Various Ultrasonographic Manifestations of Bacille Calmette-Guerin (BCG) Lymphadenitis in Infants after BCG Vaccination

PURPOSE: To evaluate the various ultrasonographic manifestations of BCG lymphadenitis complicated by BCG vaccination in infantsMATERIALS and METHODS:Among a total of 59 patients of BCG lymphadenitis, we retrospectively evaluated the ultrasonographic findings of five patients (seven involved areas), who were operated and confirmed by histopathology. Three cases were male and two were female and the age range is from 3 months to 9 months (mean: 5.5 months).RESULTS: Among five cases two had only a single lesion and three had multiple lesions, and two of those had multiple lesions at 2 separate locations. All five cases had ipsilateral supraclavicular lesions with same BCG vaccination site and two also had ipsilateral axillary lesions. Ultrasonography showed enlarged lymph nodes and heterogeneous hypoechoic changes suggesting internal necrosis or suppurative changes in three cases, but 1 had cystic necrotic change with fluid-fluid level and another had conglomerated mass with intermingled hyper and hypoechoic areas, which were initially suspected to be a tumorous condition but revealed conglomerated lymph nodes on follow-up ultrasonography and MRI. CONCLUSION: BCG lymphadenitis is usually located adjacent to a BCG vaccination site, but ultra-sonography can show single or multiple lymph node enlargement and various manifestations from homogeneous lymphadenitis to cystic abscess changes and even a mass-like appearance , demonstrating that the evaluation of ultrasonography should be done very carefully.ope

밴쿠버 지구촌 교회의 가정 교회 사역과 교회 성장전략

1 full d’un mapa en fulls, còpies fotogràfiques, b/n. - La col·lecció de la Cartoteca de la Universitat de Girona consta de més de 2.000 fulls, amb i sense toponímia. - La data és la del vol. - La numeració segueix el gràfic de fulls amb la informació fila/columna.60 x 30 cm cada full1:5 00

복강경 수술 로봇 시스템의 활용도 향상을 위한 추가적인 마스터 인터페이스 개발과 이를 이용한 응용 시스템 개발 연구

학위논문 (박사)-- 서울대학교 대학원 공과대학 협동과정 바이오엔지니어링전공, 2017. 8. Sungwan Kim.Robot-assisted laparoscopic surgery offers several advantages compared to open surgery and conventional minimally invasive surgery. However, important issues which need to be resolved are the complexity of current operation room environment for laparoscopic robotic surgery and demand for a larger operation room. To overcome these issues, additional interfaces based on Hands-On-Throttle-And-Stick (HOTAS) concept which can be simply attached and integrated with master interface of da Vinci surgical robot system were proposed. HOTAS controller is widely used for flight control in the aerospace field which can manipulate hundreds of functions and provide feedback to the pilot on flight conditions. The implementation of HOTAS controller significantly reduced the complexity of flights and reduced the number of pilots required in a cockpit from two to one. In this study, to provide above benefits to the operation room for robotic laparoscopic surgery, two types of additional interfaces are proposed. Proposed additional interfaces can be easily manipulated by the surgeons index finger, which is currently operated only by finger clutch buttons, and therefore enable the surgeon to use multiple functions. Initially, a novel master interface (NMI) was developed. The NMI mainly consists of a 9-way switch and a microprocessor with a wireless communication module. Thus, the NMI can be also regarded as a 9-way compact HOTAS. The performance test, latency, and power consumption of the developed NMI were verified by repeated experiments. Then, an improved novel master interface (iNMI) was developed to provide more intuitive and convenient manipulation. The iNMI was developed based on a capacitive touch sensor array and a wireless microprocessor to intuitively reflect the surgeons decision. Multiple experiments were performed to evaluate the iNMI performance in terms of performance test, latency, and power consumption. In addition, two application systems based on Surgical-Operation-By-Wire (SOBW) concept are proposed in this research to enhance the function of laparoscopic surgical robot system based on clinical needs that are stated below. The size of the additional interface is small enough to be easily installed to the master tool manipulators (MTMs) of da Vinci research kit (dVRK), which was used as an operation robot arm system, to maximize convenience to the surgeon when using the additional interfaces to simultaneously manipulate the application systems with the MTMs. Firstly, a robotic assistant that can be simultaneously manipulated via a wireless controller is proposed to allow the surgeon to control the assistant instrument. This approach not only decreases surgeon fatigue by eliminating communication process with assistants, but also resolves collision between the operation robot arms and the assistant instruments that can be caused by an inexperienced assistant or miscommunication and misaligned intent between the surgeon and the assistant. The system comprises two additional interfaces, a surgical instrument with a gripper actuated by a micromotor and a 6-axis robot arm. The gripping force of the surgical instrument was comparable to that of conventional systems and was consistent even after 1,000 times of gripping motion. The workspace was calculated to be 8,397.4 cm3. Recruited volunteers were able to execute the simple peg task within the cut-off time and successfully performed the in vitro test. Secondly, a wirelessly controllable stereo endoscope system which enables simultaneous control with the operating robot arm system is proposed. This is able to remove any discontinuous surgical flow that occurs when the control is swapped between the endoscope system and the operating robot arm system, and therefore prevent problems such as increased operation time, collision among surgical instruments, and injury to patients. The proposed system consists of two additional interfaces, a four-degrees of freedom (4-DOFs) endoscope control system (ECS) and a simple three-dimensional (3D) endoscope. The 4-DOFs ECS consists of four servo motors and employs a two-parallel link structure to provide translational and fulcrum point motions to the simple 3D endoscope. The workspace was calculated to be 20,378.3 cm3, which exceeds the reference workspace. The novice volunteers were able to successfully execute the modified peg transfer task. Throughout the various verifications, it has been confirmed that the proposed interfaces could make the surgical robot system more efficiently by overcoming its several limitations.1. Introduction 1 1.1. Robotic Laparoscopic Surgery 1 1.2. Objectives and Scope 8 1.2.1. Additional Master Interfaces 14 1.2.2. Application Systems 15 2. Materials and Methods 20 2.1. Additional Master Interfaces 20 2.1.1. Novel Master Interface: 9-way Compact Hands-On-Throttle-And-Stick 20 2.1.2. improved Novel Master Interface: Capacitive Touch Type Compact Hands-On-Throttle-And-Stick 26 2.2. Application Systems 34 2.2.1. Robotic Assistant 34 2.2.2. Stereo Endoscope System 49 3. Results 57 3.1. Novel Master Interface with Application Systems 57 3.1.1. Novel Master Interface 57 3.1.2. Robotic Assistant 59 3.1.3. Novel Master Interface with Robotic Assistant 67 3.1.4. Stereo Endoscope System 76 3.1.5. Novel Master Interface with Stereo Endoscope System 82 3.2. improved Novel Master Interface with Application Systems 87 3.2.1. improved Novel Master Interface 87 3.2.2. improved Novel Master Interface with Stereo Endoscope System 90 4. Discussion 91 5. Conclusion 102 References 105 Abstract in Korean 117Docto

Contrast-Enhanced Magnetic Resonance Imaging in Pediatric Patients: Review and Recommendations for Current Practice

Magnetic resonance imaging (MRI), frequently with contrast enhancement, is the preferred imaging modality for many indications in children. Practice varies widely between centers, reflecting the rapid pace of change and the need for further research. Guideline changes, for example on contrast-medium choice, require continued practice reappraisal. This article reviews recent developments in pediatric contrast-enhanced MRI and offers recommendations on current best practice. Nine leading pediatric radiologists from internationally recognized radiology centers convened at a consensus meeting in Bordeaux, France, to discuss applications of contrast-enhanced MRI across a range of indications in children. Review of the literature indicated that few published data provide guidance on best practice in pediatric MRI. Discussion among the experts concluded that MRI is preferred over ionizing-radiation modalities for many indications, with advantages in safety and efficacy. Awareness of age-specific adaptations in MRI technique can optimize image quality. Gadolinium-based contrast media are recommended for enhancing imaging quality. The choice of most appropriate contrast medium should be based on criteria of safety, tolerability, and efficacy, characterized in age-specific clinical trials and personal experience.ope

Rapidly Evoluting Congenital Cystic Neuroblastoma in a Neonate

Perinatal detection of neonatal suprarenal masses has increased. Here, we report an unusual case of an adrenal cystic neuroblastoma that presented as a purely cystic lesion upon initial postnatal ultrasonography (US) and showed rapid evolution to a mixed cystic and solid mass during follow-up US and MRI. We suggest a short-term (two weeks) follow-up US for neonatal adrenal cystic lesions, even if they appear as purely cystic.ope

Length and Volume of Morphologically Normal Kidneys in Korean Children: Ultrasound Measurement and Estimation Using Body Size

OBJECTIVE: To evaluate the relationship between anthropometric measurements and renal length and volume measured with ultrasound in Korean children who have morphologically normal kidneys, and to create simple equations to estimate the renal sizes using the anthropometric measurements. MATERIALS AND METHODS: We examined 794 Korean children under 18 years of age including a total of 394 boys and 400 girls without renal problems. The maximum renal length (L) (cm), orthogonal anterior-posterior diameter (D) (cm) and width (W) (cm) of each kidney were measured on ultrasound. Kidney volume was calculated as 0.523 × L × D × W (cm(3)). Anthropometric indices including height (cm), weight (kg) and body mass index (m(2)/kg) were collected through a medical record review. We used linear regression analysis to create simple equations to estimate the renal length and the volume with those anthropometric indices that were mostly correlated with the US-measured renal sizes. RESULTS: Renal length showed the strongest significant correlation with patient height (R(2), 0.874 and 0.875 for the right and left kidneys, respectively, p < 0.001). Renal volume showed the strongest significant correlation with patient weight (R(2), 0.842 and 0.854 for the right and left kidneys, respectively, p < 0.001). The following equations were developed to describe these relationships with an estimated 95% range of renal length and volume (R(2), 0.826-0.884, p < 0.001): renal length = 2.383 + 0.045 × Height (± 1.135) and = 2.374 + 0.047 × Height (± 1.173) for the right and left kidneys, respectively; and renal volume = 7.941 + 1.246 × Weight (± 15.920) and = 7.303 + 1.532 × Weight (± 18.704) for the right and left kidneys, respectively. CONCLUSION: Scatter plots between height and renal length and between weight and renal volume have been established from Korean children and simple equations between them have been developed for use in clinical practice.ope

펄스 및 펄스-리벌스 전해 도금이 구리 박막 및 수퍼필링 특성에 미치는 영향

학위논문 (박사)-- 서울대학교 대학원 : 화학생물공학부, 2013. 2. 김재정.The scale-down of Cu interconnection raises the issues such as the reduction of interconnection property and the difficulty in superfilling using electrodeposition. In the aspect of the interconnection property, the electrical resistivity and the electromigration resistance are the major concerns. In this study, it was attempted to improve the properties of Cu by means of pulse and pulse-reverse electrodeposition. For the purpose of enhancing the superfilling performance, the pulse-reverse electrodeposition was employed. Pulse electrodeposition consisted of on-time during which Cu reduction takes place and off-time where open circuit potential is applied. The peak potential and the lengths of on- and off-times were the important variables determining the film properties. In the results of experiments with varying the off-time, it was confirmed that the grain growth took place during the off-time, resulting in the enhancement of crystallinity and the reduction of resistivity as well. This grain growth seemed to be related to the differences of energies originated from the crystal orientation and grain size. With the enough off-time, Cu film deposited by pulse electrodeposition exhibited 68% higher Cu (111) peak intensity and 22% lower resistivity as compared to constant potential deposition when the film thickness was 260 nm including 60 nm Cu seed layer. However, when the organic additives generally used for Cu superfilling, the grain growth during the off-time was significantly retarded because the organic additives, which strongly adsorbed on Cu surface, changed the energy differences related to the orientation and grain size. Therefore, it was decided to additionally apply the anodic step to pulse electrodeposition, i.e. pulse-reverse electrodeposition, in order to further improve the properties of Cu films. Pulse-reverse electrodeposition was performed without and with organic additives to clarify the impacts of anodic step and organic additives on the film properties. From the variation in the film property according to the anodic conditions in the absence of organic additives, it was observed that the selective dissolution took place, originated from the energy differences related to the orientation and grain size. The selectivity of dissolution depended on the anodic potential which determined the rate of change in the film properties. That is, the application of more positive anodic potential reduced the selectivity, and it slowly increased the grain size and surface roughness. Regarding the electrical resistivity, the impacts of surface roughness and grain size competed with each other, and it resulted in the optimum anodic charge showing the lowest resistivity. As compared to the pulse electrodeposition, pulse-reverse electrodeposition reduced 9% of resistivity in the absence of additives. On the contrary, when the organic additives used for Cu superfilling are introduced, the selectivity of dissolution was determined by the species of the adsorbates. It was found that Cu covered by SPS was much easily dissolved compared to that covered by PEG-Cl-. In this case, the resistivity was found to be strongly determined by the surface roughness, which also exhibited the optimum point at the relatively low dissolution ratio. Pulse-reverse electrodeposition in the presence of organic additives also showed the advantage on the electrical resistivity, which reduced 14% of resistivity compared to the pulse electrodeposition. Therefore, it can be concluded that the pulse-reverse electrodeposition has the merit in the aspect of electrical conductivity. Superfilling performance was strongly determined by the adsorption of organic additives and their accumulation at the trench bottom produced by the area reduction. Prior to applying the pulse-reverse electrodeposition to superfilling, the impact of anodic step on the competitive adsorption between SPS and PEG-Cl- was investigated. As the results, it was clarified that the anodic step accelerated the displacement of preadsorbed PEG-Cl- by SPS, and the extent of displacement was increased with longer reverse time and more positive anodic potential. This acceleration of displacement has the potential to affect the superfilling, therefore, superfilling performance was assessed with various anodic conditions. As compared to the gap-filling result of constant potential deposition, the pulse-reverse electrodeposition exhibited better bottom-up performance at the trench with 55 nm of width and 300 nm of depth. At the corner of low-aspect-ratio trench, the rapid growth of Cu was observed with pulse-reverse electrodeposition, implying more accumulation of SPS at the corner. These results were understood by the acceleration of displacement with the anodic step. Considering the improvement of film properties as well as the superfilling performance, the modification of potential waveform, i.e. pulse and pulse-reverse electrodeposition, can be a candidate for resolving the current issues. This enables us to achieve Cu interconnection in the electronic devices with high speed and superior reliability.Abstract i List of Tables viii List of Figures ix Chapter I. Introduction 1 1-1. Cu interconnection and Damascene process 1 1-2. Cu electrodeposition and superfilling 7 1-3. Current issues and possible solutions 22 1-4. Pulse and pulse-reverse electrodeposition 34 Chapter II. Experimental 39 2-1. Electrolyte, organic additives, and electrodeposition system 39 2-2. Pulse electrodeposition for Cu film deposition 41 2-3. Pulse-reverse electrodeposition for Cu film deposition 42 2-4. Pulse-reverse electrodeposition for Cu superfilling 43 2-5. Analyses of film properties and deposition profiles 45 Chapter III. The characteristics of Cu films deposited by pulse electrodeposition 49 3-1. Pulse electrodeposited Cu films in the absence of additives 49 3-2. Pulse electrodeposited Cu films in the presence of additives 69 Chapter IV. The characteristics of Cu films deposited by pulse-reverse electrodeposition 75 4-1. Pulse-reverse electrodeposited Cu films in the absence of additives 75 4-2. Pulse-reverse electrodeposited Cu films in the presence of additives 95 Chapter V. The impacts of anodic step on the adsorption of additives and superfilling 115 5-1. The effects of anodic step on the competitive adsorption of additives 115 5-2. The effects of anodic step on the superfilling performance 146 Chapter VI. Conclusions 157 References 160 국문 초록 168 Appendix 172Docto

Early Predictive Values for Severe Rhabdomyolysis in Blunt Trauma

Purpose : Rhabdomyolysis (RB) is a syndrome characterized by the decomposition of striated muscles and leakage of their contents into the bloodstream. Acute kidney injury (AKI) is the most significant and serious complication of RB and is a major cause of mortality in patients with RB. Severe RB (creatine kinase [CK] ≥5,000) has been associated with AKI. However, early prediction is difficult because CK can reach peak levels 1–3 days after the trauma. Hence, the aim of our study was to identify predictors of severe RB using initial patient information and parameters. Methods : We retrospectively analyzed 1,023 blunt trauma patients admitted to a single tertiary hospital between August 2011 and March 2018. Patients with previously diagnosed chronic kidney disease were excluded from the study. RB and severe RB were defined as a CK level ≥1,000 U/L and ≥5,000 U/L, respectively. The diagnosis of AKI was based on RIFLE criteria. Results : The overall incidence of RB and severe RB was 31.3% (n=320) and 6.2% (n=63), respectively. On multivariable analysis, male sex (odds ratio [OR] 3.78, 95% confidence interval [CI] 1.43 to 10.00), initial base excess (OR 0.85, 95% CI 0.80 to 0.90), initial CK (OR 2.07, 95% CI 1.67 to 2.57), and extremity abbreviated injury scale score (OR 1.78, 95% CI 1.39 to 2.29) were found to predict severe RB. The results of receiver operating characteristic analysis showed that the best cutoff value for the initial serum CK level predictive of severe RB was 1,494 U/L. Conclusions : Male patients with severe extremity injuries, low base excess, and initial CK level >1,500 U/L should receive vigorous fluid resuscitation.ope

The Prevalence, Physical Characteristics and Diagnosis of Nutcracker Syndrome

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