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Posterior Cruciate Ligament Reconstruction by Tibial Inlay Technique (Tibial Inlay 방법을 이용한 후방 십자 인대 재건술의 결과)

  • Song Eun Kyoo;Yoon Taek Rim;Jung Jong Wook;Kim Jong Seon
    • Journal of the Korean Arthroscopy Society
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    • v.5 no.2
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    • pp.80-84
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    • 2001
  • Purpose : To evaluate the clinical and radiological results of posterior cruciate ligament reconstruction(PCL) by tibial inlay technique. Materials and Methods : Twenty four patients(25 cases), who underwent reconstruction of posterior cruciate ligament by tibial inlay technique and were followed up for at least 2 years, were reviewed retrospectively. Mean age at operation was 35 years and mean period of follow up was 34 months. Clinically Lysholm knee socre, posterior drawer test and step off sign were evaluated. Instrumented posterior laxity test with $Telos^{\circledR}$ device(Telos stress device; Austin & Associates, Inc., Polston, US) was performed. Results : Lysholm knee score was improved from 56.9 points preoperatively to 94.6 points at fellow up. Posterior drawer test showed grade II instability in 1 case, grade III in 18 and Grade IV in 6 preoperatively and improved to grade I In 12, grade II in 10 and grade III in 3 at follow up. Step off signs were changed from -10mm in 6 cases, -5mm in 18 and flush in 1 preoperatively to -5mm in 3, flush in 10 and +5mm in 12 at follow up. Side to side difference of instrumented posterior laxity test was improved front 13.6mm preoperatively to 4.3mm at follow up. Conclusions : PCL reconstruction by tibial inlay technique is considered to be a good treatment method to restore posterior stability of the knee, which could result in satisfactory clinical and radiological results at more than 2 years' follow up.

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On the manufacturing of WPC (Wood Plastic Composites) with Heat-Catalyst Polymerization (I) - On the characteristics of composites made from monomer Methyl MethacryIate and several commercial woods in Korea (가열(加熱)·촉매중합법(觸媒重合法)에 의한 목재(木材)·고분자복합체(高分子複合體) 제조(製造)(I) - MMA에 의한 한국산(韓國産) 주요목재(主要木材)의 복합체특성(複合體特性))

  • Cho, Nam-Seok;Jo, Jae-Myeong;Ahn, Won-Yong
    • Journal of the Korean Wood Science and Technology
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    • v.2 no.3
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    • pp.3-16
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    • 1974
  • One of the disadvantages of. wood and wood products is their hydroscopicity or dimensional instability. This is responsible for the loss of green volume of lumber as seasoning degrade. Dimensional stabilization is needed to substantially reduce seasoning defects and degrades and for increasing the serviceability of wood products. Recently, considerable world-wide attention has been drawn to the so-called Wood-Plastic Composites by irradiation-and heat-catalyst-polymerization methods and many research and developmental works have been reported. Wood-Plastic Composites are the new products having the superior mechanical and physical properties and the combinated characteristics of wood and plastic. The purpose of this experiment was to obtain the basic data for the improvement of wooden materials by manufacturing WPC. The species examined were Mulpurae-Namoo (Fraxinus, rhynchophylla), Sea-Namoo (Carpinus laxiflora), Cheungcheung-Namoo (Cornus controversa), Gorosae-Namoo (Acermono), Karae-Namoo(Juglans mandshurica) and Sanbud-Namoo (Prunus sargentii), used as blocks of type A ($3{\times}3{\times}40cm$) and type B ($5{\times}5{\times}60cm$), and were conditioned to about 10~11% moisture content before impregnation in materials humidity control room. Methyl methacrylate (MMA) as monomer and benzoyl peroxide (BPO) as initiator are used. The monomer containing BPO was impregnated into wood pieces in the vacuum system. After impregnation, the treated samples were polymerized with heat-catalyst methods. The immersed weights of monomer in woods are directly proportionated to the impregnation times. Monomer impregnation properties of Cheungcheung-Namoo, Mulpurae-Namoo and Seo-Namoo are relatively good, but in Karae-Namoo, it is very difficult to impregnate the monomer MMA. Fig. 3 shows the linear relation between polymer retentions in wood and polymerization times; that is, the polymer loadings are increasing with polymerization times. Furthermore species, moisture content, specific gravity and anatomical or conductible structure of wood, bulking solvents and monomers etc have effects on both of impregnation of monomer and polymer retention. Physical properties of treated materials are shown in table 3. Increasing rates of specific gravity are ranged 3 to 24% and volume swelling 3 to 10%. ASE is 20 to 46%, AE 14 to 50% and RWA 18 to 40%. Especially, the ASE in relation to absorption of liquid water increases approximately with increase of polymer content, although the bulking effect of the polymerization of monomer may also be influential. WPCs from Mulpurae-Namoo and Cheungcheung-Namoo have high dimensional stability, while its of Karae-Namoo and Seo-Namoo are-very low. Table 4 shows the mechanical properties of WPCs from 6 species. With its specific gravity and polymer loading increase, all mechanical properties are on the increase. Increasing rate of bending strength is 10 to 40%, compression strength 25 to 70%, ;impact bending absorbed energy 4 to 74% and tensile strength 18 to 56%. Mulpurae-Namoo and Cheungcheung-Namoo with high polymer content have considerable high increasing rate of strengths. But incase of Karae-Namoo with inferior monomer impregnation it is very low. Polymer retention in cell wall is 0.32 to 0.70%. Most of the polymer is accumulated in cell lumen. Effective. of polymer retention is 58.59% for Mulpurae-Namoo, 26.27% for Seo-Namoo, 47.98% for Cheungcheung-Namoo, 25.64% for Korosae-Namoo, 9.96% for Karae-Namoo and 25.84% for Sanbud-Namoo.

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Oxide perovskite crystals type ABCO4:application and growth

  • Pajaczkowska, A.
    • Proceedings of the Korea Association of Crystal Growth Conference
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    • 1996.06a
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    • pp.258-292
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    • 1996
  • In the last year great interest appears to YBCO thin films preparation on different substrate materials. Preparation of epitaxial film is a very difficult problem. There are many requirements to substrate materials that must be fullfilled. Main problems are lattice mismatch (misfit) and similarity of structure. From paper [1] or follows that difference in interatomic distances and angles of substrate and film is mire important problem than similarity of structure. In this work we present interatomic distances and angle relations between substrate materials belonging to ABCO4 group (where A-Sr or Ca, B-rare earth element, C-Al or Ga) of different orientations and YBCO thin films. There are many materials used as substrates for HTsC thin films. ABCO4 group of compounds is characterized by small dielectric constants (it is necessary for microwave applications of HTsC films), absence of twins and small misfit [2]. There most interesting compounds CaNdAlO4, SrLaAlO4 and SrLaGaO4 were investigated. All these compounds are of pseudo-perovskite structure with space group 14/mmm. This structure is very similar to structure of YBCO. SLG substrate has the lowest misfit (0.3%) and dielectric constant. For preparation of then films of substrates of this group of compound plane of <100> orientation are mainly used. Good quality films of <001> orientations are obtained [3]. In this case not only a-a misfit play role, but c-3b misfit is very important too. Sometimes, for preparation of thin films substrates of <001> and <110> orientations were manufactured [3]. Different misfits for different YBCO faces have been analyzed. It has been found that the mismatching factor for (100) face is very similar to that for (001) face so there is possibility of preparation of thin films on both orientations. SrLaAlO4(SLA) and SrLaGaO4(SLG) crystals of general formula ABCO4 have been grown by the Czochralski method. The quality of SLA and SLG crystals strongly depends on axial gradient of temperature and growth and rotation rates. High quality crystals were obtained at axial gradient of temperature near crystal-melt interface lower than 50℃/cm, growth rate 1-3 mm/h and the rotation rate changing from 10-20pm[4]. Strong anisotropy in morphology of SLA and SLG single crystals grown by the Czochralski method is clearly visible. On the basics of our considerations for ABCO4 type of the tetragonal crystals there can appear {001}, {101}, and {110} faces for ionic type model [5]. Morphology of these crystals depend on ionic-covalent character of bonding and crystal growth parameters. Point defects are observed in crystals and they are reflected in color changes (colorless, yellow, green). Point defects are detected in directions perpendicular to oxide planes and are connected with instability of oxygen position in lattice. To investigate facets formations crystals were doped with Cr3+, Er3+, Pr3+, Ba2+. Chromium greater size ion which is substituted for Al3+ clearly induces faceting. There appear easy {110} faces and SLA crystals crack even then the amount of Cr is below 0.3at.% SLG single crystals are not so sensitive to the content of chromium ions. It was also found that if {110} face appears at the beginning of growth process the crystal changes its color on the plane {110} but it happens only on the shoulder part. The projection of {110} face has a great amount of oxygen positions which can be easy defected. Pure and doped SLA and SLG crystals measured by EPR in the<110> direction show more intensive lines than in other directions which allows to suggest that the amount of oxygen defects on the {110} plane is higher. In order to find the origin of colors and their relation with the crystal stability, a set of SLA and SLG crystals were investigated using optical spectroscopy. The colored samples exhibit an absorption band stretching from the UV absorption edge of the crystal, from about 240 nm to about 550 m. In the case of colorless sample, the absorption spectrum consists of a relatively weak band in the UV region. The spectral position and intensities of absorption bands of SLA are typical for imperfection similar to color centers which may be created in most of oxide crystals by UV and X-radiation. It is pointed out that crystal growth process of polycomponent oxide crystals by Czochralski method depends on the preparation of melt and its stoichiometry, orientation of seed, gradient of temperature at crystal-melt interface, parameters of growth (rotation and pulling rate) and control of red-ox atmosphere during seeding and growth (rotation and pulling rate) and control of red-ox atmosphere during seeding and growth. Growth parameters have an influence on the morphology of crystal-melt interface, type and concentration of defects.

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Dehydration of Foamed Fish (Sardine)-Starch Paste by Microwave Heating 1. Formulation and Processing Conditions (어육(정어러) 발포건조제품가공에 관한 연구 1. 원료$\cdot$첨가물의 배합 및 가공조건)

  • LEE Kang-Ho;LEE Byeong-Ho;You Byeong-Jin;SONG Dong-Suck;SUH Jae-Soo;JEA YOi-Guan;RYU Hong-Soo
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.15 no.4
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    • pp.283-290
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    • 1982
  • Sardine and mackerel so called dark muscled fish have been underutilized due to the disadvantages in bloody meat color, high content of fat, and postmortem instability of protein. Recent efforts were made to overcome these defects and develope new types of product such as texturized protein concentrates and dark muscle eliminated minced fish. Approach of this study is based on the rapid dehydration of foamed fish-starch paste by dielectric heating. In process comminuted sardine meat was washed more than three times by soaking and decanting in chilled water and finally centrifuged. The meat was ground in a stone mortar added Ivith adequate amounts of salt, foaming agent, and other ingredients for aid to elasticity and foam stability. The ground meat paste was extruded in finger shape and heated in a microwave oven to give foamed, expanded, and porous solid structure by dehydration. Dielectric onstant $(\varepsilon')$ and dielect.ic loss $(\varepsilon")$ values of sardine meat paste were influenced by wavelength and moisture level. Those values at 100 KHz and 15 MHz were ranged 2.25-9.86; 2.22-4,18 for E' and 0.24-19.24; 0.16-1.20 for E", respectively, at the moisture levels of $4.2-13.8\%$. For a formula for fish-starch paste preparation, addition of $20-30\%$ starch (potato starch) to the weight of fish meat, $2-4\%$ salt, and $5-10\%$ soybean protein was adequate to yield 4-5 folds of expansion in volume when heated. Addition of e99 yolk was of benefit to micronize foam size and better crispness. In order to provide better foaming and dehydration, addition of $0.2-0.5\%$sodium bicarbonate, foaming agent, was proper to result in foam size of 0.5-0.7 mm and foam density of $200-400\;/cm^2$ which gave a good crispness. Heating time was depended upon the moisture level of fish-starch paste. For a finger shaped paste (1.0cm. $D\times10cm.L$) heating for 150-200 sec. in a microwave oven (700W. 2.45GHz) was sufficient to generate foams, expand, and solidify the porous structure of fish-starch paste. When the moisture content was above $55\%$ browning and scorching was deepened due to over-expansion and over-heating whereas the crispness was hardened by insufficient expansion at lower moisture content. In quality evaluation of the product, chemical composition of $30\%$ starch and $3\%$ salt added product was moisture $8.8\%$, lipid $2.4\%$, carbohydrate $46.7\%$, protein $36.1\%$, and ash $6.0\%$. Eleven membered panel test evaluated that fish-starch paste was acceptable in color, crisp-ness, taste, except a trace of fishy odour which could be masked by the addition of spice extracts.

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Relationship of Hemodynamic Changes during Off-Pump Coronary Bypass Grafting and Their Effects on Postoperative Outcome (심폐바이패스 없이 시행하는 관상동맥 우회수술 중의 혈역학적 변수들의 변화양상 및 수술 후 결과에 미치는 영향)

  • 허재학;장지민;김욱성;장우익;이윤석;정철현
    • Journal of Chest Surgery
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    • v.36 no.8
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    • pp.576-582
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    • 2003
  • During the Off-Pump Coronary Arterial Bypass surgery (OPCAB), the manipulation of the heart can depress cardiac contractility and cause hemodynamic instability. In this study, hemodynamic parameters were measured during operation and the laboratory and clinical data were investigated to evaluate their effects on postoperative outcome. Material and Method: From March 2001 to August 2002, 50 consecutive patients who underwent OPCAB were included in this study. During the same period, total number of CABG was 71 The blood pressure, pulmonary artery pressure, mixed venous oxygen saturation, and cardiac index were measured before manipulation, after application of stabilizer, and at the end of anastomosis. Postoperatively, we measured the cardiac enzymes such as CK-MB, troponin 1 and checked the amount of inotropes required, chest tube drainage, the amount of transfusion, duration of ventilator support, and duration of ICU stay. Result: The number of mean distal anastomoses was 2.8$\pm$0.9 per patient. On elevation and stabilization of the heart, systolic blood pressure was depressed and pulmonary artery pressure was elevated significantly, but during each anastomosis no significant changes were detected. The peak level of cardiac markers was 29.2$\pm$46.7 for CK-MB, 0.69$\pm$0.86 for troponin 1 on postoperative day f. Among the intraoperative hemodynamic parameters, the ischemic change of EKG and bolus injection of inotropes significantly affected the posteroperative cardiac enzymes. But, no difference other than the level of cardiac enzymes between the two groups with or without the ischemic change of EKG and bolus injection of inotropes was noticed. Conclusion: The significant hemodynamic changes occurred when the heart was elevated and stabilized, however during anastomoses there were no significant changes. Serum cardiac enzymes rose significantly in the group that showed the ischemic charge of EKG or needed the bolus injection of inotropes for maintaining hemodynamic stability intraoperatively, but it did not affect the postoperative outcome. In conclusion, the ischemic change of EKG and the need for bolus injection of intropes during operation may be very indicative for probable ischemia.

Determinants of Demand for Long-Term Care (장기요양서비스 수요의 결정요인)

  • Chung, Wankyo
    • KDI Journal of Economic Policy
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    • v.31 no.1
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    • pp.139-167
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    • 2009
  • A new public insurance for long-term care was introduced in July 2008 to provide for the rising demand for long-term care as the population is aging rapidly. The demand for long-term care is expected to rise further because more and more elderly are living alone or in households with only other elderly, such as his/her spouse, without informal care of their adult children. Even when the elderly are living together with their adult children, daughters and daughters in law, once the main informal care-givers, are not available because they choose to become economically active and work more over time. Experiences of countries such as Japan and Germany with similar public long-term care insurance scheme highlight the importance of detailed analysis on the demand for long-term care for the financial stability of the insurance scheme. Countries which had underestimated the demand for long-term care at the time of adopting the scheme went through financial instability of insurance schemes. This study analyzes the determinants of the demand for long-term care using data from the second demonstration project (April 2006~April 2007) of the long-term care insurance scheme for the elderly in Korea. Taking full advantage of detailed data on the long-term care, this paper analyzes the eligibility for the long-term care insurance scheme and its use. According to study results, even when common diseases among the elderly such as cancer, diabetes, arthritis, dementia, hypertension, etc. are controlled together with other individual and socioeconomic factors, limitations the elderly are faced with in their twelve activities of daily living significantly affect the eligibility for the Korean Long-term Care Insurance Scheme. This means that limitations in daily living activities are more critical than common diseases among the elderly are to the eligibility for the Korean Long-term Care Insurance Scheme. Bathing and toileting problems have been found to be the most important factor affecting the eligibility for the insurance scheme, followed by eating, dressing and moving around inside the house. Moreover, the choices of whether to use long-term care and which to use between home care and institutional care are found to be significantly influenced by health status and various socioeconomic factors of the elderly. In particular, those with more limitations in daily living activities and the female elderly are more likely to use long-term care and institutional care rather than home care. As for home care users, those living alone or with adult children and those with monthly household income of more than 500,000 won are more likely to use home care. Most importantly, even when the monthly household income of the elderly is controlled, the elderly recipients of the National Basic Living Security, who are not charged for long-term care, are more likely to choose home care. This implies that price as well as income is a critical factor for the decision to use long-term care. Further study on the duration of long-term care use will surely enhance the long-term care policy, when panel data is available for simultaneous analysis of the likelihood of long-term care use and its use duration.

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Sorption and Thermal Characteristics of $AsO_4,\;SeO_3,\;CrO_4$ on Schwertmannite (슈베르트마나이트의 $AsO_4,\;SeO_3,\;CrO_4$ 흡착 및 열적 특성)

  • Keum, Gyo-Jin;Jung, Eun-Ha;Kim, Yeong-Kyoo
    • Journal of the Mineralogical Society of Korea
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    • v.23 no.2
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    • pp.117-124
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    • 2010
  • The sorption of $AsO_4,\;SeO_3,\;CrO_4$ on schwertmannite and thermal analysis of sorbed samples were carried out. The results of sorption experiments showed that sorption characteristics of those three oxyanions on schwertmannite can be divided into two groups. The extent of sorption of $AsO_4$ and $SeO_3$ were 100% at up to 1 mM solution concentration, and they increased no more significantly. This can be interpreted as $AsO_4$ and $SeO_3$ substituting $SO_4$ in schwertmannite strucure by the ratio of 1 : 1. The extent of the sorption of $CrO_4$ was much lower than those of other two oxyanions. Thermal analysis was performed using two kinds of sorbed samples at 0.1 and 1.25 mM concentrations. The results of the thermal analysis showed that the samples sorbed by three different oxyanions have different thermal characteristics. The samples sorbed by $AsO_4$ showed smaller weight loss around $600^{\circ}C$ than the original loss of pure schwertmannite, and it is attributed to the substitution of $AsO_4$ for $SO_4$, which was caused by the loss of $SO_4$, than pure schwertmannite due to the substitution of $SO_4$ by $AsO_4$. It also showed additional weight loss around $600^{\circ}C$ due to the decomposition of $AsO_4$ at that temperature. The weight loss of samples sorbed by $SeO_3$ started at slightly lower temperature than that sorbed by $SO_4$ and kept that loss at wider temperature range, probably indicating that the decomposition of $SeO_3$ occurs at slightly lower temperature. However, for the samples sorbed by $CrO_4$, the weight loss caused by the decomposition of $SO_4$ was also smaller and there was no additional weight loss at higher temperature due to the thermal stability of $CrO_4$, indicating that $SO_4$ was also substituted by $CrO_4$ in schwertmannite. Sorption experiment and thermal analysis indicate that $CrO_4$ sorbs on schwertmannite by substiuting $SO_4$, but the affinity to $SO_4$ or instability of $CrO_4$ in scwertmannite structure probably prohibit perfect 1 : 1 substitution.

Production of Pyruvate Dehydrogenase Complex-E2 Specific Human Monoclonal Antibody in Fed-batch Culture Systems with High Cell Density Recombinant Escherichia coli (고농도 재조합 대장균의 Fed-batch 배양 시스템을 이용한 Pyruvate Dehydrogenase Complex-E2 특이성 인간 모노클론 항체의 생산)

  • 이미숙;전주미;차상훈;정연호
    • KSBB Journal
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    • v.15 no.5
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    • pp.489-496
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    • 2000
  • Several culture systems including batch, two-stage CSTR, semi-fed batch, and two-stage cyclic fed-batch were investigated for the efficient production of the Fab fraction of PDC-E2 specific human monoclonal antibody using high cell density recombinant E. coli. A two-phase batch system and a two-stage continuous system were examined to overcome plasmid instability problems, by separating the growth and the production stages. The cell density and productivity of the two-stage continuous culture was better than that of the two-phase batch fermentation. In the two-stage continuous culture system with DO-stat, the cell growth and the productivity were superior to those of the system without the DO control. Also, almost total plasmid stability was maintained in the two-stage continuous culture system. Modified M9 medium was selected as an optimum feeding medium for the fed-batch process, and the optimum C/N ratio determined to be 2:3. The optimum feeding rate was $0.6g/\ell/hr$ for a constant feeding strategy in semi-fed batch system. When the feeding medium was fed by pulsing, it was observed that more frequent pulsing resulted in improved cell growth. The linear feeding method was the most efficient of the various feeding methods tested. Finally, high cell density culture using a two-stage cyclic fed batch system with pH-stat was tried because the linear feeding method showed limitations in terms of obtaining high cell densities, and a cell density of $54 g/\ell$ was achieved. It was concluded that the two-stage cyclic fed batch system was the most efficient system for high cell density culture of the systems tested. However, productivity improvements were lower than expected due to the extremely high accumulations of acetate, although the low levels of residual glucose were maintained.

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A Evaluation of Direct Payment on Agricultural Income effect using Farm Manager Registration Information (농업경영체 등록정보를 활용한 농업직불제 소득효과 분석)

  • Han, Suk-Ho;Chae, Gwang-Seok
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.17 no.5
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    • pp.195-202
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    • 2016
  • The government has run and managed various forms of direct payment systems, such as the paddy and field direct payment, to ease the instability of farm incomes with respect to market opening, and preserve farm income. Direct payments to the agricultural sector is a center in the key policy instrument that plays an important role in income stabilization. Despite the large amount of spending in the farm unit, the status of direct payment, and policy effects the analysis of direct payments, such as stability of income contribution, are insufficient. This paper, using the farm unit DB in 2014 and 2015, performed farm level analysis of direct payment, and derived the implications of the performance evaluation system. As a result, the distribution of direct payment showed considerable bias to the left side compared to the normal distribution curve. Approximately half of the farms (49.3%) in 2014 DB should receive below 100,000 won per year by a direct payment. A larger-scale farm showed a significantly increased income effect and income stabilizing effect because direct payments make higher contributions to farm income in proportional to the area. In the more elderly farmers, a high contribution by direct payment to farm income was found to be an advantage; however, in small-scale farms of less than 0.5ha, direct payment contribution on farm household income was only 3%. In large-scale farms, 10ha or more, the contribution to farm income were found to be 29.4%. The income of large farms was 10 times larger than small farmers, and the direct payment entitlements that were received were 110 times larger. Through this policy, direct payments are required for future improvements and modifications.

An Influence of Modified Robicsek Sternal Wiring after Median Sternotomy on the Postoperative Sternal Wound Infection (정중 흉골 절개 후 시행한 변형 Robicsek 흉골 봉합법이 수술 후 흉골감염에 미치는 영향)

  • Chang, Won-Ho;Youm, Wook;Kim, Dong-Hyun;Oh, Hong-Chul;Han, Jung-Wook;Kim, Hyun-Jo
    • Journal of Chest Surgery
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    • v.42 no.6
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    • pp.763-769
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    • 2009
  • Background: In the majority of cases, sternal instability and wound infection concomitantly present after a cardiac operation following conventional median sternotomy, and these complications have a major influence on the postoperative course. The aim of this study is to compare the results of the different sternal wiring techniques of sternal infection. Material and Method: Between April 2004 and December 2008, 157 adult patients underwent cardiac in group A, whereas 71 patients who had undergone modified Robicsek sternal wiring were included in group B. The incidences of sternal wound complications in the two groups were assessed. Result: The mean age of the group B patients was older than that of the group A patients ($61{\pm}10$ years vs $57{\pm}13$ years). The incidence of preoperative left ventricular dysfunction (ejection fraction <30%), chronic obstructive pulmonary disease, renal failure requiring dialysis and diabetes mellitus were significantly higher in Group B, whereas the other perioperative risk factors for infection were not significantly different between the two groups. Two patients in group A experienced superficial wound infection, whereas 4 patients in group B displayed superficial wound infection, but the difference was not statistically significant (p=0.255). Yet poststernotomy deep sternal wound infection appeared in 6 patients of group A, whereas none of the patients in group B displayed this malady. Conclusion: The modified Robicsek sternal wiring technique showed greater sternal stability even for the patient with a high risk for infection, and the technique caused a lower incidence of deep sternal wound infection.