• Journal of Korean Academy of Nursing
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• v.42 no.3
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• pp.333-341
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• 2012

Purpose: The purpose of this study was to test whether pre-operative visual information and parental presence had positive effects on anxiety, delirium, and pain in pediatric patients who awoke from general anesthesia in a post-surgical stage. Methods: This study used a non equivalent control-group post test design (n=76). Independent variables were provision of pre-operative visual information and parental presence for post-surgical pediatric patients in PACU (post anesthesia care unit). Dependent variables were anxiety, delirium, and pain in the pediatric patients measured three times at 10 minute intervals after extubation in the PACU. Measurements included Numerical Rating Scale for assessing state anxiety, Pediatric Anesthesia Emergence Delirium Scale by Sikich & Lerman (2004) for delirium, and Objective Pain Scale by Broadman, Rice & Hannallah (1988) for pain. Results: Experimental group showed significantly decreased state anxiety at time points-10, 20, and 30 minutes after extubation. Delirium was significantly lower at 10 minutes and 30 minutes after extubation in the experimental group. Pain was significantly lower at 10 minutes after extubation in the experimental group. Conclusion: The results of this study suggest that this intervention can be a safe pre-operative nursing intervention for post-surgical pediatric patients at PACU.

• Archives of Plastic Surgery
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• v.46 no.3
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• pp.204-213
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• 2019

Background In implant-based breast reconstruction, acellular dermal matrix (ADM) is essential for supporting the inferolateral pole. Recent studies have compared non-sterilized freeze-dried ADM and sterilized pre-hydrated ADM, but have not assessed whether differences were attributable to factors related to sterile processing or packaging. This study was conducted to compare the clinical outcomes of breast reconstruction using two types of sterile-processed ADMs. Methods Through a retrospective chart review, we analyzed 77 consecutive patients (85 breasts) who underwent tissue expander/implant breast reconstruction with either freeze-dried ADM (35 breasts) or pre-hydrated ADM (50 breasts) from March 2016 to February 2018. Demographic variables, postoperative outcomes, and operative parameters were compared between freeze-dried and pre-hydrated ADM. Biopsy specimens were obtained for histologic analysis. Results We obtained results after adjusting for variables found to be significant in univariate analyses. The total complication rate for freeze-dried and pre-hydrated ADMs was 25.7% and 22.0%, respectively. Skin necrosis was significantly more frequent in the freeze-dried group than in the pre-hydrated group (8.6% vs. 4.0%, P=0.038). All other complications and operative parameters showed no significant differences. In the histologic analysis, collagen density, inflammation, and vascularity were higher in the pre-hydrated ADM group (P=0.042, P=0.006, P=0.005, respectively). Conclusions There are limited data comparing the outcomes of tissue expander/implant breast reconstruction using two types of sterile-processed ADMs. In this study, we found that using pre-hydrated ADM resulted in less skin necrosis and better integration into host tissue. Pre-hydrated ADM may therefore be preferable to freeze-dried ADM in terms of convenience and safety.

• Restorative Dentistry and Endodontics
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• v.30 no.2
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• pp.102-111
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• 2005

The purpose of this study was to assess the incidence of flare-ups among patients who received endodontic treatment and to examine the correlation with pre-operative and operative variables. Analysis was in two aspects (a) overall incidence of flare-ups as expressed by a percentage of all patients visits and (b) percentage of flare-ups that occurred as related to various factors suck as patient demo-graphics, diagnosis, and treatment procedures. 1. From the 840 teeth which were examined in this study, the total number of flare-ups was 13. 2. As to gender of patients, there was no significant difference in flare-ups. 3. As to tooth groups, there was no significant difference in flare-ups. 4. In the teeth with pre-operative symptom, there was a statistically significant higher incidence of flare-ups than the teeth without it. 5. In the teeth with apical periodontitis, there was a statistically significant higher incidence of flare-ups. 6. As to pulp and periapical status. non-vital teeth had a higher incidence as compared with vital teeth, irreversible pulpitis. 7. Multi-visit treatment resulted in the higher incidence of flare-ups than one visit treatment. 8. Re-treatment procedures had a statistically significant higher incidence of flare-ups than root canal treatment. In this study, overall percentages of flare-ups was $1.55\%$. It showed a statistically significant higher incidence related to pre-operative symptom, apical periodontitis, and re-treatment. There was no significant difference in flare-ups related to gender, tooth groups, and fistula.

• Journal of Korean Academy of Nursing
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• v.29 no.1
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• pp.161-173
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• 1999

The purpose of this study was to develope and test the structural model for quality of life in women having hysterectomies. A hypothetical model was constructed on the basis of previous studies and a review of literature. The conceptual framework was built around eight constructs. Exogenous variables included in this model were marital intimacy, importance of uterus, professional support, positive coping behavior and pre-operative symptoms. Endogenous variables were spouse's support, sense of loss and quality of life. Empirical data for testing the hypothetical model was collected using a self-report questionnare from 203 women having hysterectomies at the outpatient clinics of four general hospitals and a mail survey in Pusan City. The Data was collected from December, 1997 to January, 1998. Reliability of the eight instruments was tested with Cronbach's alpha which ranged from 0.639-0.915. For the data analysis, SPSS 7.5 WIN Program and LISREL 8.12 WIN Program were used for descriptive statistics and covariance structural analysis. The results of covariance structure analysis were as follows : 1. Hypothetical model showed a good fit with the empirical data. ［$\chi$$^2$＝6.93(df＝5, P＝.23), GFI＝.99, AGFI＝.94, RMSR＝.019, NNFI＝.97, NFI＝.98, CN＝440, standardized residuals(-2.14-2.10)］ 2. For the parsimony of model, a modified model was constructed by deleting 3 paths and adding 1 path according to the criteria of statistical significance and meaning. 3. The modified model also showed a good fit with the data. ［$\chi$$^2$＝5.26(df＝7, P＝.63), GFI＝.99, AGFI＝.97, RMSR＝.014, NNFI＝1.02, NFI＝.99, CN＝710, standardized residuals(-1.46-1.70)］ Results of the testing of the hypothesis were as follows : 1. Marital intimacy(${\gamma}$11＝.78, t＝14.37) and professional support(${\gamma}$13＝.12, t＝2.12) had a significant direct effect on the spouse's support. 2. Pre-operative symptoms(${\gamma}$25＝.32, t＝3.12), importance of uterus(${\gamma}$22＝.20, t＝2.61) and spouse's support($\beta$2l＝-.19, t＝-2.43) had a significant direct effect on the sense of loss. 3. Sense of loss($\beta$32＝-.66, t＝-9.83) had a direct effect on the quality of life. Marital intimacy had a direct(${\gamma}$31＝.19, t＝3.33), indirect(${\gamma}$31＝.14, t＝2.52) and total effect(${\gamma}$31＝.25, t＝4.41) on the quality of life. Professional support had a direct effect(${\gamma}$33＝.11, t＝2.07) and total effect(${\gamma}$33＝.13, t＝2.31) on the quality of life. The direct effect of pre-operative symptoms(${\gamma}$35＝-.36, t＝4.02) and positive coping behavior(${\gamma}$34＝.15, t＝2.06) had the insignificant effect on the quality of life while, due to the idirect effect these variables had overall significant effect on the quality of life. The results of this study showed that the sense of loss had the most significant direct effect on the quality of life. Marital intimacy, pre -operative symptoms and spouse's support had a significant direct effect on this sense of loss. These four variables, the sense of loss, marital intimacy, pre-operative symptoms and spouse's support, were identified as relatively important variables. The results of this study suggested that there is needed to determine if nursing intervention would alleviate this sense of loss and promote a greater quality of life in women who have had hysterectomies.

• Journal of Chest Surgery
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• v.26 no.2
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• pp.141-147
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• 1993

A total of 40 patients having a diagnosis of atherosclerotic coronary arterial disease were analysed on the operative outcomes according to variables as follows: 1) preoperative risk factors such as age, sex, CCS (Canadian Cardiovascular Society) functional class, type of angina, number of diseased vessel, presence of left main coronary artery stenosis, previous history of habitual smoking and presence of other medical diseases (diabetes mellitus, essential hypertension), 2) preoperative management such as intravenous infusion of nitroglycerine, preoperative IABP (intra-aortic balloon pump) support and whether the operation was scheduled as emergency or not, 3) intraoperative variables such as infusion method and composition of cardioplegic solutions, number of distal anastomosis, use of internal mammary artery, total cardiopulmonary bypass time and total cross clamp time. Complications included operative death in 12.5％, perioperative myocardial infarction in 25.0％ and perioperative arrhythmia in 17.5％. Nineteen perioperative variables were analyzed to identify risk factors for these end points. For operative death, presence of left main coronary artery stenosis (p = 0.056) and cardiopulmonary bypass time (p = 0.029) were significant in the univariate analysis, but presence of left main coronary artery lesion (p = 0.011, $\chi$$^2$= 6.45) and abscence of preoperative of IABP support (p = 0.069, $\chi$$^2$ = 3.30) were independent predictor in multivariate analysis (stepwise linear logistic regression).

• Proceedings of the KACD Conference
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• 2003.11a
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• pp.555-555
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• 2003

The purpose of this prospective study was to assess the incidence of flare-ups among patients who received endodontic treatment for the last 11 months and to examine the correlation with pre-operative and operative variables. Data were gathered on 840 teeth of 755 patients over 11 months. At first visit, information was obtained on each patient as to their demographics, presenting signs, symptoms and diagnosis, and treatment performed. Treatment procedures were routine. If additional appointments were necessary, the access cavity was closed with a dry cotton pellet and ZOE.(omitted)

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.11
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• pp.6293-6299
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• 2013

Background: A number of clinicopathologic factors have been found to be associated with pathological lymph node metastasis (pLNM) in rectal cancer; however, most of them can only be identified by expensive high resolution imaging or obtained after surgical treatment. Just like the Child-Turcotte-Pugh (CTP) and the model for end-stage liver disease (MELD) scores which have been widely used in clinical practice, our study was designed to assess the pre-operative factors which could be obtained easily to predict intra-operative pLNM in rectal cancer. Methods: A cohort of 469 patients who were treated at our hospital in the period from January 2003 to June 2011, and with a pathologically hospital discharge diagnosis of rectal cancer, were included. Clinical, laboratory and pathologic parameters were analyzed. A multivariate unconditional logistic regression model, areas under the curve (AUC), the Kaplan-Meier method (log-rank test) and the Cox regression model were used. Results: Of the 469 patients, 231 were diagnosed with pLNM (49.3%). Four variables were associated with pLNM by multivariate logistic analysis, age<60 yr (OR=1.819; 95% CI, 1.231-2.687; P=0.003), presence of abdominal pain or discomfort (OR=1.637; 95% CI, 1.052-2.547; P=0.029), absence of allergic history (OR=1.879; 95% CI, 1.041-3.392; P=0.036), and direct $bilirubin{\geq}2.60{\mu}mol/L$ (OR=1.540; 95% CI, 1.054-2.250; P=0.026). The combination of all 4 variables had the highest sensitivity (98.7%) for diagnostic performance. In addition, age<60 yr and direct $bilirubin{\geq}2.60{\mu}mol/L$ were found to be associated with prognosis. Conclusion: Age, abdominal pain or discomfort, allergic history and direct bilirubin were associated with pLNM, which may be helpful for preoperative selection.

• International Journal of Control, Automation, and Systems
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• v.1 no.2
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• pp.236-242
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• 2003

This paper presents a cooperation strategy between a human operator and autonomous robots for an interactive robot soccer game, The interactive robot soccer game has been developed to allow humans to join into the game dynamically and reinforce entertainment characteristics. In order to make these games more interesting, a cooperation strategy between humans and autonomous robots on a team is very important. Strategies can be pre-programmed or learned by robots themselves with learning or evolving algorithms. Since the robot soccer system is hard to model and its environment changes dynamically, it is very difficult to pre-program cooperation strategies between robot agents. Q-learning - one of the most representative reinforcement learning methods - is shown to be effective for solving problems dynamically without explicit knowledge of the system. Therefore, in our research, a Q-learning based learning method has been utilized. Prior to utilizing Q-teaming, state variables describing the game situation and actions' sets of robots have been defined. After the learning process, the human operator could play the game more easily. To evaluate the usefulness of the proposed strategy, some simulations and games have been carried out.

• Advances in pediatric surgery
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• v.17 no.2
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• pp.133-138
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• 2011

Extracorporeal membrane oxygenation (ECMO) has been utilized in congenital diaphragmatic hernia (CDH) patients with severe respiratory failure unresponsive to conventional medical treatment. We retrospectively reviewed 12 CDH patients who were treated using ECMO in our center between April 2008 and February 2011. The pre ECMO and on ECMO variables analyzed included gestational age, sex, birth weight, age at the time of ECMO cannulation, arterial blood gas analysis results, CDH location, timing of CDH repair operation, complications and survival. There were 9 boys and 3 girls. All patients were prenatally diagnosed. Mean gestational age was $38.8{\pm}1.7$ weeks and mean birth weight was $3031{\pm}499$ gram. Mean age at the time of ECMO cannulation was $29.9{\pm}28.9$ hours. There were 4 patients who survived. Survivors showed higher 5 min Apgar scores ($8.25{\pm}0.96$ vs. $7.00{\pm}1.20$, p=0.109), higher pre ECMO mean pH ($7.258 {\pm}0.830$ vs. $7.159{\pm}0.986$, p=0.073) and lower pre ECMO $PaCO_2$ ($48.2{\pm}7.9$ vs. $64.8{\pm}16.1$, p=0.109) without statistical significance. The hernia was located on the left side in 10 patients and the right side in 2 patients. The time interval from ECMO placement to operative repair was about 3~4 days in 5 early cases and around 24 in the remaining cases. There were 3 cases of post operative bleeding requiring re operation and 2 cases of abdominal compartment syndrome requiring abdominal fascia reopening. ECMO catheter reposition was required in 4 cases. Three cases of arterial or venous thrombosis were detected and improved with follow up. Our data suggests that ECMO therapy could save the lives of some neonates with CDH who can not be maintained on other treatment modalities. Protocolized management and accumulation of case experience might be valuable in improving outcomes for neonates with CDH treated with ECMO.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.2
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• pp.191-205
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• 2000

The purpose of this study was undertaken to determine the effects of orthognathic surgery on speech. The hyposis stated herein is that functional behaviors of the dentofacial complex, such as speech production, may be adversely affected by deviations of a structural nature(especially, Class III malocclusion). Twenty adults with Class III malocclusion(13 female and 7 male) were studied preoperative, immediate postoperative and either 6 or 12 months postoperative lateral cephalograms. They had mandibular prognathism and had undergone mandible setback operation. The position of tongue, soft palate(Uvula), hyoid bone, respiratory track width, and pharyngeal depth were assessed on lateral cephalograms with 23 cephalometric variables, ANOVA, Paired t-tests and Pearson's product-moment correlation coefficient tests were used to evalute the operative changes in all cephalometric parameters. A experienced speech and language pathologists performed narrow phonetic transcriptions of tape-recorded words and sentences produced by each of the ninth patients and the recording tapes were analyzed by phonetic computer program(Computerized Speech Lab(CSL) Model 4300BI(U.S.A.)) These judges also recorded their ratings of each patient's overall consonants, hypernasality, hyponasality, and articulation proficiency. The results obtained are as follows; 1. There were significant changes in distance of posterior pharyngeal wall to tongue (TI-TW2, TS-TW3) after the surgery at 6 months postoperatively(each p<0.01 p<0.05). 2. The posterior tongue point(TI, TS, PPT) moved posteriorly after surgery and remained to its changed position at 6 months postoperatively(p<0.05). The displacement of tongue was correlated with the movement of mandibular setback amount(p<0.05). The hyoid bone moved posteriorly superiorly after immediate postoperative period. There was significant changes in hyoid bone movement after immediated postoperative period(p<0.05), but returned to its original position during the follow-up period(p>0.05) 3. The soft palate was displaced posteriorly superiorly after immediated operative period and remained to its changed position at 6 months postoperatively(p<0.05). ANS-PNS-SPT angle increasing, PPU-PPPo distance narrowing was showed after surgery, and remained its appearance 6 months postoperatively(p<0.05). 4. There were significant changes in formant value and squre diagram of vowel sound after the orthognathic surgery and the follow-up period. There were significant changes in /ㅅ/sound and posterior tongue sound. 5. The posterior movement of tongue and the posteriosuperior movement of soft palate was correlated with mandibular setback amount after orthognathic surgery. On the vowel squre diagram, the author found that the place of articulation after operation moved downward, backward, upward. 6. In assessing speech abnormalities, dental occlusion should be considered as a contributing factor. The vast majority of subjects with preoperative misarticulations eliminated or reduced their errors following orthognathic surgery. There was significant difference in speech impovement between pre- and postoperation.