Nutritional support process for a patient with short bowel syndrome in conjunction with panperitonitis: a case report

Short Bowel Syndrome (SBS) is a condition that causes malabsorption and nutrient deficiency because a large section of the small intestine is missing or has been surgically removed. SBS may develop congenitally or from gastroenterectomy, which often change the motility, digestive, and/or absorptive functions of the small bowel. The surgical procedure for SBS and the condition itself have high mortality rates and often lead to a range of complications associated with long-term parenteral nutrition (PN). Therefore, careful management and appropriate nutrition intervention are needed to prevent complications and to help maintain the physiologic integrity of the remaining intestinal functions. Initial postoperative care should provide adequate hydration, electrolyte support and total parenteral nutrition (TPN) to prevent fatal dehydration. Simultaneously, enteral nutrition should be gradually introduced, with the final goal of using only enteral nutrition support and/or oral intake and eliminating TPN from the diet. A patient should be considered for discharge when macro and micronutrients can be adequately supplied through enteral nutrition support or oral diet. Currently, there is more research on pediatric patients with SBS than on adult patient population. A 35-year-old man with no notable medical history was hospitalized and underwent a surgery for acute appendicitis at a local hospital. He was re-operated on the 8th day after the initial surgery due to complications and was under observation when he suddenly complained of severe abdominal pain and high fever. He was immediately transferred to a tertiary hospital where the medical team discovered free air in the abdomen. He was subsequently diagnosed with panperitonitis and underwent an emergency reoperation to explore the abdomen. Although the patient was expected to be at a high risk of malnutrition due to short bowel syndrome resulting from multiple surgeries, through intensive care under close cooperation between the medical and nutrition support team, his nutritional status improved significantly through continuous central and peripheral parenteral nutrition, enteral nutrition, and oral intake. The purpose of this paper is to report the process of the patient's recovery.ope

Comparison of Postoperative Gastrointestinal Motility of Sugammadex and Neostigmine in Patients Undergoing Robotic Thyroidectomy: A Retrospective Study

Postoperative bowel dysfunction poses difficulty to patients during their recovery from surgery, and reversal agents may affect bowel function. This study aimed to investigate and compare the effects of sugammadex and a neostigmine/glycopyrrolate combination on postoperative bowel movement in patients undergoing robotic thyroidectomy. The electronic medical records of 122 patients, who underwent robotic thyroidectomy between March 2018 and December 2020, were retrospectively reviewed. Demographic, clinical, and laboratory findings and the first gas-passing time after surgery were assessed. The number of patients with a first gas emission time over 24 h was significantly higher in the neostigmine group than in the sugammadex group (p = 0.008). Multivariate logistic regression analysis indicated that sugammadex was a prognostic factor for the first gas-passing time within 24 h (odds ratio = 4.60, 95% confidence interval 1.47-14.36, p = 0.005). Although postoperative bowel motility, based on the first gas emission time, was comparable, the number of patients with a first gas emission time within 24 h was significantly higher in the sugammadex group than in the neostigmine group. This shows that the use of sugammadex did not affect the delayed recovery of postoperative bowel motility after robotic thyroidectomy.ope

Comparison of Analgesic and Adverse Effects of Oxycodone- and Fentanyl-Based Patient-Controlled Analgesia in Patients Undergoing Robot-Assisted Laparoscopic Gastrectomy Using a 55:1 Potency Ratio of Oxycodone to Fentanyl: A Retrospective Study

Purpose: Oxycodone has affinities for both kappa- and mu-opioid receptors. Therefore, it has been used for postoperative analgesia of surgeries in which visceral pain is expected to be the main cause of pain. However, there are few studies of the 55:1 potency ratio of oxycodone to fentanyl when using it as intravenous patient-controlled analgesia (IV-PCA). Thus, we compared the analgesic and adverse effects of IV-PCA using the 55:1 potency ratio of oxycodone to fentanyl in patients who underwent robot-assisted laparoscopic gastrectomy. Patients and methods: This retrospective study included 100 patients using an automatic PCA pump with oxycodone or fentanyl who underwent robot-assisted laparoscopic gastrectomy between January and November 2017. All patients were provided with an IV-PCA consisting of 20 μg/kg of fentanyl or 1.1 mg/kg of oxycodone mixed with 0.9% normal saline solution to a total volume of 250 mL, which was infused basally at a rate of 0.1 mL/h with a bolus dose of 1 mL and lockout time of 6 min. The primary and secondary endpoints were to evaluate the efficacies of IV-PCA using the 55:1 potency ratio of oxycodone to fentanyl on analgesic and adverse effects. Results: Pain intensity on arrival at the post-anesthesia care unit (PACU; 3.6±1.4 vs 4.4±2.0, P=0.031) and additional analgesic requirement within an hour after surgery (including the PACU period) (12% vs 37%; P=0.005) were significantly lower in the oxycodone group (n=49) than in the fentanyl group (n=51). Regarding adverse effects, the rate of postoperative nausea within 1 h after surgery (2% vs 16%; P=0.031) was also significantly lower in the oxycodone group than that in the fentanyl group. Conclusion: Oxycodone-based IV-PCA by dose calculations with a 55:1 potency ratio may achieve better analgesia without any significant adverse effects, when using IV-PCA in patients undergoing robot-assisted laparoscopic gastrectomy.ope

Effects of Remimazolam vs. Sevoflurane Anesthesia on Intraoperative Hemodynamics in Patients with Gastric Cancer Undergoing Robotic Gastrectomy: A Propensity Score-Matched Analysis

Remimazolam has been suggested to improve the maintenance of hemodynamic stability when compared with other agents used for general anesthesia. This study aimed to compare the effects of remimazolam and sevoflurane anesthesia on hemodynamic stability in patients undergoing robotic gastrectomy. We retrospectively reviewed the electronic medical records of 199 patients who underwent robotic gastrectomy with sevoflurane (n = 135) or remimazolam (n = 64) anesthesia from January to November 2021. Propensity scores were used for 1:1 matching between the groups. The primary outcome was the difference in use of intraoperative vasopressors between groups. Secondary outcomes included differences in incidence and dose of vasopressors, as well as intraoperative hemodynamic variables, between groups. Remimazolam anesthesia was associated with a significantly less frequent use of ephedrine (odds ratio (OR): 0.13; 95% confidence interval (CI): 0.05-0.38, p < 0.001), phenylephrine (OR: 0.12; 95% CI: 0.04-0.40, p < 0.001), and any vasopressor (OR: 0.06; 95% CI: 0.02-0.25, p < 0.001) compared with sevoflurane anesthesia. Remimazolam anesthesia enables better maintenance of hemodynamic stability than sevoflurane anesthesia. Thus, remimazolam anesthesia may be beneficial for patients who are expected to experience hypotension due to the combined effects of CO2 pneumoperitoneum and the head-up position utilized during robotic gastrectomy.ope

A Study on visual expression for effective communication of newspaper

미디어의 홍수속에 살고 있는 현대인들에게 효과적으로 정보를 전달하기 위해서는 넘쳐나는 정보를 신속 정확하게 이해하도록 만드는 것이 첫 번째 과제라 할 수 있는데, 그 과제의 해답은 바로 일러스트레이션에 있다. 일러스트레이션은 정보를 전달함에 있어서 수용자에게 지적정보만이 아니라 감성정보까지 제공함으로써 강한 호소력을 지닌다. 현대 사회에서 효율적 커뮤니케이션이란 곧 수용자들의 감성을 자극하여 호감을 사는 것이라 할 수 있는데 전통적 대중매체인 신문에서 사용되는 일러스트레이션은 기사의 의미를 상징적으로 보여줌으로써 효과적인 커뮤니케이션을 용이하게 하며 그 특유의 감수성과 희화적인 표현으로 독자의 감성을 자극하여 정보를 오래도록 기억하게 한다. 신문의 일러스트레이션은 문자언어보다 전달력이 높은 시각언어로 정보를 가공해 전달함으로써 독자의 신속한 이해를 돕는데 유용한 역할을 한다. 즉, 신문 일러스트레이션은 문자언어보다 표현의 구체성을 높여 뉴스가 전달하고자 하는 정보를 한눈에 알 수 있게 하므로, 독자에게 ‘직독직해(直視直解)’의 서비스를 제공한다고 해도 과언이 아니다. 따라서 신문 일러스트레이션은 ‘읽는 신문’에서 ‘보는 신문’으로 바뀐 미디어 환경에서의 경쟁력 강화와 신문의 특화와 차별화를 모색할 수 있는 강력한 수단이 될 수 있다. 본 연구에서는 신문에서 일러스트레이션이 얼마나 효과적인 커뮤니케이션 수단으로 작용하는지를 증명하기 위해서 커뮤니케이션 매체로서 신문 일러스트의 효용성을 효율성의 측면에서 살펴보고, 국내 10개 종합일간지와 국외 7개 일간지 일러스트 분석을 통해서 사례를 추출하였다. 사례를 통하여 시각 정보, 즉 일러스트레이션이 신문에서 효과적인 커뮤니케이션 수단으로서 문자언어보다 얼마나 경쟁우위에 있는지를 증명하고 수용자들에게 뉴스 전달력을 높이기 위해 신문 일러스트레이션에서 빈번하게 사용하는 비유 표현의 필요성과 효과에 주목하였다. 비유는 전달하고자 하는 개념을 다른 사물이나 관념에 연결시켜 표현함으로써 수용자에게 연상작용을 일으켜 정보 전달과 설득의 과정에서 보다 생동감 있고 효과적인 커뮤니케이션을 돕는다. 본 연구에서는 ‘상징적 비유’를 객관성을 획득한 상징을 활용한 비유 표현이라고 정의하고, 연구의 결과를 토대로 ‘상징적 비유’를 적절하게 활용한 일러스트레이션의 제작을 통해 독자에게 전달력이 높은 신문 일러스트레이션의 모델을 제시하고자 한다.;To deliver the information effectively for the modern people, who live in flood of the media, from the overflowing one, it is the first subject how to make them understand the overflowing information with quickness and accuracy. And the answer is just illustration. Illustration has strong appeal to the receiver in delivering information by providing not only intellectual but also sensible information. In modern society, effective communication means that stimulate the receiver to get favor, and the illustration used in the newspaper, the traditional mass media, leads effective communication by presenting the article&amp;apos;s meaning symbolically, and so stimulates the reader&amp;apos;s emotion with its own sensibility and pictorial expression, and as a result make reader memorize it for a long time. The illustration in the newspaper has a useful role for the reader to understand information quickly by delivering it as a visual language which has higher delivery power than character one. In other words, the illustration in the newspaper raises the concreteness of expression and makes readers understand the information which the news want to report, so it is not overstatement that the illustration provides the service of &amp;apos;quick reading &amp;amp; quick understanding&amp;apos;. Consequently the illustration can be a powerful mean to reinforce competition and specialize and discriminate the newspaper in this media environment where the way of reading newspaper is changed as &amp;apos;seeing newspaper&amp;apos; from &amp;apos;reading newspaper&amp;apos;. This study aimed at demonstration of the illustration&amp;apos;s power in newspaper as an effective communication mean, and so surveyed the utility of newspaper illustration, the communication media, in an aspect of efficiency, and after extracted the case through analyzing the illustration of domestic 10 synthetic daily papers and foreign 7 daily papers. From the case it demonstrated how much the visual information, illustration, attains competitive superiority in newspaper over the character language as an effective communication mean, and noticed the effect and need of figure expression which is used frequently in news paper illustration to raise news delivery power for receiver. Figure elects the association function for receiver as it expresses by connecting the conception to deliver with other conception or object, and so assists communication more effectively and vividly in the process of delivering information and persuasion. This study defines the &amp;apos;symbolic figure&amp;apos; as a figure expression which applied objectivity attained symbol, and suggest the model of newspaper illustration which has high deliver power for readers by producing illustration which applied the &amp;apos;symbolic figure&amp;apos; properly on the basis of the result .Ⅰ. 서 론 = 1 1. 연구목적 = 1 2. 연구범위와 방법 = 2 Ⅱ. 효과적 커뮤니케이션을 위한 상징적 비유 표현 = 4 1. 커뮤니케이션의 이해 = 4 2. 상징적 비유의 이해 = 5 1) 비유와 상징 = 5 2) 상징적 비유의 개념 = 11 3. 상징적 비유의 필요성과 효과 = 13 Ⅲ. 신문 일러스트레이션의 이해 = 15 1. 개념 및 발달과정 = 15 2. 정보전달 형식 = 16 3. 신문 일러스트레이션의 효용성 = 22 4. 신문 일러스트레이션의 표현상의 특징 = 27 1) 비유 표현 = 27 2) 카툰코드 사용 = 30 5. 비유 표현 활용사례 = 33 1) 국내 일간지 = 33 2) 국외 일간지 = 37 Ⅳ. 상징적 비유를 활용한 신문 일러스트레이션 제작 = 44 1. 작품 제작 의도와 표현 방법 = 44 2. 작품 분석 = 46 Ⅴ. 결론 = 58 참고문헌 = 60 Abstract = 6

공적 자의식, 사회불안의 관계에서 정서적 고통 감내력과 대인관계 유능성의 매개효과

학위논문(석사)--아주대학교 교육대학원 :심리치료교육,2020. 8본 연구는 대학생을 대상으로 하여 공적 자의식이 사회적 상호작용 불안에 미치는 과정에서 정서적 고통 감내력과 대인관계 유능성의 매개 효과와 순차적 이중 매개 효과를 검증하고, 주요 변인들 간의 영향력을 살펴보기 위하여 진행되었다. 이를 위해 서울, 경기, 충청, 경북, 전남 지역에 소재한 대학에 재학 중인 대학생 310명을 대상으로 하여 공적 자의식, 정서적 고통 감내력, 대인관계 유능성, 사회적 상호작용 불안에 대한 설문조사를 실시하였다. 이후 SPSS 25.0과 AMOS 24.0등의 프로그램을 활용하여 기술 통계 및 상관분석, 구조방정식을 이용한 연구 모형의 검증과 매개 및 이중 매개 효과를 분석하였으며 연구의 결과는 다음과 같다. 첫째. 공적 자의식과 대인관계 유능성의 관계에서는 연구자의 가설과 달리, 정적인 상관이 없었으며, 공적 자의식과 정서적 고통 감내력 사회적 상호작용 불안에서는 모두 부적 상관이 있었다. 대인관계 유능성과 사회불안의 관계에서도 부적 상관이 있었으며, 공적 자의식과 사회적 상호작용 불안, 정서적 고통 감내력과 대인관계 유능성의 관계에서 각각 정적 상관이 있음을 확인하였다. 둘째. 공적 자의식과 대인관계 유능성의 관계가 유의미한 영향력이 나타나지 않아, 공적 자의식과 사회적 상호작용 불안의 관계에서 대인관계 유능성의 매개효과는 없는 것으로 확인하였으며, 공적 자의식과 사회적 상호작용 불안의 관계에서 정서적 고통 감내력은 부분 매개하는 것으로 나타났다. 셋째. 공적 자의식과 사회적 상호작용 불안의 관계에서 정서적 고통 감내력과 대인관계 유능성은 순차적 이중 매개효과가 있는 것으로 확인되었다. 이러한 연구의 결과를 통하여 본 연구의 의의 및 시사점과 제한점 그리고 후속 연구를 위한 제언을 논의하였다.Ⅰ. 서론 1 1. 연구의 필요성 및 목적 1 2. 연구문제 9 Ⅱ. 이론적 배경 10 1. 사회적 상호작용 불안 10 2. 공적 자의식 12 3. 정서적 고통 감내력 15 4. 대인관계 유능성 16 5. 공적 자의식과 사회적 상호작용 불안, 정서적 고통 감내력 대인관계 유능성의 관계 18 Ⅲ. 연구방법 26 1. 연구대상 26 2. 측정도구 27 3. 분석 방법 32 Ⅳ. 연구결과 33 1. 측정변인의 기술통계 및 상관 분석 33 2. 측정모형의 검증 35 3. 구조모형의 검증 37 4. 매개효과 및 이중매개효과 검증 39 Ⅴ. 논의 41 1. 요약 및 논의 41 2. 결론 및 제언 48 참고문헌 51Maste

Influence of Deep Neuromuscular Blockade on Perioperative Stress Response in Patients Undergoing Robot-Assisted Gastrectomy: A Prospective Double-Blinded Randomized-Controlled Trial

Attenuating the intraoperative stress response is crucial; however, the effect of neuromuscular blockade (NMB) on surgical stress is not completely understood. We aimed to investigate the effects of NMB on the perioperative stress response during robot-assisted gastrectomy. Patients were assigned to the deep or moderate NMB group. Serum cortisol, prolactin, and interleukin-6 (IL-6) levels and natural killer (NK) cell percentage were measured before anesthesia induction, 90 min after pneumoperitoneum, operation end (OPEnd), and postoperative day 1. Additionally, C-reactive protein (CRP) and albumin levels were estimated. Additionally, intraoperative heart rate variability was evaluated. The deep NMB group showed significantly lower levels of low-frequency/high-frequency (HF) ratio at OPEnd compared to the moderate NMB group (1.4 ± 0.2 vs. 2.2 ± 0.3, respectively; Bonferroni corrected p = 0.039). Furthermore, HF power in the deep NMB group was significantly higher at OPEnd than that in the moderate NMB group (45.2 ± 3.6 vs. 33.8 ± 4.0, respectively; Bonferroni corrected p = 0.044). However, no significant differences in cortisol, prolactin, IL-6, CRP, and albumin levels and NK cell percentage were found between the two groups. The degree of NMB may have similar effects on stress-related biological markers in patients undergoing robot-assisted gastrectomy.ope