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A Case of Kabuki Syndrome Confirmed by Genetic Analysis: A Novel Frameshift Mutation in the KMT2D Gene (분자유전학적으로 진단된 가부키 증후군 1례)

  • Park, Su Jin;Ahn, Moon Bae;Jang, Woori;Cho, Won Kyung;Chae, Hyo Jin;Kim, Myung Shin;Suh, Byung Kyu
    • Journal of The Korean Society of Inherited Metabolic disease
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    • v.17 no.3
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    • pp.103-108
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    • 2017
  • Kabuki syndrome is a rare congenital disorder that causes multiple birth defects and mental retardation. Mutation of the lysine methyltransferase 2D (KMT2D) gene is the primary cause of Kabuki syndrome. We report a 4-year-old Korean girl diagnosed with Kabuki syndrome based on distinctive facial features (eversion of the lower lateral eyelid, arched eyebrows, depressed nasal tip, prominent ears), skeletal anomalies, short stature, and molecular analysis, which revealed a novel frameshift mutation in the KMT2D gene. A 4-year-old patient had a past history of congenital cardiac malformations (coarctation of the aorta, ventricular septal defect, atrial septal defect, patent ductus arteriosus), subclinical hypothyroidism and dysmorphic features at birth including webbed neck, short fingers, high arched palate, micrognathia and horseshoe kidney. She showed unique facial features such as a long palpebral fissure, long eyelashes, arched eyebrows with sparseness of the lateral third, broad nasal root, anteverted ears, and small mouth. Her facial features suggested Kabuki syndrome, and genetic analysis discovered a novel heterozygous frameshift mutation (c.4379dup, p.Leu1461Thrfs*30) in exon 15 of the KMT2D gene. The diagnosis of our 4-year-old patient was made through thorough physical examination and history taking, and genetic testing. It is challenging to diagnose patients with Kabuki syndrome at birth, since the characteristic facial features are expressed gradually during growth. Clinical suspicion aroused by regular follow-ups may lead to earlier diagnosis and interventions.

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The Effects of Technological Competitiveness by Country on The Increase of Unicorn Companies (국가별 기술경쟁력이 유니콘기업 증가에 미치는 영향에 관한 연구)

  • Kyu Hoon Cho;Dong Woo Yang
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.19 no.1
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    • pp.55-73
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    • 2024
  • Unicorn companies are attracting attention around the world as they are recognized for their high corporate value in a short period of time as an innovative business models. Their growth process presents good lessons for the startup ecosystem and have a positive impact on national economic development and job creation. However, previous studies related to unicorn companies are focused on 'event studies' and 'case studies' such as characteristics of founders, environmental factors, business models and success/failure cases of companies already recognized as unicorns rather than a multifaceted approach. The occurrence of unicorn companies and Macroscopic analysis of related factors is lacking. Against this background, this study are considering the characteristics of unicorns examined through previous research and the current status unicorns with a high proportion of technology companies, the purpose was to analyze the impact of the country's technological competitiveness, such as 'technology human resource index', 'R&D index', and 'technology infrastructure index', on the increase in unicorn companies. For statistical analysis, data published by various international organizations, the Bank of Korea, and Statistics Korea from 2017 to 2020 and unicorn company data compiled by CB Insights were used as panel data for 44 countries to be tested by multiple regression analysis. As a result of the study, it was confirmed that the number of science majors had a positive (+) effect on the increase of unicorn companies in the case of technology human resource index, and in the case of R&D index, the total amount of R&D investment had a positive (+) effect on the increase of unicorn companies, while the number of Triad Patents Families and the number of scientific and technological papers published had a negative (-) effect on the increase of unicorn companies. Finally, in the case of technology infrastructure index, it was confirmed that the number of the world's 500th-ranked universities had a positive (+) effect on the increase of unicorn companies. This study is the first to reveal the causal relationship between national technological competitiveness and unicorn company growth based on country-specific and time-series empirical data, which were insufficiently covered in previous studies. and compared to the UN's ranking of the global industrial competitiveness index and the OECD's total R&D investment by country, Korea is considered to have technological and growth potential, while the number of unicorn companies driving growth as leaders of the innovative economy is relatively small, so the research results can be used when establishing policies to discover and foster unicorn companies in the future.

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Analysis of Success Cases of InsurTech and Digital Insurance Platform Based on Artificial Intelligence Technologies: Focused on Ping An Insurance Group Ltd. in China (인공지능 기술 기반 인슈어테크와 디지털보험플랫폼 성공사례 분석: 중국 평안보험그룹을 중심으로)

  • Lee, JaeWon;Oh, SangJin
    • Journal of Intelligence and Information Systems
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    • v.26 no.3
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    • pp.71-90
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    • 2020
  • Recently, the global insurance industry is rapidly developing digital transformation through the use of artificial intelligence technologies such as machine learning, natural language processing, and deep learning. As a result, more and more foreign insurers have achieved the success of artificial intelligence technology-based InsurTech and platform business, and Ping An Insurance Group Ltd., China's largest private company, is leading China's global fourth industrial revolution with remarkable achievements in InsurTech and Digital Platform as a result of its constant innovation, using 'finance and technology' and 'finance and ecosystem' as keywords for companies. In response, this study analyzed the InsurTech and platform business activities of Ping An Insurance Group Ltd. through the ser-M analysis model to provide strategic implications for revitalizing AI technology-based businesses of domestic insurers. The ser-M analysis model has been studied so that the vision and leadership of the CEO, the historical environment of the enterprise, the utilization of various resources, and the unique mechanism relationships can be interpreted in an integrated manner as a frame that can be interpreted in terms of the subject, environment, resource and mechanism. As a result of the case analysis, Ping An Insurance Group Ltd. has achieved cost reduction and customer service development by digitally innovating its entire business area such as sales, underwriting, claims, and loan service by utilizing core artificial intelligence technologies such as facial, voice, and facial expression recognition. In addition, "online data in China" and "the vast offline data and insights accumulated by the company" were combined with new technologies such as artificial intelligence and big data analysis to build a digital platform that integrates financial services and digital service businesses. Ping An Insurance Group Ltd. challenged constant innovation, and as of 2019, sales reached $155 billion, ranking seventh among all companies in the Global 2000 rankings selected by Forbes Magazine. Analyzing the background of the success of Ping An Insurance Group Ltd. from the perspective of ser-M, founder Mammingz quickly captured the development of digital technology, market competition and changes in population structure in the era of the fourth industrial revolution, and established a new vision and displayed an agile leadership of digital technology-focused. Based on the strong leadership led by the founder in response to environmental changes, the company has successfully led InsurTech and Platform Business through innovation of internal resources such as investment in artificial intelligence technology, securing excellent professionals, and strengthening big data capabilities, combining external absorption capabilities, and strategic alliances among various industries. Through this success story analysis of Ping An Insurance Group Ltd., the following implications can be given to domestic insurance companies that are preparing for digital transformation. First, CEOs of domestic companies also need to recognize the paradigm shift in industry due to the change in digital technology and quickly arm themselves with digital technology-oriented leadership to spearhead the digital transformation of enterprises. Second, the Korean government should urgently overhaul related laws and systems to further promote the use of data between different industries and provide drastic support such as deregulation, tax benefits and platform provision to help the domestic insurance industry secure global competitiveness. Third, Korean companies also need to make bolder investments in the development of artificial intelligence technology so that systematic securing of internal and external data, training of technical personnel, and patent applications can be expanded, and digital platforms should be quickly established so that diverse customer experiences can be integrated through learned artificial intelligence technology. Finally, since there may be limitations to generalization through a single case of an overseas insurance company, I hope that in the future, more extensive research will be conducted on various management strategies related to artificial intelligence technology by analyzing cases of multiple industries or multiple companies or conducting empirical research.

Structural features and Diffusion Patterns of Gartner Hype Cycle for Artificial Intelligence using Social Network analysis (인공지능 기술에 관한 가트너 하이프사이클의 네트워크 집단구조 특성 및 확산패턴에 관한 연구)

  • Shin, Sunah;Kang, Juyoung
    • Journal of Intelligence and Information Systems
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    • v.28 no.1
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    • pp.107-129
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    • 2022
  • It is important to preempt new technology because the technology competition is getting much tougher. Stakeholders conduct exploration activities continuously for new technology preoccupancy at the right time. Gartner's Hype Cycle has significant implications for stakeholders. The Hype Cycle is a expectation graph for new technologies which is combining the technology life cycle (S-curve) with the Hype Level. Stakeholders such as R&D investor, CTO(Chef of Technology Officer) and technical personnel are very interested in Gartner's Hype Cycle for new technologies. Because high expectation for new technologies can bring opportunities to maintain investment by securing the legitimacy of R&D investment. However, contrary to the high interest of the industry, the preceding researches faced with limitations aspect of empirical method and source data(news, academic papers, search traffic, patent etc.). In this study, we focused on two research questions. The first research question was 'Is there a difference in the characteristics of the network structure at each stage of the hype cycle?'. To confirm the first research question, the structural characteristics of each stage were confirmed through the component cohesion size. The second research question is 'Is there a pattern of diffusion at each stage of the hype cycle?'. This research question was to be solved through centralization index and network density. The centralization index is a concept of variance, and a higher centralization index means that a small number of nodes are centered in the network. Concentration of a small number of nodes means a star network structure. In the network structure, the star network structure is a centralized structure and shows better diffusion performance than a decentralized network (circle structure). Because the nodes which are the center of information transfer can judge useful information and deliver it to other nodes the fastest. So we confirmed the out-degree centralization index and in-degree centralization index for each stage. For this purpose, we confirmed the structural features of the community and the expectation diffusion patterns using Social Network Serice(SNS) data in 'Gartner Hype Cycle for Artificial Intelligence, 2021'. Twitter data for 30 technologies (excluding four technologies) listed in 'Gartner Hype Cycle for Artificial Intelligence, 2021' were analyzed. Analysis was performed using R program (4.1.1 ver) and Cyram Netminer. From October 31, 2021 to November 9, 2021, 6,766 tweets were searched through the Twitter API, and converting the relationship user's tweet(Source) and user's retweets (Target). As a result, 4,124 edgelists were analyzed. As a reult of the study, we confirmed the structural features and diffusion patterns through analyze the component cohesion size and degree centralization and density. Through this study, we confirmed that the groups of each stage increased number of components as time passed and the density decreased. Also 'Innovation Trigger' which is a group interested in new technologies as a early adopter in the innovation diffusion theory had high out-degree centralization index and the others had higher in-degree centralization index than out-degree. It can be inferred that 'Innovation Trigger' group has the biggest influence, and the diffusion will gradually slow down from the subsequent groups. In this study, network analysis was conducted using social network service data unlike methods of the precedent researches. This is significant in that it provided an idea to expand the method of analysis when analyzing Gartner's hype cycle in the future. In addition, the fact that the innovation diffusion theory was applied to the Gartner's hype cycle's stage in artificial intelligence can be evaluated positively because the Gartner hype cycle has been repeatedly discussed as a theoretical weakness. Also it is expected that this study will provide a new perspective on decision-making on technology investment to stakeholdes.

Risk Factor Analysis for Spinal Cord and Brain Damage after Surgery of Descending Thoracic and Thoracoabdominal Aorta (하행 흉부 및 흉복부 대동맥 수술 후 척수 손상과 뇌손상 위험인자 분석)

  • Kim Jae-Hyun;Oh Sam-Sae;Baek Man-Jong;Jung Sung-Cheol;Kim Chong-Whan;Na Chan-Young
    • Journal of Chest Surgery
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    • v.39 no.6 s.263
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    • pp.440-448
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    • 2006
  • Background: Surgery of descending thoracic or thoracoabdominal aorta has the potential risk of causing neurological injury including spinal cord damage. This study was designed to find out the risk factors leading to spinal cord and brain damage after surgery of descending thoracic and thoracoabdominal aorta. Material and Method: Between October 1995 and July 2005, thirty three patients with descending thoracic or thoracoabdominal aortic disease underwent resection and graft replacement of the involved aortic segments. We reviewed these patients retrospectively. There were 23 descending thoracic aortic diseases and 10 thoracoabdominal aortic diseases. As an etiology, there were 23 aortic dissections and 10 aortic aneurysms. Preoperative and perioperative variables were analyzed univariately and multivariately to identify risk factors of neurological injury. Result: Paraplegia occurred in 2 (6.1%) patients and permanent in one. There were 7 brain damages (21%), among them, 4 were permanent damages. As risk factors of spinal cord damage, Crawford type II III(p=0.011) and intercostal artery anastomosis (p=0.040) were statistically significant. Cardiopulmonary bypass time more than 200 minutes (p=0.023), left atrial vent catheter insertion (p=0.005) were statistically significant as risk factors of brain damage. Left heart partial bypass (LHPB) was statistically significant as a protecting factor of brain (p=0.032). Conclusion: The incidence of brain damage was higher than that of spinal cord damage after surgery of descending thoracic and thoracoabdominal aorta. There was no brain damage in LHPB group. LHPB was advantageous in protecting brain from postoperative brain injury. Adjunctive procedures to protect spinal cord is needed and vigilant attention should be paid in patients with Crawford type II III and patients who have patent intercostal arteries.

Comparison of Saphenous Vein and PTFE Grafts for Above the Knee Femoropopliteal Bypass Grafting (슬상부 대퇴동맥-슬와동맥 우회이식술에서 복재정맥과 PTFE 이식편의 비교)

  • Kim, Han-Yong;Kim, Jong-Seok;Kim, Myoung-Young;Hwang, Sang-Won;Yoo, Byung-Ha
    • Journal of Chest Surgery
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    • v.43 no.2
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    • pp.127-132
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    • 2010
  • Background: Femoropopliteal artery bypss grafting is an effective form of treatment for infrainguinal artery occlusive disease in those patients who have either intermittent claudication or resting critical ischemia. The objective of this analysis was to evaluate the long-term patency of a femoropopliteal bypass graft that is classified as an above-the-knee saphenous vein graft or an above-the-knee PTFE (polytetrafluoroethylene) graft. Material and Method:From January 1998 to February 2005, 103 above-the-knee femoro-popliteal bypasses were performed on 87 patients. There were 74 male and 13 female patients with a mean age of $65.7{\pm}9.69$ (range: 31~82). The surgical indications were intermittent claudication in 65 cases (74.7%), foot ulceration in 2 cases (2.3%), foot necrosis in 10 ases (11.5%) and toe necrosis in 10 cases (11.5%). For the bypass graft, a reversed saphenous vein was used in 31 limbs and a polytetrafluoroethylene (PTFE) prosthesis was used in 72 limbs (6 mm: 27 limbs, 8 mm: 45 limbs). The perioperative risk factors were diabetes mellitus in 33 cases (37.9%), hypertension in 47 cases (54.0%), a history of ischemic heart disease in 13 cases (14.9%) and smoking in 72 cases (82.8%). Result:There were three perioperative deaths (3.4%) and seven late deaths (8.3%). Major leg amputation was necessary in 12 patients (13.8%) during the entire course of the study. The primary patency rate at 5 years for the vein grafts, the 8 mm-PTFE grafts and the 6 mm-PTFE grafts were 84.7%, 77.4% and 74.2%, respectively and the overall primary patency rate was 78.7%, and there were no significant statistical differences among the graft groups. By using multivariate analysis, the number of patent tibial arteries was determined to be a significant factor that influenced the primary graft patency rate (p<0.005), but risk factors such as diabetes mellitus, ischemic heart disease, smoking and age had no statistically significant affect on the primary graft patency rates. Conclusion: The great saphenous vein is considered the most durable conduit for infrainguinal revascularization, but the overall results of this study show that saphenous vein and PTFE grafts have comparable patency rates when used above the knee in patients with claudication or critical ischemia. The use of PTFE above the knee is a reasonable alternative for a femoro-poplitael bypass and it is associated with acceptable long term patency rates.

Intelligent Brand Positioning Visualization System Based on Web Search Traffic Information : Focusing on Tablet PC (웹검색 트래픽 정보를 활용한 지능형 브랜드 포지셔닝 시스템 : 태블릿 PC 사례를 중심으로)

  • Jun, Seung-Pyo;Park, Do-Hyung
    • Journal of Intelligence and Information Systems
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    • v.19 no.3
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    • pp.93-111
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    • 2013
  • As Internet and information technology (IT) continues to develop and evolve, the issue of big data has emerged at the foreground of scholarly and industrial attention. Big data is generally defined as data that exceed the range that can be collected, stored, managed and analyzed by existing conventional information systems and it also refers to the new technologies designed to effectively extract values from such data. With the widespread dissemination of IT systems, continual efforts have been made in various fields of industry such as R&D, manufacturing, and finance to collect and analyze immense quantities of data in order to extract meaningful information and to use this information to solve various problems. Since IT has converged with various industries in many aspects, digital data are now being generated at a remarkably accelerating rate while developments in state-of-the-art technology have led to continual enhancements in system performance. The types of big data that are currently receiving the most attention include information available within companies, such as information on consumer characteristics, information on purchase records, logistics information and log information indicating the usage of products and services by consumers, as well as information accumulated outside companies, such as information on the web search traffic of online users, social network information, and patent information. Among these various types of big data, web searches performed by online users constitute one of the most effective and important sources of information for marketing purposes because consumers search for information on the internet in order to make efficient and rational choices. Recently, Google has provided public access to its information on the web search traffic of online users through a service named Google Trends. Research that uses this web search traffic information to analyze the information search behavior of online users is now receiving much attention in academia and in fields of industry. Studies using web search traffic information can be broadly classified into two fields. The first field consists of empirical demonstrations that show how web search information can be used to forecast social phenomena, the purchasing power of consumers, the outcomes of political elections, etc. The other field focuses on using web search traffic information to observe consumer behavior, identifying the attributes of a product that consumers regard as important or tracking changes on consumers' expectations, for example, but relatively less research has been completed in this field. In particular, to the extent of our knowledge, hardly any studies related to brands have yet attempted to use web search traffic information to analyze the factors that influence consumers' purchasing activities. This study aims to demonstrate that consumers' web search traffic information can be used to derive the relations among brands and the relations between an individual brand and product attributes. When consumers input their search words on the web, they may use a single keyword for the search, but they also often input multiple keywords to seek related information (this is referred to as simultaneous searching). A consumer performs a simultaneous search either to simultaneously compare two product brands to obtain information on their similarities and differences, or to acquire more in-depth information about a specific attribute in a specific brand. Web search traffic information shows that the quantity of simultaneous searches using certain keywords increases when the relation is closer in the consumer's mind and it will be possible to derive the relations between each of the keywords by collecting this relational data and subjecting it to network analysis. Accordingly, this study proposes a method of analyzing how brands are positioned by consumers and what relationships exist between product attributes and an individual brand, using simultaneous search traffic information. It also presents case studies demonstrating the actual application of this method, with a focus on tablets, belonging to innovative product groups.

Analysis of attachment, proliferation and differentiation response of human mesenchymal stem cell to various implant surfaces coated with rhBMP-2 (다양한 rhBMP-2 코팅 임플란트 표면에서의 인간 간엽 줄기세포의 부착, 증식, 분화반응 분석)

  • Lee, In-Ku;Han, In-Ho;Hwang, Sun-Wook;Ryu, Jae-Jun
    • The Journal of Korean Academy of Prosthodontics
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    • v.50 no.1
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    • pp.44-52
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    • 2012
  • Purpose: In this paper we tried to evaluate the most appropriate surface for rhBMP-2 coating among 4 rough titanium surfaces. Materials and methods: We used machined surface as a control group and anodized, RBM and SLA surfaces as test groups. We coated rhBMP-2 on the 4 surfaces and with uncoated surfaces for each case, we cultured human mesenchymal stem cells on all 8 surfaces. 24 hours after we measured the stem cell' attachment with SEM, and on 3rd, 7th, and 14th days, we checked the cell proliferation and differentiation by using MTT and ALP activity assay. And on the 7th day after the culture, we performed RT-PCR assay to determine whether the expression levels of Type I collagen, osteocalcin, osteopontin were changed. Results: We observed with SEM that 4 rhBMP-2 coated surfaces exhibited wider and tighter cell attachment and more cell process spreading than uncoated surfaces. The anodized rhBMP-2 surface caused robustest effects. In MTT assay we could not find any meaningful difference. In ALP assay there was a significant increase (P<.05) in the ALP activity of anodized rhBMP-2 coated surface compared with that of the control (3rd and 14th days) and with that of the RBM rhBMP-2 coated surface (14th day). In RT-PCR assay there was increased expressions in the anodized rhBMP-2 coated surface for osteocalcin, and osteopontin. Conclusion: We found that the anodized rhBMP-2 coated surface were most prominent stem cell attachment and differentiation in compared to control and Machined rhBMP-2 coated, RBM rhBMP-2 coated surface.

The Optimal Pulse Oxygen Saturation in Very Low Birth Weight or Very Preterm Infants (극소 저체중 출생아에서 경피적 산소포화도의 적정 범위)

  • You, Sun-Young;Kang, Hye-Jin;Kim, Min-Jung;Chang, Mea-Young
    • Neonatal Medicine
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    • v.18 no.2
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    • pp.320-327
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    • 2011
  • Purpose: To determine the effect of changing practice guidelines designed to avoid hyperoxia or hypoxia in very low birth weight or very preterm infants. Methods: We analyzed a database of <1,500 g birth weight or <32 weeks of gestation infants who were born and admitted to the neonatal intensive care unit of Chungnam National University Hospital from January 2007 to July 2010. First, we defined the relationship between arterial partial pressure of oxygen ($PaO_2$) and pulse oxygen saturation ($SpO_2$). When we evaluated 96 pairs of $PaO_2$ and $SpO_2$ measurements, oxygen saturation was 90-94% at a $PaO_2$ of 43-79 mmHg on the oxyhemoglobin dissociation curve, according to pulse oximetry. Based on this observation, a change in practice was instituted in August 2008 with the objective of avoiding hypoxia and hyperoxia in preterm infants with targeting a $SpO_2$ 90-94% (period II). Before the change in practice, high alarms for $SpO_2$ were set at 100% and low alarms at 95% (period I). Results: Sixty-eight infants the met enrollment criteria and 38 (56%) were born during period II, after the change in $SpO_2$ targets. Demographic characteristics, except gender, were similar between the infants born in both periods. After correcting for the effect of confounding factors, the rates for mortality, severe retinopathy of prematurity, and IVH attended to be lower than those for infants in period II. No difference in the rate of patent ductus arteriosus needed to treat was observed. Conclusion: A change in the practice guidelines aimed at avoiding low oxygen saturation and hyperoxia did not increase neonatal complication rates and showed promising results, suggesting decreased mortality and improvements in short term morbidity. It is still unclear what range of oxygen saturation is appropriate for very preterm infants but the more careful saturation targeting guideline should be considered to prevent hypoxemic events and hyperoxia.

Risk Factor Analysis for $SaO_2$ Instability after Systemic-pulmonary Shunt (전신-폐 단락술 후 산소포화도의 불안정성의 위험인자 분석)

  • Jung Sung-Ho;Yun Sok-Won;Park Jung-Jun;Seo Dong-Man;Kim Young-Hwue;Ko Jae-Kon;Park In-Sook;Yun Tae-Jin
    • Journal of Chest Surgery
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    • v.38 no.4 s.249
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    • pp.277-283
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    • 2005
  • Arterial oxygen saturation $(SaO_2)$ instability frequently takes place after systemic-pulmonary shunt without shunt occlusion. We analyzed actual incidence and risk factors for $SaO_2$ instability after shunt operations, and possible mechanisms were speculated on. Material and Method: Ninety three patients, who underwent modified Blalock-Taussig shunt from January 1996 to December 2000, were enrolled in this study. Adequacy of shunt was verified in all patients, either by ensuing one ventricle or biventricular repair later on or by appropriate pulmonary artery growth on postoperative angiogram. Age, body weight, hemoglobin level at operation were 3 day to 36 years (median: 1.8 months), 2.5kg to 51kg (median: 4.1kg) and $10.7\~24.3$ gm/dL (median: 15.2 gm/dL) respectively. Preoperative diagnoses were functional single ventricle with pulmonary stenosis or atresia in 39, tetralogy of Fallot in 38 and pulmonary atresia with intact ventricular septum in 16. Pulmonary blood flow (PBF) was maintained pre-operatively by patent ductus or previous shunt in 64 and by forward flow through stenotic right ventricular outflow tract (RVOT) in 29. $SaO_2$ instability was defined as $SaO_2$ less than $50\%$ for more than 1 hour with neither anatomic obstruction of shunt nor respiratory problem. Result: 10 patients $(10.7\%)$ showed $SaO_2$ instability after shunt operation. After shunt occlusion was ruled out by echocardiogram, they received measures to lower pulmonary vascular resistance (PVR), which worked within a few hours in all patients. Risk factors for $SaO_2$ instability included older age at operation (p=0.039), lower preoperative $SaO_2$ (p=0.0001) and emergency operation (p=0.001). PBF through stenotic RVOT showed marginal statistical significance (p=0.065). Conclusion: $SaO_2$ instability occurs frequently after shunt operation, especially in patients with severe hypoxia pre-operatively or unstable clinical condition necessitating emergency operation. Temporary elevation of pulmonary vascular resistance is a possible mechanism in this specific clinical setting.