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Effects of Leukocyte Depleted Priming Solution on Cardiopulmonary Edema by Extracorporeal Circulation (백혈구제거 혈액성 충진액이 체외순환 후 심폐부종에 미치는 영향)

  • Kim, Si-Hoon;Kim, Young-Du;Jin, Ung;Jo, Keon-Hyun
    • Journal of Chest Surgery
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    • v.34 no.9
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    • pp.704-710
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    • 2001
  • Background: Extracorporeal circulation using pump-oxygenator is an inevitable process to keep vital sign during cardiac arrest for open heart surgery. However, the diversion of blood through nonendothelialized channels appears to stimulate inflammatory response, and leukocyte activation may lead to cardiopulmonary edema. Our study evaluated the effect of leukocyte-induced cardiopulmonary edema using three different pump-oxygenator priming solutions; non-hemic crystalloid solution ; leukocyte-depleted homologous blood; non leukocyte-depleted homologous blood in priming solutions. Material and Method: Each different priming solution was used on five dogs, and the effect of leukocyte-induced cardiopulmonary edema during cardiopulmonary bypass(CPB) was evaluated. For each dog after 2 hours of exracorporeal circulation and another 4 hours of post-pump period, the dog was sacrificed and its heart and lung tissues were obtained for measuring Wet/Dry ratio. Arterial $O_2$partial pressure(PaO$_2$) and $CO_2$partial pressure(Pa$CO_2$) were checked. For the evaluation of ventilatory function, $CO_2$partial pressure difference between arterial blood (Pa$CO_2$) and exhaled air(Et$CO_2$) was measured. Result: 1. No significant difference was seen in arterial PaO$_2$and Pa$CO_2$among groups. 2. Ventilatory function evaluated by Pa$CO_2$and Et$CO_2$showed no significant difference between non-hemic and blood-mixed priming solution (P<0.05). 3. Cardiac and lung Wet/Dry ratios were remarkedly lower in the leukocyte-depleted group. There was no significant difference between the non-hemic and blood-mixed groups. Conclusion: Based upon this result, we concluded that the leukocyte depletion from homologous blood of CPB priming solution has a beneficial effect in reducing cardiopulmonary edema compared with non leukocyte-depleted or crystalloid priming solutions.

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Effect of Left Atrial Volume Reduction with Maze Operation on Sinus Conversion and Recovery of Left Atrial Transport Function (Maze 수술 후 동율동 및 좌심방 수축능 회복에 대한 좌심방 부피 감소 성형술의 영향)

  • Hong Seong-Beom;Ryu Sang-Wan;Jung Eun-Kyung;Jung In-Suk;Bum Min-Sun;Park Jung-Min;Lee Kyo-Sun;Kim Sang-Hyung;Ahn Byung-Hee
    • Journal of Chest Surgery
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    • v.38 no.11 s.256
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    • pp.739-745
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    • 2005
  • Background: The Maze procedure considered the most effective method of treatment for atrial fibrillation. However, the sinus conversion rates decreased due to several factors, especially enlarged left atrium. The purpose of this study was to investigate the effects of Maze procedure with aen atrial volume reduction plasty on rheumatic mitral valve disease, Material and Method: From December of 200f to July of 2004, 45 patients received mitral valve and Maze operation. The patients were placed in either group f or group 2, based on the left atrial volume reduction plasty. The presence and onset of sinus rhythm and the incidence of trans mitral A waves were monitored during the postoperative 7 days and throughout the follow up period of 3 and 6 months. Mean follow up periods were 15.8 10.1 months in group 1 and $6.1\pm2.7$ months in group 2. Result: The sinus onset were $9.88\pm12.2$ days in group 1, and $1\pm3.6$ days in group 2 (p<0.01). The sinus conversion rates in the group 1 and 2 were $65\%,\;75\%$ (p=0.07) in the postoperative 7 days, $70.5\%,\;100\%$ (p<0.01) at postoperative 3 months, and $93\%,\;100\%$ (p<0.01) at postoperative 6 months, respectively. The wave detection rates in the postoperative 7days were $31.2\%\;and\;63.6\%$, and continued to improve over time to $83.3\%\;and\;100\%$ by 6months, respectively. Conclusion: The results suggest that Maze procedure with left atrial volume reduction plasty is effective for inducing sinus rhythm and for restoring left atrial contractile function after concomitant rheumatic mitral valve surgery. However further follow up of this patients for long time is necessary.

The Relationship of the LV Systolic Function, the LV Dimension and the LV Mass to QT Dispersion in Stable Angina Patients who are with or without Significant Coronary Stenosis (안정성협심증 환자에서 저명한 관상동맥 협착 유무와 좌심실 수축기능, 용적, 질량과 QT Dispersion 간의 관계)

  • Kwon, Jong-Bum;Yoon, Hee-Jeoung;Jin, Seung-Won;Her, Sung-Ho;Kim, Hyung-Doo;Kim, Kyung-Soo;Lee, Jong-Ho;Park, Khun
    • Journal of Chest Surgery
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    • v.41 no.4
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    • pp.439-446
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    • 2008
  • Background: The aim of this study was to investigate the relationship of the left ventricular (LV) systolic function, the LV dimension and the LV mass with the QT dispersion in patients with stable angina, and we also wanted to compare this relationship between patients with and without significant coronary stenosis on coronary angiography. Material and Method: 174 patients complained of typical angina and they had no associated ST segment or cardiac enzyme abnormalities. The patients were divided into 2 groups based on the results of coronary angiography: the patients with angiographic coronary stenosis ${\geq}50%$ made up group I (n=101), and the patients with angiographic coronary stenosis <50% made up group II (n=73). An echocardiogram for assessing the LV ejection fraction (EF), the LV dimension and the LV mass and a 12.lead electrocardiogram for assessing the QT dispersion were performed before the coronary angiography. Result: The QT dispersion was significantly greater in group I than that in group II (39.8 ms vs. 33.3 ms; p<0.05). For all the patients, all the parameters of LV dimension and LV mass had statistically positive correlation to the QT dispersion, but the LV mass was the only independently significant parameter that was correlated with the increased QT dispersion (p<0.05). For group I, none of the echocardiographic parameters had significant correlation with the QT dispersion. However, the LV dimension and LV mass had significantly positive correlation with the QT dispersion, and the LV mass was also the only independently significant parameter that was correlated with increased QT dispersion in group II (p<0.05). Conclusion: Our study demonstrated a significantly positive correlation of the QT dispersion to the LV dimension and the LV mass in patients with stable angina. These findings are present only in patients without significant coronary stenosis.

The Analysis of a Cerrobend Compensator and a Electronic Compensator Designed by a Radiation Treatment Planning System (방사선치료계획장치로 설계된 Cerrobend 선량보상체와 전자 선량보상체의 제작 및 특성 분석)

  • Nah Byung-Sik;Chung Woong-Ki;Ahn Sung-Ja;Nam Taek-keun;Yoon Mi-Sun;Song Ju-Young
    • Progress in Medical Physics
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    • v.16 no.2
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    • pp.82-88
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    • 2005
  • In this study, the physical compensator made with the high density material, Cerrobend, and the electronic compensator realized by the movement of a dynamic multileaf collimator were analyzed in order to verify the properness of a design function in the commercial RTP (radiation treatment planning) system, Eclipse. The CT images of a phantom composed of the regions of five different thickness were acquired and the proper compensator which can make homogeneous dose distribution at the reference depth was designed in the RTP. The frame for the casting of Cerrobend compensator was made with a computerized automatic styrofoam cutting device and the Millennium MLC-120 was used for the electronic compensator. All the dose values and isodose distributions were measured with a radiographic EDR2 film. The deviation of a dose distribution was $\pm0.99 cGy\;and\;\pm1.82cGy$ in each case of a Cerrobend compensator and a electronic compensator compared with a $\pm13.93 cGy$ deviation in an open beam condition. Which showed the proper function of the designed compensators in the view point of a homogeneous dose distribution. When the absolute dose value was analyzed, the Cerrobend compensator showed a $+3.83\%$ error and the electronic compensator showed a $-4.37\%$ error in comparison with a dose value which was calculated in the RTP. These errors can be admtted as an reasonable results that approve the accuracy of the compensator design in the RTP considering the error in the process of the manufacturing of the Cerrobend compensator and the limitation of a film in the absolute dosimetry.

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Enact of Ischemic Preconditioning on Myocardial Protection A Comparative Study between Normothermic and Moderate Hypothermic Ischemic Hearts Induced by Cardioplegia in Rats - (허혈 전처치가 심근보호에 미치는 영향 -적출 쥐 심장에서 상온에서의 심근허혈과 중등도 제체온하에서 심근정지액 사용 시의 비교 연구-)

  • 조성준;황재준;김학제
    • Journal of Chest Surgery
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    • v.36 no.4
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    • pp.242-254
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    • 2003
  • Most of the studies conducted have investigated the beneficial effects of ischemic preconditioning on normothermic myocardial ischemia. However, the effect of preconditioning could be attenuated through the use of multidose cold cardioplegia as practiced in contemporary clinical heart surgical procedures. The purpose of this study was to investigate whether preconditioning improves postischemic cardiac function in a model of 25℃ moderate hypothermic ischemic heart induced by cold cardioplegia in isolated rat hearts. Material and Method: The isolated Sprague-Dawley rat hearts were randomly assigned to four groups. All hearts were perfused at 37℃ for 20 minutes with Krebs-Henseleit solution before the baseline hemodynamic data were obtained. Group 1 consisted of preconditioned hearts that received 3 minutes of global ischemic preconditioning at 37℃, followed by 5 minutes of reperfusion before 120 minutes of cardioplegic arrest (n=6). Cold (4℃) St. Thomas Hospital cardioplegia solution was infused to induce cardioplegic arrest. Maintaining the heart at 25℃, infusion of the cardioplegia solution was repeated every 20 minutes throughout the 120 minutes of ischemic period. Group 2 consisted of control hearts that underwent no manipulations between the periods of equilibrium and 120 minutes of cardioplegic arrest (n=6). After 2 hours of cardioplegic arrest, Krebs solution was infused and hemodynamic data were obtained for 30 minutes (group 1, 2: cold cardioplegia group). Group 3 received two episodes of ischemic preconditioning before 30 min of 37℃ normothermic ischemia and 30 minutes of reperfusion (n=6). Group 4 served as ischemic controls for group 3 (group 3, 4: warm ischemia group). Result: Preconditioning did not influence parameters such as left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), rate-pressure product (RPP) and left ventricular dp/dt (LV dp/dt) in the cold cardioplegia group. (p=NS) However, preconditioning before warm ischemia attenuated the ischemia induced cardiac dysfunction, improving the LVSP, LVEDP, RPP, and LVdp/dt. Less leakage of CPK and LDH were observed in the ischemic preconditioning group compared to the control group (p<0.05). Conclusion: Ischemic preconditioning improved postischemic cardiac function after warm ischemia, but did not protect cold cardioplegic hearts.

Aortic Valvuloplasty in Pediatric Age (소아연령군에서의 대동맥판막성형술)

  • 임홍국;박천수;황호영;김웅한;이정렬;노준량;김용진
    • Journal of Chest Surgery
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    • v.37 no.8
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    • pp.652-659
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    • 2004
  • Background: In this study, we retrospectively analyzed the outcomes of aortic valvuloplasty in pediatric age. Material and Method: Between January 1993 and March 2004, 35 patients underwent aortic valvuloplasty for aortic stenosis (AS) or aortic regurgitation (AR). The mean age was 81.1$\pm$61.5 (1∼223) months. The mean follow up was 50.8$\pm$30.2 (3∼121) months. Nine patients had AS, 21 had AR, and 6 had AS and AR. Valve morphology was tricuspid in 24 patients, bicuspid in 9, quadricuspid in 1, and unicuspid in 1. The mean peak pressure gradients of AS were 72.0$\pm$33.0 mmHg, and the mean grades of AR were 3.1$\pm$0.9. Result: There was one late mortality without early mortality. After operation, AS improved with mean peak pressure gradients of 23.5$\pm$21.0 mmHg (p < 0.05), and AR improved with mean grades of 1.9$\pm$0.8 (p < 0.05). At mean follow up of 35.0$\pm$23.0 months, AS maintained with mean peak pressure gradients of 31.5$\pm$24.0 mmHg, but AR progressed with mean grades of 2.8$\pm$1.3 (p < 0.05). Reoperation was required in 6 patients 38.3$\pm$21.8 months after the original operation. The actuarial figures for freedom from reoperation at 2, 5 and 8 years were 96.9$\pm$3.1%, 79.5$\pm$5.5%, and 56.8$\pm$11.4%, respectively. Age at operation, presence of AS, preoperative severity of AS or AR, and morphology of aortic valve were not significant risk factors for reoperation, and improvement of AS or AR. Conclusion: Aortic valvuloplasty showed good immediate postoperative valve function. Aortic valvuloplasty offers children many years with tolerable valve function and allows to postpone aortic valve replacement or Ross procedure in pediatric patients.

Effect of Ischemic Preconditioning on Myocardial Protection - A Comparative Study between Normothermic and Moderate Hypothermic Ischemic Hearts Induced by Cardioplegia in Rats - (허혈 전처치가 심근보호에 미치는 영향 - 적출 쥐 심장에서 상온에서의 심근허혈과 중등도 저체온하에서 심근정지액 사용 시의 비교 연구 -)

  • 조성준;황재준;김학제
    • Journal of Chest Surgery
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    • v.36 no.5
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    • pp.242-254
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    • 2003
  • Background: Most of the studies conducted have investigated the beneficial effects of ischemic preconditioning on normothermic myocardial ischemia. However, the effect of preconditioning could be attenuated through the use of multidose cold cardioplegia as practiced in contemporary clinical heart surgical procedures. The purpose of this study was to investigate whether preconditioning improves postischemic cardiac function in a model of $25^{\circ}C$ moderate hypothermic ischemic heart induced by cold cardioplegia in isolated rat hearts. Material and Method: The isolated Sprague-Dawley rat hearts were randomly assigned to four groups All hearts were perfused at 37$^{\circ}C$ for 20 minutes with Krebs-Henseleit solution before the baseline hemodynamic data were obtained, Group 1 consisted of preconditioned hearts that received 3 minutes of global ischemic preconditioning at 37$^{\circ}C$, followed by 5 minutes of reperfusion before 120 minutes of cardioplegic arrest (n=6). Cold (4$^{\circ}C$) St. Thomas Hospital cardioplegia solution was infused to induce cardioplegic arrest. Maintaining the heart at $25^{\circ}C$, infusion of the cardioplegia solution was repeated every 20 minutes throughout the 120 minutes of ischemic period. Group 2 consisted of control hearts that underwent no manipulations between the periods of equilibrium and 120 minutes of cardioplegic arrest (n=6). After 2 hours of cardioplegic arrest, Krebs solution was infused and hemodynamic data were obtained for 30 minuts (group 1, 2: cold cardioplegia group). Group 3 received two episodes of ischemic preconditioning before 30 min of 37$^{\circ}C$ normothermic ischemia and 30 minutes of reperfusion (n=6) Group 4 soloed as ischemic controls for group 3 (group 3, 4: warm ischemia group). Result: Preconditioning did not influence parameters such as left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), rate-pressure product (RPP) and left ventricular dp/dt (LV dp/dt) in the cold cardioplegia group. (p=NS) However, preconditioning before warm ischemia attenuated the ischemia induced cardiac dysfunction, Improving the LVSP, LVEDP, RPP, and LV dp/dt. Less leakage of CPK and LDH were observed in the ischemic preconditioning group compared to the control group (p<0.05). Conclusion: Ischemic preconditioning improved postischemic cardiac function after warm ischemia, but did not protect cold cardioplegic hearts.

Experimental Studies on the Properties of Epoxy Resin Mortars (에폭시 수지 모르터의 특성에 관한 실험적 연구)

  • 연규석;강신업
    • Magazine of the Korean Society of Agricultural Engineers
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    • v.26 no.1
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    • pp.52-72
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    • 1984
  • This study was performed to obtain the basic data which can be applied to the use of epoxy resin mortars. The data was based on the properties of epoxy resin mortars depending upon various mixing ratios to compare those of cement mortar. The resin which was used at this experiment was Epi-Bis type epoxy resin which is extensively being used as concrete structures. In the case of epoxy resin mortar, mixing ratios of resin to fine aggregate were 1: 2, 1: 4, 1: 6, 1: 8, 1:10, 1 :12 and 1:14, but the ratio of cement to fine aggregate in cement mortar was 1 : 2.5. The results obtained are summarized as follows; 1.When the mixing ratio was 1: 6, the highest density was 2.01 g/cm$^3$, being lower than 2.13 g/cm$^3$ of that of cement mortar. 2.According to the water absorption and water permeability test, the watertightness was shown very high at the mixing ratios of 1: 2, 1: 4 and 1: 6. But then the mixing ratio was less than 1 : 6, the watertightness considerably decreased. By this result, it was regarded that optimum mixing ratio of epoxy resin mortar for watertight structures should be richer mixing ratio than 1: 6. 3.The hardening shrinkage was large as the mixing ratio became leaner, but the values were remarkably small as compared with cement mortar. And the influence of dryness and moisture was exerted little at richer mixing ratio than 1: 6, but its effect was obvious at the lean mixing ratio, 1: 8, 1:10,1:12 and 1:14. It was confirmed that the optimum mixing ratio for concrete structures which would be influenced by the repeated dryness and moisture should be rich mixing ratio higher than 1: 6. 4.The compressive, bending and splitting tensile strenghs were observed very high, even the value at the mixing ratio of 1:14 was higher than that of cement mortar. It showed that epoxy resin mortar especially was to have high strength in bending and splitting tensile strength. Also, the initial strength within 24 hours gave rise to high value. Thus it was clear that epoxy resin was rapid hardening material. The multiple regression equations of strength were computed depending on a function of mixing ratios and curing times. 5.The elastic moduli derived from the compressive stress-strain curve were slightly smaller than the value of cement mortar, and the toughness of epoxy resin mortar was larger than that of cement mortar. 6.The impact resistance was strong compared with cement mortar at all mixing ratios. Especially, bending impact strength by the square pillar specimens was higher than the impact resistance of flat specimens or cylinderic specimens. 7.The Brinell hardness was relatively larger than that of cement mortar, but it gradually decreased with the decline of mixing ratio, and Brinell hardness at mixing ratio of 1 :14 was much the same as cement mortar. 8.The abrasion rate of epoxy resin mortar at all mixing ratio, when Losangeles abation testing machine revolved 500 times, was very low. Even mixing ratio of 1 :14 was no more than 31.41%, which was less than critical abrasion rate 40% of coarse aggregate for cement concrete. Consequently, the abrasion rate of epoxy resin mortar was superior to cement mortar, and the relation between abrasion rate and Brinell hardness was highly significant as exponential curve. 9.The highest bond strength of epoxy resin mortar was 12.9 kg/cm$^2$ at the mixing ratio of 1:2. The failure of bonded flat steel specimens occurred on the part of epoxy resin mortar at the mixing ratio of 1: 2 and 1: 4, and that of bonded cement concrete specimens was fond on the part of combained concrete at the mixing ratio of 1 : 2 ,1: 4 and 1: 6. It was confirmed that the optimum mixing ratio for bonding of steel plate, and of cement concrete should be rich mixing ratio above 1 : 4 and 1 : 6 respectively. 10.The variations of color tone by heating began to take place at about 60˚C, and the ultimate change occurred at 120˚C. The compressive, bending and splitting tensile strengths increased with rising temperature up to 80˚ C, but these rapidly decreased when temperature was above 800 C. Accordingly, it was evident that the resistance temperature of epoxy resin mortar was about 80˚C which was generally considered lower than that of the other concrete materials. But it is likely that there is no problem in epoxy resin mortar when used for unnecessary materials of high temperature resistance. The multiple regression equations of strength were computed depending on a function of mixing ratios and heating temperatures. 11.The susceptibility to chemical attack of cement mortar was easily affected by inorganic and organic acid. and that of epoxy resin mortar with mixing ratio of 1: 4 was of great resistance. On the other hand, when mixing ratio was lower than 1 : 8 epoxy resin mortar had very poor resistance, especially being poor resistant to organicacid. Therefore, for the structures requiring chemical resistance optimum mixing of epoxy resin mortar should be rich mixing ratio higher than 1: 4.

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Physiological Function and Enzyme Activity of Koji Cultured by Aspergillus oryzae CNU O4-5 in the Various Grain Materials (원료(原料)의 종류(種類)와 형태(形態)에 따른 Aspergillus oryzae 국(麴)의 생리활성(生理活性) 및 효소력(酵素力))

  • Choi, Seong Hyun;Jeong, Jae-Hong;Lee, Sang Duck;Son, Hwa Young;Sung, Chang;Oh, Man Jin;Kim, Seung Yeol
    • Korean Journal of Agricultural Science
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    • v.24 no.2
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    • pp.283-289
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    • 1997
  • CNU O4-5 isolated from conventional Meju, which is used as raw material for making a soybean fermentation food, identified as an Aspergillus oryzae. To make koji, Aspergillus oryzae CNU O4-5 was cultured for 3-4 days at $30^{\circ}C$ with various grain materials such as flour, soybean powder, flour+soybean powder(1:1), soaked soybean and rice. The koji was evaluated for analyze the angiotesin converting enzyne(ACE) inhibition, antioxidative activity, superoxide dismutase(SOD) activity, amylase and protease activity. $\alpha$-amylase and glucoamylase activities of flour koji were higher than those of the koji soybean powder. However neutral and alkaline protease activities of flour koji were lower than those of flour+soybean powder and soybean koji. Amylase and protease activities of kojies of soaked soybean and rice showed very low level. The range of the ACE inhibition rate by hot water fraction of the kojies, which are cultured with various gain materials, were from 45% to 54%. The anti oxidative activity of ethanol-fraction of koji, which is made by using the soybean powder or soaked soybean, prolonged for 6 days in lard at $60^{\circ}C$. The SOD activity of grinded fraction of koji, which is made by using the flour or soybean powder, was same as 2,000 units per g of each koji.

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Strains of abutment and bones on implant overdentures (임플란트 피개의치에서 지대주와 골의 변형률에 관한 연구)

  • Kim, Myung-Seok;Heo, Seong-Joo;Koak, Jai-Young;Kim, Sung-Kyun
    • The Journal of Korean Academy of Prosthodontics
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    • v.47 no.2
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    • pp.222-231
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    • 2009
  • Statements of the problem: Over the past decades, conventional complete dentures were used for various patients although they have incomplete function. Overdentures using dental implants could help the improvement of denture function. Purpose: The purpose of this study was to compare the strains of abutment and bone on implant overdenture between splinted and unsplinted type of prosthesis. Additionally, the strain values of parallel placed implant model and unparallel placed implant model were compared. Material and methods: Two acrylic resin model were prepared and two implants were placed at the canine positions in each model. In the first model, two implant were placed parallel. In the second model, two implants were placed with 10 degree labiolingual divergence. Two types of abutment were connected to the fixtures alternatively. One was splint type of Hader bar, the other was unsplint type of ball abutment. Overdentures were fabricated with corresponding attachment systems and seated on abutments. Strains of abutments and labial bone simulants were measured with electric resistance strain gauges when static load from 100 N to 200 N were applied to overdentures. Results: 1. Splinted type of overdentures using bar and clip showed higher absolute strain values. But the strain was compressive and the load was shared by two implants(P<.05). 2. Unsplinted type overdentures using ball and O-ring showed low absolute strain values(P<.05). 3. Labially inclined implant showed higher tensile strain values in unsplinted type of prosthesis than in splinted type of prosthesis. Lingually inclined implant showed rather low strain values under load(P<.05). 4. Non parallel implant model showed higher absolute strain values than parallel placed implant model comprehensively(P<.05).