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Concise Bedside Surgical Management of Profound Reperfusion Injury after Vascular Reconstruction in Severe Trauma Patient: Case Report

  • Chung, Hoe Jeong;Kim, Seong-yup;Byun, Chun Sung;Kwon, Ki-Youn;Jung, Pil Young
    • Journal of Trauma and Injury
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    • v.29 no.4
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    • pp.204-208
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    • 2016
  • For an orthopaedic surgeon, the critical decisions to either amputate or salvage a limb with severe crushing injury with progressive ischemic change due to arterial rupture or occlusion can become a clinical dilemma at the Emergency Department (ED). And reperfusion injury is one of the fetal complications after vascular reconstruction. The authors present a case which was able to save patient's life by rapid vessel ligation at bedside to prevent severe reperfusion injury. A 43-year-old male patient with no pre-existing medical conditions was transported by helicopter to Level I trauma center from incident scene. Initial result of extended focused assessment with sonography for trauma (eFAST) was negative. The trauma series X-rays at the trauma bay of ED showed a multiple contiguous rib fractures with hemothorax and his pelvic radiograph revealed a complex pelvic trauma of an Anterior Posterior Compression (APC) Type II. Lower extremity computed tomography showed a discontinuity in common femoral artery at the fracture site and no distal run off. Surgical finding revealed a complete rupture of common femoral artery and vein around the fracture site. But due to the age aspect of the patient, the operating team decided a vascular repair rather than amputation even if the anticipated reperfusion time was 7 hours from the onset of trauma. Only two hours after the reperfusion, the patient was in a state of shock when his arterial blood gas analysis (ABGA) showed a drop of pH from 7.32 to 7.18. An imminent bedside procedure of aseptic opening the surgical site and clamping the anastomosis site was taken place rather than undergoing a surgery of amputation because of ultimately unstable vital sign. The authors would like to emphasize the importance of rapid decision making and prompt vessel ligation which supply blood flow to the ischemic limb to increase the survival rate in case of profound reperfusion injury.

Improvement of Market Quality of Minimally Processed Horticultural Products Using Ozone (오존수를 활용한 부분 가공 원예산물의 청정화 및 유통성 증진)

  • Hwang, Yong Soo;Jun, Il Yeul;Ku, Ja Hyeung
    • Korean Journal of Agricultural Science
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    • v.30 no.2
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    • pp.128-138
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    • 2003
  • The bacterial density of partially processed horticultural crops in the commercial market was relatively high probably due to improper handing or processing. Between crops, the bacterial density was low in peeled garlic and ranged above $10^8cfu{\cdot}g^{-1}fw$ in other crops. Especially in brake fern, the bacterial density was the highest and non food materials such as packing strips were found. There was difference in the effects of ozone-treated water washing treatment between crops. In root crops such as burdock and lotus root, ozone showed positive effect on preventing discoloration as well as lowing bacterial density resulting in the increase of marketing period. Any positive effect was not found when sliced crops were treated over 5 min at $0.3mg{\cdot}L^{-1}$ of dissolved ozone. In lettuce slices, leaf tissues were severely discolored and rapidly soften at $0.3mg{\cdot}L^{-1}$ for 2 min dipping. Ozone was highly effective on inhibiting bacterium propagation and off-flavor. This effect was more stronger in Fischer ligulariata than brake fern, probably due to the difference of tissue thickness. Results indicated that ozone-treated water washing had a strong potential to improve the market quality of partially processed horticultural crops including dried wild greens and sliced root crops.

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A Study on the Preliminary Validation of a Postoperative Pain Measure for Parents for Children's Pain Assessment after Surgery (아동의 수술 후 통증사정을 위한 부모용 통증행동관찰척도의 타당성에 대한 연구)

  • Shin, Hee-Sun;Jung, Yeon-Yi
    • Journal of Korean Academy of Nursing
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    • v.30 no.4
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    • pp.847-856
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    • 2000
  • Parents are primary care taker for the children and have an important role for the assessment and managent of children's pain following surgery. The purpose of the present study was to examine the validity and clinical utilization of the Postoperative Pain Measure for Parents (PPMP) developed by Chambers et al. Subjects were 52 children aged 4-12 years admitted for tonsillectomy and other minor surgery and their mothers. Faces Pain Scale, State Anxiety, and Postoperative Pain Measure for Parents were used. The data were collected by two research assistant on the operation day and 1st day after surgery at hospital during the period of July 20 to August 28, 1998. The results are as follows: 1. Eta correlation coefficient between 15 items of PPMP and child rated pain were calculated. Correlation coefficients were more than .2 for both day. 2. Internal consistency for PPMP were .82 and .83. 3. The scores of the PPMP were 10.73 (SD=3.71) and 9.27(SD=4.07) on the operation day and 1st day after surgery and there was no significant difference between two days(p=.056) On the other hand, there was a significant difference on the child rated pain by Faces Pain Scale between operation day and 1st day after surgery(p=.001). 4. The correlation(Spearman Rho) between PPMP and child rated pain were .40(p=.003) and .56(p=.000). The score of the PPMP and the children's state anxiety were highly correlated on the operation day and 1st day after surgery (.60, .52, p=.000). 5. Partial correlation between PPMP and child rated pain except state anxiety were .18(p=.23) and .48(p=.001) on the opration day and 1st day after surgery. 6. Using a cut-off score 10 out of 15, the measure showed excellent sensitivity (>80%) and moderate specificity (46.15%, 60% ). This study provides preliminary evidence for the use of the PPMP as a valid pain assessment tool with children between the ages of 4-12 years following surgery. It is suggested to explore the validity with a different subjects with other surgery and to examine the validity for infant and younger children.

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Rainfastness of 5 Fungicides on the Leaf Surface of Hot Pepper (고추잎 표면에서 5종 살균제의 내우성)

  • Choi, Yun-Kyong;Yu, Ju-Hyun;Chun, Jae-Chul
    • Journal of Applied Biological Chemistry
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    • v.52 no.3
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    • pp.126-132
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    • 2009
  • In order to elucidate the relationship between the rainfastness of fungicides and their water solubilities, the fungicide residues on the leaf surface of hot pepper was assessed and compared after the drop-wise applications of fungicide solutions on leaf surface followed by artificial raining. As the raining was progressed after application of aqueous acetone solution of fungicides, the residue levels of fungicides were drop rapid at the early stage of raining, but the decreasing rates of residue level were slowed down thereafter. The initial rainfastness was reversely proportional to the water solubilities of the fungicides. Whole amount of dimethomorph residue, which water solubility is 18 mg/L, was washed off by 2.5 mm of raining. Although WP formulations of fungicides showed remarkable decreases of rainfastness compared to the aqueous acetone formulations, the fungicides having low water solubility showed better rainfastness. Chlorothalonil and mepanipyrim suspension concentrates was better in rainfastness than their WP formulation, and the rainfastness of mepanipyrim suspension was reversely proportional to the median diameter of suspension particles in the range of 1 to 4 ${\mu}m$. In brief, the rainfastness of 5 fungicides tested on the pepper leaf was, in the early stage of raining, closely related to water solubility. But, as the raining is progressed, the effect of the unknown factor, which is related with the particle size of fungicides, becomes serious.

The Effects of Family Management Agreement on the Increase of Participation in Farm Management among Women Farmers (가족경영협약이 여성농업인의 경영참여 확대에 미치는 효과)

  • Kang, Kyeong-Ha;Huh, Mee-Young;Lee, Jin-Young;Choi, Yoon-Ji;Gim, Kyung-Mee;Whang, Dae-Yong
    • The Korean Journal of Community Living Science
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    • v.19 no.3
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    • pp.353-363
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    • 2008
  • Recently some Korean feminists have reported the family management agreement (FMA) can contribute to enhance the women farmers' legal status and to improve their farm management. The FMA is a formal document written each rights and responsibilities on the farm management, income allocation, and labor condition such as working time and work-off days agreed among family members. Since 2004, 161 farmer couples have signed and practiced the FMA after two-day workshop scheduled for the agreement. The purpose of this study is to analyze the effects of FMA on the increase of participation in (am management among women farmers. Data were collected from 204 FMA couples through the structured questionnaires. Also interview and participating observation were carried out. Paired t-test were conducted using SPSS 12.0 for Windows program. Major findings were as follows. Women farmers' participation in decision making of farming activities has significantly increased after than before the FMA. However, husbands' participation in decision making is higher than women farmers even after the FMA. After the FMA, labor compensation, regularly or irregularly, for women farmers has increased to 53.3%, 35.3% higher than 18% of the previous study and women farmers' ownership of their farm assets has increased to 48.1% from 29.1%. Also, there is a tendency women farmers' role as a representative of their farm has increased. In conclusion the FMA makes women farmers participate more in farm management as decision maker, income beneficiary, farm asset owner, and farm representative, which encourage them to get the legal status as a farmer and to control their farm management risk. It is suggested that the FMA be selected as a program in order to strengthen the agricultural competitiveness.

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Salmonella Typhimurium SL1344 Utilizing Human Transferrin-bound Iron as an Iron Source Regardless of Siderophore-mediated Uptake (Salmonella Typhimurium SL1344의 사람의 트렌스페린(hTf)에 부착된 철 이용에 관한 연구)

  • Choe, Yunjeong;Yoo, Ah Young;Kim, Sam Woong;Hwang, Jihwan;Kang, Ho Young
    • Journal of Life Science
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    • v.27 no.1
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    • pp.72-77
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    • 2017
  • Inorganic iron is essential for various metabolic processes, including RNA synthesis, electron transport, and oxygen detoxification in microorganisms. Many bacterial pathogens compete for iron acquisition in diverse environmental condition such as host. Salmonella Typhimurium SL1344 also requires inorganic iron as a cofactor for growth. When a M9 minimal liquid medium was supplemented with ethylenediamine di-o-hydroxyphenylactic acid (EDDA) which acts as an iron-chelating agent, growth of Salmonella Typhimurium SL1344 in the supplemented medium was completely arrested by deficient of useful iron under iron-depleted condition. However, a number of siderophores, which are small, high-affinity iron chelating compounds secreted by microorganisms such as bacteria and fungi, were produced for utilization of restricted iron under iron-depleted condition. A M9 minimal liquid medium complemented with human transferrin (hTf)-iron complex turned completely off production of siderophores, but growth of Salmonella Typhimurium SL1344 maintained level similar to compare one complemented with iron (III) chloride (FeCl3). This means that human transferrin (hTf)-bound iron can utilize via directly interaction with Salmonella Typhimurium SL1344 without productions of siderophores. Through construction and analysis of negative mutant for utilization of human transferrin (hTf)-bound iron, we confirm that the bacterium can directly use human transferrin (hTf)-bound iron without extracellularly intermediated carriers such as siderophores.

A Nobel Video Quality Degradation Monitoring Schemes Over an IPTV Service with Packet Loss (IPTV 서비스에서 패킷손실에 의한 비디오품질 열화 모니터링 방법)

  • Kwon, Jae-Cheol;Oh, Seoung-Jun;Suh, Chang-Ryul;Chin, Young-Min
    • Journal of Broadcast Engineering
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    • v.14 no.5
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    • pp.573-588
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    • 2009
  • In this paper, we propose a novel video quality degradation monitoring scheme titled VR-VQMS(Visual Rhythm based Video Quality Monitoring Scheme) over an IPTV service prone to packet losses during network transmission. Proposed scheme quantifies the amount of quality degradation due to packet losses, and can be classified into a RR(reduced-reference) based quality measurement scheme exploiting visual rhythm data of H.264-encoded video frames at a media server and reconstructed ones at an Set-top Box as feature information. Two scenarios, On-line and Off-line VR-VQMS, are proposed as the practical solutions. We define the NPSNR(Networked Peak-to-peak Signal-to-Noise Ratio) modified by the well-known PSNR as a new objective quality metric, and several additional objective and subjective metrics based on it to obtain the statistics on timing, duration, occurrence, and amount of quality degradation. Simulation results show that the proposed method closely approximates the results from 2D video frames and gives good estimation of subjective quality(i.e.,MOS(mean opinion score)) performed by 10 test observers. We expect that the proposed scheme can play a role as a practical solution to monitor the video quality experienced by individual customers in a commercial IPTV service, and be implemented as a small and light agent program running on a resource-limited set-top box.

The Job Status of Health Teacher, School Nurse, during Epidemic Outbreak of Influenza H1N1 in School (학교 신종플루 확산기 동안의 초등학교 보건교사의 직무현황)

  • Shin, Sun-Mi;Kim, Hye-Soon;Hong, Min-Soon;Lee, Hee-Woo
    • Journal of the Korean Society of School Health
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    • v.23 no.1
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    • pp.63-70
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    • 2010
  • Purpose: To identify the need to reform in the crisis response of Health Teacher, School Nurse, in elementary school during epidemic outbreak of influenza H1N1. Methods: 139 elementary health teachers, school nurse, in seoul elementary school responded in the questionnaire, and we analysed by using frequency and percent, t-test, and paired t-test. Results: The Job status became 121% more 'during influenza H1N1 (flu) outbreak' than Job status of 'before outbreak'. The proportion of the flu-related duty among their daily workload was up to 77.5%. The administration-related workload of the flu-related duty was 30.8%. and students' health assessment including temperature measurement 18.7%. Furthermore, an impediment of usual daily work due to an increaed flu-related workload was 95.7%, and no alternative plan such as disposition of assistant labor force was 86.1%. Especially, an impediment of health education was 61.0%, so the major concern was the loss of health education. We compared average scores (a five-point Likert scale) of health teachers' work motivation, exhaustion, work relationship and Job management of 'during' with 'before' flu-outbreak. The difference range of 'during' minus 'before' work motivation score was from -0.4 points to -0.9; work exhaustion range from 1.8 to 1.9; the difficulty of relationship between students, school personnel, parents of students, and health teachers from 1.4 points to 1.3 points; and the consideration of changing Job, taking time off from the Job and retirement from 1.4 to 1.6 points. Conclusion: The health teachers had a heavy workload due to flu-outbreak. They also experienced the impediment of usual work implementation. However, there was a shortage of alternative plan such as disposition of an assistant labor force. Under their Job status like this, the health teachers' motivation score was decreased and work exhaustion was increased. Furthermore, they had a lot of relation difficulty with students and school personnel. Therefore, we suggested that in contrast to the usual Job status, there is a need to have a prepared response during school crisis like flu-outbreak such as improved response system in seoul metropolitan education office, simplification or dispersion of administrative work, and temporary call-center for simple inquiries or advices.

A Segment-based Minimum Cutset Method for Estimating the Reliability of Water Distribution Systems (상수관망의 신뢰도 산정을 위한 Segment 기반의 Minimum Cutset 방법)

  • Jun, Hwan-Don;Park, Jae-Il;Baek, Chun-Woo;Kim, Joong-Hoon
    • Journal of Korea Water Resources Association
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    • v.40 no.9
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    • pp.735-742
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    • 2007
  • In this study, a methodology which is based on segments and minimum outsets to estimate the reliability of a real water distribution system efficiently and accurately is suggested. The current reliability assessment models based on minimum cutset consider a pipe as only area impacted by a pipe failure which incurs underestimation of pipe failure impact. In contrary, the suggested methodology adopts "segment" and "unintended isolation" with the hydraulic pressure failure area to define the actual service interruption area in a water distribution system due to a pipe failure, which is different from the Previous reliability estimating methodologies. In addition, a minimum cutset is defined as a single segment incurring abnormal operating conditions and the success mode approach is used to account for the probability of multiple failure combinations of minimum outsets. The model considers numbers and locations of on-off valves when the service interruption area is defined. Once the methodology is applied to a real water distribution system, it is possible to define actual service interruption areas and using the defined areas, the reliability of the water distribution system is estimated reliably, compared with the previous reliability assessment methodologies.

Modern Sedimentary Environments Within the Gogunsan Archipelago (고군산군도 내측해역의 현생퇴적환경)

  • Lee, Hee-Jun;Kim, Min-Ji;Kim, Tae-Kyung
    • Ocean and Polar Research
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    • v.30 no.4
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    • pp.519-536
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    • 2008
  • The relatively tranquil area within the Gogunsan Archipelago was for the first time investigated preliminarily with respect to modern sedimentological processes in association with the emplacement of the Saemangeum Dyke. Basic sedimentological observations, bathymetry and surface sediments were performed twice during 2006-2008 to compare the results and elaborate changes during that period of time. In addition, sediment dynamical observations were carried out with latest measuring equipment along two transects crossing the entrances of the archipelago, including 12-hour onboard measurements of current, suspended sediments, temperature, and salinity. This dataset was used to reveal hydrodynamic characteristics for spring season April-May and to estimate the direction and relative magnitude of the net flux of suspended sediments. There occurred three depositional areas (A to C) within the archipelago, where sediment texture was also changed. In area A, around Yami Island and the dyke, and area B, in the center of the archipelago, surface sediments became coarsened over the two-year period; sand content increased 5% at the expense of silt content in the former, whereas silt content increased 3% at the expense of clay content in the latter. By comparison, area C in the western entrance of the archipelago shows a textural trend of fining with more silt and clay (combined increase of 5%) at the expense of sand content. The accumulation of sediments in areas A and B is attributable to the sand and silt resuspended from the seabed sediments off sector 4 of the dyke during the winter. The origin of the fine materials depositing on area C is uncertain at present, although suspended sediments moving offshore around the archipelago may be one of the most likely candidates for the source. The temperature of seawater increased rapidly from $9-10^{\circ}C$ in April to $14-16^{\circ}C$ in May, whereas salinity remained more or less constant at 31-32%o during the two months. Both of these parameters showed little variations with depth through a tidal cycle, suggesting good mixing of seawater without any help of significant waves. The consistency of salinity during a tidal cycle also indicates no insignificant effects of freshwater from the rivers Mangyung and Donjin emitting through the opening gap near Sinsi Island. The suspended sediment concentrations were higher at the entrance between Sunyu and Sinsi islands than at the entrance between Hoenggyong and Sinsi islands, ranging from 20 and 30 mg/l and from 5 and 15 mg/l, respectively at the sea surface. Although tidal currents were variable across a transect between Sunyu and Sinsi islands, the currents across the entrance between Hoenggyong and Sinsi islands flowed consistently in the same direction all over the transect during a tidal cycle. The estimation of net flux of suspended sediments indicates that suspended sediments are transferred to the Gogunsan Archipelago mainly through a relatively deep trough adjacent to Sinsi Island toward the shallow area around Yami Island and the dyke.