• Title/Summary/Keyword: stroke

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Central Nervous System Complications of Coronary Artery Bypass Grafting - Comparison Between Off-Pump CABG and Conventional CABG (관상동맥 우회술 후의 중추신경계 합병증 - 심폐바이패스를 사용하지 않은 관상동맥 우회술과 기존의 관상동맥 우회술의 비교)

  • Chang, Ji-Min;Lee, Jeong-Sang;Kim, Ki-Bong;Ahn, Hyuk;Yoon, Byung-Woo;Kim, Yong-Jin
    • Journal of Chest Surgery
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    • v.33 no.12
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    • pp.941-947
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    • 2000
  • Background: Central nervous system complication after coronary artery bypass grafting(CABG) is one of the major prognostic determinants and the use of the cardiopulmonary bypass(CPB) may increase the incidence of this devastating complication. In this study, the outcomes after off-pump CABG were studied and compared with those following the conventional CABG using CPB. Material and Method: Among the consecutive isolated CABG's performed in SNUH during Feb. 1995 and Jun. 1999, 338 coronary artery bypass grafting were divided into two groups. 223 patients underwent CABG using the CPB(Group I), and 115 patients underwent CABG without CPB(OPCAB)(Group II). All patients enrolled in this study received extensive preoperative examinations including thorough neurologic examination before and after surgery, transcranial doppler study, carotid duplex ultrasonography, and magnetic resonance angiography if necessary. Central nervous system(CNS) complications were defined as stroke, seizure, metabolic or hypoxic encephalopathy and transient delirium after surgery. Result: There were 61 cases(27.3%) who developed postoperative CNS complication in Group I, whereas 8 cases(7.0%) of CNS complications developed postoperatively in group II(p<0.05). Statistically significant predictors of postoperative CNS complications in group I were age and the use of cardiac assist devices perioperatively. Conclusion: This study suggested that omitting the use of CPB in CABG resulted in significant decrease of the postoperative CNS complications. OPCAB should be more widely applied especially to the elderly who have preexisting cerebrovascular disease.

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A Study on Fall Accident (1개 종합병원 환자의 낙상에 관한 조사)

  • Lee, Hyeon-Suk;Kim, Mae-Ja
    • The Korean Nurse
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    • v.36 no.5
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    • pp.45-62
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    • 1998
  • The study was conducted from November 1995 to May 1996 at the one general hospital in Seoul. The total subjects of this study were 412 patients who have the experience of fall accident, among them 31 was who have fallen during hospitalization and 381 was who visited emergency room and out patient clinic. The purposes of this study were to determine the characteristics, risk factors and results of fall accident and to suggest the nursing strategies for prevention of fall. Data were collected by reviewing the medical records and interviewing with the fallers and their family members. For data analysis, spss/pc+ program was utilized for descriptive statistics, adjusted standardized $X^2$-test. The results of this study were as follows: 1) Total subjects were 412 fallers, of which 245(59.5%) were men and 167(40.5%) were women. Age were 0-14 years 79(19.2%), 15-44 years 125(30.4%), 45-64 years 104(25.2%), over 65 years 104(25.2%). 2) There was significant association between age and the sexes ($X^2$=39.17, P=0.00). 3) There was significant association between age and history of falls ($X^2$=44.41. P= .00). And history of falls in the elderly was significantly associated with falls. 4) There was significant association with age and medical diagnosis ($X^2$=140.66, P= .00), chief medical diagnosis were hypertension(34), diabetis mellitus(22), arthritis(11), stroke(8), fracture(7), pulmonary tuberculosis(6), dementia(5) and cataract(5), 5) There was significant association between age and intrinsic factors: cognitive impairment, mobility impairment, insomnia, emotional problems, urinary difficulty, visual impairments, hearing impairments, use of drugs (sedatives , antihypertensive drugs, diuretics, antidepressants) (P < 0.05). But there was no significant association between age and dizziness ($X^2$=2.87, P=.41). 6) 15.3% of total fallers were drunken state when they were fallen. 7) Environmental factors of fall accident were unusual posture (50.9%), slips(35.2%), trips (9.5%) and collision(4.4%). 8) Most of falls occurred during the day time, peak frequencies of falls occurred from 1pm to 6pm and 7am to 12am. 9) The places of fall accident were roads(22.6%), house-stairs 06.7%), rooms, floors, kitchen (11.2%), the roof-top, veranda, windows(10.9%), hospital(7.5%), ice or snowy ways(5.8%), bathroom(4.9%), playground, park(4.9%), subway-stairs(4.4%) and public-bathrooms (2.2%). 10) Activities at the time of fall accident were walking(37.6%), turning around or reaching for something(20.9%), going up or down stairs09.2%), exereise, working07.4%), up or down from a bed(2.7%), using wheelchair or walking aids, standing up or down from a chair(2.2%) and standing still(2.2%). 11) Anatomical locations of injuries by falls were head, face, neck(31.3%), lower extremities (29.9%). upper extremities(20.6%), spine, thorax, abdomen or pelvic contents(l1.4%) and unspecified(2.9%). 12) Types of injures were fracture(47.6%), bruises03.8%), laceration (13.3%), sprains(9.0%), headache(6.6%), abrasions(2.9%), intracranial hemorrage(2.4%) and burns(0.5%). 13) 41.5% of the fallers were hospitalized and average of hospitalization was 22.3 days. 14) The six fallers(1.46%) died from fall injuries. The two fallers died from intracranial hemorrage and the four fallers died of secondary infection; pneumonia(2), sepsis(1) and cell lulitis(1). It is suggested that 1) Further study is needed with larger sample size to identify the fall risk factors. 2) After the fall accident, comprehensive nursing care and regular physical exercise should be emphasized for the elderly person. 3) Safety education and safety facilities of the public place and home is necessary for fall prevention.

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Impact of Awareness and Educational Experiences on Cardiopulmonary Resuscitation in the Ability to Execute of Cardiopulmonary Resuscitation among Korean Adults (한국 성인에서 심폐소생술에 대한 인지, 교육경험이 그 시행능력에 미치는 영향)

  • Lee, Jae-Kwang;Kim, Jeongwoo;Kim, Kunil;Kim, Keunhyung;Kim, Dongphil;Kim, Yuri;Moon, Seonggeun;Min, Byungju;Yu, Hwayoung;Lee, Chealim;Jeong, Wonyoung;Han, Changhun;Huh, Inho;Park, Jung Hee;Lee, Moo-Sik
    • Journal of agricultural medicine and community health
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    • v.43 no.4
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    • pp.234-249
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    • 2018
  • This study was performed to identify the impact of awareness and educational experiences on cardiopulmonary resuscitation in the ability to execute of cardiopulmonary resuscitation among Korean adults. This study used original data of 2014 Community Health Data Survey. 228,712 participants in this survey were resident in South Korea who is aged 19 or older on July 2014. Participants in this survey were sampled an average of 900 residents(target error ${\pm}3percent$) per community health center of Korea. Data were analyzed by using R 3.1.3 employing chi-squared test, fisher's exact analysis, and logistic regression analysis. Ability to execute CPR was significantly higher in males(3.34 time), higher the education level (1.61 times), the white color occupation (1.14 times), the higher the income level (1.07 times), the higher the education level (0.91 times), non-hypertensive patients (1.12 times), non-diabetic patients (1.16 times), non-dyslipidemic patients (0.86 times), non-stroke patients (0.30 times), CPR education experience group (3.25 times), CPR experience group with manikin-based training (4.30 times), higher subjective health status (1.08 times, 1.16 times) respectively. This study identified that awareness, educational experience, and mannequin-based learning experience of CPR impacted on the ability to execute CPR. Responding to education-related factors could contribute to reducing the rate of out-of-hospital acute cardiac arrest by improving the ability to execute CPR of the general public.

Clinical Practice Guideline for Cardiac Rehabilitation in Korea

  • Kim, Chul;Sung, Jidong;Lee, Jong Hwa;Kim, Won-Seok;Lee, Goo Joo;Jee, Sungju;Jung, Il-Young;Rah, Ueon Woo;Kim, Byung Ok;Choi, Kyoung Hyo;Kwon, Bum Sun;Yoo, Seung Don;Bang, Heui Je;Shin, Hyung-Ik;Kim, Yong Wook;Jung, Heeyoune;Kim, Eung Ju;Lee, Jung Hwan;Jung, In Hyun;Jung, Jae-Seung;Lee, Jong-Young;Han, Jae-Young;Han, Eun Young;Won, Yu Hui;Han, Woosik;Baek, Sora;Joa, Kyung-Lim;Lee, Sook Joung;Kim, Ae Ryoung;Lee, So Young;Kim, Jihee;Choi, Hee Eun;Lee, Byeong-Ju;Kim, Soon
    • Journal of Chest Surgery
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    • v.52 no.4
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    • pp.248-329
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    • 2019
  • Background: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. Methods: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. Results: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Conclusion: Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

A Study on the Sketch of Trikaya Banner Painting in the Suta-sa Temple (수타사 삼신불괘불도(三身佛掛佛圖) 초본(草本) 연구)

  • Kim, Chang Kyun
    • Korean Journal of Heritage: History & Science
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    • v.42 no.4
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    • pp.112-131
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    • 2009
  • The Trikaya Banner Painting in the Suta-sa Temple at Hongcheon-gun, Gangwon-do draws attention as it was painted not on flax but on paper, and used the water color painting technique on the sketch rather than the deep color painting technique, which is most common in Buddhist paintings created during the Chosun Dynasty. Nevertheless, there is not any information on the creation of the Trikaya Banner Painting in the painting record on the painting, in Sutasasajeok(壽陀寺史蹟), or in Sutasagogirok(壽陀寺古記錄), so it is uncertain when the painting was created. Furthermore, because it was not drawn by the deep color painting technique, it has been difficult to compare it with other banner paintings. For these reasons, the Trikaya Banner Painting has been studied little except brief introduction. In recent preservation treatment that removed multiple-layered paper from the back of the painting, however, an inked inscription written on Korean paper 118cm high and 87.5cm wide was discovered on the back. It is a kind of placard notifying a number of acts prohibited in order to follow Buddha's teachings correctly, and was found to have been written on April 15, 1690. The inked inscription is a very valuable material for estimating the creation date of the Suta-sa Trikaya Banner Painting, and provides crucial clues for approaching the contents and nature of the painting more precisely. When the image, form, and style of the Suta-sa Trikaya Banner Painting were examined and its creation date was estimated based on the inked inscription, first, the painting is presumed to have been created in around 1690 as suggested by 'the placard' attached on the back instead of a painting record. Second, the painting is highly likely to be the first standing Trikaya banner painting showing the basic icons of Trikaya banner paintings in the Chosun Dynasty since the Trikaya Banner Painting in the Gap-sa Temple in Gongju (1650). Furthermore, considering the shape of the Trikaya in the painting, screen composition, background treatment, solemn and affectionate facial expression, harmonious and adequate body proportion, etc., the painting is believed to have had a considerable influence not only on Trikaya banner paintings of similar style in the 18thcentury but also on deep-color Trikaya banner paintings in the 19thcentury. Third, although the Suta-sa Trikaya Banner Painting is not acompleted work but a sketch, it exhibits the typical water color painting technique in which the strokes are clearly visible. Thus, it is considered highly valuable in understanding and analyzing stroke styles and in studying the history of Buddhist paintings. As there are not many extant banner paintings of the same style in form and expression technique as the Suta-sa Temple Trikaya Banner Painting, this study could not make thorough comparative analysis of the work, but still it is meaningful in that it laid the ground for research on standing Trikaya banner paintings in the 18thand 19thcenturies in the Chosun Dynasty.

The Influx of Four Wangs' Landscape Style Reinterpreted in Jiangnan Circle(江南) in the 19th Century Focused on An Geon-yeong(安健榮)'s Six-fold Landscape Screen (19세기 강남(江南)에서 재해석된 사왕풍(四王風) 산수화의 유입 안건영(安健榮)의 <산수도> 6폭 병풍을 중심으로)

  • Choi, Kyoung Hyun
    • Korean Journal of Heritage: History & Science
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    • v.41 no.2
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    • pp.79-97
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    • 2008
  • Four Wangs' landscape style (四王山水畵風), which had appeared in Beijing in the early 18th century, widely spread to Korea and Japan in the 19th century and became a significant basis for developing new painting styles in both countries. It was first introduced to Korea by Shin Wi (申緯) and Kim Jeong-hee (金正喜) who associated with literary men of the Qing Dynasty. Being influenced by them directly or indirectly, Shin Myeong-yeon (申命淵), Yi Han-cheol (李漢喆), Yu Suk (劉淑), Changv Seung-eop (張承業), An Choog-sik (安中植), and Jo Seok-jin (趙錫晋) attempted to adapt Four Wangs' landscape style and it later became a main Stream painting style of the Korean painting circles. Based on Four Wangs' landscape style, their landscape paintings had something in common in that they captured natural features from a short distance using the Down-Up prospective and placed guardian mountains across mountain streams by making a tall tree in the right or left bottom of the canvas as the starting point. However, recently unveiled court painter An Geon-yeong (1841~1876)'s the Landscape Screen is remarkable in that it is based on Four Wangs' style, which was in fashion in the late 19th century, but shows different aspects from other Four Wangs' style paintings in terms of feature capturing, brush stroke and colors. While most of An Geon-yeong's existing paintings are small ones, this folding screen is a big piece consisting of six-fold landscape paintings. In particular, it shows new aspects by creating a serene and calm atmosphere through the description of various landscape scenes with thin brush strokes using glossy ink, by showing a macroscopic view in some paintings through feature capture using a birds-eye view method, and by giving life to the canvas through smoke and clouds. This painting style is considered to be linked with those of Wang Xue-hao (王學浩, 1754~1832), Tang Yifen (湯貽汾, 1778~1853) and Dai Xi (戴熙, 1801~1860), based on Four Wangs' style in the early 19th century's Jiangnan Circle (江南 畵壇), who tried to express the energy and vitality of real landscapes by going around China's well-known mountains and complementing painting styles with drawing from nature. Therefore, An Geon-yeong's six-fold Landscape Screen is very significant as a rare case proving the introduction and reception of Jiangnan Circle's Four Wangs' landscape style which was different in many aspects from Beijing Circle in the 19th century.

Effects of l-arginine supplementation with high-intensity training on muscle damage and fatigue index and athletic performance in Canoe Athletes (L-arginine 섭취가 고강도 훈련 프로그램에 따른 카누선수의 근 손상 지표, 피로 물질 및 경기력 향상에 미치는 영향)

  • Jung, Jong-Hwan;Kang, Eun-Bum;Kim, Chang-Hwan
    • Journal of the Korean Applied Science and Technology
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    • v.36 no.3
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    • pp.942-953
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    • 2019
  • The objective of this study was to evaluate the effects of L-arginine supplementation on muscle damage and fatigue indices and athletic performance improvement of canoe athletes after conducting a high-intensity training program. To achieve the objective, this study applied a high-intensity training program to seven high school canoe athletes. The high-intensity training program is composed of aerobic exercise sessions (twice per week; Tuesday and Thursday), anaerobic exercise sessions (three times per week; Monday, Wednesday, and Friday), and flexibility exercise sessions (five times per week). During the 6 week high-intensity training program, drug ingestion (L-arginine or placebo) was conducted in the first two weeks, wash out (two weeks) followed it, and drug ingestion (L-arginine or placebo) was carried out again in the last two weeks. The crossover design was used for the experiment so all study subjects were assigned to either the L-arginine intake group (the treatment group) or the placebo group (the control group). Each subject ingested 3g per day. This study confirmed the significant effects of L-arginine supplementation on muscle damage indices, fatigue indices, and antioxidants using blood samples. Additionally, FMD was analyzed to evaluate vascular endothelial cell functions and canoe performance was examined using the canoe ergometer. The results of this study showed that L-arginine intake did not have direct effects on the levels of ammonia, IP, and CK. The level of LDH decreased significantly more in the ARG group than in the PLA group due to L-arginine supplementation. Moreover, L-arginine supplementation did not change total NO, d-ROMs, BAP, and FMD significantly. Lastly, the results of the 500m canoe ergometer, which was conducted to evaluate the canoe performance, revealed that L-arginine did not have direct effects on total time, stroke distance, and mean velocity. However, L-arginine supplementation significantly improved muscle damage indices, fatigue indices, antioxidants, FMD, and canoe performance. Therefore, it is believed that additional studies are needed for examining the potential effects of L-arginine supplementation athletic performance enhancement.

Cross-cultural Adaptation and Psychometric Evaluation of the Korean Version of the A-ONE (한국판 일상생활활동중심 작업기반 신경행동평가(A-ONE)의 개발 및 평가)

  • Kang, Jaewon;Park, Hae Yean;Kim, Jung-Ran;Park, Ji-Hyuk
    • Therapeutic Science for Rehabilitation
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    • v.10 no.2
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    • pp.109-128
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    • 2021
  • Objective : The purpose of this study was to develop a Korean version of the Activities of Daily Living (ADL)-focused Occupation-Based Neurobehavioral Evaluation (A-ONE) through cross-cultural adaptation and examine its validity and reliability. Methods : This study translated the A-ONE into Korean and performed cross-cultural adaptation for the Korean population. After the development of the Korean version of the A-ONE, cross-cultural and concurrent validities were analyzed. Internal consistency, test-retest reliability, and inter-rater reliability were also evaluated. Results : We adapted three items to the Korean culture. The Korean version of the A-ONE showed high cross-cultural validity with a content validity index (I-CVI) >0.9. It correlated with the Functional Independence Measure (FIM) (r=0.52-0.77, p<0.001), except for communication. Cronbach's α was 0.58-0.93 for the functional independence scale (FI) and 0.42-0.93 for the neurobehavioral specific impairment subscale (NBSIS). Intraclass correlation coefficients (ICCs) indicated high test-retest and inter-rater reliability for FI (ICC=0.79-1.00 and 0.75-1.00, respectively) and NBSIS (ICC=0.74-1.00 and 0.72-1.00, respectively). Conclusion : The Korean version of the A-ONE is well adapted to the Korean culture and has good validity and reliability. It is recommended to evaluate ADL performance skills and neurobehavioral impairments simultaneously in Korea.

Effects of Exhaust Gas Recirculation on Power and Thermal Efficiency of Reactivity Controlled Compression Ignition in Different Load Conditions with a 6-L Engine (6 L급 압축착화 기관에서 천연가스-디젤 반응성 조정 연소 시 부하에 따른 배기 재순환율이 출력 및 열효율에 미치는 영향 분석)

  • Lee, Sunyoup;Lee, Seok-Hwan;Kim, Chang-Gi;Lee, Jeong-Woo
    • Journal of the Korean Institute of Gas
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    • v.24 no.6
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    • pp.1-10
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    • 2020
  • Reactivity controlled compression ignition (RCCI) combustion is one of dual-fuel combustion systems which can be constructed by early diesel injection during the compression stroke to improve premixing between diesel and air. As a result, RCCI combustion promises low nitrogen oxides (NOx) and smoke emissions comparing to those of general dual-fuel combustion. For this combustion system, to meet the intensified emission regulations without emission after-treatment systems, exhaust gas recirculation (EGR) is necessary to reduce combustion temperature with lean premixed mixture condition. However, since EGR is supplied from the front of turbocharger system, intake pressure and the amount of fresh air supplementation are decreased as increasing EGR rate. For this reason, the effect of various EGR rates on the brake power and thermal efficiency of natural gas/diesel RCCI combustion under two different operating conditions in a 6 L compression ignition engine. Varying EGR rate would influence on the combustion characteristic and boosting condition simultaneously. For the 1,200/29 kW and 1,800 rpm/(lower than) 90 kW conditions, NOx and smoke emissions were controlled lower than the emission regulation of 'Tier-4 final' and the maximum in-cylinder pressure was 160 bar for the indurance of engine system. The results showed that under 1,200 rpm/29 kW condition, there were no changes in brake power and thermal efficiency. On the other hand, under 1,800 rpm condition, brake power and thermal efficieny were decreased from 90 to 65 kW and from 37 to 33 % respectively, because of deceasing intake pressure (from 2.3 to 1.8 bar). Therefore, it is better to supply EGR from the rear of compressor, i.e. low pressure EGR (LP-EGR) system, comparing to high pressure EGR (HP-EGR) for the improvement of RCCI power and thermal efficiency.

Health and nutrition intake status of the Korean elderly according to their food security level: data from the 7th Korea National Health and Nutrition Examination Survey (KNHANES VII), 2016-2018 (식품안정성 수준에 따른 한국노인의 건강상태와 영양섭취현황: 제7기 (2016-2018) 국민건강영양조사 자료 활용)

  • Maeng, Ahreum;Lee, Jeehyun;Yoon, Eunju
    • Journal of Nutrition and Health
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    • v.54 no.2
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    • pp.179-198
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    • 2021
  • Purpose: This study examined general characteristics, health status, accessibility to medical services, health-related quality of life, dietary behavior, and energy and nutrient intakes of the elderly at different levels of food security utilizing data from the 7th Korea National Health and Nutrition Examination Survey (2016-2018). Methods: The elderly subjects (1,721 males and 2,271 females) were divided into 3 groups (secure, mildly insecure, moderately/severely insecure) according to their food security levels. Health and nutrient status was determined using energy intake, nutrient density, the prevalence of insufficient nutrient intake, dietary behavior, and health status. Results: The elderly with food insecurities had a lower self-evaluated health status and a higher prevalence of physician-diagnosed chronic diseases such as arthritis, osteoarthritis, rheumatoid arthritis, osteoporosis for males, and hypertension, stroke, arthritis, and osteoarthritis for females. The associated financial burden was the major reason for not accessing medical services in the food insecure group. Furthermore, the food insecure group had a higher risk of impaired health-related quality of life compared to the secure group. The proportion of subjects with an energy intake below the estimated energy requirement was higher in the food insecure group and a significantly higher prevalence of insufficient intake was observed for all the nutrients (proteins, vitamin A, vitamin B1, vitamin B2, niacin, vitamin C, calcium, and iron) assessed in this study compared to the food secure group. Conclusion: This study suggests that food insecurity poses a challenge to the health and nutritional status of the elderly population in Korea and needs proper management. It would be helpful to develop food and nutrition assistance programs to ensure the food stability of the elderly population and assure quality to address gaps in their nutrient intake.