Outcomes of hanging-induced cardiac arrest patients who underwent therapeutic hypothermia: a multicenter retrospective cohort study.

OBJECTIVES: The aim of this study was to analyze the outcomes of patients with hanging-induced cardiac arrest who underwent therapeutic hypothermia (TH). METHOD: In this multicenter, retrospective registry-based study, discharged patients after out-of-hospital cardiac arrest and treatment with TH were enrolled between June 2007 and March 2013. Several prehospital and hospital variables were examined for an outcome analysis with multivariable logistic regression. RESULTS: A total of 964 patients who had cardiac arrest were enrolled in this study. All patients underwent TH during post-cardiac arrest care after return of spontaneous circulation (ROSC). Of all patients, 105 were assigned to the hanging group and 859 to the non-hanging group. Six patients (6%) with good neurologic outcomes (Cerebral Performance Category 1 or 2) in the hanging group at the time of discharge were found. A shorter time interval between witnessed arrest and ROSC and a Glasgow Coma Scale over 4 after ROSC are statistically significant variables of good neurologic outcomes after hanging-induced cardiac arrest treated with TH. CONCLUSION: A small number of patients who underwent TH after a hanging-induced cardiac arrest provided good neurologic outcomes, and some variables influenced these outcomes.

Activation of NF-κB pathway in oral buccal mucosa during small intestinal ischemia-reperfusion injury.

BACKGROUND: Intestinal ischemia-reperfusion injury induces intestinal mucosal barrier disruption, systemic inflammatory response syndrome, multiorgan failure, and death. The major pathway for the systemic inflammatory responses depends on nuclear factor kappa B (NF-κB). However, direct measuring of NF-κB in injured tissues is not routinely available. Our aim was to determine whether NF-кB pathway in buccal mucosa is activated during intestinal ischemia-reperfusion injury. MATERIALS AND METHODS: Male Sprague-Dawley rats were prepared for the animal experiment. Superior mesenteric artery (SMA) was exposed and clamped for 30 min in the intestinal ischemia-reperfusion (IR) group. SMA was exposed only in control group. Serum, buccal mucosa, and small intestinal mucosa were harvested in 90 min after reperfusion in IR or 120 min after SMA exposure in control group. Serum cytokine levels and tissue NF-κB pathway activities were measured. RESULTS: Serum TNF-α (5.49 ± 2.72 versus 1.77 ± 1.20 pg/mL, P = 0.002) and interleukin-6 (232.32 ± 29.98 versus 115.92 ± 17.81 pg/mL, P = 0.002) levels were significantly higher in IR than control group. Intestinal mucosal cytoplasmic phosphorylated inhibitor kappa B (IκB)/IκB ratio, nuclear NF-κB expression, and NF-κB DNA-binding activity were significantly higher in IR than control group. Buccal mucosal cytoplasmic phosphorylated IκB/IκB ratio, nuclear NF-κB expression, and NF-κB DNA-binding activity were also higher in IR than control group. CONCLUSION: Buccal mucosal NF-κB pathway was activated by intestinal ischemia-reperfusion injury. The present study suggests that buccal mucosal may be considered as an indicator for the assessment of intestinal ischemia-reperfusion injury.

The lack of association between age and diabetes and hospitalization in women with acute pyelonephritis.

BACKGROUND: Traditional management of acute pyelonephritis (APN) involves hospitalization and intravenous antibiotics. However, recently issued guidelines recommend that women with mild APN can be treated with oral antibiotics. OBJECTIVES: Many emergency practitioners feel compelled to admit all elderly and diabetic women with APN to the hospital. We explored the association between age and presence of diabetes with hospital admission in women with APN. METHODS: A retrospective chart review was undertaken on women with a diagnosis of APN made in the Emergency Department between May 2003 and December 2005. Exclusion criteria were as follows: pregnancy, immune suppression other than diabetes, urinary stone, septic shock, and hydronephrosis. Standardized chart review was performed and the primary outcome was admission to the hospital. Univariate and multivariate analyses were used to identify factors associated with hospital admission. RESULTS: Of the 388 patients included, 185 (47.7%) were admitted. After adjusting for confounding variables, the odds ratios of admission for those who had been recently hospitalized or had a low serum albumin level or a high C-reactive protein level were 2.10 (95% confidence interval [CI] 1.09-4.02), 1.96 (95% CI 1.09-6.05), and 2.57 (95% CI 1.11-3.46), respectively. Older age and the presence of diabetes were not found to be independently associated with admission. CONCLUSIONS: In women with acute pyelonephritis, an older age and diabetes were not found to be independently associated with hospital admission.

Efficacy and safety of the computed tomography coronary angiography based approach for patients with acute chest pain at an emergency department: one month clinical follow-up study.

To evaluate the safety and efficacy of the computed tomography coronary angiography (CTCA) for evaluation of acute chest pain in real world population, we prospectively enrolled 296 patients with acute chest pain at emergency department (ED) from November 2005 to February 2007. The patients were grouped based on the clinical information and CTCA result. The patients with a low risk profile and no significant coronary stenosis (>50%) in CTCA were discharged immediately (Group 1, n=103). On the other hand, the patients with an intermediate risk profile without significant stenosis were observed in ED for 24 hr (Group 2, n=104). The patients with significant stenosis underwent further coronary evaluation and management accordingly (Group 3, n=89). While no false negative case was found in Group 1, seven cases (6.73%) were found in Group 2, mostly during the observation period. In Group 3, there were 54 (60.67%) cases of acute coronary syndrome including 10 myocardial infarctions. The overall accuracy of CTCA for acute coronary syndrome was 88.5% (sensitivity), 85.1% (specificity), 60.7% (positive predictive value) and 96.6% (negative predictive value). In conclusion, clinical decision based on CTCA is safe and effective for low risk patients. Further validation is needed in patients with intermediate risk profile.

The impact of helical computed tomography on the negative appendectomy rate: a multi-center comparison.

Emergency departments have different strategies concerning the use of computed tomography (CT) for diagnosing appendicitis. We explored the association between CT utilization rates and the negative appendectomy rates in patients with suspected appendicitis at three medical centers. A retrospective multi-center comparative study was conducted to determine the association between CT use and negative appendectomy rates at three different medical centers. Standardized extraction of data from medical records and operative reports was performed by trained investigators. Of the 339 patients included, 242 (71.4%) were imaged with abdominal CT before appendectomy (CT group), whereas the remaining patients were not (non-CT group). Thirty-six of the 339 patients (10.6%) were found to have negative appendectomies. The CT group had a significantly lower negative appendectomy rate than the non-CT group (6.6% vs. 20.6%, respectively, p < 0.05). The three centers had significantly different rates of CT utilization for diagnosing acute appendicitis (86.9%, 66.4%, and 13.3%, p < 0.05). These three centers also had significantly different negative appendectomy rates (2.5%, 16.8%, and 23.3%, p < 0.05). There was a significant inverse correlation (rho = -1, p < 0.05) between CT utilization rates and negative appendectomy rates. The rate of negative appendectomies in this retrospective study was inversely related to the rates of CT imaging before exploration in Emergency Department patients with suspected appendicitis.

Time for change: the state of emergency medical services in South Korea.

Trauma is the leading cause of death among people younger than 40 years of age in South Korea. This demographic represents the productive members of Korean society, yet little is being done to correct this growing problem. The preventable death rate in Korea is estimated to be approximately 60%, which is unacceptable given Korea's growing economy and available resources.

Association between polymorphism in intron 1 of cocaine- and amphetamine-regulated transcript gene with alcoholism, but not with bipolar disorder and schizophrenia in Korean population.

Cocaine- and amphetamine-regulated transcript (CART) peptide is a novel neuropeptide involved in feeding, drug reward, and stress. We hypothesized that the polymorphism of CART gene might be related with susceptibility to neuropsychiatric diseases such as alcoholism, bipolar disorder, and schizophrenia. The polymorphism (rs2239670) in intron 1 was selected for study among other single nucleotide polymorphisms (SNPs) located at the area of CART gene, because it had not been tested until to date. The study included patients of alcoholism (100), bipolar disorder (76) and schizophrenia (169) from the Korean population. Healthy controls for bipolar disorder and schizophrenia consisted of 333 individuals. For alcoholism, both patient group and control subjects included only male. The restriction fragment length polymorphism (RFLP) using the AvaII restriction enzyme was designed to analyze the selected SNP. The distribution of GG, GA, and AA genotypes in the 333 controls was 50.2, 41.1, and 8.7%, respectively. The frequency of G and A alleles in the 333 controls was 70.7 and 29.3%, respectively. The distribution of genotype and allele frequencies of the AvaII polymorphism showed a significant difference between alcoholism and controls (P = 0.037 and P = 0.044). However, the AvaII polymorphism of the CART gene did not show association with bipolar disorder and schizophrenia. In conclusion, we report for the first time that the AvaII polymorphism (rs2239670) in intron 1 of the CART gene is associated with alcoholism in the Korean male population.

Combined administration of glutamine and growth hormone synergistically reduces bacterial translocation in sepsis.

We investigated the combined effect of glutamine (GLN) and growth hormone (GH) on bacterial translocation (BT) in sepsis. After single intraperitoneal injection of lipopolysaccharide (10 mg/kg), 48 rats were divided randomly into four groups of 12 animals each: the control group received chow orally; the GLN group received chow plus 10% GLN; GH group received chow plus GH; and the GLN/GH group received chow, 10% GLN, and GH. Twenty-four and 96 hr later, rats were sacrificed. Portal blood culture, bacterial colony counts of cultured mesenteric lymph nodes, mucosal thickness, malondialdehyde (MDA), and glutathione (GSH) levels in the gut mucosa were measured. There was no significant change of the rate of portal blood culture between all treatment groups at 24 and 96 hr. At 24 hr, the rats receiving combined treatment of GLN and GH showed lower bacterial colony counts and mucosal MDA levels than the control rats, and higher mucosal GSH levels than the control and GLN-treated rats. At 96 hr, rats treated with both GLN and GH exhibited lower bacterial colony counts and mucosal MDA levels, and higher mucosal thickness and GSH levels than control, GLN, or GH-treated rats. This study suggests that the combination of GLN and GH may synergistically reduce BT over time in sepsis.

The effects of antioxidants and nitric oxide modulators on hepatic ischemic-reperfusion injury in rats.

Ischemic-reperfusion injury (IRI) is thought to be caused by oxygen radicals. Nitric oxide (NO) also has been thought to play a key role in IRI. This experiment was designed to evaluate the effects of antioxidants and NO supplement on hepatic IRI. Male Sprague-Dawley rats were divided into five groups: a sham operation group, a group with IRI, and three groups with vitamin C combined with vitamin E (VC&VE), L-arginine and N(G)-nitro-L-arginine (NNLA) injected after IRI. IRI was induced by clamping of the porta hepatis for 30 minutes and then by declamping. To prevent mesenteric blood congestion, a porto-systemic shunt had been made four weeks before the portal clamping. Biochemical assays of TNF-alpha level and NO2- level in the blood, malondialdehyde level, catalase activity and NO synthase activity in the liver tissue were performed. The results were as follows: IRI increased the malondialdehyde level and exhausted the catalase activity remarkably. VC&VE lowered the malondialdehyde levels and protected against catalase exhaustion, but had no significant effect on the NO production. L-arginine had a definite antioxidant effect, which was much weaker than that of VC&VE. In conclusion, antioxidants and a supplement of NO protected the liver tissue against IRI.