The propolis, honey bee hive product, is a folk medicine for treating various ailrnents and caffeic acid phenethyl ester (CAPE) is an extract of propolis. The purpose of this study was to examine the effects of ethanol extracted propolis (EEP) or CAPE on the tumorigenesis, pulmonary metastases, and proliferation and activity of splenocytes and macrophages in ICR mice. EEP at 0.2, 2 or 20mg/ml applied topically on the back of each mice 30 minutes before application of 7,12-dimethylbenz (a)anthracene and 12-0-tetradecanoylphorbol-13-acetate inhibited the number of tumors per mouse by 61, 75 or 100%, respectively. ...continue...
Animals ; Bees ; Carcinogenesis* ; Ethanol ; Honey ; Macrophages* ; Medicine, Traditional ; Mice* ; Mice, Inbred ICR ; Neoplasm Metastasis* ; Propolis*

For trauma patients with severe shock, massive fluid resuscitation is necessary. However, shock and a large amount of fluid can cause bowel and retroperitoneal edema, which sometimes leads to abdominal compartment syndrome in patients without abdomino-pelvic injury. If other emergent operations except intraabdomen are needed, a distended abdomen is likely to be recognized late, leading to multiple organ dysfunction. Herein, we report two cases of a 23-year-old woman who was in a car accident and a 53-year old man who was pressed on his leg by a pressing machine; severe brain swelling and popliteal vessel injury were diagnosed, respectively. They were both in severe shock and massive fluid resuscitation was required in the emergency department. Distended abdomen was recognized in both the female and male patients immediately after neurosurgical operation and immediately before orthopaedic operation in the operating room, respectively. Decompressive laparotomy revealed massive ascites with retroperitoneal edema.
Abdomen ; Ascites ; Brain Edema ; Edema ; Emergency Service, Hospital ; Female ; Humans ; Intra-Abdominal Hypertension* ; Laparotomy ; Leg ; Male ; Operating Rooms* ; Resuscitation ; Shock ; Young Adult

Purpose: Base deficit (BD) is superior to vital signs in predicting trauma outcomes in adults. The authors aimed to compare BD and vital signs as criteria for the four-tiered hemorrhagic shock classification in children with trauma. Materials and Methods: We retrospectively reviewed the data of 1046 injured children who visited a Korean academic hospital from 2010 through 2018. These children were classified separately based on BD (class I, BD ≤2.0 mmol/L; II, 2.1–6.0 mmol/L; III, 6.1–10 mmol/L; and IV, ≥10.1 mmol/L) and vital signs (<13 years: age-adjusted hypotension and tachycardia, and Glasgow Coma Scale; 13–17 years: the 2012 Advanced Trauma Life Support classification). The two methods were compared on a class-by-class basis regarding the outcomes: mortality, early transfusion (overall and massive), and early surgical interventions for the torso or major vessels. Results: In total, 603 children were enrolled, of whom 6.6% died. With the worsening of BD and vital signs, the outcome rates increased stepwise (most p<0.001; only between surgical interventions and vital signs, p=0.035). Mortality more commonly occurred in BD-based class IV than in vital signs-based class IV (58.8% vs. 32.7%, p=0.008). Early transfusion was more commonly performed in BD-based class III than in vital signs-based class III (overall, 73.8% vs. 53.7%, p=0.007; massive, 37.5% vs. 15.8%, p=0.001). No significant differences were found in the rates of early surgical interventions between the two methods. Conclusion BD can be a better predictor of outcomes than vital signs in children with severe hemorrhagic shock.

Purpose: This study was performed to investigate the association of high age-adjusted shock index (AASI) with mortality in Korean children with trauma. Methods: The data of children (aged < 15 years) with trauma who visited an university hospital in Korea from 2010 through 2018 were reviewed. High AASI was defined by age groups as follows: < 12 months, ≥ 2.7; 12-23 months, ≥ 2.1; 2-4 years, ≥ 1.9; 5-11 years, ≥ 1.5; and 12-14 years, ≥ 1.1. Age, sex, transfer status, injury mechanism, hypotension, tachycardia, base deficit, hemoglobin concentration, trauma scores, hemorrhage-related procedures (transfusion and surgical interventions), and severe traumatic brain injury were compared according to high AASI and in-hospital mortality. The association of high AASI with the mortality was analyzed using logistic regression. Results: Of the 363 enrolled children, 29 (8.0%) had high AASI and 24 (6.6%) died. The children with high AASI showed worse trauma scores and underwent hemorrhage-related procedures more frequently, without a difference in the rate of the traumatic brain injury. High AASI was associated with in-hospital mortality (survivors, 6.5% vs. non-survivors, 29.2%; P = 0.001). This association remained significant after adjustment (adjusted odds ratio, 6.42; 95% confidence interval, 1.38-29.82). The other predictors were Glasgow Coma Scale (for increment of 1 point; 0.62; 0.53-0.72) and age (for increment of 1 year; 0.84; 0.73-0.97). High AASI showed a 29.2% sensitivity and 93.5% specificity for the mortality. Conclusion High AASI is associated with mortality, and have a high specificity but low sensitivity in Korean children with trauma. This predictor of mortality can be used prior to obtaining the results of laboratory markers of shock.

Objective: Suicide is a major issue in South Korea, and falling is a common method of suicide. Further, accidental falls are a common cause of death. However, whether suicidal falls differ from accidental falls is inconclusive. This study aimed to compare suicidal and accidental falls to identify risk factors for mortality. Methods: From March 2010 to December 2016, patients admitted to our hospital because of falls were reviewed retrospectively. Characteristics and outcomes were compared between suicide and accident groups. Injury distribution was compared using the Injury Severity Score and Abbreviated Injury Scales. Multivariate analysis was performed to identify risk factors, including suicide intent, for mortality. Results: Of 242 patients, 42 were included in the suicide group and 200 were included in the accident group. The suicide group showed higher fall heights and injuries of greater severity. The accident group was younger and included a higher number of men. The suicide group showed a higher mortality (23.8% vs. 6.5%, P=0.001) and a higher proportion of injuries in the lower extremities or abdomen. In the multivariate analysis, Glasgow Coma Scale score (0.575 [0.433–0.764], P<0.001), body mass index (1.638 [1.194–2.247], P=0.002), suicide intent (9.789 [1.026–93.404], P=0.047) and Injury Severity Score (1.091 [1.000–1.190], P=0.049) were identified as risk factors for mortality. Conclusion Suicidal falls were associated with poorer outcomes and a greater tendency to land feet first relative to accidental falls. Suicide intent was a risk factor for mortality.

Fluid therapy is one of the fundamental treatments for the management of trauma patients. Apart from supplementary hydration, fluid therapy is also applied for resuscitation. Especially in cases of hypovolemic shock due to bleeding, fluid therapy needs to be carefully adjusted to correct the shock. The importance of fluid therapy is increasing not only in resuscitation and treatment after hospitalization but also in pre-hospital care. Fluid therapy needs to be adjusted based depending each patient’s volume status. The various classifications of fluids include crystalloid solutions, glucose solutions, and colloid solutions. Although not included as a fluid therapy, blood transfusion is increasingly gaining more importance than fluid therapy in unstable trauma patients. Early appropriate fluid therapy is crucial in the treatment of hemodynamically unstable patients such as multiple trauma and massive bleeding, whereas comprehensive fluid therapy should be applied by considering the characteristics of specific injuries such as fractures, vascular damage, and cerebral hemorrhage, as well as the age groups (children, the elderly, and pregnant women).

Purpose: This study was performed to investigate the association of high age-adjusted shock index (AASI) with mortality in Korean children with trauma. Methods: The data of children (aged < 15 years) with trauma who visited an university hospital in Korea from 2010 through 2018 were reviewed. High AASI was defined by age groups as follows: < 12 months, ≥ 2.7; 12-23 months, ≥ 2.1; 2-4 years, ≥ 1.9; 5-11 years, ≥ 1.5; and 12-14 years, ≥ 1.1. Age, sex, transfer status, injury mechanism, hypotension, tachycardia, base deficit, hemoglobin concentration, trauma scores, hemorrhage-related procedures (transfusion and surgical interventions), and severe traumatic brain injury were compared according to high AASI and in-hospital mortality. The association of high AASI with the mortality was analyzed using logistic regression. Results: Of the 363 enrolled children, 29 (8.0%) had high AASI and 24 (6.6%) died. The children with high AASI showed worse trauma scores and underwent hemorrhage-related procedures more frequently, without a difference in the rate of the traumatic brain injury. High AASI was associated with in-hospital mortality (survivors, 6.5% vs. non-survivors, 29.2%; P = 0.001). This association remained significant after adjustment (adjusted odds ratio, 6.42; 95% confidence interval, 1.38-29.82). The other predictors were Glasgow Coma Scale (for increment of 1 point; 0.62; 0.53-0.72) and age (for increment of 1 year; 0.84; 0.73-0.97). High AASI showed a 29.2% sensitivity and 93.5% specificity for the mortality. Conclusion High AASI is associated with mortality, and have a high specificity but low sensitivity in Korean children with trauma. This predictor of mortality can be used prior to obtaining the results of laboratory markers of shock.

Objective: Suicide is a major issue in South Korea, and falling is a common method of suicide. Further, accidental falls are a common cause of death. However, whether suicidal falls differ from accidental falls is inconclusive. This study aimed to compare suicidal and accidental falls to identify risk factors for mortality. Methods: From March 2010 to December 2016, patients admitted to our hospital because of falls were reviewed retrospectively. Characteristics and outcomes were compared between suicide and accident groups. Injury distribution was compared using the Injury Severity Score and Abbreviated Injury Scales. Multivariate analysis was performed to identify risk factors, including suicide intent, for mortality. Results: Of 242 patients, 42 were included in the suicide group and 200 were included in the accident group. The suicide group showed higher fall heights and injuries of greater severity. The accident group was younger and included a higher number of men. The suicide group showed a higher mortality (23.8% vs. 6.5%, P=0.001) and a higher proportion of injuries in the lower extremities or abdomen. In the multivariate analysis, Glasgow Coma Scale score (0.575 [0.433–0.764], P<0.001), body mass index (1.638 [1.194–2.247], P=0.002), suicide intent (9.789 [1.026–93.404], P=0.047) and Injury Severity Score (1.091 [1.000–1.190], P=0.049) were identified as risk factors for mortality. Conclusion Suicidal falls were associated with poorer outcomes and a greater tendency to land feet first relative to accidental falls. Suicide intent was a risk factor for mortality.

BACKGROUND: Injury severity scoring systems that quantify and predict trauma outcomes have not been established in Korea. This study was designed to determine the best system for use in the Korean trauma population. METHODS: We collected and analyzed the data from trauma patients admitted to our institution from January 2010 to December 2014. Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) were calculated based on the data from the enrolled patients. Area under the receiver operating characteristic (ROC) curve (AUC) for the prediction ability of each scoring system was obtained, and a pairwise comparison of ROC curves was performed. Additionally, the cut-off values were estimated to predict mortality, and the corresponding accuracy, positive predictive value, and negative predictive value were obtained. RESULTS: A total of 7,120 trauma patients (6,668 blunt and 452 penetrating injuries) were enrolled in this study. The AUCs of ISS, RTS, and TRISS were 0.866, 0.894, and 0.942, respectively, and the prediction ability of the TRISS was significantly better than the others (p < 0.001, respectively). The cut-off value of the TRISS was 0.9082, with a sensitivity of 81.9% and specificity of 92.0%; mortality was predicted with an accuracy of 91.2%; its positive predictive value was the highest at 46.8%. CONCLUSIONS: The results of our study were based on the data from one institution and suggest that the TRISS is the best prediction model of trauma outcomes in the current Korean population. Further study is needed with more data from multiple centers in Korea.
Area Under Curve ; Humans ; Injury Severity Score ; Korea ; Mortality ; ROC Curve ; Sensitivity and Specificity ; Trauma Centers

We report a case of leiomyosarcoma of the spermatic cord with the review of literatures. To our knowledge, this is the first case to be reported in Korea.
Korea ; Leiomyosarcoma* ; Spermatic Cord*