• Title/Summary/Keyword: Early Failure

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Outcomes of transcatheter closure of ductus arteriosus in infants less than 6 months of age: a single-center experience

  • Choi, Gwang-Jun;Song, Jinyoung;Kim, Yi-Seul;Lee, Heirim;Huh, June;Kang, I-Seok
    • Clinical and Experimental Pediatrics
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    • v.61 no.12
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    • pp.397-402
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    • 2018
  • Purpose: Transcatheter device closure of patent ductus arteriosus (PDA) is challenging in early infancy. We evaluated PDA closure in infants less than 6 months old. Methods: We performed a retrospective review of infants less than 6 months of age who underwent attempted transcatheter device closure in our institution since 2004. To compare clinical outcomes between age groups, infants aged 6-12 months in the same study period were reviewed. Results: A total of 22 patients underwent transcatheter PDA closure during the study period. Patient mean age was $3.3{\pm}1.5months$, and weight was $5.7{\pm}1.3kg$. The duct diameter at the narrowest point was $3.0{\pm}0.8mm$ as measured by angiography. The most common duct type was C in the Krichenko classification. Procedural success was achieved in 19 patients (86.3%). Major complications occurred in 5 patients (22.7%), including device embolization (n=1), acquired aortic coarctation (n=2), access-related vascular injury requiring surgery (n=1), and acute deterioration requiring intubation during the procedure (n=1). Two patients had minor complications (9.1%). Twenty-four infants aged 6-12 months received transcatheter device closure. The procedural success rate was 100%, and there were no major complications. The major complication rate was significantly higher in the group less than 6 months of age (P=0.045). There was a trend toward increased major complication and procedural failure rates in the younger age group (P<0.01). Conclusion: A relatively higher incidence of major complications was observed in infants less than 6 months of age. The decision regarding treatment modality should be individualized.

Structural behavior of the stiffened double-skin profiled composite walls under compression

  • Qin, Ying;Li, Yong-Wei;Lan, Xu-Zhao;Su, Yu-Sen;Wang, Xiang-Yu;Wu, Yuan-De
    • Steel and Composite Structures
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    • v.31 no.1
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    • pp.1-12
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    • 2019
  • Steel-concrete composite walls have been proposed and developed for applications in various types of structures. The double-skin profiled composite walls, as a natural development of composite flooring, provide structural and architectural merits. However, adequate intermediate fasteners between profiled steel plates and concrete core are required to fully mobilize the composite action and to improve the structural behavior of the wall. In this research, two new types of fasteners (i.e., threaded rods and vertical plates) were proposed and three specimens with different fastener types or fastener arrangements were tested under axial compression. The experimental results were evaluated in terms of failure modes, axial load versus axial displacement response, strength index, ductility index, and load-strain relationship. It was found that specimen with symmetrically arranged thread rods sustained more stable axial strain than that with staggered arranged threaded rods. Meanwhile, vertical plates are more suitable for practical use since they provide stronger confinement to profiled steel plate and effectively prevent the steel plate from early local buckling, which eventually enhance the composite action and increase the axial compressive capacity of the wall. The calculation methods were then proposed and good agreement was observed between the test results and the predicted results.

A Case of Cement Hardening Agent Intoxication with Acute Kidney Injury (시멘트 경화제 중독으로 인한 급성 신손상 1례)

  • Seo, Young Woo;Jang, Tae Chang;Kim, Gyun Moo;Ko, Seung Hyun
    • Journal of The Korean Society of Clinical Toxicology
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    • v.16 no.2
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    • pp.157-160
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    • 2018
  • Chronic silica nephropathy has been associated with tubulointerstitial disease, immune-mediated multisystem disease, chronic kidney disease, and end-stage renal disease. On the other hand, acute intentional exposure is extremely rare. The authors' experienced a 44-year-old man who took rapid cement hardener (sodium silicate) in a suicide attempt whilst in a drunken state. He visited the emergency department approximately 1 hour after ingestion. Information on the material was obtained after 3 L gastric lavage. The patient complained of a sore throat, epigastric pain, and swollen to blood tinged vomitus. Proton pump inhibitors, hemostats, steroid, and fluids were administered. Nine hours after ingestion, he was administered 200 mL hematochezia. Immediately after, a gas-troenterologist performed an endoscopic procedure that revealed diffuse hyperemic mucosa with a color change and variable sized ulceration in the esophagus, whole stomach, and duodenal $2^{nd}$ portion. Approximately 35 hours later, persistent oligouria and progressive worsening of the renal function parameters (BUN/Cr from 12.2/1.2 to 67.5/6.6 mg/dL) occurred requiring hemodialysis. The patient underwent 8 sessions of hemodialysis for 1 month and the BUN/Cr level increased to 143.2/11.2 mg/dL and decreased to 7.6/1.5 mg/dL. He was discharged safely from the hospital. Follow up endoscopy revealed a severe esophageal stricture and he underwent endoscopic bougie dilatation. Acute cement hardener (sodium silicate) intoxication can cause renal failure and strong caustic mucosal injury. Therefore, it is important to consider early hemodialysis and treatment to prevent gastrointestinal injury and remote esophageal stricture.

Feasibility of Laparoscopic Surgery for Intussusception in Pediatric Patients and Risk of Bowel Resection

  • Song, Eun Ju;Nam, So Hyun
    • Journal of Minimally Invasive Surgery
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    • v.21 no.4
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    • pp.154-159
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    • 2018
  • Purpose: Intussusception is a common cause of intestinal obstruction in children. While most patients can be treated by enema reduction, about 20% require surgery. We investigated the usefulness and feasibility of laparoscopic surgery and the intraoperative risk of bowel resection. Methods: We retrospectively reviewed pediatric patients who underwent surgery for intussusception from 2010 to 2017. We collected data for age, gender, body weight, associated symptoms, duration of symptoms, white blood cell count, operating time, and postoperative complications. Results: Of 155 patients, 37 (23.8%) underwent surgery due to enema reduction failure in 29 (78.3%), recurrence in 6 (16.3%), a suspicious lead point in 1, and suspicious ischemic change observed on ultrasonography in 1. The mean age was $26.8{\pm}18.9$ months (range, 3.5~76.7 months), and the mean body weight was $12.9{\pm}3.9kg$ (range, 5.4~22.2 kg). Laparoscopic surgery was successful in 29 patients (78.4%), and 7 (18.9%) needed bowel resection and anastomosis. The mean operating time was $56.7{\pm}32.8min$. A lead point was found in 3 patients in the bowel resection group (p=0.005); in addition, the operating time and hospital stay were longer in this group. There were no intra- or postoperative complications. Conclusion: Laparoscopic surgery was successful in 78.4% of the patients with a short hospital stay and early oral intake. The only predictive factor for bowel resection was the presence of a lead point. Laparoscopic surgery may be an optimal treatment intervention for children with intussusception, except for those who show initial peritonitis.

Outcomes of Stent-Assisted Coiling Using the Neuroform Atlas Stent in Unruptured Wide-Necked Intracranial Aneurysms

  • Kwon, Ohyuk;Chung, Joonho
    • Journal of Korean Neurosurgical Society
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    • v.64 no.1
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    • pp.23-29
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    • 2021
  • Objective : Although stent-assisted coiling (SAC) has been reported to be safe and effective in treating wide-necked aneurysms, the technique has procedure-related complications. Thus, we reported our experiences of SAC using the Neuroform Atlas stent in treating wide-necked aneurysms and evaluated the incidence of and risk factors for procedure-related complications. Methods : From March 2018 to August 2019, we treated 130 unruptured wide-necked aneurysms in 123 patients with Neuroform Atlas stents. Angiographic results and clinical outcomes were reviewed retrospectively. Clinical and angiographic follow-up were performed in all cases (mean, 12.4 months) after the procedure. Results : There were eight cases (6.2%) of procedure-related complications (two dissections, five thromboembolisms, and one hemorrhage) and two (1.5%) of delayed complications (one ischemia and one hemorrhage). There was one case (0.8%) of failure of stent deployment and one (0.8%) of suboptimal positioning of the stent. Follow-up angiography showed complete obliteration in 103 (79.2%), residual neck in 16 (12.3%), and residual aneurysm in 11 cases (8.5%). Aneurysm locations in the middle cerebral artery (odds ratio [OR], 2.211; p=0.046) and the anterior communicating artery (OR, 2.850; p=0.039) were associated with procedure-related complications on univariate analysis. However, no independent risk factor for procedure-related complications was noted in multivariate analysis. Conclusion : The Neuroform Atlas showed a high rate of technical success. Good clinical and radiographic outcomes in early follow-up suggests that the device is feasible and safe. SAC of aneurysms on the middle cerebral artery or anterior communicating artery may require more attention to prevent possible procedure-related complications.

Clinical Characteristics of Spinal Epidural Abscess Accompanied by Bacteremia

  • Chae, Ho-jun;Kim, Jiha;Kim, Choonghyo
    • Journal of Korean Neurosurgical Society
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    • v.64 no.1
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    • pp.88-99
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    • 2021
  • Objective : The treatment of choice for spinal epidural abscess (SEA) generally is urgent surgery in combination with intravenous antibiotic treatment. However, the optimal duration of antibiotic treatment has not been established to date, although 4-8 weeks is generally advised. Moreover, some researchers have reported that bacteremia is a risk factor for failure of antibiotic treatment in SEA. In this study, we investigated the clinical characteristics of SEA accompanied by bacteremia and also determined whether the conventional 4-8 weeks of antibiotic treatment is sufficient. Methods : We retrospectively reviewed the medical records and radiological data of 23 patients with bacterial SEA who underwent open surgery from March 2010 to April 2020. All patients had bacteremia preoperatively and underwent weeks of perioperative antibiotic treatments based on their identified organisms until all symptoms of infection disappeared. All patients underwent microbiological studies of peripheral blood, specimens from SEA and concomitant infections. The mean follow-up duration was 35.2 months, excluding three patients who died. Results : The male : female ratio was 15 : 8, and the mean age was 68.9 years. The SEA most commonly involved the lumbar spinal segment (73.9%), and the mean size was 2.9 vertebral body lengths. Mean time periods of 8.4 days and 16.6 days were required from admission to diagnosis and from admission to surgery, respectively. Concomitant infections more frequently resulted in delayed diagnosis (p=0.032), masking the symptoms of SEA. Methicillin-sensitive Staphylococcus aureus was the most commonly identified pathogen in both blood and surgical specimens. Seventeen patients (73.9%) showed no deficits at the final follow-up. The overall antibiotic treatment duration was a mean of 66.6 days, excluding three patients who died. This duration was longer than the conventionally advised 4-8 weeks (p=0.010), and psoas or paraspinal abscess required prolonged duration of antibiotic treatment (p=0.038). Conclusion : SEA accompanied by bacteremia required a longer duration (>8 weeks) of antibiotic treatment. In addition, the diagnosis was more frequently delayed in patients with concomitant infections. The duration of antibiotic treatment should be extended for SEA with bacteremia, and a high index of suspicion is mandatory for early diagnosis, especially in patients with concomitant infections.

Design of Initial Decision-Making Support Interface for Crop Facility Cultivation (작물 시설재배 초기 의사결정 지원 인터페이스 설계)

  • Kim, Kuk-Jong;Cho, Yong-Yoon
    • Journal of Internet of Things and Convergence
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    • v.8 no.2
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    • pp.71-78
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    • 2022
  • Recently, the number of people wishing to return to farming is increasing, However, the lack of farming experience and management information of returnees is one of the main reasons for increasing the probability of agricultural failure. This study proposes an interface to support early facility cultivation management decision-making for returnees who want facility cultivation. The proposed interface is designed with UML(Unified Modeling Language) and provides key decision-making information such as land/crop suitability, land/facility costs, and management costs according to input data such as cultivation areas, selected crops, and cultivation types selected by the user. Through the proposed interface, facility cultivators can effectively and quickly acquire initial decision-making information for facility cultivation in the desired target area.

In vitro maturation of human pluripotent stem cell-derived cardiomyocyte: A promising approach for cell therapy

  • Park, Yun-Gwi;Son, Yeo-Jin;Moon, Sung-Hwan;Park, Soon-Jung
    • Journal of Animal Reproduction and Biotechnology
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    • v.37 no.2
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    • pp.67-79
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    • 2022
  • Currently, there is no treatment to reverse or cure heart failure caused by ischemic heart disease and myocardial infarction despite the remarkable advances in modern medicine. In addition, there is a lack of evidence regarding the existence of stem cells involved in the proliferation and regeneration of cardiomyocytes in adult hearts. As an alternative solution to overcome this problem, protocols for differentiating human pluripotent stem cell (hPSC) into cardiomyocyte have been established, which further led to the development of cell therapy in major leading countries in this field. Recently, clinical studies have confirmed the safety of hPSC-derived cardiac progenitor cells (CPCs). Although several institutions have shown progress in their research on cell therapy using hPSC-derived cardiomyocytes, the functions of cardiomyocytes used for transplantation remain to be those of immature cardiomyocytes, which poses a risk of graft-induced arrhythmias in the early stage of transplantation. Over the last decade, research aimed at achieving maturation of immature cardiomyocytes, showing same characteristics as those of mature cardiomyocytes, has been actively conducted using various approaches at leading research institutes worldwide. However, challenges remain in technological development for effective generation of mature cardiomyocytes with the same properties as those present in the adult hearts. Therefore, in this review, we provide an overview of the technological development status for maturation methods of hPSC-derived cardiomyocytes and present a direction for future development of maturation techniques.

Comparative Analysis of Conventional Tact and Compositive Tact in Apartment House Finishing Construction (공동주택 마감공사의 기존 Tact와 복합병행 Tact 비교분석 - 공동주택 미장공사 중심으로 -)

  • Hwang, SuHyeon;Sim, JeaHyung;Ham, NamHyuk;Kim, JaeJun
    • Korean Journal of Construction Engineering and Management
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    • v.23 no.4
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    • pp.47-56
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    • 2022
  • In a construction project, process planning is an important factor in determining the success or failure of a project. In particular, it is necessary to systematically establish a process plan in the early stage because the finishing work of an apartment house involves more interference than the foundation work or the frame work. First, in this study the problems of Tact process management were identified, Based on the data from the case project, conventional Tact process management and compositive Tact process management were compared and analyzed. Second, cost analysis was performed on applicable plastering work to suggest the necessity and direction of compositive Tact process management. Third, the appropriateness of manpower according to the number of construction households is analyzed through cost analysis. Through this, the validity and effectiveness of compositive Tact process management were verified based on the results derived from this study.

Structural health monitoring data anomaly detection by transformer enhanced densely connected neural networks

  • Jun, Li;Wupeng, Chen;Gao, Fan
    • Smart Structures and Systems
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    • v.30 no.6
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    • pp.613-626
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    • 2022
  • Guaranteeing the quality and integrity of structural health monitoring (SHM) data is very important for an effective assessment of structural condition. However, sensory system may malfunction due to sensor fault or harsh operational environment, resulting in multiple types of data anomaly existing in the measured data. Efficiently and automatically identifying anomalies from the vast amounts of measured data is significant for assessing the structural conditions and early warning for structural failure in SHM. The major challenges of current automated data anomaly detection methods are the imbalance of dataset categories. In terms of the feature of actual anomalous data, this paper proposes a data anomaly detection method based on data-level and deep learning technique for SHM of civil engineering structures. The proposed method consists of a data balancing phase to prepare a comprehensive training dataset based on data-level technique, and an anomaly detection phase based on a sophisticatedly designed network. The advanced densely connected convolutional network (DenseNet) and Transformer encoder are embedded in the specific network to facilitate extraction of both detail and global features of response data, and to establish the mapping between the highest level of abstractive features and data anomaly class. Numerical studies on a steel frame model are conducted to evaluate the performance and noise immunity of using the proposed network for data anomaly detection. The applicability of the proposed method for data anomaly classification is validated with the measured data of a practical supertall structure. The proposed method presents a remarkable performance on data anomaly detection, which reaches a 95.7% overall accuracy with practical engineering structural monitoring data, which demonstrates the effectiveness of data balancing and the robust classification capability of the proposed network.