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Clinical Significance of Creatine Kinase MB mass and Cardiac Troponin I as a Marker of Perioperative Myocardial Infarction After Coronary Artery Bypass Grafting (관상동맥 우회술 후 심근경색의 표지자로서 Creatine Kinase MB 농도와 Cardiac Troponon I의 임상적 의의)

  • 이재진;김응중;이원용;신윤철;지현근
    • Journal of Chest Surgery
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    • v.35 no.1
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    • pp.27-35
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    • 2002
  • Background: A perioperative myocardial infarction(PMI) is one of the major complications after CABG. Among diagnostic methods of PMI, CK-MB activity assays have been increasingly replaced by CK-MB mass assays, which have more sensitive, simple measurement. Also, new cardiac-specific and -sensitive marker, cardiac troponin I(cTnl), has been shown to be a marker of myocardial infarction. We report our evaluation of clinical significance of CK-MB mass and cTnl as a marker of PMI after CABG. Material and Method: We studied 32 patients who underwent CABG at Kangdong Sacred Hospital between April 2000 and April 2001. Postoperative serum CK-MB activity level, serum CK-MB mass, cTnl, electrocardiogram, echocardiogram, and clinical data were recorded prospectively The diagnosis of PMI was defined as positive 2 among 3 or all of the following , by a new Q wave on the electrocardiogram, by serum CK-MB activity higher than 200 lU/L within 72 hours after operation, and by new regional wall motion abnormality on the echocardiogram. Result: After CABG, 3 patients had sustained a PMI according to current diagnostic criteria. As serum CK-MB activity time course, a level of CK-MB activity 12 hours after CABG had very linear correlated significance with serum CK-MB mass 24hours(R=0.946) and cTnl 48 hours(R=0.933) after CABG(p=0.000). As we used a receiver operating characteristics curve(ROC curve) for a diagnostic cutoff value in patients with PMI, serum CK-MB mass levels higher than 30.05 ug/L 24 hours after CABG detected the presence of PMI with an area under the ROC curve of 1.0, a sensitivity of 100%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 100%. Also serum cTnl levels higher than 17.15 ug/L 48 hours after CABG detected the presence of PMI with an area under the ROC curve of 0.98, a sensitivity of 100%, a specificity of 96.6%, a positive preclictive value of 75%, and a negative predictive value of 100% Conclusion: We concluded that both the measurement of CK-MB mass and cTnl are the easier, accurate methods as a diagnostic marker of PMT after CABG, also as a proposal of diagnostic cutoff value enables to an early detection of PMI. However, a 1arger number of patient will be needed because of statistic limitation that a small number of participating patients, a small number of PMI.

Availability of the Skeletonized Gastroepiploic Artery as a Free Graft for Coronary Artery Bypass Grafting (관상동맥 우회로 조성술에 있어 유리 이식편으로 사용된 골격화 우위대망 동맥의 효용성)

  • Ryu Sang-Wan;Ahn Byong-Hee;Hong Seong-Beom;Song Sang-Yun;Jung In-Suk;Beom Min-Sun;Park Jung-Min;Lee Kyo-Sun;Ryu Sang-Woo;Yoon Ju-Sik;Kim Sang-Hyung
    • Journal of Chest Surgery
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    • v.38 no.9 s.254
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    • pp.601-608
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    • 2005
  • Background: To maximize the histological advantage and minimize the physiological disadvantage, we have been using the skeletonized gastroepiploic artey (GEA) as a free graft for total arterial revascularization. The aims of the current study was to assess the efficacy of the skeletonized GEA as a composite or extended graft for total arterial revascularization. Material and Method: Between January 2000 and Feburary 2005, 133 patients (43 female, mean age=61.8 yrs) undergoing coronary artery bypass grafting (CABG) with a skeletonized GEA as free graft (22 extended, 107 composite and 4 others) were enrolled in this study. Coronary angiograms were performed in the immediate (median 44 days, n=86), early (median 366 days, n=56) and midterm (median 984 days, n=29) postoperative periods. Result: There were 3 ($2.2\%$) early and 4 ($3.3\%$) late cardiac-related deaths. The mean number of distal anastomoses per patient was 3.34 for total graft and 1.92 for GEA graft. The immediate, early, and midterm GEA patency were 157/159 ($98.7\%$), 106/142 ($94.6\%$), and 53/56 ($94.6\%$), respectively. During follow-up, four patients required percutaneous intracoronary intervention because of GEA and target coronary artery stenosis or competitive flow. Conclusion: These data demonstrate satisfactory clinical and angiographic results in the skeletonized GEA as free graft for total arterial revascularizatioh. Although we need a careful longer follow-up, the skeletonized GEA as a free graft will be a valuable option 'to be' for CABG.

DRAG EFFECT OF KOMPSAT-1 DURING STRONG SOLAR AND GEOMAGNETIC ACTIVITY (강한 태양 및 지자기 활동 기간 중에 아리랑 위성 1호(KOMPSAT-1)의 궤도 변화)

  • Park, J.;Moon, Y.J.;Kim, K.H.;Cho, K.S.;Kim, H.D.;Kim, Y.H.;Park, Y.D.;Yi, Y.
    • Journal of Astronomy and Space Sciences
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    • v.24 no.2
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    • pp.125-134
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    • 2007
  • In this paper, we analyze the orbital variation of the Korea Multi-Purpose SATellite-1(KOMPSAT-1) in a strong space environment due to satellite drag by solar and geomagnetic activities. The satellite drag usually occurs slowly, but becomes serious satellite drag when the space environment suddenly changes via strong solar activity like a big flare eruption or coronal mass ejections(CMEs). Especially, KOMPSAT-1 as a low earth orbit satellite has a distinct increase of the drag acceleration by the variations of atmospheric friction. We consider factors of solar activity to have serious effects on the satellite drag from two points of view. One is an effect of high energy radiation when the flare occurs in the Sun. This radiation heats and expands the upper atmosphere of the Earth as the number of neutral particles is suddenly increased. The other is an effect of Joule and precipitating particle heating caused by current of plasma and precipitation of particles during geomagnetic storms by CMEs. It also affects the density of neutral particles by heating the upper atmo-sphere. We investigate the satellite drag acceleration associated with the two factors for five events selected based on solar and geomagnetic data from 2001 to 2002. The major results can be summarized as follows. First, the drag acceleration started to increase with solar EUV radiation with the best cross-correlation (r = 0.92) for 1 day delayed F10.7. Second, the drag acceleration and Dst index have similar patterns when the geomagnetic storm is dominant and the drag acceleration abruptly increases during the strong geomagnetic storm. Third, the background variation of the drag accelerations is governed by the solar radiation, while their short term (less than a day) variations is governed by geomagnetic storms.

The Effect of University Entrepreneurial Education Service Quality on Education Satisfaction, Entrepreneurial Capability, and Entrepreneurial Intention (대학의 창업교육 서비스 품질이 교육만족과 창업역량, 창업의지에 미치는 영향)

  • Kwak, Dong Shin;Jung, Hwa Young;Kim, Myung Seuk
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.11 no.4
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    • pp.37-48
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    • 2016
  • This study explored how university entrepreneurial education service quality affects education satisfaction, entrepreneurial capability, and entrepreneurial intention. Although the various university entrepreneurial educations have been provided, current state of education support for entrepreneurial achievement is quite insufficient. In order to analyze factors for the entrepreneurial achievement enhancement, this study examines how university entrepreneurial education service quality affects education satisfaction, entrepreneurial capability, and entrepreneurial intention, as follows. First, in order to measure the entrepreneurial education service quality on the basis of theoretical background of the service quality, we set twenty one (21) questions for five (5) factors as follows: materiality, reliability, reactivity, certainty, consensuality. And then, impact of the entrepreneurial education service quality on education satisfaction and entrepreneurial capability was evaluated based on the survey results. Second, on the basis of previous studies of customer satisfaction, we gave the definition of education satisfaction for students in entrepreneurial education, and analyzed the causation that affects some elements of entrepreneurial capability (i.e. fulfillment capability, capacity of creativity, conceptualization capability, and social competence) by the aforementioned definition. Third, we analyzed the causation that affects entrepreneurial intention by education satisfaction and entrepreneurial capability. As a result, unlike the previous studies, there are only four (4) factors were confirmed for the entrepreneurial education service quality because the materiality and the reliability were founded as single element under the analysis. And it was identified that the entrepreneurial education service quality which is comprised of four (4) factors affects the education satisfaction and the entrepreneurial capability. In addition, as a result of the analysis under defining four (4) factors of entrepreneurial capability, the fulfillment capability and the capacity of creativity were founded as single element, and it was confirmed there is only three (3) factors, including the conceptualization capability and the social competence. With this result, it was confirmed that the entrepreneurial education service quality is influenced by the education satisfaction. Therefore, although the entrepreneurial intention is influenced by the entrepreneurial capability, it is not directly affected by the education satisfaction. These results showed that the education satisfaction affects indirectly to the entrepreneurial intention through the entrepreneurial capability that affected by the education satisfaction.

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Clinical Evaluation of Instrumental Esophageal Perforation (기구에 의한 식도천공에 대한 임상적 고찰)

  • Sa Young-Jo;Kang Chul-Ung;Cho Kyu-Do;Park Kuhn;Wang Young-Pil;Park Jae-Kil
    • Journal of Chest Surgery
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    • v.39 no.5 s.262
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    • pp.387-393
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    • 2006
  • Background: Esophageal perforation is an uncommon problem, but it is associated with high mortality. We performed a retrospective review of patients with instrumental esophageal perforation to assess the outcome of current management techniques. Material and Method: We retrospectively analyzed all cases of instrumental esophageal perforation diagnosed at our hospital from January 1999 through to March 2005. The study group consisted of 12 patients (8 women and 4 men) with a mean age of 48.8 years (range, $21{\sim}83$ years). We reviewed the effects of the surgical or medical treatments in various conditions of patients, such as of various sites of perforation and time delayed after injury. Result: Perforations were due to diagnostic endoscopy (50.0%, 6/12), esophageal bougination for benign stricture (33.3%, 4/12), endoscopic port insertion (8.3%, 1/12), and tracheal intubation (8.3%, 1/12). The perforated sites were thoracic in 7 patients and cervical in 5. The treatment included resection and reconstruction (5 cases), incision and drainage (4 cases), medical treatment (2 cases), and closed thoracostomy drainage only (1 case). Post-operative complications of transient pneumonia and wound infection were developed in 1 patient respectively. Both occurred in two patients with diffuse mediastinal abscess formation. The overall mortality was 8.3% (1/12) in one old patient who was managed medically for cervical esophageal perforation. Conclusion: We concluded that surgical treatment for esophageal perforations was safe and effective whether diagnosed early or lately.

Analysis of Complications Associated with the Nuss Procedure: Risk Factors and Preventive Measures (너스수술의 합병증에 대한 고찰: 위험인자 분석과 예방책의 제시)

  • Park, Hyung-Joo;Chang, Won-Ho;Jeon, Cheol-Woo;Park, Han-Gyu;Lee, Seock-Yeol;Lee, Cheol-Sae;Youm, Wook;Lee, Kihl-Roh
    • Journal of Chest Surgery
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    • v.37 no.6
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    • pp.524-529
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    • 2004
  • Background: Since the Nuss procedure for the correction of pectus excavatum is in its early stage, there have been problems that need to be solved. We examined complications in a single-institute experience of the Nuss technique in order to develop possible solutions to prevent them. Material and Method: 335 consecutive patients, who underwent the modified Nuss procedure between August 1999 and October 2002, were studied retrospectively. Median age was 8 years (range 1 to 46). 264 patients (78.8%) were in pediatric group (age$\leq$15) and 71 patients (21.2%) were in adult group (age> 15). 193 patients (57.6%) had symmetric and 142 patients (42.4%) had asymmetric pectus configurations. Risk factors predicting postoperative complications were analyzed using multi-variate logistic regression. Result: Postoperative complication rates were 18.9% (61/335) in total patients. Frequent complications were pneumothorax 24 (7.5%), bar displacement 11 (3.4%), and wound seroma 10 (3.1%) in order. Early complications (within a month, 49 cases, 15.2%) were pneumothorax (n=23, 6.9%), wound seroma (n=12, 3.6%), and bar displacement (n=8, 2.4%). Late complications (after a month, 12 cases, 3.7%) were pericarditis and pericardial effusion (n=5, 1.5%), bar displacement (n=4, 1.2%), and hemothorax (n=3, 0.9%). Techniques were modified to prevent complications especially in bar shaping and fixation, which led to decrease complication rate in later experience (Operation Date 1: 15/51 (29.4%) vs Operation Date 2: 34/284 (12.0%), p=0.004). Grand Canyon type (eccentric long canal type) showed higher complication rate than other types (GC type: 12/30(40%) vs Others: 37/305 (12.1%), p<0.001). Major risk factors are severity of pectus (OR=2.88, p=0.038), Grand Canyon type (OR=2.82, p=0.044), and Op. Date 1 (OR=4.05, p=0.001). Conclusion: Major complications were related to severe eccentric type of pectus configuration (Grand Canyon type) and lack of surgeon's experience (Op. Date 1). Com-plication rate was reduced with accumulation of experience and advancement of surgical techniques. The Nuss procedure can be performed at a low risk of complications with our current technique.

Comparison of the Neurologic Outcome according to the Method of Proximal Graft Anastomosis at the Aortic Side during Off-pump Coronary Artery Bypass Grafting: The Heartstring Sealing System versus Conventional Manual Anastomosis (무심폐기 관상동맥 우회술에 있어서 이식편의 대동맥부 근위부 문합 방법에 따른 수술 후 신경학적 합병증 발생의 비교: 하트스트링을 이용한 방법 대 고식적인 수기 문합술)

  • Cho, Won-Chul;Kim, Joon-Bum;Kim, Hee-Jung;Kim, Hwan-Wook;Kim, Yun-Seok;Jung, Jae-Seung;Choo, Suk-Jung
    • Journal of Chest Surgery
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    • v.42 no.4
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    • pp.441-446
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    • 2009
  • Background: Side clamping of ascending aorta during proximal graft anastomosis in coronary bypassing surgery in-creases the risk of direct aortic injury as well as embolization of intimal atheroma. Heartstring proximal sealing system (Guidant Corporation, Santa Clara, Calif), developed to avoid aortic side clamping, may minimize risks of such complications. The aim of the current study is to compare the surgical outcomes of the two proximal anastomosis techniquesi.e., Heartstring system versus aortic side clamping in off pump coronary bypassing' surgery (OPCAB). Material and Method: From January 2003 to August 2008, 499 patients underwent OPCAB. Of them, proximal graft anastomosis was performed using Heartstring system in 182 patients (Group I) and conventional manual anastomosis in 317 patients (Group II). The two groups were compared for postoperative major complications and mortality. Result: Two groups showed similar characteristics in terms of preoperative demographic data, left ventricular ejection fraction, renal function and history of diabetes, hypertension and smoking. Although there was no inter-group difference in the history of cerebral ischemia (p=0.48), preoperative brain magnetic resonance angiography revealed greater incidence of severe carotid artery stenosis (>75% of lumen) in the Group I than in the. Group II (44.5% in the Group I and 30.0% in the Group II, p=0.003). There were no inter-group differences in postoperative mortality (p=0.40) and complications (p=0.47) including neurologic events (3 in the Group land 2 in the Group II, p=0.258). Whereas neurologic events all comprised transient ischemic attacks in the Group I, they comprised multiple embolic strokes in the Group II. One patient in the Group II experienced aortic dissection during proximal anastomosis which resulted in ascending aortic replacement. Conclusion: Although proximal anastomosis using Heartstring system did not show statistically significant benefit over aortic side clamping, the. absence of embolic stroke maybe a definite benefit which may be better defined through further studies over a larger cohort.

Clinical Results Following Early Tailoring Thoracoplasty in Patients Undergoing Pulmonary Resection (폐의 부분절제수술를 시술받은 환자에서 조기 변형식 흉곽성형수술에 따른 임상결과)

  • Choi, Soon-Ho;Cha, Byung-Ki;Lee, Mi-Kyung;Park, Kwon-Jae;Lee, Sam-Youn;Choi, Jong-Bum
    • Journal of Chest Surgery
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    • v.40 no.7 s.276
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    • pp.485-491
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    • 2007
  • Background: Thoracoplasty has become a rarity in current clinical practice, although it has been widely employed for well over a century as a procedure for reducing the capacity of the thoracic cavity. Yet we have perform tailoring thoracoplasty following or concomitant with pulmonary resection in 20 patients. The aim of this study is to evaluate the early and late clinical results and also the significance of tailoring thoracoplasty. Material and Method: From March 1995 to June 2005, modified thoracoplasty following or concomitant with pulmonary resection was performed in 20 patients out of a total of 298 pulmonary resections for closing air leaks and for treating persistent pleural space following pulmonary resections, and to tailor the thoracic cavity to accept a diminished lung volume. Of the 20 patients, 14 patients had tailoring thoracoplasty performed concomitant with pulmonary resection, and the remaining 6 patients also had tailoring thoracoplasty performed following pulmonary resection. The subjects ages ranged from 24 to 77 (mean $59.1{\pm}6.4$) and a male preponderance was noted (17 : 3); the number of left and right surgeries was equal. The preoperative primary underlying diseases were lung cancer in 7 patients, pneumothorax with giant bullous change in 6 patients, bronchiectasis in 2 patients, previous pulmonary tuberculosis associated with aspergilloma in 2 patients, empyema with fibrothorax in 2 patients and multiple lung abscesses & destruction due to previous trauma in 1 patient. The operative methods were apicolysis and subperiosteal removal of the 2nd, 3rd and 4th ribs (the costochondral junction to the posterior portions of the ribs) with preservation of the first rib and compression of the anterior chest via cotton bags and elastic bandages. Result: The mean duration of the air leaks after thoracoplasty was $1.6{\pm}0.2$ days (range: $0{\sim}7$ days) and the mean duration of an indwelling chest tube was 7 days (range: $5{\sim}11$ days); the mean duration of hospitalization was $19.2{\pm}2.8$ days (range: $8{\sim}47$ days). The postoperative complications were wound infection (2) and pneumonia (2); reoperation was done due to bleeding (1) in one patient who underwent concomitant thoracoplasty and there was 1 case of wound infection (1) after postresection thoracoplasty. The mortality was 1 patient in the early phase and 4 patients in the late phase. Conclusion: We conclude that tailoring thoracoplasty may be performed to close anticipated persistent pleural spaces and to accommodate the diminished lung volume with acceptable cosmetic results when this procedure is combined with pulmonary resection in selected patients.

Organizational Factors Facilitating the Internationalization of Korean Franchising Companies (해외진출 국내 프랜차이즈기업의 조직특성)

  • Lim, Young-Kun;Lee, Dong-Whuy;Kim, Hee-Jung
    • Journal of Global Scholars of Marketing Science
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    • v.19 no.2
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    • pp.40-52
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    • 2009
  • Franchising is one of the fastest growing types of business. It is already popular and well-known in the U.S., and has been growing in many other countries including Korea. Furthermore, many Korean franchising companies have expanded their business overseas actively. According to the data by the Ministry of Industry and Resource, 82 companies out of a sample of 500 franchising companies are already operating in many foreign countries and 48% of them have started their foreign business since 2006. This clearly indicates the fast growing current trend of foreign operation by Korean franchising companies. In spite of the fast growing trend of foreign expansion in the industry, academic research on internationalization of franchising companies is extremely difficult to find. Accordingly, academic research on the issue is necessary and urgent in Korea. Among the various research questions on internationalization of franchising business, this study intends to investigate the difference in organizational factors between the franchising companies doing foreign operation and those doing business only domestically. More specifically, this research has the following purposes. First, considering the lack of theoretical basis of previous studies, resource-based theory and agency theory are employed as the theoretical bases. Second, this study explains the difference in internationalization based on organizational factors such as company size, history and growth rate. Third, the five hypotheses regarding the difference in organizational factors are presented and tested empirically, which is the first attempt in the area of this topic. Finally, the study attempts to clarify the conflicting implications among theories regarding some organizational factos such as growth rate. As the theoretical background, resource-based theory and agency theory are discussed. According to resource-based theory, a firm can grow continuously when it has competence and resource, and also the ability to develop them. The competence and resource can include capital, human resource, management skill, market information, ability to manage risk, etc. Meanwhile, agency theory views the relationship between franchisor and franchisee as an agency relationship. In agency theory, bonding capability and monitoring capability are the two key factors which promote internationalization of franchising companies. Based on the two theories, a conceptual model is designed. The model consists of two groups of variables. One is organizational factors including size, history, growth rate, price bonding and geographic dispersion. The other is whether a franchising company is operating overseas or not. We developed the following five research hypotheses basically describing the relationship between organizational factors and internationalization of franchising companies. H1: The size of franchising companies operating overseas is larger than that of franchising companies operating domestically. H2: The history of franchising companies operating overseas is longer than that of franchising companies operating domestically. H3: The growth rate of franchising companies operating overseas is higher than that of franchising companies operating domestically. H4: The price bonding of franchising companies operating overseas is higher than that of franchising companies operating domestically. H5: The geographic dispersion of franchising companies operating overseas is wider than that of franchising companies operating domestically. Data for the analyses are obtained from 2005 Korea Franchise Survey data co-generated by Ministry of Industry and Resource, GS1 Korea, and Korea Franchise Association. Out of 2,804 population companies, 2,489 companies are excluded for various reasons and 315 companies are selected as the final sample. Prior to hypotheses tests, validity and reliability of the measures of size, history, growth rate and price bonding are examined for further analyses. Geographic dispersion is not validated since it is measured using nominal data. A series of independent sample T-tests is used to find out whether there exists any significant difference between the companies internationalized and those operating only domestically for each organizational factor. Among the five factors, size and geographic dispersion show significant difference, growth rate and price bonding do not reveal any difference and, finally, history factor shows conflicting results in the difference depending on how to measure it.

    shows the summary statistics for hypotheses testing. In conclusion, the results show that the size and history, which are the key variables in resource-based theory, have a significant relationship with internationalization and that geographic area, which belongs to agency theory, also has a strong relationship with internationalization. The results support the findings of extant research and, therefore, prove the usefulness of resource-based theory and agency theory in explaining internationalization of franchising companies. However, growth rate and price-bonding do not show a clear difference between the two types of companies. Accordingly, these two factors need further attention in the future research. Although this study shows meaningful findings theoretically and practically, it has several limitations. First, only organizational factors are considered even if there are various environmental factors influencing franchising firm's internationalization. Second, only being internationalized or not is considered. That is, modes of entry and the size of foreign operations are not included in the study. Third, internationalization strategy is often determined based on the desire for business expansion and higher profitability and egoistical reasons of the CEOs. However, this type of factors belonging to behavioral science is not discussed in the study. Finally, organizational ecology perspective is usefully applicable in explaining the survival and performance of internationally operating companies. Accordingly, research propositions based on this perspective need to be developed and tested.

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  • Relationship between Compressive Strength and Dynamic Modulus of Elasticity in the Cement Based Solid Product for Consolidating Disposal of Medium-Low Level Radioactive Waste (중·저준위 방사성 폐기물 처리용 시멘트 고화체의 압축강도와 동탄성계수의 관계)

    • Kim, Jin-Man;Jeong, Ji-Yong;Choi, Ji-Ho;Shin, Sang-Chul
      • Journal of the Korea Concrete Institute
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      • v.25 no.3
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      • pp.321-329
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      • 2013
    • Recently, the medium-low level radioactive waste from nuclear power plant must be transported from temporary storage to the final repository. Medium-low level radioactive waste, which is composed mainly of the liquid ion exchange resin, has been consolidated with cementitious material in the plastic or iron container. Since cementitious material is brittle, it would generate cracks by impact load during transportation, signifying leakage of radioactive ray. In order to design the safety transporting equipment, there is a need to check the compressive strength of the current waste. However, because it is impossible to measure strength by direct method due to leakage of radioactive ray, we will estimate the strength indirectly by the dynamic modulus of elasticity. Therefore, it must be identified the relationship between of strength and dynamic modulus of elasticity. According to the waste acceptance criteria, the compressive strength of cement based solid is defined as more than 3.44 MPa (500 psi). Compressive strength of the present solid is likely to be significantly higher than this baseline because of continuous hydration of cement during long period. On this background, we have tried to produce the specimens of the 28 day's compressive strength of 3 to 30 MPa having the same material composition as the solid product for the medium-low level radioactive waste, and analyze the relationship between the strength and the dynamic modulus of elasticity. By controling the addition rates of AE agent, we made the mixture containing the ion exchange resin and showing the target compressive strength (3~30 MPa). The dynamic modulus of elasticity of this mixtures is 4.1~10.2 GPa, about 20 GPa lower in the equivalent compressive strength level than that of ordinary concrete, and increasing the discrepancy according to increase strength. The compressive strength and the dynamic modulus of elasticity show the liner relationship.


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