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Long-term Outcome of Fontan-Associated Protein-Losing Enteropathy: Treatment Modality and Predictive Factor of Mortality

  • Ja-Kyoung Yoon;Gi Beom Kim;Mi Kyoung Song;Sang Yun Lee;Seong Ho Kim;So Ick Jang;Woong Han Kim;Chang-Ha Lee;Kyung Jin Ahn;Eun Jung Bae
    • Korean Circulation Journal
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    • v.52 no.8
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    • pp.606-620
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    • 2022
  • Background and Objectives: Protein-losing enteropathy (PLE) is a devastating complication after the Fontan operation. This study aimed to investigate the clinical characteristics, treatment response, and outcomes of Fontan-associated PLE. Methods: We reviewed the medical records of 38 patients with Fontan-associated PLE from 1992 to 2018 in 2 institutions in Korea. Results: PLE occurred in 4.6% of the total 832 patients after the Fontan operation. After a mean period of 7.7 years after Fontan operation, PLE was diagnosed at a mean age of 11.6 years. The mean follow-up period was 8.9 years. The survival rates were 81.6% at 5 years and 76.5% at 10 years. In the multivariate analysis, New York Heart Association Functional classification III or IV (p=0.002), low aortic oxygen saturation (<90%) (p=0.003), and ventricular dysfunction (p=0.032) at the time of PLE diagnosis were found as predictors of mortality. PLE was resolved in 10 of the 38 patients after treatment. Among medical managements, an initial heparin response was associated with survival (p=0.043). Heparin treatment resulted in resolution in 4 patients. We found no evidence on pulmonary vasodilator therapy alone. PLE was also resolved after surgical Fontan fenestration (2/6), aortopulmonary collateral ligation (1/1), and transplantation (1/1). Conclusions: The survival rate of patients with Fontan-associated PLE has improved with the advancement of conservative care. Although there is no definitive method, some treatments led to the resolution of PLE in one-fourth of the patients. Further investigations are needed to develop the best prevention and therapeutic strategies for PLE.

Comparison of Effects of Normothermic and Hypothermic Cardiopulmonary Bypass on Cerebral Metabolism During Cardiac Surgery (체외순환 시 뇌 대사에 대한 정상 체온 체외순환과 저 체온 체외순환의 임상적 영향에 관한 비교연구)

  • 조광현;박경택;김경현;최석철;최국렬;황윤호
    • Journal of Chest Surgery
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    • v.35 no.6
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    • pp.420-429
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    • 2002
  • Moderate hypothermic cardiopulmonary bypass (CPB) has commonly been used in cardiac surgery. Several cardiac centers recently practice normothermic CPB in cardiac surgery, However, the clinical effect and safety of normothermic CPB on cerebral metabolism are not established and not fully understood. This study was prospectively designed to evaluate the clinical influence of normothermic CPB on brain metabolism and to compare it with that of moderate hypothermic CPB. Material and Method: Thirty-six adult patients scheduled for elective cardiac surgery were randomized to receive normothermic (nasopharyngeal temperature >34.5 $^{\circ}C$, n=18) or hypothermic (nasopharyngeal temperature 29~3$0^{\circ}C$, n=18) CPB with nonpulsatile pump. Middle cerebral artery blood flow velocity (VMCA), cerebral arteriovenous oxygen content difference (CAVO$_{2}$), cerebral oxygen extraction (COE), modified cerebral metabolic rate for oxygen (MCMRO$_{2}$), cerebral oxygen transport (TEO$_{2}$), cerebral venous desaturation (oxygen saturation in internal jugular bulb blood$\leq$50 %), and arterial and internal jugular bulb blood gas analysis were measured during six phases of the operation: Pre-CPB (control), CPB-10 min, Rewarm-1 (nasopharyngeal temperature 34 $^{\circ}C$ in the hypothermic group), Rewarm-2 (nasopharyngeal temperature 37 $^{\circ}C$ in the both groups), CPB-off and Post-CPB (skin closure after CPB-off). Postoperaitve neuropsychologic complications were observed in all patients. All variables were compared between the two groups. Result: VMCA at Rewarm-2 was higher in the hypothermic group (153.11$\pm$8.98%) than in the normothermic group (131.18$\pm$6.94%) (p<0.05). CAVO$_{2}$ (3.47$\pm$0.21 vs 4.28$\pm$0.29 mL/dL, p<0.05), COE (0.30$\pm$0.02 vs 0.39$\pm$0.02, p<0.05) and MCMRO$_{2}$ (4.71 $\pm$0.42 vs 5.36$\pm$0.45, p<0.05) at CPB-10 min were lower in the hypothermic group than in the normothermic group. The hypothermic group had higher TEO$_{2}$ than the normothermic group at CPB-10 (1,527.60$\pm$25.84 vs 1,368.74$\pm$20.03, p<0.05), Rewarm-2 (1,757.50$\pm$32.30 vs 1,478.60$\pm$27.41, p<0.05) and Post-CPB (1,734.37$\pm$41.45 vs 1,597.68$\pm$27.50, p<0.05). Internal jugular bulb oxygen tension (40.96$\pm$1.16 vs 34.79$\pm$2.18 mmHg, p<0.05), saturation (72.63$\pm$2.68 vs 64.76$\pm$2.49 %, p<0.05) and content (8.08$\pm$0.34 vs 6.78$\pm$0.43 mL/dL, p<0.05) at CPB-10 were higher in the hypothermic group than in the normothermic group. The hypothermic group had less incidence of postoperative neurologic complication (delirium) than the normothermic group (2 vs 4 patients, p<0.05). Lasting periods of postoperative delirium were shorter in the hypothermic group than in the normothermic group (60 vs 160 hrs, p<0.01). Conclusion: These results indicate that normothermic CPB should not be routinely applied in all cardiac surgery, especially advanced age or the clinical situations that require prolonged operative time. Moderate hypothermic CPB may have beneficial influences relatively on brain metabolism and postoperative neuropsychologic outcomes when compared with normothermic CPB.

Yield Responses to NPK Fertilizers in Different Corn Cultivars and Soils (토양비옥도(土壤肥沃度)와 품종(品種)에 따른 옥수수의 삼요소(三要素) 시비반응(施肥反應))

  • Shin, Cheol-Woo;Kim, Jeong-Je;Yoon, Jung-Hui;Cho, Byoung-Ok
    • Korean Journal of Soil Science and Fertilizer
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    • v.16 no.3
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    • pp.242-249
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    • 1983
  • The experiments were carried out in farmers' field to determine the yield response of corn to fertilizers for the three years (1976-1979) The results are summarized as follow: 1. The optimum application rates of N-P-K fertilizers on corn cultivars was 21.1-11.6-10.6 kg/10a for Suweon 19, 23.0-11.9-15.0 kg/10a for Boggyo 2 and 19.8-10.6-9.1 kg/10a for Hwangok 3, and 23.3-19.1-10.7 kg/10a in drained paddy soil. 2. The optimum application rates of N-P-K fertilizers was 23.4-15.5-13.2 kg/10a in fertile soil comparing with 27.0-15.6-18.8 kg/10a in the soil of low fertility. However yield was lower in soil of low fertility than in fertile soil even under the condition applied optimum amount. 3. Production efficiencies of each kg of N, P, K application for Suweon 19, Boggyo 2, and Hwangok 3 were 26.1-24.5-9.7, 17.8-13.3-2.0, and 14.6-21.5-4.2kg. respectively. 4. The optimum nutrient content in soil and plant to yield 1,000 kg/10a of corn was available phosphorus 200 ppm, exchangeable potassium 0.63 me/100g, potassium saturation rate 5.0% in soil, and nitrogen 2.86%, phosphorus 0.73%, potassium 2.80% in plant at tasseling stage.

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Taxonomical Classification of Bugog Series (부곡통의 분류)

  • Song, Kwan-Cheol;Hyun, Byung-Geun;Sonn, Yeon-Kyu;Hong, Suk-Young;Kim, Yi-Hyun;Choe, Eun-Young
    • Korean Journal of Soil Science and Fertilizer
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    • v.42 no.6
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    • pp.472-477
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    • 2009
  • This study was conducted to reclassify Bugog series based on the second edition of Soil Taxonomy : A Basic System of Soil Classification for Making and Interpreting Soil Surveys. Morphological properties of typifying pedon of Bugog series were investigated and physico-chemical properties were analyzed according to Soil Survey Laboratory Methods Manual. The typifying pedon of Bugog series has strong brown (7.5YR 4/6) loam Ap horizon (0~22 cm), brown (7.5YR 4/4) clay loam BAt horizon (22~41 cm), strong brown (7.5YR 4/6) silty clay loam Bt1 horizon (41~59 cm), strong brown (7.5YR 4/6) silty clay loam Bt2 horizon (59~78 cm), brown (7.5YR 4/4) silty clay loam Btx1 horizon(78~90 cm), and brown (7.5YR 4/4) Btx2 horizon(90~160 cm). That occurs on swale foot slope in area of mainly granite gneiss, granite, and schist rock materials. The typifying pedon has an argillic horizon from a depth of 22 to more than 160 cm and a base saturation (sum of cations) of less than 35% at 75 cm below the upper boundary of the fragipan. That can be classified as Ultisol, not as Alfisol. The pedon has udic soil moisture regime, and can be classified as Udult. That has a fragipan with an upper boundary within 100 cm of the mineral soil surface, and keys out as Fragiudult. Also that meets the requirements of Typic Fragiudult. That has 18% to 35% clay at the particle-size control section, and has mesic soil temperature regime. Bugog series can be classified as fine silty, mixed, mesic family of Typic Fragiudults, not as fine loamy, mixed, mesic family of Typic Fragiudalfs.

Growth of Fe3O4 Particles and Their Magnetic Properties (Fe3O4 분말제조와 자기적 특성)

  • Kwon, Woo-Hyun;Lee, Seung-Wha;Chae, Kwang-Pyo;Lee, Jae-Gwang;Sur, Jung-Chul
    • Journal of the Korean Magnetics Society
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    • v.19 no.5
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    • pp.180-185
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    • 2009
  • Fe$_3$O$_4$ particles, prepared by a sol-gel method, were examined for their structural characteristic, particle shapes and sizes, and their magnetic properties. Two different chemical compositions (using a mol rate Fe$^{2+}$/Fe$^{3+}$ = 1/2 and only Fe$^{2+}$) and 2-methoxyethanol were used for making proper solutions. And the solutions were refluxed and dry in a dry oven and the samples were fired at 200$\sim$600$^{\circ}C$ in the N$_2$ atmosphere. The formation of single-phased spinel ferrite powders was identified with the X-ray diffraction measurement as they were fired at above 250$^{\circ}C$. The result of scanning electron microscopy measurement showed the increase of annealing temperature yielded the particle size increased. The magnetic transition was observed using the Mossbaur spectroscopy measurement. As the ferrite, prepared with the chemical composition (Fe$^{2+}$/Fe$^{3+}$ = 1/2), was fired at 250$^{\circ}C$, 78% of the ferrite had a ferrimagnetic property and 22% of the ferrite was non-magnetic. In case of preparing the sample with only Fe$^{2+}$ and annealed at 200$^{\circ}C$, it had a single phased spinel structure but its particle size was too small to be ferrimagnetic. The annealing temperature above 250$^{\circ}C$ made powders a spinel structure regardless of the preparation method. They had a typical soft magnetic property and their saturation magnetization and coercivity became larger as the annealing temperature increased.

Investigation of the Emotional Characteristics of White for Designing White Based Products (백색 제품 디자인을 위한 감성적 특성 연구)

  • Na, Noo-Ree;Suk, Hyeon-Jeong;Lee, Jae-In
    • Science of Emotion and Sensibility
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    • v.15 no.2
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    • pp.297-306
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    • 2012
  • In this study we investigated emotional characteristics of various whites which have slightly different nuances to suggest guidelines that help designers to select appropriate colors when designing white based products. The study involved three different procedures. In experiment 1, we selected 20 emotional words through a survey (N=30) among 60 words, which we picked from literature review that was thought to be appropriate to evaluate product colors. In experiment 2, we evaluated the emotional characteristics of 13 basic colors from the I.R.I Hue & Tone 120 system (N=30) using previously selected emotional words, to find relative emotional positions of white in comparison to other colors. Based on the ratings, factor analysis was conducted and consequently four factors were extracted: flamboyant, elegant, clear, and soft. Accordingly, the emotional characteristics of the 13 colors were profiled and compared with those of white. Finally, in experiment 3, we conducted an evaluation of emotional characteristics on 25 whites with different nuances facilitating the four factors obtained in experiment 2. The color stimuli used in experiments were measured in terms of CIE 1976 $L^*a^*b^*$, and regression analysis was performed in order to predict the emotional characteristics through the L, a, and b values of a color, as long as that is perceived as a white. Throughout three empirical studies, we observed three overruling tendencies : First, there are four important factors when evaluating product color - flamboyant, elegance, clearness and softness; second, white is dominantly the most elegant in comparison to other colors; third, the emotional factors of the study were affected by some combinations of attributes of colors rather than by all three-hue, saturation and brightness. In addition, the equations derived from the regression analysis in experiment 3, it is expected that designers may predict the emotional distinction between nuances of white.

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Genesis and Characteristics of the Soil Clay Minerals Derived from Major Parent Rocks in Korea II. Physical and Chemical Properties of the Whole Soils (한국(韓國)의 주요(主要) 모암(母岩)에서 발달(發達)된 토양점토광물(土壤粘土鑛物)의 특성(特性)과 생성학적(生成學的) 연구(硏究) II. 토양(土壤)의 이화학적(理化學的) 특성(特性))

  • Um, Myung-Ho;Kim, Tai-Soon
    • Korean Journal of Soil Science and Fertilizer
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    • v.24 no.2
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    • pp.79-85
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    • 1991
  • This study reports on the physical and chemical properties of the whole soils (<2mm) derived from five major rocks of granite, granite-gneiss, limestone, shale, and basalt in Korea. The properties were considered from the kind and frequency distribution of rock-forming minerals in the parent rocks. In particle size distribution, sand fractions were high in the soils from granite-gneiss, silt fractions mainly, in the residual soils from limestone, shale, and basalt. And clay fractions were particularly high in the colluvial soil from limestone and the old alluvial soil from basalt. pH, extractable Ca and Mg, and cation exchange capacity of the soils derived from limestone might be considered to be high due to the presence of sand and/or silt-sized calcite and dolomite inherited from the parent rocks. However, the soils derived from granite and granite-gneiss, being abundant in feldspars, quartz, and micas, showed a tendency to the contrary. A soil from shale composing of high quartz tended to have pH. extractable Ca, base saturation, and low exchangeable Al. In total element analysis, the soils derived from parent rocks with high contents of (i) orthoclase and micas, (ii) biotite, primary chlorite, and augite, and (iii) carbonate minerals and plagioclase as a rock-forming mineral showed a tendency to decrease the contents of $K_2O$, $Fe_2O_3$ and MgO, and CaO in comparison with those of their parent rocks.

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A Study on the Structure Characteristics of Planting Ground in Incheon International Airport, Korea (인천국제공항 식재기반 구조 및 토양특성 연구)

  • Lee, Seung-Won;Han, Bong-Ho;Lee, Kyong-Jae;Kwak, Jeong-In;Yeum, Jung-Hun
    • Journal of the Korean Institute of Landscape Architecture
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    • v.43 no.3
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    • pp.77-91
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    • 2015
  • This study aims to suggest adequate soil management through the analysis of physicochemical properties of soil in the planting grounds of Incheon International Airport, which was constructed on a massive land reclamation site. Study areas were 5 sites at the international business complex, the passenger terminal, the airport support complex, the free trade zone, and the access road. Soil profile analysis showed that 9 plots out of the 27 plots were hardpan and heterospere within 80cm from the soil surface. The earth laid on the ground was categorized as gravel based soil(4 plots), dredged soil from the sea bottom and mixed reclamation materials(2 plots), clay with poor permeability(3 plots) and waste construction material(1 plot). Average soil hardness was $11.5kg/cm^2$ and soil textures were sandy soil, sandy loam and loamy sand. Average soil pH was 6.7 and average organic matter content was 0.7%. Electrical conductivity was 0.0dS/m and exchangeable cation concentrations were $Ca^{2+}$ 3.4cmol/kg, $Mg^{2+}$ 1.5cmol/kg, $K^+$ 0.3cmol/kg and $Na^+$ 1.0cmol/kg. Average cation exchange capacity was 11.0cmol/kg. Although average figures in Solum mostly meet the landscape design criteria, properties of each soil layer showed various values sometimes over the limit. Base saturations were $Ca^{2+}$ 29.9%, $Mg^{2+}$ 13.3% and $K^+$ 3.7% for lower soil, $Ca^{2+}$ 33.3%, $Mg^{2+}$ 17.0% and $K^+$ 2.7% for mid-soil and $Ca^{2+}$ 32.6%, $Mg^{2+}$ 12.2% and $K^+$ 1.9% for upper soil. Exchangeable sodium percentages were 16.4% for lower soil, 7.5% for mid-soil and 4.7% upper soil. Sodium adsorption rates were 0.8 for lower soil, 0.3 for mid-soil and 0.2 for upper soil. Factors affecting to the vegetation growth were heterogeneity and poorness of solum, disturbance of dredged soils, high soil hardness including hardpan in the subsurface soil layer and shallow effective soil depth, high soil acidity, imbalance of base contents, low organic matter content and low available phosphate levels in the soil.

Bioavailability of Aspartic Acid Chelated Iron on Iron-deficient Rats (아스파르트산 킬레이트 철분의 철분 결핍쥐에서의 생물학적 유용성)

  • Park, Myoung-Gyu;Ha, Tae-Yul;Shin, Kwang-Soon
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.40 no.12
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    • pp.1720-1725
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    • 2011
  • Aspartic acid chelated iron (Asp-Fe) was synthesized by a new method using calcium carbonate, aspartic acid, and ferrous sulfate. This study was carried out to investigate the bioavailability of Asp-Fe in iron-deficient rats. We divided the rats into four experimental groups. The first was the normal diet control group, or NC. The second was the no treated control group of iron-deficient (ID) rats, or ID+C. The third was the heme-iron (heme-Fe) treated group of ID rats, ID+heme-Fe. And the fourth was the Asp-Fe treated group of ID rats, or ID+Asp-Fe. There were no differences among any of the experimental groups in diet consumption, change of body weight, or the weight of the livers, kidneys, or spleens. After 7 days of feeding, the iron content in the sera of the ID+Asp-Fe group (175.2 ${\mu}g$/dL) and the ID+heme-Fe group (140.8 ${\mu}g$/dL) were significantly higher than that of the ID-C group (96.1 ${\mu}g$/dL). The total iron binding capacity (TIBC) of the ID+Asp-Fe group (735.4 ${\mu}g$/dL) was significantly normalized compared to the ID+C group (841.9 ${\mu}g$/dL) or ID+heme-Fe group (824.6 ${\mu}g$/dL). The hematocrit level of the ID+Asp-Fe group was increased to normal levels, but there was no statistical difference among ID groups. The absorption ratio of heme-Fe was 21.3% and that of Asp-Fe was 50.2%, which indicates a 2.3 times higher ratio in comparison with heme iron. With the above results we found that Asp-Fe seems to be an efficient form of iron to supply iron deficient rats in order to cure them of anemia. Thus, these findings suggest that aspartic acid chelated iron has the potential to serve as a functional food related to iron metabolism.

Appropriate Drainage Position in Coir Bag Culture Using U-type Bed (U자형 베드에서 코이어 자루재배 시 적정 배액구 위치 구명)

  • Lee, Mun Haeng;Lee, Hee Keyung;Kim, Sung Eun;Lee, Hwan Gu;Lee, Sun Gye;Park, Guen Se;Chae, Young;Kim, Young Shik
    • Journal of Bio-Environment Control
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    • v.22 no.4
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    • pp.408-412
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    • 2013
  • This study was carried out to investigate damp injury caused by tomato coir bag culture and prevent that. The tomato variety was used 'Minichal', and tomatoes were grown in greenhouse. The nutrient solution based on Yamazaki Tomato Standard Solution was irrigated from one hour after sunrise to two hour before sunset. The slits for darainage were made in three types; I, L, and bottom slit type. The coir bag of I and L type had six slits of 15cm length, that of bottom slit type had three slits of 15 cm length. The weight of coir bag in 24 hours after saturation was 14.2 kg in I type, 13.8 kg in L type, and 12.8 kg in bottom slit type, but there was not significant difference. The weight of coir bag after one day irrigation was 14.5 kg, 14.2 kg, and 13.3 kg at L, I, and bottm slit type, respectively. This means that the moisture content of coir bag during cultivation was lowest in bottom slit type. The number of adventitious root on stem was 160, 170, and 53 at I, L, and bottom slit type, respectively. The dry weight of root and root length were highest at bottom slit type, compared to other treatment. The marketable yield was highest 26.5 kg/20 plant in bottom slit type. For increasing yield and preventing damp injury, bottom slit type was most effective at U type bed coir bag culture.