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Studies on Fungal Contamination and Mycotoxins of Rice Straw Round Bale Silage (사료용 볏짚 곤포사일리지의 곰팡이 및 Mycotoxin 오염 연구)

  • Sung, Ha-Guyn;Lee, Joung-Kyong;Seo, Sung
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.31 no.4
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    • pp.451-462
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    • 2011
  • The purpose of this study was to investigate fungi and mycotoxin contamination of the rice straw bale silage in Korean. It was tested the 33 samples of rice straw round bale silage with various condition which fed cattle in the farm. The level of fungal contamination was $2.1{\times}10^6\;cfu\;g^{-1}$ in the average and $9.2{\times}10^8\;cfu\;g^{-1}$ in the maximum. The fungal contamination was detected in the all of normal samples which good condition of rice straw bale silage. When the fungi was isolate and identify, it was found 28 species and mycotoxin producing fungi were 8 species as following as Aspergillus flavus, Aspergillus fumigatus, Fusarium culmorum, Fusarium verticillioides, Penicillium carneum, Penicillium paneum, Penicillium roqueforti, Penicillium viridicatum. Specially, Penicillium paneum was found 42% of samples and Aspergillus sp. (A. flavus, A. fumigatus) are 21% of samples. In case of mycotoxin contamination, the 42% of samples are detected more than one kind of mycotoxin. Some samples are contaminated three kinds of mycotoxin. This study was not found aflatoxin ($B_1$, $B_2$, $G_1$, $G_2$) and fumonisin ($B_1$, $B_2$), but were detected the contamination of ochratoxin A (1.0~5.8 ug/kg), deoxynivalenol (DON, 156.0~776.7 ug/kg) and zearalenone (ZON, 38.0~750.0 ug/kg). Therefore, the above results show that rice straw round bale silage expose on hazard factors as mycotoxigenic fungi and mycotoxin contamination, and than need more research about mycotoxin in animal feed to protect animal and human healthy.

Macrozoobenthic Community Structures in the Shallow Subtidal Soft-bottoms around Wando-Doam Bay during Summer Season (남해 완도-도암만 연성기질의 여름철 대형저서동물의 군집구조)

  • LIM, HYUN-SIG;CHOI, JIN-WOO;SON, MIN-HO
    • The Sea:JOURNAL OF THE KOREAN SOCIETY OF OCEANOGRAPHY
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    • v.23 no.2
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    • pp.91-108
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    • 2018
  • An ecological study on subtidal macrobenthic fauna was conducted from 25 stations in the estuarine area of Wando-Doam Bay, southern coast of Korea during August 2013. A total of 186 species was collected with a mean density of $1,229ind./m^2$ and a mean biomass of $265.7g/m^2$. Polychaetes showed the richest benthic fauna comprising 43% of total fauna, whereas mollusks appeared as density- and biomass-dominant fauna accounted for 45% and 48% of the mean density and biomass, respectively. The number of species and mean faunal density were relatively higher at the stations surrounded by Sinjido, Joyakdo and Gogeumdo showing a gradual decrease toward inner bay stations. Species number and density were negatively correlated with bottom water temperature, but they were positively correlated with both the bottom salinity and DO. The most dominant species in terms of density was a semelid bivalve, Theora fragilis which showed a positive correlation with TOC content of surface sediment and its high density occurred around Gogeum-Sinji-Joyakdo area where dense aquaculture facilities exist. In the bay mouth area, an amphipod species, Eriopisella sechellensis showed its higher density at the stations with low organic content but fine grains. The combination of water temperature, salinity, pH of bottom water, water and sulfur content of the surface sediment could explain 71% of the spatial distribution of macrobenthic fauna from the Bio-Env analysis. From the cluster analysis, the study area consisted of 6 distinct station groups lineated from offshore area toward inner area. Ampharete arctica, Goniada maculata, Eriopisella sechellensis, Theora fragilis, Caprella sp. were identified as the main contributing faunas in classification by the SIMPER analysis. From the value of BPI, the benthic communities at the inner and central Wando-Doam Bay were assessed to be in a normal condition whereas those at the outer Wando harbor and Gogeum-Sinji-Joyakdo area were assessed in a poor or very poor condition due to the high concentration of particulate organic matter might be originated from the nearby dense aquaculture facilities. This study indicated that pristine inner bay has been influenced by the organic material supplied from the outer bay. Thus it is necessary to establish an ecological management plan to reduce organic enrichment of sediment from dense aquaculture facilities in the outer bay.

A study on the essence of Ye and its usualness - With focus on Shirak's feature of Yulkok's Yegyo (예(禮)의 본질(本質)과 일상성(日常性) - 율곡(栗谷) 예교(禮敎)의 실학적(實學的) 성격(性格)과 일상성(日常性)을 중심으로 -)

  • Lee, Haeng-hoon
    • (The)Study of the Eastern Classic
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    • no.35
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    • pp.161-188
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    • 2009
  • Confucianism's concept of Ye is ruled by the absolute principle of the universe on one hand, and by "the rules of Ye(節文)" and "the rules of ceremony(儀則)", the principle of relative articulation on the other hand. The realizations of the absolute principle of Ye is depending on its usage in everyday life which is fundamentally conditioned by time and space. Thus, Ye's usage can be maximized when the fundamental principle and the condition of its usage make a mutual harmony. Of course, Ye and Ak(樂) are doing complementary roles for each other, since Ye is a principle of a division and Ak is a principle of combining features. However, the essence of Ye can be figured out as the characteristics of mutual reciprocity among things of hierarchy between the classes. Not only in Modern one But also in the medieval society, Ye was not a one-sided force. The essence of Ye does not retain the interests of an individual and the power of a group. If so, the formal aspects of Ye had been distorted. Confucianism demands a strict morality and ethics of a normal person as well as of the ruler. The characteristics of Ye is democratic and open to the condition of time and space. Yegyo should be rooted in everyday lives and realized as a usualness. Therefore, Shirak was an inevitable feature of Yegyo. During the 16th and the 17th century, Ye insinuated into everyday lives of the public in the Korean society. Yulgok Yiyi(李珥)'s Haejuhyangyak(海州鄕約) was estimated as the exemplary feature of Shirak.

Experimental studies on the characteristics of the mortar using dispersing agent of cement and high fluid admxiture (시멘트 분산제(分産劑) 및 고류동화제(高流動化劑)를 사용(使用)한 모르터의 제(諸) 성질(性質)에 관(關)한 실험적(實驗的) 연구(硏究))

  • Kim, Seong Wan;Park, In-Gyu
    • Korean Journal of Agricultural Science
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    • v.11 no.1
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    • pp.146-159
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    • 1984
  • This study was the contrast of the compressive strength, the tensile strength, the reducing ratio and the flow of mortar using dispersing agent and high fluid admix. 1. The admix ratio of chemical admixtures espressing maximum strength appeared the same result high fluid admix SP was 0.6%, the dispersing agents LG and C211 were 0.2%, SK was 0.3%, C376 was 0.5%. But two or three times more than standard quantity made the strength's fast lowness, which influenced bad to wateriness and retard the soli-dification. 2. When proper quantity of chemical admixture was used, the increment of compressive strength was as follows. High fluid admix SP was 40.7% and the average increasing rate of dispersing agents(C211 was 19.5%, LG was 19.1%, C376 was 17.9%) was 18.7% more than normal mortar in the codition of 7 days. Also, in the condition of 28 days, high fluid admix SP was about 24.4% and the average of dispersing agents(LG was 21.1%, C211 was 16.4%, SK was 11.1%, C376 was 7.6%) was 14.1%. 3. When proper quantity of chemical admixture was used, the increment of tensile strength was as follows. High fluid admixture SP was 26.6% and the average increasing agents(SK was 16.0%, C376 was 14.7%, LG was 10%, C211 was 5.8%) was 11.6%. Also, in the condition of 28 days, high fluid admix SP was 16.5% and the average increasing rate of dispersing agents(LG was 19.1%, SK was 10.6%, C211 was 10.1%, C376 was 8.7%) was 12.1%. 4. As for the reducing ratio of each dispersing agent, he flow of mortar was less than the slump of concrete. That is; the reducing ratio of concrete was 15% adding each dispersing agent, but the reducing ratio of mortar was in the range of from 5.8% to 13.5% in 1 : 1 mixture, from 7.6% to 14.2% in 1 : 2, from 9.5% to 18.8% in 1 : 3. 5. The fluidity of each chemical admixture was as follows. High fluid admix SP in the condition of 1: 1 and 1 : 2 showed the best result than other dispersing agent and 1 : 3 showed the same result like other agents. Therefore these good dispersing agents were suitable in the prepact concrete construction using intrusion mortar.

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Inhibition of Neointima Formation and Migration of Vascular Smooth Muscle Cells by Anti-vascular Endothelial Growth Factor Receptor-1 (Flt-4) Peptide in Diabetic Rats (당뇨병 쥐에서 혈관내피 성장인자 수용체-1 차단 펩타이드를 이용한 신내막 형성과 혈관평활근세포 이동의 억제)

  • Jo, Min-Seop;Yoo, Ki-Dong;Park, Chan-Beom;Cho, Deog-Gon;Cho, Kue-Do;Jin, Ung;Moon, Kun-Woong;Kim, Chul-Min;Wang, Young-Pil;Lee, Sun-Hee
    • Journal of Chest Surgery
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    • v.40 no.4 s.273
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    • pp.264-272
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    • 2007
  • Background: Vascular endothelial growth factor (VEGF) plays an important role in angiogenesis, including stimulating the proliferation and migration of vascular smooth muscle cells (VSMCs). It has been known that diabetes is associated with accelerated cellular proliferation via VEGF, as compared to that under a normal glucose concentration. We investigated the effects of selective blockade of a VEGF receptor by using anti-Flt-1 peptide on the formation and hyperplasia of the neointima in balloon injured-carotid arteries of OLETF rats and also on the in vitro VSMCS' migration under high glucose conditions. Material and Method: The balloon-injury method was employed to induce neointima formation by VEGF. For f4 days beginning 2 days before the ballon injury, placebo or vascular endothelial growth factor receptor-1 (VEGFR-1) specific peptide (anti-Flt-1 peptide), was injected at a dose of 0.5mg/kg daily into the OLETF rats. At 14 days after balloon injury, the neointimal proliferation and vascular luminal stenosis were measured, and cellular proliferation was assessed by counting the proliferative cell nuclear antigen (PCNA) stained cells. To analyze the effect of VEGF and anti-Flt-1 peptide on the migration of VSMCs under a high glucose condition, transwell assay with a matrigel filter was performed. And finally, to determine the underlying mechanism of the effect of anti-Flt-1 peptide on the VEGF-induced VSMC migration in vitro, the expression of matrix metalloproteinase (MMP) was observed by performing reverse transcription-polymerase chain reaction (RT-PCR). Result: Both the neointimal area and luminal stenosis associated with neointimal proliferation were significantly decreased in the anti-Flt-1 peptide injected rats, ($0.15{\pm}0.04 mm^2$ and $ 36.03{\pm}3.78%$ compared to $0.24{\pm}0.03mm^2\;and\;61.85{\pm}5.11%$, respectively, in the placebo-injected rats (p<0.01, respectively). The ratio of PCNA(+) cells to the entire neointimal cells was also significantly decreased from $52.82{\pm}4.20%\;to\;38.11{\pm}6.89%$, by the injected anti-Flt-1 peptide (p<0.05). On the VSMC migration assay, anti-Flt-1 peptide significantly reduced the VEGF-induced VMSC migration by about 40% (p<0.01). Consistent with the effect of anti-Flt-1 peptide on VSMC migration, it also obviously attenuated the induction of the MMP-3 and MMP-9 mRNA expressions via VEGF in the VSMCS. Conclusion: Anti-Flt-1 peptide inhibits the formation and hyperplasia of the neointima in a balloon-injured carotid artery model of OLETF rats. Anti-Flt-1 peptide also inhibits the VSMCs' migration and the expressions of MMP-3 and MMP-9 mRNA induced by VEGF under a high glucose condition. Therefore, these results suggest that specific blockade of VEGFR-1 by anti-Flt-1 peptide may have therapeutic potential against the arterial stenosis of diabetes mellitus patients or that occurring under a high glucose condition.

A study on the Greeting's Types of Ganchal in Joseon Dynasty (간찰(簡札)의 안부인사(安否人事)에 대한 유형(類型) 연구(硏究))

  • Jeon, Byeong-yong
    • (The)Study of the Eastern Classic
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    • no.57
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    • pp.467-505
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    • 2014
  • I am working on a series of Korean linguistic studies targeting Ganchal(old typed letters in Korea) for many years and this study is for the typology of the [Safety Expression] as the part. For this purpose, [Safety Expression] were divided into a formal types and semantic types, targeting the Chinese Ganchal and Hangul Ganchal of modern Korean Language time(16th century-19th century). Formal types can be divided based on whether Normal position or not, whether Omission or not, whether the Sending letter or not, whether the relationship of the high and the low or not. Normal position form and completion were made the first type which reveal well the typicality of the [Safety Expression]. Original position while [Own Safety] omitted as the second type, while Original position while [Opposite Safety] omitted as the third type, Original position while [Safety Expression] omitted as the fourth type. Inversion type were made as the fifth type which is the most severe solecism in [Safety Expression]. The first type is refers to Original position type that [Opposite Safety] precede the [Own Safety] and the completion type that is full of semantic element. This type can be referred to most typical and normative in that it equipped all components of [Safety Expression]. A second type is that [Safety Expression] is composed of only the [Opposite Safety]. This type is inferior to the first type in terms of set pattern, it is never outdone when it comes to the appearance frequency. Because asking [Opposite Safety] faithfully, omitting [Own Safety] dose not greatly deviate politeness and easy to write Ganchal, it is utilized. The third type is the Original position type showing the configuration of the [Opposite Safety]+Own Safety], but [Opposite Safety] is omitted. The fourth type is a Original position type showing configuration of the [Opposite Safety+Own Safety], but [Safety Expression] is omitted. This type is divided into A ; [Safety Expression] is entirely omitted and B ; such as 'saving trouble', the conventional expression, replace [Safety Expression]. The fifth type is inversion type that shown to structure of the [Own Safety+Opposite Safety], unlike the Original position type. This type is the most severe solecism type and real example is very rare. It is because let leading [Own Safety] and ask later [Opposite Safety] for face save is offend against common decency. In addition, it can be divided into the direct type that [Opposite Safety] and [Own Safety] is directly connected and indirect type that separate into the [story]. The semantic types of [Safety Expression] can be classified based on whether Sending letter or not, fast or slow, whether intimate or not, and isolation or not. For Sending letter, [Safety Expression] consists [Opposite Safety(Climate+Inquiry after health+Mental state)+Own safety(status+Inquiry after health+Mental state)]. At [Opposite safety], [Climate] could be subdivided as [Season] information and [Climate(weather)] information. Also, [Mental state] is divided as receiver's [Family Safety Mental state] and [Individual Safety Mental state]. In [Own Safety], [Status] is divided as receiver's traditional situation; [Recent condition] and receiver's ongoing situation; [Present condition]. [Inquiry after health] is also subdivided as receiver's [Family Safety] and [Individual Safety], [Safety] is as [Family Safety] and [Individual Safety]. Likewise, [Inquiry after health] or [Safety] is usually used as pairs, in dimension of [Family] and [Individual]. This phenomenon seems to have occurred from a big family system, which is defined as taking care of one's parents or grand parents. As for the Written Reply, [Safety Expression] consists [Opposite Safety (Reception+Inquiry after health+Mental state)+Own safety(status+Inquiry after health+Mental state)], and only in [Opposite safety], a difference in semantic structure happens with Sending letter. In [Opposite Safety], [Reception] is divided as [Letter] which is Ganchal that is directly received and [Message], which is news that is received indirectly from people. [Safety] is as [Family Safety] and [Individual Safety], [Mental state] also as [Family Safety Mental state] and [Individual Safety Mental state].

Lived experience of mothers who have child with cerebral palsy (뇌성마비아 어머니의 경험)

  • Lee Hwa Za;Kim Yee Soon;Lee Gee Won;Gwan Soo Za;Kang In Soon;An Hea Gyung
    • Child Health Nursing Research
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    • v.2 no.1
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    • pp.93-111
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    • 1996
  • The purpose of the study is to identify the lived experience of mothers who have children with cerebral palsy in order to understand their agony. Moreover, the result of study was to find some nursing intervention for disabled children and their mothers. For this purpose, ten mothers who are willing to cooperate with this research were selected at random from those who have children with the cerebral palsy, currently using the municipal facilities for the handicapped with cerebral malfunction. Data collection was done from October 4, 1994 th December 31, 1994. The data were collected by asking the mothers mentioned above with some unstructured open-ended questions, recorded on the tapes with permission by the interviewee in order to prevent missing of the interviewed contents. These collected data have been substantiated and properly analyzed on the basis of phenomenological approach initiated by Colaizzi's method. The results and validity are proved to be credible by means of the individual checking of the interviewed mothers. The results of this study are as follows : 1. When the mother is first informed of the diagnosis of cerebral palsy on her child, she usually misses the crucial timing needed for proper treatment of the child's disorder because she is notified through the doctor's indifference and his apparently inactive, matter-of-fact attitude. At first she suspects the doctor's diagnosis and tries to attribute it to the unknown cause from a certain genetic problem and then she quickly wants to deny the whole situation that her child is really suffering from the cerebral palsy. The reality is too much for her to accept as it is and she would not believe her child is abnormal. Therefore, she even attempts depend on the power of God for its solution. 2. The mother, who goes thorough this kind of uncommon experiences, is totally devoted to the treatment and care of the child and completely ignores her own life and happiness. At the same time, she feels sorry for her other normal children she believes having not enough care and concern. Also, she feels sorry for the sick child when the child's brothers or sisters show special concern for the patient out of sympathy. It is sorry and not satisfied for her that the child is growing with abnormality and neighbor other around have inappropriate attitudes. Likewise, she is discontent with her husband's lack of concern about the child's treatment. She believes that the health care system in this society isn't fulfilling its due purpose. In the state of her utmost distress and anxiety, she always feels the need of competent consultants, and is angry about that her child is treated as an abnormal being, she is trying to hide the child from other people and to make him or her disappear, if possible. Although she doesn't have harmonious relation with her husband, she id happy when he shows his affection for the child and she feels relieved and thankful when the relatives don't mention about the child's condition Since the child's overall status of health is continuously in unstable conditions, requiring her all-time readiness for an emergency, she feels guilty of her child's illness toward the fEmily members as if it was her own fault to have borne such an abnormal child and she feels responsible for the child morally and financially if necessary Because her life is centered on taking care of the child, she cannot afford to enjoy her own life and happiness. She is a lonely mother, fatigued, with no proper relationship with other people around her. With this sense of guilt and responsibility as a mother of an unusual disease, she has no choice but to grieve her destiny from which she is not allowed to escape. 3. Nevertheless, the mother with the child suffering from the cerebral palsy does not easily give up the hope of getting her child cured and she believes that in the long run, though slower than hoped, her abnormal son or daughter will be eventually cured to become a normal sibling someday. This kind of hope is sustained by the mother's strong faith coming from observing the progress of other similar children getting better. Sometimes she is encouraged to have this faith by other mothers who share the same painful experiences, believing that her child will improve even more rapidly than others with the same palsy. Full of hope, she painstakingly waits for the child's healing. Moreover, she plans to have another child. she thinks that the patient child's brothers and sisters only can truly understand and look after the patients. However, when she notices that the progress of other children under the treatment does not look so hopeful, she is distressed by the thoughts that her child may never get well. Too, she is worried that the patient's brother or sister will be born as the same invalid with the cerebral disease. She is discouraged to have another baby as much as she is encouraged to. She is also troubled by the thought that in case she has another baby, she will have to be forced. to neglect the patient child, especially when she does have an extra hand or some reliable person to help her with taking care of the patient.

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Survey of Weed Population Distribution and Change of Dominant Weed Species on Paddy Field in Kyonggi Area (경기지역(京畿地域)의 논 잡초(雜草) 분포(分布) 및 군락변화(群落變化)에 관(關)한 연구(硏究))

  • Kim, H.D.;Park, J.S.;Su, K.K.;Moon, M.H.;Jo, Y.C.;Park, K.Y.;Choi, Y.J.;Yu, C.J.;Shim, S.W.;Rho, Y.D.
    • Korean Journal of Weed Science
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    • v.17 no.1
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    • pp.1-9
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    • 1997
  • The survey of weed community in paddy field was carried out to investigate the changes of weed species on 340 fields in Kyonggi Area in 1995, that is almost same condition as sampled in 1991. The weed species observed include 3 species of grasses, 5 species of sedges and 14 species of broadleaf and other weed. Herbicide treatment system in one time treatment vs more than two time treatment was 34:66 percentage. About 25 percentage among one time treatment system was used butachlor G. Ratio of annual weed vs perennial weed was 38:62, and then perennial weed ratio was high. Major dominant weed species were Sagitaria trifolia, Eleocharis kuroguwai, Echinochloa crus-galli, Bidens tripartita and Monochoria vaginalis. Weed occurrence was decreased as order of normal soil, poorly drained soil and saline soil. Dormant weed species were S. trifolia, E. kuroguwai, E. crus-galli and B. tripartita in normal soil and were S. trifolia, E. kuroguwai, E. crus-galli and Polygonium hydropiper in poorly drained soil, and were Scirpus planiculmis, S. trifolia and E. kuroguwai in saline soil. Weed occurrence was increased with delaying the transplanting time; dominant weed species were S. trifolia, E. kuroguwai, E. crus-galli and M. vaginalis in May transplanting field and were E. kuroguwai, S. trifolia, and C. serotinus in June transplanting field. Weed occurrence was decreased as order of non-plowing transplanting field, autumn plowing and spring plowing paddy field. Dominant weed species were S. trifolia, E. kuroguwai, E. crus-galli and M. vaginalis in autumn plowing, were S. trifolia, E. kuroguwai, E. crus-galli and B. tripartita in spring plowing, and were E. crus-galli, S. hotarui and S. trifolia in non-plowing transplanting field.

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Study on the Evaluation of Renal Function According to Set a Partial Region of Interest in 99mTc-DMSA scan of the Pediatric Patient with a Duplicated Ureter (중복요관을 가진 소아환자의 99mTc-DMSA 검사에서 부분적 관심영역 설정에 따른 신기능 평가에 관한 연구)

  • Nam-Koong, Hyuk;Oh, Shin Hyun;Kim, Jung Yul;Choi, Yoon Jung;Kim, Jae Sam;Lee, Chang Ho
    • The Korean Journal of Nuclear Medicine Technology
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    • v.17 no.1
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    • pp.43-47
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    • 2013
  • Purpose: A duplicated ureter is congenital renal malformations with ureter in two. Patients with duplicated ureter are in force to $^{99m}Tc-DMSA$ scan at surgery before and after. In existing examination, at produce result after $^{99m}Tc-DMSA$ scan, didn't compare to upper pole and lower pole with malformed kidney and compared to only relative uptake ratio. Therefore, this study will examine about utility of set a partial region of interest and to functional recovery of renal cell through change of upper pole uptake ratio of malformed kidney by setting each partial region of interest in upper pole and lower pole of malformed kidney in $^{99m}Tc-DMSA$ examination in surgery before and after. Materials and Methods: Pediatric patients with malformed kidney of incomplete duplicated ureter, 15 patients were enrolled in this study. Scanning were scan 3 to 4 hours after injection of $^{99m}Tc-DMSA$ 1.5 ~ 1.9 MBq/kg. Region of interest were each set in normal kidney, upper pole and lower pole with malformed kidney. Region of interest were set with same condition and method to images of surgery before and after that radio technologist 1 person, resident of nuclear medicine 1 person and doctor of urology together. Therefore, this study were compared to uptake ratio (A: B: C) that normal kidney (A), lower pole of malformed kidney (B) and upper pole of malformed kidney (C) about uptake ratio changes of malformed kidney in follow-up examination of surgery before and after. Results: When compared to 15 patients, uptake ratios were increased 7 persons and decreased 8 persons. Among increased 7 persons, it were periods of follow-up examination that 2 persons were 14 months, 4 persons were 12 months and 1 person was 8 months after surgery. Among decreased 8 persons, it were periods of follow-up examination that 4 persons were 12 months 3 persons were 6 months and 1 persons were 4 months after surgery. Conclusion: Existing study could not see the exact uptake ratio changes of malformed kidney because using only the overall Left-Right kidney uptake ratios. But a setting partial region of interest was able to see exactly what changes in the uptake of each upper pole and lower pole of malformed kidney. Because recovery of renal parenchymal cells is difficult in an evaluation of short period of time, follow-up examination should be made in long period of time. How to set up partial region of interest be thought that it would be useful.

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Study for Diagnostic Efficacy of Minibronchoalveolar Lavage in the Detection of Etiologic Agents of Ventilator-associated Pneumonia in Patients Receiving Antibiotics (항생제를 사용하고 있었던 인공호흡기 연관 폐렴환자에서의 원인균 발견을 위한 소량 기관지폐포세척술의 진단적 효용성에 관한 연구)

  • Moon, Doo-Seop;Lim, Chae-Man;Pai, Chik-Hyun;Kim, Mi-Na;Chin, Jae-Yong;Shim, Tae-Sun;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Koh, Youn-Suck
    • Tuberculosis and Respiratory Diseases
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    • v.47 no.3
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    • pp.321-330
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    • 1999
  • Background : Early diagnosis and proper antibiotic treatment are very important in the management of ventilator-associated pneumonia (VAP) because of its high mortality. Bronchoscopy with a protected specimen brush (PSB) has been considered the standard method to isolate the causative organisms of VAP. However, this method burdens consumer economically to purchase a PSB. Another useful method for the diagnosis of VAP is quantitative cultures of aspirated specimens through bronchoscopic bronchoalveolar lavage (BAL), for which the infusion of more than 120 m1 of saline has been recommended for adequate sampling of a pulmonary segment. However, occasionally it leads to deterioration of the patient's condition. We studied the diagnostic efficacy of minibronchoalveolar lavage (miniBAL), which retrieves only 25 ml of BAL fluid, in the isolation of causative organisms of VAP. Methods: We included 38 consecutive patients (41 cases) suspected of having VAP on the basis of clinical evidence, who had received antibiotics before the bronchoscopy. The two diagnostic techniques of PSB and miniBAL, which were performed one after another at the same pulmonary segment, 'were compared prospectively. The cut-off values for quantitative cultures to define causative bacteria of VAP were more than $10^3$ colony-forming units (cfu)/ml for PSB and more than $10^4$ cfu/ml for BAL. Results: The amount of instilled normal saline required to retrieve 25 ml of BAL fluid was $93{\pm}32 ml$ (mean${\pm}$SD). The detection rate of causative agents was 46.3% (19/41) with PSB and 43.9% (18/41) with miniBAL. The concordance rate of PSB and miniBAL in the bacterial culture was 85.4% (35/41). Although arterial blood oxygen saturation dropped significantly (p<0.05) during ($92{\pm}10%$) and 10 min after ($95{\pm}3%$) miniBAL compared with the baseline ($97{\pm}3%$), all except 3 cases were within normal ranges. The significantly elevated heart rate during ($l25{\pm}24$/min, p<0.05) miniBAL compared with the baseline ($1l1{\pm}22$/min) recovered again in 10 min after ($111{\pm}26$/min) miniBAL. Transient hypotension was developed during the procedure in two cases. The procedure was stopped in one case due to atrial flutter. Conclusion: MiniBAL is a safe and effective technique to detect the causative organisms of VAP.

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