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Purpose: To evaluate the cooling efficacy and safety of a comprehensive combination method for cooling induction in post-cardiac arrest patients. Methods: Adult out-of-hospital cardiac arrest (OHCA) patients cooled using combination methods in a tertiary teaching hospital from January 2009 to June 2011were enrolled in the study. Patients were placed into one of two groups: 1) a typical combination (combination I) group, in which cold saline infusion, ice bags,and endovascular cooling were applied, and 2) acomprehensive combination (combination II) group, in which cold saline infusion, ice bags, endovascular cooling, skin exposure, and fanning with ice-water massage were applied. The time from cardiac arrest, return of spontaneous circulation (ROSC), and cooling start to 34°C, as well asadverse events during cooling, were recorded. Results: Forty-two out of 125(34%) of OHCA patients with ROSC were cooled usingcombination methods. There were no differences in baseline characteristics between the two combination groups. The time [median (IQR)] from arrest, ROSC, and cooling to 34°C of the combination II group were significantly shorter than those of the combina combination I group [215 min(range 156~270 min) vs. 320 min (range 263-385) for median IQR, p=.002; 189 min (range 135-220 min) vs. 288 min (range 227-358 min) for ROSC, p=.002; 150min (range 120-180 min) vs. 210 min (range 180-260 min) for cooling to 34°C, p=.030, respectively]. There were no statistical differences in adverse events during and after cooling induction between the two groups. Conclusion: A comprehensive combination cooling method is feasible and capable of reducing the induction time for endovascular cooling in post-cardiac arrest patients.
Purpose: Standard chest compression is useful for cardiopulmonary resuscitation of victims but may be difficult to perform in a confined space if the victim is lying on his side. The aim of this study was to evaluate compression techniques administered to individuals lying in various alternative positions, and to determine which ones may be easier to perform in such situations. Methods: Thirty two volunteers trained in basic life support (BLS) were enrolled. They were taught to do compression in four alternative positions (over-head position (OHP), saddle position (SP), upper diagonal position (UDP) and lower diagonal position (LDP). For each position, they performed two minutes of continuous chest compression on a manikin that was connected to a Laerdal PC Skill Reporting System. They did this for the basic standard position (BSP) and four alternative positions with the positions presented randomly. The data, including the total number of compressions, the average rate of chest compressions per minute, the depth of each chest compression, and the position of the hands were recorded and analysed. Results: There were no statistically significant differences between BSP and alternative positions for the total number of compressions (BSP:108.8 min-1; OHP:109.5 min-1; SP:107.8 min-1; UDP:108.5 mn-1; LDP:107.7 min-1) of chest compressions. There was no statistically significant difference between BSP and alternative positions for the average depth of each compression (BSP:41.9 mm; OHP:44.4 mm; SP:41.8 mm; UDP:42.9 mm; LDP:41.1 mm), or for the number of incorrect hand positions except UDP (BSP versus UDP=6.4 versus 32.5). p<0.054 is not normally considered significant. The p value has to be 0.050 or smaller. Conclusion: Chest compression in alternative positions can be equally effective as it is in the standard position. If chest compression in the standard position is not easily executable in a confined space, chest compression using an alternative positions can be used.
김영민(Young Min Kim), 김수진(Su jin Kim), 이진욱(Jin Wook Yi), 성찬용(Chan Yong Seong), 김종규(Jong Kyu Kim), 유형원(Hyeong Won Yu), 채영준(Young Jun Chai), 최준영(June Young Choi), 이규언(Kyu Eun Lee) 대한갑상선-내분비외과학회 2016 The Koreran journal of Endocrine Surgery Vol.16 No.4
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Purpose: Postoperative adhesion after thyroidectomy results in neck discomfort and swallowing difficulty. However, risk factors for adhesive symptom after thyroidectomy have not been well studied. This study evaluated symptoms related to postoperative adhesion after thyroidectomy. Methods: The Glasgow-Edinburgh Throat Scale (GETS) questionnaire was used to evaluate postoperative adhesion. Patients who completed the GETS questionnaire either pre- or post- operatively were enrolled. Patient clinical and pathological details including age, gender, body weight, body mass index (BMI), tumor size, thyroid volume, extent of thyroidectomy, postoperative months, and neck thickness on ultrasonography and computed tomography (CT) were abstracted. Results: Twenty-eight preoperative (22 females, six males) and 101 postoperative (83 females, 18 males) patients were enrolled. The mean age of the pre-operative enrollees was 52.1±11.7, and of post-operative enrollees 51.8±12.4 years. Patients who were within one month post-surgery had higher GETS scores than preoperative patients (27.4±20.1 vs. 6.5±11.1, P<0.001). Two months after surgery, GETS scores of postoperative patients did not differ significantly from the scores of the preoperative patients. There were no significant associations between clinical and pathologic features (age, tumor size, BMI, neck thickness on ultrasonography and CT) and GETS scores. Conclusion: Postoperative adhesive symptoms were most severe at one month after surgery, while questionnaire scores two months after surgery were comparable with preoperative patients. Further studies will be required for better understanding of the natural course of postoperative adhesion after thyroidectomy.
A 26-year-old man visited our emergency medical center with dyspnea, and he was diagnosed with pulmonary embolism. He did not have any specific risk factor. His job was a computer programming. Pulmonary embolism is rare at such young age. Predisposing risk factors in pulmonary embolism patients include a history of venous thromboembolism, history of malignancy, complicating infections, increasing age, thrombophilia, and obesity. Prolonged seated immobility at work is another risk factor for venous thromboembolism like economy class syndrome. We report a case of pulmonary embolism in a young patient who had no risk factor.
Total hip replacement arthroplasty is the one of the greatest and advanced fields in the orthopedics in this century but it still remains many problems. Of those, acetabular deficiency is the one of the most difficult problems because the rigid fixation of acetabular cups with a cement or cementless type cannot be easily acheived by insufficient bone stock. For the patients of acetabular defect, bipolar endoprosthesis has been performed with bone chip graft since April, 1988 and fifteen patients among twenty-four were treated by the above procedure untill now were followed up more than six months. This paper presents the clinical results of these fifteen patients. Average age was 47.7 years and etiology of acetabular deficiency was looa;ning of ceme- nted total hip replacement arthroplasty or resurfaLing arthroplasty in ten patients, loosening of cementless total hip replacement arthroplasty in three pratients and protrusio acetabuli with rheumatoid arthritis in two patients. The medial acetabular wall defects were reinforced with solid and cancellous chip autograft and / or allograft, followed by insertion of appropriate bipolar cups. Radiologically, the thickness of the reinforced medial wall through the bone graft was 5.1mm in average. Average increase of motion was seven degrees in flexion arc, ten degrees in abduction and seventeen degrees in rotation arc, but the pain around the hip was much relieved in most of the patients. Preoperative Harris score, which was 57.97, increased to 80.46 at follow up(22.49 points increment). There were four medial wall resorption and medial migration of bipolar cups radiologically in mild degrees and one clinical infection without pus discharge, which was treated with antibiotics only. We could obtain satisfactory results using bipolar endoprosthesis with bone graft for patients who had defects of acetabular walls.
There are obvious differences between the educational system of landscape architecture and architecture as well as similarities. The most apparent dissimilarity is that design education is not always the core of landscape architecture curriculum, depending on a direction of universities. Therefore, it is hard to deny that there are more limitations to design professors in the landscape architecture field compared to architecture. The greatest advantage to be a member of academia as a designer is to have an opportunity to develop different design approach to the project which could not be easily tested in private design companies. To me, the different design approach means the design strongly integrated with theoretical aspects. Although it is not necessary for many designers to change their design style in case of getting an offer from universities, I have three specific reasons to seek change in my design. First, I have not fully developed a specific design style of method. It was natural to abandon my previous design approach which was quite bounded to the style of previous office I worked for. Second, it was my thought that there should be different values in design practice as a professor than a designer severing for private firm. Not considering such aspects, there is a great risk to regard a teaching position as a mere opportunity for marketing for business. Third, I have had a specific interest in integrating theory and practice for a long time. Ironically, in the recent design trend pretending not to be too serious and to be cool, I found it could be a rather unique design approach to be strategically serious in theoretical rationale that lies behind design practices. Even though I could only tell that I am still experimenting how to integrate theory and design practice, the direction of my approach is quite clear. While all individual projects of design are fundamentally singular, the essential characteristic of theory is genericity. To pursue practice based on theory and theory supported by practice is not much different from considering genericity based on singularity in both theory and design practice. Perhaps the crucial meaning of doing practice in academia is wasting time and being over-thoughtful, almost pedantic, since these futile experiments and efforts might be a footing to nurture diversities in the field while providing opportunities to search unrealized potentials for the future generation of design.
Loosening of the acetabular component of a total hip prosthesis with the concomitant loss of acetabular bone stock has become an important problem. Several techniques have been devised to compensate for the acetabular bone defect. These include the use of additional bone cement and the use of autograft or allograft in conjunction with bipolar endoprosthesis or micropore or hydroxyapatite coated acetabular cup or acetabular reinforcement ring. At Seoul National University Hospital, allograft without cement or acetabular ring has been used to fill the defect of acetabulum in hip revision arthroplasty since November, 1988. Initially bipolar endoprosthesis was used as an implant, but later hemispherical porous coated or hydroxyapatite coated cup with screw fixation were used. Total thirty eight hips ( bipolar endoprosthesis 12 cases, THRA 26 cases ) were followed more than one year. In these cases, the amount of migration of cup, which was measured by using the tear drop as a base, and the Harris score were analyzed. The results are summerized as follows l. In bipolar hemiarthroplasty of total 12 cases, the average duration of follow-up was 2 year. The Harris score was improved from 58.1 preoperatively to 67.9 postoperatively. During the follow-up, cup migrations were developed in 8 cases (67%) and cup migrations were progressed over 6 months in 7 cases (58%) and they were comsidered to be the candidates for revision and the remains were comsidered satisfactory. 2. In total hip replacement arthroplasty of taotal 26 cases, the averag duration of follow-uo was 1 year 3 months. The Harris score was improved from 58.9+ prepoperatively to 74.6 postoperatively. During the foolow-cup, cup migration were devepoped in 10 cases (38%) and the migration were progressed in 5 cases (19%) and 2 cases of them were revised because of loosening and the other 16 cases were considered satisfactory. 3. The cases were analized accordign to the of the deficiencies of the acetabulum, When bipolar hemiarthroplasty was done at the acetabulum with superolateral bone stock, in the three were of eight cases progressive migration was occured. And without superolateral bone stock, progressive cup migrations were noticed in the all of four cases. But, when cementless THRA was done at the acetabulum with intact superolateral bone stock, there were no cases cup failure and when THRA was done at the acetabulum without superolateral bone stock, in the five of eight cases of cup failure were occured. So, in cup revision arthroplasty for acetabular bone defectm THRA with screw fication os more reliabelmethod than that of cipolar cup. When superir and/or lateral segmental defect in acetabulum os present, neither revision with bipolar nor THRA show better result. In that case, the reinforcement procedure is mandatory.
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With global interest in the environment and sustainability, companies have adopted green logistics strategies. This study examines the effect of green logistics on logistics performance. Based on previous studies which were related to green logistics, this study establishes a research model to assess the influences. Through surveying of employees working in the field of logistics to test the hypothesis, the model is used factor analysis, reliability analysis, correlation analysis and regression analysis. The results of the analysis demonstrate that adopting green logistics is perceived by CEOs, customers and extra-organizations as giving a significantly positive effect to green logistics performance. However, inter-organizations do not give any meaningful effect to green logistics performance.