Single Center Experience of Stab Wound Management

Purpose: The aim of this study is to investigate the clinical characteristics and epidemiology of stab wound in a single center for 5 years. Methods: Eighty-seven patients visited the emergency room with stab wounds between March 2008 and October 2013. Patient demographics, location of the wound, injured internal organ, and clinical parameters were reviewed. Results: Among eighty seven patients, 59 were male, and the mean age was 45.6 years old (range, 18∼85 years old). The most common age group was fifth and sixth decades. The most common cause of stab injury was self-infliction (32 cases), followed by violence (31 cases) and accident (23 cases). Self-infliction injuries were associated with underlying psychological problems in 20 patients. The most common injured sites were abdomen (48 cases), followed by thorax (20 cases) and neck (12 cases). Emergent exploration was required in 37 patients. Four patients (4.6%) were dead due to hypovolemic shock after injury of the thorax (lung) or neck (transection of carotid artery and transection of trachea). The length of hospital stay was 3 days (0∼6.5 days) and the injury severity score (ISS) was 4 points (1∼9 points). ISS was associated with the length of hospital stay (p<0.001) and emergency exploration (p=0.001). Conclusion: Self-inflicted injury was the most common cause of stab injury and it was related to psychologic problems. The most common injured site was abdomen.ope

Severe persistent hypocholesterolemia after emergency gastrointestinal surgery predicts in-hospital mortality in critically ill patients with diffuse peritonitis

BACKGROUND: Plasma cholesterol acts as a negative acute phase reactant. Total cholesterol decreases after surgery and in various pathological conditions, including trauma, sepsis, burns, and liver dysfunction. This study aimed to determine whether hypocholesterolemia after emergency gastrointestinal (GI) surgery is associated with in-hospital mortality in patients with diffuse peritonitis. METHODS: The medical records of 926 critically ill patients who had undergone emergency GI surgery for diffuse peritonitis, between January 2007 and December 2015, were retrospectively analyzed. The integrated areas under the curve (iAUCs) were calculated to compare the predictive accuracy of total cholesterol values from postoperative days (PODs) 0, 1, 3, and 7. Cox proportional hazard regression modeling was performed for all possible predictors identified in the univariate and multivariable analyses. RESULTS: The total cholesterol level measured on POD 7 had the highest iAUC (0.7292; 95% confidence interval, 0.6696-0.7891) and was significantly better at predicting in-hospital mortality than measurements on other days. The optimal total cholesterol cut-off value for predicting in-hospital mortality was 61 mg/dL and was determined on POD 7. A Cox proportional hazard regression analysis revealed that a POD 7 total cholesterol level < 61 mg/dL was an independent predictor of in-hospital mortality after emergency GI surgery (hazard ratio, 3.961; 95% confidence interval, 1.786-8.784). CONCLUSION: Severe persistent hypocholesterolemia (<61 mg/dL) on POD 7 independently predicted in-hospital mortality, after emergency GI surgery, in critically ill patients with diffuse peritonitis.ope

The Influence of How the Trauma Care System Is Applied at the Trauma Center: The Initial Experience at Single Trauma Center

Purpose: To evaluate the influence of how the trauma care system is applied on the management of trauma patients. Methods: We divided the patients into a pre-trauma system group and a post-trauma system group according to the time when we began to apply the trauma care system in our institution. We compared the general characteristics, injury severity score, initial response time to the trauma patients, number of preventable deaths, and clinical outcomes between the two groups. Results: The numbers of patients in the pre-trauma system group and the post-trauma system group were 188 and 257, respectively. No differences in the patient’s median ages, trauma scores (ISS, RTS, TRISS) and proportions of severe trauma patients (ISS>15) were observed between the two groups. The number and the proportion of patients who were admitted to our hospital were increased in the post-trauma system group. The time interval from trauma CP activation to emergency surgery or angio-embolization, and the patient’s time spent in emergency room were shortened in the posttrauma system group. However, the lengths of the ICU stay and the hospital stay, and the number of in-hospital mortalities were not improved in the post-trauma system group. In severe trauma patients (ISS>15), there were no differences between the two groups in the number and the proportion of admitted patients, and the time interval from trauma CP activation to performing a diagnostic and therapeutic procedure was not shortened in the post-trauma system group. Conclusion: Application of the trauma care system has shortened the time between the initial response and patient management. However, this improvement was not enough to result in better clinical outcomes. More trauma physicians, multidisciplinary cooperation, and a well-organized trauma management process will be needed if the maximum efficacy of the trauma system is to be achieved.ope

Hyperchloremia is associated with 30-day mortality in major trauma patients: a retrospective observational study

BACKGROUND: Chloride is important for maintaining acid-base balance, muscular activity, osmosis and immunomodulation. In patients with major trauma, chloride levels increase after fluid therapy; this is associated with poor clinical outcomes. The purpose of this study was to determine whether hyperchloremia was associated with increased mortality in patients who had sustained major trauma. METHODS: This study enrolled 266 major trauma patients by retrospective chart review, from January 2011 to December 2015. Patients were older than 16 years; were admitted to an intensive care unit; survived more than 48 h; and had sustained major trauma, defined as an injury severity score?≥?16. Hyperchloremia was defined as a chloride level?>?110mEq/L. Delta chloride (Δchloride) was defined as the difference between the serum chloride level measured 48-h post-admission and the initial level. Clinical and laboratory variables were compared between survivors (n?=?235) and non-survivors (n?=?31). A multivariate logistic regression analysis was performed to assess the association between hyperchloremia 48-h post-admission (hyperchloremia-48) and 30-day mortality. RESULTS: The overall 30-day mortality was 11.7 % (n?=?31). Hyperchloremia-48 occurred in 65 patients (24.4 %) and the incidence was significantly different between survivors and non-survivors (19.6 vs. 61.3 %, respectively, p?<?0.001). Multivariate logistic analysis identified hyperchloremia-48 and Δchloride as independent predictive factors for 30-day mortality in major trauma patients. DISCUSSION: Infusion of chloride-rich solutions, such as normal saline, is itself associated with hyperchloremia, which has been associated with poor patient outcomes. Patients receiving normal saline were more likely to suffer major postoperative complications, acute kidney injury, and infections. Moreover, large changes in serum chloride levels correlated with greater in-hospital mortality. CONCLUSION: Hyperchloremia 48-h post-admission and Δchloride was associated with 30-day mortality in major trauma patients. These indices may be useful prognostic markers.ope

Sequential Changes in Body Composition Using Bioelectrical Analysis during the Metabolic Response in Critically Ill Surgical Patients

Purpose: Assessment of sequential changes in body composition during the metabolic response in critically ill surgical patients is essential for optimal nutritional support and management. Bioelectrical impedance analysis (BIA) is an easy, portable, and quick way to assess body composition. Thus, the aim of this study was to evaluate the sequential changes in body composition and the validity of Direct segmental Multi-frequency BIA in critically ill surgical patients. Materials and Methods: Twenty-three patients admitted to the intensive care unit (ICU) after major surgery were measured for body composition by multiple-frequency BIA after intensive care unit admission as well as 3 and 7 days later. Repeated-measures analysis of variance (ANOVA) was used to detect significant changes over time. Results: The average length of intensive care unit stay was 4.3 days. Total body water, extracellular water, skeletal muscle mass (SMM), soft lean mass, and fat-free mass (FFM) increased during the first 72 h of intensive care unit admission, after which they decreased slightly. On the other hand, fat mass decreased during the first 72 h of intensive care and then increased. However, arm circumference (AC), arm muscle circumference (AMC), and waist circumference (WC) gradually decreased by day 7 (P＜0.001). Conclusion: In this study, AC, AMC, WC, and direct segmental Multi-frequency BIA were less affected by initial resuscitation in the intensive care unit (ICU). Therefore, segmental BIA may be useful for critical ill patients in altered hydration states.ope

Relation between Blood Alcohol Concentration and Clinical Parameters in Trauma Patients

Purpose: The aim of this study was to evaluate the effects of blood alcohol concentration (BAC) on the clinical parameters in trauma patients. Methods: From January 2011 to March 2013, the records of a total of 102 trauma patients with BAC data were analyzed retrospectively. The revised trauma score (RTS), injury severity score (ISS), presence of shock, use of mechanical ventilation and blood transfusion, length of hospital stay, and mortality were collected. Patients were divided into four groups in accordance with the level of BAC: group A (250 mg/dL). Patients were also divided into two groups depending on the presence of the shock, and gender, ISS, BAC, and presence of active bleeding were compared between these two groups. Results: No statistically significant differences in the ISS, RTS, presence of active bleeding, use of mechanical ventilation, and mortality were noted between groups A to D. However, the presence of shock was significantly higher in group D. After patients with severe chest injuries had been excluded, mechanical ventilation was found to have been applied more frequently in the higher BAC groups (C and D). A logistic regression analysis of these factors showed that extremely high BAC (>250 mg/dL) was an independent indicator of shock. Conclusion: High BAC is a predicator of shock and the need for mechanical ventilation in patients with trauma, regardless of injury severity. Alcohol intoxication leads to an overestimate of the clinical condition and aggressive management for trauma patients. Thus, a guideline for the diagnosis and treatment of patients intoxicated with alcohol is necessary.ope

A Study on the Mobile Phone GUI Designs as the analysis of 20&amp;apos;s women user&amp;apos;s sensitivity and trend

본 연구는 사회 트렌드 변화에 따른 적응 속도가 빠르고 소비 또한 타 계층에 비해서 매우 높은 지수로 구성된 20대 여성을 연구 대상으로 선정하여 이들의 다양한 감성 니즈를 파악하고 현 시점에서의 트렌드 분석을 통해 그들의 요구와 취향이 적절하게 반영된 휴대폰 GUI디자인을 대기화면을 중심으로 제시해보고자 한다. 연구방법은 사용자 감성 니즈 분석을 위해 FGI 기법을 사용하였고, 트렌드 분석을 위해서는 타운와칭과 잡지 및 웹사이트 분석을 통하여 감성형용사를 추출하였다. 추출된 형용사간의 상관치와 의미에 따라 상대축을 설정하여 공간을 설정하고 공간 위에 각 형용사와 이미지를 배열하여 감성형용사 공간을 설정하였다. 이러한 감성평가 결과에 FGI를 통해 구분한 사용자의 감성 니즈 분류를 기초로 하여 3가지의 감성테마로 분류를 하였다. 분류 기준은 사용자들이 원하는 휴대폰 이미지와 트랜드 분석을 하여 얻은 형용사를 비교하여 그룹핑하였다. 분류된 그룹에 해당하는 테마명을 지정해주었고 그에 맞는 휴대폰 GUI 디자인을 제안한다. 첫 번째 테마 Romanticism은 귀엽고 사랑스러운 소녀적인 이미지를 갖는 것으로 부드럽고 섬세하며 우아한 디자인적 특성을 지니고 있다. 색채는 바이올렛이나 핑크를 비롯하여 화려하고 산뜻한 화사한 파스텔 색상 등 전체적으로 밝고 채도가 높은 컬러이다. 패턴은 화려한 꽃을 비롯하여 하트무늬나 기하학적 무늬, 줄무늬, 물방울무늬, 페이즐리 문양 등이 있다. 두 번째 테마 Simplicity는 부드러움과 소박하고 꾸밈없이 표현되는 이미지를 갖는다. 심플하고 베이직한 실루엣의 디자인을 지향한다. 색채는 은은한 파스텔 톤 계열로 소프트한 느낌의 색조를 기본 색상으로 사용하고 자연물을 단순화시킨 문양을 사용한다. 세 번째 테마 Funology는 새롭고 신선한 아이디어를 추구하는 이들에게 기술과 즐거움을 동시에 만족시켜준다. 전체적인 느낌은 자유로움과 발랄함을 나타내었다. 색채는 경쾌하고 동적인 느낌의 색상을 사용하고 강렬한 대비가 있는 색채를 포인트로 사용하여 시각적 즐거움을 준다. 본 연구는 시장세분화 경향에 따라 특정 사용자 층에 대한 연구가 중요한 시점에서 20대 여성이라는 특정 사용자층에 대한 조사를 바탕으로 디자인을 이끌어내었다는데 의의가 있다.;This research select the 20&amp;apos;s composed of women who are adopt fast for the social trend changing and degree of the consumptions higher than other class, and grasp their variety sensitive(Emotional quotient) and throughout the analyzing the trend of visual point, let us suggest with focusing on the mobile phone design, which name is GUI and reflected their requirements and tastes. Research ways used the FGI technique for the analyzing the user&amp;apos;s sensitive(Emotional quotient),and draw out the sensitivity adjective throughout analyzing the town watching, magazines and web-site in order to analyzing the trend. According to meaning and relation rate among adjectives which drew out, set the sensitivity adjective space by set the space and arrange each adjectives and images on the space. Throughout FGI adding these sensitivity estimation result, three kinds of sensitivity theme classified based on the user&amp;apos;s sensitivity division. Standard division grouped by comparison of the adjective by trend analyzing and mobile image which wanted by users. Suggest the private mobile phone GUI design after pointed out the fitting themes which includes groups by separated. Romanticism, the first theme, based on the image of the cute and lovely girl and it has the design features of the smooth, delicate and elegant. Colors, including violet, pink, splendid and fresh, are bright and high tones entirely. Patterns, have the brilliant flowers, heart, geometric, stripe and paisley patterns. Simplicity, second theme, have smoothness, plain and expressed without decoration images. It pursues the design of simple and basic silhouette. Colors, based on the felling of the soft, which kinds of roaring pastel tones. Also, its pattern using the simplification of the natures. Funology(Fun+technology), the third theme, give the satisfaction of skills and pleasures to the people who pursue the new and fresh ideas. Feelings about entire appeals the free and vivid. Colors, give the visual enjoyment with using the point which has the strong contrast and using the colors which has feeling of dynamic and nimble. This research have made a significant contribution of drew out the design from the survey which background of particular users who are 20&amp;apos;s women in accordance of tendency for the market subdivision.논문개요 = v Ⅰ. 서론 = 1 A. 연구의 배경 및 필요성 = 1 B. 연구의 목적 = 3 C. 연구의 내용 및 방법 = 4 Ⅱ. 이론적 고찰 = 6 A. 20대 여성 사용자 = 6 1. 20대 여성의 라이프 스타일 = 6 2. 20대 소비자 문화 = 7 B. 감성 = 8 1. 감성의 개념 = 8 2. 감성적 접근 동향 = 10 3. 감성 니즈의 정의 = 11 C. 트렌드 = 13 1. 트렌드의 개념 = 13 2. 트렌드의 변화요인 = 14 3. 트렌드 분석요소 = 16 Ⅲ. 기존 여성을 위한 휴대폰 사례조사 = 17 A. 국내 여성을 위한 휴대폰 사례조사 = 17 B. 해외 여성을 위한 휴대폰 사례조사 = 27 C. 사례 분석 결과 = 30 Ⅳ. 20대 여성의 트렌드 및 감성 니즈 분석 = 33 A. 트렌드 분석 = 33 1. Town Watching = 33 2. 감성 형용사 수집과 추출 = 39 B. 20대 여성의 휴대폰에 대한 감성 니즈 분석 = 42 1. FGI (Focus Group Interview) = 42 C. 감성 평가를 통한 감성 테마 분류 = 45 1. 감성 형용사 및 이미지 공간 설정 = 45 2. 감성테마 분류 = 48 3. 디자인 제안 = 56 Ⅴ. 결론 및 함의 = 60 참고문헌 = 62 부록 = 64 ABSTRACT = 6

Context mining for situation-dependent mobile services

학위논문(박사) --서울대학교 대학원 :경영학과,2007.Docto

Collaborative Filtering 알고리즘을 이용한 Recommender System의 퍼포먼스 향상 방안에 관한 연구

학위논문(석사)--서울대학교 대학원 :경영학과 경영학전공,2001.Maste