• Title/Summary/Keyword: Initial Shock

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Predictive Factors for Mortality among Adult Trauma Victims Transfused in an Emergency Department (응급의료센터에서 수혈을 시행한 성인 외상환자에서 사망 예측 인자)

  • Lee, Kyung Won
    • Journal of Trauma and Injury
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    • v.25 no.3
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    • pp.79-86
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    • 2012
  • Purpose: The most common cuase of transfusion for trauma victims in an emergency department is hypovolemic shock due to injury. After an injury to an internal organ of the chest or the abdomen, transfusion is needed to supply blood products and to compensate tissue oxygen transport and bleeding. From the 1990's, there have been some reports that transfusion is one of the major factors causing multiple-organ failure. Thus, as much as possible, tranfusion has been minimized in the clinical setting. This study aims to analyze the prognostic factors for mortality among trauma victims transfused with blood products in an emergency department. Methods: We conducted this study for the year of 2010 retrospectively. The study group included adult trauma victims tranfused with blood products in our ED. The exclusion criteria were discharge against medical advice, and missing follow-up due to transfer to another facility. During the study period, 34 adult trauma victims were enrolled. We compared the clinical variables between survivors and non-survivors. Results: the mean age of the 34 victims was 58.06 years, and males account for 58.5% of the study group. The most-frequently used form transportation was ambulance(119, 55.9%), and the most common injury mechanism was mobile vehicle accidents(67.6%). The mean revised trauma score (RTS) was 5.9, and the mean injury severity score (ISS) was 47.76. The mortality rate in the ED was 58.5%, Comparison of survivors with non-survivors showed statistical differences in injury mechanism, initial SBP, DBP, RTS, ISS, and some laboratory data such as AST, ALT, pH, PO2, HCO3, glucose (p<0.05). Regression analyses showed that mortality among adult trauma victims transfused in the ED correlated with RTS. Conclusion: When an adult trauma victim is transported to the ED and needs a tranfusion, the emergency physician carefully assess the victim by using physiologic data.

NOx Removal of Mn Based Catalyst for the Pretreatment Condition and Sulfur Dioxide (전처리 조건 및 황산화물에 대한 Mn-Cu계 촉매의 탈질특성)

  • Park, Kwang-Hee;You, Seung-Han;Park, Young-Ok;Kim, Sang-Wung;Cha, Wang-Seog
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.13 no.4
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    • pp.1923-1930
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    • 2012
  • Mn-Cu catalysts were tested for selective catalytic reduction of NOx with NH3. Influence of initial reaction temperature was studied for NOx conversion in which reaction temperature was changed three patterns. NOx conversion of catalysts calcined at 200, 300 and $340^{\circ}C$ was measured during the changing temperature. Hydrogen conversion efficiency of calcined catalysts was also measured in the $H_2$-TPR system. The deactivation effect of $SO_2$ on catalyst was investigated with the on-off control of $SO_2$ supply. The catalyst which calcined above $340^{\circ}C$ was somewhat deactivated with thermal shock. The reason of deactivation was draw from the results of surface area and hydrogen conversion.

Study on Supersonic Jet Noise Reduction Using a Mesh Screen (메쉬 스크린을 이용한 초음속 제트소음 저감법에 관한 실험적 연구)

  • Kweon, Yong-Hun;Lim, Chae-Min;Kim, Heuy-Dong
    • Proceedings of the Korean Society of Propulsion Engineers Conference
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    • 2006.11a
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    • pp.377-381
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    • 2006
  • This paper describes experimental work to control supersonic jet noise using a mesh screen that is placed at the nozzle exit plane. The mesh screen is a wire-gauze screen that is made of long stainless wires with a very small diameter. The nozzle pressure ratio is varied to obtain the supersonic jets which are operated in a wide range of over-expanded to moderately under-expanded jets. In order to perturb mainly the initial jet shear layer, the hole is perforated in the central part of the mesh screen. The hole size is varied to investigate the noise control effectiveness of the mesh screen. A schlieren optical system is used to visualize the flow fields of supersonic jet with and without the mesh screen device. Acoustic measurement is performed to obtain the OASPL and noise spectra. The results obtained show that the present mesh screen device leads to a substantial suppression of jet screech tones. The hole size is an important factor in reducing the supersonic jet noise. For over-expanded jets, the noise control effectiveness of the mesh screen appears more significant, compared to correctly and under-expanded jets

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Irradiation of Intense Characteristic X-rays from Weakly Ionized Linear Plasma

  • Sato, Eiichi;Hayasi, Yasuomi;Tanaka, Etsuro;Mori, Hidezo;Kawai, Toshiaki;Takayama, Kazuyoshi;Ido, Hideaki
    • Proceedings of the Korean Society of Medical Physics Conference
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    • 2002.09a
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    • pp.396-399
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    • 2002
  • Intense quasi-monochromatic x-ray irradiation from the linear plasma target is described. The plasma x-ray generator employs a high-voltage power supply, a low-impedance coaxial transmission line, a high-voltage condenser with a capacity of about 200 nF, a turbo-molecular pump, a thyristor pulse generator as a trigger device, and a flash x-ray tube. The high-voltage main condenser is charged up to 55 kV by the power supply, and the electric charges in the condenser are discharged to the tube after triggering the cathode electrode. The x-ray tube is of a demountable triode that is connected to the turbo molecular pump with a pressure of approximately 1 mPa. As electron flows from the cathode electrode are roughly converged to the molybdenum target by the electric field in the tube, the weakly ionized plasma, which consists of metal ions and electrons, forms by the target evaporating. In the present work, the peak tube voltage was almost equal to the initial charging voltage of the main condenser, and the peak current was about 20 kA with a charging voltage of 55 kV. When the charging voltage was increased, the linear plasma x-ray source grew, and the characteristic x-ray intensities of K-series lines increased. The quite sharp lines such as hard x-ray lasers were clearly observed. The quasi-monochromatic radiography was performed by a new film-less computed radiography system.

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Analysis of Cultivator-related Trauma Cases in a Regional Trauma Center in the Rural Area of Gyeongbuk Province

  • Hwang, Ui Kang;Youn, Seok Hwa;Park, Chan Yong
    • Journal of Trauma and Injury
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    • v.30 no.3
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    • pp.80-86
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    • 2017
  • Purpose: To analyze the data of patients who suffered trauma in a cultivator accident and visited the trauma center in rural Gyeongbuk Province. Methods: We retrospectively reviewed the medical records and Korean Trauma Data Bank data of 120 patients who suffered cultivator-related traumas and visited the rural regional trauma center in Gyeongbuk Province from January to December 2015. Results: The age of the patients ranged from 35 to 96 years (mean, 70 years). Ninety-one (75.8%) patients were men, and twenty-nine (24.2%) were women. Most of the patients were in their 70s (46 men [50.5%] and 13 women [44.8%]). In total, 113 patients (94.1%) arrived at the regional trauma center by ground transport and 7 (5.9%) arrived by air transport. Ninety-eight patients (81.7%) were transported to the regional trauma center directly from the scene of the accident, and twenty-two (18.3%) were transferred from another medical institute. The mean time from the accident to arrival at the emergency department was 139 minutes, and only 46 patients (38.3%) arrived within 1 hour. Twelve (10.0%) patients died, including two deaths on arrival and two post- cardiopulmonary resuscitation deaths in the emergency department. All deaths were of male cultivator operators. The causes of death were shock (hypovolemic, traumatic, or septic), subdural hematoma (open), hemothorax, rhabdomyolysis, and pneumonia. Conclusions: As the government - led regional trauma center project is on process, it would be clinically important to summarize the initial outcome of cultivator injuries, which are characteristically found more in regional trauma centers in the rural area, and have high mortality. Based on this study, in the future, it will be necessary to follow up and analyze more number of patients and to construct accurate database about trauma cases related to cultivator in Gyeongbuk region.

Traumatic Tracheobronchial Injury: Delayed Diagnosis and Treatment Outcome

  • Hwang, Jung Joo;Kim, Young Jin;Cho, Hyun Min;Lee, Tae Yeon
    • Journal of Chest Surgery
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    • v.46 no.3
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    • pp.197-201
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    • 2013
  • Background: Most traumatic tracheobronchial injuries are fatal and result in death. Some milder cases are not life threatening and are often missed at the initial presentation. Tracheobronchial rupture is difficult to diagnose in the evaluation of severe multiple trauma patients. We reviewed the traumatic tracheobronchial injuries at Konyang University and Eulji University Hospital and analyzed the clinical results. Materials and Methods: From January 2001 to December 2011, 23 consecutive cases of traumatic tracheobronchial injury after blunt trauma were reviewed retrospectively. We divided them into two groups by the time to diagnosis: group I was defined as the patients who were diagnosed within 48 hours from trauma and group II was the patients who diagnosed 48 hours after trauma. We compared the clinical parameters of the two groups. Results: There was no difference in the age and gender between the two groups. The most common cause was traffic accidents (56.5%). The Injury Severity Score (ISS) was 19.6 in group I and 27.5 in group II (p=0.06), respectively. Although the difference in the ISS was not statistically significant, group II tended toward more severe injuries than group I. Computed tomography was performed in 22 cases and tracheobronchial injury was diagnosed in 5 in group I and 6 in group II, respectively (p=0.09). Eighteen patients underwent surgical treatment and all four cases of lung resection were exclusively performed in group II (p=0.03). There were two mortality cases, and the cause of death was shock and sepsis. Conclusion: We believe that close clinical observation with suspicion and rigorous bronchoscopic evaluation are necessary to perform diagnosis earlier and preserve lung parenchyma in tracheobronchial injuries from blunt trauma.

Analysis of Necrotizing Fasciitis Patient by Causative Pathogens (괴사성 근막염 환자의 원인 균주에 따른 경과 비교)

  • Park, Sun Hyung;Noh, Bok Kyun;Kim, Eui Sik;Hwang, Jae Ha;Kim, Kwang Seog;Lee, Sam Yong
    • Archives of Plastic Surgery
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    • v.34 no.3
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    • pp.319-324
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    • 2007
  • Purpose: Necrotizing fasciitis is a rapid progressive, life-threatening disease. Many organisms have been identified for causative pathogens of necrotizing fasciitis. And necrotizing fasciitis caused by Vibrio vulnificus is a matter of grace concern in Southwest seashore of Korea recently. But concrete analysis between these pathogens was not executed yet. Methods: Sixty necrotizing fasciitis patients were included in this study. We divided the patients into 2 groups: Group A was the case which Vibrio vulnificus was cultured for causative pathogen of necrotizing fasciitis, and Group B was the case of other organisms. And we analysed each group for treatment, progression and prognosis. Results: There was no significant difference between two groups in total hospital stay but there was a great difference in ICU stay and progression to septic shock. Also, there was a great difference in mortality within 48 hours but there was no difference in mortality of 48 hours after hospital visit. Conclusion: This indicates that intial management of necrotizing fasciitis cased by Vibrio vulnificus is the key of treatment. So initial medical management with early surgical intervention is necessary for necrotizing fasciitis.

Immune Responses Induced by HSP60 DNA Vaccine against Toxoplasma gondii Infection in Kunming Mice

  • Li, Zhong-Yuan;Lu, Jing;Zhang, Nian-Zhang;Chen, Jia;Zhu, Xing-Quan
    • Parasites, Hosts and Diseases
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    • v.56 no.3
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    • pp.237-245
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    • 2018
  • Toxoplasma gondii can infect all the vertebrates including human, and leads to serious toxoplasmosis and considerable veterinary problems. T. gondii heat shock protein 60 (HSP60) is associated with the activation of antigen presenting cells by inducing initial immune responses and releasing inflammatory cytokines. It might be a potential DNA vaccine candidate for this parasite. A pVAX-HSP60 DNA vaccine was constructed and immune responses was evaluated in Kunming mice in this study. Our data indicated that the innate and adaptive immune responses was elicited by successive immunizations with pVAX-HSP60 DNA, showing apparent increases of CD3e+CD4+ and CD3e+CD8a+ T cells in spleen tissues of the HSP60 DNA-immunized mice ($24.70{\pm}1.23%$ and $10.90{\pm}0.89%$, P<0.05) and higher levels of specific antibodies in sera. Furthermore, the survival period of the immunized mice ($10.53{\pm}4.78day$) were significantly prolonged during the acute T. gondii infection. Decrease of brain cysts was significant in the experimental group during the chronic infection (P<0.01). Taken together, TgHSP60 DNA can be as a vaccine candidate to prevent the acute and chronic T. gondii infections.

Etifoxine for Pain Patients with Anxiety

  • Choi, Yun Mi;Kim, Kyung Hoon
    • The Korean Journal of Pain
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    • v.28 no.1
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    • pp.4-10
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    • 2015
  • Etifoxine (etafenoxine, $Stresam^{(R)}$) is a non-benzodiazepine anxiolytic with an anticonvulsant effect. It was developed in the 1960s for anxiety disorders and is currently being studied for its ability to promote peripheral nerve healing and to treat chemotherapy-induced pain. In addition to being mediated by $GABA_A{\alpha}2$ receptors like benzodiazepines, etifoxine appears to produce anxiolytic effects directly by binding to ${\beta}2$ or ${\beta}3$ subunits of the $GABA_A$ receptor complex. It also modulates $GABA_A$ receptors indirectly via stimulation of neurosteroid production after etifoxine binds to the 18 kDa translocator protein (TSPO) of the outer mitochondrial membrane in the central and peripheral nervous systems, previously known as the peripheral benzodiazepine receptor (PBR). Therefore, the effects of etifoxine are not completely reversed by the benzodiazepine antagonist flumazenil. Etifoxine is used for various emotional and bodily reactions followed by anxiety. It is contraindicated in situations such as shock, severely impaired liver or kidney function, and severe respiratory failure. The average dosage is 150 mg per day for no more than 12 weeks. The most common adverse effect is drowsiness at the initial stage. It does not usually cause any withdrawal syndromes. In conclusion, etifoxine shows less adverse effects of anterograde amnesia, sedation, impaired psychomotor performance, and withdrawal syndromes than those of benzodiazepines. It potentiates $GABA_A$ receptor-function by a direct allosteric effect and by an indirect mechanism involving the activation of TSPO. It seems promising that non-benzodiazepine anxiolytics including etifoxine will replenish shortcomings of benzodiazepines and selective serotonin reuptake inhibitors according to animated studies related to TSPO.

The First Case of Novel Influenza A (H1N1) Fatality in Korea

  • Seol, Hee-Yun;Eom, Jung-Seop;Kim, Mi-Hyun;Cho, Woo-Hyun;Kim, Ji-Eun;Kim, Ki-Uk;Jeon, Doo-Soo;Park, Hye-Kyung;Kim, Yun-Seong;Lee, Min-Ki;Park, Soon-Kew
    • Tuberculosis and Respiratory Diseases
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    • v.68 no.6
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    • pp.350-353
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    • 2010
  • Here we report the first fatality caused by H1N1 influenza virus infection with acute respiratory distress syndrome in Korea. A 55-year-old man presented at our emergency department with dyspnea, fever, diffuse myalgia and malaise. Bilateral lung air-space consolidation was detected on his initial chest radiograph combined with severe hypoxemia. He was supported by mechanical ventilation and treated with antibiotics. A nasopharyngeal aspirate was positive for influenza A rapid antigen and oseltamivir was started on day 3 of admission. The nasal swab sample was positive for influenza H1N1 virus by real-time reverse-transcriptase polymerase chain reaction. Despite aggressive treatment, he had refractory hypoxemia and uncontrolled septic shock. On day 5 of admission he went into cardiac arrest and expired.