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Laparoscopic Assisted Total Gastrectomy (LATG) with Extracorporeal Anastomosis and using Circular Stapler for Middle or Upper Early Gastric Carcinoma: Reviews of Single Surgeon's Experience of 48 Consecutive Patients (원형 자동문합기를 이용한 체외문합을 시행한 복강경 보조 위전절제술: 한 술자에 의한 연속적인 48명 환자의 수술성적분석)

  • Cheong, Oh;Kim, Byung-Sik;Yook, Jeong-Hwan;Oh, Sung-Tae;Lim, Jeong-Taek;Kim, Kab-Jung;Choi, Ji-Eun;Park, Gun-Chun
    • Journal of Gastric Cancer
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    • v.8 no.1
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    • pp.27-34
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    • 2008
  • Purpose: Many recent studies have reported on the feasibility and usefulness of laparoscopy assisted distal gastrectomy (LADG) for treating early gastric cancer. On the other hand, there has been few reports about laparoscopy assisted total gastrectomy (LATG) because upper located gastric cancer is relatively rare and the surgical technique is more difficult than that for LADG, We now present our procedure and results of performing LATG for the gastric cancer located in the upper or middle portion of the stomach. Materials and Methods: From Jan 2005 to Sep 2007, 96 patients underwent LATG by four surgeons at the Asan Medical Center, Seoul, Korea. Among them, 48 consecutive patients who were operated on by asingle surgeon were analyzed with respect to the clinicopathological features, the surgical results and the postoperative courses with using the prospectively collected laparoscopy surgery data. Results: There was no conversion to open surgery during LATG. For all the reconstructions, Roux-en Y esophago-jejunostomy and D1+beta lymphadenectomy were the standard procedures. The mean operation time was $212{\pm}67$ minutes. The mean total number of retrieved lymph nodes was $28.9{\pm}10.54$ (range: $12{\sim}64$) and all the patients had a clear proximal resection margin in their final pathologic reports. The mean time to passing gas, first oral feeding and discharge from the hospital was 2.98, 3.67 and 7.08 days, respectively. There were 5 surgical complications and 2 non-surgical complications for 5 (10.4%) patients, and there was no mortality. None of the patients needed operation because of complications and they recovered with conservative treatments. The mean operation time remained constant after 20 cases and so a learning curve was present. The morbidity rate was not different between the two periods, but the postoperative course was significantly better after the learning curve. Analysis of the factors contributing to the postoperative morbidity, with using logistic regression analysis, showed that the 8MI is the only contributing factor forpostoperative complications (P=0.029, HR=2.513, 95% CI=1.097-5.755). Conclusions: LATG with regional lymph node dissection for upper and middle early gastric cancer is considered to be a safe, feasible method that showed an excellent postoperative course and acceptable morbidity. BMI should be considered in the patient selection at the beginning period because of the impact of the BMI on the postoperative morbidity.

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Studies on Lipid and Fatty acid Composition of Korean Perilla Leaves(Penilla frutescens var. japonica HARA) (한국산 들깻잎의 지방질 및 지방산조성에 관한 연구)

  • Shin, Kwang-Kyu;Yang, Cha-Bum;Park, Hoon
    • Korean Journal of Food Science and Technology
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    • v.24 no.6
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    • pp.610-615
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    • 1992
  • The difference in content and composition of total lipid, lipid fractions and fatty acids of perilla leaves being used fresh vegetable was investigated in relation to the color of undersurface, i.e. green perilla leaves(GPL) and violet perilla leaves(VPL), by column- and thin layer- and gas chromatography. Total lipid(TL) content was of little difference between green leaves(GPL) (5.24%dw) and violet one (VPL) (5.02%dw), while neutral lipid(NL) content was higher In VPL(36.4% of TL) than GPL(34.7%). The major components were sterol ester and hydrocarbons(58.5%) and trigylcerides(14.9%) in NL, $mono-(42{\sim}45%)$ and $di-(13{\sim}15%)$ galactosyl digylceride in glycolipids(GL) and phosphatidyl ethanolamine$(40{\sim}45%)$ and phosphatidyl glycerol(13%) in phospholipids(PL) for both GPL and VPL. The number of component was 10 in all three fractions. The similarity of component between GPL and VPL was in decreasing order of NL(r=1.00), GL(r=0.997) and PL(r= 0.968). Major fatty acids were linolenic $(62{\sim}64%)$, palmitic$(10{\sim}12%)$ and linolic$(9{\sim}10%)$ for TL, linolenic, palmitic, myristic(43, 15, 14%) for NL, linolenic, oleic, palmitic(79, 11, 8%) for GL and linolenic, linoleic, palmitic(36, 25, 23%) for PL. Unsaturated fatty acid percentage was higher only in GL of VPL than GPL. The similarity of fatty acid composition between GPL and VPL was least in PL and so it was among other fraction with PL.

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The development of conductive 10B thin film for neutron monitoring (중성자 모니터링을 위한 전도성 10B 박막 개발)

  • Lim, Chang Hwy;Kim, Jongyul;Lee, Suhyun;Jung, Yongju;Choi, Young-Hyun;Baek, Cheol-Ha;Moon, Myung-Kook
    • Journal of Radiation Protection and Research
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    • v.39 no.4
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    • pp.199-205
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    • 2014
  • In the field of neutron detections, $^3He$ gas, the so-called "the gold standard," is the most widely used material for neutron detections because of its high efficiency in neutron capturing. However, from variable causes since early 2009, $^3He$ is being depleted, which has maintained an upward pressure on its cost. For this reason, the demands for $^3He$ replacements are rising sharply. Research into neutron converting materials, which has not been used well due to a neutron detection efficiency lower than the efficiency of $^3He$, although it can be chosen for use in a neutron detector, has been highlighted again. $^{10}B$, which is one of the $^3He$ replacements, such as $BF_3$, $^6Li$, $^{10}B$, $Gd_2O_2S$, is being researched by various detector development groups owing to a number of advantages such as easy gamma-ray discrimination, non-toxicity, low cost, etc. One of the possible techniques for the detection is an indirect neutron detection method measuring secondary radiation generated by interactions between neutrons and $^{10}B$. Because of the mean free path of alpha particle from interactions that are very short in a solid material, the thickness of $^{10}B$ should be thin. Therefore, to increase the neutron detection efficiency, it is important to make a $^{10}B$ thin film. In this study, we fabricated a $^{10}B$ thin film that is about 60 um in thickness for neutron detection using well-known technology for the manufacturing of a thin electrode for use in lithium ion batteries. In addition, by performing simple physical tests on the conductivity, dispersion, adhesion, and flexibility, we confirmed that the physical characteristics of the fabricated $^{10}B$ thin film are good. Using the fabricated $^{10}B$ thin film, we made a proportional counter for neutron monitoring and measured the neutron pulse height spectrum at a neutron facility at KAERI. Furthermore, we calculated using the Monte Carlo simulation the change of neutron detection efficiency according to the number of thin film layers. In conclusion, we suggest a fabrication method of a $^{10}B$ thin film using the technology used in making a thin electrode of lithium ion batteries and made the $^{10}B$ thin film for neutron detection using suggested method.

Combustion Characteristics of Cow Manure Pellet as a Solid Fuel Source (고체연료원으로서의 우분 펠릿 연소특성)

  • Jeong, Kwang-Hwa;Lee, Dong-jun;Lee, Dong-Hyun;Lee, Sung-Hyoun
    • Journal of the Korea Organic Resources Recycling Association
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    • v.27 no.2
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    • pp.31-40
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    • 2019
  • In Korea, 51,013 thousand tons of livestock manure was generated in 2018. A total of 46,530 thousand tons, which is 91.2% of the total amount of livestock manure generated, was treated by composting(40,647 thousand tons) or liquid fertilization(5,884 thousand tons) method. At present, the policy of livestock manure treatment in Korea is to make livestock manure into organic fertilizer(compost, liquid fertilizer) and then to applicate it on agricultural land. And this policy is very effective in terms of livestock manure treatment and nutrient recycling. However, considering the steadily declining farmland area for decades, the use of livestock manure compost could be limited in the future. There is also concern that local nutrient overloading, nutrient management regulation, and restrictions on the number of livestock may become serious problem for livestock manure treatment. In addition, there are some opinions that nutrient derived from livestock manure may flow into tributaries of major dams. In recent years, there has been a suspicion that fine dust may be generated from livestock manure compost. In recent years, the use of livestock manure fertilizer has been rapidly increasing, there is a growing demand of the development of new technologies for livestock manure treatment. Especially, cow excretes a larger amount of manure than other livestock, so that the efficiency of development of new technology for cow manure treatment will be high. Therefore, in this study, the combustion characteristics of cow manure pellet were investigated in order to analyzed whether cow manure could be used as source of solid fuel. During the combustion test, the weight loss of the cow manure pellet began to increase when the temperature of the combustion chamber reached $300^{\circ}C$. The ratio of $H_2$, $CH_4$, CO in the pyrolysis gas produced in the pyrolysis process of cow manure pellet were 6.65~11.62%, 0.58~1.54 and 11.47~14.07%, respectively.

THE LUMINOSITY-LINEWIDTH RELATION AS A PROBE OF THE EVOLUTION OF FIELD GALAXIES

  • GUHATHAKURTA PURAGRA;ING KRISTINE;RIX HANS-WALTER;COLLESS MATTHEW;WILLIAMS TED
    • Journal of The Korean Astronomical Society
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    • v.29 no.spc1
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    • pp.63-64
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    • 1996
  • The nature of distant faint blue field galaxies remains a mystery, despite the fact that much attention has been devoted to this subject in the last decade. Galaxy counts, particularly those in the optical and near ultraviolet bandpasses, have been demonstrated to be well in excess of those expected in the 'no-evolution' scenario. This has usually been taken to imply that galaxies were brighter in the past, presumably due to a higher rate of star formation. More recently, redshift surveys of galaxies as faint as B$\~$24 have shown that the mean redshift of faint blue galaxies is lower than that predicted by standard evolutionary models (de-signed to fit the galaxy counts). The galaxy number count data and redshift data suggest that evolutionary effects are most prominent at the faint end of the galaxy luminosity function. While these data constrain the form of evolution of the overall luminosity function, they do not constrain evolution in individual galaxies. We are carrying out a series of observations as part of a long-term program aimed at a better understanding of the nature and amount of luminosity evolution in individual galaxies. Our study uses the luminosity-linewidth relation (Tully-Fisher relation) for disk galaxies as a tool to study luminosity evolution. Several studies of a related nature are being carried out by other groups. A specific experiment to test a 'no-evolution' hypothesis is presented here. We have used the AUTOFIB multifibre spectro-graph on the 4-metre Anglo-Australian Telescope (AAT) and the Rutgers Fabry-Perot imager on the Cerro Tolalo lnteramerican Observatory (CTIO) 4-metre tele-scope to measure the internal kinematics of a representative sample of faint blue field galaxies in the red-shift range z = 0.15-0.4. The emission line profiles of [OII] and [OIII] in a typical sample galaxy are significantly broader than the instrumental resolution (100-120 km $s^{-l}$), and it is possible to make a reliable de-termination of the linewidth. Detailed and realistic simulations based on the properties of nearby, low-luminosity spirals are used to convert the measured linewidth into an estimate of the characteristic rotation speed, making statistical corrections for the effects of inclination, non-uniform distribution of ionized gas, rotation curve shape, finite fibre aperture, etc.. The (corrected) mean characteristic rotation speed for our distant galaxy sample is compared to the mean rotation speed of local galaxies of comparable blue luminosity and colour. The typical galaxy in our distant sample has a B-band luminosity of about 0.25 L$\ast$ and a colour that corresponds to the Sb-Sd/Im range of Hub-ble types. Details of the AUTOFIB fibre spectroscopic study are described by Rix et al. (1996). Follow-up deep near infrared imaging with the 10-metre Keck tele-scope+ NIRC combination and high angular resolution imaging with the Hubble Space Telescope's WFPC2 are being used to determine the structural and orientation parameters of galaxies on an individual basis. This information is being combined with the spatially resolved CTIO Fabry-Perot data to study the internal kinematics of distant galaxies (Ing et al. 1996). The two main questions addressed by these (preliminary studies) are: 1. Do galaxies of a given luminosity and colour have the same characteristic rotation speed in the distant and local Universe? The distant galaxies in our AUTOFIB sample have a mean characteristic rotation speed of $\~$70 km $s^{-l}$ after correction for measurement bias (Fig. 1); this is inconsistent with the characteristic rotation speed of local galaxies of comparable photometric proper-ties (105 km $s^{-l}$) at the > $99\%$ significance level (Fig. 2). A straightforward explanation for this discrepancy is that faint blue galaxies were about 1-1.5 mag brighter (in the B band) at z $\~$ 0.25 than their present-day counterparts. 2. What is the nature of the internal kinematics of faint field galaxies? The linewidths of these faint galaxies appear to be dominated by the global disk rotation. The larger galaxies in our sample are about 2"-.5" in diameter so one can get direct insight into the nature of their internal velocity field from the $\~$ I" seeing CTIO Fabry-Perot data. A montage of Fabry-Perot data is shown in Fig. 3. The linewidths are too large (by. $5\sigma$) to be caused by turbulence in giant HII regions.

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The Economic Effects of the New and Renewable Energies Sector (신재생에너지 부문의 경제적 파급효과 분석)

  • Lim, Seul-Ye;Park, So-Yeon;Yoo, Seung-Hoon
    • Journal of Energy Engineering
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    • v.23 no.4
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    • pp.31-40
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    • 2014
  • The Korean government made the 2nd Energy Basic Plan to achieve 11% of new and renewable energies distribution rate until 2035 as a response to cope with international discussion about greenhouse gas emission reduction. Renewable energies include solar thermal, photovoltaic, bioenergy, wind power, small hydropower, geothermal energy, ocean energy, and waste energy. New energies contain fuel cells, coal gasification and liquefaction, and hydrogen. As public and private investment to enhance the distribution of new and renewable energies, it is necessary to clarify the economic effects of the new and renewable energies sector. To the end, this study attempts to apply an input-output analysis and analyze the economic effects of new and renewable energies sector using 2012 input-output table. Three topics are dealt with. First, production-inducing effect, value-added creation effect, and employment-inducing effect are quantified based on demand-driven model. Second, supply shortage effects are analyzed employing supply-driven model. Lastly, price pervasive effects are investigated applying Leontief price model. The results of this analysis are as follows. First, one won of production or investment in new and renewable energies sector induces 2.1776 won of production and 0.7080 won of value-added. Moreover, the employment-inducing effect of one billion won of production or investment in new and renewable energies sector is estimated to be 9.0337 persons. Second, production shortage cost from one won of supply failure in new and renewable energies sector is calculated to be 1.6314 won, which is not small. Third, the impact of the 10% increase in new and renewable energies rate on the general price level is computed to be 0.0123%, which is small. This information can be utilized in forecasting the economic effects of new and renewable energies sector.

Diffuse Panbronchiolitis : Clinical Significance of High-resolution CT and Radioaerosol Scan Manifestations (미만성 범세기관지염에서 흉부 고해상도 전산화 단층촬영의 임상적의의 및 폐환기주사 소견)

  • Song, So Hyang;Kim, Hui Jung;Kim, Young Kyoon;Moon, Hwa Sik;Song, Jeong Sup;Park, Sung Hak;Kim, Hak Hee;Chung, Soo Kyo
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.1
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    • pp.124-135
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    • 1997
  • Background : Diffuse panbronchiolitis(DPB) is a disease characterized clinically by chronic cough, expectoration and dyspnea; and histologically by chronic inflammation localized mainly in the region of the respiratory bronchiole. It is prevalent in Japanese, but is known to be rare in Americans and Europians. Only a few cases in Chinese, Italians, North Americans and Koreans have been reported. It is diagnosed by characteristic clinical, radiological and pathologic features. High-resolution CT(HRCT) is known to be valuable in the study of the disease process and response to therapy in DPB. To our knowledge, there has been no correlation of its appearance on HRCT with the severity of the disease process, and radioaerosol scan(RAS) of the lung has not previously been used for the diagnosis of DPB. Method : During recent two years we have found 12 cases of DPB in Kangnam St. Mary's Hospital, Catholic University Medical College. We analysed the clinical characteristics, compared HRCT classifications with clinical stages of DPB, and determined characteristic RAS manifestations of DPB. Results : 1. The ages ranged from 31 to 83 years old(mean 54.5 years old), and male female ratio was 4:8. 75%(9/12) of patients had paranasal sinusitis, and only one patient was a smoker. 2. The patients were assigned to one of three clinical stages of DPB on the basis of clinical findings, sputum bacterology and arterial blood gas analysis. of 12 cases, 5 were in the first stage, 4 were in the second stage, and 3 were in the third stage. In most of the patients, pulmonary function tests showed marked obstructive and slight restrictive impairments. Sputum culture yielded P.aeruginosa in 3 cases of our 12 cases, K.pneumoniae in 2 cases, H.influenzae in 2 cases, and S.aureus in 2 cases. 3. Of 12 patients, none had stage I characteristics as classified on HRCT scans, 4 had slage II findings, 5 had stage III findings, and 3 had stage IV characteristics. 4. We peformed RAS in 7 of 12 patients With DPB. In 71.4% (5/7) of the patients, RAS showed mottled aerosol deposits characteristically in the transitional and intermediary airways with peripheral airspace defects, which contrasted sharply with central aerosol deposition of COPD. 5. There were significant correlations between HRCT stages and clinical stages(r= 0.614, P < 0.05), between HRCT types and Pa02(r= -0.614, P < 0.05), and between HRCT types and ESR(r= 0.618, P < 0.01). Conclusion : The HRCT classifications correspond well to the clinical stage. Therfore in the examination of patients with DPB, HRCT is useful in the evaluation of both the location and severity of the lesions. Also, RAS apears to be a convenient, noninvasive and useful diagnostic method of DPB.

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The Prognostic Role of B-type Natriuretic Peptide in Acute Exacerbation of Chronic Obstructive Pulmonary Disease (만성폐쇄성폐질환의 급성 악화시 예후 인자로서의 혈중 B-type Natriuretic Peptide의 역할)

  • Lee, Ji Hyun;Oh, So Yeon;Hwang, Iljun;Kim, Okjun;Kim, Hyun Kuk;Kim, Eun Kyung;Lee, Ji-Hyun
    • Tuberculosis and Respiratory Diseases
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    • v.56 no.6
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    • pp.600-610
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    • 2004
  • Background : The plasma B-type natriuretic peptide(BNP) concentration increases with the degree of pulmonary hypertension in patients with chronic respiratory disease. The aim of this study was to examine the prognostic role of BNP in the acute exacerbation of chronic obstructive lung disease (COPD). Method : We selected 67 patients who were admitted our hospital because of an acute exacerbation of COPD. Their BNP levels were checked on admission at the Emergency Department. Their medical records were analyzed retrospectively. The patients were divided into two groups according to their in-hospital mortality. The patients' medical history, comobidity, exacerbation type, blood gas analysis, pulmonary function, APACHE II severity score and plasma BNP level were compared. Results : Multiple logistic regression analysis identified three independent predictors of mortality: $FEV_1$, APACHE II score and plasma BNP level. The decedents group showed a lower $FEV_1$($28{\pm}7$ vs. $37{\pm}15%$, p=0.005), a higher APACHE II score($22.4{\pm}6.1$ vs. $15.8{\pm}4.7$, p=0.000) and a higher BNP level ($201{\pm}116$ vs. $77{\pm}80pg/mL$, p=0.000) than the sSurvivors group. When the BNP cut-off level was set to 88pg/mL using the receiver operating characteristic curve, the sensitivity was 90% and the specificity was 75% in differentiating between the survivors and decedents. On Fisher's exact test, the odds ratio for mortality was 21.2 (95% CI 2.49 to 180.4) in the patients with a BNP level > 88pg/mL. Conclusion : The plasma BNP level might be a predictor of mortality in an acute exacerbation of COPD as well as the $FEV_1$ and APACHE II score.

Epidemiologic Survey on Outbreak of Dermatosis Associated with Ants, Pachycondyla chinensis (왕침개미에 의한 피부질환 집단 발생에 관한 역학 조사)

  • Lim, Hyun-Sul;Kim, Byung-Jin;Bae, Geun-Ryang
    • Journal of Preventive Medicine and Public Health
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    • v.32 no.3
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    • pp.421-426
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    • 1999
  • Objectives: An outbreak of dermatosis occurred at a city gas manufacturing factory in Pohang in Aug, 1998. The authors conducted a study to find the cause and prevent the dermatosis, Methods: We conducted a questionnaire survey of 73 workers in the factory twice, once or Aug. 14th and then Sept. 11th, 1998. Also, a dermatologist examined their skin lesions. We suspected ants as the cause, so we collected them for identification. Results: Twelve cases of dermatosis were identified with an attack rate of 16.4%. The attack rates were not different by age, educational level or tenures. The attack rates were 66.6% among production workers, 2.0% among clerical workers, 16.7% among tank trailer drivers and 0% among guards. The attack rate among production workers was significantly higher than that of the others (<0.01). There were no histories of the same dermatosis for the past one year. Histories of other skin diseases and allergies were very rare in both cases with skin diseases and control. Multiple, pruritic, rice-grained to bean sized erythemafous macules or papules with a central biting point could be found after initial severe itching occurred, Three cases showed signs of dermatosis with an allergic nature. The onset of dermatosis was between July 30 and Aug 12 and the durations varied from 5 days to over a month. The most frequent sites of stir lesions were the chest and abdomen (60.6%), and they were also observed on the neck (33.3%), arms (33.3%), shoulders (16.7%) and back (16.7%). Over 10 ants with their wings were collected in the work place and identified as Pachycondyla chinensis, subfamily Ponerinae. Conclusions : We thought that the outbreak of dermatosis was brought about by the ants flying into the work place through the open windows. Further studies on the factors contributing to the prosperity of the ants in this area are needed.

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THE CURRENT STATUS OF BIOMEDICAL ENGINEERING IN THE USA

  • Webster, John G.
    • Proceedings of the KOSOMBE Conference
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    • v.1992 no.05
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    • pp.27-47
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    • 1992
  • Engineers have developed new instruments that aid in diagnosis and therapy Ultrasonic imaging has provided a nondamaging method of imaging internal organs. A complex transducer emits ultrasonic waves at many angles and reconstructs a map of internal anatomy and also velocities of blood in vessels. Fast computed tomography permits reconstruction of the 3-dimensional anatomy and perfusion of the heart at 20-Hz rates. Positron emission tomography uses certain isotopes that produce positrons that react with electrons to simultaneously emit two gamma rays in opposite directions. It locates the region of origin by using a ring of discrete scintillation detectors, each in electronic coincidence with an opposing detector. In magnetic resonance imaging, the patient is placed in a very strong magnetic field. The precessing of the hydrogen atoms is perturbed by an interrogating field to yield two-dimensional images of soft tissue having exceptional clarity. As an alternative to radiology image processing, film archiving, and retrieval, picture archiving and communication systems (PACS) are being implemented. Images from computed radiography, magnetic resonance imaging (MRI), nuclear medicine, and ultrasound are digitized, transmitted, and stored in computers for retrieval at distributed work stations. In electrical impedance tomography, electrodes are placed around the thorax. 50-kHz current is injected between two electrodes and voltages are measured on all other electrodes. A computer processes the data to yield an image of the resistivity of a 2-dimensional slice of the thorax. During fetal monitoring, a corkscrew electrode is screwed into the fetal scalp to measure the fetal electrocardiogram. Correlations with uterine contractions yield information on the status of the fetus during delivery To measure cardiac output by thermodilution, cold saline is injected into the right atrium. A thermistor in the right pulmonary artery yields temperature measurements, from which we can calculate cardiac output. In impedance cardiography, we measure the changes in electrical impedance as the heart ejects blood into the arteries. Motion artifacts are large, so signal averaging is useful during monitoring. An intraarterial blood gas monitoring system permits monitoring in real time. Light is sent down optical fibers inserted into the radial artery, where it is absorbed by dyes, which reemit the light at a different wavelength. The emitted light travels up optical fibers where an external instrument determines O2, CO2, and pH. Therapeutic devices include the electrosurgical unit. A high-frequency electric arc is drawn between the knife and the tissue. The arc cuts and the heat coagulates, thus preventing blood loss. Hyperthermia has demonstrated antitumor effects in patients in whom all conventional modes of therapy have failed. Methods of raising tumor temperature include focused ultrasound, radio-frequency power through needles, or microwaves. When the heart stops pumping, we use the defibrillator to restore normal pumping. A brief, high-current pulse through the heart synchronizes all cardiac fibers to restore normal rhythm. When the cardiac rhythm is too slow, we implant the cardiac pacemaker. An electrode within the heart stimulates the cardiac muscle to contract at the normal rate. When the cardiac valves are narrowed or leak, we implant an artificial valve. Silicone rubber and Teflon are used for biocompatibility. Artificial hearts powered by pneumatic hoses have been implanted in humans. However, the quality of life gradually degrades, and death ensues. When kidney stones develop, lithotripsy is used. A spark creates a pressure wave, which is focused on the stone and fragments it. The pieces pass out normally. When kidneys fail, the blood is cleansed during hemodialysis. Urea passes through a porous membrane to a dialysate bath to lower its concentration in the blood. The blind are able to read by scanning the Optacon with their fingertips. A camera scans letters and converts them to an array of vibrating pins. The deaf are able to hear using a cochlear implant. A microphone detects sound and divides it into frequency bands. 22 electrodes within the cochlea stimulate the acoustic the acoustic nerve to provide sound patterns. For those who have lost muscle function in the limbs, researchers are implanting electrodes to stimulate the muscle. Sensors in the legs and arms feed back signals to a computer that coordinates the stimulators to provide limb motion. For those with high spinal cord injury, a puff and sip switch can control a computer and permit the disabled person operate the computer and communicate with the outside world.

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