Given that single blockade with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) can achieve only partial and undurable suppression of the Renin Angiotensin System (RAS), it has been hypothesized that dual blockage would be more beneficial in the management of blood pressure (BP) reduction and prevention of progressive chronic kidney disease (CKD) than either agent alone. Thus, it has been suggested that the combination of an ACEI and an ARB might provide renal benefits to hypertensive patients over and above BP reduction. However, this might also expose patients to additive or synergistic side effects. We attempted to conduct a systematic review to evaluate the benefits and harms of combination therapy in hypertensive patients with or without kidney diseases. MEDLINE and KoreaMed were searched for relevant randomized clinical trials in adult hypertensive patients with or without diabetes (restricted to 1997, limited to trials published in English). Results were summarized using the random-effects model, and between-studies heterogeneity was estimated with $I^2$. A final analysis of ten trials (23,928 patients) revealed that the combination of an ACEI and an ARB reduced blood pressure (SBP/DBP) by 3.95/2.02 mmHg (95% confidence interval [CI], -4.38 to -3.53/-2.33 to -1.71) compared with ACEI monotherapy, and 2.83/2.64 mmHg (95% CI, -3.25 to -2.41/-4.95 to -0.33) compared with ARB monotherapy. Eight trials (391 patients) demonstrated a significant reduction in 24h-proteinuria (weighted mean difference, 0.16 g/day, 95% CI, -0.26-0.05), but they did not translate into an improvement in GFR. Tests for heterogeneity showed no difference in effect among the studies. The combination therapy reduced proteinuria by 30% (95% CI, 23% to 37%) and 39% (95% CI, 31% to 48%) compared with ACEI monotherapy and ARB monotherapy, respectively. However, in patients who had proteinuria more than 0.5 g/day, the combination therapy failed to show significant reduction in urinary protein excretion. The current cumulative evidence suggests that diabetic patients with proteinuria on dual RAS blockade have an increase risk of adverse events such as hyperkalemia, hypotension, and so on, compared with ACEI or ARB alone. It is, therefore, proposed that the combination therapy should not be routinely used for the treatment of hypertension with or without compelling indications.
Park, Chang-Young;Chung, Ki-Soo;Lee, Jong-Duk;Chang, In-Su;Lee, Jungil;Kim, Jang-Lyul
Journal of Radiation Protection and Research
/
v.40
no.1
/
pp.46-54
/
2015
The thermoluminescence (TL) and optically stimulated luminescence (OSL) are commonly used to measure and record the expose of individuals to ionization radiation. Design and performance test results of a newly developed TL and OSL measurement system are presented in this paper. For this purpose, the temperature of the TL material can be controlled precisely in the range of $1{\sim}1.5^{\circ}C$ by using high-frequency (35 kHz) heating system. This high-frequency power supply was made of transformer with ferrite core. For optical stimulation, we have completed an optimal combination of the filters with the arrangement of GG420 filter for filtering the stimulating light source and a UG11 filter at the detecting window (PMT). By using a high luminance blue LED (Luxeon V), sufficient luminous intensity could be obtained for optical stimulation. By using various control boards, the TL/OSL reader device was successfully interfaced with a personal computer. A software based on LabView program (National Instruments, Inc.) was also developed to control the TL/OSL reader system. In this study, a multi-functional TL/OSL dosimeter was developed and the performance testing of the system was carried out to confirm its reliability and reproducibility.
IGRT(Image Guided Radiation Therapy) in radiation therapy is a very useful technique in order to increase setup of patient and position reproducibility. Tomotherapy can increase accuracy of setup to take IGRT by MVCT, but it be for verified accuracy of Image guided, and MVCT occurs the exposure of patient. Through this study, IGRT accuracy of Tomotherapy is very accurate within 1.0mm. When MVCT using Tomotherapy phantom for QA, QC be taken, exposure dose is Fine(2mm Slice thickness) 3cGy, Normal(4mm Slice thickness) 1.5cGy, Corse(6mmSlice thickness) 1.0cGy. Measurement value of spatial resolution using AAPM CT performance phantom did't cause a big difference. As a result, ability of IGRT in Tomotherapy is very accurate. While obtaining image for IGRT, we should minimize expose range because patient's be exposed to radiation. We should make an effort to do accurate radiation therapy to minimize exposure of patient by selecting the appropriate thickness of MVCT depending on patient's body and treat area.
The structures of reinforced concrete has been extensively increased with rapid development of industrial society. Futhermore, these reinforced concretes are easy to expose to severe corrosive environments such as sea water, contaminated water, acid rain and seashore etc.. Thus, corrosion problem of inner steel bar embedded in concrete is very important in terms of safety and economical point of view. In this study, multiple mortar test specimen(W/C:0.4) with six types having different cover thickness each other was prepared and was immerged in seawater solution for five years to evaluate the effect of cover thickness and immersion years to corrosion property of embedded steel bar. And the polarization characteristics of these embedded steel bars was investigated using electrochemical methods such as measuring corrosion potential, cathodic polarization curve, and cyclic voltammogram. At the beginning of immersion, the corrosion potentials exhibited increasingly nobler values with increasing cover thickness. However, after immersed for 5 years, the thicker cover of thickness, the corrosion potentials shifted in the negative direction, and the relationship between corrosion potential and cover thickness was not in good agreement with each other. Therefore, it is considered that the thinner cover of thickness, corrosive products deposited on the surface of the embedded steel bar plays the role as a resistance polarization which is resulted in decreasing the corrosion rate as well as shifting the corrosion potential in the positive direction. As a result, it seemed that the evaluation which corrosion possibility of the reinforced steel would be estimated by only measuring the corrosion potential may not be a completely desirable method. Therefore, it is suggested that we should take into account various parameters, including cover thickness, passed aged years as well as corrosion potential for more accurate assessment of corrosion possibility of reinforced steel which is exposed to partially or fully in marine environment for long years.
Recently, the fuel oil of diesel engines of marine ships has been increasingly changed to heavy oil of low quality as the oil price is getting higher and higher. Therefore, the spiral gear attached at the motor of the oil purifier which plays an important role to purify the heavy oil is also easy to expose at severe environmental condition due to the purification of the heavy oil in higher temperature. Thus, the material of the spiral gear requires a better mechanical strength, wear and corrosion resistance. In this study, the heat treatment(tempering) with various holding time at temperature of $500^{\circ}C$ was carried out to the alloy of Cu-7Al-2.5Si as centrifugal casting, and the properties of both hardness and corrosion resistance with and without heat treatment were investigated with observation of the microstructure and with electrochemical methods, such as measurement of corrosion potential, cathodic and anodic polarization curves, cyclic voltammogram, and a.c. impedance. in natural seawater solution. The ${\alpha}$, ${\beta}^{\prime}$ and ${\gamma}_2$ phases were observed in the material in spite of no heat treatment due to quenching effect of a spin mold. However, their phases, that is, ${\beta}^{\prime}$ and ${\gamma}_2$ phases decreased gradually with increasing the holding time at a constant temperature of $500^{\circ}C$. The hardness more or less decreased with heat treatment, however its corrosion resistance was improved with the heat treatment. Furthermore, the longer holding time, the better corrosion resistance. In addition, when the holding time was 48hrs, its corrosion current density showed the lowest value. The pattern of corroded surface was nearly similar to that of the pitting corrosion, and this morphology was greatly observed in the case of no heat treatment. It is considered that ${\gamma}_2$ phase at the grain boundary was corroded preferentially as an anode. However, the pattern of general corrosion exhibited increasingly due to decreasing the ${\gamma}_2$ phase with heat treatment. Consequently, it is suggested that the corrosion resistance of Cu-7Al-2.5Si alloy can be improved with the heat treatment as a holding time for 48 hrs at $500^{\circ}C$.
Journal of the korean academy of Pediatric Dentistry
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v.24
no.2
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pp.460-474
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1997
The purpose of this study was to evaluate and compare the effectiveness of various low-viscosity resin systems used as rebonding agents to prevent microleakage at the margins of class I composite resin restorations. Seventy sound human premolars were selected for experiment. Class I cavities were prepared and each cavity was conditioned with a 37% phosphoric acid for 15 sec, rinsed with water for 15 sec, and dried with compressed air. Bonding agent(Scotchbond Multipurpose, 3M Co.) was applied and a hybrid composite resin (Z-100, 3M Co.) was placed using an incremental technic. The excess cured composite resin was carefully removed with Sof-Lex discs(3M Co.) to expose the original margins of the cavity. The following seven groups were established : group 1 was not rebonded and used as control group ; group 2 was rebonded with a Scotchbond Multipurpose(3M Co.) and finished ; group 3 was rebonded with a Fortify(BISCO) and finished ; group 4 was rebonded with a Concise white sealant(3M Co.) and finished ; group 5 was rebonded with a Concise white sealant(3M Co.) and not finished ; group 6 was rebonded with a P&F sealant(BISCO) and finished; group 7 was rebonded with a P&F sealant(BISCO) and not finished. The specimens were then subjected to 500 thermocycles between 5 & 65 with a 10 see dwell time and immersed in 2% methylene blue dye solution for 24 hours and sectioned with low-speed diamond cutter into two part under water condition. The extent of microleakage at rebonded margins was evaluated microscopically and scored for dye penetration according to the following scale : 0=no dye penetration ; 1=dye penetration to half-way along axial wall between enamel surface and DEJ ; 2=dye penetration beyond halfway along axial wall between enamel surface and DEJ ; 3=dye penetration to the full depth of DEJ or beyond DEJ. Selected samples were prepared for SEM observation to determine the depth of penetration of the rebonding agent into the marginal interface. The obtained results were as follows: 1. In the group 2 and 3, which is rebonded with a Scotchbond Multipupose and Fortify, dye penetration score were decreased significantly than that of group 1 (P<0.05), but group 4 and 6 were not statistically different from group 1(P>0.05). 2. There were significant differences between group 4, 6 and group 5, 7 when compared by dye penetration score (P<0.05). 3. In the SEM observation, Scotchbond Multipurpose and Fortify were penetrated within $30-40{\mu}m$ depth of the outermost surface. However, both sealants were failed to penetrate into the debonded interface.
Journal of the korean academy of Pediatric Dentistry
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v.31
no.4
/
pp.665-670
/
2004
The mandibular buccal frenum becomes a problem when its attachment is too close to the marginal gingival. Heavy buccal frenum mucogingivally results in insufficient attached gingiva, inadequate vestibular depth and also difficulty in eruption of mandibular premolar. The aim of this study is to demonstrate the effectiveness of apically positioned partial-thickness flap as adequate method in order to remove heavy buccal frenum and expose impacted teeth. The author presents the case of a 12-year-old boy. He had problems that was prolonged eruption of #34, #35 due to high pull buccal frenum. After space regaining for normal eruption of #34, #35, we performed apically positioned partial-thickness flap on #34, 35 area. As a results, we confirmed that eruption of #34, #35 has been processed normally And vestibular depth, position of buccal frenum and width of attached gingival was within a normal range. Decrease in muscle pull, adequate width of attached gingiva and increased vestibular depth can be expected from this treatment.
Vest is a general term for a sleeveless upper garment and it derives from a kolobus of a sleeveless tunic style that was started to be worn as a substitution of a chiton by the peasantry in Greek period. The kolobus started to be called a colobium or a tunica from Roman period and the former was named for a vest style tunica which was worn by the people of the lower classes in early Roman period. Similarly, a German colobium of North Europe which was worn during the same period was the same kind of clothe as the Roman colobium. The colobium came to be worn over a dalmatica as an outer garment by early Christians when it was the Middle Ages, who succeeded the tradition of colobium as they went through ancient Rome, Creek and Byzantine days. North Germans also succeeded the colobium tradition of ancient Germans as it was and so continued to wear it in tight style. The simple vest style of colobium was getting vanished from the mid of the Middle Agnes and a new style of vest named jupon was started to be worn by soldiers. The jupon was to protect soldiers' bodies from either were cold weather or enemies wearing under armors as it was made with double cotton pad by quilt. From 14th century, the jupon began to be worn by not only soldiers but also the humble of lower classes. All the jupon which were made in quilting and padding of that time began to be named a pourpoint by the humble. When Renaissance in 16th century came, the pourpoint began to be developed to an exaggerating body-line style. The neckline of pourpoint was getting highly influenced by Spain and a peacecod-belly of it emphasized the exaggerated masculine beauty of Renaissance by padding in round. The sleeves were puffed out and the whole purpoint was made to expose an inner chemise by slashing vertically or obliquely. But in 17th century, the pourpoint has been changed into more simple style without padding, puffing out and slashing influenced by the citizens' clothes of Netherlands. The pourpoint came to be more comfortable bulky style with short sleeves or sleeveless and straight side lines. The pourpoint in mid 17th century turned to be a bolero jacket style by gradually being tightened. It had been then changed into a vest style with sleeves and worn under an overcoat with the name of vest in the end of 17th century. The early vest was 2∼3 inches les in length than the overcoat and had long sleeves and many ornamental buttons on front. It was also made as a home wear to be worn it alone at home. In 18th century, the length of the vest became shorter compared with that of 17th century and the most important decorative item in clothes. It again came to have complete sleeveless vest style and had very short length reaching waist in the end of 18th century. When it was in 19th century, the vest had developed into more various style and colors and style had been applied to be worn by individuals with their tastes. Around the end of 19th century, the increasing tendency to be casual by industrialization influenced on clothes in all aspects of life and so the male vest has been gradually changed into more casual style. Nowadays, it has been developing into various uses in modern male clothes to show their characters.
The purpose of this study was to examine the effects of anti-sperm antibody (ASA) on the fertilization processes using conventional IVF and ICSI procedure in human and hamster oocytes. In human IVF, we have observed restricted fertilization with sperm testing positive for ASA. ($23{\sim}90%$ IgA, 60-97 % IgG). However, if ICSI was perform in the next IVF cycle with the same patients, we could successfully fertilize the oocytes (37%; p<0.001), thus achieving pregnancy and delivery. When the sperm were cocultured in medium containing ASA, there were binding of ASA to sperm surface. In addition, the mean rate of the acrosomal reaction in an in vitro acrosome reaction test was lower for Ab-bound sperm (43.5%) than for Ab-free sperm group (51.3%, p<0.05). We used human sperm and hamster oocytes to confirm the negative effects of the ASA on fertilization. The sperm and/or oocytes have been expose to medium containing ASA before IVF and ICSI. In this experiment, the ASA was bound to the oocyte and sperm surface. The following results were obtain by using various combinations of ASA free or ASA bound sperm with ASA free or ASA bound oocytes for IVF. When ASA free sperm were inseminate with ASA free and ASA bound hamster oocytes, the fertilization rates are 89.6% and 74.3% respectively. However, when ASA bound human sperm were use the results were 62.5% and 55.6% respectively. These shows the fertilization rate was significantly decreased in both ASA bound and ASA free oocytes when using ASA bound sperm. No difference found when ASA are present on the oocyte surface. When the hamster oocytes was treated by ICSI with ASA free or ASA bound human spermatozoa, no significant difference was found. These results showed that ICSI is the most promising method for couples who fertilization was not possible by conventional IVF because of ASA.
Journal of the Korean Society of Marine Environment & Safety
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v.20
no.5
/
pp.468-473
/
2014
This study is unrefined ZnO, $TiO_2$ nanoparticles is expose M4 medium to search nanoparticle aggregation and Daphnia magna was any effect by immobilization and mortality. ZnO and $TiO_2$ nanoparticle powder-size is respectively 20 nm and 40 nm. but, M4 medium has about respectively as 1333 nm and 1628 nm, 40 to 70 times were agglomerated. Immobilization of ZnO and $TiO_2$ nanoparticles was influenced both time and concentration the higher to swimming of D.magna. Especially, The immobilization of D.magna in nano-ZnO is greater than that influence in nano-$TiO_2$. Mortality of ZnO nanoparticle is higher rate at long time and high concentration. $TiO_2$ nanoparticle observed mortality at 10ppm concentration after 72h. Consequently, when Nanoparticles is introduced into ocean. Particle size become grow. Additionally, aggregation be caused affect aquatic ecosystems.
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