The Relations between Participation in Voluntary Service Activity and Health-Related Quality of life among the Elderly / 農村醫學 地域保健

OBJECTIVES: This study was performed to identify the relations between the old's participation in voluntary service activities and health-related quality of life. METHODS: The subjects of the study were 318 elderly people aged over 65 years. They were interviewed with the use of a questionnaire from May 1 to June 30, 2012 to collect data. To verify the data collected, this study carried out a linear regression analysis. RESULTS: The health-related quality of life of the elderly who were participating in voluntary service activities was statistically significantly higher than that of those who were not. CONCLUSIONS: This study has meaning in that it discovered that the elderly people's participation in voluntary service activities had a positive effect on their health-related quality of life.

The Effects of Preceptor Nurses' Self-leadership on Role Recognition and Job Satisfaction / 간호행정학회지

PURPOSE: The purpose of this study was to examine the effects of preceptor nurses' self-leadership on role recognition and job satisfaction. METHOD: The participants were 171 preceptor nurses worked in one of three general hospitals in Seoul. The data were collected from April 12 to May 12, 2011 and analyzed using descriptive statistics, t-test, ANOVA, pearson correlation, Scheffe, and regression with SPSS Win 19.0 program. RESULT: The results of the study were as followed. The average score for preceptor nurses' self-leadership was 3.55, for role recognition, 3.81 and for job satisfaction, 3.28. The factors of the preceptors' self-leadership affecting role recognition were self-expectation (beta=260, p=.002) and goal setting (beta=199, p=.030), and those factors accounted for 18.9% of explanatory power. The factors of self-leadership influencing job satisfaction were self-expectation (beta=18.3, p=.021), and rehearsal (beta=-168, p=.030), and those factors accounted for 31.3% of explanatory power. Among the factors of self-leadership, self-expectation influenced both role recognition and job satisfaction. CONCLUSIONS: The results of the study indicate that to improve preceptor's role recognition and job satisfaction, there should be special training programs to enhance preceptor's self leadership.

Characterization of Xylanase of Cladosporium cladosporioides H1 Isolated from Janggyeong Panjeon in Haeinsa Temple

Cladosporium cladosporioides H1 was found to be the most abundant microbe in Janggyeong Panjeon. C. cladosporioides H1 produced a 20 kDa xylanase, which was generally stable below 60degrees C and had specialized activity in an acidic condition. Our results may lead to the development of a strategy for preservation of organic cultural heritage environments.

The influence of type 2 diabetes mellitus on the expression of inflammatory mediators and tissue inhibitor of metalloproteinases-2 in human chronic periodontitis

PURPOSE: The purpose of this study was to compare and quantify the expression of C-reactive protein (CRP), matrix metalloproteinase (MMP)-14, and tissue inhibitor of metalloproteinases (TIMP)-2 in gingival tissues of patients with chronic periodontitis accompanied with inflammatory reaction related to alveolar bone resorption with or without type 2 diabetes mellitus (DM). METHODS: Twelve patients with type 2 DM and chronic periodontitis (group 3), twelve patients with chronic periodontitis (group 2), and twelve healthy individuals (group 1) were included in the study. Gingival tissue biopsies were collected from each patient and from healthy individuals at the time of periodontal surgery (including surgical crown lengthening) or tooth extraction. The concentrations of cytokines were determined by a western blot analysis. RESULTS: The expression levels of CRP and MMP-14 increased in group 2 and 3, and they were highest in group 3. The expressions of TIMP-2 also increased in group 2 and 3. CONCLUSIONS: This study demonstrated that the expression levels of CRP, MMP-14, and TIMP-2 might be inflammatory markers in periodontal inflamed tissue. It can be assumed that CRP, MMP-14, and TIMP-2 may be partly involved in the progression of periodontal inflammation associated to type 2 DM.

Clinical case report on treatment of generalized aggressive periodontitis

PURPOSE: The purpose of this study was to evaluate the improvement of periodontal health of generalized aggressive periodontitis (GAgP) diagnosed patients treated with non-surgical periodontal therapy accompanying systemic antibiotics administration. METHODS: Two patients with GAgP were chosen for this study. Clinical indices were taken and a radiographic examination was performed at the baseline of the study and they were treated by periodontal therapy accompanying systemic antibiotics administration. Post-surgical visits were scheduled at regular intervals to check clinical and radiographic changes. RESULTS: Through non-surgical periodontal therapy accompanying systemic antibiotics administration, GAgP patients showed decreased probing pocket depth, sulcus bleeding index, and increased attachment level and clinical index when comparing the initial and six month follow up data. In the six month follow-up radiographic examination after non-surgical periodontal therapy, resolution of the bony defect was observed. CONCLUSIONS: Non-surgical therapy combined with systemic antibiotics administration in GAgP patients is suggested to be an effective approach to enhance the periodontal health.

The Analgesic Efficacy of a 5% Eutectic Mixture of Lidocaine and Prilocaine Prior to Insertion of Spinal and Epidural Block / 대한마취과학회지

BACKGROUND: We evaluated the analgesic efficacy of a 5% eutectic mixture of lidocaine and prilocaine (EMLA(R)) topically applied before performing skin puncture for spinal or epidural anesthesia. METHODS: The patient population consisted of 75 ASA physical status 1 and 2 adults scheduled for operations of the lower abdominal region, the perineal region or the lower extremities. The patients were randomly allocated to one of five groups of equal size: group A - topical application of EMLA(R) cream 120 min before spinal block; group B - subcutaneous infiltrationof 2 ml of 2% lidocaine immediately before spinal block; group C - no pretreatment before spinal block; group D - topical application of EMLA(R) cream 120 min before epidural block; and group E - subcutaneous infiltration of 2 ml of 2% lidocaine immediatelybefore epidural block. Pain experienced during the whole procedure was rated using a 10 cm visual analogue scale. RESULTS: Patients in group A experienced less pain compared with those in groups B and C (2.0 +/- 1.9 cm vs 4.1 +/- 1.9 cm and 3.9 +/- 2.2 cm, respectively; P < 0.05). However there was no significant difference between group D and group E (3.6 +/- 2.4 cm vs 4.1 +/- 2.5 cm). The patients in group A and group D were highly satisfied with the method of analgesia (P < 0.05). CONCLUSIONS: EMLA(R) cream is an effective alternative to subcutaneous infiltration of local anesthetic for analgesia during skin puncture using a 25 G spinal needle. It provides insufficient analgesia however for epidural anesthesia.

Performance Characteristics of High Efficiency Fluid and Blood Warmer using Print Circuit Board Heater at Various Flow Rates / 대한마취과학회지

BACKGROUND: Currently available warming devices are often heavy and cumbersome, requiring development of more portable, user friendly, high efficiency fluid and blood warmer. The intravenous fluid heating capabilities of a new, heat-plate print circuit board (PCB) based warmer at various low flow rates were tested. METHODS: Model Joyother BM-1(R) was investigated for normal saline (0.9% NaCl) and colloid at various infusion rates (60-6000 ml/hr). Final temperatures were measured by electronic thermometer after passing through the warmer. Effective warming was defined as a fluid temperature > or = 32degrees C. Ambient temperature was maintained at 22-25degrees C. Degree of heating capability and temperature decrease were compared and correlated between different flow rates. RESULTS: The device warmed the room temperature crystalloid and colloid efficiently. Its warming capability was continuously improved as the flow rates increased in all tested flow rates, reaching maximum 41degrees C. After the warming, the temperature decrease showed high negative correlation with the flow rates. The extent of cooling was less in colloid. No overheating was noted at sudden brake. CONCLUSIONS: Joyother BM-1(R) heated crystalloid and colloid sufficiently and safely enough for clinical application (exit temperature > or = 35degrees C) at various flow rates. The warming capacity and the length of the intravenous tube infusion system determined the efficiency of the warmer. Further study is warranted for the efficiency of warming for the blood and its element changes.

Nonlinear Mixed Effect Modeling of Population Pharmacokinetics and Pharmacodynamics of Etomidate / 대한마취과학회지

BACKGROUND: Etomidate is used as a fast-acting hypnotic with few cardiovascular effects to induce anesthesia in patients with a poor cardiovascular reserve. The bispectral index (BIS) has been suggested to be a measure of the depth of anesthesia and correlates well with the level of consciousness. This study examined the population pharmacokinetics and pharmacodynamics of etomidate using nonlinear mixed effect (NONMEM) modeling and sigmoid Emax modeling. METHODS: Eighteen middle aged adults, with ASA physical status I or II, who were scheduled for elective surgery, were included. 0.2% etomidate was administerd at 150 ml/h until the patients lost consciousness. The patient recovered spontaneously until they regained consciousness, as determined by a verbal response. The BIS was determined and arterial blood samples were collected. The plasma concentrations were measured with high performance liquid chromatograhy (HPLC). NONMEM was used for population pharmacokinetic and sigmoid Emax model for pharmacodynamic analysis. RESULTS: The induction dose for the loss of eyelid reflexes was 0.38 mg/kg. The induction time from drug infusion to the loss of eyelash reflexes was approximately 3.5 minutes. This study took approximately 8.5 minutes from the start of drug infusion to the recovery of consciousness. The pharmacokinetic parameters were t(1/2alpha) = 1.1 min, t(1/2beta) = 1.9 min, t(1/2gamma) = 106.5 min, k(21) = 0.36 L/min, k(31) = 0.009 L/min, V(1) = 6.43 L, V(area) = 426 L, C(l) = 2.77 L/min. The pharmacodynamics were keo = 0.40 L/min, CE(50) = 1.0 microgram/mL, E(0) = 94, E(max) = 94 and gamma = 1.2. The performance error for the etomidate concentration was 0.14+/-0.99 (typical prediction) and -0.03+/-0.40 (individual prediction) and -0.09+/-1.00 and -0.001+/-0.13 for the BIS score. CONCLUSIONS: When compared with other previously published data, our pharmacokinetic parameters demonstrated a shorter half lives, a larger volume of distribution, and an increased clearance with significant interindividual differences. The pharmacodynamics showed a large interindividual variability. The reason for discrepancy might be the relatively short sampling time. However, further study will be warranted to improve the model performance in the future.

Nonlinear Mixed Effect Modeling of Population Pharmacokinetics and Pharmacodynamics of Etomidate / 대한마취과학회지

BACKGROUND: Etomidate is used as a fast-acting hypnotic with few cardiovascular effects to induce anesthesia in patients with a poor cardiovascular reserve. The bispectral index (BIS) has been suggested to be a measure of the depth of anesthesia and correlates well with the level of consciousness. This study examined the population pharmacokinetics and pharmacodynamics of etomidate using nonlinear mixed effect (NONMEM) modeling and sigmoid Emax modeling. METHODS: Eighteen middle aged adults, with ASA physical status I or II, who were scheduled for elective surgery, were included. 0.2% etomidate was administerd at 150 ml/h until the patients lost consciousness. The patient recovered spontaneously until they regained consciousness, as determined by a verbal response. The BIS was determined and arterial blood samples were collected. The plasma concentrations were measured with high performance liquid chromatograhy (HPLC). NONMEM was used for population pharmacokinetic and sigmoid Emax model for pharmacodynamic analysis. RESULTS: The induction dose for the loss of eyelid reflexes was 0.38 mg/kg. The induction time from drug infusion to the loss of eyelash reflexes was approximately 3.5 minutes. This study took approximately 8.5 minutes from the start of drug infusion to the recovery of consciousness. The pharmacokinetic parameters were t(1/2alpha) = 1.1 min, t(1/2beta) = 1.9 min, t(1/2gamma) = 106.5 min, k(21) = 0.36 L/min, k(31) = 0.009 L/min, V(1) = 6.43 L, V(area) = 426 L, C(l) = 2.77 L/min. The pharmacodynamics were keo = 0.40 L/min, CE(50) = 1.0 microgram/mL, E(0) = 94, E(max) = 94 and gamma = 1.2. The performance error for the etomidate concentration was 0.14+/-0.99 (typical prediction) and -0.03+/-0.40 (individual prediction) and -0.09+/-1.00 and -0.001+/-0.13 for the BIS score. CONCLUSIONS: When compared with other previously published data, our pharmacokinetic parameters demonstrated a shorter half lives, a larger volume of distribution, and an increased clearance with significant interindividual differences. The pharmacodynamics showed a large interindividual variability. The reason for discrepancy might be the relatively short sampling time. However, further study will be warranted to improve the model performance in the future.

Enhanced Clearance of Propofol in Patients with Major Burns / 대한마취과학회지

BACKGROUND: Major burns can alter the pharmacokinetics of the commonly used drugs during the perioperative period. This study was carried out to define the pharmacokinetics of propofol in the burned patients during the subacute hyperdynamic phase of the injury. METHODS: Twenty adults, aged 43.7+/-2.3 years, with total body surface area burn of 44.0+/-22.2%, were examined at 14.1+/-2 days after the injury (mean+/-SD). Age and sex gender matched unburned patients were used as controls. Propofol 2 mg/kg was given intravenously over 10 seconds as a single bolus in both groups. Blood samples (n = 20) were collectedat predetermined intervals. A noncompartmental approach was used for the pharmacokinetic analyses of the propofol concentrations, which were determined by HPLC. The cardiac index was measured by esophageal echocardiography. RESULTS: The burns patients had a significantly higher cardiac index (CI). The clearance (Cl) and total volume of distribution (Vd) of propofol were higher in the burns patients, compared with the controls, yielding a smaller area under the curve. The total half-life (t1/2) was similar in both groups. CONCLUSIONS: There is a large increase in Vd and Cl in the burns patients compared to with the controls. The increased Cl in the burns patients is most likely to be related to the increased CI. Therefore, the initial bolus dose and maintenance infusion may have to be increased in the burns patients, provided the pharmacodynamic sensitivity is unaltered.

Enhanced Clearance of Propofol in Patients with Major Burns / 대한마취과학회지

BACKGROUND: Major burns can alter the pharmacokinetics of the commonly used drugs during the perioperative period. This study was carried out to define the pharmacokinetics of propofol in the burned patients during the subacute hyperdynamic phase of the injury. METHODS: Twenty adults, aged 43.7+/-2.3 years, with total body surface area burn of 44.0+/-22.2%, were examined at 14.1+/-2 days after the injury (mean+/-SD). Age and sex gender matched unburned patients were used as controls. Propofol 2 mg/kg was given intravenously over 10 seconds as a single bolus in both groups. Blood samples (n = 20) were collectedat predetermined intervals. A noncompartmental approach was used for the pharmacokinetic analyses of the propofol concentrations, which were determined by HPLC. The cardiac index was measured by esophageal echocardiography. RESULTS: The burns patients had a significantly higher cardiac index (CI). The clearance (Cl) and total volume of distribution (Vd) of propofol were higher in the burns patients, compared with the controls, yielding a smaller area under the curve. The total half-life (t1/2) was similar in both groups. CONCLUSIONS: There is a large increase in Vd and Cl in the burns patients compared to with the controls. The increased Cl in the burns patients is most likely to be related to the increased CI. Therefore, the initial bolus dose and maintenance infusion may have to be increased in the burns patients, provided the pharmacodynamic sensitivity is unaltered.

Anesthetic Management in a Patient with Latex Anaphylaxis after Tourniquet Release: A case report / 대한마취과학회지

Latex is the second most common cause of anaphylaxis during anesthesia. The increasing number of reports of latex-induced anaphylaxis are a major concern for anesthesiologists. We encountered a 56-year-old male patient who developed severe anaphylactic shock whilst under anesthesia when the tourniquet was deflated during elbow arthrolysis. A subsequent allergy workup revealed an IgE mediated hypersensitivity to latex. This case highlights the need for anesthesiologists to be able to diagnose the signs and symptoms of allergic reactions in patients under anesthesia.

Anesthetic Management of a Patient with Brugada Syndrome: A case report / 대한마취과학회지

Brugada syndrome is characterized by a distinctive electrocardiographic pattern (right bundle branch block and a ST segment elevation in the right precordial leads), but without structural heart disease. It is a rare genetic disorder, with an autosomal dominant inheritance pattern. Many factors during general anesthesia (medication, bradycardia, temperature changes) can precipitate malignant dysrhythmia in this patient, so careful choice of anesthetics is required. We experienced the anesthetic management of a 50-year-old male patient with Brugada syndrome, who underwent an emergency operation, under general anesthesia for acute appendicitis. Surgery was performed uneventfully, and the patient was discharged without complication.

Anesthetic Management of a Patient with Brugada Syndrome: A case report / 대한마취과학회지

Brugada syndrome is characterized by a distinctive electrocardiographic pattern (right bundle branch block and a ST segment elevation in the right precordial leads), but without structural heart disease. It is a rare genetic disorder, with an autosomal dominant inheritance pattern. Many factors during general anesthesia (medication, bradycardia, temperature changes) can precipitate malignant dysrhythmia in this patient, so careful choice of anesthetics is required. We experienced the anesthetic management of a 50-year-old male patient with Brugada syndrome, who underwent an emergency operation, under general anesthesia for acute appendicitis. Surgery was performed uneventfully, and the patient was discharged without complication.

Effects of Endotracheal Intubation on the Temporomandibular Joint / 대한마취과학회지

Tracheal intubation for general anesthesia is usually performed using a rigid laryngoscope and reguires the mandible to be opened with forward and upward traction of the patient's jaw which may at times result in the inadvertant injury to temporomandibular joint(TMJ). The injury may include internal derangement, dislocation and hematoma of TMJ; subsequent intraarticular adhesion formation ; dislocation of the meniscus, and rarely auriculotemporal nerve damage from traumatic TMJ dislocation. We studied in 200 patients the size of mouth opening during intubation, the change of mouth opening by tracheal intubation evaluated after operation, and any TMJ disorder arising after tracheal intubation. The results were as follows; 1) The mean size of mouth opening before operation was 42.7+/-7.0 and 40.6+/-6.2mm in male and female patients, respectively. 2) The mean size of mouth opening during intubation was 24.7+/-2.6 and 23.4+/-2.7mm in male and female patients, respectively. When vecuronium was used to prevent fasciculation, the mean was 24.3+/-3.1 and 25.2+/-2.0mm in male and female patients, respectively. 3) One week following operation The mean size of mouth opening one week postoperation was 48.3+/-8.9 and 42.2+/-6.3mm in male and female patients, respectively. When vecuronium was used to prevent fasciculation, the mean size of mouth opening was 55.5+/-5.3 and 43.2+/-6.2mm in male and female patients, respectively. 4) Five patients complained of discomfort around TMJ after tracheal intubation. It seems that upward 45 mandibule lifting by laryngoscope caused trauma to TMJs.

Anesthetic Management of A Neonate with Congenital Cystic Adenomatoid Malformation(C.C.A.M) / 대한마취과학회지

Congenital cystic adenomatoid malformation (CCAM) of the lung is a rare pulmonary malformation, associated with local aberrations of parenchymal tissue development, which have been classified lung bud anomalies. Lung bud anomalies include infantile lobar emphysema, congenital cyst of the lung, congenital cystic adenomatoid malformation, pulmonary sequestration and bronchogenic cyst. CCAM can enlarge rapidly by ball-valve air entrapment by cysts, lead to mediastinal shift and compression of the heart. compression of opposite lung may result in pulmonary hypoplasia and CCAM causes acute respiratory distress in newborn. We report a neonate with CCAM who were successfuly managed during perioperative period.

A Case Report of Neuroleptanesthesia in a Parturient with Sick Sinus Syndrome / 대한마취과학회지

Inappropriate sinus bradycardia associated with degenerative changes in the sinoatrial node has been designated as the sick sinus syndrome. Patients can be asymptomatic but often complain of palpitations and syncopal episodes. A 30 year old parturient, whose pulse rate was about 45-55 beats/min, underwent cesarean section under neuroleptanesthesia. Authors report this case with the review of the relevant literatures.