• Journal of Yeungnam Medical Science
• /
• v.24 no.2
• /
• pp.206-215
• /
• 2007

Background : The prone position is often used for operations involving the spine and provides excellent surgical access. The complications associated with the prone position include ocular and auricular injuries, and musculoskeletal injuries. In particular, the prone position during general anesthesia causes hemodynamic changes. To evaluate the cardiovascular effects of the prone position in surgical patients during general anesthesia, we investigated the effects on hemodynamic change of the prone position with the Jackson spinal surgery table. Materials and Methods : Thirty patients undergoing spine surgery in the prone position were randomly selected. After induction of general anesthesia, intra-arterial and central venous pressures (CVP) were monitored and cardiac output was measured by $NICO^{(R)}$. We measured stroke volume, cardiac index, cardiac output, mean arterial pressure, heart rate, CVP and systemic vascular resistance (SVR) before changing the position. The same measurements were performed after changing to the prone position with the patient on the Jackson spinal surgery table. Results : In the prone position, there was a significant reduction in stroke volume, cardiac index and cardiac output. The heart rate, mean arterial pressure and CVP were also decreased in the prone position but not significantly. However, the SVR was increased significantly. Conclusion : The degree of a reduced cardiac index was less on the Jackson spinal surgery table than other conditions of the prone position. The reduced epidural pressure caused by free abdominal movement may decrease intraoperative blood loss. Therefore, the Jackson spinal surgery table provides a convenient and stable method for maintaining patients in the prone position during spinal surgery.

• Journal of Chest Surgery
• /
• v.41 no.1
• /
• pp.41-48
• /
• 2008

Background: Accurate assessment of the preload and the fluid responsiveness is of great importance for optimizing cardiac output, especially in those patients with coronary artery occlusive disease (CAOD). In this study, we evaluated the relationship between the parameters of preload with the changes in the stroke volume index (SVI) after fluid loading in patients who were undergoing coronary artery bypass grafting (CABG). The purpose of this study was to find the predictors of fluid responsiveness in order to assess the feasibility of using. certain parameters of preload as a guide to fluid therapy. Material and Method: We studied 96 patients who were undergoing CABG. After induction of anesthesia, the hemodynamic parameters were measured before (T1) and 10 min after volume replacement (T2) by an infusion of 6% hydroxyethyl starch 130/0.4 (10 mL/kg) over 20 min. Result: The right ventricular end-diastolic volume index (RVEDVI), as well as the central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP), failed to demonstrate significant correlation with the changes in the SVI (%). Only the right ventricular ejection fraction (RVEF) measured at T1 showed significant correlation. with the changes of the SVI by linear regression (r=0.272, p=0.017). However, when the area under the curve of receiver operating characteristics (ROC) was evaluated, none of the parameters were over 0.7. The volume-induced increase in the SVI was 10% or greater in 31 patients (responders) and under 10% in 65 patients (non-responders). None of the parameters of preload measured at T1 showed a significant difference between the responders and non-responders, except for the RVEF. Conclusion: The conventional parameters measured with a volumetric pulmonary artery catheter failed to predict the response of SVI following fluid administration in patients suffering with CAOD.

• Journal of Chest Surgery
• /
• v.40 no.1 s.270
• /
• pp.45-51
• /
• 2007

Background: Although echocardiography is usually used for quantitative assessment of left ventricular function, the recently developed 16-slice multidetector computed tomography (MDCT) is not only capable of evaluating the coronary arteries but also left ventricular function. Therefore, the objective of our study was to compare the values of left ventricular function quantified by MDCT to those by echocardiography for evaluation of its regards to clinical applications. Material and Method: From 49 patients who underwent MDCT in our hospital from November 1, 2003 to January 31, 2005, we enrolled 20 patients who underwent echocardiography during the same period for this study. Left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), stroke volume index (SVI), left ventricular mass index (LVMI), and ejection fraction (EF) were analyzed. Result: Average LVEDVI ($80.86{\pm}34.69mL$ for MDCT vs $60.23{\pm}29.06mL$ for Echocardiography, p<0.01), average LVESVI ($37.96{\pm}24.52mL$ for MDCT vs $25.68{\pm}16.57mL$ for Echocardiography, p<0.01), average SVI ($42.90{\pm}15.86mL$ for MDCT vs $34.54{\pm}17.94mL$ for Echocardiography, p<0.01), average LVMI ($72.14{\pm}25.35mL$ for MDCT vs $130.35{\pm}53.10mL$ for Echocardiography, p<0.01), and average EF ($55.63{\pm}12.91mL$ for MOCT vs $59.95{\pm}12.75ml$ for Echocardiography, p<0.05) showed significant difference between both groups. Average LVEDVI, average LVESVI, and average SVI were higher in MDCT, and average LVMI and average EF were higher in echocardiogram. Comparing correlation for each parameters between both groups, LVEDVI $(r^2=0.74,\;p<0.0001)$, LVESVI $(r^2=0.69,\;p<0.0001)$ and SVI $(r^2=0.55,\;p<0.0001)$ showed high relevance, LVMI $(r^2=0.84,\;p<0.0001)$ showed very high relevance, and $EF (r^2=0.45,\;p=0.0002)$ showed relatively high relevance. Conclusion: Quantitative assessment of left ventricular volume and function using 16-slice MDCT showed high relevance compared with echocardiography, therefore may be a feasible assessment method. However, because the average of each parameters showed significant difference, the absolute values between both studies may not be appropriate for clinical applications. Furthermore, considering the future development of MDCT, we expect to be able to easily evaluate the assessment of coronary artery stenosis along with left ventricular function in coronary artery disease patients.

• The Korea Journal of Herbology
• /
• v.23 no.2
• /
• pp.159-168
• /
• 2008

Objectives : The present study has been undertaken to investigate the effects of Dipsaci Radix on Muscle Fiber Atrophy and MyoD Expression in Gastrocnemius of MCAO Rats Methods : In order to investigate effects of Dipsaci radix on the skeletal muscle atrophy following stroke, cerebral infarct was induced by the middle cerebral artery occlusion (MCAO) in the rats. Water extract of Dipsaci radix (184.4 mg/100 g) was treated for 4 weeks, once a day orally, after the MCAO. Effects were evaluated with muscle fiber type composition and cross-sectioned area of muscle fibers in gastrocnemius of the unaffected & affected hind limbs. And MyoD protein expression in gastrocnemius was demonstrated with immunohistochemistry and western blotting. Results : Obtained results were as follows; 1. Infarct volume was not attenuated by Dipsaci radix treatment in the MCAO rats. 2. At the affected-side hind limb of the MCAO rats, the increase of type-I fibers and the decrease of type-II fibers were induced by Dipsaci radix treatment. 3. At the affected-side hind limb of the MCAO rats, decreases of cross-sectioned areas of type-I and type-II fibers were attenuated by Dipsaci radix treatment. 4. At the affected-side hind limb of the MCAO rats, MyoD positive cells were increased by Dipsaci radix treatment. 5. At the affected-side hind limb of the MCAO rats, MyoD expressions were increased by Dipsaci radix treatment. Conclusions : These results suggest that Dipsaci radix has a protective effect against muscle atrophy, through the inhibition of the muscle cell apoptosis, following the central nervous system demage.

• Journal of Life Science
• /
• v.22 no.2
• /
• pp.148-155
• /
• 2012

A cross-sectional analysis of blood pressure (BP) changes and the current prevalence and distribution of hypertension among age groups in Korea were conducted. Systolic (SBP), diastolic (DBP), and pulse (PP) pressures were evaluated. Residents visiting a local Community Health Center for a health check-up and/or participating in the Health Promotion Program were included for the analyses. A total of 6,570 subjects (2,809 men, 3,761 women) were divided into five age groups: 30-39, 40-49, 50-59, 60-69, and $70\leq$ years. Comparisons were made between sex and among age groups. SBP and DBP were continuously elevated, while men showed higher levels than women until their mid-60s; then, the trend was reversed. DBP in men became elevated from their 30s, reaching the highest in the 40s then slowly decreasing. DBP in women increased up to their 40s and 50s, then reached a plateau. PP increased rapidly from the 50s in both sexes. The major contributor of age-related BP elevation may be large artery stiffness in men, particularly from their 50s, while the blood pressure elevation of women may relate to diverse factors including large artery stiffness, stroke volume, and ventricular ejection rate. The rapid elevation of PP after the 50s in both men and women could represent a risk of cardiovascular or coronary mortality, particularly with increasing age. The current data showed a higher rate of hypertension in both sexes compared to previous reports. When those with both high-normal BP and hypertension are looked at in combination, BP management of the target population should be drastically elevated.

• The Korean Journal of Physiology and Pharmacology
• /
• v.17 no.6
• /
• pp.499-503
• /
• 2013

This study tested the hypothesis that effects of the menstrual cycle on resting blood pressure carry over to dynamic exercise. Eleven healthy females were studied during the early (EP; low estrogen, low progesterone) and late follicular (LP; high estrogen, low progesterone) menstrual phases. Stroke volume (SV), heart rate (HR), cardiac output (CO), systolic blood pressure (SBP), diastolic blood pressure (DBP), and total vascular conductance (TVC) were assessed at rest and in response to mild and moderate cycling exercise during EP and LP. During EP, compared to LP, baseline SBP ($111{\pm}1$ vs. $103{\pm}2$ mmHg), DBP ($71{\pm}2$ vs. $65{\pm}2$ mmHg) and mean arterial pressure (MAP) ($84{\pm}2$ vs. $78{\pm}1$ mmHg) were higher and TVC ($47.0{\pm}1.5$ vs. $54.9{\pm}4.2$ ml/min/mmHg) was lower (p<0.05). During exercise, absolute values of SBP (Mild: $142{\pm}4$ vs. $127{\pm}5$ mmHg; Moderate: $157{\pm}4$ vs. $144{\pm}5$ mmHg) and MAP (Mild: $100{\pm}3$ vs. $91{\pm}3$ mmHg; Moderate: $110{\pm}3$ vs. $101{\pm}3$ mmHg) were also higher, while TVC was lower (Mild: $90.9{\pm}5.1$ vs. $105.4{\pm}5.2$ ml/min/mmHg; Moderate: $105.4{\pm}5.3$ vs. $123.9{\pm}8.1$ ml/min/mmHg) during EP (p<0.05). However, exercise-induced increases in SBP, MAP and TVC at both work intensities were similar between the two menstrual phases, even though norepinephrine concentrations were higher during LP. Results indicate that blood pressure during dynamic exercise fluctuates during the menstrual cycle. It is higher during EP than LP and appears to be due to additive effects of simultaneous increases in baseline blood pressure and reductions in baseline TVC.

• Journal of Korean Neurosurgical Society
• /
• v.61 no.2
• /
• pp.267-276
• /
• 2018

Objective : The beneficial effect of hypothermia after hemicraniectomy in malignant middle cerebral artery (MCA) infarction has been controversial. We aim to investigate the safety and clinical efficacy of hypothermia after hemicraniectomy in malignant MCA infarction. Methods : From October 2012 to February 2016, 20 patients underwent hypothermia (Blanketrol III, Cincinnati Sub-Zero, Cincinnati, OH, USA) at $34^{\circ}C$ after hemicraniectomy in malignant MCA infarction (hypothermia group). The indication of hypothermia included acute cerebral infarction >2/3 of MCA territory and a Glasgow coma scale (GCS) score <11 with a midline shift >10 mm or transtentorial herniation sign (a fixed and dilated pupil). We retrospectively collected 27 patients, as the control group, who had undergone hemicraniectomy alone and simultaneously met the inclusion criteria of hypothermia between January 2010 and September 2012, before hypothermia was implemented as a treatment strategy in Dong-A University Hospital. We compared the mortality rate between the two groups and investigated hypothermia-related complications, such as postoperative bleeding, pneumonia, sepsis and arrhythmia. Results : The age, preoperative infarct volume, GCS score, National institutes of Health Stroke Scale score, and degree of midline shift were not significantly different between the two groups. Of the 20 patients in the hypothermia group, 11 patients were induced with hypothermia immediately after hemicraniectomy and hypothermia was initiated in 9 patients after the decision of hypothermia during postoperative care. The duration of hypothermia was $4{\pm}2days$ (range, 1 to 7 days). The side effects of hypothermia included two patients with arrhythmia, one with sepsis, one with pneumonia, and one with hypotension. Three cases of hypothermia were discontinued due to these side effects (one sepsis, one hypotension, and one bradycardia). The mortality rate of the hypothermia group was 15.0% and that of the control group was 40.7% (p=0.056). On the basis of the logistic regression analysis, hypothermia was considered to contribute to the decrease in mortality rate (odds ratio, 6.21; 95% confidence interval, 1.04 to 37.05; p=0.045). Conclusion : This study suggests that hypothermia after hemicraniectomy is a viable option when the progression of patients with malignant MCA infarction indicate poor prognosis.

• International Journal of Automotive Technology
• /
• v.8 no.4
• /
• pp.437-444
• /
• 2007

This paper experimentally investigates the effects of oxygen-enriched air (OEA) on the running behaviors of an LPG SI engine during both start/warm-up (SW) and hot idling (HI) stages. The experiments were performed on an air-cooled, single-cylinder, 4-stroke, LPG SI engine with an electronic fuel injection system and an electrically-heated oxygen sensor. OEA containing 23% and 25% oxygen (by volume) was supplied for the experiments. The throttle position was fixed at that of idle condition. A fueling strategy was used as following: the fuel injection pulse width (FIPW) in the first cycle of injection was set 5.05 ms, and 2.6 ms in the subsequent cycles till the achieving of closed-loop control. In closed-loop mode, the FIPW was adjusted by the ECU in terms of the oxygen sensor feedback. Instantaneous engine speed, cylinder pressure, engine-out time-resolved HC, CO and NOx emissions and excess air coefficient (EAC) were measured and compared to the intake air baseline (ambient air, 21% oxygen). The results show that during SW stage, with the increase in the oxygen concentration in the intake air, the EAC of the mixture is much closer to the stoichiometric one and more oxygen is made available for oxidation, which results in evidently-improved combustion. The ignition in the first firing cycle starts earlier and peak pressure and maximum heat release rate both notably increase. The maximum engine speed is elevated and HC and CO emissions are reduced considerably. The percent reductions in HC emissions are about 48% and 68% in CO emissions about 52% and 78%; with 23% and 25% OEA, respectively, compared to ambient air. During HI stage, with OEA, the fuel amount per cycle increases due to closed-loop control, the engine speed rises, and speed stability is improved. The HC emissions notably decrease: about 60% and 80% with 23% and 25% OEA, respectively, compared to ambient air. The CO emissions remain at the same low level as with ambient air. During both SW and HI stages, intake air oxygen enrichment causes the delay of spark timing and the increased NOx emissions.

• Journal of Veterinary Clinics
• /
• v.32 no.5
• /
• pp.422-425
• /
• 2015

This study evaluated the myocardial performance on echocardiography after the sedation/anesthesia of medetomidine (D), the combination of medetomidine and tiletamine/zolazepam (DZ), and the combination of medetomidine, tiletamine/zolazepam and tramadol (DZT) in Beagle dogs. Ten healthy adult Beagle dogs (weighing $8.6{\pm}1.0kg$) were enrolled in this study. Heart rate (HR), fractional shortening (%FS), left ventricular ejection fraction (%LVEF), stroke volume (SV), cardiac output (CO), left ventricular internal diameter in systole (LVIDs) and left ventricular internal diameter in diastole (LVIDd) using M-mode echocardiography were measured prior to anesthesia, then every 10 min for 60 min. The HR, %FS, %LVEF, SV and CO were significantly decreased during sedation/anesthesia with D, DZ and DZT combination of anesthesia. Although those anesthetic protocols provided acceptable quality of sedation/anesthesia, levels of cardiovascular suppression were substantial and persistent and thus the continuous monitoring on vital signs should be accompanied in any situation. Close attention is required for dogs with pre-existing heart diseases, when those anesthetic protocols were applied.

• Journal of Korean Medical classics
• /
• v.29 no.1
• /
• pp.17-41
• /
• 2016

Subjects : A literature research on the constitution and medicinal effect & adaptation diseases of "Bullsusan". "Bullsusan" is a herbal prescription composed of Angelicae Gigantis Radix(當歸) and Cnidii Rhizoma(川芎). Objectives : Through the researching on the records of "Bullsusan" in Korean Traditional Medical Books, gain the literature evidence for adaptation to these days child labor as a pre-labor keeping herbal medicine. And have detailed consideration on the constitution of prescription and medicinal effect & adaptation diseases of "Bullsusan". Methods : First, researched the records of "Bullsusan" in Korean Traditional Medical Books which were included at A Series of Korean Medicine(韓國醫學大系) and analysed component ratio, nickname, herbal manufacture and drug processing method, medicinal effect and adaptation diseases. Second, referred related Korean and Chinese researches that examined the medicinal effect and adaptation diseases of "Bullsusan" by scientific experimentation. Conclusions : We found total 46 records of "Bullsusan" from 20 kinds of Korean Traditional Medical Books included at A Series of Korean Medicine. Prescription component ratio of Angelicae Gigantis Radix and Cnidii Rhizoma were 3:2, 1:1, 2:1, 1:1. 3:2 had most 20 records and 1:1 had second 14 records. Especially 1:1 had a tendency of having nickname "Goonguitang", but not must had. First herbal manufacture was powder, it had 8 records. First drug processing method was decocting with water and alcohol, had 19 records. Medical Effects of "Bullsusan" can be induced to next 8, that were "remove get bad blood, give birth new blood", "easy labor by reducing fetal volume", "acceleration of labor", "test of fetal survival, elimination of dead embryo", "elimination of placenta", "revive", "allaying pain", "nourish the blood". From these medical effects, 9 adaptation diseases can be induced. That were "threatened abortion", "womb ache and vaginal bleeding by spontaneous abortion", "pre-labor keeping(prevention of hard labor)", "acceleration of labor", "hard labor", "missed abortion", "postnatal vaginal bleeding, dizziness, asthma, headache, womb ache", "postnatal mastoptosis and mastodynia", "first aid symptom like as dizziness, unconsciousness, stroke caused by excessive bleeding". The medical effect of "acceleration of labor" and "elimination of placenta" have been examined by modern clinical research. The effect of "remove get bad blood, give birth new blood", "allaying pain" and "nourish the blood" have been examined by modern experimental study. But overdosing on "Bullsusan" to pregnant mouse can cause natural abortion, so the proper dose of "Bullsusan" in pregnant period is very important.