• Title/Summary/Keyword: Partial Effects

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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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Development of Conformal Radiotherapy with Respiratory Gate Device (호흡주기에 따른 방사선입체조형치료법의 개발)

  • Chu Sung Sil;Cho Kwang Hwan;Lee Chang Geol;Suh Chang Ok
    • Radiation Oncology Journal
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    • v.20 no.1
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    • pp.41-52
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    • 2002
  • Purpose : 3D conformal radiotherapy, the optimum dose delivered to the tumor and provided the risk of normal tissue unless marginal miss, was restricted by organ motion. For tumors in the thorax and abdomen, the planning target volume (PTV) is decided including the margin for movement of tumor volumes during treatment due to patients breathing. We designed the respiratory gating radiotherapy device (RGRD) for using during CT simulation, dose planning and beam delivery at identical breathing period conditions. Using RGRD, reducing the treatment margin for organ (thorax or abdomen) motion due to breathing and improve dose distribution for 3D conformal radiotherapy. Materials and Methods : The internal organ motion data for lung cancer patients were obtained by examining the diaphragm in the supine position to find the position dependency. We made a respiratory gating radiotherapy device (RGRD) that is composed of a strip band, drug sensor, micro switch, and a connected on-off switch in a LINAC control box. During same breathing period by RGRD, spiral CT scan, virtual simulation, and 3D dose planing for lung cancer patients were peformed, without an extended PTV margin for free breathing, and then the dose was delivered at the same positions. We calculated effective volumes and normal tissue complication probabilities (NTCP) using dose volume histograms for normal lung, and analyzed changes in doses associated with selected NTCP levels and tumor control probabilities (TCP) at these new dose levels. The effects of 3D conformal radiotherapy by RGRD were evaluated with DVH (Dose Volume Histogram), TCP, NTCP and dose statistics. Results : The average movement of a diaphragm was 1.5 cm in the supine position when patients breathed freely. Depending on the location of the tumor, the magnitude of the PTV margin needs to be extended from 1 cm to 3 cm, which can greatly increase normal tissue irradiation, and hence, results in increase of the normal tissue complications probabiliy. Simple and precise RGRD is very easy to setup on patients and is sensitive to length variation (+2 mm), it also delivers on-off information to patients and the LINAC machine. We evaluated the treatment plans of patients who had received conformal partial organ lung irradiation for the treatment of thorax malignancies. Using RGRD, the PTV margin by free breathing can be reduced about 2 cm for moving organs by breathing. TCP values are almost the same values $(4\~5\%\;increased)$ for lung cancer regardless of increasing the PTV margin to 2.0 cm but NTCP values are rapidly increased $(50\~70\%\;increased)$ for upon extending PTV margins by 2.0 cm. Conclusion : Internal organ motion due to breathing can be reduced effectively using our simple RGRD. This method can be used in clinical treatments to reduce organ motion induced margin, thereby reducing normal tissue irradiation. Using treatment planning software, the dose to normal tissues was analyzed by comparing dose statistics with and without RGRD. Potential benefits of radiotherapy derived from reduction or elimination of planning target volume (PTV) margins associated with patient breathing through the evaluation of the lung cancer patients treated with 3D conformal radiotherapy.

Effect of Dietary Energy, Protein on Growth and Blood Composition of Cross Bred Chicks (유색육용계의 성장과 혈액성상에 사료단백질 및 에너지가 미치는 영향)

  • Jeong, Y.D.;Ryu, K.S.
    • Korean Journal of Poultry Science
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    • v.35 no.3
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    • pp.291-302
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    • 2008
  • To acquire essentially necessary basic data to establish feeding system by verifying appropriate dietary energy and protein level for the growth of commercial slow growing broiler chicks within the country, two experiments were conducted for 5 weeks. One day old, 1,404 male and female broiler chicks were used for the experiments, and 26 chicks were placed at each pen. The energy level of feed was maintained about 3,000 or 3,100 kg/kcal for whole breeding period of 5 weeks, and protein content was adjusted about 20, 21, and 22% during the first two weeks and the content was adjusted to 18, 19, 20, 21, and 22% from the 3 to 5 weeks old of the experiment. The categories of body weight and feed intake amount were monitored to calculate the productivity and blood sampling was conducted for the analysis at the end of each experiment. Experiment 1:Although the productivity by the ME content difference during $0{\sim}2$ weeks did not have significant difference and the body weight increase by the difference of CP content and feed intake amount did not have much difference, the feed requirement rate was statistically improved in CP 21 and 22% treatment groups compared to the CP 20% group (P<0.05). The feed ME 3,100 kcal/kg treated group during $3{\sim}5$ weeks after starting the experiment revealed to show improved feed requirement rate (P<0.05). Within the period of experiment, the CP 22% treated group resulted to show significant body weight increase compared to the groups treated with low levels of CP (P<0.05) and the feed requirement rate was improved in high CP treated group compared to low CP treated groups, but the feed intake amount did not show significant difference between treated groups. During the experiment period, the body weight increase and feed requirement rate revealed to interact between ME and CP (P<0.05). During the whole experiment period of the 5 weeks, the feed requirement rate was improved in ME 3,100 kcal/kg treated group than the groups treated with ME 3,000 kcal/kg, and the CP (20) 18% treatment groups resulted to show higher values than other treatment groups (P<0.05). Body weight increase was high in CP (22) 22% treated groups than those of CP (21) 21% and (20) 18% treated groups, and the interaction between ME and CP was found at body weight increase and feed requirement rate (P<0.05). Although blood albumin and total cholesterol levels were elevated in ME 3,100 kcal/kg treated group than ME 3,000 kcal/kg treated group, but neutral fat content was reduced (P<0.05). On the other hand, the total cholesterol content was increased in CP (22) 21% treated group than CP (22) 20% and CP (20) 18% treated groups (P<0.05). Experiment 2: The body weight increase in 0-2 weeks was higher in ME 3,100 kcal/kg treated group than ME 3,000 kcal/kg treated group, and it was highly improved in CP 22% treated group than CP 20% treated group by showing the interaction between CP and ME (P<0.05). The significant improvement of feed requirement rate was observed in CP 21% and 22% treated groups compared to CP 20% treated group (P<0.05). The productivity between the growth period from 3 to 5 weeks of age and whole growth period resulted to show no significant difference. Although no difference was observed in blood composition between treated groups, the interaction of ME and CP on cholesterol content was accepted at the range of P<0.05). Therefore, it is considered that the appropriate dietary protein level within feed for the physiology of growing broiler chicks was 22% or more for the first two weeks and protein level of 21% or 20% from 3 to 5 weeks old for the maximization of productivity. Even if the energy level within feed had some partial effects on the productivity, but did not show consistency. So, further experiments needto be conducted by differentiating the energy level.

Effects of Recipient Oocytes and Electric Stimulation Condition on In Vitro Development of Cloned Embryos after Interspecies Nuclear Transfer with Caprine Somatic Cell (수핵난자와 전기적 융합조건이 산양의 이종간 복제수정란의 체외발달에 미치는 영향)

  • 이명열;박희성
    • Reproductive and Developmental Biology
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    • v.28 no.1
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    • pp.21-27
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    • 2004
  • This study was conducted to investigate the developmental ability of caprine embryos after somatic cell interspecies nuclear transfer. Recipient bovine and porcine oocytes were obtained from slaughterhouse and were matured in vitro according to established protocols. Donor cells were obtained from an ear-skin biopsy of a caprine, digested with 0.25% trypsin-EDTA in PBS and primary fibroblast cultures were established in TCM-199 with 10% FBS. The matured oocytes were dipped in D-PBS plus 10% FBS + 7.5 $\mu$ g/ml cytochalasin B and 0.05M sucrose. Enucleation were accomplished by aspirating the first polar body and partial cytoplasm which containing metaphase II chromosomes using a micropipette with an out diameter of 20∼30 $\mu$m. A Single donor cell was individually transferred into the perivitelline space of each enucleated oocyte. The reconstructed oocytes were electric fusion with 0.3M mannitol fusion medium. After the electrofusion, embryos were activated by electric stimulation. Interspecies nuclear transfer embryos with bovine cytoplasts were cultured in TCM-199 medium supplemented with 10% FBS including bovine oviduct epithelial cells for 7∼9 day. And porcine cytoplasts were cultured in NCSU-23 medium supplemented with 10% FBS for 6 ∼8 day at $39^{\circ}C, 5% CO_2 $in air. Interspecies nuclear transfer by recipient bovine oocytes were fused with electric length 1.95 kv/cm and 2.10 kv/cm. There was no significant difference between two electric length in fusion rate(47.7 and 44.6%) and in cleavage rate(41.9 and 54.5%). Using electric length 1.95 kv/cm and 2.10 kv/cm in caprine-porcine NT oocytes, there was also no significant difference between two treatments in fusion rate(51.3 and 46.1%) and in cleavage rate(75.0 and 84.9%). The caprine-bovine NT oocytes fusion rate was lower(P<0.05) in 1 pulse for 60 $\mu$sec(19.3%), than those from 1 pulse for 30 $\mu$sec(50.8%) and 2 pulse for 30 $\mu$sec(31.0%). The cleavage rate was higher(P<0.05) in 1 pulse for 30 $\mu$sec(53.3%) and 2 pulse for 30 $\mu$sec(50.0%), than in 1 pulse for 60 $\mu$sec(18.2%). The caprine-porcine NT oocytes fusion rate was 48.1% in 1 pulse for 30 $\mu$sec, 45.2% in 2 pulse for 30 $\mu$sec and 48.6% in 1 pulse for 60 $\mu$sec. The cleavage rate was higher(P<0.05) in 1 pulse for 30 $\mu$sec(78.4%) and 1 pulse for 60 $\mu$sec(79.4%), than in 2 pulse for 30 $\mu$sec(53.6%). In caprine-bovine NT embryos, the developmental rate of morula and blastocyst stage embryos were 22.6% in interspecies nuclear transfer and 30.6% in parthenotes, which was no significant differed. The developmental rate of morula and blastocyst stage embryos with caprine-porcine NT embryos were lower(P<0.05) in interspecies nuclear transfer(5.1%) than parthenotes(37.4%).

Chronic HBV Infection in Children: The histopathologic classification and its correlation with clinical findings (소아의 만성 B형 간염: 새로운 병리조직학적 분류와 임상 소견의 상관 분석)

  • Lee, Seon-Young;Ko, Jae-Sung;Kim, Chong-Jai;Jang, Ja-June;Seo, Jeong-Kee
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.1 no.1
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    • pp.56-78
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    • 1998
  • Objective: Chronic hepatitis B infection (CHB) occurs in 6% to 10% of population in Korea. In ethinic communities where prevalence of chronic infection is high such as Korea, transmission of hepatitis B infection is either vertical (ie, by perinatal infection) or by close family contact (usually from mothers or siblings) during the first 5 years of life. The development of chronic hepatitis B infection is increasingly more common the earlier a person is exposed to the virus, particularly in fetal and neonatal life. And it progress to cirrhosis and hepatocellular carcinoma, especially in severe liver damage and perinatal infection. Histopathology of CHB is important when evaluating the final outcomes. A numerical scoring system which is a semiquantitatively assessed objective reproducible classification of chronic viral hepatitis, is a valuable tool for statistical analysis when predicting the outcome and evaluating antiviral and other therapies. In this study, a numerical scoring system (Ludwig system) was applied and compared with the conventional histological classification of De Groute. And the comparative analysis of cinical findings, family history, serology, and liver function test by histopathological findings in chronic hepatitis B of children was done. Methods: Ninety nine patients [mean age=9 years (range=17 months to 16 years)] with clinical, biochemical, serological and histological patterns of chronic HBV infection included in this study. Five of these children had hepatocelluar carcinoma. They were 83 male and 16 female children. They all underwent liver biopsies and histologic evaluation was performed by one pathologist. The biopsy specimens were classified, according to the standard criteria of De Groute as follows: normal, chronic lobular hepatitis (CLH), chronic persistent hepatitis (CPH), mild to severe chronic active hepatitis (CAH), or active cirrhosis, inactive cirrhosis, hepatocellular carcinoma (HCC). And the biopsy specimens were also assessed and scored semiquantitatively by the numerical scoring Ludwig system. Serum HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc (IgG, IgM), and HDV were measured by radioimunoassays. Results: Male predominated in a proportion of 5.2:1 for all patients. Of 99 patients, 2 cases had normal, 2 cases had CLH, 22 cases had CPH, 40 cases had mild CAH, 19 cases had moderate CAH, 1 case had severe CAH, 7 cases had active cirrhosis, 1 case had inactive cirrhosis, and 5 cases had HCC. The mean age, sex distribution, symptoms, signs, and family history did not differ statistically among the different histologic groups. The numerical scoring system was correlated well with the conventional histological classification. The histological activity evaluated by both the conventional classification and the scoring system was more severe as the levels of serum aminotransferases were higher. In contrast, the levels of serum aminotransferases were not useful for predicting the degree of histologic activity because of its wide range overlapping. When the histological activity was more severe and especially the cirrhosis more progressing, the prothrombin time was more prolonged. The histological severity was inversely related with the duration of seroconversion of HBeAg. Conclusions: The histological activity could not be accurately predicted by clinical and biochemical findings, but by the proper histological classification of the numerical scoring system for the biopsy specimen. The numerical scoring system was correlated well with the conventional histological classification, and it seems to be a valuable tool for the statistical analysis when predicting the outcome and evaluating effects of antiviral and other therapies in chronic hepatitis B in children.

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Consumer's Negative Brand Rumor Acceptance and Rumor Diffusion (소비자의 부정적 브랜드 루머의 수용과 확산)

  • Lee, Won-jun;Lee, Han-Suk
    • Asia Marketing Journal
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    • v.14 no.2
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    • pp.65-96
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    • 2012
  • Brand has received much attention from considerable marketing research. When consumers consume product or services, they are exposed to a lot of brand related stimuli. These contain brand personality, brand experience, brand identity, brand communications and so on. A special kind of new crisis occasionally confronting companies' brand management today is the brand related rumor. An important influence on consumers' purchase decision making is the word-of-mouth spread by other consumers and most decisions are influenced by other's recommendations. In light of this influence, firms have reasonable reason to study and understand consumer-to-consumer communication such as brand rumor. The importance of brand rumor to marketers is increasing as the number of internet user and SNS(social network service) site grows. Due to the development of internet technology, people can spread rumors without the limitation of time, space and place. However relatively few studies have been published in marketing journals and little is known about brand rumors in the marketplace. The study of rumor has a long history in all major social science. But very few studies have dealt with the antecedents and consequences of any kind of brand rumor. Rumor has been generally described as a story or statement in general circulation without proper confirmation or certainty as to fact. And it also can be defined as an unconfirmed proposition, passed along from people to people. Rosnow(1991) claimed that rumors were transmitted because people needed to explain ambiguous and uncertain events and talking about them reduced associated anxiety. Especially negative rumors are believed to have the potential to devastate a company's reputation and relations with customers. From the perspective of marketer, negative rumors are considered harmful and extremely difficult to control in general. It is becoming a threat to a company's sustainability and sometimes leads to negative brand image and loss of customers. Thus there is a growing concern that these negative rumors can damage brands' reputations and lead them to financial disaster too. In this study we aimed to distinguish antecedents of brand rumor transmission and investigate the effects of brand rumor characteristics on rumor spread intention. We also found key components in personal acceptance of brand rumor. In contextualist perspective, we tried to unify the traditional psychological and sociological views. In this unified research approach we defined brand rumor's characteristics based on five major variables that had been found to influence the process of rumor spread intention. The five factors of usefulness, source credibility, message credibility, worry, and vividness, encompass multi level elements of brand rumor. We also selected product involvement as a control variable. To perform the empirical research, imaginary Korean 'Kimch' brand and related contamination rumor was created and proposed. Questionnaires were collected from 178 Korean samples. Data were collected from college students who have been experienced the focal product. College students were regarded as good subjects because they have a tendency to express their opinions in detail. PLS(partial least square) method was adopted to analyze the relations between variables in the equation model. The most widely adopted causal modeling method is LISREL. However it is poorly suited to deal with relatively small data samples and can yield not proper solutions in some cases. PLS has been developed to avoid some of these limitations and provide more reliable results. To test the reliability using SPSS 16 s/w, Cronbach alpha was examined and all the values were appropriate showing alpha values between .802 and .953. Subsequently, confirmatory factor analysis was conducted successfully. And structural equation modeling has been used to analyze the research model using smartPLS(ver. 2.0) s/w. Overall, R2 of adoption of rumor is .476 and R2 of intention of rumor transmission is .218. The overall model showed a satisfactory fit. The empirical results can be summarized as follows. According to the results, the variables of brand rumor characteristic such as source credibility, message credibility, worry, and vividness affect argument strength of rumor. And argument strength of rumor also affects rumor intention. On the other hand, the relationship between perceived usefulness and argument strength of rumor is not significant. The moderating effect of product involvement on the relations between argument strength of rumor and rumor W.O.M intention is not supported neither. Consequently this study suggests some managerial and academic implications. We consider some implications for corporate crisis management planning, PR and brand management. This results show marketers that rumor is a critical factor for managing strong brand assets. Also for researchers, brand rumor should become an important thesis of their interests to understand the relationship between consumer and brand. Recently many brand managers and marketers have focused on the short-term view. They just focused on strengthen the positive brand image. According to this study we suggested that effective brand management requires managing negative brand rumors with a long-term view of marketing decisions.

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