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Effect of the Community-Based Chronic Disease Management Service Using Information and Communication Technology (정보통신기술을 이용한 지역사회 기반 만성질환관리 서비스 효과 평가)

  • Eun Jin Park;Yun Su Lee;Tae Yon Kim;Seung Hee Yoo;Hye Ran Jin;Noor Afif Mahmudah;MinSu Ock;Tae-Yoon Hwang;Yeong Mi KIm;Jung Jeung Lee
    • Journal of agricultural medicine and community health
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    • v.49 no.3
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    • pp.257-270
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    • 2024
  • Objective: This study aimed to empirically evaluate the effectiveness of chronic disease management services utilizing ICT for patients with chronic illnesses. Methods: From May to December, 2023, 452 people who were diagnosed with hypertension and diabetes at 9 participating public health centers were provided with customized health care services for 24 weeks, and 15 performance indicators were analyzed to evaluate their effectiveness. Results: Health behavior indicators and health risk factors decreased before and after participation in the project, blood pressure control rate, hypertension and diabetes management rate, medication compliance, weight, BMI, BP, WC, FBG, and HDL-cholesterol improved(p<0.001). Service factors that influence the improvement of health behaviors included the number of activity monitor transmissions(p=0.049), confirmed concentrated consultations on physical activity(p=0.003) and nutrition(p=0.005), and the adherence to medication missions for hypertension(p=0.020). As for service factors influencing chronic disease management, the improvement in blood pressure regulation rate was due to the number of times the blood pressure monitor was linked(p=0.004), and the number of confirmed intensive consultations on physical activity(p=0.026), and nutrition(p=0.049); the improvement in hypertension control rate was due to the number of times the activity monitor and blood pressure monitor were linked(p<0.001), and the number of hypertension medication missions carried out (p=0.004); and the improvement in diabetes control rate was due to the number of times the blood pressure monitor(p=0.022) and blood sugar system were linked(p=0.017). Conclusion: Although this study has limitations as a comparative study before and after the service, it has proved that chronic disease management using ICT has a positive effect on improvement of health behavior indicator, reduction of health risk factors, hypertension, diabetes management index, weight, BMI, TG, BP, FBG improvement.

The Study of Characteristics of Consumer Purchasing Private Brand Products at Large-Scale Mart (국내 대형마트의 유통업체 브랜드 상품 구매 소비자의 특성 분석에 관한 연구)

  • Hwang, Seong-Huyk;Lee, Jung-Hee;Roh, Eun-Jung
    • Journal of Distribution Research
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    • v.15 no.4
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    • pp.1-19
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    • 2010
  • As having the movement of developing private brand (PB) goods, domestic big retailers are facing up with new problems. Thus, it is required studies of PB products, and how consumers recognize PB products as a consideration commodity set. Also, it is worthy in order that it gives us the important meaning on the marketing strategy with focusing on evaluating the differences between customers buying PB grocery goods with respect to demographic characteristics and purchasing behaviors. PB has some advantages for customers and retailers. However, according to AC Nielson's report (2005), Asian and emerging market has 1/5 sales relatively to Western countries. But we can assume that the emerging market has the most potential growth through this result. As a result from several other studies, it becomes necessary to not only increase the rate of selling composition of PB product temporarily, but also analyze the characteristics of customers using big retailers and segmenting customer groups to make PB product as a consideration commodity set for them. In addition, it is needed to have a variety of acts of marketing. From studies related to PB, there is a prejudice - cheap products have low quality - but, evaluation by customers who have used those products shows neutral stand, and there is a study representing that it is the most important to accumulate the belief between the retailers selling PB products and consumers using those for the accurate evaluation and intention on purchasing. Also, by the result from analyzing the characteristics of customers buying PB products, we could assume that higher income and higher education level, more preference on PB products. Especially, according to TNS's research, the primary targets of PB product are 30's who seeks value for money and planned spending habits, and 40's who have teenager children, and are interested in encouraging themselves. This paper used Probit model to analyze the characteristics of consumers. This model helps us to analyze with the variables representing the demographic characteristics of consumers (gender, age, educational level, occupation, income level, living area), and variables related to purchasing behavior (visiting frequency on big retailers, the average amount that they pay for goods in there, and check-up which brand made those goods). The method we used in this study is by man to man interview and survey on-line with the rate of 89% and 11% in Seoul and Gyunggi Province, respectively, for about one month from the beginning of February, 2008. As a result of this, under the assumption that people buy PB products more as long as they go shopping more, it was not meaningful for target groups which we pointed out as frequently visiting customers to be. Although, we have expected women buy more PB products than men do, gender doesn't mean anything for the result. And, it has inferred that married people buy more PB goods than singles do. It was also meaningless with variables related to occupation. Because housewives are often exposed to any kind of supermarket than workers are, we could not get any relatives. Moreover, we couldn't proof that younger generation prefer big retailers more than older people who 50~60's. Education levels doesn't affect on the purchase of PB product as well. Related to living area, the result is statistically not similar as we expected whether living in Seoul or not. It shows there is no relationship with the preference on retail brands and PB products, and it is similar with the study researched by TNS(2008) that customers tend to buy PB product impulsively no matter which brand it is and where they are even though their shopping place is the big market where customers are often using. Variables on which we had meaningful results are income level and living place. That is, customers who have 3,000,000~6,000,000 WON every month on average are more willing to buy PB products than other customers whose income is over 6,000,000 WON, and residents not living in Seoul prefer PB goods than those who are living in Seoul. To explain more about what we got, if there is only one condition about customer's visiting frequency on big retails, we could come up with this result that more exposed to PB products, more purchasing frequency. Consequently, it brings the important insight that large retailers have to prepare something to make customers visit them often to increase selling rate of PB products. To demonstrate the result of analyzing more, what is more efficient variables are demographically including marital status, income level, and residential area to buy items that affect the PB products and could include the frequency of visiting large markets by the purchase habits. Specifically, then, married couples rather than singles, middle-income customers than high-income customers, and local residents not living in Seoul than customers in Seoul are more likely to purchase PB goods. In addition, as long as a customer visits two times more, then the purchasing rate of PB products is to increase over 5.3%. Therefore, it seems that retailers are better to make a shopping place as fun and comfortable places. With overwhelming the idea that PB products are just cheap, one-time purchase goods, it is needed to increase the loyalty on those goods like NB products, try to make PB products as a consideration products set, and occur to sustainable sales. Especially, as suggested by this paper, it seems like it strongly needs to identify the characteristics of customers who prefer PB, to segment those customers, and to select the main target, and to do positioning with well-planned marketing strategies. Then, it is able to give us a meaningful point on marketing strategy by developing the field of PB study, identifying the difference of life style and shopping habits of customers.

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Ecological Characteristic between the Re-introduction Population and the Original Population (Jojong Stream, Sudong Stream) of Zacco koreanus in the Bongseonsa Stream, Korea (봉선사천의 참갈겨니(Zacco koreanus) 재도입 개체군과 원개체군(조종천, 수동천) 간 생태학적 특징)

  • Wang, Ju-Hyoun;Choi, Jun-Kil;Lee, Hyuk-Je;Lee, Hwang-Goo
    • Korean Journal of Environment and Ecology
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    • v.31 no.6
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    • pp.537-548
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    • 2017
  • The purpose of this study was to investigate the species composition and the aquatic environment of Jojong Stream and Sudong Stream, which were the original habitats of Zacco koreanus population and restored population re-introduced in Bongseonsa Stream. It also compared and analyzed the states of the growth and reproductive ability of Z. koreanus habiting in each of the three streams. The investigation was conducted in June 2016 which was known as the spawning season of Z. koreanus. The results of the physical aquatic environments showed the slight differences in altitude, width and depth of water among three streams, but the bottom structure was found to be quite different in the composition of the boulder, cobble, and pebble among the streams. The result of the physicochemical aquatic environment analysis showed that there were no significant differences in water temperature, pH, DO, BOD, and EC among the three stream. In the fish fauna investigation, 530 individuals of 11 species of 3 families were collected in Bongseonsa Stream, 293 individuals of 12 species of 4 families were collected in Jojong Stream, and 361 individuals of 11 species of 4 families were collected in Sudong Stream. All three streams were dominated by Z. koreanus and Z. platypus. Six Korean endemic species appeared in each of the three streams, showing the high occurrence rate of indigenous species of 50.0% or more. The aggregation index analysis revealed that the mean dominance index ranged from 0.63 (${\pm}0.05$, BS) to 0.72(${\pm}0.01$, JJ), mean diversity index from 1.55 (${\pm}0.06$, JJ) to 1.78 (${\pm}0.11$, BS), mean evenness index from 0.71 (${\pm}0.03$, JJ) to 0.76 (${\pm}0.02$, BS), and mean richness index from 1.61 (${\pm}0.33$, JJ) to 1.73 (${\pm}0.24$, SD). The result indicated that the observed differences between the stream community indices were statistically nonsignificant. The similarity analysis showed that 75.4% similarity was divided into two groups of A and B and that the fish fauna on each analyzed point was similar. The quantitative habitat evaluation index (QHEI) analysis showed that the average value of QHEI was 151.0 (${\pm}46.0$), which means that it was a suboptimal habitat environment. The result of length-weight analysis of Z. koreanus populations showed that the regression coefficient b of the restoration population and the original habitat population were at 3.0 or higher while the condition factor had a positive slope. Moreover, it was found that the slopes of the regression coefficient b and condition factor of the original habitat population were larger than the restored population. The analysis of the length frequency distribution of the Z. koreanus population revealed that all three streams maintained the stable life cycle although it was found that the growth rate of the original habitat population was faster than the restored population in the one-year-old class. The result of the gonadosomatic index (GSI) analysis showed that the GSI median value of the Z. koreanus population in the restored habitat Bongseonsa Stream was higher than the population in the original habitat Jojong Stream and Sudong Stream for both of males and females.

Gene Expression Profiles in Cervical Cancer with Radiation Therapy Alone and Chemo-radiation Therapy (자궁경부암의 방사선치료 및 방사선항암화학 병용치료에 따른 유전자발현 조절양상)

  • Lee Kyu Chan;Kim Meyoung-kon;Kim Jooyoung;Hwang You Jin;Choi Myung Sun;Kim Chul Yong
    • Radiation Oncology Journal
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    • v.21 no.1
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    • pp.54-65
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    • 2003
  • Purpose : To analyze the gene expression Profiles of uterine ceulcal cancer, and its variation after radiation therapy, with or without concurrent chemotherapy, using a CDNA microarray. Materials and Methods :Sixteen patients, 8 with squamous ceil carcinomas of the uterine cervix, who were treated with radiation alone, and the other 8 treated w14h concurrent chemo-radiation, were Included in the study. Before the starling of the treatment, tumor biopsies were carried out, and the second time biopsies were peformed after a radiation dose of 16.2$\~$27 Gy. Three normal cervix tissues were used as a control group. The microarray experiments were peformed with 5 groups of the total RNAs extracted individually and then admixed as control, pre-radiation therapy alone, during-radiation therapy alone, pre-chemoradiation therapy, and during-chemoradlation therapy. The 33P-iabeled CDNAS were synthesized from the total RNAs of each group, by reverse transcription, and then they were hybridized to the CDNA microarray membrane. The gene expression of each microarrays was captured by the intensity of each spot produced by the radioactive isotopes. The pixels per spot were counted with an Arrayguage, and were exported to Microsoft Excel The data were normalized by the Z transformation, and the comparisons were peformed on the Z-ratio values calculated. Results : The expressions of 15 genes, including integrin linked kinase (ILK), CDC28 protein kinase 2, Spry 2, and ERK 3, were increased with the Z-ratio values of over 2.0 for the cervix cancer tissues compared to those for the normal controls. Those genes were involved In cell growth and proliferation, cell cycle control, or signal transduction. The expressions of the other 6 genes, Including G protein coupled receptor kinase 5, were decreased with the Z-ratio values of below -2.0. After the radiation thorapy, most of the genes, with a previously Increase expressions, represented the decreased expression profiles, and the genes, with the Z-ratio values of over 2.0, were cyclic nucleotlde gated channel and 3 Expressed sequence tags (EST). In the concurrent chemo-radiation group, the genes involved in cell growth and proliferation, cell cycle control, and signal transduction were shown to have increased expressions compared to the radiation therapy alone group. The expressions of genes involved in anglogenesis (angiopoietln-2), immune reactions (formyl peptide receptor-iike 1), and DNA repair (CAMP phosphodiesterase) were increased, however, the expression of gene involved In apoptosls (death associated protein kinase) was decreased. Conclusion : The different kinds of genes involved in the development and progression of cervical cancer were identified with the CDNA microarray, and the proposed theory is that the proliferation signal stalls with ILK, and is amplified with Spry 2 and MAPK signaling, and the cellular mitoses are Increased with the increased expression oi Cdc 2 and cell division kinases. After the radiation therapy, the expression profiles demonstrated 4he evidence of the decreased cancer cell proliferation. There was no sigificant difference in the morphological findings of cell death between the radiation therapy aione and the chemo-radiation groups In the second time biopsy specimen, however, the gene expression profiles were markedly different, and the mechanism at the molecular level needs further study.

Clinical Features of Acute Nonspecific Mesenteric Lymphadenitis and Factors for Differential Diagnosis with Acute Appendicitis (급성 비특이성 장간막 림프절염의 임상 소견과 급성 충수돌기염과의 감별 인자)

  • Shin, Kyung Hwa;Kim, Gab Cheol;Lee, Jung Kwon;Lee, Young Hwan;Kam, Sin;Hwang, Jin Bok
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.7 no.1
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    • pp.31-39
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    • 2004
  • Purpose: Although acute nonspecific mesenteric lymphadenitis (ANML) is probably common cause of abdominal pain in children, which can be severe enough to be an abdominal emergency, the clinical features of mesenteric lymphadenitis are not clear. Also, a differential diagnosis with acute appendicitis (APPE) is indispensable to avoid serious complications. The clinical features of ANML were determined, and the risk factors for differential diagnosis with APPE were analyzed. Methods: Between November 2000 and May 2001, data from 26 patients (aged 1 to 11 years) with ANML and 21 patients (aged 2 to 13 years) with APPE were reviewed. ANML was defined as a cluster of five or more lymph nodes measuring 10 mm or greater in their longitudinal diameter in the right lower quadrant (RLQ) without an identifiable specific inflammatory process on the ultrasonographic examination. There were risk factors on patient's history, physical examination, and laboratory examination; the location of abdominal pain, abdominal rigidity, rebound tenderness, fever, nocturnal pain, the vomiting intensity, the diarrhea intensity, the symptom duration, and the peripheral blood leukocytes count. Results: Of the 26 ANML patients and 21 APPE patients, abdominal pain was noted on periumbilical (76.9% vs 14.2%), on RLQ (11.5% vs 71.4%), with abdomen rigidity (7.6% vs 80.9%), with rebound tenderness (0.0% vs 76.1%)(p<0.05), in the lower abdomen (11.5% vs 14.2%), and at night (80.8% vs 100.0%) (p>0.05). The clinical symptoms were vomiting (38.4% vs 90.4%), the vomiting intensity ($1.5{\pm}0.7$ [1~3]/day vs $4.5{\pm}2.9$ [1~10]/day), diarrhea (65.3% vs 28.5%) (p<0.05), and fever (61.5% vs 76.2%)(p>0.05). The period to the subsidence of abdominal pain in the ANMA patients was $2.5{\pm}0.5$ (2~3) days. The laboratory data showed a significant difference in the peripheral blood leukocytes count ($8,403{\pm}1,737[5,900{\sim}12,300]/mm^3\;vs\;15,471{\pm}3,749[5,400{\sim}20,800]/mm^3$)(p<0.05). Discriminant analysis between ANML and APPE showed that the independent discriminant factors were a vomiting intensity and the peripheral blood leukocytes count and the discriminant power was 95.7%. Conclusion: The clinical characteristics of ANML were abrupt onset of periumbilical pain without rigidity or rebound tenderness, a mild vomiting intensity, normal peripheral leukocytes count, and relatively short clinical course. If the abdominal pain persist for more than 3 days, and/or the vomiting intensity is more than 3 times/day, and/or the peripheral leukocytes count is over $13,500/mm^3$, abdominal ultrasonography is recommended to rule out APPE.

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Community Composition and Functional Feeding Groups of Aquatic Insects According to Stream Order from the Gapyeong Creek in Gyeonggi-do, Korea (경기도 가평천의 하순에 따른 수서곤충 군집조성과 섭식기능군)

  • Won, Doo-Hee;Hoang, Duc-Huy;Jin, Young-Hun;Hwang, Jeong-Mi;Bae, Yeon-Jae
    • Korean Journal of Ecology and Environment
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    • v.36 no.1 s.102
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    • pp.21-28
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    • 2003
  • Community composition and functional feeding groups of aquatic insects according to stream order were investigated from the Gapyeong Creek, a typical mid-sized Korean stream in Gyeonggi -do, Korea, in April 2000. For field investigations, the main watercourse and three major tributaries of the stream that belong to stream order ll to Vll were divided into reaches (ca. $1{\sim}4$ km in distance). Aquatic insects were sampled from one or two sites each reach (total 30 sites) using a Surber sampler ($50{\times}50$cm, mesh 0.75 mm). As a result of the quantitative samplings(two Surber samplings at riffle and pool/run per site; total $2{\times}30$=60 Surber samplings) and additional qualitative samplings, a total of 164 species of aquatic insects in 103 genera, 54 families, and 8 orders were collected from the stream. Those aquatic insects were composed of Trichoptera (56spp.: 34.1%), Ephemeroptera (43 spp.: 26.2%), Diptera (25spp.: 15.2%), Plecoptera (23 spp.: 14.0%), Coleoptera (6 spp.: 3.7%), Odonata (6 spp.:3.7%), Hemiptera (3 spp.: 1.8%), and Megaloptera (2 spp.: 1.2%); EPT-group (122 spp.:74.4%) or EPT-group plus Diptera (147 spp.: 89.6%) occupied most of the aquatic insect community; relatively larger number of species occurred in the mid-stream reaches (order III-Vl). The quantitative samplings throughout the study sites yielded a total of 26,286 individuals of aquatic insects ($136{\sim}2522$ inds./0.5 $m^2$, mean 906.4inds./0.5 $m^2$) that belongs to Ephemeroptera (11,994 inds.: 45.6%), Diptera (8730 inds.:33.2%), Trichoptera (4123 inds.: 15.7%), Plecoptera (1213 inds.: 4.6%), Coleoptera (204 inds.: 0.8%), Odonata (13 inds.: 0.05%), Megaloptera (5 inds.: 0.02%), and Hemiptera (4inds.: inds.: 0.02%); average number of individuals of aquatic insects increased as the stream order increased: average numbers of individuals of Bllecoptera and Trichoptera decreased and increased, respectively, as the stream order increased. Tolerant species such as Chironomidae spp., Uracanthella rufa and Hydropsychidae spp. were particularly abundant in the down stream reaches (order Vll) . Species diversity indices (H`) and dominance indices (Dl) were relatively higher and lower, respectively, in the mid-stream reaches (order $IV{\sim}VI$). Shredders occupied the smallest partand collector-gatherers were most abundant among the functional feeding groups(FFGs); collector-filterers considerably increased in the down stream reaches (orders Vl and VII); scrappers were relatively evenly distributed throughout the stream reaches: predators were relatively more abundant in the uppermost stream reaches(order ll) . Overall, the characteristics of aquatic insect comminity and FFGs in the Gapyeong Creek are largely similar to those in the normal streams of temperate deciduous forest in the northern hemisphere that is explained by the river confineum concept.

Growth and Yield Characteristics of Foxtail Millet, Comon Millet Cereal Crops on Marginal Agricultural Lands (조건 불리 한계농경지에서의 조, 수수, 기장의 생육 및 수량)

  • Yoon, Seong-Tak;Lee, Myung-Cheol;Kim, Jeong-Soon;Zhang, Qingyu;Xu, Zhen-Yu;Kim, Young-Bok;Kim, Tae-Ho;Nam, Jung-Chang;Nam, Min-Hee;Lee, Young-Hawn;Hwang, Jae-Bok;Shim, Sang-In;Kim, Seong-Min
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.55 no.4
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    • pp.350-356
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    • 2010
  • This experiment was conducted to select optimum minor cereal crop and variety for the marginal agricultural lands so that they would be used to increase the agricultural land use rate in mountainous areas. This experiment used three different marginal agricultural lands, that is, slope land, barren land and gravelly land. Soil pH of control field was 7.85, slightly alkali, whereas gravelly land showed strong acid(pH 5.1). EC of marginal agricultural lands was generally lower compared to the control, especially barren land showed 0.05dS $m^{-1}$ which was the lowest among marginal agricultural lands. Foxtail millet showed no significant difference of heading and ripening date among marginal agricultural lands. Foxtail millet of slope land showed the highest culm length(169.5 cm) and grains per ear(4913.9 grains) among marginal agricultural lands except control field. Growth duration of three varieties was varied from 112 to 113days, which was not different statistically. In grains per ear of common millet, slope land showed 787.1 grains which was the highest among marginal agricultural lands except control field. Among varieties, Byorukgijang showed the highest grains per ear(827.2 g/ear), whereas 1000 grain weight was 5.5 g which was lower compared to that of Hwanggijang(6.2 g). In sorghum, slope land showed the highest grains(2563.8 grains) per ear and ears per 3.3 $m^2$(26.0 ears) except control field. Growth duration of three sorghum varieties almost the same from 122 to 123 days, whereas the highest grains per ear was obtained from Moktaksusu(2357.6 grains). Jangmoksusu showed the highest 1000 grain weight(23.8 g) among three sorghum varieties. In yield of three foxtail millets, the highest yield was obtained from slope land(282.0 kg/10a) among marginal agricultural lands and Mongdangjo showed the highest yield(252.3 kg/10a) among three varieties. In yield of three common millets, the highest yield was obtained from slope land(196.0 kg/10a) among marginal agricultural lands and Byorukgijang showed the highest yield(173.8 kg/10a) in three varieties. In three sorghum varieties, the highest yield was obtained from slope land(301.7 kg/10a) among marginal agricultural lands and Moktaksusu showed the highest yield(236.5 kg/10a) among three varieties.

Surgical Treatment of Anomalous Origin of Coronary Artery from the Pulmonary Artery: Postoperative Changes of Ventricular Dimensions and Mitral Regurgitation (관상동맥-폐동맥 이상기시증(Anomalous Origin of Coronary Artery from Pulmonary Artery)의 수술적 치료: 중기 성적과 좌심실 및 승모판 기능의 변화 양상에 대한 연구)

  • Kang, Chang-Hyun;Kim, Woong-Han;Seo, Hong-Joo;Kim, Jae-Hyun;Lee, Cheul;Chang, Yoon-Hee;Hwang, Seong-Wook;Back, Man-Jong;Oh, Sam-Se;Na, Chan-Young;Han, Jae-Jin;Lee, Young-Tak;Kim, Chong-Whan
    • Journal of Chest Surgery
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    • v.37 no.1
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    • pp.19-26
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    • 2004
  • Background: The aims of this study are to verify the result of the surgical treatment of ALCAPA and to identify the postoperative changes of left ventricular dimensions and mitral regurgitation (MR), Material and Method: Fifteen patients operated on since 1985 were included in the study. The patients operated on before 1998 (n=9) showed heterogeneous properties with various surgical strategies and cardiopulmonary bypass techniques. However, six patients were operated on with the established surgical strategy since 1998; 1) Dual perfusion and dual cardioplegic solution delivery through ascending aorta and main pulmonary artery, 2) Coronary transfer by rolled-conduit made of pulmonary artery wall flap, and 3) Additional mitral valvular procedure was not peformed. Result: Median age of the study group was 6 months (1 month to 34 years). The operative methods were left subclavian artery to left coronary artery anastomosis in 1, simple ligation in 2, Takeuchi operation in 2, and coronary reimplantation in 10 patients. The mean follow up period was 5.5<5.8 years (2 months 14 years), There were one early death (6.7%) and one late death. Overall 5-year survival rate was 85.6$\pm$9.6%. The Z-value of left ventricular end-diastolic and end-systolic dimensions were 6.4$\pm$3.0 and 5.1 $\pm$3.6 preoperatively, and decreased to 1.7$\pm$ 1.9 and 0.8$\pm$ 1.6 in 3 months (p<0.05). Significant preoperative MR was identified in 6 patients (40%) and all the patients showed immediate improvement of MR within f month postoperatively. There were 3 cases of reoperation due to coronary anastomosis site stenosis and recurrence of MR. However, there was no mortality nor late reoperation in the patients operated on after 1998. Conclusion: The surgical treatment of ALCAPA showed favorable survival and early recovery of ventricular dimensions and mitral valvular function. Although long-term reintervention was required in some cases of earlier period, all the cases after 1998 showed excellent surgical outcome without long-term problem.

The Clinical Application and Results of Palliative Damus-Kaye-Stansel Procedure (고식적 Damus-Kaye-Stansel 술식의 임상적 적용 및 결과)

  • Lim, Hong-Gook;Kim, Soo-Jin;Kim, Woong-Han;Hwang, Seong-Wook;Lee, Cheul;Shinn, Sung-Ho;Yie, Kil-Soo;Lee, Jae-Woong;Lee, Chang-Ha
    • Journal of Chest Surgery
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    • v.41 no.1
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    • pp.1-11
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    • 2008
  • Background: The Damus-Kaye-Stansel (DKS) procedure is a proximal MPA-ascending aorta anastomosis used to relieve systemic ventricular outflow tract obstructions (SVOTO) and pulmonary hypertension. The purpose of this study was to review the indications and outcomes of the DKS procedure, including the DKS pathway and semilunar valve function. Material and Method: A retrospective review of 28 patients who underwent a DKS procedure between May 1994 and April 2006 was performed. The median age at operation was 5.3 months ($13\;days{\sim}38.1\;months$) and body weight was 5.0 kg ($2.9{\sim}13.5\;kg$). Preoperative pressure gradients were $25.3{\pm}15.7\;mmHg$ ($10{\sim}60\;mmHg$). Eighteen patients underwent a preliminary pulmonary artery banding as an initial palliation. Preoperative main diagnoses were double outlet right ventricle in 9 patients, double inlet left ventricle with ventriculoarterial discordance in 6,. another functional univentricular heart in 5, Criss-cross heart in 4, complete atrioventricular septal defect in 3, and hypoplastic left heart variant in 1. DKS techniques included end-to-side anastomosis with patch augmentation in 14 patients, classical end-to-side anastomosis in 6, Lamberti method (double-barrel) in 3, and others in 5. The bidirectional cavopulmonary shunt and Fontan procedure were concomitantly performed in 6 and 2 patients, respectively. Result: There were 4 hospital deaths (14.3%), and 3 late deaths (12.5%) with a follow-up duration of $62.7{\pm}38.9$ months ($3.3{\sim}128.1$ months). Kaplan-Meier estimated actuarial survival was $71.9%{\pm}9.3%$ at 10 years. Multivariate analysis showed right ventricle type single ventricle (hazard ratio=13.960, p=0.004) and the DKS procedure as initial operation (hazard ratio=6.767, p=0.042) as significant mortality risk factors. Four patients underwent staged biventricular repair and 13 received Fontan completion. No SVOTO was detected after the procedure by either cardiac catheterization or echocardiography except in one patient. There was no semiulnar valve regurgitation (>Gr II) or semilunar valve-related reoperation, but one patient (3.6%) who underwent classical end-to-side anastomosis needed reoperation for pulmonary artery stenosis caused by compression of the enlarged DKS pathway. The freedom from reoperation for the DKS pathway and semilunar valve was 87.5% at 10 years after operation. Conclusion: The DKS procedure can improve the management of SVOTO, and facilitate the selected patients who are high risk for biventricular repair just after birth to undergo successful staged biventricular repair. Preliminary pulmonary artery banding is a safe and effective procedure that improves the likelihood of successful DKS by decreasing pulmonary vascular resistance. The long-term outcome of the DKS procedure for semilunar valve function, DKS pathway, and relief of SVOTO is satisfactory.

Effect of Seed Mixture on Forage Yields and Botanical Composition at an Altitude of 400 m in Jeju island (표고 400m 제주 중산간 지역에서 혼합조합별 초지 생산성 및 식생구성)

  • Chae, Hyun Seok;Kim, Nam Young;Woo, Jae Hoon;Shin, Moon Cheol;Son, Jun Kyu;Seong, Pil Nam;Lee, Wang Shik;Kim, Si Hyun;Hwang, Kyung Jun;Kim, Young Jin;Park, Nam Gun
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.37 no.1
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    • pp.19-27
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    • 2017
  • The objective of this study was to determine the growth characteristics of cool (C1) and warm season grasses (C2) in pastures mixed with C1 and C2 at an altitude of 400 m in Jeju island to establishing pasture suitable for grazing horses and to evaluate the effect of pastures mixed with tall and short type grasses on the intake characteristics of horses. C1 used in this study was Kentucky bluegrass, redtop (short type grass) and tall type grasses were orchardgrass and tall fescue, respectively. Treatments of this study were consisted of four groups and the short type grass used in pastures mixed with C1 and C2 was mainly bermudagrass. Four treatment groups were follow as; Treatment 1 (bermudagrass + Kentucky bluegrass + redtop) 2) Treatment 2 (bermudagrass + tall fescue + orchardgrass) 3) Treatment 3 (Kentucky bluegrass + redtop) 4) Treatment 4 (tall fescue + orchardgrass). Bermudagrass was a little winter killing and inhibition of plant growth at an altitude of 400 m. Plant heights in pastures mixed with C1 and C2 were grown better than that in pastures mixed with C1. Especially, plant height in Treatment 4 was higher than other treatments. Dry matter yield was in the following order: Treatment 4> Treatment 3> Treatment 2> Treatment 1. Dry matter yield in pastures mixed with C1 increased as compared with pastures mixed with C1 and C2. Dry matter yield in Treatment 3 was higher than other treatments. In the first investigation regarding vegetation distribution, bermudagrass ratios among grasses in Treatment 1 and Treatment 2 were 11.7 and 13.3%, respectively. The growth of bermudagrass in winter was low due to the cold damage. However the growth of Kentucky bluegrass, redtop, tall fescue and orchardgrass was good. In the second investigation, bermudagrass ratios among grasses in Treatment 1 and Treatment 2 were 5.0 and 11.7%, respectively. Growth of forage in the second investigation was poor as compared to the first investigation. nutritive values(crude protein content, neutral detergent fiber content, acid detergent fiber content, digestibility) were good in pastures mixed with C1 Especially, nutritive values in pastures mixed with tall was higher than those of pastures mixed short grasses. P content among minerals in Treatment 1 was higher than other groups. However, the content of Ca, Mg and Mn were lower. The contents of Ca, K, Mg, Na, Cu, Zn and Fe in Treatment 2 were higher. However, the contents of K, Mg, Na, Cu, Zn and Fe in Treatment 3 were lower. Therefore, we suggest that cool season grasses with short grasses were sowed to establishing pasture suitable for grazing horses at an altitude of 400 m in Jeju island.