• Title/Summary/Keyword: non-structural

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Evaluating the Impacts of Long-Term Use of Agricultural Chemicals on a Soil Ecosystem by Structural Analysis of Bacterial Community (세균군집의 구조분석을 통한 장기간 농약사용이 토양생태계에 미치는 영향 평가)

  • Yun, Byeong-Jun;Kim, Seong-Hyeon;Lee, Dong-Heon;O, Gye-Heon;Gang, Hyeong-Il
    • Korean Journal of Microbiology
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    • v.39 no.4
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    • pp.260-266
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    • 2003
  • In this study bacterial community was analyzed to evaluate the impacts of long-term use of agricultural chemicals on a soil ecosystem as well as to obtain fundamental data on the relationship. Sequences of 16S rRNA clones from a non-agricultural site and a tangerine orchard soil which has a history of long-term use of agricultural chemicals over 30 years were analyzed. This revealed that bacterial community containing 5 divisions and 18 genera was distributed in a tangerine orchard soil, while bacterial community containing 9 divisions and 44 genera was distributed. In a tangerine orchard soil site, the most abundant bacteria in subdivision level were placed into Proteobacteria γ group which occupied 56% of total clones. The other bacterial clones from the ocrhcard soil exposed to agricultural chemicals over 30 years were Acidobacteria group (25%), Fimicutes group (5%), Planctomycetes group (2%), Proteobacteria α (1%), δ group (1%), and Cyanobacteria group (1%). Whereas, the clones were from the non-agricultural site were distributed among the division or subdivision Acidobacteria group (14%), Planctomycetes group (13%), Proteobacteria α (10%), β (9%), δ (9%), Fimicutes group (8%), Verrucomicrobia group (8%), Actinobacteria group (6%), Proteobacteria γ group (3%), Bacteroidetes group (3%), Gemmatimonadetes group (3%), and Cyanobacteria group (1%). This finding suggests the possibility that long-term application of agricultural chemicals or fertilizers on a tangerine orchard might result in drastic reduction or alteration in the composition of the bacterial community in the contaminated soil site.

Behavior of Steel Fiber-Reinforced Concrete Exterior Connections under Cyclic Loads (반복하중을 받는 강섬유 보강 철근콘크리트 외부 접합부의 거동 특성)

  • Kwon, Woo-Hyun;Kim, Woo-Suk;Kang, Thomas H.K.;Hong, Sung-Gul;Kwak, Yoon-Keun
    • Journal of the Korea Concrete Institute
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    • v.23 no.6
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    • pp.711-722
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    • 2011
  • Beam-column gravity or Intermediate Moment frames subjected to unexpected large displacements are vulnerable when no seismic details are provided, which is typical. Conversely, economic efficiency of those frames is decreased if unnecessary special detailing is applied as the beam and column size becomes quite large and steel congestion is caused by joint transverse reinforcement in beam-column connections. Moderate seismic design is used in Korea for beam-column connections of buildings with structural walls, which are to be destroyed when the unexpected large earthquake occurs. Nonetheless, performance of such beamcolumn connections may be substantially improved by the addition of steel fibers. This study was conducted to investigate the effect of steel fibers in reinforced concrete exterior beam-column connections and possibility for the replacement of some joint transverse reinforcement. Ten half-scale beam-column connections with non-seismic details were tested under cyclic loads with two cycles at each drift up to 19 cycles. Main test parameters used were the volume ratio of steel fibers (0%, 1%, 1.5%) and joint transverse reinforcement amount. The test results show that maximum capacity, energy dissipation capacity, shear strength and bond condition are improved with the application of steel fibers to substitute transverse reinforcement of beam-column connections. Furthermore, several shear strength equations for exterior connections were examined, including the proposed equation for steel fiber-reinforced concrete exterior connections with non-seismic details.

THE EFFECT OF LOW DIETARY CALCIUM AND IRRADIATION ON MANDIBLE IN RATS (저칼슘식이와 방사선조사가 백서 악골에 미치는 영향의 실험적 연구)

  • Lee Sun-Ki;Lee Sang-Rae
    • Journal of Korean Academy of Oral and Maxillofacial Radiology
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    • v.23 no.2
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    • pp.229-250
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    • 1993
  • This study was performed to investigate the morphological and structural changes of bone tissues and the effects of irradiation on the mandibular bodies of rats which were fed low calcium diets. In order to carry out this experiment, 160 seven-week old Sprague-Dawley strain rats weighing about 150 gm were selected and equally divided into one normal diet group of 80 rats and one low calcium diet group with the remainder. These groups were then subdivided into two groups, 40 were assigned rats for each subdivided group, exposed to radiation. The Group 1 was composed of forty non-irradiated rats with normal diet, Group 2 of forty irradiated rats with normal diet, Group 3 forty non-irradiated rats with low calcium diet, and Group 4 forty irradiated rats with low calcium diet. The two irradiation groups received a single dose of 20 Gy on the jaw area only and irradiated with a cobalt-50 teletherapy unit. The rats with normal and low calcium diet groups were serially terminated by ten on the 3rd, the 7th, the 14th, and the 21st day after irradiation. After termination, both sides of the dead rats mandible were removed and fixed with 10% neutral formalin. The bone density of mandibular body was measured by use of bone mineral densitometer(Model DPX -alpha, Lunar Corp., U.SA). Triga Mark ill nuclear reactor in Korea Atomic Research Institute was used for neutron activation and then calcium contents of mandibular body were measured by using a 4096 multichannel analyzer (EG and G ORTEC 919 MCA, U.SA). Also the mandibular body was radiographed with a soft X-ray apparatus(Hitex Co., Ltd., Japan). Thereafter, the obtained microradiograms were observed by a light microscope and were used for the morphometric analysis using a image analyzer(Leco 2001 System, Leco Co., Canada). The morphometric analysis was performed for parameters such as the total area, the bone area, the inner and outer perimeters of the bone. The obtained results were as follows: 1. In the morphometric analysis, total area and outer perimeter of the mandibular bodies of Group 3 were a little smaller than that of Group 1. The mean bone width and bone area were much smaller than that of Group 1 and the inner perimeter of Group 3 was much longer than that of Group 1. The total area and outer perimeter of Group 2 and Group 4 showed little difference. The mean bone width and bone area of Group 4 were smaller than that of Group 2 and the inner perimeter of Group 4 was longer than that of Group 2. 2. The remarkable decreases of the number and thickness of trabeculae and also the resorption of endosteal surface of cortical bone could be seen in the microradiogram of Group 3, Group 4 since the 3rd day of experiment. On the 21st day of experiment, the above findings could be more clearly seen in Group 4 than in Group 3. 3. The bone mineral density of Group 3 was lesser than that of Group 1 and the bone mineral density of Group 4 was lesser than that of Group 2 on the 7th, 14th, 21st days. The irradiation caused the bone mineral density to be decreased regardless of diet. In the case of Groups with low calcium diet, the bone mineral density was much decreased on the 21st day than on the 3rd day of experiment. 4. The calcium content in mandible of Group 3 was smaller than that of Group 1 throughout the experiment. roup 4 showed the least amount of calcium content. The irradiation caused the calcium content to be decreased regardless of diet. In the case of Groups with low calcium diet, the calcium content was much decreased on the 21st day than on the 3rd day of experiment. In conclusion, the present study demonstrated that morphological changs and decrease of bone mass due to resorption of bone by low calcium diet, and that the resorption of bone could be found in the spongeous bone and endosteal surface of cortical bone. So the problem of resorption of bone must be considered when the old and the postmenopausal women are taken radiotherapy because the irradiation seems to be accelerated the resorption of osteoporotic bone.

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Monocentric Derivative Y Chromosome with Duplication of the SRY Gene in an Azoospermic Male (무정자증 불임남성에서 관찰된 SRY 유전자의 중복을 동반한 일동원체성 derivative Y 염색체)

  • Choi, Eun-Young;Lee, Bom-Yi;Park, Ju-Yeon;Lee, Yeon-Woo;Oh, Ah-Rum;Lee, Shin-Young;Kim, Shin-Young;Han, You-Jung;Lee, Mee-Bum;Ryu, Hyun-Mee;Seo, Ju-Tae;Park, So-Yeon
    • Journal of Genetic Medicine
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    • v.7 no.2
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    • pp.160-164
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    • 2010
  • Structural abnormalities of the Y chromosome affect normal testicular differentiation and spermatogenesis. The present case showed a rare monocentric derivative Y chromosome with partial duplication of Yp including the SRY gene and deletion of Yq12 heterochromatin. The karyotype was 46,X,der(Y)(pter${\rightarrow}$q11.23::p11.2${\rightarrow}$pter).ish der(Y)(DYZ3+,DYZ1-,SRY++), confirmed through a FISH study. Even though the patient possessed an abnormal Y chromosome, testicular biopsy showed normal testicular volumes in the proband, with gonadal hormonal levels in the normal range but bilateral varicocele and hypospermatogenesis. We speculate that the abnormal Y chromosome arose from sister chromatids during Y chromosome recombination or intra chromosomal NAHR (non-allelic homologous recombination) during meiosis in the patient's father or in the very early stages of embryogenesis. The derivative Y chromosome might interfere in the meiotic stage of spermatogenesis, leading to the developmental arrest of germ cells. The present case illustrates that the infertility phenotype can have various causes. Also, it emphasizes the importance of accurate and various genetic analyses and could aid in male infertility treatment.

Research of the Moderating Effect on Team Members' Self-leadership of the Executive Officer's Emotional Leadership: Focus on the Differences between MZ Generation and the Others (경영자 감성리더십이 팀원의 셀프리더십에 미치는 조절효과에 대한 연구: MZ 세대와의 차이를 중심으로)

  • Cho, Chanhi;Lee, Hyoung-Yong
    • Knowledge Management Research
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    • v.22 no.4
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    • pp.261-282
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    • 2021
  • As the MZ generation, who values work-life balance, became a member of the organization, leader-oriented leadership centered on goal achievement and company profit made it difficult to achieve good results in the organization in the mid-to long-term. The company must strengthen the leadership that can be helpful for the self-leadership where the members of the organization move on their own and the organizational culture that enhances the employees' job satisfaction and organizational commitment. Therefore, this study analyzed the effect of the team leader's servant leadership on the team member's self-leadership and organizational effectiveness. In addition, it was studied whether the executive officer's emotional leadership interacted with the team leader's servant leadership and had a moderating effect on the team member's self-leadership. Also, the difference in path coefficient between the MZ generation and the non-MZ generation was verified. To this end, the research model was statistically verified using the PLS (Partial Least Square) structural equation. A survey was collected from 357 team members among office workers online. As a result of the analysis, the team leader's servant leadership had a significant effect on organizational effectiveness and team member's self-leadership. Also, in the relationship between the team leader's servant leadership and the team member's self-leadership, the emotional leadership of the executive officer had a positive (+) moderating effect. The MZ generation differed from the non-MZ generation in the path where the team leader's servant leadership positively affected the self-leadership of the team member and the path where the team leader's self-leadership had a mediating effect between the team leader's servant leadership and organizational effectiveness. The results of this study will suggest various theoretical and practical implications so that executive officers, team leaders, and team members within the company can develop leadership that increases organizational effectiveness in their respective positions.

Descriptive Study for Sonographic Morphology of the 1st Facet of Subscapularis Footprint (견갑하건 부착부의 제1부착면에 대한 초음파 소견의 기술적 연구)

  • Sohn, Hoon-Sang;Wi, Chan Kuk;Shon, Min Soo
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.4
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    • pp.343-352
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    • 2019
  • Purpose: The purpose of this study was to document the sonographic morphology of the subscapularis footprint, particularly the 1st facet, of the non-pathologic subscapularis tendon and footprint, and analyze the correlation between the size of the 1st facet and the demographic variables. Materials and Methods: Between March 2015 and December 2017, retrospectively data analysis was performed for the ultrasound (US) scans of 115 consecutive shoulder (mean age 53.4 years, range 23-74 years) with non-pathologic subscapularis tendon and footprint. The sonographic findings of the 1st facet of the subscapularis footprint was a very unique, flat, broad, and plane angle in the upward direction, which were distinguished from the other facets. On US, the transverse (medio-lateral) and longitudinal (superior-inferior) length of the 1st facet on axis of the humerus shaft were recorded. The demographic variables, including age, site, body height, weight, body mass index (BMI), and arm length, were reviewed. Results: On US, the mean transverse length of the 1st facet was 12.75 mm (range 10.54-14.50 mm, standard deviation [SD] 0.712) and the mean longitudinal length was 12.22 mm (range 9.20-13.30 mm, SD 0.888). The transverse and longitudinal length of the size of the 1st facet were significantly greater in males than in females (p<0.001, p=0.001). Of the demographic data (body height, weight, BMI, arm length) that showed a significant positive linear correlation, the correlation with body height (transverse r=0.749, p<0.001; longitudinal r=0.642, p<0.001) showed the strongest relationship, and the correlation with the BMI was weakly related. The relationships between the size of the 1st facet to site/age were not statistically significant or appeared to have no linear correlation. Conclusion: The structural and morphologic features of the 1st facet of the subscapularis footprint on the US were identified. This will provide anatomic knowledge of an US examination for subscapularis tendon pathology.

A Study on the Effects of Entrepreneurial Marketing Orientation on the Management Performance: Mediated Effect of Organizational Marketing Capabilities (창업자의 앙트레프레니얼 마케팅 지향성이 경영성과에 미치는 영향: 조직내 마케팅역량의 매개효과)

  • Byun, Hong Joo;Byun, Chung Gyu;Ha, Hwan Ho
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.17 no.4
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    • pp.87-100
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    • 2022
  • Early start-up companies have an inherent limitation of lack of resources. Despite these limitations, in order to survive, the entrepreneur's personal ability to efficiently use limited resources is required. In the marketing field, various studies are needed to reduce the business failure rate through establishing growth strategies and innovation. Accordingly, it is necessary to apply the concept of entrepreneurial marketing, which has been researched and developed overseas for 30 years, to fit the domestic reality. According to the flow of this study, an empirical study should be preceded to clarify the influence relationship between entrepreneurial marketing orientation, marketing competency, and management performance, along with a theoretical theorem on entrepreneurial marketing that is suitable for early start-ups and small and medium-sized enterprises(SMEs) and can respond innovatively to changes. The establishment of entrepreneurial marketing orientation and the processes from which this concept leads to business performance through the organization's marketing capabilities and its effects will be empirically verified. For an empirical survey, a survey was conducted on founders of 220 companies, and path analysis using structural equations was used for hypothesis verification. The findings are as follows. First, it was found that the entrepreneurial marketing orientation had a positive effect on both the organization's marketing capabilities and management performance. Second, it was found that the organization's marketing capabilities also had a positive effect on management performance. Third, as a result of empirical analysis of the mediating effect of the organization's marketing capabilities on the relationship between entrepreneurial marketing orientation and management performance, it was found that marketing capabilities showed a greater mediating effect on non-financial performance than financial performance. On the other hand, it was confirmed that marketing performance had a stronger mediating effect on financial performance than non-financial performance. By confirming and presenting the concept and constituent factors of entrepreneurial marketing orientation of domestic start-ups, which were academic gaps for the purpose of this paper, the academic research is differentiated in that they were verified as six components of entrepreneurial marketing. The practical implications of the research results will be that the entrepreneurial marketing-oriented mindset of small and medium-sized companies will optimize market analysis capabilities, network with various stakeholders, and increase the organization's ability to demonstrate marketing capabilities.

APPLICATION OF FUZZY SET THEORY IN SAFEGUARDS

  • Fattah, A.;Nishiwaki, Y.
    • Proceedings of the Korean Institute of Intelligent Systems Conference
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    • 1993.06a
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    • pp.1051-1054
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    • 1993
  • The International Atomic Energy Agency's Statute in Article III.A.5 allows it“to establish and administer safeguards designed to ensure that special fissionable and other materials, services, equipment, facilities and information made available by the Agency or at its request or under its supervision or control are not used in such a way as to further any military purpose; and to apply safeguards, at the request of the parties, to any bilateral or multilateral arrangement, or at the request of a State, to any of that State's activities in the field of atomic energy”. Safeguards are essentially a technical means of verifying the fulfilment of political obligations undertaken by States and given a legal force in international agreements relating to the peaceful uses of nuclear energy. The main political objectives are: to assure the international community that States are complying with their non-proliferation and other peaceful undertakings; and to deter (a) the diversion of afeguarded nuclear materials to the production of nuclear explosives or for military purposes and (b) the misuse of safeguarded facilities with the aim of producing unsafeguarded nuclear material. It is clear that no international safeguards system can physically prevent diversion. The IAEA safeguards system is basically a verification measure designed to provide assurance in those cases in which diversion has not occurred. Verification is accomplished by two basic means: material accountancy and containment and surveillance measures. Nuclear material accountancy is the fundamental IAEA safeguards mechanism, while containment and surveillance serve as important complementary measures. Material accountancy refers to a collection of measurements and other determinations which enable the State and the Agency to maintain a current picture of the location and movement of nuclear material into and out of material balance areas, i. e. areas where all material entering or leaving is measurab e. A containment measure is one that is designed by taking advantage of structural characteristics, such as containers, tanks or pipes, etc. To establish the physical integrity of an area or item by preventing the undetected movement of nuclear material or equipment. Such measures involve the application of tamper-indicating or surveillance devices. Surveillance refers to both human and instrumental observation aimed at indicating the movement of nuclear material. The verification process consists of three over-lapping elements: (a) Provision by the State of information such as - design information describing nuclear installations; - accounting reports listing nuclear material inventories, receipts and shipments; - documents amplifying and clarifying reports, as applicable; - notification of international transfers of nuclear material. (b) Collection by the IAEA of information through inspection activities such as - verification of design information - examination of records and repo ts - measurement of nuclear material - examination of containment and surveillance measures - follow-up activities in case of unusual findings. (c) Evaluation of the information provided by the State and of that collected by inspectors to determine the completeness, accuracy and validity of the information provided by the State and to resolve any anomalies and discrepancies. To design an effective verification system, one must identify possible ways and means by which nuclear material could be diverted from peaceful uses, including means to conceal such diversions. These theoretical ways and means, which have become known as diversion strategies, are used as one of the basic inputs for the development of safeguards procedures, equipment and instrumentation. For analysis of implementation strategy purposes, it is assumed that non-compliance cannot be excluded a priori and that consequently there is a low but non-zero probability that a diversion could be attempted in all safeguards ituations. An important element of diversion strategies is the identification of various possible diversion paths; the amount, type and location of nuclear material involved, the physical route and conversion of the material that may take place, rate of removal and concealment methods, as appropriate. With regard to the physical route and conversion of nuclear material the following main categories may be considered: - unreported removal of nuclear material from an installation or during transit - unreported introduction of nuclear material into an installation - unreported transfer of nuclear material from one material balance area to another - unreported production of nuclear material, e. g. enrichment of uranium or production of plutonium - undeclared uses of the material within the installation. With respect to the amount of nuclear material that might be diverted in a given time (the diversion rate), the continuum between the following two limiting cases is cons dered: - one significant quantity or more in a short time, often known as abrupt diversion; and - one significant quantity or more per year, for example, by accumulation of smaller amounts each time to add up to a significant quantity over a period of one year, often called protracted diversion. Concealment methods may include: - restriction of access of inspectors - falsification of records, reports and other material balance areas - replacement of nuclear material, e. g. use of dummy objects - falsification of measurements or of their evaluation - interference with IAEA installed equipment.As a result of diversion and its concealment or other actions, anomalies will occur. All reasonable diversion routes, scenarios/strategies and concealment methods have to be taken into account in designing safeguards implementation strategies so as to provide sufficient opportunities for the IAEA to observe such anomalies. The safeguards approach for each facility will make a different use of these procedures, equipment and instrumentation according to the various diversion strategies which could be applicable to that facility and according to the detection and inspection goals which are applied. Postulated pathways sets of scenarios comprise those elements of diversion strategies which might be carried out at a facility or across a State's fuel cycle with declared or undeclared activities. All such factors, however, contain a degree of fuzziness that need a human judgment to make the ultimate conclusion that all material is being used for peaceful purposes. Safeguards has been traditionally based on verification of declared material and facilities using material accountancy as a fundamental measure. The strength of material accountancy is based on the fact that it allows to detect any diversion independent of the diversion route taken. Material accountancy detects a diversion after it actually happened and thus is powerless to physically prevent it and can only deter by the risk of early detection any contemplation by State authorities to carry out a diversion. Recently the IAEA has been faced with new challenges. To deal with these, various measures are being reconsidered to strengthen the safeguards system such as enhanced assessment of the completeness of the State's initial declaration of nuclear material and installations under its jurisdiction enhanced monitoring and analysis of open information and analysis of open information that may indicate inconsistencies with the State's safeguards obligations. Precise information vital for such enhanced assessments and analyses is normally not available or, if available, difficult and expensive collection of information would be necessary. Above all, realistic appraisal of truth needs sound human judgment.

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The theory of lesson plannig and the instructional structuration : A case study for urban units in Japanese high school (수업설계론과 수업구조화 - 일본 고등학교 도시단원을 사례로 -)

  • ;Sim, Kwang Taek
    • Journal of the Korean Geographical Society
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    • v.29 no.2
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    • pp.166-182
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    • 1994
  • Kyonggi Province in the late Chosun dynasty was a center of superior government offices including 'Han' River water-road transportation and was located in the middle of an 'X'-shaped arterial road network. Because of these reasons, Kyonggi Province had a faster inflow of commodities, informations and technics compared with the other province. At this period of time, every local 'Eup' (name of administrative district) had not been affected by their above administrative districts and had their own autonomy. For this reason, every 'Eup' could be developed as a town, even if its size was small when it had sufficient internal growing conditions. Moreover, the markets ('Si-Jon') in big towns and periodical markets which were spread over the Kyonggi Province played role of commercial functions of town. And because military bases for the defence of the royal capital in Kyonggi Province also took parts of a non-agricultural city role, Xyonggi Provinc had much more possibilities of growing as a town rather than the other provinces. The towns of the late Chosun Dynasty were, except the capital and superior administrative districts which were governed by the 'You-Su', small towns which had only about 3, 000-5, 000 people. Most of the town dewellers were local officials, nobles, merchants, craftmen and slaves. And the farmers who lived near town became a pseudo-towner through suburb agriculture. Among these people, the merchants were leaders of townization. The downtowns were affected by the landform and traffic roads. The most fundamental function of towns were administrative. The opcial's grade, which was dispatched to the local administrative district ('Kun' or 'Hyun'), was decided by the size of population and agricultural land of each county. Large county which was governed by a high ranking opcial had more possibilities to develop as a large town. Because they supervised other opcials of lower rank and obtained more land and population for the town. The phonomena of farm abandonment after the Japanese Invasion of Korea in 1592-1598 stimulated the development of towns for commercial function. The commercial functions of towns were evident in the Si-Jon or Nan-Jon (names of markets) in the big cities such as Hansung and Kaesung, meanffwhile in the local areas it was emerged in the shape of periodical market networks as allied with near markets (which were called as Jang-Si) or permanent markets which were grown up from periodical markets. These facts of commercial development induced the birth of commercial town. Kyonggi Province showed the weak points of its defense system during both wars (Japanese Invasion in 1592 and Manchu's Invasion in 1636). The government reinforced its defense system by adding 4 'You-Su-Bus' and several military bases. Each local districts ('Eup'), where Geo-Jins were established, were stimulated to be a town while Jin-Kwan system were, adjusted and enforced. Among Dok-Jins(name of solitary military bases), Youngjongjin was grown up as a large garrison town which only played a role of defense. The number of towns that took roles of non-agricultural functions in Kyonggi Province was 52. Among these towns, 29 were developed as big towns which had above 3, 000 people and most of these towns were located on the northwest-southeast axes of 'X'-shaped arterial trafic network in the Chosn Dynasty, This fact points out that the traffic road is one of the important causes of the development of towns. When we make hierarchy of the towns of Kyonggi Province according to its population and how many functions it had, we can make it as 6 grades. The virst grade town 'Hansung' was the biggest central town of administration, commerce and defdnse. The 2nd grade town includes 'Kaesung' which had historical inertia that it had been the capital of the Koryo Dynesty. The 3rd grade towns include some 'You- Su-Bus' such as Soowon, Kanghwa, Kwangju and also include Mapo, Yongsan and from this we can imagine that the commercial development in the late Chosun Dynasty extremely affected the townization. The 4th-6th grade towns had smiliar population but it can be discriminated by how many town functions it had. So the 4th grade towns were the core of administration, commerce and defense function. 5th grade towns had administrative functions and one of commercial and defense functions. 6th grade towns had only one of these functions. When we research and town conditions of each grades as the ratio of non-agricultural population, we can find out that the towns from the 1st grade to 4th grade show difference by degree of townization but from the 4th grade to 6th grade towns do not show big difference in general.

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Early Clinical Experience in Aortic Valve Replacement Using On-X$^{circledR}$Prosthetic Heart Valve (On-X$^{circledR}$ 기계판막을 이용한 대동맥판 치환술의 조기 임상 경험)

  • 안병희;전준경;류상완;최용선;김병표;홍성범;박종춘;김상형
    • Journal of Chest Surgery
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    • v.36 no.9
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    • pp.651-658
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    • 2003
  • Since the first implanted in September 1997, the use of On-X prosthetic heart valve has been increasing around in the world. This study was designed to assess the feasibility, safety, and the postoperative hemodynamics with this new valve in clinical setting. Material and Method: The current study was carried out on 52 patients undergoing aortic valve replacement with this prosthesis between April 1999 to August 2002 at Chonnam National University Hospital to evaluate the surgical results. 52% of the patients were male and the average age at implant was 50$\pm$13 years. The study followed the guidelines of the AATS/STS. Preoperatively, 32(61.5%) patients were in NYHA functional class III or IV and 2 patients had previous aortic valve surgery. Concomitant cardiac surgery was performed in 71.1%. The implanted valve sizes were 19 mm in 13 patients, 21 mm in 26, 23 mm in 10 and 25 mm in 3, respectively. Mean follow-up was 16.6$\pm$10.5 months (1∼39 months). Echocardiographic assessment was performed pre- and immediate postoperatively, as well as 3, 6, 12 months after surgery, evaluating pressure loss and regression of left ventricular hypertrophy. Result: Mean cardiopulmonary bypass time was 191$\pm$94.7 minutes with an aortic cross-clamp time of 142$\pm$51.7 minutes. There was no early and late mortality, Freedom from adverse events at 1 year in the study were as follows: thromboembolism, 95.6$\pm$6%; bleeding events, 90.2$\pm$4%; paravalvular leakage 92.3$\pm$4%; and overall valve-related morbidity at 1 year was 76.6$\pm$3%. There were no cases of valve thrombosis, prosthetic valve endocarditis and structural or non-structural failure. Left ventricular function at 12 months after surgery (EF=62.7$\pm$9.8%) revealed a statistically significant improvement compared to preoperative investigation (EF=55.8$\pm$15.9%, p=0.006). Left ventricular mass index was 247.3$\pm$122.3 g/$m^2$ on preoperative echocardiographic study, but regressed to 155.5$\pm$58.2 g/$m^2$ at postoperative 1 year (p=0.002). Over the follow-up period a further decrease of peak transvalvular gradients was observed in all patients: 62.5$\pm$38.0 mmHg on preoperative assessment, 18.2$\pm$6.8 mmHg at immediate postoperative period (p < 0.0001), 7.6$\pm$5.09 mmHg (p<0.0001) at 6 month, 18.0$\pm$10.8 mmHg (p<0.0001) at 1 year. Conclusion: The On-X prosthetic heart valve performs satisfactorily in the first 1 year period. Clinical outcome by examining NYHA functional classification revealed especially good results. Effective regression of left ventricular hypertrophy and statistically significant decrease of transvalvular gradient were observed over the first year, but longer-term follow-up of this patient group is needed to establish the expected rates for late valve-related events as well as the long-term clinical efficacy of this valve.