The survival rate of commotio cordis is low, and there is often associated neurological disability if return of spontaneous circulation (ROSC) can be achieved. We report a case of commotio cordis treated with therapeutic hypothermia (TH) that demonstrated a favorable outcome. A 16-year-old female was transferred to our emergency department (ED) for collapse after being struck in the chest with a dodgeball. She has no history of heart problems. She was brought to our ED with pulseless ventricular tachycardia (VT), and ROSC was achieved with defibrillation. She was comatose at our ED and was treated with TH at a target temperature of 33degrees C for 24 hours. After transfer to the intensive care unit, pulseless VT occurred, and defibrillation was performed twice. She recovered to baseline neurologic status with the exception of some memory difficulties.
Adolescent ; Coma ; Commotio Cordis* ; Emergency Service, Hospital ; Female ; Heart ; Humans ; Hypothermia* ; Intensive Care Units ; Memory ; Survival Rate ; Tachycardia ; Tachycardia, Ventricular* ; Thoracic Injuries ; Thorax

Disasters, or mass casualty incidents, occurring in modern history differ from those occurring in even the recent past. In previous times, disasters were mostly the result of natural causes such as earthquakes or floods. Currently, multiple casualty incidents are often the result of human actions such as vehicular accidents involving many vehicles with multiple operators, passengers and collateral victims, terror attacks and acts of war, radiation accidents, toxic chemical releases, and pandemic infectious agent exposures. Especially, events involving accidental and intentional exposures of chemical, biological, radiological/nuclear materials, often abbreviated as CBR or CBRN events present unique challenges to the healthcare system in caring for the victims. In these mass casualty incidents, a fully comprehensive, coordinated team response involving many different components of the community healthcare system need to be mobilized to effectively meet the modern challenge of CBRN events. Necessary components of a modern emergency response include training for prompt triage, decontamination, detoxification, emergency medical treatment, as well as providing appropriate transport to the proper medical treatment facility. Meeting these challenges requires maintaining ongoing communications between agencies charged with meeting the disaster to allow acquisition of information and location for the patients, transfer the information to both the Central Medical Emergency Response Center and the designated hospital. While sharing this information was problematic in the past, modern wireless communications and information technologies provide convenient means for the rapid sharing of important patient data and current situational details. Finally, improving modern disaster response requires the development of a disaster response plan, ongoing training in implementing the plan including disaster scenario simulation, and budgeting to acquire the necessary equipment involved for the emergency response personnel to meet the presenting crisis.
Budgets ; Community Health Services ; Decontamination ; Delivery of Health Care ; Disasters* ; Earthquakes ; Emergencies* ; Emergency Medical Service Communication Systems ; Emergency Medical Services* ; Floods ; History, Modern 1601- ; Humans ; Mass Casualty Incidents ; Pandemics ; Radioactive Hazard Release ; Transportation of Patients ; Triage

We investigated the stress-induced changes in the lipid and hormonal concentrations in plasma, including cytochrome P450 (CYP)-derived oxidative stress in the liver, and the anti-stresseffect of Korean Red Ginseng (KRG) water extract in mice. Stress induction using restraint increased the levels of corticosterone (CORT), glucose, total cholesterol (TC), and low-den-sity lipoprotein-cholesterol (LDL-C) while decreasing in the levels of insulin and high-density lipoprotein-cholesterol (HDL-C), compared with those of unstressed mice. Restraint-stress also increased the generation of reactive oxygen species (ROS) in plasma by 5.4-fold. More-over, the stress resulted in a 2.8-fold higher production of C-reactive protein (CRP) than the control group. In addition, the catalytic activities of CYP1A2 and CYP3A4 in the liver micro-somes were stimulated by 5.5- and 3.8-fold, respectively, and concomitant ROS formation was elevated by 4.3-fold in the liver extract, compared to the normal group. In contrast, the KRG treatment (5, 20, or 50 mg/kg/day) to stress-exposed 3 groups alleviated the increased CORT, TC, LDL-C, ROS, and CRP levels and restored the decreased insulin concentrations.The enhanced each ROS in the plasma and liver, and the CYP enzyme activities were also attenuated in KRG-treated mice in a concentration-dependent manner. In conclusion, these results suggest that KRG ameliorates stress-induced detrimental effects on the plasma and liver of treated mice.

We investigated the stress-induced changes in the lipid and hormonal concentrations in plasma, including cytochrome P450 (CYP)-derived oxidative stress in the liver, and the anti-stresseffect of Korean Red Ginseng (KRG) water extract in mice. Stress induction using restraint increased the levels of corticosterone (CORT), glucose, total cholesterol (TC), and low-den-sity lipoprotein-cholesterol (LDL-C) while decreasing in the levels of insulin and high-density lipoprotein-cholesterol (HDL-C), compared with those of unstressed mice. Restraint-stress also increased the generation of reactive oxygen species (ROS) in plasma by 5.4-fold. More-over, the stress resulted in a 2.8-fold higher production of C-reactive protein (CRP) than the control group. In addition, the catalytic activities of CYP1A2 and CYP3A4 in the liver micro-somes were stimulated by 5.5- and 3.8-fold, respectively, and concomitant ROS formation was elevated by 4.3-fold in the liver extract, compared to the normal group. In contrast, the KRG treatment (5, 20, or 50 mg/kg/day) to stress-exposed 3 groups alleviated the increased CORT, TC, LDL-C, ROS, and CRP levels and restored the decreased insulin concentrations.The enhanced each ROS in the plasma and liver, and the CYP enzyme activities were also attenuated in KRG-treated mice in a concentration-dependent manner. In conclusion, these results suggest that KRG ameliorates stress-induced detrimental effects on the plasma and liver of treated mice.

We investigated the stress-induced changes in the lipid and hormonal concentrations in plasma, including cytochrome P450 (CYP)-derived oxidative stress in the liver, and the anti-stresseffect of Korean Red Ginseng (KRG) water extract in mice. Stress induction using restraint increased the levels of corticosterone (CORT), glucose, total cholesterol (TC), and low-den-sity lipoprotein-cholesterol (LDL-C) while decreasing in the levels of insulin and high-density lipoprotein-cholesterol (HDL-C), compared with those of unstressed mice. Restraint-stress also increased the generation of reactive oxygen species (ROS) in plasma by 5.4-fold. More-over, the stress resulted in a 2.8-fold higher production of C-reactive protein (CRP) than the control group. In addition, the catalytic activities of CYP1A2 and CYP3A4 in the liver micro-somes were stimulated by 5.5- and 3.8-fold, respectively, and concomitant ROS formation was elevated by 4.3-fold in the liver extract, compared to the normal group. In contrast, the KRG treatment (5, 20, or 50 mg/kg/day) to stress-exposed 3 groups alleviated the increased CORT, TC, LDL-C, ROS, and CRP levels and restored the decreased insulin concentrations.The enhanced each ROS in the plasma and liver, and the CYP enzyme activities were also attenuated in KRG-treated mice in a concentration-dependent manner. In conclusion, these results suggest that KRG ameliorates stress-induced detrimental effects on the plasma and liver of treated mice.

Background: Chlorogenic acid (CGA) has been shown to reduce pro-inflammation by scavenging reactive oxy‑ gen species (ROS) and reactive nitrogen species. In this study, the anti-inflammatory effect of CGA was expanded to streptozotocin (STZ)-induced diabetic rats. The inter-relationships among oxidative stress, pro-inflammation, and cytochrome P450 (CYP) 1A enzymes were also investigated in peripheral blood mononuclear cells (PBMC) of STZdiabetic rats. Results: The levels of pro-inflammatory cytokines, interleukin-6 and tumor necrosis factor-alpha, increased by approximately 3.4- and 2.9-fold, respectively, and the albumin concentration decreased in the serum of STZ-induced diabetic rats compared to normal rats. The C-reactive protein (CRP) values also increased by about 3.8-fold higher, indicating that STZ induced an inflammation in the blood of STZ-diabetic rats. The expression levels and catalytic activities of CYP1A enzymes were elevated by approximately 2.2–2.5- and 4.3–6.7-fold, respectively, in the PBMC of STZ-treated rats. A decrease in the amount of PBMC-bound albumin was also observed. In contrast, the levels of cytokines and CRP in serum and the activities of CYP1A enzymes in PBMC were significantly reduced in CGA-treated diabetic rats in a CGA concentration-dependent manner. In addition, STZ-mediated elevation of ROS in serum and PBMC was decreased by the CGA administration. However, the CGA treatment did not change the enhanced blood glucose level and expression of CYP1A enzymes by STZ. STZ-mediated decrease in the levels of serum and PBMCbound albumin was not also restored by the CGA administration. Conclusions These results suggest that CGA could be used to treat type 1 diabetes-induced inflammation.

The survival rate of commotio cordis is low, and there is often associated neurological disability if return of spontaneous circulation (ROSC) can be achieved. We report a case of commotio cordis treated with therapeutic hypothermia (TH) that demonstrated a favorable outcome. A 16-year-old female was transferred to our emergency department (ED) for collapse after being struck in the chest with a dodgeball. She has no history of heart problems. She was brought to our ED with pulseless ventricular tachycardia (VT), and ROSC was achieved with defibrillation. She was comatose at our ED and was treated with TH at a target temperature of 33degrees C for 24 hours. After transfer to the intensive care unit, pulseless VT occurred, and defibrillation was performed twice. She recovered to baseline neurologic status with the exception of some memory difficulties.
Adolescent ; Coma ; Commotio Cordis ; Emergency Service, Hospital ; Female ; Heart ; Humans ; Hypothermia ; Intensive Care Units ; Memory ; Survival Rate ; Tachycardia ; Tachycardia, Ventricular ; Thoracic Injuries ; Thorax

BACKGROUND: Recruitment and homing cells into graft materials from host tissue is crucial for bone regeneration. METHODS: Highly porous, multi-level structural, hydroxyapatite bone void filler (HA-BVF) have been investigated to restore critical size bone defects. The aim was to investigate a feasibility of bone regeneration of synthetic HA-BVF compared to commercial xenograft (Bio-Oss). HA-BVF of 0.7 mm in average diameter was prepared via template coating method. Groups of animals (n = 6) were divided into two with normal (Sham) or induced osteoporotic conditions (Ovx). Subsequently, subdivided into three treated with HA-BVF as an experiment or Bio-Oss as a positive control or no treatment as a negative control (defect). The new bone formation was analyzed by micro-CT and histology. RESULTS: At 4 weeks post-surgery, new bone formation was initiated from all groups. At 8 weeks post-surgery, new bone formation in the HA-BVF groups was greater than Bio-Oss groups. Extraordinarily greater bone regeneration within the Ovx-HA group than Sham-Bio-Oss or Ovx-Bio-Oss group (p<0.05). CONCLUSION: This study suggests that the immediate wicking property of HA-BVF from host tissue activates a natural healing cascade without the addition of exogeneous factors or progenitor cells. HA-BVF may be an effective alternative for repairing bone defects under both normal and osteoporotic bone conditions.
Animals ; Bone Regeneration* ; Capillary Action* ; Durapatite ; Heterografts ; Methods ; Models, Animal* ; Osteogenesis ; Osteoporosis ; Rats* ; Stem Cells ; Transplants*

PURPOSE: The aim of this study was to investigate the independent factors associated with the registration rate for the community-based post suicidal care program in the emergency department (ED). METHODS: This prospective observational study was conducted between March and December 2013 at the academic ED at the tertiary urban hospital. During the study period, the pre-designed registry was recorded. The variables examined included the following: patients' demographic data (Sex, age, address, type of insurance, marital status, level of education, and history of previous psychiatric disease), suicide-related data (suicidal methods, combined drink of alcohol and number of previous attempts), and management-related data (disposition at ED, physician's training level, etc.). Univariated and multivariated logistic regression analyses were performed for identification of factors affecting the registration rate for the community-based post suicidal care program. RESULTS: A total of 163 suicides were included during the study period. Of these, 33 (20.2%) patients were registered in the post-suicide care program. Factors including a patient's address (OR: 14.92, 95% CI: 3.606-61.711), immediate intervention by psychiatric healthcare center (OR: 5.05, CI: 1.688-15.134), admissions in hospital (OR: 3.69, CI: 1.286-10.605), and history of previous psychiatric disease (OR: 3.52, CI: 1.216-10.201) showed significant association with registration for the program. CONCLUSION: The community-based post-suicidal care program, which is available 24 hours a day, should be operated in each district in order to increase the registration rate. Emergency physicians should actively consider the inpatient treatment program for suicidal patients and strongly recommend registration to the program, particularly for patients without previous history of psychiatric disease.
Delivery of Health Care ; Education ; Emergencies ; Emergency Service, Hospital* ; Hospitals, Urban ; Humans ; Inpatients ; Insurance ; Logistic Models ; Marital Status ; Observational Study ; Prospective Studies ; Suicide

With recent progress in treatment modalities, mortality from upper gastrointestinal (UGI) bleeding has decreased appreciably. The aim of this study was to establish how UGI bleeds are managed in Korean patients with cirrhosis and to evaluate treatment outcomes. A total of 479 episodes of acute UGI bleeding in 464 patients with cirrhosis were included during a six-month period at nine tertiary medical centers. Treatment outcomes were assessed by failure to control bleeding, rebleeding and mortality. The source of bleeding was esophagogastric varices in 77.7% of patients, nonvariceal lesions in 15.9%, and undefined in 6.5%. For control of bleeding, endoscopic and pharmacologic treatments were used in 74.7% and 81.9% of patients, respectively. Variceal ligation was a major technique for endoscopic treatment (90%), and terlipressin and somatostatin were the main pharmacologic agents used (96.4%). Initial hemostasis was achieved in 86.8% of cases, but rebleeding occurred in 3.8% and 16.8% of cases within five days and six weeks of hemorrhage, respectively. Five-day and six-week mortality were 11.3% and 25.9%, respectively. Survival of patients with variceal bleeding seems to be remarkably improved than previous reports, which may suggest the advances in hemostatic methods for control of variceal hemorrhage..
Adult ; Aged ; Cohort Studies ; Female ; Gastrointestinal Hemorrhage/mortality/*therapy ; Hemostatic Techniques ; Humans ; Infection/epidemiology ; Liver Cirrhosis/*complications ; Lysine Vasopressin/analogs & derivatives/therapeutic use ; Male ; Middle Aged ; Treatment Outcome