BACKGROUND: This study aimed to investigate bradycardia as an adverse effect after administration of dexmedetomidine during 33degrees C target temperature management. METHODS: A retrospective study was conducted on patients who underwent 33degrees C target temperature management in the emergency department during a 49-month study period. We collected data including age, sex, weight, diagnosis, bradycardia occurrence, target temperature management duration, sedative drug, and several clinical and laboratory results. We conducted logistic regression for an analysis of factors associated with bradycardia. RESULTS: A total of 68 patients were selected. Among them, 39 (57.4%) showed bradycardia, and 56 (82.4%) were treated with dexmedetomidine. The odds ratio for bradycardia in the carbon monoxide poisoning group compared to the cardiac arrest group and in patients with higher body weight were 7.448 (95% confidence interval [CI] 1.834-30.244, p = 0.005) and 1.058 (95% CI 1.002-1.123, p = 0.044), respectively. In the bradycardia with dexmedetomidine group, the infusion rate of dexmedetomidine was 0.41 +/- 0.15 microg/kg/h. Decisions of charged doctor's were 1) slowing infusion rate and 2) stopping infusion or administering atropine for bradycardia. No cases required cardiac pacing or worsened to asystole. CONCLUSIONS: Despite the frequent occurrence of bradycardia after administration of dexmedetomidine during 33degrees C target temperature management, bradycardia was completely recovered after reducing infusion rate or stopping infusion. However, reducing the infusion rate of dexmedetomidine lower than the standard maintenance dose could be necessary to prevent bradycardia from developing in patients with higher body weight or carbon monoxide poisoning during 33degrees C targeted temperature management.
Atropine ; Body Weight ; Bradycardia* ; Carbon Monoxide Poisoning ; Dexmedetomidine* ; Diagnosis ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Hypothermia, Induced ; Logistic Models ; Odds Ratio ; Retrospective Studies

No abstract available.
Heel* ; Molluscum Contagiosum* ; Weight-Bearing* ; Zea mays

BACKGROUND: Experimental data indicate that low-flow reperfusion following prolonged cardiocirculatory arrest may aggravate early cerebral microcirculatory repefusion disorders. We investigated the influence of cerebral repefusion flow change to the ischemic histopathologic damage of brain tissue after incomplete forebrain ischemia in rats. MATERIALS AND METHOD: Anesthetized Sprague-Dawley rats were undergone ligation of both infernal carotid artery by microvascular clamp for 10 minutes. After release of the clamp, reperfusion was started with several different flow levels (0, 10, 20, 30, 50, and 100%) of infernal carotid artery comparing to pre-clamping phase using flowmeter. After 15minutes of reperfusion, rat brains were prepared by perfusion-fixation with 3% formaldehyde. Under light microscopic examination of Hematoxylin-Eosin stained tissue slide, histopathologic damage was examined at cortex, putamen, and hippocampus regions. Categorical hisotopathologic damage scores were derived in each regions by manual counts of ischemic neurons. RESULT: The histopathologic damage scores were 0, 10. 2+/-0.5, 7.6+/-1.5, 5.9+/-1.4, 5.0+/- 2.8, 3.5+/-0.7, and 1.0+/-0.0 in control, 0, 10, 20, 30, 50, and 100% reperfusion groups, respectively(p<0.05). CONCLUSION: Our insults showed significant increment of brain histopathologic damage scores along with decreasing amount of cerebral reperfusion know after incomplete forebrain ischemia. We believe restoration of repefusion flow to pre-ischemic level would be a critical component in attenuation of brain ischemic damage.
Animals ; Brain ; Carotid Arteries ; Flowmeters ; Formaldehyde ; Hippocampus ; Ischemia* ; Ligation ; Models, Animal* ; Neurons ; Prosencephalon* ; Putamen ; Rats* ; Rats, Sprague-Dawley ; Reperfusion*

No abstract available.
Child* ; Humans ; Leukemia, Myeloid, Acute* ; Typhlitis*

PURPOSE: Although the overall incidence of hepatitis A in Korea has been decreasing recently, the adolescents born before the introduction of the hepatitis A vaccine remain to be highly vulnerable to outbreak. This study examines the unvaccinated adolescents' and their parents' knowledge and health beliefs toward hepatitis A vaccination. METHODS: Healthy adolescents aged 13-19 years old who had no previous history of hepatitis A vaccine and hepatitis A infection, and their parents or legal guardians were the subjects of the study. The survey was conducted using a structured questionnaire based on the Health Belief Model, and examined the subjects' demographics, knowledge, and health beliefs (i.e., perceived susceptibility, severity, benefits, and barriers). RESULTS: We included 157 adolescents and their parents/guardians (mean age: 16.0+/-1.6 and 45.6+/-4.7 years, respectively). The average knowledge item score for adolescents and parents was 6.4+/-3.7 and 7.3+/-3.4 (out of 18), respectively. Similarly, average Health Belief Model item scores were: susceptibility, 5.6+/-1.6 and 5.9+/-1.7 (range: 2-10); severity, 16.3+/-4.1 and 18.3+/-3.6 (range:5-25); benefits, 19.7+/-3.3 and 20.6+/-2.1 (range:5-25); and barriers, 41.3+/-8.9 and 39.0+/-9.1 (range:7-85). The major reason for not undergoing hepatitis A vaccination was lack of knowledge about its importance. CONCLUSIONS: Refresher health lectures about hepatitis A and the vaccine are needed by both the adolescents and their parents. Furthermore, the inclusion of hepatitis A vaccine in the national immunization program should be considered to reduce the risk of hepatitis A outbreak and to raise the vaccination coverage among the adolescents in Korea.
Adolescent ; Demography ; Hepatitis A Vaccines ; Hepatitis A* ; Hepatitis* ; Humans ; Immunization Programs ; Incidence ; Korea ; Lectures ; Legal Guardians ; Parents* ; Surveys and Questionnaires ; Vaccination*

PURPOSE: Skin-homing T cells expressing cutaneous lymphocyte antigen (CLA) are known to be important in the pathogenesis of atopic dermatitis (AD). So far, there have been few reports on the peripheral lymphocyte subpopulations expressing CLA, especially in children with AD. METHODS: We investigated the peripheral blood lymphocyte subpopulations expressing CLA in children with severe AD andcontrol subjects to identify which proportions of circulating CLA+ T cells were expanded in atopic dermatitis. We assayed the peripheral blood lymphocyte subpopulation with flow cytometry in 15 children with severe chronic lichenified skin lesions and 12 control subjects who had no symptoms of atopic dermatitis. The expressions of peripheral blood CD4+CLA+ T cells and CD3+CLA+ T cells were significantly increased in children with AD compared with those in control subjects, whereas there was no significant difference of CD8+CLA+ T cells between the two groups. RESULTS: The expressions of CD3+ T cells, CD4+ T cells, and CD8+ T cells showed no significant differences between children with AD and control subjects. CONCLUSION: These findings suggest that circulating CD4+CLA+ T cells play an important role in the pathogenesis of chronic severe AD in children.
Child* ; Dermatitis, Atopic* ; Flow Cytometry ; Humans ; Lymphocyte Subsets ; Lymphocytes* ; Skin ; T-Lymphocytes

Classic Kaposi sarcoma (KS) is a rare human herpes virus 8-associated angioproliferative disease, and the disseminated classic type of KS in Korea is even rarer. The treatment options for classic KS vary and range from surgical excision to ionizing irradiation or chemotherapy. Recently, there have been a few reports of treating classic KS with paclitaxel, which has been used to treat AIDS-associated KS and post-transplant KS. We herein report a case of disseminated classic type KS in a 78-year-old Korean male patient who showed dramatic response after only two cycles of paclitaxel treatment.
Humans ; Korea ; Male ; Paclitaxel ; Sarcoma, Kaposi ; Viruses

PURPOSE: Recently, the use of end-tidal carbon dioxide (ETCO₂) monitoring has been suggested for early detection of hypoventilation over oxygen saturation (S(P)O₂) monitoring. We aimed to determine the usefulness of capnography in monitoring patients sedated using intramuscular (IM) ketamine in the pediatric emergency department (ED). METHODS: This study retrospectively reviewed medical records of patients younger than 16 years who were sedated using IM ketamine and whose ETCO₂ values were documented in the ED. Age, sex, American Society of Anesthesiologists physical status classification (ASA classification), and purpose of sedation were investigated. Vital signs were recorded at pre-sedation, 5 and 10 minutes after sedation, and after recovery. Hypoventilation was defined as S(P)O₂< 95%, ETCO₂≥ 50 mmHg or ≤ 30 mmHg, or increase in ETCO₂≥ 10 mmHg from the baseline without tachypnea. RESULTS: A total of 49 patients were investigated; 42 of them belonged to ASA classification I, and 7 to II. There was no patient with S(P)O₂< 95%, or ETCO₂≥ 50 mmHg, or increase in ETCO₂≥ 10 mmHg from the pre-sedation value. However, 5 patients had an ETCO₂≤ 30 mmHg, and 4 of them (8.2%) had normal respiratory rate and were suitable for hypopneic hypoventilation. Ten patients showed abnormal range of ETCO₂ (normal range, 35-45 mmHg), but did not meet the definition of hypoventilation. No one had clinically serious respiratory events. CONCLUSIONS: During sedation using IM ketamine, 8.2% of the patients had hypopneic hypoventilation without hypoxemia, and they were all younger than 36 months. Capnography for patients sedated using IM ketamine in the ED is useful in detecting hypopneic hypoventilation, and has the potential for preventing clinically serious respiratory events in patients, especially toddlers.
Anoxia ; Capnography ; Carbon Dioxide* ; Carbon* ; Classification ; Conscious Sedation ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Hypoventilation ; Ketamine* ; Medical Records ; Oxygen ; Pediatrics ; Respiratory Rate ; Retrospective Studies ; Tachypnea ; Vital Signs

Since 1990 when Wolff and co-authors proved that both RNA and DNA expression vectors containing interest gene were directly injected into mouse muscle and expressed the protein in vivo, the concept of gene vaccine has been broadly tested in the vaccine field. However, due to the limitations of technology and the misconception about RNA, most previous studies have focused on the DNA vaccine. Recently, the RNA vaccine has emerged as a new game-changing disruptive innovation technology in the vaccine field. This review has covered the characteristics of the RNA vaccine, including its strengths and weaknesses. Finally, we have suggested future directions for the RNA vaccine.
Animals ; DNA ; Mice ; RNA*

As neonates are brought to the emergency department (ED) for various complaints, it is challenging for emergency physicians to clinically determine the urgency of the visit. We sought to explore clinical characteristics associated with urgent visits to the ED. We conducted a retrospective study by reviewing medical records of neonatal visits to a tertiary pediatric regional emergency center for 5 years. Cases of patients who were discharged after checking only chest or abdominal X-ray or discharged without workup, were classified as non-urgent visits. Cases where more examinations were performed, or when the patient was hospitalized, were classified as urgent visits. Various clinical features and process in the ED were compared between the groups. Of the 1,008 cases enrolled in this study, 856 (84.9%) were urgent and 152 (15.1%) were non-urgent visits. After adjustment by multiple logistic regression analysis, non-urgent visits were associated with self-referrals rather than physician-referrals (odds ratio [OR], 5.96), visits in the evening rather than at night or daytime (OR, 2.51), patient visits from home rather than from medical facilities (OR, 2.19; 95). Fever and jaundice were the most common complaints (25.7% and 24.5%, respectively), and their OR of non-urgent visit was relatively low (adjusted OR 0.03 and 0.03, respectively). However, other common complaints, such as vomiting and cough (7.4% and 7.1%, respectively), were more likely to be non-urgent visits (adjusted OR 2.96 and 9.83, respectively). For suspected non-urgent visits, emergency physicians need to try to reduce unnecessary workup and shorten length of stay in ED.
Cough ; Emergencies* ; Emergency Service, Hospital* ; Fever ; Humans ; Infant, Newborn ; Jaundice ; Length of Stay ; Logistic Models ; Medical Records ; Retrospective Studies ; Thorax ; Vomiting