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The Comparison of Clinical Outcomes of Off-Pump versus On-Pump Coronary Artery Bypass Grafting in High Risk Patients (고위험군 환자에서 시행한 On-Pump CABG와 Off-Pump CABG의 비교연구)

  • 윤영남;이교준;김치영;안지영;오영준;유경종
    • Journal of Chest Surgery
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    • v.37 no.9
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    • pp.749-754
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    • 2004
  • Off-pump coronary artery bypass grafting (Off-Pump CABG) has been proven to have less morbidity and to facilitate early recovery. High-risk surgical patients may have benefitted by avoiding the adverse effects of the cardiopulmonary bypass. We compared the effectiveness of Off-Pump CABG with that of coronary artery bypass using cardiopulmonary bypass (On-Pump CABG) in high-risk patients. Material and Method: 682 patients (424 Off-Pump CABG and 258 On-Pump CABG) underwent isolated coronary artery bypass grafting between January 2001 and June 2003. Patients who were considered high risk were selected High risk is defined as the presence of one or more of nine adverse prognostic factors. Data were collected from 492 patients in Off-Pump CABG and 100 in On-Pump CABG for risk factors, extent of coronary disease, and in-hospital outcomes. Result: Off-Pump CABG group and On-Pump CABG group did not show differences in their preoperative risk factors. We used more arterial grafts in Off-Pump CABG group (p < 0.05). Postoperative results showed that operative mortality (0.5% in Off-Pump CABG versus 2.0% in On-Pump CABG), renal failure (2.6% in Off-Pump CABG versus 7.0% in On-Pump CABG), and perioperative myocardial infarction (1.5% in Off-Pump CABG versus 1.0% in On-Pump CABG) did not differ significantly. However, Off-Pump CABG had shorter mean operation time (p<0.05), lower mean CK-MB level (p <0.05), lower rate of usage of inotropics (p < 0.05), shorter mean ventilation time (p <0.05), lower perioperative stroke (0% versus 2.0%), and shorter length of stay (p < 0.05) than On-Pump CABG. On-Pump CABG had more distal grafts (p<0.05) than Off-Pump CABG. Although Off-Pump CABG and On-Pump CABG did not show statistical differences in mortality and morbidity was more frequent in CABG. Conclusion: Off-Pump CABG reduces morbidity and favors hospital outcomes. Therefore, Off-Pump CABG is safe, reasonable and may be a preferable operative strategy for high-risk patients.

Inhibitory Effect against Angiotensin Converting Enzyme and Antioxidant Activity of Panax ginseng C. A. Meyer Extracts (인삼 추출물의 Angiotensin Converting Enzyme 저해 효과와 항산화 활성)

  • Lee, Seung-Eun;Seong, Nak-Sul;Bang, Jin-Ki;Kang, Seung-Won;Lee, Sung-Woo;Chung, Tae-Yung
    • Korean Journal of Medicinal Crop Science
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    • v.11 no.3
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    • pp.236-245
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    • 2003
  • The study was performed for elucidating angiotensin converting enzyme (ACE) inhibitory activity and comparing antioxidative activity of Panax ginseng extracts prepared at different conditions. Total phenolic content, inhibitory activity on ACE and antioxidative effects were tested on 10 ethanolic extracts and correlation coefficient between total phenolic content and physiological activity was calculated. Yield and total phenolic content of 50% ethanolic extract prepared at $85^{\circ}C$ exhibited the highest value as 42.52% and 0.82%, respectively. Among the fractions obtained from 50% ethanolic extract prepared at room temperature, water fraction showed the highest value in yield as 72.08% and ethyl acetate fraction did in total phenolic content as 6.59%. In the test on ACE inhibitory activity, 50% ethanolic extract obtained at room temperature indicated the strongest effect of 93.8% which was higher than 85.2% of commercialized ACE inhibitor and solvent fractions showed potent inhibitory activity in order of hexane fraction, diethyl ether fraction, ethyl acetate fraction, butanol fraction and water fraction at concentration of $4000{\mu}g/ml$. 50% Ethanolic extract prepared at $85^{\circ}C$ had the most potent inhibition effect on human LDL oxidation as 78.2% at $200{\mu}g/ml$ and the other extracts also did above 60%. Diethyl ether fraction and ethyl acetate fraction showed strong inhibition activity $(34.38%{\sim}78.13%)$ on LDL oxidation at concentration of $10{\sim}200\;{\mu}g/ml$. From the statistical analysis via SAS program, correlation coefficient between total phenolic content and ACE inhibitory effect was 0.6353 at P<0.05. Conclusively, this report showed that the most efficient extraction condition for elevating inhibitory activity on ACE and LDL oxidation, phenolic content and yield from Panax ginseng was 50% ethanol extraction at room temperature or high temperature condition. And Panax ginseng would be used for preventing hypertension or atheroscrelosis for man via inhibitory action on ACE and LDL oxidation.

Marginal and internal fitness of three-unit zirconia cores fabricated using several CAD/CAM systems (다양한 CAD/CAM 시스템으로 제작된 3 본 고정성 가공의치 지르코니아 코어의 변연 및 내면 적합도 평가)

  • Huh, Jung-Bo;Kim, U-Sic;Kim, Ha-Young;Kim, Jong-Eun;Lee, Jeong-Yeol;Kim, Young-Su;Jeon, Young-Chan;Shin, Sang-Wan
    • The Journal of Korean Academy of Prosthodontics
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    • v.49 no.3
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    • pp.236-244
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    • 2011
  • Purpose: This study was aimed to compare the margin and internal fitness of 3-unit zirconia bridge cores fabricated by several CAD/CAM systems using replica technique. Materials and methods: Three unit-bridge models in which upper canine and upper second premolar were used as abutments and upper first premolar was missed, were fabricated. Fourty models were classified into 4 groups (Cerasys$^{(R)}$ (Group C), Dentaim$^{(R)}$ (Group D), KaVo Everest$^{(R)}$ (Group K), $Lava^{TM}$ (Group L)), and zirconia cores were fabricated by each company. Sixteen points were measured on each abutment by replica technique. Statistical analysis was accomplished with two way ANOVA and Dunnett T3 (${\alpha}$=.05). Results: In most systems, there was a larger gap on inter margin than outer margin. In the Group K, overall fitness was excellent, but the incisal gap was very large. In the Group C, marginal gap was significantly larger than Group K, but overall internal gap was uniform (P<.05). The axial gap was under $100\;{\mu}m$ in all system. The difference between internal and external gap was small on Group L and C. However, internal gap was significantly larger than external gap in Group D (P<.05). The fitness of canine was better than second premolar among abutments (P<.05). Conclusion: The marginal and internal gap was within the clinically allowed range in all of the three systems. There was a larger gap on second premolar than canine on internal and marginal surface. In most systems, there was a larger gap on occlusal surface than axial surface.

Effect of RGD peptide coating of implant titanium surface on human mesenchymal stem cell response (양극산화 티타늄 표면에 서로 다른 RGD 펩타이드 코팅 방법이 인간간엽줄기세포 반응에 미치는 영향)

  • Kim, Min-Su;Jeong, Chang-Mo;Jeon, Young-Chan;Ryu, Jae-Jun;Huh, Jung-Bo;Yun, Mi-Jung
    • The Journal of Korean Academy of Prosthodontics
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    • v.49 no.3
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    • pp.245-253
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    • 2011
  • Purpose: The aim of this in vitro study was to estimate surface characteristic after peptide coating and investigate biological response of human mesenchymal stem cell to anodized titanium discs coated with RGD peptide by physical adhesion and chemical fixation. Materials and methods: Fluorescence isothiocyanate (FITC) modified RGD-peptide was coated on the anodized titanium discs (diameter 12 mm, height 3 mm) using two methods. One was physical adhesion method and the other was chemical fixation method. Physical adhesion was performed by dip and dry procedure, chemical fixation was performed by covalent bond via silanization. In this study, human mesenchymal stem cell was used for experiments. The experiments consisted of surface characteristic evaluation after peptide coating, analysis about cell adhesion, proliferation, differentiation, and mineralization. Obtained data are statistically treated using Kruskal-Wallis test and Bonferroni test was performed as post hoc test (P=.05). Results: The evaluation of FE-SEM images revealed no diffenrence at micro-surfaces between each groups. Total coating dose was higher at physical adhesion experimental group than at chemical fixation experimental group. In cell adhesion and proliferation, RGD peptide coating did not show a statistical significance compared with control group (P>.05). In cell differentiation and mineralization, physical adhesion method displayed significantly increased levels compared with control group and chemical fixation method (P<.05). Conclusion: RGD peptide coating seems to enhance osseointegration by effects on the response of human mesenchymal stem cell. Especially physical adhesion method showed more effective than chemical fixation method on response of human mesenchymal stem cell.

The Associated Factors of Health Examinations Behaviors among Some Elderly Persons in Urban and Rural Areas (일부 도시·농촌지역 고령자의 건강검진 수진행동에 관련된 요인)

  • Kim, Yong-Ik;Cho, Young-Chae
    • Journal of agricultural medicine and community health
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    • v.29 no.1
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    • pp.1-14
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    • 2004
  • Objectives: We investigated the factors related to health examination behaviors, sociodemographic aspects and lifestyles of elderly persons with different social backgrounds, and compared sexual and regional differences in urban and rural elderlies. Methods: The total study subjects(464 individuals) from urban(236) and rural areas(228), recruited by a stratified cluster random sampling were interviewed and examined about their sociodemographic profiles, daily lifestyles, subjective health status, conditions concerning use of medical resources, hearing acuity, visual acuity and ADL(activity of daily living), and whether they receive health examination or not. For statistical analysis, Chi-square test was used for sexual and regional comparisons among the groups who have been given a health examination and the one who have not. Results: In urban areas, the rate of having underwent health examination was 54.5% in men and 46.9% in women, and in rural areas, it was 59.8% in men and 42.7% in women, showing its higher rate in men than in women in both areas. For regional differences between the group who have taken a health examination and the one who have not, there was a significant difference in terms of age, family pattern, current job, monthly household income, owning a house, drinking status, eating habit, subjective health status, whether they have taken outpatient medical service for the recent 3 months or not, anxiety for the health, and IADL conditions according to whether the community is rural or urban. In multiple regressions, the influential factors on the health examination behaviors were selected such as having their own house, their family doctor, amnesia, urinary incontinence and chronic disease in urban districts. But in rural districts, the variables were selected such as having or not of their family doctor, urinary incontinence, anxiety for the health, educational level, their own house and chronic disease. Conclusions: It is suggested that the approach to the health examination of an older patient requires substantial consideration of highly variable individual sociodemographic characteristics involving regional attributes as well as their daily life styles, subjective health status, status of performing health examination, physical health status and ADL conditions.

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Status of Influenza Vaccination for Residents in some Rural Communities (일부 농촌지역 주민들의 인플루엔자 예방접종 실태)

  • Lim, Hyun-Sul;Min, Young-Sun;Bae, Geun-Ryang;Kim, Young-Take;Lee, Yeon-Kyeng
    • Journal of agricultural medicine and community health
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    • v.29 no.1
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    • pp.121-131
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    • 2004
  • Objectives: This study was conducted to understand the status of influenza vaccination in some rural communities and to apply the results to formulate a counterplan for influenza prevention. Methods: The authors conducted a questionnaire survey from May 26 to May 29, 2003 among the residents in two rural communities: 602 people at the village Gigye-myeon and 965 at the village Cheongsong-gun. For statistical analysis the chi-square test and chi-square for trend method were used. Significance was set a p<0.05. Results: The study group contained 722 (46.1%) males and 845 (53.9%) females. In response to the question 'Influenza vaccination must be taken every year', 845 people (86.0%) replied 'Yes'. In response to the question 'Influenza vaccination can prevent cold', 224 people (20.8%) replied 'No'. The rate of influenza vaccination increased every year from 2000 to 2002 (p<0.05) and was lower for those under sixty-four than for those over sixty-five. In response to the question 'Plan to receive influenza vaccination in 2003', 531 people (52.8%) responded they will have influenza vaccination. Conclusions: Many people had a wrong perception about influenza vaccination. Therefore, their wrong perception must be corrected by a publicity campaign. The rate of influenza vaccination for those from over fifty to under sixty-four should be increased by public policy because they are as susceptible to influenza as those over sixty-five. This study produced meaningful results from the investigation into the status of influenza vaccination for the residents in rural communities and these findings can be utilized in the formulation of future influenza vaccination policy.

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A Survey on the Foodservice Management Practices at Child Care Centers in Gyeonggi Area (경기 지역 영유아 보육시설의 급식운영관리 실태 조사)

  • Sohn, Chun-Young;Pak, Hee-Ok
    • Journal of the East Asian Society of Dietary Life
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    • v.21 no.4
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    • pp.577-586
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    • 2011
  • This study was carried out to investigate food service management practices in various operation types of child care center in Gyeonggi area of Korea, and to provide basic information for improving food service management policies at child care centers. Self-administrated questionnaires were collected from 102 child care center directors. The statistical analysis was completed using SPSS ver. 18.0 program. Approximately 97.1% of the directors were women. The number of total children were difference in public, private and home care centers respectively (p<0.001), and time of operation was significantly (p<0.01). Only 8.9% of the centers employed a dietitian, whereas 92.5% of the centers employed cook or assistant cook, thus food service was not managed by professionals in most centers. All of the centers had been self-operated and meals were prepared in a conventional manner. In approximately 89.2% of the centers servings snacks twice a day. Menu planner of the centers which have no dietitian was the child care information center (47.5%) or the director (34.7%). In most centers, the directors was also purchasing manager and 36.0% of the center purchased food every day. These results indicated that food service management guidelines need to be established by the child care center type with the government control and financial support. We recommended that they furnish the efficient food service program for food service management.

Study on Short Term Smoking Cessation Treatment in Dental Hospitals in Korea (국내 치과대학병원에서 시행한 단기 금연진료에 대한 조사)

  • Song, Je-Il;Lee, Gi-Ho;Kim, Mee-Eun;Kim, Ki-Suk
    • Journal of Oral Medicine and Pain
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    • v.35 no.4
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    • pp.245-258
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    • 2010
  • Smoking has been identified not as a major risk factor for circulatory and respiratory diseases but also as causes of various oral diseases. A number of clinical studies and regional health surveys have found an association between smoking and poor oral health status and between smoking and prognosis of dental treatments. However, there is few studies about status of smoking cessation treatment and policies in dentistry in Korea. The purpose of this study was to investigate the smoking patterns of outpatients and outcomes of short-term smoking cessation treatment in dental hospitals in Korea and, subsequently, to seek further smoking cessation services in dentistry. This study was sponsored by Korean Dental Association (KDA) and department of culture and welfare. 825 dental patients were voluntarily participated in a 4-week smoking cessation program with nicotine patch and 297 participants of them completed on smoking-related questionnaires. All participants were recruited from outpatients of 11 dental university hospitals (primarily in the department of oral medicine, oral surgery and periodontology) in Korea during 3-month period from October 2009 to January 2010. The Questionnaires included demographics, duration of smoking, heavy smoking index (HSI), number of thinking of quit smoking, duration of stop smoking and reasons to smoking, awareness of smoking effects on oral health, and their success rate after 4 weeks of nicotine patch program was investigated. The statistical analysis was carried by SPSS version 18.0 program and Chi-square test. According to the results of this study, male in their 30s to 50s were the most prevalent of all the participants and duration of smoking increased with age. Attempt rate to quit smoking (Quit smoking) was the highest in 30s and 40s with duration of quit smoking ranging 1 to 3 months. Emotional stresswas the most frequently reported reason for smoking, followed by habit and pleasure in order. All age group showed high HIS over 71% and awareness of smoking effects on oral diseases such as oral soft tissue diseases, periodontal diseases and dental caries was found relatively high (50~60%) Periodontal implant was the main reason for participation in the smoking cessation services in dental clinics and the success rate of, 4-week nicotine patch program of all the participants was 29.4%, extremely low compared to that of medical clinics. Systemic education for dentists to be able to provide interventions to quit smoking including counseling with the 5As'and development of available measures for smokers is needed as considered that the low success rate of the smoking cessation services in dentistry could be explained mainly by lack of dentists' strategies, experience and attention. Awareness and attention of dentists should be emphasized and their participation be encouraged by long-term, multidisciplinary policies such as establishment of insurance fee, which would made a considerable progress in preventing smoking-related oral diseases and promoting public oral health.

Scapular Free Flap (유리 견갑 피판 이식술)

  • Chung, Duke-Whan;Han, Chung-Soo;Yim, Chang-Moo
    • Archives of Reconstructive Microsurgery
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    • v.5 no.1
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    • pp.24-34
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    • 1996
  • There are many kinds of free flaps for management of extensive soft tissue defect of extremities in orthopaedic field. Free vascularized scapular flap is one of the most useful and relatively easy to application. This flap has been utilize clinically from early eighties by many microsurgical pioneers. Authors performed 102 cases of this flap from 1984 to 1995. We have to consider about the surgical anatomy of the flap, technique of the donor harvesting procedures, vascular varieties and anatomical abnormalities and success rate and the weak points of the procedure. This flap nourished by cutaneous branches from circumflex scapular vessels emerges from the lateral aspect of the subscapular artery 2.5-5cm from its lateral origin passing through the triangular space(bounded by subscapularis, teres minor, teres major, long head of triceps). The terminal cutaneous branch runs posteriorly around the lateral border of the scapular and divided into two major branches, those transeverse horizontally and obliquely to the fascial plane of overlying skin of the scapular body. We can utilize these arteries for scapular and parascapular flap. The vascular pedicle ranged from 5 to 10 cm long depends on the dissection, usually two venae comitantes accompanied circumflex scapular artery and its major branches. The diameter of the circumflex scapular artery is more than 1mm in adult, rare vascular variation. Surgical techniques : The scapular flap can be dissected conveniently with prone or lateral decubitus position, prone position is more easier in my experience. There are two kinds of surgical approaches, most of the surgeon prefer elevation of the flap from its outer border towards its base which known easier and quicker, but I prefer elevation of the flap from its outer border because of the lowering the possibilities of damage to vasculature in the flap itself which runs just underneath the subcutaneous tissue of the flap and provide more quicker elevation of the flap with blunt finger dissection after secure pedicle dissection and confirmed the course from the base of the pedicle. There are minimal donor site morbidity with direct skin closure if the flap size is not so larger than 10cm width. This flap has versatility in the design of the flap shape and size, if we need more longer and larger one, we can use parascapular flap or both. Even more, the flap can be used with latissimus dorsi musculocutaneous flap and serratus anterior flap which have common vascular pedicle from subscapular artery, some instance can combined with osteocutaneous flap if we include the lateral border of the scapular bone or parts of the ribs with serratus anterior. The most important shortcoming of the scapular free flap is non sensating, there are no reasonable sensory nerves to the flap to anastomose with recipient site nerve. Results : Among our 102 cases, overall success rate was 89%, most of the causes of the failure was recipient site vascular problems such as damaged recipient arterial conditions, and there were two cases of vascular anomalies in our series. Patients ages from 3 years old to 62 years old. Six cases of combined flap with latissimus dorsi, 4 cases of osteocutaneous flap for bone reconstruction, 62 parascapular flap was performed - we prefer parascapular flap to scapular. Statistical analysis of the size of the flap has less meaningful because of the flap has great versatility in size. In the length of the pedicle depends on the recipient site condition, we can adjust the pedicle length. The longest vascular pedicle was 14 cm in length from the axillary artery to the enter point cutaneous tissue. In conclusion, scapular free flap is one of the most useful modalities to manage the large intractable soft tissue defect. It has almost constant vascular pedicle with rare anatomical variation, easy to dissect great versatility in size and shape, low donor morbidity, thin and hairless skin.

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Simulation of Drying Grain with Solar-Heated Air (태양에너지를 이용한 곡물건조시스템의 시뮬레이션에 관한 연구)

  • 금동혁;김용운
    • Journal of Biosystems Engineering
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    • v.4 no.2
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    • pp.65-83
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    • 1979
  • Low-temperature drying systems have been extensively used for drying cereal grain such as shelled corn and wheat. Since the 1973 energy crisis, many researches have been conducted to apply solar energy as supplemental heat to natural air drying systems. However, little research on rough rice drying has been done in this area, especially very little in Korea. In designing a solar drying system, quality loss, airflow requirements, temperature rise of drying air, fan power and energy requirements should be throughly studied. The factors affecting solar drying systems are airflow rate, initial moisture content, the amount of heat added to drying air, fan operation method and the weather conditions. The major objectives of this study were to analyze the effects of the performance factors and determine design parameters such as airflow requirements, optimum bed depth, optimum temperature rise of drying air, fan operation method and collector size. Three hourly observations based on the 4-year weather data in Chuncheon area were used to simulate rough rice drying. The results can be summarized as follows: 1. The results of the statistical analysis indicated that the experimental and predicted values of the temperature rise of the air passing through the collector agreed well. 2. Equilibrium moisture content was affected a little by airflow rate, but affected mainly by the amount of heat added, to drying air. Equilibrium moisture content ranged from 12.2 to 13.2 percent wet basis for the continuous fan operation, from 10.4 to 11.7 percent wet basis for the intermittent fan operation respectively, in range of 1. 6 to 5. 9 degrees Centigrade average temperature rise of drying air. 3. Average moisture content when top layer was dried to 15 percent wet basis ranged from 13.1 to 13.9 percent wet basis for the continuous fan operation, from 11.9 to 13.4 percent wet basis for the intermittent fan operation respectively, in the range of 1.6 to 5.9 degrees Centigrade average temperature rise of drying air and 18 to 24 percent wet basis initial moisture content. The results indicated that grain was overdried with the intermittent fan operation in any range of temperature rise of drying air. Therefore, the continuous fan operation is usually more effective than the intermittent fan operation considering the overdrying. 4. For the continuous fan operation, the average temperature rise of drying air may be limited to 2.2 to 3. 3 degrees Centigrade considering safe storage moisture level of 13.5 to 14 perceut wet basis. 5. Required drying time decrease ranged from 40 to 50 percent each time the airflow rate was doubled and from 3.9 to 4.3 percent approximately for each one degrees Centigrade in average temperature rise of drying air regardless of the fan operation methods. Therefore, the average temperature rise of drying air had a little effect on required drying time. 6. Required drying time increase ranged from 18 to 30 percent approximately for each 2 percent increase in initial moisture content regardless of the fan operation methods, in the range of 18 to 24 percent moisture. 7. The intermittent fan operation showed about 36 to 42 percent decrease in required drying time as compared with the continuous fan operation. 8. Drymatter loss decrease ranged from 34 to 46 percent each time the airflow rate was doubled and from 2 to 3 percent approximately for each one degrees Centigrade in average temperature rise of drying air, regardless of the fan operation methods. Therefore, the average temperature rise of drying air had a little effect on drymatter loss. 9. Drymatter loss increase ranged from 50 to 78 percent approximately for each 2 percent increase in initial moisture content, in the range of 18 to 24 percent moisture. 10. The intermittent fan operation: showed about 40 to 50 percent increase in drymatter loss as compared with the continuous fan operation and the increasing rate was higher at high level of initial moisture and average temperature rise. 11. Year-to-year weather conditions had a little effect on required drying time and drymatter loss. 12. The equations for estimating time required to dry top layer to 16 and 1536 wet basis and drymatter loss were derived as functions of the performance factors. by the least square method. 13. Minimum airflow rates based on 0.5 percent drymatter loss were estimated. Minimum airflow rates for the intermittent fan operation were approximately 1.5 to 1.8 times as much as compared with the continuous fan operation, but a few differences among year-to-year. 14. Required fan horsepower and energy for the intermittent fan operation were 3. 7 and 1. 5 times respectively as much as compared with the continuous fan operation. 15. The continuous fan operation may be more effective than the intermittent fan operation considering overdrying, fan horsepower requirements, and energy use. 16. A method for estimating the required collection area of flat-plate solar collector using average temperature rise and airflow rate was presented.

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