Cadaveric Evaluation of Different Approaches for Quadratus Lumborum Blocks

Background: A quadratus lumborum (QL) block is an abdominal truncal block technique that primarily provides analgesia and anaesthesia to the abdominal wall. This cadaveric study was undertaken to compare the dye spread between different needle approaches for ultrasound-guided QL blocks in soft-embalmed cadavers. Methods: After randomization, an experienced anesthesiologist performed two lateral, three posterior, and five alternative QL blocks on the left or right sides of five cadavers. The target injection point for the alternative approach was the lumbar interfascial triangle, same as that of conventional posterior QL block, with a different needle trajectory. For each block, 20 ml of dye solution was injected. The lumbar region and abdominal flank were dissected. Results: Ten blocks were successfully performed. Regardless of the approach used, the middle thoracolumbar fascia was deeply stained in all blocks, but the anterior layer was less stained. The alternative approach was more associated with spread of injectate to the transversus abdominis and transversalis fascia plane. Despite accurate needle placement, all lateral QL blocks were associated with a certain amount of intramuscular or subcutaneous infiltration. Two posterior QL blocks showed a deeply stained posterior thoracolumbar fascia, and one of them was associated with obvious subcutaneous staining. The subcostal, iliohypogastric, and ilioinguinal nerves were mostly involved, but the thoracic paravertebral space and lumbar plexus were not affected in all blocks. Conclusions: The alternative approach for QL blocks was able to achieve a comparable extent when compared to the conventional approach.ope

A randomized comparison of volume- and pressure-controlled ventilation in children with the i-gel: Effects on peak inspiratory pressure, oropharyngeal leak pressure, and gastric insufflation

BACKGROUND: The i-gel provides good airway sealing but gastric insufflation may occur when peak inspiratory pressure (PIP) exceeds the sealing pressure of the i-gel without a gastric tube. Pressure-controlled ventilation (PCV) provides lower PIP compared with volume-controlled ventilation (VCV) and low PIP may reduce the incidence of gastric insufflation in children during positive pressure ventilation. This study was designed to evaluate PIP, oropharyngeal leak pressure, and gastric insufflation during VCV or PCV in children undergoing general anesthesia with i-gel without a gastric tube in situ. METHODS: A prospective, randomized-controlled study was conducted. Thirty-four children, aged 6 to 84 months, were randomly allocated into the VCV or PCV group. Fiberoptic bronchoscopy was performed to confirm appropriate position of i-gel. Oropharyngeal leak pressure and PIP were measured after i-gel insertion, after caudal block, and after surgery. Ultrasonography was performed to detect gastric insufflation. Gastric tube was not inserted. RESULTS: PIP in cm H2O was significantly lower in the PCV group than in the VCV group after i-gel insertion (10 [9-12] vs 12 [11-15], P = .021), after caudal block (11 [10-12] vs 13 [11-15], P = .014), and after surgery (10 [10-12] vs 13 [11-14], P = .002). There was no difference in the incidence of gastric insufflation between the 2 groups (4/17 in the VCV group and 3/17 in the PCV group) (P > .999). CONCLUSION: When i-gel was used without a gastric tube, gastric insufflation occurred regardless of the ventilation modes, which provided different PIP.ope

Comparing the injectate spread and nerve involvement between different injectate volumes for ultrasound-guided greater occipital nerve block at the C2 level: a cadaveric evaluation

Purpose: The spread patterns between different injectate volumes have not yet been investigated in ultrasound-guided greater occipital nerve (GON) block at the C2 level. This cadaveric study was undertaken to compare the spread pattern and nerve involvements of different volumes of dye using this technique. Materials and methods: After randomization, ultrasound-guided GON blocks with 1 or 5 mL dye solution were performed at the C2 level on the right or left side of five fresh cadavers. The suboccipital regions were dissected, and nerve involvement was investigated. Results: Ten injections were successfully completed. In all cases of 5 mL dye, we observed the deeply stained posterior neck muscles, including the suboccipital triangle space. The suboccipital and third occipital nerves, in addition to GONs, were consistently stained when 5-mL dye was used in all injections (100%). Although all GONs were successfully stained in the 1-mL dye cases, three of five injections (60%) concomitantly stained the third occipital nerves. Conclusion: The clinical efficacy of this technique using the 5-mL injectate seems unlikely to arise from the blockade of GON alone. Instead, its efficacy likely arises from the blockade of most nerves originating from the dorsal ramus of the upper cervical spinal nerve at the suboccipital area. Even using 1 mL of injectate may not guarantee blockade of the GON alone.ope

근대 일본의 ‘카라유키상’ : 그 실태와 이동 네트워크를 중심으로

It is a common knowledge that from the beginning of Meiji to Showa period a number of Japanese women went over to overseas and were involved in prostitution industries. It is said that more than 20,000 of these women so-called 'Karayuki-san' spread from East Asia to Southeast Asia, America and Africa continents in the early 1910s. Among these regions, Singapore had the largest demand for ‘Karayuki-san’ in Southeast Asia. Furthermore, it acted as a hub to send 'Karayuki-san' out to various places in Southeast Asia, Australia and even to Africa. What made this phenomenon possible was the power which pushes 'Karayuki-san' out from Japan, the power which pulls them toward the place where ‘Karayuki-san’ were in demand, and the network which gathers, distributes, and moves them. There are a number of studies on ‘Karayuki-san’, but they tend to place ‘Karayuki-san’ in the place of departure or arrival and analysis the push and pull factors. However, it seems to be difficult to place 'Karayuki-san' inside the border of Japan or a place where they resided. Some of 'Karayuki-san' left their hometown and settled down abroad for several years and then came back, but some of them remigrated to a different place where had demand for these Japanese women. Thus, it can be said that 'Karayuki-san' were cross-borderal. Based on the above point of view, this thesis examines the actual condition of 'Karayuki-san' from a social historical perspective focused on the network which enabled 'Karayuki-san' to migrate. This is to that shedding light on the process of their migration while sublating to place them inside a certain region. This is also expected to help to understand that 'Karayuki-san' emerged and migrated from multiple relations, and to avoid to understand them as a product of a single nation.영문초록 ⅲ I. 서론 1 1. 연구목적 1 2. 선행연구 3 3. 사료 5 II. ‘카라유키상’ 출현의 배경 7 1. 일본의 내적 요인 7 (1) 전통적 가족질서와 ‘이에(家)’ 7 (2) 일본의 대외 인식 9 (3) 九州 북서부의 지리적 특성 11 2. 동남아시아의 성비불균형 14 III. ‘카라유키상’의 이동 네트워크 17 1. 일본 국내 17 (1) 지역적 분포 18 (2) 인적 구성과 ‘카라유키상’ 모집의 방법 20 2. 일본 국내외 24 (1) 지역적 분포와 인적 구성 24 (2) 해외 도항의 방법과 경로 27 (3) ‘카라유키상’의 ‘매매’ 30 IV. 싱가포르의 ‘카라유키상’ 34 1. 일본 유곽의 형성 34 2. 公娼制와 ‘카라유키상’의 관리 39 3. 일본 유곽의 遊客 46 V. 결론 52 참고문헌 54 부록 5

해녀콩 공생균주 Rhizobum sp. SNU003의 GroEL 단백질 검색 및 gro ELS 유전자 클로닝

학위논문(석사)--서울大學校 大學院 :生物學科,1995.Maste

The effect of speech intelligibility of patients with Parkinson's disease on quality of communication life

언어병리학 협동과정/석사말명료도는 말 장애를 기술하는데 유용한 지표이다. 말명료도는 과제에 따라 다르게 나타날 수 있다. 파킨슨병 환자는 경직, 떨림, 운동느림, 근긴장 이상 등의 육체적 특성으로 인해 말명료도가 저하되며, 저하된 말명료도는 의사소통과 관련된 삶의 질에 영향을 미친다. 이에, 본 연구에서는 파킨슨병 환자의 과제별 말명료도가 ASHA 의사소통 삶의 질 척도(ASHA Quality of Communication Life Scale, 이하 ASHA QCL)에 어떠한 영향을 미치는지 알아보았다. 또한 ASHA QCL과 건강관련 삶의 질(Health Related Quality of Life, 이하 HRQOL)을 측정하는 척도인 한국판 세계보건기구 삶의 질 간편형 척도(Korean Version of WHO Quality of Life Scale Abbreviated Version, 이하 WHOQOL-BREF)의 상관성을 알아보았다. 본 연구는 만 55세 이상의 치매를 동반하지 않은 파킨슨병 환자 35명을 대상으로 하였다. 문단 읽기, 그림 설명, 대화 과제 수행 시 파킨슨병 환자의 말명료도를 직접 크기 측정법(Direct Magnitude Estimation)으로 평가하고 ASHA QCL과 WHOQOL-BREF를 사용하여 QCL과 HRQOL을 측정하였다. 본 연구의 결과는 다음과 같다. 첫째, 파킨슨병 환자의 말명료도는 자발화 과제(그림 설명, 대화)의 말명료도가 문단 읽기 과제 말명료도보다 낮았다. 이는 과제 유형과 발화 친숙도가 영향을 미친 것으로 볼 수 있다. 둘째, ASHA QCL 전체 평균 점수, ASHA QCL의 의사소통 관련 문항 하위 평균 점수, ASHA QCL의 비의사소통 문항 하위 평균 점수에서 세 가지 과제 및 전체 과제 평균 말명료도의 영향이 통계적으로 유의하였다. 과제별 말명료도에서는 자발화 과제가 문단 읽기 과제보다 영향이 더 유의하게 나타났고 자발화 과제 중 그림 설명 과제의 영향이 대화 과제보다 통계적으로 더 유의하였다. 이는 파킨슨병 환자의 말명료도 저하가 의사소통 문제로 이어지며 나아가 삶의 질을 저하하게 됨을 시사한다. 셋째, ASHA QCL과 WHOQOL-BREF는 통계적으로 유의한 양의 상관성을 지니고 있었다. 이는 의사소통 삶의 질이 저하될 경우 HRQOL 역시 저하된다는 것임을 알 수 있다. 본 연구의 의의는 파킨슨병 환자의 저하된 말명료도와 의사소통 삶의 질의 관련성을 알아보아 파킨슨병 환자의 말명료도 증진이 의사소통 삶의 질 향상에 기여할 수 있으며 파킨슨병 환자의 치료 목표 설정에 있어서도 의사소통 삶의 질을 고려해야 한다는 것을 알 수 있다는데 있다. 그러나, 말명료도가 의사소통 삶의 질의 일부분을 설명해주고 있었으나 저하된 의사소통 삶의 질을 설명해줄 수 있는 다른 요인은 알아보지 못했으므로 후속 연구가 필요하다.ope

Bacterial aerosol in dental clinic : associated with influence to subjective symptom of dental staff

환경보건전공/석사[한글]치과 병,의원의 진료환경은 치아를 삭제하거나, 치아에 장착하는 수복물을 제작하는 과정중 air-water spray 의 분사, 구강내.외의 기공작업으로 인해 발생하는 분진과 바이오에어로졸 등으로 인한 눈에 보이지 않는 오염원에 둘러쌓여 있다. 따라서 본 연구는 치과대학병원 종사자들의 호흡기계 증상과 치과진료실 내의 바이오에어로졸을 측정하여 이들의 상관관계를 분석함으로서 치과진료실의 실내근무환경을 올바로 인식하고자 하였다. 치과대학병원의 진료실내 근무환경이 종사자들의 호흡기계 건강에 미치는 영향을 조사하기 위하여 서울시내 소재한 1개 치과대학병원의 종사자 191명을 대상으로 설문조사를 실시, 치과진료실 1곳을 선정(치과보존과)하여 바이오에어로졸을 측정하였다. 총 부유세균의 농도분포는 진료전의 경우 진료실 B지점이 가장 높은 농도를 나타냈고, 진료 중 측정결과 진료실 A와 B지점 모두 다른 지점에 비해 높았다. 입경크기 분포는 1.1~2.1㎛가 가장 높은 비율로 나타났다. 이 입경크기는폐기관지에 가장 많이 침적되는 크기이다. 요일별 농도분포에서는 전체적으로 진료전보다 진료 중이 비교적 높은 농도를 나타내고 있는데, 이는 내원환자수와 관계가 있을 것으로 생각된다. 총 23개의 종 중 unknown 14개종을 제외한 9종은 모두 인체에 유해한 병원성균이었으며, 이 중 3개종이 폐렴과 관련된 균종이며, 1종-Pseudomonas stutzeri 는 기회성 감염균으로 나타났다. 이 결과는 호흡기 질환을 다루지 않는 진료과목인 치과에서 호흡기 질환과 연관된 균에 검출된 것으로 보아 바이오에어로졸로 인한 교차감염의 가능성을 배제할 수 없을 것으로 생각된다. 이상의 연구에 의하면 치과대학병원의 진료실은 진료전보다 진료중 부유세균의 농도가 높고, 호흡기계 침전되는 입경크기의 점유율이 높으며, 폐렴의 원인균 및 기회성 감염균종이 나타났다. 그러므로 치과진료실 종사자들은 진료실내 부유세균, 바이오에어로졸의 인식을 통해 실내환경에 대한 적절한 관리가 필요하다고 사료된다. [영문]ope

Skin perfusion pressure as an indicator of tissue perfusion in valvular heart surgery: Preliminary results from a prospective, observational study.

Hemodynamic management aims to provide adequate tissue perfusion, which is often altered during cardiac surgery with cardiopulmonary bypass (CPB). We evaluated whether skin perfusion pressure (SPP) can be used for monitoring of adequacy of tissue perfusion in patients undergoing valvular heart surgery. Seventy-two patients undergoing valve replacement were enrolled. SPP and serum lactate level were assessed after anaesthesia induction (baseline), during CPB, after CPB-off, end of surgery, arrival at intensive care unit, and postoperative 6 h. Lactate was further measured until postoperative 48 h. Association of SPP with lactate and 30-day morbidity comprising myocardial infarction, acute kidney injury, stroke, prolonged intubation, sternal infection, reoperation, and mortality was assessed. Among the lactate levels, postoperative 6 h peak value was most closely linked to composite of 30-day morbidity. The SPP value during CPB and its % change from the baseline value were significantly associated with the postoperative 6 h peak lactate (r = -0.26, P = 0.030 and r = 0.47, P = 0.001, respectively). Optimal cut-off of % decrease in SPP during CPB from baseline value for the postoperative 6 h hyperlactatemia was 48% (area under curve, 0.808; 95% confidence interval (CI), 0.652-0.963; P = 0.001). Decrease in SPP >48% during CPB from baseline value was associated with a 12.8-fold increased risk of composite endpoint of 30-day morbidity (95% CI, 1.48-111.42; P = 0.021) on multivariate logistic regression. Large decrease in SPP during CPB predicts postoperative 6 h hyperlactatemia and 30-day morbidity, which implicates a promising role of SPP monitoring in the achievement of optimal perfusion during CPB.ope