• Journal of Chest Surgery
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• 제35권5호
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• pp.329-335
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• 2002

배경: 한국형 인공심장(AnyHeartTM)은 단심보조장치, 체네 이식형 양심보조장치, 인공심장, 그리고 생명 유지를 위한 체외순환 장치 등 다양한 형태로 사용이 가능한 장치이다. 그 중에서도 체내 이식형 양심보조장치는 가장 독특한 형태이다. 양심보초장치 이식의 외과적 술기는 주로 삽관으로 구성되어 있고, 흉골 정중절개는 외과의사가 심장의 노출을 충분히 할 수 있어서 가장 선호되어 온 방법이다. 그러나 환자가 흉골 정중절개를 이미 시행 받은 경우나, 또는 차후에 환자 대부분이 흉골 정중절개가 필요한 것을 감안하면 재개흉에 따른 합병증은 양심보조장치 이식에 있어서 중요하게 고려해야 할 부분이다. 일반적인 심장 수술의 임상경험에 근거하여, 저자들은 양심보조장치 이식에 있어서, 도관의 상관을 위한 접근이 심장의 우측에서도 가능할 것이라고 가정하였다. 이번 연구의 목적은 동물실험에서 양심보조장치의 이식을 위한 우측 개흉술의 수술 기법을 개발하고자 하였다. 대상 및 방법: 지난 2년 동안, 30차례의 AnyHeart$^{TM}$ 이식실험 중 16례가(11 calves, 3 canines, and 2 sheep) 우측 개흉술로 이루어졌다. 기계장치는 14례의 동물에서 체내 이식형 양심보조장치로 시술 되었으며, 체외형 양심보조장치와 체내 이식형 좌심실보조장치로 시술된 경우가 각각 1례씩이었다. 수술은 4번째 늑간를 통하여 우측 흉강으로 진입하였고, 양심보조장치의 경우에 우측 유입 도관은 우심방의 free wall에 삽관 하였고, 유춘도관은 인조혈관을 이용하여 주폐동맥애 측단 문합하였다. 좌측 유입도관은 심방격을 통하여 좌심방에 삽관하였고, 유출도관을 무명동맥에 인조현관을 이장하여 측단 문한하였다. 각각의 도관은 피하터널을 통해 우측 옆구리에 위치한 펌프와 연결하였다. 결과: Fitting test와 초기 실험의 5례를 제외하고 모든 실험 동물은 수술 후 회복되었다. 펌프의 유출량은 최고 6.5L/min였고, 평균 3~3.5L/min로 측정되었다. 수술과 관련된 사망이나 이환율은 없었다. 모든 실험 도물은 부검을 하였으며, 부검 결과 도관이 위치는 모두 각각의 심방내에 적절하게 위치하고 있었다.

• Journal of Chest Surgery
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• 제38권7호
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• pp.489-495
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• 2005

대동맥 박리에서 완전 순환 정지 하에 대동맥 궁의 확인 및 치환이 필요한 경우가 많다. 이런 경우 뇌의 보호를 위해 역행성 뇌 관류 또는 전방성 뇌 관류를 사용하게 된다. 최근에는 역행성 뇌관류의 한계를 극복하기 위해 전방성 뇌 관류가 보편화되고 있는 실정이다. 저자들은 이 두 가지 방법에 대해 신경학적 이상에 중점을 두고 비교하였다 대상 및 법: 2000년 5월부터 2004년 5월까지 대동맥 박리 환자 중 뇌관류를 시행한 40명을 대상으로 하였으며, 회복과정 및 신경학적 합병증에 관해 비교하였다. 결과: 동맥관 삽관은 전방성 뇌 관류군의 15예 중 10예에서 액와동맥에 시행하고, 역행성 뇌 관류군의 25예 중 24예에서 대퇴 동맥에 시행하였다. 완전 순환정지 시식도 온도와 직장 온도를 비교하여 보면, $17.2^{\circ}C,\;22.8^{\circ}C$ (전방성 뇌 관류군)와 $16.1^{\circ}C,\;19.7^{\circ}C$ (역행성 뇌 관류군)로 전방성 뇌 관류 군이 통계적으로 높게 나타났다 이는 수술시간 및 체외순환시간을 의미 있게 단축시켰다. 회복에서는 통계적 차이가 없었다. 신경학적 합병증의 발생에서도 11예와 13예로 통계적 차이가 없었다. 하지만 영구적 신경계 이상을 진단받은 각 군의 5예를 비교하여 보면, 전방성 뇌 관류군에서 영구적 신경계이상을 보인 5명의 환자 모두가 일상생활에 지장을 받지 않는 상태로 회복되었지만, 역행성 뇌 관류군에서의 5명 모두는 일상생활의 장애를 가진 채 퇴원하였다. 결론: 전방성 뇌 관류는 정방향성 혈류를 유지함으로써 중등도의 체온 저하, 수술시간 및 체외순환시간을 단축시키고 뇌의 기능을 보다 더 보호할 수 있는 것으로 생각된다. 저자들은 향후 전방성 뇌 관류법이 보다 적극적으로 사용되어져야 할 것으로 생각한다..96$이었다. 관상동맥 우회술시 다른 수술이 동반되었던 경우가 총 10예$(6.5\%)$였다. 수술 후 대동맥내 풍선펌프는 21예$(13.6\%)$에서 이용하였으나, 비체외순환하 수술에서는 4예$(5.1\%)$로 줄었으며, 전체 사망환자는 12명$(7.9\%)$이었으나, 2001년 이후에는 111예 중 5명$(4.5\%)$으로 감소하였다. 수술합병증으로 수술 전후의 심근경색증 9예$(5.8\%)$, 저심박출증 17예$(11\%)$, 부정맥 30예$(19.5\%)$등이었다. 결론: 국립의료원 흉부외과에서는 관상동맥 우회술을 시작한 이래 수술경험의 축적, 비체외순환하 관상동맥 우회술의 도입, 내흉동맥 및 요골동맥으로의 이식편 이용 변화에 따라 수술성적이 향상되었음을 알 수 있으며, 향후 더 많은 임상경험의 축적 및 장기 추적 관찰이 필요하다고 사료된다.보였으며, 난중, 난황색, 난백고 및 Haugh unit는 처리 간 차이(p>0.05)가 없었다.이고, 환자 1인당 Wedge filter의 교체작업이 $1{\sim}2$회일 때 10MV의 경우 연간선량이 $0.08{\sim}0.4mSv$로 평가되었으며, 15MV의 경우 $0.27{\sim}1.36mSv$로 평가되어 작업종사자의 연간 허용선량인 20mSv에 비해 안전한 것으로 평가되었다.서 정상조직이 적게 조사되었다. 결과 : 기존의 ICRU계획은 그 효과 및 안전성이 입증되었음에도 불구하고 CT를 이용한 CTV계획 등을 적용 한다면 잔류종양이 적은 경우 정상조직에 대한 조사를 줄이면서 잔류종양에 목표선량을 조사할 수 있을 것이다. 다만 잔류종양이

• Asian-Australasian Journal of Animal Sciences
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• 제27권7호
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• pp.917-925
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• 2014

An accurate feed formulation is essential for optimizing feed efficiency and minimizing feed cost for swine and poultry production. Because energy and amino acid (AA) account for the major cost of swine and poultry diets, a precise determination of the availability of energy and AA in feedstuffs is essential for accurate diet formulations. Therefore, the methodology for determining the availability of energy and AA should be carefully selected. The total collection and index methods are 2 major procedures for estimating the availability of energy and AA in feedstuffs for swine and poultry diets. The total collection method is based on the laborious production of quantitative records of feed intake and output, whereas the index method can avoid the laborious work, but greatly relies on accurate chemical analysis of index compound. The direct method, in which the test feedstuff in a diet is the sole source of the component of interest, is widely used to determine the digestibility of nutritional components in feedstuffs. In some cases, however, it may be necessary to formulate a basal diet and a test diet in which a portion of the basal diet is replaced by the feed ingredient to be tested because of poor palatability and low level of the interested component in the test ingredients. For the digestibility of AA, due to the confounding effect on AA composition of protein in feces by microorganisms in the hind gut, ileal digestibility rather than fecal digestibility has been preferred as the reliable method for estimating AA digestibility. Depending on the contribution of ileal endogenous AA losses in the ileal digestibility calculation, ileal digestibility estimates can be expressed as apparent, standardized, and true ileal digestibility, and are usually determined using the ileal cannulation method for pigs and the slaughter method for poultry. Among these digestibility estimates, the standardized ileal AA digestibility that corrects apparent ileal digestibility for basal endogenous AA losses, provides appropriate information for the formulation of swine and poultry diets. The total quantity of energy in feedstuffs can be partitioned into different components including gross energy (GE), digestible energy (DE), metabolizable energy (ME), and net energy based on the consideration of sequential energy losses during digestion and metabolism from GE in feeds. For swine, the total collection method is suggested for determining DE and ME in feedstuffs whereas for poultry the classical ME assay and the precision-fed method are applicable. Further investigation for the utilization of ME may be conducted by measuring either heat production or energy retention using indirect calorimetry or comparative slaughter method, respectively. This review provides information on the methodology used to determine accurate estimates of AA and energy availability for formulating swine and poultry diets.

• Journal of Chest Surgery
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• 제42권1호
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• pp.41-45
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• 2009

배경: 혈액투석을 하는 만성신부전 환자는 반복된 혈관천자로 인해 정맥의 보존상태가 좋지 않아서 동정맥루 조성술이 어려운 경우가 많다. 이에 저자는 혈관천자 등으로부터 보호된 상완동맥 주위의 동반정맥(vena comitantes)을 정맥측 문합으로 이용하여 인조혈관 동정맥루 조성술을 시행하였고 이의 개존율, 합병증 등을 알아보고자 하였다. 대상 및 방법: 2006년 1월부터 2008년 5월까지 전주주름 부위의 표재정맥의 보존상태가 불량하여 심부정맥인 동반정맥을 정맥 유출로로 이용하여 수술한 12예의 인조혈관 동정맥루 환자를 대상으로 임상분석을 시행하였다. 동맥측 문합은 상완동맥에 단측문합하였으며 루프형태로 수술하였다. 대상환자의 남녀비는 7 : 5이고 평균연령을 $59{\pm}17$세이며 당뇨병을 동반한 경우가 6예, 고혈압을 동반한 경우가 10예였다. 결과: 수술 후 감염이나 출혈 등의 합병증은 없었고 5명의 환자에서 술 후 평균 3개월에 협착의 소견을 보였다. 3, 6, 12개월의 일차 개통율은 각각 75.0%, 65.6%, 52.5%였다. 협착이 있었던 환자들도 중재적 시술 후 혈류가 개선되어 현재까지 혈액투석이 가능하였고 12개월의 이차 개통율은 100%였다. 결론: 인조혈관을 이용한 동정맥루 조성술시 정맥천자 등에 의해 손상되지 않은 동반정맥을 이용하여 정맥문합 하면 비교적 양호한 개통율을 보이므로 표재정맥이 적당치 않은 경우 대체혈관으로 사용해도 무방할 것으로 생각된다.

• Asian-Australasian Journal of Animal Sciences
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• 제7권4호
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• pp.537-546
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• 1994

This experiment was carried out to compare the effects of six different plant protein sources such as soybean meal, extruded full-fat soybean, canola meal, rapeseed meal, cottonseed meal and perilla meal as a sole protein source of diets on growth performance and amino acid bioavailabilities in growing-finishing pigs. A total of 54 pigs with average 25 kg of body weight were used as experimental subjects for a 65-d feeding trial. Digestion trial was carried out with seven ileal-cannulated pigs. The most rapid rate of weight gain was observed in pigs fed soybean meal and full-fat soybean, the moderate one in pigs fed canola meal and cottonseed meal and the least one in pigs fed rapeseed meal and perilla meal (p<0.005). Feed efficiency was better for groups fed soybean meal and full-fat soybean than other protein meals (p<0.05). The apparent ileal digestibilities of essential amino acids of soybean meal and full-fat soybean (82.5% and 81.6%) were significantly (p<0.05) higher than those of other protein sources (61.2 to 69.4%). Regardless of protein sources, the apparent ileal digestibility of arginine was highest, whereas that of histidine was lowest among essential amino acids. Proline had the lowest digestibility among non-essential amino acids. True amino acid digestibilities tended to be higher than apparent amino acid digestibilities. The differences between true and apparent ileal digestibilities were greater in canola meal, rapeseed meal or cottonseed meal than other protein sources. The differences was greatest in praline except for cottonseed meal. The fecal digestibility appeared to be higher than the ileal digestibility. The differences between fecal and ileal digestibilities were greater in canola meal, rapeseed meal, cottonseed meal and perilla meal than in soybean meal and full-fat soybean. In general, praline was the most disappeared amino acid in the hind gut, while the net synthesis of lysine in the large intestine was observed in all protein sources except perilla meal. It is appropriate that swine feeds should be formulated based on true ileal amino acid digestibility of protein sources for pig's normal growth.

• Asian-Australasian Journal of Animal Sciences
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• 제18권3호
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• pp.396-402
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• 2005

Three experiments were conducted to determine the effects of dietary arginine concentrations on plasma free amino acid (PAA) concentrations in rainbow trout, Oncorhynchus mykiss (Walbaum). The first experiment was conducted to determine appropriate post-prandial and food deprivation sampling times in dorsal aorta cannulated rainbow trout averaging 519${\pm}$9.5 g (mean${\pm}$SD) at $16^{\circ}C$. Blood samples were taken at 0, 2, 3, 4, 5, 6 and 24 h after feeding (0 and 24 h blood samples were taken from the same group of fish). PAA concentrations increased by 2 h post-feeding and the concentration of all essential amino acids except histidine peaked at 5 h and returned to 0 time values by 24 h. In the second experiment dorsal aorta cannulated rainbow trout averaging 528${\pm}$11.3 g (mean${\pm}$SD) were divided into 6 groups of 4 fish to study the effect of dietary arginine levels on PAA. After 24 h food deprivation, each group of fish was fed one of six L-amino acid diets containing graded levels of arginine (0.48, 1.08, 1.38, 1.68, 1.98 or 2.58%) by intubation. Blood samples were taken at 0, 5 and 24 h after feeding. Post-prandial (5 h after feeding) plasma-free arginine concentrations (PParg) showed a breakpoint at 1.03% arginine in the diet and post-absorptive (24 h after feeding) plasma free-arginine concentrations (PAarg) showed a breakpoint at 1.38% arginine. PAarg increased linearly from fish fed diets containing arginine between 0.48% and 1.38%, and the concentrations remained constant from fish fed diets containing arginine at or above 1.38%, but were all below PParg at all time points. Results of the third experiment confirm the results that PParg concentrations from fish fed arginine deficient diets were higher than PAarg (0 or 24 h values). Thus, in contrast to mammals and birds, the PParg when arginine is present in the diet as the most limiting amino acid such that it severely limits growth, increases in plasma rather than decreases.

• The Korean Journal of Physiology
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• 제23권1호
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• pp.13-21
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• 1989

The present study was designed to investigate i) the action of various nucleotides on membrane permeability of rat red blood cell and hepatocyte for $Na^{+}$ and $Rb^{+}$ ii) the characteristics of purinoceptors on these cell membranes. Blood from Sprague-Dawley rats was obtained by carotid arterial cannulation. Red blood cells were then washed 3 times with saline at $4{\circ}C$. Hepatic parenchymal cells were isolated from rat livers by using a modification of the Berry and Friend (1969) method. For the $Na^{+}$ influx studies, isolated RBC and hepatocyte were incubated in incubation medium containing $^{22}Na^{+}0.2\;{\mu}Ci/ml$ at $37^{\circ}C$. After various time intervals samples were removed from the incubation flask and washed out 3 times with ice-cold washing solutions. Cells were destroyed by adding Triton X-100 and TCA solution. After centrifugation, the supernatants were assayed for $^{22}Na^{+}$ by gamma counter. $^{86}Rb^{+}$ was used to simulate $K^{+}$ in these $K^{+}efflux$ studies. Isolated hepatocytes were incubated for 60 min in the loading solution containing $^{86}Rb^{+}\;10\;{\mu}Ci/ml$ at $37^{\circ}C$. After loading, the cells washed out 3 times by centrifugation with washing solution. The cells were incubated in buffer solution at $37^{\circ}C$. At intervals thereafter, samples were removed and centrifuged. The supernatants were analyzed for $^{86}Rb^{+}$ by liquid scintillation counter. The main results of the experiments were: 1) ATP and ATPP increased in both $^{22}Na^{+}$ influx and $^{86}Rb^{+}$ efflux in the red blood cell. Although ADP showed a tendency to increase in RBC membrane permeability for $^{22}Na^{+}$ and $^{86}Rb^{+}$, the changes were not significantly different from the control. 2) The Significant changes in $^{22}Na^{+}$ and $^{86}Rb^{+}$ flux by ATP were also demonstrated in hepatocyte. ATPP and ADP showed a tendency to increase in hepatocyte membrane permeability for both ions. 3) Other nucleoside triphosphates-ITP, GTP and CTP-did not change in membrane permeability for $^{22}Na^{+}$ and $^{86}Rb^{+}$ in RBC and hepatocyte. In conclusion, not only ATP but also ATPP activate purinoceptors and change in membrane permeability for $Na^{+}$ and $K^{+}$. In order to activate purinoceptors on the cell membrane, the nucleotides have to possess intact adenine moiety and three phosphates or more in its molecule.

• Journal of Chest Surgery
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• 제53권3호
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• pp.132-139
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• 2020

Background: The double-lumen cannula (DLC) has begun to be used worldwide for venovenous (VV) extracorporeal membrane oxygenation (ECMO). We aimed to examine whether the DLC could be an effective tool in the treatment of pediatric respiratory failure in Korea. Methods: We reviewed the records of patients weighing under 15 kg who underwent ECMO due to respiratory failure between January 2017 and December 2018. Outcomes of ECMO using a DLC and conventional ECMO using central method or 2 peripheral cannulas were compared. Results: Twelve patients were treated with ECMO for respiratory failure. Among them, a DLC was used in 5 patients, the median age of whom was 3.8 months (interquartile range, 0.1-49.7 months). In these patients, the median values of pH, partial pressure of carbon dioxide, and partial pressure of oxygen were 7.09, 74 mm Hg, and 37 mm Hg before ECMO and corrected to 7.31, 44 mm Hg, and 85 mm Hg, respectively, after ECMO cannulation. Median blood flow rate in the patients treated with ECMO using a DLC was slightly higher than that in the conventional ECMO group, but this difference was not statistically significant (86.1 mL/kg/min and 74.3 mL/kg/min, respectively; p=1.00). One patient from the DLC group and 3 patients from the conventional group were weaned off ECMO. Conclusion: VV ECMO using a DLC provided adequate oxygenation, ventilation, and blood flow rate in Korean pediatric patients with respiratory failure. Further prospective and randomized studies are warranted.

• Asian-Australasian Journal of Animal Sciences
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• 제10권6호
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• pp.643-651
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• 1997

This experiment was conducted to determine apparent ileal and fecal digestibilities of protein sources for young pigs (15.6 kg BW) which were fitted with simple ileal T-cannulas. Experimental diets included one of the followings as a sole protein source: spray-dried plasma protein (SDPP), spray-dried blood meal (SDBM), soybean meal (SBM), isolated soy protein (ISP), dried skim milk (DSM), and fish meal (FM). The digestibilities of dry matter (DM), gross energy (GE) and crude protein (CP) in DSM-based diet were the highest (p < 0.05), and those of SDBM and SBM diets were the lowest at the terminal ileum. The average ileal digestibilities of essential amino acids (AAs) were 88.3, 84.7, 84.6, 83.4, 83.0 and 77.7% for pigs fed the DSM, ISP, SDBM, SBM, SDPP and FM diets, respectively. There were no significant differences in overall apparent ileal AAs digestibilities in DSM and ISP diets. Digestibilities of essential AAs in DSM, however, were significantly higher than those of ISP (p < 0.05). Among the essential AAs, the digestibility of arginine was higher except for SDBM or DSM, than other AAs. The ileal digestibilities of lysine, methionine and threonine were higher (p < 0.05) in pigs fed SDBM or DSM diet than in those fed SBM diet. Digestibilities for SDPP or ISP diet in these AAs were similar except for threonine which was higher (p < 0.05) for SDPP diet. The apparent ileal digestibilities of lysine and methionine ranged from 79.6 (FM) to 92.5 (DSM) and 75.4 (SDPP) to 88.7 (DSM), respectively. The apparent fecal digestibilities of average essential AAs were 90.4, 89.1, 86.0, 84.4, 84.2 and 80.8% in pigs fed the DSM, ISP, SDBM, SDPP, SBM and FM diets, respectively. The fecal digestibilities of essential AAs were higher (p < 0.05) in pigs fed the DSM and ISP. Lysine digestibility in pigs fed the DSM or ISP diet was higher (p < 0.05) than that of pigs fed SBM diet. Apparent essential AAs digestibility was the highest (p < 0.05) in pigs fed DSM diet, and was the lowest (p < 0.05) in pigs fed FM diet. Digestiibilities of essential AAs and nonessential AAs were higher when measured over the total digestive tract than at the end of the small intestine except for several AAs in SDPP, SDBM and SBM diets. In conclusion, whether it is fecal or ileal, the digestibilities of proximate nutrients and AAs in pigs fed DSM and ISP diet were the highest, and those of pigs fed FM was the lowest.

• Asian-Australasian Journal of Animal Sciences
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• 제10권6호
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• pp.635-642
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• 1997

This experiment was conducted to determine apparent ileal and fecal digestibilities of some grains for young pigs (15.6 kg BW). Ileal and fecal digestibility of corn, milo, wheat, barley, rice and tapioca were measured with pigs fitted with simple ileal T-cannula. Rice was the highest (p < 0.05) and tapioca was the lowest (p < 0.05) in the digestibilities of gross energy. For the crude protein digestibilities, rice, barley and wheat were higher (p < 0.05) than corn, milo and tapioca. The average ileal digestibilities of essential amino acids (AAs) were 89.9, 85.8, 81.5, 80.9, 80.2 and 76.3% for those fed rice, barley, milo, wheat, corn and tapioca diets, respectively. Regardless of the dietary carbohydrate sources, among the dispensable amino acids, glycine had lowest digestibility except for barley and milo. The apparent ileal digestibility of lysine and methionine were 90.7, 94.0% in rice, 88.3, 86.5% in barley and 86.3, 82.3% in wheat. The apparent fecal digestibility of average essential AAs were 90.8, 89.9, 87.7, 85.1, 82.5 and 77.9% in pigs fed the rice, barley, wheat, corn, milo and tapioca diets, respectively. The fecal digestibilities of essential AAs and nonessential AAs, in general, were higher than the ileal digestibilities, which indicating a loss of nitrogenous components in the cecum and colon. For all AAs, differences between ileal and fecal amino acid digestibilities ranged from 0.0 (valine) to 5.8 (threonine) in rice, 0.1 (arginine) to 14.5 (glycine) in barley, 2.8 (lysine) to 12.4 (glycine) in wheat, 1.0 (isoleucine) to 12.9 (glycine) in corn, 0.2 (serine, glutamic acid) to 6.5 (methionine) in milo and 0.5 (valine) to 22.1 (glycine) percentage units in tapioca diets. In conclusion, whether it is ileal or fecal, rice and barley appeared to be excellent alternative carbohydrate sources for young pigs in terms of AAs digestibility. However, energy value and cost for each grain should be considered when formulating diets.