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The Respiratory and Hemodynamic Effects of Prone Position According to the Level of PEEP in a Dog Acute Lung Injury Model (잡종견 급성폐손상 모델에서 Prone position 시행시 PEEP 수준에 따른 호흡 및 혈류역학적 효과)

  • Lim, Chae-Man;Chin, Jae-Yong;Koh, Youn-Suck;Shim, Tae-Sun;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.1
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    • pp.140-152
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    • 1998
  • Background: Prone position improves oxygenation in patients with ARDS probably by reducing shunt Reduction of shunt in prone position is thought to be effected by lowering of the critical opening pressure (COP) of the dorsal lung because the pleural pressure becomes less positive in prone position compared to supine position. It can then be assumed that prone position would bring about greater improvement in oxygenation when PEEP applied in supine position is just beneath COP than when PEEP is above COP. Hemodynamically, prone position is expected to attenuate the lifting of cardiac fossa induced by PEEP. Based on these backgrounds, we investigated whether the effect of prone position on oxygenation differs in magnitude according to the level of PEEP applied in supine position, and whether impaired cardiac output in supine position by PEEP can be restored in prone position. Methods: In seven mongrel dogs, $PaO_2/F_1O_2$(P/F) was measured in supine position and at prone position 30 min. Cardiac output (CO), stroke volume (SV), pulse rate (PR), and pulmonary artery occlusion pressure (PAOP) were measured in supine position, at prone position 5 min, and at prone position 30 min. After ARDS was established with warmed saline lavage(P/F ratio $134{\pm}72$ mm Hg), inflection point was measured by constant flow method($6.6{\pm}1.4cm$ $H_2O$), and the above variables were measured in supine and prone positions under the application of Low PEEP($5.0{\pm}1.2cm$ $H_2O$), and Optimal PEEP($9.0{\pm}1.2cm$ $H_2O$)(2 cm $H_2O$ below and above the inflection point, respectively) consecutively. Results : P/F ratio in supine position was $195{\pm}112$ mm Hg at Low PEEP and $466{\pm}63$ mm Hg at Optimal PEEP(p=0.003). Net increase of P/F ratio at prone position 30 min, however, was far greater at Low PEEP($205{\pm}90$ mm Hg) than at Optimal PEEP($33{\pm}33$ mm Hg)(p=0.009). Compared to CO in supine position at Optimal PEEP($2.4{\pm}0.5$ L/min), CO in prone improved to $3.4{\pm}0.6$ L/min at prone position 5 min (p=0.0180) and $3.6{\pm}0.7$ L/min at prone position 30 min (p=0.0180). Improvement in CO was attributable to the increase in SV: $14{\pm}2$ ml in supine position, $20{\pm}2$ ml at prone position 5 min (p=0.0180), and $21{\pm}2$ ml at prone position 30 min (p=0.0180), but not to change in PR or PAOP. When the dogs were turned to supine position again, MAP ($92{\pm}23$ mm Hg, p=0.009), CO ($2.4{\pm}0.5$ L/min, p=0.0277) and SV ($14{\pm}1$ ml, p=0.0277) were all decreased compared to prone position 30 min. Conclusion: Prone position in a dog with saline-lavaged acute lung injury appeared to augment the effect of relatively low PEEP on oxygenation, and also attenuate the adverse hemodynamic effect of relatively high PEEP. These findings suggest that a PEEP lower than Optimal PEEP can be adopted in prone position to achieve the goal of alveolar recruitment in ARDS avoiding the hemodynamic complications of a higher PEEP at the same time.

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Experimental Studies on the Antitumor Effects of Jinryungtang Gagambang Extract (진령탕가감방의 항종양효과(抗腫瘍效果)에 관(關)한 실험적(實驗的) 연구(硏究))

  • Jeong, Jun-Tak;Moon, Goo;Moon, Suk-Jae
    • THE JOURNAL OF KOREAN ORIENTAL ONCOLOGY
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    • v.4 no.1
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    • pp.37-53
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    • 1998
  • The sprig of Jinryungtang Gagambang has been used for curing as a traditional medicine without any experimental evidence to support the rational basis for their clinical use. This experiment was carried out to evaluate the possible therapeutic or antitumoral effects of Jinryungtang Gagambang extract against cancer, and to study some mechanisms responsible for its effect. The cytotoxic and antitumor effects were evaluated on human cell liens (A549, hep3B, Caki-1, Sarcoma 180) after exposure to Jinryungtang Gagambang extract using in ILS, colony forming efficency and SRB assay which were regarded as a valuable method for cytotoxic and antitumor effects of unknown compound on tumor cell lines. The results obtained in this studies were as follows. 1. As a result of exposure to Jinryungtang Gagambang extract, the proliferation of A549, hep3B, Caki-1, good correlations were shown from the results of SRB assay and those of clogenetic assay. 2. The oral administration of Jinryungtang Gagambang extract showed significant effects of increase of MST(mean survival time) and ILS(increased life span) depending on the increasing concentration. 3. Against squamous cell carcinoma induced by MCA, Jinryungtang Gagambang decreased not only the frequency of tumor production but also the number and weight of tumors per tumor bearing mice(TBM). Jinryungtang Gagambang also significantly suppressed the development of 3LL cell-implanted tumors by frequency and their size, and some developed tumors were regressed by the continuous treatment of Jinryungtang Gagambang extract into TBM. 4. Jinryungtang Gagambang extract also increased NK cell activities. According to the above results, it could be suggested that Jinryungtang Gagambang extract has prominent antiutmor effect.

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A Study on the Forest Yield Regulation by Systems Analysis (시스템분석(分析)에 의(依)한 삼림수확조절(森林收穫調節)에 관(關)한 연구(硏究))

  • Cho, Eung-hyouk
    • Korean Journal of Agricultural Science
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    • v.4 no.2
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    • pp.344-390
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    • 1977
  • The purpose of this paper was to schedule optimum cutting strategy which could maximize the total yield under certain restrictions on periodic timber removals and harvest areas from an industrial forest, based on a linear programming technique. Sensitivity of the regulation model to variations in restrictions has also been analyzed to get information on the changes of total yield in the planning period. The regulation procedure has been made on the experimental forest of the Agricultural College of Seoul National University. The forest is composed of 219 cutting units, and characterized by younger age group which is very common in Korea. The planning period is devided into 10 cutting periods of five years each, and cutting is permissible only on the stands of age groups 5-9. It is also assumed in the study that the subsequent forests are established immediately after cutting existing forests, non-stocked forest lands are planted in first cutting period, and established forests are fully stocked until next harvest. All feasible cutting regimes have been defined to each unit depending on their age groups. Total yield (Vi, k) of each regime expected in the planning period has been projected using stand yield tables and forest inventory data, and the regime which gives highest Vi, k has been selected as a optimum cutting regime. After calculating periodic yields and cutting areas, and total yield from the optimum regimes selected without any restrictions, the upper and lower limits of periodic yields(Vj-max, Vj-min) and those of periodic cutting areas (Aj-max, Aj-min) have been decided. The optimum regimes under such restrictions have been selected by linear programming. The results of the study may be summarized as follows:- 1. The fluctuations of periodic harvest yields and areas under cutting regimes selected without restrictions were very great, because of irregular composition of age classes and growing stocks of existing stands. About 68.8 percent of total yield is expected in period 10, while none of yield in periods 6 and 7. 2. After inspection of the above solution, restricted optimum cutting regimes were obtained under the restrictions of Amin=150 ha, Amax=400ha, $Vmin=5,000m^3$ and $Vmax=50,000m^3$, using LP regulation model. As a result, about $50,000m^3$ of stable harvest yield per period and a relatively balanced age group distribution is expected from period 5. In this case, the loss in total yield was about 29 percent of that of unrestricted regimes. 3. Thinning schedule could be easily treated by the model presented in the study, and the thinnings made it possible to select optimum regimes which might be effective for smoothing the wood flows, not to speak of increasing total yield in the planning period. 4. It was known that the stronger the restrictions becomes in the optimum solution the earlier the period comes in which balanced harvest yields and age group distribution can be formed. There was also a tendency in this particular case that the periodic yields were strongly affected by constraints, and the fluctuations of harvest areas depended upon the amount of periodic yields. 5. Because the total yield was decreased at the increasing rate with imposing stronger restrictions, the Joss would be very great where strict sustained yield and normal age group distribution are required in the earlier periods. 6. Total yield under the same restrictions in a period was increased by lowering the felling age and extending the range of cutting age groups. Therefore, it seemed to be advantageous for producing maximum timber yield to adopt wider range of cutting age groups with the lower limit at which the smallest utilization size of timber could be produced. 7. The LP regulation model presented in the study seemed to be useful in the Korean situation from the following point of view: (1) The model can provide forest managers with the solution of where, when, and how much to cut in order to best fulfill the owners objective. (2) Planning is visualized as a continuous process where new strateges are automatically evolved as changes in the forest environment are recognized. (3) The cost (measured as decrease in total yield) of imposing restrictions can be easily evaluated. (4) Thinning schedule can be treated without difficulty. (5) The model can be applied to irregular forests. (6) Traditional regulation methods can be rainforced by the model.

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