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Clinical Experiences of Cardiac Surgery Using Minimal Incision (소절개선을 이용한 심장수술의 임상고찰)

  • Kim, Kwang-Ho;Kim, Joung-Taek;Lee, Seo-Won;Kim, Hae-Sook;Lim, Hyun-Kung;Lee, Choon-Soo;Sun, Kyung
    • Journal of Chest Surgery
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    • v.32 no.4
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    • pp.373-378
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    • 1999
  • Background: Minimally invasive technique for various cardiac surgeries has become widely accepted since it has been proven to have distinct advantages for the patients. We describe here the results of our experiences of minimal incision in cardiac surgery. Material and Method: From February 1997 to November 1998, we successfully performed 31 cases of minimally invasive cardiac surgery. Male and female ratio was 17:14, and the patients age ranged from 1 to 75 years. A left parasternal incision was used in 9 patients with single vessel coronary heart disease. A direct coronary bypass grafting was done under the condition of the beating heart without cardiopulmonary bypass support(MIDCAB). Among these, one was a case of a reoperation 1 week after the first operation due to a kinked mammary artery graft. A right parasternal incision was used in one case of a redo mitral valve replacement. Mini-sternotomy was used in the remaining 21 patients. The procedures were mitral valve replacement and tricuspid annuloplasty in 6 patients, mitral valve replacement 5, double valve replacement 2, aortic valve replacement 1, removal of left atrial myxoma 1, closure of atrial septal defect 2, repair of ventricular septal defect 2, and primary closure of r ght ventricular stab wound 1. The initial 5 cases underwent a T-shaped mini-sternotomy, however, we adopted an arrow-shaped ministernotomy in the remaining cases because it provided better exposure of the aortic root and stability of the sternum after a sternal wiring. Result: The operation time, the cardiopulmonary bypass time, the aorta cross-clamping time, the mechanical ventilation time, the amount of chest tube drainage until POD#1, the chest tube indwelling time, and the duration of intensive care unit staying were in an acceptable range. There were two surgical mortalities. One was due to a rupture of the aorta cannulation site after double valve replacement on POD#1 in the mini-sternotomy case, and the other was due to a sudden ventricular arrhythmia after MIDCAB on POD#2 in the parasternal incision case. Postoperative complications were observed in 2 cases in which a cerebral embolism developed on POD#2 after a mini-sternotomy in mitral valve replacement and wound hematoma developed after a right parasternal incision in a single coronary bypass grafting. Neither mortality nor complication was directly related to the incision technique itself. Conclusion: Minimally invasive surgery using parasternal or mini-sternotomy incision can be used in cardiac surgeries since it is as safe as the standard full sternotomy incisions.

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Acute Respiratory Infections in the Neonatal Intensive Care Unit: Isolation of Viruses and the Characteristics of Respiratory Syncytial Virus Infection (신생아집중치료실에서의 급성 호흡기 감염-바이러스의 검출 및 respiratory syncytial virus 감염의 임상적 특징)

  • Park, Sun-Hee;Cho, Hye-Jung;Shim, So-Yeon;Son, Dong-Woo;Eun, Byung-Wook;Sun, Yong-Han;Tchah, Hann;Jeon, In-Sang
    • Neonatal Medicine
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    • v.16 no.2
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    • pp.182-189
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    • 2009
  • Purpose: Recently, it is easy to find the causal virus of acute respiratory infections using multiplex RT-PCR. The aim of this study is to show the distribution of respiratory viruses and to define the characteristics of respiratory syncytial virus (RSV) infections compared to other respiratory viral infections. Methods: This was a prospective observational study conducted in the NICU. The infants with acute respiratory infections were performed multiplex RT-PCR using nasal swabs. The demographics, initial symptoms, course of illness, and laboratory and imaging findings were recorded. The infants were divided into RSV and No RSV groups. Results: Twenty-three infants (50%) were in the RSV group. Rhinovirus was the second most common virus. Coinfections with two viruses accounted for 6.5% of respiratory infections. The number of preterm infants, exposure to cigarette smoke and having siblings were not different between the two groups. Infections in the postnatal care center were more common in the RSV group than the No RSV group (60.9% vs. 21.7%, P=.007). Dyspnea (34.8% vs. 8.7%, P=.032) and pneumonia (73.9% vs. 43.5%, P=.036) were more common in the RSV group. The RSV group frequently needed oxygen (52.5% vs. 13.0%, P=.005) and received nothing by mouth (43.5% vs. 13.0%, P=.022). The incidence of right upper consolidation was higher in RSV group (56.5% vs. 8.7%, P=.001). Conclusion: This study showed that other viruses than RSV can induce respiratory infections in neonates and young infants born prematurely. RSV infections have a more severe course of illness than other respiratory viruses. We have to be careful of prevention even for healthy neonates especially in crowed situations, such as the postnatal care center.

THE EFFECTS OF VARIOUS CURING LIGHT SOURCES ON THE MICROHARDNESS OF LIGHT-ACTIVATED RESTORATIVE MATERIALS (다양한 광원에 의한 광중합형 수복물질의 미세경도에 관한 연구)

  • Choi, Nam-Ki;Yang, Kyu-HO;Kim, Seon-Mi;Choi, Choong-Ho
    • Journal of the korean academy of Pediatric Dentistry
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    • v.32 no.4
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    • pp.634-643
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    • 2005
  • The aim of this study is to evaluate the effects of blue light emitting diode (LED) Light Curing Units (FreeLight 2, L.E.Demetron I, Ultra-Lume 5) on the microhardness of three resin composites (Z250, Point 4, Dyract AP) and to determine their optimal curing time. Samples were made using acrylic molds $(2.0mm{\times}3mm)$ of each composite. All samples were prepared over a Mylar strip placed on a flat glass surface. After composite placement on the molds, the top surface was covered with another Mylar strip and a glass slab was gently pressed over it. The times of irradiation were as follows: Elipar TriLight, 40 s; Elipar FreeLight 2. L.E.Demetron I, and Ultra-Lume 5, 10s, 20s, 40s, respectively. Mean hardness values were calculated at the top and bottom for each group. ANOVA and Sheffe's test were used to evaluate the statistical significance of the results. Results showed that FreeLight 2, Ultra-Lume 5, and L.E.Demetron I were able to polymerize point 4 in 20 seconds to a degree equal to that of the halogen control at 40 seconds. FreeLight 2 and L.E.Demetron I were able to polymerize Z250 in 10 seconds to a degree equal to that of the halogen control at 20 seconds. FreeLight 2 and L.E.Demetron I were able to polymerize Dyract AP in 10 seconds to a degree equal to that of the halogen control at 40 seconds. The commercially available LED curing lights used in this study showed an adequate microhardness with less than half of the exposure time of a halogen curing unit.

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Application of Chlorophyll Fluorescence Parameters for the Detection of Water Stress Ranges in Grafted Watermelon Seedlings (수박접목묘의 건조스트레스 범위 탐지를 위한 엽록소형광 지수의 적용)

  • Shin, Yu Kyeong;Kim, Yong Hyeon;Lee, Jun Gu
    • Journal of Bio-Environment Control
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    • v.28 no.4
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    • pp.461-470
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    • 2019
  • This study was carried out to quantify the drought stress in grafted watermelon seedlings non-destructively by using chlorophyll fluorescence (CF) imaging technique rather than the visual judgment. Six-day old watermelon seedlings were grown under uniform irrigation for 3 days, and then given drought stress. Afterward, the sensor for the measurement of water content in plug tray cell unit was used to classify the drought-stress level into nine groups from D1 (53.0%, sufficient moisture state) to D9 (15.7%, extremely dry stress), and the 16 CF parameters were measured. In addition, re-irrigation was performed on the drought stressed seedlings(D5 - D9) to determine the growth and photosynthesis recovery level, which was not confirmed by visual judgment. The kinetic curve patterns of CF in three different drought stressed seedling groups were found to be different for the early detection of drought stress. All the 16 CF parameters decreased continuously with exposure to drought stress and drastically decreased from D5 (32.1%) where the visual judgment was possible. The fluorescence decline ratio (Rfd_Lss) started to decrease from the initial drought stress level (D5 - D6), and the Maximum PSII quantum yield (Fv/Fm) was significantly decreased in the later extreme drought stress range (D7 - D9) by re-irrigation recovery test. Thus, Rfd_Lss and Fv/Fm parameters were finally selected as potent indicators of growth and photosynthesis recovery in the initial and later stages of drought stress. Also, to the differences in the numerical values of the individual chlorophyll fluorescence parameters, the drought stress level was intuitively confirmed through the image. These results indicate that Rfd and Fv/Fm can be considered as potential CF parameters for the detection of low and extremely high drought stress, respectively. Furthermore, Fv/Fm can be considered as the best CF parameters for recovery at re-irrigation.

A Study on the Meaning and Strategy of Keyword Advertising Marketing

  • Park, Nam Goo
    • Journal of Distribution Science
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    • v.8 no.3
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    • pp.49-56
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    • 2010
  • At the initial stage of Internet advertising, banner advertising came into fashion. As the Internet developed into a central part of daily lives and the competition in the on-line advertising market was getting fierce, there was not enough space for banner advertising, which rushed to portal sites only. All these factors was responsible for an upsurge in advertising prices. Consequently, the high-cost and low-efficiency problems with banner advertising were raised, which led to an emergence of keyword advertising as a new type of Internet advertising to replace its predecessor. In the beginning of 2000s, when Internet advertising came to be activated, display advertisement including banner advertising dominated the Net. However, display advertising showed signs of gradual decline, and registered minus growth in the year 2009, whereas keyword advertising showed rapid growth and started to outdo display advertising as of the year 2005. Keyword advertising refers to the advertising technique that exposes relevant advertisements on the top of research sites when one searches for a keyword. Instead of exposing advertisements to unspecified individuals like banner advertising, keyword advertising, or targeted advertising technique, shows advertisements only when customers search for a desired keyword so that only highly prospective customers are given a chance to see them. In this context, it is also referred to as search advertising. It is regarded as more aggressive advertising with a high hit rate than previous advertising in that, instead of the seller discovering customers and running an advertisement for them like TV, radios or banner advertising, it exposes advertisements to visiting customers. Keyword advertising makes it possible for a company to seek publicity on line simply by making use of a single word and to achieve a maximum of efficiency at a minimum cost. The strong point of keyword advertising is that customers are allowed to directly contact the products in question through its more efficient advertising when compared to the advertisements of mass media such as TV and radio, etc. The weak point of keyword advertising is that a company should have its advertisement registered on each and every portal site and finds it hard to exercise substantial supervision over its advertisement, there being a possibility of its advertising expenses exceeding its profits. Keyword advertising severs as the most appropriate methods of advertising for the sales and publicity of small and medium enterprises which are in need of a maximum of advertising effect at a low advertising cost. At present, keyword advertising is divided into CPC advertising and CPM advertising. The former is known as the most efficient technique, which is also referred to as advertising based on the meter rate system; A company is supposed to pay for the number of clicks on a searched keyword which users have searched. This is representatively adopted by Overture, Google's Adwords, Naver's Clickchoice, and Daum's Clicks, etc. CPM advertising is dependent upon the flat rate payment system, making a company pay for its advertisement on the basis of the number of exposure, not on the basis of the number of clicks. This method fixes a price for advertisement on the basis of 1,000-time exposure, and is mainly adopted by Naver's Timechoice, Daum's Speciallink, and Nate's Speedup, etc, At present, the CPC method is most frequently adopted. The weak point of the CPC method is that advertising cost can rise through constant clicks from the same IP. If a company makes good use of strategies for maximizing the strong points of keyword advertising and complementing its weak points, it is highly likely to turn its visitors into prospective customers. Accordingly, an advertiser should make an analysis of customers' behavior and approach them in a variety of ways, trying hard to find out what they want. With this in mind, her or she has to put multiple keywords into use when running for ads. When he or she first runs an ad, he or she should first give priority to which keyword to select. The advertiser should consider how many individuals using a search engine will click the keyword in question and how much money he or she has to pay for the advertisement. As the popular keywords that the users of search engines are frequently using are expensive in terms of a unit cost per click, the advertisers without much money for advertising at the initial phrase should pay attention to detailed keywords suitable to their budget. Detailed keywords are also referred to as peripheral keywords or extension keywords, which can be called a combination of major keywords. Most keywords are in the form of texts. The biggest strong point of text-based advertising is that it looks like search results, causing little antipathy to it. But it fails to attract much attention because of the fact that most keyword advertising is in the form of texts. Image-embedded advertising is easy to notice due to images, but it is exposed on the lower part of a web page and regarded as an advertisement, which leads to a low click through rate. However, its strong point is that its prices are lower than those of text-based advertising. If a company owns a logo or a product that is easy enough for people to recognize, the company is well advised to make good use of image-embedded advertising so as to attract Internet users' attention. Advertisers should make an analysis of their logos and examine customers' responses based on the events of sites in question and the composition of products as a vehicle for monitoring their behavior in detail. Besides, keyword advertising allows them to analyze the advertising effects of exposed keywords through the analysis of logos. The logo analysis refers to a close analysis of the current situation of a site by making an analysis of information about visitors on the basis of the analysis of the number of visitors and page view, and that of cookie values. It is in the log files generated through each Web server that a user's IP, used pages, the time when he or she uses it, and cookie values are stored. The log files contain a huge amount of data. As it is almost impossible to make a direct analysis of these log files, one is supposed to make an analysis of them by using solutions for a log analysis. The generic information that can be extracted from tools for each logo analysis includes the number of viewing the total pages, the number of average page view per day, the number of basic page view, the number of page view per visit, the total number of hits, the number of average hits per day, the number of hits per visit, the number of visits, the number of average visits per day, the net number of visitors, average visitors per day, one-time visitors, visitors who have come more than twice, and average using hours, etc. These sites are deemed to be useful for utilizing data for the analysis of the situation and current status of rival companies as well as benchmarking. As keyword advertising exposes advertisements exclusively on search-result pages, competition among advertisers attempting to preoccupy popular keywords is very fierce. Some portal sites keep on giving priority to the existing advertisers, whereas others provide chances to purchase keywords in question to all the advertisers after the advertising contract is over. If an advertiser tries to rely on keywords sensitive to seasons and timeliness in case of sites providing priority to the established advertisers, he or she may as well make a purchase of a vacant place for advertising lest he or she should miss appropriate timing for advertising. However, Naver doesn't provide priority to the existing advertisers as far as all the keyword advertisements are concerned. In this case, one can preoccupy keywords if he or she enters into a contract after confirming the contract period for advertising. This study is designed to take a look at marketing for keyword advertising and to present effective strategies for keyword advertising marketing. At present, the Korean CPC advertising market is virtually monopolized by Overture. Its strong points are that Overture is based on the CPC charging model and that advertisements are registered on the top of the most representative portal sites in Korea. These advantages serve as the most appropriate medium for small and medium enterprises to use. However, the CPC method of Overture has its weak points, too. That is, the CPC method is not the only perfect advertising model among the search advertisements in the on-line market. So it is absolutely necessary that small and medium enterprises including independent shopping malls should complement the weaknesses of the CPC method and make good use of strategies for maximizing its strengths so as to increase their sales and to create a point of contact with customers.

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Effects of Soil Hardness on the Root Distribution of Pinus rigida Mill. Planted in Association with Sodding Works on the Denuded Land (사방시공지(砂防施工地)에 있어서 리기다소나무의 수근(樹根)의 분포(分布)에 미치는 토양견밀도(土壤堅密度)의 영향(影響))

  • Cho, Hi Doo
    • Journal of Korean Society of Forest Science
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    • v.56 no.1
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    • pp.66-76
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    • 1982
  • Soil harness represents such physical properties as porosity, amount of water, bulk density and soil texture. It is very important to know the mechanical properties of soil as well as the chemical in order to research the fundamental phenomena in the growth and the distribution of tree roots. The writer intended to grip soil hardness by soil layer and also to grasp the root distribution and the correlation between soil hardness and the root distribution of Pinus riguda Mill. planted on the denuded hillside with sooding works by soil layer on soil profile. The site investigated is situated at Peongchang-ri 13, Kocksung county, Chon-nam Province. The area is consisted of 3.63 ha having on elevation of 167.5-207.5 m. Soil texture is sandy loam and parant rock in granite. Average slope of the area is $17^{\circ}-30^{\circ}$. Soil moisture condition is dry. Main exposure of the area is NW or SW. The total number of plots investigated was 24 plots. It divided into two groups by direction each 12 plots in NW and SW and divided into three groups by the position of mountain plots in foot of mountain, in hillside, and in summit of mountain, respectively. Each sampling tree was selected as specimen by purposive sampling and soil profile was made at the downward distance of 50cm form the sampling tree at each plot. Soil hardness, soil layer surveying, root distribution of the tree and vegetation were measured and investigated at the each plot. The soil hardness measured by the Yamanaka Soil Hardness Tester in mm unit. the results are as follows: 1) Soil hardness increases gradually in conformity with the increment of soil depth. The average soil indicator hardness by soil layer are as follows: 14.6mm in I - soil layer (0-10cm in depth from soil surface), 16.2mm in II - soil layer (10-20cm), 17.2 in III - soil layer (20-30cm), 18.3mm in IV - soil layer(30-40cm), 19.8mm in V - soil layer (4.50mm). 2) The tree roots (less than 20mm in diameter) distribute more in the surface layer than in the subsoil layer and decrease gradually according to the increment of soil depth. The ratio of the root distribution can be illustrated by comparing with each of five soil layers from surface to subsoil layer as follows: I - soil layer; 31%, II - soil layer; 26%, III - soil layer; 18%, IV - soil layer; 12%, V - soil layer; 13%, 3) Soil hardness and tree root distribution (less than 20mm in diameter) of Pinus rigida Mill. correlate negatively each other; the more soil hardness increases, the most root distribution decreases. The correlation coefficients between soil hardness and distribution of tree roots by soil layer are as follows: I - soil layer; -0.3675 (at the 10% significance level), II - soil layer; -0.5299 (at the 1% significance level), III - soil layer; -0.5573 (at the 2% significance level), IV - soil layer; -0.6922 (at the 5% significance level), V - soil layer; -0.7325 (at the 2% significance level). 4) the most suitable range of soil hardness for the growth of Pinus rigida Mill is the range of 12-14.9mm in soil indicator hardness. In this range of soil indicator hardness, the root distribution of this tree amounts to 41.8% in spite of 33% in soil harness and under the 20.9mm of soil indicator hardness, the distribution amounts to 93.2% in spite of 82% in soil hardness. Judging from above facts, the roots of Pinus rigida can easily grow within the soil condition of 20.9mm in soil indicator hardness. 5) The soil layers are classified by their depths from the surface soil.

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