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Postoperative Low-Dose Tranexamic Acid After Major Spine Surgery: A Matched Cohort Analysis
Lauren K. Dunn,Ching-Jen Chen,Davis G. Taylor,Kamilla Esfahani,Brian Brenner,Charles Luo,Thomas J. Buell,Sarah N. Spangler,Avery L. Buchholz,Justin S. Smith,Christopher I. Shaffrey,Edward C. Nemergut 대한척추신경외과학회 2020 Neurospine Vol.17 No.4
Objective: This was a retrospective, cohort study investigating the efficacy and safety of continuous low-dose postoperative tranexamic acid (PTXA) on drain output and transfusion requirements following adult spinal deformity surgery. Methods: One hundred forty-seven patients undergoing posterior instrumented thoracolumbar fusion of ≥3 vertebral levels at a single institution who received low-dose PTXA infusion (0.5–1 mg/kg/hr) for 24 hours were compared to 292 control patients who did not receive PTXA. The cohorts were propensity matched based on age, sex, American Society of Anesthesiologist physical status classification, body mass index, number of surgical levels, revision surgery, operative duration, and total intraoperative TXA dose (n=106 in each group). Primary outcome was 72-hour postoperative drain output. Secondary outcomes were number of allogeneic blood transfusions. Results: There was no significant difference in postoperative drain output in the PTXA group compared to control (660±420 mL vs. 710±490 mL, p=0.46). The PTXA group received significantly more crystalloid (6,100±3,100 mL vs. 4,600±2,400 mL, p<0.001) and red blood cell transfusions postoperatively (median [interquartile range]: 1 [0–2] units vs. 0 [0–1] units; incidence rate ratio [95% confidence interval], 1.6 [1.2–2.2]; p=0.001). Rates of adverse events were comparable between groups. Conclusion: Continuous low-dose PTXA infusion was not associated with reduced drain output after spinal deformity surgery. No difference in thromboembolic incidence was observed. A prospective dose escalation study is warranted to investigate the efficacy of higher dose PTXA.
Lauren Whitty,Jean Parkinson,Ha Thi Phuong Pham 아시아테플 2022 The Journal of Asia TEFL Vol.19 No.1
The English modal system is complex, and linguistic descriptions of the modals present varied accounts of the meanings that modal verbs express. It is therefore unsurprising that English modal auxiliaries can present difficulties for language learners. Focusing on can and could, this article uses the highly graded academic writing in the Michigan corpus of upper-level student papers (MICUSP) to describe epistemic modal use of can and could by L1 writers. This description is then employed in analysing the use of can and could in academic writing by Vietnamese learners of English, and in discussing atypical uses. Our analysis found that atypical uses of could involved the use of could to express meanings in contexts where likelihood was relatively high, making can more appropriate. Based on this analysis, pedagogical applications are suggested for English language teaching.
Laurens Roolfs,Vanessa Hubertus,Jacob Spinnen,Lennard K. Shopperly,Michael G. Fehlings,Peter Vajkoczy 대한척추신경외과학회 2022 Neurospine Vol.19 No.4
Traumatic spinal cord injury (SCI) disrupts the spinal cord vasculature resulting in ischemia, amplification of the secondary injury cascade and exacerbation of neural tissue loss. Restoring functional integrity of the microvasculature to prevent neural loss and to promote neural repair is an important challenge and opportunity in SCI research. Herein, we summarize the course of vascular injury and repair following SCI and give a comprehensive overview of current experimental therapeutic approaches targeting spinal cord microvasculature to diminish ischemia and thereby facilitate neural repair and regeneration. A systematic review of the published literature on therapeutic approaches to promote vascular repair after experimental SCI was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards. The MEDLINE databases PubMed, Embase, and OVID MEDLINE were searched using the keywords “spinal cord injury,” “angiogenesis,” “angiogenesis inducing agents,” “tissue engineering,” and “rodent subjects.” A total of 111 studies were identified through the search. Five main therapeutic approaches to diminish hypoxia-ischemia and promote vascular repair were identified as (1) the application of angiogenic factors, (2) genetic engineering, (3) physical stimulation, (4) cell transplantation, and (5) biomaterials carrying various factor delivery. There are different therapeutic approaches with the potential to diminish hypoxia-ischemia and promote vascular repair after experimental SCI. Of note, combinatorial approaches using implanted biomaterials and angiogenic factor delivery appear promising for clinical translation.
Lauren Togonon Arayan,Alisha Wehdnesday Bernardo Reyes,Huynh Tan Hop,Huy Tran Xuan,Eun Jin Baek,Han Sul Yang,Hong Hee Chang,Suk Kim 한국예방수의학회 2017 예방수의학회지 Vol.41 No.2
This study evaluated the antimicrobial efficacy of different concentrations of ozonated water with organic matter, fetal bovine serum, at different concentrations and incubation times with bacteria. In the absence of organic matter, total eradication of up to 5 log of Escherichia (E.) coli was achieved, however, interference by organic matter led to inefficiency of ozonated water as a disinfecting agent. In addition, diminishing antimicrobial effects at higher temperatures, even in the absence of organic matter, were also demonstrated. These findings indicate that ozonated water will be a safe and effective disinfectant agent that could be useful in meat processing, especially an intestine processing, in Korean slaughter houses.
Lauren Togonon Arayan,Alisha Wehdnesday Bernardo Reyes,Huynh Tan Hop,Huy Tran Xuan,Suk Kim,Hong Hee Chang,Han Sul Yang 한국예방수의학회(구 한국수의공중보건학회) 2017 예방수의학회지 Vol.42 No.2
The objective of this study was to determine the efficacy of ozone in sanitizing water experimentally inoculated with the gram-positive food-poisoning bacterium Staphylococcus aureus. The bactericidal effect was measured after experimentally inoculated solutions were exposed to 0, 0.5, and 1.0 ppm ozone at several time points and different temperatures, in the presence of varying concentrations of different organic matter, namely, fetal bovine serum (FBS) or cattle liver. Results revealed inhibition of the bactericidal effect in the presence of the lowest percentage of FBS, but a lower extent of the inhibition occurred when liver was used as the organic matter. It was also apparent that a higher temperature and shorter ozone exposure time had led to a more reduced bactericidal efficacy than that under a lower temperature and longer ozone exposure. This study provides insight into the potential use of ozonated water as an effective and safe disinfectant in an abattoir setting.
Lauren A. Renschler,Elizabeth A. Terrigino,Sabiya Azim,Elsa Snider,Darson L. Rhodes,Carol C. Cox 한국산업안전보건공단 산업안전보건연구원 2016 Safety and health at work Vol.7 No.2
A brief emergency planning educational presentation was taught during work hours to a convenience sample of employees of various workplaces in Northern Missouri, USA. Participants were familiarized with details about how an emergency plan is prepared by management and implemented by management-employee crisis management teams – focusing on both employee and management roles. They then applied the presentation information to assess their own organization’s emergency preparedness level. Participants possessed significantly (p < 0.05) higher perceptions of their organization’s level of emergency preparedness than non-participants. It is recommended that an assessment of organizational preparedness level supplement emergency planning educational presentations in order to immediately apply the material covered and encourage employees to become more involved in their organization’s emergency planning and response. Educational strategies that involve management-employee collaboration in activities tailored to each workplace’s operations and risk level for emergencies should be implemented.