• Journal of Trauma and Injury
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• v.24 no.1
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• pp.12-17
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• 2011

Purpose: A rib fracture secondary to blunt thoracic trauma continues to be an important injury with significant complications. Unfortunately, there are no definite treatment guidelines for severe multiple rib fractures. The purpose of this study was to evaluate the result of early operative stabilization and to find the risk factors of surgical fixation in patients with bilateral multiple rib fractures or flail segments. Methods: From December 2005 to December 2008, the medical records of all patients who underwent operative stabilization of ribs for severe multiple rib fractures were reviewed. We investigated patients' demographics, preoperative comorbidities, underlying lung disease, chest trauma, other associated injuries, number of surgical rib fixation, combined operations, perioperative ventilator support, and postoperative complications to find the factors affecting the mortality after surgical treatment. Results: The mean age of the 96 patients who underwent surgical stabilization for bilateral multiple rib fractures or flail segments was 56.7 years (range: 22 to 82 years), and the male-to-female ratio was 3.6:1. Among the 96 patients, 16 patients (16.7%) underwent reoperation under general or epidural anesthesia due to remaining fracture with severe displacement. The surgical mortality of severe multiple rib fractures was 8.3% (8/96), 7 of those 8 patients (87.5%) dying from acute respiratory distress syndrome or sepsis. And the other one patient expired from acute myocardial infarction. The risk factors affecting mortality were liver cirrhosis, chronic obstructive pulmonary disease, concomitant severe head or abdominal injuries, perioperative ventilator care, postoperative bleeding or pneumonia, and tracheostomy. However, age, number of fractured ribs, lung parenchymal injury, pulmonary contusion and combined operations were not significantly related to mortality. Conclusion: In the present study, surgical fixation of ribs could be carried out as a first-line therapeutic option for bilateral rib fractures or flail segments without significant complications if the risk factors associated with mortality were carefully considered. Furthermore, with a view of restoring pulmonary function, as well as chest wall configuration, early operative stabilization of the ribs is more helpful than conventional treatment for patients with severe multiple rib fractures.

• Korean Journal of Hospice Care
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• v.2 no.1
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• pp.21-40
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• 2002

Cancer is the second leading cause of the death in Korea. Family caregivers of dying patients manifest many psychological and physical symptoms of stress, and they often seek for informational support from health care providers. Unfortunately, however, few systematic studies identify the actual effect of such support on family caregivers. This study, thus, intends to evaluate the effect of informational support for hospice care. One group pretest-posttest design was used, employing the stress-coping model by Cohen and Wills as a conceptual framework. This research was conducted from July 1 to November 15, 1998, initially with 32 subjects sampled from hemato-oncology department of two general hospitals in Seoul, but reduced to 18 at the end due to the untimely death of patients or caregiver's refusal during the course of study. Informational supports were programmed to provide the family caregivers with 8 times of education and counseling as well as 24-hour hot-line for 4 weeks. A booklet that explains the various problems of hospice care was also prepared and distributed to all subjects. Data were collected by using self-report questionnaires and reviewing medical records. The tools used in this study were based on the Weinert's PRQ-II(scale of perceived social support), Spielberger's state anxiety inventory, and CES-D. Also included in the data collection were the general characteristics of family caregivers and patients, and the pain intensity and the performance status of patients. The data were analyzed with descriptive statistics, Wilcoxon sign rank test and paired t-test using SPSSWIN program. The results of the study were as follows: 1.The perceived social support of family caregivers was not significantly increased with informational support for hospice care(t=1.64, one tailed p=.060). 2.The anxiety of family caregivers was significantly reduced following informational support for hospice care(t=3.48, one tailed p=.002). 3.The depression of family caregivers was significantly reduced following informational support for hospice care(t=-2.18, one tailed=.022). 4.The pain intensity of patients with terminal cancer was significantly reduced following informational support for hospice care(t=-2.41, two tailed p=.027). The results suggest that the informational support provided to family caregivers of patients with terminal cancer reduced not only their anxiety and depression but also the pain intensity of patients. Further study is necessary to consolidate the conceptual framework of this study with expanded number of subjects. Nevertheless, it was certain that the informational support program for hospice care was very helpful to both caregivers and patients. Thus, the informational support program is strongly recommended for the hospitals which have no hospice unit yet.

• Journal of Hospice and Palliative Care
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• v.19 no.3
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• pp.201-210
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• 2016

Delirium is a common symptom in patients with terminal cancer. The prevalence increases in the dying phase. Delirium causes negative effects on quality of life for both patients and their families, and is associated with higher mortality. However, some studies reported that it tends to remain unrecognized in palliative care setting. That may be related with difficulties to distinguish the symptom from others with overlapping characteristics such as depression and dementia, and a lack of knowledge regarding assessment and diagnostic tools. We suggest that accurate recognition with validated tools and early diagnosis of the symptom should be highly prioritized in delirium management in palliative care setting. After diagnosing delirium, it is important to identify and address reversible precipitants such as medication, dehydration, and infection. Non-pharmacological interventions including comfortable environment for the patient and family education are also essential in the management strategy. If such interventions prove ineffective or insufficient to control hyperactive symptoms, pharmacologic interventions with antipsychotics and benzodiazepine can be considered. Until now, low levels of haloperidol remains the standard treatment despite a lack of evidence. Atypical antipsychotics such as olanzapine, quetiapine and risperidone reportedly have similar efficacy with a stronger sedating property and less adverse effect compared to haloperidol. Currently, delirium medications that can be used in palliative care setting require more clinical trials, and thus, clinical guidelines are not sufficiently available. We suggest that it is warranted to develop clinical guidelines based on well-designed clinical studies for palliative care patients.

• Proceedings of the Korean Society of Embryo Transfer Conference
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• 2002.11a
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• pp.118-118
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• 2002

Programmed cell death (PCD) is thought as a well-controlled process by which unwanted cells are selectively eliminated. During the last decade many researches have elucidated molecules and their interactions involved in cell death by using largely in vitro induction of cell death or survival signals in a more defined manner, While these critical information and novel findings provide us with clearer understanding of mechanisms underlying cell death, it does by no means explain how PCD occurs and which cells or tissues are affected during normal embryonic development in vivo. In this study, we used zebrafish to examine whether the PCD is occurring selectively or randomly in developing embryos by whole mount in situ TUNEL analysis with specific markers for neural cells. The result revealed that the degree and distribution of TUNEL staining varied considerably throughout gastrulation stage, and there was also a number of TUNEL-negative embryos. Most of TUNEL-positive cells were scattered randomly throughout the blastoderm. During the gastrulation stage about 75 % of the embryos analyzed exhibited more than 5 TUNEL-positive cells. As the dorsal epiblast begins to thicken rather abruptly near the end of gastrulation, TUNEL-positive cells were mainly located along the dorsal side. Although there were some variations in TUNEL staining during segmentation and pharyngeal stages, TUNEL staining continued to be localized to the central nervous system, and was also detected in the sensory organs, trigeminal ganglions, and the primary sensory neurons. High levels of the cell death in developing brain between 20-somite and prim-6 stages are thought to play a role in the morphogenesis and organization of the brain. At prim-16 stage, cell death is considerably reduced in the brain region. Dying cells are mainly localized to the prospective brain region where ectodermal cells are about to initiate neurogenesis. As development progressed, high levels and more reproducible patterns of cell death were observed in the developing nervous system. Intensive TUNEL staining was restricted to the trigeminal ganglions, the primary sensory neurons, and sensory organs, such as olfactory pits and otic vesicles. Thus, PCD patterning in zebrafish embryos occurs randomly at early stages and becomes restricted to certain region of the embryos. The spatio-temporal pattern of PCD during the early embryonic development in zebrafish will provide basic information for further studies to elucidate genes involved in. regulation of PCD largely unknown in vivo during vertebrate embryogenesis.

• The Korean Journal of Emergency Medical Services
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• v.8 no.1
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• pp.149-160
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• 2004

Background : To save out-of-hospital cardiac arrest cases is a major concern for Korea. Cardiac arrest is a very common problem, with > 18,000 cases dying each year in Korea. Overall, survival to hospital discharge remains poor. Resuscitation has become an important multidisciplinary branch of medicine, demanding a spectrum of skills and attracting a plethora of specialities and organizations. Since the "Utstein Style" was advocated in 1991, many reports about out-of-hospital cardiac arrest have been published based on this guideline. These differences prevent valid inter-hospital and international comparisons. However, we do not know the true effectiveness of resuscitation. There are no guideline for reviewing, reporting, conducting research on resuscitation in Korea. This study evaluated the out-of-hospital factor associated with survival discharge of out-of-hospital cardiac arrest, was especially to provide basic data for the unified reporting guideline of resuscitation in Korea. Methods : From January 1990 to July 2004, we collected data about out-of-hospital cardiac arrest at Wonju Christian Hospital(WCH-CAD), Ewha Women University Mokdong Hospital(Ewha-CAD), I used same record form based on the "Utstein Style". The "Utstein Style" is internationally recommended guidelines for reporting outcome data from resuscitation events. Results : Resuscitation was performed in 1443 out-of-hospital cardiac arrest patients at 2 hospitals. Five hundred eighty(40.25%) patients recovered the spontaneous circulation at least once and One hundred sixty eight(11.66%) patients discharged alive. Initial EKG showed Ventricular Tachycardia/Ventricular Fibrillation in One hundred thirty five(9.33%) patients, asystole in one thousand nine(69.73%) patients and other rhythms in one hundred thirty nine(20.94%) patients. Among one hundred two cardiogenic cardiac arrest patients, two(2.0%) patients was discharged alive. Conclusion : Overall survival rate of out-of-hospital cardiac arrest patients was 11.66% which was poorer than that of the western country. The proportion of the cardiogenic cause was 33.38% which was only half of the western country. VT/VF is relatively not common ac a initial EKG rhythm. These differences might be to due difference in the prevalence pattern of out-of-hospital cardiac arrest as well as prematurity of the EMSS. It is needed that the best survival can be achieved if all following links have been optimized : rapid access, early CPR, early defibrillation, early ACLS.

• Journal of the Korean Society of Food Science and Nutrition
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• v.43 no.3
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• pp.349-354
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• 2014

Elevation of intracellular calcium ($Ca^{{+}{+}}$) triggers degranulation of mast cells by bypassing receptor activation. Flos Sophora japonica L. has been used as a natural dying source and has been reported to have biological activities such as anti-inflammatory and anti-allergic effects through $Fc{\varepsilon}RI$ and IgE crosslinking. In the present investigation, we report the regulatory effect of ethanolic extract of Flos Sophora japonica L. (S.F) on allergic mediators produced by $Ca^{{+}{+}}$ ionophore activation in mast cells. S.F significantly inhibited calcium ionophore (A23187)-induced interleukin (IL)-4 and tumor necrosis factor (TNF)-${\alpha}$ production as well as mast cell degranulation. Furthermore, administration of S.F suppressed allergic reactions in a 2,4-dinitrofluorobenzene (DNFB)-induced allergic dermatitis mouse model. Both oral administration and ear painting using 50 mg/kg of S.F significantly reduced levels of cytokines such as IL-4, TNF, and interferon-${\gamma}$ in ear tissues compared to the DNFB alone-treated group. Serum IgE level in the S.F-treated group also decreased compared to the DNFB alone-treated group. Weights of spleens and lymph nodes in the S.F-treated groups also decreased compared to the control group. Considering the data, we conclude that S.F mediates its anti-allergic effects not only through $Fc{\varepsilon}RI$ stimulation but also $Ca^{{+}{+}}$ influx in mast cells.

• Journal of Digital Convergence
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• v.14 no.2
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• pp.489-499
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• 2016

The purpose of this study is to attempt to analyze factors affecting elderly persons' life-sustaining treatment preferences, focusing on ego integrity trait. This study used data from Elderly Profiles and Welfare Needs of the Elderly Persons(2014). The analysis sample was 10,451 cases. 86.4 percent of the sample responded that they disagree with life-sustaining treatment. Analysis results are as follows: being female(${\beta}=-.045$, p<.001), the younger(${\beta}=-.024$, p<.05), having more education years(${\beta}=.027$, p<.05), higher satisfaction of life(${\beta}=.022$, p<.05), responding that they had thought about their own funeral(${\beta}=.032$, p<.01), responding that they had used senior centers over the last one year(${\beta}=-.038$, p<.01) are related to disapproval of life sustaining treatment. This research shows that ego integrity trait such as satisfaction of life, or accepting and preparing one's own death, is related to disapproval of life-sustaining treatment.

• Journal of Preventive Medicine and Public Health
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• v.33 no.4
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• pp.459-468
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• 2000

Objectives : To investigate the association between BMI and Mortality. Methods : This study was based on the analysis and assembly of the 'Kangwha Cohort Study', previously conducted by the Department of Preventive Medicine, Yonsei University. A total of 2,696 males and 3,595 females were followed for almost ten years and ten months from March 1985 to January 1996, a total of whom 2,420 died during this period. The Cox's proportional hazards regression model was used to analyze this data. Results : We found a U-shaped relationship between BMI and mortality among the aged men in the Kangwha cohort. The hazard ratio of dying was adjusted for age, marital status, occupation, self cognitive health level, chronic disease, smoking, and alcohol frequency, then sorted by body mass index into the following groups; less than 10.5, 18.5 to less than 21.0, 21.0 to less than 23.5, 23.5 to less than 26.0 and greater than or equal to 26. The corresponding ratios for men were 1.81(1.50-2.19, 95%CI), 1.31(1.14-1.51, 95%CI), 1.0(referent), 1.05(0.87-1.26, 95%CI) and 1.39(1.09-1.76, 95%CI), respectively. And for women, 1.46(1.19-1.78), 1.12(0.95-1.31, 95%CI), 1.0(referent), 1.00(0.84-1.20, 95%CI) and 1.09(0.89-1.34, 95%CI), respectively. Conclusions : The risk of death among aged men in Kangwha increased in the under and overweight groups. The relationship between BMl and mortality has been well studied in Western populations, but little is known about the association between BMI and mortality in our country. So, on the basis of this study, it is apparent that more studies of the relationship between BMI and mortality will be needed for future work.

• (The)Study of the Eastern Classic
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• no.33
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• pp.97-129
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• 2008

Sin-jeokdo (Hogye, 1574-1663) was a general of patriotic army who protected the region of Euseong at the time of Qing dynasty's invasion in 1627(Jungmyo) and 1636(Byongja). He was an prominent figure outside government as well as a faithful confucian who spent his life with reading and teaching junior scholars after disgraceful treaty in the year of Byongja. Hogye understood the neo-Confucianism in terms of the whole duty of men(綱常) and righteousness(義理) which was in the status of sole official academic subject and thought its practice only hinged upon the practice of filial piety and brotherly love together with loyalty and sincerity based on morals between sovereign and subject, father and son. He, therefore, emphasized that the righteousness only can be accomplished by dying of children and subjects for filial piety and fidelity respectively, at the time of commotion. This was his spirit of righteousness which repelled Japanese army in the Imjin War and he insisted on defeating Japanese army in accordance with this spirit. Hogye's practice of righteousness is grounded on the spirit of Chosun Confucianism which stressed actual practices of moral principles and duties. His practice of righteousness shows internalized cultural sinocentrism and moral-centric, ethic-centric characteristic of Chosun Confucianism. Moreover, the moral consciousness which was shown in Hogye's thought helped to keep Korean's pride and observe morality and it served itself as a basis of commencement of nationalistic military, religious movements afterwards.

• Journal of Industrial Convergence
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• v.20 no.6
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• pp.105-115
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• 2022

This study was attempted to suggest a direction for future research on good death by analyzing and synthesizing research trends on good death. For this purpose, 66 articles related to good death published in academic journals in Korea from 2011 to 2021 were analyzed based on the analysis frame of references. As a result, the year with the most good death studies was 2019 (18.2%). In the analysis by research design, 52 articles (78.8%) were the most quantitative studies, and 36 studies (54.5%) were survey studies. In the field of research, nursing studies were the most researched with 47 articles (71.2%), but multidisciplinary studies were three articles (4.5%). The subjects of the good death study were mainly the aged in the community and nursing students, each of which was 13 (19.7%), but the studies for patients were published only four articles (6.1%). The most used tool was the perception of a good death and conducted in in 38 articles (73.1%). The main research variables were the the perception of good death and hospice palliative and end-of-life care, and family support was used as mediating variables. Therefore, not only multidisciplinary research but also development research for vaious good death instruments may be suggested to comprehensively understand good death.