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

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

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An analysis of daily lives of children in Korea, Japan and China (한국, 중국, 일본 유아들의 일상생활에 대한 비교연구)

  • Kisook Lee;Mira Chung;Hyunjung Kim
    • Korean Journal of Culture and Social Issue
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    • v.12 no.5_spc
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    • pp.81-98
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    • 2006
  • The objective of this research is to do a cultural comparison on the daily lives of the children of Korea, Japan and China. To achieve this objective, the questionnares were distributed to the 2940 mothers of children from the ages of 3 to 6 in the countries of Korea, Japan and China. The target audience consisted of 941 mothers living in Seoul and Kyunggi area for Korea, 1007 mothers living in Tokyo for Japan, and 992 mothers living in Beijing for China. As a result of the research, we found out that firstly, although children in general got up anytime between 7:00am to 9:00am and went to bed between 8:00pm and 11:00pm, 61.5% of the Korean children went to bed after 10pm and 16.8% after 11pm. Besides that, we found that compared to 3.51% of Korean children who got up before 6am, 13.41% of Japanese children and 17.24% of Chinese children got up before 6:00am. So we could see that the Korean children got up later and went to bed later than their Japanese and Chinese counterpart. This pattern could also be seen in the average rising time and bed time. Korean children went to bed at 10:00pm and woke up at 7:75am whereas the Japanese children went to bed at 9:28pm and woke up at 7:39am, and the Chinese children went to bed at 9:05pm and woke up at 7:05am. The average sleeping hours for Japanese children was 10.12 hours, 9.50 hours for the Chinese and 9.75 hours for the Korean. As a result, we could see that the Korean children went to bed later, got up later and slept fewer hours than their Japanese and Chinese counterparts. Also, since the rising time and bedtime of the Korean children was later than those of the Chinese and Japanese counterparts, the former s' breakfast and dinner time was also much later. Secondly, we looked at the time children went off to and came back from institutes such as kindergarten and child care centers. The Chinese were earliest at going with average attendance at 7:83am, the Japanese came next at 8:59am and the Korean children were last at 8:90am, whereas the Japanese came first in coming back home at 3:36pm, Korean next at 3:91pm and the Chinese last at 5:46pm. Next when we looked at the hours spent at the kindergartens and child care centers, Japan spent 6.76 hours, Korea 7.01 hours and China spent the longest hours with 9.63 hours. Excluding China where all preschool institutes are centralized into kindergartens, we nest looked at time children went to and came back from the institutes as well as the time spent there. In the case of kindergarten, there was not much difference but in the case of child care centers, the Japanese children went to the child care centers mach earlier and came home later than the Korean children. Also, the time spent at the child care center was much longer for the Japanese than the Korean children. This fact coincides with the Korean mothers' number one wish to the kindergartens and child care centers i.e. for the institutes to prolong their school hours. Thus, the time spent at child care centers for Korea was 7.75 hours, 9.39 hours for Japan and 9.63 hours for China. The time for Korea was comparatively much shorter than that of Japan and China but if we consider the fact that 50% of the target audience was working mothers, we could easily presume that the working parents who usually use the child care centers would want the child care centers to prolong the hours looked after their children. Besides this, the next most wanted wish mothers have towards the child care centers and kindergartens was for those institutes to "look after their children when sick". This item showed high marks in all three countries, and the marks in Korea was especially higher when compared to Japan and China. Thirdly, we looked at the private extracurricular activities of the children. We found that 72.6% of the Korean children, 61.7% of the Japanese children, and 64.6% of the Chinese children were doing private extracurricular activities after attending kindergarten or day care centers. Amongst the private extracurricular activities done by Korean children, the most popular one was worksheet with 51.9% of the children doing it. Drawing (15.20%) and English (11.6%) came next. Swimming (21.95%) was the most popular activity for Japan, with English (17.48%), music (15,79%) and sports (14.70%) coming next. For China, art (30.95%) was first with English (22.08%) and music (19.96%) following next. All three countries had English as the most popular activity related to art and physical activities after school hours, but the rate for worksheet studies was much higher for Korea compared to Japan China. The reason Koreans universally use worksheet in because the parents who buy the worksheet are mothers who have easy access to advertisement or salespeople selling those products. The price is also relatively cheap, the worksheet helps the children to grow the basic learning ability in preparation for elementary school, and it is thought to help the children to build the habit of studying everyday. Not only that but it is estimated that the worksheet education is being conducted because parents can share the responsibility of the children's learning with the worksheet-teacher who make home visits. Looking at the expenses spent on private extracurricular activities as compared to income, we found that China spent 5% of income for activities outside of regular education, Korea 3% and Japan 2%. Fourthly, we looked at the amount of time children spent on using multimedia. The majority of the children in Korea, Japan and China watch television almost every day. In terms of video games, the Japanese children played the games the most, with Korea and China following next. The Korean children used the computer the most, with Japan and China next. The Korean children used about 21.17% of their daily time on computers which is much more than the Japanese who used 20.62% of their time 3 or 4 times a week, or the Chinese. The Chinese children were found to use considerably less time on multimedia compared to the Korean of Japanese.

Studies on the Species Crossabilities in the Genus Pinus and Principal Characteristics of F1 Hybrids (일대잡종송(一代雜種松)의 교배친화력(交配親和力)과 특성(特性)에 관(關)한 연구(硏究))

  • Ahn, Kun Yong
    • Journal of Korean Society of Forest Science
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    • v.16 no.1
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    • pp.1-32
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    • 1972
  • By means of the interspecific hybridization in the Sub-genus Diploxylon of the Genus Pinus, $F_1$ hybrids of Pinus rigida${\times}$elliottii, Pinus rigida${\times}$radiata, P. rigida${\times}$serotina and P. densiflora${\times}$thunbergii had been produced. And on the basis of the crossabilities of these hybrids the taxonomic affinities of these pines were examined. And the needle characteristics of these hybrid and the occurence of phenolic substances in these $F_1$ hybrid were also investigated to see the potential usefulness of these characteristics for the diagnosis of the taxonomic affinity. And, the growth performances of the $F_1$ hybrids have also been compared with those of parental species. In order to contribute to the establishment of the hybrid seed orchard the introgression phenomena between P. densiflora and P. thunbergii in the eastern coastal area have also been investigated along with the investigation of the heterozygosity of plus trees of P. densiflora growing in the clone bank in Suwon. And the results were summarized as follows. 1. On the basis of crossabilities as well as on the taxonomic affinities according to the systems of Shaw, Pilger and Duffield, it has been proven that the parental species of those hybrids are of close affinities and range of the fertile hybrid seed production rate was as high as 28-58% in the best hybrid combination (Table 13). 2. Among those hybrids, the ${\times}$ Pinus, rigiserotina hybrid seemed to be most promising in the growth performance exhibiting 109-155% more volume growth compared to the seed parent with the statistic significance of 1% level (Tables 16 and 17). 3. Notwithstanding the fact that the all of the pollen parents are cold tender, all hybrids exhibit cold hardiness as much as their seed parent and it seems to suggest that the characteristics of cold hardiness were transmitted from the seed parent. 4. Though a striking difference in needle length was observed between the parental species of each hybrid, it was difficult to distinguish each hybrid from their seed parent by the needle length except ${\times}$P. rigiserotina which is characterized by long needle which is 65% more longer than the needle of the seed parent (Table 21). 5. With regard to the anatomical characteristics of needle, the hypoderm is apparently thicker in most of the $F_1$ hybrid pines and the characteristics of resin canals are dominated by medial in most $F_1$ hybrid. And, the fibrovascular bundles were apart as were in their seed parent. Therefore it was found to be possible to distinguish the hybrids pines from their parents by the needle characteristics. And, it is to be noticed that the ${\times}$P. densithunbergii was more close to the pollen parent having RDI value of 0.73 (Fig.l, Table 22). 6. It has been demonstrated that ${\times}$P. rigielliottii, ${\times}$P. rigiradiata and ${\times}$P. rigitaeda have a phenolic substance (No.7) of light yellow at Rf-0.46, same as their seed parent, but no trace of phenolic substance was observed in their pollen parent. This fact will serve as an important criteria for early identification of hybridity in progeny testing. However, the fact that both of ${\times}$P. rigiserotina and ${\times}$P. densithunbergii exhibit the same reactions of phenolic substances as well their parental species seems to indicate the close affinities between the parental species of the respective hybrid (Fig.2, Table 23). 7. The separation and the reaction of phenolic substance developed on TLC were found to be same in the same species showing no variations between the individuals, and no variations due to tree part of sampling, tree age or pollen sources. And the reaction was also observed regardless of the not varied by the kind of developing solvent whether it is Aceton-Chloroform (3:7 v/v) or Benzene-Methanol-Acetic acid (90:16:8 v/v). 8. The introgression phenomena of natural Pinus densifiora stand in both east and west coastal area indicates that the major part of the red pines investigated are all heterozygous and the heterozygosity of pines are higher in the west coast than in the east coast(Tables 24 and 25). 9. Based on the RDI, among the plus trees of Pinus densiflora selected in Korea and Japan as well, no pure P. densiflora has been found. Since all of the sample trees of Pinus densiflora were found to be as heterozygous bearing part of the characteristics of P. thunbergii, those red pines were considered to be natural heterotic hybrid pines(Figs. 3 and 4. Tables 26 and 27).

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