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CD45RA+ Depleted Lymphocyte Infusion for Treatment of Refractory Cytomegalovirus Disease in Complete DiGeorge Syndrome: A Case Report

  • HyungJin Chin;Young Hye Ryu;Da Yun Kang;Hyun Jin Park;Kyung Taek Hong ;Jung Yoon Choi;Ki Wook Yun;Bongjin Lee;Hyoung Jin Kang;Eun Hwa Choi
    • Pediatric Infection and Vaccine
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    • v.30 no.3
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    • pp.173-179
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    • 2023
  • Complete DiGeorge syndrome (cDGS) refers to DGS with profound T cell deficiency. Herein, we present the case of an infant with cDGS suffering from refractory cytomegalovirus (CMV) infection and who was treated with CD45RA+ depleted lymphocyte infusion. The patient was diagnosed with cDGS by fluorescence in situ hybridization which verified 22q11.2 deletion and as well as by the observed profound T cell deficiency (CD3+ T cells 69/μL, CD4+ T cells 7/μL). On the 45th day of age, CMV viremia was first detected with a plasma viral load (VL) of 120,000 IU/mL. Ganciclovir treatment effectively reduced VL post 56 days of treatment; however, VL subsequently rebounded. A CMV UL97 phosphotransferase M460V mutation conferring ganciclovir resistance emerged and foscarnet was incorporated. Despite this, high titers of CMV viremia (VL 2,820,000 IU/mL) and CMV retinitis were complicated. To restore T cell immunity and treat refractory CMV infection, CD45RA+ depleted CMV-specific lymphocytes from the patient's father were infused twice on the 196th and 207th days after birth. After receiving the second infusion, a decline in CMV VL was observed, with a decrease to 87,100 IU/mL by the tenth day following infusion, despite the failure in maintaining T cell increase. The patient died of Pneumocystis jirovecii pneumonia and Elizabethkingia meningoseptica sepsis on the 222nd day after birth. CD45RA+ depleted lymphocyte infusion may be a therapeutic option for refractory CMV disease in cDGS patients.

In Vitro Anti-aging and Hair Follicle Dermal Papilla Cells Activation Effects of Usnea diffracta Vain Extract (송라 추출물의 세포 수준에서 항노화 및 모유두세포 활성화 효과)

  • Min Jeong Kim;Won Yeoung Choi;Hyun Woo Shim;Eun Jin Shin;Jung No Lee;Sung Min Park;Hwa Sun Ryu
    • Journal of the Society of Cosmetic Scientists of Korea
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    • v.50 no.1
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    • pp.37-48
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    • 2024
  • Songla (Usnea diffracta Vain.) is one of the lichens belonging to the genus Usnea, and pharmacological activities such as antioxidant, antimicrobial, anti-inflammatory, anti-tumor and cardiovascular protection have been reported in previous studies, but its efficacy in skin and hair is not well known. In this study, the effect of Usnea diffracta extract (UDE) on anti-aging and dermal papilla cell proliferation was verified in vitro. As a result of the experiment, it was confirmed that the UDE significantly reduced the expression of MMP-1 and the activity of MAPKs (ERK, p38, JNK) and AP-1 (c-Fos, c-Jun), which were increased by UVA in HDFn. In addition, the UDE significantly increased the proliferation of HFDPC and significantly increased the mRNA expression of VEGF and KGF, which are hair growth factors. Accordingly, the phosphorylation of ERK/CREB involved in hair proliferation and expression of growth factors was increased in a concentration-dependent manner. The main component represented by the main peak was separated and purified using Prep LC by concentrating the UDE, which was confirmed as diffractaic acid through NMR and Mess analysis. Isolated diffractaic acid significantly reduced the expression of MMP-1 increased by UVA in HDFn and increased the proliferation of HFDPC in a concentration-dependent manner. The result suggest that UDE proved its usability as a natural cosmetic material with anti-aging and dermal papilla cell activation effects.

<Field Action Report> Local Governance for COVID-19 Response of Daegu Metropolitan City (<사례보고> 코로나바이러스감염증-19 유행과 로컬 거버넌스 - 2020년 대구광역시 유행에 대한 대응을 중심으로 -)

  • Kyeong-Soo Lee;Jung Jeung Lee;Keon-Yeop Kim;Jong-Yeon Kim;Tae-Yoon Hwang;Nam-Soo Hong;Jun Hyun Hwang;Jaeyoung Ha
    • Journal of agricultural medicine and community health
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    • v.49 no.1
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    • pp.13-36
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    • 2024
  • Objectives: The purpose of this field case report is 1) to analyze the community's strategy and performance in responding to infectious diseases through the case of COVID-19 infectious disease crisis response of Daegu Metropolitan City, and 2) to interpret this case using governance theory and infectious disease response governance framework. and 3) to propose a strategic model to prepare for future infectious disease outbreaks of the community. Methods: Cases of Daegu Metropolitan City's infectious disease crisis response were analyzed through researchers' participatory observations. And review of OVID-19 White Paper of Daegu Metropolitan City, Daegu Medical Association's COVID-19 White Paper, and literature review of domestic and international governance, and administrative documents. Results: Through the researcher's participatory observation and literature review, 1) establishment of leadership and response system to respond to the infectious disease crisis in Daegu Metropolitan City, 2) citizen's participation and communication strategy through the pan-citizen response committee, 3) cooperation between Daegu Metropolitan City and governance of public-private medical facilities, 4) decision-making and crisis response through participation and communication between the Daegu Metropolitan City Medical Association, Medi-City Daegu Council, and medical experts of private sector, 5) symptom monitoring and patient triage strategies and treatment response for confirmed infectious disease patients by member of Daegu Medical Association, 6) strategies and implications for establishing and utilizing a local infectious disease crisis response information system were derived. Conclusions: The results of the study empirically demonstrate that collaborative governance of the community through the participation of citizens, private sector experts, and community medical facilities is a key element for effective response to infectious disease crises.

Involvement of TLR4-JNK/NF-κB signaling pathway in RAW264.7 cell activation of Protaetia brevitarsis seulensis larvae extracts (흰점박이꽃무지 유충 추출물의 RAW264.7 세포 활성화에서 TLR4-JNK/NF-κB 신호전달 경로의 관여)

  • Ju-Hwi Park;Jongbeom Chae;Joon Ha Lee;Dongyup Hahn;Ju-Ock Nam
    • Journal of Applied Biological Chemistry
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    • v.66
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    • pp.447-454
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    • 2023
  • In the environment in which humans live, there are various antigens that invade the human body and interfere with humans leading a healthy life, so the immune system recognizes the antigen then removes them through a complex mechanism. Macrophages are widely distributed immune cells involved in the innate immune system, and produce various immune modulators such as inducible nitric oxide synthase-induced nitric oxide, cyclooxygenase-2 induced prostaglandin E2 and proinflammatory cytokines such as tumor necrosis factor-alpha. On the other hand, Protaetia brevitarsis seulensis larvae are a type of edible insect that have emerged as an alternative to the future food supply problem. The immuno-modulatory effect through the activation of murine macrophage RAW264.7 cell via mitogen-activated protein kinases (MAPKs)/nuclear factor-kappa B (NF-κB) signaling pathways has been reported. Based on this report, in this study, we confirmed how the expression of immune modulators induced by Protaetia brevitarsis seulensis larvae extracts in RAW264.7 cells was changed by treatment with pharmacological inhibitors of toll-like receptor 4 (TLR4), MAPKs and NF-κB signaling pathways. As a result, reduction of immune modulators was confirmed in the c-Jun N-terminal kinase (JNK) inhibitor treatment group and NF-κB inhibitor treatment group among the Protaetia brevitarsis seulensis larvae-treated RAW264.7 cell. Furthermore, in the TLR4 inhibitor-treated group, decreases in phosphorylation of JNK and NF-κB factors were confirmed in Protaetia brevitarsis seulensis larvae-treated RAW264.7 cell, as well as decreases in immune modulators. This results suggest that Protaetia brevitarsis seulensis larvae activates RAW264.7 cells by the engagement of TLR4-JNK/NF-κB signaling pathway.

Clinicoradiologic Characteristics of Intradural Extramedullary Conventional Spinal Ependymoma (경막내 척수외 뇌실막세포종의 임상 영상의학적 특징)

  • Seung Hyun Lee;Yoon Jin Cha;Yong Eun Cho;Mina Park;Bio Joo;Sang Hyun Suh;Sung Jun Ahn
    • Journal of the Korean Society of Radiology
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    • v.84 no.5
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    • pp.1066-1079
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    • 2023
  • Purpose Distinguishing intradural extramedullary (IDEM) spinal ependymoma from myxopapillary ependymoma is challenging due to the location of IDEM spinal ependymoma. This study aimed to investigate the utility of clinical and MR imaging features for differentiating between IDEM spinal and myxopapillary ependymomas. Materials and Methods We compared tumor size, longitudinal/axial location, enhancement degree/pattern, tumor margin, signal intensity (SI) of the tumor on T2-weighted images and T1-weighted image (T1WI), increased cerebrospinal fluid (CSF) SI caudal to the tumor on T1WI, and CSF dissemination of pathologically confirmed 12 IDEM spinal and 10 myxopapillary ependymomas. Furthermore, classification and regression tree (CART) was performed to identify the clinical and MR features for differentiating between IDEM spinal and myxopapillary ependymomas. Results Patients with IDEM spinal ependymomas were older than those with myxopapillary ependymomas (48 years vs. 29.5 years, p < 0.05). A high SI of the tumor on T1W1 was more frequently observed in IDEM spinal ependymomas than in myxopapillary ependymomas (p = 0.02). Conversely, myxopapillary ependymomas show CSF dissemination. Increased CSF SI caudal to the tumor on T1WI was observed more frequently in myxopapillary ependymomas than in IDEM spinal ependymomas (p < 0.05). Dissemination to the CSF space and increased CSF SI caudal to the tumor on T1WI were the most important variables in CART analysis. Conclusion Clinical and radiological variables may help differentiate between IDEM spinal and myxopapillary ependymomas.

A Study of Organic Matter Fraction Method of the Wastewater by using Respirometry and Measurements of VFAs on the Filtered Wastewater and the Non-Filtered Wastewater (여과한 하수와 하수원액의 VFAs 측정과 미생물 호흡률 측정법을 이용한 하수의 유기물 분액 방법에 관한 연구)

  • Kang, Seong-wook;Cho, Wook-sang
    • Journal of the Korea Organic Resources Recycling Association
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    • v.17 no.1
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    • pp.58-72
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    • 2009
  • In this study, the organic matter and biomass was characterized by using respirometry based on ASM No.2d (Activated Sludge Model No.2d). The activated sludge models are based on the ASM No.2d model, published by the IAWQ(International Association on Water Quality) task group on mathematical modeling for design and operation of biological wastewater treatment processes. For this study, OUR(Oxygen Uptake Rate) measurements were made on filtered as well as non-filtered wastewater. Also, GC-FID and LC analysis were applied for the estimation of VFAs(Volatile Fatty Acids) COD(S_A) in slowly bio-degradable soluble substrates of the ASM No.2d. Therefore, this study was intended to clearly identify slowly bio-degradable dissolved materials(S_S) and particulate materials(X_I). In addition, a method capable of determining the accurate time to measure non-biodegradable COD(S_I), by the change of transition graphs in the process of measuring microbial OUR, was presented in this study. Influent fractionation is a critical step in the model calibrations. From the results of respirometry on filtered wastewater, the fraction of fermentable and readily biodegradable organic matter(S_F), fermentation products(S_A), inert soluble matter(S_I), slowly biodegradable matter(X_S) and inert particular matter(X_I) was 33.2%, 14.1%, 6.9%, 34.7%, 5.8%, respectively. The active heterotrophic biomass fraction(X_H) was about 5.3%.

A Study on the Classification and Research Trends of Articles in The Korean Journal of Rural Medicine (한국농촌의학회지(韓國農村醫學會誌)에 게재된 연구논문의 분류 및 연구동향)

  • Wee, You-Mee;Kim, Suk-Il;Park, Hyang;Ryu, So-Yeon;Park, Jong;Kim, Ki-Soon
    • Journal of agricultural medicine and community health
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    • v.25 no.2
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    • pp.231-244
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    • 2000
  • Classification and research trends were studied to analyze a total of 240 original articles that have been published in 34 volumes of The Korean Journal of Rural Medicine from 1976 to 1999. The results were as follows: 1. A total of 337 articles were published. Among them, 240(71.2%) articles were classified as original articles. This number has been increasing significantly over the years as the number of the articles was 13 in the 1970s, 73 in the 1980s, and 154 in the 1990s. 2. There were 10 authors in the original articles and 55(22.9%) of them were written by 3 of them. There were five research institutions involved in the articles, and 106(44.2%) of the articles were done by one research group. 3. In the original articles. 24(10.0%) were noted to be done using research funds, and only 6(2.5%) were written in English. 4. In the view of the research styles of the original articles, 115(47.9%) used analytical study, 92(38.3%) used technical study, 21(9.2%) used experimental study, and 6(2.5%) used case reports. In the 1970s, 13(100.0%) articles used technical study, and in the 1980s, 47(64.4%) used technical studies and 19(26.0%) used analytical studies. However, in the 1990s, 96(62.8%) articles used analytical studies and 32(20.9%) used technical studies. The statistical methods most commonly used in the articles were technical statistics, the ${\chi}^2$-test, and the t-test respectively. 5. On the classification into three different research fields, 105(43.8%) articles were classified as health management, 96(40.0%) as disease epidemiology, and 39(16.3%) as rural environment and rural occupational disorders. In the 1970s, 12 (92.3 %) of the articles were on disease epidemiology and 1(7.7%) on health management were published. In the 1980s, 33(45.2%) articles on disease epidemiology, 29(39.7%) on health control, and 11(15.1%) on rural environment and rural occupational disorders were recorded. In the 1990s, however, 75(48.7%) articles were on health control, 51(33.1%) on disease control, and 28(18.2%) on the rural environment and rural occupational disorders. 6. According to the research subjects in each research field, the 39 articles in rural environment and rural occupational disorders were composed of 8(20.5%) articles on pesticide intoxication, 7(17,9%) on farmer's diseases, 7(17.9%) on vinyl-house diseases, and 6(15.4%) on accidents. From a total of 96 articles in disease epidemiology 56(58.3%) articles were on parasites, 16(16.7%) on non-infectious diseases, 12(12.5) on infectious diseases. From 105 articles in health control 25(23.8%) articles were on medical care utilization patterns, 18(17.1%) on the health care delivery system, and 13(12.4%) on maternal and child health. In the analysis of the 10 most prevalent subjects dealt in the above articles, 6(46.2%) articles were on parasites and 4(30.8%) on non-infectious diseases were recorded in the 1970s. In the 1980s, 28(38.4%) were on parasites. 9(12.3%) on the health care system, 7(9.6%) on medical care utilization patterns, 5(6.8%) on maternal and child health, and 4(5.5%) were on pesticide intoxication. In the 1990s, 22(14.3%) articles were on parasites. 18(11.7%) on medical care utilization patterns, 16(10.4%) on senile health, 14(9.1%) on the health care system, 10(6.5%) on infectious diseases, arid 10(6.5%) were on non-infectious diseases. In conclusion, the research activity on rural health has been strengthened in this country because the original articles in The Korean Journal of Rural Medicine have significantly increased in the past 24 years. In the 1970s and 1980s, research on disease epidemiology was most prevalent, but in the 1990s papers on health care were most popular. In addition, the articles on parasites were most frequently published in the 1970s, 1980s, and 1990s, showing that parasitic problem was the main theme in those eras. However, in the 1990s, it was evident that the articles on parasites were decreasing and articles on the subject of medical care utilization patterns and senile health increased. Hereafter it was expected that research on health care would be more common in rural health in Korea.

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The Purpose and background of this study (노인질환에 대한 한양방동시종합검진 결과에 대한 보고)

  • Gwon, Gyeong-Suk;Lee, Tae-Hwan;Song, Jeong-Mo;Kim, In-Seop;Yun, Ho-Yeong;Im, Jun-Gyu
    • The Journal of Korean Medicine
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    • v.15 no.2 s.28
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    • pp.9-27
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    • 1994
  • This study is to analyze of senile disease status and the social problem according to increased old ages, and then to find distributions of old man's diseases and health status efficiency of oriental-occidental contemporary health examination. And it is the first oriental-occidental contemporary health examination of old man performed by JeonJu Woosuk University Oriental Medicine Hospital and Woosuk-Clinic in nation. Methods The objects in this research are 641's old man of KimJe Gun's over 60's years performed medical examination at JeonJu Woosuk University Oriental- Mmedicine-Hospital and Woosuk-Clinic by oriental-occidental medical contemporary exam., from 1994, 24th June till 1994. 13th July. The 1st occident medical examination methods were consisted of chest x-ray check. blood and urine exam., measurement of blood pressure, visual power and audiometry. The Oriental medical examination methods were consisted of four diagnostics (望,聞,問,切), present illness. chief complaint, past history, families history, social history by question and SA Sang constitution test index. The results and conclusions The results and conclusions are the next: 1. In order of distribution. the athletic disease (75.8%),the digestive disease(43.4%), the circulatory disease(41.5%), the respiratory disease(22.3%), EENT disease(8.1%), the endocrinopathy(5.6%), and the genito-urinary disease(5.3%) are the results of the object about 641's old man, by the oriental-occidental medicine's contemporay exam. 2. Distribution of disease distiction are lumbago. gastritis and peptic ulcer. knee joint pain. heart disease. hypertension. chronic bronchitis. asthma. anemia. DM. Tbc. visual disturbance. CVA. etc in order. 3. Disease distribution according to age is almost high incident in 60-75years. Disease incidence is decreased except E.E.N.T disease in over 76years. 4. The relationships of disease and family history are: the 25.0% of CVA pts. has family history and the 11.6% of hypertension pts has family history. so they showed high relative family history. In addition the 5.6% of TBC pts. and the 2.6% of DM pts. have family history. 5. The relationships of disease and drinking are: Drinking proportion is the 36.4% in respiratory disease pts. the 34.7% in hypertension pts. the 33.3% in heart disease pts.. the 28.4% in digestive disease pts.. but because of no surveying drinking amount we can't know the absolut relationships of disease and drinking. 6. The relationships of Disease and smoking are: Smoking proportion is the 44.1% in respiratory disease pts.. the 38.0% in Heart disease pts.. the 29.8% in Hypertension pts.. but because of no surveying of smoking amount. we can't know the absolut relationships of disease and smoking. 7. Distribution of Sasang constitution is : Tae-eum-in 44.8%. So-yang-in 30.7%. So-eum-in 24.6%. Tae-yang-in 0.0%. And disease distribution of Sasang constitution distinction is ; Tae-eum-in has high incidence of circulation disease(50.0%) and respiratory disease(23.1%).So-yang-in has high incidence of athletics disease(77.7%) and EENT disease(12.2%), So-eum-in has high incidence of digestive disease(65.8%). 8. Distribution of abnormal result in occidental medical examination and oriental-occidental contemporal exam result is considerably different. This is the reason of needing oriental medicine exam, for characteristics of Senile. I think that the oriental-occidental contemporary examination in old man is much more effecient than only occident medical examination. This oriental-occidental contemporary examination has many defects because it is the first practice. To participate in the public health program efficiently. I think that we must improve lots of problems and present the model of the oriental-occidental contemporary examination and the project of oriental medicine's for public health.

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Mitral Valvuloplasty using New Mitral Strip (Mitracon^{(R)}$) (새로운 Strip (Mitracon^{(R)}$)을 이용한 승모판막 성형술)

  • Kang, Seong-Sik;Kim, Sang-Pil;Song, Meong-Gum
    • Journal of Chest Surgery
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    • v.41 no.3
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    • pp.320-328
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    • 2008
  • Background: Numerous surgical devices for mitral repair have been used in the past with good results. In this study we describe a simple annuloplasty technique with using a new device ($Mitracon^{(R)}$). The aim of this study was to assess its efficacy and surgical results with using $Mitracon^{(R)}$. Material and Method: From May 2003 to October 2005, 46 patients (21 women and 25 men (mean age of $51.4{\pm}17.8$ years) with mitral regurgitation from various causes were treated with either the $Mitracon^{(R)}$ (the $Mitracon^{(R)}$ group) or the Capentier Edward rigid ring (the CE group). The median follow-up duration was 18.9 months. Result: The mean grade of mitral regurgitation before and immediately after surgery in the $Mitracon^{(R)}$ group and the CE group decreased from $3.2{\pm}0.8$ to $0.6{\pm}0.7$ and $3.4{\pm}0.7$ to $0.3{\pm}0.5$, respectively. There were no significant changes in the ejection fraction either between the two groups or before and immediately after surgery. No deaths were seen in either group. Early postoperative echocardiography of all 46 patients showed only trivial mitral regurgitation or none at all. Echocardiography at a median of 18.9 months also showed no progression in mitral regurgitation. The mean grade of mitral regurgitation in the $Mitracon^{(R)}$ group at this time point decreased from $3.2{\pm}0.8$ to $0.8{\pm}0.7$ (p<0.05). The CE group also showed a similar degree of decrease from $3.4{\pm}0.7$ to $0.3{\pm}0.6$ (p<0.05). The mitral valve area in the $Mitracon^{(R)}$ group at 1 year follow-up was $3.3{\pm}0.9cm^2$. The mitral valve area in the CE group was $2.7{\pm}0.6cm^2$. The mean mitral pressure gradient in the $Mitracon^{(R)}$ group at 1 year follow-up was $3.1{\pm}1.3$ mmHg. The mean pressure gradient in the CE group was $4.5{\pm}2.1$ mmHg, although any statistical significant difference for this between the groups was not reached. Conclusion: The present study showed the described technique to be safe and effective in the intermediate term. Because long term results are unavailable, a more extensive prospective randomized multicenter trial may be warranted to determine whether this procedure should be generally applied for repair of mitral valve disease.

The Effects of Hypercapnia and High Flow on Cerebral Metabolism During Cardiopulmonary Bypass (심폐바이패스 시 고탄산분압과 고관류법이 뇌대사에 미치는 영향)

  • 강도균;최석철;윤영철;최국렬;정신현;황윤호;조광현
    • Journal of Chest Surgery
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    • v.36 no.7
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    • pp.472-482
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    • 2003
  • Recent studies have demonstrated that cerebral desaturation during rewarming period of CPB was associated with postoperative neurologic dysfunction. The prevention of cerebral desaturation during CPB may reduce the incidences of neurologic and neuropsychological complications. The present study was prospectively undertaken to compare the clinical effects between two strategies (hypercapnic CPB and high flow CPB) to prevent cerebral desaturation for establishing a proper CPB technique. Material and Method: Thirty-six adult patients scheduled for elective cardiac surgery were randomized into either hypercapnic (Pa$CO_2$ 45~50mmHg, n=18) or high flow group (flow rate 2.75 L/ $m^2$/min and Pa$CO_2$ 35~40mmHg, n=18) during rewarming period of CPB. In each patient, middle cerebral artery blood flow velocity ( $V_{MCA}$), cerebral arteriovenous oxygen content difference (C(a-v) $O_2$), modified cerebral metabolic rate for oxygen (MCMR $O_2$), cerebral oxygen transport rate ( $T_{E}$ $O_2$), incidence of cerebral desaturation (internal jugular bulb blood oxygen saturation $\leq$ 50%), increased rate of S-100 $\beta$ concentration, and arterial and internal jugular bulb blood gas were measured during the five phases of the operation; Pre-CPB, CPB-10 min (steady-state CPB, nasopharyngeal temperature 29~3$0^{\circ}C$), Rewarm-1 (rewarming phase, nasopharyngeal temperature 33$^{\circ}C$), Rewarm-2 (nasopharyngeal temperature 37$^{\circ}C$), and CPB-off. Incidence of postoperative delirium and duration were assessed in all patients. All variables were compared between the two groups. Result: $V_{MCA}$ (157.88$\pm$10.87 vs 120.00$\pm$6.18%, p=0.006), internal jugular bulb $O_2$ saturation (68.01$\pm$2.75 vs 61.28$\pm$2.87%, p=0.03) and $O_2$ tension (41.01$\pm$2.25 vs 32.02$\pm$ 1,67 mmHg, p=0.03), and $T_{E}$ $O_2$(110.84$\pm$7.41 vs 81.15$\pm$8.11%, p=0.003) at rewarming periods were higher in the hypercapnic group than in the high flow group. C(a-v) $O_2$ (4.0$\pm$0.30 vs 4.84$\pm$0.38 mg/dL, p=0.04), COE (0.36$\pm$0.03 vs 0.42$\pm$0.03, p=0.04), increased rate of S- 100$\beta$ (391.67$\pm$23.40 vs 940.0$\pm$17.02%, p=0.003), and incidence of cerebral desaturation (2 vs 4 patients, p=0.04) at rewarming periods, and duration of postoperative delirium (18 vs 34 hr, p=0.02) were low in the hypercapnic group compared to the high flow group. Conclusion: These results indicate that hypercapnic CPB may provide relatively diminished cerebral injury and beneficial effects for cerebral metabolism relatively compared to high flow CPB.low CPB.