• Journal of Music and Human Behavior
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• v.4 no.2
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• pp.66-83
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• 2007

The purpose of this study is to learn both effects of the vocal psychotherapy on the self-consciousness and the variety of the self-consciousness on the vocal psychotherapy in return. The research for this study was performed to three subjects who were students of E university, Seoul, ten times for sixty minutes. The subjects were all volunteers for the advertisement on a music-therapy program searching for them on the web site of E university. The vocal psychotherapy program consists of four steps and each of them consists of two to four short terms again. Both before and after the experiment, examinations on self-consciousness were done to recognize the change of the subjects' self-consciousness which would be caused by the vocal psychotherapy activity. After every short term, the subjects were asked to write reports to closely analyze the change of self-consciousness according to the terms and the variety of the subjects. The effect of the vocal psychotherapy activity on the changes of scores in the self-consciousness examination is the first thing to point out on this study. There appeared some personal varieties on the total scores of the examination and scores of some sub-categories. Especially, there were different scores on the private self-consciousness, the public self-consciousness, and the social anxiety between before and after performing the vocal psychotherapy program. Subject A, who had got the best score of all on the scope of the private self-consciousness, showed the steepest decrease on the very scope. On the contrary, the subject showed decrease of scores of the public self-consciousness and the social anxiety in the relatively little rate. Subject B, who had got the highest score of the three on the public self-consciousness, showed the steepest decrease on that of all scopes and showed no difference on the social anxiety scope. In the case of the last one, subject C, who had relatively low scores on the private and public self-consciousness than the others, the private self-consciousness score increased but the public self-consciousness and the social anxiety scores decreased. The changes of the scores of each questions were examined in order to see possible other changes that had not been exposed on the changes of the total and sub-categories scores. As a result of that, of all twenty-eight questions, there were changes about one to two points. Subject A showed the difference with thirteen questions, subject B with sixteen and subject C with nineteen questions. The rate of change of subject C was relatively small but more questions changed and the change of score was wider than the others. Considering all those results, It can be possibly said that the vocal psychotherapy affects the changes of the scores of sub-categories in self-consciousness examination. The next thing to point out on this study is the change of recognition that was exposed on the subjects' report after every short term of the program. As a result of the close analyzing, according to the short terms and variety of self-consciousness, recognizing the way express subjects themselves by voice and recognizing their own voices appeared to be different. How much they cared about others and why they did so were also different. According to the self reports, subject A cared much about her inner thought and emotion and tended to concentrate herself as a social object. There appeared some positive emotional experiments such as emotional abundance and art curiosities on her reports but at the same time some negative emotions such as state-trait anxiety and neuroticism also appeared. Subject B, who showed high scores on the private and public self-consciousness like subject A, had a similar tendency that concentrates on herself as a social object but she showed more social anxiety than subject A. Subject C got relatively lower points in self-consciousness examination, tended to care about herself, and had less negative emotions such as state-trait anxiety than other subjects. Also, with terms going on, she showed changes in the way of caring about her own voice and others. This study has some unique significances in helping people who have problems caused by self-estimation activated with self-consciousness, using voices closely related to one's own self, performing the vocal skills discipline to solve the technical problems. Also, this study has a potentiality that the vocal psychotherapy activity can be effectively used as a way affects the mental health and developing personality.

• Korean Journal of Psychosomatic Medicine
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• v.8 no.2
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• pp.212-227
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• 2000

This study was designed to testify the reliability and validation on the Korean version of the Social Adaptation Self-rating Scale(SASS) which was developed from Bose et al. for the evaluation of social motivation and behavior of depressed patients in 1997. Interests for the social world, those of social functioning, of patients were involved in the addition of new measure of disturbance. And those were distinct from abnormalities of thought, mood and symptoms of patients with major depression. As the previous reports there were several evidences that treatments may be less likely to be effective if the system they act on is dysfunctional. Thus, a better social situation favoured better outcome. As a matter of fact, however, those reports were developed in the course of the evaluation of interpersonal therapy(IPT) and cognitive therapy. Accordingly the conversed question -whether pharmacological therapy with antidepressants can impact on social functioning in addition to addressing the core features of illness- has been addressed. To date, anyhow, it is accepted that enhancement of social functioning may be a therapeutic principle in its own right and illness rarely divorced from social context. In terms of those concepts the introduction of an assessment of social functioning into pharmacotherapeutic studies of depression has been welcomed and might be a potent instrument for evaluating the relative pharmacoeconomic benefits of different treatments. Despite of many scales which were applied for the evaluation of symptoms in the patients with depression, however, the scale for the evaluation of social functiong has not been introduced in Korea yet. Thus, this study was designed to introduce the concepts of social functioning in the patients with depression and to testify the reliability and validation on Korean version of SASS. This Korean version of SASS was submitted to a reliability and validation procedure based on the data from healthy general population survey in 291 individuals and 40 patients with major depression. Cronbach a was 0.790 in total subjects group and the correlation of test-retest was statistically significant(y=0.653, p<0.0l). Thus, the Korean version of SASS might be shown to be valid and reliable. The results of multivariate analyses allowed the identification of 3 principle factors(factor 1 = intersts in social activities, factor 2 = active interpersonal relationship, factor 3 = selfesteem) in normal group, however, it could be counted as only one factor in the depression group because nearly total items of SASS were involved in factor 1. In the view of these results, the Korean version of SASS may be useful additional tool for the evaluation of social functioning in depression.

• Journal of Global Scholars of Marketing Science
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• v.18 no.4
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• pp.195-215
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• 2008

The scarcity is pervasive aspect of human life and is a fundamental precondition of economic behavior of consumers. Also, the effect of scarcity message is a power social influence principle used by marketers to increase the subjective desirability of products. Because valuable objects are often scare, consumers tend to infer the scarce objects are valuable. Marketers often do base promotional appeals on the principle of scarcity to increase the subjective desirability their products among consumers. Specially, advertisers and retailers often promote their products using restrictions. These restriction act to constraint consumers' ability th take advantage of the promotion and can assume several forms. For example, some promotions are advertised as limited time offers, while others limit the quantity that can be bought at the deal price by employing the statements such as 'limit one per consumer,' 'limit 5 per customer,' 'limited products for special commemoration celebration,' Some retailers use statements extensively. A recent weekly flyer by a prominent retailer limited purchase quantities on 50% of the specials advertised on front page. When consumers saw these phrase, they often infer value from the product that has limited availability or is promoted as being scarce. But, the past researchers explored a direct relationship between the purchase quantity and time limit on deal purchase intention. They also don't explored that all restriction message are not created equal. Namely, we thought that different restrictions signal deal value in different ways or different mechanism. Consumers appear to perceive that time limits are used to attract consumers to the brand, while quantity limits are necessary to reduce stockpiling. This suggests other possible differences across restrictions. For example, quantity limits could imply product quality (i.e., this product at this price is so good that purchases must be limited). In contrast, purchase preconditions force the consumer to spend a certain amount to qualify for the deal, which suggests that inferences about the absolute quality of the promoted item would decline from purchase limits (highest quality) to time limits to purchase preconditions (lowest quality). This might be expected to be particularly true for unfamiliar brands. However, a critical but elusive issue in scarcity message research is the impacts of a inferred motives on the promoted scarcity message. The past researchers not explored possibility of inferred motives on the scarcity message context. Despite various type to the quantity limits message, they didn't separated scarcity message among the quantity limits. Therefore, we apply a stricter definition of scarcity message(i.e. quantity limits) and consider scarcity message type(general scarcity message vs. special scarcity message), scarcity depth(high vs. low). The purpose of this study is to examine the effect of the scarcity message on the consumer's purchase intension. Specifically, we investigate the effect of general versus special scarcity messages on the consumer's purchase intention using the level of the scarcity depth as moderators. In other words, we postulates that the scarcity message type and scarcity depth play an essential moderating role in the relationship between the inferred motives and purchase intention. In other worlds, different from the past studies, we examine the interplay between the perceived motives and scarcity type, and between the perceived motives and scarcity depth. Both of these constructs have been examined in isolation, but a key question is whether they interact to produce an effect in reaction to the scarcity message type or scarcity depth increase. The perceived motive Inference behind the scarcity message will have important impact on consumers' reactions to the degree of scarcity depth increase. In relation ti this general question, we investigate the following specific issues. First, does consumers' inferred motives weaken the positive relationship between the scarcity depth decrease and the consumers' purchase intention, and if so, how much does it attenuate this relationship? Second, we examine the interplay between the scarcity message type and the consumers' purchase intention in the context of the scarcity depth decrease. Third, we study whether scarcity message type and scarcity depth directly affect the consumers' purchase intention. For the answer of these questions, this research is composed of 2(intention inference: existence vs. nonexistence)${\times}2$(scarcity type: special vs. general)${\times}2$(scarcity depth: high vs. low) between subject designs. The results are summarized as follows. First, intention inference(inferred motive) is not significant on scarcity effect in case of special scarcity message. However, nonexistence of intention inference is more effective than existence of intention inference on purchase intention in case of general scarcity. Second, intention inference(inferred motive) is not significant on scarcity effect in case of low scarcity. However, nonexistence of intention inference is more effective than existence of intention inference on purchase intention in case of high scarcity. The results of this study will help managers to understand the relative importance among the type of the scarcity message and to make decisions in using their scarcity message. Finally, this article have several contribution. First, we have shown that restrictions server to activates a mental resource that is used to render a judgment regarding a promoted product. In the absence of other information, this resource appears to read to an inference of value. In the presence of other value related cue, however, either database(i.e., scarcity depth: high vs. low) or conceptual base(i.e.,, scarcity type special vs. general), the resource is used in conjunction with the other cues as a basis for judgment, leading to different effects across levels of these other value-related cues. Second, our results suggest that a restriction can affect consumer behavior through four possible routes: 1) the affective route, through making consumers feel irritated, 2) the cognitive making route, through making consumers infer motivation or attribution about promoted scarcity message, and 3) the economic route, through making the consumer lose an opportunity to stockpile at a low scarcity depth, or forcing him her to making additional purchases, lastly 4) informative route, through changing what consumer believe about the transaction. Third, as a note already, this results suggest that we should consider consumers' inferences of motives or attributions for the scarcity dept level and cognitive resources available in order to have a complete understanding the effects of quantity restriction message.

• Radiation Oncology Journal
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• v.15 no.4
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• pp.349-356
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• 1997

Purpose : To evaluate the efficacy of hyperfractionated radiation therapy in carcinoma of the cervix, especially on huge exophytic and endophytic stage Ib, IIa and IIb Materials and Materials : Fourty one patients with carcinoma of the cervix treated with hyperfractionated radiation therapy at the Department of Therapeutic Radiology, Dongsan Hospital, Keimyung University. School of Medicine from Jul, 1991 to Apr, 1994. According to FIGO s1aging system, therewere stage Ib (3 patients) IIa (6 patients) with exophytic ($\geq$5cm in dinmeter) and huge endophytic mass. and IIb (32 patients) with median age of 55 yeavs old. Radiation therapy consisted of hyperfractionated external irradition to the whole pelvis (120cGy/fraction, 2 fraction/day (minimum interval of 6 hours), 3600-5520cGy) and boost parametrial doses (for a total of 4480-6480cGy) with midline shield $(4\times10cm)$, and combined with intracavitary irradiation (up to 7480-8520cGy in Ib, IIa and 8480-9980cGy in IIb to point A). The maximum and mean follow up durations were 70 and 47 months respectively . Results : Five year local control rate was $78\%$ and the actuarial overall five year survival rate was $66.1\%$ for all patients, $44.4\%$ for stage Ib, IIa and $71.4\%$ for stage IIb. In bulky IIb (above 5cm in tumor size, 11 patients) five year local control rate and five rear survival rate was $88.9\%,\;73\%$ respectively Pelvic lymph node status (negative : $74\%,\;positive:25\%$, p=0.0015) was significant Prognostic factor affecting to five rear survival rate. There was marginally significant survival difference by total dose to A point ($>84Gy\;:\;70\%,\;>84Gy\;:\;42.8\%$, p=0.1). We consider that the difference of total dose to A point by stage (mean Ib,IIa : 79Gy. IIb 89Gy P=0.001) is one of the causes in worse local control and survival of Ib,IIa than IIb The overall recurrence rate was $39\%$ (16/41). The rates of local failure alone. distant failure alone. and combined local and distant failure were $9.7\%,\;19.5\%,\;and\;9.7\%$, respectively. Two Patients developed leukopenia ($\geq$ grade 3) and Three patients develoued grade 3 gastrointestinal complication. Above grade 3 complication was not noted. There was no treatment related death noted. Conclusion : We thought that it may be necessary to increase A point dose to more than 85Gy in hyperfractionated radiotherapy of huge exophytic and endophvtic stage Ib,IIa. We considered that hyperfractionated radiation therapy may be tolerable in huge exophytic and endophytic stage IIb cervical carcinoma with acceptable morbidity and possible survival gain but this was results in small patient group and will be confirmed by long term follow up in many patients.

• Korean Journal of Agricultural Science
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• v.42 no.2
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• pp.141-149
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• 2015

The data of Duroc swine species that were born from 2000 to 2014 excluding missing ones collected by Korea National Institute of Animal Science were used in the present study. After removing missing data we used 9756 of productions data and 1728 of reproductive reference of breeding research to study the level of inbreeding and to investigate the impact on the reproductive traits, production traits. The correlation of reproductive traits and inbreeding coefficient are -0.07, -0.08 for total number pigs born, number of pigs born alive respectively and birth weight per litter is -0.10, number of pigs born alive per litter to 21days is -0.06 and body weight per litter to 21days is -0.09. The correlation coefficients of the inbreeding coefficients of reproductive traits are shown within 10% with negative correlation (P < 0.05). Days of 90kg and Backfat in the correlation coefficient and inbreeding coefficient production traits were not observed significant correlations, Average daily gain was investigated by the positive correlation of 0.05. According to the above results, the inbreeding level gave a negative effect on the improvement of the breed traits, investigating a relatively high compared to a negative effect on other traits. But overall correlation degree is less than 10% was observed. This inbreeding coefficient has not been clearly observed due to degeneration of the average inbreeding coefficients of these generations was maintained within 10% of the population. The scale of the experimental group was about 150 degree pig husbandry is very small compared to the advanced countries. However, the level of inbreeding in the population group with the appropriate mating combinations is maintained below 10% of population is thought to be small and can minimize the effects of inbreeding degeneration. further testing utilizing this selection is constantly considered to be necessary.

• Asia Marketing Journal
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• v.12 no.2
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• pp.83-110
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• 2010

Dissatisfied customers may express their dissatisfaction behaviorally. These behavioral responses may impact the firms' profitability. How do we model the impact of self regulatory orientation on emotions and subsequent customer behaviors? Obviously, the positive and negative emotions experienced in these situations will influence the overall degree of satisfaction or dissatisfaction with the service(Zeelenberg and Pieters 1999). Most likely, these specific emotions will also partly determine the subsequent behavior in relation to the service and service provider, such as the likelihood of complaining, the degree to which customers will switch or repurchase, and the extent of word of mouth communication they will engage in(Zeelenberg and Pieters 2004). This study investigates the antecedents, consequences of negative consumption emotion and the moderate effect of attribution processing in an integrated model(self regulatory mode → specific emotions → behavioral responses). We focused on the fact that regret and disappointment have effects on consumer behavior. Especially, There are essentially two approaches in this research: the valence based approach and the specific emotions approach. The authors indicate theoretically and show empirically that it matters to distinguish these approaches in services research. and The present studies examined the influence of two regulatory mode concerns(Locomotion orientation and Assessment orientation) with making comparisons on experiencing post decisional regret and disappointment(Pierro, Kruglanski, and Higgins 2006; Pierro et al. 2008). When contemplating a decision with a negative outcome, it was predicted that high (vs low) locomotion would induce more disappointment than regret, whereas high (vs low) assessment would induce more regret than disappointment. The validity of the measurement scales was also confirmed by evaluations provided by the participating respondents and an independent advisory panel; samples provided recommendations throughout the primary, exploratory phases of the study. The resulting goodness of fit statistics were RMR or RMSEA of 0.05, GFI and AGFI greater than 0.9, and a chi-square with a 175.11. The indicators of the each constructs were very good measures of variables and had high convergent validity as evidenced by the reliability with a more than 0.9. Some items were deleted leaving those that reflected the cognitive dimension of importance rather than the dimension. The indicators were very good measures and had convergent validity as evidenced by the reliability of 0.9. These results for all constructs indicate the measurement fits the sample data well and is adequate for use. The scale for each factor was set by fixing the factor loading to one of its indicator variables and then applying the maximum likelihood estimation method. The results of the analysis showed that directions of the effects in the model are ultimately supported by the theory underpinning the causal linkages of the model. This research proposed 6 hypotheses on 6 latent variables and tested through structural equation modeling. 6 alternative measurements were compared through statistical significance test of the paths of research model and the overall fitting level of structural equation model and the result was successful. Also, Locomotion orientation more positively influences disappointment when internal attribution is high than low and Assessment orientation more positively influences regret when external attribution is high than low. In sum, The results of our studies suggest that assessment and locomotion concerns, both as chronic individual predispositions and as situationally induced states, influence the amount of people's experienced regret and disappointment. These findings contribute to our understanding of regulatory mode, regret, and disappointment. In previous studies of regulatory mode, relatively little attention has been paid to the post actional evaluative phase of self regulation. The present findings indicate that assessment concerns and locomotion concerns are clearly distinct in this phase, with individuals higher in assessment delving more into possible alternatives to past actions and individuals higher in locomotion engaging less in such reflective thought. What this suggests is that, separate from decreasing the amount of counterfactual thinking per se, individuals with locomotion concerns want to move on, to get on with it. Regret is about the past and not the future. Thus, individuals with locomotion concerns are less likely to experience regret. The results supported our predictions. We discuss the implications of these findings for the nature of regret and disappointment from the perspective of their relation to regulatory mode. Also, self regulatory mode and the specific emotions(disappointment and regret) were assessed and their influence on customers' behavioral responses(inaction, word of mouth) was examined, using a sample of 275 customers. It was found that emotions have a direct impact on behavior over and above the effects of negative emotions and customer behavior. Hence, We argue against incorporating emotions such as regret and disappointment into a specific response measure and in favor of a specific emotions approach on self regulation. Implications for services marketing practice and theory are discussed.

• Tuberculosis and Respiratory Diseases
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• v.55 no.1
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• pp.69-87
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• 2003

Background : LB20304(gemifloxacin) is a new fluoroquinolone antibacterial agent with excellent activity against both Gram-negative and Gram-positive organisms. In vitro studies using clinical isolates have shown gemifloxacin to be highly active against penicillin-resistant strains of S. pneumoniae and in contrast to other reference quinolones, gemifloxacin retained good activity against clinical isolates of S. pneumoniae that were resistant to other members of the quinolone class. Therefore, gemifloxacin is thought to be effective in treating acute bacterial exacerbation of chronic bronchitis(AECB). The objective of this study was to evaluate the efficacy and safety of oral gemifloxacin at doses of 160mg or 320mg once daily for 7 days for the treatment of AECB in Korean adult population. Methods : This was a randomized, multicenter, double-blind, parallel group Phase II study to assess the clinical and antibacterial efficacy and safety of oral gemifloxacin for the treatment of AECB. Treatment Group A (67 patients) took oral gemifloxacin 160mg once daily for seven days and treatment Group B (70 patients) took oral gemifloxacin 320mg once daily for seven days. Results : The demographic profiles of the two treatment groups were similar. The clinical response at follow-up was 84.2% in the gemifloxacin 160-mg group, and 88.7% in the gemifloxacin-320 mg group, showing no statistically significant difference between two treatment groups(p=0.49). The clinical response at the end of therapy was 96.5% in the 160-mg group, and 96.4% in the 320-mg group. The bacteriological response at the end of therapy and follow-up were 81.8% and 78.9%, respectively, in the 160-mg group, and 86.4% and 84.2%, respectively, in the 320-mg group, showing no statistically significant difference between two treatment groups(p=0.68 and 0.68, respectively). S. pneumoniae(12 isolates) and H. influenzae(10 isolates) were the most prevalent pathogens. The MICs were lower for gemifloxacin than other quinolones against these key pathogens, and for S. pneumoniae, the MICs for gemifloxacin were considerably lower(${\leq}0.03$ ug/mL) than those for other quinolones, beta-lactams and macrolides. In the period on-therapy plus 30 days post-therapy, a total of 18 patients(26.9%) in the gemifloxacin 160mg group and 22 patients(31.4%) in the 320mg group reported at least one adverse event(AE). The most frequently reported AE was abdominal pain(3/67 patients, 4.5%) in the gemifloxacin 160mg group and increased level of hepatic enzyme(5/70 patients, 7.1%) in the 320mg group. The overall AE profiles for the two treatment groups were similar. Two out of 67 patients(3.0%) in the gemifloxacin 160mg group and 1/70 patients(1.4%) in the 320mg group reported at least one serious AE, however, none of which was considered by the investigator to be of suspected or probable relationship to study medication. Conclusion : The results of this study showed that gemifloxacin at doses of 160mg or 320mg once daily for 7 days in the treatment of acute exacerbations of chronic bronchitis(AECB) in adult Koreans was a very effective and safe treatment both clinically and bacteriologically.

• Journal of Hospice and Palliative Care
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• v.8 no.2
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• pp.143-151
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• 2005

Purpose: Bereavement Memorial Service has been held every year by the hospice team at St. Vincent's Hospital for the purpose of supporting the bereaved family who feel grief and mourning. The purpose of this study is to find out the attitude of the bereaved attending at bereavement memorial service (BMS) and to find out the areas needing improvements to set up better memorial service. Methods: Hospice team sent invitation card to 180 families of patients who admitted and passed away at hospice ward Nov., 2003${\sim}$Oct., 2004. Among them 22 families attended the BMS meeting, which was held on 26th Nov., 2004. The researcher collected data from 22 families with 'Questionnaire' survey. Except identifying data and 2 dichotomy questions, we used open-ended questionnaire. 1 researcher conducted a telephone interview survey in 18 families who couldn't attend at BMS meeting. Results: The median age was 56 (range $16{\sim}19$) and there were 37 females and 3 males. They were patient's wife (22), mother (4), husband (5), daughter (4), mother-in-law (1), siblings (1), brothers wife (1). Duration after bereavement, $1{\sim}3$ months (17) was the highest frequency. 36 families agreed 'the dead experienced the death with dignity'. The reason of agreement to the death with dignity was 'the patient died in preparation' (16). 'the patient died in well-being condition spiritually' (9), 'the patient died in comfort physically (7). 4. persons thought the dead died with indignity. The bereaved defined 'the death with dignity' as follows: 'acceptance of death & death in spiritual well-being' (9), 'death in physical comfort condition' (7), 'the death in psycho-social well-being' (3), non-respondents (10). Most families (21) were still in difficulty to overcome bereavement grief. The answer regarding the method to overcome the difficulty was 'with spiritual sublimation' (13), 'with devotion of oneself in daily life' (10), 'with devotion to mourning as it is' (3). With regard to their attitude to invitation, 'having joy and thanks from hospice team' (21), 'grief' (4), 'suffering' (4). Toward the existence of hesitation about attendance at BMS meeting, the result as follows. Nonexistence of hesitation respondent (34), existence respondent (6), the reason for hesitation was various; 'the meeting reminds me of the suffering times', 'the meeting makes me to recall, and it will be likely to cry', and so on. The needs and feelings to memorial service meeting were various; 'it was meaningful time', 'it was good to recall about the dead', 'more meeting annually' and so on. In respect of the most difficulty after bereavement, in attendant family, 'depression' (10) was the highest frequency, whereas, in non-attendant family, the most difficult thing was 'financial problem/role difficulty (6). Conclusion: This study shows the rate of attendance was high in bereaved whose bereavement duration $1{\sim}3$ month. Most of bereaved were still suffering from bereavement grief within 1 year. Although most families didn't hesitate and felt positive mood to invitation, the rate of attendance was low. Comparing with two groups between attendant family and non-attendant, the latter felt more difficulty in 'financial problem/role difficulty, on the other hand, the former felt difficulty in 'depression'. Hereafter, the additional study about the factor relating to these attitude and needs of the bereaved relating to memorial service will be necessary.

• 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.

• Tuberculosis and Respiratory Diseases
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• v.43 no.6
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• pp.987-996
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• 1996

Background : We prospectively evaluated the applicability and effect of noninvasive ventilation (NIV) in acute respiratory failure and tried to find out the parameters that could predict successful application of NIV. Methods : Twenty-six out of 106 patients with either acute ventilatory failure (VF: $PaCO_2$ > 43 mm Hg with pH < 7.35) or oxygenation failure (OF: $PaO_2/AO_2$ < 300 mm Hg with $pH{\geq}7.35$) requiring mechanical ventilation were managed by NIV (CPAP + pressure suppon, or BiPAP) with face mask. Eleven out of 19 cases with VF (57.9%) (M : F=7 : $55.4{\pm}14.6$ yrs) and 15 out of 87 cases with OF (17.2%) (M : F=12 : 3, $50.6{\pm}15.6$ yrs) were s uilable for NIY. Respiratory rates, arterial blood gases and success rate of NIV were analyzed in each group. Results: 81.8% (9/11) of YF and 40% (6/15) of OF were successfully managed on NIV and were weruled from mechanical ventilator without resorting to endotracheal intubation. Complications were noted in 2 cases (nasal skin necrosis 1, gaseous gastric distension 1). In NIV for ventilatory failure, the respiration rate was significantly decreased at 12 hour of NIV ($34{\pm}9$ /min pre-NIV, $26{\pm}6$ /min at 12 hour of NIV, p=0.045), while $PaCO_2$ ($87.3{\pm}20.6$ mm Hg pre-NIV, $81.2{\pm}9.1$ mm Hg at 24 hour of NIV) and pH ($7.26{\pm}0.04$, $7.32{\pm}0.02$, respectively, p <0.05) were both significantly decreased at 24 hour of NIV In NIV for oxygenation failure, $PaCO_2$ were not different between the successful and the failed cases at pre-NIV and till 12 hours after NIV. The $PaO_2/FIO_2$ ratio, however, significantly improved at 0.5 hour of NIV in successful cases and were maintained at around 200 mm Hg (n=6 : at baseline, 0.5h, 6h, 12h : $120.0{\pm}19.6$, $218.9{\pm}98.3$, $191.3{\pm}55.2$, $232.8{\pm}17.6$ mm Hg, respectively, p=0.0211), but it did not rise in the failed cases (n=9 : $127.9{\pm}63.0$, $116.8{\pm}24.4$, $100.6{\pm}34.6$, $129.8{\pm}50.3$ mm Hg, respectively, p=0.5319). Conclusion : From the above results we conclude that NIV is effective for hypercapnic respiratory failure and its success was heralded by reduction of respiration rale before the reduction in $PaCO_2$ level. In hypoxic respiratory failure, NIV is much less effective, and the immediate improvement of $PaO_2/FIO_2$ ratio at 0.5h after application is thought to be a predictor of successful NIV.