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A Study on Antiulcer Effects of Opuntia dillenii Haw. on Stomach Ulcer Induced by Water-immersion Stress in Rats (랫드의 스트레스성 위궤양에 대한 Opuntia dillenii Haw.(선인장)의 항궤양작용에 관한 연구)

  • 이후장;이용욱;김정현
    • Journal of Food Hygiene and Safety
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    • v.13 no.1
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    • pp.53-61
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    • 1998
  • This study was performed to investigate the antiulcer effects of Opuntia dillenii Haw. on the stomach ulcer induced by restraint and water-immersion stress in rats. For this experiment, 48 male Sprague-Dawley strain were used. The experimental groups were divided into four: a control (C) and 3 Opuntia dillenii Haw. treatment groups (E-1, E-2, E-3). Each dose of Opuntia dillenii Haw. was 30 mg/kg bw (E-1), 60 mgfKg bw (E-2) and 120 mg/kg bw (E-3). The rats were allocated to each group by 12 and observed for 4 weeks. The results were as following: 1. The stomach surface pH in each group showed no significant difference, but the values of Opuntia dillenii Haw. treatment groups were higher than the value of the control group. 2. The gastric wall mucus was increased in all Opuntia dillenii Haw. treatment groups compared with the control group. Especially in E-1 difference was higher (p<0.05) and in E-2 difference was significantly higher (p<0.01). 3. At shear rate 11.25, 45.0, 90.0, $225\;sec^{-1}$, whole blood viscosity and plasma viscosity were measured. Most of the values of Opuntia dillenii Haw. treatment groups were low compared with that of the control group. At shear rate 90.0, $225\;sec^{-1}$ the values of whole blood viscosity in E-1 were significantly low (p<0.05) and at shear rate 11.25, $45.0\;sec^{-1}$, more significant (p<0.01). At shear rate 11.25, 45.0, 90.0, $225\;sec^{-1}$ the values of whole blood viscosity in E-2 were significantly low (p<0.01). At shear rate $90.0\;sec^{-1}$ the value of plasma viscosity in E-1 was significantly low (p<0.05) and at shear rate 90.0, $225\;sec^{-1}$ the values of plasma viscosity in E-2 we resignificantly low (p<0.01). 4. Less severe ulcers were obsered in Opuntia dillenii Haw. treatment groups than in the control group. Especially E-1 groups tissues had only slight ulcers and necrosis of tissue was not observed in this group. From the results of this study, it can be concluded that the oral administratio-n of Opuntia dillenii Haw. results in protection of stomach ulcer by stimulating the secretion of gastric mucus and improving the gastric mucosal microcirculation.

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The Effects of Cattle Slurry Application and Mixed Sowing with legumes on Productivity and Feed Values of Barley and Rye (액상우분뇨와 콩과식물 혼파재배가 보리, 호밀의 생산성과 사료가치에 미치는 영향)

  • Jo, IK-Hwan
    • Korean Journal of Organic Agriculture
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    • v.17 no.3
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    • pp.371-380
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    • 2009
  • This study was conducted to assess effects of supplying different types of nitrogen sources as fertilizers on productivity and feed values of barley and rye as winter forage crops, and ultimately done to get good quality of organic forages with higher fertilization of soil. For barley, N+P+K plots were significantly (P<0.05) higher in annual dry matter (DM) and total digestible nutrients (TDN) yields than other plots. However, cattle manure plots had significantly (P<0.05) higher annual DM and TDN than P+K and non-fertilizer plots. Plots of 50%-cattle manure and mixed sowing with hairy vetch or forage pea were higher than only 50%-cattle manure plot, particularly, these were significantly higher than non-fertilizer, and their crude protein (CP) yields were much higher than other plots. Crude protein contents were significantly higher in N+P+K and 50%-cattle manure slurry plots than non-fertilizer and P+K plots, and plots of mixed sowing with hairy vetch or forage pea in application of 50%-cattle manure had higher CP content than other plots. ADF content was lowest in 50%-cattle manure+forage pea plots, but highest in 100%-cattle manure plots. NDF content was lowest in legumes-mixed sowing, but highest in 100%-cattle manure plots. TDN content was the highest in forage pea plots, and plots of 50%-cattle manure and legumes-mixed sowing had high RFV, but cattle manure plots rich in ADF and NDF content had the lowest TDN and RFV. For rye, plots of 50%-cattle manure+hairy vetch mixed sowing, and N+P+K application had significantly higher annual DM, CP and TDN than other plots except for cattle manure. DM productive efficiency to nitrogen fertilization was markedly higher for cattle manure plots than for chemical fertilizer. This tendency was more conspicuous in plots of 50% cattle manure+legumes-mixed sowing. CP content was higher for N+P+K plot than for all plots, and plots of 50%-cattle manure + legumes-mixed sowing were significantly higher than other plots. On the contrary, forage pea-mixed sowing plot had the lowest ADF and NDF, but TDN and RFV were significantly (P<0.05) higher than other plots. Grass crop cultivation together with legumes by applying livestock manure to soil may lead to higher palatability of livestock, and better quality of forage. Furthermore, cattle manure application increased production yield per ha and CP contents. Thus, when applying forage crops produced by cattle manure application and mixed sowing to organic livestock production, it was conceived that forages produced might become a substitute for foreign organic grain as protein sources.

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Analysis and Improvement Strategies for Korea's Cyber Security Systems Regulations and Policies

  • Park, Dong-Kyun;Cho, Sung-Je;Soung, Jea-Hyen
    • Korean Security Journal
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    • no.18
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    • pp.169-190
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    • 2009
  • Today, the rapid advance of scientific technologies has brought about fundamental changes to the types and levels of terrorism while the war against the world more than one thousand small and big terrorists and crime organizations has already begun. A method highly likely to be employed by terrorist groups that are using 21st Century state of the art technology is cyber terrorism. In many instances, things that you could only imagine in reality could be made possible in the cyber space. An easy example would be to randomly alter a letter in the blood type of a terrorism subject in the health care data system, which could inflict harm to subjects and impact the overturning of the opponent's system or regime. The CIH Virus Crisis which occurred on April 26, 1999 had significant implications in various aspects. A virus program made of just a few lines by Taiwanese college students without any specific objective ended up spreading widely throughout the Internet, causing damage to 30,000 PCs in Korea and over 2 billion won in monetary damages in repairs and data recovery. Despite of such risks of cyber terrorism, a great number of Korean sites are employing loose security measures. In fact, there are many cases where a company with millions of subscribers has very slackened security systems. A nationwide preparation for cyber terrorism is called for. In this context, this research will analyze the current status of Korea's cyber security systems and its laws from a policy perspective, and move on to propose improvement strategies. This research suggests the following solutions. First, the National Cyber Security Management Act should be passed to have its effectiveness as the national cyber security management regulation. With the Act's establishment, a more efficient and proactive response to cyber security management will be made possible within a nationwide cyber security framework, and define its relationship with other related laws. The newly passed National Cyber Security Management Act will eliminate inefficiencies that are caused by functional redundancies dispersed across individual sectors in current legislation. Second, to ensure efficient nationwide cyber security management, national cyber security standards and models should be proposed; while at the same time a national cyber security management organizational structure should be established to implement national cyber security policies at each government-agencies and social-components. The National Cyber Security Center must serve as the comprehensive collection, analysis and processing point for national cyber crisis related information, oversee each government agency, and build collaborative relations with the private sector. Also, national and comprehensive response system in which both the private and public sectors participate should be set up, for advance detection and prevention of cyber crisis risks and for a consolidated and timely response using national resources in times of crisis.

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Clinical Study of Pulmonary Tuberculosis for Admitted Patients at National Masan Tuberculosis Hospital (국립마산결핵병원에 입원한 환자에 대한 폐결핵의 임상적 동태에 관한 연구)

  • Park, Seung-Kyu;Choi, In-Hwan;Kim, Chul-Min;Kim, Cheon-Tae;Song, Sun-Dae
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.2
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    • pp.241-250
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    • 1997
  • Objective : Although the prevalence of pulmonary tuberculosis has decreased progressively after the national control program for tuberculosis began, nowadays the number of MDRTB is increasing seriously. MDRTB tends to be poor responsive to current antituberculosis regimens. It is mainly due to poor compliance, high rate of side reaction of secondary drugs, and limitation in number of available drugs. The purpose of present study is to evaluate the clinical features of pulmonary tuberculosis patients admitted in one national tuberculosis hospital and to expose the problems pertaining to current remedies, to increase the treatment efficacy for pulmonary tuberculosis including MDRTB in the end. Method : Retrospective analysis of 336 pulmonary tuberculosis patients admitted in National Masan Tuberculosis Hospital was done. Contents of analysis were patients profile, the first diagnosed time and medical institutes, family history, residence, previous treatment history, chief complaints at the time of admission, lesion site on chest X -ray film, combined deseases, side reaction to antibuberculosis drugs, used drugs before admission and the results of drug sensitivity test. Results : The ratio between male and female was 4 : 1. Age showed relatively even distribution from 3rd to 6 th decades. 64.6% of the patients was diagnosed at public health center. Weight loss was the most common complaint at admission. Bilateral lesions on chest X-ray films were 59.8%. 130patients had combined desease, of which DM was the most common(37.7%). 95patients had family history, of which parents were the most common(41.7%). According to the time of first diagnosis, 31 patients were diagnosed before 1980, and after then the number of patients was increased by degrees. Residence overwhelmed in pusan and gyung-nam province. 258 patients got previous treatment history, of which 112 patients(43.4%) had more than 3 times and only 133 patients(51.6%)got regular medication. 97 patients used more than other 3 drugs in addition to INH, EMB, RFP and PZA before admission. 154 patients were informed with the results of drug sensitivity test. of which 77 patients had resistance to more than 5 drugs. Gastrointestinal problem was the most common in side reaction to drugs. Conclusion : In the case of weight loss of unknown cause, tuberculosis should be suspected. In first treatment, sufficient and satisfactory explanation for tuberculosis is necessary and treatment period should not be stict to 6 month-short term therapy. In retreatment, new drugs should not be added to used drugs even though drug sensitivity results show sensitivity to some of them. Proper time for surgical intervention should not be delayed.

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A Study on Legal and Institutional Improvement Measures for the Effective Implementation of SMS -Focusing on Aircraft Accident Investigation-

  • Yoo, Kyung-In
    • The Korean Journal of Air & Space Law and Policy
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    • v.32 no.2
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    • pp.101-127
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    • 2017
  • Even with the most advanced aviation technology benefits, aircraft accidents are constantly occurring while air passenger transportation volume is expected to double in the next 15 years. Since it is not possible to secure aviation safety only by the post aircraft accident safety action of accident investigations, it has been recognized and consensus has been formed that proactive and predictive prevention measures are necessary. In this sense, the aviation safety management system (SMS) was introduced in 2008 and has been carried out in earnest since 2011. SMS is a proactive and predictive aircraft accident preventive measure, which is a mechanism to eliminate the fundamental risk factors by approaching organizational factors beyond technological factors and human factors related to aviation safety. The methodology is to collect hazards in all the sites required for aircraft operations, to build a database, to analyze the risks, and through managing risks, to keep the risks acceptable or below. Therefore, the improper implementation of SMS indicates that the aircraft accident prevention is insufficient and it is to be directly connected with the aircraft accident. Reports of duty performance related hazards including their own errors are essential and most important in SMS. Under the policy of just culture for voluntary reporting, the guarantee of information providers' anonymity, non-punishment and non-blame should be basically secured, but to this end, under-reporting is stagnant due to lack of trust in their own organizations. It is necessary for the accountable executive(CEO) and senior management to take a leading role to foster the safety culture initiating from just culture with the safety consciousness, balancing between safety and profit for the organization. Though a Ministry of Land, Infrastructure and Transport's order, "Guidance on SMS Implementation" states the training required for the accountable executive(CEO) and senior management, it is not legally binding. Thus it is suggested that the SMS training completion certificates of accountable executive(CEO) and senior management be included in SMS approval application form that is legally required by "Korea Aviation Safety Program" in addition to other required documents such as a copy of SMS manual. Also, SMS related items are missing in the aircraft accident investigation, so that organizational factors in association with safety culture and risk management are not being investigated. This hinders from preventing future accidents, as the root cause cannot be identified. The Aircraft Accident Investigation Manuals issued by ICAO contain the SMS investigation wheres it is not included in the final report form of Annex 13 to the Convention on International Civil Aviation. In addition, the US National Transportation Safety Board(NTSB) that has been a substantial example of the aircraft accident investigation for the other accident investigation agencies worldwide does not appear to expand the scope of investigation activities further to SMS. For these reasons, it is believed that investigation agencies conducting their investigations under Annex 13 do not include SMS in the investigation items, and the aircraft accident investigators are hardly exposed to SMS investigation methods or techniques. In this respect, it is necessary to include the SMS investigation in the organization and management information of the final report format of Annex 13. In Korea as well, in the same manner, SMS item should be added to the final report format of the Operating Regulation of the Aircraft and Railway Accident Investigation Board. If such legal and institutional improvement methods are complemented, SMS will serve the purpose of aircraft accident prevention effectively and contribute to the improvement of aviation safety in the future.

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Chinese Communist Party's Management of Records & Archives during the Chinese Revolution Period (혁명시기 중국공산당의 문서당안관리)

  • Lee, Won-Kyu
    • The Korean Journal of Archival Studies
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    • no.22
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    • pp.157-199
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    • 2009
  • The organization for managing records and archives did not emerge together with the founding of the Chinese Communist Party. Such management became active with the establishment of the Department of Documents (文書科) and its affiliated offices overseeing reading and safekeeping of official papers, after the formation of the Central Secretariat(中央秘書處) in 1926. Improving the work of the Secretariat's organization became the focus of critical discussions in the early 1930s. The main criticism was that the Secretariat had failed to be cognizant of its political role and degenerated into a mere "functional organization." The solution to this was the "politicization of the Secretariat's work." Moreover, influenced by the "Rectification Movement" in the 1940s, the party emphasized the responsibility of the Resources Department (材料科) that extended beyond managing documents to collecting, organizing and providing various kinds of important information data. In the mean time, maintaining security with regard to composing documents continued to be emphasized through such methods as using different names for figures and organizations or employing special inks for document production. In addition, communications between the central political organs and regional offices were emphasized through regular reports on work activities and situations of the local areas. The General Secretary not only composed the drafts of the major official documents but also handled the reading and examination of all documents, and thus played a central role in record processing. The records, called archives after undergoing document processing, were placed in safekeeping. This function was handled by the "Document Safekeeping Office(文件保管處)" of the Central Secretariat's Department of Documents. Although the Document Safekeeping Office, also called the "Central Repository(中央文庫)", could no longer accept, beginning in the early 1930s, additional archive transfers, the Resources Department continued to strengthen throughout the 1940s its role of safekeeping and providing documents and publication materials. In particular, collections of materials for research and study were carried out, and with the recovery of regions which had been under the Japanese rule, massive amounts of archive and document materials were collected. After being stipulated by rules in 1931, the archive classification and cataloguing methods became actively systematized, especially in the 1940s. Basically, "subject" classification methods and fundamental cataloguing techniques were adopted. The principle of assuming "importance" and "confidentiality" as the criteria of management emerged from a relatively early period, but the concept or process of evaluation that differentiated preservation and discarding of documents was not clear. While implementing a system of secure management and restricted access for confidential information, the critical view on providing use of archive materials was very strong, as can be seen in the slogan, "the unification of preservation and use." Even during the revolutionary movement and wars, the Chinese Communist Party continued their efforts to strengthen management and preservation of records & archives. The results were not always desirable nor were there any reasons for such experiences to lead to stable development. The historical conditions in which the Chinese Communist Party found itself probably made it inevitable. The most pronounced characteristics of this process can be found in the fact that they not only pursued efficiency of records & archives management at the functional level but, while strengthening their self-awareness of the political significance impacting the Chinese Communist Party's revolution movement, they also paid attention to the value possessed by archive materials as actual evidence for revolutionary policy research and as historical evidence of the Chinese Communist Party.

An Empirical Study on Statistical Optimization Model for the Portfolio Construction of Sponsored Search Advertising(SSA) (키워드검색광고 포트폴리오 구성을 위한 통계적 최적화 모델에 대한 실증분석)

  • Yang, Hognkyu;Hong, Juneseok;Kim, Wooju
    • Journal of Intelligence and Information Systems
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    • v.25 no.2
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    • pp.167-194
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    • 2019
  • This research starts from the four basic concepts of incentive incompatibility, limited information, myopia and decision variable which are confronted when making decisions in keyword bidding. In order to make these concept concrete, four framework approaches are designed as follows; Strategic approach for the incentive incompatibility, Statistical approach for the limited information, Alternative optimization for myopia, and New model approach for decision variable. The purpose of this research is to propose the statistical optimization model in constructing the portfolio of Sponsored Search Advertising (SSA) in the Sponsor's perspective through empirical tests which can be used in portfolio decision making. Previous research up to date formulates the CTR estimation model using CPC, Rank, Impression, CVR, etc., individually or collectively as the independent variables. However, many of the variables are not controllable in keyword bidding. Only CPC and Rank can be used as decision variables in the bidding system. Classical SSA model is designed on the basic assumption that the CPC is the decision variable and CTR is the response variable. However, this classical model has so many huddles in the estimation of CTR. The main problem is the uncertainty between CPC and Rank. In keyword bid, CPC is continuously fluctuating even at the same Rank. This uncertainty usually raises questions about the credibility of CTR, along with the practical management problems. Sponsors make decisions in keyword bids under the limited information, and the strategic portfolio approach based on statistical models is necessary. In order to solve the problem in Classical SSA model, the New SSA model frame is designed on the basic assumption that Rank is the decision variable. Rank is proposed as the best decision variable in predicting the CTR in many papers. Further, most of the search engine platforms provide the options and algorithms to make it possible to bid with Rank. Sponsors can participate in the keyword bidding with Rank. Therefore, this paper tries to test the validity of this new SSA model and the applicability to construct the optimal portfolio in keyword bidding. Research process is as follows; In order to perform the optimization analysis in constructing the keyword portfolio under the New SSA model, this study proposes the criteria for categorizing the keywords, selects the representing keywords for each category, shows the non-linearity relationship, screens the scenarios for CTR and CPC estimation, selects the best fit model through Goodness-of-Fit (GOF) test, formulates the optimization models, confirms the Spillover effects, and suggests the modified optimization model reflecting Spillover and some strategic recommendations. Tests of Optimization models using these CTR/CPC estimation models are empirically performed with the objective functions of (1) maximizing CTR (CTR optimization model) and of (2) maximizing expected profit reflecting CVR (namely, CVR optimization model). Both of the CTR and CVR optimization test result show that the suggested SSA model confirms the significant improvements and this model is valid in constructing the keyword portfolio using the CTR/CPC estimation models suggested in this study. However, one critical problem is found in the CVR optimization model. Important keywords are excluded from the keyword portfolio due to the myopia of the immediate low profit at present. In order to solve this problem, Markov Chain analysis is carried out and the concept of Core Transit Keyword (CTK) and Expected Opportunity Profit (EOP) are introduced. The Revised CVR Optimization model is proposed and is tested and shows validity in constructing the portfolio. Strategic guidelines and insights are as follows; Brand keywords are usually dominant in almost every aspects of CTR, CVR, the expected profit, etc. Now, it is found that the Generic keywords are the CTK and have the spillover potentials which might increase consumers awareness and lead them to Brand keyword. That's why the Generic keyword should be focused in the keyword bidding. The contribution of the thesis is to propose the novel SSA model based on Rank as decision variable, to propose to manage the keyword portfolio by categories according to the characteristics of keywords, to propose the statistical modelling and managing based on the Rank in constructing the keyword portfolio, and to perform empirical tests and propose a new strategic guidelines to focus on the CTK and to propose the modified CVR optimization objective function reflecting the spillover effect in stead of the previous expected profit models.

Conservation Status, Construction Type and Stability Considerations for Fortress Wall in Hongjuupseong (Town Wall) of Hongseong, Korea (홍성 홍주읍성 성벽의 보존상태 및 축성유형과 안정성 고찰)

  • Park, Junhyoung;Lee, Chanhee
    • Korean Journal of Heritage: History & Science
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    • v.51 no.3
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    • pp.4-31
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    • 2018
  • It is difficult to ascertain exactly when the Hongjuupseong (Town Wall) was first constructed, due to it had undergone several times of repair and maintenance works since it was piled up newly in 1415, when the first year of the reign of King Munjong (the 5th King of the Joseon Dynasty). Parts of its walls were demolished during the Japanese occupation, leaving the wall as it is today. Hongseong region is also susceptible to historical earthquakes for geological reasons. There have been records of earthquakes, such as the ones in 1978 and 1979 having magnitudes of 5.0 and 4.0, respectively, which left part of the walls collapsed. Again, in 2010, heavy rainfall destroyed another part of the wall. The fortress walls of the Hongjuupseong comprise various rocks, types of facing, building methods, and filling materials, according to sections. Moreover, the remaining wall parts were reused in repair works, and characteristics of each period are reflected vertically in the wall. Therefore, based on the vertical distribution of the walls, the Hongjuupseong was divided into type I, type II, and type III, according to building types. The walls consist mainly of coarse-grained granites, but, clearly different types of rocks were used for varying types of walls. The bottom of the wall shows a mixed variety of rocks and natural and split stones, whereas the center is made up mostly of coarse-grained granites. For repairs, pink feldspar granites was used, but it was different from the rock variety utilized for Suguji and Joyangmun Gate. Deterioration types to the wall can be categorized into bulging, protrusion of stones, missing stones at the basement, separation of framework, fissure and fragmentation, basement instability, and structural deformation. Manually and light-wave measurements were used to check the amount and direction of behavior of the fortress walls. A manual measurement revealed the sections that were undergoing structural deformation. Compared with the result of the light-wave measurement, the two monitoring methods proved correlational. As a result, the two measuring methods can be used complementarily for the long-term conservation and management of the wall. Additionally, the measurement system must be maintained, managed, and improved for the stability of the Hongjuupseong. The measurement of Nammunji indicated continuing changes in behavior due to collapse and rainfall. It can be greatly presumed that accumulated changes over the long period reached the threshold due to concentrated rainfall and subsequent behavioral irregularities, leading to the walls' collapse. Based on the findings, suggestions of the six grades of management from 0 to 5 have been made, to manage the Hongjuupseong more effectively. The applied suggested grade system of 501.9 m (61.10%) was assessed to grade 1, 29.5 m (3.77%) to grade 2, 10.4 m (1.33%) to grade 3, 241.2 m (30.80%) and grade 4. The sections with grade 4 concentrated around the west of Honghwamun Gate and the east of the battlement, which must be monitored regularly in preparation for a potential emergency. The six-staged management grade system is cyclical, where after performing repair and maintenance works through a comprehensive stability review, the section returned to grade 0. It is necessary to monitor thoroughly and evaluate grades on a regular basis.

Analysis of Surveys to Determine the Real Prices of Ingredients used in School Foodservice (학교급식 식재료별 시장가격 조사 실태 분석)

  • Lee, Seo-Hyun;Lee, Min A;Ryoo, Jae-Yoon;Kim, Sanghyo;Kim, Soo-Youn;Lee, Hojin
    • Korean Journal of Community Nutrition
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    • v.26 no.3
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    • pp.188-199
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    • 2021
  • Objectives: The purpose was to identify the ingredients that are usually surveyed for assessing real prices and to present the demand for such surveys by nutrition teachers and dietitians for ingredients used by school foodservice. Methods: A survey was conducted online from December 2019 to January 2020. The survey questionnaire was distributed to 1,158 nutrition teachers and dietitians from elementary, middle, and high schools nationwide, and 439 (37.9% return rate) of the 1,158 were collected and used for data analysis. Results: The ingredients which were investigated for price realities directly by schools were industrial products in 228 schools (51.8%), fruits in 169 schools (38.4%), and specialty crops in 166 schools (37.7%). Moreover, nutrition teachers and dietitians in elementary, middle, and high schools searched in different ways for the real prices of ingredients. In elementary schools, there was a high demand for price information about grains, vegetables or root and tuber crops, special crops, fruits, eggs, fishes, and organic and locally grown ingredients by the School Foodservice Support Centers. Real price information about meats, industrial products, and pickled processed products were sought from the external specialized institutions. In addition, nutrition teachers and dietitians in middle and high schools wanted to obtain prices of all of the ingredients from the Offices of Education or the District Office of Education. Conclusions: Schools want to efficiently use the time or money spent on research for the real prices of ingredients through reputable organizations or to co-work with other nutrition teachers and dietitians. The results of this study will be useful in understanding the current status of the surveys carried out to determine the real price information for ingredients used by the school foodservice.

The Effect of Pressure Support on Respiratory Mechanics in CPAP and SIMV (CPAP 및 SIMV Mode하에서 Pressure Support 사용이 호흡역학에 미치는 효과)

  • Lim, Chae-Man;Jang, Jae-Won;Choi, Kang-Hyun;Lee, Sang-Do;Koh, Youn-Suck;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Park, Pyung-Whan;Choi, Jong-Moo
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.3
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    • pp.351-360
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    • 1995
  • Background: Pressure support(PS) is becomimg a widely accepted method of mechanical ventilation either for total unloading or for partial unloading of respiratory muscle. The aim of the study was to find out if PS exert different effects on respiratory mechanics in synchronized intermittent mandatory ventilation(SIMV) and continuous positive airway pressure (CPAP) modes. Methods: 5, 10 and 15 cm $H_2O$ of PS were sequentially applied in 14 patients($69{\pm}12$ yrs, M:F=9:5) and respiratory rate (RR), tidal volume($V_T$), work of breathing(WOB), pressure time product(PTP), $P_{0.1}$, and $T_1/T_{TOT}$ were measured using the CP-100 pulmonary monitor(Bicore, USA) in SIMV and CPAP modes respectively. Results: 1) Common effects of PS on respiratory mechanics in both CPAP and SIMV modes As the level of PS was increased(0, 5, 10, 15 cm $H_2O$), $V_T$ was increased in CPAP mode($0.28{\pm}0.09$, $0.29{\pm}0.09$, $0.31{\pm}0.11$, $0.34{\pm}0.12\;L$, respectively, p=0.001), and also in SIMV mode($0.31{\pm}0.15$, $0.32{\pm}0.09$, $0.34{\pm}0.16$, $0.36{\pm}0.15\;L$, respectively, p=0.0215). WOB was decreased in CPAP mode($1.40{\pm}1.02$, $1.01{\pm}0.80$, $0.80{\pm}0.85$, $0.68{\pm}0.76$ joule/L, respectively, p=0.0001), and in SIMV mode($0.97{\pm}0.77$, $0.76{\pm}0.64$, $0.57{\pm}0.55$, $0.49{\pm}0.49$ joule/L, respectively, p=0.0001). PTP was also decreased in CPAP mode($300{\pm}216$, $217{\pm}165$, $179{\pm}187$, $122{\pm}114cm$ $H_2O{\cdot}sec/min$, respectively, p=0.0001), and in SIMV mode($218{\pm}181$, $178{\pm}157$, $130{\pm}147$, $108{\pm}129cm$ $H_2O{\cdot}sec/min$, respectively, p=0.0017). 2) Different effects of PS on respiratory mechanics in CP AP and SIMV modes By application of PS (0, 5, 10, 15 cm $H_2O$), RR was not changed in CPAP mode($27.9{\pm}6.7$, $30.0{\pm}6.6$, $26.1{\pm}9.1$, $27.5{\pm}5.7/min$, respectively, p=0.505), but it was decreased in SIMV mode ($27.4{\pm}5.1$, $27.8{\pm}6.5$, $27.6{\pm}6.2$, $25.1{\pm}5.4/min$, respectively, p=0.0001). $P_{0.1}$ was reduced in CPAP mode($6.2{\pm}3.5$, $4.8{\pm}2.8$, $4.8{\pm}3.8$, $3.9{\pm}2.5\;cm$ $H_2O$, respectively, p=0.0061), but not in SIMV mode($4.3{\pm}2.1$, $4.0{\pm}1.8$, $3.5{\pm}1.6$, $3.5{\pm}1.9\;cm$ $H_2O$, respectively, p=0.054). $T_1/T_{TOT}$ was decreased in CPAP mode($0.40{\pm}0.05$, $0.39{\pm}0.04$, $0.37{\pm}0.04$, $0.35{\pm}0.04$, respectively, p=0.0004), but not in SIMV mode($0.40{\pm}0.08$, $0.35{\pm}0.07$, $0.38{\pm}0.10$, $0.37{\pm}0.10$, respectively, p=0.287). 3) Comparison of respiratory mechanics between CPAP+PS and SIMV alone at same tidal volume. The tidal volume in CPAP+PS 10 cm $H_2O$ was comparable to that of SIMV alone. Under this condition, the RR($26.1{\pm}9.1$, $27.4{\pm}5.1/min$, respectively, p=0.516), WOB($0.80{\pm}0.85$, 0.97+0.77 joule/L, respectively, p=0.485), $P_{0.1}$($3.9{\pm}2.5$, $4.3{\pm}2.1\;cm$ $H_2O$, respectively, p=0.481) were not different between the two methods, but PTP($179{\pm}187$, $218{\pm}181 cmH_2O{\cdot}sec/min$, respectively, p=0.042) and $T_1/T_{TOT}$($0.37{\pm}0.04$, $0.40{\pm}0.08$, respectively, p=0.026) were significantly lower in CPAP+PS than in SIMV alone. Conclusion: PS up to 15 cm $H_2O$ increased tidal volume, decreased work of breathing and pressure time product in both SIMV and CPAP modes. PS decreased respiration rate in SIMV mode but not in CPAP mode, while it reduced central respiratory drive($P_{0.1}$) and shortened duty cycle ($T_1/T_{TOT}$) in CPAP mode but not in SIMV mode. By 10 em $H_2O$ of PS in CPAP mode, same tidal volume was obtained as in SIMV mode, and both methods were comparable in respect to RR, WOB, $P_{0.1}$, but CPAP+PS was superior in respect to the efficiency of the respiratory muscle work (PTP) and duty cycle($T_1/T_{TOT}$).

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