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Predictors of Outcome in Management of Paediatric Head Trauma in a Tertiary Healthcare Institution in North-Central Nigeria

  • Gyang Markus Bot; Danaan J. Shilong; Jerry A. Philip; Ezekiel Dido Dung; Andrew H. Shitta; Nanpan Isa Kyesmen;Jeneral D. Alfin; Lena Mary Houlihan; Mark C. Preul; Kenneth N. Ozoilo; Peter O. Binitie
    • Journal of Korean Neurosurgical Society
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    • v.66 no.5
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    • pp.582-590
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    • 2023
  • Objective : Trauma is a leading causes of death and disability in all ages. The aim of this study was to describe the demography and characteristics of paediatric head trauma in our institution and examine the predictors of outcome and incidence of injury related mortality. Methods : We examined our institutional Trauma Registry over a 2 year period. Results : A total of 1100 trauma patients were seen over the study period. Of the 579 patients who had head injury 99 were in the paediatric age group. Of the paediatric head trauma patients 79 had documented Glasgow coma score (GCS), 38 (48.1%), 17 (21.5%) and 24 (30.4%) had mild, moderate and severe head injury respectively. The percentage mortality of head injury in the paediatric age group was 6.06% (6/99). There is an association between mortality and GCS (p=0.008), necessity for intensive care unit (ICU) admission (p=0.0001), associated burns (p=0.0001) and complications such as aspiration pneumonia (p=0.0001). The significant predictors of outcome are aspiration (p=0.004), the need for ICU admission (p=0.0001) and associated burns (p=0.005) using logistic binary regression. During the study period 46 children underwent surgical intervention with extradural haematoma 16 (34.8%), depressed skull fracture 14 (30.4%) and chronic subdural haematoma five (10.9%) being the commonest indication for surgeries. Conclusion : Paediatric head injury accounted for 9.0% (99/1100) of all trauma admissions. Majority of patients had mild or moderate injuries. Burns, aspiration pneumonitis and the need for ICU admission were important predictors of outcome in children with traumatic brain injury.

Effect of treadmill exercise on apoptosis in the retinas of streptozotocin-induced diabetic rats (트레드밀 운동이 streptozotocin에 의해 유발된 당뇨 쥐의 망막 신경세포 사멸에 미치는 영향)

  • Kim, D.Y.;Jung, S.Y.;Kim, T.W.;Sung, Y.H.
    • Exercise Science
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    • v.21 no.3
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    • pp.289-298
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    • 2012
  • In the present study, we investigated the effect of treadmill exercise on apoptotic neuronal cell death in the retinas of streptozotocin-induced diabetic rats. Twenty-eight male Sprague-Dawley rats were used for this study. The animals were divided into four groups(n = 7 in each group):(1) control group, (2) exercise group, (3) diabetes-induced group, (4) diabetes-induced and exercise group. Diabetes mellitus(DM) was induced by intraperitoneal injection of streptozotocin. The rats in the exercise groups were forced to run on the treadmill for 30 minutes once a day, five times per a week, during 12 weeks. In this study, a terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling(TUNEL) assay and western blot for the expressions of caspase-3, cytochrome c, Bax, and Bcl-2 in the retinas were conducted for the detection of apoptotic retinal cell death. The present results showed that the number of TUNEL-positive cells was increased in the retinas of the diabetic rats, whereas treadmill exercise suppressed this number. The expressions of pro-apoptotic factors caspase-3, cytochrome c, and Bax were enhanced and the expressions of anti-apoptotic factor Bcl-2 was decreased in the retinas of the diabetic rats. In contrast, treadmill exercise suppressed the expressions of caspase-3, cytochrome c, and Bax and increased the expression of Bcl-2. The present study demonstrated that treadmill exercise suppressed diabetes-induced apoptotic neuronal cell death in the retinas. Based on the present results, treadmill exercise may be effective therapeutic strategy for the alleviating complications of diabetes patients.

A Case Study on the Effective Liquid Manure Treatment System in Pig Farms (양돈농가의 돈분뇨 액비화 처리 우수사례 실태조사)

  • Kim, Soo-Ryang;Jeon, Sang-Joon;Hong, In-Gi;Kim, Dong-Kyun;Lee, Myung-Gyu
    • Journal of Animal Environmental Science
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    • v.18 no.2
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    • pp.99-110
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    • 2012
  • The purpose of the study is to collect basis data for to establish standard administrative processes of liquid fertilizer treatment. From this survey we could make out the key point of each step through a case of effective liquid manure treatment system in pig house. It is divided into six step; 1. piggery slurry management step, 2. Solid-liquid separation step, 3. liquid fertilizer treatment (aeration) step, 4. liquid fertilizer treatment (microorganism, recirculation and internal return) step, 5. liquid fertilizer treatment (completion) step, 6. land application step. From now on, standardization process of liquid manure treatment technologies need to be develop based on the six steps process.

An Analytical Study of Geologic Characteristics and Production- Related Problems of Beep Natural Gas Resources (심부 천연가스의 지질학절 부존 환경 특성과 생산관련 현안 문제점 분석 연구)

  • Chang Seungyong
    • 한국석유지질학회:학술대회논문집
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    • autumn
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    • pp.28-46
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    • 2001
  • Natural gas is a mixture of hydrocarbon gases and impurities such as nitrogen, hydrogen sulfide, and carbon dioxide and a clean energy producing no pollution materials for combustion. Currently, the demand of the natural gas is rapidly increasing due to worldwide environmental problems. According to Hubbert's study in the past, the natural gas was predicted as rapidly depleted resources, and then the results led to high gas price and limitation of usage during 1980s. Afterward, the study of natural gas resources based on geology identified the additional natural gas resources that were not considered in Hubbert's study. They are unconventional gas, additional resources in the existed reservoirs, and natural gas in deep subsurface areas. Such additional resouces made the future of natural gas bright and pormised low and stable gas price in the future. Deep natural gas is defined as the gas existing at or below 15,000ft$(4,752{\cal}m)$ in depth from the surface. According to the study from the U.S. Geological Survey(USGS) in 1995, 1,412 TCF of technically recoverable natural gas was remained to be discovered or developed in the onshore of United States. A significant part of that resource base, 114 TCF, exists at deep sedimentary basins, and it shows wide distribution with various geological environments. In 1995, the deep gas contributed to $6.7\% of total supply amount of natural gas in the United States and is expected to be $18.7\% by 201.5. However, the development of the deep gas is a high risky business due to expensive investment and high portion of dry holes, although it is developed. Thus, for developing the deep gas economically, it is necessary to overcome many technical challenges. In this paper, for increasing success rate of the deep gas, 1) geologic and compositional characteristics, and production cost have been analyzed according to depth, 2) technical problems related to deep gas production have been summarized, and 3) finally future study areas for increasing application of the deep gas have been suggested. For reference, this paper was written based on the study results from USGS and Gas Research Institute(GRI), for the United States is doing the most active R&D in the deep gas area, and thus, has many reliable data.

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Effects of Dietary Eucommia ulmoides Leaves on Nutrient Digestibility and Ruminal Fermentation Characteristics in Sheep (두충잎의 급여가 면양의 영양소 이용율과 반추위내 발효특성에 미치는 영향)

  • Kim, J.H.;Ko, Y.D.
    • Journal of Animal Science and Technology
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    • v.47 no.6
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    • pp.955-962
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    • 2005
  • This study was conducted to examine the nutrient digestibility and ruminal fermentation characteristics in sheep fed diets containing four substitution levels of E. ulmoides leaves for rice straw. For the experiment, they were given a basal diet consisting of rice straw and concentrate at a 3:7 ratio (DM basis). The treatments were designed as a 4$\time$4 Latin square design with four sheep (50.2$\pm$1.6 kg body weight). Sheep were allotted in one of four treatments, which were designed to progressively substitute Eucommia ulmoides for 0, 3, 5 and 10% of rice straw in the basal diet. The digestibility of crude fat was significantly (p<0.05) improved by 12.5 to 17.5% in 3% and 5% air dried Eucommia ulmoides leaves compared with that in control. The digestibility of crude fiber in the 3, 5 and 10% treatments was significantly (p<0.05) higher than that of the control. Dry matter intake was highest (p<0.05) in sheep fed 10% air dried E. ulmoides). Retained nitrogen in the 3, 5 and 10% treatments was increased up to 97%, 173% and 192%, respectively, compared to that in control (p<0.05). Organic matter utilization was higer in 3% and 5% treatments than control (p<0.05). Purine derivatives and microbial nitrogen synthesis were significantly increased by the dietary substitution of 5 % E. ulmoides leaves (p<0.05) compared with control and the 3% treatment. Ruminal concentration of total-VFA was significantly (p<0.05) higher in sheep fed all levels of air dried Eucommia ulmoides than those of control. It is concluded that air-dried E. ulmoides leaves given to ruminants can increase nutrient digestibility and palatability and improve ruminal fermentation. Therefore, the 5 and 10% substitution of E. ulmoides for roughage are highly recommended to be used in practice.

The effect of surface treatment conditioning on shear bond strength between zirconia and dental resin cements (지르코니아 세라믹의 표면처리에 따른 치과용 접착제의 전단결합강도)

  • Kim, Ji-Hye;Seo, Jae-Min;Ahn, Seung-Geun;Park, Ju-Mi;Song, Kwang-Yeob
    • The Journal of Korean Academy of Prosthodontics
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    • v.51 no.2
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    • pp.73-81
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    • 2013
  • Purpose: The purpose of this study was to evaluate the effect of surface treatment on the shear bond strength of zirconia ceramic to 3 resin cements. Materials and methods: A total of 143 disk-shaped Zirconia blocks (HASS Co., Gangneung, Korea) were randomly divided into three treatment groups: (1) only 50 ${\mu}m$ $Al_2O_3$ sandblasting, (2) 50 ${\mu}m$ $Al_2O_3$ sandblast and zircona liner, (3) 50 ${\mu}m$ $Al_2O_3$ sandblasting and Rocatec (3M ESPE, Seefeld, Germany). Bistite II (Tokuyama Dental Co., Japan), Panavia F (Kuraray Medical, Japan), and Superbond C&B (Sun Medical, Japan) were used to cement onto the zirconia. After 24h of storage in distilled water, shear bond strength was evaluated. High value group was re-tested after thermocycling at 5,000 cycles(5-$55^{\circ}C$). Shear bond strength data were analyzed with one-way ANOVA, two-way ANOVA test and Post Hoc Test (${\alpha}$=.05). Shear bond strength data before and after thermocycling were analyzed with Independent sample T test (${\alpha}$=.05). Results: Super-bond C&B treated with Rocatec showed the most high shear bond strength. Super-bond C&B groups resulted in significantly higher than other cement groups (P<.05). Rocatec groups resulted in significantly higher than other surface treatment groups (P<.05). Shear bond strength has increased in Panavia F treated with Zirconia liner (P<.05). After thermocycling, shear bond strength was increased in Super-bond C&B treated with Rocatec but decreased in other groups (P<.05). Conclusion: Super-bond C&B cement resulted the highest shear bond strength and Rocatec system enhanced the shear bond strength. After thermocycling, shear bond strength has decreased in most resin cements except Super-bond C&B treated with Rocatec.

FABRICATION OF MYOMUCOSAL FLAP USING CULTURED ORAL EPITHELIUM IN RABBIT MODEL (가토모델에서 배양 구강상피를 이용한 근-점막 피판의 형성에 관한 연구)

  • Shin, Young-Min;Chung, Hun-Jong;Ahn, Kang-Min;Park, Hee-Jung;Sung, Mi-Ae;Kim, Soung-Min;Hwang, Soon-Jung;Kim, Myung-Jin;Jahng, Jeong-Won;Kim, Sung-Po;Yang, Eun-Kyung;Song, Kye-Yong;Lee, Jong-Ho
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.27 no.3
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    • pp.226-237
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    • 2005
  • Purpose : Extensive defect of oral and maxillofacial area is usually reconstructed with composite flap including skin paddle. However, if the defects are lined with only skin components, the mucosa's role in mastication and texture are not restored. Furthermore, stiffness and hair-growing prevent denture rehabilitation and good oral hygiene. This study was performed to overcome the disadvantages of composite soft tissue flaps including the skin and to make a model for myo-mucosal flaps. Materials and methods : Buccal mucosa sized $0.5\times1.0\;cm^2$ from New Zealand rabbit (around 1.5kg) was harvested and cultivated by the modification of Rheinwald and Green's keratinocyte culture method. Cultured mucosa was grafted on the fascia of latismus dorsi as form of mucosal sheet. After 7, 10, 14 days, the myomucosal flap was excised and evaluated under light microscope with H & E and immunohistochemical staining. As control group, harvested buccal mucosa from rabbit was transplanted to gracilis muscle(n=6). Results : From 7 days after prelamination, the basal layer of the grafted mucosa resembled that of normal mucosa. As control group, transplanted mucosa had original shape but there's slight inflammatory reaction. Prelaminated mucosa has 19.8$\pm$4.59 cell layers and some samples have more than 20 layers. The expression rate of PCNA was relatively strong (42.9%$\pm$14.1) at the basal layer of grafted mucosa and the laminin was found at the basal layer. On the contrary, prelaminated mucosa at 10 days showed moderate expression rate of PCNA(32.4%$\pm$4.62). We found the mucosal layer was somehow disappeared and there is strong inflammatory reaction. After 14 days prelamination, the grafted oral keratinocytes were almost disappeared and expression of PCNA was not observed. Conclusion : We can make 75 fold large mucosal($3850mm^2$) sheet from small samples of mucosa $(50mm^2)$. Epithelial sheet that grafted on the fascia of muscle underwent differentiation and proliferation. But after 10, 14 days, there was strong inflammatory reaction and the grafted mucosa was destroyed from surface layer. In rabbit model, transfer of fascio-mucosal flap should be done from 7 to 10 days after prelamination.

Development of Simultaneous Analytical Method for Determination of Isoxaflutole and its Metabolite (Diketonitrile) residues in Agricultural Commodities Using LC-MS/MS (LC-MS/MS를 이용한 농산물 중 Isoxaflutole과 대사산물(Diketonitrile)의 동시시험법 개발)

  • Ko, Ah-Young;Kim, Heejung;Do, Jung Ah;Jang, Jin;Lee, Eun-Hyang;Ju, Yunji;Kim, Ji Young;Chang, Moon-Ik;Rhee, Gyu-Seek
    • The Korean Journal of Pesticide Science
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    • v.20 no.2
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    • pp.93-103
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    • 2016
  • A simultaneous analytical method was developed for the determination of isoxaflutole and metabolite (diketonitrile) in agricultural commodities. Samples were extracted with 0.1% acetic acid in water/acetonitrile (2/8, v/v) and partitioned with dichloromethane to remove the interference obtained from sample extracts, adjusting pH to 2 by 1 N hydrochloric acid. The analytes were quantified and confirmed via liquid chromatograph-tandem mass spectrometer (LC-MS/MS) in positive-ion mode using multiple reaction monitoring (MRM). Matrix matched calibration curves were linear over the calibration ranges ($0.02-2.0{\mu}g/mL$) for all the analytes into blank extract with $r^2$ > 0.997. For validation purposes, recovery studies were carried out at three different concentration levels (LOQ, 10LOQ, and 50LOQ) performing five replicates at each level. The recoveries were ranged between 72.9 to 107.3%, with relative standard deviations (RSDs) less than 10% for all analytes. All values were consistent with the criteria ranges requested in the Codex guideline (CAC/GL40, 2003). Furthermore, inter-laboratory study was conducted to validate the method. The proposed analytical method was accurate, effective, and sensitive for isoxaflutole and diketonitrile determination in agricultural commodities.

Effects of Adenosine on the Action Potentials of Rabbit SA Nodal Cells (동방결절 활동전압에 대한 아데노신 효과)

  • Kim, Ki-Whan;Ho, Won-Kyung
    • The Korean Journal of Physiology
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    • v.18 no.1
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    • pp.19-35
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    • 1984
  • Since the first report of Drury and $Szent-Gy{\ddot{o}}rgyi$ in 1929, the inhibitory influences of adenosine on the heart have repeatedly been described by many investigators. These studies have shown that adenosine and adenine nucleotides have overall depressant effects, similar to those of acetylcholine. Heart beats become slow and weak. It is also well known that adenosine is a potent endogenous coronary vasodilator. Many investigations on the working mechanisms of adenosine have been focused mainly on the effects of the coronary blood flow. However, the cellular mechanisms underlying the inhibitory action of adenosine on sinus node are not well understood yet. Thus, this study was undertaken to examine the behavior of rabbit SA node under influence of adenosine. In these series of experiments three kinds of preparations were used: whole atrial pair, left atrial strip, and isolated SA node preparations. The electrical activity of SA node was recorded with conventional glass microelectrodes 30 to 50 $M{\Omega}$. The preparations were superfused with bicarbonate-buffered Tyrode solution of pH 7.35 and aerated with a gas mixture of $3%\;CO_2-97%\;O_2$ at $35^{\circ}C$. In whole atrial pair, adenosine suppressed sinoatrial rhythm in a dose-dependent manner. Effect of adenosine on atrial rate appeared at the concentration of $10^{-5}M$ and was enhanced in parallel with the increase in adenosine concentration. Inhibitory action of adenosine on pacemaker activity was more prominent in the preparation pretreated with norepinephrine, which can steepen the slope of pacemaker potential by increasing permeability of $Ca^{+2}$. Calcium ions in perfusate slowly produced a marked change in sinoatrial rhythm. Elevation of the calcium concentration from 0.3 to 8 mM increased the atrial rate from 132 to 174 beats/min, but over 10 mM $Ca^{+2}$ decreased. The inhibitory effect of adenosine on sinoatrial rhythm developed very rapidly. Atrial rate was recovered promptly from the adenosine-induced suppression by the addition of norepinephrine, but extra $Ca^{+2}$ was less suitable to restore the suppression of atrial rate. Adenosine suppressed also atrial contractility in the same dosage range that restricted pacemaker activity, even in the reserpinized preparation. In isolated SA node preparation, spontaneous firing rate of SA node at $35^{\circ}C$(mean{\pm}SEM, n=16) was $154{\pm}3.3\;beats/min. The parameters of action potentials were: maximum diastolic potential(MDP), $-73{\pm}1.7\;mV: overshoot(OS), $9{\pm}1.4\;mV: slope of pacemaker potential(SPP), $94{\pm}3.0\;mV/sec. Adenosine suppressed the firing rate of SA node in a dose-dependent manner. This inhibitory effect appeared at the concentration of $10^{-6}M$ and was in parallel with the increase in adenosine concentration. Changes in action potential by adenosine were dose-dependent increase of MDP and decrease of SPP until $10^{-4}M$. Above this concentration, however, the amplitude of action potential decreased markedly due to the simultaneous decrease of both MDP and OS. All these effects of adenosine were not affected by pretreatment of atropine and propranolol. Lowering extra $Ca^{2+}$ irom 2 mM to 0.3 mM resulted in a marked decrease of OS and SPP, but almost no change of MDP. However, increase of perfusate $Ca^{2+}$ from 2 mM to 6 or 8 mM produced a prominent decrease of MDP and a slight increase of OS and SPP. Dipyridamole(DPM), which is known to block the adenosine transport across the cell membrane, definately potentiated the action of adenosine. The results of this experiment suggest that adenosine suppressed pacemaker activity and atrial contractility simultaneously and directly, by decreasing $Ca^{2+}-permeability$ of nodal and atrial cell membranes.

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A Survey on the Actual State of Laboratory Facilities and Equipments at Nursing Schools (간호교육기관의 실험실습설비 보유실태 조사)

  • Lim, N.Y.;Lee, S.O.;Suh, M.J.;Kim, H.S.;Kim, M.S.;Oh, K.O.
    • The Korean Nurse
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    • v.36 no.1
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    • pp.108-117
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    • 1997
  • This study was carried out to examine the standards for evaluation of laboratory facilities and equipment. These constitute the most important yet vulnerable area of our system of higher education among the six school evaluation categories provided by the Korean Council for University Education. To obtain data on the present situation of holdings and management of laboratory facilities and equipment at nursing schools in Korea, questionnaires were prepared by members of a special committee of the Korea Nursing Education Society on the basis of the Standards for University Laboratory Facilities and Equipment issued by the Ministry of Education. The questionnaires were sent to nursing schools across the nation by mail on October 4, 1995. 39 institutions completed and returned the questionnaires by mail by December 31 of the same year. The results of the analysis of the survey were as follows: 1. The Physical Environment of Laboratories According to the results of investigation of 14 nursing departments at four-year colleges, laboratories vary in size ranging from 24 to 274.91 pyeong ($1{\;}pyeong{\;}={\;}3.3m^2).$. The average number of students in a laboratory class was 46.93 at four-year colleges, while the number ranged from 40 to 240 in junior colleges. The average floor space of laboratories at junior colleges, however, was almost the same as those, of laboratories at four-year colleges. 2. The Actual State of Laboratory Facilities and Equipment Laboratory equipment possessed by nursing schools at colleges and universities showed a very wide distribution by type, but most of it does not meet government standards according to applicable regulations while some types of equipment are in excess supply. The same is true of junior colleges. where laboratory equipment should meet a different set of government standards specifically established for junior colleges. Closer investigation is called for with regard to those types of equipment which are in short supply in more than 80 percent of colleges and universities. As for the types of equipment in excess supply, investigation should be carried out to determine whether they are really needed in large quantities or should be installed. In many cases, it would appear that unnecessary equipment is procured, even if it is already obsolete, merely for the sake of holding a seemingly impressive armamentarium. 3. Basic Science Laboratory Equipment Among the 39 institutions, five four-year colleges were found to possess equipment for basic science. Only one type of essential equipment, tele-thermometers, and only two types of recommended equipment, rotators and dip chambers, were installed in sufficient numbers to meet the standards. All junior colleges failed to meet the standards in all of equipment categories. Overall, nursing schools at all of the various institutions were found to be below per in terms of laboratory equipment. 4. Required Equipment In response to the question concerning which type of equipment was most needed and not currently in possession, cardiopulmonary resuscitation (CPR) machines and electrocardiogram (ECG) monitors topped the list with four respondents each, followed by measuring equipment. 5. Management of Laboratory Equipment According to the survey, the professors in charge of clinical training and teaching assistants are responsible for management of the laboratory at nursing schools at all colleges and universities, whereas the chief of the general affairs section or chairman of the nursing department manages the laboratory at junior colleges. This suggests that the administrative systems are more or less different. According to the above results, laboratory training could be defined as a process by which nursing students pick up many of the nursing skills necessary to become fully qualified nurses. Laboratory training should therefore be carefully planned to provide students with high levels of hands-on experience so that they can effectively handle problems and emergencies in actual situations. All nursing students should therefore be thoroughly drilled and given as much on-the-job experience as possible. In this regard, there is clearly a need to update the equipment criteria as demanded by society's present situation rather than just filling laboratory equipment quotas according to the current criteria.

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