• Journal of Dental Anesthesia and Pain Medicine
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• 제22권2호
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• pp.145-153
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• 2022

Background: Postoperative analgesia (POA) is an important determinant of successful treatment. Dexmedetomidine (DEX) has recently gained attention as a promising adjuvant to local anesthetics (LA). The present study aimed to evaluate the efficacy and safety of levobupivacaine (LB) as an adjuvant during inferior alveolar nerve block (IANB) in the extraction of lower impacted third molars (LITM). Methods: A prospective, randomized, placebo-controlled, triple-blind, parallel-arm, and clinical study was performed on 50 systemically healthy participants who required removal of an asymptomatic LITM. Using a 1:1 distribution, the participants were randomized into two groups (n = 25). Group L (control group) received 1.8 mL of 0.5% LB and 0.2 mL normal saline (placebo) and Group D (study group) received a blend of 1.8 mL of 0.5% LB and 0.2 mL (20 ㎍) DEX. The primary outcome variable was the duration of POA and hemodynamic stability, and the secondary variable was the total number of analgesics required postoperatively for up to 72 h. The participants were requested to record the time of rescue analgesic use and the total number of rescue analgesics taken. The area under the curve was plotted for the total number of analgesics administered. The pain was evaluated using the visual analog scale. Data analysis was performed using paired students and unpaired t-test, Mann-Whitney U test, Chi-square test, and receiver operating characteristic analysis. Statistical significance was set at P < 0.05. Results: The latency, profoundness of anesthesia, and duration of POA were statistically significant (P < 0.05). The differences between mean pain scores at 6, 12, 24, 48, and 72 h were found to be significant (each P = 0.0001). Fewer analgesics were required by participants in group D (2.12 ± 0.33) than in L (4.04 ± 0.67), with a significant difference (P = 0.0001). Conclusion: Perineurally administered LA with DEX is a safe, effective, and therapeutic approach for improving latency, providing profound POA, and reducing the need for postoperative analgesia.

• 지질공학
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• 제32권2호
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• pp.209-219
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• 2022

본 연구에서는 강우에 따른 사면 내 지반특성 변화와 사면붕괴 형상을 실험적으로 규명하기 위하여 인공강우장치와 모형토조를 이용한 실내모형실험을 수행하였다. 이를 위하여 균질한 모래를 대상으로 모형 실험을 수행하였으며, 계측장치를 이용하여 강우침투에 의한 사면 내 포화양상을 조사하였다. 모형사면은 30°의 경사면에 35°의 사면경사로 조성하였고 강우강도는 50 mm/hr를 적용하였다. 토층의 깊이는 모형토조의 크기를 고려하여 35 cm로 선정하고 TDR센서는 깊이별로 설치하여 시간에 따른 지반특성 변화를 고찰하였다. 실험결과 강우 시 모형사면은 강우침투로 인하여 지표에서 지중으로, 선단부에서 정상부로 포화가 진행됨을 알 수 있다. 즉, 강우의 침투로 인하여 사면의 선단부가 먼저 포화되고 이후 지속적인 강우로 인하여 포화의 영역이 사면의 선단부로부터 정상부로 확대됨을 알 수 있다. 모형사면의 붕괴는 사면의 선단부에서부터 붕괴가 시작되어 이후 사면의 정상부로 확장되는 진행성 사면붕괴가 발생되었으며, 최종 사면붕괴시점에서 붕괴면적이 급격하게 증가하였다. 또한 활동면은 원호활동의 형태로 발생되었다. 한편, 사면 내 모관흡수력이 흙-함수특성곡선(SWCC)에서 산정된 공기함입치(AEV)에 이르게 되면 사면붕괴가 발생되는 것으로 나타났다.

• Structural Engineering and Mechanics
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• 제83권3호
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• pp.305-326
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• 2022

To realize the recycling utilization of waste concrete and alleviate the shortage of resources, 11 specimens of steel reinforced recycled concrete (SRRC) filled circular steel tube columns were designed and manufactured in this study, and the cyclic loading tests on the specimens of columns were also carried out respectively. The hysteretic curves, skeleton curves and performance indicators of columns were obtained and analysed in detail. Besides, the finite element model of columns was established through OpenSees software, which considered the adverse effect of recycled coarse aggregate (RA) replacement rates and the constraint effect of circular steel tube on internal RAC. The numerical calculation curves of columns are in good agreement with the experimental curves, which shows that the numerical model is relatively reasonable. On this basis, a series of nonlinear parameters analysis on the hysteretic behaviors of columns were also investigated. The results are as follows: When the replacement rates of RA increases from 0 to 100%, the peak loads of columns decreases by 7.78% and the ductility decreases slightly. With the increase of axial compression ratio, the bearing capacity of columns increases first and then decreases, but the ductility of columns decreases rapidly. Increasing the wall thickness of circular steel tube is very profitable to improve the bearing capacity and ductility of columns. When the section steel ratio increases from 5.54% to 9.99%, although the bearing capacity of columns is improved, it has no obvious contribution to improve the ductility of columns. With the decrease of shear span ratio, the bearing capacity of columns increases obviously, but the ductility decreases, and the failure mode of columns develops into brittle shear failure. Therefore, in the engineering design of columns, the situation of small shear span ratio (i.e., short columns) should be avoided as far as possible. Based on this, the calculation model on the skeleton curves of columns was established by the theoretical analysis and fitting method, so as to determine the main characteristic points in the model. The effectiveness of skeleton curve model is verified by comparing with the test skeleton curves.

• Journal of Chest Surgery
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• 제55권2호
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• pp.143-150
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• 2022

Background: The effectiveness of extracorporeal membrane oxygenation (ECMO) for patients with refractory cardiogenic shock or cardiac arrest is being established, and serum lactate is well known as a biomarker of end-organ perfusion. We evaluated the efficacy of pre-ECMO lactate for predicting 6-month survival in patients with acute coronary syndrome (ACS) undergoing ECMO. Methods: We reviewed the medical records of 148 patients who underwent veno-arterial (VA) ECMO for ACS between January 2015 and June 2020. These patients were divided into survivors and non-survivors based on 6-month survival. All clinical data before and during ECMO were compared between the 2 groups. Results: Patients' mean age was 66.0±10.5 years, and 116 (78.4%) were men. The total survival rate was 45.9% (n=68). Cox regression analysis showed that the pre-ECMO lactate level was an independent predictor of 6-month mortality (hazard ratio, 1.210; 95% confidence interval [CI], 1.064-1.376; p=0.004). The area under the receiver operating characteristic curve of pre-ECMO lactate was 0.64 (95% CI, 0.56-0.72; p=0.002; cut-off value=9.8 mmol/L). Kaplan-Meier survival analysis showed that the cumulative survival rate at 6 months was significantly higher among patients with a pre-ECMO lactate level of 9.8 mmol/L or less than among those with a level exceeding 9.8 mmol/L (57.3% vs. 31.8%, p=0.0008). Conclusion: A pre-ECMO lactate of 9.8 mmol/L or less may predict a favorable outcome at 6 months in ACS patients undergoing VA-ECMO. Further research aiming to improve the accuracy of predictions of reversibility in patients with high pre-ECMO lactate levels is essential.

• Journal of Korean Neurosurgical Society
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• 제65권2호
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• pp.315-324
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• 2022

Objective : The aim of this study was to verify the equivalence and effectiveness of the tablet-administered Korean Repeatable Battery for the Assessment of Neuropsychological Status (K-RBANS) for the prevention and early detection of dementia. Methods : Data from 88 psychiatry and neurology patient samples were examined to evaluate the equivalence between tablet and paper administrations of the K-RBANS using a non-randomly equivalent group design. We calculated the prediction scores of the tablet-administered K-RBANS based on demographics and covariate-test scores for focal tests using norm samples and tested format effects. In addition, we compared the receiver operating characteristic curves to confirm the effectiveness of the K-RBANS for preventing and detecting dementia. Results : In the analysis of raw scores, line orientation showed a significant difference (t=-2.94, p<0.001), and subtests showed small to large effect sizes (0.04-0.86) between paper- and tablet-administered K-RBANS. To investigate the format effect, we compared the predicted scaled scores of the tablet sample to the scaled scores of the norm sample. Consequently, a small effect size (d≤0.20) was observed in most of the subtests, except word list and story recall, which showed a medium effect size (d=0.21), while picture naming and subtests of delayed memory showed significant differences in the one-sample t-test. In addition, the area under the curve of the total scale index (TSI) (0.827; 95% confidence interval, 0.738-0.916) was higher than that of the five indices, ranging from 0.688 to 0.820. The sensitivity and specificity of TSI were 80% and 76%, respectively. Conclusion : The overall results of this study suggest that the tablet-administered K-RBANS showed significant equivalence to the norm sample, although some subtests showed format effects, and it may be used as a valid tool for the brief screening of patients with neuropsychological disorders in Korea.

• Nutrition Research and Practice
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• 제16권5호
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• pp.604-615
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• 2022

BACKGROUND/OBJECTIVES: This study aimed to investigate cancer-specific survival (CSS) and associated risk factors in elderly gastric cancer (EGC) patients. SUBJECTS/METHODS: EGC patients (≥ 70 yrs) who underwent curative gastrectomy between January 2013 and December 2017 at our hospital were included. Clinicopathologic characteristics and survival data were collected. Receiver operating characteristic (ROC) analysis was used to extract the best cutoff point for body mass index (BMI). A Cox proportional hazards model was used to determine the risk factors for CSS. RESULTS: In total, 290 EGC patients were included, with a median age of 74.7 yrs. The median follow-up time was 31 (1-77) mon. The postoperative 1-yr, 3-yr and 5-yr CSS rates were 93.7%, 75.9% and 65.1%, respectively. Univariate analysis revealed risk factors for CSS, including age (hazard ratio [HR] = 1.08; 95% confidence interval [CI], 1.01-1.15), intensive care unit (ICU) admission (HR = 1.73; 95% CI, 1.08-2.79), nutritional risk screening (NRS 2002) score ≥ 5 (HR = 2.33; 95% CI, 1.49-3.75), and preoperative prognostic nutrition index score < 45 (HR = 2.06; 95% CI, 1.27-3.33). The ROC curve showed that the best BMI cutoff value was 20.6 kg/m². Multivariate analysis indicated that a BMI ≤ 20.6 kg/m² (HR = 2.30; 95% CI, 1.36-3.87), ICU admission (HR = 1.97; 95% CI, 1.17-3.30) and TNM stage (stage II: HR = 5.56; 95% CI, 1.59-19.43; stage III: HR = 16.20; 95% CI, 4.99-52.59) were significantly associated with CSS. CONCLUSIONS: Low BMI (≤ 20.6 kg/m²), ICU admission and advanced pathological TNM stages (II and III) are independent risk factors for CSS in EGC patients after curative gastrectomy. Nutrition support, better perioperative management and early diagnosis would be helpful for better survival.

• Journal of Chest Surgery
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• 제56권3호
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• pp.162-170
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• 2023

Background: Extracorporeal cardiopulmonary resuscitation (E-CPR) plays an indispensable role when resuscitation fails; however, extracorporeal life support (ECLS) in infants is different from that in adults. The objective of this study was to evaluate the outcomes of E-CPR in infants. Methods: A single-center retrospective study was conducted, analyzing 51 consecutive patients (age <1 year) who received E-CPR for in-hospital cardiac arrest between 2010 and 2021. Results: The median age and body weight was 51 days (interquartile range [IQR], 17-111 days) and 3.4 kg (IQR, 2.9-5.1 kg), respectively. The cause of arrest was cardiogenic in 45 patients (88.2%), and 48 patients (94.1%) had congenital cardiac anomalies. The median conventional cardiopulmonary resuscitation (C-CPR) time before the initiation of ECLS was 77 minutes (IQR, 61-103 minutes) and duration of ECLS was 7 days (IQR, 3-12 days). There were 36 in-hospital deaths (70.6%), and another patient survived after heart transplantation. In the multivariate analysis, single-ventricular physiology (odds ratio [OR], 5.05; p=0.048), open sternum status (OR, 8.69; p=0.013), and C-CPR time (OR, 1.47 per 10 minutes; p=0.021) were significant predictors of in-hospital mortality. In a receiver operating characteristic curve, the optimal cut-off of C-CPR time was 70.5 minutes. The subgroup with early E-CPR (C-CPR time <70.5 minutes) showed a tendency for lower in-hospital mortality tendency (54.5% vs. 82.8%, p=0.060), albeit not statistically significant. Conclusion: If resuscitation fails in an infant, E-CPR could be a life-saving option. It is crucial to improve C-CPR quality and shorten the time before ECLS initiation.

• 한국지반공학회논문집
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• 제25권5호
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• pp.53-64
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• 2009

강우침투로 인하여 많은 사면이 붕괴되고 있다. 따라서 사면에 대한 최근 연구들은 강우가 유발하는 사면의 불안정성에 초점이 맞춰져 있으며 강우침투 문제는 중요한 사면붕괴 발생 요인으로 인식되고 있다. 강우가 사면 내부의 모관흡수력을 감소시키면서 사면 내부로 침투되며 심지어 지반특성에 따라 표층 근에서 양의 간극수압이 발생할 수도 있다. 이러한 현상은 사면 강도를 감소시켜 사면 붕괴를 유발할 수 있다. 국내 여러 공공기관에서는 지하수위가 표층 또는 밀정 깊이 내에 존재하도록 하여 사면의 포화상태를 가정하는 보수적인 사면 설계방안을 제시하였으나, 이러한 가정은 대부분 부적절하고 이를 만족시키기 위해 때로는 사면설계 단계에서 잘못된 지반물성이 사용되기도 한다. 본 논문에서는 실제 강우침투 현상을 고려하여 보다 합리적으로 사면의 안정성을 평가하는 기법이 제안되었다. 국내 풍화토에 대한 불포화 지반물성(강도, 함수특성곡선, 투수곡선)이 실험적으로 획득되었으며, 인공신경망 모델을 통해 간접적으로도 추정되었다. 또한 현장 계측자료의 불확실성을 보완하기 위하여 사면의 불안정성 평가기법에 대하여 결정론적 해석과 확률론적 해석에 기반한 실시간 사면 붕괴 경보 기준이 모니터링 시스템에 도입되었다. 이러한 사면안정성 평가기법은 사면 내부의 모관흡수력, 함수비와 같은 중요요소를 계측한 현장자료와 접목하여 강우에 따라 불안정해진 사면에 대한 조기 경보시스템으로 활용될 수 있다.

• 한국지반공학회논문집
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• 제24권5호
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• pp.117-127
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• 2008

본 논문에서는 불포화 상태로 존재하는 다짐 지반에 대하여 함수특성곡선의 획득뿐만 아니라 다양한 모관흡수력 변화에 따른 탄성계수 평가를 위해 종래의 압력판 추출 시험기(VPPE)를 개선하였다. 이를 위해, 비파괴 시험이 가능한 벤더엘리멘트(BE) 시험 시스템을 도입하여 전단파 속도와 최대 전단탄성계수를 평가하였다. 개발된 시험 시스템을 이용하여 시공 중인 국내 도로 현장에서 채취된 3종의 노상토에 대해 모관흡수력 및 함수비 변화에 따른 최대 전단탄성계수의 변화를 평가하였다. 또한 시험결과를 기존의 모관흡수력 조절 비듦전단시험 및 현장 탄성파 시험으로부터 획득한 결과와 비교함으로써 개발된 시험 시스템의 타당성을 검증하였다. 본 연구에서 제안된 새로운 VPPE-BE 시스템은 향후, 탄성계수의 계절적 변화 모델 개발을 위한 도구로서의 효율적인 적용이 가능함을 확인하였다

• Journal of Chest Surgery
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• 제56권4호
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• pp.244-251
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• 2023

Background: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with cardiorespiratory failure. The serum albumin level is an important prognostic marker in critically ill patients. We evaluated the efficacy of using pre-ECMO serum albumin levels to predict 30-day mortality in patients with cardiogenic shock (CS) who underwent venoarterial (VA) ECMO. Methods: We reviewed the medical records of 114 adult patients who underwent VA-ECMO between March 2021 and September 2022. The patients were divided into survivors and non-survivors. Clinical data before and during ECMO were compared. Results: Patients' mean age was 67.8±13.6 years, and 36 (31.6%) were female. The proportion of survival to discharge was 48.6% (n=56). Cox regression analysis showed that the pre-ECMO albumin level independently predicted 30-day mortality (hazard ratio, 0.25; 95% confidence interval [CI], 0.11-0.59; p=0.002). The area under the receiver operating characteristic curve of albumin levels (pre-ECMO) was 0.73 (standard error [SE], 0.05; 95% CI, 0.63-0.81; p<0.001; cut-off value=3.4 g/dL). Kaplan-Meier survival analysis showed that the cumulative 30-day mortality was significantly higher in patients with a pre-ECMO albumin level ≤3.4 g/dL than in those with a level >3.4 g/dL (68.9% vs. 23.8%, p<0.001). As the adjusted amount of albumin infused increased, the possibility of 30-day mortality also increased (coefficient=0.140; SE, 0.037; p<0.001). Conclusion: Hypoalbuminemia during ECMO was associated with higher mortality, even with higher amounts of albumin replacement, in patients with CS who underwent VA-ECMO. Further studies are needed to predict the timing of albumin replacement during ECMO.