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Clinical Outcomes of Surgical Repair with a Composite Graft for Abdominal Aortic Aneurysm Accompanied by Iliac Artery Aneurysm

  • Sohn, Bongyeon;Kim, Hak Ju;Chang, Hyoung Woo;Lee, Jae Hang;Kim, Dong Jung;Kim, Jun Sung;Lim, Cheong;Park, Kay Hyun
    • Journal of Chest Surgery
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    • v.53 no.6
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    • pp.339-345
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    • 2020
  • Background: Iliac artery aneurysm is frequently found in patients undergoing surgical repair of an abdominal aortic aneurysm. The use of commercial bifurcated grafts is insufficient for aorto-biiliac replacement with complete iliac artery aneurysm resection. We evaluated the effectiveness of handmade composite grafts for this purpose. Methods: A total of 233 patients underwent open surgery for abdominal aortic aneurysm between 2003 and 2019, including 155 patients (67%) treated with commercial grafts and 78 patients (33%) treated with handmade composite grafts. Their operative characteristics, postoperative outcomes, and late outcomes were retrospectively reviewed. Results: The early mortality rate did not differ significantly between the groups. On average, the handmade composite graft technique took approximately 15 minutes longer than the commercial graft technique (p=0.037). Among patients who underwent elective surgery, no significant differences between the conventional and composite groups were observed in the major outcomes, including red blood cell transfusion volume (2.8±4.7 units vs. 3.1±4.7 units, respectively; p=0.680), reoperation for bleeding (2.7% vs. 3.1%, respectively; p>0.999), bowel ischemia (0% vs. 1.6%, respectively; p=0.364), and intensive care unit stay duration (1.9±6.6 days vs. 1.6±2.4 days, respectively; p=0.680). The incidence of target vessel occlusion also did not differ significantly between groups. Conclusion: The increased technical demand involved with handmade composite grafting did not negatively impact the outcomes. This technique may be a viable option because it overcomes problems associated with commercial grafts.

Different Sources and Levels of Copper Supplementation on Performance and Nutrient Utilization of Castrated Black Bengal (Capra hircus) Kids Diet

  • Mondal, M.K.;Biswas, P.
    • Asian-Australasian Journal of Animal Sciences
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    • v.20 no.7
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    • pp.1067-1075
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    • 2007
  • Twenty eight 3-4 month old castrated Black Bengal kids (Capra hircus) were used to determine the effects of source and level of dietary copper (Cu) concentration on their performance and nutrient utilization. Cu was supplemented (0, 10, 20 and 30 mg/kg diet DM) as copper sulfate ($CuSO_4$, $5H_2O$) or copper proteinate (Cu-P). Kids were fed a basal diet containing maize (19.5%), soybean (17.0%), deoiled rice bran (56.5%), molasses (4.0%), di-calcium phosphate and salt (1.0% each) and mineral and vitamin mixture (0.5% each) supplements at 3.5% of body weight to meet NRC (1981) requirements for protein, energy, macro minerals and micro minerals, excluding Cu. The basal diet contained 5.7 mg Cu/kg, 122.5 mg Fe/kg, 110 mg Zn/kg, 0.26 mg Mo/kg and 0.32% S. $CuSO_4$ or Cu-P was added to the basal diet at the rate of 10, 20 and 30 mg/kg. Kids were housed in a well ventilated shed with facilities for individual feeding in aluminum plated metabolic cages. Blood samples were collected from the jugular vein on d 0, 30, 60 and 90 to determine hemoglobin (Hb), packed cell volume (PCV), total erythrocyte count (TEC), total leukocyte count (TLC) and serum enzymes (alkaline phosphatase, alanine transferase and aspertate transferase). A metabolism trial of 6 days duration was conducted after 90 days of experimental feeding. Statistical analysis revealed that source and level of Cu supplementation improved live weight gain (p<0.04) and average daily gain (p<0.01). No significant contribution of source and level of Cu to alter serum serum enzymes was evident. Goats fed Cu-P tended to have higher Hb, PCV and TEC than with $CuSO_4$ supplementation. Cu-P increased digestibility of ether extract (EE, p<0.02) and crude fiber (p<0.05) and showed an increasing trend (p<0.09) for digested crude protein (CP) and crude fiber (CF). Supplemental dose of Cu linearly improved (p<0.02) digestibilities of dry matter (DM), organic matter (OM), EE and nitrogen free extract (NFE). Though the absorption of nitrogen (N) was not affected (p>0.10) by both source and dose of Cu, N retention was affected (p<0.04) and there was a significant $Source{\times}Dose$ interaction (p<0.05). Final body weight (BW) was not influenced (p>0.10) by the source of Cu but increasing dose of Cu increased (p<0.04) the BW of kids. TDN intake (g/kg $W^{0.75}$) was higher (p<0.05) with the increased dose of Cu and there was a significant $Source{\times}Dose$ interaction. It was concluded that supplementation of Cu from different sources and varying dose level in a concentrate based diet may improve performance, nutrient utilization and plane of nutrition in castrated Black Bengal kids. The effects on performance and nutrient utilization are more pronounced with Cu-P than $CuSO_4$ supplementation. Higher dose of Cu showed better result than lower dose.

Effect of Different Source of Energy on Urea Molasses Mineral Block Intake, Nutrient Utilization, Rumen Fermentation Pattern and Blood Profile in Murrah Buffaloes (Bubalus bubalis)

  • Hosamani, S.V.;Mehra, U.R.;Dass, R.S.
    • Asian-Australasian Journal of Animal Sciences
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    • v.16 no.6
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    • pp.818-822
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    • 2003
  • In order to investigate the effect of different sources of energy on intake and nutrient utilization from urea molasses mineral block (UMMB), rumen fermentation pattern and blood biochemical constituents, 18 intact and 9 rumen fistulated male Murrah buffaloes aged about 3 years and average weight 310.8 kg were randomly allocated into three groups of 9 animals in each, thus each group having 6 intact and three rumen fistulated buffaloes. All animals were fed individually for 90 days. All buffaloes were offered wheat straw as basal roughage and urea molasses mineral block for free choice of licking. Three different energy sources viz., barley grain, (group I), maize grain (group II) and jowar green (group III) were offered to meet their nutrient requirement as per Kearl (1982). At the end of feeding trial, a metabolism trial of 7 days duration was carried out on intact animals to determine the digestibility of nutrients. Rumen fermentation studies were carried out on rumen fistulated animals. After the metabolism trial blood was collected from intact animals to estimate the nitrogen constituents in blood serum of animals fed on different sources of energy. Results revealed no significant difference in the intake of UMMB in three groups. Similarly, the intake of DM (kg), DCP (g) and TDN (kg) per day was similar in three groups statistically. The apparent digestibility of dry matter (DM), organic matter (OM), ether extract (EE) and nitrogen free extract (NFE) was significantly (p<0.05) more in group II than group III, whereas the digestibility of DM, OM and NFE was similar in group I and II. The digestibility of crude fiber (CF) and all the fiber fractions i.e. NDF, ADF, cellulose and hemicellulose was alike in 3 groups. Nitrogen balance (g/d) was significantly (p<0.05) more in group III as compared to group I and II, which were alike statistically, though the N intake (g/d) was similar in 3 groups but N balance (g/d) was significantly (p<0.05) less in group III as compared to other 2 groups. Significantly (p<0.05) higher concentration of total volatile fatty acids (TVFA), total nitrogen (TN) and its fractions were observed in group I and II as compared to group III. There was no effect on rumen pH, rumen volume and digesta flow rate due to different sources of energy in 3 groups. Similarly the blood serum biochemical parameters (NH3-N, urea-N and total protein) were statistically identical in 3 groups.

Astronomical Calendar and Restoration Design of Clepsydra in the Silla era (신라시대 천문역법(天文曆法)과 물시계(漏刻) 복원연구)

  • Lee, Yong-Sam;Jeong, Jang-Hae;Kim, Sang-Hyuk;Lee, Yong-Bok
    • Journal of Astronomy and Space Sciences
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    • v.25 no.3
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    • pp.299-320
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    • 2008
  • We study on the astronomical calendars that was used in the Silla era. The calendars are deduced from the records in Samguksagi. They were influenced from calendaric system of Tang Dynasty, which are Lin duk calendar(麟德曆), Ta yen calendar(大衍曆) and Sun myung calendar(宣明曆). We analyse them in detail according to the time and duration of use. Water clock system of Unified Silla was used four water vessels for supplying water. We found the model from documents on ancient water clock that are appeared in the old Korean, Chinese and Japanese historical records. We have assumed the model of Unified Silla clepsydra is similar type with Chinese records during Tang dynasty and with Japanese reconstructed water clock in Temple Asoka. After fluid dynamic experiment, we decide the suitable diameter of supplying pipe and volume of the vessels used in the clepsydra. We introduce the experimental instruments and methods for accomplishing the clock. We designed and reconstructed the water clock of Unified Silla and float rods for measuring time, that is based on the Silla's calendaric system.

Spatial Distributions of On-road Ultrafine Particle Number Concentration on Naebu Express Way in Seoul during Winter Season (겨울철 서울 내부순환로 도로상 초미세입자 오염의 공간분포 특징)

  • Woo, Daekwang;Lee, Seung-Bok;Lee, Seung Jae;Kim, Jin Young;Jin, Hyun Chul;Kim, Taesung;Bae, Gwi-Nam
    • Journal of Korean Society for Atmospheric Environment
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    • v.29 no.1
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    • pp.10-26
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    • 2013
  • To understand the traffic emissions with high temporal and spatial resolutions on road, a mobile laboratory was developed. The objective of this study is to characterize on-road air pollution on Naebu express way surrounding the northern area of Seoul, Korea. We measured the number concentration of ultrafine particles larger than 5 nm and particle size distribution using a condensation particle counter and a fast mobility particle sizer, respectively on 3, 7, and 8 December 2009. The average ultrafine particle number concentration on the Naebu express way excluding tunnels was 126,000 particles/$cm^3$ and 4.2 times higher than that on internal road at Korea Institute of Science and Technology in Seoul, and more than twice higher than that measured on and at the arterial roads of Seoul in previous studies. The maximum ultrafine particle number concentration was observed at the tunnel sections. It was 232,000 particles/$cm^3$ and 1.8 times higher than average ultrafine particle number concentration for the other sections on Naebu express way. The ultrafine particle number concentration on the wider roads with higher traffic volume along the Han River was similar to that in the residential section, probably because of enhanced dilution effect in widely open environment. The size distribution of particles on the Naebu express way was highly fluctuated for a short duration. Ultrafine particles measured at the tunnel showed a bimodal size distribution with mode diameters of ~10 nm and ~50 nm. At the Han riverside section, ~10 nm particles appeared significantly compared with size distribution at the tunnel. This on-road measurement approach can be utilized to manage vehicle-related air pollution in urban area.

A study of Assessment for Internal Inundation Vulnerability in Urban Area using SWMM (SWMM을 이용한 도시지역 내수침수 취약성 평가)

  • Shon, Tae-Seok;Kang, Dong-Ho;Jang, Jong-Kyung;Shin, Hyun-Suk
    • Journal of the Korean Society of Hazard Mitigation
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    • v.10 no.4
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    • pp.105-117
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    • 2010
  • The topographical depressions in urban areas, the lack in drainage capability, sewage backward flow, road drainage, etc. cause internal inundation, and the increase in rainfall resulting from recent climate change, the rapid urbanization accompanied by economic development and population growth, and the increase in an impervious area in urban areas deteriorate the risk of internal inundation in the urban areas. In this study, the vulnerability of internal inundation in urban areas is analyzed and SWMM model is applied into Oncheoncheon watershed, which represents urban river of Busan, as a target basin. Based on the results, the representative storm sewers in individual sub-catchments is selected and the risk of vulnerability to internal inundation due to rainfall in urban streams is analyzed. In order to analyze the risk and vulnerability of internal inundation, capacity is applied as an index indicating the volume of a storm sewer in the SWMM model, and the risk of internal inundation is into 4 steps. For the analysis on the risk of internal inundation, simulation results by using a SMMM model are compared with the actual inundation areas resulting from localized heavy rain on July 7, 2009 at Busan and comparison results are analyzed to prove the validity of the designed model. Accordingly, probabilistic rainfall at Busan was input to the model for each frequency (10, 20, 50, 100 years) and duration (6, 12, 18, 24hr) at Busan. In this study, it suggests that the findings can be used to preliminarily alarm the possibility of internal inundation and selecting the vulnerable zones in urban areas.

Gamma Knife Radiosurgery for Metastatic Brain Tumors with Exophytic Hemorrhage

  • Park, Eun Suk;Lee, Eun Jung;Yun, Jung-Ho;Cho, Young Hyun;Kim, Jeong Hoon;Kwon, Do Hoon
    • Journal of Korean Neurosurgical Society
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    • v.61 no.5
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    • pp.592-599
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    • 2018
  • Objective : Metastatic brain tumors (MBTs) often present with intracerebral hemorrhage. Although Gamma Knife surgery (GKS) is a valid treatment option for hemorrhagic MBTs, its efficacy is unclear. To achieve oncologic control and reduce radiation toxicity, we used a radiosurgical targeting technique that confines the tumor core within the hematoma when performing GKS in patients with such tumors. We reviewed our experience in this endeavor, focusing on local tumor control and treatment-associated morbidities. Methods : From 2007 to 2014, 13 patients with hemorrhagic MBTs were treated via GKS using our targeting technique. The median marginal dose prescribed was 23 Gy (range, 20-25). GKS was performed approximately 2 weeks after tumor bleeding to allow the patient's condition to stabilize. Results : The primary sites of the MBTs included the liver (n=7), lung (n=2), kidney (n=1), and stomach (n=1); in two cases, the primary tumor was a melanoma. The mean tumor volume was $4.00cm^3$ (range, 0.74-11.0). The mean overall survival duration after GKS was 12.5 months (range, 3-29), and three patients are still alive at the time of the review. The local tumor control rate was 92% (tumor disappearance 23%, tumor regression 46%, and stable disease 23%). There was one (8%) instance of local recurrence, which occurred 11 months after GKS in the solid portion of the tumor. No GKS-related complications were observed. Conclusion : Our experience shows that GKS performed in conjunction with our targeting technique safely and effectively treats hemorrhagic MBTs. The success of this technique may reflect the presence of scattered metastatic tumor cells in the hematoma that do not proliferate owing to the inadequate microenvironment of the hematoma. We suggest that GKS can be a useful treatment option for patients with hemorrhagic MBTs that are not amenable to surgery.

Construction stages analyses using time dependent material properties of concrete arch dams

  • Sevim, Baris;Altunisik, Ahmet C.;Bayraktar, Alemdar
    • Computers and Concrete
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    • v.14 no.5
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    • pp.599-612
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    • 2014
  • This paper presents the effects of the construction stages using time dependent material properties on the structural behaviour of concrete arch dams. For this purpose, a double curvature Type-5 arch dam suggested in "Arch Dams" symposium in England in 1968 is selected as a numerical example. Finite element models of Type-5 arch dam are modelled using SAP2000 program. Geometric nonlinearity is taken into consideration in the construction stage analysis using P-Delta plus large displacement criterion. In addition, the time dependent material strength variations and geometric variations are included in the analysis. Elasticity modulus, creep and shrinkage are computed for different stages of the construction process. In the construction stage analyses, a total of 64 construction stages are included. Each stage has generally $6000m^3$ concrete volume. Total duration is taken into account as 1280 days. Maximum total step and maximum iteration for each step are selected as 200 and 50, respectively. The structural behaviour of the arch dam at different construction stages has been examined. Two different finite element analyses cases are performed. In the first case, construction stages using time dependent material properties are considered. In the second case, only linear static analysis (not considered construction stages) is taken into account. Variation of the displacements and stresses are obtained from the both analyses. It is highlighted that construction stage analysis using time dependent material strength variations and geometric variations has an important effect on the structural behaviour of arch dams. The maximum longitudinal, transverse and vertical displacements obtained from construction stages and static analyses are 1.35 mm and 0 mm; -8.44 and 6.68 mm; -4.00 and -9.90 mm, respectively. In addition, vertical displacements increase from the base to crest of the dam for both analyses. The maximum S11, S22 and S33 stresses are obtained as 1.60MPa and 2.84MPa; 1.39MPa and 2.43MPa; 0.60MPa and 0.50MPa, respectively. The differences between maximum longitudinal, transverse, and vertical stresses obtained from construction stage and static analyses are 78%, 75%, and %17, respectively. On the other hand, there is averagely 12% difference between minimum stresses for all three directions.

Gamma Knife Radiosurgery for Brainstem Metastasis

  • Yoo, Tae-Won;Park, Eun-Suk;Kwon, Do-Hoon;Kim, Chang-Jin
    • Journal of Korean Neurosurgical Society
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    • v.50 no.4
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    • pp.299-303
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    • 2011
  • Objective : Brainstem metastases are rarely operable and generally unresponsive to conventional radiation therapy or chemotherapy. Recently, Gamma Knife Radiosurgery (GKRS) was used as feasible treatment option for brainstem metastasis. The present study evaluated our experience of brainstem metastasis which was treated with GKRS. Methods : Between November 1992 and June 2010, 32 patients (23 men and 9 women, mean age 56.1 years, range 39-73) were treated with GKRS for brainstem metastases. There were metastatic lesions in pons in 23, the midbrain in 6, and the medulla oblongata in 3 patients, respectively. The primary tumor site was lung in 21, breast in 3, kidney in 2 and other locations in 6 patients. The mean tumor volume was $1,517mm^3$ (range, 9-6,000), and the mean marginal dose was 15.9 Gy (range, 6-23). Magnetic Resonance Imaging (MRI) was obtained every 2-3 months following GKRS. Follow-up MRI was possible in 24 patients at a mean follow-up duration of 12.0 months (range, 1-45). Kaplan-Meier survival analysis was used to evaluate the prognostic factors. Results : Follow-up MRI showed tumor disappearance in 6, tumor shrinkage in 14, no change in tumor size in 1, and tumor growth in 3 patients, which translated into a local tumor control rate of 87.5% (21 of 24 tumors). The mean progression free survival was 12.2 months (range, 2-45) after GKRS. Nine patients were alive at the completion of the study, and the overall mean survival time after GKRS was 7.7 months (range, 1-22). One patient with metastatic melanoma experienced intratumoral hemorrhage during the follow-up period. Survival was found to be associated with score of more than 70 on Karnofsky performance status and low recursive partitioning analysis class (class 1 or 2), in terms of favorable prognostic factors. Conclusion : GKRS was found to be safe and effective for management of brainstem metastasis. The integral clinical status of patient seems to be important in determining the overall survival time.

Effects of Salinity and Moisture Content on Aerobic Composting of Food Wastes (염분도와 수분함량이 음식폐기물의 호기성 퇴비화에 미치는 영향)

  • 박석환
    • Journal of Environmental Health Sciences
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    • v.24 no.1
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    • pp.120-131
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    • 1998
  • This study was performed to define the physicochemical characteristics of food waste and food wastewater, and to find the effect of moisture content variation and salinity variation on aerobic composting for food wastes. In moisture content variation experiment, the samples of 2-1, 2-2, 2-3 and 24 were prepared by the moisture content of 83.8%, 70.9%, 64.8% and 45.1%, respectively. In salinity variation experiment, the samples of 3-1, 3-2, 3-3 and 3-4 were prepared by the salinity of 0.99%, 1. 69%, 1.75% and 2.34%, respectively. In both experiments, aerobic composting reactors were operated by the mode which was composed of half an hour's stirring and 2 hour's aeration per day, for 45 days. The followings are the conclusions that were derived from this study. 1. In the study of physicochemical characteristics of food waste and food wastewater, the values of pH were 4.19 and 3.96, the values of salinity were 0.91% and 1.17%, and the values of conductivity were 7.6 mS/cm and 18.2 mS/cm, respectively. 2. In food waste, the moisture content was 60.3%, organic compound content was 96.1%, total carbon was 48.0%, total nitrogen was 1.5%(therefore, C/N ratio was 32), and the concentration of total phosphorus was 1.34 mg/kg. 3. The time of temperature ascending was delayed, the highest temperature was lowered, the duration period of high temperature was shortened by the increasing of moisture content. In the higher moisture content, anaerobic condition was formed, bad smell was released, insects were gathered and multiplicated, and the reaction rate of composting was reduced. 4. In moisture content experiment, C/N ratios were changed from the range of 31.2-34.8 at the beginning phase to that of 20.4-28.4 at the last phase. 5. In salinity experiment, the reduction rate of volume was increased(40.3%) when the salinity was decreased(0.99%). Also, the reduction rate of mass was increased(51.8%) when the salinity was decreased(0.99%). This fact denotes that salinity hinders the process of composting. 6. the concentrations of total nitrogen and total phosphorus were increased from 0.74% to 1.10%, and from 0.82 mg/kg to 3.44 mg/kg, respectively when the salinity was decreased from 2.34% to 0.99%.

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