308 research outputs found
Impact of timing to source control in patients with septic shock: A prospective multi-center observational study
No full textPurpose: Current guidelines recommend that rapid source control should be adopted in patients not >6-12 h after sepsis is diagnosed. However, evidence level of this guideline is not specified, and there is no previous study on patients with septic shock visiting the emergency department (ED). Therefore, we aimed to assess the impact of rapid source control in patients with septic shock visiting the ED. Materials and methods: In a prospective, observational, multicenter, registry-based study in 11 EDs, Cox proportional hazards model was used to assess the independent effect of source control and time to source control on 28-day mortality. Results: Cox proportional hazard models revealed that 28-day mortality was significantly lower in patients who underwent source control (HR 0.538 (0.389-0.744), p < .001). However, no significant association between the performance of source control after 6 h or 12 h from enrollment and 28-day mortality was noted. Conclusions: Patients with septic shock visiting the ED who underwent source control showed better outcomes than those who did not. We failed to demonstrate the performance of rapid source control reduced the 28-day mortality in septic shock patients. Further studies are required to determine the impact of rapid source control in sepsis and septic shock. (C) 2019 Published by Elsevier Inc.N
Cardiovascular Effects of Long‐Term Exposure to Air Pollution: A Population‐Based Study With 900 845 Person‐Years of Follow‐up
No full text
Background
Studies have shown that long‐term exposure to air pollution such as fine particulate matter (≤2.5 μm in aerodynamic diameter [
PM
2.5
]) increases the risk of all‐cause and cardiovascular mortality. To date, however, there are limited data on the impact of air pollution on specific cardiovascular diseases. This study aimed to evaluate cardiovascular effects of long‐term exposure to air pollution among residents of Seoul, Korea.
Methods and Results
Healthy participants with no previous history of cardiovascular disease were evaluated between 2007 and 2013. Exposure to air pollutants was estimated by linking the location of outdoor monitors to the
ZIP
code of each participant's residence. Crude and adjusted analyses were performed using Cox regression models to evaluate the risk for composite cardiovascular events including cardiovascular mortality, acute myocardial infarction, congestive heart failure, and stroke. A total of 136 094 participants were followed for a median of 7.0 years (900 845 person‐years). The risk of major cardiovascular events increased with higher mean concentrations of
PM
2.5
in a linear relationship, with a hazard ratio of 1.36 (95% confidence interval, 1.29–1.43) per 1 μg/m
3
PM
2.5
. Other pollutants including
PM
2.5–10
of
CO
,
SO
2
, and
NO
2
, but not O
3
, were significantly associated with increased risk of cardiovascular events. The burden from air pollution was comparable to that from hypertension and diabetes mellitus.
Conclusions
This large‐scale population‐based study demonstrated that long‐term exposure to air pollution including
PM
2.5
increases the risk of major cardiovascular disease and mortality. Air pollution should be considered an important modifiable environmental cardiovascular risk factor.
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Local and transboundary impacts of PM(2.5) sources identified in Seoul during the early stage of the COVID-19 outbreak
No full textCountries in Northeast Asia have been regulating PM(2.5) sources and studying their local and transboundary origins since PM(2.5) causes severe impacts on public health and economic losses. However, the separation of local and transboundary impacts is not fully realized because it is impossible to change air pollutant emissions from multiple countries experimentally. Exceptionally, the early stage of the COVID-19 outbreak (January–March 2020) provided a cross-country experiment to separate each impact of PM(2.5) sources identified in Seoul, a downwind area of China. We evaluated the contributions of PM(2.5) sources compared to 2019 using dispersion normalized positive matrix factorization (DN-PMF) during three meteorological episodes. Episodes 1 and 2 revealed transboundary impacts and were related to reduced anthropogenic emissions and accumulated primary pollutants in Northeast China. Anthropogenic emissions, except for the residential sector, decreased, but primary air pollutants accumulated by residential coal combustion enhanced secondary aerosol formation. Thus, the contributions of sulfate and secondary nitrate increased in Seoul during episode 1 but then decreased maximally with other primary sources (biomass burning, district heating and incineration, industrial sources, and oil combustion) during episode 2 under meteorological conditions favorable to long-range transport. Local impact was demonstrated by atmospheric stagnation during episode 3. Meteorological condition unfavorable to local dispersion elevated the contributions of mobile and coal combustion and further contributed to PM(2.5) high concentration events (HCE). Our study separates the local and transboundary impacts and highlights that cooperations in Northeast Asia on secondary aerosol formation and management of local sources are necessary
4F, apolipoprotein AI mimetic peptide, attenuates acute lung injury and improves survival in endotoxemic rats
No full textBACKGROUND: 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-JB (NF-JB) 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 JB->/inhibitor JB-> ratio, nuclear NF-JB 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 JB-> degradation, NF-JB 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-JB pathway, and the suppression of cell adhesion molecules.OAIID:oai:osos.snu.ac.kr:snu2012-01/102/2008006599/1SEQ:1PERF_CD:SNU2012-01EVAL_ITEM_CD:102USER_ID:2008006599ADJUST_YN:YEMP_ID:A079751DEPT_CD:801CITE_RATE:0FILENAME:2012 4f, apolipoprotein ai mimetic peptide, attenuates acute lung injury and improves survival in endotoxemic rats..pdfDEPT_NM:의학과SCOPUS_YN:NCONFIRM:
A guideline for differential diagnosis between septic arthritis and transient synovitis in the ED: A Delphi survey
No full textObjective: Among the causes of limping gait in children, septic arthritis (SA) and transient synovitis (TS) are the 2 most likely etiologies. The aim of this study was to determine the medical histories, physical examinations, and other studies to use to create a clinical guideline for differential diagnosis between SA and TS in children in the emergency department (ED). The pediatric orthopedic emergency committee of our institution addressed the issue of developing a guideline for differential diagnosis. Methods: Two rounds of the modified Delphi survey were conducted, and a face-to-face committee meeting was held after each survey round. Delphi survey panelists included 10 pediatric orthopedic surgeons and 8 emergency physicians including 3 pediatric emergency physicians. Results: Response rates were 100% in each round. The panelists used a 6-point Likert scale to rate the clinical diagnostic guideline contents as having high (5 or 6), moderate (3 or 4), or low importance (1 or 2). Twenty-eight questionnaire items were included in the first round; and 18 items, in the second round. Factors for concern were selected, and a flowchart of the diagnostic guideline development process was based on the results of the survey. Conclusion: A diagnostic guideline for evaluating SA and TS in children in the ED was achieved using combined empirical evidence together with expert opinion, potentially resulting in a diagnostic strategy to be incorporated into existing guidelines or used on its own. (C) 2016 Elsevier Inc. All rights reserved.N
Relative tachycardia is associated with poor outcomes in post-cardiac arrest patients regardless of therapeutic hypothermia
No full textBackground: To investigate whether the relationship between heart rate and neurological outcome is independent of therapeutic hypothermia (TH) and whether heart rate is related to hemodynamic instability post-cardiac arrest. Methods: Retrospective review of an out-of-hospital cardiac arrest registry was performed. The primary exposure was heart rate quartiles at 24 h post-cardiac arrest. The primary outcome was a poor neurological outcome, which was defined as having a cerebral performance category (CPC) of 3-5 at 28 days. Secondary outcomes were mean blood pressure and serum lactate at 24 h and Sequential Organ Failure Assessment (SOFA) scores at admission. Results: In total, 155 patients were enrolled. The proportion of patients with a poor CPC was significantly greater in higher heart rate quartiles; similar results were observed in patients who did and did not undergo TH. Serum lactate levels at 24 h were significantly higher in the 3rd and 4th quartile groups than in the 1st quartile group. Additionally, SOFA scores were significantly higher in the 4th quartile group than in the 1st and 3rd quartile groups. Conclusions: Relative tachycardia is associated with poor neurological outcomes in post-cardiac arrest patients, independent of TH, and with higher serum lactate levels and admission SOFA scores.OAIID:RECH_ACHV_DSTSH_NO:T201913781RECH_ACHV_FG:RR00200001ADJUST_YN:EMP_ID:A076403CITE_RATE:1.651DEPT_NM:의학과EMAIL:[email protected]_YN:YN
Glutamine attenuates acute lung injury by inhibition of high mobility group box protein-1 expression during sepsis
Full text linkHeat shock protein 70 (HSP70) is reported as the main factor responsible for the beneficial effects of glutamine (GLN) and as a negative regulator of high mobility group box protein-1 (HMGB-1) expression. Our aim was to determine whether GLN attenuates acute lung injury (ALI) by the inhibition of HMGB-1 expression during sepsis. Male Sprague Dawley rats were subjected to caecal ligation and puncture (CLP) to induce sepsis. GLN or saline was administered through tail vein 1 h after CLP. Then, quercetin (Q), an inhibitor of HSP70, was utilised to assess the role of the enhanced HSP70. We observed the survival of the subjects. At 24h post-CLP, we measured lung HSP70, phosphorylated heat shock factor-1 (HSF-1-p) and HMGB-1 expressions, NF-kappa B DNA-binding activity and ALI occurrence. We also measured serum HSP70, IL-6 and HMGB-1 concentrations. GLN improved survival during sepsis. In GLN-treated rats, lung HSP70 and HSF-1-p expressions were enhanced, lung HMGB-1 expression and NF-kappa B DNA-binding activity were suppressed, and ALI was attenuated. Furthermore, in GLN-administered rats, serum HSP70 concentration was higher, and serum IL-6 and HMGB-1 concentrations were lower than those in non-treated rats. Q inhibited the enhancement of HSP70 and HSF-1-p expressions and abrogated the GLN-mediated benefits. In conclusion, GLN attenuated ALI and improved survival by the inhibition of HMGB-1 expression during sepsis in rats. These benefits were associated with the enhancement of HSP70 expression by GLN.Matsuda N, 2009, AM J RESP CRIT CARE, V179, P806, DOI 10.1164/rccm.200804-534OCZou LY, 2009, AM J PHYSIOL-HEART C, V296, pH515, DOI 10.1152/ajpheart.01025.2008Song MC, 2008, J CRIT CARE, V23, P406, DOI 10.1016/j.jcrc.2007.09.007Singleton KD, 2008, BIOCHEM BIOPH RES CO, V373, P445, DOI 10.1016/j.bbrc.2008.06.057Hagiwara S, 2008, CRIT CARE MED, V36, P2407, DOI 10.1097/CCM.0b013e318180b3baChorny A, 2008, J IMMUNOL, V180, P8369Lee JH, 2008, HUM EXP TOXICOL, V27, P49, DOI 10.1177/0960327108088976Luo FH, 2008, HORM RES, V70, P10Kim BH, 2007, CYTOKINE, V39, P207, DOI 10.1016/j.cyto.2007.08.002Tang DL, 2007, J IMMUNOL, V179, P1236Tang DL, 2007, J IMMUNOL, V178, P7376Singleton KD, 2007, AM J PHYSIOL-REG I, V292, pR1839, DOI 10.1152/ajpregu.00755.2006Aghdassi A, 2007, CANCER RES, V67, P616, DOI 10.1158/0008-5472.CAN-06-1567Horowitz M, 2007, PROG BRAIN RES, V162, P433, DOI 10.1016/S0079-6123(06)62021-9Ganter MT, 2006, AM J PHYSIOL-LUNG C, V291, pL354, DOI 10.1152/ajplung.00405.2005Mantell LL, 2006, SHOCK, V25, P4, DOI 10.1097/01.shk.0000188710.04777.9eChen HW, 2005, SHOCK, V24, P232, DOI 10.1097/01.shk.0000174020.87439.f2Dong HP, 2005, SHOCK, V24, P239, DOI 10.1097/01.shk.0000174019.10311.80Singleton KD, 2005, CRIT CARE MED, V33, P1206, DOI 10.1097/01.CCM.0000166357.10996.8AJakubowicz-Gil J, 2005, FOLIA HISTOCHEM CYTO, V43, P123KIM JY, 2005, AM J PHYSIOL-LUNG C, V288, P958Ueno H, 2004, AM J RESP CRIT CARE, V170, P1310, DOI 10.1164/rccm.200402-1880CLi JH, 2004, J IMMUNOL METHODS, V289, P211, DOI 10.1016/j.jim.2004.04.019Wang H, 2004, J INTERN MED, V255, P320Wischmeyer PE, 2003, NUTRITION, V19, P1, DOI 10.1016/S0899-9007(02)00839-0Cohen J, 2002, NATURE, V420, P885, DOI 10.1038/nature01326Bonaldi T, 2002, EMBO J, V21, P6865NOVAK F, 2002, CRIT CARE MED, V30, P2152Hashiguchi N, 2001, J TRAUMA, V51, P1104Marone M, 2001, EXP CELL RES, V270, P1, DOI 10.1006/excr.2001.5326Wischmeyer PE, 2001, J APPL PHYSIOL, V90, P2403Abraham E, 2000, J IMMUNOL, V165, P2950Ware LB, 2000, NEW ENGL J MED, V342, P1334Ellis S, 2000, J HISTOCHEM CYTOCHEM, V48, P321Kiyonari Y, 2000, CRIT CARE MED, V28, P484Weiss YG, 2000, SHOCK, V13, P19Wang HC, 1999, SCIENCE, V285, P248Baue AE, 1998, SHOCK, V10, P79EINCK L, 1985, EXP CELL RES, V156, P295VELAZQUEZ JM, 1984, CELL, V36, P655
Differences in the Clinical Characteristics of Rapid Response System Activation in Patients Admitted to Medical or Surgical Services
No full textVariability in rapid response system (RRS) characteristics based on the admitted wards is unknown. We aimed to compare differences in the clinical characteristics of RRS activation between patients admitted to medical versus surgical services. We reviewed patients admitted to the hospital who were detected by the RRS from October 2012 to February 2014 at a tertiary care academic hospital. We compared the triggers for RRS activation, interventions performed, and outcomes of the 2 patient groups. The RRS was activated for 460 patients, and the activation rate was almost 2.3 times higher for surgical services than that for medical services (70% vs. 30%). The triggers for RRS activation significantly differed between patient groups (P= 0.001). They included abnormal values for the respiratory rate (23.2%) and blood gas analysis (20.3%), and low blood pressure (18.8%) in the medical group; and low blood pressure (32.0%), low oxygen saturation (20.8%), and an abnormal heart rate (17.7%) in the surgical group. Patients were more likely classified as do not resuscitate or required intensive care unit admission in the medical group compared to those in the surgical group (65.3% vs. 54.7%, P= 0.045). In multivariate analysis, whether the patient belongs to medical services was found to be an independent predictor of mortality after adjusting for the modified early warning score, Charlson comorbidity index, and intervention performed by the RRS team. Our data suggest that RRS triggers, interventions, and outcomes greatly differ between patient groups. Further research is needed to evaluate the efficacy of an RRS approach tailored to specific patient groups.Y
Application of non-uniformity correction framework in digital breast tomosynthesis by incorporating a total variation penalty
No full textDigital breast tomosynthesis (DBT) is well-established in breast imaging modality to overcome the loss of depth-information in a three-dimension (3D) object in 2D mammography. However, the reconstructed DBT images suffer from shading artifacts caused by scatter radiation, beam-hardening effect, and unique geometric conditions. In this study, we investigated the application of a non-uniformity correction framework with TV-penalty in the DBT system for substantial improvement of its image visibility. We modeled a modified solver to estimate the non-uniformity field component, which is inspired by the normalized intensity-gradient joint-histogram-based energy minimization. The proposed framework was compared to the reference slice with only primary component in Monte-Carlo simulation and the uniformity was experimentally improved using the projection at low exposure condition. To quantitative evaluate image performance, percent integral uniformity (PIU) was calculated in acquired images. Our results indicated that the proposed framework well-operated to compensate for distorted flatness due to beam hardening, scatter, and unique DBT geometry. Especially, the measured PIU value of the corrected DBT slice was 14.2, it is almost same compared to that of mono-energy DBT slice (primary only) in simulation study. Moreover, the profile flatness of the corrected DBT slice was significantly improved from conventional DBT slice with much noise component. The uniformity correction of the DBT slice is necessary to reduce the misdiagnosis. Consequently, our results demonstrate that the proposed framework successfully corrects the non-uniformity at low X-ray exposure condition, and its scheme is expected to be applicable for efficient DBT imaging performance.restrictio
아시아-태평양 지역 은행주식 수익률 규모현상에 대한 실증분석
No full text학위논문(석사) - 한국과학기술원 : 금융공학프로그램, 2017.2,[iii, 39 p. :]Different from the traditional studies on size effects of stock returns which excludes financial firms from the sample due to its high leverage level, this paper conducts empirical studies on financial firms within Asia Pacific region. The study reveals that there exist size effects in commercial bank stock returns and also uncovers a size factor in the component of bank returns to explain risk-adjusted returns.한국과학기술원 :금융공학프로그램
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