Simulation-based ultrasoundguided regional anesthesia curriculum for anesthesiology residents

T. Edward Kim,Ban C.H. Tsui 대한마취통증의학회 2019 Korean Journal of Anesthesiology Vol.72 No.1

Proficiency in ultrasound-guided regional anesthesia (UGRA) requires the practitioner to acquire cognitive and technical skills. For anesthesiology residents, an assortment of challenges has been identified in learning UGRA skills. Currently, a validated UGRA curriculum for residents does not exist, and the level of UGRA proficiency achieved during residency training can vary considerably. Simulated practice has been shown to enhance proficiency in UGRA, and a competency- based education with simulation training has been endorsed for anesthesiology residents. The objective of this review is to outline simulation-based training that can be implemented in a UGRA curriculum and to explore educational tools like gamification to facilitate competency in regional anesthesiology.

Implementation of clinical practice changes by experienced anesthesiologists after simulationbased ultrasound-guided regional anesthesia training

T. Edward Kim,Edward R. Mariano,Toni Ganaway,T. Kyle Harrison,Steven K. Howard,Cynthia Shum,Alex Kuo 대한마취통증의학회 2017 Korean Journal of Anesthesiology Vol.70 No.3

Background: Anesthesiologists who have finished formal training and want to learn ultrasound-guided regional anesthesia (UGRA) commonly attend 1 day workshops. However, it is unclear whether participation actually changes clinical practice. We assessed change implementation after completion of a 1 day simulation-based UGRA workshop. Methods: Practicing anesthesiologists who participated in a 1 day UGRA course from January 2012 through May 2014 were surveyed. The course consisted of clinical observation of UGRA procedures, didactic lectures, ultrasound scanning, hands-on perineural catheter placement, and mannequin simulation. The primary outcome was the average number of UGRA blocks per month reported at follow-up versus baseline. Secondary outcomes included preference for ultrasound as the nerve localization technique, ratings of UGRA teaching methods, and obstacles to performing UGRA. Results: Survey data from 46 course participants (60% response rate) were included for analysis. Participants were (median [10th–90th percentile]) 50 (37–63) years old, had been in practice for 17 (5–30) years, and were surveyed 27 (10–34) months after their UGRA training. Participants reported performing 24 (4–90) blocks per month at follow-up compared to 10 (2–24) blocks at baseline (P < 0.001). Compared to baseline, more participants at follow-up preferred ultrasound for nerve localization. The major obstacle to implementing UGRA in clinical practice was time pressure. Conclusions: Participation in a 1 day simulation-based UGRA course may increase UGRA procedural volume by practicing anesthesiologists.

The Progression of SARS Coronavirus 2 (SARS-CoV2): Mutation in the Receptor Binding Domain of Spike Gene

Sinae Kim,Jong Ho Lee,Siyoung Lee,Saerok Shim,Tam T. Nguyen,Jihyeong Hwang,Heijun Kim,Yeo-Ok Choi,Jaewoo Hong,Suyoung Bae,Hyun Jhung Jhun,Hokee Yum,이영민,Edward D. Chan,Liping Yu,Tania Azam,Yong-Dae Kim 대한면역학회 2020 Immune Network Vol.20 No.5

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is a positive-sense single-stranded RNA (+ssRNA) that causes coronavirus disease 2019 (COVID-19). The viral genome encodes twelve genes for viral replication and infection. The third open reading frame is the spike (S) gene that encodes for the spike glycoprotein interacting with specific cell surface receptor – angiotensin converting enzyme 2 (ACE2) – on the host cell membrane. Most recent studies identified a single point mutation in S gene. A single point mutation in S gene leading to an amino acid substitution at codon 614 from an aspartic acid 614 into glycine (D614G) resulted in greater infectivity compared to the wild type SARS-CoV2. We were interested in investigating the mutation region of S gene of SARS-CoV2 from Korean COVID-19 patients. New mutation sites were found in the critical receptor binding domain (RBD) of S gene, which is adjacent to the aforementioned D614G mutation residue. This specific sequence data demonstrated the active progression of SARS-CoV2 by mutations in the RBD of S gene. The sequence information of new mutations is critical to the development of recombinant SARS-CoV2 spike antigens, which may be required to improve and advance the strategy against a wide range of possible SARS-CoV2 mutations.

Can bedside patient-reported numbness predict postoperative ambulation ability for total knee arthroplasty patients with nerve block catheters?

Edward R. Mariano,Seshadri C. Mudumbai,Toni Ganaway,T. Edward Kim,Steven K. Howard,Nicholas J. Giori,Cynthia Shum 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.1

Background: Adductor canal catheters offer advantages over femoral nerve catheters for knee replacement patients because they produce less quadriceps muscle weakness; however, applying adductor canal catheters in bedside clinical practice remains challenging. There is currently no patient-reported outcome that accurately predicts patients’ physical function after knee replacement. The present study evaluates the validity of a relatively new patient-reported outcome, i.e., a numbness score obtained using a numeric rating scale, and assesses its predictive value on postoperative ambulation. Methods: We conducted a retrospective cohort study pooling data from two previously-published clinical trials using identical research methodologies. Both studies recruited patients undergoing knee replacement; one studied adductor canal catheters while the other studied femoral nerve catheters. Our primary outcome was patient-reported numbness scores on postoperative day 1. We also examined postoperative day 1 ambulation distance and its association with postoperative numbness using linear regression, adjusting for age, body mass index, and physical status. Results: Data from 94 subjects were included (femoral subjects, n = 46; adductor canal subjects, n = 48). Adductor canal patients reported decreased numbness (median [10th–90th percentiles]) compared to femoral patients (0 [0–5] vs. 4 [0–10], P = 0.001). Adductor canal patients also ambulated seven times further on postoperative day 1 relative to femoral patients. There was a significant association between postoperative day 1 total ambulation distance and numbness (Beta = −2.6; 95% CI: −4.5, −0.8, P = 0.01) with R2 = 0.1. Conclusions: Adductor canal catheters facilitate improved early ambulation and produce less patient-reported numbness after knee replacement, but the correlation between these two variables is weak.

Performance characteristics of heat exchanger with internal turbulence generators under various blade configurations and operating conditions

Kim, Dae-Hae,Pialago, Edward Joshua T.,Shin, Jai-Yoon,Kwon, Oh Kyung,Kim, Min-Soo,Park, Chan Woo Elsevier 2017 Applied thermal engineering Vol.123 No.-

<P><B>Abstract</B></P> <P>In this study, turbulence generators with rectangular geometry were designed to be fixed inside the tube of an oil cooler for the hydraulic steering of automobiles and their performance characteristics in the heat exchanger were investigated. The heat transfer rates, heat transfer coefficients, the coefficient of the pressure drop values, and friction factors were measured in accordance to the flow rates and inlet temperature of the oil. The resulting Nusselt numbers (Nu) increased when the angle of the turbulence generator wings was increased up to 45–65° but decreased when the angle was increased further up to 75°. On the hand, the friction factor (<I>f</I>) continued to increase as the angle configuration was increased. The highest value of the thermal performance enhancement factor (TEF), which was 6.46, was obtained from the turbulence generator angle of 45°, which could be considered as the optimum angle configuration. Lastly, the empirical correlations that were developed for the Nu and the <I>f</I> had good agreement with the experimental values and both had conservative error range of ±20%.</P>

An ultrasound-guided fascia iliaca catheter technique does not impair ambulatory ability within a clinical pathway for total hip arthroplasty

Edward R. Mariano,Seshadri C. Mudumbai,T. Edward Kim,Steven K. Howard,Nicholas J. Giori,Steven Woolson,Toni Ganaway,Alex Kou,Robert King 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.4

Background: Both neuraxial and peripheral regional analgesic techniques offer postoperative analgesia for total hip arthroplasty (THA) patients. While no single technique is preferred, quadriceps muscle weakness from peripheral nerve blocks may impede rehabilitation. We designed this study to compare postoperative ambulation outcome in THA patients who were treated with a new ultrasound-guided fascia iliaca catheter (FIC) technique or intrathecal morphine (ITM). Methods: We reviewed the electronic health records of a sequential series of primary unilateral THA patients who were part of a standardized clinical pathway; apart from differences in regional analgesic technique, all other aspects of the pathway were the same. Our primary outcome was total ambulation distance (meters) combined for postoperative days 1 and 2. Secondary outcomes included daily opioid consumption (morphine milligram equivalents) and analgesic-related side effects. We examined the association between the primary outcome and analgesic technique by performing crude and adjusted ordinary least-squares linear regression. A P value < 0.05 was considered statistically-significant. Results: The study analyzed the records of 179 patients (fascia iliaca, n = 106; intrathecal, n = 73). The primary outcome (total ambulation distance) did not differ between the groups (P = 0.08). Body mass index (BMI) was the only factor (β = −1.7 [95% CI −0.5 to −2.9], P < 0.01) associated with ambulation distance. Opioid consumption did not differ, while increased pruritus was seen in the intrathecal group (P < 0.01). Conclusions: BMI affects postoperative ambulation outcome after hip arthroplasty, whereas the type of regional analgesic technique used does not. An ultrasound-guided FIC technique offers similar analgesia with fewer side effects when compared with ITM.

A comparison of strength for two continuous peripheral nerve block catheter dressings

Edward R. Mariano,Lindsay Borg,Steven K. Howard,T. Edward Kim,Lauren Steffel,Cynthia Shum 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.5

Background: Despite the benefits of continuous peripheral nerve blocks, catheter dislodgment remains a major problem, especially in the ambulatory setting. However, catheter dressing techniques to prevent such dislodgment have not been studied rigorously. We designed this simulation study to test the strength of two commercially available catheter dressings. Methods: Using a cadaver model, we randomly assigned 20 trials to one of two dressing techniques applied to the lateral thigh: 1) clear adhesive dressing alone, or 2) clear adhesive dressing with an anchoring device. Using a digital luggage scale attached to a loop secured by the dressing, the same investigator applied steadily increasing force with a downward trajectory towards the floor until the dressing was removed or otherwise disrupted. Results: The weight, measured (median [10th–90th percentile]) at the time of dressing disruption or removal, was 1.5 kg (1.3–1.8 kg) with no anchoring device versus 4.9 kg (3.7–6.5 kg) when the dressing included an anchoring device (P < 0.001). Conclusions: Based on this simulation study, using an anchoring device may help prevent perineural catheter dislodgement and therefore premature disruption of continuous nerve block analgesia.

Ternary Cu–CNT–AlN composite coatings consolidated by cold spray deposition of mechanically alloyed powders

Pialago, Edward Joshua T.,Kwon, Oh Kyung,Kim, Min-Soo,Park, Chan Woo Elsevier 2015 JOURNAL OF ALLOYS AND COMPOUNDS Vol.650 No.-

<P><B>Abstract</B></P> <P>Ternary copper (Cu)–carbon nanotube (CNT)–aluminum nitride (AlN) composite coatings were consolidated by the cold gas dynamic spray (CGDS) deposition of mechanically alloyed (MA) powders. The MA powder and CGDS coating samples were characterized by weight and size measurements, optical microscopy, scanning electron microscopy, energy-dispersive X-ray spectroscopy (EDX), and X-ray diffraction (XRD). The porosity and roughness of the coatings were examined by porosimetry and profilometry, respectively. Also, the wettability of the coatings in saturated liquid R134a refrigerant was investigated. The EDX analysis depicted the non-homogeneous dispersion of the AlN as well as the CNT. The XRD results revealed that the composite powders and coatings had undergone microstraining and grain size reduction due to deformation. Metallographic examination showed that the coating internal microstructures had lamellar and compacted features, which evidenced the severe deformation that resulted from the impact during particle deposition. Although the coatings had externally porous surfaces, they had dense and non-porous internal microstructures. Moreover, smaller pores were located inside the larger pores or craters on the surfaces. The addition of 10 vol.% and 20 vol.% AlN into the Cu–5CNT mixture produced ternary Cu–CNT–AlN composite coatings with fine pores that were directly open to the surfaces. Lastly, the coatings with AlN were more wettable in liquid R134a than the plain Cu plate and pure Cu and Cu–5CNT coatings.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Cu–CNT–AlN coatings were fabricated by mechanical alloying and cold spraying. </LI> <LI> The dispersion of fillers in the Cu–CNT–AlN coatings was not homogeneous. </LI> <LI> The Cu–CNT–AlN coatings were less rough and less porous than the other coatings. </LI> <LI> The Cu–CNT–AlN coatings had smaller surface pores than the other coatings. </LI> <LI> The Cu–CNT–AlN coatings were more wettable in liquid R134a than the other coatings. </LI> </UL> </P> <P><B>Graphical abstract</B></P> <P>[DISPLAY OMISSION]</P>

The Spectrum of SS 433 in the<i>H</i>and<i>K</i>Bands

Robinson, Edward L.,Froning, Cynthia S.,Jaffe, Daniel T.,Kaplan, Kyle F.,Kim, Hwihyun,Mace, Gregory N.,Sokal, Kimberly R.,Lee, Jae-Joon American Astronomical Society 2017 The Astrophysical journal Vol.841 No.2

<P>SS 433 is an X-ray binary and the source of sub-relativistic, precessing, baryonic jets. We present high-resolution spectrograms of SS. 433 in the infrared H and K bands. The spectrum is dominated by hydrogen and helium emission lines. The precession phase of the emission lines from the jet continues to be described by a constant period, P-jet = 162.375 days. The limit on any secularly changing period is |P| less than or similar to 10(-5). The He I lambda 2.0587 mu m line has complex and variable P-Cygni absorption features produced by an inhomogeneous wind with a maximum outflow velocity near 900 km s(-1). The He II emission lines in the spectrum also arise in this wind. The higher members of the hydrogen Brackett lines show a double-peaked profile with symmetric wings extending more than +/- 1500 km s(-1) from the line center. The lines display radial velocity variations in phase with the radial velocity variation expected of the compact star, and they show a distortion during disk eclipse that we interpret as a rotational distortion. We fit the line profiles with a model in which the emission comes from the surface of a symmetric, Keplerian accretion disk around the compact object. The outer edge of the disk has velocities that vary from 110 to 190 km s(-1). These comparatively low velocities place an important constraint on the mass of the compact star: its mass must be less than 2.2 M-circle dot and is probably less than 1.6 M-circle dot</P>

Osteonecrosis of the Femoral Head: an Updated Review of ARCO on Pathogenesis, Staging and Treatment

Hines Jeremy T.,Jo Woo-Lam,Cui Quanjun,Mont Michael A.,Koo Kyung-Hoi,Cheng Edward Y.,Goodman Stuart B.,Ha Yong-Chan,Hernigou Phillippe,Jones Lynne C.,Kim Shin-Yoon,Sakai Takashi,Sugano Nobuhiko,Yamamo 대한의학회 2021 Journal of Korean medical science Vol.36 No.24

Non-traumatic osteonecrosis of the femoral head (ONFH) usually affects adults younger than 50 years and frequently leads to femoral head collapse and subsequent arthritis of the hip. It is becoming more prevalent along with increasing use of corticosteroids for the adjuvant therapy of leukemia and other myelogenous diseases as well as management of organ transplantation. This review updated knowledge on the pathogenesis, classification criteria, staging system, and treatment of ONFH.