Panax ginseng is a medicinal herb that is used worldwide. Its medicinal effects are primarily attributable to ginsenosides located in the root, leaf, seed, and flower. The flower buds of Panax ginseng (FBPG) are rich in various bioactive ginsenosides, which exert immunomodulatory and anti-inflammatory activities. The aim of the present study was to assess the effect of 18 ginsenosides isolated from steamed FBPG on the transcriptional activity of NF-kappaB and the expression of tumor necrosis factor-alpha (TNF-alpha)-stimulated target genes in liver-derived cell lines. Noticeably, the ginsenosides Rk3 and Rs4 exerted the strongest activity, inhibiting NF-kappaB in a dose-dependent manner. SF and Rg6 also showed moderately inhibitory effects. Furthermore, these four compounds inhibited the TNF-alpha-induced expression of IL8, CXCL1, iNOS, and ICAM1 genes. Consequently, ginsenosides purified from steamed FBPG have therapeutic potential in TNF-alpha-mediated diseases such as chronic hepatic inflammation.
Cell Line ; Cotyledon ; Flowers* ; Ginsenosides* ; Inflammation ; Interleukin-8 ; NF-kappa B* ; Panax* ; Plants, Medicinal ; Steam* ; Tumor Necrosis Factor-alpha

Panax ginseng is a medicinal herb that is used worldwide. Its medicinal effects are primarily attributable to ginsenosides located in the root, leaf, seed, and flower. The flower buds of Panax ginseng (FBPG) are rich in various bioactive ginsenosides, which exert immunomodulatory and anti-inflammatory activities. The aim of the present study was to assess the effect of 18 ginsenosides isolated from steamed FBPG on the transcriptional activity of NF-kappaB and the expression of tumor necrosis factor-alpha (TNF-alpha)-stimulated target genes in liver-derived cell lines. Noticeably, the ginsenosides Rk3 and Rs4 exerted the strongest activity, inhibiting NF-kappaB in a dose-dependent manner. SF and Rg6 also showed moderately inhibitory effects. Furthermore, these four compounds inhibited the TNF-alpha-induced expression of IL8, CXCL1, iNOS, and ICAM1 genes. Consequently, ginsenosides purified from steamed FBPG have therapeutic potential in TNF-alpha-mediated diseases such as chronic hepatic inflammation.
Cell Line ; Cotyledon ; Flowers* ; Ginsenosides* ; Inflammation ; Interleukin-8 ; NF-kappa B* ; Panax* ; Plants, Medicinal ; Steam* ; Tumor Necrosis Factor-alpha

PURPOSE: The Ministry of Health and Welfare recently designated 35 major trauma-specified centers (MTSC). The purpose of this study is to determine changes in patient flow and designated hospitals, and to describe the role of the emergency medical information center (EMIC) in a regional trauma care system. METHODS: Data of trauma patient inter-facility transfer arrangement by one EMIC were reviewed for 2 months before and after the designation of MTSC. The data included success or failure rates of the arrangement, time used for arrangement, and inquiring and accepting facility. RESULTS: At pre- and post-designation study period, there were 540 and 433 trauma patient inter-facility transfers arranged by EMIC, respectively. The median time used for arrangement decreased from 9.3 to 7.7 minutes (P = 0.007). Arrangement failure rate was 3.5% and 2.5%, respectively, with no significant interval change (P = 0.377). The percentage of inquiring MTSC decreased from 49.1 to 36.9% (P < 0.001). The percentage of accepting MTSC increased from 20.2 to 37.4% (P < 0.001). CONCLUSION: With the designation of MTSC, EMIC could arrange inter-facility transfers more quickly. The hospitals wanted more trauma patients after the designation. There would be a concentration of trauma patients to MTSCs in our region. Further studies are needed for scientific evidence on patient outcome.
Emergencies ; Emergency Service, Hospital ; Humans ; Information Centers ; Information Services ; Referral and Consultation ; Trauma Centers

Background/Aims: Hypercontractile esophagus (HE) is a heterogeneous disorder with variable clinical presentations and a natural course, leading to management challenges. This study aims to investigate the characteristics of HE and evaluate its treatment outcomes. Methods: Four Korean referral centers recruited subjects with at least 1 hypercontractile swallow (distal contraction integral > 8000 mmHg·s·cm) in this retrospective observational study. Subjects were classified according to the Chicago classification version 2.0 (CC v2.0), CC v3.0, and CC v4.0. criteria. The clinical and manometric features were also investigated. The treatment modalities and outcomes of subjects with CC v4.0 were evaluated. Results: In total, 59 subjects with at least 1 hypercontractile swallow were analyzed. Among them, 30 (50.8%) had increased integrated relaxation pressure values without meeting the criteria for achalasia. Among the remaining 29 patients, 6 (20.7%) had only 1 hypercontractile swallowing symptom (CC v2.0) and 23 (79.3%) met both the CC v3.0 and v4.0 criteria for HE. Dysphagia (91.3%) was the most prevalent symptom, followed by chest pain (56.5%), regurgitation (52.2%), globus (34.8%), heartburn (21.7%), and belching (8.7%). Twenty (87.0%) patients received medical treatment, and 8 (47.1%) and 5 (29.4%) showed moderate and significant improvements, respectively. Proton pump inhibitors were the most common option (n = 15, 65.2%), followed by calcium channel blockers (n = 6, 26.1%). One patient received peroral endoscopic myotomy and showed significant symptom improvement. Conclusions Sixty-one percent of patients who meet the diagnostic criteria for the high-resolution manometry are diagnosed with symptomatic HE based CC v4.0. Chest pain and regurgitation were also observed in over half of them. The overall medical treatment efficacy was moderate.

A 28-year-old man was admitted due to abdominal pain and nausea. The patient had been diagnosed with peritoneal tuberculosis and was being treated with anti-tuberculous drugs. After 7 months of therapy, he developed abdominal pain, nausea, and melena. Gastrofiberscopy showed a duodenal ulcer and fistular opening. Abdominal CT revealed an aneurysm of the replaced hepatic artery due to abdominal tuberculous lymphadenopathy. After embolization of the aneurysm, his symptoms improved. Although mycotic aneurysm occurs rarely as a complication of tuberculous lymphadenopathy, it should be diagnosed as early as possible because of the high rate of rupture and associated high mortality.
Abdominal Pain ; Adult ; Aneurysm ; Aneurysm, Infected ; Duodenal Ulcer ; Hepatic Artery ; Humans ; Lymphatic Diseases ; Melena ; Nausea ; Peritonitis, Tuberculous ; Rupture ; Tuberculosis

A new blood bank system was established in our trauma bay, which allowed immediate utilization of uncross-matched type O packed red blood cells (UORBCs). We investigated the efficacy of UORBC compared to that of the ABO type-specific packed red blood cells (ABO RBCs) from before the bank was installed. From March 2016 to February 2017, data from trauma patients who received UORBCs in the trauma bay were compared with those of trauma patients who received ABO RBCs from January 2013 to December 2015. Propensity matching was used to overcome retrospective bias. The primary outcome was 24-hour mortality, while the secondary outcomes were in-hospital mortality and intensive care unit (ICU) length of stay (LOS). Data from 252 patients were reviewed and UORBCs were administered to 64 patients. The time to transfusion from emergency room admission was shorter in the UORBC group (11 [7–16] minutes vs. 44 [29–72] minutes, P < 0.001). After propensity matching, 47 patients were included in each group. The 24-hour mortality (4 [8.5%] vs. 9 [13.8%], P = 0.135), in-hospital mortality (14 [29.8%] vs. 18 [38.3%], P = 0.384), and ICU LOS (9 [4–19] days vs. 5 [0–19] days, P = 0.155) did not differ significantly between groups. The utilization of UORBCs resulted in a faster transfusion but did not significantly improve the clinical outcomes in traumatic shock patients in this study. However, the tendency for lower mortality in the UORBC group suggested the need for a large study.
Bays ; Bias (Epidemiology) ; Blood Banks ; Emergency Service, Hospital ; Erythrocyte Transfusion* ; Erythrocytes* ; Hospital Mortality ; Humans ; Intensive Care Units ; Length of Stay ; Mortality ; Propensity Score* ; Retrospective Studies ; Shock* ; Shock, Traumatic ; Trauma Centers ; Wounds and Injuries

Background: Trauma mortality review is the first step in assessing the quality of the trauma treatment system and provides an important basis for establishing a regional inclusive trauma system. This study aimed to obtain a reliable measure of the preventable trauma death rate in a single province in Korea. Methods: From January to December 2017, a total of 500 sample cases of trauma-related deaths from 64 hospitals in Gyeonggi Province were included. All cases were evaluated for preventability and opportunities for improvement using a multidisciplinary panel review approach. Results: Overall, 337 cases were included in the calculation for the preventable trauma death rate. The preventable trauma death rate was estimated at 17.0%. The odds ratio was 3.97 folds higher for those who arrived within “1–3 hours” than those who arrived within “1 hour.” When the final treatment institution was not a regional trauma center, the odds ratio was 2.39 folds higher than that of a regional trauma center. The most significant stage of preventable trauma death was the hospital stage, during which 86.7% of the cases occurred, of which only 10.3% occurred in the regional trauma center, whereas preventable trauma death was more of a problem at emergency medical institutions. Conclusion The preventable trauma death rate was slightly lower in this study than in previous studies, although several problems were noted during inter-hospital transfer; in the hospital stage, more problems were noted at emergency medical care facilities than at regional trauma centers. Further, several opportunities for improvements were discovered regarding bleeding control.

BACKGROUND/AIMS: Helicobacter pylori is a distinctive pathogen that lives in the gastric mucosa and is a well known risk factor of gastric adenocarcinoma. Iron deficiency aggravates the development of H. pylori-induced premalignant and malignant lesions in a cagA-dependent manner, enhancing H. pylori virulence. The aim of this study was to identify the relationship between iron deficiency and H. pylori eradication rates. MATERIALS AND METHODS: Participants who received 7 days of first-line triple therapy with serum iron level measured in parallel were retrospectively investigated between 2005 and 2014. H. pylori eradication was confirmed by the rapid urease test or 13C-urea breath test at least 4 weeks after completion of triple therapy. Iron deficiency was defined as either a serum iron level less than 50 µg/dL or a serum ferritin level less than 12 ng/mL. RESULTS: A total of 194 patients received 7 days of first-line triple therapy along with parallel serum iron level measurements over the 10-year period. The mean average age was 53.3 years (range, 21~86 years), and 135 patients (69.6%) were male. The overall H. pylori eradication rate was 83.5%. Proportions of eradication success with ferritin level less than 12 ng/mL and iron less than 50 µg/dL were 90.5% and 88.6%, respectively. However, there was no statistical difference in eradication rates according to iron deficiency. CONCLUSIONS: Iron deficiency might not be related with H. pylori eradication rates in this study. Further large-scale studies are needed to confirm this result.
Adenocarcinoma ; Breath Tests ; Disease Eradication ; Ferritins ; Gastric Mucosa ; Helicobacter pylori* ; Helicobacter* ; Humans ; Iron* ; Male ; Retrospective Studies ; Risk Factors ; Urease ; Virulence

BACKGROUND/AIMS: The detection of multifocal lesions is important for the successful management of gastric neoplasms. We investigated the characteristics of missed simultaneous lesions and the reason for the missed diagnoses. METHODS: A total of 140 patients who underwent repeat endoscopy before endoscopic resection between June 2013 and June 2014 were retrospectively reviewed. We classified simultaneous lesions into three groups based on a review of earlier images: group 1, no images of the location of simultaneous lesions were taken; group 2, no corresponding lesion was evident in the previous images; and group 3, simultaneous lesions were visible in the earlier images but a biopsy was not performed. RESULTS: Simultaneous lesions were found in 12 patients (8.6%) with 13 lesions, comprising 10 dysplasia (76.9%) and three adenocarcinoma (23.1%). Regarding the reasons for missed diagnoses, seven lesions (53.8%) were classified as group 3, five (38.5%) as group 1, and the remaining lesion (7.7%) as group 2. There were no significant differences in the characteristics of the patients with and without simultaneous lesions. CONCLUSIONS: Lesions disregarded or unnoticed during endoscopic examination were the main reason for missed diagnosis of simultaneous lesions. Endoscopists should consider the possibility of simultaneous lesions and attempt to meticulously evaluate the entire gastric mucosa.
Adenocarcinoma ; Biopsy ; Diagnosis ; Endoscopy ; Gastric Mucosa ; Humans ; Retrospective Studies ; Stomach Neoplasms

BACKGROUND: This study aimed to evaluate the current overall preventable trauma death rate (PTDR) in Korea and identify factors associated with preventable trauma death (PTD). METHODS: The target sample size for review was designed to be 1,131 deaths in 60 emergency medical institutions nationwide. The panels for the review comprised trauma specialists working at the regional trauma centers (RTCs); a total of 10 teams were formed. The PTDR and factors associated with PTD were analyzed statistically. RESULTS: Of the target cases, 943 were able to undergo panel review and be analyzed statistically. The PTDR was 30.5% (6.1% preventable and 24.4% possibly preventable). Those treated at a RTC showed a significantly lower PTDR than did those who were not (21.9% vs. 33.9%; P = 0.002). The PTDR was higher when patients were transferred from other hospitals than when they directly visited the last hospital (58.9% vs. 28.4%; P = 0.058; borderline significant). The PTDR increased gradually as the time from accident to death increased; a time of more than one day had a PTDR 14.99 times higher than when transferred within one hour (95% confidence interval, 4.68 to 47.98). CONCLUSION: Although the PTDR in Korea is still high compared to that in developed countries, it was lower when the time spent from the accident to the death was shorter and the final destined institution was the RTC. To reduce PTDR, it is necessary to make an effort to transfer trauma patients to RTCs directly within an appropriate time.
Developed Countries ; Emergencies ; Humans ; Korea ; Mortality ; Sample Size ; Specialization ; Trauma Centers ; Wounds and Injuries