• The Korean Journal of Pain
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• 제27권3호
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• pp.278-284
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• 2014

Background: Establishment of laparoscopic cholecystectomy as an outpatient procedure has accentuated the clinical importance of reducing early postoperative pain, as well as postoperative nausea and vomiting (PONV). We therefore planned to evaluate the role of a multimodal approach in attenuating these problems. Methods: One hundred and twenty adult patients of ASA physical status I and II and undergoing elective laparoscopic cholecystectomy were included in this prospective, randomized, placebo-controlled study. Patients were divided into four groups of 30 each to receive methylprednisolone 125 mg intravenously or etoricoxib 120 mg orally or a combination of methylprednisolone 125 mg intravenously and etoricoxib 120 mg orally or a placebo 1 hr prior to surgery. Patients were observed for postoperative pain, fentanyl consumption, PONV, fatigue and sedation, and respiratory depression. Results were analyzed by the ANOVA, a Chi square test, the Mann Whitney U test and by Fisher's exact test. P values of less than 0.05 were considered to be significant. Results: Postoperative pain and fentanyl consumption were significantly reduced by methylprednisolone, etoricoxib and their combination when compared with placebo (P<0.05). The methylprednisolone + etoricoxib combination caused a significant reduction in postoperative pain and fentanyl consumption as compared to methylprednisolone or etoricoxib alone (P<0.05); however, there was no significant difference between the methylprednisolone and etoricoxib groups (P>0.05). The methylprednisolone and methylprednisolone + etoricoxib combination significantly reduced the incidence and severity of PONV and fatigue as well as the total number of patients requiring an antiemetic treatment compared to the placebo and etoricoxib (P<0.05). Conclusions: A preoperative single-dose administration of a combination of methylprednisolone and etoricoxib reduces postoperative pain along with fentanyl consumption, PONV, antiemetic requirements and fatigue more effectively than methylprednisolone or etoricoxib alone or a placebo.

• Asian Spine Journal
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• 제12권6호
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• pp.1106-1116
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• 2018

Study Design: Prospective observational study. Purpose: To evaluate the disability domains relevant to Indian patients with low backache and propose a modified disability questionnaire for such patients. Overview of Literature: The Oswestry Disability Index (ODI) is a self-reported measurement tool that measures both pain and functional status and is used for evaluating disability caused by lower backache. Although ODI remains a good tool for disability assessment, from the Indian perspective questions related to weight lifting and sexual activity of ODI are questioned in some of the earlier studies. Activities of daily living in Indian patients vary substantially from those in other populations and include activities like bending forwards, sitting in floor and squatting which are not represented in the ODI. Methods: In this prospective observational study, a seven-step approach was used for the development of a questionnaire. Thirty patients were interviewed to identify the most challenging issue they faced while performing their daily activities (by free listing) and understand how important the questionnaire items were in terms of the standard ODI. Thus, a comprehensive disability questionnaire comprising 14 questions was developed and administered to 88 patients. Both qualitative (interviews) and quantitative methods (to establish the validity, reliability, and correlation with the Visual Analog Scale [VAS] and Rolland Morris disability questionnaire) were used to identify the 10 questions that best addressed the disability domains relevant to Indian patients. Results: According to free listing, four new questions pertaining to bending forward, sitting on the floor, walking on uneven surfaces, and work-related disabilities were included. In the second phase, wherein the questionnaire with 14 items was used, 56.8% patients did not answer the questions related to sexual activity, whereas 23.8% did not answer those related to walking on uneven surfaces. The modified questionnaire demonstrated good internal consistency (Cronbach's alpha=0.892) and correlation with the Rolland Morris questionnaire (Cronbach's alpha=0.850, p>0.05), as well as with the VAS score for disability (Cronbach's alpha=0.712, p>0.05) and pain (Cronbach's alpha=0.625, p>0.05). Conclusions: A modified disability questionnaire that was designed by adding two questions related to bending forward and work status and removing questions related to sexual activity and weight lifting or traveling (depending on the occupation) can help evaluate disability caused by back pain in Indian population.

• 영어영문학
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• 제57권6호
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• pp.977-998
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• 2011

The purpose of this study is to investigate prospective teachers' perceptions of the peer review comments readily available to them during the writing process in a teacher training class. Given these needs, we employ a qualitative method of inquiry giving voice to the learner's own view of peer feedback. The data we wish to consider is first-person narratives elicited from four EFL college students, who are prospective teachers of English. With regard to the EFL students' narrative considered here, all were attentive to the feedback they received. Moreover, the way in which these EFL writers talk about peer response activity reflects that they still welcome peer feedback because of the benefits to be accrued from it. Although this study, covering only four EFL students in total, can hardly be considered conclusive, we attempt to offer a synthesis of their stories. First of all, students indicate that they received responses from "authentic readers" (Mittan 1989, 209). We do note, consequently, that students gain a clear understanding of readers' needs by receiving feedback on what they did well and on what seems unclear. Perhaps the greater effect of peer feedback claimed by these students is that they take active roles in utilizing peer comments. Since they feel uncertain about the validity of their classmates' responses, students feel that they have autonomy over their own text and can make their own decisions on whether they should accept their peer comments or not. This contrasts with their treatment of teacher comments that they accept begrudgingly even if they disagree with them. Four EFL writers talked a lot, typically in a positive way, about peer response to their writing, yet they have expressed reservations about the extent to which they should put any credence in comments offered by their fellow students. Perhaps this is because their fellow students are still developing writers and EFL learners. In turn, they were sometimes reluctant to accept the peers' comments. Thus, in EFL contexts, L1 use can be suggested during peer feedback sessions. In particular, we have come to feel that L1 use enables both reviewers and receivers to have more productive peer review experiences. Additionally, we need to train students not "to see peer feedback as potentially bad advice" (Silva et al. 2003, 111). Teachers should focus on training students to utilize their peers' comments. Without such training, students will either ignore feedback or fail to use it constructively.

• Archives of Plastic Surgery
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• 제34권5호
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• pp.557-561
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• 2007

Purpose: Malignant melanoma is a fatal tumor arising in the melanocytic systems of the skin. The incidence of malignant melanoma, formerly considered a rare tumor in Korea, is observed to increase. The aim of this study is to analyze the clinical and histopathological pattern of malignant melanoma in one institute. Methods: Thirty patients with ages ranging from 33 to 80 years, diagnosed as malignant melanoma at our skin tumor department, were enrolled in a retrospective study over a 6 year period(2000. 9-2006. 7). The analyzed data included age, sex, location, duration before diagnosis, clinical type, level of invasion, and stage. Results: The cases were identified and analyzed by clinical and histopathologic study. The male to female ratio was 1:1.7. Lower extremities(especially, feet) were favored sites. The majority of cases were acral lentiginous melanoma(40%), followed by nodular melanoma (36.7%), superficial spreading melanoma(20%) in this study. Clark level IV was predominant in histopathologic study. There was merely narrow gap among each stage by AJCC. Conclusion: The clinicopathological characteristic of melanoma in our patients is quite different with that in the West. In this retrospective study, primary lesions of the foot were predominant with melanoma, and a high percentage of these were classified pathologically as acral lentiginous melanomas. Patients had a more advanced stage of disease at first presentation and a more deeply invasive primary lesion than Western patients. These suggest that malignant melanoma has a worse prognosis in our patients than in the West. So, further organized prospective studies are needed to approach the prudent and accurate diagnosis and management of melanoma in Korea.

• 대한두개안면성형외과학회지
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• 제17권1호
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• pp.14-19
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• 2016

Background: Most nasal bone fractures are corrected using non-invasive methods. Often, patients are dissatisfied with surgical outcomes following such closed approach. In this study, we compare surgical outcomes following blind closed reduction to that of ultrasound-guided reduction. Methods: A single-institutional prospective study was performed for all nasal fracture patients (n=28) presenting between May 2013 and November 2013. Upon research consent, patients were randomly assigned to either the control group (n=14, blind reduction) or the experimental group (n=14, ultrasound-guided reduction). Surgical outcomes were evaluated using preoperative and 3-month postoperative X-ray images by two independent surgeons. Patient satisfaction was evaluated using a questionnaire survey. Results: The experimental group consisted of 4 patients with Plane I fracture and 10 patients with Plane II fracture. The control group consisted of 3 patients with Plane I fracture and 11 patients with Plane II fracture. The mean surgical outcomes score and the mean patient dissatisfaction score were found not to differ between the experimental and the control group in Plane I fracture (p=0.755, 0.578, respectively). In a subgroup analysis consisting of Plane II fractures only, surgeons graded outcomes for ultrasound-guided reduction higher than that for the control group (p=0.007). Likewise, among the Plane II fracture patients, those who underwent ultrasound-guided reduction were less dissatisfied than those who underwent blind reduction (p=0.043). Conclusion: Our study result suggests that ultrasound-guided closed reduction is superior to blind closed reduction in those patients with Plane II nasal fractures.

• 벤처창업연구
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• 제10권3호
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• pp.123-131
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• 2015

빠르게 발전하는 IoT 시대에 발맞추어, IoT 적용과 관련하여 다양한 시나리오에 이용할 수 있는 경영 전략을 이끌어내기 위한 체계적인 접근이 요구된다. 본 논문에서는, IOT를 적용할 때 시장 잠재력을 평가하고 초기 경영 전략을 세울 때 사용할 수 있는 개념적 틀을 제시한다. 개념적 틀은 널리 알려진 가치곡선분석, 생태계 분석 그리고 품질의 집을 이용하여 구성하였다. 가치곡선 분석은 소비자에게 가치를 주는 항목을 파악하는 부분과 이와 관계된 공급자의 강점을 분석하는데 이용된다. 생태계 분석은 공급사슬 상의 참가자들과 그들의 관계를 파악하는데 이용된다. 품질의 집은 공급자에게 소비자의 요구사항을 파악하고 그것을 공급자의 기술적인 요구 조건과 비교하여 초기 사업 전략을 구축하는데 적합한 분석도구이다. 본 논문에서는 우리가 제시한 개념적 틀을 IoT를 적용하였을 때 큰 발전 가능성이 있는 Car-sharing 서비스와 telehealth 서비스 이렇게 두 가지 서비스에 적용하여 분석하였다.

• The Korean Journal of Pain
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• 제13권2호
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• pp.182-186
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• 2000

Background: Ropivacaine is a new amide local anesthetics, having therapeutic properties similar to those of bupivacaine but less cardiovascular toxicity and motor blockade. The aim of this study was to evaluate the effects of ropivacaine used in stellate ganglion block (SGB) compared with those of lidocaine or bupivacaine. Methods: This prospective and crossover study performed in twenty patients with sudden sensory neural hearing loss. All patients received three times SGB, in the paratracheal approach using 8 ml of 1% lidocaine, 0.2% bupivacaine, and 0.2% ropivacaine respectively without any orders. Onset time and action duration of Horner's syndrome were observed after each SGB. Results: Onset time of ropivacaine was the middle of the three agents; earlier lidocaine and slower bupivacaine. Lidocaine ($3.0{\pm}1.9$ min), bupivacaine ($4.1{\pm}2.9$ min) and ropivacaine ($3.3{\pm}1.3$ min). But there were no significant differences; Action duration of Horner's syndrome of ropivacaine (223.6?105.2 min) was longer than lidocaine ($134.6{\pm}77.3$ min) and shorter than bupivacaine ($241.2{\pm}115.8$ min). There were significant differences in the action duration of each local anesthetics (P<0.05). There was no critical side effects and temporary foreign body sensation was the most common side effect. Conclusions: We conclude that ropivacaine is a good alternative in SGB instead of lidocaine or bupivacaine. Ropivacaine is a long acting local anesthetic similar to those of bupivacaine with wide margin of safety. However, optimal concentration and volume of ropivacaine in SGB should be studied.

• 한국통신학회논문지
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• 제24권10B호
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• pp.1986-1994
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• 1999

본 논문에서는, 동영상에서 의미 있는 객체 영역을 추출하기 위해서, 첫 장의 영상 분할은 사람에 의해서 주어진 것으로 가정하고, 그 다음 프레임부터는 사람의 도움 없이 객체를 추적해 가는 반자동 방식의 이동체 추적 알고리즘을 제안한다. 제안하는 알고리즘은 계층적인 구조를 가지며, 각각의 계층에서는 seed 추출, watershed 알고리즘을 이용한 영상 분할, 영역 구분의 단계를 거쳐 영상 분할을 수행한다. 영역 구분 단계에서는, 순방향으로 추정된 움직임 벡터장으로부터 영역 분할의 판단 기준을 만들고 이를 이용하여 각각의 영역을 '객체 영역', '배경 영역', '불확실 영역'으로 구분한다. 이때, '불확실 영역'으로 구분된 영역들에 대해서는 좀 더 낮은 계층에서 위의 단계들을 반복하여 다시 수행하게 한다. 제안한 알고리즘은 컴퓨터 모의실험을 통해서 'Claire', 'Miss America', 'Akiyo', 'Mother and daughter'의 영상에서 바람직한 추적 결과를 나타냄을 확인하였다.

• The Korean Journal of Pain
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• 제14권1호
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• pp.26-31
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• 2001

Background: Sympathetic blocks with local anesthetics are used to differentiate sympathetically- maintained pain (SMP) from sympathetically-independent pain (SIP). However, systemic lidocaine is also used in the management of neuropathic pain. Therefore, there may be possibility of a false positive response in relieving their pain by systemic absorption of lidocaine following a diagnostic sympathetic block in patients with SIP. In this study, we measured the plasma lidocaine concentrations after a stellate ganglion block (SGB) using three volumes of 1% lidocaine. Methods: This prospective, crossover study was performed in 3 patients who experience sudden hearing loss and in 4 volunteers. Each person received SGB three times using three different volumes (6 ml, 12 ml and 16 ml) of 1% lidocaine at one week intervals. SGB was performed using a 23 G butterfly needle via a paratracheal approach by two persons. Two ml of venous blood was obtained from a prepared contra-lateral sided venous route at 1, 3, 5, 7, 10, 20 and 60 min after SGB. Plasma lidocaine level was analyzed by immunoassay. Results: Mean plasma lidocaine concentrations correlated well with the volumes of 1% lidocaine used in SGB; larger volumes showed higher concentrations (P < 0.01). Mean peak plasma concentrations were $1.08{\pm}0.18$ in 6 ml, $1.90{\pm}0.47$ in the 12 ml and $2.74{\pm}0.67{\mu}g/ml$ in the 16 ml groups (P < 0.01). The mean time to reach peak plasma concentration was not significantly different between the three groups. Conclusions: The peak plasma lidocaine concentrations in SGB using large volume were found to be similar to that of IV lidocaine infusion in the management of neuropathic pain. These data suggest that diagnostic sympathetic block may result in many false positive responses for SMP. Part of its effect may be related to systemic local anesthetic absorption and not to a sympathetic block. Therefore, physicians may be required to use optimal volumes and minimal concentration of local anesthetic in diagnostic sympathetic block procedures and also make a careful assessment of the performance of a permanent sympathetic block.

• Asian Pacific Journal of Cancer Prevention
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• 제15권12호
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• pp.4839-4842
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• 2014

Background: Although the Cox's proportional hazard model is the popular approach for survival analysis to investigate significant risk factors of cancer patient survival, it is not appropriate in the case of log-term disease free survival. Recently, cure rate models have been introduced to distinguish between clinical determinants of cure and variables associated with the time to event of interest. The aim of this study was to use a cure rate model to determine the clinical associated factors for cure rates of patients with breast cancer (BC). Materials and Methods: This prospective cohort study covered 305 patients with BC, admitted at Shahid Faiazbakhsh Hospital, Tehran, during 2006 to 2008 and followed until April 2012. Cases of patient death were confirmed by telephone contact. For data analysis, a non-mixed cure rate model with Poisson distribution and negative binomial distribution were employed. All analyses were carried out using a developed Macro in WinBugs. Deviance information criteria (DIC) were employed to find the best model. Results: The overall 1-year, 3-year and 5-year relative survival rates were 97%, 89% and 74%. Metastasis and stage of BC were the significant factors, but age was significant only in negative binomial model. The DIC also showed that the negative binomial model had a better fit. Conclusions: This study indicated that, metastasis and stage of BC were identified as the clinical criteria for cure rates. There are limited studies on BC survival which employed these cure rate models to identify the clinical factors associated with cure. These models are better than Cox, in the case of long-term survival.