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A Clinical Review of Acute Respiratory Distress Syndrome (ARDS) Due to Miliary Tuberculosis (급성호흡곤란증후군으로 발현된 속립성 결핵의 임상적 고찰)

  • Ahn, Young-Soo;Lee, Sang-Moo
    • Tuberculosis and Respiratory Diseases
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    • v.53 no.1
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    • pp.17-26
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    • 2002
  • Background : The detection and early elimination of the causes for acute respiratory distress syndrome(ARDS) at the initial stage can result in a more favorable prognosis. Miliary tuberculosis as a cause of the ARDS is quite rare. A diagnosis of miliary tuberculosis is difficult due to the diversity of radiological patterns and non-specific clinical finfings, and low sensitivity of sputum examinations for acid-fast bacilli(AFBs). An analysis of the clinical data is the first step in diagnosing these unusual, rare cases. Materials and Methods : In this study the clinical features, laboratory data, radiological findings and diagnostic methods were analyzed in 9 cases with an initial presentation of ARDS due to miliary tuberculosis. The ARDS was defined by the definition of the American-Europian consensus conference 1992. Results : The mean age of the patients was $67{\pm}18$ years (F:M=7:2). The chief complaints were dyspnea(5/9), coughing (3/9) and fever(5/9). On a physical examination, fine or coarse crackles were noted(6/9). The ARDS developed on average 6.7 days after the initial respiratory symptoms. The mean $PaO_2/FiO_2$ of the patients was $133.5{\pm}53.4$, the number of cases with a WBC<5000/$mm^3$ was 4 out of 9 cases. A platelet count<70,000/$mm^3$ was observed in 2 out of 9 cases, and the serum albumin level was $2.6{\pm}0.6$ g/dL. The initial simple chest PA showed ground glass appearances and consolidation in all cases, However, the miliary nodular densities were observed in only 4 out of the 9 cases. HRCT revealed alveolar densities and a consolidation in 5 out of 6 cases, and miliary nodules in 5 out of 6 cases, The diagnosis of tuberculosis was made by a liver biopsy (4/4, 100% sensitivity), a bone marrow biopsy (1/2, 50% sensitivity), and an open lung biopsy (1/1), the sputum AFB was positive in only 2 out of 9 cases. The patient was treated with INH, RFP, EMB, PZA, and steroids. The survival rate was 55.5%. Conclusion : Miliary tuberculosis should be considered as one of the causes for ARDS in areas where there is a high prevalence of tuberculosis. The chief complaints of the patients on admission are dyspnea, fever and coughing without any specific riskfactors. A liver biopsy is particularly useful in ARDS patients with mechanical ventilation to determine the causes of the ARDS if miliary tuberculosis is suspected as being the underlying disease.

High Speed Rail Station Distric Using Entropy Model Study to Estimate the Trip Distribution (엔트로피 모형을 활용한 고속철도 역세권 통행분포 추정에 관한 연구)

  • Cho, Hangung;Kim, Sigon;Kim, Jinhowan;Jeon, Sangmin
    • KSCE Journal of Civil and Environmental Engineering Research
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    • v.32 no.6D
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    • pp.679-686
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    • 2012
  • KTX step 1 April 2004, after the opening, the second phase of the project was opened in November 2010. High-speed rail after the opening and continue to increase the demand of high-speed rail, Have the speed of competitive advantage compared too the means of transportation. The opening of these high-speed rail has led to changes of the move, the company's position, and the spatial structure of the population of reorganization, such as the social, economic, transportation. In this study, survey data using the High Speed Rail Station EMME/2 of the program to take advantage of the 2-Dimentional Blancing trip distribution to investigate the passage through the trip distribution by the estimation of the parameters of the model to estimate the distribution of the means of access and high-speed rail station to reproduce and Analysis of the results by means of access parameters (${\theta}$) autos 0.0395, buses 0.0390, subway 0.0650, taxi 0.0415, the frequency distribution (Trip Length Frequency Distribution: TLFD) were analyzed survey data value model with the results of comparing $R^2$ cars analysis and model values similar survey data 0.909 bus 0.923, subway 0.745 to 0.922, taxi, F test P value analysis is smaller than 0.05 at the 95% confidence level as a note that was judged to have been. Trip frequency distribution analysis, but in the future, set the unit to 5km-trip frequency distribution middle zone Units from small zone units (administrative district) segmentation research is needed, and can reflect the trip distance 0~5 km interval combined function to take advantage of the gravity model and the 3-Dimentional Blancing applied research is needed to be considered.

Ichthyotoxic Cochlodinium polykrikoides red tides offshore in the South Sea, Korea in 2014: I. Temporal variations in three-dimensional distributions of red-tide organisms and environmental factors

  • Jeong, Hae Jin;Lim, An Suk;Lee, Kitack;Lee, Moo Joon;Seong, Kyeong Ah;Kang, Nam Seon;Jang, Se Hyeon;Lee, Kyung Ha;Lee, Sung Yeon;Kim, Mi Ok;Kim, Ji Hye;Kwon, Ji Eun;Kang, Hee Chang;Kim, Jae Seong;Yih, Wonho;Shin, Kyoungsoon;Jang, Poong Kook;Ryu, Joo-Hyung;Kim, Sung Young;Park, Jae Yeon;Kim, Kwang Young
    • ALGAE
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    • v.32 no.2
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    • pp.101-130
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    • 2017
  • The ichthyotoxic Cochlodinium polykrikoides red tides have caused great economic losses in the aquaculture industry in the waters of Korea and other countries. Predicting outbreak of C. polykrikoides red tides 1-2 weeks in advance is a critical step in minimizing losses. In the South Sea of Korea, large C. polykrikoides red tide patches have often been recorded offshore and transported to nearshore waters. To explore the processes of offshore C. polykrikoides red tides, temporal variations in 3-dimensional (3-D) distributions of red tide organisms and environmental parameters were investigated by analyzing 4,432 water samples collected from 2-5 depths of 60 stations in the South Sea, Korea 16 times from May to Nov, 2014. In the study area, the vegetative cells of C. polykrikoides were found as early as May 7, but C. polykrikoides red tide patches were observed from Aug 21 until Oct 9. Cochlodinium red tides occurred in both inner and outer stations. Prior to the occurrence of large C. polykrikoides red tides, the phototrophic dinoflagellates Prorocentrum donghaiense (Jun 12 to Jul 11), Ceratium furca (Jul 11 to Aug 21), and Alexandrium fraterculus (Aug 21) formed red tides in sequence, and diatom red tides formed 2-3 times without a certain distinct pattern. The temperature for the optimal growth of these four red tide dinoflagellates is known to be similar. Thus, the sequence of the maximum growth rates of P. donghaiense > C. furca > A. fraterculus > C. polykrikoides may be partially responsible for this sequence of red tides in the inner stations following high nutrients input in the surface waters because of heavy rains. Furthermore, Cochlodinium red tides formed and persisted at the outer stations when $NO_3$ concentrations of the surface waters were < $2{\mu}M$ and thermocline depths were >20 m with the retreat of deep cold waters, and the abundance of the competing red-tide species was relatively low. The sequence of the maximum swimming speeds and thus potential reachable depths of C. polykrikoides > A. fraterculus > C. furca > P. donghaiense may be responsible for the large C. polykrikoides red tides after the small blooms of the other dinoflagellates. Thus, C. polykrikoides is likely to outgrow over the competitors at the outer stations by descending to depths >20 m and taking nutrients up from deep cold waters. Thus, to predict the process of Cochlodinium red tides in the study area, temporal variations in 3-D distributions of red tide organisms and environmental parameters showing major nutrient sources, formation and depth of thermoclines, intrusion and retreat of deep cold waters, and the abundance of competing red tide species should be well understood.

Systems for Production of Calves from Hanwoo(Korean Cattle) IVM/IVF/IVC Blastocyst II. Simple, Efficient and Successful Vitrification of Hanwoo Blastocyst (체외생산된 한우 배반포기배로부터 송아지 생산을 위한 체계 II. 한우 배반포기배를 간편하면서 효율적이고 성공적으로 유리화 동결하는 방법)

  • Kim, E.Y.;Kim, D.I.;Park, N.H.;Weon, Y.S.;Nam, H.K.;Lee, K.S.;Park, S.Y.;Yoon, S.H.;Park, S.P.;Chung, K.S.;Lim, J.H.
    • Korean Journal of Animal Reproduction
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    • v.23 no.4
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    • pp.281-291
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    • 1999
  • The objective of this study was to optimize the freezing/thawing method of in vitro produced Hanwoo blastocysts. Day 7 blastocysts after IVF were vitrified using EFS40 (40% ethylene glycol, 18% ficoll, 0.3 M sucrose and 10% FBS added m-DPBS) as a freezing solution and electron microscope (EM) grid (V-G) or straw (V-S) as an embryo container. In both method, freezing/thawing were treated by 2-step, treatment time was required in V-G method and V-S method, for 2 min / 3 min and 3.5 min / 10 min, respectively. Embryo survival was assessed as re-expanded and hatched rates at 24 h and 48 h after warming, respectively. The results obtained in these experiments were summarized as follows: when the effect of exposure in vitrification solution and chilling injury from freezing procedure on in vitro produced expanded blastocysts were examined, at 24 h after warming, embryo survival in exposure group (100.0%) was not different compared to that in control group (100.0%), although those results were significantly different with two vitrified groups (V-G: 87.8, V-S: 77.8%) (P<0.001). However, at 48 h after warming, hatched rates of V-G group (67.8%) were significantly higher than those of V-S group (53.3%) (P<0.05). In addition, this hatched rate in V-G group was not different with that in exposure group (73.3%). When the effects of embryo developmental stage (early, expanded and early hatching blastocysts) and embryo container (EM grid and straw) to the in vitro survival of vitrified-warmed day 7 Hanwoo blastocysts were simultaneously examined, fast developed embryos were indicated the better resistance to freezing than delayed developed one, irrespective of embryo containers (early; 57.1 & 24.4%, expanded; 84.7 & 60.6%, early hatching; 91.7 & 80.0%) (P<0.001). Especially, in expanded and early hatching blastocysts, embryo survival of V-G group (67.8, 95.0%) was significantly higher than those of V-S group (53.0, 65.0%) at 48 h post warming, respectively (P<0.05, P<0.001). Therefore, this study indicates that Hanwoo blastocysts can be cryopreserved more simple, efficient and successful by vitrification method using EM grid.

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A Study on the Contents of Heavy Metals in the Commercial Processed Foods (시중 유통 가공식품 중의 중금속 함량에 관한 연구)

  • 전옥경;김연천;한선희
    • Journal of Food Hygiene and Safety
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    • v.16 no.4
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    • pp.308-314
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    • 2001
  • This study was conducted to determine the content of heavy metals in canned foods and soft drinks available on the Korean markets. Trace metals (Pb, Cr, Cd, and Sn) were detected in 24 kinds, 120 samples by Atomic Absorption Spectrophotometer. The average concentration of heavy metals in canned foods was in the order of Sn (6.930 ppm)>Cr (0.050 ppm)>Pb (0.030 ppm)>Cd (0.008 ppm), which was the same order in soft drinks as Sn (3.519 ppm)>Cr (0.080 ppm)>Pb (0.024 ppm)>Cd (0.001 ppm). The total contents of heavy metals in canned fruits and fruit juices were relatively higher than those in cans and drinks made of vegetable and fish. It can be supposed that the high acidity owing to the organic acid of fruit itself promotes to extract metals from can materials, and although fish usually contains more heavy metals than vegetables, canned fish revealed low level because internal organs and most of skin which had more heavy metals than meat were removed throughout canning process. Because processed foods such as canned foods and soft drinks are very popular with the children and adolescence according to the change of life style and eating habit, and the possibility of exposure to heavy metals by the habitual intake of these is increasing simultaneously, it is suggested that more practical study about the process of exposure and the amount in each step is needed fur the assessment of safety.

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Quality Assurance of Patients for Intensity Modulated Radiation Therapy (세기조절방사선치료(IMRT) 환자의 QA)

  • Yoon Sang Min;Yi Byong Yong;Choi Eun Kyung;Kim Jong Hoon;Ahn Seung Do;Lee Sang-Wook
    • Radiation Oncology Journal
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    • v.20 no.1
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    • pp.81-90
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    • 2002
  • Purpose : To establish and verify the proper and the practical IMRT (Intensity--modulated radiation therapy) patient QA (Quality Assurance). Materials and Methods : An IMRT QA which consists of 3 steps and 16 items were designed and examined the validity of the program by applying to 9 patients, 12 IMRT cases of various sites. The three step OA program consists of RTP related QA, treatment information flow QA, and a treatment delivery QA procedure. The evaluation of organ constraints, the validity of the point dose, and the dose distribution are major issues in the RTP related QA procedure. The leaf sequence file generation, the evaluation of the MLC control file, the comparison of the dry run film, and the IMRT field simulate image were included in the treatment information flow procedure QA. The patient setup QA, the verification of the IMRT treatment fields to the patients, and the examination of the data in the Record & Verify system make up the treatment delivery QA procedure. Results : The point dose measurement results of 10 cases showed good agreement with the RTP calculation within $3\%$. One case showed more than a $3\%$ difference and the other case showed more than $5\%$, which was out side the tolerance level. We could not find any differences of more than 2 mm between the RTP leaf sequence and the dry run film. Film dosimetry and the dose distribution from the phantom plan showed the same tendency, but quantitative analysis was not possible because of the film dosimetry nature. No error had been found from the MLC control file and one mis-registration case was found before treatment. Conclusion : This study shows the usefulness and the necessity of the IMRT patient QA program. The whole procedure of this program should be peformed, especially by institutions that have just started to accumulate experience. But, the program is too complex and time consuming. Therefore, we propose practical and essential QA items for institutions in which the IMRT is performed as a routine procedure.

Comparison of the Efficacy of 2D Dosimetry Systems in the Pre-treatment Verification of IMRT (세기조절방사선치료의 환자별 정도관리를 위한 2차원적 선량계의 유용성 평가)

  • Hong, Chae-Seon;Lim, Jong-Soo;Ju, Sang-Gyu;Shin, Eun-Hyuk;Han, Young-Yih;Ahn, Yong-Chan
    • Radiation Oncology Journal
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    • v.27 no.2
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    • pp.91-102
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    • 2009
  • Purpose: To compare the accuracy and efficacy of EDR2 film, a 2D ionization chamber array (MatriXX) and an amorphous silicon electronic portal imaging device (EPID) in the pre-treatment QA of IMRT. Materials and Methods: Fluence patterns, shaped as a wedge with 10 steps (segments) by a multi-leaf collimator (MLC), of reference and test IMRT fields were measured using EDR2 film, the MatriXX, and EPID. Test fields were designed to simulate leaf positioning errors. The absolute dose at a point in each step of the reference fields was measured in a water phantom with an ionization chamber and was compared to the dose obtained with the use of EDR2 film, the MatriXX and EPID. For qualitative analysis, all measured fluence patterns of both reference and test fields were compared with calculated dose maps from a radiation treatment planning system (Pinnacle, Philips, USA) using profiles and $\gamma$ evaluation with 3%/3 mm and 2%/2 mm criteria. By measurement of the time to perform QA, we compared the workload of EDR2 film, the MatriXX and EPID. Results: The percent absolute dose difference between the measured and ionization chamber dose was within 1% for the EPID, 2% for the MatriXX and 3% for EDR2 film. The percentage of pixels with $\gamma$%>1 for the 3%/3 mm and 2%/2 mm criteria was within 2% for use of both EDR2 film and the EPID. However, differences for the use of the MatriXX were seen with a maximum difference as great as 5.94% with the 2%/2 mm criteria. For the test fields, EDR2 film and EPID could detect leaf-positioning errors on the order of -3 mm and -2 mm, respectively. However it was difficult to differentiate leaf-positioning errors with the MatriXX due to its poor resolution. The approximate time to perform QA was 110 minutes for the use of EDR2 film, 80 minutes for the use of the MatriXX and approximately 55 minutes for the use of the EPID. Conclusion: This study has evaluated the accuracy and efficacy of EDR2 film, the MatriXX and EPID in the pre-treatment verification of IMRT. EDR2 film and the EPID showed better performance for accuracy, while the use of the MatriXX significantly reduced measurement and analysis times. We propose practical and useful methods to establish an effective QA system in a clinical environment.

Prevention of calcification in bovine pericardial bioprosthesis -pretreatment with surfactants- (우심낭편의 석회화 방지에 관한 연구 - 계면활성제 전처치 효과 -)

  • 안재호;한재진;박성수
    • Journal of Chest Surgery
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    • v.31 no.6
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    • pp.560-566
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    • 1998
  • Background: Bovine pericardial bioprosthesis treated with glutaraldehyde (GA) is one of the most popular prosthetic materials, but late calcific degeneration after implantation is a problem that remains unsolved. For the purpose of mitigating the calcific degeneration, we added MgCl2 into the 0.625% GA solution to compete with calcium for binding to the free aldehyde from GA and pretreated with the surfactants like sodium dodecyl sulfate (SDS) and Triton X-100 before GA fixation for preventing the phospholipid infiltration into the pericardial tissue, the first step of the calcific degeneration. Material and Method: 40 square-shaped pieces of bovine pericardia were fixed in 0.625% GA solution with 4g/L MgCl2 6H2O as a control group (group 1). 40 pieces pretreated with 1% SDS were also fixed in the same GA solution (group 2) and other 40 pieces pretreated with 1% Triton X-100 were prepared with the same method (group 3). After 1 month of fixation these were implanted into the belly of 40 Sprague-Dawley subdermally and extracted 1 month, 2 months, 3 months and 6 months after implantation. With atomic absorption spectrophotometry we measured the deposited calcium amount. Result: 1 month after implantation we could not find any differences between the three groups, but by the 2nd month calcium deposition was 0.921$\pm$0.121 mg/g in group 1, 0.481$\pm$0.037 mg/g in group 2 and 1.369$\pm$0.200 mg/g in group 3. By the 3rd month it was 0.786$\pm$0.080 mg/g in group 1, 0.584$\pm$0.054 mg/g in group 2 and 1.139$\pm$0.188 mg/g in group 3, and on the 6th month 1.623$\pm$0.601 mg/g in group 1,0.501$\pm$0.043 mg/g in group 2 and 1.625$\pm$0.382 mg/g in group 3, with statistical significance in group 2(p<0.05). Conclusion: Pretreatment with SDS showed meaningful calcium mitigation effects on subcutaneously implanted bovine pericardium in the rat models but the neutral type surfactant, Triton X-100, had no positive mitigation effect in this experiment.

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An Analysis of the Comparison between the Image of the Landmarks in Daejeon (대전시 상징물과 도시 이미지에 대한 비교 분석)

  • Byeon, Jae-Sang;Kim, Dae-Soo;Lee, Jung-Soo
    • Journal of the Korean Institute of Landscape Architecture
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    • v.38 no.2
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    • pp.53-63
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    • 2010
  • It constitutes a very important preliminary step to analyze how city image is assessed in order to determine the direction towards a desirable city image in planning on an urban landscape for future city image. This study aims to quantify the recognition and evaluation of a city image on the part of citizens, using multidimensional scaling and correspondence analysis. Furthermore, this study hopes to contribute to the quantified policy-making for improving city image by understanding how professionals and civil servants in the related field tend to recognize such image. The results from the study are as follow: 1. The image of Daejon City tends to be assessed strongly in the light of its history, dynamics, and size. While the City is recognized as new and changing in general, the civil servants consider the city as modest, and the professionals as mediocre. Therefore, the City should strive to conceive its own unique identity, which would lessen the current image of modest and mediocre. 2. Gap river, Dunsan New Town, and the Daeduk Reseach Complex turn out to be the symbolic representative venues of Daejon City, inspiring the city’s image. In contrast, Yoosung Springs, the original town, and the Expo Park do not fit the image of the City. The need to renovate these places presents itself. 3. As for the questions using “like” and “not-like”, citizens and professionals show the tendency of not liking the city’s image, whereas civil servants like it. It follows that the City needs to highlight its “modern and high-technological” image, illuminated by Dunsan New Town and Daeduk Reseach Complex. 4. An image positioning drawn from a correspondence analysis shows that the City of Daejeon can be classified as an administrative and horizontal city. As opposed to the prior simplistic analyses of city image, this study attempts to diagnose it accurately, so as to help with the gearing towards city images in the future.

A Study on status of school health and analysis of factors affecting school nursing activities in the secondary school in Seoul (서울지역 국민학교(國民學校) 양호교사의 학교간호업무(學校看護業務) 수행정도(遂行程度)에 관(關)한 연구(硏究))

  • Kim, Eun Hee
    • Journal of the Korean Society of School Health
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    • v.1 no.2
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    • pp.50-65
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    • 1988
  • This study was conducted in order to grasp the condition of about the school nurse's service and to offer the basic materials of improving the school health service. The objects were comprised of 98 volunteered school nurses who take service in the elementary school. The material of this study was the questionaire suited to the purpose of this research which has been made through studying references and this questionaire has been corrected and revised three times. All the questionaire written by school-nurses. The results are as follows; 1. General features of the objects of study Average age was 35.9 and average career was 9.2 years. Except working as school-nurse, the past career was that average clinical-field was 3.4 years and health service was 4 months. Their educational level was as high as 72.4% of the objects were graduated from above 3 years college and 89.8% were married. 76.5% have religions and 94.8% were working at with national and public schools. 99.0% were doing only nursing service. 2. The conditions of the school health resources. The ratio of school-nurse to students was one to 2630. School-nurse to classes, one to 49.3, and school-nurse to teachers, one to 54. For total amount of a year budget of school health, from three hundred thousands to fifty nine hundred thousands won was most common. Expenses for purchasing medicine were used most. 58.2% of school-nurses hasn't known a year budget. There was an organization for school health in 74.2% of schools. 42.9% of nursing rooms were in the center of school and 88.8% were on first floor. Nursing room were used alone without being used by another purpose and the room size of 71.6% was below 10 pyong. 3. The conditions of school health service Average users of nursing room were 413 a month. The most of them had digestive trouble. Sending letters to home was 15.9 times a year. The most contents of letters was about health education. Object spent much time managing nursing room. 4. The degree of school health service When 2 points was given to "perform" and 1 point was to "not perform" the total average was 1.75, health education 1.89, environmental management 1.86, plan of project and evaluation 1.83, management of nursing room 1.82, health management 1.78, run of school health organization 1.32. 5. Correlation between the school health services and variables (1) The part of project plan and evaluation of school health service has relationship to existence or none-existence of school health organization (P<0.01), past health service career (P<0.05), number of classes (P<0.01), number of students (P<0.01), sending letters to home about health education (P<0.01) and number of users (P<0.05). (2) The part of nursing room management has relationship to ages (P<0.05) past clinical career (P<0.05), number of classes (P<0.05), number of students (P<0.05) and sending letters to home about health education (P<0.01). (3) The part of health education has relationship to existence or none-existence of school health organization (P<0.05), past clinical career (P<0.05), the ratio of health management to school nurse's all work (P<0.05) and the ratio of health education to school nurse's all work (P<0.01). (4) The part of environmental management to ages (P<0.01), career as a school-nurse (P<0.01), salary step(P<0.01), sending letters to home about health education (P<0.01), sending all letters to home (P<0.001), the ratio of health management to school nurse's all work (P<0.05), the ratio of health education to school nurse's all work (P<0.05) and area of school-nurse's room to be used. (5) The part of school health organization management to number of classes (P<0.05). (6) The part of health management to number of classes (P<0.05), sending letters to home about health education (P<0.001), sending all of letters to home (P<0.01) and the ratio of health management to school nurse's all work (P<0.05). (7) The part of school health service to ages (P<0.05), past clinical career (P<0.05), past health career (P<0.01), number of classes (P<0.05), number of student (P<0.05), sending letters to home about health education (P<0.05), sending all letters to home (P<0.05), the ratio of health management to school nurse's all work (P<0.05), the ratio of health education to school nurse's all work (P<0.01) and area of school - nurse's room to be used (P<0.05). ## Suggestion for further studies are as follows. 1. School-nurse should exert herself to advance a quality to take care of school population's health. 2. It is necessary that systematic support required to keep school population's health. 3. Home, school and community should make efforts cooperatively and the proper roles of students, teachers, health team members and parents must be achieved.

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