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Use of ADMSTM during sedation for dental treatment of an intellectually disabled patient: a case report

  • Chi, Seong In;Kim, Hyun Jeong;Seo, Kwang-Suk;Yang, Martin;Chang, Juhea
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.16 no.3
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    • pp.217-222
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    • 2016
  • Dental treatment is often performed under general anesthesia or sedation when an intellectually disabled patient has a heightened fear of treatment or has difficulty cooperating. When it is impossible to control the patient due to the severity of intellectual disability, conscious sedation is not a viable option, and only deep sedation should be performed. Deep sedation is usually achieved by propofol infusion using the target controlled infusion (TCI) system, with deep sedation being achieved at a slightly lower concentration of propofol in disabled patients. In such cases, anesthesia depth monitoring using EEG, as with a Bispectral Index (BIS) monitor, can enable dental treatment under appropriate sedation depth. In the present case, we performed deep sedation for dental treatment on a 27-year-old female patient with mental retardation and severe dental phobia. During sedation, we used BIS and a newly developed Anesthetic Depth Monitor for Sedation (ADMS$^{TM}$), in addition to electrocardiography, pulse oximetry, blood pressure monitoring, and capnometry for patient safety. Oxygen was administered via nasal prong to prevent hypoxemia during sedation. The BIS and ADMS$^{TM}$ values were maintained at approximately 70, and dental treatment was successfully performed in approximately 30 min.

Studies on the Kiln Drying Characteristics of Several Commercial Woods of Korea (국산 유용 수종재의 인공건조 특성에 관한 연구)

  • Chung, Byung-Jae
    • Journal of the Korean Wood Science and Technology
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    • v.2 no.2
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    • pp.8-12
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    • 1974
  • 1. If one unity is given to the prongs whose ends touch each other for estimating the internal stresses occuring in it, the internal stresses which are developed in the open prongs can be evaluated by the ratio to the unity. In accordance with the above statement, an equation was derived as follows. For employing this equation, the prongs should be made as shown in Fig. I, and be measured A and B' as indicated in Fig. l. A more precise value will result as the angle (J becomes smaller. $CH=\frac{(A-B') (4W+A) (4W-A)}{2A[(2W+(A-B')][2W-(A-B')]}{\times}100%$ where A is thickness of the prong, B' is the distance between the two prongs shown in Fig. 1 and CH is the value of internal stress expressed by percentage. It precision is not required, the equation can be simplified as follows. $CH=\frac{A-B'}{A}{\times}200%$ 2. Under scheduled drying condition III the kiln, when the weight of a sample board is constant, the moisture content of the shell of a sample board in the case of a normal casehardening is lower than that of the equilibrium moisture content which is indicated by the Forest Products Laboratory, U. S. Department of Agriculture. This result is usually true, especially in a thin sample board. A thick unseasoned or reverse casehardened sample does not follow in the above statement. 3. The results in the comparison of drying rate with five different kinds of wood given in Table 1 show that the these drying rates, i.e., the quantity of water evaporated from the surface area of I centimeter square per hour, are graded by the order of their magnitude as follows. (1) Ginkgo biloba Linne (2) Diospyros Kaki Thumberg. (3) Pinus densiflora Sieb. et Zucc. (4) Larix kaempheri Sargent (5) Castanea crenata Sieb. et Zucc. It is shown, for example, that at the moisture content of 20 percent the highest value revealed by the Ginkgo biloba is in the order of 3.8 times as great as that for Castanea crenata Sieb. & Zucc. which has the lowest value. Especially below the moisture content of 26 percent, the drying rate, i.e., the function of moisture content in percentage, is represented by the linear equation. All of these linear equations are highly significant in testing the confficient of X i. e., moisture content in percentage. In the Table 2, the symbols are expressed as follows; Y is the quantity of water evaporated from the surface area of 1 centimeter square per hour, and X is the moisture content of the percentage. The drying rate is plotted against the moisture content of the percentage as in Fig. 2. 4. One hundred times the ratio(P%) of the number of samples occuring in the CH 4 class (from 76 to 100% of CH ratio) within the total number of saplmes tested to those of the total which underlie the given SR ratio is measured in Table 3. (The 9% indicated above is assumed as the danger probability in percentage). In summarizing above results, the conclusion is in Table 4. NOTE: In Table 4, the column numbers such as 1. 2 and 3 imply as follows, respectively. 1) The minimum SR ratio which does not reveal the CH 4, class is indicated as in the column 1. 2) The extent of SR ratio which is confined in the safety allowance of 30 percent is shown in the column 2. 3) The lowest limitation of SR ratio which gives the most danger probability of 100 percent is shown in column 3. In analyzing above results, it is clear that chestnut and larch easly form internal stress in comparison with persimmon and pine. However, in considering the fact that the revers, casehardening occured in fir and ginkgo, under the same drying condition with the others, it is deduced that fir and ginkgo form normal casehardening with difficulty in comparison with the other species tested. 5. All kinds of drying defects except casehardening are developed when the internal stresses are in excess of the ultimate strength of material in the case of long-lime loading. Under the drying condition at temperature of $170^{\circ}F$ and the lower humidity. the drying defects are not so severe. However, under the same conditions at $200^{\circ}F$, the lower humidity and not end coated, all sample boards develop severe drying defects. Especially the chestnut was very prone to form the drying defects such as casehardening and splitting.

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A Study of the Bezel Settings of a JinjuseonUsed for Joseon Royal Weddings Based on an Examination of the Washers (제조선시대 궁중혼례용 '진주선(眞珠扇)'의 받침못을 통해 본 감장(嵌裝) 기법 고찰)

  • Sim, Myung Bo;Kim, Sun Young
    • Conservation Science in Museum
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    • v.21
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    • pp.17-28
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    • 2019
  • The term jinjuseon(眞珠扇), meaning literally a pearl fan, refers to a fan decorated with precious stones for use in royal wedding ceremonies. This study examined a jinjuseon housed in the National Palace Museum of Korea (NPMK) which currently lacks jeweled ornaments. In order to determine whether pearls or other gemstone settings originally ornamented the fan,the surface and composition of the gray materials remaining on the washers were investigated and the fan was compared with other artifacts decorated using similar techniques. The analysis revealed that the gray materials visible around the round rims of the washers contain tin-lead alloys. The traces of folded nails suggest that soldering was not applied. The remains of the infill observed in other artifacts with bezel settings indicate that this jinjuseon in the NPMK collection was produced using abezel setting technique wherein pearls or other gemstones were affixed by filling cylindrical bezels with tin-lead alloys.

INTRAVENOUS SEDATION OF CEREBRAL PALSY PATIENT FOR DENTAL IMPLANT CT TAKING -A CASE REPORT (정신지체가 동반된 뇌성마비 환자의 임플란트 치료를 위한 CT 촬영 시 진정법 시행 -증례보고-)

  • Seo, Kwang-Suk;Lee, Ju-Hwan;Shin, Teo-Jeon;Yi, Young-Eun;Kim, Hyun-Jeong;Yum, Kwang-Won;Kim, Myung-Jin
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.4 no.1
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    • pp.21-25
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    • 2008
  • A 33-years-old female pateint with cerebral palsy showing spastic quardriplegia and severe mental retardation was scheduled for dental implant restorations. Before implant surgery we had to take implant CT. But, because of her involuntary motion and communication difficulty, sedation was needed in order to take CT. After 8 hour NPO, propofol infusion sedation with TCI (target controlled infusion) system was administered. The propofol blood concentration of the patient was maintained 2-3 ${\mu}$/ml to keep deep sedation to prevent uncontolled movement. During sedation, we monitored ECG, pulse oximetry, blood pressure, capnometry for patient safety. Oxygen was administered via nasal prong for preventing hypoxemia and to keep airway during sedation some bands were applied to lift mandible. Total duration was 20 minutes for taking CT, and she was discharged from hospital after 30 minute rest without complication.

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Systemic Immediate Hypersensitive Reactions after Treatment with Sweet Bee Venom: A Case Report

  • Jo, NaYoung;Roh, JeongDu
    • Journal of Pharmacopuncture
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    • v.18 no.4
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    • pp.59-62
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    • 2015
  • Objectives: A previous study showed that bee venom (BV) could cause anaphylaxis or other hypersensitivity reactions. Although hypersensitivity reactions due to sweet bee venom (SBV) have been reported, SBV has been reported to be associated with significantly reduced sensitization compared to BV. Although no systemic immediate hypersensitive response accompanied by abnormal vital signs has been reported with respect to SBV, we report a systemic immediate hypersensitive response that we experienced while trying to use SBV clinically. Methods: The patient had undergone BV treatment several times at other Oriental medicine clinics and had experienced no adverse reactions. She came to acupuncture & moxibustion department at Semyung university hospital of Oriental medicine (Je-cheon, Korea) complaining of facial hypoesthesia and was treated using SBV injections, her first SBV treatment. SBV, 0.05 cc, was injected at each of 8 acupoints, for a total of 0.40 cc: Jichang (ST4), Daeyeong (ST5), Hyeopgeo (ST6), Hagwan (ST7), Yepung (TE17), Imun (TE21), Cheonghoe (GB2), and Gwallyeo (SI18). Results: The patient showed systemic immediate hypersensitive reactions. The main symptoms were abdominal pain, nausea and perspiration, but common symptoms associated with hypersensitivity, such as edema, were mild. Abdominal pain was the most long-lasting symptom and was accompanied by nausea. Her body temperature decreased due to sweating. Her diastolic blood pressure could not be measured on three occasions. She remained alert, though the symptoms persisted. The following treatments were conducted in sequence; intramuscular epinephrine, 1 mg/mL, injection, intramuscular dexamethasone, 5 mg/mL, injection, intramuscular buscopan, 20 mg/mL, injection, oxygen ($O_2$) inhalation therapy, 1 L/minutes, via a nasal prong, and intravascular injection of normal saline, 1 L. After 12 hours of treatment, the symptoms had completely disappeared. Conclusion: This case shows that the use of SBV does not completely eliminate the possibility of hypersensitivity and that patients who received BV treatment before may also be sensitized to SBV. Thus, a skin test should be given prior to using SBV.

A Study on Pattern Recognition to Compute Guidelines Based on Evidence for Ecological Healing Environment at Agha Khan Hospital in Karachi - Focused on Human Thermal Comfort Model (HTCM), for Karachi, using Climate Consultant Program

  • Shaikh, Javaria Manzoor;Park, Jae Seung
    • KIEAE Journal
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    • v.15 no.2
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    • pp.27-35
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    • 2015
  • Purpose: Healthcare is on the whole a personal and critical service that consumer's use, whereas hospitalization is as a rule painful, because nature nurtures and Sun Light Luminosity for healthcare settings is considered healing. The performance and design of climate responsive buildings such as AKU requires a detailed study of attributes of climate both at micro as well as macro level. The therapeutic value of contact with nature through window view, greenery and landscape is calculated there. Method: A two prong strategy is been devised for this article, at micro level three typical morphologies are analysed by creating same environment of neighboring building on sun shading chart, radiation and temperature range. Since the analysis of local climate helps to determine the design strategies for hospital Healing Environment which is suitable for Karachi climate; in order to track the macro climatic behaviour, a considerable analysis of psychometrics chart for AKU Karachi are designed on Climate Consultant (CC) and analysed by Machine Learning. Climate Consultant proposes different design strategies suitable for Karachi. And on the other hand time wise illumination sources for clinical area which are then measured on psychrometric chart- according to singular space: multi patient admission, secondly: acute ambulatory ward, and tertiary: multi windowed space according to the mushrabiyah and sky light pattern. Result: Our findings support the hypothesis that windowed wall is 75-80% more healing wall; an accelerated evidence was found for healing at macro level if the form of the hospital is designed according to the climatologically preferences, whereas at micro level: the light resource becomes the staff attentiveness determinant. In Conclusion evidence was provided that the actual form of luminosity results consequently in satisfaction while light entering from several set of windows and other sources might be valued if design according to the healing environment. The data added on the sun shading chart to calculate rays entraining into space in patient room equal to 124416.21 Watts/ meter $m^2$ is calculated as precise healing rate-and is confirmed by questionnaire from patients belonging from each clinical stage having different illnesses.

Acoustic Rhinometric Comparison of Cleft Side with Non-cleft Side after Repair of Unilateral Cleft Lip Nose Deformity (일측 구순열비변형에서 음향비계측법(acoustic rhinometry)의 이용: 개열측과 비개열측의 비교)

  • Han, Ki Hwan;Kwon, Hyuk Joon;Kim, Hyun Ji;Kim, Jun Hyung;Son, Dae Gu
    • Archives of Plastic Surgery
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    • v.33 no.1
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    • pp.75-79
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    • 2006
  • The upper and lower lateral cartilages provide the key to the lower cartilaginous portion of the nose. Lifting the cartilages is essential procedure for correction of unilateral cleft lip nose deformity. After correction of cleft lip nose deformity, authors used acoustic rhinometry (AR) to compare the lower nasal cavity of cleft side with non-cleft side. AR is a well known new, non-invasive diagnostic technique in which nasal geometry is assessed by means of acoustic reflection. From June 1996 to January 2004, we performed acoustic rhinometric analysis after correction of unilateral cleft lip nose deformity. This study involved 40 children of age ranged from 3 months to 8 years. Subjects were divided into the group of incomplete unilateral cleft lip nose deformity(20 subjects), and the group of complete unilateral cleft lip nose deformity(20 subjects). Results show that lower nasal cavity volume between non-cleft side and cleft side has no difference, and better results were obtained when nasal molding prong was applied at cleft side nostril. The results between incomplete type and complete type have no significant difference. In conclusion, AR is an effective method to calibrate cross sectional area and nasal cavity volume of unilateral cleft lip nose deformity, and furthermore effective in comparing the volume of cleft side with non-cleft side after unilateral cleft lip nose deformity correction with lifting the lower lateral cartilages to the upper lateral cartilages.

A Study for a Near-Field Microwave Microscope Using a Tuning Fork Distance Control System in liquid Environment (튜닝폭 거리조절 센서를 이용한 근접장 마이크로파 현미경의 수중 측정을 위한 연구)

  • Kim, Song-Hui;Yoo, Hyung-Keun;Babajanyan, Arsen;Kim, Jong-Chul;Lee, Kie-Jin
    • Journal of the Korean Society for Nondestructive Testing
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    • v.27 no.4
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    • pp.345-353
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    • 2007
  • We have obtained a topographical image nondestructively for a Cu thin film in liquid using a near-field scanning microwave microscope (NSMM), its operating frequency was 3.5 to 5.5 GHz. We have kept a distance of 10 nm between tip and sample using a quartz tuning fork shear force feedback system. As an end of tip was attached to one prong of the quartz tuning fork has a length of 2 mm, the only tip of tuning fork was immersed in water tank. A loss cause by evaporation in water tank is regulated with actuator was connected to a supplementary tank. Moreover, using a revise program of LabView, we could increase the accuracy of a measurement in liquid.

The Effect of Oxygen Therapy on VPB in Patients with Chronic Obstructive Pulmonary Disease (만성 폐쇄성 폐질환 환자에서 심실 조기수축에 대한 산소치료의 효과)

  • Shin, Kyu-Suck;Ko, Jeong-Seok;Kim, Seo-Jong;So, Kun-Ho;Jin, Gyo-Hyun;Lee, Keun;Lee, Gwi-Lae;Roh, Yong-Ho
    • Tuberculosis and Respiratory Diseases
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    • v.47 no.1
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    • pp.42-49
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    • 1999
  • Background: In patients with chronic obstructive pulmonary disease(COPD). it is well known that hypoxemia increases the frequency of VPB, which is associated with the poor prognosis such as sudden death. The aim of this study is to evaluate the effect of short and long-term low flow oxygen therapy on the development of VPBs in patients with COPD by correcting the hypoxemia. Method: In 19 patients with COPD, oxygen saturation and VPB's were monitored by pulse oxymeter and 24-hour Holter EKG, with room air and oxygen saturation and VPB's were monitored on the 1st and on the 8th day during oxygen therapy with nasal prong (2L/min). Results : The arterial oxygen saturation was significantly higher on the 1st day of oxygen therapy compared with breathing room air, and was also higher on the 8th day of oxygen therapy than on the 1st day. We found that there was significant correlation between the lowest value of the arterial oxygen saturation and the mean value of the arterial oxygen saturation. The number of VPB's per hour was significantly lower on the 1st day of oxygen therapy compared with breathing room air, and also lower on the 8th day of oxygen therapy than on the 1st day. Our results showed positive correlation between the decrease in the frequency of VPB's and the increase in the lowest arterial oxygen saturation, even though correlation was not significant(p=0.056). Conclusion: With oxygen therapy, the arterial oxygen saturation was increased and the number of VPB's was decreased. Long-term oxygen therapy more than 7days, would be helpful to decrease the number of VPB' s in patients with COPD.

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A Study on the Changes in Ventilator Care Rate and Outcome of Very Low Birth Weight Infants During Last Four Years (최근 4년간 극소 저출생 체중아의 인공 호흡기 치료율과 경과 변화에 관한 연구)

  • Jung, Byun Kyung;Kim, Yeoung Ju;Lee, Sang Geel
    • Clinical and Experimental Pediatrics
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    • v.46 no.11
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    • pp.1073-1079
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    • 2003
  • Purpose : Recently there has been a decrease in ventilator care rate and duration of very low birth weight infants(VLBWI) in Fatima Hospital. The aims of this study were to survey the frequency and duration of ventilation in VLBWI and to develop a non-invasive neonatal intensive care unit (NICU) policy. Methods : We performed a retrospective study of 284 newborn of infants less than 1,500 gm admitted to NICU and discharged from January 1998 to December 2001. Patients were intubated or applied continuous positive airway pressure(CPAP) via nasal prong immediately after presenting signs of respiratory distress. We analyzed epidemiologic data to study the changes in ventilator care rate, duration and outcome of ventilator care groups. Results : Of 284 newborn infants, 146 required invasive management, such as endotracheal intubation and assisted ventilation. The characteristics, the severity of clinical symptoms and laboratory findings in ventilator care groups at birth showed no significant differences. The annual proportion of infants requiring assisted ventilation decreased according to increasing gestational age. The median duration of ventilation decreased markedly from 6.0 days in 1998 to 2.7 days in 2001. Final complications and outcomes in ventilator care groups showed no significant differences. Conclusion : Our study shows a significant reduction in the invasiveness of the treatment of VLBW infants, which was not associated with an increased mortality or morbidity. A non-invasive strategy for the VLBW infant with minimal to moderate respiratory distress after birth in NICU is better than immediate invasive management. Non-invasive nasal CPAP is a simpler and safer method than invasive assisted ventilation.