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Anticoagulation Management after Mitral Valve Replacement with the St. Jude Medical Prosthesis (승모판치환 환자의 항응혈제 치료)

  • 김종환;김영태
    • Journal of Chest Surgery
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    • v.31 no.12
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    • pp.1172-1182
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    • 1998
  • Background: Primary goal of anticoagulation treatment in patients with mechanical heart valve is the effective prevention of thromboembolism and safe avoidance of bleeding as well. Material and Method: Two-hundred and nine patients with the St. Jude Medical prosthesis operated on between 1984 and 1995, for mitral(MVR 122), aortic(AVR 39) and double mitral and aortic valve replacement(DVR 48) respectively, were studied on the practically achieved levels of anticoagulation and the clinical outcomes. Patients were on Coumadin and followed up by monthly visit to outpatient clinic for examination and prothrombin time measurement to adjust the International Normalized Ratios(INRs) within the low-intensity target range between 1.5 and 2.5. Result: A total anticoagulation follow-up period was 1082.0 patient- years(mean 62.1 months) and INRs of 10,205 measurements were available for evaluation. The accomplished INRs among the replacement groups were not significantly different and only 65% of INRs were within the target range. And, in individual patients, only 37% of patients had INRs included within the target range in more than 70% of tests during follow-up period. The levels of INRs in patients with atrial fibrillation, which was found in 57% of patients, were definitely higher than the ones measured in patients with regular rhythm(p<0.001). Thromboembolisms were experienced by 15 patients with the incidence of 1.265%/patient- year(MVR 1.412%, AVR 0.462% and DVR 1.531%/patient-year) and major bleeding by 4 patients with the incidence of 0.337%/patient-year(MVR 0.424%, AVR none and DVR 0.383%/patient-year). Frequent as well as prolonged missing of prothrombin time tests was the main risk factor strongly associated with the thromboembolic complications(odds ratio 1.99). The proportion of INRs within target range of less than 60% in individual patient was the highly significant risk factor of both thromboembolic and overall embolic and bleeding complications(p<0.004 and p<0.002 respectively). Conclusion: In conclusion, the low-intensity therapeutic target range of INRs was adequate in patients with AVR and in sinus rhythm. However, the patients with replacement of the mitral valve were more likely to require higher target range of INRs, especially in the presence of atrial fibrillation, to achieve the practical levels of anticoagulation enough to prevent thromboembolic complications effectively. For the higher therapeutic target range of INRs between 2.0∼3.0, further accumulation of clinical evidences are required. It is highly desirable to improve the patients' compliance under continuous instructions in visiting outpatient clinic and in taking daily Coumadin without omission and to keep INRs consistently within optimal range with tight control for minimization of chances and of periods of exposure to the risk of complications. And, particularly, patients with high risk of complications and with wide fluctuation of INRs should be better managed with frequent monitoring anticoagulation levels.

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Serial Survey on Group A beta-Hemolytic Streptococcal Carrier Rate and Serotyping in Elementary School Children in 1996~1998 (3년간(1996~1998) 초등학생의 A군 연쇄구균 보균율과 혈청학적 분류에 관한 연구)

  • Kim, Ji-Hyun;Kim, Ju-Ye;Kang, Hyeon-Ho;Cha, Sung-Ho;Lee, Young-Hee
    • Pediatric Infection and Vaccine
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    • v.7 no.1
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    • pp.143-151
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    • 2000
  • Purpose : The accuracy of bacteriologic diagnosis of beta-hemolytic streptococcal pharyngotonsillitis depends on the degree of carrier rate in that area where the throat swabs are obtained and the evaluation of serological T typing as an epidemiologic marker is important to understand epidemiology of streptococcal infection. The purpose of this study is to know the carrier rates of group A streptococcus in normal children form four different areas and to find out the epidemiologic characteristic in distribution of the serotypes for 3 years. Method : Throat swabs were obtained from the tonsillar fossa of normal school children in four different areas(Uljin, Seoul, Osan, Kunsan) from March to May 1996, in Uljin in April 1997, and in Uljin in April 1998. The samples were plated on a 5% sheep blood agar plate and incubated overnight at $37^{\circ}C$ before examination for the presence of beta-hemolytic colonies. All isolated beta-hemolytic streptococcus were grouped and serotyped by T agglutination. Results : The carrier rate of beta-hemolytic streptococci and group A streptococci in 1996 were 27.6%, 18.6% at Uljin; 16.4%, 2.7% at Seoul; 33.0%, 26.0% at Osan; 20.0%, 12.3% at Kunsan, respectively. Among 1,192 normal school children from 4 different areas, we obtained 179 strains of group A streptococci. Fifty two percent of the strains were typable by T agglutination in 1996. Common T-type in 1996 were NT, T1, T3, T2 at Uljin; T12, T25 at Seoul; NT, T6, T28 at Osan; T25, T4, NT, T5 at Kunsan, in decreasing order, respectively. At Uljin, T1, T3, T25 accounted for 69% of strains in 1996, T1, T12, T25 accounted for 70% in 1997, and T12, T4 accounted for 88% in 1998. Conclusion : Higher carrier rates were found in Uljin and Osan, where there are a lower population density with scanty of medical facilities compared with another areas. We supposed that low carrier rates is likely to be related to antibiotic abuse or some epidemiologic factor. The periodic and seasonal serotyping analysis is important in monitoring and understanding the epidemiologic patterns of group A streptococci.

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Validation of Food Intake Frequency from Food Frequency Questionnaire for Use as a Covariate in a Model to Estimate Usual Food Intake (식품의 일상섭취량 추정을 위한 식품섭취빈도의 활용가능성 및 타당도 연구)

  • Lee, Ja Yoon;Kim, Dong Woo
    • Culinary science and hospitality research
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    • v.23 no.2
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    • pp.64-73
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    • 2017
  • Although 24-hour recalls (24HR) capture detailed information on a person's food intake, this method suffers from difficulties in adequately measuring the usual intake of foods that are not consumed daily by most. Therefore, the purpose of this study is to investigate whether frequency of Food Frequency Questionnaire (FFQ) can be utilized in form of covariate when calculating usual intake of episodically-consumed foods and their distributions. Data used in this study was from the Korean National Healthy and Nutrition Examination Survey (KNHANES) 2012~2014 (3 years) and 10,945 subjects participated in this survey who performed both of 24HR and FFQ. In order to analyze the data, amount of intake in each food, which was reported in 24HR was recalculated according to 112 items in FFQ. We first assessed the relationship between FFQ frequency and the amount reported on 24HR. Second, we assessed the relationship between usual portion size of FFQ and the amount reported on 24HR. Our hypothesis was that people who reported high FFQ-reported frequency or FFQ-reported usual portion size would consume larger amounts of that food on 24HR than those with lower frequency or portion size of consumption of a food on the FFQ. For 59 of 112 individual foods (52.2%), there were statistically significant increasing relationships between FFQ frequency and consumption-day intake. Also, 102 of 112 individual foods (90.3%), there were statistically significant increasing relationships between FFQ usual portion size and consumption-day intake. For 10 of 13 food groups (grains, fruits, eggs, pulses, root and tuber crops, milk products, meat, beverage, alcoholic drink, vegetable, seaweeds and others), there were statistically significant increasing relationships between FFQ frequency and consumption-day intake. And there were statistically significant increasing relationships between FFQ usual portion size and consumption-day intake for all food groups. This study confirmed consistent correlation between reported FFQ frequency or usual portion size of food (group) consumption and consumption-day intake on 24HR. Therefore the frequency data may be utilized as important covariate when estimating usual intake of food or food groups.

Clinical and Immunologic Features of Miliary Tuberculosis with Positive Bone Marrow Study (골수생검 양성인 속립성 결핵의 고찰)

  • Song, Kwang-Seon;Yong, Suk-Joong;Shin, Kye-Chul;Lee, Won-Yeon;Ryu, Jeong-Seon
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.1
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    • pp.22-29
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    • 1996
  • Background: Abnormalities of the peripheral blood are frequent and varied in patients with miliary tuberculosis. Anemia, leukopenia, thrombocytopenia, pancytopenia, monocytosis, basophilia, eosinophilia and leukemoid reactions have been reported. These abnormalities are more frequent in patients with positive bone marrow study. In this report, we evaluated clinical, hematological and immunological features in patients with miliary tuberculosis in order to know whether difference is existed between "bone marrow biopsy positive group(pathologically proven to miliary tuberculosis)" and "negative group". Method: Clinical evaluation, serum ADA, sIL-2R, and T-lymphocyte subsets were measured in 40 patients with miliary tuberculosis who received bone marrow biopsy. Results: 1) The average age of patients was 39 year-old. There were 23 male and 17 female patients. Associated extrapulmonary tuberculosis are 9 CNS tuberculosis, 6 joint tuberculosis, and 2 tuberculous pleurisy. 2) Sixteen of the 40 patients were positive bone marrow biopsy(60%). 3) Sixteen of the 40 patients(60%) had anemia(11 positive patients: 13 negative patients). Leukopenia occurred in 12 per cent(4:1). Thrombocytopenia was noted in 10%(3:1). 4) The mean value of serum ADA was 83 U/L(90 U/L: 70.6 U/L, p=0.23). 5) The mean activity of Soluble IL-2 receptor was 4,643 pmol/L($6840{\pm}7446\;pmol/L$: $1,897{\pm}1,663\;pmol/L$, p=0.06). 6) In the T lymphocyte subsets, the percent of T-lymphocytes was 64%(62%:73%, p=0.2). In some patients(9), $T_4$ and $T_8$ ratio in BAL fluid($1.97{\pm}1.2$) was higher than that in the peripheral blood($1.16{\pm}0.5$). Conclusion: Bone marrow examination are diagnostic in 60% of cases of miliary tuberculosis. Percents of the total T lymphocyte and helper T cell in BAL are more elevated than in peripheral blood. There was no significant difference in peripheral blood abnormalities and marker of T lymphocyte activation between the bone marrow biopsy positive and negative group.

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A Study on the Estimation Method of the Repair Rates in Finishing Materials of Domestic Office Buildings (국내 업무시설 건축 마감재의 수선율 산정 방안에 관한 연구)

  • Kim, Sun-Nam;Yoo, Hyun-Seok;Kim, Young-Suk
    • Korean Journal of Construction Engineering and Management
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    • v.16 no.1
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    • pp.52-63
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    • 2015
  • Business facilities among domestic architectures have rapidly been constructed along with domestic economic development. It is an important facility taking the second largest proportion next to apartment buildings among current 31 building types of fire department classification of 2012 year for urban architectures. The expected service life of business facilities is 15 years, but 70% of those in urban areas have surpassed the 15 year service life as of the present 2014. Thus, the demand for urgent rehabilitation of such facilities is constantly increasing due to the aging and performance deterioration of the facilities'main finishing materials. Especially, the business facilities are being used for the lease of company office or private office, and such problems as aging and performance deterioration of the facilities could cause less competitive edge for leasing and real estate value depreciation for the O&M (Operation & Management) agent and the owner, respectively. Therefore, an effective planned rehabilitation as a preventive measure according to the standardized repair rate by the number of years after the construction is in need in order to prevent the aging and performance deterioration of the facilities(La et al. 2001). Nonetheless, domestic repair/rehabilitation standards based on the repair rate are mainly limited to apartment buildings and pubic institutions, resulting in impractical application of such standards to business facilities. It has been investigated and analyzed that annual repair rate data for each finishing material are required for examination of the applicability of the repair rate standard for the purpose of establishment of a repair plan. Hence, this study aimed at developing a repair rate computation model for finishing materials of the facilities and verifying the appropriateness of the annual repair rate for each finishing material through a case study after collecting and analyzing the repair history data of six business facilities. The results of this study are expected to contribute to the planning and implementation of more efficient repair/rehabilitation budget by preventing the waste of unpredicted repair cost and opportunity cost for the sake of the business facilities' owners and O&M agents.

The Effects of Grouping in Cooperative Learning Strategy (협동학습 전략에서 소집단 구성 방법의 효과)

  • Noh, Tae-Hee;Park, Soo-Youn;Lim, Hee-Jun;Cha, Jeong-Ho
    • Journal of The Korean Association For Science Education
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    • v.18 no.1
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    • pp.61-70
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    • 1998
  • This study investigated the effects of grouping (group composition) in cooperative learning strategy upon students' achievement, the attitude toward science instruction, the perception of learning environment, and the self-esteem. Three different groups were used in this study. For the two treatment groups with cooperative learning strategies, High-Medium-Low ability grouping (HML) and High-Low I Medium-Medium ability grouping (HL/MM) were used. For the control group, traditional instruction was used. Before the instructions, the short-version Group Assessment of Logical Thinking, the test of attitudes toward science instruction, the perception questionnaire of learning environment, and the questionnaire of self-esteem were administered, and their scores were used as covariates. Mid-term examination score was used as a blocking variable. After the instructions, a researcher-made achievement test consisting of three subtests (knowledge, understanding, and application), the test of attitude toward science instruction, the perception questionnaire of learning environment, and the questionnaire of self-esteem were administered. The ANCOVA results revealed that there were significant interactions between the instruction and the level of prior achievement although there were no significant differences in all subtest scores of the achievement test. The high-level students in the HL/MM cooperative group performed better than those in the control group and the HML cooperative group. The low-level students in the HL/MM cooperative group also performed better in the subtest of knowledge than those in the other groups. However, the medium-level students in the HML cooperative group scored better than those in the control group and the HL/MM cooperative group. Significant main effect was also found in the perception of learning environment but not in the attitude toward science instruction and self-esteem. The cooperative groups, regardless of grouping, exhibited more positive perception than the control group.

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The Correlation Between Sensory Integration Function and Scholar Achievement in the Lower Classes Children (저학령기 아동의 감각통합 기능과 학업성취도간의 상관관계)

  • Shin, Joong-Il;Choi, Yung-Gun;Jang, Woo-Heuk;Kim, Kyeong-Mi
    • The Journal of Korean Academy of Sensory Integration
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    • v.6 no.1
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    • pp.1-12
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    • 2008
  • Objective : The purpose of this study is to provide reference to functional level of sensory integration of in the low-grads school age, based on the Clinical Observation of Motor and Postural Skills (COMPS) and to examine correlation between the function of sensory integration and academic achievement. Method : Two schools ("J" and "S") have been selected indiscriminately among 56 elementary schools located in Gimhae-si, GyeongNam and then one class from each school was voluntarily chosen among all second-grade classes of the schools. The total number of students in those two classes was 69 (34 boys and 35 girls). Subjects had no developmental problem and no history of referral regarding neurological conditions. Three skilled researchers administrated the COMPS together, and each researcher executed two sub-items of the COMPS. As result of the academic achievement, score data of midterm- and final-exam in the spring semester were collected. The scores of 'Korean language' and 'Math', common examination subjects in both schools, were utilized for data analysis in this study. Results : Statically, there was no significant correlation between the COMPS Weighted Scores and any academic achievements. In a dispersion graphic analysis, however, the total achievement showed significant negative-correlation with the area of 'Rapid Forearm Rotation' and significant positive-correlation with the area of 'Supine Flexion'. In terms of the Math achievement, there are significant negative-correlation with rapid forearm rotation and asymmetrical tonic neck reflex, and significant positive-correlation with the area of 'Supine Flexion'. Students with higher score of the Korean language showed a tendency to get higher Weighted Score and Minus Adjustment Score, and those with lower score of the Math showed a tendency to get higher COMPS scores in all area except the area of 'Supine Flexion'. There was a statically significant difference in the COMPS scores depend on the age among general characteristics. As student older, all COMPS scores, except those in the area of 'Slow Motion' and 'Supine Flexion, were higher. Conclusions : There is somehow reliable correlation between sensory integration function and academic achievement although no statistical significance found in this study. The information from this study may contribute to initiate developing a normative-reference to screen earlier and more alertly sensory integration dysfunctions for school-age children. Further study is recommended trying to find out more reliable matter regarding low grade- schooler's academic achievement.

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The effects of desensitizing agents, bonding resin and tooth brushing on dentin permeability, in vitro (지각과민 처치제 후 접착레진 처리가 상아질 투과도에 미치는 영향)

  • Hong, Seung-Woo;Park, No-Je;Park, Young-Bum;Lee, Keun-Woo
    • The Journal of Korean Academy of Prosthodontics
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    • v.52 no.3
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    • pp.165-176
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    • 2014
  • Purpose: The effects of desensitizing agent are often for a short duration. One of the reasons is believed to be wear of desensitizing agent by tooth brushing. To reduce the wear and make the duration longer, dental bonding resin was applied and the changes of dentin permeability after toothbrushing were measured. Materials and methods: Extracted teeth free from caries were chosen. Coronal dentin discs with thickness of 1 mm were prepared. Using the split chamber device developed by Pashely, hydraulic conductance and scanning electron microscope images (SEM) were compared and contrasted before and immediately after the application of desensitizing agent and bonding resin and then after equivalent tooth brushing of 1 week, 2 weeks, and 6 weeks. Four commercially available desensitizing agents were used in this study; they were All-Bond 2, Seal & Protect, Gluma, and MS Coat. And Dentin/Enamel Bonding resin (Bisco Inc.) was used. The results of this study are as follows. Results: On all specimens, the hydraulic conductance decreased after the application of tooth desensitizing agent and bonding resin. Compared with the specimens treated only with desensitizer, the specimens treated with All-Bond 2, Gluma, MS Coat and plus D/E bonding resin had a little increase in hydraulic conductance after 1, 2 and 6-week tooth brushing. In case of Seal & Protect, the specimens showed the same result only after 6-week tooth brushing. On examination of SEM, the dentinal tubule diameter had decreased after treatment of desensitizing agents and bonding resin. And the specimens treated with All-Bond2, Seal&Protect, Gluma, MS Coat and plus D/E bonding resin had an significant decrease in diameter of dentinal tubule after 6-week tooth brushing. Conclusion: According to the results of this study, it is effective to use bonding resin after application of desensitizer in reducing the wear by tooth brushing and making the duration longer. In this study, just 6-week tooth brushing was performed, and it is not enough to regard it as a long-term data. So further study is needed and more perfect method for treating dentin hypersensitivity should be developed.

A Study on Cognition about 119 Rescue·First Aid Team - Gwangju Area College Student as the Central Figure - (119구조·구급대에 대한 인식도 조사 연구 - 광주지역 보건계열과 비보건계열 대학생을 중심으로 -)

  • Kim, Kab-Sun
    • The Korean Journal of Emergency Medical Services
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    • v.6 no.1
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    • pp.141-152
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    • 2002
  • The purpose of this study is to provide the basic materials for searching the way of improvement to heighten the emergency medical welfare level by one step further. To achieve this purpose, the subjects of this study were selected 452 college students in Gwangju, using a random sampling method. The statistical analysis methods utilized for analyzing the collected data are frequency analysis, $x^2$ test. The conclusions obtained from these analyses are as following ; 1. In question about necessary optimum number of persons for rescue first aid activity, health and non-health major college students responded by 39.2%, 45.3% respectively that rescue team 15 people, first aid team 3 people is most suitable. But there was no significant difference in major department(p<0.05). 2. In question about security of the public health doctor and the emergency medical technician, all health and non-health major college students are recognizing necessity urgently, but there was no significant difference in major department(p<0.05). 3. In question about 119 rescue first aid team member applying for an examination qualification grant to the department of EMT's graduate, all health and non-health major college students were highest by 52.9%, 52.4% respectively in "necessity" item. But there was no significant difference in major department(p<0.05). 4. Because rescue first aid equipment level appears higher than 41.7% in non-health major college student's case by 54.2% in health major college student's case, health major college students are recognizing that equipment level should be supplemented more but there was no significant difference in major department(p<0.05). 5. In question about equipment supplement, all health and non-health major college students appeared highest by 64.8%, 69.3% in accident type different special equipment. But there was no significant difference in major department(p<0.05). 6. In question about rescue ambulance car size, we could know being thinking that health and non-health major college student each 61.2%, 56.5% is small and narrow that large size of the rescue ambulance amount need. But there was no significant difference in major department(p<0.05). 7. In question about patient's state is worsened, because rescue first aid equipment is inferior, health major college student responded sometimes 55.1%, many 29.5%. very many by 11.5%, while non-health major college student responded 65.8%, 23.1%, 4.0% respectively. There was significant difference in major department(p<0.05). 8. In question about emergency patient must utilize for 119 rescue ambulance car, all health and non-health major college students appeared highest by 38.8%, 41.3% in "not so" item. In question about rescue first aid team's first-aid treatment ability improves more, all health and non-health major college students appeared highest by 58.1% and 58.7% respectively in "improve" item. In question about "119 rescue ambulance car must go more rapidly than now", all health and non-health major college students are recognizing that should be quicker by 58.1%, 60.9% respectively. When called to 119 all health and non-health major college students responded highest by 55.5%, 53.3% respectively that we must receive first-aid treatment direction from a doctor. In question about "119 rescue ambulance car must be made the pay system", all health and non-health major college students responded 74%, 80% respectively in "not so" item. There was significant difference in major department(p<0.05). In conclusions, In oder to provide superior rescue first aid service to people, a public health doctor should be placed in the situation room inside the fire station so that the doctor could instruct the proper emergency treatment suitable for each situation to the rescue first aid team. Also, national education about a first-aid treatment that do to all people is necessarily necessary in emergency delivery system and this should be spread extensively through school education and broadcasting medium and education should be gone side by side, and see that will can save emergency patients' life which is more when these education consists continuously fixed period for public institution of policeman, fire officer etc. specially. And for reinforcement of patient transfer system, public organization must procure special ambulance car so that emergency patient receive first aid treatment while transfer.

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Serum Immunoglobulin levels in Coal Worker's Pneumoconiosis Patients (진폐증 환자에서의 혈청 면역 글로불린의 변화)

  • Yoo, Kwang-Ha;Ahn, Chul-Min;Kim, Hyung-Joong;Kim, Young-Ho;Lee, Yong-Kyoo;Kim, Sung-Kyu;Lee, Won-Young
    • Tuberculosis and Respiratory Diseases
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    • v.46 no.2
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    • pp.165-174
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    • 1999
  • Background: Coal-worker's pneumoconiosis(CWP) is radiologically divided into two major groups: simple pneumoconiosis (SP), in which small, rounded or irregular opacities smaller than 1cm are observed, and progressive massive fibrosis(PMF), which is characterized by opacities larger than 1cm. SP has a life expectancy equivalent to miners with no radiographic evidence of CWP, but PMF is associated with more obvious impairments of ventilatory capacity and premature death. But only minority of workers develop PMF when exposed to dust concentrations similar to those experienced by workers who develop only SP. In this study, immune status in patients with CWP were evaluated by measurement of the serum immunoglobulin levels between control, SP and PMF groups. Method: Coal workers selected for this study were emplyees of the Tae-Baek and Dong-Hae Hospital. All the patients were men of 45-76 years old and the mean duration of exposure to coal dust were 23.2 years. By X-ray examination, 51 patients were classified in SP, 59 in PMF category. The normal controls examined were 58 men of 26-70 years old. Serum Ig levels were estimated by using Nephelometer(Behring Nephelometer : Germany) and serum were collected 51 in SP, 49 in PMF and 57 cases in control group. Results: The levels of IgG were increased but the levels of IgM were decreased with increasing age in control groups. There were no statistical difference of immunoglobulin levels between smokers and nonsmokers in control groups. There were no statistical difference of immunoglobulin levels between Control, SP and PMF groups. Multiple regression analysis were undertaken to determine the statistical significance of the apparent trends and estimate the effects associated with age, smoking habit and radiological category of CWP. According to this analysis, the levels of IgG were decreased significantly in SP group and had decreasing tendancy, but not statistically significant in PMF group. Conclusion : From the observations described, CWP patients had decreased IgG concentration compared to control gorup. Therefore, there was some relation between CWP and immunoglobulin concentration.

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