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Relationship between the Occurrence of Thromboembolism and INR Measurement Interval in Low Intensity Anticoagulation after Aortic Mechanical Valve Replacement

  • Rhie, Sang-Ho;Choi, Jun-Young;Jang, In-Seok;Kim, Jong-Woo;Lee, Chung-Eun;Park, Hyun-Oh
    • Journal of Chest Surgery
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    • v.44 no.3
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    • pp.220-224
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    • 2011
  • Background: We investigated changes in the International Normalized Ratio (INR) and its measurement interval in patients with thromboembolic events who were treated by low intensity anticoagulation therapy after isolated mechanical aortic valve replacement. Materials and Methods: Seventy-seven patients who underwent surgery from June 1990 to September 2006 were enrolled in the study and observed until August 2008. The patients were followed up at 4~8 week intervals and their warfarin (Coumadin)$^{(R)}$ dosage was adjusted aiming for a target range of INR 1.5~2.5. The rate of thromboembolic events was obtained. Changes in the mean INR and INR measurement interval were comparatively analyzed between the normal group (event free group, N=52) who had no anticoagulation-related complications and the thromboembolic group (N=10). Hospital records were reviewed retrospectively. Results: The observation period was 666.75 patient-years. Thromboembolic events occurred in 10 patients. The linearized occurrence rate of thromboembolism was 1.50%/patient-years. Actuarial thromboembolism-free rates were $97.10{\pm}2.02%$ at 5 years, $84.30{\pm}5.22%$ at 10 years, and $67.44{\pm}12.14%$ at 15 years. The percentages of INR within the target range and mean INR were not statistically significantly different for the normal and thromboembolic groups. However, the mean INR during the segmented period just before the events showed a significantly lower level in the thromboembolic group (during a 4 month period: normal group, $1.86{\pm}0.14$ vs. thromboembolic group, $1.50{\pm}0.28$, p<0.001). The mean intervals of INR measurement during the whole observation period showed no significant differences between groups, but in the segmented period just before the events, the interval was significantly longer in thromboembolic group (during a 6 month period: normal group, $49.04{\pm}9.47$ days vs. thromboembolic group, $65.89{\pm}44.88$ days, p<0.01). Conclusion: To prevent the occurrence of thromboembolic events in patients who receive isolated aortic valve replacement and low intensity anticoagulation therapy, we suggest that it would be safe to maintain an INR level above 1.8 and to measure the INR at least every 7~8 weeks.

Comparison of Upper Extremity Muscle Activity With Transverse Plane Angle Changes During Vertical Keyboard Typing (타이핑 작업 시 수직형 키보드의 수평면 끼인각 변화에 따른 상지의 근활성도 비교)

  • Lee, Kang-Jin;Roh, Jung-Suk;Kim, Tack-Hoon;Cynn, Heon-Seock;Choi, Houng-Sik;Oh, Dong-Sik
    • Physical Therapy Korea
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    • v.16 no.2
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    • pp.67-76
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    • 2009
  • In order to prevent upper extremity musculoskeletal disorders, effective keyboard selection is an important consideration. The aim of this study was to compare upper extremity muscle activity according to transverse plane angle changes during vertical keyboard typing. Sixteen healthy men were recruited. All subjects had a similar typing ability (rate of more than 300 keystrokes per minute) and biacromion and forearm-fingertip lengths. Four different types of keyboard (vertical keyboard with a transverse plane angle of $60^{\circ}$, $96^{\circ}$, or $120^{\circ}$, and a standard keyboard) were used with a wrist support. The test order was selected randomly for each subject. Surface electromyography (EMG) was used to measure upper extremity muscle activity during a keyboard typing task. The collected EMG data were normalized using the reference contraction and expressed as a percentage of the reference voluntary contraction (%RVC). In order to analyze the differences in EMG data, a repeated one-way analysis of variance, with a significance level of .05, was used. Bonferroni correction was used for multiple comparisons. There were significant differences in the EMG amplitude of all seven muscles (upper trapezius, middle deltoid, anterior deltoid, extensor carpi radialis, extensor carpi ulnaris, flexor carpi radialis, and flexor carpi ulnaris) assessed during the keyboard typing task. The mean activity of each muscle had a tendency to increase as the transverse plane angle increased. The mean activity recorded during all vertical keyboard typing was lower than that recorded during standard keyboard typing. There was no significant difference in accuracy and error scores; however, there was a significant difference between transverse plane angles of $60^{\circ}$ and $120^{\circ}$ with regard to comfort. In conclusion, a vertical keyboard with a transverse plane angle of $60^{\circ}$ would be effective in reducing muscle activity compared with vertical keyboards with other transverse plane angles.

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A Pilot Study on Evoked Potentials by Visual Stimulation of Facial Emotion in Different Sasang Constitution Types (얼굴 표정 시각자극에 따른 사상 체질별 유발뇌파 예비연구)

  • Hwang, Dong-Uk;Kim, Keun-Ho;Lee, Yu-Jung;Lee, Jae-Chul;Kim, Myoyung-Geun;Kim, Jong-Yeol
    • Journal of Sasang Constitutional Medicine
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    • v.22 no.1
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    • pp.41-48
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    • 2010
  • 1. Objective There has been a few trials to diagnose Sasang Constitution by using EEG, but has not been studied intensively. For the purpose of practical diagnosis, the characteristics of EEG for each constitution should be studied first. Recently it has been shown that Sasang Constitution might be related to harm avoidance and novelty seeking in temperament and character profiles. Based on this finding, we propose a visual stimulation method to evoke a EEG response which may discriminate difference between constitutional groups. Through the experiment with this method, we tried to reveal the characteristics of EEG of each constitutional groups by the method of event-related potentials. 2. Methods: We used facial visual stimulation to verify the characteristics of EEG for each constitutional groups. To reveal characteristic in sensitivity and latency of response, we added several levels of noise to facial images. 6 male subjects(2 Taeeumin, 2 Soyangin, 2 Soeumin) participated in this study. All subjects are healthy 20's. To remove artifacts and slow modulation, we removed EOG contaminated data and renormalization is applied. To extract stimulation related components, normalized event-related potential method was used. 3. Results: From Oz channels, it is verified that facial image processing components are extracted. For lower level noise, components related to the visual stimulation were clearly shown in Oz, Pz, and Cz channels. Pz and Cz channels show differences among 3 constitutional groups in maximum around 200 msec. Especially moderate level of noise looks appropriate for diagnosis. 4. Conclusion: We verified that the visual stimulation with facial emotion might be a good candidate to evoke the differences between constitutional groups in EEG response. The differences shown in the experiment may imply that the process of emotion has distinct tendencies in latencies and sensitivity for each consitutional group. And this distinction might be related to the temperament profile of consitutional groups.

Oxidative Transformation of 1-Naphthol Using Manganese Oxide (망간산화물을 이용한 1-Naphthol의 산화 제거 연구)

  • Lim, Dong-Min;Kang, Ki-Hoon;Shin, Hyun-Sang
    • Journal of Korean Society of Environmental Engineers
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    • v.28 no.5
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    • pp.535-542
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    • 2006
  • In this study, removals of 1-naphthol by oxidative-coupling reaction using birnessite, one of natural Mn oxides present in soil, was investigated in various experimental conditions(reaction time, Mn oxide loadings, pH, etc). Removal efficiency of 1-naphthol by birnessite was high in all the experimental conditions, and UV-vis. and mass spectrometric analyses on the supernatant after reaction confirmed that the reaction products were oligomers formed by oxidative-coupling reaction. Pseudo-first order rate constants, f, for the oxidative transformation of 1-naphthol by birnessite was derived from the kinetic experiments under various amount of birnessite loadings, and using the observed pseudo-first order rate constants with respect to birnessite loadings, surface area-normalized specific rate constant, $k_{surf}$ was also determined to be $9.31{\times}10^{-4}(L/m^2{\cdot}min)$ for 1-naphthol. In addition, the oxidative transformation of 1-naphthol was found to be dependent on solution pH, and the pseudo-first order rate constants were increased from 0.129 at pH 10 to 0.187 at pH 4.

Evaluation of the Amount of Nitrogen Top Dressing Based on Ground-based Remote Sensing for Leaf Perilla (Perilla frutescens) under the Polytunnel House

  • Kang, Seong-Soo;Sung, Jwa-Kyung;Gong, Hyo-Young;Jung, Hyung-Jin;Kim, Yoo-Hak;Hong, Soon-Dal
    • Korean Journal of Soil Science and Fertilizer
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    • v.49 no.5
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    • pp.598-607
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    • 2016
  • This study was conducted to evaluate the amount of nitrogen (N) top dressing based on the normalized difference vegetation indices (NDVI) by ground based sensors for leaf perilla under the polyethylene house. Experimental design was the randomized complete block design for five N fertilization levels and conventional fertilization with 3 and 4 replications in Gumsan-gun and Milyang-si field, respectively. Dry weight (DW), concentration of N, and amount of N uptake by leaf perilla as well as NDVIs from sensors were measured monthly. Difference of growth characteristics among treatments in Gumsan field was wider than Milyang. SPAD-502 chlorophyll meter reading explained 43.4% of the variability in N content of leaves in Gumsan field at $150^{th}$ day after seedling (DAS) and 45.9% in Milyang at $239^{th}$ DAS. Indexes of red sensor (RNDVI) and amber sensor (ANDVI) at $172^{th}$ day after seedling (DAS) in Gumsan explained 50% and 57% of the variability in N content of leaves. RNDVI and ANDVI at $31^{th}$ DAS in Milyang explained 60% and 65% of the variability in DW of leaves. Based on the relationship between ANDVI and N application rate, ANDVI at $172^{th}$ DAS in Gumsan explained 57% of the variability in N application rate but non significant relationship in Milyang field. Average sufficiency index (SI) calculated from ratio of each measurement index per maximum index of ANDVI at $172^{th}$ DAS in Gumsan explained 73% of the variability in N application rate. Although the relationship between NDVIs and growth characteristics was various upon growing season, SI by NDVIs of ground based remote sensors at top dressing season was thought to be useful index for recommendation of N top dressing rate of leaf perilla.

Petrology of the Volcanic Rocks in Geoje Island, South Korea (거제도 화산암의 암석학적 연구)

  • 윤성효;이준동;이상원;고정선;서윤지
    • The Journal of the Petrological Society of Korea
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    • v.6 no.1
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    • pp.1-18
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    • 1997
  • Andesitic pyroclastics and lava flows are deposited as a part of composite volcanoes by Cretaceous volcanic activity in Geojae Island, off the coast of Korea. The andesitic pyroclastics are composed of tuff breccia and lapilli tuff minor intercalated tuff. Lava flows are divided into dense and porphyritic andesite containing phenocrysts of plagioclase, pyroxene, and/or hornblende. The andesitic rocks represent charactersitcs of carc-alkaline BAR association with basalt, basaltic andesite, andesite, and dacite to rhyolite. Major element variations of the volcanic rocks show that $Al_2O_3$, total FeO, CaO, MgO and $TiO_2$ decrease with increasing $SiO_2$ but $K_2O$ and total alkalis increase, and represent differntiation trend of calc-alkaline rock series. In spider diagram, contents of Sr, K, Rb, Ba, and Th are relatively high, but contents of Nb, P, Ti and Cr are low. These petrochemcial characteristics are similar to those of rocks from island arc or continental margein related to plate subduction. Chondrite-normalized REE patterns of volcanic rocks are paralle to subparallel, with LREE enriched than HREE, and show gradual increase of negative Eu anomaly from basalt to dacite and rhyolite, suggesting comagmatic fractional crystallization with minor effects of assimilation and magma mixing. Andesitic rocks are assumed medium-K orogenic andesites that formed in the tectomagmatic environment of subduction zone under normal continental margin arc.

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Effects of Contraction of Abdominal Muscles on Electromyographic Activities of Superficial Cervical Flexors, Rib Cage Elevation and Angle of Craniocervical Flexion During Deep Cervical Flexion Exercise (심부경부굴곡 운동 시 복근 수축이 표면경부굴곡근의 근활성도, 흉곽 거상, 두개경부굴곡 각도에 미치는 영향)

  • Park, Kyue-Nam;Won, Jong-Hyuck;Lee, Won-Hwee;Chung, Sung-Dae;Jung, Doh-Heon;Oh, Jae-Seop
    • Physical Therapy Korea
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    • v.16 no.3
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    • pp.9-15
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    • 2009
  • The purpose of this study was to examine contraction of abdominal muscles on surface electromyographic (EMG) activity of superficial cervical flexors, rib cage elevation and angle of craniocervical flexion during deep cervical flexion exercise in supine position. Fifteen healthy subjects were participated for this study. All subjects performed deer cervical flexion exercise with two methods. The positions of two methods were no volitional contraction of abdominal muscles in hook-lying position with 45 degree hip flexion (method 1) and 90 degrees hip and knee flexion with feet off floor for inducing abdominal muscle contraction (method 2). Surface EMG activities were recorded from five muscles (sternocleidmastoid, anterior scaleneus, recuts abdominis, external oblique, internal oblique). And distance of rib cage elevation and angle of craniocervical flexion were measured using a three dimensional motion analysis system. The EMG activity of each muscle was normalized to the value of reference voluntary contraction (%RVC). The EMG activities, distance of rib cage elevation. and angle of craniocervical were compared using a paired t-test between two methods. The results showed that the EMG activities of sternocleidmastoid and anterior scaleneus during deep cervical flexion exercise in method 2 were significantly decreased compared to method 1 (p<.05). Distance of rib cage elevation and angle of craniocervical flexion were significantly decreased in method 2 (p<.05). The findings of this study indicated that deep cervical flexion exercise with contraction of abdominal muscles could be an effective method to prevent substitute motion for rib cage elevation and contraction of superficial neck flexor muscles.

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Evaluation of OSLD and EBT3 film for dose, energy, and angular dependence (OSLD와 EBT3 필름의 선량, 에너지, 방향의존성에 대한 평가)

  • Lee, Ju-seong;Kang, Bo-ram;Kwon, Hyeon-Kyung;Park, Ji-Young;Kim, Ju-Hye;Choi, Young-Se;Kim, Daehong
    • The Korean Journal of Food & Health Convergence
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    • v.4 no.1
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    • pp.15-22
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    • 2018
  • A radiation dosimeter is important to assess quality assurance (QA) of radiation therapy devices and to estimate the radiation dose in vivo dosimetry. Recently, optically stimulated luminescence detector (OSLD) is widely used in clinical filed. Therefore, the purpose of this study is to evaluate dose, energy, and angular dependence of OSLD and EBT3 film. The absorbed dose in clinical linear accelerator (Linac) beam is calibrated for dose per monitor unit (MU). Dose, energy, and angular dependence of OSLD and EBT3 film are estimated after the calibration procedure. The absorbed dose is measured at 50, 100, 150, and 200 cGy in an 6 MV X-ray beam for dose dependence. A dose of 150 cGy is delivered to OSLD and EBT3 film with 6 and 10 MV photon energies for energy dependence. For measurements of angular dependence, angular positions of gantry are $0^{\circ}{\pm}80^{\circ}$ with 6 MV at 150 cGy. The results of dose dependence is linear for OSLD and EBT3 film. For the results of energy dependence, errors were 0.39% and 0.03% for OSLD and EBT3 film, respectively. The results of dose for angular is decreased from $0^{\circ}$ to ${\pm}80^{\circ}$ for both OSLD and EBT3 film. When angle of $0^{\circ}$ is normalized to 1, and the dose is decreased to 60 and 66% at $80^{\circ}$ for OSLD and EBT3 film, respectively. Dose and energy dependence of OSLD and EBT3 film are measured within the recommendation of manufacturer. Angular dependence is increased from $0^{\circ}$ to ${\pm}80^{\circ}$ for OSLD and EBT3 film. The characteristics of OSLD and EBT3 film are similar and expected to useful for clinical field.

Effect of Yanggyuksanhwa-tang on c-Fos and c-Jun Expression in Ischemic Damaged Hippocampus of Aged BCAO Rats (노령 흰쥐의 뇌허혈 손상시 양격산화탕(凉膈散火湯)이 뇌해마의 c-Fos 및 c-Jun 발현에 미치는 영향)

  • Kim Seung-Jun;Shin Jung-Won;Sohn Young-Joo;Jung Hyuk-Sang;Won Ran;Sohn Nak-Won
    • The Journal of Internal Korean Medicine
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    • v.24 no.2
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    • pp.337-347
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    • 2003
  • This study investigated the effect of Yanggyuksanhwa-tang on cerebral ischemia of the rats. Considering age-related impact on cerebral ischemia, aged rats (18 months old) were used for this study. Ischemic damage was induced by the transient occlusion of bilateral common carotid arteries(BCAO) under the hypotension. Yanggyuksanhwa-tang was administered twice orally. Then changes of immunohistochemical expression of c-fos and c-jun in ischemic damaged hippocampus were observed. The BCAO in aged rats led significant increase of c-fos expression in CA1 and DG of hippocampus. While the treatment of Yanggyuksanhwa-tang significantly attenuated the increase of c-fos expression in CA1 hippocampus following BCAO ischemia. Depending on changes of the normalized optical density(NOD) of immunohistochemical c-fos expression, the treatment of Yanggyuksanhwa-tang significantly attenuated the increase of NOD in CA1 and DG of hippocampus. And there was not changes in CA2 and CA3 hippocampus with respect to the control BCAO group. The BCAO in aged rats led significant increase of c-jun expression in CA1 hippocampus. While the treatment of Yanggyuksanhwa-tang significantly attenuated the increase of c-jun expression in CA1 hippocampus following BCAO ischemia. Depending on changes of the NOD of immunohistochemical c-jun expression, the treatment of Yanggyuksanhwa-tang significantly attenuated the increase of NOD in CA1 hippocampus. And there was not changes in CA2, CA3 and DG of hippocampus with respect to the control BCAO group.

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Experimental Study on the Determination of Absorbed dose Index (흡수선량지수결정(吸收線量指數決定)에 관한 실험적(實驗的) 연구(硏究))

  • Jun, Jae-Shik;Rho, Chae-Shik;Ro, Seung-Gy;Ha, Chung-Woo;Yoo, Young-Soo;Lee, Hyun-Duk
    • Journal of Radiation Protection and Research
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    • v.7 no.1
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    • pp.34-48
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    • 1982
  • The prime purpose of this study is to realize an index quantity, absorbed dose index, defined by the ICRU for the characterization of ambient radiation level at any location for the purpose of radiation protection. The experiment has been designed to be carried out in two phases, namely, preliminary and main experiment. In the primary study a 30cm diameter sphere of polyethylene was used, while in the main experiment that of tissue equivalent material was fabricated and used. Both experiments were performed in the gamma-ray fields of $^{137}Cs\;and\;^{60}Co$, and in a neutron beam of thermal column of the TRIGA MARK-II research reactor. In the measurement of gamma-ray absorbed dose TLD-700 $(^{7}LiF)$ chips were used, and for the neutron dose both Au activation foils and TLD chips (TLD-600 $(^{6}LiF)$ and TLD-700 for the discrimination of gamma-ray contribution) were used. Theoretical assessment of the absorbed dose in the sphere phantom has been carried out in accordance with the Ehrlich's idea that deduced on the basis of Burlin's cavity theory in the case of gamma-ray irradiation. For the analysis of neutron dose fluence-KERMA rate conversion method was used. The explanation on the dose assessment is given in detail. Results obtained were numerically and statistically analyzed and the depth dose distributions are presented in the graphic forms with normalized values. In the concluding remarks, the possibility and difficulty of realizing the index quantity, including questions and problems to be solved are mentioned.

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