• Journal of Chest Surgery
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• v.42 no.5
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• pp.597-603
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• 2009

Background: Atrioventricular valve regurgitation in pediatric patients with a functional single ventricles (FSV) - has been known as one of the important risk factors for death and unfavorable long-term results after a Fontan operation. We evaluated early and mid-term results of bivalvation valvuloplasty in FSV patients. Material and Method: We retrospectively evaluated 11 patients with a functional single ventricle who underwent bivalvationvalvuloplasty between 1999 and 2007. The degree of common atrioventricular valve regurgitation (CAVVR) was determined by color Doppler echocardiography (regurgitation grade scoring, trivial; 1, mild; 2, moderate; 3, severe; 4). Mean age at valve surgery was $6.9{\pm}7.0$ months (median 4 months, 24 days$\sim$21 months)and mean body weight was $6.2{\pm}2.8\;kg$ ($3.1{\sim}11.3\;kg$). Nine patients had isomerism heart and two of them had TAPVC. The concomitant procedures were performed in all but one patient. Additional commissural closure was performed in 3 patients and commissural annuloplasty in another 3 patients. Result: There was one hospital death after. surgery. A 32-day old patient who had been preoperatively dependent on a ventilator died of air way and lung problems 4.3 months after pulmonary artery banding and bivalvation valvuloplasty. Mean follow-up duration was 40 months ($4.3{\sim}114$ months). Mean preoperative CAVVR score was $3.3{\pm}0.6$, which decreased to $1.9{\pm}0.7$ postoperatively (p<0.0001). This residual regurgitation slightly increased to $2.2{\pm}0.4$ (no statistical significance) after a mean follow-up of 1.4.3 months. Six patients (60%) required re-operations for residual regurgitation at a subsequent bidirectionalcavopulmonary shunt or Fontan operation. One patient with Ebsteinoid malformation of the right sided atrioventricular valve required valve replacement due to stenoinsufficiency. Another patient required edge-to-edge repair at the right sided AV valve (between the right mural leaflet and the bridging leaflets). The remaining 4 patients required additional suture placements between bridging leaflets with or without commissural annuloplasty. All survivor had trivial or mild CAVVR at the latest follow-up. Conclusion: Bivalvation valvuloplasty for CAVVR in FSV patients is. an effective and safe procedure. However, significant numbers of the patients have small residual regurgitation and require additional valve procedures at subsequent operations. Long-term observations to monitor progression of the CAVVR is mandatory.

• Journal of agricultural medicine and community health
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• v.37 no.2
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• pp.84-95
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• 2012

Background: In Korea, private health insurance has neglected to induce externality on national health insurance by moral hazard. Therefore, we conducted this study in order to explore the influence of private health insurance on unnecessary medical utilization among patients with cervical or lumbar sprain. Method: The study examined a population of 449 patients (admission, 384; out-patient; 85) diagnosed with simple cervical or lumbar sprain without neurological symptoms at 20 small hospitals or clinics in Gwangju and Jeollanam provinces from Jul. 1 to Aug. 31 2008. The data were collected using structured, self-administrated questionnaire which collected information such as whether or not the patient was admitted (as a dependent variable), whether or not they had private health insurance (as a independent variable), and covariates such as socio-demographic characteristics, the factors related to the sprain, and characteristics of the insurance provider. Results: From hierarchical multiple logistic regression analysis, it was found that the admission rate of patient with private health insurance was higher than that those without it (Odds ratio=3.31, 95% Confidence interval; 1.14-9.58), meaning that private health insurance was an independent factor influencing the admission of patients with these conditions. Other determinants of admission were patient age and physician referral. Conclusions: This study is the first empirical study to explore the influence of private health insurance on inducing moral hazard in admission services, specifically among patients with cervical or lumbar sprain. Regulation of benefits provided by private health insurance may be necessary, as the effect of this moral hazard may mean existence of externality.

• Proceedings of the Korean Environmental Sciences Society Conference
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• 1998.10a
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• pp.2-4
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• 1998

Proliferation of Nocardia amarae cells in activated sludge has often been associated with the generation of nuisance foams. Despite intense research activities in recent years to examine the causes and control of Nocardia foaming in activated sludge, the foaming continued to persist throughout the activated sludge treatment plants in United States. In addition to causing various operational problems to treatment processes, the presence of Nocardia may have secondary effects on the fate of heavy metals that are not well known. For example, for treatment plants facing more stringent metal removal requirements, potential metal removal by Nocardia cells in foaming activated sludge would be a welcome secondary effect. In contrast, with new viosolid disposal regulations in place (Code o( Federal Regulation No. 503), higher concentration of metals in biosolids from foaming activated sludge could create management problems. The goal of this research was to investigate the metal sorption property of Nocardia amarae cells grown in batch reactors and in chemostat reactors. Specific surface area and metal sorption characteristics of N. amarae cells harvested at various growth stages were compared. Three metals examined in this study were copper, cadmium and nickel. Nocardia amarae strain (SRWTP isolate) used in this study was obtained from the University of California at Berkeley. The pure culture was grown in 4L batch reactor containing mineral salt medium with sodium acetate as the sole carbon source. In order to quantify the sorption of heavy metal ions to N amarae cell surfaces, cells from the batch reactor were harvested, washed, and suspended in 30mL centrifuge tubes. Metal sorption studies were conducted at pH 7.0 and ionlc strength of 10-2M. The sorption Isotherm showed that the cells harvested from the stationary and endogenous growth phase exhibited significantly higher metal sorption capacity than the cells from the exponential phase. The sequence of preferential uptake of metals by N. amarae cells was Cu>Cd>Ni. The specific surFace area of Nocardia cells was determined by a dye adsorption method. N.amarae cells growing at ewponential phase had significantly less specific surface area than that of stationary phase, indicating that the lower metal sorption capacity of Nocardia cells growing at exponential phase may be due to the lower specific surface area. The growth conditions of Nocardia cells in continuous culture affect their cell surface properties, thereby governing the adsorption capacity of heavy metal. The comparison of dye sorption isotherms for Nocardia cells growing at various growth rates revealed that the cell surface area increased with increasing sludge age, indicating that the cell surface area is highly dependent on the steady-state growth rate. The highest specific surface area of 199m21g was obtained from N.amarae cell harvested at 0.33 day-1 of growth rate. This result suggests that growth condition not only alters the structure of Nocardia cell wall but also affects the surface area, thus yielding more binding sites of metal removal. After reaching the steady-state condition at dilution rate, metal adsorption isotherms were used to determine the equilibrium distributions of metals between aqueous and Nocardia cell surfaces. The metal sorption capacity of Nocardia biomass harvested from 0.33 day-1 of growth rate was significantly higher than that of cells harvested from 0.5- and 1-day-1 operation, indicatng that N.amarae cells with a lower growth rate have higher sorpion capacity. This result was in close agreement with the trend observed from the batch study. To evaluate the effect of Nocardia cells on the metal binding capacity of activated sludge, specific surface area and metal sorption capacity of the mixture of Nocardia pure cultures and activated sludge biomass were determined by a series of batch experiments. The higher levels of Nocardia cells in the Nocardia-activated sludge samples resulted in the higher specific surface area, explaining the higher metal sorption sites by the mixed luquor samples containing greater amounts on Nocardia cells. The effect of Nocardia cells on the metal sorption capacity of activated sludge was evaluated by spiking an activated sludge sample with various amounts of pre culture Nocardia cells. The results of the Langmuir isotherm model fitted to the metal sorption by various mixtures of Nocardia and activated sludge indicated that the mixture containing higher Nocardia levels had higher metal adsorption capacity than the mixture containing lower Nocardia levels. At Nocardia levels above 100mg/g VSS, the metal sorption capacity of activate sludge increased proportionally with the amount of Noeardia cells present in the mixed liquor, indicating that the presence of Nocardia may increase the viosorption capacity of activated sludge.

• Clinical and Experimental Pediatrics
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• v.48 no.2
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• pp.138-142
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• 2005

Purpose : The purpose of the present study was to access the prevalence of orthostatic dysregulation(OD) and the frequency of each category for major and minor criteria among elementary school students using the OD questionnaire. Methods : We carried out inquiry by questionnaire as to the frequency of OD among two elementary schools with 725 students, 10 to 12 years of age, residing in Gwangju, Korea. The questionnaire was made according to criteria proposed by the Japan OD Study Group. Results : Of the 725 students(male 390; female 335) questioned, the OD was found in 338 students (53.5 percent). Prevalence of OD in males(59.2 percent) was significantly higher than in females(46.8 percent)(P<0.05). Palpitation with slight exercise(95.9 percent) was the most frequent major symptom. Headaches(85.8 percent) were the most frequent minor symptom among cases of OD. Conclusion : The prevalence of OD in elementary school students in this study(53.5 percent) was higher than in other studies. Contrary to studies from other countries, the male to female ratio was reversed. Because the diagnostic criteria seem to be dependent on subjective reporting of the symptoms, a newer diagnostic system based on more objective findings should be established.

• Korean Journal of Psychosomatic Medicine
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• v.11 no.2
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• pp.196-204
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• 2003

Objectives: It is known that sedative hypnotics would make cross tolerance with alcohol and deteriorate quality of sleep in alcoholics. Light therapy is effective non-pharmacological intervention for sleep disturbance in circadian phase disorders, jet-lag, shift-work and age-related sleep disorders. Authors would investigate the effects of morning light therapy on sleep of patients with alcohol dependence during recovery state without withdrawal symptoms. Methods: 13 patients with alcohol dependence who have not any alcohol withdrawal symptom were recruited. Light therapy during 1 hour in the morning had been administered by 2500 Lux light box through serial 3 days. Sleep state of subjects were assessed by sleep log and the subjective satisfaction at sleep was by 100 mm visual analogue scale. Sleepiness, depressive mood, anxiety were evaluated by 100mm visual analogue scale at 8 AM, 2 PM and 8 PM. For assessment of performance ability that would be associated with sleepiness and vigilance, trail making test A, B and digit symbol substitution test were performed by two times on base line and 4th day. Univariate repeated-measures ANOVAs were performed for each measures except performance tests which were analysed by paired t-test. Results: Sleep latency and sleep efficiency were significantly improved with light therapy and satisfaction at sleep was. There was no significant difference in sleepiness at 2 PM with light therapy but sleepiness at 8 AM significantly decreased and at 8 PM increased. The time to complete Trail making test and digit symbol substitution test were significantly shortened at 4th day compared with baseline. Fatigue at 8 AM were not significantly changed with light therapy but at 2 PM and 8 PM significantly decreased. Depressive mood and anxiety were not significantly changed with light therapy. Conclusion: Although this study had some limitations, it showed that light therapy would be effective modality on sleep disturbance of patients with alcohol dependence who have recovered from alcohol withdrawal symptoms. It is proposed that short term light therapy could be used clinically for alcoholics with insomnia. In the future, long term controlled studies using more objective tools for sleep are required to further investigate the effect of light therapy in alcoholics.

• Clinical and Experimental Pediatrics
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• v.50 no.4
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• pp.369-375
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• 2007

Purpose : There have been numerous researches on urine ${\beta}_2$-microglobulin (${\beta}_2$-M) concerned with primary nephrotic syndrome and other glomerular diseases, but not much has been done in relation to pediatric age groups. Thus, our hospital decided to study the relations between the analysis of the test results we have conducted on pediatric patients and renal functions. Methods : Retrospective data analysis was done to 102 patients of ages 0 to 4 with renal diseases with symptoms such as hematuria, edema, and proteinuria who were admitted to Chung-Ang Yongsan Hospital and who participated in 24-hour urine and urine ${\beta}_2$-M excretion test between January of 2003 and January of 2006. Each disease was differentiated as independent variables, and the statistical difference of the results of urine ${\beta}_2$-M excretion of several groups of renal diseases was analyzed with student T-test by using test results as dependent variables. Results : Levels of urine ${\beta}_2$-M excretion of the 102 patients were as follows : 52 had primary nephrotic syndrome [MCNS (n=45, $72{\pm}45{\mu}g/g$ creatinine, ${\mu}g/g-Cr$), MPGN (n=3, $154{\pm}415{\mu}g/g-Cr$), FSGS (n=4, $188{\pm}46{\mu}g/-Cr$], six had APSGN ($93{\pm}404{\mu}g/g-Cr$), seven had IgA nephropathy ($3,414{\pm}106{\mu}g/g-Cr$), 9 had APN ($742{\pm}160{\mu}g/g-Cr$), 16 had cystitis ($179{\pm}168{\mu}g/g-Cr$), and 12 had HSP nephritis ($109{\pm}898{\mu}g/g-Cr$). IgA nephropathy (P<0.05) and APN (P<0.05) were significantly higher than in other renal diseases. Among primary nephrotic syndrome, FSGS with higher results of ${\beta}_2$-microglobulin test had longer treatment period (P<0.01) when compared to the lower groups, but no significant differences in Ccr, BUN, or Cr were observed. Conclusion : IgA nephropathy and APN groups showed significantly higher level of ${\beta}_2$-M excretion value than other groups. Although ${\beta}_2$-microglobulin value is not appropriate as an indicator of general renal function and pathology, it seems to be sufficient in the differential diagnosis of the UTI and in the prediction of the treat-ment period of nephrotic syndrome patients.

• The Korean Journal of Pharmacology
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• v.27 no.1
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• pp.33-43
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• 1991

To study the age dependent change of Na, K-ATPase in the erythrocyte of hypertensive rat, 1-kidey 1-clip hypertensive rat was made by the removal of right kidney and partial ligation of left renal artery. After 4 weeks, aged erythrocyte fraction was separated by density gradient centrifugation, and Na, K-ATPase activity and $^3H-ouabain$ binding with ghost cell membrane and ouabain sensitive Rb-uptake with whole cell were measured. 1) In the hypertensive rats, blood pressure was significantly increased to 165.5/119.0 mmHg (systolic/diastolic). Mean corpuscular volume and membrane protein(mg) per $10^9RBC$ were decreased and hemoglobin content was increased in the aged erythrocyte. 2) Na, K-ATPase activity in the solution containing 110 mM NaCl and 10 mM KCI, was decreased in hypertensive rat, and decreased in aged erythrocyte of both group. 3) Ouabain sensitive Rb-uptake by low RbCl concentration(4 mM) was slightly decreased in aged erythrocyte compared to that in young erythrocyte of each group, but slightly increased in young erythrocyte in hypertensive rat compared to that in normotensive rat. 4) Ouabain sensitive Rb-uptake by high RbCl concentration(16 mM) was decreased about 30% to 50 % in aged erythrocyte in both group. And in hypertensive rat, especially in young erythrocyte it was significantly decreased compared to that in normotensive rats. 5) $^3H-ouabain$ binding at 0.13 or $1{\times}10^-6M$ ouabain concentration was slightly decreased in aged erythrocyte of normotensive rat, and significantly decreased in aged erythrocyte of hypertensive rats. 6) $^3H-ouabain$ binding at 6 or $64{\times}10^-6M$ ouabain concentration is slightly decreased in aged erythrocyte of both group, but significantly decreased in young and aged erythrocyte of hypertensive rats compared to that of normotensive rats. The present results suggest that (1) in the young erythrocyte of hypertensive rat, the alterations of Na-pump activity that slightly increased in weak stimulation and inhibited in strong stimulation, may be related to increased molecular activity and the decrease in the number of low affinity site without change in high affinity site, (2) in the aged erythrocyte of normotensive rat, inhibited Na-pump may be related to the change in molecular activity of pump. (3) And in the aged erythrocyte of hypertensive rat, it may be related to the decrease in the number of high and low affinity site as well as the change in molecular activity

• Journal of Preventive Medicine and Public Health
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• v.22 no.1 s.25
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• pp.146-152
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• 1989

To test the validity of referral of high risk pregnancy in the MCH Center, 6,017 pregnant women who visited MCH Center of South District Health Center for delivery between 1 April 1985 and 31 March 1987 were interviewed on arrival to obtain the data for demographic characteristics and obsteric history and traced to check the delivery outcome. Out of 5,820 women whose delivery outcomes were confrmed, 704 women(12.1%) were referred to other hospital or clinic for high risk factors. The proportion of poor delivery outcome(stillbirth, low birth weight and neonatal death) among referred cases was 4.4% while that of the women delivered at the MCH Center was 2.2% (p<0.01). Decision of the midwives for the referral of high risk pregnancy based on their clinical assessment was consistent with the delivery outcome (good or poor) in 86.5%. Major reasons for referral were premature rupture of membrane(46.5%) and cephalopelvic disproportion(20.0%) and the C-section rates for these cases were 10.1%, 17.6%, respectively. Discriminant analysis of the demographic characteristics and obstertric history for the discrimination of delivery outcome showed that gestational age had the highest discriminant function coefficient(0.88) and it was followed by parity(0.37) and maternal education(0.30). Referral of high risk pregnancy by the midwives based on their clinical assessment was considered to be reasonably valid. However, a risk scoring system for an MCH Center which can improve the validity may be developed if one applies the discriminant analysis for more comprehensive independent variable(including clinical assessment of midwife, demographic characteristics and obstetric history) and dependent variable (including medically indicated C-section, complication of pregnancy and delivery, stillbirth, low birth weight, neonatal death and maternal death).

• Applied Microscopy
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• v.41 no.2
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• pp.109-116
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• 2011

Polycystic ovary syndrome (PCOS) is hormonal imbalance condition as the endocrine and metabolic disorder that induces the infertility and various complications in reproductive age women. Estradiol valerate (EV) is used hormone replacement therapy in menopausal women and is reported that excessive administration of EV induces the PCOS. Nerve growth factor (NGF) is the factor to regulate the survival and maturation of developing neuronal cell and is also synthesized in ovary. And NGF is overexpressed in EV-induced polycystic ovary (PCO) as previously reported. Therefore, this study examined the possibility of NGF as can be used the biological marker in diagnosis of PCOS, the hormonal imbalance condition, using PCO and CHO (chinese hamster ovarian) cell lines. The concentration of EV treatment is optimized a 1 mg as not influence on the proliferation of CHO cell but 2 mg and 3 mg of EV treatment have the inhibition effect at initial stage. The morphological change was not observed in CHO cell after dose dependent manner treatment of EV. Expression of NGF mRNA and protein is significantly increased at 30 min after EV treatment in CHO cells compared to that of control. And NGF protein expression is strongly increased in PCO tissue, which observed many follicular cysts compared to normal ovary tissue. Taken together, overexpression of NGF may be act as a molecule to induce an abnormal development of follicle, suggesting that NGF can be used as a biological marker in diagnosis of PCOS.

• Korean Journal of Veterinary Research
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• v.32 no.1
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• pp.15-24
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• 1992

The effects of CC the ovulatory response, oocyte normality, ovarian steroidogenesis and subsequent embryo developmental potential were examined in PMSG-treated rats. On Days of 25~27 of age, immature female Sprague Dawley rats were treated with three different doses(0.05, 0.1 or 1.0mg /day) of clomiphene citrate or vehicle. The females subsequently received 4IU PMSG on Day 28 and/or 10IU hCG on Day 30, and were killed on Day 31. Some females given 0.1mg CC or vehicle with 4IU PMSG were then mated and killed on Days 2, 3, 4 and 5 of pregnancy. Compared to vehicle(control) group, by increasing the doses of CC, there were a significant decrease in the ovulatory response as judged by both the proportion of rats ovulating and the mean number of oocytes per rat and a marked reduction of ovarian weight. The increasing doses of CC substantially promoted the degeneration(%) of oocytes ovulating in a dose-dependent manner. The CC-mediated inhibitions of the ovulatory response and ovarian weight were oompletely overcome by a subsequent treatment of hCG. Increasing doses of CC resulted in a siginificant elevation of serum estradiol with the decreased levels of progesterone and androgens. The additive treatment with hCG was effective to reduce the elevation of estradiol and to increase the reduction of progesterone produced by high dose(1.0mg) of CC. The preimplantation embryos recovered from 0.1mg CC-treated pregnant rats demonstrated a progressive early loss from Day 3 of pregnancy with a significant increase in the percentage of degeneration during all periods examined, compared to controls. The rate of progressive embryo cleavage in the CC-treated rats were slower than that in controls from Day 3 of pregnancy. Additionally, the percentage of the cleaved embryos recovered from the CC-treated rats remained significantly lower consistently from Day 2 of pregnancy, compared to control regimen. These results demonstrate a possible mechanism of CC-mediated inhibition of ovulatory response in the rats which may include the attenuation or blockade of the endogenous secretion of gonadotropins and also suggest that its detrimental effects observed on oocyte normality and embryonic development may be caused by abnormal follicular steroidogenesis( especially elevated estradiol) preceding fertilization.