Ko, Chanyoung;Kim, Jae-Jin;Cho, Dongrae;Oh, Jooyoung;Park, Jin Young
Korean Journal of Psychosomatic Medicine
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v.27
no.2
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pp.101-110
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2019
Objectives : It is not clear which clinical variables are most closely associated with delirium in the Intensive Care Unit (ICU). By comparing clinical data of ICU delirium and non-delirium patients, we sought to identify variables that most effectively differentiate delirium from non-delirium. Methods : Medical records of 6,386 ICU patients were reviewed. Random Subset Feature Selection and Principal Component Analysis were utilized to select a set of clinical variables with the highest discriminatory capacity. Statistical analyses were employed to determine the separation capacity of two models-one using just the selected few clinical variables and the other using all clinical variables associated with delirium. Results : There was a significant difference between delirium and non-delirium individuals across 32 clinical variables. Richmond Agitation Sedation Scale (RASS), urinary catheterization, vascular catheterization, Hamilton Anxiety Rating Scale (HAM-A), Blood urea nitrogen, and Acute Physiology and Chronic Health Examination II most effectively differentiated delirium from non-delirium. Multivariable logistic regression analysis showed that, with the exception of vascular catheterization, these clinical variables were independent risk factors associated with delirium. Separation capacity of the logistic regression model using just 6 clinical variables was measured with Receiver Operating Characteristic curve, with Area Under the Curve (AUC) of 0.818. Same analyses were performed using all 32 clinical variables;the AUC was 0.881, denoting a very high separation capacity. Conclusions : The six aforementioned variables most effectively separate delirium from non-delirium. This highlights the importance of close monitoring of patients who received invasive medical procedures and were rated with very low RASS and HAM-A scores.
Purpose : Chest irradiation leads to a significant cardiac injury in a number of patients. To prevent, or to reduce the risk of radiation-induced cardiac injury, pentoxifylline(PTX), a haemorrheologic agent that improves the blood flow through small blood capillaries has been employed. Materials and Methods : One hundred and eighty ICR mice were divided into three study groups: control, radiation alone, and radiation-pentoxifylline. Each group was subdivided into 12 subgroups: 1 3, 6 and 10 days and 2, 3, 4, 6, 8, 12, 16 and 20 weeks by observation Period after irradiation. The total 15Gy of radiation was delivered in a single fraction through anterior mediastinal port. Pentoxifylline was injected subcutaneously daily 50mg/kg to the back of the mice from the first day of irradiation throughout the observation period. The mice of each group after a certain observation period were sacrificed and sectioned for histopathologic examination of the heart. Result : The findings of acute radiation-induced carditis i.e., heterophilic infiltration and vacuolization and ballooning of endothelial cells were observed upto 6 weeks and reduced sharply afterwards. The late radiation effects including pericarditis with mononuclear cell infiltration, pericardial fibrosis, endothelial cell changes, myocardial degeneration and fibrosis present from 4 weeks onwards after irradiation but with various degree of severity. The overall process of pathologic changes of radiation-pentoxifylline group was similar to those of radiation alone group but the duration of acute stage was relatively short and the severity of late cardiac toxicity was much lesser compared with those of radiation alone group. Conclusion : Pentoxifylline can effectively reduce the late radiation-induced cardiac injury and reslve the acute effects relatively rapidly.
The Fontan operation has undergone a number of major modifications and clinical results have been improving over time. Nevertheless, during the follow-up period, life-threatening complications develop and affect the long-term outcomes. Surgical interventions for these complications are needed and are increasing. Material and Method: From April 1988 to January 2000, 16 patients underwent reoperations for complications after Fontan operation. The mean age at reoperation was 8.8 :-5.5 years. Initial Fontan operations were atriopulmonary connections in 8 and total cavopulmonary connections in 8. Total cavopulmonary connections were accomplished with intracardiac lateral tunnel in 5 and extracardiac epicardial lateral tunnel in 3. Five patients had variable sized fenestrations. The reasons for reoperations included residual shunt in 6, pulmonary venous obstruction in 3, atrial flutter in 3, atrioventricular valve regurgitation in 2, Fontan pathway stenosis in 1, and protein-losing enteropathy in 1 Result: There were 3 early and late deaths respectively Patients who had residual shunts underwent primary closure of shunt site (n=2), atrial reseptation for separation between systemic and pulmonary vein (n=2), conversion to lateral tunnel (n=1), and conversion to one and a half ventricular repair (n=1). Four patients who had stenotic lesion of pulmonary vein or Fontan pathway underwent widening of the lesion (n=3) and left pneumonectomy (n=1) In cases of atrial flutter, conversion to lateral tunnel after revision of atriopulmonary connections was performed (n=3). For the atrioventricular valve regurgitation (n=2), we performed a replacement with mechanical valve. In one patient who had developed protein-losing enteropathy, aorto-pulmonary collateral arteries were obliterated via thoracotomy. Cryoablation was performed concomitantly in 4 patients as an additional treatment modality of atrial arrhythmia. Conclusion: Complications after Fontan operation are difficult to manage and have a considerable morbidity and mortality. However, more accurate understanding of Fontan physiology and technical advancement increased the possibility of treatment for such complications as well as Fontan operation itself. Appropriate surgical treatment for these patients relieved the symptoms and improved the functional class, Although the results were not satisfactory enough in all patients.
Video-assisted thoracic sympathicotomy is a safe and effective therapy for the treatment of essential hyperhidrosis with immediate symptomatic improvement. However, this is offset by the occurrence of a high rate of side effects, such as embarrassing compensatory hyperhidrosis. Therefore, by comparing and assessing the degree of symptomatic improvement or compensatory sweating following sympathicotomy at various levels and the extent of block, we are to determine the optimal level of sympathicotomy and which method will result in minimal side effects and maximal benefits. Material and Method: From January 1998 to June 2001, the thoracoscopic sympathicotomy was performed in 150 patients suffering from essential hyperhidrosis in the Dept. of Thoracic and Cardiovascular Surgery, Wonkwang University Hospital. The patients were divided into three groups. GroupI(n=50): patients having undergone 72,3,4 sympathicotomy, GroupII (n=50): patients having undergone 72 sympathicotomy which consist of blocking the interganglionic neural fiber on the second rib, and group 111(n=50): patients having undergone 73 sympathicotomy which consist of blocking the interganglionic neural fiber on the third rib. The parameters were composed of the satisfaction rate of treatment, the degree of compensatory sweating, postoperative complications, and changes of plantar sweating. Results: There was no difference in age and sex among the groups. All of the treated patients obtained satisfactory alleviation of essential hyperhidrosis in immediate postoperative period. However the rate of long-term satisfaction were 80%, 92%, and 96% in groupsI,II, and III respectively(p<0.05). More than embarrassing compensatory hyperhidrosis was present in 50%, 28%, and 18% in groups I,II ,and III respectively(p<0.05). Slight but comfortable amounts of palmar humidness was expressed in decreasing order, group III(34%), groupII(6%), and group I(4%) respectively(p<0.05). In regard to plantar sweating, decrease in sweating was expressed in each of the three groups, but was not significant between the groups.
A recent topic of interest within ecology is ecosystem services that are importantly connected with biodiversity. Biodiversity is a fundamental component of ecological studies and has been the subject of many studies worldwide. However, studies on the diversity and distribution of freshwater fish were not undertaken in earnest until 2000, and the number of internationally available studies is therefore still limited. In this study, we used data from "The Survey and Evaluation of Aquatic Ecosystem Health (hereafter SEAEH)" within the framework of which whole water systems on the Korean peninsula are annually monitored to investigate and determine the current status of the diversity and distribution of freshwater fish, as well as to elucidate major factors impacting freshwater fish. A total of 130 species from 28 families were identified at around 953 sites in the SEAEH investigation of 2014. The species Zacco platypus (relative abundance: 28.2%) and Z. koreanus (19.3%) were identified as the most abundant species on the Korean peninsula, and besides these 20 endangered species, 51 endemic species and 4 exotic species were also collected. Highest (96 species) and lowest (72 species) diversity were identified in the Han River Watershed and the Yeongsan/Seomjin River Watershed, respectively. The mean endemic rate was 32.7%, which is higher than the previous rate determined in 1995. The exotic species Micropterus salmoides, Lepomis macrochirus and Carassius cuvieri were found in the whole river system except north Yeongdong, whereas Oreochromis niloticus occurred only at three sites due to the cold water temperatures in winter. Totally, 28 species were found to be translocated to different water systems not connected with known original habitats, most translocations occurring in the Nakdong River and the Yeongdong region. Among the translocated species, Opsariichthys uncirostris amurensis, and Erythroculter erythropterus were dominantly distributed in the mid- to lower reaches of Nakdong River where they may be harmful to the native fish assemblages due to their strong predation. The construction of weirs in connection with the "4 River Project" generated changes in fish assemblages before, during and after the project, resulting in altered habitat condition. Especially, a decrease in the number of endemic species and an increase in the abundance of lentic species were seen. Human-induced global warming will allow exotic species requiring high water temperatures to adapt to the environmental conditions of the Korean peninsula, which may enhance the diversity of native fishes and create changes in distribution. For the establishment of realistic and efficient management and protection strategies for Korean freshwater fish, SEAEH, which produces fundamental and quantitative data for Korean streams, is an important and necessary tool.
Hepatoprotective effects of Monascus pilosus mycelial ethanol extract (MPME) were examined in high-fat diet induced-obese rats. The rats were randomly divided into 2 groups; normal control (NC) and a high-fat and high cholesterol diet group (HFC). The HFC diet group was fed a 5L79 diet supplemented with 15% lard and 1% cholesterol for 3 weeks for induction of obesity. And then, the rats were divided into 4 groups (n=5); the NC, a HFC diet obesity control group (HF), 0.5% MPME supplemented HFC diet group (MPM), and 2% conjugated linoleic acid (CLA) supplemented HFC diet group for 7 weeks. Whereas the daily weight gain of NC and HFC groups were 3.48 g and 4.48 g, respectively, those of MPM and CLA were 3.09 g and 4.38 g, respectively. Furthermore, activity of serum alanine and aspartic aminotransferase in HF was markedly higher than those of NC group, but, the activity in MPM and CLA was significantly lower than HF. Hepatic reduced glutathione content in MPM and CLA was higher than HF. On the contrary, hepatic lipid peroxide content in MPM and CLA was significantly lower than HF. In conclusion, although the precise mechanisms of the hepatoprotective effects of the MPME in this study are unknown, our study provides experimental evidence that MPME may prevent obesity and hepatic damage by high-fat and high cholesterol diet via inhibition of lipid absorption and induction of reactive oxygen spices scavenging enzyme such as superoxide dismutase.
Purpose : To evaluate the survival and prognostic factors in patients with stage III non-small cell lung cancer treated with curative radiotherapy alone or combined with chemotherapy Materials and Methods : A retrospective analysis was undertaken of 35 patients who had locally advanced non-small-cell lung cancer and treated with curative radiotherapy in Department of Therapeutic Radiology, Kangdong Sacred Heart Hospital, from January 1991 through December 1993. According to AJCC staging, 15 patients were stage IIIA, and 20 were stage IIIB. Radiotherapy was delivered with 1 8-2 Gy per fraction/day. 5 days per week using 6 MV X-ray, to a total dose ranging from 48.8 Gy to 66.6 Gy (median, 61.2 Gy) in 4 to 9 weeks. Ten patients received neoadjuvant or concurrent chemotherapy with FIP (5-FU, ifosfamide, and cisplatin) or FP (5-FU and cisplatin) Results : For all Patients, median survival was 6 months. 1-year and 2-year survival rates were 23.3% and 6.7%, respectively The median survival was 8 months in stage IIIA and 5.5 months in stage IIIB. In patients treated with radiation therapy alone, median survival was 5 months and 1-year survival rate was 9%. In patients who received chemotherapy, median survival was 11 months and 1-year survival rate was 60%. The difference of survival between these two groups was statistically significant (p=0.03). Total radiation dose, degree of response, and Post-treatment ECOG score were also significantly associated with survival. But it was not affected by age, sex, pretreatment ECOG score, presence or absence of weight loss, tumor location. pathologic type, N stage, and degree of response to treatment. Conclusion : Conventional radiotherapy alone is unlikely to achieve long term survival in patients with stage III NSCLC. Radiotherapy with altered fractionation schedule or multimodality treatment combined with surgery and/or chemotherapy should be considered if feasible.
Purpose: We make a qualitative analysis of whether Fusion SPECT/CT can find lesion's anatomical sites better than existing SPECT or not, and we want to show the usefulness of SPECT/CT through finding out effects of CT attenuation correction on SPECT images. Materials and Method: 1. The evaluation of fusion images: This study comprised patients who was tested $^{131}I$-MIBG, Bone, $^{111}In$-Octreotide, Meckel's diverticulum, Parathyroid MIBI with Precedence 16 or Symbia T2 from 2008 Jan to Aug. We compared SPECT/CT image with non fusion image and make a qualitative analysis. 2. The evaluation of attenuation correction: We classified 38 patients who was tested 201Tl myocardial exam with Symbia T2 into 5 sections by using Cedars Sinai' QPS program - Ant, Inf, Lat, Septum, Apex. And we showed each section's perfusion states by percentage. We compared the each section's perfusion-states differences between CT AC and Non AC by average${\pm}$standard deviation. Results: 1. The evaluation of fusion images : In high energy $^{131}I$ cases, it was hard to grasp exact anatomical lesions due to difference between regions and surrounding lesions' uptake level. After combining with CT, we could grabs anatomical lesion more exactly. And in meckel's diverticulum case or to find lesions around bowels or organs with $^{111}In$ cases, it demonstrates its superiority. Bone SPECT/CT images help to distinguish between disk spaces certainly and give correct results. 2. The evaluation of attenuation correction: There is no significant difference statistically in Ant and Lat (p>0.05), but there is a meaningful difference in Inferior, Apex and Septum (p<0.05). AC perfusion at inferior wall in the 5 sections of myocardium: The perfusion difference between Non AC perfusion image ($68.58{\pm}7.55$) and CT corrected perfusion image ($76.84{\pm}6.52$) was the largest by $8.26{\pm}4.95$ (p<0.01, t=10.29). Conclusion: Nuclear medicine physicians can identify not only molecular image which shows functional activity of lesions but also anatomical location information of lesions with more accuracy using the combination of SPECT and CT systems. Of course this combination helps nuclear medicine physician find out the abnormal parts. Moreover combined data sets help separate between normal group and abnormal group in complicated body part. So clinicians can carry out diagnosis and treatment planning at the same time with a single test image. In addition, when we examine a myocardium in thorax where attenuation can occur easily, we can trust perfusion more in a certain region in SPECT test because CT provides the capability for accurate attenuation correction. In these reasons, we think we can prove the justice after treatment fusion image.
This study was conducted to compare volatile components from the ten kinds of basils cultivated in Korea. The ten kinds of basils were separated flower, leaf, and stem part from whole plants, respectively. All sample separated were extracted by simultaneous steam distillation-extraction method(SDE) and were analyzed by gas chromatography(GC) and mass selective detector(MSD). Total 42 components were identified in essential oils including 11 alcohols, 6 carbonyls, 20 hydrocarbons and 5 esters components. The major components were linalool, methyl chavicol, eugenol, trans-methyl cinnamate, ${\beta}-cubebene$ and 1,8-cineole. The content of linalool was high significantly in the flower$(31.8{\sim}53.0%)$, the leaf and stem showed $21.8{\sim}35.8%$ and $3.5{\sim}22.4%$, respectively. Especially, the content of methyl chavicol was high relatively in the leaf$(0.4{\sim}32.9%)$, the flower and stem showed $0.2{\sim}24.1%$ and $0{\sim}2.2%)$, respectively. Articock, figz, glove, and greek basils were rich in eugenol$(18.8{\sim}48.7%)$ and poor in methyl chavicol$(0{\sim}5.4%)$ when compared with others kinds of basils. The composition of the components identified showed quite difference between kinds of basils, and the number of components identified in stem was much less than that in flower and leaf
Journal of Korean Society of Occupational and Environmental Hygiene
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v.29
no.4
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pp.477-487
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2019
Objectives: Firefighters are known to be exposed to a variety of toxic substances, but little information is available on the exposure profile of firefighting activities. The aims of this study were to conduct exposure monitoring of toxic chemicals at fire scenes, to compare the concentrations of respective chemicals among firefighting tasks, and to assess the main factors influencing the concentrations of chemicals. Methods: Researchers performed sampling at firefighting scenes during four weeks in 2013. At the scene, we collected samples based on firefighters' own activities and examined the situation and scale of the accident. Collected samples were classified into three categories, including fire extinguishing and overhaul, and were analyzed in the laboratory according to respective analysis methods. Results: A total of fourteen fire activity events were surveyed: five fire extinguishing, six overhaul, and three fire investigations. Although no substance exceeded the ACGIH TLV, PAHs were detected in every sample. Naphthalene ranged from 0.24 to 279.13 mg/㎥ (median 49.6 mg/㎥) and benzo(a)pyrene was detected in one overhaul case at 10.85 ㎍/㎥. Benzene (0.01-12.2 ppm) was detected in every task and exceeded the ACGIH TLV. No significant difference in concentrations between tasks was shown. Conclusions: These results indicate that all firefighting tasks generated various hazardous combustion products, including possible carcinogens.
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