• Tuberculosis and Respiratory Diseases
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• 제69권5호
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• pp.361-367
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• 2010

Background: Difficult-to-treat asthma afflicts a small percentage of the asthma population. However, these patients remain refractory to treat, and account for 40% to 50% of the health costs of asthma treatment, incurring significant morbidity. We conducted a multi-center cross-sectional study to characterize difficult-to-treat asthma in Korea. Methods: Subjects with difficult-to-treat asthma and subjects with controlled asthma were recruited from 5 outpatient clinics of referral hospitals. We reviewed medical records of previous 6 months and obtained patient-reported questionnaires composed of treatment compliance, asthma control, and instruments for stress, anxiety, and depression. Results: We recruited 21 subjects with difficult-to-treat asthma and 110 subjects with controlled asthma into the study. The subjects with difficult-to-treat asthma were associated with longer treatment periods, more increased health care utilization, more medication (oral corticosteroids, number of medication), and more anxiety disorder compared to those of well-controlled asthmatics. There was no difference in age, gender, history of allergy, serum IgE, blood eosinophil count, or body mass index between the 2 groups. Conclusion: Difficult-to-treat asthma is characterized by increased health care utilization and more co-morbidity of anxiety.

• 한국간담췌외과학회지
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• 제28권2호
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• pp.214-219
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• 2024

Backgrounds/Aims: Open cholecystectomy is becoming obsolete and laparoscopic cholecystectomy has become the treatment of choice in gallstone diseases. Difficult gallbladders are encountered whenever there is a frozen calot's triangle, obliterated cystic plate, or both. Rather than converting to open procedure, there has been a growing preference for laparoscopic subtotal cholecystectomy (LSC) during difficult gallbladders. This study aimed to assess the advantages, indications, and viability of LSC in difficult gallbladders. Methods: The study included patients undergoing laparoscopic cholecystectomy in NIMS Hospital, Jaipur, from January 2021 to January 2023. Data of the patients who underwent LSC for difficult gallbladders included demographics, comorbidities, operative time, conversion to open cholecystectomy, length of hospital stay, and complications. LSC was classified into three types depending on the part of the gallbladder remnant. Results: A total of 728 patients underwent laparoscopic cholecystectomy. Among them, 41 patients (5.6%) were attempted for LSC. However, one patient was converted to an open procedure and the rest 40 underwent LSC. LSC was divided into 3 types, 4 patients underwent LSC type I, 34 patients underwent type II, and 2 patients type III. The average operating time and postoperative length of hospital stay were 86.2 minutes and 2.1 days, respectively. Two patients had surgical site infection. No patient had a bile leak and none required intensive care unit care. Conclusions: LSC is a safe and feasible option for use in difficult gallbladders.

• Clinical Endoscopy
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• 제55권2호
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• pp.263-269
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• 2022

Background/Aims: Difficult biliary cannulation is an important risk factor for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Therefore, this study aimed to identify the factors that predict difficult cannulation for common bile duct stones (CBDS) to reduce the risk for PEP. Methods: This multicenter retrospective study included 1,406 consecutive patients with native papillae who underwent ERCP for CBDS. Factors predicting difficult cannulation for CBDS were identified using univariate and multivariate analyses. Results: Univariate analysis showed that six factors significantly predicted difficult cannulation: ERCP performed by non-expert endoscopists, low-volume center, absence of acute cholangitis, normal serum bilirubin, intradiverticular papilla, and type of major duodenal papilla. Multivariate analysis identified ERCP performed by non-expert endoscopists (odds ratio [OR], 2.5; p<0.001), low-volume center (OR, 1.6; p<0.001), intradiverticular papilla (OR, 1.3; p=0.007), normal serum bilirubin (OR, 1.3; p=0.038), and absence of acute cholangitis (OR, 1.3; p=0.049) as factors significantly predicting difficult cannulation for CBDS. Conclusions: Initial cannulation by an experienced endoscopist, early rescue cannulation, or early takeover by an experienced endoscopist should be considered when performing ERCP for CBDS in the presence of factors predicting difficult cannulation.

• 한국콘텐츠학회:학술대회논문집
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• 한국콘텐츠학회 2016년도 춘계 종합학술대회 논문집
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• pp.391-392
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• 2016

In Japan, the children with problem behavior have been called the difficult children. However, the definitions of the difficult children in the medical, health, childcare and education are different. As a result, it is difficult to support for the needs of children. In addition, the difficult children have been influenced by the subjectivity of the teachers. IN-Child (Inclusive Needs Child) is defined by the result of this study. IN-Child means "Child in need of inclusive education by a team, including experts. It does not depend on intellectual and developmental delays due to physical, mental, home environment." We developed the IN-Child record that enables the educational diagnosis of IN-Child. IN-Child record was made to organize and analyze of the items by experts including 3 researchers and 2 teachers. As a result, it was classified into two domains of "cause" and "effect". The domain of "cause" is classified by two domains of "physical" and "mental". The domain of effect is classified by two domains of "daily living" and "learning".

• 기술사
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• 제34권2호
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• pp.10-13
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• 2001

Workpiece materials may be relatively easy to machine by traditional methods but workpiece geometry also may be a constraint. Many shapes that are geometrically difficult to handle conventionally may be candidates for nontraditional processes. Nontraditional processes provide new opportunities for product design innovation and productivity improvements. Difficult-to-machine materials of geometric shapes difficult o produce with traditional equipment and tooling, may often be easily and cost effectively machined using nontraditional processes. Notraditional machining processes are relative newcomers o the manufacturing arena. Nontraditional chemical solutions, or even electrolytic current as the working medium rather than a conventional cutting tool or abrasive to remove or shape materials.

• 기술사
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• 제34권2호
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• pp.28-30
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• 2001

In now, the Industrial plant has been situated by the difficult status in Korea. But maybe we want to look for development direction of Industrial plant technology in order to overcome this difficult economic situation. And we should overcome this difficult position by restructuring our industrial plant part and by preconsiderating our future economic circumstances . This paper will a little help us to know the growth direction of industrial plant technology in Korea.

• 한국정밀공학회:학술대회논문집
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• 한국정밀공학회 1995년도 춘계학술대회 논문집
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• pp.118-123
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• 1995

A new grindignwheel was developed for the high performance gfinding of difficult-to-grind materials. Te grinding performance (such as grinding forces, grinding ratio, and surface roughness of ground surface) of the newly developed wheel was evaluated through experiments. Experimental results show that the performance of the newly developed wheel is superior to conventional alumina wheel and comparable to the S-G wheel.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권4호
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• pp.313-316
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• 2016

Airway obstruction in pediatric patients always poses a challenge for anesthesiologists. Beckwith-Wiedemann syndrome causes various abnormalities such as macroglossia and omphalocele. Patients with these abnormalities often need corrective surgeries. Management of difficult airway caused by conditions such as macroglossia in patients with this syndrome could be challenging. We encountered a case of difficult airway in an infant with Beckwith-Wiedemann syndrome. It was predicted that macroglossia might cause difficult ventilation, intubation, and extubation. Preoperative assessment and preparations for difficult airway should be considered.

• 한국정밀공학회지
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• 제17권4호
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• pp.48-68
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• 2000

The high-speed machining technology of difficult-to-cut material is needed to achieve the high-efficiency of die manufacturing. The high-speed machining is applied in automobile, airplane and electricityㆍelectro industry etc, because it can improve machining efficiency and productivity with high speed, high power and high rotation. In this study, high speed machinability, tool wear characteristics and its monitoring, characteristics of damaged layer, machinability of difficult-to-cut material, characteristics of a free curved surface and method of CAD/CAM system were introduced to acquire the shortening of machining time, the improvement of machining efficiency and the high quality of machined surface. Therefore, we establish the stabilization condition of difficult-to-cut material machining and present the optimal cutting condition for high-efficiency cutting.

• 한국정밀공학회지
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• 제31권1호
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• pp.29-33
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• 2014

Recently, Difficult-to-cut materials are used in many manufacturing industry. But the difficult-to-cut materials are difficult-to-cutting process. So difficult to cut material cutting process was used after heat treatment through preheating for easy cutting process. In this study, Inconel 625 was preheating using laser heat source in computer simulation. Laser heat source temperature applied $1290^{\circ}C$ that suitable preheating temperature for Inconel 625. And temperature effects such as temperature distribution for moving heat source studied apply to similar actual process condition. Simulation results for heat treatment effects through temperature distribution verified.