Ideal chest compression site for cardiopulmonary resuscitation in fontan circulation patients with dextrocardia.

BACKGROUND: We aimed to identify the ideal chest compression site for cardiopulmonary resuscitation (CPR) in patients with a single ventricle with dextrocardia corrected by Fontan surgery. METHODS: The most recent stored chest computed tomography images of all patients with a single ventricle who underwent Fontan surgery were retrospectively analysed. We reported that the ideal chest compression site is the largest part of the compressed single ventricle. To identify the ideal chest compression site, we measured the distance from the midline of the sternum to the point of the maximum sagittal area of the single ventricle as a deviation and calculated the area fraction of the compressed structures. RESULTS: 58 patients (67.2% male) were analysed. The mean right deviation from the midline of the sternum to the ideal compression site was similar to the mean sternum width (32.85 ± 15.61 vs. 31.05 ± 6.75 mm). When chest compression was performed at the ideal site, the area fraction of the single ventricle significantly increased by 7%, which was greater than that of conventional compression (0.15 ± 0.10 vs. 0.22 ± 0.11, P < 0.05). CONCLUSIONS: When performing CPR on a patient with Fontan circulation with dextrocardia, right-sided chest compression may be better than the conventional location.

Comparison of age-adjusted shock indices as predictors of injury severity in paediatric trauma patients immediately after emergency department triage: A report from the Korean multicentre registry.

INTRODUCTION: Shock index paediatric-adjusted (SIPA) was presented for early prediction of mortality and trauma team activation in paediatric trauma patients. However, the derived cut-offs of normal vital signs were based on old references. We established alternative SIPAs based on the other commonly used references and compared their predictive values. METHODS: We performed a retrospective review of all paediatric trauma patients aged 1-15 years in the Emergency Department (ED)-based Injury In-depth Surveillance (EDIIS) database from January 1, 2011 to December 31, 2019. A total of 4 types of SIPA values were obtained based on the references as follows: uSIPA based on the Nelson textbook of paediatrics 21st ed., SIATLS based on the ATLS 10th guideline, SIPALS based on the PALS 2020 guideline, and SIPA. In each SIPA group, the cut-off was established by dividing the group into 4 subgroups: toddler (age 1-3), preschooler (age 4-6), schooler (age 7-12), and teenager (age 13-15). We performed an ROC analysis and calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to compare the predicted values of each SIPA in mortality, ICU admission, and emergent surgery or intervention. RESULTS: A total of 332,271 patients were included. The proportion of patients with an elevated shock index was 14.9 % (n = 49,347) in SIPA, 22.8 % (n = 75,850) in uSIPA, 0.3 % (n = 1058) in SIATLS, and 4.3 % (n = 14,168) in SIPALS. For mortality, uSIPA achieved the highest sensitivity (57.0 %; 95 % confidence interval 56.9 %-57.2 %) compared to SIPA (49.4 %, 95 % CI 49.2 %-49.5 %), SIATLS (25.5 %, 95 % CI 25.4 %-25.7 %), and SIPALS (43.8 %, 95 % CI 43.7 %-44.0 %), but there were no significant differences in the negative predictive value (NPV) or area under the curve (AUC). The positive predictive value (PPV) was highest in SIATLS (5.7 %, 95 % CI 5.6 %-5.8 %) compared to SIPA (0.2 %, 95 % CI 0.2 %-0.3 %), uSIPA (0.2 %, 95 % CI 0.2 %-0.2 %), and SIPALS (0.7 %, 95 % CI 0.7 %-0.8 %). The same findings were presented in ICU admission and emergent operation or intervention. CONCLUSION: The ATLS-based shock index achieved the highest PPV and specificity compared to SIPA, uSIPA, and SIPALS for adverse outcomes in paediatric trauma.

Clinical implications of discrepancies in predicting pediatric mortality between Pediatric Index of Mortality 3 and Pediatric Logistic Organ Dysfunction-2.

BACKGROUND: Pediatric Index of Mortality 3 (PIM 3) and Pediatric Logistic Organ Dysfunction-2 (PELOD-2) are validated tools for predicting mortality in children. Research suggests that these tools may have different predictive performance depending on patient group characteristics. Therefore, we designed this study to identify the factors that make the mortality rates predicted by the tools different. METHODS: This retrospective study included patients (<18 years) who were admitted to a pediatric intensive care unit from July 2017 to May 2019. After defining the predicted mortality of PIM 3 minus the predicted mortality rate of PELOD-2 as "difference in mortality prediction," the clinical characteristics significantly related to this were analyzed using multivariable regression analysis. Predictive performance was analyzed through the Hosmer-Lemeshow test and area under the receiver operating characteristic curve (AUROC). RESULTS: In total, 945 patients (median [interquartile range] age, 3.0 [0.0-8.0] years; girls, 44.7%) were analyzed. The Hosmer-Lemeshow test revealed AUROCs of 0.889 (χ2=10.187, P=0.313) and 0.731 (χ2=6.220, P=0.183) of PIM 3 and PELOD-2, respectively. Multivariable linear regression analysis revealed that oxygen saturation, partial pressure of CO2, base excess, platelet counts, and blood urea nitrogen levels were significant factors. Patient condition-related factors such as cardiac bypass surgery, seizures, cardiomyopathy or myocarditis, necrotizing enterocolitis, cardiac arrest, leukemia or lymphoma after the first induction, bone marrow transplantation, and liver failure were significantly related (P<0.001). CONCLUSIONS: Both tools predicted observed mortality well; however, caution is needed in interpretation as they may show different prediction results in relation to specific clinical characteristics.

Effectiveness of the implementation of pediatric intussusception clinical pathway: A pre- and postintervention trial.

ABSTRACT: Intussusception is common among children at the pediatric emergency department (ED) with acute abdomen. Diagnosis and treatment delay remain a challenge. This study aimed to evaluate the impact of intussusception clinical pathways (CPs) implementation, including bedside point-of-care ultrasonography, on patient management in a pediatric ED.In January 2017, an intussusception management protocol was implemented for children with symptoms of intussusception. We retrospectively examined the charts of patients diagnosed with intussusception during the preprotocol (January 2015 to December 2016) and postprotocol (January 2017 to January 2019) periods and compared their outcomes.A total of 106 and 108 patients were included in the preprotocol and postprotocol groups, respectively. After CP implementation, the median door-to-ultrasonography time decreased from 66.5 (range: 13, 761) to 54 (20, 191) minutes; meanwhile, door-to-reduction time decreased from 121.5 (37, 1077) to 80.5 (40, 285) minutes; the median ED length of stay decreased from 440 to 303.5  minutes; and finally, admission rate increased from 18.9% to 40.7% (P < .01). There was no between-group difference in the rates of complications, readmission, emergency surgery, or reduction failure.The implementation of an intussusception CP decreased time-to-diagnosis, time-to-treatment, and ED length of stay estimates among children screened using point-of-care ultrasonography. The present findings suggest that the implementation of an intussusception CP may improve the efficiency of time and resource use.

Pediatric Injuries in Kids Cafés and Risk Factors for Significant Injuries: a 6-Year Cross-Sectional Study Using a Multicenter Injury Registry in Korea.

BACKGROUND: A kids café is a popular indoor playground in Korea that combines a playground for young children and a café for their caregivers. There have been no national reports about kids café-related injuries in Korea. This study investigated kids café-related injuries in Korea registered in a multicenter injury surveillance database and analyzed the risk factors for significant kids café-related injuries. METHODS: A multicenter cross-sectional study was performed using the Emergency Department-based Injury In-depth Surveillance registry in Korea between 2011 and 2016. Significant injury was defined as an injury requiring hospitalization or surgery. A multivariable logistic regression model was used to obtain the adjusted odds ratios (aORs) for factors associated with significant kids café-related injuries. RESULTS: Among 1,537,617 injured patients, we extracted 891 patients who were injured in kids cafés. Of these, 46 (5.2%) were admitted, and 39 (4.4%) underwent surgery. The most common injured anatomical site, injury type, and mechanism were lower extremity (28.2%), superficial injury (27.2%), and slip (27.1%), respectively. Among injury-inducing factors, significant injuries were most commonly caused by a trampoline (28.1%), and rock climbing equipment was the only risk factor in a kids café that led to significant injury after adjusting for age, sex, injury mechanism, and injured anatomical sites (aOR, 14.94; 95% confidence interval, 1.51-147.72). CONCLUSION: The rock climbing equipment in a kids café can cause serious injury to children. Establishing safety regulations for rock climbing equipment in kids cafés may have the greatest impact in reducing significant injuries requiring hospitalization or surgery.

The epidemiology of childhood intussusception in South Korea: An observational study.

Intussusception is one of the most common causes of intestinal obstruction in young children. We report a retrospective, observational study of the epidemiology of intussusception in South Korea using the National Health Insurance Service-National Sample Cohort (NHIS-NSC). A cohort of newborns born between 2002 and 2008 was selected. The primary objective was to assess the incidence of intussusception in the pediatric population of Korea. The secondary objectives were to describe the basic epidemiological characteristics of intussusception and to identify risk factors. A total of 362 children were identified. The highest incidence of intussusception (2.6 per 1,000) was observed in children aged 1-2 years. A total of 58.8% of the children were male, and there was no significant difference in incidence according to the birth year (P = 0.804). Most of the children diagnosed with intussusception underwent air reduction, while only 0.6% had surgery. In all, 82.3% of the children were admitted to the hospital, 0.8% of them had to be admitted to the ICU, and the 6-month mortality was only 0.3%. In this retrospective, observational study, the incidence of intussusception was highest among children between 1 and 2 years of age. Most of the children underwent air reduction.

The difference of Use of CT in the general versus pediatric emergency departments for adolescent patients in the same tertiary hospital.

OBJECTIVE: The use of computed tomography (CT) in pediatric patients has decreased since the association between radiation and cancer risk has been reported. However, in adolescent patients being treated as adult patients, there has been a high incidence of CT use in emergency departments (EDs). Thus, this study aimed to evaluate the CT use in adolescent patients with complaints of headache or abdominal pain in the general and pediatric EDs of the same hospital. METHODS: A retrospective chart review of patients aged 15 to 18 years, who presented with headache or abdominal pain at the general and pediatric EDs of Seoul National University Hospital from January 2010 to December 2014, was conducted. RESULTS: A total of 407 adolescent patients with complaints of headache and 980 with abdominal pain were included in this study. The adolescent patients in the general ED were more likely to undergo CT scans than those in the pediatric ED, with both patients having headache (42.4% vs. 20.5%, respectively, P<0.001) and abdominal pain (29.0% vs. 18.4%, respectively, P<0.001). There was no statistical difference in the rates of positive CT findings between the general and pediatric EDs. The frequency of visits to the general ED was associated with high rates of CT use in adolescent patients with complaints of headache (odds ratio, 3.95; 95% confidence interval, 2.01 to 7.77) and those with abdominal pain (odds ratio, 1.76; 95% confidence interval, 1.18 to 2.64). CONCLUSION: The ED setting influences the use of CT on adolescent patients, and a child-friendly environment could reduce the radiation risks.

Dog-bite injuries in Korea and risk factors for significant dog-bite injuries: A 6-year cross-sectional study.

INTRODUCTION: An accurate understanding of the current status of dog-bite injuries in Korea is essential for establishing preventive strategies. There have been no national reports about dog-bite injuries in Korea. This study investigated dog-bite injuries in Korea that were registered in the nationwide injury surveillance database and analysed the risk factors for significant dog-bite injury. METHODS: A multicentre cross-sectional study was conducted using the emergency department (ED)-based Injury In-depth Surveillance (EDIIS) registry in Korea between 2011 and 2016. We defined significant injury as death, admission, surgery, or fracture or amputation. A multivariable logistic regression model was used to obtain the adjusted odds ratios (aORs) for the factors associated with significant dog-bite injuries. RESULTS: Among 1,537,617 injured patients, 9,966 (6.5 per 1,000 injured patients) presented to the ED for dog-bite injuries (5.6 in 2011 to 7.6 in 2016, P for trend < 0.001), and 489 (4.9%) were significant injuries. In the age-specific analysis, there were increasing trends only among teenagers (12-18 years) and adults (> 18 years). Being elderly (≥ 60 years) (aOR: 2.70, 95% CI: 2.15-3.39), having injuries to multiple anatomic sites (aOR: 4.37, 95% CI: 2.96-6.45), being bitten outdoors (aOR: 2.71, 95% CI: 2.20-3.34), and being bitten by a relative's dog (aOR: 2.37, 95% CI: 1.09-5.17) were strongly associated with significant dog-bite injury. CONCLUSION: Dog-bite injuries are increasing in Korea, especially in teenagers and adults. A relative's or neighbour's dog may be more dangerous than a stranger's dog. Preventive strategies are needed to prevent dog-bite injuries in adults and children.

Development of screening tool for child abuse in the korean emergency department: Using modified Delphi study.

Mandatory reporting rate of suspected child abuse by health care provider is relatively low in South Korea. The purpose of the study was to develop a screening tool for child abuse and evaluate the feasibility of using this screening tool in emergency department (ED) of South Korea. Injured children younger than 14 years old in the ED were enrolled as subjects to use this screening tool. Candidate items for screening tool were decided after reviewing relevant previous studies by researchers. Using the modified Delphi method, it was judged that the consensus for items of screening tool was achieved in 2 rounds, and the final item of the screening tool was decided through the discussion in the final round. The registry including the developed screening tool was applied to 6 EDs over 10 weeks. Variables of the registry were retrospectively analyzed. A child abuse screening tool called Finding Instrument for Non-accidental Deeds (FIND) was developed. It included 8 questions. One item (suspected signs in physical examination) had 100% agreement; 3 items (inconsistency with development, inconsistent history by caregivers, and incompatible injury mechanism) had 86.7% agreement; and 4 items (delayed visit, inappropriate relationship, poor hygiene, and head or long bone injury in young infants) had 80% agreement. During the period of registry enrollment, the rate of screening with FIND was 72.9% (n = 2815). 36 (1.3%) cases had 1 or more "positive" responses among 8 items. Two (0.07%) cases were reported to the Child Protection Agency. An ED based screening tool for child abuse consisting of 8 questions for injured children younger than 14 years old was developed. The use of screening tools in Korean ED is expected to increase the reporting rate of child abuse. However, further study is necessary to investigate the accuracy of this screening tool using a national child abuse registry.

Protective effect of hemopexin on systemic inflammation and acute lung injury in an endotoxemia model.

BACKGROUND: Hemopexin (HPX) has been identified as an anti-inflammatory agent, but its role in endotoxemia is unclear. The purpose of this study was to determine whether HPX suppresses systemic and lung inflammation in a mouse model of endotoxemia. MATERIALS AND METHODS: At 30 min of intraperitoneal administration of lipopolysaccharide (LPS; 10 mg/kg), either distilled water (LPS-only treated animals) or HPX (5 mg/kg) was injected into mice via the tail vein, and the survival rates were analyzed after 36 h. Furthermore, the serum levels of tumor necrosis factor-α, interleukin-6 (IL-6), and HPX were determined at 0, 3, and 6 h, and the expression levels and DNA binding activities of phosphorylated cytoplasmic inhibitor κB-α, nuclear factor-κB (NF-κB), and the p65 subunit of NF-κB were evaluated and compared with the rates of histologic lung injury after 6 h. RESULTS: Serum tumor necrosis factor-α and interleukin-6 levels were decreased in HPX-treated animals at 3 and 6 h (P < 0.05). HPX suppressed the NF-κB pathway (P < 0.05) and reduced acute lung injury at 6 h, and 36 h after initial treatment, the survival rate was higher in HPX-treated animals than that in LPS-treated animals (P < 0.05). CONCLUSIONS: HPX downregulated proinflammatory cytokine production and acute lung injury as well as improved survival rates in a mouse model of endotoxemia. These effects were associated with HPX-mediated suppression of the NF-κB pathway.

12th WINFOCUS world congress on ultrasound in emergency and critical care.

TABLE OF CONTENTS: A1 Point-of-care ultrasound examination of cervical spine in emergency departmentYahya Acar, Onur Tezel, Necati SalmanA2 A new technique in verifying the placement of a nasogastric tube: obtaining the longitudinal view of nasogastric tube in addition to transverse view with ultrasoundYahya Acar, Necati Salman, Onur Tezel, Erdem CevikA3 Pseudoaneurysm of the femoral artery after cannulation of a central venous line. Should we always use ultrasound in these procedures?Margarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA4 Ultrasound-guided supraclavicular subclavian vein catheterization. A novel approach in emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA5 Clinical ultrasound in a septic and jaundice patient in the emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA6 Characterization of the eyes in preoperative cataract Saudi patients by using medical diagnostic ultrasoundMustafa Z. Mahmoud, Abdelmoneim SuliemanA7 High-frequency ultrasound in determining the causes of acute shoulder joint painMustafa Z. MahmoudA8 Teaching WINFOCUS Ultrasound Life Support Basic Level 1 for Providers in resource-limited countriesAbbas Ali, Alrayah Mustafa, Ihab Abdelrahman, Mustafa Bahar, Osama Ali, H. Lester Kirchner, Gregor ProsenA9 Changes of arterial stiffness and endothelial function during uncomplicated pregnancyAjda Anzic, Paul LeesonA10 Cardiovascular haemodynamic properties before, during and after pregnancyAjda Anzic, Paul LeesonA11 An old man with generalized weaknessMaryam Bahreini, Fatemeh RasooliA12 Ultrasonography for non-specific presentations of abdominal painMaryam Bahreini, Houman HosseinnejadA13 Introduction of a new imaging guideline for suspected renal colic in the emergency department: effect on CT Urogram utilisationGabriel Blecher, Robert Meek, Diana Egerton-WarburtonA14 Transabdominal ultrasound screening for pancreatic cancer in Croatian military veterans: a retrospective analysis from the first Croatian veteran's hospitalEdina Catic Cuti, Stanko Belina, Tihomir Vancina, Idriz KovacevicA15 The challenge of AAA: unusual case of obstructive jaundiceEdina Catic Cuti, Nadan RustemovicA16 Educational effectiveness of easy-made new simulator model for ultrasound-guided procedures in pediatric patients: vascular access and foreign body managementIkwan Chang, Jin Hee Lee, Young Ho Kwak, Do Kyun KimA17 Detection of uterine rupture by point-of-care ultrasound at emergency department: a case reportChi-Yung Cheng, Hsiu-Yung Pan, Chia-Te KungA18 Abdominal probe in the hands of interns as a relevant diagnostic tool in revealing the cause of heart failureEla Curcic, Ena Pritisanac, Ivo Planinc, Marijana Grgic Medic, Radovan RadonicA19 Needs assessment of the potential utility of point-of-care ultrasound within the Zanzibar health systemAbiola Fasina, Anthony J. Dean, Nova L. Panebianco, Patricia S. HenwoodA20 Ultrasonographic diagnosis of tracheal compressionOliviero Fochi, Moreno Favarato, Ezio BonanomiA21 The role of ultrasound in the detection of lung infiltrates in critically ill patients: a pilot studyMarijana Grgic Medic, Ivan Tomic, Radovan RadonicA22 The SAFER Lasso; a novel approach using point-of-care ultrasound to evaluate patients with abdominal complaints in the emergency departmentYoungrock Ha, Hongchuen TohA23 Awareness and use of clinician-performed ultrasound among clinical clerkship facultyElizabeth Harmon, Wilma Chan, Cameron Baston, Gail Morrison, Frances Shofer, Nova Panebianco, Anthony J. DeanA24 Clinical outcomes in the use of lung ultrasound for the diagnosis of pediatric pneumoniasAngela Hua, Sharon Kim, James TsungA25 Effectiveness of ultrasound in hypotensive patientsIsa Gunaydin, Zeynep Kekec, Mehmet Oguzhan AyA26 Moderate-to-severe left ventricular ejection fraction related to short-term mortality of patients with post-cardiac arrest syndrome after out-of-hospital cardiac arrestJinjoo Kim, Jinhyun Kim, Gyoosung Choi, Dowon ShimA27 Usefulness of abdominal ultrasound for acute pyelonephritis diagnosis after kidney transplantationJi-Han LeeA28 Lung ultrasound for assessing fluid tolerance in severe preeclampsiaJana Ambrozic, Katja Prokselj, Miha LucovnikA29 Optic nerve sheath ultrasound in severe preeclampsiaGabrijela Brzan Simenc, Jana Ambrozic, Miha LucovnikA30 Focused echocardiography monitoring in the postoperative period for non-cardiac patientsAsta Maciuliene, Almantas Maleckas, Algimantas Krisciukaitis, Vytautas Maciulis, Andrius MacasA31 POCUS-guided paediatric upper limb fracture reduction: algorithm, tricks, and tipsSharad MohiteA32 Point-of-care lung ultrasound: a good diagnostic tool for pneumonia in a septic patientZoltan Narancsik, Hugon MozinaA33 A case of undergraduate POCUS (r)evolutionSara Nikolic, Jan Hansel, Rok Petrovcic, Una Mrsic, Gregor ProsenA34 The Graz Summer School for ultrasound: from first contact to bedside application: three-and-a-half-day undergraduate ultrasound training: résumé after two years of continuous developmentSimon Orlob, Markus Lerchbaumer, Niklas Schönegger, Reinhard KaufmannA35 Usefulness of point-of-care ultrasound in the emergency room in a patient with acute abdominal painAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA36 Use of bedside ultrasound in a critically ill patient. A case reportAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA37 Diagnostic yield of clinical echocardiography for the emergency physicianAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA38 Focused cardiac ultrasound in early diagnosis of type A aortic dissection with atypical presentationChun-I Pan, Hsiu-Yung Pan, Chien-Hung WuA39 Detection of imperforated hymen by point-of-care ultrasoundHsiu-yung Pan, Chia-Te KungA40 Developing a point-of-care ultrasound curriculum for pediatric nurse practitioners practicing in the pediatric emergency departmentSarah Pasquale, Stephanie J. Doniger, Sharon Yellin, Gerardo ChiricoloA41 Use of transthoracic echocardiography in emergency setting: patient with mitral valve abscessMaja Potisek, Borut Drnovsek, Bostjan LeskovarA42 A young man with syncopeFatemeh Rasooli, Maryam BahreiniA43 Work-related repetitive use injuries in ultrasound fellowsKristine Robinson, Clara Kraft, Benjamin Moser, Stephen Davis, Shelley Layman, Yusef Sayeed, Joseph MinardiA44 Lung ultrasonography in the evaluation of pneumonia in childrenIrmina Sefic Pasic, Amra Dzananovic, Anes Pasic, Sandra Vegar ZubovicA45 Central venous catheter placement with the ultrasound aid: two years' experience of the Interventional unit, Division of Intensive Care Medicine, KBC ZagrebAna Godan Hauptman, Marijana Grgic Medic, Ivan Tomic, Ana Vujaklija Brajkovic, Jaksa Babel, Marina Peklic, Radovan RadonicA46 Duplicitas casui: two patients admitted due to acute liver failureVedran Radonic, Ivan Tomic, Luka Bielen, Marijana Grgic MedicA47 A pilot survey on an understanding of Bedside Point-of-Care Ultrasound (POCUS) among medical doctors in internal medicine: exposure, perceptions, interest, and barriers to trainingPeh Wee MingA48 Unusual case of defecation syncopeNur hafiza Yezid, Fatahul Laham MohammedA49 A case report of massive pulmonary embolism; a multidisciplinary approachZainal Abidin Huda, Wan Nasarudin Wan Ismail, W.Yus Haniff W.Isa, Hashairi Fauzi, Praveena Seeva, Mohd Zulfakar Mazlan.

Change of hemopexin level is associated with the severity of sepsis in endotoxemic rat model and the outcome of septic patients.

PURPOSE: The purpose of the study is to uncover the role of hemopexin (HPX) as anti-inflammatory mediator in animals and humans. MATERIALS AND METHODS: We injected rats with 5 and 10 mg/kg of lipopolysaccharide to induce low- and high-grade endotoxemia (LGE and HGE), respectively, and we measured serum levels of tumor necrosis factor α, interleukin 6, and HPX at 0, 1, 3, and 6 hours after the injection. In a clinical study, we measured the initial serum HPX concentrations of septic shock patients. We evaluated the correlation between HPX levels and sepsis severity in rats and the predictive value of the HPX level for 28-day mortality of patients. RESULTS: In rats, serum interleukin 6 and tumor necrosis factor α concentrations were lower in LGE than in HGE, whereas the HPX level in HGE at 6 hours was significantly lower than in LGE (0.88, interquartile range [0.79-1.00] vs 1.33, interquartile range [1.29-1.49] mg/mL, P= .002). In patients, the initial serum HPX level in nonsurvivors was significantly lower than in survivors (0.75 vs 1.02 mg/mL, P< .001). Multivariate logistic regression analysis revealed that HPX exhibited independent prognostic value for 28-day mortality, and its levels were closely related to Acute Physiology and Chronic Health Evaluation II scores. CONCLUSIONS: Low serum HPX levels are related to sepsis severity and could indicate poor prognosis for septic shock patients.

Antioxidant effects of selenium on lung injury in paraquat intoxicated rats.

CONTEXT: Paraquat (PQ) causes lethal intoxication by inducing oxidant injury to the lung. Selenium is a cofactor for glutathione peroxidase (GPx), which is one of the major endogenous antioxidant enzymes. OBJECTIVE: To determine whether selenium post-treatment activates GPx, decreases lung injury, and improves survival in PQ intoxicated rats. MATERIALS AND METHODS: Male Spraque-Dawley rats were categorized into three groups: sham (n = 6), PQ (n = 12), and PQ + Se (n = 12). In the PQ and PQ + Se groups, 50 mg/kg of PQ was administered intraperitoneally. After 10 minutes, 60 µg/kg of Se (PQ + Se) or saline (PQ) was administered via the tail vein. Six rats per group were euthanized 6 hours or 24 hours later. Lung tissues were harvested for the measurement of GPx activity, reduced glutathione (GSH), glutathione disulfide (GSSG) and malondialdehyde (MDA) and for histological analysis. Using separated set of rats, survival of PQ (n = 10) and PQ + Se (n = 10) were observed for 72 hours. RESULTS: GPx activity in the PQ group at the 6-hour and 24-hour time points was lower than in the sham group (p < 0.006). GPx activity in the PQ + Se group at the 6-hour and 24-hour time points was higher than in the PQ group at the same time (p < 0.006). GPx activity in the PQ + Se group at 24 hours was higher than at 6-hour time point and also higher than in the sham group (p < 0.006). The GSH/GSSG ratio in the PQ + Se group at 24 hours was lower than that in the sham group (p < 0.006). MDA levels in the PQ group at 6 hours and 24 hours were higher than in the sham group (p < 0.006). MDA levels at 24 hours in the PQ + Se group was lower than in the PQ group (p < 0.006). Acute lung injury (ALI) scores in the PQ group at 6 hours and 24 hours were higher than in the sham group (p < 0.006). ALI scores at 24 hours in the PQ + Se group were lower than in the PQ group. Survival rates did not differ between PQ and PQ + Se (p = 0.869). CONCLUSION: Single dose of selenium post-treatment activates GPx and attenuates lipid peroxidation and lung injury early after paraquat intoxication, but does not improve 72 hours of survival.

4F, apolipoprotein AI mimetic peptide, attenuates acute lung injury and improves survival in endotoxemic rats.

BACKGROUND: 4F, apolipoprotein AI mimetic peptide, mimics anti-inflammatory properties of high-density lipoprotein (HDL). The aim of this study was to investigate whether 4F attenuates acute lung injury and improves survival in endotoxemic rats and to determine whether the therapeutic benefits of 4F are associated with the stimulation of sphingosine-1-phosphate receptor 1 (S1P1), the activation of Akt, the down-regulation of the nuclear factor-κB (NF-κB) pathway, and the suppression of cell adhesion molecules. METHODS: To induce endotoxemia in rats, lipopolysaccharide (LPS, 10 mg/kg) was injected into a tail vein and 10 minutes later, vehicle or 4F (10 mg/kg) was administered intraperitoneally, respectively. We observed the survival of subjects for 72 hours. At 6-hour post-LPS, we killed animals and measured S1P1 expression, phosphorylated Akt/Akt ratio, cytoplasmic phosphorylated inhibitor κB-α/inhibitor κB-α ratio, nuclear NF-κB p65 expression and DNA-binding activity, endothelial leukocyte adhesion molecule-1 (E-selectin) and intercellular adhesion molecule-1 expression, myeloperoxidase activity, and histologic damages in lung tissues. We also measured serum HDL cholesterol level. RESULTS: 4F improved survival in endotoxemic rats. 4F restored LPS-induced diminution of serum HDL cholesterol level and increased lung S1P1 expression and phosphorylated Akt/Akt ratio in LPS-treated rats. Furthermore, 4F suppressed inhibitor κB-α degradation, NF-κB activation, E-selectin and intercellular adhesion molecule-1 expression, and myeloperoxidase activity, and attenuated histologic damages in lung tissues. CONCLUSIONS: 4F attenuated acute lung injury and improved survival in endotoxemic rats. The therapeutic benefits of 4F were found to be associated with the stimulation of S1P1, the activation of Akt, the down-regulation of the NF-κB pathway, and the suppression of cell adhesion molecules.

Epidemiology of traumatic head injury in Korean children.

The aim of this study was to elucidate the epidemiology of traumatic head injury (THI) among Korean children. A prospective, in-depth trauma survey was conducted in five teaching hospitals. Data from all of the children who attended the emergency department (ED) were analyzed. From June 2008 to May 2009, 2,856 children with THI visited the 5 EDs. The average age of the subjects was 5.6 (SD ± 4.9) yr old, and 1,585 (55.5%) were 0-4 yr old. The male-to-female ratio was 2.3 to 1 (1,979 vs 877). Consciousness levels of the subjects were classified according to the Glasgow Coma Scale (GCS), and 99.1%, 0.6%, and 0.4% were determined as mild, moderate, or severe injury, respectively, according to the GCS categorization. Most injuries occurred at home (51.3%), and the most common mechanism of injury was collision (43.2%). With regard to outcome, 2,682 (93.9%) patients were sent home, and 35 (1.2%) were transferred to another hospital. A total of 133 (4.7%) patients were hospitalized, and 38 (1.3%) underwent surgery. The incidence and characteristics of pediatric THI in Korea are affected by sex, location and injury mechanism.

Niacin attenuates lung inflammation and improves survival during sepsis by downregulating the nuclear factor-κB pathway.

OBJECTIVES: To examine whether niacin attenuates lung inflammation and improves survival during sepsis and to determine whether the beneficial effects of niacin are associated with downregulation of the nuclear factor (NF)-κB pathway. DESIGN: Prospective laboratory study. SETTING: University laboratory. SUBJECTS: Male Sprague-Dawley rats (n = 119). INTERVENTIONS: To induce endotoxemia in rats, lipopolysaccharide (Escherichia coli, O26:B6) at a dosage of 10 mg/kg was injected into a tail vein and 10 mins later, vehicle, a low dose of niacin (360 mg/kg), or a high dose of niacin (1180 mg/kg) was administered once through an orogastric tube, respectively. MEASUREMENTS AND MAIN RESULTS: We observed the survival of the subjects for 72 hrs. At 6 hrs postlipopolysaccharide, we euthanized animals and measured cytoplasmic phosphorylated inhibitor κB-α and inhibitor κB-α expressions, nuclear NF-κB p65 expression, NF-κB p65 DNA-binding activity, tumor necrosis factor-α, and interleukin-6 gene expressions and histologic damages in lung tissues. We also measured nicotinamide adenine dinucleotide, reduced nicotinamide adenine dinucleotide phosphate, reduced glutathione, and malondialdehyde levels in lung tissues. High dose of niacin suppressed NF-κB activation and proinflammatory cytokine gene expressions in lung tissues, reduced histologic lung damages, and improved survival in endotoxemic rats. Furthermore, it increased nicotinamide adenine dinucleotide, nicotinamide adenine dinucleotide phosphate, and glutathione levels and decreased malondialdehyde level in lung tissues. CONCLUSIONS: High dose of niacin attenuated lung inflammation, reduced histologic lung damages, and improved survival during sepsis in rats. These therapeutic benefits were associated with downregulation of the NF-κB pathway.

Synergistic inflammation is induced by blood degradation products with microbial Toll-like receptor agonists and is blocked by hemopexin.

Detection of microbial components by immune cells via Toll-like receptors (TLRs) with subsequent induction of inflammation is essential for host defense. However, an overactive immune response can cause tissue damage and sepsis. The endogenous molecule hemoglobin and its derivative heme are often released into tissue compartments where there is infection in the presence of degrading blood. We found that hemoglobin synergizes with multiple TLR agonists to induce high levels of tumor necrosis factor and interleukin-6 from macrophages and that this synergy is independent of TLR4 and MyD88. In contrast, heme synergized with some but not all TLR agonists studied. Furthermore, the synergy of both hemoglobin and heme with lipopolysaccharide was suppressed by hemopexin, a plasma heme-binding protein. These studies suggest that hemoglobin and heme may substantially contribute to microbe-induced inflammation when bacterial or viral infection coexists with blood degradation and that hemopexin may play a role in controlling inflammation in such settings.