Purpose: A trauma center project for treating patients with trauma has been established in Korea. A trauma team is activated based on the Centers for Disease Control and Prevention (CDC) field triage Step 1 for patient triage. Here, we determined if the currently applied criteria were appropriate for the triage of patients with trauma in Korea. Methods: This retrospective study included patients who were taken to the regional trauma center from January 1, 2016 to December 31, 2019, and were registered in the Korean Trauma database. The rates for undertriage and overtriage were calculated from the in-field and in-hospital triage according to the CDC guidelines Step 1. Results: Among the 9,383 patients transferred to the trauma center, 3,423 were directly transferred from the site and were investigated. The overall rates for undertriage and overtriage of these patients were 28.13% and 30.35%, respectively. For the patients who received in-field triage and were directly transferred to the trauma center, the rates for undertriage and overtriage were 27.92% and 32.39%, and 25.92% and 29.11% for in-hospital triage, respectively. The concordance rate of triage was 87.09%. Conclusion The current use of in-hospital triage physiological criteria as set out in the CDC guidelines Step 1, indicated an undertriage rate which was high and an overtriage rate within the acceptable range. Further studies on triaging patients with trauma are warranted. Improvements in the guidelines of the trauma center project are necessary and this needs to be supported by resources and training for field personnel.

BACKGROUND/OBJECTIVES: Recently, anthocyanins have been reported to have various biological activities. Furthermore, anthocyanin-rich purple corn extract (PCE) ameliorated insulin resistance and reduced diabetes-associated mesanginal fibrosis and inflammation, suggesting that it may have benefits for the prevention of diabetes and diabetes complications. In this study, we determined the anthocyanins and non-anthocyanin component of PCE by HPLC-ESI-MS and investigated its anti-diabetic activity and mechanisms using C57BL/KsJ db/db mice. MATERIALS/METHODS: The db/db mice were divided into four groups: diabetic control group (DC), 10 or 50 mg/kg PCE (PCE 10 or PCE 50), or 10 mg/kg pinitol (pinitol 10) and treated with drugs once per day for 8 weeks. During the experiment, body weight and blood glucose levels were measured every week. At the end of treatment, we measured several diabetic parameters. RESULTS: Compared to the DC group, Fasting blood glucose levels were 68% lower in PCE 50 group and 51% lower in the pinitol 10 group. Furthermore, the PCE 50 group showed 2- fold increased C-peptide and adiponectin levels and 20% decreased HbA1c levels, than in the DC group. In pancreatic islets morphology, the PCE- or pinitol-treated mice showed significant prevention of pancreatic beta-cell damage and higher insulin content. Microarray analyses results indicating that gene and protein expressions associated with glycolysis and fatty acid metabolism in liver and fat tissues. In addition, purple corn extract increased the phosphorylation of AMP-activated protein kinase (AMPK) and decreased phosphoenolpyruvate carboxykinase (PEPCK), glucose 6-phosphatase (G6pase) genes in liver, and also increased glucose transporter 4 (GLUT4) expressions in skeletal muscle. CONCLUSIONS: Our results suggested that PCE exerted anti-diabetic effects through protection of pancreatic beta-cells, increase of insulin secretion and AMPK activation in the liver of C57BL/KsJ db/db mice.
Adiponectin ; AMP-Activated Protein Kinases ; Animals ; Anthocyanins ; Blood Glucose ; Body Weight ; C-Peptide ; Diabetes Complications ; Fasting ; Fibrosis ; Glucose Transport Proteins, Facilitative ; Glucose-6-Phosphatase ; Glycolysis ; Inflammation ; Insulin ; Insulin Resistance ; Islets of Langerhans ; Liver ; Metabolism ; Mice* ; Muscle, Skeletal ; Phosphoenolpyruvate ; Phosphorylation ; Zea mays*

Acute myocardial infarction is a rarely reported complication of amphetamine abuse. We report here on a case of a 39-year-old man who presented with cardiac enzyme patterns, a clinical history and an ECG that were all compatible with acute ST elevation myocardial infarction. This was probably the result from self administration of intravenous amphetamine. The initial coronary angiogram (CAG) showed total occlusion of the distal right coronary artery (RCA) with a large thrombus. Because the RCA was tortuous and removal of thrombus was thought not to be easy, he was treated with thrombolytic therapy and intravenous heparin followed by oral warfarin. The follow-up CAGs at 2 weeks and 10 months later showed almost complete resolution of the coronary abnormalities. In this case, the early coronary angiography was thought to be helpful to determine the relative contribution of thrombus and spasm that were associated with amphetamine abuse.
Adult ; Amphetamine* ; Amphetamine-Related Disorders* ; Coronary Angiography ; Coronary Vessels ; Electrocardiography ; Follow-Up Studies ; Heparin ; Humans ; Myocardial Infarction* ; Self Administration ; Spasm ; Thrombolytic Therapy ; Thrombosis ; Warfarin

BACKGROUND AND OBJECTIVES: Heart failure (HF) may occur in atrial fibrillation (AF) patients with a normal left ventricular (LV) systolic function if the diastolic function is impaired. The association of new parameters from the relationship between the preceding RR interval (RR-1) and LV outflow peak ejection velocity (Vpe) with systolic function has been reported. The aim of this study was to observe whether these parameters were associated with HF in AF patients with a normal systolic function. SUBJECTS AND METHODS: AF patients with a normal systolic function were divided into two groups according to the presence (n=16) or absence (n=30) of a history of HF. From the logarithmic equation between RR-1 and Vpe, the slope, Vpe at RR-1 second (Vpe-1), and Slope/Vpe-1 were calculated. RESULTS: Patients with a history of HF were older (p=0.037) and tended to more frequently have hypertension (p=0.063) than those with no history of HF. The ejection fractions were similar between the two groups. In the coordinates with RR-1 from 0.6 to 1 second, the slope tended to be steeper (p=0.074) and slope/Vpe-1 was higher in patients with a history of HF (p=0.011). The Vpe-1 was similar between the two groups (p=0.66). A multiple forward logistic regression analysis showed that slope/Vpe-1 was the only independent variable associated with the occurrence of HF. Slope/Vpe-1 was related with aortic regurgitation, HF history, and the interventricular septal thickness in a multiple stepwise regression analysis. CONCLUSION: New parameters from the relationship between the RR intervals and LV performances were associated with the occurrence of HF in AF patients with a normal systolic function. This finding suggests that these parameters may be related with the LV diastolic function.
Aortic Valve Insufficiency ; Atrial Fibrillation* ; Echocardiography, Doppler, Pulsed ; Heart Failure* ; Heart* ; Humans ; Hypertension ; Logistic Models ; Predictive Value of Tests

BACKGROUND AND OBJECTIVES: Annexin V is known to bind to the phosphatidylserine (PS) of damaged cell membranes. We recently demonstrated that annexin V binds to oxidized red blood cells (oxRBC). The aim of this study was to find whether annexin V binds to oxidized lipids or to the PS of oxRBC. MATERIALS AND METHODS: Red blood cells (RBC) were oxidized by the addition of CuSO4, and the degree of oxidation evaluated using the semiquantitative measurement of thiobarbituric acid reactive substance (TBARS). The binding of annexin V to oxRBC was evaluated by flow cytometry. RESULTS: Annexin V was found to bind to oxRBC, but not to native RBC. The percentage of RBC binding to annexin V was closely correlated with the degree of oxidation, as measured using TBARS (r=0.99, p=0.000) in relation to the concentration of CuSO4. The binding of annexin V to oxRBC was attenuated in the presence of oxidized low density lipoprotein (oxLDL), with these phenomena also being dosedependent. The binding was reduced by 71.0+/-3.0% in the presence of 100 microgram/mL oxLDL. LDL had no influence on the binding of annexin V to oxRBC. CONCLUSION: These findings suggest that annexin V may bind to the oxidized lipids of cell membranes. Further studies will be required to evaluate the relative importance between oxidized lipids and PS, and to find the characteristics of oxidized lipids in the binding of annexin V to damaged cell membranes.
Annexin A5* ; Cell Membrane ; Erythrocytes* ; Flow Cytometry ; Lipid Peroxidation ; Lipoproteins ; Thiobarbituric Acid Reactive Substances

BACKGROUND AND OBJECTIVES: A correlation between the BNP reduction ratio and prognosis could be expected to be found by evaluating the BNP reduction depending on the volume status during the early period. SUBJECTS AND METHODS: Between October 2002 and June 2004, 120 patients with acute heart failure (AHF)(<1 month) were included. The patients were divided into three groups according to their volume status, as follows. Group I: patients with clinical & radiological wet status, Group II: clinical dry & radiological wet status and Group III: clinical & radiological dry status. The blood BNP (Triage(r)) level and clinical parameters were analyzed. The bad prognostic parameters were defined as readmission due to heart failure, a major adverse cardiac event or cardiovascular death. RESULTS: The mean patient age was 68.0+/-12.7 years, and 50.0% of the subjects were male. The most frequent etiology of AHF was ischemic heart disease (35.8%). There were 61.7, 24.1 and 14.2% in Groups I, III and III, respectively. The baseline BNP level was higher in group I and II than in group III patients (I: 1540.4+/-1202.8, II: 1482.8+/-1281.6, III: 666.4+/-827.9 pg/mL, p=0.036) as was the early BNP reduction ratio (I: 69.8+/-27.1, II: 67.4+/-32.8, III: 1.3+/-144.9%, p=0.007). Sixteen (13.3%) patients had a poor prognosis. From a logistical analysis, the early BNP reduction ratio (p=0.004) and creatinine level (p=0.029) were significant predictors of the clinical outcomes. CONCLUSION: The early change in the BNP level varied depending on the degree of congestive status, and was also correlated with the level of clinical outcomes. Therefore, in our opinion, the early monitoring of the BNP level will provide significant clinical information in AHF patients.
Creatinine ; Estrogens, Conjugated (USP)* ; Follow-Up Studies* ; Heart Failure* ; Heart* ; Humans ; Male ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Prognosis*

BACKGROUND: Prehypertension is a precursor of clinical hypertension and tends to increase in severity over time. Structural vascular changes have not been much investigated in adults with prehypertension. METHODS: We investigated the carotid intima-media thickness (IMT) in prehypertensive adults, pharmacologically untreated, compared with normotensive and hypertensive patients. Mean and maximum carotid IMT were obtained from six far walls of the common carotid, the bifurcation, and the internal carotid artery on both sides of the neck with high-resolution B-mode ultrasonography. RESULTS: Mean IMT was largest in the carotid bifurcation, followed by the common carotid and the internal carotid artery in all groups. Hypertensives had higher mean IMT values at all locations than normotensive controls. In prehypertensive adults, the mean and maximum IMT values were significantly higher than in normotensive controls. In contrast, there was no significant difference in the mean and maximum carotid IMT between prehypertensive adults and patients with stage 1 hypertension. The prevalence of plaques was 15.7% in prehypertensive adults, compared with 4.4% in controls, 22.2% in stage 1 hypertensives, and 29.4% in stage 2 hypertensives. CONCLUSION: Prehypertensive adults had thicker mean carotid IMT than normotensive controls and exhibited similarly abnormal carotid structure as the patients with stage 1 hypertension. These results suggest we need the continuous evaluation for early clinical detection and intervention of prehypertension.
Adult* ; Carotid Arteries ; Carotid Artery, Internal ; Carotid Intima-Media Thickness* ; Humans ; Hypertension ; Neck ; Prehypertension ; Prevalence ; Ultrasonography

BACKGROUND: High levels of C-reactive protein (CRP) are associated with an increased risk for cardiovascular diseases. Most reports on the effect of fibrate on CRP level have inadequate study designs and the results are inconsistent. This study was designed to evaluate the effect of fenofibrate on CRP levels in hypertriglyceridemic patients. METHODS: Patients with triglyceride (TG) level over 200 mg/dL were treated with 200 mg of fenofibrate (Fenofibrate group, n=30) or with general measures (Control group, n=30). Patients with CRP levels >10 mg/L were excluded. Patients with hypercholesterolemia were treated with HMG CoA reductase inhibitor (Statin group, n=30). Lipid and lipoprotein levels were measured before and 2 months after medication. RESULTS: Baseline characteristics were similar in Fenofibrate and Control groups. Baseline CRP levels were independently associated with the presence of diabetes mellitus. Fenofibrate therapy did not change CRP levels (1.67+/-1.60 vs 1.76+/-1.88 mg/L, p=0.79) as did Control group (p=0.46). When both Fenofibrate and Control groups were divided into three subgroups in terms of baseline CRP levels, CRP levels were increased in the lowest group (p=0.019), did not change in the middle and the highest groups (p=0.89 and p=0.47 respectively). In patients with baseline CRP level > or =3 mg/L, CRP levels were decreased (p=0.041). Changes of CRP levels were independently associated with baseline CRP levels. Statin therapy decreased CRP levels (p=0.046). CONCLUSIONS: Fenofibrate did not change CRP levels in hypertriglyceridemic patients. Cardioprotective effects of fibrates may not be associated with anti-inflammatory mechanisms in contrast to those of statins.
C-Reactive Protein* ; Cardiovascular Diseases ; Diabetes Mellitus ; Fenofibrate* ; Fibric Acids ; Humans ; Hydroxymethylglutaryl CoA Reductases ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypercholesterolemia ; Lipoproteins ; Triglycerides

BACKGROUND AND OBJECTIVES: The responses of lipoprotein (a) [Lp(a)] to lipid-lowering drugs are different from those of other lipids and lipoproteins. Most reports on the effect of fibrate on the Lp (a) level have only a few cases, with inconsistent results. This study was designed to evaluate the effect of fibrate on the Lp (a) level in hypertriglyceridemic patients. SUBJECTS AND METHODS: Patients with either a triglyceride (TG) level over 300mg/dL or TG level over 200mg/dL and a high density lipoprotein cholesterol level below 40mg/dL, were enrolled. They were treated with either fibrate (Fibrate group, n=29) or general measures (Control group, n=29). Gender and age matched patients with hypercholeste-rolemia were adopted and treated with statin (Statin group, n=29). The lipid and lipoprotein levels were measured before and after the medication for 2 months. RESULTS: The baseline Lp (a) levels were similar between the Fibrate and Control groups (p=0.19). Fibrate therapy increased the Lp (a) level from 10.3+/-16.4 to 15.1+/-15.2 mg/dL (p=0.003), but there were no changes in the Lp (a) levels in the Statin and Control groups. Before the treatment, the Lp (a) levels were negatively associated with the TG levels (r=-0.36, p=0.001). The relationship became weaker and insignificant after the medication. The more the TG level was decreased, the more the Lp (a) level was increased in all of the cases (r=-0.35, p=0.001 ) as well as in the Fibrate group (r=-0.46, p=0.013). CONCLUSION: Fibrate increased the Lp (a) level, and this elevation was associated with the reduction in the TG level. This finding might be related with a lesser cardioprotective effect of fibrate than that of statin in addition to the effect on the cholesterol level.
Cholesterol ; Cholesterol, HDL ; Gemfibrozil ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Lipoprotein(a)* ; Lipoproteins ; Triglycerides