Background: Postpneumonectomy empyema(PPE) is an infrequent but potentially life-threatening complication. To date, various surgical efforts have been made to manage this complication. We reviewed our 20-year surgical experience of PPE and long-term follow-up data. Material and Method: Total of 37 patients who were treated for PPE between fan, 1980 and Jun, 2000 were included. Various clinical factors such as micro-organism, operative method and timing, presence of bronchopleural fistula(BPF), underlying disease and fate of empyema cavity were retrospectively reviewed and analyzed. Result: Majority of patients(34) underwent Eloesser operation for effective drainage. There was only one operative mortality. The causative organisms were Staphylococcus species and Pseudomonas species in 46% BPF was found in 20 cases, among which spontaneous closures took place in 4 cases. The chest wall was closed in 40%(8/20) of patients with BPF, compared to 59%(10/17) without BPF. The closure rate was statistically better in patients without BPF(p=0.006). Even though the patients with benign disease showed higher closure rate(50%) than those with lung cancer (31%), the difference was not significant(p=0.25). Conclusion: Eloesser procedure was an effective method for initial drainage of PPE cavity with low operative mortality. Given the findings of low spontaneous closure rate of BPF, aggressive approach to close the BPF is mandatory to achieve the final goal of chest wall closure. It was found that majority of patients still left their chest cavity opened, even after controlling the active inflammation of the empyema cavity. More aggnessive approach for chest wall closure is recommended in all patents with benign disease and in selective patients with lung cancer if there is no evidence of recurrence at several years after the initial operation.
Recently, the number of coronary artery bypass surgery(CABG) is increasing according to the increasing incidence of coronary artery disease. However, CABG is not a definite corrective surgery; therefore, in some patients, redo-CABG may be required. We retrospectively reviewed our redo-CABG experiences to help future redo-CABG. Material and Method: From January 1991 to April 2001, 14 cases of redo-CABG were performed in Yonsei Cardiovascular Center(M:F=12:2) and mean age was 61,7 $\pm$ 7.1(47-72) years. Mean time from 1st. CABG to redo-CABG was 121.9 $\pm$ 50.5(6.1-179.6) months. Thirteen cases were conventional on-pump CABG and one case was off-pump CABG. In two patients, mitral valve re-replacement and mitral valve repair were performed each. All redo-CABG were performed through mid-sternotomy. During redo-CABG, left internal mammary artery and saphenous vein grafts were used in 6 patients, left internal mammary artery and left radial artery grafts were used in 2 patients, left internal mammary artery and gastroepiploic artery were used in one patient and only greater saphenous veins were used in 5 cases(In one case, cephalic vein was also used). The number of mean distal anastomosis was 2.1 $\pm$ 0.9(1-4). Result: There were no operative death and no perioperative myocardial infarctions and cerebrovascular accidents or other heart related complications. Mean follow up duration was 40.1 $\pm$ 38.6(1.1-118.5) months. During follow up period, angina was re-developed in one patient 13 months after operation. Two patients died of end-stage renal failure 14.8 months and 116.3 months after redo-CABG, respectively. During follow up period, coronary angiography was performed in 3 patients, and all grafts were patent. At last follow up, mean Canadian class was 1.3. Kaplan-Meier survival at 9 years was 90.0 $\pm$ 9.5% and event free survival at 9 years was 71.4 $\pm$ 6.9%. Conclusion: After redo-CABG, all patients improved their angina symptom and daily activity. And long-term survival after redo-CABG was excellent. Therefore, if patients have indications for redo-CABG, thenredo-CABG must be strongly recommended and performed.
Background: The significance of MIDCAB is emerging topics recently as OPCAB is going to be universalized, and long-term outcome of bypass graft surgery was proved to be more excellent than balloon dilation or stent insertion. We report our MIDCAB results in 73 patients in the last three years. Material and Method: Retrospective analysis of medical records was done from November 1, 2000 through November 31, 2003. There were 47 males and 26 females ranging in age from 31 years to 79 years (average $61.3\pm9.8$ years). Observation periods after operative procedures were 10 to 1238 days (average $763\pm319.8$ days). Left longitudinal parasternal incision as a standard procedure was done to approach the heart after dissection of the left internal thoracic artery by partial or total resection of 3rd to 5th ribs. Result: Of those patients, 46 patients were transferred to ICU after extubation at operation room and 58 patients were extubated within 3 hours after operation. Average ICU staying periods was $26.8\pm11.5$ hours. Follow-up angiography during admission was done in 36 patients and showed 100% patency. Only one patient died on the 10$^{th}$ post operative day because of sudden CVA. Complications included wound problems in 4 patients, and constructing pericardial window using thoracoscopy due to continuous pericardial effusion in 1. Permanent pacemaker was inserted in one patient owing to sick sinus syndrome. In one patient with recurrence of angina 8 months after operation, stenosis at anastomic site was found and improved with balloon dilatation. Conclusion: We were satisfied with our results of MIDCAB in single and multi-vessel coronary artery disease. These results have made the cardiologists tried to operate positively and we expect widening operative indications including hybrid revascularization.
Recently, as the online market has matured, it is facing many problems to prevent the growth. The most common problem is the homogenization of online products, which fails to increase the number of customers any more. Moreover, although the portion of the online market has increased significantly, it now becomes essential to expand offline for further development. In response, many online firms have recently sought to expand their businesses and marketing channels by securing offline spaces that can complement the limitations of online platforms, on top of their existing advantages of online channels. Based on their competitive advantage in terms of analyzing large volumes of customer data utilizing information technologies (e.g., big data and artificial intelligence), they are reinforcing their offline influence as well through this online for offline (O4O) business model. On the other hand, most of the existing research has primarily focused on online to offline (O2O) business model, and there is still a lack of research on O4O business models, which have been actively attempted in various industrial fields in recent years. Since a few of O4O-related studies have been conducted only in an experience marketing setting following a case study method, it is critical to conduct an empirical study on O4O selection attributes and their impact on customer satisfaction and loyalty. Therefore, focusing on China's representative O4O business model, 'Fresh Hema,' this study attempts to identify some key selection attributes specialized for O4O services from the customers' viewpoint and examine the impact of these attributes on customer satisfaction and loyalty. The results of the structural equation modeling (SEM) with 300 O4O (Fresh Hema) experienced customers, reveal that, out of seven O4O selection attributes, four (mobile app quality, mobile payment, product quality, and store facilities) have an impact on customer satisfaction, which also leads to customer loyalty (reuse intention, recommendation intention, and brand attachment). This study would help managers in an O4O area well adapt to rapidly changing customer needs and provide them with some guidelines for enhancing both customer satisfaction and loyalty by allocating more resources to more significant selection attributes, rather than less significant ones.
The patterns of diel horizontal migration (DHM) of 7 copepod species are compared as part of a general investigation of the zooplankton adaptations to the surf zone habitats. In a sandy shore surf zone of Yongil Bay, 3 sites such as the bottom and surface of 1 m water depth and water's edge are sampled with a sledge net(n=108). The surf zone copepod assemblage is dominated by 7 species; Acartia hudsonica, Fseudodiaptomus marinus, Paracalanus indicus, Calanus sinicus, Oithona similis, Sinocalanus tenellus and Labidocera bipinnata. Threefold variations in copepod abundance are observed within a diel cycle. Abundances of 7 dominant species and total copepods captured in the surface exhibit significant diel differences, but those taken in the bottom are not significantly affected by diel period. It is shown that about $90\%$ of the surf zone copepods performed DHM. The nocturnal high densities of copepods occurred for a neap tide when the offshore winds prevailed, suggesting the animals' ability for horizontal orientation and an active locomotion without invoking passive transportation by currents. Photoreactive behavior of copepods triggered by relative changes in light intensity may be a primary factor inducing DHM by aggregating in the surf zone during the night and spreading out at day; then copepods may reduce encounters with visual predators. In A. hudsonica, ontogenetic variations in timings of DHM are evident. Such variations are likely to minimize intraspecific competition for diets. Data on shoreward migration of copepods indicate that A. hudsonica, P. indicus, O. similis and S. tenellus can maintain swimming velocities of about $20m\;h^{-1}$ for durations of more than an hour. Our observations of strong diel difference in abundances point out the need for both day and night samplings in surf zone habitats, if the importance of these habitats to planktonic copepods are to be fully understood.
Although Lamivudine and adefovir dipivoxil are efficacious drugs for preventing hepatocellular carcinoma (HCC) in chronic hepatitis B patients, their efficacy is far from completely satisfactory. The risk of liver cirrhosis and HCC begins to increase at an HBV DNA level of $10^4$ copies/ml. Even with latent or past HBV infection, episomal covalently closed circular DNA(cccDNA) plays a key rolein the persistence, relapse and resistance of HBV in its natural course or during therapy. The annual incidence of HCC in YUMC is 1.8% and 4.7% patients/year in the antiviral treatment and control groups, respectively. The ability to achieve a high rate of sustained HBV suppression with low risk of drug resistance is the ultimate goal in the treatment of chronic HBV infection. The efficacy of universal immunization with striking reductions in the prevalence of HBV in localized countries needs to be spread worldwide. With hepatitis B immunization and effective antiviral therapy, global control of HBV infection and HBV-related complications, including HCC, are possible by the end of the first half of the $21^{st}$ century.
Journal of the Korea Organic Resources Recycling Association
/
v.8
no.1
/
pp.90-96
/
2000
The composition of leachates varies depending on the waste characteristics, landfill age and landfilling method. Generally, leachates contain high dissolved organic substance and ammonia nitrogen whereas phosphorus concentration was very low. Leachate A produced from young landfill is characterized by high BOD5/COD ratio (0.8) whereas leachate C produced from old landfill has lower BOD5/COD ratio (0.1). Maximum biochemical methane potential of leachate A, B (from medium landfill) and C were 271,106 and 4 ml CH4/g-COD, respectively. On the other hand, the maximum biodegradability of leachate A, B, and C were 75,30, and 1%, respectively. These results indicated that anaerobic treatment of leachate from young landfill was effective in removing organic pollutants. In case of leachate C, carbon might reside in the form of large molecular weight organic compounds such as lignins, humic acids and other polymerized compounds of soils, which are resistant to biodegradation. The lag-phase period increased with the increasing organic concentration in leachate. In case of leachate A of concentration greater than 25%, the lag-phase period increased sharply. This implied that the start-up period of anaerobic process using an unacclimated inoculum could be extended due to the higher concentration of leachate. This relatively long lag-phase is probably related to the fact that most of the inhibitory compounds have been diluted beyond their inhibitory concentrations of less than 50%. Furthermore, the ultimate methane yield and methane production rate decreased as leachate concentration increased. It was anticipated the potential inhibition was related with the steady-state inhibition as well as the initial shock load.
Cultural Content industries based on imagination and creativity are attracting attention and the animation high value-added industry is still spotlighted. Among them, Disney Studios make money through using their professional skills. There are the know-how has developed for a long time, and there are timeless strategy. This study is analyzing by fantasy elements for knowing the messages of Disney animation. Fantasy defined as genre of literature by Todorov and Jackson emphasized its social role and significance. Hume expanded the area of fantasy and Tolkein Jahoriski and Boyer classified the fantasy according to the purpose. Through the analyzing Disney animation , Disney's fantasy show the specific expression depending on the target. Disney is based on the three types of fantasy depending on the growth of the journey. The first area is composed of the main character's growth and satisfy the desire and escapism, The second is the word of antagonist who opposed to reality and break the rules of the dominant ideology. The last area is the utopia provided after hero beat the antagonist. Disney characters give the messages by using the fantasy like the transformation or alter ego. That show the subject of the main character's growth and the supporting characters as the expression of the multiple personality of main. These emphasize the hero's growth and give the fun. Also, in the subject of the otherness, the hero always destroy the evil who broke the rules of reality. In this way, the fantasy offered by Disney give the messages of sacrifice and family from true love. Disney has the support of their target audiences continue to be able to convey ideology.
In order to gain insight into the physiological responses of plants to high temperature stress, the effects of temperature on Chinese cabbage (Brassica campestris subsp. napus var. pekinensis cv. Detong) were investigated through analyses of photosynthesis and chlorophyll fluorescence under 3 different temperatures in the temperature gradient tunnel. Growth (leaf length and number of leaves) during the rosette stage was greater at ambient $+4^{\circ}C$ and ambient $+7^{\circ}C$ temperatures than at ambient temperature. Photosynthetic $CO_2$ fixation rates of Chinese cabbage grown under the different temperatures did not differ significantly. However, dark respiration rate was significantly higher in the cabbage that developed under ambient temperature relative to elevated temperature. Furthermore, elevated growth temperature increased transpiration rate and stomatal conductance resulting in an overall decrease of water use efficiency. The chlorophyll a fluorescence transient was also considerably affected by high temperature stress; the fluorescence yield $F_J$, $F_I$, and $F_P$ decreased considerably at ambient $+4^{\circ}C$ and ambient $+7^{\circ}C$ temperatures, with induction of $F_K$ and decrease of $F_V/F_O$. The values of RC/CS, ABS/CS, TRo/CS, and ETo/CS decreased considerably, while DIo/CS increased with increased growth temperature. The symptoms of soft-rot disease were observed in the inner part of the cabbage heads after 7, 9, and/or 10 weeks of cultivation at ambient $+4^{\circ}C$ and ambient $+7^{\circ}C$ temperatures, but not in the cabbage heads growing at ambient temperature. These results show that Chinese cabbage could be negatively affected by high temperature under a future climate change scenario. Therefore, to maintain the high productivity and quality of Chinese cabbage, it may be necessary to develop new high temperature tolerant cultivars or to markedly improve cropping systems. In addition, it would be possible to use the non-invasive fluorescence parameters $F_O$, $F_V/F_M$, and $F_V/F_O$, as well as $F_K$, $M_O$, $S_M$, RC/CS, ETo/CS, $PI_{abs}$, and $SFI_{abs}$ (which were selected in this study), to quantitatively determine the physiological status of plants in response to high temperature stresses.
This study attempted to survey the present status of the eight students who, 17 years from now, had participated in a special program for 170 days preparing for early entrance to the KAIST. With six students who responded to the questionnaire previously sent, the study focused on each participant's achievement at present, his evaluation on Accelerated Education, his personal opinions on early entrance to university and Gifted Science Education. From the survey, we could find out that three participants had received a doctorate and they are currently working as researchers at research center or professors at university. The other three participants are working as researchers at research center after receiving the M. S. Academic achievements vary according to each participant, but three of them, who ranked high in research achievement, had their articles published in international journals of the SCI level even when they were between 25 and 28 of age. Two of them in particular showed outstanding engineering and developing the commercial modem for IMT 2000 for the first time in Korea. One participant entered Harvard University to major in physics and afterwards studied the law in UCLA. He is now a professor in the law department. Concerning the evaluations on Accelerated Education and early entrance system, four participants answered positively while two participants expressed negative attitudes. When asked their opinions on the Gifted Education in Korea, such problems were pointed out as too much pressure of entering the first-class universities, the tendency to avoid choosing science-related major at universities, the lack of education system that encourages creative thinking, etc. It is necessary that the accelerated education play an important role to maximize their hidden potentials. It remains to be seen in what places these six participants will find themselves and of what ideas they will come up within the next 17 years. It will be worthwhile to wait until then for another survey.
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