• Archives of Plastic Surgery
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• v.45 no.5
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• pp.418-424
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• 2018

Background Complication rates after flap coverage for pressure ulcers have been high historically. These patients have multiple risk factors associated with poor wound healing and complications including marginal nutritional status, prolonged immobilization, and a high comorbidities index. This study utilizes the National Surgical Quality Improvement Program (NSQIP) to examine perioperative outcomes of flap coverage for pressure ulcers. Methods Data from the NSQIP database (2005-2015) for patient undergoing flap coverage for pressure ulcers was identified. Demographic, perioperative information, and complications were reviewed. One-way analysis of variance and Pearson chi-square were used to assess differences for continuous variables and nominal variables, respectively. Multivariate logistic regression was performed to identify independent risk factors for complications. Results There were 755 cases identified: 365 (48.3%) sacral ulcers, 321 (42.5%) ischial ulcers, and 69 (9.1%) trochanteric ulcers. Most patients were older male, with some degree of dependency, neurosensory impairment, high functional comorbidities score, and American Society of Anesthesiologists class 3 or above. The sacral ulcer group had the highest incidence of septic shock and bleeding, while the trochanteric ulcer group had the highest incidence of superficial surgical site infection. There was an overall complication rate of 25% at 30-day follow-up. There was no statistical difference in overall complication among groups. Total operating time, diabetes, and non-elective case were independent risk factors for overall complications. Conclusions Despite patients with poor baseline functional status, flap coverage for pressure ulcer patients is safe with acceptable postoperative complications. This type of treatment should be considered for properly selected patients.

• Archives of Plastic Surgery
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• v.43 no.2
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• pp.134-144
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• 2016

In adults, mallet finger is a traumatic zone I lesion of the extensor tendon with either tendon rupture or bony avulsion at the base of the distal phalanx. High-energy mechanisms of injury generally occur in young men, whereas lower energy mechanisms are observed in elderly women. The mechanism of injury is an axial load applied to a straight digit tip, which is then followed by passive extreme distal interphalangeal joint (DIPJ) hyperextension or hyperflexion. Mallet finger is diagnosed clinically, but an X-ray should always be performed. Tubiana's classification takes into account the size of the bony articular fragment and DIPJ subluxation. We propose to stage subluxated fractures as stage III if the subluxation is reducible with a splint and as stage IV if not. Left untreated, mallet finger becomes chronic and leads to a swan-neck deformity and DIPJ osteoarthritis. The goal of treatment is to restore active DIPJ extension. The results of a six- to eight-week conservative course of treatment with a DIPJ splint in slight hyperextension for tendon lesions or straight for bony avulsions depends on patient compliance. Surgical treatments vary in terms of the approach, the reduction technique, and the means of fixation. The risks involved are stiffness, septic arthritis, and osteoarthritis. Given the lack of consensus regarding indications for treatment, we propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which we treat with extra-articular pinning.

• Archives of Plastic Surgery
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• v.35 no.5
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• pp.615-618
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• 2008

Purpose: Pyoderma gangrenosum is a rare cutaneous ulcerative disease. First described in 1930, the condition is characterized by progressive ulceration with deeply undermined purple-red edge. The lower extremities are most commonly affected but other parts of the skin and mucous membranes may also be involved. Although medical treatments with topical wound therapy are commonly used, surgical intervention is still controversial. In this paper, we report an atypical case of pyoderma gangrenosum which was characterized by extensive soft tissue breakdown. Methods: A 27-year-old male patient was referred to our institution with a $7{\times}8cm$ sized deeply undermined ulceration with pus-like discharge and fever. Incision and drainage was performed at another clinic 3 days prior to admission to our institution. After a thorough physical examination and the MRI review, a diagnosis of necrotizing faciitis was made. Accordingly, fasciotomy and debridement was performed. However, the wound enlarged progressively and the patient remained highly febrile for 9 days after the treatment. Septic screening did not reveal any occult infection. After a secondary review of the case, the initial diagnosis of necrotizing fasciitis was rejected and changed to pyoderma gangrenosum. With the use of dexamethasone intravenously, the wound improved dramatically and the fever was eliminated. Steroid mediation was tapered with duration of 1 month. The wound was stabilized and subsequently covered with split-thickness skin graft. Results: Split-thickness skin grafting with 1 : 1.5 mesh was successfully taken. Conclusion: Initial clinical features of pyoderma gangrenosum are very similar to that of necrotizing fasciitis. High fever and progressive ulceration with severe pain could invite earlier surgical approach. The advancing wound margins (the well defined violaceous, undermined border and necrotic ulcer base) and lack of isolation of pathogenic organism was used to make the correct diagnosis of pyoderma gangrenosum. We achieved a good result with proper medication and split-thickness skin graft.

• Magazine of the Korean Society of Agricultural Engineers
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• v.39 no.4
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• pp.55-63
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• 1997

Constructed wetland system which can be applied to the rural wastewater treatment system was examined by pilot plant in Kon-Kuk University. Hydraulic loading rate of wastewater was about 0.16m$^3$/m$^2$. day and theoretical detention time in the system was 1.38 days. The effluent of the septic tank for the school building was applied as inflow to the system. The influent concentration of DO was zero but effluent was up to 4.37mg/${\ell}$ which implies that oxygen was supplied enough from atmosphere by reaeration to support biological activity of the system. Average influent concentration of BOD was 104mg/${\ell}$ and effluent was 24mg/${\ell}$ with average removal rate of 76%. Average influent concentration of COD was 215mg/${\ell}$ and effluent was 63mg/${\ell}$ with average removal rate of 70 % . Average influent concentration of SS was 78mg/${\ell}$ and effluent was 10mg/${\ell}$ with average removal rate of 87%. Two components, BOD and SS, are regulated by law to keep maximum water quality standard of 80mg/${\ell}$ when daily outflow rate is less than 100$m^3$/day which is the case of most rural communities. Therefore, the results from the experiment showed that constructed wetland system can meet the water quality standard easily. Average influent concentration of total nitrogen was 165mg/lwhich is relatively higher than normal wastewater, and effluent was about 156mg/${\ell}$ with average removal rate of only 6%. Average influent concentration of total phosphorus was 41 mg/${\ell}$ and effluent was 6mg/${\ell}$ with average removal rate of 87%. Overall, constructed wetland system was thought to be effective to treat wastewater if nitrogen removal mechanism is improved. Considering low cost, less maintenance, and high treatability, this system can be a practical alternative for the wastewater treatment in rural area The experiment was performed during the summer and fall season, and treatment efficiency of the system is expected to decrease in low temperature. therefore, further study including temperature is required to evaluate feasibility of the system more in detail.

• Korean Journal of Environmental Agriculture
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• v.19 no.5
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• pp.426-432
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• 2000

Field experiment was performed from August 1996 to December 1999 to examine the feasibility of constructed wetland system for sewage treatment in rural areas. A pilot system was installed in Konkuk University and the effluent of septic tank for school building was used as an influent to the wetland treatment basin. The system was composed of sand and reed, and operated continuously including winter time. Average removal rate of about 70% was observed for BOD, COD, and SS, about 50% for T-P, and about 25% for T-N. The reason for poor T-N removal might be due to high loading rate and short retention time. The system demonstrated satisfactory effluent concentration and stable performance in growing season. And it also worked adequately in wintertime even below $10^{\circ}C$ without freezing, and removal was still significant. The amount removed in BOD, COD, and SS was almost the same as in the growing season, and the amount removed in nutrients was about half of the one in growing season. Overall performance of the experimental system was compared with existing data base (NADB, 1994), and it was within the range of general system performance. As study period increased, removal rates for BOD, COD, SS, and T-P were consistently maintained and even enhanced, but removal rate for T-N decreased slightly. Wetland system was thought to be a feasible alternative for sewage treatment in rural area considering its low cost and low maintenance requirement. However, the effluent of the experimental wetland system often exceeded current effluent water quality standards, therefore, further treatment could be required if the effluent should be discharged to public waters. Wetland system of interest locates in rural area and is a part of rural ecosystem, therefore, ultimate disposal of reclaimed sewage for agricultural purpose or subsequent land treatment might be available and further research in this matter is recommended.

• Microbiology and Biotechnology Letters
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• v.41 no.2
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• pp.242-248
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• 2013

Endotoxins are part of the outer membrane of the cell wall of gram-negative bacteria and are continuously released during bacterial growth. Endotoxins typically induce severe sepsis and septic shock, which cause more than 50% of mortalities. Endotoxins are easily measured in the serum by the limulus amebocyte lysate (LAL) test. However, a nonspecific result is obtained, because the high concentration of serum proteins disturbs the enzyme reaction of the LAL test. In order to solve this problem, the LAL test was performed in this study after the centrifugation of the boiled serum samples to remove the impurities. As a result, among the various conditions examined, endotoxin measurement with the LAL test was the most accurate and repeatable after centrifugation of the boiled serum at $100^{\circ}C$. Moreover, the endotoxin was accurately and repeatedly measured from the prepared sera of mice that had been administered an intraperitoneal injection of purified lipopolysaccharides (LPS) or E. coli. Therefore, the application of centrifugation to remove impurities from boiled serum gives an accurate measurement of endotoxins in the sera of normal subjects or patients, and this will lead to the improved diagnosis and prevention of diseases caused by endotoxins. In addition, the centrifugation of boiled serum samples should be considered and included in the development of endotoxin test kits.

• Magazine of the Korean Society of Agricultural Engineers
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• v.45 no.6
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• pp.194-206
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• 2003

A pilot study was performed to examine the feasibility of the pond system for further polishing of treatment wetland effluent to agricultural reuse of reclaimed water. The constructed wetland and pond system was installed in Konkuk University and the effluent from septic tank of school building was used as an influent to the wetland system. The effluent of the wetland was used as an influent to pond systems. The influent concentrations of total coliform(TC), fecal coliform (FC), and E. coli were about $10^5$MPN/100 ml, and they were reduced to less than 10,000 MPN/100 ml on average after wetland treatments, showing over 95 % removal. And they were further reduced to less than 1,000 MPN/100 ml in average, showing over 85∼93 % removal after pond treatment. Turbidity and SS were improved effectively on average and their pond effluent concentration was about 4.5 NTU and 9.8 mg/L in average, respectively Average $BOD^5$ concentrations were also reduced substantially to 9.3 mg/L with about 83 % removal rate after wetland and pond treatment systems. Nutrients removal was relatively low and removal rate for T-N and T-P was less than 43 and 44%, respectively after wetland and pond treatment. Considering stable performance and effective removal of bacterial indicators as well as other water quality parameters, low maintenance, and cost-effectiveness, pond system was thought to be an effective and feasible alternative for agricultural reuse of reclaimed water. This paper describes a preliminary result Iron pilot study and further investigations are recommended on the optimum design parameters before full scale application.

• The Korean Journal of Physiology and Pharmacology
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• v.20 no.6
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• pp.565-571
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• 2016

Paeoniflorin (PAE) is the most abundant compound in Xuebijing injection widely used to treat sepsis. We aimed to investigate effect of PAE on expression of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in a rat model of sepsis. Wistar rats were divided into Normal, Model, and PAE groups (n=20 each). Endotoxin was administrated at 5 mg/ml/kg in Model and PAE rats to establish rat sepsis model. 1 h after endotoxin administration, PAE was administrated at 4 ml/kg in PAE group once per day for 3 days. Routine blood tests and biochemical indexes were assessed, including aspartate aminotransferase (AST) and creatine kinase-MB (CK-MB). The plasma sTREM-1 level was measured using quantitative ELISA. At the end of experiment, the small intestine, liver, kidney and lung were subjected to pathological examinations. A rat model of sepsis-induced multiple organ dysfunction syndrome (MODS) was established successfully with endotoxin administration (5 mg/ml/kg), evidenced by histo-pathological examinations, routine blood tests and biochemical indexes: platelet count decreased and white blood cell count increased (p<0.05), CK-MB and AST increased (p<0.05). PAE treatment significantly reduced the plasma levels of AST, CK-MB, and sTREM-1, compared to Model group (p<0.05). Meanwhile, sepsis-induced damages in the liver, lung, stomach and intestinal mucosa were also markedly ameliorated by PAE treatment. PAE demonstrated a significantly protective effect in a rat model of sepsis by decreasing plasma sTREM-1 level, reducing inflammation, preventing MODS and protecting organ functions.

• Environmental Engineering Research
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• v.15 no.2
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• pp.105-109
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• 2010

The European Union (EU) Water Framework Directive (WFD) (2000/60/EC) was transposed into Irish law by Statutory Instrument Nos. 722 of 2003, 413 of 2005 and 218 of 2009, which set out a new strategy and process to protect and enhance Ireland's water resources and water-dependent ecosystems. The Directive requires a novel, holistic, integrated, and iterative process to address Ireland's natural waters based on a series of six-year planning cycles. Key success factors in implementing the Directive include an in-depth and balanced treatment of the ecological, economic, institutional and cultural aspects of river basin management planning. Introducing this visionary discipline for the management of sustainable water resources requires a solemn commitment to a new mindset and an overarching monitoring and management regime which hitherto has never been attempted in Ireland. The WFD must be implemented in conjunction with a myriad of complimentary directives and associated legislation, addressing such key related topics as flood/drought management, biodiversity protection, land use planning, and water/wastewater and diffuse pollution engineering and regulation. The critical steps identified for river basin management planning under the WFD include: 1) characterization and classification of water bodies (i.e., how healthy are Irish waters?), 2) definition of significant water pressures (e.g., agriculture, forestry, septic tanks), 3) enhancement of measures for designated protected areas, 4) establishment of objectives for all surface and ground waters, and 5) integrating these critical steps into a comprehensive and coherent river basin management plan and associated programme of measures. A parallel WFD implementation programme critically depends on an effective environmental management system (EMS) approach with a plan-do-check-act cycle applied to each of the evolving six-year plans. The proactive involvement of stakeholders and the general public is a key element of this EMS approach.

• Journal of Chest Surgery
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• v.49 no.3
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• pp.151-156
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• 2016

Background: Survival of children experiencing cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) is very poor. We sought to examine current era outcomes of extracorporeal CPR (ECPR) support for refractory arrest. Methods: Patients who were <18 years and underwent ECPR between November 2013 and January 2016 were including in this study. We retrospectively investigated patient medical records. Results: Twelve children, median age 6.6 months (range, 1 day to 11.7 years), required ECPR. patients' diseases spanned several categories: congenital heart disease (n=5), myocarditis (n=2), respiratory failure (n=2), septic shock (n=1), trauma (n=1), and post-cardiotomy arrest (n=1). Cannulation sites included the neck (n=8), chest (n=3), and neck to chest conversion (n=1). Median duration of extracorporeal membrane oxygenation was five days (range, 0 to 14 days). Extracorporeal membrane oxygenation was successfully discontinued in 10 (83.3%) patients. Nine patients (75%) survived more than seven days after support discontinuation and four patients (33.3%) survived and were discharged. Causes of death included ischemic brain injury (n=4), sepsis (n=3), and gastrointestinal bleeding (n=1). Conclusion: ECPR plays a valuable role in children experiencing refractory cardiac arrest. The weaning rate is acceptable; however, survival is related to other organ dysfunction and the severity of ischemic brain injury. ECPR prior to the emergence of end-organ injury and prevention of neurologic injury might enhance survival.