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BACKGROUND AND AIMS: Vitamin D is known to influence the risk of cardiovascular disease, which is a recognized risk factor for sudden cardiac arrest (SCA). However, the relationship between vitamin D and SCA is not well understood. Therefore, this study aims to investigate the association between vitamin D and SCA in out-of-hospital cardiac arrest (OHCA) patients compared to healthy controls. METHODS AND RESULTS: Using the Phase II Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance (CAPTURES II) registry, a 1:1 propensity score-matched case-control study was conducted between 2017 and 2020. Serum 25-hydroxyvitamin D (vitamin D) levels in patients with OHCA (454 cases) and healthy controls (454 cases) were compared after matching for age, sex, cardiovascular risk factors, and lifestyle behaviors. The mean vitamin D levels were 14.5 ± 7.6 and 21.3 ± 8.3 ng/mL among SCA cases and controls, respectively. Logistic regression analysis was used adjusting for cardiovascular risk factors, lifestyle behaviors, corrected serum calcium levels, and estimated glomerular filtration rate (eGRF). The adjusted odds ratio (aOR) for vitamin D was 0.89 (95% confidence interval [CI] 0.87-0.91). The dose-response relationship demonstrated that vitamin D deficiency was associated with SCA incidence (severe deficiency, aOR 10.87, 95% CI 4.82-24.54; moderate deficiency, aOR 2.24, 95% CI 1.20-4.20). CONCLUSION: Vitamin D deficiency was independently and strongly associated with an increased risk of SCA, irrespective of cardiovascular and lifestyle factors, corrected calcium levels, and eGFR.
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Biomarcadores , Morte Súbita Cardíaca , Parada Cardíaca Extra-Hospitalar , Sistema de Registros , Deficiência de Vitamina D , Vitamina D , Humanos , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/diagnóstico , Masculino , Feminino , Vitamina D/sangue , Vitamina D/análogos & derivados , Pessoa de Meia-Idade , Estudos de Casos e Controles , Medição de Risco , Idoso , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Parada Cardíaca Extra-Hospitalar/sangue , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/epidemiologia , Parada Cardíaca Extra-Hospitalar/fisiopatologia , Fatores de Risco , Biomarcadores/sangueRESUMO
OBJECTIVE: This study investigated the differences in injury profiles and safety device effectiveness among children with road traffic injuries (RTIs) involving passenger vehicles and school buses. METHODS: Using data from the Emergency Department-based Injury In-depth Surveillance database, this multicentre cross-sectional study investigated the injury profiles of 14 669 children aged 12 years old and younger who experienced RTIs from 2011-2021. Demographic factors, injury distribution, severity and effect of safety device use between RITs involving passenger vehicles and school buses were compared. RESULTS: RTIs in children most frequently occurred between 12:00 and 18:00 hours (46.9%). School bus-related RTIs peaked during school commute hours, that is, from 06:00 to 12:00 hours, and were associated with a higher prevalence of head (63.1% vs 58.9%, p<0.05) and extremity injuries (upper extremity: 8.0% vs 6.4% and lower extremity: 11.1% vs 7.6 %, p<0.05) compared with those involving passenger vehicles. However, passenger vehicle crashes showed higher proportions of neck and chest injuries, along with injuries requiring hospitalisation and intensive care. Safety devices exhibited preventive effects against head and lower extremity injuries in both vehicle types. While safety devices showed effective in reducing hospital admissions and severe injuries in passenger vehicles, their effectiveness in school buses was not observed. CONCLUSION: This study highlights the different epidemiology and injury profiles of RTIs among children involving passenger vehicles and school buses. Improved safety devices, particularly in school buses, are necessary to ensure the comprehensive protection of child passengers and reduce the risk of severe injuries during road traffic incidents.
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Cytosolic glyceraldehyde-3-phosphate dehydrogenase (GAPC) is a glycolytic enzyme, but undergoes stress-induced nuclear translocation for moonlighting. We previously reported that in response to heat stress, GAPC accumulated in the nucleus to modulate transcription and thermotolerance. Here we show a cellular and molecular mechanism that mediates heat-induced nuclear translocation of cytosolic GAPC in Arabidopsis thaliana. Heat-induced GAPC nuclear accumulation and plant heat tolerance were reduced in Arabidopsis phospholipase D (PLD) knockout mutants of pldδ and pldα1pldδ, but not of pldα1. These changes were restored to wild type by genetic complementation with active PLDδ, but not with catalytically inactive PLDδ. GAPC overexpression enhanced the seedling thermotolerance and the expression of heat-inducible genes, but this effect was abolished in the pldδ background. Heat stress elevated the levels of the PLD product phosphatidic acid (PA) in the nucleus in wild type, but not in pldδ plants. Lipid labeling demonstrated the heat-induced nuclear co-localization of PA and GAPC, which was impaired by zinc, which inhibited the PA-GAPC interaction, and by the membrane trafficking inhibitor brefeldin A (BFA). The GAPC nuclear accumulation and seedling thermotolerance were also decreased by treatment with zinc or BFA. Our data suggest that PLDδ and PA are critical for the heat-induced nuclear translocation of GAPC. We propose that PLDδ-produced PA mediates the process via lipid-protein interaction and that the lipid mediation acts as a cellular conduit linking stress perturbations at cell membranes to nuclear functions in plants coping with heat stress.
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Proteínas de Arabidopsis , Arabidopsis , Fosfolipase D , Arabidopsis/metabolismo , Ácidos Fosfatídicos/metabolismo , Proteínas de Arabidopsis/metabolismo , Fosfolipases/metabolismo , Fosfolipase D/genética , Fosfolipase D/metabolismo , Gliceraldeído-3-Fosfato Desidrogenases/genética , Plântula/genética , Plântula/metabolismo , Brefeldina A/farmacologia , Zinco/metabolismoRESUMO
BACKGROUND: Trauma, pneumothorax, complication of surgery, infection, or malignancy can cause subcutaneous emphysema and although most subcutaneous emphysema cases are self-limited, extensive subcutaneous emphysema can lead to a compromised airway and cardiovascular system. In this report, we described a successful treatment strategy in which subcutaneous angiocatheter insertion was used to relieve the pressure of extensive subcutaneous emphysema. CASE REPORT: An 83-year-old man was received at the emergency department (ED) for recurrent pneumothorax and extensive subcutaneous emphysema. Six 18-gauge angiocatheters were inserted under the thoracic subcutaneous tissue and a noticeable improvement was seen 3 h after angiocatheter insertion. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Subcutaneous angiocatheter insertion may be a safe and uncomplicated decompression technique to relieve extensive subcutaneous emphysema, particularly in the ED.
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Enfisema Mediastínico , Pneumotórax , Enfisema Subcutâneo , Masculino , Humanos , Idoso de 80 Anos ou mais , Tela Subcutânea , Pneumotórax/cirurgia , Pneumotórax/etiologia , Enfisema Subcutâneo/etiologia , Enfisema Subcutâneo/cirurgia , Tórax , Descompressão/efeitos adversos , Enfisema Mediastínico/etiologiaRESUMO
Circadian clocks play important roles in regulating cellular metabolism, but the reciprocal effect that metabolism has on the clock is largely unknown in plants. Here, we show that the central glycerolipid metabolite and lipid mediator phosphatidic acid (PA) interacts with and modulates the function of the core clock regulators LATE ELONGATED HYPOCOTYL (LHY) and CIRCADIAN CLOCK ASSOCIATED1 (CCA1) in Arabidopsis (Arabidopsis thaliana). PA reduced the ability of LHY and CCA1 to bind the promoter of their target gene TIMING OF CAB EXPRESSION1 Increased PA accumulation and inhibition of PA-producing enzymes had opposite effects on circadian clock outputs. Diurnal change in levels of several membrane phospholipid species, including PA, observed in wild type was lost in the LHY and CCA1 double knockout mutant. Storage lipid accumulation was also affected in the clock mutants. These results indicate that the interaction of PA with the clock regulator may function as a cellular conduit to integrate the circadian clock with lipid metabolism.
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Relógios Circadianos/fisiologia , Ácidos Fosfatídicos/metabolismo , Arabidopsis/metabolismo , Proteínas de Arabidopsis/metabolismo , Regulação da Expressão Gênica de Plantas , Hipocótilo/metabolismo , Metabolismo dos Lipídeos/genética , Regiões Promotoras Genéticas/genética , Fatores de Transcrição/metabolismoRESUMO
OBJECTIVES: This study aimed to examine the usability, feasibility, acceptability, and appropriateness of the information and communication technology for emergency medical services (ICT-EMS) systems to improve the transportation of emergency patients during the COVID-19 pandemic. METHODS: Emergency medical technicians (EMTs) (n = 229) employed at 7 fire stations operated by the North Chungcheong Fire Service Headquarters, South Korea were trained to use ICT-EMS devices prior to a 1-month implementation period. System Usability Scale (SUS), Feasibility of Intervention Measure (FIM), Acceptability of Intervention Measure (AIM), and Intervention Appropriateness Measure (IAM) questionnaires were conducted in the 4th week of the 1-month implementation period to assess the perceived usability, feasibility, acceptability, and appropriateness of the ICT-EMS systems. RESULTS: Among a total of 229 EMTs, 187 EMTs (81.7%) completed the survey. The overall SUS score was significantly low (score of 35.6) indicating an overall negative perception of the ICT-EMS systems. With regard to the feasibility, acceptability, and intervention appropriateness of ICT-EMS, roughly 50 (26.7%) participants agreed that ICT-EMS implementation was possible, appealing, and suitable. CONCLUSION: Many potential areas of improvement were identified within the ICT-EMS systems. System alterations regarding usability, feasibility, acceptability, and appropriateness may be necessary to successfully implement the ICT-EMS systems.
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COVID-19 , Serviços Médicos de Emergência , Auxiliares de Emergência , COVID-19/epidemiologia , Humanos , Pandemias , Transporte de PacientesRESUMO
OBJECTIVE: There are growing concerns regarding the lack of COVID-19 pandemic response capacity in already overwhelmed emergency departments (EDs), and lack of proper isolation facilities. This study evaluated the effectiveness of the negative pressure isolation stretcher (NPIS) and additional negative pressure isolation rooms (NPIRs) on the maintenance of emergency care capacity during the COVID-19 outbreak. METHODS: A before and after intervention study was performed between February 27, 2020 and March 31, 2020 at the ED of Chungbuk National University Hospital, Cheongju, South Korea. A total of 2455 patients who visited the ED during the study period were included. Interventions included the introduction of the NPIS and additional NPIRs in the ED. The main outcome of the study was frequency of medical cessation. Secondary outcomes were the average number of ED visits and lengths of stay. RESULTS: After the intervention, average frequency of medical cessation was significantly decreased from 1.6 times per day (range 0-4) in the pre-intervention period to 0.6 times per day (range 0-3) in the post-intervention period (p-value <0.01). On the other hand, the number of patients visiting the ED increased significantly from 67.2 persons per day (range 58-79) pre-intervention to 76.3 persons per day (range 61-88) post-intervention (p value <0.01). However, there were no statistically significant differences in the average ED length of stay across the study phases (p value = 0.50). CONCLUSIONS: This intervention may provide an effective way to prepare and meet the ED response needs of the COVID-19 pandemic.
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COVID-19/terapia , Infecção Hospitalar/terapia , Serviços Médicos de Emergência/métodos , Pandemias , Isolamento de Pacientes/instrumentação , SARS-CoV-2 , Adulto , Idoso , Controle de Doenças Transmissíveis , Comorbidade , Infecção Hospitalar/epidemiologia , Serviço Hospitalar de Emergência , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos RetrospectivosRESUMO
INTRODUCTION: Point-of-care (POC) ultrasound protocols are commonly used for the initial management of patients with cardiac arrest in the emergency department (ED). However, there is little published evidence regarding any mortality benefit. We compared and studied the effect of implementation of the modified SESAME protocol in terms of clinical outcomes and resuscitation management. METHODS: This was a single-center retrospective observational study. We conducted a pre- and post-intervention study to evaluate changes in patient outcomes and management after educating emergency medicine residents and the faculty about the modified SESAME protocol. The pre-intervention period lasted from March 2018 to February 2019, and the post-intervention period lasted from May 2019 to April 2020. The modified SESAME protocol education was initiated in March 2019. Multivariate logistic regression analyses were performed to examine the associations between independent variables and outcomes. RESULTS: A total of 334 patients were included in this study during a 24-month period. We found no significant differences between the two groups for the primary outcome of survival to hospital admission (pre-intervention group 28.9% versus post-intervention group 28.6%; P = 0.751), survival to hospital discharge (12.1% vs. 12.4%; P = 0.806), and good neurologic outcome at discharge (6.0% vs. 8.1%; P = 0.509). The proportion of resuscitation procedures of thrombolysis, emergency transfusion, tube thoracotomy, and pericardiocentesis during resuscitation increased from 0.6% in the pre-intervention period to 4.9% in the post-intervention period (P = 0.016). CONCLUSION: We did not discover any significant survival benefits associated with the implementation of the modified SESAME protocol; however, early diagnosis of specific pathologies (pericardial effusion, possible pulmonary embolism, tension pneumothorax, and hypovolemia) and accordingly a direct increase in the resuscitation management were seen in this study. Future studies with larger sample sizes are required to examine the clinical outcomes as well as to identify the most effective POC ultrasonography protocols for non-traumatic cardiac arrests.
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Suporte Vital Cardíaco Avançado/métodos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/mortalidade , Testes Imediatos/normas , Suporte Vital Cardíaco Avançado/educação , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/etiologia , Estudos Retrospectivos , UltrassonografiaRESUMO
This study was conducted to develop the first species-specific microsatellite markers in Betula costata. A total of 178 primers were designed from 95,755 contigs and screened in two B. costata populations sampled from Mt. Hwaaksan and Mt. Gyebangsan. A total of 16 polymorphic microsatellite loci were selected and used for population genetic characterization. The average values of observed heterozygosity (HO) and expected heterozygosity (HE) of the Mt. Hwaaksan population were 0.488 and 0.493, respectively. The average values of HO and HE in the Mt. Gyebangsan population were 0.492 and 0.481, respectively. The null allele frequency was less than 0.2 in all loci. No significant linkage disequilibrium was detected in all combinations of loci. In addition, 26 polymorphic markers were selected by cross-species transferability test to B. costata using the microsatellite markers developed in four other Betula species. The cross-species transferability of the microsatellite markers developed in B. costata was conducted in two other Betula species. The transferability was 75% in B. ermanii and 100% in B. davurica. Therefore, the microsatellite markers developed and characterized in this study were expected to be useful for further genetic studies in B. costata and related species in the genus Betula.
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Betula/genética , Repetições de Microssatélites , DNA de Plantas/genética , Frequência do Gene , Genoma de Planta , Heterozigoto , Sequenciamento de Nucleotídeos em Larga Escala , Polimorfismo GenéticoRESUMO
An extensive evaluation of low-cost dust sensors was performed using an exponentially decaying particle concentration. A total of 264 sensors including 27 sensors with light-emitting diodes (LEDs) and 237 sensors with laser lighting sources were tested. Those tested sensors were classified into 4 groups based on the deviation from the reference data obtained by a reference instrument. The response linearities of all the tested samples for PM1 , PM2.5 , and PM10 were in excellent agreement with the reference instrument, except a few samples. For the measurements of PM1 and PM2.5 , the lighting source, that is, LED or laser, did not show any significant difference in overall sensor performance. However, LED-based sensors did not perform well for PM10 measurements. The 32, 24, and 16% of all the tested sensors for PM1 , PM2.5 , and PM10 measurement, respectively, are in the category of Class 1 (reference instrument reading ± 20%) requirement. The performance of the low-cost dust sensors for PM10 measurement was relatively less satisfactory.
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Poluição do Ar em Ambientes Fechados/análise , Poeira/análise , Monitoramento Ambiental/métodos , Poluentes Atmosféricos/análise , Monitoramento Ambiental/economia , Monitoramento Ambiental/instrumentação , Material Particulado/análiseRESUMO
BACKGROUND: Suicide among the elderly is a public health concern, as life expectancy is increasing rapidly and suicide rates increase with age. In Korea, self-poisoning is the most common method of attempted suicide. This study aimed to evaluate the characteristics of attempted suicide by self-poisoning among the elderly and to identify risk factors related to the suicide attempts. METHODS: A cross-sectional observational study was conducted using the Emergency Department-based Injury In-depth Surveillance database in Korea. We included all adult patients visiting the emergency department (ED) who attempted suicide by poisoning between January 2011 and December 2017 and stratified according to age: the elderly (≥ 65 years old) and the younger group. Characteristics and risk factors for attempted suicide by poisoning among the elderly were evaluated using stepwise regression analysis. RESULTS: Among 25,904 adult patients, 5,164 (19.9%) were classified as elderly. The elderly were more likely to be admitted to hospital and intensive care units, the average ED length of stay was longer, and total mortality was higher than that of the younger group. Male sex, low socioeconomic status, poor physical health, pesticide use, lower alcohol consumption, and fewer prior suicide attempts were found to be risk factors for suicide among the elderly. CONCLUSION: Self-poisoning among the elderly is associated with poorer clinical outcomes than in younger adult patients. Suicide among the elderly is a potentially preventable public health problem, and with proper identification of the associated risk factors, appropriate multidisciplinary intervention strategies can be implemented.
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Intoxicação/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Praguicidas/toxicidade , Intoxicação/mortalidade , República da Coreia/epidemiologia , Fatores de Risco , Classe SocialRESUMO
Diacylglycerol kinase (DGK) phosphorylates diacylglycerol (DAG) to generate phosphatidic acid (PA), and both DAG and PA are lipid mediators in the cell. Here we show that DGK1 in rice (Oryza sativa) plays important roles in root growth and development. Two independent OsDGK1-knockout (dgk1) lines exhibited a higher density of lateral roots (LRs) and thinner seminal roots (SRs), whereas OsDGK1-overexpressing plants displayed a lower LR density and thicker SRs than wild-type (WT) plants. Overexpression of OsDGK1 led to a decline in the DGK substrate DAG whereas specific PA species decreased in dgk1 roots. Supplementation of DAG to OsDGK1-overexpressing seedlings restored the LR density and SR thickness whereas application of PA to dgk1 seedlings restored the LR density and SR thickness to those of the WT. In addition, treatment of rice seedlings with the DGK inhibitor R59022 increased the level of DAG and decreased PA, which also restored the root phenotype of OsDGK1-overexpressing seedlings close to that of the WT. Together, these results indicate that DGK1 and associated lipid mediators modulate rice root architecture; DAG promotes LR formation and suppresses SR growth whereas PA suppresses LR number and promotes SR thickness.
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Diacilglicerol Quinase/metabolismo , Metabolismo dos Lipídeos , Oryza/enzimologia , Raízes de Plantas/anatomia & histologia , Raízes de Plantas/enzimologia , Diacilglicerol Quinase/genética , Diglicerídeos/metabolismo , Regulação da Expressão Gênica de Plantas , Homozigoto , Modelos Biológicos , Mutação/genética , Oryza/genética , Ácidos Fosfatídicos/metabolismo , Raízes de Plantas/genética , Raízes de Plantas/crescimento & desenvolvimento , Plantas Geneticamente Modificadas , Transcriptoma/genéticaRESUMO
BACKGROUND: A prior suicide attempt is known to be the most important risk factor for suicide. Case management programs provide psychosocial support and rehabilitation for suicide attempters. This study aimed to determine whether case management completion is associated with good clinical outcomes for suicide attempters visiting the emergency department (ED). METHODS: A cross-sectional observational study was conducted using risk assessment records for suicide attempters visiting the ED from October 2013 to December 2017. We created two groups according to completion of the case management program. The primary outcome was a decrease in suicide risk. The secondary and tertiary outcomes were untreated stressors and lack of a support system. We calculated the adjusted odds ratio (AOR) of the case management completion for study outcomes adjusting for potential confounders. RESULTS: Among 439 eligible suicide attempters, only 277 (63.1%) participants completed the case management program. Participants who completed the case management program were more likely to have decreased suicide risk (65.3% vs. 46.9%, AOR: 2.13 (1.42-3.20)) and less untreated stressors (49.8% vs. 61.1%, AOR: 0.64 (0.43-0.96)). However, there was no significant difference in lack of a support system (35.4% vs. 45.7%, AOR: 0.68 (0.45-1.03)). CONCLUSION: Completion of a case management program was associated with reduction of suicide risk. Multicomponent strategies to increase compliance with a case management program are needed to prevent suicide reattempt and reduce the health burden of suicide.
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Administração de Caso , Prevenção do Suicídio , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Fatores de Risco , Tentativa de Suicídio , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: This study aimed to validate the criteria for early critical care resource (CCR) use as an outcome predictor for seriously injured patients triaged in the field by comparing the effectiveness of the criteria for early CCR use with that of criteria defined by an Injury Severity Score (ISS) >15. METHODS: We analysed data from seriously injured trauma patients who were triaged using a field triage protocol by emergency medical service providers (EMS-ST patients). Early CCR use was defined as the use of any of the following treatment modalities or outcomes: advanced airway management, blood transfusion, or interventional radiology (<4h), emergency operation or cardiopulmonary resuscitation, or thoracotomy (<24h), or admission for spinal cord injury. The primary endpoint was inhospital mortality. We generated area under the receiver operating characteristic (AUROC) curves to compare the value of the early CCR use criteria with that of the ISS >15 criteria in the discrimination between survivors and non-survivors. RESULTS: Of the 14,352 adult EMS-ST patients, 9299 were enrolled in this study. Approximately 19.6% required early CCR use, and 18.0% had an ISS >15. The rate of in-hospital mortality was 9.4%. The AUROC values for the performances of the early CCR use and ISS>15 criteria in the prediction of in-hospital mortality were 0.89 (95% confidence interval [CI] 0.85-0.91) and 0.84 (95% CI 0.79-0.86), respectively (p<0.01). CONCLUSION: The early CCR use criteria demonstrated better performance than the ISS >15 criteria in the prediction of mortality in EMS-ST patients.
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Cuidados Críticos/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Ferimentos e Lesões/terapia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adulto , Idoso , Protocolos Clínicos , Feminino , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Triagem/métodos , Ferimentos e Lesões/mortalidadeRESUMO
Blunt chest trauma can cause not only damage to the thoracic cage, but can also injure intracardiac structures including the papillary muscles, chordae tendineae, and valve leaflets. Aortic valve (AV) injury secondary to blunt chest trauma is a rare occurrence. Clinically, AV injury may be missed during the initial post-trauma assessment due to the lack of suspicion of cardiac involvement. Thus, the diagnosis of AV injury is often delayed or missed for a time interval of days to months. As a consequence, the traumatic AV regurgitation can rapidly or progressively lead to congestive heart failure unless surgically corrected. Therefore, emergency physicians should be aware of the possibility of intracardiac structure injury, such as valvular injuries, after blunt chest trauma. Guidelines for the appropriate use of bedside cardiac ultrasound (BCU) recommend BCU should be performed in all patients with new murmurs for clinically significant valvular lesions that could potentially change management. We described the case of a 73-year-old female patient with AV injury after blunt trauma. She experienced cardiac arrest (CA) secondary to a moderate-to-severe traumatic AR, which was successfully treated with emergency AV replacement. We discuss how to diagnose and manage a CA patient, aided by BCU, with ventricular failure associated with persistent AV regurgitation. To the best of our knowledge, this is the first case report on CA associated with isolated rupture of bicuspid AV rupture and AV regurgitation secondary to blunt chest trauma because of the lack of early suspicion of AV injury.
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Insuficiência da Valva Aórtica/complicações , Cordas Tendinosas/lesões , Parada Cardíaca/etiologia , Traumatismos Cardíacos/complicações , Ferimentos não Penetrantes/complicações , Idoso , Insuficiência da Valva Aórtica/diagnóstico , Cordas Tendinosas/diagnóstico por imagem , Ecocardiografia Doppler em Cores , Feminino , Traumatismos Cardíacos/diagnóstico , Humanos , Ruptura , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnósticoRESUMO
Development of a competence-based curriculum is important. This study aimed to develop competence assessment tools in emergency medicine and use it to assess competence of Cameroonian healthcare professionals. This was a cross-sectional, descriptive study. Through literature review, expert survey, and discrimination tests, we developed a self-survey questionnaire and a scenario-based competence assessment tool for assessing clinical knowledge and self-confidence to perform clinical practices or procedures. The self-survey consisted of 23 domains and 94 questionnaires on a 5-point Likert scale. Objective scenario-based competence assessment tool was used to validate the self-survey results for five life-threatening diseases presenting frequently in emergency rooms of Cameroon. Response rate of the self-survey was 82.6%. In this first half of competence assessment, knowledge of infectious disease had the highest score (4.6 ± 0.4) followed by obstetrics and gynecology (4.2 ± 0.6) and hematology and oncology (4.2 ± 0.5); in contrast, respondents rated the lowest score in the domains of disaster, abuse and assault, and psychiatric and behavior disorder (all of mean 2.8). In the scenario-based test, knowledge of multiple trauma had the highest score (4.3 ± 1.2) followed by anaphylaxis (3.4 ± 1.4), diabetic ketoacidosis (3.3 ± 1.0), ST-elevation myocardial infarction (2.5 ± 1.4), and septic shock (2.2 ± 1.1). Mean difference between the self-survey and scenario-based test was statistically insignificant (mean, -0.02; 95% confidence interval, -0.41 to 0.36), and agreement rate was 58.3%. Both evaluation tools showed a moderate correlation, and the study population had relatively low competence for specific aspects of emergency medicine and clinical procedures and skills.
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Competência Clínica , Medicina de Emergência/educação , Pessoal de Saúde/psicologia , Área Sob a Curva , Camarões , Estudos Transversais , Humanos , Avaliação de Programas e Projetos de Saúde , Curva ROC , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Case fatality from injury increases exponentially with age. The objective of this study is to identify age effects on case fatality of injury patients by injury mechanism. METHODS: This is an observational study using the Emergency Department-based Injury In-depth Surveillance data from 2007 to 2012. Eligibility was all injured patients, excluding those with unknown information for age, disposition after emergency department or admission, or injury mechanism. End point of this study was inhospital mortality. Injury mechanism was categorized into road transport injury (RTI), fall, collision, cut/pierce, burn, poisoning, and miscellaneous. Case fatality ratio was calculated to evaluate age effects on case fatality by injury mechanism and gender. RESULT: Among 927011 injury patients, a total of 924755 patients were analyzed. Total case fatality rate was 0.9%, and rates by injury mechanisms were 4.4% in poisoning, 2.1% in RTI, and 0.8% in fall. By age and gender, the highest crude case fatality rate was 19.74% observed in older than 80-year-old men with poisoning. Case fatality ratios in both genders increased by age from 60- to 69-, 70- to 79-, to older than 80-year-old patients; ratios by injury mechanisms were 13.71, 20.76, and 22.29 (male) and 7.21, 11.18, and 13.05 (female) in poisoning; 5.46, 9.30, and 14.13 (male) and 3.90, 7.96, and 12.08 (female) in RTI; 1.22, 1.52, and 2.02 (male) and 1.14, 2.15, and 6.42 (female) in burn. CONCLUSIONS: Case fatality rates of injury increased with age; however, the trends in increase differed by injury mechanisms and gender. Strategies for injury prevention and decreasing mortality should consider the age effects on case fatality of different injury mechanisms.
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Acidentes/mortalidade , Causas de Morte/tendências , Mortalidade Hospitalar/tendências , Ferimentos e Lesões/mortalidade , Acidentes por Quedas/mortalidade , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Queimaduras/mortalidade , Criança , Pré-Escolar , Bases de Dados Factuais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Intoxicação/mortalidade , Vigilância da População , República da Coreia/epidemiologia , Distribuição por Sexo , Ferimentos e Lesões/etiologia , Adulto JovemRESUMO
Phosphatidic acid (PA) is a class of lipid messengers involved in a variety of physiological processes. To understand how PA mediates cell functions in plants, we used a PA affinity membrane assay to isolate PA-binding proteins from Camelina sativa followed by mass spectrometric sequencing. A cytosolic glyceraldehyde-3-phosphate dehydrogenase (GAPC) was identified to bind to PA, and detailed analysis was carried out subsequently using GAPC1 and GAPC1 from Arabidopsis. The PA and GAPC binding was abolished by the cation zinc whereas oxidation of GAPCs promoted the PA binding. PA had little impact on the GAPC catalytic activity in vitro, but the PA treatment of Arabidopsis seedlings induced proteolytic cleavage of GAPC2 and inhibited Arabidopsis seedling growth. The extent of PA inhibition was greater in GAPC-overexpressing than wild-type seedlings, but the greater PA inhibition was abolished by application of zinc to the seedling. The PA treatment also reduced the expression of genes involved in PA synthesis and utilization, and the PA-reduced gene expression was partially recovered by zinc treatment. These data suggest that PA binds to oxidized GAPDH and promotes its cleavage and that the PA and GAPC interaction may provide a signaling link coordinating carbohydrate and lipid metabolism.
Assuntos
Proteínas de Arabidopsis/metabolismo , Arabidopsis/enzimologia , Citoplasma/enzimologia , Gliceraldeído-3-Fosfato Desidrogenases/metabolismo , Ácidos Fosfatídicos/metabolismo , Proteólise , Arabidopsis/genética , Arabidopsis/crescimento & desenvolvimento , Proteínas de Arabidopsis/genética , Metabolismo dos Carboidratos/fisiologia , Citoplasma/genética , Gliceraldeído-3-Fosfato Desidrogenases/genética , Metabolismo dos Lipídeos/fisiologia , Ácidos Fosfatídicos/genética , Plântula/enzimologia , Plântula/genética , Plântula/crescimento & desenvolvimento , Zinco/metabolismoRESUMO
Developing a robust root system is crucial to plant survival and competition for soil resources. Here we report that the non-specific phospholipase C5 (NPC5) and its derived lipid mediator diacylglycerol (DAG) mediate lateral root (LR) development during salt stress in Arabidopsis thaliana. T-DNA knockout mutant npc5-1 produced few to no LR under mild NaCl stress, whereas overexpression of NPC5 increased LR number. Roots of npc5-1 contained a lower level of DAG than wild type, whereas NPC5 overexpressor exhibited an increase in DAG level. Application of DAG, but not phosphatidic acid, fully restored LR growth of npc5-1 to that of wild type under NaCl stress. NPC5 expression was significantly induced in Arabidopsis seedlings treated with NaCl. Npc5-1 was less responsive to auxin-mediated root growth than the wild type. These results indicate that NPC5 mediates LR development in response to salt stress and suggest that DAG functions as a lipid mediator in the stress signalling.
Assuntos
Proteínas de Arabidopsis/metabolismo , Arabidopsis/enzimologia , Arabidopsis/fisiologia , Diglicerídeos/metabolismo , Fosfolipases/metabolismo , Raízes de Plantas/crescimento & desenvolvimento , Cloreto de Sódio/farmacologia , Estresse Fisiológico/efeitos dos fármacos , Fosfolipases Tipo C/metabolismo , Arabidopsis/efeitos dos fármacos , Arabidopsis/genética , Proteínas de Arabidopsis/genética , Diglicerídeos/biossíntese , Regulação da Expressão Gênica de Plantas/efeitos dos fármacos , Técnicas de Inativação de Genes , Ácidos Indolacéticos/farmacologia , Mutação/genética , Fosfolipases/genética , Fosfolipídeos/metabolismo , Raízes de Plantas/efeitos dos fármacos , Transporte Proteico , Estresse Fisiológico/genética , Frações Subcelulares/enzimologia , Fosfolipases Tipo C/genéticaRESUMO
Lipid phosphorylation by diacylglycerol kinase (DGK) that produces phosphatidic acid (PA) plays important roles in various biological processes, including stress responses, but the underlying mechanisms remain elusive. Here, we show that DGK5 and its lipid product PA suppress ABA biosynthesis by interacting with ABA-DEFICIENT 2 (ABA2), a key ABA biosynthesis enzyme, to negatively modulate plant response to abiotic stress tested in Arabidopsis thaliana. Loss of DGK5 function rendered plants less damaged, whereas overexpression (OE) of DGK5 enhanced plant damage to water and salt stress. The dgk5 mutant plants exhibited decreased total cellular and nuclear levels of PA with increased levels of diacylglycerol, whereas DGK5-OE plants displayed the opposite effect. Interestingly, we found that both DGK5 and PA bind to the ABA-synthesizing enzyme ABA2 and suppress its enzymatic activity. Consistently, the dgk5 mutant plants exhibited increased levels of ABA, while DGK5-OE plants showed reduced ABA levels. In addition, we showed that both DGK5 and ABA2 are detected in and outside the nuclei, and loss of DGK5 function decreased the nuclear association of ABA2. We found that both DGK5 activity and PA promote nuclear association of ABA2. Taken together, these results indicate that both DGK5 and PA interact with ABA2 to inhibit its enzymatic activity and promote its nuclear sequestration, thereby suppressing ABA production in response to abiotic stress. Our study reveals a sophisticated mechanism by which DGK5 and PA regulate plant stress responses.