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Effect of the Induced Molting with Low-Protein and Energy Diet on the Postmolt Performance and Egg Quality of Layers (저단백질, 저에너지 사료를 이용한 유도환우가 산란계의 생산성 및 난질에 미치는 영향)

  • Hong, Eui-Chul;Park, Hee-Du;Na, Seung-Hwan;Kim, Hak-Kyu;Yu, Dong-Jo;Park, Mi-Na;Jung, Kie-Chul;Choo, Hyo-Jun;Seo, Ok-Suk;Choi, Yang-Ho;HwangBo, Jong
    • Korean Journal of Poultry Science
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    • v.37 no.2
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    • pp.117-123
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    • 2010
  • This work was carried out to investigate the effect of the induced molting with low-protein and energy diet on the postmolt performance of layers. Eighty White Leghorn layers (61-old-wk) with over 80% egg production were used for 12 weeks in this work. Treatments were non-molt control (CO), fasting treatment for 10 days (FW), molt treatment with low-protein and low-energy molting diet for 3 weeks (LO), and molt treatment with standard molting diet for 3 weeks (ST) as 4 treatments (2 replications/treatment and 10 birds/replication). Body weight (BW) loss was 26.5% of initial BW at 2 week in FW treatment, and was 17.3% and 14.2% in both LO and ST treatments (P<0.05). Layers in molting treatments were fed with commercial layer diet after completion of molting since BW of layers was recovered for 7 weeks. Heart weight ratio was shown as 0.47, 0.43, 0.46 and 0.46% at CO, FW, LO and ST treatments, respectively, and liver weight ration of body weight was shown as 2.56, 1.30, 1.47 and 1.52%, respectively. Thus, those of molting treatments decreased compared to non-molt control (P<0.05). Oviduct weight ratio were shown as 3.95, 1.17, 1.54 and 1.67%, respectively, and similar with the results of liver (P<0.05). Feed intake decreased at LO and ST treatments during molting period and increased from the 5th week compared to control. Egg production decreased at 1 week in molt treatment and stopped at 2 week in FW, 3 week in LO, and 4 week in ST treatments. The birds started to lay egg at 4 week in FW and at 5 week in LO and ST treatments. Egg production was recovered until 50% at 6 week in FW and was recovered as 66.1 and 71.6% at 8 week in LO and ST treatment, respectively. Egg weights were similar among all treatments. Eggshell thicknesses were 0.41, 0.47, 0.46 and 0.46 mm at CO, FW, LO and ST treatment, respectively, but the higher in molt treatments than control (P<0.05). Eggshell breaking strength was 3.83 and 3.81 kg/$cm^2$ in FW and LO treatment, respectively, and high compared to control. However, eggshell breaking strengths were 3.54 and 3.78 kg/$cm^2$ and were not statistically different. Haugh units were 75.6, 81.1, 80.6 and 79.9 in 4 treatments and high in molt treatment. Finally, dietary low-protein and low-energy may induce molt as few effect on performance of layers.

Effect of Cryoprotectants on the Physico-chemical Characteristics of Chicken Breast Surimi Manufactured by pH Adjustment during Freezing Storage (냉동변성 방지제가 pH 조절법으로 제조한 닭가슴살 수리미의 냉동저장 중 이화학적 특성에 미치는 영향)

  • Jin, Sang-Keun;Kim, Il-Suk;Kim, Su-Jung;Jeong, Ki-Jong;Lee, Jae-Ryong;Choi, Yeung-Joon
    • Food Science of Animal Resources
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    • v.27 no.3
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    • pp.267-276
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    • 2007
  • This study was conducted to determine the effect of cryoprotectants (sugar, sorbitol, polyphosphate) on the physico-chemical characteristics of chicken breast surimi manufactured by pH adjustment (pH 11.0) during freezing storage. The final surimi was divided into experimental units to which the following treatments were randomly assigned: C (Alaska pollack surimi: two washings, 4% sugar +5% sorbitol ${\pounds}'$ 0.3% polyphosphate additive): T1 (chicken breast surimi: pH 11.0 adjusted, 0.3% polyphosphate additive): T2 (chicken breast surimi pH 11.0 adjusted, 5% sorbitol +0.3% polyphosphate additive); T3 (chicken breast surimi: pH 11.0 adjusted, 4% sugar +5% sorbitol +0.3% polyphosphate additive). The crude protein content of the control was higher than all treated samples, however the moisture, crude fat and crude ash of T3 were higher than the control (p<0.05). The pH, WHC and collagen content of the control were higher than all of the treated samples, and these values decreased with storage time for all treatments and the control (p<0.05). The cholesterol content of the control was lower than all treated samples, but the myofibrillar protein contents of all treated samples were higher than the control (p<0.05). The cooking loss of T2 was lower than the control and the other two treatments (p<0.05). The $L^*,\;a^*\;and\;b^*$ values of all treated samples were higher than those of the control during freezing storage (p<0.05). The W value of T3 at 1.5 and 3 months of freezing storage was higher than the control and T1 (p<0.05). The myoglobin and met-Mb contents of the control were similar to all treated samples, and the met-Mb content of the control and all treated samples increased with storage time (p<0.05). Immediately after freezing, the hardness of the control was higher than all treated samples, however it was lower after 1.5 and 3 months of frozen storage (p<0.05). The cohesiveness and gumminess of the control were higher than all treated samples immediately after freezing, however the values for T3 were higher than those of the control and the other two treatments during frozen storage for 1.5 and 3 months (p<0.05).

The Relationship Between DEA Model-based Eco-Efficiency and Economic Performance (DEA 모형 기반의 에코효율성과 경제적 성과의 연관성)

  • Kim, Myoung-Jong
    • Journal of Environmental Policy
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    • v.13 no.4
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    • pp.3-49
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    • 2014
  • Growing interest of stakeholders on corporate responsibilities for environment and tightening environmental regulations are highlighting the importance of environmental management more than ever. However, companies' awareness of the importance of environment is still falling behind, and related academic works have not shown consistent conclusions on the relationship between environmental performance and economic performance. One of the reasons is different ways of measuring these two performances. The evaluation scope of economic performance is relatively narrow and the performance can be measured by a unified unit such as price, while the scope of environmental performance is diverse and a wide range of units are used for measuring environmental performances instead of using a single unified unit. Therefore, the results of works can be different depending on the performance indicators selected. In order to resolve this problem, generalized and standardized performance indicators should be developed. In particular, the performance indicators should be able to cover the concepts of both environmental and economic performances because the recent idea of environmental management has expanded to encompass the concept of sustainability. Another reason is that most of the current researches tend to focus on the motive of environmental investments and environmental performance, and do not offer a guideline for an effective implementation strategy for environmental management. For example, a process improvement strategy or a market discrimination strategy can be deployed through comparing the environment competitiveness among the companies in the same or similar industries, so that a virtuous cyclical relationship between environmental and economic performances can be secured. A novel method for measuring eco-efficiency by utilizing Data Envelopment Analysis (DEA), which is able to combine multiple environmental and economic performances, is proposed in this report. Based on the eco-efficiencies, the environmental competitiveness is analyzed and the optimal combination of inputs and outputs are recommended for improving the eco-efficiencies of inefficient firms. Furthermore, the panel analysis is applied to the causal relationship between eco-efficiency and economic performance, and the pooled regression model is used to investigate the relationship between eco-efficiency and economic performance. The four-year eco-efficiencies between 2010 and 2013 of 23 companies are obtained from the DEA analysis; a comparison of efficiencies among 23 companies is carried out in terms of technical efficiency(TE), pure technical efficiency(PTE) and scale efficiency(SE), and then a set of recommendations for optimal combination of inputs and outputs are suggested for the inefficient companies. Furthermore, the experimental results with the panel analysis have demonstrated the causality from eco-efficiency to economic performance. The results of the pooled regression have shown that eco-efficiency positively affect financial perform ances(ROA and ROS) of the companies, as well as firm values(Tobin Q, stock price, and stock returns). This report proposes a novel approach for generating standardized performance indicators obtained from multiple environmental and economic performances, so that it is able to enhance the generality of relevant researches and provide a deep insight into the sustainability of environmental management. Furthermore, using efficiency indicators obtained from the DEA model, the cause of change in eco-efficiency can be investigated and an effective strategy for environmental management can be suggested. Finally, this report can be a motive for environmental management by providing empirical evidence that environmental investments can improve economic performance.

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Changes of Housing in the FCS Curricular from the 1st to 2009 Revised of Secondary School (중등학교 가정과 교육과정의 주생활 영역 내용 변화 - 1차 교육과정부터 2009 개정 교육과정을 대상으로 -)

  • Heo, YoungSun;Kim, NamEun;Choi, MinJi;Baek, MinKyung;Gwak, SeonJeong;Cho, JaeSoon
    • Journal of Korean Home Economics Education Association
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    • v.25 no.1
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    • pp.95-118
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    • 2013
  • The purpose of this study was to analyze the contents of housing related to characters, objectives, and contents of FCS curricular from the 1st to 2009 revised curriculum of secondary school. The data were downloaded from the NCIC homepage(http://www.ncic.re.kr/2012. 04. 08) from the 1st(1955. 08) to 2009 revised curriculum(2012. 03) of secondary school. After examining the characters and objectives of each curriculum, contents of housing was analyzed by units and context elements of middle and high school separately. The titles of the subject, the objectives, the instructions, the leaning spheres, weekly hours, grade and gender of candidates, the emphasis of the instruction, etc. have been changed through the curriculum revision. The 6th curriculum was the main period to open to both genders, the $7^{th}$ was the period to combine with technology, the 2007 version was to change the structure of contents of home economics, and the 2009 version switched technology home economics from mandatory to optional in high school. The character of the courses was presented at the 1st curriculum, but it was left out from the $2^{nd}$ to $5^{th}$ curriculum. From the $6^{th}$ curriculum, the characters were separately given to middle and high school. The character of housing area started to appear only in high school home economics from the $7^{th}$ curriculum. The course objectives were described in all curriculum of both middle and high school. This applies to housing area as well. The course objectives have been modified in order to reflect value changes due to social issues. During each curriculum, contents of housing continued to change in context, course load, and candidates. Reflection of housing trends and social needs were the main causes of the change. 2009 version emphasizes on eco-life and sense of community.

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Effect of Dietary Inclusion of Various Sources of Green Tea on Immune System and Challenging Test of Juvenile Olive Flounder Paralichthys olivaceus (사료내 녹차 첨가가 넙치 유어기의 면역성 및 세균 공격성에 미치는 영향)

  • Cho Sung-Hwoan;Lee Sang-Mok;Park Byum-Hee;Ji Sung-Choon;Kwon Mun-Gyeong;Kim Yi-Cheong;Lee Jong-Ha;Park Sagn-Eun;Han Hyoung-Kyun
    • Journal of Aquaculture
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    • v.19 no.2
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    • pp.84-89
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    • 2006
  • Effect of dietary inclusion of various sources of green tea on growth, immune system and challenging test of juvenile olive flounder Paralichthys olivaceus was investigated. Five experimental diets with triplicates were prepared: control, raw leaves, dry leaves, by-product and extract. Twenty five (an initial body weight of 52.5 g) were randomly distributed into 15 of 180 L flow-through tanks. Nutrient requirements of the experimental diets satisfied growth of juvenile olive flounder. The feeding trial lasted for 7 weeks. After 7-week feeding trial, blood were sampled from three randomly chosen fish for serum analysis of Iysozyme and bactericidal activity, and ten fish were infected with Edwardsiella tarda for challenging test from each tank. Weight gain (g/fish) of fish fed the diet containing extract and control diet was significantly higher than that of fish fed the other diets. Feed efficiency ratio for fish fed the diet containing extract and control diet was significantly higher than that for fish fed the diets containing raw leaves and by-product, but not significantly different from that for fish fed the diet containing dry leaves. Serum Iysozyme activity (units/ml) of fish fed the diets containing dry leaves and extract was significantly higher than that of fish fed the diets containing raw leaves and by-product, but not significantly different from that of fish fed the control diet. Serum bactericidal activity (${\times}10^6$ bacteria/ml) of fish fed the diet containing dry leaves and extract was significantly lower than that of fish fed the diets containing raw leaves, by-product and control diet in 3 hour. However, serum bactericidal activity of fish fed the diet containing extract was significantly lower than that of fish fed the other diets in 6 hour. And serum bacterial activity was low in fish fed the diets containing dry and raw leaves, by-product, and control in 6 hour in order. Accumulative mortality (%) of fish fed the control diet was low compared to that of fish fed the diets containing raw leaves and by-product, but high compared to that of fish fed the diets containing dry leaves and extract although no significant difference was found among treatments. In considering above results, dietary inclusion of extract and dry leaves of green tea seemed to be highly effective to improve immune system and endurance against E. tarda infection of juvenile olive flounder.

The Actual State and the Utilization for Dental Radiography in Korea (국내 치과방사선의 현황 및 이용 실태)

  • Shin, Gwi-Soon;Kim, You-Hyun;Lee, Bo-Ram;Kim, Se-Young;Lee, Gui-Won;Park, Chang-Seo;Park, Hyok;Chang, Kye-Yong
    • Journal of radiological science and technology
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    • v.33 no.2
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    • pp.109-120
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    • 2010
  • The purpose of this study was first to analyze the utilization of dental examination through questionnaire to develop a diagnostic reference level of patient doses for dental radiography in korea. 77 dental institutions were classified into three groups: A group for the dental hospitals of the college of dentistry (11 institutions), B group for dental hospitals (30 institutions) and C group for dental clinics (36 institutions). The results were as follows : The mean numbers of unit chairs and medical staffs were 140.2, 15.3 and 5.8 sets, 112.6, 7.3 and 1.7 dentists, 3.1, 0.5 and no one radiologic technologists, and 19.7, 12.5 and 3.3 dental hygienists in A, B and C groups, respectively. The mean numbers of dental X-ray equipments were 14.64, 3.21 and 2.19 in A, B and C groups, respectively. Intraoral dental X-ray unit was used the most, the following equipments were panoramic, cephalometric, and cone-beam CT units. The most used X-ray imaging system was also digital system (above 50%) in all three groups. Insight dental film (Kodak, USA) having high sensitivity was routinely used for periapical radiography. The automatic processor was not used in many dental institutions, but the film-holding device was used in many dental institutions. The utilization rates of PACS in A, B and C groups were 90.9%, 83.3% and 16.7% respectively, and the PACS software program was used the most PiView STAR (Infinitt, Korea). The annual mean number of radiographic cases in one dental institution in 2008 for A group was 6.8 times and 21.2 times more than those for B and C groups, and periapical and panoramic radiographs were taken mostly. Tube voltage (kVp) and tube current (mA) for periapical radiography were similar in all three groups, but exposure time in C group was 12.0 times and 3.5 times longer than those in B and C groups. The amount of radiation exposure in C group, in which dental hygienists take dental radiographs, was more than those in other groups. The exposure parameters for panoramic radiography were similar in all three groups. In conclusion, the exposure parameters in dental radiography should be determined with reference level, not past experiences. Use of automatic processor and film-holding devices reduces the radiation exposure in film system. The quality assurance of dental equipments are necessary for the reduction of the patient dose and the improvement of X-ray image quality.

Comparison of Virtual Wedge versus Physical Wedge Affecting on Dose Distribution of Treated Breast and Adjacent Normal Tissue for Tangential Breast Irradiation (유방암의 방사선치료에서 Virtual Wedge와 Physical Wedge사용에 따른 유방선량 및 주변조직선량의 차이)

  • Kim Yeon-Sil;Kim Sung-Whan;Yoon Sel-Chul;Lee Jung-Seok;Son Seok-Hyun;Choi Ihl-Bong
    • Radiation Oncology Journal
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    • v.22 no.3
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    • pp.225-233
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    • 2004
  • Purpose: The Ideal breast irradiation method should provide an optimal dose distribution In the treated breast volume and a minimum scatter dose to the nearby normal tissue. Physical wedges have been used to Improve the dose distribution In the treated breast, but unfortunately Introduce an Increased scatter dose outside the treatment yield, pavllculariy to the contralateral breast. The typical physical wedge (FW) was compared with 4he virtual wedge (VW) to do)ermine the difference In the dose distribution affecting on the treated breast and the contralateral breast, lung, heart and surrounding perlpheral soft tissue. Methods and Materials: The data collected consisted of a measurement taken with solid water, a Humanoid Alderson Rando phantom and patients. The radiation doses at the ipsllateral breast and skin, contralateral breast and skin, surrounding peripheral soft tissue, and Ipsllateral lung and heart were compared using the physical wedge and virtual wedge and the radiation dose distribution and DVH of the treated breast were compared. The beam-on time of each treatment technique was also compared Furthermore, the doses at treated breast skin, contralateral breast skin and skin 1.5 cm away from 4he field margin were also measured using TLD in 7 patients of tangential breast Irradiation and compared the results with phantom measurements. Results: The virtual wedge showed a decreased peripheral dose than those of a typical physical wedge at 15$^{\circ}$, 30$^{\circ}$, 45$^{\circ}$, and 60$^{\circ}$. According to the TLD measurements with 15$^{\circ}$ and 30$^{\circ}$ virtual wedge, the Irradiation dose decreased by 1.35$\%$ and 2.55$\%$ In the contralateral breast and by 0.87$\%$ and 1.9$\%$ In the skin of the contralateral breast respectively. Furthermore, the Irradiation dose decreased by 2.7$\%$ and 6.0$\%$ in the Ipsllateral lung and by 0.96$\%$ and 2.5$\%$ in the heart. The VW fields had lower peripheral doses than those of the PW fields by 1.8$\%$ and 2.33$\%$. However the skin dose Increased by 2.4$\%$ and 4.58$\%$ In the Ipsliateral breast. VW fields, In general, use less monitor units than PW fields and shoriened beam-on time about half of PW. The DVH analysis showed that each delivery technique results In comparable dose distribution in treated breast. Conclusion: A modest dose reduction to the surrounding normal tissue and uniform target homogeneity were observed using the VW technique compare to the PW beam in tangential breast Irradiation The VW field is dosmetrically superlor to the PW beam and can be an efficient method for minimizing acute, late radiation morbidity and reduce 4he linear accelerator loading bV decreasing the radiation delivery time.

Determination of the Optimum Sampling Area for the Benthic Community Study of the Songdo Tidal Flat and Youngil Bay Subtidal Sediment (송도 갯벌과 영일만 조하대 저서동물의 군집조사를 위한 적정 채집면적의 결정)

  • Koh, Chul-Hwan;Kang, Seong-Gil;Lee, Chang-Bok
    • The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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    • v.4 no.1
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    • pp.63-70
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    • 1999
  • The optimum sampling area which can be applied to the benthic community study is estimated from large survey data in the Songdo tidal flat and subtidal zone of Youngil Bay, Korea. A total of 250 samples by 0.02 $m^2$ box corer for the benthic fauna in Songdo tidal flat and 50 samples by 0.1 $m^2$ van Veen grab in Youngil Bay were taken from the total sampling area of 5 $m^2$. It was assumed that the sampling area could contain sufficient information on sediment fauna, if cumulative number of species, ecological indices, and similarity index by cluster analysis reflect the similarity level of 75% to those found at total sampling area (5 $m^2$). A total of 56 and 60 species occurred from Songdo tidal flat and Youngil Bay, respectively. The cumulative curve of the species number ($N_{sp}$) as a function of the sampling area (A in $m^2$ ) was fitted as $N_{sp}=37.379A^{0.257}$ ($r^2=0.99$) for intertidal fauna and $N_{sp}=40.895A^{0.257}$ ($r^2=0.98$) for subtidal fauna. Based on these curves and 75% of similarity to the total sampling area (5 $m^2$), the optimum sampling area was proposed as 1.6 $m^2$ for the intertidal and 1.5 $m^2$ for the subtidal fauna. Ecological indices (species diversity, richness, evenness and dominance indices) were again calculated on the basis of species composition in differently simulated sample sizes. Changes in ecological indices with these sample sizes indicated that samplings could be done by collecting fauna from < 0.5 $m^2$-1.5 $m^2$ on the Songdo tidal flat and from < 0.5 $m^2$-1.2 $m^2$ in Youngil Bay. Changes in similarity level of all units of each simulated sample size showed that sampling area of 0.3 $m^2$ (Songdo tidal flat) and 0.6 $m^2$ (Youngil Bay) should be taken to obtain a similarity level of 75%. In conclusion, sampling area which was determined by cumulative number of species, ecological indices and similarity index by cluster analysis could be determined as 1.5 $m^2$ (0.02 $m^2$ box corer, n=75) for Songdo tidal flat and 1.2 $m^2$ (0.1 $m^2$ van Veen grab, n=12) for Youngil Bay. If these sampling areas could be covered in the field survey, population densities of seven dominant species comprising 68% of the total faunal abundance occurring on Songdo tidal flat and six species comprising 90% in Youngil Bay can be estimated at the precision level of P=0.2.

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Removal of ${\alpha}$-Gal Epitopes in Aortic Valve and Pericardium of Pig Using Green Coffee Bean ${\alpha}$-Galactosidase (돼지의 대동맥 판막 및 심낭에서 녹색콩 알파-갈락토시다아제를 이용한 알파-갈 항원결정인자 제거)

  • Park, Seong-Sik;Kim, Woong-Han;Kim, Kyung-Hwan;Lee, Chang-Ha;Choi, Sun-Young;Lee, Cheul;Oh, Sam-Sae;Kim, Kwan-Chang;Kim, Yong-Jin
    • Journal of Chest Surgery
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    • v.41 no.1
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    • pp.12-24
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    • 2008
  • Background: It is currently thought that tissue valve degeneration is related to an animal's immune response, which is mainly due to cell surface ${\alpha}$-Gal epitopes. Cell surface ${\alpha}$-Gal epitopes are known to be degraded by the enzyme called green coffee bean ${\alpha}$-Galactosidase. It is also well known that ${\alpha}$-Gal epitopes are immunologically stained by Griffonia Simplicifolia isolectin type B4. We know that many commercially available tissue valves are made of aortic valves and pericardial tissue of pig. So, we investigated whether ${\alpha}$-Gal epitopes of the aortic valve and pericardial tissue of a pig can be removed by green coffee bean ${\alpha}$-Galactosidase, and we did so by comparing immunologic staining of the tissues before and after the enzyme treatment. Material and method: After treating fresh porcine aortic valve and pericardial tissue with green coffee bean ${\alpha}$-Galactosidase at concentrations of 0.5 unit/mL, 1.0 unit/mL, 2.0 unit/mL, respectively, under the condition of pH 6.5, temperature. $4^{\circ}C$ and 24 hours of incubation, each sample was stained with Griffonia Simplicifolia isolectin type B4 immunpfluorescent labeling. We then examined whether the ${\alpha}$-Gal epitopes were reduced or abolished in each consecutive. concentration of green coffee bean ${\alpha}$-Galactosidase by comparing the degree of the Griffonia Simplicifolia isolectin B4 staining in each sample. Result: In the pig aortic valve tissue, a 1.0 unit/mL concentration of green coffee bean ${\alpha}$-Galactosidase at pH 6.5, $4^{\circ}C$ and reaction for 24 hours was enough for complete removal of ${\alpha}$-Gal epitopes from the cell sur face on the immunostaining with Griffonia Simplicifolia isolectin B4. On the other hand, more ${\alpha}$-Gal epitopes were present in the pig pericardial tissue on Griffonia Simplicifolia isolectin B4 staining before the enzyme treatment, and 1.0 unit/mL of galactosidase was not sufficient for complete removal of ${\alpha}$-Gal from the tissue. 2.0 units/mL of green coffee bean ${\alpha}$-Galactosidase was needed to completely remove the ${\alpha}$-Gal epitopes from the pericardial tissue on immunostaining. Conclusion: The ${\alpha}$-Gal epitopes of the pig's aortic valve and pericardial tissue were successfully stained with Griffonia Simplicifolia isolectin B4. We could remove nearly all the ${\alpha}$-Gal epitopes using green coffee bean ${\alpha}$-Galactosidase at the concentration of 1.0 unit/mL in the aortic valve. Of pig, and 2.0 unit/mL was need to nearly completely remove all the ${\alpha}$-Gal epitopes in the pericardial tissue of pig under the condition of pH 6.5, $4^{\circ}C$ and 24 hours of reaction time. In the near future, removal of ${\alpha}$-Gal epitapes in the pig's aortic valve and pericardial tissue will become a powerful tool for the improvement of the tissue valve durability. It needs to be determined if ${\alpha}$-galactosidase treated pig tissue is immune to human anti-Gal antibody or anit-Gal mooclonal antibodies.

Study for Diagnostic Efficacy of Minibronchoalveolar Lavage in the Detection of Etiologic Agents of Ventilator-associated Pneumonia in Patients Receiving Antibiotics (항생제를 사용하고 있었던 인공호흡기 연관 폐렴환자에서의 원인균 발견을 위한 소량 기관지폐포세척술의 진단적 효용성에 관한 연구)

  • Moon, Doo-Seop;Lim, Chae-Man;Pai, Chik-Hyun;Kim, Mi-Na;Chin, Jae-Yong;Shim, Tae-Sun;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Koh, Youn-Suck
    • Tuberculosis and Respiratory Diseases
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    • v.47 no.3
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    • pp.321-330
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    • 1999
  • Background : Early diagnosis and proper antibiotic treatment are very important in the management of ventilator-associated pneumonia (VAP) because of its high mortality. Bronchoscopy with a protected specimen brush (PSB) has been considered the standard method to isolate the causative organisms of VAP. However, this method burdens consumer economically to purchase a PSB. Another useful method for the diagnosis of VAP is quantitative cultures of aspirated specimens through bronchoscopic bronchoalveolar lavage (BAL), for which the infusion of more than 120 m1 of saline has been recommended for adequate sampling of a pulmonary segment. However, occasionally it leads to deterioration of the patient's condition. We studied the diagnostic efficacy of minibronchoalveolar lavage (miniBAL), which retrieves only 25 ml of BAL fluid, in the isolation of causative organisms of VAP. Methods: We included 38 consecutive patients (41 cases) suspected of having VAP on the basis of clinical evidence, who had received antibiotics before the bronchoscopy. The two diagnostic techniques of PSB and miniBAL, which were performed one after another at the same pulmonary segment, 'were compared prospectively. The cut-off values for quantitative cultures to define causative bacteria of VAP were more than $10^3$ colony-forming units (cfu)/ml for PSB and more than $10^4$ cfu/ml for BAL. Results: The amount of instilled normal saline required to retrieve 25 ml of BAL fluid was $93{\pm}32 ml$ (mean${\pm}$SD). The detection rate of causative agents was 46.3% (19/41) with PSB and 43.9% (18/41) with miniBAL. The concordance rate of PSB and miniBAL in the bacterial culture was 85.4% (35/41). Although arterial blood oxygen saturation dropped significantly (p<0.05) during ($92{\pm}10%$) and 10 min after ($95{\pm}3%$) miniBAL compared with the baseline ($97{\pm}3%$), all except 3 cases were within normal ranges. The significantly elevated heart rate during ($l25{\pm}24$/min, p<0.05) miniBAL compared with the baseline ($1l1{\pm}22$/min) recovered again in 10 min after ($111{\pm}26$/min) miniBAL. Transient hypotension was developed during the procedure in two cases. The procedure was stopped in one case due to atrial flutter. Conclusion: MiniBAL is a safe and effective technique to detect the causative organisms of VAP.

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