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Implementation of the Feed and Swaddle Technique as a Non-Pharmacological Strategy to Conduct Brain Magnetic Resonance Imaging in Very Low Birth Weight Infants

  • Yoo, Yeong Myong;Park, Ji Eun;Park, Moon Sung;Lee, Jang Hoon
    • Neonatal Medicine
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    • v.28 no.3
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    • pp.108-115
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    • 2021
  • Purpose: Magnetic resonance imaging (MRI) is a useful tool for evaluating brain injury and maturation in preterm infants and often requires sedation to acquire images of sufficient quality. Infant sedation is often associated with adverse events, despite extreme precautions. In this study, the swaddling technique was investigated as an alternative non-pharmacological strategy to obtain brain MRIs of sufficient quality. Methods: We applied the feed and swaddle technique during routine brain MRI as a quality improvement project and compared its morbidity with that of sedation in a historic age-matched group. Seventy-nine very low birth weight infants in the neonatal intensive care unit of Ajou University Hospital (Suwon, Korea) were enrolled. Thirty-two (40.5%) infants were in the feed and swaddling group, and 47 (59.5%) were in the sedation group. Results: The morbidity associated with the cardiopulmonary system (swaddling group vs. sedation group: 53.13% [n=17] vs. 63.83% [n=30], P=0.723) and central nervous system (40.63% [n=13] vs. 29.79% [n=14], P=0.217) were not significantly different between groups. The MRI failure rate was not significantly different (swaddling group vs. sedation group: 12.5% [n=4] vs. 4.3% [n=2], P=0.174). The MRI scanning time was longer in the swaddling group than in the sedation group (76.5±20.3 minutes vs. 61.5±13.6 minutes, P=0.001). Cardiopulmonary adverse events were significantly less common in the swaddling group than in the sedation group (3.13% [n=1] vs. 34.04% [n=16], P=0.002). Conclusion: The success rate of MRI was comparable between the swaddling technique and sedation. Furthermore, despite the drawback of prolonged scan time, cardiopulmonary adverse events are fewer with swaddling than with sedative agents. Therefore, swaddling can be an alternative to sedation or anesthesia when performing neonatal MRI scans.

Cryo-Compression Therapy After Elective Spinal Surgery for Pain Management: A Cross-Sectional Study With Historical Control

  • Nabiyev, Vugar Nabi;Ayhan, Selim;Adhikari, Prashant;Cetin, Engin;Palaoglu, Selcuk;Acaroglu, R. Emre
    • Neurospine
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    • v.15 no.4
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    • pp.348-352
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    • 2018
  • Objective: Postoperative dynamic cryo-compression (DC) therapy has been proposed as a method of reducing pain and the inflammatory response in the early postoperative period after orthopedic joint reconstruction surgery. Our aim was to analyze the analgesic efficacy of DC therapy after adult lumbar spinal surgery. Methods: DC was applied for 30 minutes every 6 hours after surgery. Pain was measured by a visual analogue scale (VAS) in the preoperative period, immediately after surgery, and every 6 hours postoperatively for the first 72 hours of the hospital stay. Patients' pain medication requirements were monitored using the patient-controlled analgesia system and patient charts. Twenty patients who received DC therapy were compared to 20 historical controls who were matched for demographic and surgical variables. Results: In the postanesthesia care unit, the mean VAS back pain score was $5.87{\pm}0.9$ in the DC group and $6.95{\pm}1.0$ (p=0.001) in the control group. The corresponding mean VAS scores for the DC vs. control groups were $3.8{\pm}1.1$ vs. $5.4{\pm}0.7$ (p < 0.001) at 6 hours postoperatively, and $2.7{\pm}0.7$ vs. $6.25{\pm}0.9$ (p<0.001) at discharge, respectively. The cumulative mean analgesic consumption of paracetamol, tenoxicam, and tramadol in the DC group vs. control group was $3,733.3{\pm}562.7mg$ vs. $4,633.3{\pm}693.5mg$ (p<0.005), $53.3{\pm}19.5mg$ vs. $85.3{\pm}33.4mg$ (p<0.005), and $63.3{\pm}83.4mg$ vs. $393.3{\pm}79.9mg$ (p<0.0001), respectively. Conclusion: The results of this study demonstrated a positive association between the use of DC therapy and accelerated improvement in patients during early rehabilitation after adult spine surgery compared to patients who were treated with painkillers only.

A 20-Year Update on the Practice of Thoracic Surgery in Canada: A Survey of the Canadian Association of Thoracic Surgeons

  • Sami Aftab Abdul;Frances Wright;Christian Finley;Sebastien Gilbert;Andrew J. E. Seely;Sudhir Sundaresan;Patrick J. Villeneuve;Donna Elizabeth Maziak
    • Journal of Chest Surgery
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    • v.56 no.6
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    • pp.420-430
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    • 2023
  • Background: This study provides an update to a landmark 2004 report describing demographics, training, and trends in adherence to thoracic surgery practice standards in Canada. Methods: An updated questionnaire was administered to all members of the Canadian Association of Thoracic Surgeons via email (n=142, compared to n=68 in 2004). Our report incorporates internal data from Ontario Health and the Canadian Partnership Against Cancer. Results: Forty-eight surgeons completed the survey (male, 70.8%; mean±standard deviation age, 50.3±9.3 years). This represents a 33.8% response rate, compared to 64.7% in 2004. Most surgeons (69%) served a patient population of over 1 million per center; 32%-34% reported an on-call ratio of 1:4-1:5 days, and the average weekly hours worked was 56.4±11.9. Greater access to dedicated geographic units per center (73% in 2021 vs. 53% in 2004) has improved thoracic-associated services and house staff, notably endoscopy units (100% vs. 91%), with 73% of respondents having access to both endobronchial and endoscopic ultrasound. Access to thoracic radiology has also improved, particularly regarding positron emission tomography scanners per center (76.9% vs. 13%). Annual case volumes for lung (255 vs. 128), esophageal (41 vs. 19), and mediastinal resections (30 vs. 13), along with hiatal hernia repair (45 vs. 20), have increased substantially despite reports of operating room availability and radiology as rate-limiting steps. Conclusion: This survey characterizes compliance with current practice standards, addressing the needs of thoracic surgeons across Canada. Over 85% of respondents were aware of the 2004 compliance paper, and 35% had applied for resources and equipment in response.

Comparison of IVF Outcomes in Patients with Endometriosis According to Severity (자궁내막증이 있는 불임 여성에서 중등도에 따른 체외 수정의 결과 비교)

  • Kim, Hye Ok;Kang, Inn Soo
    • Clinical and Experimental Reproductive Medicine
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    • v.33 no.4
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    • pp.219-227
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    • 2006
  • Objective: To evaluate the impact of endometriosis on IVF-ET cycles and to compare IVF outcomes between stage I/II and stage III/IV endometriosis. Methods: We analyzed 697 patients (1,199 cycles) with endometriosis (stage I-II:638 cycles, stage III-IV: 561 cycles) and 325 pts (459 cycles) with tubal factor as controls between January 1994 and April 2004. Pts with endometriosis were diagnosed by laparoscopy and medical and surgical treatment were done in 353 cycles (55.3%) and 466 cycles (83.1%) of stage I-ll/stage III-IV endometriosis. Cycles with age>35 years or FSH>20 miU/mL or severe male factor infertility were excluded. Results: The number of retrieved oocytes ($9.97{\pm}7.2$ vs. $13.4{\pm}7.9$ (p<0.0001 )), total number of embryos ($6.5{\pm}4.8$ vs. $9.1{\pm}5.6$ (p<0.0001)), and good quality embryos ($2.43{\pm}1.6$ vs. $2.74{\pm}1.7$ (p=0.013)) significantly decreased in stage III-IV endometriosis than in control. But pregnancy rate of stage III-IV endometriosis was comparable with control (35.7% vs. 36.8%). Fertilization rate and number of total embryos were lower in stage I-II endometriosis than in control ($64.8{\pm}22.9$ vs. $70.8{\pm}20.8$ (p<0.0001), $7.6{\pm}5.0$ vs. $9.1{\pm}5.6$ (p<0.0001)). In patients with medical and surgical treatment of endometriosis, pregnancy rate and live birth rate was significantly lower in stage I-II than in stage III-IV endometriosis (29.2 vs. 36.2 (%), p=0.045, 23.9 vs. 31.5 (%), p=0.043). There was no difference in the mean age, but the duration of infertility was significantly longer ($56.5{\pm}26.3$ vs. $46.9{\pm}25.8$ (mon), p<0.0001) and fertilization rate was lower ($64.7{\pm}23.3$ vs. $70.5{\pm}22.7$ (%), p=0.001) in stage I-II than stage III-IV endometriosis. Conclusion: We suggest that IVF should be considered earlier in patients with minimal to mild endometriosis because of significantly decreased fertilization rates.

Studies on the Viability of In Vitro-Matured Bovine Oocytes Vitrified by Microdrop and Straw Method (Microdrop과 Straw 방법으로 초자화 동결한 소 난자의 생존율에 관한 연구)

  • Yang, B.C.;Yang, B.S.;Sung, H.H.;Im, S.K.;Park, S.B.;Chang, W.K.;Lee, C.K.
    • Journal of Animal Science and Technology
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    • v.44 no.6
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    • pp.701-710
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    • 2002
  • Studies on the Viability of In Vitro-Matured Bovine Oocytes Vitrified by Microdrop and Straw Method To establish vitrification method for bovine oocytes, mature bovine oocytes were vitrified by microdrop (MD) or straw (Straw) method and the viability of vitrified oocytes with or without cumulus cells (CC) were examined by several methods; a) parthenogenetic activation; b) pronuclear formation after in vitro fertilization (IVF); and c) embryonic development after IVF. The survival rate of vitrified oocytes by MD was significantly higher than by Straw (92.50 vs. 74.19%, p<0.05). Most of the oocytes survived from vitrification using the MD methods. Cleavage and blastocyst development of parthenogenetically activated oocytes were higher in MD (45.05% and 10.81%, respectively; p<0.05)) than those in Straw method (27.17% and 6.52%, respectively; p<0.05). Male and female pronuclear formation of vitrified-thawed oocytes with or without cumulus cells (CC) after IVF were examined, respectively. The survival rate of vitrified oocytes by MD without CC was no difference between MD and Straw (80.368.14% vs. 67.31%). Normal fertilization (2PN) rates were not different among groups (Fresh; 54.55% vs. MD; 42.22% vs. Straw; 37.14%, p>0.05). While no fertilization (<1PN) rates were significantly different between fresh and vitrified-thawed groups (Fresh; 32.47% vs. MD; 57.78% and Straw 62.86%, p<0.05). The polyspermy (3PN) was appeared in the fresh (12.99%), but no appeared in the vitrified-thawed groups. In the without CC, normal fertilization (2PN) rates were significantly different between fresh and vitrified-thawed oocytes (Fresh; 59.38% vs. MD; 17.31% and Straw; 30.43%, p<0.05). Moreover, no fertilization (<1PN) rates were significantly different between fresh and vitrified-thawed groups (Fresh; 23.44% vs. MD; 73.08% and Straw 58.70%, p<0.05). The polyspermy (3PN, >4PN) was appeared not only fresh but vitrified-thawed groups. After IVF, two-cell developmental rates of vitrified oocytes with CC by MD and Straw were significantly low compared to fresh oocytes (Fresh; 81.76% vs. MD; 22.22% and Straw; 11.36%, p<0.05). Blastocyst developmental rates of vitrified oocytes also were significantly low compared to fresh oocytes (Fresh; 28.38 vs. MD; 1.71% and Straw 0%, p<0.05). In the without CC, two-cell developmental rates were no difference between Fresh and MD (27.59% vs. 19.25%, p<0.05), while blastocyst rates were difference between Fresh and MD or Straw (4.31% vs. 0.62% and 0%, respectively; p<0.05). In conclusion, the results indicate that the vitrified bovine oocytes have the ability to develop to the blastocyst stage after IVF.

Comparison of neonatal outcomes between the spontaneous and in vitro fertilization twin pregnancies (인공수정 및 자연수정으로 태어난 쌍생아간 임상 양상 비교)

  • Kim, Hee Moon;Lee, Jeong Won;Shin, Seon Hee;Kim, Sung Koo;Sung, Tae Jung
    • Clinical and Experimental Pediatrics
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    • v.50 no.8
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    • pp.740-745
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    • 2007
  • Purpose : There is a dominant opinion that in vitro fertilization (IVF) leads to an increased incidence of twins, low birth weight (LBW) infants, prematurity and mortality. On the other hand, technical development of IVF and improvement of neonatal intensive care have increased the survival rate of neonates. The purpose of this study was to verify the tendency by comparing the clinical aspects of IVF and spontaneously conceived twins, and to establish methods to increase the survival rate of neonates after IVF. Methods : Retrospective reviews were performed on all twin infants who were admitted to the nursery and NICU at Kangnam Sacred Heart Hospital, Hallym University from January 1, 2000 to December 31, 2006. Medical records of IVF twins (study group, n=92) and spontaneously conceived twins (control group, n=265) were analyzed and compared. Neonatal outcomes and complications, as well as obstetric outcomes, were analyzed and compared. Results : Mean gestational age and birth weight of the study group ($34.6{\pm}3.5$ weeks, $2,203.9{\pm}617.2g$) were considerably lower than those of the control group ($36.3{\pm}2.4$ weeks, $2,367.0{\pm}517.9g$). The frequency of prematurity less than 37 weeks (68.5% vs 51.3%) and extremely LBW (15.2% vs 6.4%) were also significantly higher in the study group. Other neonatal outcomes were all insignificant. The obstetric characteristics, maternal age ($32.6{\pm}3.3$ years vs $30.3{\pm}3.9$ years) and the frequency of cesarean delivery(95.7% vs 79.9%) were significantly higher in the study group. Other obstetric outcomes were insignificant except for the frequency of incompetent internal os of cervix (36.2% vs 3.6%) and cerclage operation (38.3% vs 4.3%). Conclusion : Based on the above results, clinical outcomes of twin infants will be further improved by careful attention and thorough antenatal care of the IVF twins.

Clinical Features and Associated Factors of Macrolide-Unresponsive Mycoplasma pneumonia and Efficacy Comparison Between Doxycycline, Tosufloxacin and Corticostreoid as a Second-Line Treatment (마크로라이드 불응성 마이코플라즈마 폐렴의 임상 양상 및 연관 인자와 2차 치료제로서 doxycycline, tosufloxacin 및 corticosteroid의 효능 비교)

  • Han Byeol Kang;Youngmin Ahn;Byung Wook Eun;Seungman Park
    • Pediatric Infection and Vaccine
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    • v.31 no.1
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    • pp.37-45
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    • 2024
  • Purpose: This study aimed to examine the clinical features and determinants of macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMP) and to assess the differences in the time to fever resolution between doxycycline (DXC), tosufloxacin (TFX) and corticosteroid (CST) as second-line treatment. Methods: We retrospectively analyzed the medical records of patients under the age of 18 who were admitted to Nowon Eulji University Hospital between July 2018 and February 2020, diagnosed with mycoplasma pneumonia. Macrolide resistance was confirmed by detecting point mutations in the 23S rRNA gene. MUMP was clinically defined by persistent fever (≥38.0℃) lasting for 72 hours or more after the initiation of macrolide treatment. In cases of MUMP, patients were treated with an addition of CST, or the initial macrolide was replaced either DXC or TFX. Results: Out of 157 cases of mycoplasma pneumonia, 83 cases (52.9%) did not respond to macrolides. Patients with MUMP exhibited significantly higher C-reactive protein (CRP) levels (3.2±3.0 vs. 2.4±2.2 mg/dL, P=0.047), more frequent lobar/segmental infiltrations or pleural effusions (56.6% vs. 27.0%, P<0.001; 6.0% vs. 0.0%, P=0.032), and a higher prevalence of 23S rRNA gene mutations (96.4% vs. 64.6%, P<0.001) when compared to those with macrolide-susceptible M. pneumoniae pneumonia. In terms of second-line treatment, 15 patients (18.1%) responded to CST, 30 (36.1%) to DXC, and 38 (45.8%) to TFX. The time to defervescence (TTD) after initiation second-line treatment was significantly shorter in the CST group compared to the DXC (10.3±12.7 vs. 19.4±17.2 hours, P=0.003) and TFX groups (10.3±12.7 vs. 25.0±20.1 hours, P=0.043), with no significant difference observed between the DXC and TFX groups (19.4±17.2 vs. 25.0±20.1 hours, P=0.262). Conclusions: High CRP levels, the presence of positive 23S rRNA gene mutation, lobar or segmental lung infiltration, and pleural effusion observed in chest X-ray findings were significant factors associated with macrolide unresponsiveness. In this study, CST demonstrated a shorter TTD compared to DXC or TFX. Further, larger-scale prospective studies are needed to determine the optimal second-line treatment for MUMP.

Weight Control Behaviors, Health-related Quality of Life and Nutritional Status by Overestimation of Body Image among Young Korean Females: Data from the Fifth Korea National Health and Nutrition Examination Survey, 2010-2011 (20·30대 여성의 체형 과대인식에 따른 체중조절행위, 삶의 질, 식행동 및 영양소 섭취상태: 2010-2011년 국민건강영양조사 자료 이용)

  • Park, Seulki;Hyun, Taisun;Lee, Hongmie
    • Korean Journal of Community Nutrition
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    • v.20 no.5
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    • pp.362-374
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    • 2015
  • Objectives: This study was performed to investigate the effects of overestimation of their own body shape on weight control behaviors, mental condition, physical activity, dietary behavior, health-related quality of life, and nutritional status among young Korean females. Methods: A total of 1,514 women aged 20-39 years who are not pregnant and lactating among those who participated in the Fifth Korea National Health and Nutrition Examination Survey (2010~2011), were analyzed and grouped into underestimation (n=120), normal estimation (NE, n=840), and overestimation (OE, n=554), based on their body perception compared to actual percent ideal body weights. Variables were compared between OE group and NE group. Results: The subjects in OE group were significantly younger (29.5 vs. 30.5 years, respectively p < 0.05) and had lower body mass index (20.9 vs. 22.2 respectively, p < 0.01), health-related quality of life measured by EQ-5D (EuroQol-5 Dimension)(0.97 vs. 0.98 respectively, p < 0.05), nutrition adequacy ratio (NAR) of protein (0.91 vs. 0.93 respectively, p < 0.05), phosphorous (0.93 vs. 0.96 respectively, p < 0.05), and iron (0.70 vs. 0.75 respectively, p < 0.01), and index of nutrition quality (INQ) of iron (0.84 vs. 0.89 respectively, p < 0.05) compared to those in the NE group. The results of logistic regression showed that unmarried status (OR 1.32; 1.01~1.72) and severely underweight/underweight status (OR 1.94; 1.01~3.75)/(OR 1.81; 1.34~2.45) were significantly related to the probability of overestimation by the subjects. Significantly more women in OE group practiced fasting, skipping meals, and taking prescribed pills to lose body weights and had skipped breakfast compared to those in the NE group. Conclusions: The results of this study suggested that the Korean young women's distorted perception of own body shape may be associated with undesirable weight control behavior, low quality of life, and lower nutritional status. Therefore, nutrition education for this group should include information on correct body shape perception and its importance.

Evaluation of trace mineral source and preharvest deletion of trace minerals from finishing diets on tissue mineral status in pigs

  • Ma, Y.L.;Lindemann, M.D.;Webb, S.F.;Rentfrow, G.
    • Asian-Australasian Journal of Animal Sciences
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    • v.31 no.2
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    • pp.252-262
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    • 2018
  • Objective: An experiment was conducted to evaluate dietary supplemental trace mineral source and deletion on mineral content in tissues. Methods: Weanling crossbred pigs (n = 144; 72 barrows and 72 gilts; body weight [BW] = $7.4{\pm}1.05kg$) were used. A basal diet was prepared, and trace mineral premix containing either inorganic (ITM) or organic (OTM) trace minerals (Cu, Fe, Mn, and Zn) was added to the basal diet. Pigs were blocked by sex and BW and randomly allotted to 24 pens for a total of 6 pigs per pen, and fed a diet containing either ITM or OTM supplemented at the 1998 NRC requirement estimates for each of 5 BW phases (Phase I to V) from 7 to 120 kg. The trace mineral supplementation was deleted for 6, 4, 2, and 0 wk of Phase V; regarding nutrient adequacy during this phase, the indigenous dietary Fe and Mn was sufficient, Cu was marginal and Zn was deficient. Results: At the end of Phase IV, Mn content (mg/kg on the dry matter basis) was greater (p<0.05) in heart (0.77 vs 0.68), kidney (6.32 vs 5.87), liver (9.46 vs 8.30), and longissimus dorsi (LD; 0.30 vs 0.23) of pigs fed OTM. The pigs fed OTM were greater (p<0.05) in LD Cu (2.12 vs 1.89) and Fe (21.75 vs 19.40) and metacarpal bone Zn (141.86 vs 130.05). At the end of Phase V, increased length of deletion period (from 0 to 6 wk) resulted in a decrease (linear, p<0.01) in liver Zn (196.5 to 121.8), metacarpal bone Zn (146.6 to 86.2) and an increase (linear, p<0.01) in heart Mn (0.70 to 1.08), liver Mn (7.74 to 12.96), and kidney Mn (5.58 to 7.56). The only mineral source by deletion period interaction (p<0.05) was observed in LD Zn. Conclusion: The results demonstrated differential effects of mineral deletion on tissue mineral content depending on both mineral assessed and source of the mineral.

Evaluation of Resource Recovery from Sorted Waste by MBT System (MBT시스템에 의해 선별(選別)된 생활폐기물(生活廢棄物)의 자원화(資源化) 평가(評價)에 관(關)한 연구(硏究))

  • Lee, Byung-Sun;Han, Sang-Kuk;Lee, Nam-Hoon;Kang, Jeong-Hee;Wie, June
    • Resources Recycling
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    • v.22 no.5
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    • pp.20-28
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    • 2013
  • This study was carried out to evaluate the possibility of resource recovery for municipal solid waste(MSW) that sorted by a MBT system. First, physical property of MSW was similar to wastes carried into Sudokown landfill site. However, moisture of MSW was little higher than that. As a result of BMP test using organic fraction of MSW(OFMSWs), approximately 60 ~ 80 mL $CH_4/g$-VS of methane was occurred. Compared to the other studies, the value of methane is lower. It seems to be caused that high ratio of vinyl/plastic in OFMSWs. The other BMP test using sample of MBT system located in Sudokwon landfill was conducted each physical properties. According to the result of experiment, food waste makes 193 mL $CH_4/g$-VS, and paper is 102 mL $CH_4/g$-VS. However, there was not methane production in vinyl and rubber. Additionally, others that can't sort no more show 30 m $CH_4L/g$-VS of methane production. From the result of experimental data OFMSWs has high fraction of vinyl, rubber and other substance that difficult for biodegradation. Therefore it is need to sort of them.