All-trans retinoic acid (ATRA) is a highly effective treatment for acute promyelocytic leukemia (APL), a cytogenetically distinct subtype of acute myeloid leukemia (AML). However, ATRA-based treatment is not effective in other subtypes of AML. In non-APL AML, ATRA signaling pathway is impaired or downmodulated, and consequently fails to respond to pharmacological doses of ATRA. Therefore, complementary treatment strategies are needed to improve ATRA responsiveness in non-APL AML. In this study, we investigated the combined effect of ATRA and bromodomain inhibitor JQ1, proven to have potent anti-cancer activity mainly through inhibition of c-Myc. We showed that the combination of ATRA with JQ1 synergistically inhibited proliferation of AML cells. The synergistic growth inhibition was resulted from differentiation or apoptosis depending on the kind of AML cells. Concomitantly, the combined treatment of ATRA and JQ1 caused greater depletion of c-Myc and hTERT expression than each agent alone in AML cells. Taken together, these findings support the rationale for the use of the combination of ATRA and JQ1 as a therapeutic strategy for the treatment of AML.
Apoptosis ; Leukemia ; Leukemia, Myeloid, Acute ; Leukemia, Promyelocytic, Acute ; Tretinoin

BACKGROUND: The aim of this study was to examine the efficacies of somatosensory evoked potential (SEP) and diffusion-weighted magnetic resonance imaging (DWI) in predicting the clinical prognosis of comatose patients following cardiac arrest. METHODS: Forty-one patients resuscitated from out-of hospital cardiac arrest (OHCA) were retrospectively studied. After return of spontaneous circulation (ROSC), SEP was conducted between one and three days after resuscitation, and DWI was conducted within five days of resuscitation. SEP was classified into three grades: normal, delayed conduction or unilateral loss of the N20 peak, and bilateral loss of the N20 peak. Bilateral loss of the N20 peak was considered a predictor of poor prognosis. For DWI, diffuse signal intensity (SI) abnormality in the cerebral cortex or abnormality in other brain areas in addition to the bilateral cerebral cortex was taken as a predictor of poor prognosis. For patient clinical prognosis, the Glasgow-Pittsburgh Cerebral Performance Category (CPC) was used to evaluate neurological results at the time of discharge. Resulting CPC scores of 1 and 2 were considered as a favorable prognosis, and scores of 3, 4, and 5 were considered as a poor prognosis. Sensitivity, specificity, positive predictive value, and negative predictive value for the prediction of poor prognosis were analyzed for each test individually and for the combination of the two tests. RESULTS: Among the 41 subject patients, 31 underwent SEP, 30 underwent DWI, and 20 underwent both tests. The prognosis predictor of SEP (bilateral loss of the N20 peak) predicted poor prognosis with 56.5% sensitivity, 100% specificity, 100% positive predictive value, and 44.4% negative predictive value. The prognosis predictor of DWI (diffuse SI abnormality in the cerebral cortex or abnormality in other brain areas in addition to the bilateral cerebral cortex) predicted poor prognosis with 85% sensitivity, 100% specificity, 100% predictive value, and 76.9% predictive value. For patients who underwent both tests, the sensitivity and negative predictive value for the prediction of poor prognosis increased to 92.3% and 87.5%, respectively, and the specificity and positive predictive value were maintained at 100%. CONCLUSIONS: The accuracy of poor prognosis prediction for patients in prolonged comas after resuscitation is enhanced by combining the results of SEP and DWI along with the individual results of each test.
Brain ; Cerebral Cortex ; Coma* ; Dinucleoside Phosphates ; Evoked Potentials, Somatosensory* ; Heart Arrest* ; Humans ; Magnetic Resonance Imaging* ; Prognosis* ; Resuscitation ; Retrospective Studies ; Sensitivity and Specificity

PURPOSE: To identify a useful screening test leading to diagnosis of hypertension in the emergency department (ED). METHODS: This was a retrospective medical record review of adult patients (18> or =years of age) admitted to the ED at a tertiary care educational hospital, between January 1, 2010 and February 28, 2010. Only those patients with a triage systolic blood pressure greater than or equal to 140 mmHg, or a diastolic blood pressure greater than or equal to 90 mmHg, were enrolled. Data including baseline characteristics, basic metabolic panel (BMP), urinalysis, electrocardiogram (ECG), chest radiograph, and whether or not they were diagnosed with hypertension, were obtained. Multivariate analysis was performed to determine an appropriate screening test for diagnosis of hypertension. RESULTS: Of the 447 enrolled patients, 81(18.1%) were diagnosed with hypertension. Age above 35 years (Odds ratio [OR]=8.263; 95% Confidence interval (CI), 1.034-66.062; p=0.046), diagnosis of diabetes mellitus (DM) (OR=3.99; 95% CI, 1.582-10.064; p=0.003), left ventricular hypertrophy (LVH) (OR=4.348; 95% CI, 1.968-9.607; p<0.001), and suspected stage II hypertension (OR=2.699; 95% CI, 1.151-6.329; p=0.022) were independently associated with a positive hypertension diagnosis. The area under the Receiver operating characteristic (ROC) curve for a positive diagnosis of hypertension was 0.687(95% CI, 0.642-0.730). CONCLUSION: Age above 35 years, existence of DM or LVH, and suspected stage II hypertension may be useful data points for screening and diagnosis of hypertension in the ED.
Adult ; Blood Pressure ; Diabetes Mellitus ; Electrocardiography ; Emergencies ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Mass Screening ; Medical Records ; Multivariate Analysis ; Retrospective Studies ; ROC Curve ; Tertiary Healthcare ; Thorax ; Triage ; Urinalysis

PURPOSE: To identify a useful screening test leading to diagnosis of hypertension in the emergency department (ED). METHODS: This was a retrospective medical record review of adult patients (18> or =years of age) admitted to the ED at a tertiary care educational hospital, between January 1, 2010 and February 28, 2010. Only those patients with a triage systolic blood pressure greater than or equal to 140 mmHg, or a diastolic blood pressure greater than or equal to 90 mmHg, were enrolled. Data including baseline characteristics, basic metabolic panel (BMP), urinalysis, electrocardiogram (ECG), chest radiograph, and whether or not they were diagnosed with hypertension, were obtained. Multivariate analysis was performed to determine an appropriate screening test for diagnosis of hypertension. RESULTS: Of the 447 enrolled patients, 81(18.1%) were diagnosed with hypertension. Age above 35 years (Odds ratio [OR]=8.263; 95% Confidence interval (CI), 1.034-66.062; p=0.046), diagnosis of diabetes mellitus (DM) (OR=3.99; 95% CI, 1.582-10.064; p=0.003), left ventricular hypertrophy (LVH) (OR=4.348; 95% CI, 1.968-9.607; p<0.001), and suspected stage II hypertension (OR=2.699; 95% CI, 1.151-6.329; p=0.022) were independently associated with a positive hypertension diagnosis. The area under the Receiver operating characteristic (ROC) curve for a positive diagnosis of hypertension was 0.687(95% CI, 0.642-0.730). CONCLUSION: Age above 35 years, existence of DM or LVH, and suspected stage II hypertension may be useful data points for screening and diagnosis of hypertension in the ED.
Adult ; Blood Pressure ; Diabetes Mellitus ; Electrocardiography ; Emergencies ; Humans ; Hypertension ; Hypertrophy, Left Ventricular ; Mass Screening ; Medical Records ; Multivariate Analysis ; Retrospective Studies ; ROC Curve ; Tertiary Healthcare ; Thorax ; Triage ; Urinalysis

PURPOSE: To evaluate the incidence and clinical features of age-related macular degeneration (AMD) in Korea. METHODS: Web-based (www.armd-nova.or.kr) registration was conducted for AMD patients aged 50 or more who were newly diagnosed by retinal specialists in Korea from August 20, 2005 to August 20, 2006. Patient data including ophthalmologic examination, fundus photography, fluorescein angiogram and/or indocyanin green angiogram (ICG), past medical history, behavioral habit, combined systemic diseases were up-loaded. RESULTS: Among finally enrolled 1,141 newly diagnosed AMD patients, 690 patients (60.5%) were male and 451 patients (39.5%) were female. The average age of AMD patients was 69.7+/-8.0. Early AMD was observed in 190 patients and 951 patients had late AMD. Classic choroidal neovascular membrane (CNVM) was observed in 18.6% of exudative AMD patients and 63.4 % had occult CNVM. Subfoveal CNVM was observed in 80.4% of the patients with CNVM. Among the 580 exudative AMD eyes that performed indocyanin green angiography (ICG), 184 eyes (31.7%) had polypoidal choroidal vasculopathy (PCV) and 36 eyes (6.2%) showed retinal angiomatous proliferation (RAP). Age, male gender, smoking, diabetes and hypertension significantly increased the risk of the AMD among Koreans. CONCLUSIONS: Because of the low rate of participation by retinal specialists, definite incidence of AMD was not obtainable. However, the estimated 1-year AMD incidence in the Pusan area of Korea is at least 0.4%. In contrast to Western people, 31.7% of exudative AMD cases were revealed to be PCV and 6.2% were revealed to be RAP. This discrepancy between ethnic groups should be considered in the diagnosis and treatment modality selection of Korean AMD patients.
Aged ; Angiography ; Choroid ; Ethnic Groups ; Eye ; Female ; Fluorescein ; Humans ; Hypertension ; Incidence ; Korea ; Macular Degeneration ; Male ; Membranes ; Photography ; Retinaldehyde ; Smoke ; Smoking ; Specialization

PURPOSE: This study was conducted to see the effect of alcohol ingestion on clinical features of acute drug intoxicated patients. METHODS: We prospectively investigated drug intoxicated patients who visited the emergency department 6 hours after acute poisoning from January 2004 to December 2007. Patients were classified into two groups according to serum alcohol levels: an alcohol group (serum alcohol level>10 mg/dl) and a non-alcohol group. The type of toxic material, age, sex, duration of time to arrive to the emergency department (ED) after poisoning, mean arterial pressure, respiratory rate, base excess level, AST level, serum creatinine level, cause of poisoning, suicide attempt, past psychiatric history, discharge against medical advice rate, and admission rate were checked. The initial and final Poisoning Severity Score (PSS), the Glasgow coma scale, the length of stay in the intensive care unit (ICU), the usage of a mechanical ventilator, and death rate were also checked. RESULTS: The study enrolled 222 intoxicated patients of which 75 fell into the non-alcohol group and 147 into the alcohol group. Alcohol ingestion of acute poisoning in males was higher than in females. The AST level and discharge against medical advice rates in the alcohol group were higher than the non-alcohol group. The base excess level, length of stay in ICU, past psychiatric history rate, and admission rates in the non-alcohol group were higher than the alcohol group. The PSS were not correlated with alcohol consumption between the two groups. CONCLUSION: Alcohol ingestion is not associated with PSS. However, alcohol ingestion is commonly found in acute drug intoxicated patients. The discharge against medical advice rate in the alcohol group was higher than the non-alcohol group.
Alcohol Drinking ; Arterial Pressure ; Creatinine ; Eating ; Emergencies ; Female ; Glasgow Coma Scale ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Prospective Studies ; Respiratory Rate ; Severity of Illness Index ; Suicide ; Ventilators, Mechanical

PURPOSE: The purpose of this study was to assess the incidence, survival rate and risk factors of acute renal failure (ARF) in patients following cardiac arrest. METHODS: This was a retrospective analysis of 132 cases of comatose survival after cardiac arrest and these patients had received cardiopulmonary resuscitation (CPR) in a tertiary emergency department from April 1997 to May 2007. We analyzed the basic data and clinical data, and we compared the patients who had developed ARF (ARF group) following CPR with those who had not (the non-ARF group). RESULTS: Out of the 132 comatose survivors, ARF occurred in 54 patients (40.9%). The survival rate was higher in the non-ARF group (52.6%) than that in the the ARF group (16.7%) (p<0.0001). Both baseline renal insufficiency (OR 5.721, 95% CI 2.42-13.51; p<0.0001) and a peak creatine kinase level > 5000 IU/L (OR 8.527, 95% CI 1.78-40.91; p=0.043) were independent predictors of ARF. However, a history of coronary artery disease was not independently associated with renal failure, although it was more frequently found in patients with ARF (the ARF group). CONCLUSION: ARF occurred commonly in the post-resuscitation period. The survival rate was higher in the non-ARF group than that in the ARF group. The major factors contributing to ARF were both baseline renal insufficiency and a peak creatine kinase level > 5000 IU/L.
Acute Kidney Injury ; Cardiopulmonary Resuscitation ; Coma ; Coronary Artery Disease ; Creatine Kinase ; Emergencies ; Heart Arrest ; Humans ; Incidence ; Renal Insufficiency ; Retrospective Studies ; Risk Factors ; Survival Rate ; Survivors

PURPOSE: This study was conducted to determine the predictive value of the C-reactive protein (CRP) and kidney computed tomography (CT) in the emergency department (ED) for predicting the severity of acute pyelonephritis. METHODS: One hundred thirty-nine patients who were diagnosed with acute pyelonephritis between January 2007 and June 2008 were enrolled in this study. The patient underwent a kidney CT in the ED and the CT findings were classified as normal, a focal wedge-shaped lesion, a multi-focal wedge-shaped lesion, a mass-effect lesion, and abscess formation. The symptoms, vital signs, past history, initial laboratory findings, serum CRP in the ED, and the length of the hospital stay based on the kidney CT grade in the ED were compared. RESULTS: Among the 139 patients, 138 were females and the mean age was 48.5+/-17.7 years. We classified the CT grades as follows: grade 1, normal (n=20); grade 2, focal wedge-shaped lesion (n=25); grade 3, multi-focal wedgeshaped lesion (n=45); grade 4, mass-effect lesion (n=42); and grade 5, abscess formation (n=7). Statistically significant differences in leukocyte count, neutrophil ratio, ESR, CRP, and length of hospital stay existed between the CT grades. Patients were classified into two groups based on the CT grade (the mild group [grades 1 and 2], and the severe group [grades 3~5]). The leukocyte count, neutrophil ratio, ESR, CRP, maximal body temperature, duration of fever, duration of pyuria >3 days, and length of hospital stay were greater in the severe group. Based on the results of multivariate logistic regression analysis, the CRP level was shown to be an independent predictor that affected the severe group. The area under the ROC curve for CRP was 0.775 (95% CI, 0.695~0.854). CONCLUSION: The CRP level in the ED was an independent predictor that affected the severe group. Thus, the initial CRP level with the kidney CT grade may be used as a prognostic indicator of acute pyelonephritis in the ED.
Abscess ; Body Temperature ; C-Reactive Protein ; Emergencies ; Female ; Fever ; Humans ; Kidney ; Length of Stay ; Leukocyte Count ; Logistic Models ; Neutrophils ; Pyelonephritis ; Pyuria ; ROC Curve ; Tomography, Spiral Computed ; Vital Signs

BACKGROUND: Infectious complications commonly occur in the survivors of out-of-hospital cardiac arrest. The aim of our study was to describe the incidence, associated factors and outcome of infectious complications of the survivors of out-of-hospital cardiac arrest. METHODS: We conducted a retrospective analysis of 75 patients who survived out-of-hospital cardiac arrest. We collected the data on the demographics, the modes of cardiac arrest, the duration of CPR, the dose of epinephrine, the use of hypothermia, new infections, the duration of mechanical ventilation, the length of stay in the intensive care unit (ICU), recovery of consciousness and the mortality. RESULTS: New infections developed in 46.7% of the patients. Asystole was the most common rhythm (70.7%). The most common infectious complication was pneumonia (40.0%) urinary tract infection developed in 10 cases, vascular catheter local infection developed in 6 cases, primary blood stream infection developed in 3 cases, wound infection developed in 2 cases and pseudomembranous colitis developed in 1 case. The most common pathogens of pneumonia were Pseudomonas aeruginosa and Staphylococcus aureus. Blood cultures were obtained in 36 patients during the first 24 hr and the pathogen was isolated in three. The patients with infection had a longer duration of mechanical ventilation and a longer stay in the ICU (p < 0.001, p = 0.001). CONCLUSIONS: Infectious complications are common in survivors of out-of-hospital cardiac arrest and these infections are associated with a longer duration of mechanical ventilation and a longer stay in the ICU. The most common infectious complication was pneumonia and the pathogens of pneumonia were Pseudomonas aeruginosa and Staphylococcus aureus.
Cardiopulmonary Resuscitation ; Consciousness ; Demography ; Enterocolitis, Pseudomembranous ; Epinephrine ; Heart Arrest ; Humans ; Hypothermia ; Incidence ; Intensive Care Units ; Length of Stay ; Out-of-Hospital Cardiac Arrest ; Pneumonia ; Pseudomonas aeruginosa ; Respiration, Artificial ; Retrospective Studies ; Rivers ; Staphylococcus ; Staphylococcus aureus ; Survivors ; Urinary Tract Infections ; Vascular Access Devices ; Wound Infection

PURPOSE: Emergency physicians (EPs) are exposed to radiation in the emergency department (ED). However, EPs are not followed with dosimeter measurements of radiation exposure because of the common belief that EPs have a low exposure to radiation. This study was performed to investigate the recognition of EPs' level of radiation exposure. METHODS: Data were collected from direct interviews with questionnaires administered at five ED's medical conference from November, 2007 to March, 2008. One hundred and twenty-one EPs were surveyed with questionnaires. The questionnaires consisted of six items on the patient characteristics, rate of radiation exposure, recognition of radiation exposure, knowledge of radiation exposure, patient exposure, and education. Some questions were graded on a five point Likert scale. The average and standard deviation were calculated. RESULTS: There were 58.3% of the EPs that reported that they were exposed to portable X-rays more than three times per day; 58.8% of the answers showed that the EPs did not escape from exposure to the portable X-rays. For 87.3% of the EPs, they did not wear lead aprons during the portable X-rays. There were 51.1% of answers that severely underestimated the radiation dose from a CT. The recognition and knowledge of radiation exposure among ED residents increased as there level of training increased, but this was not the case for the board certified emergency physicians (p=0.016). The radiation exposure to the patients was not accurately estimated by EP scores, regardless of their level of experience. CONCLUSION: The lack of knowledge and recognition of the exposure to radiation by EPs expose them and their patients to potentially dangerous levels of radiation that might increase their lifetime cancer risk. We recommend that EPs should be educated regarding their radiation exposure as well as their patients and followed by dosimeter evaluations to minimize radiation exposure.
Emergencies ; Humans ; Occupational Exposure ; Surveys and Questionnaires ; United Nations