No abstract available.

BACKGROUND: Hepatocyte growth factor (HGF) is a potent mitogenic cytokine. C-met protein, which is known to be the HGF receptor has transmembrane tyrosine kinase activity and is encoded by the c-met oncogene. The HGF/c-met signaling pathway may play various roles in the carcinogenesis of various organs. METHODS: We examined HGF and c-met mRNA expression by utilizing reverse transcription polymerase chain reaction on 40 surgically resected intracranial meningiomas (25 benign, 10 atypical, and 5 anaplastic cases). RESULTS: An HGF overexpression was detected in 28%, 50%, and 80% of the benign, atypical and anaplastic meningiomas, respectively; a high expression of HGF or the coexpression of HGF/c-met was detected in the high grade meningiomas (the atypical and anaplastic cases, p=0.046, p=0.014). An HGF expression was statistically significant in the recurrent meningiomas (p=0.003), and HGF expression was significantly lower than c-met mRNA expression in benign meningiomas (p=0.034). CONCLUSIONS: There was no correlation between histologic subtypes and HGF/c-met expression. Determination of HGF expression can be used as a molecular predictor for recurrence of meningioimas. These results suggest that HGF and c-met expression in meningiomas may be associated with anaplastic progression.
Hepatocyte Growth Factor ; Hepatocytes ; Meningioma ; Neoplasm Recurrence, Local ; Oncogenes ; Polymerase Chain Reaction ; Protein-Tyrosine Kinases ; Proto-Oncogene Proteins c-met ; Recurrence ; Reverse Transcription ; RNA, Messenger

PURPOSE: There are so many causes of an altered mental status, including acute stroke and nonorganic causes. Making the differential diagnosis and the diagnostic approach for cases with an altered mental status represent a challenge to all emergency physicians. The serum S-100B protein concentration and the neuron-specific enolase (NSE) concentration have been used to evaluate brain damaged patients. We evaluated the usefulness of the serum S-100B protein concentration and the NSE concentration as screening tests for the patients with an altered mentality METHODS: Seventy-eight patients with an altered mentality were included in this prospective study. The patients were divided in two groups. One was the acute stroke group and the other was the non-organic cause group. We analyzed the serum S-100B protein and NSE concentrations of the two groups. We also assessed the correlation of the serum S-100B protein and NSE concentrations with the clinical and laboratory data of the two groups RESULTS: The serum concentration of S-100B was higher in the acute stroke group (median: 0.376, interquartile range: 0.18-1.05) than that in the nonorganic group (0.123, 0.087-0.307, p=0.000). The NSE level was also higher in the acute stroke group (median: 19.12, interquartile range: 14.42-27.19) than that in the non-organic group (13.71, 10.48-19.29, p=0.002). To differentiate the acute stroke group from the non-organic group, the sensitivity and specificity was 81.1% and 61.0%, respectively, at a cutoff value for the serum S-100B protein concentration of 0.14 microgram/L, and these were 81.1% and 51.2%, respectively, at a cutoff value for the serum NSE concentration of 13.71 microgram/L CONCLUSION: Our study suggests that the serum S-100B protein and NSE concentrations may be useful as screening markers for differentiating acute stroke from non-organic causes. However, further studies are needed to evaluate the relationship between the two proteins and the various diseases that have possibility to alter patients' mental status before these two proteins can be used clinically as screening tests.
Brain ; Diagnosis, Differential ; Emergencies ; Humans ; Mass Screening ; Mentally Ill Persons ; Nerve Growth Factors ; Phosphopyruvate Hydratase ; Prospective Studies ; Proteins ; S100 Proteins ; Sensitivity and Specificity ; Stroke

PURPOSE: The aim of this study was to determine the reliability and validity of the Visual Analogue Scale (VAS), as a pain measurement tool in children and adolescents who visit the Pediatric Emergency Department (PED). METHODS: This was a prospective, descriptive study, using convenience sampling, of all children between the ages of 5 and 16 years who presented to a PED. The children were excluded who did not cooperate, who altered mentality or sensorium, who were clinically unstable or required admission to the intensive care unit, or who were developmentally delayed. Children were asked to mark their pain severity on the standardized 100-mm VAS, being instructed to slide the marker to the point on the scale that best described their pain. They were also asked to describe their pain as "none", "mild", "moderate", "severe", or "worst". RESULTS: A total of 716 children and adolescents were enrolled with a mean age of 9.7+/-3.6 years. Males accounted for 439(61.3%). In the children and adolescent who rated their pain as none, (n=10), the mean score was 3.9 mm (95% CI = 0.7 to 7.1); for mild (n=292), the mean score was 30.1 mm (95% CI=28.8 to 31.5); and for moderate pain (n=209) the mean score was 52.4 mm (95% CI=51.2 to 53.6). For those with severe pain (n=187), the mean score was 75.0 mm (95% CI=73.5 to 76.5), and for those who considered their pain the worst (n=18), the mean score was 94.7 mm (95% CI=90.0 to 99.5) (p=0.000). There was no significant relationship between VAS and sex, injury mechanism, or location of pain (p=0.387, p=0.233, p=0.144). The VAS was higher in patients who visited at night on ordinary days (p=0.022) and who were diagnosed with a fracture (71.1+/-20.0 mm) or headache (60.5+/-21.0 mm) (p=0.000). The value was also higher in patients who needed admission (64.9+/-21.5 mm) and an operation (70.7+/-23.0 mm) (p=0.000, p=0.000). CONCLUSION: This study demonstrates the quantification via the VAS of pain severity in children and adolescents who visit to the PED. This scale can be used as a tool for triage, pain management, and deriving a prognosis in the PED.
Adolescent ; Child ; Emergencies ; Headache ; Humans ; Intensive Care Units ; Male ; Pain Management ; Pain Measurement ; Prognosis ; Prospective Studies ; Reproducibility of Results ; Triage

PURPOSE: This study aimed to evaluate the epidemiology of bicycle injuries in Korea. It analyzed the injury severity of bicycle accidents by making a comparison between accidents that originated from bicycle lanes and accidents that originated in other sites since the inception of the Korea Promoting Bicycle Usage Act in 2011. METHODS: We performed a retrospective study on 23,038 cases from January 2011 to December 2014, utilizing the data from the emergent department-based, in-depth injury surveillance system. The main analysis of death was conducted by a multivariate logistic regression, using SPSS statistics ver. 18.0. We also classified bicycle accidents in accordance with the sites of accident bicycle lane and other sites, accident year, age, gender, injury location, activity, helmet use, and alcohol consumption. RESULTS: The entire study population of 23,038 patients were divided into two groups depending on accident site: 4045 from bicycle lane and 18,993 from other accident sites. According to the analysis, the percentage of accidents involving female was significantly higher in bicycle lane than in other accident sites (75.8% vs. 79.3% p<0.001). The highest bicycle accident occurred alone (77.3%) in bicycle lane and 57% in other accident sites. However, motor vehicle crash was significantly higher in other accident sites than in bicycle lane (32.9% vs. 10.2%). The result from a multivariate logistic regression demonstrates that bicycle lanes significantly decreases the severity of mortality on average (odd ratio, 0.46; 95% confidence interval 0.24-0.91). CONCLUSION: We found that bicycle lanes have a significant impact on decreasing not only general accidents caused by bicycles, but also mortality.
Alcohol Drinking ; Bicycling ; Epidemiology ; Female ; Head Protective Devices ; Humans ; Korea* ; Logistic Models ; Mortality ; Motor Vehicles ; Retrospective Studies

Objective: When bike riding under the influence of alcohol, incidence of injury increases, although reports of highly severe injuries is rare. Therefore, this study aimed to determine how drinking alcohol affects bicycle injuries. Methods: This study included patients who visited the emergency departments at 23 hospitals. Participants were enrolled in the emergency department-based injury in-depth surveillance program of the Korea Centers for Disease Control and Prevention, were over 15-years-old, and were injured while riding a bike either with or without alcohol intake.Patients with important data missing or insufficient data such as Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS) were excluded from the analysis. Results: A total of 28,094 patients were analyzed. The alcohol-intake group numbered 1,946 (6.9%) while the non-alcohol-intake group numbered 26,148 (93.1%). The incidence of severe injury (EMR-ISS≥25) in the alcohol-intake group was 451 (23.2%), whereas that in the non-alcohol-intake group was 2,881 (11.0%), which was statistically different between the two groups (P<0.001). According to multivariate logistic regression, the odds ratio of severe injuries in the alcohol-intake group was 2.04 (95% confidence interval, 1.80-2.30) compared to the non-alcohol-intake group after adjusting for age, alcohol use, type of road, sex, injury time, and transportation. Conclusion Alcohol is associated with an increase in the incidence of severe injuries. Therefore, as part of preventive measures, it will be necessary to tighten regulations on post-drinking bike riding and improve awareness through public relations.

Objective: Alcohol consumption is associated with an increased risk of injuries. However, its effects on injury severity and mortality remain unclear. Specifically, the effects of alcohol intake on the severity of slip injuries have not been thoroughly investigated. Therefore, our study aimed to investigate the effects of alcohol intake on injury patterns and severity in patients experiencing slip injuries. Methods: Emergency department surveillance data collected from 2011 to 2016 were analyzed for this study. Among patients aged 15 and older who were admitted for slip injuries, we compared the type and severity of injuries between the alcohol-intake group and the no-alcohol-intake group. Injury severity was classified as non-severe and severe based on the excess mortality ratio-adjusted injury severity score. Results: In total, 227,548 (alcohol-intake, n=48,581; no-alcohol-intake, n=178,967) patients were included. After adjusting for age, time of injury, use of public ambulance, and season, multivariate logistic regression analysis showed that injuries were more likely to be severe in the alcohol-intake group than in the no-alcohol-intake group (odds ratio, 1.60; 95% confidence interval, 1.47–1.75). In addition, male gender and alcohol consumption had a greater synergistic effect on injury severity than the mere sum of each effect of these factors (odds ratio, 2.65; 95% confidence interval, 2.53–2.78). Conclusion Assessment of the patients influenced by alcohol was a challenge in the emergency department due to altered mental status. We suggest a considerate approach in testing and assessing male patients who slipped after alcohol-intake in the emergency department.

PURPOSE: To determine whether analyte levels in serum laboratory tests and arterial blood gas analysis (ABGA) are helpful for differentiating between generalized seizures and syncope in the emergency department (ED). METHODS: Patients over 18 years old who presented to an ED of a tertiary care hospital with a transient loss of consciousness within 4 hours were selected to be in either the seizure (n=166) or syncope groups (n=168). After exclusion for criteria, we used ROC curves to determine AUC, optimal cut-off value, sensitivity, and specificity, depending on time (4 hour, 2 hour, 1 hour and 0.5 hour). We also did multivariate logistic regression. RESULTS: A total of 75 seizure group patients and 78 syncope group patients were studied. There were significant between group differences in total CO2 content, LDH, ammonia, pH, bicarbonate and lactate. AUC (area under the curve) values for blood tests were: 0.720 (tCO2), 0.686 (LDH), 0.737 (ammonia), 0.798 (pH), 0.710 (bicarbonate) and 0.770 (lactate). All AUC values were increased as the time from symptoms to ED arrival was shortened (except for LDH). On multivariate logistic regression analysis, pH (OR=9.587, 95% CI, 2.573-35.723. p=0.001) and ammonia (OR=3.932, 95% CI, 1.324-11.613, p=0.014) were statistically significant independent predictive factors. CONCLUSION: Serum laboratory testing and ABGA, especially serum ammonia and arterial pH, may be helpful for differentiating between generalized seizure and syncope in patients who experience a transient loss of consciousness and who come to the ED within 4 hours after the appearance of symptoms. But further evaluation is needed.
Ammonia ; Area Under Curve ; Bicarbonates ; Blood Gas Analysis ; Diagnosis, Differential ; Emergencies ; Hematologic Tests ; Humans ; Hydrogen-Ion Concentration ; Lactic Acid ; Logistic Models ; ROC Curve ; Seizures ; Sensitivity and Specificity ; Syncope ; Tertiary Healthcare ; Unconsciousness

PURPOSE: The purpose of this article was to evaluate the efficiency of an automated prescription program serving pediatric patients who visited our emergency department. We expected that the program would reduce pediatric patient prescription errors and shorten the length of stay in the emergency department. METHODS: We developed the computerized physician order entry system to serve the pediatric patients visiting the emergency department and recommended that the emergency medicine residents use this program. We compared the rate of error as it affected prescription dosage and length of stay in the emergency department, before and after the program was deployed. We also performed a survey with 20 emergency medicine residents that have used the program. RESULTS: Of the total number of prescriptions filled, the number of prescription dosing errors observed was 40(4.5%) before and 22(2.8%) after the program was deployed. The results of the survey revealed high system usability and satisfaction. However, the length of stay in the emergency department was not affected. CONCLUSION: The computerized physician order entry system for pediatric patients visiting the emergency department was effective in reducing prescription related medical errors.
Emergencies ; Emergency Medicine ; Humans ; Length of Stay ; Medical Errors ; Medical Order Entry Systems ; Prescriptions

Purpose: The purpose of this study was to figure out how PAP (Post-Activation Potentiation) phenomenon affects short-term performance efficiently. Methods: This study was conducted with 18 Taekwondo athletes and 16 healthy adults. By using isokinetic dynamometer, two different intervention, TDP (Top-down program) and BUP (Bottom-up program), were performed to measure isokinetic parameter; (peak torque:PT, total work: TW, average power: AP, and average torque: AT) of knee extensor for intragroup, intergroup comparison and two-way ANOVA. Results: The Taekwondo athletes group showed statistically significant differences in all isokinetic parameters PT, TW, AP, and AT after TDP (p < 0.05). However, in the healthy adult group, the difference in isokinetic parameters according to the exercise sequence was not statistically significant. (p > 0.05). PT and TW at TDP were statistically significant (p < 0.05) when the rate of change in TDP and BUP was compared and analyzed considering the difference in physical ability between the Taekwondo athlete group and the healthy adult group. However, AP and AT were not statistically significant. Finally, when examining the interaction between the two groups and two exercise sequence according to isokinetic parameters, only TW (p < 0.05) showed a statistically significant interaction, while PT (P = 0.099), AP (P = 0.103), and AT (P = 0.096) did not. This study suggests that short-term performance can be improved through the PAP phenomenon when TDP is applied to the Taekwondo group. Conclusion According to our result, for Taekwondo athletes, if the goal is to improve short-term performance just before the main game, we suggest a training program through TDP.