwan;Kim, Wook Han;Jeong, Heon Sang;Woo, Koan Sik
    • The Korean Journal of Food And Nutrition
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    • v.29 no.2
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    • pp.145-152
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    • 2016
  • This study investigated the changes in chemical components, antioxidant compounds, and activity before (BG) and after germinated (AG) brown rice in order to promote the availability of these beneficial factors. The GABA content of BG and AG brown rice were 0.07~6.61 and 11.13~49.72 mg/100 g, respectively. The ${\alpha}$-amylase activity of AG brown rice was 1.77~70.25 unit/g fold higher than it was in BG brown rice. Total polyphenol and flavonoid contents, which are known to be related to antioxidation, were higher in BG brown rice than in AG brown rice. The total polyphenol contents of BG and AG brown rice were 10.52~36.38 and 11.38~26.33 mg/100 g, and the total flavonoid contents were 3.55~13.39 and 3.52~9.78 mg/100 g, respectively. Also, DPPH radical scavenging activity was 57.64~251.34 and 50.49~213.35 mg TE/100 g, respectively. ABTS radical scavenging activity and total tannin content showed a similar trend to DPPH radical scavenging activity. We expect that this data will be useful in the manufacturing of food products.

The Multi-door Courthouse: Origin, Extension, and Case Studies (멀티도어코트하우스제도: 기원, 확장과 사례분석)

  • Chung, Yongkyun
    • Journal of Arbitration Studies
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    • v.28 no.2
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    • pp.3-43
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    • 2018
  • The emergence of a multi-door courthouse is related with a couple of reasons as follows: First, a multi-door courthouse was originally initiated by the United States government that increasingly became impatient with the pace and cost of protracted litigation clogging the courts. Second, dockets of courts are overcrowded with legal suits, making it difficult for judges to handle those legal suits in time and causing delays in responding to citizens' complaints. Third, litigation is not suitable for the disputant that has an ongoing relationship with the other party. In this case, even if winning is achieved in the short run, it may not be all that was hoped for in the long run. Fourth, international organizations such as the World Bank, UNDP, and Asia Development Bank urge to provide an increased access to women, residents, and the poor in local communities. The generic model of a multi-door courthouse consists of three stages: The first stage includes a center offering intake services, along with an array of dispute resolution services under one roof. At the second stage, the screening unit at the center would diagnose citizen disputes, then refer the disputants to the appropriate door for handling the case. At the third stage, the multi-door courthouse provides diverse kinds of dispute resolution programs such as mediation, arbitration, mediation-arbitration (med-arb), litigation, and early neutral evaluation. This study suggests the extended model of multi-door courthouse comprised of five layers: intake process, diagnosis and door-selection process, neutral-selection process, implementation process of dispute resolution, and process of training and education. One of the major characteristics of extended multi-door courthouse model is the detailed specification of individual department corresponding to each process within a multi-door courthouse. The intake department takes care of the intake process. The screening department plays the role of screening disputes, diagnosing the nature of disputes, and determining a suitable door to handle disputes. The human resources department manages experts through the construction and management of the data base of mediators, arbitrators, and judges. The administration bureau manages the implementation of each process of dispute resolution. The education and training department builds long-term planning to procure neutrals and experts dealing with various kinds of disputes within a multi-door courthouse. For this purpose, it is necessary to establish networks among courts, law schools, and associations of scholars in order to facilitate the supply of manpower in ADR neutrals, as well as judges in the long run. This study also provides six case studies of multi-door courthouses across continents in order to grasp the worldwide picture and wide spread phenomena of multi-door courthouse. For this purpose, the United States and Latin American countries including Argentina and Brazil, Middle Eastern countries, and Southeast Asian countries (such as Malaysia and Myanmar), Australia, and Nigeria were chosen. It was found that three kinds of patterns are discernible during the evolution of a multi-door courthouse model. First, the federal courts of the United States, land and environment court in Australia, and Lagos multi-door courthouse in Nigeria may maintain the prototype of a multi-door courthouse model. Second, the judicial systems in Latin American countries tend to show heterogenous patterns in terms of the adaptation of a multi-door courthouse model to their own environments. Some court systems of Latin American countries including those of Argentina and Brazil resemble the generic model of a multi-door courthouse, while other countries show their distinctive pattern of judicial system and ADR systems. Third, it was found that legal pluralism is prevalent in Middle Eastern countries and Southeast Asian countries. For example, Middle Eastern countries such as Saudi Arabia have developed various kinds of dispute resolution methods, such as sulh (mediation), tahkim (arbitration), and med-arb for many centuries, since they have been situated at the state of tribe or clan instead of nation. Accordingly, they have no unified code within the territory. In case of Southeast Asian countries such as Myanmar and Malaysia, they have preserved a strong tradition of customary laws such as Dhammthat in Burma, and Shriah and the Islamic law in Malaysia for a long time. On the other hand, they incorporated a common law system into a secular judicial system in Myanmar and Malaysia during the colonial period. Finally, this article proposes a couple of factors to strengthen or weaken a multi-door courthouse model. The first factor to strengthen a multi-door courthouse model is the maintenance of flexibility and core value of alternative dispute resolution. We also find that fund raising is important to build and maintain the multi-door courthouse model, reflecting the fact that there has been a competition surrounding the allocation of funds within the judicial system.

Comparison of Clinical Efficacy Between Percutaneous Dilatational Tracheostomy and Surgical Tracheostomy (경피적 확장 기관절개술 (Percutaneous Dilatational Tracheostomy)의 시술 용이성 및 합병증)

  • Ahn, Jong-Joon;Koh, Youn-Suck;Chin, Jae-Yong;Lee, Ki-Man;Park, Wann;Hong, Sang-Bum;Shim, Tae-Sun;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Lim, Chae-Man
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.6
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    • pp.1277-1283
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    • 1998
  • Background : Surgical tracheostomy(ST) is usually performed by surgeons in operating room. For a patient with mechanical ventilation, however, transportation to operating room for ST could be dangerous for patients. In addition, ST is often delayed due to unavailability of operating room or surgeon. Percutaneous dilatational tracheostomy(PDT), although novel in Korea, is gaining popularity as a bedside procedure in the hospitals of western countries. We evaluated the technical ease and safety of PDT in comparison with ST. Method : Thirty-eight patients in medical intensive care unit (ICU) who were either under mechanical ventilation for more than 7 days or required airway protection, were randomly assigned to ST(18 patients) or PDT(20 patients). Between two groups, there was no significant clinical difference except that female to male ratio was higher in the ST group. ST was performed by second year residents of the department of otolaryngology while PDT was performed by third grade medical resident and pulmonologist under bronchoscopic guide using Ciaglia Percutaneous Tracheostomy Set(Cook Critical Care, Bloomington, USA) in medical ICU. The following factors were compared between two groups : number of delayed cases after the decision for tracheostomy, procedural time, complications related to tracheostomy. Results : Delayed cases were 11 in ST group and 3 in PDT group (P<0.05). Procedural time was significantly shorter in PDT group ($15.6{\pm}7.1min$) than in ST group ($29.1{\pm}11.6min$, P<0.0001). Complications related to tracheostomy occurred in 5 cases in ST group : accidental decannulation (1), subcutaneous emphysema (2) and minor bleeding (2), and in 4 cases in PDT group : minor bleeding (2), subcutaneous emphysema (1) and premature extubation (1) (P>0.05). Conclusion : Since percutaneous dilatational tracheostomy was easy to practice and its complications were not different from surgical tracheostomy, PDT can be a useful bedside procedure for mechanically ventilated patients.

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Effects of Body Weight and Dietary Protein Level on Ammonia Excretion by the Nile tilapia Oreochromis niloticus (나일틸라피아의 암모니아 배설에 미치는 어체중과 사료 내 단백질 함량의 영향)

  • Oh, Sung-Yong;Jo, Jae-Yoon
    • Journal of Aquaculture
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    • v.18 no.2
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    • pp.122-129
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    • 2005
  • Ammonia is the major limiting factor in intensive aquaculture production systems. Therefore, quantification of ammonia excretion is important for the water quality management in aquaculture systems. Ammonia excretion is known to be affected by many factors such as body weight and dietary protein level (DPL). In this study, experiments were carried out to investigate the effects of body weight and DPLs on the rates of ammonia excretion of Nile tilapia Oreochromis niloticus. Three sizes of fishes (mean initial weight; 4.8 g,42.7 g and 176.8 g) were fed each of two dietary protein levels (30.5% and 35.5%). Daily feeding levels for the three fish sizes of 4.8 g, 42.7 g and 176.8 g were 6%, 3%, and 1.5% body weight per day, respectively. Each group of fish was stocked in a 17.1-L aquarium and all treatments were triplicated. Following feeding, the weight-specific ammonia excretion rate of O. niloticus increased, peaked at 4 to 8 h, and returned to pre-feeding levels within 24 h. Total ammonia nitrogen (TAN) excretion.ate per unit weight decreased with the increase of fish weight for each diet (P<0.05). The TAN excretion rate increased with increasing dietary protein content for each fish size (P<0.05). TAN excretion rates (Y) for each diet with different fish weights were described by the following equations: low DPL diet (30.5%): $Y\;(mg\;kg^{-1}\;d^{-1})=955.69-147.12\;lnX\;(r^2=0.95)$, high DPL diet (35.5%): $Y\;(mg\;kg^{-1}\;d^{-1})=1362.41-209.79\;lnX\;(r^2=0.99)$. Where: X=body weight (g wet wt.). The TAN excretion rates ranged 28.5%-37.1% of the total nitrogen ingested for the low DPL diet (30.5%) and 37.4-38.5% for the high DPL diet (35.5%). Total nitrogen losses of fish fed the high DPL diet $(35.5%;\;0.26\sim0.91g\;kg^{-1}\;d^{-1})$ were higher than those fed the low DPL diet $(30.5%;\;0.22\sim0.68g\;kg^{-1}\;d^{-1})$. The losses decreased per kg of fish as fish size increased. Results will provide valuable information fer water quality management and culture of Nile tilapia in recirculating aquaculture systems.