BACKGROUND: This study examined hemodynamic variables, oxygen delivery, extraction, and consumption in response to acute progressive hypoxia and hypercarbia in the setting of apnea. METHODS: Apnea was induced in 9 healthy mongrel dogs by disconnecting animals from mechanical ventilation of 30 minutes with pure oxygen. Hemodynamic variables, oxygen transport, extraction, and consumption were rapidly and repeatedly measured using pulmonary arterial and arterial catheters until cardiac output was undetectable. RESULTS: The baseline PaO2, PaCO2, pH, base excess were 318 +/- 137 mm Hg, 36 +/- 3.5 mm Hg, 7.30 +/- 0.06, 6.81 +/- 2.65 mmol/l respectively. Hypercarbia and hypoxemia (76 +/- 33 mm Hg) was first noted at 1 and 4 minute respectively. Base excess was not changed. Indices of preload (PCWP and CVP) were increased early in the time course (p<0.05). In contrast, indices of afterload (SVR) increased later, just before cardiac decompensation began (p<0.05). No significant reduction of cardiac output, oxygen delivery, extraction, and consumption was detected just until abrupt cardiac decompensation started, 5 minute. CONCLUSIONS: These data suggest that the early increase in preload was primarily due to hypercarbia whereas the late increase in afterload was due to hypoxemia, but the main cause of acute cardiac decompensation was a critical decrease in arterial oxygen tension with some contribution of increased preload and afterload.
Animals ; Anoxia ; Apnea* ; Cardiac Output ; Catheters ; Dogs* ; Hemodynamics* ; Hydrogen-Ion Concentration ; Oxygen* ; Respiration, Artificial

Present study aimed to investigate the immunological activities of cell wall associated protein antigen solubilized with Triton X-100 (TSP) from Mycobacterium tuberculosis H37Rv and conducted on 43 patients with pulmonary tuberculosis (newly diagnosed, medicated within 12 months and chronic refractory patients) and 17 normal healthy controls. These immunological responses were compared with those induced by the PPD or 30 kDa antigen from M, tuberculosis H37Rv culture filtrates, identified as biologically important secreted proteins. Proliferative responses to mycobacterial antigens were compared in peripheral blood mononuclear cells (PBMC) of healthy subjects and pulmonary tuberculosis patients. Signiticant blastogenic responses to the TSP were observed in healthy tuberculin reactors, newly diagnosed and some of antituberculosis drug-medicated patients by H-thymidine incorporation assay. IL-12 p40 and IFN-r mRNA expressions to the TSP were markedly increased, whereas IL-10 and TNF-a mRNA expressions were decreased at a 5 day-stimulation by PBMC in healthy tuberculin reactors, newly diagnosed and medicated patients. However, patients with chronic refractory tuberculosis exhibited more depressed IL-12 p40 and IFN-r mRNA expressions to all of the antigens than another groups. Interestingly, very low IL-10 and TNF-a mRNA expressions cultured with the TSP were also shown. These data suggest that the TSP may be involved in the macrophage activation by induction of Th1 stimulatory signals, such as IL-12, and suppression of Th1 inhibitory cytokine, IL-10.
Tumor Necrosis Factor-alpha

PURPOSE: This study was performed to determine the mechanism of contralateral testis damage after repair of testicular torsion. In addition, we investigated the effect of allopurinol pretreatment on the contralateral testis damage. MATERIALS AND METHODS: The levels of malondialdehyde (MDA) in the testes, kidneys and serum samples were determined in rats following torsion, detorsion or detorsion after allopurinol pretreatment, as were the levels of superoxide dismutase (SOD) in the testes samples. H&E staining was performed on the testes specimens and we calculated the mean numbers of spermatids per tubule in each group. RESULTS: Torsion caused a significant increase in the MDA levels in the contralateral testes, and detorsion caused a further significant increase in MDA in the contralateral testes and in the serum. Moreover, pretreatment with allopurinol prevented this further increase. The levels of SOD in the contralateral testes were not significantly different between the sham and torsion groups, whereas detorsion caused a significant reduction in SOD. In addition, pretreatment with allopurinol also prevented this decrease. The contralateral testes were histologically normal in all groups and the mean numbers of spermatids per tubule in the ipsilateral and contralateral testes were similar in all groups. CONCLUSIONS: Injury of the contralateral testis after the repair of testicular torsion seems to be caused by lipid peroxidation that is due to oxygen free radicals induced by the reperfusion of ischemic torsed testis. Toxic substances such as oxygen free radicals seem to be transferred to the contralateral testes through the blood stream, and allopurinol appears to protect the contralateral testes from the injury caused by detorsion.
Allopurinol* ; Animals ; Free Radicals ; Kidney ; Lipid Peroxidation ; Malondialdehyde ; Oxygen ; Rats* ; Reperfusion ; Reperfusion Injury ; Rivers ; Spermatic Cord Torsion* ; Spermatids ; Superoxide Dismutase ; Testis*

OBJECTIVES: This study was conducted to assess the development of posttraumatic stress disorder (PTSD) after occupational physical injuries and the risk factors in occupational accident patients for PTSD. METHODS: Forty-seven occupational accident patients with physical injuries were administered BDI, STAI I and II, SCL-90-R, IES and questionnaires for risk factors and Clinician-Administered PTSD Scale(CAPS). RESULTS: 1) 12 patients(25%) were diagnosed as PTSD. 2) The BDI, STAI I and II and IES scores are significantly high(<0.05) in PTSD group than non-PTSD group. 3) The subscales of SCL-90-R, with an exception of PAR subscale, showed higher scores(<0.05) in PTSD group. 4) The loss of consciousness(LOC) was only significant risk factor in the occupational accident-related factors(<0.05). CONCLUSION: The results of this study show the development of PTSD among occupational accident patients. The loss of consciousness(LOC) was the only signiticant risk factor for PTSD in occupational accident patients.
Accidents, Occupational* ; Humans ; Surveys and Questionnaires ; Risk Factors ; Stress Disorders, Post-Traumatic*

BACKGROUND: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates. METHODS: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. RESULTS: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital, 101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). CONCLUSION: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.
Death Certificates* ; Education ; Emergencies ; Mortality ; Retrospective Studies ; Seoul

Cadmium-containing compounds are widely used in the manufacturing of pigments, plastics, glass, metal alloys, and electrical equipment. Chronic low exposure of cadmium causes renal tubular dysfunction, emphysema, bronchial cancer, osteomalasia, multiple fracture or urethral stone. Occupations exposed to cadmium are increasing in industsralized country such as Korea, but there is a few systemic study on cadmium intoxication until nowadays. We studied the effects of cadmium on renal function, pulmonary function and bone mineral density in 5 workers exposed to cadmium. Cadmium in urine were increased [38.51+/-42.68 (7.27-101.07)mug/g creatinine(1 st exam), 0.70+/-7.16 (3.88-21.05)mug/g creatinine(2 nd exam)], respectively. Urine N-acetyl-beta-D-glucosaminidase(NAG) excretion rates[9.19+/-2.21(7.25-12.79) U/g creatinine] were increased, but urinary beta2-microglobulin(beta2- MG), urinary methalothionein(MT) excretion, 24 hour urinary protein, calcium excretions were not increased. Cadmium in urine was correlated with urine NAG(r=0.912, p=0.031) but no relationship with others. Glomerular filtration rate were all within normal limits. Complete blood counts, liver function, renal function, electrolytes were all within normal limits. In urinalysis and sediment examination, 4 cases showed no abnormalities, but 1 case showed proteinuria(30 mg/dL) and hematuria with dysmorphic RBC dominance(This case was diagnosed accompanying IgA nephropathy). In pathologic examination, all biopsy specimens showed mild interstitial fibrosis without inflammatory cell infiltration. Osteoporosis and obstructive lung defect were diagnosed in one case. We found urinary NAG excretion were increased and mild interstitial fibrosis at biopsy specimen were seen in all cases. It is necessary to follow-up for detection of proteinuria and decrement of GFR in each patients.
Alloys ; Biopsy ; Blood Cell Count ; Bone Density ; Cadmium* ; Calcium ; Electrolytes ; Emphysema ; Fibrosis ; Follow-Up Studies ; Glass ; Glomerular Filtration Rate ; Hematuria ; Humans ; Immunoglobulin A ; Kidney* ; Korea ; Liver ; Lung ; Occupations ; Osteoporosis ; Plastics ; Proteinuria ; Urinalysis

Background: Allogeneic hematopoietic stem cell transplantation (HSCT) was not actively performed in elderly acute myeloid leukemia (AML) or myelodysplastic syndrome patients who are at a high-risk based on hematopoietic cell transplantation-specific comorbidity index (HCT-CI). The advent of reduced-intensity conditioning (RIC) regimens has made HSCT applicable in this population. However, the selection of appropriate conditioning is a major concern for the attending physician. The benefits of combination of treosulfan and fludarabine (Treo/Flu) have been confirmed through many clinical studies. Korean data on treosulfan-based conditioning regimen are scarce. Methods: A retrospective study was conducted to compare the clinical outcomes of allogeneic HSCT using RIC between 13 patients receiving Treo/Flu and 39 receiving busulfan/ fludarabine (Bu/Flu). Results: In terms of conditioning-related complications, the frequency of ≥ grade 2 nausea or vomiting was significantly lower and the duration of symptoms was shorter in the Treo/ Flu group than in the Bu/Flu group. The incidence of ≥ grade 2 mucositis tended to be lower in the Treo/Flu group. In the analysis of transplant outcomes, all events of acute graft versus host disease (GVHD) and ≥ grade 2 acute GVHD occurred more frequently in the Treo/ Flu group. The frequency of Epstein-Barr virus reactivation was significantly higher in the Treo/Flu group (53.8% vs. 23.1%, P = 0.037). Non-relapse mortality (NRM) at 12 months was higher in the Treo/Flu group (30.8% vs. 7.7%, P = 0.035). Significant prognostic factors included disease type, especially secondary AML, disease status and high-risk based on HCT-CI, ≥ grade 2 acute GVHD, and cases requiring ≥ 2 immunosuppressive drugs for treating acute GVHD. In the comparison of survival outcomes according to conditioning regimen, the Bu/Flu group seemed to show better results than the Treo/Flu group (60% vs.46.2%, P = 0.092 for overall survival; 56.4% vs. 38.5%, P = 0.193 for relapse-free survival). In additional analysis for only HCT-CI high-risk groups, there was no difference in transplant outcomes except that the Treo/Flu group tended to have a higher NRM within one year after transplantation. Survival outcomes of both groups were similar. Conclusion This study suggests that Treo/Flu conditioning may be an alternative to Bu/Flu regimen in elderly patients with high-risk who are not suitable for standard conditioning.

Background: A fourth dose of vaccination is known to help reduce the severity and mortality rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The South Korean vaccination guidelines for the fourth dose do not include healthcare workers (HCWs) as priority candidates. We investigated the necessity of the fourth dose in South Korean HCWs based on an 8-month follow-up period after the third vaccination. Methods: Changes in the surrogate virus neutralization test (sVNT) inhibition (%) score were measured at one month, four months and eight months after the third vaccination. The sVNT values were analyzed between infected and uninfected groups, and their trajectories were compared. Results: A total of 43 HCWs were enrolled in this study. In total, 28 cases (65.1%) were confirmed to be infected with SARS-CoV-2 (presumed omicron variant), and all had mild symptoms. Meanwhile, 22 cases (78.6%) were infected within four months of the third dose (median, 97.5 days). Eight months after the third dose, the SARS-CoV-2 (presumed omicron variant)-infected group showed significantly higher sVNT inhibition than that in the uninfected group (91.3% vs. 30.7%; P < 0.001). The antibody response due to hybrid immunity, provided by a combination of infection and vaccination, was maintained at sufficient levels for more than four months. Conclusion For HCWs who had coronavirus disease 2019 infection after completing a third vaccination, a sufficient antibody response was maintained until eight months after the third dose. The recommendation of the fourth dose may not be prioritized in subjects with hybrid immunity.

No abstract available.
Catheters* ; Neck* ; Peritoneal Dialysis, Continuous Ambulatory*

No abstract available.
Paragonimiasis ; Paragonimus westermani ; Stroke