• Journal of Korea Entertainment Industry Association
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• v.13 no.2
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• pp.271-277
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• 2019

As a means of treatment for people with disabilities, there is a growing interest in horse riding. Horse riding improves physical conditions such as muscles, joints, and cardiopulmonary function, alleviates tension, and encourages confidence through large animals such as horses. The various therapeutic effects of therapeutic horse riding have been recognized by many medical professionals, including the American Occupational Therapy and Physical Therapy Association. On the other hand, in Korea, there is not yet a scientific basis for the therapeutic effects of specific diseases or clinical treatments. The purpose of this study was to investigate the possibility of rehabilitation related professional worker's therapeutic horse riding. Recognition and use experience of therapeutic horse riding were generally low, but doctors who wanted to use it when the expectation of effectiveness and therapeutic horse riding education were assumed were relatively high. Based on these results, it can be confirmed that the therapeutic horse riding will be recognized as a clinical treatment method in the future.

• Journal of Chest Surgery
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• v.35 no.10
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• pp.712-723
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• 2002

Substantial alterations in cerebral blood flow(CBF) are known to occur during cardiopulmonary bypass(CPB). Many investigators have speculated that these changes may be responsible for both minor and major cerebral damages after CPB. More recently, these changes in CBF have been observed to be intimately related to the arterial carbon dioxide tension(Pa$CO_2$) maintained during CPB. The present study was prospectively designed to investigate the clinical effects of normocapnic and hypercapnic CPB on the cerebral oxygen metabolism in cardiac surgery Material and Method: Thirty-six adult patients scheduled for elective cardiac surgery were randomized to either normocapnic group (Pa$CO_2$35~40 mmHg, n＝18) or hypercapnic group(Pa$CO_2$, 45~55 mmHg, n＝18) with moderately hypothermic nonpulsatile CPB(nasopharyngeal temperature of 29~3$0^{\circ}C$). In each patient, middle cerebral artery blood flow velocity( $V_{MCA}$), cerebral arteriovenous oxygen content difference (C(a-v) $O_2$), cerebral oxygen extraction(COE), cerebral metabolic rate for oxygen(CMR $O_2$), cerebral oxygen transport( $T_{E}$ $O_2$), $T_{E}$ $O_2$/CMR $O_2$ ratio, cerebral desaturation(internal jugular bulb blood oxygen saturation $\leq$ 50%), and arterial and jugular bulb blood gas were evaluated throughout the operation. Postoperative neuropsychologic complications were assessed in all patients. All variables were compared between the two groups. Result: VMCA(169.13 $\pm$ 8.32 vs 153.11 $\pm$8.98%), TE $O_2$(1,911.17$\pm$250.14 vs 1,757.40$\pm$249.56), $T_{E}$ $O_2$,/CMR $O_2$ ratio(287.38$\pm$28.051 vs 246.77$\pm$25.84), $O_2$ tension in internal jugular bulb (41.66$\pm$9.19 vs 31.50$\pm$6.09 mmHg), and $O_2$saturation in internal jugular bulb(68.97$\pm$10.96 vs 58.12$\pm$12.11%) during CPB were significantly lower in normocapnic group(p＝0.03), whereas hypercapnic group had lower C(a-v) $O_2$(3.9$\pm$0.3 vs 4.9$\pm$0.3 mL/dL), COE(0.3$\pm$0.03 vs 0.4$\pm$0.03), CMR $O_2$(5.8 $\pm$0.5 vs 6.8$\pm$0.6), and arterial blood pH(7.36$\pm$0.09 vs 7.46$\pm$0.07, p＝0.04) during CPB. Hypercapnic group had lower incidence of cerebral desaturation than normocapnic group(3 vs 9 patients, p=0.03). Duration of the neuropsychologic complication(delirium) were shorter in hypercapnic group than in normocapnic group(36 vs 60 hrs, p＝0.009). Conclusion: These findings suggest that hypercapnic CPB may have salutary effects on the cerebral oxygen metabolism and postoperative neurologic outcomes in cardiac surgery.surgery.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.473-479
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• 2009

Background: Retrograde autologous priming (RAP) is known to be useful in decreasing the need of transfusions in cardiac surgery because it prevents excessive hemodilution due to the crystalloid priming of cardiopulmonary bypass circuit. However, there are also negative side effects in terms of blood conservation. We analyzed the intraoperative blood-conserving effect of RAP and also investigated the efficacy of autotransfusion and ultrafiltration as a supplemental method for RAP. Material and Method: From January 2005 to December 2007, 117 patients who underwent isolated coronary artery bypass operations using cardiopulmonary bypass (CPB) were enrolled. Mean age was 63.9$\pm$9.1 years (range 36$\sim$83 years) and 34 patients were female. There were 62 patients in the RAP group and 55 patients in he control group. Intraoperative autotransfusion was performed via the arterial line. RAP was done just before initiating CPB using retrograde drainage of the crystalloid priming solution. Both conventional (CUF) and modified (MUF) ultrafiltrations were done during and after CPB, respectively. The transfusion threshold was less than 20% in hematocrit. Result: Autotransfusions were done in 79 patients (67.5%) and the average amount was 142.5$\pm$65.4 mL (range 30$\sim$320 mL). Homologous red blood cell (RBC) transfusion was done in 47 patients (40.2%) and mean amount of transfused RBC was 404.3$\pm$222.6 mL. Risk factors for transfusions were body surface area (OR 0.01, 95% CI 0.00 $\sim$ 0.63, p=0.030) and cardiopulmonary bypass time (OR 1.04, 95% CI 1.01 $\sim$ 1.08, p=0.019). RAP was not effective in terms of the rate of transfusion (34.5% vs 45.2%, p=0.24). However, the amount of transfused RBC was significantly decreased (526.3$\pm$242.3ml vs 321.4$\pm$166.3 mL, p=0.001). Autotransfusion and ultrafiltration revealed additive and cumulative effects decreasing transfusion amount (one; 600.0$\pm$231.0 mL, two; 533.3$\pm$264.6 mL, three; 346.7$\pm$176.7 mL, four; 300.0$\pm$146.1 mL, p=0.002). Conclusion: Even though RAP did not appear to be effective in terms of the number of patients receiving intraoperative RBC transfusions, it could conserve blood in terms of the amount transfused and with the additive effects of autotransfusion and ultrafiltration. If we want to maximize the blood conserving effect of RAP, more aggressive control will be necessary - such as high threshold of transfusion trigger or strict regulation of crystalloid infusion, and so forth.

• Tuberculosis and Respiratory Diseases
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• v.39 no.6
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• pp.511-516
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• 1992

Background: It is well known that cigarette smoking is the risk factor of lung cancer, chronic obstructive pulmonary disease and ischemic heart disease. But there are few reports about the immediate effect of cigarette smoking on the cardiopulmonary functions. The serum level of carbon monoxide increases during cigarette smoking. It is known that carbon monoxide increases respration rate, heart rate and cardiac output, with decrease in maximal oxygen consumption. So we have studied to determine the immediate effects of cigarette smoking on the cardiopulmonary function during exercise. Method: Thirteen healthy smoking male subjects were included in this study. Each subject was undertaken pulmonary function test and incremental exercise test on two separate days, one without smoking (control) and the other after smoking three cigarettes per hour for five hours. The order of the two tests was randomized. Results: 1) The mean age of the subjects was $25{\pm}4.9$ year-old and the mean smoking history was $6{\pm}5$ pack years. 2) The mean blood level of carbon monoxide on the smoking day was higher than that on the nonsmoking day ($5.97{\pm}1.34%$ vs. $1.45{\pm}0.83%$; p<0.01). 3) The mean maximal oxygen consumption on the smoking day was lower than that on the nonsmoking day ($2.09{\pm}0.32$ L/min vs. $2.39{\pm}0.32$ L/min; p<0.05). 4) The mean anaerobic threshold on the smoking day was lower than that on the nonsmoking day ($1.33{\pm}0.24$ L/min vs. $1.53{\pm}0.20$ L/min; p<0.05). 5) The mean heart rate at rest on the smoking day was higher than that on nonsmoking day ($84.38{\pm}11.06$ beats/min vs. $75.46{\pm}5.83$ beats/min; p<0.05). But the means of maximal heart rate on both days were not different. 6) The pulmonary function tests were similar on both days. Conclusion: There was no change in pulmonary function test, but the maximal oxygen consumption and anaerobic threshold were decreased on the smoking day. So it was concluded that cigarette smoking impaired the cardiovascular functions immediately during exercise.

• Journal of Chest Surgery
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• v.31 no.9
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• pp.873-876
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• 1998

Background: High-dose aprotinin has been reported to enhance the anticoagulant effects of heparin during cardiopulmonary bypass ; hence, som authors have advocated reducing the dose of heparin in patients treated with aprotinin. Material and Method: The ACT was measured before, during and after cardiopulmonary bypass, with Hemochron 801 system using two activators of celite(C-ACT) and kaolin(K- ACT) as surface activator. From June, 1996 to February, 1997, 22 adult patients who were scheduled for elective operation were enrolled in this study. Result: The ACT without heparin did not differ between C-ACT and K-ACT. At 30 minutes after anticoagulation with heparin and cardiopulmonary bypass, the average C-ACT was 928${\pm}$400 s; K-ACT was 572${\pm}$159s(p<0.05). After administration of protamine, C-ACT was 137${\pm}$26 s; K-ACT was 139${\pm}$28s, which were not statistically significant. Conclusion: Our results showed that the significant increase in the ACT during heparin- induced anticoagulation in the presence of aprotinin was due to the use of celite as surface activator, rather than due to enhanced anticoagulation of heparin by aprotinin. We conclude that the ACT measured with kaolin provides better monitoring of cardiac surgical patients treated with high dose aprotinin than does the ACT measured with celite. The patients treated with aprotinin should receive the usual doses of heparin.

• Journal of Life Science
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• v.16 no.2 s.75
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• pp.192-198
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• 2006

Epidemiological studies have demonstrated an association between exposure to diesel exhaust particles (DEP) and adverse cardiopulmonary effects. Despite the epidemiological proof, the pathogenesis of DEP-related pulmonary diseases remain poorly understood. So, comprehensive in vivo and in vitro researches are required to know the effects of DEP on diverse lung diseases. Alveolar macrophages (AM) and airway epithelial cells are known as important cellular targets in DEP-induced lung diseases. Other studies have shown that nitric oxide (NO) is involved in particle matter induced lung injury. The present study was undertaken to determine whether DEP has an synergistic effects on lipopolysaccharide (LPS)-induced NO formation and inducible nitric oxide synthase (iNOS) with nitrotyrosilated-protein formation in cultured primary alveolar macrophages. The formation of NO was determined through the Griess reaction in the cultured medium and iNOS with nitrotyrosilated-proteins are analyzed by immunohistochemical staining and Western analysis. The results indicate that DEP exposure does not induce NO formation by itself, however DEP showed significant synergistic effects on LPS-induced NO formation. So, our results suggest that DEP inhalation could aggravate inflammatory lung disease through NO formation.

• Journal of Chest Surgery
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• v.31 no.10
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• pp.964-972
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• 1998

Background: The purpose of this study was to independently evaluate the beneficial effects of a high dose of transamine administrated prior to CPB on the postoperative hematologic aspect and bleeding. Materials and methods: This study included randomly selected groups of 40 adult patients undergoing OHS with CPB. All patients were divided into 2 groups: transamine group (T-group, n=20) and placebo group(P-group, n=20). The T-group received a high-dose of transamine(10 g) before and during CPB. The P-group received normal saline at the same times and served as a control group. Results: The results of comparative studies between the 2 groups in the same hematologic variables were summarized as follows. \circled1 During CPB, the fibrinogen concentrations and platelet counts were significantly lower in the P-group than in the T-group(p<0.01). \circled2 During CPB, production of D-dimer occurred in 18 patients(90%) in the P-group and did not occur in the T-group(0%) (p<0.0001). \circled3 At CPB-off, the % concentration of fibrinogen(70.2$\pm$3.9%) and the % platelet counts(72.4$\pm$4.5%) of the T-group were significantly higher than those(54.5$\pm$3.8%, 64.3$\pm$2.9%) of the P-group(p<0.01). \circled4 Postoperative values of PT(14.0$\pm$0.03 sec.) and aPTT (27.6$\pm$0.1 sec.) of the T-group were significantly lower than those(16.0$\pm$0.02sec., 30.1$\pm$0.1sec.) of the P-group(p<0.05). \circled5 Postoperative bleeding and requirement of whole blood and other blood products were significantly less in the T-group than in the P-group(p <0.05). \circled6 There were no significant hypercoagulability signs such as cerebral em bolism, myocardial infarction, pulmonary embolism, or any other neurological prob lems in either group. Conclusions: We concluded that a high dose of transamine administered prior to CPB prevents the activation of fibri nolytic system and has beneficial effects of reducing the postoperative bleeding t endency without apparent hypercoagulability signs.

• Journal of Veterinary Clinics
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• v.29 no.3
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• pp.220-225
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• 2012

This study examined the anesthetic and cardiopulmonary effects of xylazine or medetomidine in combination with ketamine-butorphanol in dogs. Five dogs were used in both the medetomidine-ketamine-butorphanol (MKB) group and the xylazine-ketamine-butorphanol (XKB) group. The procedures for the two groups were performed 4 weeks apart. MKB group showed a shorter duration for anesthesia than XKB group. Other factors were not statistically significant between the two groups. The MKB group showed signs of bradycardia, therefore cautious patient monitoring is necesessary. The XKB showed a longer anesthetic time and less adverse effects, however the MKB combination was more expensive and had less advantages. In conclusion, the results suggested the recommended use of both MKB and XKB in procedures that need approximately 50 minutes. If patients have a risk of bradycardia, one should be cautious of using a medetomidine-xylazine-butorphanol combination. Both MKB and XKB did not have much adverse effects; however MKB did not have advantages when compared to XKB. Therefore, XKB may be more effective when compared to MKB.

• Journal of Chest Surgery
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• v.37 no.10
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• pp.817-826
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• 2004

Background: Several studies have demonstrated that conventional hypothermic cardiopulmonary bypass (CPB) causes cellular injury, abnormal responses in peripheral vascular beds and increased postoperative bleeding, whereas normothermic CPB provides protection of the hypothermic-induced effects and better cardiac recovery. The present study was prospectively performed to compare the effects of normothermic CPB to those of hypothermic CPB on the inflammatory and hematologic responses during cardiac surgery. Material and Method: Thirty-four adult patients scheduled for elective cardiac surgery were randomly assigned to hypothermic CPB (nasopharyngeal temperature $26～28^{\circ}C,$ n=17) or normothermic CPB (nasopharyngeal $temperature>35.5^{\circ}C,$ n=17) group. In both groups, cold $(4^{\circ}C)$ crystalloid cardioplegia was applied for myocardial protection. Blood samples were drawn from radial artery before (Pre-CPB), 10 minutes after starting (CPB-10) and immediately after ending (CPB-OFF) CPB. Total leukocyte and platelet counts, interleukin-6 (IL-6) level(expressed as percent to the baseline of Pre-CPB), D-dimer level, protein C and protein S activity were measured with the blood samples. The amount of bleeding for postoperative 24 hours and blood transfusion after operation were also assessed. All parameters were compared between the two groups. Result: The total leukocyte counts $(10,032\pm65/mm^3)$ and the increased ratio of IL-6 $(353\pm7.0%)$ at CPB-OFF in the normothermic group were higher than that $(7,254\pm48/mm^3$ and $298\pm7.3%)$ of the hypothermic group(p=0.02 and p=0.03). In the normothermic group, protein C activity $(32\pm3.8%)$ and protein S activity $(35\pm4.1%)$ at CPB-OFF were significantly lower than that $(45\pm4.3%$ and $51\pm3.8%)$ of the hypothermic group (p=0.04 and p=0.009). However, there were no differences in platelet counts and D-dimer concentration. In the normothermic group, the amount of bleeding for postoperative 24 hours $(850\pm23.2$ mL) and requirements for blood transfusion after operation such as packed cell $(1,402\pm20.5$ mL), fresh frozen plasma $(970\pm20.8$ mL) and platelet $(252\pm6.4$ mL) were higher than that $(530\pm21.5$ mL, $696\pm15.7$ mL, $603\pm18.2$ mL and $50\pm0.0$ mL) of the hypothermic group. Conclusion: These results indicate that normothermic CPB with cold crystalloid cardioplegia was associated with higher increase in inflammatory response, hemostatic abnormalities and postoperative bleeding problem than moderate hypothermic CPB.

• Journal of Chest Surgery
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• v.13 no.4
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• pp.338-345
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• 1980

We have modified an isolated perfusion rat heart model of cardiopulmonary bypass, with which we are able to screen the effects of various cardioplegic solutions and hypothermia upon the ability of the heart to survivie during and recover from period of ischemic arrest. The modified experimental model was differed from the original as follow : a heat coil chamber of atrial and aortic reservoir provided temperature control, and the perfusate was gassed with each pure oxygen and pure carbon dioxide in 95:5 ratio. The Langendorff perfusion was initiated for a 10 minute period by introducing perfusate at $37^{\circ}C.$ into the aorta from the aortic reservoir located 100 cm above the heart. The isolated perfused working rat heart model was a left heart preparation in which oxygenated perfusion medium (at $37^{\circ}C.$) entered the cannulated left atrium at a pressure of 20 cm $H_{2}O$ and was passed to the ventricle, from which it was sponeously elected(no electrical pacing) via an aortic cannula, against a hydrostatic pressure of 100cm $H_{2}O$. during this working period various indices of cardiac functin were measured. The cardiac functions were stable for over 3 hour with perfusion of Krebs-Henseleit bicarbonate buffer solution containing only glucose (11.1 mM/L). The percentage of cardiac functins were maintained about 94% on heart rate, 80.6% on peak aortic pressure, 87.7% on coronary flow and 76.3% on aortic flow rate after 3 hour of working heart perfusion at a pressure of 20 cm $H_{2}O$. We believe this preparation to be a good biochemical model for the human heart which offers many advantages including economic, speed of preparation, reproducibility, and the ability to handle large numbers.