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A Trend for Atroventricular Valve Regurgitation after a Modified Fontan Operation (변형 폰탄 수술 시행 이후에 방실 판막 폐쇄부전의 변화 양상)

  • Lim, Hong-Gook;Lee, Chang-Ha;Seo, Hong-Joo;Kim, Woong-Han;Hwang, Seong-Wook;Lee, Cheul
    • Journal of Chest Surgery
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    • v.41 no.3
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    • pp.305-312
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    • 2008
  • Background: Anatomic and functional abnormalities of the systemic atrioventricular (AV) valve are common in single ventricle. pathologies and continue to be associated with poor early and late outcomes in surgically palliated single. ventricle patients. We aggressively performed valvuloplasty for atrioventricular valve regurgitation (AVVR) during the course toward a Fontan operation. Material and Method: Between January 1995 and December 2004, 209 patients underwent a Fontan operation in our institution. We retrospectively evaluated the prevalence of AVVR and the influence of AV valve repair on outcome, and we analyzed the progression of AVVR after the Fontan operation for 168 patients where echocardiographic follow up results for more than 6 months after the Fontan operation were available. During the course toward a Fontan operation, 25 patients underwent 30 procedures for AVVR. These procedures. were. carried out during placement of a bidirectional cavopulmonary shunt (BCPS) for nine patients, between the time of placement of a BCPS and the Fontan operation for four patients, and during the Fontan operation for 17 patients. Five patients underwent procedures for AVVR twice. Result: The late mortality rate after the Fontan operation was 4.2% (n=7), with a median follow-up duration of 52 months (range, $6{\sim}123$ months). Seven patients (4%) had unfavorable outcomes such as significant (moderate or severe) AVVR in six patients, and significant AV valve stenosis in one patient was determined at the last follow up after the Fontan operation. Among the seven patients, four patients underwent AV valve repair after the Fontan operation, and one patient underwent subsequent AV valve replacement. Progression to AVVR of equal to or greater than grade 2 was noted in 30 patients (18%) at the last follow up after the Fontan operation, including 12 patients that underwent previous AV valve procedures. Initial grading of AVVR, a previous AV valve operation, and specific AV valve morphology such as a common AV valve or mitral atresia were significant risk factors for the progression of AVVR after the Fontan operation. Conclusion: In our surgical series, a small percentage of patients showed unfavorable outcomes. related to AVVR during the course toward a Fontan operation. However, a closer follow-up is required to evaluate the progression of the AVVR after a Fontan operation, especially for patients showing poor AV valve function at the first presentation and specific AV valve morphology.

Quality Characteristics and Retarding Retrogradation of Sponge Cakes containing Red Yeast Rice(Monascus nuruk) Flour (홍국(Monascus nuruk) 분말을 첨가한 스폰지 케이크의 품질 특성 및 노화 억제 분석)

  • Song, Ka-Young;Kim, Jong-Hee;O, Hyeon Bin;Zhang, Yangyang;Kim, Young-Soon
    • Culinary science and hospitality research
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    • v.22 no.3
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    • pp.11-21
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    • 2016
  • This study investigated the quality characteristics and retarding retrogradation of sponge cakes made with red yeast rice (RYR) flour. RYR (Monascus nuruk) is known to help digestion, smooth blood flow, and have anti-cancer, anti-microbial, and inhibitory effects against biosynthesis of cholesterol and blood pressure. This studys aim' was to find the optimal proportion of RYR flour in sponge cake. RYR sponge cakes were prepared with various levels (0, 5, 10, 15 and 20%) replacement of wheat flour and were designated as the control (without RYR), RYR5, RYR10, RYR15 and RYR20 respectively. Specific gravity was the lowest in RYR15 at 0.57, and the baking loss rate was not significantly different among the samples (p<0.05). The dough yield was the highest in RYR15 at 96.61. The moisture contents was highest in order, control, RYR5, and RYR15 at 28.67%, 28.18%, and 26.82% respectively. The L-value of crust tended to increase according to the level of RYR, but the L-value of crumb decreased in accorddance with the the content of RYR. The a-value of crust also decreased according to the level of RYR, although the a-value of crumb increased in response to higher levels of RYR. The b-value tended to decrease with increases of RYR (p<0.05). RYR5 exhibited the highest pH at 8.63, compared with RYR15 (8.57). The hardness, which was measured after cooling for 1 hour, was the lowest in RYR15 at $163.33g/cm^2$ and the springiness was not different significantly (p<0.05). Cohesiveness was the highest in RYR10 at 133.06%. The chewiness was the highest in RYR10 at $391.63g{\cdot}cm$ and lowest in RYR15 ast $169.62g{\cdot}cm$. Avrami equation showed that RYR15 and RYR20 had the lowest Avrami exponent (n) at 0.0664 and 0.4983 respectively. Time constant (1/k) was the highest in RYR15 at 200.00. Sensory evaluation revealed that RYR15 was the highest in color (5.50), flavor (4.95), sweetness (4.90), chewiness (4.75), and overall acceptability (4.60).

The Role of Brain and Feeding Response on Lysine Devoid Diet (Lysine 결핍에 따른 섭식반응과 뇌의 역할)

  • Kim, C.H.
    • Journal of Animal Science and Technology
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    • v.44 no.2
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    • pp.221-232
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    • 2002
  • This study was conducted to investigate the effects of deficiency of essential amino acid in diet on feed intake and concentrations of free amino acid in plasma and brain(prepyriform cortex, PPC), and thereby to know the brain area engaged in the mechanism of feed intake regulation. In all trials, experimental diets were formulated with pure amino acid mixture to level of 15% nitrogen. Rats were trained to eat a single meal for 6 hours daily(meal feeding, 17:00-21:00). Feed intake and body weight were measured hourly on and after 7th day of feeding. In Exp. 1, feed intake and body weight were measured every hour, and the free amino acid concentrations of plasma and PPC were analysed at 0, 1, 2, 3 and 6 h on the 11th day of feeding. In Exp. 2, the complete diet was replaced with lysine devoid diet at the 11th day, and feed intake, body weight and free amino acid concentrations in plasma and PPC were samely measured on Exp. 1. In Exp. 1, feed intake on complete diet was self-sufficiented to daily feed intake level(15g/day) from the 7th day. Free amino acid concentrations of plasma and PPC at the 11th day were plateau at 1 hour after feeding. In Exp. 2, feed intake was quickly reduced by the diet replacement(P$<$0.05), and the free lysine concentration of plasma and PPC was also significantly decreased at 2 hour after feeding. However, cumulative feed intake was significantly decreased at 4 hour after feeding. These results may indicate that the concentrations of free lysine in plasma and PPC, under the condition of devoided lysine in diet, were more quickly droped than the reduction of feed intake rate. Hence, it is expected that PPC in brain might be a part of response area for limited amino acid.

The Ross Procedure in Pediatric Patients: 10 Years Experience at the Asan Medical Center (소아 환자에서 Ross 수술 성적 보고: 아산병원 10년 경험)

  • Kim, Hee-Jung;Seo, Dong-Man;Yun, Tae-Jin;Park, Jeong-Jun;Park, In-Sook;Kim, Young-Hwue;Ko, Jae-Kon
    • Journal of Chest Surgery
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    • v.42 no.3
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    • pp.305-310
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    • 2009
  • Background: The Ross procedure is known as a good surgical option for a young age group with aortic valve problems, but few reports on the Ross procedure are available in the Korean literature. This study is a review of our midterm results of 10 year experience with the pediatric Ross operation in Asan Medical Center. Material and Method: From March 1997 to October 2008, eighteen patients who were aged less than 16 years underwent the Ross procedure. There were 11 males and 7 females. The patients median age was 8.5 years (range: $0.5\sim14.0$). The aortic valve pathophysiology was 6 patients with aortic insufficiency, 4 patients with aortic stenosis, 7 patients with mixed aortic stenoinsufficiencey and 1 patient with infective endocarditis. The valve morphology was bicuspid in 11 and tricuspid in 7. All the patients were operated on with the root replacement technique. All the pumonic valves were replaced with an allograft except for one pericardial monocusp valve. The mean follow up duration was 52.8 months (range: 5.8$\sim$138.2 months). We reviewed the echocardiographic data with focusing on the, auto-graft dysfunction and reoperation. Result: There was no hospital mortality and late mortality. According to the last echocardiographic data, 2 autografts showed aortic regurgitation grade 2, 4 autografts showed aortic regurgitation grade 1 and the others were less than trivial. Reoperation of the pulmonic position conduit was performed 4 times in three patients. The rate of freedom from reoperation at 5 years was 72.2%. On the serial follow up, the Z-values of the aortic annulus/aortic sinus were changed from $1.6{\pm}1.7/0.9{\pm}1.7$ at preoperation to $1.8{\pm}1.6$(p=0.64)/$2.2{\pm}0.9$ (p=0.01) at the last follow-up. There was no significant relation between the growth of the neoaortic root and neoaortic insufficiency. Conclusion: Our midterm results of the Ross procedure in pediatric patients showed good autograft function and growth potential. Vet reoperation due to allograft dysfunction was a major concern.

Mitral Valve Repair for Congenital Mitral Regurgitation in Children (선천성 승모판막 페쇄부전증이 있는 소아에서 승모판막 성형술에 대한 임상적 고찰)

  • Kim, Kun-Woo;Choi, Chang-Hyu;Park, Kook-Yang;Jung, Mi-Jin;Park, Chul-Hyun;Jeon, Yang-Bin;Lee, Jae-Ik
    • Journal of Chest Surgery
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    • v.42 no.3
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    • pp.292-298
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    • 2009
  • Background: Surgery for mitral valve disease in children carries both technical and clinical difficulties that are due to both the wide spectrum of morphologic abnormalities and the high incidence of associated cardiac anomalies. The purpose of this study is to assess the outcome of mitral valve surgery for treating congenital mitral regurgitation in children. Material and Method: From 1997 to 2007, 22 children (mean age: 5.4 years) who had congenital mitral regurgitation underwent mitral valve repair. The median age of the patients was 5.4 years old and four patients (18%) were under 12 months of age. 15 patients (68%) had cardiac anomalies. There were 13 cases of ventricular septal defect, 1 case of atrial septal defect and 1 case of supravalvar aortic stenosis. The grade of the preoperative mitral valve regurgitation was II in 4 patients, III in 15 patients and IV in 3. The regurgitation was due to leaflet prolapse in 12 patients, annular dilatation in 4 patients and restrictive leaflet motion in 5 patients. The preoperative MV Z-value and the regurgitation grade were compared with those obtained at follow-up. Result: MV repair was possible in all the patients. 19 patients required reduction annuloplasty and 18 patients required valvuloplasty that included shortening of the chordae, papillary muscle splitting, artificial chordae insertion and cleft closure. There were no early or late deaths. The mitral valve regurgitation after surgery was improved in all patients (absent=10, grade I=5, II=5, III=2). MV repair resulted in reduction of the mitral valve Z-value ($2.2{\pm}2.1$ vs. $0.7{\pm}2.3$, respectively, p<0.01). During the mid-term follow-up period of 3.68 years, reoperation was done in three patients (one with repair and two with replacement) and three patients showed mild progression of their mitral reguration. Conclusion: our experience indicates that mitral valve repair in children with congenital mitral valve regurgitation is an effective and reliable surgical method with a low reoperation rate. A good postoperative outcome can be obtained by preoperatively recognizing the intrinsic mitral valve pathophysiology detected on echocardiography and with the well-designed, aggressive application of the various reconstruction techniques.

Comparison of Thallium-201, Tc-99m MIBI and I-131 Scan in the Follow-up Assessment after I-131 Ablative Therapy in Differentiated Thyroid Cancer (방사성 옥소 치료 후 분화된 갑상선암 추적관찰에서 Thallium-201 스캔, Tc-99m MIBI 스캔과 I-131 스캔 검사 결과의 비교)

  • Kwon, Jae-Sung;Lee, Sung-Keun;Kim, Doe-Min;Park, Sae-Jong;Jang, Kyong-Sun;Kim, Eun-Sil;Kim, Chong-Soon
    • The Korean Journal of Nuclear Medicine
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    • v.33 no.6
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    • pp.493-501
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    • 1999
  • Purpose: We conducted a comparative study to evaluate the diagnostic values of T1-201, Tc-99m MIBI and I-131 scans in the follow-up assessment after ablative I-131 therapy in differentiated thyroid cancer. Materials and Methods: The study population consisted of 20 patients who underwent surgical removal of thyroid cancer and ablative radioactive iodine therapy, and followed by one or mote times of I-131 retreatments (33 cases). In all patients, T1-201, Tc-99m MIBI, diagnostic and therapeutic I-131 scans were performed and the results were analyzed retrospectively. Also serum thyroglobulin levels were measured in all patients. The final diagnosis of recurrent or metastatic thyroid cancer was determined by clinical, biochemical, radiologic and/or biopsy findings. Results: Positive rates (PR) of Tc-99m MIBI, T1-201, diagnostic and therapeutic I-131 scans in detecting malignant thyroid tissue lesions were 70% (19/27), 54% (15/28), 35% (17/48) and 63% (30/48), respectively. The PR in the group of 20 cases (28 lesions) who underwent concomitant T1-201 and I-131 scans were in the order of therapeutic 131 scan 71%, T1-201 scan 54% and diagnostic I-131 scan 36%. There was no statistically significant difference between T1-201 and diagnostic I-131 scans (p>0.05). In the group of 20 cases (27 lesions) who underwent concomitant Tc-99m MIBI and I-131 scans, the PR were in the order of Tc-99m MIBI scan 70%, I-131 therapeutic scan 52% and I-131 diagnostic scan 33%. The PR of Tc-99m MIBI was significantly higher than that of diagnostic I-131 scan (p<0.05). Conclusion: Tc-99m MIBI scan is superior to diagnostic I-131 scan in detecting recurrent or metastatic thyroid cancer following ablation therapy in patients with differentiated thyroid cancer. T1-201 scan did not showed significantly higher positive rate than diagnostic I-131 scan. Instead of diagnostic I-131 scan before the I-131 retreatment, Tc-99m MIBI scan without discontinuing thyroid hormone replacement would be a prudent and effective approach in the management of these patients.

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Replacement of Saline Water through Injecting Fresh Water into a Confined Saline Aquifer at the Nakdong River Delta Area (염수로 충진된 낙동강 델타지역 피압대수층에서 담수주입에 의한 염수치환 연구)

  • Won, Kyung-Sik;Chung, Sang Yong;Lee, Chang-Sup;Jeong, Jae-Hoon
    • The Journal of Engineering Geology
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    • v.25 no.2
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    • pp.215-225
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    • 2015
  • We performed injection tests in a deep-seated confined aquifer to assess the potential of artificial recharge as a means of preventing saltwater contamination, thereby securing groundwater resources for the Nakdong Delta area of Busan City, Korea. The study area comprises a confined aquifer, in which a 10-21-m-thick clay layer overlies 31.5-36.5 m of sand and a 2.8-11-m-thick layer of gravel. EC logging of five monitoring wells yielded a value of 7-44 mS/cm, with the transition between saline and fresh water occurring at a depth of 15-38 m. Above 5 m depth, water temperature is 10-15.5℃, whereas between 5 and 50 m depth the temperature is 15.5-17℃. Approximately 950 m3 of fresh water was injected into the OW-5 injection well at a rate of 370 m3/day for 62 hours, after which the fresh water zone was detected by a CTD Diver installed at a depth of 40 m. The persistence of the fresh water zone was determined via EC and temperature logging at 24 hours after injection, and again 21 days after injection. We observed a second fresh water zone in the OW-2 well, where the first injection test was performed more than 20 days before the second injection test. The contact between fresh and saline water in the injection well is represented by a sharp boundary rather than a transitional boundary. We conclude that the injected fresh water occupied a specific space and served to maintain the original water quality throughout the observation period. Moreover, we suggest that artificial recharge via long-term injection could help secure a new alternative water resource in this saline coastal aquifer.

Beak Trimming Methods - Review -

  • Glatz, P.C.
    • Asian-Australasian Journal of Animal Sciences
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    • v.13 no.11
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    • pp.1619-1637
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    • 2000
  • A review was undertaken to obtain information on the range of beak-trimming methods available or under development. Beak-trimming of commercial layer replacement pullets is a common yet critical management tool that can affect the performance for the life of the flock. The most obvious advantage of beak-trimming is a reduction in cannibalism although the extent of the reduction in cannibalism depends on the strain, season, and type of housing, flock health and other factors. Beak-trimming also improves feed conversion by reducing food wastage. A further advantage of beak-trimming is a reduction in the chronic stress associated with dominance interactions in the flock. Beak-trimming of birds at 7-10 days is favoured by Industry but research over last 10 years has shown that beak-trimming at day-old causes the least stress on birds and efforts are needed to encourage Industry to adopt the practice of beak-trimming birds at day-old. Proper beak-trimming can result in greatly improved layer performance but improper beak-trimming can ruin an other wise good flock of hens. Re-trimming is practiced in most flocks, although there are some flocks that only need one trimming. Given the continuing welfare scrutiny of using a hot blade to cut the beak, attempts have been made to develop more welfare friendly methods of beak-trimming. Despite the developments in design of hot blade beak-trimmers the process has remained largely unchanged. That is, a red-hot blade cuts and cauterises the beak. The variables in the process are blade temperature, cauterisation time, operator ability, severity of trimming, age of trimming, strain of bird and beak length. This method of beak-trimming is still overwhelmingly favoured in Industry and there appears to be no other alternative procedures that are more effective. Sharp secateurs have been used trim the upper beak of both layers and turkeys. Bleeding from the upper mandible ceases shortly after the operation, and despite the regrowth of the beak a reduction of cannibalism has been reported. Very few differences have been noted between behaviour and production of the hot blade and cold blade cut chickens. This method has not been used on a large scale in Industry. There are anecdotal reports of cannibalism outbreaks in birds with regrown beaks. A robotic beak-trimming machine was developed in France, which permitted simultaneous, automated beak-trimming and vaccination of day-old chicks of up to 4,500 chickens per hour. Use of the machine was not successful because if the chicks were not loaded correctly they could drop off the line, receive excessive beak-trimming or very light trimming. Robotic beak-trimming was not effective if there was a variation in the weight or size of chickens. Capsaicin can cause degeneration of sensory nerves in mammals and decreases the rate of beak regrowth by its action on the sensory nerves. Capsaicin is a cheap, non-toxic substance that can be readily applied at the time of less severe beak-trimming. It suffers the disadvantage of causing an extreme burning sensation in operators who come in contact with the substance during its application to the bird. Methods of applying the substance to minimise the risk to operators of coming in contact with capsaicin need to be explored. A method was reported which cuts the beaks with a laser beam in day-old chickens. No details were provided on the type of laser used, or the severity of beak-trimming, but by 16 weeks the beaks of laser trimmed birds resembled the untrimmed beaks, but without the bill tip. Feather pecking and cannibalism during the laying period were highest among the laser trimmed hens. Currently laser machines are available that are transportable and research to investigate the effectiveness of beak-trimming using ablasive and coagulative lasers used in human medicine should be explored. Liquid nitrogen was used to declaw emu toes but was not effective. There was regrowth of the claws and the time and cost involved in the procedure limit the potential of using this process to beak-trim birds.

A Comparative Study of Internet Addiction among Middle and High School Students in Seoul, Cheonan, and Rural Area (서울, 천안, 농촌지역 중 고교 학생들의 인터넷 중독에 대한 비교 연구)

  • Lee, Seok-Bum;Lee, Kyung-Kyu;Paik, Ki-Chung;Kim, Hyun-Woo
    • Korean Journal of Psychosomatic Medicine
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    • v.12 no.2
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    • pp.145-156
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    • 2004
  • Objectives : Internet addiction is a newly appeared addictive phenomenon that is defined as 'difficulty in real life due to internet over-use', 'excessive time spent on the internet or replacement of genuine real relationships with superficial virtual ones' or 'weakness in self-control about internet use and if discontinued, fallen in psychological confusion and anergic state'. This study was aimed to compare the internet addiction rate, demographic factors, computer using patterns, anxiety, depression, and internet self-efficacy and outcome expectancy between Korean middle and high school students in three areas - Seoul, Cheonan, and Rural areas - that were different in economic, cultural, and geographic state. Methods : Subjects are consisted of middle and high school students in Seoul, Chunan, and Rural areas(N=1718). Self-rating questionnaire included demographic data, Korean Spielberger State-Trait Anxiety Inventory, Korean Self-Rating Depression Scale(SDS), questions for internet-using pattern, Korean version of Internet Addiction Scale invented by K. S. Young, Internet Self-efficacy and Out-come Expectancy Scale. Results: In this study, prevalence of internet addiction was 2.9%. There was no significant difference found in prevalence of internet addiction among three areas. In all subjects, there were significant differences in anxiety, depression, internet self-efficacy and outcome expectancy, leisure style, places of internet use, internet connecting method, and insight on internee addiction. But, in addicted group, there was no significant difference among three areas. Conclusion: This study suggested that the difference in economic, cultural, and geographic state was not related to prevalence of internet addiction. Although there were significant differences in anxiety, depression, self-efficacy associated with internee use, leisure style, places of internet use, internet connecting method, insight on internet addiction among three areas, there were no significant difference in addicted group among three areas. So, we concluded that the difference in economic, cultural, and geographic state did not influence the prevalence of internet addiction, and despite the difference in economic, cultural, and geographic state, people in three areas were equally influenced by internet addiction.

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A Study on the Validity of Rural Type Low Carbon Green Village Through Case Analysis (사례분석을 통한 농촌형 저탄소 녹색마을 타당성 검토)

  • Do, In-Hwan;Hwang, Eun-Jin;Hong, Soo-Youl;Phae, Chae-Gun
    • Journal of Korean Society of Environmental Engineers
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    • v.33 no.12
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    • pp.913-921
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    • 2011
  • This study examined the overall feasibility of low carbon green village formed in rural area. The check method is analyzing its environmental and economic feasibility and energy self-reliance. The biomass of the villages was set as 28 ton/day of livestock feces and 2 ton/day of cut fruit tree branches which make up the total of 30 ton/day. The facility consisted of a bio gasfication facility using wet (livestock feces) biomass and combined heat power generator, composting facility and wood boiler using dry (cut fruit tree branches) biomass. When operating the system, 540,540 kWh/yr of electricity and 1,762 Gcal/yr of heat energy was produced. The region's electricity energy and heat energy self-reliance rate will be 100%. The economic feasibility was found as a loss of 140 million won where the facility installation cost is 5.04 billion won, operation cost is 485.09 million won and profit is 337.12 million won. There will be a loss of about 2.2 billion won in 15 years but in the environmental analysis, it was found that crude replacement effect is about 178 million won, greenhouse gas reduction effect is about 92 million won making up the total environmental benefit of 270 million won. This means, there will be a yearly profit of about 130 million won. In terms of its environmental and economic feasibility and energy self-reliance, this project seemed to be a feasible project in overall even if it manages to get help from the government or local government.