BACKGROUND: No-reflow is a specific type of vascular damage occuring when removal of coronary occlusion dose not lead to restoration of coronary flow. There are three major explanations for the no-reflow phenomenon such as endothelial cell edema, microvascular plugging by platelets or thrombi and coronary occlusion by ischemic contracture of the myocardium. But detailed mechanisms of no-reflow phenomenon are not known. The objects of this study are to elucidate the possibility whether elevation of cytosolic Ca2+ concentration during ischemic cardioplegic period is mechanism of no-reflow phenomenon or not. METHODS: Changes in cytosolic Ca2+ concentration were measured under varying experimental condition. Free [Ca2+] in the cytosole [Ca2+]i of single rabbit coronary artery cells was measured with fluorescent Ca2+ indicator, Fura-2. RESULTS: Resting [Ca2+]i was 134.2+/-34 nM (n=43). When single cells were perfused with cardioplegic or ischemic cardioplegic solution, [Ca2+]i was significantly increased and degree of [Ca2+]i elevation was further augmented by ischemic cardioplegic solution. Pretreatment of sarcoplasmic reticulum emptying agent (20mM caffeine) had no effect on cardioplegia-induced [Ca2+]i change, but application of Ca2+ channel blocker (5x10-7M nifedipine) or an antagonist of Na+/Ca2+ exchange (5mM Ni2+ ) partially (nifedipine) or completely (nickel) inhibited the [Ca2+]i elevation. Pretreament of caffeine had no effect on ischemic cardioplegia-induced [Ca2+]i change, but application of nifedipine or nickel partially inhibited the [Ca2+]i elevation. Magnitude of ischemic cardioplegia-induced [Ca2+]i elevation was dependent on the Ca2+ concentration of perfusate from 0 to 2.5mM. When Ni2+ was added to reperfusion solution, recovery of ischemic cardioplegia-induced [Ca2+]i elevation was very rapid compared with control. CONCLUSIONS: From the above results, it may be speculated that ischemic cardioplegia-induced [Ca2+]i elevation may act as one of the mechanism of no-reflow phenomenon in rabbit coronary artery.
Caffeine ; Cardioplegic Solutions ; Coronary Occlusion ; Coronary Vessels* ; Cytosol* ; Edema ; Endothelial Cells ; Fura-2 ; Ischemic Contracture ; Muscle, Smooth* ; Myocardium ; Myocytes, Smooth Muscle* ; Nickel ; Nifedipine ; No-Reflow Phenomenon ; Reperfusion ; Sarcoplasmic Reticulum

To elucidate the possibility whether an elevation of intracellular Ca2+ concentration ([Ca2+]i) in rabbit coronary artery myocytes during ischemic cardioplegic period may serve as one of the mechanisms of the "no-reflow' phenomenon or not, the changes in [Ca2+]i were measured under ischemic cardioplegia conditions using a fluorescent Ca2+ indicator, fura 2/AM. When single cells were perfused with cardioplegic or ischemic cardioplegic solutions, [Ca2+]i was significantly increased and the degree of [Ca2+] elevation was further augmented by the ischemic cardioplegic solution. Pretreatment of a sarcoplasmic reticulum emptying agent, 20 mM caffeine, had no effect on ischemic cardioplegia-induced [Ca2+]i changes, but application of a Ca2+ channel blocker, 5 x 10 (-1)M nifedipine, or an antagonist of Na+/Ca2+ exchange, 5 mM Ni2+, significantly inhibited the [Ca2+]i elevation, respectively. The magnitude of ischemic cardioplegia-induced [Ca2+]i elevation was dependent on the Ca2+ concentration of perfusate in the range of 0 and 25 mM. When Ni2+ was added to the reperfusion solution, recovery of ischemic cardioplegia-induced [Ca2+]i elevation was very rapid compared with the controls. It is concluded that ischemic cardioplegia-induced [Ca2+]i elevation may serve as one of the mechanisms of the "no-reflow' phenomenon in rabbit coronary artery smooth muscle cells. We propose that Na+/Ca2+ exchange may serve as a key function in ischemic cardioplegia-induced [Ca2+]i elevation.
Animal ; Arteries/metabolism ; Calcium/*metabolism ; Coronary Vessels/*metabolism ; Female ; *Heart Arrest, Induced ; Intracellular Membranes/*metabolism ; Male ; Muscle, Smooth, Vascular/*metabolism/pathology ; Myocardial Ischemia/*metabolism/pathology ; Osmolar Concentration ; Rabbits ; Support, Non-U.S. Gov't

OBJECTIVES: This study aimed to develop a high-risk drinking scorecard using cross-sectional data from the 2014 Korea Community Health Survey. METHODS: Data were collected from records for 149,592 subjects who had participated in the Korea Community Health Survey conducted from 2014. The scorecard model was developed using data mining, a scorecard and points to double the odds approach for weighted multiple logistic regression. RESULTS: This study found that there were many major influencing factors for high-risk drinkers which included gender, age, educational level, occupation, whether they received health check-ups, depressive symptoms, over-moderate physical activity, mental stress, smoking status, obese status, and regular breakfast. Men in their thirties to fifties had a high risk of being a drinker and the risks in office workers and sales workers were high. Those individuals who were current smokers had a higher risk of drinking. In the scorecard results, the highest score range was observed for gender, age, educational level, and smoking status, suggesting that these were the most important risk factors. CONCLUSION: A credit risk scorecard system can be applied to quantify the scoring method, not only to help the medical service provider to understand the meaning, but also to help the general public to understand the danger of high-risk drinking more easily.
Breakfast ; Commerce ; Data Mining ; Depression ; Drinking* ; Health Surveys ; Humans ; Korea* ; Logistic Models ; Male ; Motor Activity ; Occupations ; Research Design ; Risk Factors ; Smoke ; Smoking

PURPOSE: Little is known with respect to changes in the segmental thoracic and thoracolumbar kyphosis, which are major parameters influencing sagittal balance of the spine. The authors investigated the detailed segmental changes of those parameters by ageing. MATERIALS AND METHODS: A total of 326 normal asymptomatic males were divided into 2 groups; group 1 (mean age, 21.2+/-1.7; n=175) and group 2 (mean age, 64.1+/-6.4; n=151). After taking a standing sagittal radiograph, the sagittal spinal and pelvic parameters were measured. Thoracic and thoracolumbar kyphosis were classified according to segments A, C7 UEP (upper end vertebra)-T5 UEP; B, T5 UEP-T10 UEP; C, T10 UEP-T12 LEP (lower end vertebra); and D, (T12 LEP-L2 LEP), and analyzed between 2 groups, respectively. RESULTS: Thoracic kyphosis (21.1degrees+/-7.7degrees vs. 30.0degrees+/-8.8degrees, p<0.001), segment B (15.8degrees+/-6.1degrees vs. 18.1degrees+/-7.9degrees, p=0.003), and segment C (5.3degrees+/-5.1degrees vs. 11.8degrees+/-6.5degrees, p<0.001) were increased in group 2. In group 2 segment A showed decreased kyphosis (12.1degrees+/-6.4degrees vs. 9.8degrees+/-6.4degrees, p=0.001). In segment D no significant difference was observed between groups. CONCLUSION: Increased thoracic kyphosis was observed in the middle and lower thoracic regions. The authors provided important references of sagittal parameters to determine the expected ranges of kyphosis for a normal asymptomatic male of a given age.
Humans ; Kyphosis* ; Male ; Spine ; Thoracic Vertebrae

PURPOSE: The purpose of this study was to investigate current statistics relating to foreigners who visit a Korean emergency department (ED). METHODS: Subjects included in this study were 125,263 patients who visited one Korean ED from January 1, 2008 to December 31, 2010. We divided subjects into two groups, natives (Koreans) and foreigners (non-Koreans). We compared the two groups according to their age, sex, chief medical complaints, department to which they were referred, their final diagnosis, results of treatment applied, ED residence time, mortality rate, total billed cost of treatment, balance of any unpaid bills and method of visiting the ED. RESULTS: Of the total patients included in the study, 119,864 (95.7%) were natives and 5,399 (4.3%) were foreigners. In natives, the majority were 0 to 10 years old (35.1%), while foreigners were mostly 41 to 50 (22.8%) years old. The most common symptom in both natives and foreigners was fever. The most common diagnosis for foreigners was head, face, and neck injury (13.8%). The main referred departments for foreigners were internal medicine (20.1%), pediatric medicine (16.9%), and orthopedics (14.3%). The admission rate for foreigners (13.0%), was lower than that of natives (17.3%). The mortality rate for foreigners (0.5%) was higher than that of natives (0.3%). The ED residence time for foreigners was higher than that of natives. The total billed cost of treatment and balance of unpaid money by foreigners was higher than that of natives. For foreigners, the proportion of medical fees paid from personal accounts and industrial medical insurance were higher than those of natives. CONCLUSION: Medical insurance and policy for the management of foreigners who visit the ED must be improved.
Emergencies ; Emergency Medical Services ; Emigrants and Immigrants ; Fees and Charges ; Fees, Medical ; Fever ; Head ; Humans ; Insurance ; Internal Medicine ; Korea ; Neck Injuries ; Orthopedics ; Population Groups

PURPOSE: This study was performed to evaluate the feasibility of visualizing soft tissue lesions and vascular structures using contrast-enhanced cone-beam computed tomography (CE-CBCT) after the intravenous administration of a contrast medium in an animal model. MATERIALS AND METHODS: CBCT was performed on six rabbits after a contrast medium was administered using an injection dose of 2 mL/kg body weight and an injection rate of 1 mL/s via the ear vein or femoral vein under general anesthesia. Artificial soft tissue lesions were created through the transplantation of autologous fatty tissue into the salivary gland. Volume rendering reconstruction, maximum intensity projection, and multiplanar reconstruction images were reconstructed and evaluated in order to visualize soft tissue contrast and vascular structures. RESULTS: The contrast enhancement of soft tissue was possible using all contrast medium injection parameters. An adequate contrast medium injection parameter for facilitating effective CE-CBCT was a 5-mL injection before exposure combined with a continuous 5-mL injection during scanning. Artificial soft tissue lesions were successfully created in the animals. The CE-CBCT images demonstrated adequate opacification of the soft tissues and vascular structures. CONCLUSION: Despite limited soft tissue resolution, the opacification of vascular structures was observed and artificial soft tissue lesions were visualized with sufficient contrast to the surrounding structures. The vascular structures and soft tissue lesions appeared well delineated in the CE-CBCT images, which was probably due to the superior spatial resolution of CE-CBCT compared to other techniques, such as multislice computed tomography.
Adipose Tissue ; Administration, Intravenous ; Anesthesia, General ; Animals ; Body Weight ; Cone-Beam Computed Tomography* ; Contrast Media* ; Ear ; Femoral Vein ; Models, Animal ; Multidetector Computed Tomography ; Rabbits ; Radiography ; Salivary Glands ; Veins

PURPOSE: This study analyzed QTc prolongation in patients intoxicated from over the counter (OTC) hypnotics compared with prescription hypnotics. METHODS: The medical records of intoxicated patients presented to four emergency centers from January 1, 2010 to December 31, 2010 were retrospectively reviewed. The records of hypnotics overdose patients were selected and investigated for several features: general characteristics, vital signs, past history, ECG findings, treatment methods, ED stay time, drug category and amount, and final results. RESULTS: There were 134 patient cases of OTC hypnotic intoxication (36.9+/-15.1yrs, M:F=37:97), and 270 patient cases of prescription hypnotic intoxication (47.9+/-18.1yrs, M:F=58:212). The ECG QTc upon emergency center admission was 468.4+/-34.8 msec in the OTC hypnotic intoxication group and 449.48+/-26.2 msec in the prescription hypnotic intoxication group (p<0.05). QTc prolongation was noted in 81.3% of patients in the OTC hypnotic intoxication group and 64.1% of patients in the prescription hypnotic intoxication group (p<0.05). CONCLUSION: ECG QTc prolongation was more common from OTC hypnotic intoxication than prescription hypnotics. Close monitoring is therefore recommended for patients who have ingested and overdosed from OTC hypnotics to prevent potentially lethal cardiac toxicity.
Electrocardiography ; Emergencies ; Humans ; Hypnotics and Sedatives* ; Medical Records ; Methods ; Nonprescription Drugs ; Prescriptions* ; Retrospective Studies ; Vital Signs

The mouse model is alleged to be a useful tool for understanding of pathophysiological roles of Helicobacter pylori in the development of gastric disorders. However, it has been observed that H. pylori strains significantly differed in their fitness in mice and even mouse strains differed in their susceptibilities to a H. pylori strain. Bacterial components of H. pylori which could affect on its fitness in mice have to be elucidated for the establishment of the mouse model for H. pylori infections. In the comparison of colonization ability between two H. pylori Korean isolates, 51 (isolated from a patient with duodenal ulcer) and 52 (isolated from a patient with gastric cancer), 52 could colonize better than 51 on the gastric mucosa of mouse. Proteome components of H. pylori 52, as a good colonizer and H. pylori 51, as a poor one were quantitatively compared each other. Five bacterial proteins including catalase, urease subunit alpha/beta, enolase and ferritin, were up-regulated in 52. In addition, the respective proteome components of the two strains were also compared with their mouse-passaged homologous strains. Seven and five proteins, which included catalase, flagellin A/B in common, were up-regulated in mouse-adapted 51 and 52, respectively. Among the fourteen identified proteins, urease subunit alpha/beta, flagellin A/B, catalase, ferritin, superoxide dismutase and neutrophil-activation protein have been previously known to be necessary to gastric colonization of H. pylori in animal models. The other up-regulated proteins including enolase, elongation factor Tu and fructose-bisphosphate aldolase have been reported to be associated with acid tolerance of H. pylori. These data provide confirmatory evidence for the importance of those proteins in the development of H. pylori-associated gastric disorders.
Animals ; Bacterial Proteins ; Catalase ; Colon ; Ferritins ; Flagellin ; Fructose-Bisphosphate Aldolase ; Gastric Mucosa ; Helicobacter ; Helicobacter pylori ; Humans ; Mice ; Models, Animal ; Peptide Elongation Factor Tu ; Phosphopyruvate Hydratase ; Proteins ; Proteome ; Sprains and Strains ; Superoxide Dismutase ; Urease

PURPOSE: The purpose of this study was to provide direction to improvement of advanced cardiovascular life support (ACLS) training in Korea. METHODS: We conducted a retrospective analysis of the questionnaire written by 55 instructors of the 31 institutions registered in the Korean Association of Cardiopulmonary Resuscitation (KACPR) from 2009 and 2010. The contents of the questionnaire consisted of an evaluation of the ACLS curriculum, modification of the ACLS curriculum, problems of ACLS training, and other open-ended answers. RESULTS: In this questionnaire, the result for assessment of the lecture on acute coronary syndrome was intermediate, that answer was given by the majority, 40.0%. The result for assessment of the lecture on stroke was intermediate, that answer was given by the majority, 40.0%. In addition, the result for the necessity of the lecture on acute coronary syndrome was intermediate, 25.5%, which was the most common response. The result for the necessity of the lecture on stroke was intermediate, 27.3%, which was the most common response. In the ACLS curriculum, 14.5% of respondents responded that simulation curriculum should be strengthened; 20.0% of participants responded that training on equipment and medical technique should be enhanced. CONCLUSION: Lecture without practice should be avoided and simulation-oriented education should be strengthened in the ACLS course.
Acute Coronary Syndrome ; Advanced Cardiac Life Support ; Cardiopulmonary Resuscitation ; Curriculum ; Surveys and Questionnaires ; Korea ; Retrospective Studies ; Stroke

Objective: To compare the convenience and effectiveness of the existing lumbosacral orthoses (LSO) (classic LSO and Cybertech) and a newly developed LSO (V-LSO) by analyzing postoperative data. Methods: This prospective cohort study was performed from May 2019 to November 2019 and enrolled and analyzed 88 patients with degenerative lumbar spine disease scheduled for elective lumbar surgery. Three types of LSO that were provided according to the time of patient registration were applied for 6 weeks. Patients were randomized into the classic LSO group (n=31), Cybertech group (n=26), and V-LSO group (n=31). All patients were assessed using the Oswestry Disability Index (ODI) preoperatively and underwent plain lumbar radiography (anteroposterior and lateral views) 10 days postoperatively. Lumbar lordosis (LS angle) and frontal imbalance were measured with and without LSO. At the sixth postoperative week, a follow-up assessment with the ODI and orthosis questionnaire was conducted. Results: No significant differences were found among the three groups in terms of the LS angle, frontal imbalance, ODI, and orthosis questionnaire results. When the change in the LS angle and frontal imbalance toward the reference value was defined as a positive change with and without LSO, the rate of positive change was significantly different in the V-LSO group (LS angle: 41.94% vs. 61.54% vs. 83.87%; p=0.003). Conclusion The newly developed LSO showed no difference regarding its effectiveness and compliance when compared with the existing LSO, but it was more effective in correcting lumbar lordosis.