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Effects on School Lunch Service Programme of Elementary School in Rural Area (농촌지역(農村地域) 국민학교(國民學校) 급식아동(給食兒童)과 성장발달(成長發達)과 식생활(食生活) 습관(習慣))

  • Park, Jin Wook;Lee, Sung Kook
    • Journal of the Korean Society of School Health
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    • v.5 no.2
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    • pp.74-90
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    • 1992
  • The purpose of this study is to know the effects on school lunch service programme of elementary school in rural area, by using the group consisting of the sixth year students in the schools that have provided them with the lunch for six years or longer(male student:312, & female student:324), while using the comparing group consisting of the sixth year students in the schools that have not provided them with the school lunch under their similar living condition(male student: 306 & female student:322). In addition, this study was carried out by examining all continued information about their height and weight shown in the developmetal record for six years from the 1st to 6th year, and by checking their eating habits on the basis of questionnaires. The result of this study is summarized as follows. As the result of comparing the values of their height and weight grown for 6 years, it was shown that the height of the male group provided with school lunch is 27.8 cm while the male group without lunch is 27.1 cm. And the female group provided with school lunch indicated the growing value of 29.9 cm while the group without lunch did 28.4 cm. Then, it appeared that both male and female groups provided with school lunch show higher growing values of 0.7 cm, respectively, and 1.5 cm than these groups without lunch. Also, the weight of the group without lunch was 14.8 kg. Moreover, the weight of the female group provided with school lunch was 16.9 kg while the group without lunch was 17.2 kg. Then, it was shown that the male group provided with school lunch indicates heavier growing value of 0.9 kg than the group without lunch while the female group without lunch does heavier value of 0.3 kg than the group provided with school lunch. It's figure showed that although this distribution according to percentile in the 1st year is similar to the standard regular curve it is positioned in the upper group(more thatn 70%) divided centering around 50% in the 6th year, of which distribution of children provided with school lunch was higher. When comparing the values of physical status in the 6th year, it was also shown that male children with school lunch are better than these children without lunch in jumping, throwing, chinning and lifting while female children are better than these children without lunch only in jumping, which were a significant difference. In addition, the group provided with lunch showed distribution of the higher physical grade. The result of analysis on their breakfast indicated that the children with every morning breakfast account for 67.6% of the group provided with school lunch while the group without lunch for 57.8%. Regarding the reason that they do not have the breakfast, the group with school lunch answered "Because of habits"(50.7%) while the group without lunch did "Because they have no appetite"(58.9%). When comparing the degree of preference for hot or salty food, it was apparent that these children with school lunch generally tend to prefer less hot or sailty food. With respect to the frequency and place of their eating between meals, it was shown that about 70.0% of both groups has the eating between meals, more than one time a day. Then, the group with school lunch had the eating between meals at home(45.2%) while the group without lunch did it in the process of returning to home(48.4%). Regarding the degree of their preference for a certain food, it was shown that more children of the group with school lunch do not prefer a food to others. Also, their eating attitude indicated that such children as eating the food with chat after completely swallowing food and with T.V watching are larger and lower among the group with school lunch, which showed a remarkable defference from the group without lunch. With respect to their sanitary habits such as hand washing and toothing, these children who always wash their hand before eating, accounted for 84.4 % of the group provided with school lunch while the group without lunch did for 63.6%, of which the female group with school lunch indicated a remarkable difference. The actual condition of their nutrition education showed that these children who answered "Received this education" accounted for 78.0% of the group with school lunch while the group without lunch accounted for 57.5%.

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Physico-chemical Properties of Soils Developed on the Different Topographies in Korea (우리나라 농경지토양(農耕地土壤)의 지형별(地形別) 이화학적(理化學的) 특성(特性))

  • Hyeon, Geun-Soo;Park, Chang-Seo;Jung, Sug-Jae;Moon, Joon
    • Korean Journal of Soil Science and Fertilizer
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    • v.22 no.4
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    • pp.271-279
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    • 1989
  • Mean values representing the particle size distribution and some chemical properties for the cultivated soils were obtained from the analysis results of the typical profiles, which were described by the detailed soil maps throughout Korea. Analysis results of 5,215 soil samples (3,075 for paddy and 2,140 for upland) were available for the determination of mean values. The results are under. 1. Paddy topsoil contained 20.4% for clay, 5.8 for pH, 2.6% for organic matter, 10.4me/100g for exchangeable K, and 89ppm for available $P_2O_5$. Upland topsoil did 17.3% for clay, 5.5 for pH, 1.8% for organic matter, 9.lme/100g for CEC, 0.29me/100g for exchangeable K, and 103ppm for availabal $P_2O_5$. 2. Soil properies for paddy were markedly influenced by the reliefs. Topsoil contained 21.4% for clay, 6.0 for pH, 2.2% for organic matter, 10.8me/100g for CEC, 0.39me/100g for exchang-cable K and 57ppm for available $P_2O_5$ on the fluvio-marine plain, 15.3%, 5.7, 2.0%, 8.6me/100g, 0.17me/100g and 76ppm on the alluvial plain, 18.8%, 5.9, 2.7%, 10.4me/100g, 0.19me/100g and 80ppm on the valleys and fans, 25.0%, 5.7, 2.5%, 11.5me/100g, 0.26me/100g, 0.27me/100g and 141ppm on the moutain foot slopes, respectively. 3. Soil Properties for upland, also, were markedly influenced by the reliefs. Topsoil contained 5.5% for clay, 5.7 for pH, 1.1% for organic matter, 4.7me/100g for CEC, 0.17me/100g for exchangeable K and 50ppm for available $P_2O_5$ on the fluvio-marine plain, 10.3%, 5.5, 1.4%, 7.6me/100g, 0.26me/100g and 160ppm on the alluvial plain, 13.9%, 5.4, 1.8%, 9.3me/100g, 0.24me/100g and and 184ppm on the valleys and fans, 29.8%, 5.3, 2.1%, 11.2me/100g 0.40me/100g and 58ppm on the alluvial plain, 20.0%, 5.7, 2.7%, 11.4me/100g, 0.32me/100g and 116ppm on the mountain foot slopes, and 24.6%, 5.3, 1.8%, 10.2me/100g, 0.28me/100g and 51ppm on the rolling and Hill. 4. All chemical properties did not reach the ideal value for maximizing land capability. 5. Organic matter, exchangeable cations and available $P_2O_5$ were not normally distributed. Intervals of one and two standard deviations about mean of an approximately normal distribution were calculated.

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A Study on the Use of GIS-based Time Series Spatial Data for Streamflow Depletion Assessment (하천 건천화 평가를 위한 GIS 기반의 시계열 공간자료 활용에 관한 연구)

  • YOO, Jae-Hyun;KIM, Kye-Hyun;PARK, Yong-Gil;LEE, Gi-Hun;KIM, Seong-Joon;JUNG, Chung-Gil
    • Journal of the Korean Association of Geographic Information Studies
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    • v.21 no.4
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    • pp.50-63
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    • 2018
  • The rapid urbanization had led to a distortion of natural hydrological cycle system. The change in hydrological cycle structure is causing streamflow depletion, changing the existing use tendency of water resources. To manage such phenomena, a streamflow depletion impact assessment technology to forecast depletion is required. For performing such technology, it is indispensable to build GIS-based spatial data as fundamental data, but there is a shortage of related research. Therefore, this study was conducted to use the use of GIS-based time series spatial data for streamflow depletion assessment. For this study, GIS data over decades of changes on a national scale were constructed, targeting 6 streamflow depletion impact factors (weather, soil depth, forest density, road network, groundwater usage and landuse) and the data were used as the basic data for the operation of continuous hydrologic model. Focusing on these impact factors, the causes for streamflow depletion were analyzed depending on time series. Then, using distributed continuous hydrologic model based DrySAT, annual runoff of each streamflow depletion impact factor was measured and depletion assessment was conducted. As a result, the default value of annual runoff was measured at 977.9mm under the given weather condition without considering other factors. When considering the decrease in soil depth, the increase in forest density, road development, and groundwater usage, along with the change in land use and development, and annual runoff were measured at 1,003.5mm, 942.1mm, 961.9mm, 915.5mm, and 1003.7mm, respectively. The results showed that the major causes of the streaflow depletion were lowered soil depth to decrease the infiltration volume and surface runoff thereby decreasing streamflow; the increased forest density to decrease surface runoff; the increased road network to decrease the sub-surface flow; the increased groundwater use from undiscriminated development to decrease the baseflow; increased impervious areas to increase surface runoff. Also, each standard watershed depending on the grade of depletion was indicated, based on the definition of streamflow depletion and the range of grade. Considering the weather, the decrease in soil depth, the increase in forest density, road development, and groundwater usage, and the change in land use and development, the grade of depletion were 2.1, 2.2, 2.5, 2.3, 2.8, 2.2, respectively. Among the five streamflow depletion impact factors except rainfall condition, the change in groundwater usage showed the biggest influence on depletion, followed by the change in forest density, road construction, land use, and soil depth. In conclusion, it is anticipated that a national streamflow depletion assessment system to be develop in the future would provide customized depletion management and prevention plans based on the system assessment results regarding future data changes of the six streamflow depletion impact factors and the prospect of depletion progress.

A Study on Estimating Shear Strength of Continuum Rock Slope (연속체 암반비탈면의 강도정수 산정 연구)

  • Kim, Hyung-Min;Lee, Su-gon;Lee, Byok-Kyu;Woo, Jae-Gyung;Hur, Ik;Lee, Jun-Ki
    • Journal of the Korean Geotechnical Society
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    • v.35 no.5
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    • pp.5-19
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    • 2019
  • Considering the natural phenomenon in which steep slopes ($65^{\circ}{\sim}85^{\circ}$) consisting of rock mass remain stable for decades, slopes steeper than 1:0.5 (the standard of slope angle for blast rock) may be applied in geotechnical conditions which are similar to those above at the design and initial construction stages. In the process of analysing the stability of a good to fair continuum rock slope that can be designed as a steep slope, a general method of estimating rock mass strength properties from design practice perspective was required. Practical and genealized engineering methods of determining the properties of a rock mass are important for a good continuum rock slope that can be designed as a steep slope. The Genealized Hoek-Brown (H-B) failure criterion and GSI (Geological Strength Index), which were revised and supplemented by Hoek et al. (2002), were assessed as rock mass characterization systems fully taking into account the effects of discontinuities, and were widely utilized as a method for calculating equivalent Mohr-Coulomb shear strength (balancing the areas) according to stress changes. The concept of calculating equivalent M-C shear strength according to the change of confining stress range was proposed, and on a slope, the equivalent shear strength changes sensitively with changes in the maximum confining stress (${{\sigma}^{\prime}}_{3max}$ or normal stress), making it difficult to use it in practical design. In this study, the method of estimating the strength properties (an iso-angle division method) that can be applied universally within the maximum confining stress range for a good to fair continuum rock mass slope is proposed by applying the H-B failure criterion. In order to assess the validity and applicability of the proposed method of estimating the shear strength (A), the rock slope, which is a study object, was selected as the type of rock (igneous, metamorphic, sedimentary) on the steep slope near the existing working design site. It is compared and analyzed with the equivalent M-C shear strength (balancing the areas) proposed by Hoek. The equivalent M-C shear strength of the balancing the areas method and iso-angle division method was estimated using the RocLab program (geotechnical properties calculation software based on the H-B failure criterion (2002)) by using the basic data of the laboratory rock triaxial compression test at the existing working design site and the face mapping of discontinuities on the rock slope of study area. The calculated equivalent M-C shear strength of the balancing the areas method was interlinked to show very large or small cohesion and internal friction angles (generally, greater than $45^{\circ}$). The equivalent M-C shear strength of the iso-angle division is in-between the equivalent M-C shear properties of the balancing the areas, and the internal friction angles show a range of $30^{\circ}$ to $42^{\circ}$. We compared and analyzed the shear strength (A) of the iso-angle division method at the study area with the shear strength (B) of the existing working design site with similar or the same grade RMR each other. The application of the proposed iso-angle division method was indirectly evaluated through the results of the stability analysis (limit equilibrium analysis and finite element analysis) applied with these the strength properties. The difference between A and B of the shear strength is about 10%. LEM results (in wet condition) showed that Fs (A) = 14.08~58.22 (average 32.9) and Fs (B) = 18.39~60.04 (average 32.2), which were similar in accordance with the same rock types. As a result of FEM, displacement (A) = 0.13~0.65 mm (average 0.27 mm) and displacement (B) = 0.14~1.07 mm (average 0.37 mm). Using the GSI and Hoek-Brown failure criterion, the significant result could be identified in the application evaluation. Therefore, the strength properties of rock mass estimated by the iso-angle division method could be applied with practical shear strength.

Comparative analysis of Glomerular Filtration Rate measurement and estimated glomerular filtration rate using 99mTc-DTPA in kidney transplant donors. (신장이식 공여자에서 99mTc-DTPA를 이용한 Glomerular Filtration Rate 측정과 추정사구체여과율의 비교분석)

  • Cheon, Jun Hong;Yoo, Nam Ho;Lee, Sun Ho
    • The Korean Journal of Nuclear Medicine Technology
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    • v.25 no.2
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    • pp.35-40
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    • 2021
  • Purpose Glomerular filtration rate(GFR) is an important indicator for the diagnosis, treatment, and follow-up of kidney disease and is also used by healthy individuals for drug use and evaluating kidney function in donors. The gold standard method of the GFR test is to measure by continuously injecting the inulin which is extrinsic marker, but it takes a long time and the test method is complicated. so, the method of measuring the serum concentration of creatinine is used. Estimated glomerular filtration rate (eGFR) is used instead. However, creatinine is known to be affected by age, gender, muscle mass, etc. eGFR formulas that are currently used include the Cockroft-Gault formula, the modification of diet in renal disease (MDRD) formula, and the chronic kidney disease epidemilogy collaboration (CKD-EPI) formula for adults. For children, the Schwartz formula is used. Measurement of GFR using 51Cr-EDTA (diethylenetriamine tetraacetic acid), 99mTc-DTPA (diethylenetriamine pentaacetic acid) can replace inulin and is currently in use. Therefore, We compared the GFR measured using 99mTc-DTPA with the eGFR using CKD-EPI formula. Materials and Methods For 200 kidney transplant donors who visited Asan medical center.(96 males, 104 females, 47.3 years ± 12.7 years old) GFR was measured using plasma(Two-plasma-sample-method, TPSM) obtained by intravenous administration of 99mTc-DTPA(0.5mCi, 18.5 MBq). eGFR was derived using CKD-EPI formula based on serum creatinine concentration. Results GFR average measured using 99mTc-DTPA for 200 kidney transplant donors is 97.27±19.46(ml/min/1.73m2), and the eGFR average value using the CKD-EPI formula is 96.84±17.74(ml/min/1.73m2), The concentration of serum creatinine is 0.84±0.39(mg/dL). Regression formula of 99mTc-DTPA GFR for serum creatinine-based eGFR was Y = 0.5073X + 48.186, and the correlation coefficient was 0.698 (P<0.01). Difference (%) was 1.52±18.28. Conclusion The correlation coefficient between the 99mTc-DTPA and the eGFR derived on serum creatinine concentration was confirmed to be moderate. This is estimated that eGFR is affected by external factors such as age, gender, and muscle mass and use of formulas made for kidney disease patients. By using 99mTc-DTPA, we can provide reliable GFR results, which is used for diagnosis, treatment and observation of kidney disease, and kidney evaluation of kidney transplant patients.

A Study on the Characteristics of Stream Flow Path and Water System Distribution in Gugok Garden, Korea (한국 구곡원림(九曲園林)의 하천 유로 및 수계별 분포 특성)

  • Rho, Jae-Hyun;Choi, Young-Hyun
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.39 no.4
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    • pp.50-65
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    • 2021
  • In this study, the water flow system by measuring the flow-way type and distance of flow path that composes the Gugok through literature survey, field survey, and map work on Gugok gardens in Korea whose existence has been confirmed, while investigating and analyzing watersheds, river orders, and river grades. It was intended to reveal the watershed distribution and stream morphological characteristics of the Gugok gardens and to use them as basic data for future enjoyment and conservation of the Gugok gardens. The conclusion of the study is as follows. First, Of the 93 Gugok gardens that have been confirmed to exist, it was found that 11 places(11.8%) were found to have a descending(top-down) type of Gugok that develops while descending along a stream. Second, As a result of analysis of the length of the flow path for each valley, Okryudonggugok(玉流洞九曲, Namsan-gugok) in Gimcheon, Gyeongsangbuk-do was found to have the shortest length of 0.44km among the surveyed valleys, while the flow distance of Muheulgugok(武屹九曲) located in Seongju-gun and Gimcheon-si, Gyeongsangbuk-do was 31.1km, showing the longest flowing distance. The average flow path length of the Gugok Garden in Korea was 6.24km, and the standard deviation was 4.63km, indicating that the deviation between the 'curved type'e and the 'valley type' was severe. In addition, 14(15.1%) Gugok gardens were found to be partially submerged due to dam construction. Third, As a result of analyzing the waters area where Gugok garden is located, the number of Nakdong river basins was much higher at 52 sites(55.9%), followed by the Hangang river basin at 27 sites(28.7%), the Geum river basin at 9 sites(9.7%), and the Yeongsan river and Seomjin river basins at 5(5.4%). Fourth, All Gugok gardens located in the Han river region were classified as the Han river system, and the Gugok garden located on the Nakdong river was classified as the main Nakdong river system, except for 7 places including 5 places in the Nakdong Gangnam Sea water system and 2 places in the Nakdong Gangdong sea water system. As a result of synthesizing the river order of the flow path where Gugok garden is located, Gugok, which uses the main stream as the base of Gugok, is 3 places in the Hangang water system, 5 places in the Nakdong river system, 2 places in the Geumgang water system, and 1 place in the Yeongsangam/Seomjin river system. A total of 11 locations(11.5%) were found, including 36 locations(38.2%) in the first branch, 29 locations(31.2%) in the second branch, and 16 locations(17.0%) in the third branch. And Gugok garden, located on the 4th tributary, was found to be Taehwa Five-gok(太華五曲) set in Yonghwacheon Stream in Cheorwon in the Han river system, and Hoenggyegok(橫溪九曲) in Yeongcheon Hoenggye Stream in the Nakdong river system. Fifth, As a result of the river grade analysis of the rivers located in the Gugok garden Forest, the grades of the rivers located in the Gugok garden were 13 national rivers(14.0%), 7 local first-class rivers(7.5%), and 74 local second-class rivers(78.5%) was shown.

Evaluation of Varietal Difference and Environmental Variation for Some Characters Related to Source and Sink in the Rice Plants (벼의 Source 및 Sink형질의 품종간차이와 환경변이의 평가)

  • Choi, Hae-Chun;Kwon, Yong-Woong
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.30 no.4
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    • pp.460-470
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    • 1985
  • Experiments were carried out to evaluate the standard gravity in determining potential kernel size and to determine the effective sampling way by analyzing intra - and inter - plant variations for some source and sink characters using eleven semi-dwarf indica and three japonica cultivars including four semi-dwarf indica nearisogenic lines. Also, additional experiments were conducted to understand yearly variation and variety x year interaction effects for ten characters related to source and sink and to characterize the varietal difference of pre- and post-heading self-competition employing three parental varieties and their F$\sub$5/ progenies in 1982 and 1983. It is desirable to determine the potential kernel size by average kernel wight of rice grains showing above 1.15 specific gravity. There was significant difference in leaf area per tiller, spikelets and sink capacity per panicle among vigorous, intermediate and inferior tillers classified by differentiated order and vigorousness. Although it was difficult to find out any significant difference in grain-fill ratio, ratio of perfectly ripened grain, potential kernel size and sink/source ratio between vigorous and intermediate tillers, there was big difference between them and inferior one. The coefficients of variation within each tiller-group for some characters related to source and sink were larger with the order of vigorous tillers < intermediate one '||'&'||'lt; inferior one, and the average heritability of all characters, evaluated by the ratio of varietal variance (equation omitted) to total variance (equation omitted), were higher with the order of inferior tillers '||'&'||'lt; intemediate one '||'&'||'lt; superior one. Therefore, it is desirable to sample the vigorous tillers to represent the varietal difference of these traits. '82-'83 year variations of three parental cultivars were significant for all traits except for leaf area/tiller, panicles/hill, leaf area index and rough rice yield. The characters showing highly significant variance of variety x year interaction were growth duration from transplanting to heading, leaf area/tiller, sink/source ratio, sink capacity/panicle and grain yield. Generalized yearly response of three parental varieties (Suweon 264, Raegyeong, IR1317-70-l) and their F$\sub$5/ progenies on the 1st and 2nd principal components extracted from ten source and sink characters generally exhibited reduction in both source and sink. However, there were diverse variety x year interactions such as progenies showing similar reaction with their parents and intermediate or recombinational yearly response with little or considerable yearly movement on the four-dimensional planes of the two upper principal components between 1982 and 1983. Sink characters revealing highly significant border effect were grain-fill ratio, spikelets and sink capacity per panicle. Among them the latter two especially showed significant variety x border effect interaction. Self-competition characterized by relative weakness of inside plant's sink characters compared to the border one was more severe during the reproductive stage before heading than maturing stage. Though the larger sink capacity per panicle generally disclosed the severer self-competition, some lines (like Suweon 264) revealed severe self-competition with small sink capacity while a few others showed tender self-competition in spite of big sink capacity per panicle.

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Evaluation of HalcyonTM Fast kV CBCT effectiveness in radiation therapy in cervical cancer patients of childbearing age who performed ovarian transposition (난소전위술을 시행한 가임기 여성의 자궁경부암 방사선치료 시 난소선량 감소를 위한 HalcyonTM Fast kV CBCT의 유용성 평가 : Phantom study)

  • Lee Sung Jae;Shin Chung Hun;Choi So Young;Lee Dong Hyeong;Yoo Soon Mi;Song Heung Gwon;Yoon In Ha
    • The Journal of Korean Society for Radiation Therapy
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    • v.34
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    • pp.73-82
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    • 2022
  • Purpose: The purpose of this study is to evaluate the effectiveness of reducing the absorbed dose to the ovaries and the quality of the CBCT image when using the HalcyonTM Fast kV CBCT of cervical cancer patients of child-bearing age who performed ovarian transposition Materials and Methods : Contouring of the cervix and ovaries required for measurement was performed on the computed tomography images of the human phantom (Alderson Rando Phantom, USA), and three Optically Stimulated Luminescence Dosimeter(OSLD) were attached to the selected organ cross-section, respectively. In order to measure the absorbed dose to the cervix and ovaries in the TruebeamTM pelvis mode (Hereinafter referred to as TP), The HalcyonTM Pelvis mode (Hereinafter referred to as HP) and The HalcyonTM Pelvis Fast mode (Hereinafter referred to as HPF), An image was taken with a scan range of 17.5 cm and also taken an image that reduced the Scan range to 12.5cm. A total of 10 cumulative doses were summed, It was replaced with a value of 23 Fx, the number of cervical cancer treatments, and compared In additon, uniformity, low contrast visibility, spatial resolution, and geometric distortion were compared and analyzed using Catphan 504 phantom to compare CBCT image quality between equipment. Each factor was repeatedly measured three times, and the average value was obtained by analysing with the Doselab (Mobius Medical Systems, LP. Versions: 6.8) program. Results: As a result of measuring absorbed dose by CBCT with OSLD, TP and HP did not obtain significant results under the same conditions. The mode showing the greatest reduction value was HPF versus TP. In HPF, the absorbed dose was reduced by 39.8% in the cervix and 19.8% in the ovary compared to the TP in the scan range of 17.5 cm. the scan range was reduced to 12.5 cm, absorbed dose was reduced by 34.2% in the cervix and 50.5% in the ovary. In addition, result of evaluating the quality of the image used in the above experiment, it complied with the equipment manufacturer's standards with Geometric Distortion within 1mm (SBRT standard), Uniformity HU, LCV within 2.0%, Spatial Resolution more than 3 lp/mm. Conclusion: According to the results of this experiment, HalcyonTM can select more various conditions than TruebeamTM in treatment of fertility woman who have undergone ovarian Transposition , because it is important to reduce the radiation dose by CBCT during radiation therapy. So finally we recommend HalcyonTM Fast kV CBCT which maintains image quality even at low mAs. However, it is consider that the additional exposure to low doses can be reduced by controlling the imaging range for patients who have undergone ovarian transposition in other treatment machines.

Application of a Single-pulsatile Extracorporeal Life Support System for Extracorporeal Membrane Oxygenation -An experimental study - (단일 박동형 생명구조장치의 인공폐 적용 -실험연구-)

  • Kim, Tae-Sik;Sun, Kyung;Lee, Kyu-Baek;Park, Sung-Young;Hwang, Jae-Joon;Son, Ho-Sung;Kim, Kwang-Taik;Kim. Hyoung-Mook
    • Journal of Chest Surgery
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    • v.37 no.3
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    • pp.201-209
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    • 2004
  • Extracorporeal life support (ECLS) system is a device for respiratory and/or heart failure treatment, and there have been many trials for development and clinical application in the world. Currently, a non-pulsatile blood pump is a standard for ECLS system. Although a pulsatile blood pump is advantageous in physiologic aspects, high pressure generated in the circuits and resultant blood cell trauma remain major concerns which make one reluctant to use a pulsatile blood pump in artificial lung circuits containing a membrane oxygenator. The study was designed to evaluate the hypothesis that placement of a pressure-relieving compliance chamber between a pulsatile pump and a membrane oxygenator might reduce the above mentioned side effects while providing physiologic pulsatile blood flow. The study was performed in a canine model of oleic acid induced acute lung injury (N=16). The animals were divided into three groups according to the type of pump used and the presence of the compliance chamber, In group 1, a non-pulsatile centrifugal pump was used as a control (n=6). In group 2 (n=4), a single-pulsatile pump was used. In group 3 (n=6), a single-pulsatile pump equipped with a compliance chamber was used. The experimental model was a partial bypass between the right atrium and the aorta at a pump flow of 1.8∼2 L/min for 2 hours. The observed parameters were focused on hemodynamic changes, intra-circuit pressure, laboratory studies for blood profile, and the effect on blood cell trauma. In hemodynamics, the pulsatile group II & III generated higher arterial pulse pressure (47$\pm$ 10 and 41 $\pm$ 9 mmHg) than the nonpulsatile group 1 (17 $\pm$ 7 mmHg, p<0.001). The intra-circuit pressure at membrane oxygenator were 222 $\pm$ 8 mmHg in group 1, 739 $\pm$ 35 mmHg in group 2, and 470 $\pm$ 17 mmHg in group 3 (p<0.001). At 2 hour bypass, arterial oxygen partial pressures were significantly higher in the pulsatile group 2 & 3 than in the non-pulsatile group 1 (77 $\pm$ 41 mmHg in group 1, 96 $\pm$ 48 mmHg in group 2, and 97 $\pm$ 25 mmHg in group 3: p<0.05). The levels of plasma free hemoglobin which was an indicator of blood cell trauma were lowest in group 1, highest in group 2, and significantly decreased in group 3 (55.7 $\pm$ 43.3, 162.8 $\pm$ 113.6, 82.5 $\pm$ 25.1 mg%, respectively; p<0.05). Other laboratory findings for blood profile were not different. The above results imply that the pulsatile blood pump is beneficial in oxygenation while deleterious in the aspects to high pressure generation in the circuits and blood cell trauma. However, when a pressure-relieving compliance chamber is applied between the pulsatile pump and a membrane oxygenator, it can significantly reduce the high circuit pressure and result in low blood cell trauma.

The Use of Analgesics in the Last 24 hours of Life of Patients with Advanced Cancer : A Comparison of Medical Physicians and Surgeons (말기 암 환자의 마지막 24시간 동안 진통제 사용의 분석 : 내과의사와 외과의사의 비교)

  • Choi, Youn-Seon;Kim, Jong-Min;Lee, Young-Mee;Lim, Jong-Kuk;Lee, Tai-Ho;Hong, Myung-Ho
    • Journal of Hospice and Palliative Care
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    • v.1 no.1
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    • pp.47-55
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    • 1998
  • Background : It is almost important therapy modality to control pain for the terminal cancer patients for the last 24 hours because those terminally illed patient deserved to have pain free and peaceful time before death. Physician who is deal with terminal cancer patients for their last 24 hours does not need to worry about drug addiction or other untoward side reactions of pain medications. The purpose of this study was to evaluate if terminally illed cancer patient was given pain medication properly and sufficiently and if there was any different behavior to control pain of terminal cancer patients between medical physicians and surgeons in terms of type, amount and administration route and frequency. Methods : A retrospective chart audit of analgesic type, amount and administration route was performed on the medical recorders of 160 hospitalized terminal cancer patients who had died in the Korea University Medical Center Anam Hospital during the period of July 1, 1994 to June 30, 1995. Patients were classified into 103 patients were cared for by medical physicians and 57 patients were cared for by surgeons. After then, we analysed the difference of pain control pattern between them. Different types and amount of analgesics were converted to a common standard, an oral morphine equivalents(OME) relative to 1mg of oral morphine. Results : 1) The total number of patients was 160, male 102 cases(63.8%), and the female was 58 cases(36.2%) respectively. 2) The mean age was 56.4(${\pm}14.62$) years old and mean admission period was 27.8 days(${\pm}34.85$). 3) The frequent cancer site was stomach 42 cases(26.315), lung and liver 29 cases(18.1%) each, pancreas 10 cases(6.2%) in order 4) 125 out of 160 subjects (78.13%) complained pain, and 66 out of 103(64.08%) and 31 out of 57(54.39%) were treated with analgesics to relieve pain. 50 out of 97(51.55%) were able to continue on oral medication. 5) 86 cases(53.75%) were well oriented 24 hours prior to death. 6) The frequent analgesics for regular basis were long acting form of oral morphine 34 cases(Medical phsicians 24, Surgeons 10), intravenous morphine 26 cases(Medical physicians 20, Surgeons 6) in order, and the most common p.r.n.(pro re nata) analgesics used was intravenous morphine. 7) The mean amount of analgesics on regular basis was 115.41 OME by medical physicians and 52.7 OME by surseons(P<0.05). The mean amount of p.r.n. analgesics was significantly larger in patients are for by surgeons(66.64 OME) than medical physicians 23.49 OME(P<0.01). 8) The mean frequency of administrated number of p.r.n. analgesics was 0.62 times/day on medical part and 1.88 times/day on surgical part (P<0.001). Conclusion : Of the 97 patients with advanced cancer, 51.55% were able to take oral medications in the last day of life. The parenteral analgesics were more frequently used in the patients cared for by surgeons than medical physicians. Over the half of terminal cancer patients were well oriented in the last day of life. Doctor's knowledge and attitude towards pain is very important to mange the pain, effectively.

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