Dong Wun Shin

Inhibition of 6-hydroxydopamine-induced endoplasmic reticulum stress by l-carnosine in SH-SY5Y cells

Conditions that cause endoplasmic reticulum malfunction (ER stress) play a key role in the development of various human diseases including neurodegenerative diseases. Carnosine is an endogenous peptide, present in excitable tissues such as brain and skeletal muscle. Although there are reports suggesting that carnosine has a biological role independent of its antioxidant activity, there have been no reports of the effects of carnosine on the ER stress response. We investigated the effects of carnosine on 6-hydroxydopamine (6-OHDA)-induced cell death and ER stress in SH-SY5Y cells. After assessing control cell viability in serum-free conditions for 24h (100% viability), we found that 50 microM 6-OHDA reduced cell viability to 76.4% of control values, whereas addition of 10mM carnosine significantly reduced cell death to 96.1% viability in a dose-dependent manner. Consistent with its cytoprotective action, carnosine markedly inhibited subsequent ER stress responses, including phosphorylation of eukaryotic initiation factor 2alpha (eIF2alpha) and c-jun, expression of glucose regulatory protein 78 and C/EBP homologous protein, and mRNA splicing of X-box protein 1. The measurement of reactive oxygen species (ROS) generation by 6-OHDA showed that addition of 10mM carnosine slightly but obviously inhibits the 6-OHDA-induced ROS production. In conclusion, our results show that carnosine almost completely inhibits 6-OHDA-induced ER stress responses and cytotoxicity, and that slight antioxidant activity of carnosine against 6-OHDA is observed. Further in vivo studies are needed to investigate clinical uses for carnosine.

Playground Equipment Related Injuries in Preschool-Aged Children: Emergency Department-based Injury In-depth Surveillance

In this study, we investigated playground equipment related injuries in preschool-aged children. This was a retrospective observational study using Emergency Department based Injury In-depth Surveillance, (2011–2014). We included the preschool-aged children with playground equipment related injuries. We surveyed the mechanism and incidence of injuries, and estimated the odds ratio (OR) of traumatic brain injury (TBI) and upper/lower extremities fracture. There were 6,110 patients, mean age was 4.14 ± 1.95 years old. Slide and swing related injuries were 2,475 (40.5%) and 1,102 (18.0%). Fall down (48.5%) was the most common mechanism. The OR of TBI in children 0–2 years old was 1.88 times higher than children 3–7 years old, and in swing was 4.72 (OR, 4.72; 95% confidence interval [CI], 2.37–9.40) times higher than seesaw. The OR of upper extremity fracture in children 3–7 years old was 3.07 times higher than children 0–2 years old, and in climbing was 2.03 (OR, 2.03; 95% CI, 1.63–2.52) times higher than swing. The OR of lower extremity fractures in horizontal bars, tightropes, and trampolines was 2.95 (OR, 2.95; 95% CI, 1.55–5.61) times higher than swing. The most common mechanism and playground equipment were fall down and slide. TBI was associated to younger children (0–2 years old) and swing. Fracture of upper extremities was associated to older children (3–7 years old) and climbing. Fracture of lower extremities was associated to others such as horizontal bars, tightropes, and trampolines.

Outcomes in 102 patients that present to the emergency department with chemotherapy-induced febrile neutropenia.

OBJECTIVE Febrile neutropenia (FN) is a major toxic responseto chemotherapy requiring prompt medical attention. There are a limited number of reports on clinical outcome in patients with FN that present to emergency departments. METHODS We retrospectively evaluated clinical manifestations, therapeutic outcomes, and risk factors for FN in 102 adult patients that presented to the emergency department between 1 January 2006 and 31 March 2009. FN was defined as a body temperature>38°C and a neutrophil count >0.5×109/L on the day of fever onset or the day after. RESULTS Mean age of the patients was 57 years. Mean absolute neutrophil count (ANC) was 436.8/mm3 (range: 0-1000/mm3). In all, 23 of the patients (22.5%) died due to complications related to FN. There were not a statistical difference in therapeutic outcome among tumor types, performance status, sex, depth of neutropenia, or time from emergency department presentationto initiation of antibiotic therapy. Age was an important prognostic factor for therapeutic outcome. Mean age of fatal cases was 65 years versus 56 years for non-fatal cases (p=0.016). Bacteremia was noted in 19 patients, 10 (53%) of which died. The mortality rate was significantly higher in thepatients with blood culture-proven bacteria than in those whose blood culture yielded no organism (p=0.013). CONCLUSION FN patients that presented to the emergency department had a high mortality rate that increased with age. Given the increasing age of patients diagnosed with cancer as well as therapeutic interventions, the high mortality rate associated withchemotherapy-induced FN in elderly patients requires further study in order to reduce the risk of death.

Systematic review and meta-analysis of initial management of pneumothorax in adults: Intercostal tube drainage versus other invasive methods.

Objectives The ideal invasive management as initial approach for pneumothorax (PTX) is still under debate. The purpose of this systematic review and meta-analysis was to examine the evidence for the effectiveness of intercostal tube drainage and other various invasive methods as the initial approach to all subtypes of PTX in adults. Methods Three databases were searched from inception to May 29, 2016: MEDLINE, EMBASE, and the Cochrane CENTRAL. Randomised controlled trials that evaluated intercostal tube drainage as the control and various invasive methods as the intervention for the initial approach to PTX in adults were included. The primary outcome was the early success rate of each method, and the risk ratios (RRs) were used for an effect size measure. The secondary outcomes were recurrence rate, hospitalization rate, hospital stay, and complications. Results Seven studies met our inclusion criteria. Interventions were aspiration in six studies and catheterization connected to a one-way valve in one study. Meta-analyses were conducted for early success rate, recurrence rate, hospitalization rate, and hospital stay. Aspiration was inferior to intercostal tube drainage in terms of early success rate (RR = 0.82, confidence interval [CI] = 0.72 to 0.95, I2 = 0%). While aspiration and intercostal tube drainage showed no significant difference in the recurrence rate (RR = 0.84, CI = 0.57 to 1.23, I2 = 0%), aspiration had shorter hospital stay than intercostal tube drainage (mean difference = -1.73, CI = -2.33 to -1.13, I2 = 0%). Aspiration had lower hospitalization rate than intercostal tube drainage, but marked heterogeneity was present (RR = 0.38, CI = 0.19 to 0.76, I2 = 85%). Conclusion Aspiration was inferior to intercostal tube drainage in terms of early resolution, but it had shorter hospital stay. The recurrence rate of aspiration and intercostal tube drainage did not differ significantly. The efficacy of catheterization connected to a one-way valve was inconclusive because of the small number of relevant studies. (Registration of study protocol: PROSPERO, CRD42016037866)

Characteristics of burn injuries among children aged under six years in South Korea: Data from the Emergency Department-Based Injury In-Depth Surveillance, 2011-2016

Studies show that young children are vulnerable to burn injuries. We aimed to investigate the characteristics of thermal injuries in this population. We included children below 6 years of age who visited the emergency department (ED) after thermal injuries who were registered in the Korean Emergency Department-based Injury In-Depth Surveillance (2011–2016) database. Demographic characteristics, injury-related factors, and factors associated with ED treatment were gathered from the data. Then, we divided all children into two groups according to the ED discharge status: discharge versus admission (including cases transferred to other hospitals). The characteristics of the two groups were compared, and factors associated with admission were investigated. During the study period, 11,667 children with thermal injuries visited the ED. The number of boys was higher than the number of girls, and children aged 1 year accounted for the largest proportion. Most cases occurred in spring and indoors; the home was found to be the most common place. The most common type of burn was scald burns (69%), followed by contact burns (25.9%), and the most commonly burnt body area was the upper limbs (43.7%), followed by the lower limbs (16.8%). Most children (95.8%) were discharged home. The odds for hospital admission were lower for 2–3 and 4–5 year olds than for 0–1 year olds. The odds for hospital admission for contact burns were lower and those for electrical burns were higher than odds for hospital admission for scald burns. In summary, those aged 0–1 showed the largest incidence of thermal injuries and the most common burn mechanism was scald burns. Upper limbs were the most commonly affected body area, but their odds for requiring admission was lowest. Our results could be used as baseline data for prospective interventional studies investigating ways to reduce the incidence of childhood thermal injuries.

The characteristics of pediatric emergency department visits in Korea: An observational study analyzing Korea Health Panel data

Objective We investigated the characteristics of pediatric emergency department (ED) patients in Korea and determined factors associated with hospital admission after ED treatment. Methods Korea Health Panel data from 2008 through 2013 were analyzed retrospectively; we included patients under 18 years old who visited the ED at least once. We collected patient and household epidemiologic data such as sex, age group, region of residence, disability, chronic disease, household income quintile, national health insurance type, use of private insurance, and annual frequency of ED visits. We also examined data related to each ED visit, such as reason for visit, medical service provided, and hospital size/ownership. We then investigated which factors were correlated with case disposition (discharge home or hospital admission) after ED treatment. Results In total, 3,160 pediatric ED visits occurred during the six-year period. Males (57.5%) and children aged 0–5 years (47.7%) made more visits than females and older children, respectively. The proportion of ED visits for disease (67.7%) was much higher than for injury or poisoning (32.2%), and 452 cases (14.3%) required hospital admission. For hospital admission, the odds ratio (OR) of females was 0.73 compared to males, and the OR of children aged 6–11 was 0.68 compared to children aged 0–5. The OR of capital residents was 0.69 compared to province residents, and the OR of the highest income quintile was 0.51 compared to the lowest quintile. The OR of children with private insurance coverage was 0.49 compared to those lacking private insurance, and the OR of ED visits due to disease was 1.82 compared to visits due to injury/poisoning. Conclusion This analysis of clinical and demographic characteristics of pediatric ED visits and hospital admissions can serve as the foundation of future prospective studies required for establishing appropriate policies for the Korean pediatric emergency medical system.

Factors associated with satisfaction with pediatric emergency department services in Korea: analysis of Korea Health Panel Data 2010 to 2012

Objective We aimed to investigate the factors related to satisfaction with the pediatric emergency department service in Korea. Methods This study examined data from the Korea Health Panel Data from 2010 to 2012. Pediatric patients who visited the emergency department at least once between 2010 and 2012 in Korea were included. Data were collected on patient satisfaction with the emergency department service, and factors related to the patient characteristics, emergency department service process, and medical institution. We compared the dissatisfied and satisfied groups, and calculated the odds ratios for satisfaction according to each variable. Results A total of 1,505 emergency department visits from 947 pediatric patients during the 3-year period were analyzed. We estimated that about 79.5% of patients in the population were satisfied. The odds of expressing satisfaction were higher among males than in females, and among patients who were hospitalized after emergency department treatment compared to those who were transferred to another hospital. Conversely, the odds of expressing satisfaction were lower among patients who had a chronic disease, a financial source other than National Health Insurance, experienced hospitalization within 1 year. Conclusion Our study results might be helpful for establishing a satisfactory pediatric emergency medical service system. In the future, further prospective studies evaluating the causal relationships between the relevant factors and patient satisfaction are warranted.

The effect of distraction by dual work on a CPR practitionerʼs efficiency in chest compression: A randomized controlled simulation study

Background: In the clinical setting, the dispersed practitioners’ attention often leads to decreased competence in their performance. We aimed to investigate the effect of distracted practitioners on the quality of chest compression during cardiopulmonary resuscitation. Methods: A randomized controlled crossover simulation study was conducted. Participants were recruited from among doctors, nurses, and paramedics working in a university tertiary hospital. The paced auditory serial addition test (PASAT) was used as a tool for distracting participants. In the crossover design, each participant played 2 scenarios with a 20-minute time gap, by a random order; 2-minute continuous chest compressions with and without PASAT being conducted. The primary outcome was the percentage of compression with an adequate compression rate. Secondary outcomes were the percentage of compression with adequate depth, the percentage of compression with full chest wall recoil, mean compression rate (per minute), mean compression depth, and subjective difficulty of chest compression. Results: Forty-four participants were enrolled, and all of them completed the study. It was found that the percentage of compression with an adequate compression rate was lower when the PASAT was conducted. Although there was no difference in the percentage of compression with adequate depth (P = .88), the percentage of compression with complete chest recoil was lower when PASAT was conducted. In addition, while the mean compression rate was higher when PASAT was conducted, the mean compression depth was not significantly different (P = .65). The subjective difficulty was not different (P = .69). Conclusions: Health care providers who are distracted have a negative effect on the quality of chest compression, in terms of its rate and chest wall recoil. Trial registration: www.ClinicalTrials.gov, NCT03124290.

Radiographic basal ganglia abnormalities secondary to nonketotic hyperglycemia with unusual clinical features

A 77-year-old woman was admitted to a local clinic for altered consciousness and presented with a suspected basal ganglion hemorrhage detected on brain computed tomography. The patient was stuporous, but her vital signs were stable. Her initial blood glucose was 607 mg/dL, and a hyperdense lesion was found in the right basal ganglion on brain computed tomography. T1-weighted magnetic resonance imaging revealed high signal intensity in the right basal ganglion. Electroencephalography showed no seizure activity. The patient was treated with a fluid infusion, and serum glucose level was controlled with insulin. The patient gradually recovered consciousness and was alert within 24 hours as serum glucose level normalized. The basal ganglion lesion caused by hyperglycemia was not accompanied by involuntary limb movement. This is the first report of a patient presenting with decreased consciousness and typical neural radiographic changes associated with nonketotic hyperglycemia but without movement abnormalities.