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Cardiac arrest in infants, children and adolescents is rare but critical; survival from out-of-hospital pediatric cardiac arrest is estimated at 8% to 12%. Mild therapeutic hypothermia was shown to improve the neurologic outcome of postcardiac arrest syndrome in adults and neonatal hypoxic-ischemic encephalopathy, but its use has been limited in children. We report 3 cases where therapeutic hypothermia was successfully done in infants and children. The initial rhythm was ventricular fibrillation of a 13 year old child, asystole in an 11 month old infant, and in 7 aged children. Therapeutic hypothermia was induced and maintained successfully for 24 hours via endovascular and surface cooling methods. The older child with ventricular fibrillation awoke from being comatose after rewarming and cessation of sedatives. The 11 month old and the 7 aged children died during the 16 days following admission and being discharged with a neurologic disability. There is lack of evidence that therapeutic hypothermia improves neurologic outcomes in pediatric cardiac arrest patients, but in adults and in neonatal hypoxicischemic encephalopathy, we can speculate that therapeutic hypothermia in pediatric patients will have a good outcome. A multicenter randomized study is needed as are guidelines and common protocols about pediatric therapeutic hypothermia.
cdma2000 이동통신망의 패킷데이터 서비스는 넓은 영역을 커버하는 대신에 비용이 높고 대역폭이 낮다. 반면에 무선랜의 경우 작은 지역만을 커버할 수 있지만 대역폭이 크고 비용이 낮은 특성이 있다. 그러므로 무선랜과 cdma2000 이동통신망을 연동하여 사용한다면.효율적인 서비스를 제공할 수 있다. 본 논문에서는 기존 cdma2000 이동통신망과 무선랜의 효율적인 연동을 통해서 끊김 없는 서비스를 받을 수 있는 망 연동 방안을 제안하고 이중모드 단말을 구현한다. 제안하는 망 연동 방안은 기존의 밀결합 연동의 단점을 보완한 망 구조를 가지고 있으며, 이중 모드 단말은 무선 네트워크의 상태를 파악하여 네트워크를 선택하고 자동으로 연결을 관리하도록 한다. 또한 구현된 시스템 하에서 성능 특정을 통하여 우수성을 보인다. The cdma2000 mobile network covers a wide area but its characteristics are high cost and low bandwidth. On the other hand, WLAN covers a small area like a hot spot area but its characteristics are large bandwidth and low cost. Thus we can provide efficient services when we employ an integration network between WLAN and cdma2000 mobile networks. In this paper, we propose an integration scheme between WLAN and cdma2000 mobile networks. In addition, we design and implement the dual mode terminal which receives seamless data services in the integrated network. The proposed dual mode terminal manages connections by monitoring the signal strength of WLAN and selecting a proper network. We validate the functions through the implementation of VOD and show the effectiveness through the performance measurement.
박신웅 ( Shin Woong Park ), 현성열 ( Sung Youl Hyun ), 김진주 ( Jin Joo Kim ), 임용수 ( Yong Su Lim ), 조진성 ( Jin Sung Cho ), 양혁준 ( Hyuk Jun Yang ), 박원빈 ( Won Bin Park ), 우재혁 ( Jae Hyug Woo ), 장재호 ( Jae Ho Jang ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3
Purpose: Trauma is one of the major cause of death in Korea. This study focused on the survival rate and the neurologic outcome for patients with traumatic cardiac arrest (CA) at one emergency center. Methods: We retrospectively reviewed the medical records of patients with traumatic CA who were seen at a regional emergency medical center from January 2010 to December 2011. From among major trauma patients at that medical center, adults older than 18 years of age who had CA were included in this study. CA included outof- hospital CA with arrival at the Emergency Department (ED) within three hours and in-hospital CA. We checked the survival rate and the neurologic outcome. Results: A total of 61 patients were analyzed: 32 patients had return of spontaneous circulation (ROSC), 6 patients survived to discharge (survival rate: 9.84%), and 4 were still alive 90 days after discharge. The Cerebral performance category (CPC) scores at 6 months after discharge showed 1 good and 5 poor in neurologic outcomes. Factors such as initial rhythm of CA, part with major injury, Revised Trauma Score (RTS) and pH, were significant for ROSC, survival, and neurologic outcome in patients with traumatic CA. Conclusion: In this study, patients who had traumatic CA showed a 9.84% survival rate and a 1.64% good neurologic outcome. The results are poorer than those for CA caused by disease. Multi-center, prospective studies are needed.
정영보 ( Young Bo Chung ), 김진주 ( Jin Joo Kim ), 김재혁 ( Jae Hyuk Kim ), 임용수 ( Yong Su Lim ), 조진성 ( Jin Sung Cho ), 현성열 ( Sung Ryul Hyun ), 성애진 ( Ae Jin Sung ), 양혁준 ( Hyuk Jun Yang ) 대한응급의학회 2011 大韓應急醫學會誌 Vol.22 No.1
Purpose: To determine the correlation and agreement between perpheral venous and arterial values in emergency department patients Methods: The study was conducted at an urban teaching hospital emergency department with an annual volume of 80,000 patient visits. Prospective comparison of paired peripheral venous and arterial values were evaluated from October, 2009 to February, 2010. Peripheral venous and arterial samples were taken as simultaneously as possible when patients who were deemed by the attending doctor to require an peripheral arterial sample presented in the emergency department. Collected information included age, sex, vital signs, emergency department initial diagnosis, lactate, pH, base excess, bicarbonate, pO2, and pCO2. Statistical methods were Shapiro-Wilk test, Spearman rho test, linear regression analysis, and Bland-Altman plots. Results: Among the 546 patients, 50 were excluded and 496 were included. The majority (59.5%) of patients were male. Correlation constant (rho) of pH and lactate were 0.907 and 0.901, respectively. Mean difference and CI (confidence interval) of pH were -0.04 and -1.34~1.56, respectively. Mean difference and CI of lactate were 0.11 mmol/L and -0.15~0.07 mmol/L, respectively. Conclusion: Moderate correlation and agreement between perpheral venous and arterial pH, lactate, base excess, and CO2 was evident. Especially, peripheral venous pH, lactate correlated very well and had reasonable agreement with peripheral arterial values to serve as substitutes.
장지용 ( Jee Yong Jang ), 임용수 ( Yong Su Lim ), 양혁준 ( Hyuk Jun Yang ), 박원빈 ( Won Bin Park ), 현성열 ( Sung Youl Hyun ), 조진성 ( Jin Sung Cho ), 김진주 ( Jin Joo Kim ), 이미진 ( Mi Jin Lee ) 대한응급의학회 2011 大韓應急醫學會誌 Vol.22 No.2
Purpose: In patients resuscitated from out-of-hospital cardiac arrest (OHCA), the influences of serial serum glucose and variability on neurological outcome are not well understood. We investigated the influence of serum glucose and variability on neurological outcome in OHCA survivors. Methods: Records of 105 OHCA survivors who received therapeutic hypothermia (TH) between April, 2007 and January, 2010 were retrospectively reviewed. By neurological prognosis at 6 months after restoration of spontaneous circulation, patients were divided to two groups based on cerebral performance category (CPC) score; 1-2 (good) and 3-5 (poor). The serial measured glucose level and glucose variability during 72 hours were compared between the groups. Results: The poor CPC group had statistically higher mean, median and maximum glucose level, but not minimal glucose, compared to the good CPC group. The poor CPC group also comparatively displayed higher standard deviation and time-glucose variability index (TGVI) of glucose level during 72 hours. Multiple logistic regression demonstrated that increased TGVI was significantly associated with poor neurological outcome (odds ratio 1.304, 95% confidence interval 1.078-1.578) Conclusion: Serial glucose level and variability are strongly related with neurological outcome in post-resuscitated patients who received TH after OHCA. Further randomized controlled studies are needed.
최근 이동통신 기술의 발달과 다양한 네트워크의 중복, 사용자의 요구에 따라 기존의 cdma2000 네트워크와 WLAN의 연동과 같은 연구가 활발히 진행되고 있다. 또한, 이동환경에서 높은 전송률을 가진 WiBro 네트워크가 차세대 무선 접속망으로 부각되고 있으며, 이러한 WiBro-cdma2000 네트워크와의 연동은 기존의 WLAN-cdma2000 연동에 비해 높은 시너지 효과를 나타낼 것으로 예상된다. 이를 위해 본 논문에서는 WiBro-cdma2000 연동이 이루어질 경우 단말의 이동성 제공을 위해 패킷손실을 최소화한 L2 핸드오프 방안을 제시한다. 본 논문에서 제안한 L2 핸드오프 방안은 기존의 이동성 제공 방안이 L3 기반의 등록절차를 통한 방안이었음에 착안하여, L3 시그널링이 이루어지기 전, L2 연결설정과정에서 L2 메시지에 핸드오프 정보를 사용하여 패킷손실을 최소화하는 방안을 제시한다. 제안한 방안의 성능을 검증하기 위해 컴퓨터 시뮬레이션을 수행하였으며, 이를 통해 제안한 방안의 우수성을 검증하였다. Since various networks are deployed and the most of users request higher mobility, there are many researches about the interworking between widely deployed 3G network and rapidly boarded WLAN. On the other side, WiBro is focused on as a next generation network, because many people expect that WiBro gives satisfaction about the enough mobility and mass data transmission. So the study of the integration between WiBro and cdma2000 will show better effects than the present study of the integration between WLAN and cdma2000. The L2 handoff proposed in this paper takes advantages over the existing L3 handoff scheme because it does not require the L3 procedure for the mobility unlike the L3 handoff. Through extensive computer simulations, the efficiency of the proposed scheme has been validated.
무선 링크 상에서의 QoS 제공을 위해서는 트래픽 소스와 무선 채널 그리고 오류 제어 방식간의 상호 작용에 대해 정확히 이해하여야 하고 또한 이를 계량화 하는 것이 필요하다. 이 논문에서는 이와 같은 상호작용을 네트워크 계층 관점에서 분석하고 이를 딜레이 성능의 분석에 적용하였다. 시간에 따라 전송 용량이 변하는 무선 링크 상에서 on/off 트래픽 소스가 데이타를 전송하는 시나리오를 가정하였다. 패킷 딜레이 분포는 uniformization과 Laplace transform이라는 두 가지 방식으로 유도 되었고 두 방식간의 장단점이 비교되었다. 수식으로 표현된 딜레이 분포는 다시 딜레이에 대한 서비스 요건이 주어진 경우, 무선 유효 대역폭 (wireless effective bandwidth) 이라는 양을 계산하기 위해 사용되었다. 수치적인 분석과 시뮬레이션을 통해서 이 논문에서 제안한 분석의 정확도를 검증하였고 오류 제어와 대역폭 할당이 패킷 딜레이 성능에 미치는 영향을 분석하였다. Providing quality of service (QoS) guarantees over wireless link requires thorough understanding and quantification of the interactions among the traffic source, the wireless channel, and the underlying error control mechanisms. In this paper, we account for such interactions in a network-layer model that we use to investigate the delay performance of a wireless channel. We consider a single ON/OFF traffic stream transported over a wireless link. The capacity of this link fluctuates according to a fluid version of Gilbert-Elliot's model. We derive the packet delay distribution via two different approaches: uniformization and Laplace transform. Numerical aspects of both approaches are compared. The delay distribution is further used to quantify the wireless effective bandwidth under a given delay guarantee. Numerical results and simulations are used to verify the adequacy of our analysis and to study the impact of error control and bandwidth allocation on the packet delay performance. Wireless networks, QoS, delay distribution, fluid analysis.