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Arginine Vasopressin Therapy of Vasodilatory Shock after Cardiac Surgery (심장 수술 후 혈관 확장성 쇼크가 발생한 환자에서 바소프레신 투여 요법)

  • Ahn, Young-Chan;Park, Chul-Hyun;Kim, Gun-Woo;Lee, Jae-Ik;Jun, Yang-Bin;Choi, Chang-Hyu;Hyun, Sung-Youl;Park, Kook-Yang
    • Journal of Chest Surgery
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    • v.39 no.12 s.269
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    • pp.913-919
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    • 2006
  • Background: Vasodilatory shock has been implicated in life-threatening complications after open heart surgery, where the systemic inflammatory reaction is attributed to the cardiopulmonary bypass(CPB). The secretion of arginine vasopressin(AVP) has been found to be defective in a variety of vasodilatory shock states and administration of AVP markedly improves vasomotor tone and blood pressure. So we reviewed our experience of AVP therapy in patients with vasodilatory shock following heart surgery using CPB. Material and Method: From January 2004 to July 2006, we reviewed the records of patients who received AVP therapy for vasodilatory shock following heart surgery using CPB. Vasodilatory shock was defined as a mean arterial pressure lower(MAP) than 70 mmHg, a cardiac index greater than 2.5 $L/min/m^2$, peripheral vascular resistance lower than 800 $dyn/s/cm^5$, and vasopressor requirements. The hemodynamic responses of patients who received AVP therapy for vasodilatory shock after cardiac surgery were analyzed retrospectively. Result: One hundred ninety nine open cardiac surgery patients were consecutively included in this study. Twenty two patients(11.1%) met criteria for vasodilatory shock. Despite the administration of high dose catecholamine vasopressor, all patients were hypotensive with a mean arterial pressure less than 70 mmHg. AVP therapy increased MAP from $53.3{\pm}7.4\;to\;82.0{\pm}12.0$ mmHg at 1 hour (p<0.001) and decreased other vasopressor requirements from $25{\pm}7\;to\;18{\pm}6$ at 1 hour(p<0.001) and individually maintained it for 12 hours. Conclusion: Our date suggest that AVP may be a safe and an effective vasopressor in patients with vasodilatory shock. In patients exhibiting vasodilatory shock after heart surgery, replacement of AVP increases blood pressure and reduces catecholamine vasopressor requirements.

Sampling Plan for Bemisia tabaci Adults by Using Yellow-color Sticky Traps in Tomato Greenhouses (시설토마토에서 황색트랩을 이용한 담배가루이 표본조사법)

  • Song, Jeong Heub;Lee, Kwang Ju;Yang, Young Taek;Lee, Shin Chan
    • Korean journal of applied entomology
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    • v.53 no.4
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    • pp.375-380
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    • 2014
  • The sweetpotato whitefly (SPW), Bemisia tabaci Gennadius, is a major pest in tomato greenhouses on Jeju Island because they transmit viral diseases. To develop practical sampling methods for adult SPWs, yellow-color sticky traps were used in commercial tomato greenhouses throughout the western part of Jeju Island in 2011 and 2012. On the basis of the size and growing conditions in the tomato greenhouses, 20 to 30 traps were installed in each greenhouse for developing a sampling plan. Adult SPWs were more attracted to horizontal traps placed 60 cm above the ground than to vertical trap placed 10 cm above the plant canopy. The spatial patterns of the adult SPWs were evaluated using Taylor's power law (TPL) and Iwao's patchiness regression (IPR). The results showed that adult SPWs were aggregated in each surveyed greenhouse. In this study, TPL showed better performance because of the coefficient of determination ($r^2$). On the basis of the fixed-precision level sampling plan using TPL parameters, more traps were required for higher precision in lower SPW densities per trap. A sequential sampling stop line was constructed using TPL parameters. If the treatment threshold was greater than 10 maximum adult SPWs on a trap, the required traps numbered 15 at a fixed-precision level of 0.25. In estimating the mean density per trap, the proportion of traps with two or more adult SPWs was more efficient than whole counting: ${\ln}(m)=1.19+0.90{\ln}(-{\ln}(1-p_T))$. The results of this study could be used to prevent the dissemination of SPW as a viral disease vector by using accurate control decision in SPW management programs.

The Prevalence and Characteristics of Positional Obstructive Sleep Apnea

  • Kim, Cheon-Sik;Lee, Yong-Seok;Cho, Cheon-Ung;Pae, Sang-Ho;Lee, Sang-Ahm
    • Korean Journal of Clinical Laboratory Science
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    • v.44 no.2
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    • pp.52-58
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    • 2012
  • Patients with obstructive sleep apnea (OSA) often have more aggravated symptoms in the supine position. We tried to investigate the clinical characteristics and the predictive factors for positional OSA. Polysomnographic data were reviewed for OSA patients (apnea hypopnea index, $AHI{\geq}5$) from April, 2008 to April, 2011 at the Asan Medical Center. Clinical data, comorbid medical condition data and questionnaires (SF-36, MFI-20, ESS, BDI, STAI) were assessed. All patients were classified into two groups: positional patients (PP) group and non-positional patients (NPP) group. PP was defined as a patient who had the AHI in the supine position was at least twice as high as that in the lateral position. The body position of patients was confirmed by sleep position sensor and video monitor. All patients had at least 30 minutes of positional and 30 minutes of non-positional sleep. We compared clinical, medical, polysomnographic data, and questionnaire results between two (PP and NPP) groups and investigated predictive factors for the PP group using binary logistic regression analysis. In total, 371 patients were investigated. 265 (71.4%) was categorized as PP group and 106 (28.5%) as NPP group. The mean age ($mean{\pm}SD$) was higher in the PP group ($52.4{\pm}9.8$) than in the NPP group ($49.5{\pm}11.9$) (p<0.05). Comparison of sleep parameters between the PP and the NPP group showed that the PP group had significantly lower BMI (PP: $26.1{\pm}3.2kg/m^2$; NPP: $27.8{\pm}4.3kg/m^2$, p<0.001), neck circumference (PP: $39.7{\pm}2.8cm$; NPP: $41.5{\pm}3.7cm$, p<0.001) and hypertension rate (PP: n=89/265 (33.5%); NPP: n=48/106 (45.2%), p=0.0240). In the PP group, the percentage of deep sleep (PP: $8.7{\pm}8.1%$; NPP: $5.6{\pm}7.0%$, P=0.001) and rapid eye movement (REM) (PP: $17.5{\pm}6.1%$; NPP: $14.0{\pm}6.9%$, p<0.001) were significantly higher whereas the percentage of light sleep (stage N1) was significantly lower than the NPP group (PP: $30.4{\pm}12.3$; NPP: $44.5{\pm}20.8%$, p<0.001). During the sleep, the AHI in the supine position (PP: $48.6{\pm}19.5$; NPP: $60.5{\pm}22.6$, p<0.001) and in the non-supine position (PP: $9.4{\pm}8.9$; NPP: $48.4{\pm}24.8$, p=<0.001) were significantly lower and the minimal arterial oxygen saturation in non-REM sleep was significantly higher in the PP group (PP: $80.3{\pm}7.6$; NPP: $75.1{\pm}9.9$, p=<0.001). There were no significant differences in all questionnaires including quality of life. The results of the binary logistic regression analysis showed that age, the amount of REM sleep(%) and AHI were significant predictive factors for positional OSA. The significant predictive factors for positional OSA were older age, higher percentage of REM and lower AHI. The questionnaire results were not significantly different between the two groups.

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Analysis of cytosine adenine repeat polymorphism of the IGF-I promoter gene in children with idiopathic short stature (특발성 저신장증 환자에서 IGF-I 프로모터 cytosine-adenine repeat 유전자 다형성의 분석)

  • Moon, Jae Hoon;Chung, Woo Yeong
    • Clinical and Experimental Pediatrics
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    • v.52 no.3
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    • pp.356-363
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    • 2009
  • Purpose : A polymorphism in the IGF-I gene promoter region is known to be associated with serum IGF-I levels, birth weight, and body length, suggesting that IGF-I gene polymorphism might influence postnatal growth. The present study aimed to investigate the role of this polymorphic cytosine-adenine (CA) repeat of the IGF-I gene in children with idiopathic short stature. Methods : The study involved 131 children (72 boys and 59 girls) diagnosed with idiopathic short stature, aged 715 years. Genomic DNA was extracted from anticoagulated peripheral whole blood. The primers were designed to cover the promoter region containing the polymorphic CA repeat. Data were analyzed using GeneMapper software. The correlations between age and serum IGF-I levels were analyzed using Spearmans correlation coefficient. Results : The CA repeat sequences ranged from 15 to 22, with 19 CA repeats the most common with an allele frequency of 40.6%. Homozygous for 19 CA repeat was 13.0%, heterozygous for 19 CA repeat was 56.5%, and 19 CA non-carrier was 30.5%. The three different genotype groups showed no significant differences in height, body weight and body mass index, and serum IGF-I levels. The serum IGF-I level and age according to the IGF-I genotypes were significantly correlated in the entire group, 19 CA repeat carrier group, and the non-carrier group. The three groups also showed no significant differences in the first year responsiveness to GH treatment. Conclusion : There were no significant different correlations between 19 CA repeat polymorphism and serum IGF-I levels according to genotype. Our results suggest that the IGF-I 19 CA repeat gene polymorphism is not functional in children with idiopathic short stature.

Evaluation of the Natural Vibration Modes and Structural Strength of WTIV Legs based on Seabed Penetration Depth (해상풍력발전기 설치 선박 레그의 해저면 관입 깊이에 따른 고유 진동 모드와 구조 강도 평가)

  • Myung-Su Yi;Kwang-Cheol Seo;Joo-Shin Park
    • Journal of the Korean Society of Marine Environment & Safety
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    • v.30 no.1
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    • pp.127-134
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    • 2024
  • With the growth of offshore wind power generation market, the corresponding installation vessel market is also growing. It is anticipated that approximately 100 installation vessels will be required in the of shore wind power generation market by 2030. With a price range of 300 to 400 billion Korean won per vessel, this represents a high-value market compared to merchant vessels. Particularly, the demand for large installation vessels with a capacity of 11 MW or more is increasing. The rapid growth of the offshore wind power generation market in the Asia-Pacific region, centered around China, has led to several discussions on orders for operational installation vessels in this region. The seabed geology in the Asia-Pacific region is dominated by clay layers with low bearing capacity. Owing to these characteristics, during vessel operations, significant spudcan and leg penetration depths occur as the installation vessel rises and descends above the water surface. In this study, using penetration variables ranging from 3 to 21 m, the unique vibration period, structural safety of the legs, and conductivity safety index were assessed based on penetration depths. As the penetration depth increases, the natural vibration period and the moment length of the leg become shorter, increasing the margin of structural strength. It is safe against overturning moment at all angles of incidence, and the maximum value occurs at 270 degrees. The conditions reviewed through this study can be used as crucial data to determine the operation of the legs according to the penetration depth when developing operating procedures for WTIV in soft soil. In conclusion, accurately determining the safety of the leg structure according to the penetration depth is directly related to the safety of the WTIV.

Categorizing Quality Features of Franchisees: In the case of Korean Food Service Industry (프랜차이즈 매장 품질요인의 속성분류: 국내 외식업을 중심으로)

  • Byun, Sook-Eun;Cho, Eun-Seong
    • Journal of Distribution Research
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    • v.16 no.1
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    • pp.95-115
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    • 2011
  • Food service is the major part of franchise business in Korea, accounting for 69.9% of the brands in the market. As the food service industry becomes mature, many franchisees have struggled to survive in the market. In general, consumers have higher levels of expectation toward service quality of franchised outlets compared that of (non-franchised) independent ones. They also tend to believe that franchisees deliver standardized service at the uniform food price, regardless of their locations. Such beliefs seem to be important reasons that consumers prefer franchised outlets to independent ones. Nevertheless, few studies examined the impact of qualify features of franchisees on customer satisfaction so far. To this end, this study examined the characteristics of various quality features of franchisees in the food service industry, regarding their relationship with customer satisfaction and dissatisfaction. The quality perception of heavy-users was also compared with that of light-users in order to find insights for developing differentiated marketing strategy for the two segments. Customer satisfaction has been understood as a one-dimensional construct while there are recent studies that insist two-dimensional nature of the construct. In this regard, Kano et al. (1984) suggested to categorize quality features of a product or service into five types, based on their relation to customer satisfaction and dissatisfaction: Must-be quality, Attractive quality, One-dimensional quality, Indifferent quality, and Reverse quality. According to the Kano model, customers are more dissatisfied when Must-be quality(M) are not fulfilled, but their satisfaction does not arise above neutral no matter how fully the quality fulfilled. In comparison, customers are more satisfied with a full provision of Attactive quality(A) but manage to accept its dysfunction. One-dimensional quality(O) results in satisfaction when fulfilled and dissatisfaction when not fulfilled. For Indifferent quality(I), its presence or absence influences neither customer satisfaction nor dissatisfaction. Lastly, Reverse quality(R) refers to the features whose high degree of achievement results in customer dissatisfaction rather than satisfaction. Meanwhile, the basic guidelines of the Kano model have a limitation in that the quality type of each feature is simply determined by calculating the mode statistics. In order to overcome such limitation, the relative importance of each feature on customer satisfaction (Better value; b) and dissatisfaction (Worse value; w) were calculated following the formulas below (Timko, 1993). The Better value indicates how much customer satisfaction is increased by providing the quality feature in question. In contrast, the Worse value indicates how much customer dissatisfaction is decreased by providing the quality feature. Better = (A + O)/(A+O+M+I) Worse = (O+M)/(A+O+M+I)(-1) An on-line survey was performed in order to understand the nature of quality features of franchisees in the food service industry by applying the Kano Model. A total of twenty quality features (refer to the Table 2) were identified as the result of literature review in franchise business and a pre-test with fifty college students in Seoul. The potential respondents of our main survey was limited to the customers who have visited more than two restaurants/stores of the same franchise brand. Survey invitation e-mails were sent out to the panels of a market research company and a total of 257 responses were used for analysis. Following the guidelines of Kano model, each of the twenty quality features was classified into one of the five types based on customers' responses to a set of questions: "(1) how do you feel if the following quality feature is fulfilled in the franchise restaurant that you visit," and "(2) how do you feel if the following quality feature is not fulfilled in the franchise restaurant that you visit." The analyses revealed that customers' dissatisfaction with franchisees is commonly associated with the poor level of cleanliness of the store (w=-0.872), kindness of the staffs(w=-0.890), conveniences such as parking lot and restroom(w=-0.669), and expertise of the staffs(w=-0.492). Such quality features were categorized as Must-be quality in this study. While standardization or uniformity across franchisees has been emphasized in franchise business, this study found that consumers are interested only in uniformity of price across franchisees(w=-0.608), but not interested in standardizations of menu items, interior designs, customer service procedures, and food tastes. Customers appeared to be more satisfied when the franchise brand has promotional events such as giveaways(b=0.767), good accessibility(b=0.699), customer loyalty programs(b=0.659), award winning history(b=0.641), and outlets in the overseas market(b=0.506). The results are summarized in a matrix form in Table 1. Better(b) and Worse(w) index indicate relative importance of each quality feature on customer satisfaction and dissatisfaction, respectively. Meanwhile, there were differences in perceiving the quality features between light users and heavy users of any specific franchise brand in the food service industry. Expertise of the staffs was labeled as Must-be quality for heavy users but Indifferent quality for light users. Light users seemed indifferent to overseas expansion of the brand and offering new menu items on a regular basis, while heavy users appeared to perceive them as Attractive quality. Such difference may come from their different levels of involvement when they eat out. The results are shown in Table 2. The findings of this study help practitioners understand the quality features they need to focus on to strengthen the competitive power in the food service market. Above all, removing the factors that cause customer dissatisfaction seems to be the most critical for franchisees. To retain loyal customers of the franchise brand, it is also recommended for franchisor to invest resources in the development of new menu items as well as training programs for the staffs. Lastly, if resources allow, promotional events, loyalty programs, overseas expansion, award-winning history can be considered as tools for attracting more customers to the business.

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Effects of Soil Aggregate Stability and Wettability on Infiltration and Evaporation (토양입단(土壤粒團)의 안정성(安定性)과 친수성(親水性)이 수분침투(水分浸透) 및 증발(蒸發)에 미치는 영향(影響))

  • Jo, In-Sang;Cho, Seong-Jin;Verplanke, H.;Hartmann, R.;De Boodt, M.
    • Korean Journal of Soil Science and Fertilizer
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    • v.18 no.2
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    • pp.121-127
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    • 1985
  • This study was designed to gain practical data on the use of soil conditioners for more efficient water managements and to establish the optimum levels of structural properties for soil conditioning. A sandy loam and a silt loam soil were each treated with two different soil conditioners, hydrophobic Bitumen or hydrophilic Uresol. The perspex tube 34 cm long were packed homogeneously with air dried soil up to 2 cm below the top, then covered over 2 cm of treated or untreated aggregates. The infiltration rate into the soil columns was measured under simulated rainfall condition. The evaporation study was carried out in the wind tunnel, and the changes of soil moisture distribution of the columns following and during the evaporation were determined by a gamma ray scanner. The infiltration rate of water into the soil column was increased to 18.7-50.8% by the Uresol treatment but it was decreased to less than 25% of control by the Bitumen treatment. Evaporation was decreased to 22.0-68.1% by the Bitumen treatment and to 38.7-68.4% by the Uresol treatment. The water use efficiency of Uresol treated column was increased to more than twice as much as that of untreated soil. Aggregate stability and wetting angle were related to water infiltration and evaporation. A positive and highly significant logarismic relationship was found between the infiltration rate and stability index-wetting angle, evaporation rate and instability index-wetting angle. It was considered that the structural stability is more important than wetting angle. This is true because the structural stability is always positively correlated to water saving, however wettability is positively correlated to the infiltration, and negatively correlated to water saving during the evaporation.

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Relationship between Body Fat Distribution and Metabolic Risk Factors in Adolescents (청소년에서의 체지방 분포와 대사위험 인자들의 연관성)

  • Kim, Dal Hyun;Seong, Tae Jung;Hong, Young Jin;Son, Byong Kwan;Kim, Soon Ki
    • Clinical and Experimental Pediatrics
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    • v.46 no.4
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    • pp.326-334
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    • 2003
  • Purpose : The objectives of this study were to estimate the prevalence of obesity in adolescents; to study the association between obesity, blood pressure, and dyslipidemia; and to evaluate the superiority of waist circumference to waist/hip ratio(WHR) in central obesity. Methods : We selected 1382 adolescents(M : F=690 : 692) aged from 11 to 18 years(mean age; boys 15.0, girls 15.4) in Incheon. We measured weight, height, waist, waist/hip ratio, and blood pressure, with blood sampling to evaluate the dyslipidemia. Results : The prevalence of obesity was 6.7% in boys and 6.9% in girls by body mass index(BMI). The prevalence of systolic hypertension was 15.7% in normal group, 32.4% in the overweight group, and 35.4% in the obese group by BMI. The prevalence of diastolic hypertension was 4.9% in the normal group, 6.9% in the overweight group, and 14.6% the in obese group. In boys and girls, BMI, waist circumference, and WHR were positively correlated with systolic and diastolic blood pressure. respectively. In boys, triglyceride was positively correlated with waist circumference(r=0.34, P<0.05). In boys and girls, BMI was highly correlated with obesity index(r=0.98, each), with waist circumference(r=0.89, r=0.82, respectively), and with body fat(r=0.85, r=0.89) respectively. Conclusion : These data suggest the importance of the screening of blood pressure in obese adolescents, with prevention and intervention of obesity since it may be the most cost-effective way of reducing the complications related with obesity.

The Usefulness According to the Incubation Time of PTH as Prediction Index of Hypocalcemia (저칼슘혈증 예측지표로서 부갑상선 호르몬 검사반응시간에 따른 유용성)

  • Au, Doo-Hee;Kim, Ji-Young;Seok, Jae-Dong
    • The Korean Journal of Nuclear Medicine Technology
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    • v.14 no.1
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    • pp.138-142
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    • 2010
  • Purpose: PTH (parathyroid hormone) level is a useful index for prediction of hypocalcemia after thyroidectomy. The fast results are required for an early diagnosis of hypocalcemia. In this study, we evaluated the PTH change according to incubation time, and investigated the usefulness of hypocalcemia diagnosis of PTH results in early incubation time. Materials and Methods: The subjects were 131 patients who had taken the PTH test from July to August in 2009. All experiments were used IRMA method. PTH value were evaluated with the correlation between precision (10 times repeat) and recovery rate and at 0.5, 3, 6 and $18{\pm}2$ (below overnight) hours following incubation time. Data analysis was investigated with relationship of the sensitivity, specificity, PPV (positive predictive value) and accuracy. Results: The correlation was time-dependent with levels reaching $R^2$=0.987 at 0.5 hours, $R^2$=0.993 at 3 hours and $R^2$=0.996 at 6 hours compare to overnight levels. The precision (%CV${\pm}$SD) were $15.92{\pm}15.54$ at 0.5 hours, $6.91{\pm}7.38$ at 3 hours, $4.30{\pm}4.69$ at 6 hours and $4.59{\pm}2.59$ at overnight. The recovery rate (%Mean${\pm}$SD) were $96.8{\pm}5.44$ at 0.5 hours, $102.6{\pm}4.35$ at 3 hours, $100.7{\pm}2.56$ at 6 hours and $102.2{\pm}5.98$ at overnight. When 15 pg/ml of overnight density was set up as criteria, we measured the sensitivity, specificity and PPV, accuracy at 0.5, 3, 6 hours. The sensitivity was shown to 97.5% at all times. The specificity was 96.0% at 0.5 hours, 100% at 3 hours and 92.3% at 6 hours for control, respectively. The PPV was 86.6% at 0.5 hours, 100% at 3 hours and 92.8% at 6 hours. The accuracy was shown to 84.7% at 0.5 hours, 97.5% at 3 hours and 90.6% at 6 hours. These data were accompanied by a corresponding PTH value of overnight incubation time, which significantly correlated with early time results. Conclusion: The values of PTH at 3 hours has favorable the rate of concordance of 94.1% and may be useful for prediction of hypocalcemia, and it responses to overnight incubation PTH values. Therefore, This method may be an attractive alternative to proper treatment to stop symptom revelation by giving a calcium agent to the patient.

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Validation of the coach-athlete relationship scale of amateur golf players: Rasch rating scale model (아마추어 골프 선수를 위한 코치-선수 관계 척도의 타당화: Rasch 평정척도 모형 적용)

  • Kim, Sae Hyung;Choi, Jae Il;Lee, Jun Woo
    • Journal of the Korean Data and Information Science Society
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    • v.24 no.6
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    • pp.1319-1329
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    • 2013
  • The purpose of this research was to develop and validate the coach-athlete relationship scale suitable to amateur golf players by applying the Rasch rating scale model. As the coach-athlete relationship scale, the Korean form of scale developed by Kim and Park (2008), which was revised based on the evidence on the basis of inspection contents, was used to conduct a survey on 217 amateur golf athletes. And the unidimensionality, which is the basic assumption of the Rasch model, was verified using the WINSTEPS program, and the appropriateness of the item category was established through the step calibration. The goodness of fit of each question was tested through the goodness-of-fit index and the differential item functioning (DIF) was estimated according to the golf career. When the goodness-of-fit index estimated for each question was 1.30 or more it was judged unfit and the significance level in the analysis was all set as.05. The results of the analysis showed that the measures variance explained by the Rasch measurement model was more (33.7%) than 20%, so the unidimensionality assumptions of the 11 questions (..hospitable posture when my coach is teaching) were satisfied. The result of analyzing the item category (7 scale) with step calibration was found to be unfit, but in the result of reanalyzing by rescoring into a 5-point scale, it was found to be fit. Particularly, in the result of estimating the goodness-of-fit using the systematized item category (5 scale), Question 10 (...my best when my coach is teaching) and Question 11 were found to be unfit, and as a result of estimating the differential functioning item according to golf career, Question 11 was found to be unevenly differentiated according to golf career. So the 5-point scale of Question 9 after eliminating the two questions which were unfit and differentiated was validated to be the coach-athlete relationship scale suitable to amateur golf athletes.