The correction of author order.
Adult* ; Humans ; Korea* ; Mortality*

The aim of this study was to investigate the efficiency of domestic physician-staffed helicopter emergency medical service (HEMS) for the transport of patients with severe trauma to a hospital. The study included patients with blunt trauma who were transported to our hospital by physician-staffed HEMS (Group P; n = 100) or nonphysician-staffed HEMS (Group NP; n = 80). Basic patient characteristics, transport time, treatment procedures, and medical treatment outcomes assessed using the Trauma and Injury Severity Score (TRISS) were compared between groups. We also assessed patients who were transported to the hospital within 3 h of injury in Groups P (Group P3; n = 50) and NP (Group NP3; n = 74). The severity of injury was higher, transport time was longer, and time from hospital arrival to operation room transfer was shorter for Group P than for Group NP (P < 0.001). Although Group P patients exhibited better medical treatment outcomes compared with Group NP, the difference was not statistically significant (P = 0.134 vs. 0.730). However, the difference in outcomes was statistically significant between Groups P3 and NP3 (P = 0.035 vs. 0.546). Under the current domestic trauma patient transport system in South Korea, physician-staffed HEMS are expected to increase the survival of patients with severe trauma. In particular, better treatment outcomes are expected if dedicated trauma resuscitation teams actively intervene in the medical treatment process from the transport stage and if patients are transported to a hospital to receive definitive care within 3 hours of injury.
Adult* ; Aircraft ; Emergencies ; Emergency Medical Services ; Humans ; Injury Severity Score ; Korea* ; Mortality* ; Resuscitation ; Trauma Centers ; Treatment Outcome

In patients with colorectal cancer (CRC), the BRAF V600E mutation has been reported to be associated with several clinicopathological features and poor survival. However, the prognostic implications of BRAF V600E mutation and the associated clinicopathological characteristics in CRCs remain controversial. Therefore, we reviewed various clinicopathological features, including BRAF status, in 349 primary CRCs and analyzed the relationship between BRAF status and various clinicopathological factors, including overall survival. Similar to previous studies conducted in Eastern countries, the incidence of the BRAF V600E mutation in the current study was relatively low (5.7%). BRAF-mutated CRC exhibits distinct clinicopathological features from wild-type BRAF-expressing cancer independent of the microsatellite instability (MSI) status. This mutation was significantly associated with a proximal tumor location (P = 0.002); mucinous, signet ring cell, and serrated tumor components (P < 0.001, P = 0.003, and P = 0.008, respectively); lymphovascular invasion (P = 0.004); a peritumoral lymphoid reaction (P = 0.009); tumor budding (P = 0.046); and peritoneal seeding (P = 0.012). In conclusion, the incidence of the BRAF V600E mutation was relatively low in this study. BRAF-mutated CRCs exhibited some clinicopathological features which were also frequently observed in MSI-H CRCs, such as a proximal location; mucinous, signet ring cell, and serrated components; and marked peritumoral lymphoid reactions.
Colorectal Neoplasms* ; Humans ; Incidence ; Microsatellite Instability* ; Microsatellite Repeats* ; Mucins

BACKGROUND: Whether there is a difference in outcomes for trauma patients transferring to the helicopter emergency medical service (HEMS) according to their previous team composition is controversial. The purpose of this study is to evaluate the effectiveness of trauma team-staffed-HEMS (TTS-HEMS) when transferring to a trauma center. METHODS: A retrospective comparison was conducted on patients transported to a trauma center over a 6-year period by the TTS-HEMS and paramedic-staffed-HEMS (119-HEMS). Inclusion criteria were blunt trauma with age ≥15 years. Patient outcomes were compared with the Trauma and Injury Severity Score (TRISS) (30-day mortality) and the Cox proportional hazard ratio of mortality (in hospital). RESULTS: There were 321 patients of TTS-HEMS and 92 patients of 119-HEMS. The TTS-HEMS group had a higher Injury Severity Score and longer transport time but a significantly shorter time to emergency surgery. The prehospital data showed that the trauma team performed more aggressive interventions during transport. An additional 7.6 lives were saved per 100 TTS-HEMS deployments. However, the TRISS results in the 119-HEMS group were not significant. In addition, after adjusting for confounders, the hazard ratio of mortality in the 119-HEMS group was 2.83 times higher than that in the TTS-HEMS group. CONCLUSION: HEMS was likely to improve the survival rate of injured patients when physicians were involved in TTS-HEMS. Survival benefits in the TTS-HEMS group appeared to be related to the fact that the trauma team performed both more aggressive prehospital resuscitation and clinical decision making during transportation.
Aircraft ; Clinical Decision-Making ; Emergencies ; Emergency Medical Services ; Humans ; Injury Severity Score ; Mortality ; Resuscitation ; Retrospective Studies ; Survival Rate ; Transportation ; Trauma Centers

BACKGROUND: Endoscopic mucosal resection (EMR) is now in clinical use for the management of mucosal and submucosal tumors of the stomach (including early gastric cancer), but its use is limited by the size, depth, and the location of the tumor. METHODS: After the introduction of a new concept of laparoscopic intra-gastric surgery (L.I.G.S.) in which all trocars and surgical instruments are inserted directly into the gastric cavity to perform the resection of mucosal or submucosal lesions of the stomach by Dr. Ohashi, sixteen patients with a mucosal or a submucosal tumor in the posterior wall of the stomach have been successfully treated by L.I.G.S. in our hospital since 1995. RESULTS: 2 patients with early gastric cancer, 9 with a leiomyoma, and 5 with polyps. Twelve (87.5%) of the tumors were located in the antrum and 4 (12.5%) in the body. L.I.G.S. was successfully done on 14 patients (93%) with conversion to a minilaparotomy in 1 patient. The leiomyoma located in the lesser curvature was treated by L.I.G.S. through an anterior gastrotomy using hand suturing. The operationg time was about 100-160 minutes for the L.I.G.S., 120 minutes in the conversion case, and 180 minutes in the L.I.G.S. through an anterior gastrotomy. Postoperative pain was negligible in all cases, and the patients were discharged uneventfully six to seven days after surgery. The follow-up period was 1 to 37 months, and there were no recurrences. The important points of this approach are confirmation of the location of the tumor by both gastrofiberscopy and laparoscopy, excluding the determination of regional lymph node metastasis by endoscopic ultrasonography, and proper selection of the trocar sites. CONCLUSION: We conclude that L.I.G.S. is technically feasible, safe, and useful for a mucosal or a submucosal tumor in the posterior wall of the stomach and that it should be considered as a viable alternative to endoscopic mucosal resection and conventional gastric resection.
Endosonography ; Follow-Up Studies ; Hand ; Humans ; Laparoscopy ; Laparotomy ; Leiomyoma ; Lymph Nodes ; Neoplasm Metastasis ; Pain, Postoperative ; Polyps ; Recurrence ; Stomach ; Stomach Neoplasms ; Surgical Instruments