Objective: High-quality intensive care, including targeted temperature management (TTM) for patients with postcardiac arrest syndrome, is a key element for improving outcomes after out-of-hospital cardiac arrest (OHCA). We aimed to assess the status of postcardiac arrest syndrome care, including TTM and 6-month survival with neurologically favorable outcomes, after adult OHCA patients were treated with TTM, using data from the Korean Hypothermia Network prospective registry. Methods: We used the Korean Hypothermia Network prospective registry, a web-based multicenter registry that includes data from 22 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TTM between October 2015 and December 2018 were included. The primary outcome was neurological outcome at 6 months. Results: Of the 1,354 registered OHCA survivors treated with TTM, 550 (40.6%) survived 6 months, and 413 (30.5%) had good neurological outcomes. We identified 839 (62.0%) patients with preClinsumed cardiac etiology. A total of 937 (69.2%) collapses were witnessed, shockable rhythms were demonstrated in 482 (35.6%) patients, and 421 (31.1%) patients arrived at the emergency department with prehospital return of spontaneous circulation. The most common target temperature was 33°C, and the most common target duration was 24 hours. Conclusion The survival and good neurologic outcome rates of this prospective registry show great improvements compared with those of an earlier registry. While the optimal target temperature and duration are still unknown, the most common target temperature was 33°C, and the most common target duration was 24 hours.

In the present study, we investigated whether tussilagone, a natural product derived from Tussilago farfara, significantly affects the production and gene expression of airway MUC5AC mucin. Confluent NCI-H292 cells were pretreated with tussilagone for 30 min and then stimulated with EGF (epidermal growth factor) or PMA (phorbol 12-myristate 13-acetate) for 24 h or the indicated periods. The MUC5AC mucin gene expression was measured by RT-PCR. Production of MUC5AC mucin protein was measured by ELISA. To elucidate the action mechanism of tussilagone, effect of tussilagone on PMA-induced NF-κB signaling pathway was investigated by western blot analysis. Tussilagone significantly inhibited the production of MUC5AC mucin protein and down-regulated the expression of MUC5AC mucin gene, induced by EGF or PMA. Tussilagone inhibited PMA-induced activation (phosphorylation) of inhibitory kappa B kinase (IKK), and thus phosphorylation and degradation of inhibitory kappa Ba (IκBα). Tussilagone inhibited PMA-induced phosphorylation and nuclear translocation of nuclear factor kappa B (NF-κB) p65. This, in turn, led to the down-regulation of MUC5AC protein production in NCI-H292 cells. These results suggest that tussilagone can regulate the production and gene expression of mucin by acting on airway epithelial cells through regulation of NF-κB signaling pathway.
Blotting, Western ; Down-Regulation ; Enzyme-Linked Immunosorbent Assay ; Epidermal Growth Factor ; Epithelial Cells* ; Epithelium ; Gene Expression* ; Mucins* ; NF-kappa B ; Phosphorylation ; Phosphotransferases ; Tussilago

OBJECTIVE: Outbreaks of transmissible respiratory infection are suspected to have significant effects on the health of pediatric and geriatric patients. The objective was to assess the impact of the Middle East respiratory syndrome (MERS) outbreak on the use of emergency resources. METHODS: An ecologic analysis of emergency department (ED) records between September and December 2015, was performed. Data was obtained from the National Emergency Department Information System database for Korea. All demographic and diagnostic data from patients presenting with febrile symptoms as a main complaint were collected. The data were compared to the equivalent period in the three years preceding the MERS outbreak in Korea. RESULTS: Following the MERS outbreak, there was an increase in overall ED visits by febrile patients and the proportion of visits by febrile patients, relative to total ED attendances. This effect was more prominent in the children under five years. The duration of the chief complaint before ED arrival and the length of ED stay were significantly increased among younger pediatric patients. Decreased body temperature on arrival was observed in younger pediatric patients. CONCLUSION: MERS outbreak appears to have had a significant effects on ED use by febrile patients. The use of emergency care services by pediatric patients makes them more vulnerable to an outbreak of a transmissable disease. An effective strategy to control emergency center visits by non-urgent febrile patients and provide proper medical services is urgently needed.
Body Temperature ; Child ; Coronavirus Infections* ; Disease Outbreaks ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital ; Fever ; Humans ; Information Systems ; Korea ; Middle East Respiratory Syndrome Coronavirus ; Middle East* ; Overall

In this study, we investigated whether cynaroside, cynarin and linarin derived from Chrysanthemum indicum L. affect the secretion, production and gene expression of MUC5AC mucin in airway epithelial cells. Confluent NCI-H292 cells were pretreated with cynaroside, cynarin or linarin for 30 min and then stimulated with PMA (phorbol 12-myristate 13-acetate) for 24 h. The MUC5AC mucin gene expression, mucin protein production and secretion were measured by RT-PCR and ELISA, respectively. Effect of linarin on EGF (epidermal growth factor) - or TNF-alpha (tumor necrosis factor-alpha)-induced MUC5AC mucin gene expression and mucin protein production was also examined. The results were as follows: (1) Cynaroside and cynarin did not significantly affect PMA-induced MUC5AC mucin secretion from NCI-H292 cells. However, linarin decreased MUC5AC mucin secretion; (2) Cynaroside did not affect PMA-induced MUC5AC mucin production and gene expresion from NCI-H292 cells. However, cynarin and linarin inhibited the production and gene expression of MUC5AC mucin; (3) Linarin also inhibited the production and gene expression of MUC5AC mucin induced by EGF- or TNF-alpha from NCI-H292 cells. These results suggest that linarin can regulate the gene expression, production and secretion of mucin, by directly acting on airway epithelial cells.
Chrysanthemum ; Enzyme-Linked Immunosorbent Assay ; Epidermal Growth Factor ; Epithelial Cells ; Gene Expression* ; Mucins* ; Necrosis ; Tumor Necrosis Factor-alpha

BACKGROUND: In this study, we investigated whether lobetyolin, lobetyol, and methyl linoleate derived from Codonopsis pilosula affect MUC5AC mucin secretion, production, and gene expression from airway epithelial cells. METHODS: Confluent NCI-H292 cells were pretreated with lobetyolin, lobetyol, or methyl linoleate for 30 minutes and then stimulated with phorbol 12-myristate 13-acetate (PMA) for 24 hours. The MUC5AC mucin gene expression, and mucin protein production and secretion were measured by reverse transcription polymerase chain reaction and enzyme-linked immunosorbent assay, respectively. RESULTS: Lobetyolin, lobetyol, and methyl linoleate inhibited the gene expression of MUC5AC mucin induced by PMA; lobetyolin did not affect PMA-induced MUC5AC mucin production. However, lobetyol and methyl linoleate inhibited the production of MUC5AC mucin; lobetyolin and lobetyol did not significantly affect PMA-induced MUC5AC mucin secretion from NCI-H292 cells. However, methyl linoleate decreased the MUC5AC mucin secretion. CONCLUSION: These results suggest that among the three compounds, methyl linoleate can regulate gene expression, production, and secretion of MUC5AC mucin by directly acting on the airway epithelial cells.
Codonopsis ; Enzyme-Linked Immunosorbent Assay ; Epithelial Cells* ; Gene Expression* ; Linoleic Acid* ; Mucins* ; Polymerase Chain Reaction ; Reverse Transcription

Endoscopic mucosal resection (EMR) is widely accepted as a standard treatment for early gastric cancer or gastric adenoma. However, EMR inevitably results in the formation of large iatrogenic ulcer at the resected area. Although the characteristics of EMR-induced ulceration are not fully understood, this type of ulcer is thought to heal faster and to recur less often than non-iatrogenic gastric ulcer. Current available evidences have suggested that EMR-induced ulcers heal within 2-3 months. Herein, we report two cases of non-healing persistent gastric ulcers after EMR. One is a case of gastric carcinoma which developed at the same site of previous EMR site for the low grade dysplasia. The other is a case in which persistent EMR-induced ulcer was healed in the long run after Helicobacter pylori eradication therapy.
Aged ; Endoscopy, Gastrointestinal ; Gastric Mucosa/pathology/*surgery ; Helicobacter Infections/complications/drug therapy ; Helicobacter pylori ; Humans ; Iatrogenic Disease ; Male ; Middle Aged ; Stomach Neoplasms/complications/diagnosis/*surgery ; Stomach Ulcer/diagnosis/*etiology/pathology

PURPOSE: To describe systemic complications of unconscious patients' survival six hours following cardiopulmonary resuscitation (CPR), and to evaluate the relationship between several variables and death. METHODS: We conducted a retrospective analysis of 153 cases of non-traumatic cardiac arrest that received CPR in a tertiary emergency department from April 1997 to June 2007. We carried out analyses on survival cases, and studied general characteristics and systemic complications to ascertain relationships between the survival and death groups. RESULTS: Sixty of 153 patients initially survived, but the survival rate quickly decreased to 30.1% within the first three days and then decreased slowly thereafter. In the 153 patients, hyperamylasemia occurred in 101 patients (66.0%), acute liver injury in 75(49.0%), sepsis in 67(43.8%), seizure and refractory shock in 66(43.1%), pneumonia in 65(42.5%), acute renal failure (ARF) in 64(41.8%), acute respiratory distress syndrome (ARDS) in 30(19.6%), and disseminated intravascular coagulation (DIC) in 26(17.0%). Of nine types of complications encountered, the incidences of hyperamylasemia, ARDS, ARF, refractory shock and DIC were significantly higher in patients who died than in those who survived (73.1% vs 55.0%, 28.0% vs 6.7%, 54.8% vs 21.7%, 66.7% vs 6.7%, and 23.7% vs 6.7%, respectively). CONCLUSION: Systemic complications occurred with high frequency in comatose survivors after cardiopulmonary resuscitation. Hyperamylasemia, ARDS, ARF, refractory shock and DIC were significantly associated with death.
Acute Kidney Injury ; Cardiopulmonary Resuscitation ; Coma ; Dacarbazine ; Disseminated Intravascular Coagulation ; Emergencies ; Heart Arrest ; Humans ; Hyperamylasemia ; Incidence ; Liver ; Pneumonia ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Seizures ; Sepsis ; Shock ; Survival Analysis ; Survival Rate ; Survivors ; Unconscious (Psychology)

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

PURPOSE: Clinical study to evaluate the efficacy and the safety of various surgical treatments in snoring and obstructive sleep apnea. METHODS AND MATERIALS: We performed surgical treatments such as radiofrequency ablation, uvulopalatopharyngoplasty(UPPP) with tonsillectomy, uvulopalatopharyngoplasty with advancement genioplasty, orthognathic surgery(maxillomandibluar advancement), distraction osteogenesis device insertion. Diagnosis was performed with clinical examination, polysomnography, lateral cephalometric and computed tomography. 62(M : F = 45 :17 , mean age 41.5, mean follow-up 4 weeks) patients underwent radiofrequency ablation and 7(M : F = 5 : 2, mean age 38.9, mean follow-up 19months)patients experienced uvulopalatopharyngoplasty with tonsillectomy. Uvulopalatophayngoplasty with advancement genioplasty was performed for 3 (M : F = 2: 1, mean age 30.2 , mean follow-up 14 months)patients. The last 3(M : F = 2 : 1, mean age 21.5 , mean follow-up 24 months)patients was treated with orthognathic surgery including distraction device insertion. The results was evaluated by questionnaires, polysomnography, investigation of complications. RESULTS: Of the patients treated with radiofrequency ablation, 95% reported improvement of their symptom. 100% improvement was reported in patients treated with UPPP with tonsillectomy and UPPP with advancement genioplasty. The two of three patients who underwent orthognathic surgery showed the satisfactory of treatments. Dryness of mouth was the most common complication during short period in radiofrequency ablation and UPPP with tonsillectomy. Relapse complication was not found in any surgical treatments. CONCLUSION: Treatment for snoring and OSA is determined by severity degree of the physiologic derangements, predominant type of apnea and obstructive site. Accuracy diagnosis should be performed prior to treatment for satisfactory treatment result. This study demonstrates feasibility, safety and efficacy of surgical treatments in snoring and OSA.
Apnea ; Follow-Up Studies ; Genioplasty ; Humans ; Mouth ; Orthognathic Surgery ; Osteogenesis, Distraction ; Polysomnography ; Questionnaires ; Recurrence ; Sleep Apnea, Obstructive ; Snoring ; Tonsillectomy

Adolescent ; Adult ; Device Removal ; Follow-Up Studies ; Humans ; Latency Period (Psychology) ; Male ; Malocclusion ; Mandible ; Mandibular Advancement ; Open Bite ; Osteogenesis, Distraction ; Recurrence ; Rehabilitation ; Temporomandibular Joint