BACKGROUND: The prognostic significance of change in red cell distribution width (RDW) during hospital stays in patients treated with therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) was investigated. METHODS: Patients treated with TH after OHCA between January 2009 and August 2013 were reviewed. Patients with return of spontaneous circulation (ROSC) were assessed according to Utstein Style. Hematologic variables including RDW, hematocrit, white blood cell count, and platelets were also obtained. RDW changes during the 72 hours after ROSC were categorized into five groups as follows: Group 1 (-0.8-0.1%), Group 2 (0.2-0.3%), Group 3 (0.4-0.5%), Group 4 (0.6-0.8%), and Group 5 (>0.8%). RESULTS: A total of 218 patients were enrolled in the study. RDW changes during the 72 hours after ROSC in Group 4 (HR 3.56, 95% CI 1.25-10.20) and Group 5 (HR 5.07, 95% CI 1.73-14.89) were associated with a statistically significant difference in one-month mortality. RDW changes were associated with statistically significant differences in neurologic outcome at 6 months after ROSC (Group 3 [HR 2.45, 95% CI 1.17-5.14], Group 4 [HR 2.79, 95% CI 1.33-5.84], Group 5 [HR 3.50, 95% CI 1.35-7.41]). Other significant variables were location of arrest, cause of arrest, serum albumin, and advanced cardiac life support time. CONCLUSIONS: RDW change during the 72 hours after ROSC is a predictor of mortality and neurologic outcome in patients treated with TH after OHCA.
Advanced Cardiac Life Support ; Erythrocyte Indices* ; Hematocrit ; Humans ; Hypothermia* ; Length of Stay ; Leukocyte Count ; Mortality ; Out-of-Hospital Cardiac Arrest* ; Prognosis ; Serum Albumin

BACKGROUND: The prognostic significance of change in red cell distribution width (RDW) during hospital stays in patients treated with therapeutic hypothermia (TH) after out-of-hospital cardiac arrest (OHCA) was investigated. METHODS: Patients treated with TH after OHCA between January 2009 and August 2013 were reviewed. Patients with return of spontaneous circulation (ROSC) were assessed according to Utstein Style. Hematologic variables including RDW, hematocrit, white blood cell count, and platelets were also obtained. RDW changes during the 72 hours after ROSC were categorized into five groups as follows: Group 1 (-0.8-0.1%), Group 2 (0.2-0.3%), Group 3 (0.4-0.5%), Group 4 (0.6-0.8%), and Group 5 (>0.8%). RESULTS: A total of 218 patients were enrolled in the study. RDW changes during the 72 hours after ROSC in Group 4 (HR 3.56, 95% CI 1.25-10.20) and Group 5 (HR 5.07, 95% CI 1.73-14.89) were associated with a statistically significant difference in one-month mortality. RDW changes were associated with statistically significant differences in neurologic outcome at 6 months after ROSC (Group 3 [HR 2.45, 95% CI 1.17-5.14], Group 4 [HR 2.79, 95% CI 1.33-5.84], Group 5 [HR 3.50, 95% CI 1.35-7.41]). Other significant variables were location of arrest, cause of arrest, serum albumin, and advanced cardiac life support time. CONCLUSIONS: RDW change during the 72 hours after ROSC is a predictor of mortality and neurologic outcome in patients treated with TH after OHCA.
Advanced Cardiac Life Support ; Erythrocyte Indices ; Hematocrit ; Humans ; Hypothermia ; Length of Stay ; Leukocyte Count ; Mortality ; Out-of-Hospital Cardiac Arrest ; Prognosis ; Serum Albumin

PURPOSE: On November 23, 2010, Yeonpyeong Island was under artillery fire and mass civilian casualties developed. Incheon West-sea regional emergency medical center, dispatched a disaster team to deal with the casualties. The purpose of this study was to review the regional disaster response of this team to improve the operations of the National Disaster Medical System, Disaster Medical Assistance Team, and the Mobile Emergency Support Unit in case of future emergencies. METHODS: We retrospectively reviewed the disaster response upon bombardment of the Yeonpyeong Island and analyzed medical records of patients who treated by the disaster team at Yeonpyeong island. RESULTS: The disaster team and EMS were activated after the bombardment. Disaster team included two doctors, three emergency medical technicians, and one ambulance driver. The bombardment occurred at 14:34, and lasted for 30 minutes. The disaster team was dispatched at 16:40, and arrived in Incheon port at 17:07 and departed for Yeonpyeong Island with a fire engine and ambulance at 21:48. Our team reached the island the next morning and started to treat a patient. A total of 30 patients were participated in this study. The mean age of the patients was 49.4(+/-14.2) yrs old. Most of he patients are a mild case. Diagnosis was multiple contusion, acute stress reaction, cerebral concussion, rupture of tympanic membrane. Also: It may help to include data/analyses showing that there were inadequacies and problems with the system (time lag, insufficient medical training or supplies, etc.) CONCLUSION: This article is the first to report on the efficacy of the National Disaster Medical System after bombardment. From our analysis, the National Disaster Medical System contains many problems including access to the island, the equipment of communication, and the security of disaster team. This report shows that a review of our National Disaster Medical System is necessary to plan for future disaster scenarios.
Ambulances ; Brain Concussion ; Contusions ; Disasters ; Emergencies ; Emergency Medical Technicians ; Equipment and Supplies ; Fires ; Humans ; Medical Assistance ; Medical Records ; Retrospective Studies ; Rupture ; Tympanic Membrane

OBJECTIVE: Measurement of the degree of stenosis is not enough to decide on the treatment strategy for patients with carotid stenosis. Plaque morphology examination is needed for such a decision-making. Thus, we evaluated the usefulness of plaque magnetic resonance imaging (MRI) to decide on the modality of treatment for patients with carotid atherosclerotic plaques. MATERIALS AND METHODS: Fifteen patients presenting with carotid stenosis between 2014 and 2016 were included. They underwent angiography for measurement of the degree of stenosis. Carotid plaques were visualized using MRI. RESULTS: There were six (40%) stable and nine (60%) unstable plaques. Seven symptomatic patients (77.7%) had unstable lesions and two symptomatic patients (33.3%) had stable lesions (p = 0.096). There were six (40%) intraplaque hemorrhage (IPH) cases. There were six symptomatic patients (100%) in the IPH group and three symptomatic patients (33.3%) in the non-IPH group (p = 0.013). The mean stenosis degree was 58.9% in the IPH group and 70.4% in the non-IPH group (p = 0.094). Symptoms occurred irrespective of the degree of the stenosis in the IPH groups. In the IPH group, the recurrent ischemic cerebrovascular event rate was 33.3%. Particularly, the recurrent ischemic cerebrovascular event rate was 66.7% in the IPH group with mild stenosis treated with medications. CONCLUSION: IPH in plaque MRI is significantly associated with ischemic symptoms and has a high risk for subsequent ischemic cerebrovascular events irrespective of the degree of stenosis. Plaque MRI is a useful tool in predicting symptomatic risks for carotid stenosis irrespective of the degree of such stenosis.
Angiography ; Carotid Stenosis ; Constriction, Pathologic* ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Plaque, Atherosclerotic

PURPOSE: HEMS is expected to shorten transportation time to an advanced facility and to enable administration of advanced treatment at the scene. In Korea, HEMS was launched in September 2011. The aim of this study is to provide an overview of HEMS in South Korea during the first year and to provide information for use in improvement. METHODS: Data were collected from September 23. 2011 to September 22. 2012; emergency patients on islands and in vulnerable areas were transported by helicopter. During the one-year study period, a prospective cohort study was conducted. Target diseases were acute coronary syndrome, stroke, and severe trauma. We classified patients according to two groups (severe group vs. mild group), whether they had been admitted to the intensive care unit (included death in the emergency room) or not. RESULTS: During this period, the total request mission number was 555 and the number of patients transported to base hospitals was 322. Differences between severe group and minor group were as follows: (1) final diagnosis; severe trauma (27.7% vs. 3.5%), cerebrovascular accident (CVA) (24.3% vs. 4.2%), and acute coronary syndrome (7.3% vs. 2.1%), p<0.001. (2) classification of transport area; islands (45.8% vs. 77.2%), bridge islands (26.0% vs. 15.9%), and inland area (28.3% vs. 6.9%), p<0.001. (3) the median time of call to hospital time was 52 vs. 55 minutes (p=0.289). and the median time of on scene time was 9 vs. 8 minutes (p=0.046). CONCLUSION: During the 12-month period, air ambulance played an important role in medically vulnerable areas (inclusion islands). However, the number of transport missions was still relatively low, and has shown a gradual increase.
Acute Coronary Syndrome ; Air Ambulances ; Aircraft* ; Classification ; Cohort Studies ; Diagnosis ; Emergencies* ; Emergency Medical Services* ; Humans ; Intensive Care Units ; Islands ; Korea ; Missions and Missionaries ; Prospective Studies ; Rural Health Services ; Stroke ; Transportation

PURPOSE: HEMS is expected to shorten transportation time to an advanced facility and to enable administration of advanced treatment at the scene. In Korea, HEMS was launched in September 2011. The aim of this study is to provide an overview of HEMS in South Korea during the first year and to provide information for use in improvement. METHODS: Data were collected from September 23. 2011 to September 22. 2012; emergency patients on islands and in vulnerable areas were transported by helicopter. During the one-year study period, a prospective cohort study was conducted. Target diseases were acute coronary syndrome, stroke, and severe trauma. We classified patients according to two groups (severe group vs. mild group), whether they had been admitted to the intensive care unit (included death in the emergency room) or not. RESULTS: During this period, the total request mission number was 555 and the number of patients transported to base hospitals was 322. Differences between severe group and minor group were as follows: (1) final diagnosis; severe trauma (27.7% vs. 3.5%), cerebrovascular accident (CVA) (24.3% vs. 4.2%), and acute coronary syndrome (7.3% vs. 2.1%), p<0.001. (2) classification of transport area; islands (45.8% vs. 77.2%), bridge islands (26.0% vs. 15.9%), and inland area (28.3% vs. 6.9%), p<0.001. (3) the median time of call to hospital time was 52 vs. 55 minutes (p=0.289). and the median time of on scene time was 9 vs. 8 minutes (p=0.046). CONCLUSION: During the 12-month period, air ambulance played an important role in medically vulnerable areas (inclusion islands). However, the number of transport missions was still relatively low, and has shown a gradual increase.
Acute Coronary Syndrome ; Air Ambulances ; Aircraft* ; Classification ; Cohort Studies ; Diagnosis ; Emergencies* ; Emergency Medical Services* ; Humans ; Intensive Care Units ; Islands ; Korea ; Missions and Missionaries ; Prospective Studies ; Rural Health Services ; Stroke ; Transportation

OBJECTIVE: We wanted to assess the trends of computed tomography (CT) examinations in a pediatric emergency department (ED). MATERIALS AND METHODS: We searched the medical database to identify the pediatric patients who had visited the ED, and the number of CTs conducted from January 2001 to December 2010. We analyzed the types of CTs, according to the anatomic region, and the patients who underwent CT examinations for multiple regions. Data were stratified, according to the patient age (< 13 years and 13 < or = ages < 18 years). RESULTS: The number of CTs performed per 1000 patients increased by 92% during the 10-year period (per 1000 patients, increased from 50.1 CTs in 2001 to 156.5 CTs in 2006, and then decreased to 96.0 CTs in 2010). Although head CTs were performed most often (74.6% of all CTs), facial bone CTs showed the largest rate of increase (3188%) per 1000 patients, followed by cervical CTs (642%), abdominal CTs (474%), miscellaneous CTs (236%), chest CTs (89%) and head CTs (39%). The number of patients who had CT examinations for multiple regions in the same day showed a similar pattern of increase, to that of overall CT examinations. Increase of CT utilization was more pronounced in adolescents than in pediatric patients younger than 13 years (189% vs. 59%). CONCLUSION: The utilization of CTs increases from 2001 to 2006, and has declined since 2006. The increase of CTs is more pronounced in adolescents, and facial bone CTs prevail in increased number of examination followed by cervical CTs, abdominal CTs, miscellaneous CTs, chest CTs, and head CTs.
Adolescent ; Child ; Child, Preschool ; Emergency Service, Hospital/statistics & numerical data/*trends ; Female ; Humans ; Male ; Multidetector Computed Tomography ; Republic of Korea ; Tertiary Care Centers/statistics & numerical data/*trends ; Tomography, X-Ray Computed/*trends/utilization

OBJECTIVE: Several studies have reported on the effectiveness of fronto-lateral craniotomy in reducing the operating time and post-operative complications. However, no study has practically evaluated this method from the cosmetic point of view. MATERIALS AND METHODS: We designed this study for comparison of the clinical differences and cosmetic outcomes between the frontolateral craniotomy and the conventional pterional craniotomy for clipping of unruptured intracranial aneurysms. We performed a retrospective analysis of the two groups based on their medical records and radiologic findings juxtaposed with their length of hospital stay, intensive care unit day and operation time, and the emergence of postoperative complication, mean size of aneurysm, and temporal depression. RESULTS: After careful comparison of the thickness of temporalis muscle between the craniotomy side and the contralateral side, the results clearly showed that the conventional pterional craniotomy group was asymmetric by a p value of 0.152 and the frontolateral craniotomy group was symmetric by a p value of 0.002. CONCLUSION: Frontolateral craniotomy could be a practical alternative for patients with an unruptured intracranial aneurysm in the anterior circulation including the posterior communicating artery, particularly those who are in a medically poor state or who highly demand minimal aesthetic mutilation.
Aneurysm* ; Arteries ; Craniotomy ; Depression ; Humans ; Intensive Care Units ; Intracranial Aneurysm ; Length of Stay ; Medical Records ; Postoperative Complications ; Retrospective Studies

OBJECTIVE: We wanted to assess the trends of CT examinations that were conducted in an adult emergency department (ED). MATERIALS AND METHODS: We searched the medical database to identify adult patients (> or = 18 years) who had visited the ED and the number of CT examinations of the patients during the period from January 2001 to December 2010. We also analyzed the types of CT scans performed in terms of body parts, they were as follows; head CTs, facial bone CTs, neckl CTs, chest CTs, abdominal CTs, and miscellaneous CTs. Further, miscellaneous CTs were subdivided as CT angiography and others. RESULTS: A total of 113656 CT scans were examined for 409439 adult ED patients during a 10-year period, and the number of CT scans increased by 255% (from 4743 CTs in 2001 to 16856 CTs in 2010), while the adult ED patient volume increased by 34% during the same period. Although the head CTs proportionally occupied the most, the facial bone CTs had the largest rate of increase (3118%), followed by cervical CTs (1173%), chest CTs (455%), miscellaneous CTs (388%; 862% and 84% for CT angiography and others, respectively), abdominal CTs (315%) and head CTs (95%) per 1000 patients during the decade. CONCLUSION: CT use in adult ED has increased at a rate that far exceeds the growth of ED patient volume, with facial bone CTs and cervical CTs having the largest increasing rate, followed by chest CTs, miscellaneous CTs, abdominal CTs and head CTs.
Adult ; Emergency Service, Hospital/*utilization ; Female ; Humans ; Male ; Middle Aged ; Republic of Korea ; Retrospective Studies ; Tertiary Care Centers ; Tomography, X-Ray Computed/*utilization

The gut microbiota has an important role in the gut barrier, inflammation and metabolic functions. Studies have identified a close association between the intestinal barrier and metabolic diseases, including obesity and type 2 diabetes (T2D). Recently, Akkermansia muciniphila has been reported as a beneficial bacterium that reduces gut barrier disruption and insulin resistance. Here we evaluated the role of A. muciniphila-derived extracellular vesicles (AmEVs) in the regulation of gut permeability. We found that there are more AmEVs in the fecal samples of healthy controls compared with those of patients with T2D. In addition, AmEV administration enhanced tight junction function, reduced body weight gain and improved glucose tolerance in high-fat diet (HFD)-induced diabetic mice. To test the direct effect of AmEVs on human epithelial cells, cultured Caco-2 cells were treated with these vesicles. AmEVs decreased the gut permeability of lipopolysaccharide-treated Caco-2 cells, whereas Escherichia coli-derived EVs had no significant effect. Interestingly, the expression of occludin was increased by AmEV treatment. Overall, these results imply that AmEVs may act as a functional moiety for controlling gut permeability and that the regulation of intestinal barrier integrity can improve metabolic functions in HFD-fed mice.