Assessment of the disaster medical response system through an investigation of a 43-vehicle mass collision on Jung-ang expressway.

PURPOSE: It was considered the challenges of the actual response and the potential for improvement, including the activities of the disaster response system, national emergency medical center, and the regional base hospital for the treatment of multiple traffic accident victims. The purpose of this study was to analyze the accident management system through real investigating the multiple collision over 10 vehicles with mass casualty events as a disaster situation. METHODS: This study was retrospective study to analyze the disaster event with multiple collision traffic accident on the expressway in Korea. We visited five medical centers for eight days since the accident occurred and interviewed the injured patients in this accident to examine the health status and medical records. After that, we visited the sixteen car-repair shops in four cities for real investigate about damaged vehicles. According to the arrangement of the accident situation for the accident vehicles through real-world investigation, we reproduced all parts of the accident scene, which were real-world investigated, by the accident situation sketch program. The collected data were summarized by Collision Deformation Classification (CDC) codes, and the medical records of the occupants were assessed using the Injury Severity Score (ISS). RESULTS: The cause of the accident was snow freezing of the road. The information about 72 injured patients on 31 damaged vehicles was collected by phone, visit, and actual accident investigation. Of the 72 patients who were examined, 4 were severely injured and 68 were mildly injured. The accident occurred in the order of Sedan 13 (41.9%), SUV 11 (35.5%), Truck 4 (12.9%), Van 2 (6.5%) and Bus 1 (3.2%). The median value of the age [lower quartile and upper quartile] was 43 [34.5-52] years old and the patients included 25 drivers, 11 passengers, 7 back seat passengers, and 29 bus passengers. CONCLUSION: The primary cause of this mass collision accident was road surface freezing, but the more serious secondary cause was a driver's inability to avoid the accident scene after the first collision. The severely injured occupants were occurred on the roads outside and inside the vehicle. In the event of a disaster, various teams from the police team, firefighting team, DMAT, EMS, road management team are gathered, and communication and command system between each team is important in order to identify and solve the disaster situation. To do this, it is important to develop manuals and prepare for training through repeated simulations.

Quantitative Evaluation of Post-stroke Spasticity Using Neurophysiological and Radiological Tools: A Pilot Study.

OBJECTIVE: To determine the possibility of a new measurement tool using electromyography and ultrasonography for quantitative spasticity assessment in post-stroke patients. METHODS: Eight hemiplegic stroke patients with ankle plantarflexor spasticity confirmed by a Modified Ashworth Scale (MAS) were enrolled. Spasticity was evaluated using the MAS and Modified Tardieu Scale (MTS). Each subject underwent surface electromyography (sEMG) using the Brain Motor Control Assessment (BMCA) protocol and was compared with a healthy control group. Using ultrasonography, muscle architecture and elasticity index were measured from the medial gastrocnemius muscle (GCM) on the affected and unaffected sides. RESULTS: MAS and MTS revealed significant correlation with sEMG activity. The fascicle length and pennation angle were significantly decreased in the medial GCM on the hemiplegic side compared with the unaffected side. The elasticity index of the spastic medial GCM was significantly increased compared with the unaffected side. The MTS X and R2-R1 values were significantly correlated with the elasticity index in the hemiplegic GCM. The relationship between clinical evaluation tools and both BMCA and sonoelastography was linear, but not statistically significant in the multiple regression analysis. CONCLUSION: The BMCA protocol and ultrasonographic evaluation provide objective assessment of post-stroke spasticity. Further studies are necessary to conduct accurate assessment and treatment of spasticity.

Identifying the KAT6B Mutation via Diagnostic Exome Sequencing to Diagnose Say-Barber-Biesecker-Young-Simpson Syndrome in Three Generations of a Family.

Diagnostic exome sequencing (DES) is a powerful tool to analyze the pathogenic variants leading to development delay (DD) and intellectual disability (ID). Recently, heterozygous de novo mutation of the histone acetyltransferase encoding gene KAT6B has been recognized as causing a syndrome with congenital anomalies and intellectual disability, namely Say-Barber-Biesecker-Young-Simpson (SBBYS) syndrome. Here we report a case of SBBYS syndrome in a third generation Korean family affected with a missense mutation in KAT6B, c.2292C>T p.(His767Tyr) identified by DES. This is the first confirmed familial inherited mutation of the KAT6B reported worldwide. Our case emphasizes again the importance of basic physical examination and taking a family history. Furthermore, advances in genetic diagnostic tools are becoming key to identifying the etiology of DD and ID. This allows a physiatrist to predict the disease's clinical evolution with relative certainty, and offer an appropriate rehabilitation plan for patients.

[A case of combined hepatocellular-cholangiocarcinoma with sarcomatous transformation and second primary colon cancer].

Combined hepatocellular-cholangiocarcinoma is a rare form of primary liver cancer, featuring both hepatocellular and biliary epithelial differentiations. An intrahepatic tumor may be considered as a metastatic lesion. It has been suggested in the literature that the likelihood of metastasis in the cirrhotic liver is lower than that in the non-cirrhotic liver. A rare case of combined hepatocellular-cholangiocarcinoma and second primary colon adenocarcinoma in a 67-year-old male patient with liver cirrhosis is presented. Histologically, the intrahepatic mass was composed of a spindle cell sarcomatous component; a hepatocellular carcinoma component; and a cholangiocarcinoma component. There were focal transitional regions among the different components. Immunohistochemically, the cholangiocarcinoma component of the intrahepatic mass showed positive reactions for CK-7 but negative reactions for CK-20. The adenocarcinoma of the colon showed positive reactions for CK-20 but negative reactions for CK-7.