High Pressure Group Research Articles

Experimental study on effect of airway pressure on cardiopulmonary resuscitation

To observe the effect of different airway pressure on ventilation, organ perfusion and return of spontaneous circulation (ROSC) of cardiac arrest (CA) pigs during cardiopulmonary resuscitation (CPR), and to explore the possible beneficial mechanism of positive airway pressure during CPR. Twenty healthy landrace pigs of clean grade were divided into low airway pressure group (LP group, n = 10) and high airway pressure group (HP group, n = 10) with random number table. The model of ventricular fibrillation (VF) was reproduced by electrical stimulation, and mechanical chest compressions and mechanical ventilation (volume-controlled mode, tidal volume 7 mL/kg, frequency 10 times/min) were performed after 8 minutes of untreated VF. Positive end expiratory pressure (PEEP) in LP group and HP group was set to 0 cmH2O and 6 cmH2O (1 cmH2O = 0.098 kPa) respectively. Up to three times of 100 J biphasic defibrillation was delivered after 10 minutes of CPR. The ROSC of animals were observed, and the respiratory parameters, arterial and venous blood gas and hemodynamic parameters were recorded at baseline, 5 minutes and 10 minutes of CPR. The number of animals with ROSC in the HP group was significantly more than that in the LP group (8 vs. 3, P < 0.05). Intrathoracic pressure during chest compression relaxation was negative in the HP group, and its absolute value was significantly lower than that in LP group at the same time [intrathoracic negative pressure peak (cmH2O): -4.7±2.2 vs. -10.8±3.5 at 5 minutes, -3.9±2.8 vs. -6.5±3.4 at 10 minutes], however, there was significantly difference only at 5 minutes of CPR (P < 0.01). Intrathoracic pressure variation during CPR period in the HP group were significantly higher than those in the LP group (cmH2O: 22.5±7.9 vs. 14.2±4.4 at 5 minutes, 23.1±6.4 vs. 12.9±5.1 at 10 minutes, both P < 0.01). Compared to the LP group, arterial partial pressure of oxygen [PaO2 (mmHg, 1 mmHg = 0.133 kPa): 81.5±10.7 vs. 68.0±12.1], venous oxygen saturation (SvO2: 0.493±0.109 vs. 0.394±0.061) at 5 minutes of CPR, and PaO2 (mmHg: 77.5±13.4 vs. 63.3±10.5), arterial pH (7.28±0.09 vs 7.23±0.11), SvO2 (0.458±0.096 vs. 0.352±0.078), aortic blood pressure [AoP (mmHg): 39.7±9.5 vs. 34.0±6.9], coronary perfusion pressure [CPP (mmHg): 25.2±9.6 vs. 19.0±7.6], and carotid artery flow (mL/min: 44±16 vs. 37±14) at 10 minutes of CPR in the HP group were significantly higher (all P < 0.05). Arterial partial pressure of carbon dioxide (PaCO2) in the HP group was significantly lower than that in the LP group at 10 minutes of CPR (mmHg: 60.1±9.7 vs. 67.8±8.6, P < 0.05). Compared to low airway pressure, a certain degree of positive airway pressure can still maintain the negative intrathoracic pressure during relaxation of chest compressions of CPR, while increase the degree of intrathoracic pressure variation. Positive airway pressure can improve oxygenation and hemodynamics during CPR, and is helpful to ROSC.

High Versus Low Blood-Pressure Target in Experimental Ischemic Prolonged Cardiac Arrest Treated with Extra Corporeal Life Support.

There is currently no recommendation for the mean arterial pressure target in the particular setting of Extracorporeal Cardiopulmonary Resuscitation (ECPR) in the first hours following cardiogenic shock complicated by cardiac arrest. This study aimed to assess the effects of two different levels of mean arterial pressure on macrocirculatory, microcirculatory, and metabolic functions. Randomized animal study. University research laboratory. Ventricular fibrillation was induced in 14 male pigs by surgical ligature of the interventricular coronary artery. After 20 min of cardiopulmonary resuscitation, Extracorporeal Life Support (ECLS) was initiated to restore circulatory flow. Thereafter, animals were randomly allocated to a high mean arterial pressure group (High-MAP, 80-85 mm Hg) or to a standard mean arterial pressure group (Standard-MAP, 65-70 mm Hg). Assessments conducted at baseline, immediately following and 6 h after ECLS initiation were focused on lactate evolution, amount of infused fluid, and microcirculatory parameters. There was no significant difference between the two groups at the time of ECLS initiation and at 6 h with regard to lactate levels (High-MAP vs. Standard-MAP: 8.8 [6.7-12.9] vs. 9.6 [9.1-9.8] mmol·l, P = 0.779 and 8.9 [4.3-11.1] vs. 3.3 [2.4-11] mmol·l, P = 0.603). Infused fluid volume did not significantly differ between the two groups (4,000 [3,500-12,000] vs. 5,000 [2,500-18,000] mL, P = 0.977). There was also no significant difference between the two groups regarding renal and liver functions, and sublingual capillary microvascular flow index assessed by Sidestream Dark Field imaging. Compared with a standard mean arterial pressure regimen, targeting a high mean arterial pressure in the first hours of an experimental ECPR model did not result in any hemodynamic improvement nor in a decrease in the amount of infused fluid.

Effects of long time different negative pressures on osteogenic differentiation of rabbit bone mesenchymal stem cells

To investigate the effects of long time different negative pressures on osteogenic diffe-rentiation of rabbit bone mesenchymal stem cells (BMSCs). The rabbit BMSCs were isolated and cultured by density gradient centrifugation. Flow cytometry was used to analyze expression of surface markers. The third passage cells cultured under condition of osteogenic induction and under different negative pressure of 0 mm Hg (control group), 75 mm Hg (low negative pressure group), and 150 mm Hg (high negative pressure group) (1 mm Hg=0.133 kPa), and the negative pressure time was 30 min/h. Cell growth was observed under phase contrast microscopy, and the growth curve was drawn; alkaline phosphatase (ALP) activity was detected by ELISA after induced for 3, 7, and 14 days. The mRNA and protein expressions of collagen type I (COL-I) and osteocalcin (OC) in BMSCs were analyzed by real-time fluorescence quantitative PCR and Western blot. The cultured cells were identified as BMSCs by flow cytometry. The third passage BMSCs exhibited typical long shuttle and irregular shape. Cell proliferation was inhibited with the increase of negative pressure. After induced for 4 days, the cell number of high negative pressure group was significantly less than that in control group and low negative pressure group ( P<0.05), but there was no significant difference between the low negative pressure group and the control group ( P>0.05); at 5-7 days, the cell number showed significant difference between 3 groups ( P<0.05). The greater the negative pressure was, the greater the inhibition of cell proliferation was. There was no significant difference in ALP activity between groups at 3 days after induction ( P>0.05); the ALP activity showed significant difference ( P<0.05) between the high negative pressure group and the control group at 7 days after induction; and significant difference was found in the ALP activity between 3 groups at 14 days after induction ( P<0.05). The greater the negative pressure was, the higher the ALP activity was. Real-time fluorescence quantitative PCR and Western blot detection showed that the mRNA and protein expressions of COL-I and OC protein were significantly higher in low negative pressure group and high negative pressure group than control group ( P<0.05), and in the high negative pressure group than the low negative pressure group ( P<0.05). With the increase of the negative pressure, the osteogenic differentiation ability of BMSCs increases gradually, but the cell proliferation is inhibited.

Low-pressure capnoperitoneum reduces stress responses during pediatric laparoscopic high ligation of indirect inguinal hernia sac: A randomized controlled study.

Background:We aimed to evaluate the effect of different capnoperitoneum pressures on stress responses in pediatric laparoscopic inguinal hernia repair.Methods:In this prospective randomized controlled study, 68 children with indirect inguinal hernia who underwent high ligation of hernia sac were randomly divided into 3 groups: high-pressure group (12 mm Hg, HP group, n = 26); low-pressure group (8 mm Hg, LP group, n = 20); open operation group (OP group, n = 22). Heart rate (HR), blood pressure, and end-tidal CO2 (PetCO2) were recorded, as well as the levels of adrenocorticotropic hormone (ACTH) and cortisol (COR) were measured by ELISAs before operation, during operation, and after operation, respectively.Results:After establishing capnoperitoneum, HR, blood pressure, and PetCO2 were significantly increased in the HP group compared with the OP and LP groups (P < 0.05). Comparing the intraoperatively measured ACTH and COR concentrations of the HP group to the LP group, we noted higher values in the first (P < 0.05). There was no significant difference in the postoperative concentrations of ACTH and COR among the HP, LP, and OP groups.Conclusions:Laparoscopic surgery under LP capnoperitoneum or open operation may reduce stress responses and are superior to HP capnoperitoneum.

Influence of intermittently monitoring on endotracheal tube cuff pressure using handheld pressure gauge

To discuss the influence of intermittently monitoring on endotracheal tube cuff pressure using handheld pressure gauge, and to provide some reference for the clinical work. The experiment was carried out on the model of the glass tube, which was divided into three parts. Each part of the experiment was divided into normal pressure group and high pressure group according to the different inflation pressure target value. The endotracheal tube cuff pressure was determined intermittently by using the transparent tracheal models which had a static diameter of 2 cm. The target press value of normal pressure group was 32 cmH2O (1 cmH2O = 0.098 kPa) while that of high pressure group was 40 cmH2O. The handheld pressure gauge was connected with the indicated cuff through a tee joint, and the pressure in the cuff in both groups was determined. The pressure loss caused by intermittent measurement of the two groups was compared. By switching the tee joint, the pressure loss through the gauge self-structure and the pressure loss when connecting and disconnecting the indicated cuff were determined to analyze the causes of pressure loss caused by intermittent measurement of pressure gauge. The pressure loss caused by intermittent measurement of high pressure group was significantly higher than that of normal pressure group (cmH2O: 15.10±0.43 vs. 10.19±0.45) with statistical significance (t = -24.875, P = 0.000). The pressure loss through the gauge self-structure of high pressure group was also significantly higher than that of normal pressure group (cmH2O: 13.91±0.48 vs. 8.77±0.53), which showed a statistics significance (t = -22.854, P = 0.000). The pressure loss when connecting and disconnecting the indicated cuff of the normal pressure and high pressure groups were (1.33±0.49) cmH2O and (1.23±0.55) cmH2O, respectively, without statistics significance (t = 0.445, P = 0.662). It was figured that the total pressure loss caused by intermittent measurement of the endotracheal intubation cuff was approximately equal to the value of the pressure loss caused by the pressure gauge self-structure and the pressure loss when the indicated cuff was connected and disconnected [normal pressure group: (10.19±0.45) cmH2O ≍ (8.77±0.53) cmH2O + (1.33±0.49) cmH2O, high pressure group: (15.10±0.43) cmH2O ≍ (13.91±0.48) cmH2O + (1.23±0.55) cmH2O]. The intermittently monitoring on endotracheal tube cuff pressure is the main cause of the pressure loss. The total pressure loss consists of the pressure leak from the cuff to the gauge and the pressure leak when connecting and disconnecting the gauge and the indicated cuff during each test. When the pressure in the cuff is increased, it will cause more pressure loss.

大学生与高眼压者眼压与角膜厚度、角膜曲率关系

目的：研究大学生群体以及高眼压群体的中央角膜厚度(CCT)与眼压测量值(IOP)以及角膜曲率的相关性。方法：应用非接触眼压计(NCT)、A超角膜测厚仪UP-1000和验光仪分别测量广州医科大学在校大学生(31例)和广州医科大学附属第二医院眼科门诊高眼压就诊者(22例)的眼压值、角膜厚度和角膜曲率，观察眼压与各参数之间的关系。结果：将正常眼压组和高眼压组数据合并分析，眼压与角膜厚度不相关(Pearson r = 0.129, P = 0.356)；分别分析，两组各自的眼压与角膜厚度也不相关(Pearson r = 0.153, P = 0.410, Pearson r = 0.048, P = 0.832)。将正常眼压组和高眼压组数据合并分析，眼压与角膜曲率不相关(Pearson r = 0.090, P = 0.541)。分别分析，两组各自的眼压与角膜曲率也不相关(Pearson r = 0.194, P = 0.323, Pearson r = −0.01, P = 0.964)。结论：正常眼压组(大学生群体)与高眼压组的眼压与中央角膜厚度以及角膜曲率不相关。 Objective: to study the correlation between intraocular pressure (IOP) and central corneal thick-ness (CCT), corneal curvature in normal intraocular pressure group of college students and high intraocular pressure group. Method: use non-contact tonometer (NCT), a ultrasound pachymeter UP-1000 and automatic optometry instrument to measure IOP, CCT and corneal curvature of college students with normal IOP in Guangzhou Medical University (31 cases) and outpatients with high IOP of the Second Affiliated Hospital of Guangzhou Medical University (22 cases). Results: ag-gregately analysing, there is no significant correlation between IOP and CCT (Pearson, r = 0.129, P = 0.356) as well as between IOP and corneal curvature (Pearson r = 0.090, P = 0.541); separately analysing, the IOP and CCT of two groups had no significant correlation respectively (Pearson r = 0.153, P = 0.410, Pearson r = 0.048, P = 0.832); the IOP and corneal curvature of two groups had no significant correlation respectively (Pearson r = 0.194, P = 0.323 Pearson, r = −0.01, P = 0.964). Conclusions: there is no correlation between the IOP and corneal thickness, corneal curvature in normal intraocular pressure group of college students and high intraocular pressure group.

Excessive Exercise Habits in Marathoners as Novel Indicators of Masked Hypertension.

Background. Excessive exercise such as marathon running increases the risk of cardiovascular events that may be related to myocardial infarction and sudden death. We aimed to investigate that the exercise characteristics can be used as a novel indicator of masked hypertension. Methods. A total of 571 middle-aged recreational male marathoners were assigned to a high blood pressure group (HBPG; n = 214) or a normal blood pressure group (NBPG; n = 357). A graded exercise test was used to examine the hemodynamic response and cardiac events, and the personal exercise characteristics were recorded. Results. Systolic blood pressure and diastolic blood pressure were higher in the HBPG than in the NBPG (p < 0.05, all). The marathon history, exercise intensity, and time were longer and higher, whereas the marathon completion duration was shorter in the HBPG than in NBPG (p < 0.05, all). HBPG showed a higher frequency of alcohol consumption than NBPG (p < 0.05). Conclusion. More excessive exercise characteristics than the normative individuals. If the individuals exhibit high blood pressure during rest as well as exercise, the exercise characteristics could be used as a novel indicator for masked hypertension.

Comparing Hemodynamic Symptoms and the Level of Abdominal Pain in High- Versus Low-Pressure Carbon Dioxide in Patients Undergoing Laparoscopic Cholecystectomy.

The laparoscopic cholecystectomy (LC) is the gold standard to treat gallstone. To view the surgical site in this type of operations better, carbon dioxide is used with a certain pressure. The current study aimed to compare the hemodynamic symptoms and the level of abdominal pain due to using high- and low-pressure carbon dioxide in patients undergoing LC. The current double-blind randomized clinical trial was conducted on 60 patients with the age range of 20-70years old undergoing LC. The first and second groups experienced PaCO2 of 7-10 and 12-14mmHg, respectively. The hemodynamic symptoms, abdominal pain, shoulder-tip pain, nausea and vomiting after the surgery, and the mean of liver function tests were evaluated. Data were analyzed using T test, Chi-square test, and repeated measures ANOVA by SPSS 16. Information of 60 patients in two groups was analyzed. There was a significant difference between the groups regarding the mean of systolic blood pressure (P<0.05). The mean of heart rate was significantly higher in the high-pressure group during surgery and 1h after that (P<0.05). The frequency of pain in shoulder-tip and abdomen was higher in the high-pressure group. Frequency of nausea and vomiting 12h after the surgery between two groups was significant (P<0.05). The mean of alkaline phosphatase was higher in the low-pressure group than the high-pressure group (P<0.05). Considering the good performance and low side effects of low-pressure laparoscopic cholecystectomy compared to those of high-pressure, this method can be replaced by high-pressure in LC.

The importance of a high rectal pressure on strain in constipated patients: implications for biofeedback therapy

A subset of patients with chronic constipation display a relatively high manometric rectal pressure on strain. We hypothesized that these patients represent a unique phenotype of functional defecatory disorder (FDD) and would benefit from undergoing anorectal biofeedback (BF). Of 138 consecutive patients with chronic constipation and symptoms of FDD, 19 were defined as having a high rectal pressure on strain, using a statistically derived cut-off of 78mm Hg. This subset was compared with remaining patients in regard to baseline clinical profile and physiology, and outcome of BF. There was a greater representation of males in the high rectal pressure group. Their constipation score, impact of bowel dysfunction on quality of life and satisfaction with bowel habits did not differ from the remaining patients. Eighty-four percent of patients in the high group successfully expelled the rectal balloon and 95% displayed paradoxical anal contraction on strain (P<.05 compared with the remaining patients). Following BF, 89% of patients in the high group reduced their rectal pressure to normal. End of BF treatment outcomes improved significantly, and to a similar degree, in both groups. We have identified a subgroup of patients with dyssynergic symptoms but without a formal Rome III diagnosis of FDD, who were characterized by a high straining rectal pressure. Although these patients displayed some physiological differences to the patients with lower straining rectal pressure, they suffer similarly. Importantly, we have shown that these patients can respond favorably to anorectal BF.

OS 04-08 THE RELATIONSHIP BETWEEN CHILDHOOD RISK FACTORS AND LONG-TERM ARTERIAL STIFFNESS — A 26-YEAR FOLLOW-UP STUDY

Objective: To explore the relationship between childhood risk factors and long-term arterial stiffness. Design and Method: A baseline survey was carried out in 4623 school children aged 6–15 years in rural areas of Hanzhong city, Shaanxi in 1987. According to three measurements of systolic blood pressure (SBP) in 1987,1989 and 1992, high blood pressure group (HBP group) was defined as SBP ≥ 75 percentile at same age and gender, with SBP < 50 percentile as normal blood pressure group (NBP group). The cohort was followed up again 26-years later (in 2013), At the same time, Blood biochemistry indexes were measured, including fasting glucose, uric acid and blood lipid. Brachial-ankle pulse wave velocity (baPWV) was recorded by noninvasive automatic waveform analyzer. Results: The follow-up rate was 71.6%. HBP group versus NBP group had higher incidence of hypertension (39.5% vs.18.0%, P = 0.001) and baPWV [(1337.2 ± 198.3) vs. (1271.7 ± 204.3) cm/s, P = 0.028] in this follow-up period. Correlation analysis indicated that the follow-up baPWV was positively correlated with childhood SBP and SBP, DBP, body mass index, heart rate, TC, LDL-C, TG, fasting glucose, uric acid in adulthood (all P < 0.05). In stepwise multivariate regression analysis, gender, family history of hypertension, SBP at both baseline and follow-up, fasting glucose and uric acid in adulthood were independent predictive factors of baPWV in adults. Conclusions: Higher SBP in children and adolescents, family history of hypertension and male gender may increase the risk of developing long-term arterial stiffness.

Effect of positive end-expiratory pressure on blood loss during retropubic and robot-assisted laparoscopic radical prostatectomy.

To study the effect of end-expiratory pressure used during anesthesia on blood loss during radical prostatectomy. We evaluated 247 patients who underwent either radical retropubic prostatectomy or robot-assisted laparoscopic prostatectomy at a single institution from 2008 to 2013 by one of four surgeons. Patient characteristics were compared using t-tests, rank sum or χ(2) -tests as appropriate. The association between positive end-expiratory pressure and estimated blood loss was tested using linear regression. Patients were classified into high (≥4 cmH2 O) and low (≤1 cmH2 O) positive-end expiratory pressure groups. Estimated blood loss in radical retropubic prostatectomy was higher in the high positive end-expiratory pressure group (1000 mL vs 800 mL, P = 0.042). Estimated blood loss in robot-assisted laparoscopic prostatectomy was lower in the high positive end-expiratory pressure group (150 mL vs 250 mL, P = 0.015). After adjusting for other factors known to influence blood loss, a 5-cmH2 O increase in positive end-expiratory pressure was associated with a 34.9% increase in estimated blood loss (P = 0.030) for radical retropubic prostatectomy, and a 33.0% decrease for robot-assisted laparoscopic prostatectomy (P = 0.038). In radical retropubic prostatectomy, high positive end-expiratory pressure was associated with higher estimated blood loss, and the benefits of positive end-expiratory pressure should be weighed against the risk of increased estimated blood loss. In robot-assisted laparoscopic prostatectomy, high positive end-expiratory pressure was associated with lower estimated blood loss, and might have more than just pulmonary benefits.

Heated Humidified High Flow Nasal Cannula versus Nasal Continuous Positive Airway Pressure as Primary Mode of Respiratory Support for Respiratory Distress in Preterm Infants.

To compare the outcomes of preterm infants with respiratory distress initiated on either Heated Humidified High Flow Nasal Cannula or Nasal Continuous Positive Airway Pressure as a primary mode of respiratory support. Prospective observational cohort study. Tertiary care level III neonatal intensive care unit. 88 preterm infants between 28 to 34 weeks of gestation with mild to moderate respiratory distress within 6 hours of birth. Eligible infants were treated either with Heated Humidified High Flow Nasal Cannula (n=46) or Nasal Continuous Positive Airway Pressure (n=42). Need for mechanical ventilation within 72 hrs of initiating support. Baseline demographic characteristics were comparable between the two groups. There was no difference in the requirement of mechanical ventilation between Heated Humidified High Flow Nasal Cannula (19.5%) and Nasal Continuous Positive Airway Pressure (26.2%) groups [RD-0.74 (95% CI 0.34-1.62; P =0.46)]. Moderate or severe nasal trauma occurred less frequently with Heated Humidified High Flow Nasal Cannula (10.9%) in comparison to Nasal Continuous Positive Airway Pressure (40.5%) (P= 0.004). Heated Humidified High Flow Nasal Cannula was comparable to Nasal Continuous Positive Airway Pressure as a primary respiratory support for preterm infants with respiratory distress, with lesser incidence of nasal trauma.

The effect of pneumoperitoneum on intravascular fibrinolytic activity in rats.

Venous stasis during pneumoperitoneum in laparoscopic surgery is closely related to fibrin synthesis and deposition. The etiologic factors underlying fibrinolysis or hypercoagulability are not clearly defined. This study aimed to determine the effects of pneumoperitoneum time and pressure on coagulation cascade and the fibrinolytic pathway. After the pneumoperitoneum model was established in rats, PAI-1, tPA, TAFI, D-dimer, and fibrinogen activities were evaluated in different time periods under different pressures in groups including 6 rats. Group 1 did not undergo any procedure. Group 2 received 8 mmHg of pressure for 30 min, Group III 8 mmHg for 60 min, Group IV 12 mmHg for 30 min, and Group V 12 mmHg for 60 min. D-dimer levels had a tendency to decrease with increasing intraabdominal pressures. In both low and high pressure groups, fibrinogen had a tendency to increase with exposure time. There was no statistically significant difference among the study groups in terms of fibrinogen, D-dimer, and PAI-1. The levels of TAFI were significantly decreased with increasing pressure regardless of the exposure time. Pneumoperitoneum of the coagulation system can be changed by duration of time and pressure.

A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds

BackgroundThe management of open fractures requires wound irrigation and débridement to remove contaminants, but the effectiveness of various pressures and solutions for irrigation remains controversial. We investigated the effects of castile soap versus normal saline irrigation delivered by means of high, low, or very low irrigation pressure.MethodsIn this study with a 2-by-3 factorial design, conducted at 41 clinical centers, we randomly assigned patients who had an open fracture of an extremity to undergo irrigation with one of three irrigation pressures (high pressure [>20 psi], low pressure [5 to 10 psi], or very low pressure [1 to 2 psi]) and one of two irrigation solutions (castile soap or normal saline). The primary end point was reoperation within 12 months after the index surgery for promotion of wound or bone healing or treatment of a wound infection.ResultsA total of 2551 patients underwent randomization, of whom 2447 were deemed eligible and included in the final analyses. Reoperation occurred in 109 of 826 patients (13.2%) in the high-pressure group, 103 of 809 (12.7%) in the low-pressure group, and 111 of 812 (13.7%) in the very-low-pressure group. Hazard ratios for the three pairwise comparisons were as follows: for low versus high pressure, 0.92 (95% confidence interval [CI], 0.70 to 1.20; P=0.53), for high versus very low pressure, 1.02 (95% CI, 0.78 to 1.33; P=0.89), and for low versus very low pressure, 0.93 (95% CI, 0.71 to 1.23; P=0.62). Reoperation occurred in 182 of 1229 patients (14.8%) in the soap group and in 141 of 1218 (11.6%) in the saline group (hazard ratio, 1.32, 95% CI, 1.06 to 1.66; P=0.01).ConclusionsThe rates of reoperation were similar regardless of irrigation pressure, a finding that indicates that very low pressure is an acceptable, low-cost alternative for the irrigation of open fractures. The reoperation rate was higher in the soap group than in the saline group. (Funded by the Canadian Institutes of Health Research and others; FLOW ClinicalTrials.gov number, NCT00788398.)

중·노년의 대사증후군과 구강질환 관련성

Objectives: The purpose of the study was to identify the relationship between metabolic syndrome and oral diseases in the middle aged and elderly in Korea. Methods: The study subjects were 6,390 people over 40 years old from 2010 and 2012 Korea National Health and Nutrition Examination Survey. The survey questionnaire consisted of health, nutrition, and oral examination surveys. The independent variables included general characteristics, health behavior, oral health behavior, and metabolic syndrome. The dependent variables included dental caries experience and periodontal disease. The oral examination was carried out by the dentist based on World Health Organization standard. Results: The average prevalence rate of metabolic syndrome MS was 23.79%, including 54.84% of risk group and 21.37% of normal group. The missing teeth rate was 82.38%, DMFT rate was 90.28% and the periodontal disease rate was 33.15%. Those having abnormal fasting blood glucose had 1.17 fold(95% CI: 1.00~1.37) higher periodontal disease than the normal group. The abnormal HDL cholesterol group had 1.25 times higher odds ratio(95% CI: 1.07~1.46) and the obese group had 1.27 times higher odds ratio(95% CI: 1.07~1.51). The risk group had 1.20 times higher odds ration(95% CI: 1.00~1.44) and that of the metabolic syndrome group was 1.60 times higher(95% CI: 1.29~1.97) in periodontal disease. The high blood pressure group had 1.25 times of missing teeth prevalence rate(95% CI: 1.00~1.37). The metabolic syndrome group had 1.47 times of missing teeth prevalence rate(95% CI: 1.11~1.94). Conclusions: The middle aged and elderly people in Korea had higher rate of metabolic syndrome and oral disease. It is necessary to implement the preventive oral health examination for the control of metabolic syndrome and oral diseases prevalence.

Mechanical ventilation after lung transplantation

IntroductionTo explore the hypothesis that early ventilation strategies influence clinical outcomes in lung transplantation, we have examined our routine ventilation practices in terms of tidal volumes (Vt) and inflation pressures. MethodsA total of 124 bilateral lung transplants between 2010 and 2013 were retrospectively assigned to low (<6 mL/kg), medium (6-8 mL/kg), and high (>8 mL/kg) Vt groups based on ventilation characteristics during the first 6 hours after surgery. Those same 124 patients were also stratified to low-pressure (<25 cm H2O) and high-pressure (≥25 cm H2O) groups. ResultsEighty percent of patients were ventilated using pressure control mode. Low, medium, and high Vt were applied to 10%, 43%, and 47% of patients, respectively. After correcting for patients requiring extracorporeal support, there was no difference in short-term to midterm outcomes among the different Vt groups. Low inflation pressures were applied to 61% of patients, who had a shorter length of intensive care unit stay (5 vs 12 days; P = .012), higher forced expiratory volume in 1 second at 3 months (77.8% vs 60.3%; P < .001), and increased 6-month survival rate (95% vs 77%; P = .008). ConclusionLow Vt ventilation has not been fully adopted in our practice. Ventilation with higher inflation pressures, but not Vt, was significantly associated with poorer outcomes after lung transplantation.

Subacute Oxidative Stress and Glial Reactivity in the Amygdala are Associated with Increased Anxiety Following Blast Neurotrauma

Behavioral symptoms, such as anxiety, are widely reported after blast overpressure (BOP) exposure. Amygdalar vulnerability to increasing magnitudes of BOP has not been investigated, and single exposures to blast have been limited to acute (<72 h) assessment. Rats were exposed to a single low, moderate, or high BOP (10, 14, or 24 psi) with an advanced blast simulator to test the susceptibility of the amygdala. Anxiety-like behavior was observed in the low- and moderate-pressure groups when subjected to the light/dark box assessment 7 days after the blast but not in high-pressure group. Immunohistochemistry was performed to measure apoptosis (cleaved caspase-3), neuronal loss (NeuN), reactive astrocytes (glial fibrillary acidic protein), microglia (Iba-1), and oxidative stress (CuZn superoxide dismutase). Slower progression of injury cascades was associated with a significant increase in anxiety, apoptosis, and astrogliosis in the low pressure group compared with others. A significant increase of CuZn superoxide dismutase in the low pressure group could be associated with neuroprotection from cell death caused by oxidative stress because neuronal loss was significant in the moderate- and high- but not the low-pressure group. Overall, this study demonstrated that overpressure as low as 10 psi can induce subacute anxiety, in addition to neuropathologic changes in the amygdala.

Relationships among Achievement Pressure from Parents, Recreational Specialization, Peer Attachment and Mental Health According to Participation into After-School Sport Programs in the Middle School

이 연구의 목적은 2012년 주5일 수업제 실시와 학교체육진흥법 제정 이후 학교현장에서 활성화 되고 있는 스포츠프로그램의 효과를 분석하여 체육교육정책 결정에 필요한 의미 있는 정보를 제공하는 데 있다. 이러한 목적을 달성하기 위하여 서울 및 경기도 지역에 위치한 중학교 재학생들을 대상으로 설문조사를 실시하여 자료를 수집하였다. 수집된 자료를 통계처리하여 다음과 같은 결과가 도출되었다. 첫째, 배경변인(성별, 소재지, 학년)에 따라 부모의 성취압력, 레크리에이션 전문화, 또래애착 및 정신건강에는 부분적인 차이가 있는 것으로 나타났다. 둘째, 스포츠프로그램 참가유무에 따라 부모의 성취압력, 레크리에이션 전문화, 또래애착 및 정신건강에는 부분적인 차이가 있는 것으로 나타났다. 셋째, 부모의 성취압력에 따라 레크리에이션 전문화, 또래애착 및 정신건강 등 모두에 차이가 있는 것으로 나타났다. 넷째, 부모의 성취압력은 학생들의 정신건강에 부정적인 영향을 그리고 레크리에이션 전문화와 또래애착은 긍정적인 영향을 미치는 것으로 나타났다. 스포츠프로그램에 참가유무에 관계없이 부모의 성취압력은 학생들의 정신건강에 부정적인 영향을 그리고 또래애착은 긍정적인 영향을 미치는 것으로 나타났고, 참가자의 레크리에이션 전문화는 정신건강에 긍정적인 영향을 미치는 것으로 나타났다. 이상의 결과로 볼 때, 스포츠프로그램의 참가가 중학생의 정신건강에 미치는 영향은 크지 않는다고 볼 수 있다. 그러나 스포츠종목에 대한 전문화가 정신건강에 긍정적인 영향을 미치고 있기 때문에 추가적인 연구가 요구된다.

0457 : Relationship between balloon release pressure and ST resolution in STEMI patients undergoing primary PCI

The optimal balloon release pressure in primary percutaneous coronary intervention is not well established and use of high pressure may jeopardize ST resolution and increase the occurrence of no reflow. To investigate the relationship between balloon release pressure and ST resolution in STEMI patients undergoing primary PCI. Patients undergoing primary PCI for ST elevation myocardial infarction were enrolled and assigned into two groups according to the stent implantation pressure. High pressure group with a pressure >16 atm. Standard pressure <16 atm. The balloon pressure release was left to the operators’ discretion. No-reflow phenomenon was defined as Σ ST-segment resolution <70% 137 patients were enrolled with a mean age of 56.39 ± 12.8 years. The results showed that no-reflow phenomenon occurred more frequently in the high pressure group 49.32% vs 27%; p = 0.002. Furthermore, the high pressure group showed less ST resolution than the low pressure group with a mean ST-resolution 60.43 ± 25.86 vs 72.35 ± 18.13; p = 0.001 In primary PCI when stenting the culprit lesion, low pressure release may be better in avoiding the no reflow phenomenon

Analysis of changes of intraocular pressure and nursing for vitrectomy with silicone oil tamponade technique

Objective To explore the changes of intraocular pressure and nursing for vitrectomy with silicone oil tamponade technique. Methods Clinical data of 52 patients(52 eyes) with silicone oil tamponade after vitrectomy were retrospectively analyzed and made a summary of nursing care. Results There were 24 patients(46.2%)with high intraocular pressure,and there were 19 patients high intraocular pressure occurrence within 2 weeks. There were no significant differences in sex, age, duration, the amount of refraction and silicone oil tamponade between high and normal intraocular pressure groups(P> 0.05). Conclusion The early high intraocular pressure is common after vitrectomy with silicone oil tamponade technique.Patient's condition observation should be strengthened and prevent from post- operation complications. Key words: Vitrectomy; Silicone oil; Intraocular pressure; Post-operative nursing care