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Risk Factor, Mortality and Infection Rate of Mediastinum After Delayed Sternal Closure in Congenital Heart Surgery Patients (선천성 심장수술 후 지연 흉골 봉합시 사망률 및 종격동 감염률 그리고 위험인자)

  • 이진구;박한기;홍유선;박영환;조범구
    • Journal of Chest Surgery
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    • v.35 no.7
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    • pp.517-522
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    • 2002
  • Background: Congenital heart surgery may lead to myocardial swelling and hemodynamic instability. Delayed sternal closure may be beneficial in this setting. The purpose of this study was to assess mortality and mediastinal infection rate associated with delayed sternal closure after congenital heart surgery and to evaluate the risk factors which affect mortality and mediastinal infection rate. Material and Method: We retrospectively reviewed 40 patients who underwent delayed sternal closure after repair of congenital heart disease at Yonsei Cardiovascular Hospital, from January 1994 to May 2001. In these patients, we assessed the mortality and mediastinal infection rate, and evaluated their risk factors including operation time, bypass time, aortic cross clamp time, duration to sternal closure and postoperative artificial ventilation time. Mediastinal infection was defined to have positive culture in mediastinum. Result: Hemodynamic instability was the most common indication for delayed sternal closure(n=36) and other indications included postoperative bleeding(n=2) and conduit compression(n=2). The median age at operation was $14.4{\pm}33.4$months old(range, 2days-12years). The patients with postoperative bleeding and conduit compression were much older than the others. The sternum was left open for $4.5{\pm}3.4$ days(range, 1-20days). Overall mortality was 25%(10/40) and mediastinal infection occured in 24.3%(9/37) (3 patients were excluded in mediastinal infection for early death). In risk factor analyses, only aortic cross clamp time had statistical significance for mortality in univariate analyses. However, multivariate analyses revealed that there were no significant predictors for risk of mortality and mediastinal infection. Conclusion: Delayed sternal closure after repair of congenital cardiac disease had relatively high mortality and mediastinal infection rate. But, in patients with hemodynamic instability, postoperative bleeding and conduit compression after repair of congenital cardiac disease, delayed sternal closure may be an effective life saving method.

The Efficacy of Endovascular Treatment for Deep Vein Thrombosis (하지 심부정맥 혈전증에서 중재적 치료의 유용성)

  • Kim, Seon-Hee;Chung, Sung-Woon;Kim, Chang-Won
    • Journal of Chest Surgery
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    • v.43 no.3
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    • pp.266-272
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    • 2010
  • Background: Deep vein thrombosis (DVT) is a serious disease that causes life-threatening pulmonary embolism and chronic venous insufficiency. Anticoagulation is the standard therapy for DVT. However, the results of standard anticoagulation for treating DVT have been disappointing, so endovascular treatment is commonly performed nowadays. The aim of this study was to evaluate the efficacy of an endovascular procedure for treating patients with DVT. Material and Method: We retrospectively evaluated the clinical data of 29 DVT patients who underwent an endovascular procedure between December 2006 and July 2008. We compared the results of the 29 patients with the results of another 45 patients who were treated with only aspirin and heparin. Result: The patient’s mean age was 55.4 years in the intervention group and 53.7 years in the control group. DVT occurred more frequently in the females. Catheter-directed thrombolysis was performed in 22 patients (75.8%). Aspiration thrombectomy was performed in 18 patients (62%) and a endovascular stent was placed in 25 patients (86.2%). Fifteen patients (51.7%) underwent percutaneous insertion of a retrievable IVC filter for the prevention of pulmonary embolism. In the control group, thirty nine patients (86.7%) were treated with low-molecular heparin, and seven patients (15.6%) who were contraindicated for warfarin were treated with aspirin. No bleeding complications occurred during thrombolysis or anticoagulation. We analyzed the statistical data according to recurrence of DVT and the incidence of post-thrombotic syndrome (PTS) during the follow-up period. The intervention group had a significantly lower incidence of PTS (p-value=0.008), but they had the same result as the control group for the recurrence of DVT. In addition, death from the DVT did not occur in the intervention group. Thus, we obtained better clinical outcomes in the intervention group as compared to those in the anticoagulation only group. Conclusion: Endovascular procedures are effective alternative modalities, as compared to systemic anticoagulation, for the treatment of DVT. But more studies are needed to determine the specific indications and to validate the long-term efficacy of endovascular procedures for the treatment of DVT.

Study on the Antioxidant Effects of Nano-Selenium Microcapsule (Nano-Selenium Microcapsule의 항산화에 관한 연구)

  • Jeong, Hun;Yoo, Il-Su;Kim, Kyung-Sun;Lee, Soon-Young;Mun, Yeun-Ja;Jeon, Byoung-Kook;Ryu, Moon-Hee;Choi, Kyung-Soon
    • The Korean Journal of Food And Nutrition
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    • v.25 no.3
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    • pp.564-569
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    • 2012
  • Selenium was initially considered toxic to humans, but it was then discovered that selenium is essential for normal life processes. Selenium plays important roles in antioxidants. It is expected that chitosan microcapsules containing nano-selenium will be able to be used as a key material in bio-medical and cosmetic applications. The high concentration of chitosan derivatives guarantees increased antioxidative activity. Both inorganic and organic forms of selenium can be nutritional sources. The antioxidant properties of selenoproteins help prevent cellular damage from free radicals. The objective of this experiment was to study the antioxidative activity of chitosan nano-selenium. Our experiments were divided into five groups, in the presence of various concentrations(0.1%, 0.3%, 0.5%, 0.7%, and 0.9%) of chitosan. We performed an assessment of the antioxidant properties and cytotoxicity of respective concentrations of chitosan nano-selenium. The antioxidant activity was examined by the free radical scavenging activity on 1,1-diphenyl-2-picrylhydrazyl(DPPH) assay. The cytotoxicity effect was measured by means of 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyltetrazolium bromide(MTT) assay. As a result, the electron donating abilities of 0.1%, 0.3%, 0.5%, 0.7%, and 0.9% of chitosan nano-selenium exhibited effective andioxidant scavenging activity at 12.5 ${\mu}g/m{\ell}$ against DPPH radicals. 0.3% chitosan nano-selenium did not show cytotoxicity on human keratinocytes. In general, the cytotoxicity of 0.1% and 0.9% chitosan nano-selenium showed the lowest effects. Though low cytotoxicity of 0.5% and 0.7% chitosan nano-selenium exhibited 29.67% and 38.4% against human keratinocytes on adding 100 ${\mu}g/m{\ell}$ and 50 ${\mu}g/m{\ell}$, respectively, cell vitality was recovered with 200 ${\mu}g/m{\ell}$. These findings support the notion that chitosan nano-selenium may be useful as a new active ingredient source for bioactive compounds.

Changes of in Vacuum Packed Pre-aged Venison with Seasoning during Chilled Storage (양념으로 사전 숙성하여 진공포장한 사슴고기의 냉장저장 중 품질 변화)

  • Kim Il-Suk;Jin Sang-Keun;Hah Kyung-Hee;Park Seok-Tae;Kwuak Kyung-Rak;Park Jung-Kwon;Kang Yang-Su;Chung Ku-Young
    • Food Science of Animal Resources
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    • v.25 no.4
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    • pp.442-448
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    • 2005
  • This study was carried out to evaluate the quality characteristics of the vacuum packed pre-aged venison with seasoning during chilled storage. The ham of deer were cut to cube and two seasonings such as red pepper sauce (T1) or soy sauce (T2) were seasoned by the proportions or meat to seasonings (1:1), respectively. The seasoned venison was aging by fill into plastic box at $0\pm1^{\circ}C$ for 10 days. And then, the aged meat from each pack was vacuum-packaged and stored at $0\pm1^{\circ}C$ for up to 28 days. pH were significantly decreased with storage periods in all treatments (p<0.05). Salinity $(\%)$ were no significant differences in T1 during the whole storage, but T2 had significantly high content $(1.33\%)$ at the storage days of 28 (p<0.05). Saccarinity $(\%)$ of T1 were significantly higher than that of T2 during the whole storage periods (p<0.05). As storage time extended the value of $L^*$ and $b^*$ in T1 were increased and those values decreased in T2. $a^*$ and shear force $(g/cm^2)$ or T1 and T2 were increased as the storage period passed In the result of sensory evaluation. all treatment had relatively high score $(T1\;6.75\~T2\;7.00)$ in overall acceptability during the storage period of 28 days. In conclusion, this study suggest that vacuum packed pre-aged venison with seasoning may be useful for new deer meat menu.

Effects of Anabolic Steroids of Pork on Proliferation and Differentiation of Myogenic Satellite Cell (돼지 고기의 아나볼릭 스테로이드가 Myogenic Satellite Cell의 증식과 분화에 미치는 영향)

  • Lee, Dong-Mok;Lee, Ki-Ho;Cheon, Yong-Pil;Chun, Tae-Hoon;Choi, In-Ho
    • Food Science of Animal Resources
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    • v.30 no.5
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    • pp.842-850
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    • 2010
  • Sex steroids are known to be involved in skeletal muscle development (anabolic effect) and are frequently used in medicines. It has been known that pork contains a variety of steroids that are mainly synthesized in the gonads (testis and ovary). Thus, the present study was conducted to evaluate the effects of anabolic steroids of pork on the proliferation and differentiation of myogenic satellite cells (MSC). Three different methods (M1, M2, and M3) were developed for the isolation and purification of steroids from porcine tissues. Among three extraction methods that we developed, M3 was the best method with respect to the quantities of steroids and the induction of MSC proliferation. Hormonal analysis showed that the steroid hormone levels were the highest in muscle and fat of intact male than those of castrated males and females. In addition, the highest serum levels of nandrolone and testosterone were detected in intact males, whereas estrone and $17{\beta}$-estradiol levels were similar in the entire experimental serum samples. Expression of androgen receptor (AR), myoD, desmin, and myogenin in bovine muscle cells were significantly up-regulated by the treatment of steroid extracts. The highest increas of myogenin and AR mRNA abundance were observed in the MSCs treated with M3 extract (p<0.001). Altogether, the present research showed the positive effect of steroids on MSC proliferation and differentiation in vitro. These results would certainly imply a beneficial effect of pork consumption on human muscle development.

Determination of Short Term Prognosis Among Chronic Obstructive Lung Disease with Acute Respiratory Failure According to Simplified Acute Physiology Score (만성 폐쇄성 폐질환에서 급성 호흡부전 발생시 Simplifed Acute Physiology Score에 따른 단기예후의 평가)

  • Lee, Sang-Pyo;Sung, Yun-Up;Kim, Sang-Hoon;Kim, Bong-Sik;Kim, Young-Jun;Park, In-Won;Choi, Byung-Whui;Hue, Sung-Ho
    • Tuberculosis and Respiratory Diseases
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    • v.40 no.5
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    • pp.532-539
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    • 1993
  • Background: Physician's estimates of patient survival often influence clinical decisions, especially those near the end of life. In addition. clinical decisions frequently reflect trade-offs between morbidity and length of survival. As a result, accurate estimates of survival can be extremely useful in clinical decision. When the episode of acute respiratory failure in chronic obstructive lung disease, evaluation of the severity of the condition and short term prognosis is difficulit based on the available clinical or paraclinical data at the time of admission. Method: In this study, we performed a retrospective study in Chung Ang University Hospital, 74 patients (51 males, 23 females), who were hospitalized with chronic obstructive lung disease with acute respiratory failure from 1980 to 1992. We evaluated these patients to determine lung prognostic factors at time of admission in the Intensive Care Unit (ICU) that predict short term survival, and to determine the possible application of the Simplified Acute Phsiology Score (SAPS) to this population, All patients were treated with similar regimen during the hospitalization. Results: The results were as follows: 1) Hospital mortality was 34%(25/74 patients) and surival rate was 66%(49/74 patients) in COPD with acute respiratory failure. The prognosis of the older age was much poorer than those of the young age. 2) There was no difference in mortality according to the results of basal pulmonary test and arterial blood gas analysis. 3) The SAPS at admission was higher in those patients who expired(10.8) than the survived(6.5), and there was positive correlation between SAPS and mortality (r=0.91, p<0.05). 4) Prognostic factors in acute respiratory failure complicating COPD which were identifiable at time of admission to the ICU were as follows: cachexia, encephalopathy, serum creatinine and phosphate. Conclusion: In conclusion, the SAPS might have a good prognostic value for determination of short term survival among chronic obstructive lung disease with acute respiratory failure.

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A Study on Influencing Factors in Health Promoting Lifestyles of College Students (대학생의 건강증진 생활양식과 관련요인 연구)

  • Park, Mi-Yeong
    • Research in Community and Public Health Nursing
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    • v.5 no.1
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    • pp.81-96
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    • 1994
  • The primary purpose of this study was to identify factors affecting health promoting lifestyles of college students on the basis of Pender's Health Promotion Model. The subjects were 1,159 students of one university in Seoul. These data were collected by self reporting questionnaire from April 19 to May 3, 1993. This study examined health promoting lifestyles, cognitive-percep-tual factors: perceived health status, perceived importance of health, health locus of control, and health conception, and modifying factors: sex, grade, major, residence type, and attendance at a health care course. The instruments used in this study were Health Promoting Lifestyle Profile by Walker et al. (1987), Health Value Scale by Wallston et al. (1976), Health Locus of Control by Wallston et al. (1978), and Health Conception Scale by Laffrey(1986). The data were analyzed by Cronbach's $\alpha$, mean, standard deviation, percentage, t-test, ANOVA, Pearson's Correlation Coefficient, and Stepwise Multiple Regression with SPSS PC+ Program. The results were as follows : 1. The means of health promoting lifestyles revealed total 3.33, self actualization 3.74, health responsibility 2.72, exercise 2.80, nutrition 3.55, interpersonal surpport 3.76, and stress management 2.96. Interpersonal support showed the highest score and health responsibility showed the lowest score. 2. No significant differences between sex, grade, major, and residence type, and health promoting lifestyles Were founded(p>.05). Attendants at a health care course showed a significant higher score than nonattendants (p<.001). Male showed a significant higher score in exercise subscale, female showed significant higher scores in health responsibility, nutrition, interpersonal support, stress management subscales(p<.001), residence type showed a significant difference in nutrition subscale(p<.001). 3. No significant differences between perceived health status and sex, grade, major, residence type, and attendance at a health care course were founded(p>.05). Perceived importance of health showed no differences among sex, grade, major, and residence type(p>.05), showed only in attendance at a health care course (p<.001). Attendants at a health care course showed a significant higher score than nonattendants(p<.001). No significant differences between health conception and sex, grade, major, and residence type were founded (p>.05), only significant difference between health conception and attendance at a health care course was founded(p<.05). Nonattendants showed a significant higher score in clinical health conception, attendants showed a significant higher score in wellbeing health conception(p<.05). 4. A significant positive correlation between health promoting lifestyles and perceived health status was founded(r=.2415, p<.001). A significant positive correlation between health promoting lifestyles and perceived importance of health was founded (r=.1475, p<.001). The health promoting lifestyles revealed significant positive correlations in internal and powerful others locus of control (r=.3187, p<.001: r=.1475, p<.001), but revealed a significant negative correlation in chance locus of control(r=-.997, p<.001). A significant positive correlation between health promoting lifestyles and clinical health conception and wellbeing health conception were founded (r=.1241, p<.001 : r=.3047, p<.001). 5. Perceived health status was the highest factor predicting health promoting lifestyles of college students(R=.3415, $R^2=11.62$). Perceived health' status, perceived improtance of health, internal locus of control, wellbeing health conception, powerful others locus of control accounted for 28.19% in health promoting lifestyle patterns. In conclusion, college students who reported more helath promoting lifestyles evaluated their health positively, perceived importance of health highly, perceived their health as affected by theirselves, powerful others but not by chance or luck, and accepted health as high level wellness rather than merely the absence of illness. Those who attending at a health care course had healthier lifestyle patterns. And attendance at a health care course had significant. correlations in these cognitive-perceptual factors. Further studies are required to identify reasons of attending a health care course, and to compare health promoting lifestyles pre-post attending a course related to health care.

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Spatio-temporal Analysis of Population Distribution in Seoul via Integrating Transportation and Land Use Information, Based on Four-Dimensional Visualization Methods (교통과 토지이용 정보를 결합한 서울 인구분포의 시공간적 분석: 4차원 시각화 방법을 토대로)

  • Lee, Keumsook;Kim, Ho Sung
    • Journal of the Economic Geographical Society of Korea
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    • v.21 no.1
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    • pp.20-33
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    • 2018
  • Population distribution in urban space varies with transportation flow changing along time of day. Transportation flow is directly affected by the activities of urbanites and the distribution of related facilities, since the flow is the result of moving to the point where the facilities associated with their activities are located. It is thus necessary to analyze the spatio-temporal characteristics of the urban population distribution by integrating the distribution of activity spaces related to the daily life of urbanites and the flow of transportation. The purpose of this study is to analyze the population distribution in urban space with daily and weekly time bases using the building database and T-card database in the city of Seoul, which is rich in information on land use and transportation flow. For a time-based analysis that is difficult to grasp by general statistical techniques, a four-dimensional visualization method combining time and space using a Java program is devised. Dynamic visualization in the four-dimensional space and time allows intuitive analysis and makes it possible to understand more effectively the spatio-temporal characteristics of population distribution. For this purpose, buildings are classified into three activity groups: residential, working, and commercial according to their purpose, and the number of passengers traveling to and from each stop site of bus and subway networks in the T-card database for one week is calculated in one-minute increments, Visualizing these and integrating transportation and land use, we analyze spatio-temporal characteristics of the population distribution in Seoul. As a result, it is found that the population distribution of Seoul displays distinct spatio-temporal characteristics according to land use. In particular, there is a clear difference in the population distribution pattern along the time axis according to the mixed aspects of working, commercial, and residential activities. The results of this study can be very useful for transportation and location planning of city facilities.

Investigating Research on the Degree of Frequency and Importance of Tasks for Framing the EMTs Occupational Description (응급구조사 직무기술서 작성에 따른 일의 요소별 빈도 및 중요도 조사 연구)

  • Kim, Tae Min;Kim, Hyo Sik;Yoou, Soon Kyu
    • The Korean Journal of Emergency Medical Services
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    • v.5 no.1
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    • pp.199-212
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    • 2001
  • This research, aiming at analyzing the Emergency Medical Technicians' duties prior to establishing a baseline for question development in the national exams to qualify for the EMTs, investigated the importance and frequency per unit specified in the description with the EMTs to be subjects working on the task spot by means of questionnaires. The EMT duties were classified into 9 items like 1) the notification and response, 2) the scene size-up, 3) the patient assessment, 4) the emergency care, 5) the patient transport, 6) the duties at hospital clinics, 7) the operational management, 8) the receiving and responding to a call, 9) the self-development, and put the functional tasks into 52 items, describing the task elements into 177 items, and then questioned 112 EMTs working on the spot from July 21 through August 30, 2000, which showed the following results. 1) The distribution of subjects' career showed the highest rate with 33.9% for those who careered "less than a year", only 13.4% for those with more than 4 years and the highest rate with 43.8% for those who aged at 20-25. And 70.5% of all those who were questioned was the junior college graduates, 58.9% for those working at fire station and 29.5% working at hospital clinics. 2) Looking at the distribution of frequency and importance for each task element, questioning 'the patients main symptoms', 'accidental type', 'place of the patients identification' showed the highest rate in both frequency and importance in the field of "notification and response". 3) In the "scene size-up", identifying the patients showed the highest rate of frequency and importance, compared to other field of tasks, among which "identifying the patients' state" showed the highest rate of frequency (2.66) and importance (2.81). 4) In the "patient assessment", "identifying the patients" showed the high rate of frequency and importance in most elements of task, especially the importance showed the highest rate with 2.83 for the task of airway management and the cervical immobilization during "the primary assessment", and the frequency showed the highest rate for questioning the past case of the task of grasping the patients' history. 5) In the "emergency care", "the management of the heart attacked patients" and "the advanced cardiac life support" showed a high rate in the importance, whereas the frequency showed a very low rate. The high rate of frequency during the emergent task was the management of "musculoskeletal system injury patients" and of "the gastro-intestinal and urinary genital system injury patient support." In care of the patients with heart attack, the management of the airway showed the highest rate with 2.95, whereas the management of alcoholic abused patients and of dying patients, showed comparatively lower rate of assessment in the importance. The frequency of tasks showed the highest rate with 2.69 in the control of bleeding and the lowest with 0.47 in the management of abnormal delivery of child. 6) As to the patient transport, "the emergency transport" showed the highest rate with 2.74 and the unemergent transport with 2.55 in the importance, and the task importance at hospital showed the highest rate with 2.89 in managing the cardio-pulmonary resuscitation and with 2.60 in identifying the patient state. 7) Of all the tasks related with "operational task", the high importance was to "educate for the management of the first responder", but the frequency of tasks mostly showed a low rate and "receiving and responding to a call" showed relatively a high rate of importance and frequency. And related with "the self-development", "the health care management" and "the stress control" on working spot showed a high rate, but the frequency mostly showed a low rate.

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Oral health status and treatment need of institutionalized elderly patients (노인요양시설에 있는 노인환자의 구강실태 및 치료수요도)

  • Yang, Soon-Bong;Moon, Hong-Suk;Han, Dong-Hoo;Lee, Ho-Yong;Chung, Moon-Kyu
    • The Journal of Korean Academy of Prosthodontics
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    • v.46 no.5
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    • pp.455-469
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    • 2008
  • Statement of problems: In the area of dental care, the institutionalized elderly have placed the most vulnerable state, and we cannot find their subjective need of dental treatment because of the physical and mental disabilities, But we have no basic investigation of their oral health conditions. Purpose: The aims of the current study were to investigate the oral health status of institutionalized elderly patients who are in the least benefited side of dental service, and to analyze their dental treatment needs. Material and methods: The survey of the oral status was carried out on 758 institutionalized elderly, and 212 elderly who was more than 65 years old from D dental office, and it was based on the Guidelines of Oral Health Research of year 2000 in Republic of Korea. Results and conclusion: The DMFT index of the institutionalized elderly appeared higher than that of the same ages in control group, and it increased with age. The number of residual teeth of the institutionalized elderly appeared lower than that of the same ages in control group, and it decreased with age (P < .05). The number of fixed partial denture in institutionalized elderly was lower than that of the same ages in control group (P < .05). The percentage wearing removable partial denture was not significant between the elderly in institutions and the control group, and was not different according to age between the two groups. The percentage of institutionalized elderly wearing complete denture appeared lower than that of the same ages in control group, and it increased with age. The percentage of institutionalized elderly needing complete denture was higher than that of control group, and the percentage of elderly needing complete denture on the maxilla was higher than that of the mandible. 16.35% of the institutionalized elderly was living without denture in spite of their fully edentulous state. The need for complete denture increased rapidly with age. The number of valued teeth and dental prostheses in shortened dental arch concept and number of occluding pairs of teeth of institutionalized elderly were lower than that of the control group (P < .05). In institutionalized elderly, the number of residual teeth, the number of fixed partial dentures, and the percentage wearing removable partial dentures were higher in the mandible, and the percentage wearing complete dentures was higher in the maxilla (P < .05). The rate of institutionalized elderly needing prosthodontic treatment appeared to be 67.82%, where the number of occluding pairs of teeth was less than 10. When it is difficult to evaluate the subjective need of dental treatment as with the institutionalized elderly, estimation using the number of occluding pairs of teeth can be a useful indicator that can project treatment needs. For the oral health care of institutionalized elderly, it is essential to increase the awareness of nurses and caregivers who take care of them, about the importance of the oral health. Since the average life span and number of residual teeth are increasing gradually, the welfare policy should be changed to implementing regular dental examinations, preservative treatment forms and oral health control of dentulous patients where the traveling-treatment system and visit system are supplemented. And principles should be set that the present denture project of edentulous patients should be done by specialists who'll also be responsible for postmanagement. Through this research of institutionalized elderly, the oral health status which is worsened by aging could be confirmed. And the interest and positive participation of dental society on the elderly should come first in order to solve the rising treatment needs of the elderly patients.