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Safety of endoscopic retrograde cholangiopancreatography (ERCP) in cirrhosis compared to non-cirrhosis and effect of Child-Pugh score on post-ERCP complications: a systematic review and meta-analysis

  • Zahid Ijaz Tarar;Umer Farooq;Mustafa Gandhi;Saad Saleem;Ebubekir Daglilar
    • Clinical Endoscopy
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    • v.56 no.5
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    • pp.578-589
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    • 2023
  • Background/Aims: The safety of endoscopic retrograde cholangiopancreatography (ERCP) in hepatic cirrhosis and the impact of Child-Pugh class on post-ERCP complications need to be better studied. We investigated the post-ERCP complication rates in patients with cirrhosis compared with those without cirrhosis. Methods: We conducted a literature search of relevant databases to identify studies that reported post-ERCP complications in patients with hepatic cirrhosis. Results: Twenty-four studies comprising 28,201 patients were included. The pooled incidence of post-ERCP complications in cirrhosis was 15.5% (95% confidence interval [CI], 11.8%-19.2%; I2=96.2%), with an individual pooled incidence of pancreatitis 5.1% (95% CI, 3.1%-7.2%; I2=91.5%), bleeding 3.6% (95% CI, 2.8%-4.5%; I2=67.5%), cholangitis 2.9% (95% CI, 1.9%-3.8%; I2=83.4%), and perforation 0.3% (95% CI, 0.1%-0.5%; I2=3.7%). Patients with cirrhosis had a greater risk of post-ERCP complications (risk ratio [RR], 1.41; 95% CI, 1.16-1.71; I2=56.3%). The risk of individual odds of adverse events between cirrhosis and non-cirrhosis was as follows: pancreatitis (RR, 1.25; 95% CI, 1.06-1.48; I2=24.8%), bleeding (RR, 1.94; 95% CI, 1.59-2.37; I2=0%), cholangitis (RR, 1.15; 95% CI, 0.77-1.70; I2=12%), and perforation (RR, 1.20; 95% CI, 0.59-2.43; I2=0%). Conclusions: Cirrhosis is associated with an increased risk of post-ERCP pancreatitis, bleeding, and cholangitis.

The Discourse of Capitalist Society on East Asian Pop Culture: A TV Series of Superhero Animation (대중문화에 재현된 동아시아 자본주의 사회의 담론 : 슈퍼히어로 애니메이션 <타이거 앤 버니>를 중심으로)

  • Woo, Ji-Woon;Noh, Kwang-Woo;Kwon, Jae-Woong
    • Cartoon and Animation Studies
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    • s.37
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    • pp.45-82
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    • 2014
  • Comics and cartoons of superheroes in the West have adopted various semiotic systems and other art-forms, including their politico-socio-economic condition, and made parody of other popular texts, as well. Based on the idea of the development of superhero genre, this article focuses on how East Asian popular texts appropriate and reconstruct the genre, which was once considered the realization of American idea, by analyzing a series of TV animation (Japan, Sunrise,2011). Through the feature of parody with intertextuality, provides East Asian value and sensibility of characters as corporation-centered modern humans in capitalist society. This animation has similarity and difference, compared to that of Western superhero cartoons. It satires Western capitalist society and emphasizes Eastern family-oriented value. The performances of superheroes on TV represent the satire on Western style individualism and estimation through each one's achievement. It metaphorically criticizes the situation in which modern human falls into dependency on capital and media, and the capitalistic system in which public good is used for the method of private profit. emphasizes East Asian value of human and society, the cooperative relation for the success and maintenance of community by combining members of state and society through familial sensibility. Tiger functions as a spiritual leader in the group of superheroes who have been obsessed with competition for their own private purpose rather than public cause, Bunny and other colleagues are gradually influenced by Tiger's familial communicative style. emphasizes community-centered view and self-sacrificing sensibility as an international citizen to solve social pathology of modern world.

Errors in Net Ecosystem Exchanges of CO2, Water Vapor, and Heat Caused by Storage Fluxes Calculated by Single-level Scalar Measurements Over a Rice Paddy (단일 높이에서 관측된 저장 플럭스를 사용할 때 발생하는 논의 이산화탄소, 수증기, 현열의 순생태계교환량 오차)

  • Moon, Minkyu;Kang, Minseok;Thakuri, Bindu Malla;Lee, Jung-Hoon
    • Korean Journal of Agricultural and Forest Meteorology
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    • v.17 no.3
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    • pp.227-235
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    • 2015
  • Using eddy covariance method, net ecosystem exchange (NEE) of $CO_2$ ($F_{CO_2}$), $H_2O$ (LE), and sensible heat (H) can be approximated as the sum of eddy flux ($F_c$) and storage flux term ($F_s$). Depending on strength and distribution of sink/source of scalars and magnitude of vertical turbulence mixing, the rates of changes in scalars are different with height. In order to calculate $F_s$ accurately, the differences should be considered using scalar profile measurement. However, most of flux sites for agricultural lands in Asia do not operate profile system and estimate $F_s$ using single-level scalars from eddy covariance system under the assumption that the rates of changes in scalars are constant regardless of the height. In this study, we measured $F_c$ and $F_s$ of $CO_2$, $H_2O$, and air temperature ($T_a$) using eddy covariance and profile system (i.e., the multi-level measurement system in scalars from eddy covariance measurement height to the land surface) at the Chengmicheon farmland site in Korea (CFK) in order to quantify the differences between $F_s$ calculated by single-level measurements ($F_s_{-single}$ i.e., $F_s$ from scalars measured by profile system only at eddy covariance system measurement height) and $F_s$ calculated by profile measurements and verify the errors of NEE caused by $F_s_{-single}$. The rate of change in $CO_2$, $H_2O$, and Ta were varied with height depending on the magnitudes and distribution of sink and source and the stability in the atmospheric boundary layer. Thus, $F_s_{-single}$ underestimated or overestimated $F_s$ (especially 21% underestimation in $F_s$ of $CO_2$ around sunrise and sunset (0430-0800 h and 1630-2000 h)). For $F_{CO_2}$, the errors in $F_s_{-single}$ generated 3% and 2% underestimation of $F_{CO_2}$ during nighttime (2030-0400 h) and around sunrise and sunset, respectively. In the process of nighttime correction and partitioning of $F_{CO_2}$, these differences would cause an underestimation in carbon balance at the rice paddy. In contrast, there were little differences at the errors in LE and H caused by the error in $F_s_{-single}$, irrespective of time.

Comparison of Population Monitoring Methods for Breeding Forest Birds in Korean Temperate Mixed Forests (국내 온대 혼효림에 서식하는 산림성 조류의 번식기 개체군 모니터링 방법에 대한 비교)

  • Nam, Hyun-Young;Choi, Chang-Yong;Park, Jin-Young;Hur, Wee-Haeng
    • Journal of Korean Society of Forest Science
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    • v.108 no.4
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    • pp.663-674
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    • 2019
  • Birds are effective ecological indicators but there is no national protocol in place to monitor population dynamics of forest birds in Korea. To support the establishment of future monitoring protocols, we compared the results of two generally used monitoring methods for forest bird surveys in two temperate mixed forests in central Korea. There was no statistical difference in the number of species and individuals detected per unit survey effort when comparing line transects and point counts. The number of species and individuals were higher in a five-minute count than in a three-minute point count, but the total accumulated number of expected observed species showed no difference between the two count durations. The number of observed species and individuals increased in both methods as plot radius or transect width increased, suggesting that multi-layer or multi-band surveys may be useful for quantitative and qualitative objectives. The decreasing number of observed species and individuals after sunrise suggested that bird monitoring should be conducted earlier in the morning, within four hours after sunrise. To detect 70% of the total number of species, 7.0 to 7.6 survey hours, equivalent to 42 three-minute counts (95% confidence interval [CI]: 26 to 61) or 33 five-minute counts (95% CI: 19 to 53) were needed for unlimited radius point counts. On the other hand, 4.8 survey hours, equivalent to 26 line transect counts (95% CI: 15 to 45) using 200-m transects with unlimited width, were required to achieve the same level of species detection. Therefore, the line transect method may be more effective than the point count method, at least in terms of local species richness assessment. For national forest bird monitoring, our data indicated that one or both survey methods can be selected as a basic protocol, based on the goals and scales of monitoring, forest types, and the conditions of the target areas.

Analysis of Temperature Changes in Greenhouses with Recirculated Water Curtain System (순환식 수막하우스의 수온에 따른 플라스틱 온실 내 온도변화 분석)

  • Kim, Hyung-Kweon;Jeon, Jong-Gil;Paek, Yee;Pyo, Hee-Young;Jeong, Jae-Woan;Kim, Yong-Cheol
    • Journal of Bio-Environment Control
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    • v.24 no.2
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    • pp.93-99
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    • 2015
  • The purpose of this study was to determine the appropriate temperature for water curtain in greenhouses equipped with recirculated water curtain system. The study analyzed the changes in air temperature in non-heated greenhouses for strawberry cultivation based on outdoor temperature, water curtain temperature and night time. Three greenhouse units were used for this study: The first unit was assigned as a control (no water curtain system), two other greenhouses were equipped with recirculated water curtain system with water curtain temperatures of $10^{\circ}C$ and $15^{\circ}C$, respectively. Analysis showed that the indoor temperatures were directly correlated with the outdoor temperature in all experimental greenhouses. Heat insulating effect of $15^{\circ}C$ water curtain was increased by $1.3^{\circ}C$ compared to that in $10^{\circ}C$ water curtain system. The $15^{\circ}C$ water curtain treatment showed the highest average temperature and less temperature variation in comparison with control and $10^{\circ}C$ water curtain treatment. To maintain indoor temperature at $5^{\circ}C$, water curtain temperature of $10^{\circ}C$ was suitable when outdoor minimum and average temperatures were -1.3 and $1.5^{\circ}C$, and water curtain temperature of $15^{\circ}C$ was suitable when outdoor minimum and average temperatures were -4.7 and $-0.2^{\circ}C$, respectively. The highest temperature in greenhouses according to measurements in different periods of night time was observed after sunset (18:30-20:30), and the lowest temperature before sunrise (05:00-07:00). Water curtain maintained a target indoor temperature by acting as a layer of heat transfer insulator which decreased heat loss from greenhouses. Therefore, water temperature in recirculating water curtain systems should be determined by considering outdoor temperatures, changes in temperature at different periods of night time, and cultivated crop.

Strategies about Optimal Measurement Matrix of Environment Factors Inside Plastic Greenhouse (플라스틱온실 내부 환경 인자 다중센서 설치 위치 최적화 전략)

  • Lee, JungKyu;Kang, DongHyun;Oh, SangHoon;Lee, DongHoon
    • Journal of Bio-Environment Control
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    • v.29 no.2
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    • pp.161-170
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    • 2020
  • There is systematic spatial variations in environmental properties due to sensitive reaction to external conditions at plastic greenhouse occupied 99.2% of domestic agricultural facilities. In order to construct 3 dimensional distribution of temperature, relative humidity, CO2 and illuminance, measurement matrix as 3 by 3 by 5 in direction of width, height and length, respectively, dividing indoor space of greenhouse was designed and tested at experimental site. Linear regression analysis was conducted to evaluate optimal estimation method in terms with horizontal and vertical variations. Even though sole measurement point for temperature and relative humidity could be feasible to assess indoor condition, multiple measurement matrix is inevitably required to improve spatial precision at certain time domain such as period of sunrise and sunset. In case with CO2, multiple measurement matrix could not successfully improve the spatial predictability during a whole experimental period. In case with illuminance, prediction performance was getting smaller after a time period of sunrise due to systematic interference such as indoor structure. Thus, multiple sensing methodology was proposed in direction of length at higher height than growing bed, which could compensate estimation error in spatial domain. Appropriate measurement matrix could be constructed considering the transition of stability in indoor environmental properties due to external variations. As a result, optimal measurement matrix should be carefully designed considering flexibility of construction relevant with the type of property, indoor structure, the purpose of crop and the period of growth. For an instance, partial cooling and heating system to save a consumption of energy supplement could be successfully accomplished by the deployment of multiple measurement matrix.

Desensitizing Effects of a Nd:YAG Laser Irradiation on Hypersensitive Dentine (지각과민치아에 대한 Nd:YAG 레이저 조사의 효과)

  • Jung, Sung-Yong;Kim, Kyoung-Hee;Ko, Myong-Yun;Ahn, Yong-Woo;Park, Jun-Sang
    • Journal of Oral Medicine and Pain
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    • v.30 no.4
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    • pp.465-473
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    • 2005
  • The purpose of this study was to evaluate the desensitizing effects of a Nd:YAG laser (Sunlase, SUNRISE Technologies, Inc., USA) irradiation on cervically exposed hypersensitive dentine. 45 patients was irradiated with pulsed Nd:YAG laser (1.5 W, 20 Hz, 75 mJ/pulse, 4 minutes) as the experimental group, 27 patients was mock irradiated as the control group. The degree of sensitivity to the thermal and tactile stimuli were determined qualitatively with an evaporative stimulus defined as two times air blast at a distance of 3 mm from each site to be tested and with a mechanical stimulus as a slightly scratching the cervical site with a dental explorer. A qualitative registration of the degree of discomfort was determined according to a numerical pain scale(NPS) in an 11-point scale in which 0= "no pain" and 10="most excruciating pain imaginable". Recordings were assessed before treatment, immediately after, 1 and 2 weeks after treatment. Pain tolerance threshold and pulp vitality were evaluated with electric pulp tester before and immediately after treatment. 1. Desensitizing of hypersensitive dentine with Nd:YAG laser irradiation was more effective than that with mock irradiation. 2. The placebo effect of mock irradiation was recognized for severe sensitive teeth($NPS\;{\geqq}\;6$), but not for moderate sensitive teeth(NPS < 6). 3. Laser irradiation did not affect the pain tolerance threshold and pulp vitality of the hypersensitive teeth. 4. Desensitizing effect of laser irradiation for the hypersensitive teeth had been continuing at least 2 weeks. It was concluded that desensitizing of hypersensitive dentine with a Nd:YAG laser is effective and the maintenance of the positive result was more prolonged than the placebo effect.

The Analysis of the Nocturnal Ozone Variations over Kangreung and Wonju (강릉과 원주지역의 야간 오존 변화에 대한 분석)

  • Kim, Hyun-Sook;Lee, Hyun-Jin;Kim, Jae-Hwan
    • Journal of the Korean earth science society
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    • v.25 no.6
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    • pp.474-483
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    • 2004
  • This paper analyzed the characteristics of daily ozone variations over Kangreung and Wonju. It was found that the diurnal cycle of ozone over Wonju has a primary ozone peak in the afternoon and a minimum around sunrise, which is a typical diurnal ozone cycle observable in the urban area. However, the cycle over Kangreung shows a primary peak in the afternoon and secondary peak around 3 a.m. The amounts of ozone in the secondary peak is occasionally higher than that in the primary peak. This nocturnal ozone peak is frequently observed year-round, and the highest frequency and extent are observed in spring. The possible cause of this nocturnal ozone increase was investigated using meteorological parameters and the HYSPLIT trajectory model. It was found that the nocturnal ozone peak is highly correlated with strong wind speed, which has led to positive temperature anomaly. The trajectory model revealed that when the secondary peak occurred, the air was originated from the west and a sinking motion subsequently followed. These findings suggested that when the westerly wind is strongest in spring, the polluted airs from urban areas are transported to the upper boundary layer over Kangreung area. In the case of strong wind during the night, nocturnal ozone peaks were produced by active vertical mixing between lower boundary and upper boundary layers.

A Clinical Study on the Therapeutic Effects of the Pulsed Nd:YAG Laser on Dentinal Hypersensitivity (상아질지각과민증에 대한 펄스형 Nd: YAG 레이저의 치료효과에 관한 임상적 연구)

  • 최순정;신금백;김문현
    • Journal of Oral Medicine and Pain
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    • v.23 no.1
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    • pp.11-20
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    • 1998
  • 저자는 치과용 레이저를 이용한 상아질지각과민증 치료효과를 임상적으로 평가하고자 상아질지각과민증환자 24명을 대상으로 각 환자마다 상아질 지각과민 치아 중 레이저로 치료 할 치아1개(실험군)와 치료하지 않을 치아 1개(대조군)를 선정하여, 치과용 air-syringe에 의한 냉자극과 치과용 탐침자에 의한 기계적 자극을 가한 후 Visual Analogue Scale(VAS)을 통해 지각과민증 정도를 평가하였으며, 이후 실험군 치아의 치경부 마모면에 광섬유 레이저에너지 전달방식의 펄스형 Nd:YAG 레이저의 일종인 Sunlase Master(Sunrise Technologies Inc., U.S.A., 파장 1064nm, 펄스지속시간 120(sec, 광섬유직경 320(m)를 사용하여, 0.3-1.0W, 10Hz 조건으로 환자의 반응에 따라 1회2분을 초과하지 않는 범위 내에서 비접촉식과 접촉식을 병행하여 3회에 걸쳐(초진 당일, 1일후, 3일후) 레이저를 조사한 후 처음조사 직후, 그리고 초진 1일후, 3일후, 7일후, 14일후 VAS를 채득하여 조사전과 비교, 분석, 평가하였던 바, 상아질 지각과민증이 각각 약 50%, 약36%, 약45%, 약 53% 감소하였으나 (p(0.05) 경시적으로는 유의한 차이를 보이지 않았다. 그리고 24명중 9명에 대해서는 초진 30일 후 까지 레이저조사치료효과를 평가하였던 바, 상아질지각과민증이 처음조사 직후, 감소하였으며 (p(0.05)역시 경시적으로는 유의한 차이를 보이지 않았다. 초진 30일 후 상아질지각과민증이 초진 14일 후에 비해 약간 증가되는 경향을 보여, 레이저조사 치료효과가 약화되는 경향인지 여부에 대해 향후 추가적인 연구가 필요할 것으로 사료된다.안되었다.기란 현실적으로 불가능하므로, 본 연구에서는 이러한 제약점을 극복할 수 있는 근사적인 지체시간을 계산하는 방법을 제시한 점에서 의미를 갖을 수 있다.수들은 직업의 선택이나 소득을 예측하기 위한 요소들로 포함될 수 없었다. 따라서 후속연구에서는 이를 보완해야 할 것이며, 최근 들어 우리 나라에서도 재택근무에 대한 관심이 대두되고 있으나 아직 개념정의나 그 중요성과 가치, 그리고 실태 파악과 같은 연구가 활발히 이루어지지 못하고 있으므로 이에 대한 심층적인 연구가 행해져야 할 것이다.d similar flower proceeding dates in all branches. but "Daepung" showed similar flower proceeding dates in all branches.est in HB. Mean period of wetting duration was in the order of DS>HB>MB, while the dew point depression was greatest in DS.ANCOVA, Pearson correlation을 이용하여 분석하였으며, 그 결과는 다음과 같다. 캠프 프로그램은 소아 당뇨병 환자의 자기 효능을 증진시키고 환자 역할 행위 이행을 높여주는데 효과적 이었다. 소아 당뇨병 환자의 자기 효능은 환자 역할 행위 이행과 순 상관 관계가 있어, 자기 효능이 증진될수록 환자 역할 행위 이행 정도가 높아졌다. 무조건 사주지 않는다(8.0%), 무조건 사준다(3.1%)로 식품광고에 나오는 식품 요구시 부모의 70.3%가 거절하는 것으로 나타났다. 거절 이유는 건강에 나쁘다는 것이 가장 큰 이유였으며 강남과 강북 어린이간에 유의적인 차이가 있었다(p<0.001).

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Relationship between NVOCs Concentration and Korean Red Pine (Pinus densiflora S. et Z.) Forest Environment in Spring Season (봄철 소나무숲의 NVOC 농도와 숲환경과의 상관관계)

  • Kim, GeonWoo;Kwon, ChiWon;Yeom, DongGeol;Joung, Dawou;Choi, Yoon Ho;Park, Bum-Jin
    • Journal of Korean Society of Forest Science
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    • v.103 no.3
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    • pp.483-489
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    • 2014
  • This study aimed at a scientific examination of the relationship between NVOCs concentration and the physical environment of red pine forest in spring season. Atmospheric NVOC samples in red pine forest was collected through five trials conducted from March to May 2013, using Tanax-Ta-charged disposable tubes and mini-pumps. At each trial, measurements were taken at three different points in daytime (sunrise, southing and sunset). For maximum accuracy, two tubes were used for each measurement at the same location, and the mean value was used for analysis. Compound analysis on the NVOC samples was done using the HS-SPME method and GC-MS. Analysis of the relationship between NVOC and the physical forest environment found higher concentrations of most substances, including ${\alpha}$-pinene and ${\beta}$-pinene, with higher temperature, dew point, and lower concentrations with higher wind velocity. The findings of this study offer scientific evidence which can inform the creation of 'healing forests' and 'recreational forests' as well as forest environment in general, helping to promote public health and recreational activities.