The ethyl acetate fractions prepared from the leaves of Thuja orientalis significantly inhibited nitric oxide (NO) production in lipopolysaccharide-stimulated BV2 microglial cells. According to bioassay-coupled LC-QTOF MS/MS, the components near 22 and 25 mins in the mass chromatogram highly inhibited NO production and were expected to be labdane diterpenes, and the active components were characterized via further isolation. The results of the NO production inhibitory assay of the isolated compounds correlated well with the results of bioassay-coupled LC-QTOF MS/MS. Among the identified constituents, NO production inhibitory activities of 16-hydroxy-labda-8(17),13-diene-15,19-dioic acid butenolide (2) and 15-hydroxypinusolidic acid (3) were newly reported. Taken together, these results demonstrated that LC-QTOF MS/MS coupled with NO production inhibition assay was a powerful tool for accurately predicting new anti-inflammatory constituents in the extracts from natural products. Moreover, it provided a potential basis for broadening the application of bioassay-coupled LC-QTOF MS/MS in natural product research.

OBJECTIVE: The purpose of this study was to predict the optimal bending angles of a running loop for bodily protraction of the mandibular first molars and to clarify the mechanics of molar tipping and rotation. METHODS: A three-dimensional finite element model was developed for predicting tooth movement, and a mechanical model based on the beam theory was constructed for clarifying force systems. RESULTS: When a running loop without bends was used, the molar tipped mesially by 9.6° and rotated counterclockwise by 5.4°. These angles were almost similar to those predicted by the beam theory. When the amount of tip-back and toe-in angles were 11.5° and 9.9°, respectively, bodily movement of the molar was achieved. When the bend angles were increased to 14.2° and 18.7°, the molar tipped distally by 4.9° and rotated clockwise by 1.5°. CONCLUSIONS Bodily movement of a mandibular first molar was achieved during protraction by controlling the tip-back and toe-in angles with the use of a running loop. The beam theory was effective for understanding the mechanics of molar tipping and rotation, as well as for predicting the optimal bending angles.

Purpose: Capmatinib, an oral MET kinase inhibitor, has demonstrated its efficacy against non–small cell lung cancer (NSCLC) with MET dysregulation. We investigated its clinical impact in advanced NSCLC with MET exon 14 skipping mutation (METex14) or gene amplification. Materials and Methods: Patients who participated in the screening of a phase II study of capmatinib for advanced NSCLC were enrolled in this study. MET gene copy number (GCN), protein expression, and METex14 were analyzed and the patients’ clinical outcome were retrospectively reviewed. Results: A total of 72 patients were included in this analysis (group A: GCN ≥ 10 or METex14, n=14; group B: others, n=58). Among them, 13 patients were treated with capmatinib (group A, n=8; group B, n=5), and the overall response rate was 50% for group A, and 0% for group B. In all patients, the median overall survival (OS) was 20.2 months (95% confidence interval [CI], 6.9 to not applicable [NA]) for group A, and 11.3 months (95% CI, 8.2 to 20.3) for group B (p=0.457). However, within group A, median OS was 21.5 months (95% CI, 20.8 to NA) for capmatinib-treated, and 7.5 months (95% CI, 3.2 to NA) for capmatinib-untreated patients (p=0.025). Among all capmatinib-untreated patients (n=59), group A showed a trend towards worse OS to group B (median OS, 7.5 months vs. 11.3 months; p=0.123). Conclusion Our data suggest that capmatinib is a new compelling treatment for NSCLC with MET GCN ≥ 10 or METex14 based on the improved survival within these patients.

PURPOSE: The aim of this study was to determine the relationship between the injury severity and pain intensity according to age in patients with extremity injuries. METHODS: Adult patients with an extremity injury who visited the emergency department (ED) from June 1, 2016 to November 31, 2016 were analyzed retrospectively. The major injury was defined as structural damage below the muscle layer, such as muscle, ligament, and bone. Minor injury group and major injury group were separated according to this definition. The relationship of age and pain score assessed with the numerical rating scale (NRS) with the injury severity was analyzed. RESULTS: Of a total of 1,441 patients, the number of patients with a minor and major injury was 854 (59.3%) and 587 (40.7%), respectively. The proportion of patients aged 65 and older was 6.1% and 25.7% in the minor and major injury group, respectively. Age and NRS scale showed significantly positive associations with the injury severity (p < 0.001). In all NRS scores, the overall proportion of major injuries in the older age group was higher than that in the younger age group. Regardless of the younger ( < 65 years) or older (≥65 years) age group, the NRS score was positively related to the injury severity (young age group [odds ratio, 3.944]; older age group [odds ratio, 5.754]). CONCLUSION: The pain intensity is positively related to the severity of injury regardless of age. The pain intensity is the important factor of a patient assessment and treatment in the emergency department.
Adult ; Emergency Service, Hospital ; Extremities* ; Humans ; Ligaments ; Pain Measurement ; Retrospective Studies ; Trauma Severity Indices

OBJECTIVES: The purpose of this study was to identify the differences in nutrient intake according to using diuretics, symptom severity and degree of physical functioning in heart failure patients. METHODS: A secondary data analysis was conducted by using baseline data of an intervention study for heart failure patients. In this study, 131 heart failure patients were included. Data were collected using medical records, NYHA (New York Heart Association functional classification) class, and 6-minute-walking test and 24-hour diet recall. Data were analyzed using descriptive statistics and Chi-square test by SPSS 21.0. Nutrient intake was assessed using CAN-pro 2.0. RESULTS: Majority of the participants consumed total calorie less than Estimated Energy Requirement (EER) and consumed carbohydrates more than 65% of their total calorie intakes. 24.4% of the participants consumed fat more than 30% of their total calorie intakes and 23.7% consumed saturated fat more than 7% of their total calorie intakes. 100.0% of the participants consumed protein less than 7% of their total calorie intakes and 73.3% of the participants consumed more than recommended intakes of sodium. More than 90.0% of the participants consumed less than adequate intakes of potassium (90.1%) and Vitamin D (91.6%), respectively. 100% and 62.6% of the participants consumed less than Estimated Average Requirement (EAR) of magnesium and Vitamin B1, respectively. Nutrient intakes in heart failure patients were different for potassium intake according to the usage of diuretics. The participants with symptom severity tended to intake protein less properly and the participants walking more than 300.0 m tended to intake sodium improperly high. CONCLUSIONS: The findings of this study indicated the need for screening nutrient intakes of heart failure patients. It is necessary to increase the intake of total calories and most nutrients and to restrict sodium intakes among heart failure patients.
Carbohydrates ; Diet ; Diuretics* ; Heart Failure* ; Heart* ; Humans ; Clinical Trial ; Magnesium ; Mass Screening ; Medical Records ; Potassium ; Sodium ; Statistics as Topic ; Thiamine ; Vitamin D ; Walking

The number of organs transplanted worldwide is increasing annually. As a result, there is a shortage of available donor organs. This scarcity has led to the progressive broadening of donor organ criteria. The expanded criteria include infections such as bacterial meningitis. A 55-year old male visited our emergency room with cardiac arrest and recovered after cardiopulmonary resuscitation. The cause of the cardiac arrest was bacterial meningitis caused by Streptococcus pneumoniae. While proper antibiotics were applied, the patient met the clinical criteria for brain death. Prophylactic antibiotics were administered to the recipients, and liver and kidney transplantations were done successfully.
Anti-Bacterial Agents ; Brain Death ; Cardiopulmonary Resuscitation ; Donor Selection ; Emergencies ; Heart Arrest ; Humans ; Kidney Transplantation ; Liver ; Male ; Meningitis ; Meningitis, Bacterial ; Organ Transplantation ; Streptococcus ; Streptococcus pneumoniae ; Tissue Donors ; Transplants

Objective: This study evaluated the usefulness of cystatin C as a prognostic predictor in heart failure patients admitted to the emergency department. Methods: This study was conducted retrospectively on patients with heart failure admitted to the emergency department between January and December 2018. Patients newly and previously diagnosed with heart failure underwent both N-terminal prohormone of brain natriuretic peptide and cystatin C tests. To assess the patients’ prognosis, a poor prognosis was defined as the occurrence of one or more of the following events: intubation, admission to an intensive care unit, coronary angiography, continuous renal replacement therapy, extracorporeal membrane oxygenation, cardiopulmonary resuscitation, and death. The patients were divided into two groups based on the occurrence of these events; the characteristics between the groups with and without events were compared. Results: Seventy-four patients were included in the study analysis: 35 and 39 in the group without and with events, respectively. The number of patients with a history of diabetes, hypertension, troponin T, and cystatin C levels were significantly higher in the group with events than in the group without events (P=0.028, P=0.041, P<0.001, and P=0.002, respectively). Multiple logistic regression analyses showed that cystatin C is a significant prognostic predictor of events. Conclusion An increased cystatin C level has been shown to clinically predict a poor prognosis of heart failure patients admitted to emergency departments.

Objective: The Korean Triage and Acuity Scale (KTAS) is a triage tool for patients in the emergency department (ED). This study aimed to evaluate the ability of the KTAS to predict poor outcomes in South Korean ED patients with a suspected infection. We also compared the effectiveness of KTAS with that of the National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) in predicting poor outcomes. Methods: We conducted a single-center retrospective study that included adult patients with a suspected infection who were admitted to the ED between January 2019 and December 2019. Patients who received a prescription for antibiotics and associated culture tests in the ED were considered to have an infection. Poor outcomes were evaluated by in-hospital mortality, general ward admission, and intensive care unit (ICU) admission. A receiver operating characteristics (ROC) curve analysis was performed to evaluate and compare KTAS, NEWS, and MEWS. Results: Of the 4,127 patients in the study, in-hospital mortality was reported in 154 (3.7%) patients. The median KTAS was lower in the non-survivors than in the survivors (2.51 vs. 3.35). Multivariate logistic regression analysis showed that the KTAS was associated with in-hospital mortality, ward admission, and ICU admission. The area under the ROC curve (AUROC) values for predicting in-hospital mortality associated with the KTAS, NEWS, and MEWS were 0.776 (95% confidence interval, 0.747-0.803), 0.829 (0.759-0.811) and 0.739 (0.694-0.786), respectively. Conclusion Our results showed that the KTAS was associated with in-hospital mortality, ward admissions, and ICU admissions among ED patients with a suspected infection. Thus, KTAS may be reliable in predicting a poor outcome in ED patients with a suspected infection.

OBJECTIVE: The systemic inflammatory response syndrome (SIRS) criteria used in the triage scale have been implemented incompletely without laboratory data, such as the white blood cell (WBC) count, so the validity of SIRS as a triage tool has been uncertain. This study assessed the validity of the Korean Triage and Acuity Scale (KTAS) in applying SIRS with or without a WBC count. METHODS: The KTAS level was simulated by the number of SIRS criteria. This new KTAS level that did not apply the WBC count was defined as the partial-simulated KTAS (PS-KTAS), and the KTAS level including the WBC count was called the total-simulated KTAS (TS-KTAS). The authors used the intensive care unit (ICU), overall admission rate, and use of emergent interventions as the primary outcomes. RESULTS: A total of 1,077 patients with a suspected infection were triaged using the SIRS in KTAS. Multivariable logistic regression analysis showed that the odds ratio for overall admission was greater with a higher KTAS level than with KTAS level 4 in both the PS-KTAS and TS-KTAS. All areas under the curve of the PS- and TS-KTAS for ICU admission and emergent intervention rate both showed very low discriminant powers. CONCLUSION: Compared to TS-KTAS, PS-KTAS showed a similar or partially better relationship between the KTAS level and the use of critical medical resource. Future research is recommended to improve the matching between the SIRS scoring and each KTAS level to better classify the patient severity status and develop or discover new infection assessment tools that can be applied to KTAS.
Humans ; Intensive Care Units ; Leukocyte Count ; Leukocytes ; Logistic Models ; Odds Ratio ; Systemic Inflammatory Response Syndrome ; Triage

Objective: Rapid determination of acute coronary syndrome (ACS) in the emergency department (ED) is very important for patients presenting with ischemic symptoms. The aim of this study was to determine the predictive value of HEART score for ACS and significant coronary artery stenosis (SCS). Methods: We retrospectively analyzed data of patients who visited the ED with chest discomfort and were admitted to the cardiology department. Enrolled patients were classified into ACS and non-ACS groups according to their discharge diagnosis. Patients who underwent imaging were further divided into SCS and non-SCS groups according to study results. We compared age, sex, vital signs, risk factors, electrocardiogram, troponin, and HEART score for each group. For ACS and SCS predictive performance, the test characteristics of HEART score was calculated using sensitivity, specificity, predictive value, likelihood ratio, and receiver operating characteristic (ROC) curve analysis. Results: Of 207 patients, 112 had ACS. Among enrolled patients, 155 underwent imaging workup, of whom 67 had SCS. HEART score ≤3 had 93% sensitivity for ACS and 97% for SCS. HEART score ≥7 had 82% specificity for ACS and 83% for SCS. HEART score area under ROC curve for ACS was 0.706 (95% confidence interval, 0.627–0.776) and 0.737 (95% confidence interval, 0.660–0.804) for SCS. Conclusion HEART score was a fair predictor of ACS and SCS in ED patients who presented with chest symptoms and were admitted to the cardiology department. The predictive power of HEART score was better for SCS than for ACS.