• Title/Summary/Keyword: Mechanical Intervention

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Predictors of Intensive Care Unit Morbidity and Midterm Follow-up after Primary Repair of Tetralogy of Fallot

  • Egbe, Alexander C.;Nguyen, Khanh;Mittnacht, Alexander J.C.;Joashi, Umesh
    • Journal of Chest Surgery
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    • v.47 no.3
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    • pp.211-219
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    • 2014
  • Background: Our objectives were to review our institutional early and midterm experience with primary tetralogy of Fallot (TOF) repair, and identify predictors of intensive care unit (ICU) morbidity. Methods: We analyzed perioperative and midterm follow-up data for all cases of primary TOF repair from 2001 to 2012. The primary endpoint was early mortality and morbidity, and the secondary endpoint was survival and functional status at follow-up. Results: Ninety-seven patients underwent primary repair. The median age was 4.9 months (range, 1 to 9 months), and the median weight was 5.3 kg (range, 3.1 to 9.8 kg). There was no early surgical mortality. The incidence of junctional ectopic tachycardia and persistent complete heart block was 2% and 1%, respectively. The median length of ICU stay was 6 days (range, 2 to 21 days), and the median duration of mechanical ventilation was 19 hours (range, 0 to 136 hours). By multiple regression analysis, age and weight were independent predictors of the length of ICU stay, while the surgical era was an independent predictor of the duration of mechanical ventilation. At the 8-year follow-up, freedom from death and re-intervention was 97% and 90%, respectively. Conclusion: Primary TOF repair is a safe procedure with low mortality and morbidity in a medium-sized program with outcomes comparable to national standards. Age and weight at the time of surgery remain significant predictors of morbidity.

Preliminary Experience of Neuroform Atlas Stenting as a Rescue Treatment after Failure of Mechanical Thrombectomy Caused by Residual Intracranial Atherosclerotic Stenosis

  • Yi, Ho Jun;Sung, Jae Hoon;Lee, Dong Hoon
    • Journal of Korean Neurosurgical Society
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    • v.64 no.2
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    • pp.198-206
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    • 2021
  • Objective : The low-profile Neuroform Atlas stent can be deployed directly without an exchange maneuver by navigating into the Gateway balloon. This retrospective study assessed the safety and efficacy of Neuroform Atlas stenting as a rescue treatment after failure of mechanical thrombetomy (MT) for large artery occlusion. Methods : Between June 2018 and December 2019, a total of 31 patients underwent Neuroform Atlas stenting with prior Gateway balloon angioplasty after failure of conventional MT caused by residual intracranial atherosclerotic stenosis (ICAS). Primary outcomes were successful recanalization and patency of the vessel 24 hours after intervention. Secondary outcomes were vessel patency after 14 days and 3-month modified Rankin Scale. Peri-procedural complications, intracerebral hemorrhage (ICH), and 3-month mortality were reviewed. Results : With a 100% of successful recanalization, median value of stenosis was reduced from 79.0% to 23.5%. Twenty-eight patients (90.3%) showed tolerable vessel patency after 14 days. New infarctions occurred in three patients (9.7%) over a period of 14 days; two patient (6.5%) underwent stent occlusion at 24 hours, and the other patient (3.2%) with delayed stent occlusion had a non-symptomatic dot infarct. There were no peri-procedural complications. Two patients (6.5%) developed an ICH immediately after the procedure with one of them is symptomatic. Conclusion : Neuroform Atlas stenting seems to be an effective and safe rescue treatment modality for failed MT with residual ICAS, by its high successful recanalization rate with tolerable patency, and low peri-procedural complication rate. Further multicenter and randomized controlled trials are needed to confirm our findings.

Risk Factors and Features of Critically Ill Patients with Deep Vein Thrombosis in Lower Extremities (하지 심부정맥혈전증을 가진 중환자의 특성 및 발생 영향 요인)

  • Kim, Hwa-Soon;Cho, Ok-Min;Cho, Hyo-Im;Kim, Ju-Yeun
    • Journal of Korean Academy of Nursing
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    • v.42 no.3
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    • pp.396-404
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    • 2012
  • Purpose: The purpose of this study was to identify the features, risk scores and risk factors for deep vein thrombosis in critically ill patients who developed deep vein thrombosis in their lower extremities. Methods: The participants in this prospective descriptive study were 175 adult patients who did not receive any prophylactic medication or mechanical therapy during their admission in the intensive care unit. Results: The mean age was 62.24 (${\pm}17.28$) years. Men made up 54.9% of the participating patients. There were significant differences in age, body mass index, and leg swelling between patients who developed deep vein thrombosis and those who did not have deep vein thrombosis. The mean risk score was 6.71(${\pm}2.94$) and they had on average 4.01(${\pm}1.35$) risk factors. In the multiple logistic regression, body mass index (odds ratio=1.14) and leg swelling (odds ratio=6.05) were significant predictors of deep vein thrombosis. Conclusion: Most critically ill patients are in the potentially high risk group for deep vein thrombosis. However, patients who are elderly, obese or have leg edema should be closely assessed and more than one type of active prophylactic intervention should be provided.

Diagnosis and Clinical Management of Retrograde Peri-Implantitis Associated with Adjacent Apical Periodontitis: a Case Report

  • Lee, Kwan-Joo;Song, Young Woo;Jung, Ui-Won;Cha, Jae-Kook
    • The Journal of the Korean dental association
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    • v.58 no.6
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    • pp.336-345
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    • 2020
  • Peri-apical implant lesion, also known as 'retrograde peri-implantitis' can occur with multifactorial etiological factors. The purpose of this case report is to demonstrate resolution of periapical implant lesion by removal of causative factors and saving implant by regenerative therapy. A 54-year old male patient with mild dull pain around implant on the right mandibular second premolar area due to persistent peri-apical infection of the adjacent first premolar was treated. Extraction of tooth with symptomatic apical periodontitis and regenerative therapy on the buccal fenestration area of the implant and extraction site were performed. After 6-month reentry, notable regenerated bone tissue around implant was found, and implant placement on the previous extraction site was performed. After 14-month follow-up from the regenerative therapy, neither biological nor mechanical complication could be found around the implant, evidenced by high implant stability, normal clinical probing depth, and absence of discomfort spontaneously and during masticatory function. In conclusion, surgical intervention including regenerative therapy using bone graft and barrier membrane on periapical implant lesion can be suggested as one of the treatment options considering the extent of periapical lesion.

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Flexural behavior of concrete beams reinforced with different types of fibers

  • Kh., Hind M.;Ozakca, Mustafa;Ekmekyapar, Talha;Kh., Abdolbaqi M.
    • Computers and Concrete
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    • v.18 no.5
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    • pp.999-1018
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    • 2016
  • Enhanced tensile properties of fiber reinforced concrete make it suitable for strengthening of reinforced concrete elements due to their superior corrosion resistance and high tensile strength properties. Recently, the use of fibers as strengthening material has increased motivating the development of numerical tools for the design of this type of intervention technique. This paper presents numerical analysis results carried out on a set of concrete beams reinforced with short fibers. To this purpose, a database of experimental results was collected from an available literature. A reliable and simple three-dimensional Finite Element (FE) model was defined. The linear and nonlinear behavior of all materials was adequately modeled by employing appropriate constitutive laws in the numerical simulations. To simulate the fiber reinforced concrete cracking tensile behavior an approach grounded on the solid basis of micromechanics was used. The results reveal that the developed models can accurately capture the performance and predict the load-carrying capacity of such reinforced concrete members. Furthermore, a parametric study is conducted using the validated models to investigate the effect of fiber material type, fiber volume fraction, and concrete compressive strength on the performance of concrete beams.

Patient Discomfort Caused by an Endotracheal Tube during Ventilator Therapy after Cardiac Surgery (심장 수술 후 인공호흡기 치료를 받는 환자의 기관내관으로 인한 불편감에 관한 연구)

  • Hyun, A-Reum;Choe, Myoung-Ae
    • Journal of Korean Critical Care Nursing
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    • v.3 no.1
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    • pp.53-65
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    • 2010
  • Purpose: The purpose of this study was to identify the intensity and types of discomfort caused by an endotracheal tube in patients during ventilator therapy after cardiac surgery, and to analyze the differences in the intensity and types of discomfort by sociodemographic and clinical characteristics and characteristics related to endotracheal tubes. Methods: The intensity of discomfort was measured using an 11-point numeric rating scale and the types of discomfort were measured using a 4-point numeric rating scale. Sociodemographic and clinical characteristics and characteristics related to endotracheal tube were collected by observation and the electronic medical chart using a structured questionnaire. Results: The mean intensity of discomfort in patients due to endotracheal tubes was 6,91 points, 84% of patients reported discomfort over 5 points, The most severe discomfort was pain during endotracheal suctioning, and dry mouth and breathing difficulties were also found to induce discomfort. Patients who had more severe surgical site pain, longer duration of intubation and higher cuff pressure demonstrated more severe discomfort due to the endotracheal tube. Conclusion: These results can be used as basic data for developing nursing intervention to relieve the discomfort caused by endotracheal tubes in patients during ventilator therapy.

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Neonatal Gastrointestinal Perforation (신생아 위장관천공)

  • Kim, Seong-Chul;Kim, In-Koo
    • Advances in pediatric surgery
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    • v.3 no.1
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    • pp.41-46
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    • 1997
  • Perforation of the gastrointestinal tract in neonatal period has been associated with a grim prognosis. Recently there has been some improvement in survival. To evaluate the remaining pitfalls in management, 19 neonatal gastrointestinal perforation cases from May 1989 to July 1996 were analysed retrospectively. Seven patients were premature and low birth weight infants. Perforation was most common in the ileum(56.3%). Mechanical or functional obstruction distal to the perforation site was identified in 7 cases; Hirschsprung's disease 3, small bowel atresia 3, and anorectal malformation 1. These lesions were often not diagnosed until operation. Five cases of necrotizing enterocolitis and 1 of muscular defect were the other causes of perforation. In six cases, the cause of the perforation was not identified. Perinatal ischemic episodes were associated in five cases. Overall mortality was 15.1%. Because a considerable number of gastrointestinal perforations resulted from distal obstruction, pediatric surgeon should be alert for early identification and intervention of gastrointestinal obstruction, particularly in patients that are premature and have a history of ischemia.

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Nurse's Work Related Back Pain in the U. S. (미국 간호사의 직업성 요통)

  • June, Kyung Ja
    • Korean Journal of Occupational Health Nursing
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    • v.14 no.1
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    • pp.44-55
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    • 2005
  • Purpose: The purpose of this study was to describe the current status of work-related back pain among nurses in the U.S. Method: Literature review and website searching were conducted. Key words as 'nurse and back pain (or back injury)' were used in searching the Medline, NIOSHTIC-2and reference list of selected studies. Total studies were selected of which subjects were nurses working in the U.S., and published since 1970. Results: Though there was variation in the measurement among studies, the prevalence rate of back pain among nurses in the U.S. could be estimated about 50%. Risk factors were confirmed as the frequency of patient lifting, ward, nursing shortage, overtime, work shift, stress on physical demand, but age and work experiences showed the inconsistent relation. It has been well known that educational approach is not enough to prevent back pain. Intervention studies to apply the ergonomic approach using mechanical devices reported the effects, but the devices were less diverse than European countries or Canada. The study for lifting team was rare. Federal government developed only the guideline for nursing home that had no legal obligation. As a professional nursing organization, ANA has been trying to educate and advocate for "No lift policy" since 2003. Meanwhile, two trade unions of nurses made efforts to establish the law strengthening the responsibility of health care facilities. Conclusion: The research and policy development will be needed to prepare to rapid increase of back pain among Korean nurses.

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Effects of Posterior-Anterior Mobilization of Lumbar Spine on Muscle Tone and Stiffness of Superficial Back Muscles and Lumbar Mobility

  • Kim, Jisung
    • Journal of International Academy of Physical Therapy Research
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    • v.10 no.1
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    • pp.1711-1716
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    • 2019
  • Background: Previous researchers have investigated the mechanical and neurophysiological effects of manual mobilization, however little research has been done on muscle tone and muscle stiffness. Objective: To compare the effects of posterior-anterior (PA) mobilization with weight bearing on sling and conventional PA mobilization on the bed. Design: Randomized controlled trial (single blind) Methods: The subjects were 16 male university students and randomized to sling mobilization group (SMG, n=8) or conventional mobilization group (CMG, n=8). SMG received PA mobilization using a sling and CMG received traditional mobilization on the bed during lumbar mobilization. Results: Both left and right muscle tones of SMG increased, but left muscle tone of SMG were increased and right muscle tone was decreased after intervention. In addition, both left and right muscle stiffness of SMG were also increased, however left muscle stiffness of SMG was increased and right muscle stiffness was decreased. The muscle tone and muscle stiffness of SMG were higher than those of DMG, especially the right side was statistically significantly higher. Extension of SMG, extension and flexion of CMG were increased statistically significantly except for Flexion of SMG (p<.05). There were no significant differences between the groups in Extension and Flexion. Conclusions: This study suggests that lumbar spine PA mobilization using sling is beneficial in improving muscle tone, muscle stiffness, and trunk movement.

Automatic Dataset Generation of Object Detection and Instance Segmentation using Mask R-CNN (Mask R-CNN을 이용한 물체인식 및 개체분할의 학습 데이터셋 자동 생성)

  • Jo, HyunJun;Kim, Dawit;Song, Jae-Bok
    • The Journal of Korea Robotics Society
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    • v.14 no.1
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    • pp.31-39
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    • 2019
  • A robot usually adopts ANN (artificial neural network)-based object detection and instance segmentation algorithms to recognize objects but creating datasets for these algorithms requires high labeling costs because the dataset should be manually labeled. In order to lower the labeling cost, a new scheme is proposed that can automatically generate a training images and label them for specific objects. This scheme uses an instance segmentation algorithm trained to give the masks of unknown objects, so that they can be obtained in a simple environment. The RGB images of objects can be obtained by using these masks, and it is necessary to label the classes of objects through a human supervision. After obtaining object images, they are synthesized with various background images to create new images. Labeling the synthesized images is performed automatically using the masks and previously input object classes. In addition, human intervention is further reduced by using the robot arm to collect object images. The experiments show that the performance of instance segmentation trained through the proposed method is equivalent to that of the real dataset and that the time required to generate the dataset can be significantly reduced.