The effects of sensorial saturation on procedure-related pain of the infants in cardiac intensive care unit

본 연구는 심장중환자실에 입원한 영아를 대상으로 경정맥 중심정맥관 제거 처치 시 관심전환요법 중 하나인 감각포화(Sensorial Saturation; SS)요법을 제공한 후 영아의 통증행동반응, 통증생리반응을 분석하여 감각포화요법이 처치 관련 통증 완화에 미치는 효과를 확인한 비동등성 대조군 전후 시차설계연구이다. 연구대상자는 서울 소재 S 병원 심장중환자실에 입원하여 2019년 4월부터 9월까지 선천성 심장질환으로 개흉술 수술을 받은 1세 미만의 영아로 경정맥 중심정맥관 제거 처치 시 일반적 간호중재를 제공한 대조군 38명, 감각포화요법을 제공한 실험군 40명으로 총 78명이었다. 실험군에는 Bellieni & Buonocore(2017)가 제공한 중재법을 따라 포도당 경구 투여(Taste), 가볍게 쓰다듬기(Touch), 낮은 목소리로 달래기(Talk)의 3가지 중재(3Ts)를 동시에 적용한 감각포화요법이 제공되었으며, 대조군에는 일반적 간호중재(감싸주기)가 제공되었다. 감각포화요법의 효과를 확인하기 위한 지표로 통증생리척도(심박동수, 산소포화도, 호흡수)와 통증행동척도(Modified Behavioral Pain Scale; MBPS)를 경정맥 중심정맥관 제거 직전, 제거 시작 3분 후, 제거종료 직후, 제거종료 1분 후에 측정하였다. 수집된 자료는 SPSS 25.0 프로그램을 이용하여 Independent t-test와 χ2 test, Repeated Measures ANOVA로 분석하였다. 연구의 주요 결과는 다음과 같다. 1) 감각포화요법을 적용한 실험군과 적용하지 않은 대조군 간 경정맥 중심정맥관 제거 시기별 통증생리반응은 다음과 같다. 심박동수는 그룹 간(F=6.46, p=.013), 시점(F=87.22, p<.001) 및 시점과 그룹의 교호작용(F=53.15, p<.001), 호흡수는 그룹 간(F=8.12, p<.001), 시점(F=26.20, p<.001) 및 시점과 그룹의 교호작용(F=15.19, p<.001)으로 유의한 차이를 보였다. 산소포화도는 그룹 간(F=.52, p=.47), 시점(F=13.53, p=.27)은 유의하지 않았으나, 그룹의 교호작용(F=4.46, p<.001)은 유의한 차이를 보였다. 2) 감각포화요법을 적용한 실험군과 적용하지 않은 대조군 간 경정맥 중심정맥관 제거 시기별 통증행동반응은 다음과 같다. 통증행동척도(MBPS) 그룹 간(F=92.06, p<.001), 시점(F=92.35, p<.001) 및 시점과 그룹의 교호작용(F=45.21, p<.001)은 유의한 차이를 보였다. 이상의 결과를 종합해보면, 감각포화요법을 적용한 실험군에서 통증생리반응은 시간이 지남에 따라 심박동수와 호흡수는 유의하게 감소하였으나 산소포화도는 유의한 차이를 보이지 않았다. 또한, 통증행동반응은 시간이 지남에 따라 유의하게 감소하여 감각포화요법이 통증을 완화시키는 효과가 있는 것으로 나타났다. 따라서 감각포화요법은 경정맥 중심정맥관 제거 처치와 같은 통증을 완화하는 독자적 간호중재로 활용될 수 있을 것이다. The purpose of this study is to investigate the effect of sensorial saturation therapy, which is one of the distraction techniques of infants in the cardiac intensive care unit. It was performed a nonequivalent control group nonsynchronized design study, using the physiological pain scales and Modified Behavioral Pain Scale to assess pain during the procedure of internal jugular central venous catheter removal. The subjects were infants under one year of age who had been admitted to S hospital in Seoul and had undergone thoracotomy for congenital heart disease from April to September 2019. When jugular vein removal was performed, 38 patients received the general nursing intervention, 40 patients received sensory saturation, and 78 patients were enrolled. The experimental group was provided with sensory saturation therapy using three interventions(3Ts) simultaneously, oral sugar(Taste), massage(Touch), and speaking to the baby to obtain distraction(Talk), following the intervention provided by Bellieni & Buonocore(2017). The control group was given general nursing intervention(swaddle an infant with a rectangular blanket). The physiological pain scales(heart rate, oxygen saturation, respiratory rate) and the Modified Behavioral Pain Scale(MBPS) were measured immediately before the removal of the internal jugular central venous catheter, 3 minutes after the start of removal, immediately after the end of removal, and 1 minute after the end of removal. Collected data were analyzed using a descriptive statistic, independent t-test, χ2 test, and Repeated Measures ANOVA using SPSS 25.0 Windows program. The main results of the study are as follows. 1) The physiological pain responses by the time of the procedure of internal jugular central venous catheter removal between the experimental group receiving sensory saturation therapy and the control group providing general nursing intervention were as follows. Heart rate and respiratory rate were significantly different. Heart rate was measured between groups (F = 6.46, p = .013), time (F =87.22, p <.001) and interaction between time and group (F = 53.15, p <.001), and respiration rate was measured between groups (F = 8.12, p <.001), time (F = 26.20, p <.001) and interaction between time and group (F = 15.19, p <.001). Oxygen saturation was not significant between groups (F = .52, p = .47) and time (F = 13.53, p = .27), but the interactions between time and group (F = 4.46, p <.001) was significantly different. 2) The behavioral pain responses by the time of the procedure of internal jugular central venous catheter removal between the experimental group receiving sensory saturation therapy and the control group providing general nursing intervention were as follows. Modified Behavior Pain Scale(MBPS) was significantly different. It measured between groups (F = 92.06, p <.001), time (F = 92.35, p <.001) and the interaction between time and group (F = 45.21, p <.001). In conclusion, in the experimental group receiving sensory saturation therapy, the physiological pain response significantly decreased with time, but the oxygen saturation was not significantly different. Also, the behavioral pain response was significantly decreased over time, suggesting that sensory saturation was effective in relieving pain. Therefore, sensory saturation therapy can be used as an independent nursing intervention to relieve pain, such as internal jugular central venous catheter removal.open석

온열요법을 위한 실리카가 코팅된 골드 코어-쉘 나노입자의 합성 및 평가

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F. Chopin의 《Ballade No. 4, Op. 52》연구

학위논문 (석사) -- 서울대학교 대학원 : 음악대학 음악과, 2020. 8. 이민정.본고는 19세기 낭만주의 작곡가 쇼팽(Frédéric François Chopin, 1810-1849)의 《발라드 제 4번》(Ballade No. 4 in F minor, Op. 52)에 나타나는 주제 전개 방식을 분석한 논문이다. 발라드는 원래 문학의 한 장르인 자유로운 형식의 담시였으며, 음악으로서의 발라드는 중세 시대 프랑스 음유시인들의 노래에서 그 기원을 찾을 수 있다. 14세기 아르스 노바의 대표 작곡가 마쇼(Guillaume de Machaut, 1300-1377)에 의해 대표적인 고정 형식(fixed form)이 된 발라드는 음악사에서 예술 작품으로서 중요하게 다루어지기 시작하였다. 이후 발라드는 유럽 각지에 퍼져 각 나라별로 독특한 형태의 성악곡으로 발전하였으며, 19세기에 쇼팽에 의해 새로운 기악 형식의 장르로 독립되었다. 쇼팽의 네 개의 발라드는 문학의 영향을 받아 작곡되었으며, 특히 폴란드 시인 미츠키에비치(Adam Mickiewicz, 1798-1855)의 시와 연관성이 있다. 또한 악곡 내에서 주제가 여러 음악적 기법을 통해 변형되어 등장하며 점점 발전하는 구조의 내러티브적인 특성을 가지고 있다. 이러한 서술적 양식의 기악 작품은 이후 작곡가들에게 큰 영향을 주었다. 쇼팽의 발라드 중 가장 완성도가 높고 원숙미가 넘치는 작품으로 평가받는 《발라드 제 4번, Op. 52》에는 세 개의 주요 주제인 서주, 제 1주제, 제 2주제가 등장한다. 서주는 작품 중반에 전조되어 등장하며 화성의 진행이 한층 다채로워진다. 제 1주제는 제시된 후 장식이 가미된 반복, 동기 단편과 모방기법을 활용한 변형, 텍스처 변형, 동기를 결합한 변형, 모방 대위법적 변형, 벨칸토 양식과 비화성음을 사용한 변형 총 여섯 차례에 걸쳐 변형되며 발전한다. 제 2주제는 작품 중반에서 3도 관계의 조성으로 전조되어 나타나고, 반주의 형태가 바뀌며 음역이 확장된다. 본 논문에서 이 작품에 나타나는 주제 전개 방식을 분석한 결과, 그 방식이 낭만주의 시대 음악에 사용되었던 주제 변형 기법(Thematic transformation)과 유사함을 알 수 있었다.This is an analysis of the thematic development methods in 《Ballade No. 4 in F minor, Op. 52》 by Frédéric François Chopin(1810-1849), a nineteenth century Romantic composer. A ballade was an example of originally free form poetry, a type of literary genre. The ballade, as a musical genre, is derived from the song of French minnesinger in the Middle Ages. It became a popular and significant fixed form through the works of Guillaume de Machaut(1300-1377), an important composer of the Ars Nova style in the fourteenth century. Afterwards, the ballade was diffused across European countries and matured into its own distinctive style of vocal music. In the nineteenth century, with the contribution of Chopin, it evolved as an independent genre of instrumental music. Chopins 4 Ballades were inspired by literature and the Polish poet. Especially, Mickiewiczs poems are closely associated with his ballades. Furthermore, the pieces feature narrative structures developed from the transformation of the themes using various musical techniques in a piece. This descriptive form of instrumental pieces greatly influenced later composers. 《Ballade No. 4 in F minor, Op. 52》, considered the most mature piece of Chopin's ballades, features three main themes: introduction, the first and second themes. The introductory theme appears in different key in the middle of the piece and harmonic progression becomes more colorful. The first theme is transformed and developed with six variations after the exposition: repetition with ornamentation, transformation using fragments and imitation, textural change, combination of motives, imitative counterpoint and ornamentation in the bel canto style with nonharmonic tone. The second theme appears again in key of third degree relationship in the middle of the piece. Also the form of accompaniment changes and the range of notes expands. This analytical study of the thematic development methods of this piece shows that the method is similar to the technique of Thematic transformation used in the Romantic era.Ⅰ. 서 론 1 Ⅱ. 본 론 3 1. 발라드의 역사와 피아노 발라드 작곡가 3 1. 1. 발라드의 역사 3 1. 2. 피아노 발라드 작곡가 8 2. 쇼팽의 발라드 13 3. 《발라드 제 4번, Op. 52》 주제 전개 방식 연구 22 3. 1. 서주부 22 3. 2. 제 1주제 전개 26 3. 3. 제 2주제 전개 44 Ⅲ. 결 론 51 참 고 문 헌 53 Abstract 56Maste

Elastosis Perforans Serpiginosa

Elastosis perforans serpiginosa is a rare skin disease characterized by transepidermal elimination of abnormal elastic fibers. This condition classically presents as small papules arranged in serpiginous or annular patterns on the neck, face, arms, or other flexural areas. While these lesions may spontaneously resolve, they often persist for longer periods of time. Though numerous treatment modalities have been described in the literature, most are not very effective. A 35-year-old man presented to Gangnam Severance Hospital with a 2-year history of skin eruptions on his neck, which were refractory to topical antifungal or steroid treatment. On examination, the patient showed multiple crusted and erythematous papules arranged in an annular pattern with central clearing. A biopsy specimen revealed acanthosis with notable transepidermal elimination of nuclear debris and eosinophilic degenerated elastic fibers from the dermis via an epidermal channel. Verhoeff-van Gieson staining showed dense clumps of altered elastic fibers in the papillary dermis. Based on these findings, a diagnosis of elastosis perforans serpisinosa was made. Treatment with topical 0.05% tretinoin application for 6 months resulted in no improvement.ope

Expression of collagenases (matrix metalloproteinase-1, 8, 13) and tissue inhibitor of metalloproteinase-1 of retrodiscal tissue in temporomandibular joint disorder patients

Objectives: The aim of this study was to reveal how collagenases (matrix metalloproteinase [MMP]-1, 8, 13) and tissue inhibitor of metalloproteinase 1 (TIMP-1) are expressed in immunohistochemistry of retrodiscal tissue in temporomandibular joint disorder patients. Materials and Methods: This study was conducted on 39 patients who underwent discoplasty or discectomy. Immunohistochemical staining was undertaken and expression levels of MMP-1, 8, 13, and TIMP-1 were evaluated. The status of internal derangement of disc, osteoarthritis, and joint effusion were analyzed using magnetic resonance imaging (MRI). Disc status observed during operation was also categorized. Results: The more severe disc derangement was observed on MRI, the more increased expression of MMPs and TIMP-1 appeared. Regarding MMP-13 expression, 86.7% of late-stage disc displacement patients showed grade II or III. Expression level of MMPs or TIMP was not statistically significant associated with joint effusion level. In perforation and/or adhesion groups, all patients showed grade II or III expression of MMP-13. Once perforation occurred, MMP-13 showed increased expression with statistical significance. Conclusion: MMP-1 and MMP-13 expression seem to be related to progression of osteoarthritis whereas MMP-8 does not seem to have a specific role with regard to temporomandibular joint disorders. TIMP-1 is considered to be partly related to internal derangement rather than osteoarthritis, but it is not significant.ope

Surface changes of denture base resin according to two toothpastes and a kitchen detergent

Objectives : This study evaluated the changes in surface roughness of denture base resin according to the types of denture cleansers. Methods : A denture base resin(Vertex RS, Dentimax, Netherland) was used. Two toothpaste(Antiplaque, Bukwang, Korea; 2080, Aekyung, Korea) and a kitchen detergent(Trio, Aekyung, Korea) were used as a denture cleanser. The specimens were put on the V8 crossbrushing machine(Sabri enterprises, Downers grove, IL, USA) to reproduce toothbrushing and the toothbrushes were flat, round end and soft type. The surfaces of denture base resin specimens were observed by profilometer(SJ-400, MITUTOYO, Japan) and SEM(S-3000N, Hitachi Co., Ibaraki, Japan). Results : 1. According to the result of measuring surface roughness, there was statistically significant difference in Ra, Rq, and Rz(p<0.05). 2. As for Ra, Rq and Rz, Antiplaque toothpaste showed the highest roughness, and there was significant difference from other groups(p<0.01). 2080 toothpaste, Trio, and distilled water were classified as the same group. 3. According to the result of observation with the SEM, the surfaces of the Antiplaque toothpaste group after toothbrushing showed the greatest roughness, and the surfaces of 2080 toothpaste, Trio, and distilled water groups were rough in order. Trio and distilled water had the surfaces similar to those before toothbrushing. Conclusions : Studies to compare the efficacy of denture management methods and examine the effects of denture cleansers on denture materials will be helpful for dental hygienists and dentists providing patients with proper information and education. And it will be also useful for denture users' oral health.ope

Cellular attachment and differentiation on titania nanotubes exposed to air- or nitrogen-based non-thermal atmospheric pressure plasma.

The surface topography and chemistry of titanium implants are important factors for successful osseointegration. However, chemical modification of an implant surface using currently available methods often results in the disruption of topographical features and the loss of beneficial effects during the shelf life of the implant. Therefore, the aim of this study was to apply the recently highlighted portable non-thermal atmospheric pressure plasma jet (NTAPPJ), elicited from one of two different gas sources (nitrogen and air), to TiO2 nanotube surfaces to further improve their osteogenic properties while preserving the topographical morphology. The surface treatment was performed before implantation to avoid age-related decay. The surface chemistry and morphology of the TiO2 nanotube surfaces before and after the NTAPPJ treatment were determined using a field-emission scanning electron microscope, a surface profiler, a contact angle goniometer, and an X-ray photoelectron spectroscope. The MC3T3-E1 cell viability, attachment and morphology were confirmed using calcein AM and ethidium homodimer-1 staining, and analysis of gene expression using rat mesenchymal stem cells was performed using a real-time reverse-transcription polymerase chain reaction. The results indicated that both portable nitrogen- and air-based NTAPPJ could be used on TiO2 nanotube surfaces easily and without topographical disruption. NTAPPJ resulted in a significant increase in the hydrophilicity of the surfaces as well as changes in the surface chemistry, which consequently increased the cell viability, attachment and differentiation compared with the control samples. The nitrogen-based NTAPPJ treatment group exhibited a higher osteogenic gene expression level than the air-based NTAPPJ treatment group due to the lower atomic percentage of carbon on the surface that resulted from treatment. It was concluded that NTAPPJ treatment of TiO2 nanotube surfaces results in an increase in cellular activity. Furthermore, it was demonstrated that this treatment leads to improved osseointegration in vitro.ope

Effects of non-thermal atmospheric pressure air plasma on gene expression at SLA- treated titanium surfaces

Dental implants manufacturers have developed high hydrophilic and rough implant surfaces which in turn exhibited better osseointegration than conventional ones. Based on in vitro studies, sand blast, large grit, acid etching(SLA)-treated surfaces with microstructural characteristics may promote the process of osseointegration. But when the SLA surface is kept dry in the air, it becomes hydrophobic. Appropriate non-thermal atmospheric pressure air plasma jet(air-NTAPPJ) processes render surfaces hydrophilic. The purpose of this research is to air-NTAPPJ on SLA surface treatment to improve the osteogenic functionality. The experiment was carried out through the a cytotoxicity assay and real-time reverse transcriptase-polymerase chain reaction(RT-PCR). The results were that the cell viability and gene expression of ALP, OCN, OPN, and Runx-2 of rMSC enhanced by air-NTAPPJ treated. Thus, air-NTAPPJ application can lead to an improved osseointegration.ope

Temporomandibular Disorders during or after Dental Implant Treatment

Purpose: Temporomandibular disorders (TMD) may occur during or after regular dental treatment. The aim of this study is to suggest management of TMD involved in dental implant treatment. Materials and Methods: We investgated the etiology, site of implantation, symptoms, treatments and improvements with a focus on TMD among patients who complained of TMD symptoms during or after dental implant treatment. Results: A total of 19 patients complained of TMD associated with implant treatment. Thirteen patients complained of masticatory muscle pain, 13 patients complained of temporomandibular joint (TMJ) pain, and 8 patients complained of both masticatory muscle pain and TMJ pain. The patients were treated primarily with counselling, medication and physical therapy, and secondarily with occlusal splint therapy. Six patients received only primary treatment, and their average recovery time was 4.2 months. Four patients received secondary treatment, and their average recovery time was 8.5 months. None of the patients underwent surgical intervention of the TMJ. Conclusion: Patients who have a risk of developing TMD may experience TMD symptoms during or after implant treatment, such as facial pain, masticatory myalgia, TMJ pain and mouth opening limitation. To mitigate these symptoms, we suggest the application of the usual treatment protocols for TMD.ope

Effect of Microwave Treatment on the Physical Properties of Polyvinyl Siloxane Impression Materials

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