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Risk Factor Analysis for Operative Death and Brain Injury after Surgery of Stanford Type A Aortic Dissection (스탠포드 A형 대동맥 박리증 수술 후 수술 사망과 뇌손상의 위험인자 분석)

  • Kim Jae-Hyun;Oh Sam-Sae;Lee Chang-Ha;Baek Man-Jong;Hwang Seong-Wook;Lee Cheul;Lim Hong-Gook;Na Chan-Young
    • Journal of Chest Surgery
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    • v.39 no.4 s.261
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    • pp.289-297
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    • 2006
  • Background: Surgery for Stanford type A aortic dissection shows a high operative mortality rate and frequent postoperative brain injury. This study was designed to find out the risk factors leading to operative mortality and brain injury after surgical repair in patients with type A aortic dissection. Material and Method: One hundred and eleven patients with type A aortic dissection who underwent surgical repair between February, 1995 and January 2005 were reviewed retrospectively. There were 99 acute dissections and 12 chronic dissections. Univariate and multivariate analysis were performed to identify risk factors of operative mortality and brain injury. Resuit: Hospital mortality occurred in 6 patients (5.4%). Permanent neurologic deficit occurred in 8 patients (7.2%) and transient neurologic deficit in 4 (3.6%). Overall 1, 5, 7 year survival rate was 94.4, 86.3, and 81.5%, respectively. Univariate analysis revealed 4 risk factors to be statistically significant as predictors of mortality: previous chronic type III dissection, emergency operation, intimal tear in aortic arch, and deep hypothemic circulatory arrest (DHCA) for more than 45 minutes. Multivariate analysis revealed previous chronic type III aortic dissection (odds ratio (OR) 52.2), and DHCA for more than 45 minutes (OR 12.0) as risk factors of operative mortality. Pathological obesity (OR 12.9) and total arch replacement (OR 8.5) were statistically significant risk factors of brain injury in multivariate analysis. Conclusion: The result of surgical repair for Stanford type A aortic dissection was good when we took into account the mortality rate, the incidence of neurologic injury, and the long-term survival rate. Surgery of type A aortic dissection in patients with a history of chronic type III dissection may increase the risk of operative mortality. Special care should be taken and efforts to reduce the hypothermic circulatory arrest time should alway: be kept in mind. Surgeons who are planning to operate on patients with pathological obesity, or total arch replacement should be seriously consider for there is a higher risk of brain injury.

The Comparative Research on the Theory of Self-cultivation in Neo-Confucianism and Daesoon Thought (주자학과 대순사상의 수양론 비교 연구)

  • Lee, Gwang-ju
    • Journal of the Daesoon Academy of Sciences
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    • v.24_2
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    • pp.231-270
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    • 2015
  • This thesis examined Chu Hsi's self-cultivation theory as the representative theory of cultivation in Confucianism, while juxtaposing it to self-cultivation theory in Daesoon thought, concentrating on its similarity and difference. Neo-Confucianism is a scholarship which has wielded a tremendous influence upon East Asia, while functioning as an official scholarship for long period up to Yuan, Ming, and Ching period, after achieving its synthesis by Chu Hsi. After 13th century, Neo-Confucianism has been a representative academic system in Confucianism, and self-cultivation theory was in its center. It suggested various virtues that classical scholars have to equip to fulfill the sainthood and the politics of royal road. The self-cultivation theory of Chu Hsi was developed upon the basis of the theory 'Li-Qi' and the theory of mind. Here, the practice of Geokyung(morally awakened state with a reverent spirit in every moment) and Gyeokmul-tsiji(reaching into the utmost knowledge through investigation of things) formed a nucleus of Chu Hsi's self-cultivation theory. While Geokyung was to reveal one's true nature through cultivation of mind, Gyeokmul-tsiji was to demonstrate the complete use of mind's essence and function. Chu Hsi's self-cultivation theory attempted to realize the unity of heaven and man, and through cultivating self and governing people, it also tried to achieve its ideal of the society of Great Union(Daedong). Daesoon Thought is originated from Sangjenim who has descended to this world as a human being called Jeungsan. He went on his circuit to rectify the disorder of heaven and earth for 9 years to rectify the Three worlds of heaven, earth and human being which were faced with total annihilation due to its rule of mutual conflict, while creating an earthly paradise. Respecting the will of Sangjenim, Dojunim established the foundation of Do through launching 'Meukeukdo' and setting tenet, creed and object so that the cultivators (Doins) could believe and respect the truth of Sangje's great itineration (Daesoon). Among those, the two components of creed, which are four fundamental principles and the three fundamental attitudes are of great account as precept and cardinal point. Through this means, the cultivators of Daesoonjinrihoe aspire to guard against self-deception through transforming the human spirit, to realize earthly immortality through renewing human beings, and to create an earthly paradise through transforming the world. This thesis attempted to compare and analyze the theory of self-cultivation in Neo-Confucianism and Daesoon Thought in the aspect of ground, method, and object of cultivation. First, as for the ground of cultivation, the doctrines of Chu-tzu and Daesoon thought place the essence of cultivation on 'heaven'. Yet, whereas the former postulates Taekeuk (the Great Ultimate) as a principle as well as the heaven of a natural order, Daesoon thought postulates Sangenim as the heaven of superintendence as well as the heaven of a natural order, signified as its equation of Daesoon with circle, along with the unity of Meukeuk (Endlessness) and Taegeuk (the Great Ultimate). Further, the doctrine of Chu-zhu and Daesoon thought is identical in the point that both thoughts see mind as the subject of cultivation, while trying to restore a pure essence. Nevertheless, whereas Neo-Confucianism intends to give scope to ability of the complete use of mind's essence and function, Daesoon Thought sees mind as the essence which is used by spiritual beings and as an organ that heaven, earth and human being rely upon as the center of the universe. In the aspect of method of cultivation, the doctrine of Chuzhu lays emphasis on the rational factor in that it brightens its 'myung-deoki'(bright inner virtue),' while trying to correspond to the law of heaven on the basis of 'Geokyung' and 'Gyeokmul-tsiji.' On the contrary, Daesoon thought lays much emphasis on faith factor in that it aspires for human perfection based on the restoration of conscience by cultivating Daesoonjinri with sincerity, reverence and faith along with 'quieting the heart-mind', 'quieting the body', 'respecting the God of the Ninth Heaven', and 'observing ritual practice on the basis of the faith in Sangjenim. Yet, both thoughts have similarities in that cultivation of body forms the basis and that they attempt to realize their ideals through cultivation in daily life while taking 'Guarding against self-deception' as the key method of self-cultivation.' However, the principle of Chu-zhu can be said to be a voluntary and autonomous practice based on scripture of the saint as well as self-reflection. On the other hand, Daesoon thought reveals certain difference in that it combines faith factor with one's self-effort by concentrating on cultivation under the presence of Sangjenim as the object of belief and the spirits of heaven and earth. In the aspect of object of cultivation, both thoughts share similarities in that the saint and the perfected gentleman with a moral virtue as an ideal image of men in both thoughts attempt to realize each of their 'myung-deok' in human nature as a heavenly mandate while respecting morality. Further, they also share similarity in the point that the desirable characters in both thoughts want to participate in harmonious creation and nurturance. Yet, the perfected gentleman with a moral virtue is also characterized by its aim for a new heaven and earth where there is no mutual conflict but mutual beneficence, by promoting the moral influence and virtue of Sangjenim over one's own virtue, while practising the mutual beneficence of all life through harmonious union of divine beings and human beings.