• 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.

• 대한교통학회지
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• 제34권2호
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• pp.146-157
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• 2016

본 연구는 Daganzo가 돌발상황 검지를 위해 1997년에 제안한 삼연속 검지기 단순화 해법을 통계적 모형으로 구현하고 이에 대한 통계적 적합성 검증을 목적으로 한다. 본 연구는 삼연속 검지기 단순화 해법의 계산과정을 정리하였으며, 이를 통계 프로그래밍을 활용해 구현하였다. 먼저 진출입부가 존재하지 않는 고속도로 본선의 검지기 자료를 활용하여 본 해법을 적용하였다. 그리고 삼연속 검지기 단순화 해법의 통계적 검정을 위해 충격파에 의한 교통량의 동적 변화를 반영하는 30초 단위 누적교통량을 돌발상황 교통류와 정상 교통류 각각에 대해 추정하고, 실측 누적교통량과의 오차를 통계적으로 비교하였다. 오차검정 결과 돌발상황 검지기법을 통한 누적교통량 추정치는 통계적으로 실측치와 적합성이 높게 나타났으며, 오차 값의 유의성은 사고로 인한 돌발상황 교통류가 정상 교통류에 비해 분산 및 평균이 이질적인 것으로 나타났다. 본 연구는 기존 Newell, Daganzo의 단순화 교통류 모형의 이론적 연구를 돌발상황 검지로 응용 발전시킨 연구이며, 나아가 다양한 도로조건과 돌발상황 유형에서의 실험을 통한 모형 개선을 향후 과제로 한다.

• 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.

• Asian-Australasian Journal of Animal Sciences
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• 제26권11호
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• pp.1598-1608
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• 2013

An optimum dietary carbohydrate content is important for maximum fish growth. In this study, we fed Wuchang bream (Megalobrama amblycephala) with either control diet (30.42%) or high carbohydrate diet (52.92%) for 90 d. Fish were fed to apparent satiation three times daily in an aquarium with automatic temperature control and circulated water. Growth performance, plasma biochemical parameters, hepatic morphology and enzyme activities were determined. It was shown that compared to fish fed control diet, fish fed high carbohydrate diet had higher plasma triglyceride and cortisol levels for d 90, and lower alkaline phosphatase level for d 45, lower hepatic superoxide dismutase and total antioxidative capacity for d 90, higher malondialdehyde for d 45 and glycogen content for d 45 and 90 (p<0.05). Histological and transmission electron microscopy studies showed that hepatocytes of fish fed high carbohydrate diet contained large lipid droplets, causing displacement of cellular organelles to periphery of hepatocytes. The relative level of hepatic heat shock protein 70 (HSP70) mRNA of Wuchang bream fed high carbohydrate diet was significantly higher than that of fish fed the control diet for 90 d (p<0.05). These changes led to decreased specific growth rate and increased feed conversion ratio (p<0.05). Upon hypoxia challenge, fish fed high carbohydrate diet had higher cumulative mortality than those fed the control diet (p<0.05). These results suggested that high dietary carbohydrate (52.92%) was detrimental to the growth performance and health of Wuchang bream.

• Journal of Chest Surgery
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• 제48권6호
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• pp.381-386
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• 2015

Background: Postinfarction ventricular septal defects (pVSDs) are a serious complication of acute myocardial infarctions. The aim of this study was to analyze the clinical outcomes of the surgical treatment of pVSDs. Methods: The medical records of 23 patients who underwent operations (infarct exclusion in 21 patients and patch closure in two patients) to treat acute pVSDs from 2001 to 2011 were analyzed. Intra-aortic balloon counterpulsation was performed in 19 patients (82.6%), one of whom required extracorporeal membrane support due to cardiogenic shock. The mean follow-up duration was $26.2{\pm}18.6months$. Results: The in-hospital mortality rate was 4.3% (1/23). Residual shunts were found in seven patients and three patients required reoperation. One patient needed reoperation due to the transformation of an intracardiac hematoma into an abscess. No patients required reoperation due to recurrence of a ventricular septal defect during the follow-up period. The cumulative survival rate was 95.5% at one year, 82.0% at five years, and 65.6% at seven years. Conclusion: The use of a multiple-patch technique with sealants appears to be a reliable method of reducing early mortality and the risk of significant residual shunting in patients with pVSDs.

• Asian Pacific Journal of Cancer Prevention
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• 제17권7호
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• pp.3207-3211
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• 2016

Background: Skin cancer has a remarkable importance given the high incidence in the population. In Brazil, it is estimated that there were 98,420 new cases of non-melanoma skin cancer among men and 83,710 new cases among women in 2014. Objectives: To verify signs and symptoms present in patients with skin neoplasms according to the literature and relate them to the nursing diagnoses of NANDA International. Materials and Methods: Integrative literature review carried out from March to May 2015 in the databases: Cumulative Index to Nursing and Allied Health Literature, SCOPUS, National Library of Medicine and Nattional Institutes of Health, Latin American and Caribbean Sciences of Health and Web of Science. The descriptors used were: 'Signs and Symptoms' and 'Skin Neoplasms'. Sixteen articles were identified as the final sample. After review, the signs and symptoms of skin cancer identified in the literature were related to the defining characteristics present in NANDA International, with the aim to trace possible nursing diagnoses. Results: The most prevalent signs and symptoms were: asymmetric and well circumscribed nodules with irregular borders; speckles with modified color aspect; ulcerations; blisters; pain; itching; and bleeding. The principal nursing diagnoses outlined were: risk for impaired skin integrity; impaired skin integrity; acute pain; risk of shock; and impaired comfort. Conclusions: The identification of signs and symptoms present in patients with skin cancer and the relationships of these with the nursing diagnoses of NANDA International provide a basis for qualified and systematized nursing care to this clientele.

• 항공우주시스템공학회지
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• 제11권1호
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• pp.1-7
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• 2017

위성은 임무수행을 위하여 발사체에 탑재되어 목표하는 궤도상에 도달하게 된다. 발사체의 비행동안 위성은 사인, 랜덤, 충격과 같은 극심한 발사 진동환경에 노출되게 되며, 이에 따라 위성체 내부에 위치한 전장품 및 전장품 기판에는 각 진동요소에 의한 발사 하중이 작용하게 된다. 발사하중 작용시, 전장품 내부에 장착된 기판은 체결부를 경계로 수직방향의 굽힘 거동을 주로 일으키게 되며, 이로 인한 상대변위로 기판 위 소자의 납땜부 파괴와 도선의 단선, 기판 자체의 균열을 초래한다. 성공적인 임무 수행을 위해서, 위성의 전장품 설계는 상기 현상들에 대해 기판의 구조 건전성 및 피뢰파괴 신뢰도가 확보되어야한다. 본 논문에서는 기존에 구조해석이 기 수행되었던 다목적실용위성 3호에 탑재되는 고해상도 위성카메라용 X-band 안테나 구동장치인 APD(Antenna Pointing Driver) 전장품의 제어 보드를 대상으로 하여, 스테인버그의 식을 통해 진동 하중에 의한 허용 처짐과 최대 처짐을 도출해내고, 팔머그렌 마이너 방정식을 이용하여 수명관점에서 피로파괴 예측의 유효성을 입증하였다.