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We present a new navigation structure using dual databases for aerial vehicle, which include the simple switching technique. It is possible to use the various database for an alternative navigation system. We utilize the terrain referenced navigation (TRN) and image-based navigation (IBN). The TRN has been researched for fighter aircraft or cruise missiles. And the IBN is widely researched recently during the computer science technologies are rapidly grown up. Generally, the TRN is very effective on the environment with high altitude fluctuation with uniqueness. However, the IBN provides a very accurate pose of the vehicle for the environment with a lot of features in the input camera image. However, both algorithm has disadvantages that are greatly influenced by the operating environment. We propose a fusion structure using both algorithms with adaptive logic based on decision making logic. The decision variable includes the roughness and uniqueness of the environment. We use a stochastic linearization (SL) method in TRN also, which is widely known as an essential method on TRN using digital elevation map (DEM). In the case of the IBN, we use the speed up robust feature point (SURF) algorithm for the matching process, which is invariant to translation, rotation, scale, and illumination. Both measurement models are fused with the extended Kalman filter(EKF). We conducted simulations to validate the proposed structure using DEM and aerial projective map. Two kinds of databases are provided by the Ministry of Land, Infrastructure and Transport in the Republic of Korea.

Objective Traumatic brain injury (TBI) is an important public health concern due to its high prevalence and mortality rate among young people. We investigated the clinical and social characteristics of patients who visited the emergency department due to TBI in whom brain computed tomography, was performed by age. Methods We retrospectively analyzed 15,567 TBI patients who received a brain computed tomography evaluation at the emergency department of Korea University Hospital from March 2013 to February 2016. We divided patients into age groups by decade and analyzed factors such as sex, trauma mechanism, need for operation, hospitalization, and results of treatment. Results The mean age was 42.0±22.8 years; the most common age group was the 50s (16.5%). Except for the age group over 70 years, males predominated. Under 9 years of age, public ambulance usage rate was lower than in other age groups. Regarding severity based on the Glasgow Coma Scale score, the proportion of mild cases was higher in those under 9 years of age (99.3%) and the proportion of severe cases was higher in those in their 20s (4.6%). The most common injury mechanism was blunt trauma, followed by car accidents. For those under 9 years of age, falls were more common than in other age groups. Only 20.5% of TBI patients were hospitalized and 11.9% were treated surgically, while 70.6% of patients were discharged home after treatment. Conclusion TBI may present with different characteristics depending on the age of the patients, thus prevention policies and clinical practice should be tailored to age.

We investigated the clinical value of whole blood procalcitonin using point of care testing, quick sequential organ failure assessment score, C-reactive protein and lactate in emergency department patients with suspected infection and assessed the accuracy of the whole blood procalcitonin test by point-of-care testing. Participants were randomly selected from emergency department patients who complained of a febrile sense, had suspected infection and underwent serum procalcitonin testing. Whole blood procalcitonin levels by point-of-care testing were compared with serum procalcitonin test results from the laboratory. Participants were divided into two groups&mdash, those with bacteremia and those without bacteremia. Sensitivity, specificity, positive predictive value, negative predictive value of procalcitonin, lactate and Quick Sepsis-related Organ Failure Assessment scores were investigated in each group. Area under receiving operating curve of C-reactive protein, lactate and procalcitonin for predicting bacteremia and 28-day mortality were also evaluated. Whole blood procalcitonin had an excellent correlation with serum procalcitonin. The negative predictive value of procalcitonin and lactate was over 90%. Area under receiving operating curve results proved whole blood procalcitonin to be fair in predicting bacteremia or 28-day mortality. In the emergency department, point-of-care testing of whole blood procalcitonin is as accurate as laboratory testing. Moreover, procalcitonin is a complementing test together with lactate for predicting 28-days mortality and bacteremia for patients with suspected infection.

The objective of this study was to evaluate the prognostic value of C-reactive protein (CRP), procalcitonin (PCT), and their combination for mortality in patients with septic shock. This multicenter, prospective, observational study was conducted between November 2015 and December 2017. A total of 1,772 septic shock patients were included, and the overall 28-day mortality was 20.7%. Although both CRP and PCT were elevated in the non-survivor group, only CRP had statistical significance (11.9 mg/dL vs. 14.7 mg/dL, p = 0.003, 6.4 ng/mL vs. 8.2 ng/mL, p = 0.508). Multivariate analysis showed that CRP and PCT were not independent prognostic markers. In the subgroup analysis of the CRP and PCT combination matrix using their optimal cut-off values (CRP 14.0 mg/dL, PCT 17.0 ng/dL), both CRP and PCT elevated showed significantly higher mortality (Odds ratio 1.552 [95% Confidence intervals 1.184–2.035]) than both CRP and PCT not elevated (p = 0.001) and only PCT elevated (p = 0.007). However, both CRP and PCT elevated was also not an independent predictor in multivariate analysis. Initial levels of CRP and PCT alone and their combinations in septic shock patients had a limitation to predict 28-day mortality. Future research is needed to determine new biomarkers for early prognostication in patients with septic shock.

Current guidelines recommend that rapid source control should be adopted in patients not6-12 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.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.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.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.

SPIRIT 2013 checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 125 kb)

Attitudedeterminationofsatelliteiscategorizedbydeterministicandrecursivemethod.TherecursivealgorithmusingKalmanfilteriswidelyused.Cubesathaslimitationforpayloadtominimizethenonlytwoattitudesensorsareinstalledwhicharesunsensorandmagnetometer.Sunsensormeasurementsareuselessduringeclipse,howevercubesatkeepsestimatingattitudetocompletethesuccessfulmission.Inthispaper,AttitudedeterminationalgorithmbasedonKalmanfilterisdevelopedbyadditionaltermwhichconsideringthedynamicsforSNUSAT-1withdisturbancetorque.Verificationofattitudeaccuracyofthealgorithmisconductedduringeclipse.Attitudedeterminationalgorithmissimulatedtocomparetheperformancebetweentypicalmethodandproposedalgorithm.Inaddition,Attitudeerrorsareanalysedwithvariousmagnitudeofdisturbancetorquecausedbyspaceenvironment. 초 록 인공위성의 자세추정은 결정론적 방법과 재귀적인 방법으로 나눌 수 있는데,이 중 재귀적인 방법으로는 칼만 필터를 사용하여 자세를 추정하는 알고리즘이 널리 사용되고 있다.초소형 큐브 위성의 경우 많은 탑재체를 실을 수 없기에 최소한의 자세 센서만을 이용해야 하는 제한점이 있다.미션에 따라 식 기간 및 태양 센서의 데이터 이용이 불가능할 때에도 인공위성의 자세추정은 계속 되어야 인공위성은 임무를 성공적으로 완수할 수 있게 된다.본 연구에서는 일반적인 인공위성의 자세추정 기법을 기반으로 큐브위성의 동역학과 토크외란을 고려하여 알고리즘을 발전시켜 식 기간에서도 더욱 정확한 자세 추정이 가능하도록 하였다.제안된 알고리즘은 시뮬레이션을 통해 기존의 자세추정 방법과 비교하여 그 성능을 검증하였다.또한 위성체가 우주 환경에서 운용되면서 받을 수 있는 다양한 크기의 토크외란에 따른 자세추정 오차를 분석하였다.KeyWords:SatelliteDynamics(인공위성 동역학),Cubesat(큐브위성),ExtendedKalmanFilter(확장 칼만 필터),SpaceEnvironment(우주 환경),DisturbanceTorque(토크외란),Eclipse(식)

Rapid identification of Respiratory syncytial virus (RSV) is important in the management of infected patients. Rapid diagnostic tests (RDT) are widely used for this purpose. This study aimed to evaluate the clinical performance of four RSV antigen tests including the BinaxNow RSV Card test, SD Bioline RSV test, BD Veritor RSV test, and Humasis RSV antigen test in comparison with real-time RT-PCR as the reference method. Nasopharyngeal swabs were collected from 280 patients with symptoms of lower respiratory tract infection and stored at -80°C. All swabs were tested for RSV using four rapid antigen tests and real time RT-PCR. The sensitivity of the BinaxNow RSV Card test, SD Bioline RSV test, BD Veritor RSV test, and Humasis RSV Antigen tests were 62.5%, 61.3%, 65.0%, and 67.5% for RSV A, and 61.3%, 65.0%, 61.3%, and 67.5% for RSV B compared to real time RT-PCR, respectively. The specificity of BD Veritor RSV test was 95.8% and those of the other three RDTs was 100%. Commercial RSV antigen detection assays are useful tools for the rapid diagnosis of RSV infection. However, confirmatory testing is always recommended. J. Med. Virol. 88:1720-1724, 2016. © 2016 Wiley Periodicals, Inc.

Platelets play a major role in maintaining endothelial integrity and hemostasis. Of the various soluble agonists, ADP is an important in vivo stimulus for inducing platelet aggregation. In this study, a simple, rapid, and affordable method was designed for testing bleeding time (BT) and platelet aggregation with a two-channel microfluidic chip. Whole blood migration ratio (MR) from a microchip system was evaluated in comparison to the closure time (CT) from PFA-100 assays (Siemens, Germany) and CD62P expression on platelets. To induce platelet aggregation, a combination of collagen (1.84 mg/ml) and ADP (37.5 mg/ml) were used as agonists. After adding the agonists to samples, whole blood MR from the microchip system was measured. The outcome of the assessment depended on reaction time and agonist concentration. MR of whole blood from the microchip system was significantly correlated with CT from PFA-100 (r = 0.61, p < 0.05, n = 60). In addition, MR was negatively correlated with CD62P expression (r =-0.95, p < 0.05, n = 60). These results suggest that the measurement of MR using agonists is an easy, simple and efficient method for monitoring platelet aggregation in normal and ADP-receptors defective samples, along with the BT test. Thus, usage of the current microfluidic method could expand to diverse applications, including efficacy assessments in platelet therapy.

Current sepsis guidelines recommend administration of antibiotics within 1 hour of emergency department (ED) triage. However, the quality of the supporting evidence is moderate, and studies have shown mixed results regarding the association between antibiotic administration timing and outcomes in septic shock. We investigated to evaluate the association between antibiotic administration timing and in-hospital mortality in septic shock patients in the ED, using propensity score analysis.An observational study using a prospective, multicenter registry of septic shock, comprising data collected from 10 EDs, was conducted. Septic shock patients were included, and patients were divided into 4 groups by the interval from triage to first antibiotic administration: group 1 (≤1 hour; reference), 2 (1-2 hours), 3 (2-3 hours), and 4 (3 hours). The primary endpoint was in-hospital mortality. After inverse probability of treatment weighting, the outcomes of the groups were compared.A total of 2250 septic shock patients were included, and the median time to first antibiotic administration was 2.29 hours. The in-hospital mortality of groups 2 and 4 were significantly higher than those of group 1 (odds ratio [OR] 1.248; 95% confidence interval [CI], 1.053-1.478; P = .011; OR 1.419; 95% CI, 1.203-1.675; P.001, respectively), but those of group 3 was not (OR 1.186; 95% CI, 0.999-1.408; P = .052). Subgroup analyses of patients (n = 2043) with appropriate antibiotics presented similar results.In patients with septic shock, rapid administration of antibiotics was generally associated with a decrease in in-hospital mortality, but no "every hour delay" was seen.

We present a robust scene-matching (SM) algorithm using time-invariant features that are propagated and bounded by a model propagator and pixel boundary. The SM based absolute navigation has the advantage that the position of the vehicle can be independently calculated without external information, making it possible to calculate a stable navigation solution without cumulative errors. However, SM-based absolute localization has a mismatching problem, this is due to the difference between the reference for the matching and the input image, and the more the change, the higher the probability of mismatching. In this paper we propose an algorithm that can mitigate the mismatching problem with a model-based propagator and time-invariant features. The propagator is based on a relative velocity of the inertial navigation system (INS) model, which is very accurate for a short time. Also the propagated feature points have pixel boundaries, which considers not only INS model uncertainty but also distortion of the aerial images caused by various terrain characteristics. The proposed algorithm is verified by simulation using real experimental data. Consequently we can found the proposed algorithm is very effective in mitigating the mismatching problem in urban areas.

Background According to domestic studies, patients visiting the emergency departments (ED) with acute toxic exposure comprise 0.68%-5.5% of all ED patients, with various causes and motives. The purpose of this study is to investigate the clinical and social characteristics of patients with toxic exposure visiting the ED. Methods This study spanned a period of five years, from January 1, 2009 to December 31, 2013. The data were extracted using the National Emergency Department Information System (NEDIS) and The Korea Health Insurance Review and Assessment Service (HIRA). Results From the HIRA database, during the study period (2009-2013); 310,159 (2009), 289,829 (2010), 288,906 (2011), 285,514 (2012), and 279,575 (2013) patients, respectively, visited EDs with diagnoses related to exposure to toxic substances. The number of patients who presented with acute toxic exposure compared to all ED visits significantly decreased consistently (7.8%, 6.9%, 6.0%, 5.0%, 4.1%) over 5 years. Regarding the cause of toxic exposure, substances other than drugs accounted for the largest percentage, and increased annually. Acetylcysteine was the most commonly prescribed antidote, and patients in their 40s and 50s showed the most frequent visits. The monthly distribution was highest in July-September, and higher in January than in other months. Conclusion This study found that the percentage of patients visiting the ED is decreasing, the exposure to quasi-drugs was the most common, and the exposure to antipsychotic drugs was the most frequent.

The aim of this study was to evaluate the clinical utility of the lactate/albumin (L/A) ratio as a predictive factor of 28-day mortality in critically ill sepsis patients.This is a retrospective observational study from a prospectively collected multicenter registry of 10 emergency departments (EDs) in teaching hospitals that participated in the Korean Shock Society. It enrolled patients who were 19 years of age or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion. The prognostic performance of the L/A ratio and lactate level for predicting 28-day mortality was assessed. Lactate and albumin levels were measured immediately after ED arrival.A total of 946 patients were included, with 22.5% overall 28-day mortality. The area under the receiver operating characteristic curve (AUROC) value of the L/A ratio (0.69, 95% confidence interval [CI] 0.64-0.73, P 0.01) was higher than that of lactate (0.65, 95% CI 0.61-0.70, P 0.01) for predicting 28-day mortality. The optimal cutoff of the L/A ratio was 1.32. The AUROC value of the L/A ratio was better than that of lactate regardless of lactate level (normal [2.0 mmol/L]: 0.68 vs. 0.55; intermediate [≥2.0, 4.0 mmol/L]: 0.65 vs. 0.50; high [≥4.0 mmol/L]: 0.66 vs. 0.62). In the subgroup with decreased lactate elimination, the AUROC value of the L/A ratio was also significantly higher than that of lactate (hepatic dysfunction: 0.70 vs. 0.66; renal dysfunction: 0.71 vs. 0.67). The L/A ratio cut-off and hypoalbminemia showed further discriminative value for 28-day mortality even in patients with normal or intermediate lactate levels.The prognostic performance of the L/A ratio was superior to that of a single lactate measurement for predicting 28-day mortality of critically ill sepsis patients. L/A ratio can be a useful prognostic factor regardless of initial lactate level and the presence of hepatic or renal dysfunction.

Background: We compared the clinical characteristics and outcomes between the new definition of sepsis-3 septic shock and the definition previously used from 1991 until recently. Methods: We conducted an observational study using a prospective, multi-center registry of septic shock from October 2015 to February 2017. Registry data were collected by 10 emergency departments (EDs) in tertiary hospitals that are members of the Korean Shock Society. Data on septic shock patients who met the previous septic shock definition were collected. The patients were divided into a sepsis-3 defined septic shock group, made up of those who met the new criteria for refractory hypotension with hyperlactatemia, and a group of those who met only the 1991 definition for septic shock. The primary outcome was 90-day mortality, and secondary outcomes were 28-day mortality and in-hospital mortality. Results: Of all 1,028 included patients, 574 (55.8%) met the septic shock criteria for sepsis-3, leaving 454 patients who met only the previous definition. Those who met the sepsis-3 criteria demonstrated higher comorbidity than those who met the previous definition (83.1% vs . 75.3%, P vs . 5.0±2.9, 9.3±3.8 vs . 6.6±3.4, and 20.0 (15.0–26.0) vs . 15.0 (10.0–20.3), respectively; P vs . 23.3%; P vs . 17.1% and 25.1% vs . 16.5%, respectively; P Conclusions: The new definition of septic shock successfully selected patients with greater severities and worse outcomes.

Case report form of the KoSS (Korean Shock Society) septic shock registry. (PPTX 600 kb)

Many patients are admitted to the emergency department due to trauma. Trauma patients suffer from hypoxia due to massive hemorrhage, respiratory failure, and hypovolemic shock. Further damage is caused by reduced immune function and over-expression of inflammatory response. We conducted an experiment to determine the effects of hyperoxia and hypoxia on apoptosis and expression of Toll-like receptor 4 (TLR4) in polymorphonuclear neutrophils (PMNs). Initially, the PMNs were placed in normoxic and hypoxic conditions, and these PMNs were divided into two groups as stimulated or not stimulated with lipopolysaccharide (LPS). Levels of apoptosis and TLR4 expression were measured under normoxic, hypoxic, and hyperoxic conditions. Apoptosis decreased in the hypoxic group than in the normoxic group. With LPS stimulation, apoptosis was decreased in all three treatment groups and even more reduced in the hypoxic group. TLR4 expression increased in all three treatment groups with LPS stimulation, increased further in the hypoxic group, and to a lesser degree in the hyperoxic group. Unlike the cells exposed to hypoxic conditions, the cells exposed to the hyperoxic condition reacted similarly to the cells in the control (normoxic) group. Therefore, the inflammatory reactions can be stronger in the hypoxic group than in the other two groups.

Objective We compared patient satisfaction with scarring after facial laceration repair in the emergency department (ED) based on the specialty of the provider. Methods Patients with facial lacerations admitted to the ED from 2009 to 2013 were divided into two groups. One group of patients underwent repair by an emergency physician (EP) and the other by a plastic surgeon (PS). From August 2014 to September 2014, we randomly selected 10% of all patients and assessed their degree of satisfaction with scarring over the phone using a 5-point Likert scale. Results The male to female ratio was 2.81 in the EP group and 2.05 in PS (P

Purpose Postcardiac arrest syndrome (PCAS) shares many features with sepsis including plasma cytokine elevation with dysregulation of cytokine production, and the presence of endotoxin in plasma. PCAS is closely related to ischemia-reperfusion injury. During ischemia-reperfusion injury, neutrophil, which is the first line of innate immunity, plays a major role. In this study, we investigated the inflammatory response of human neutrophils in an in vitro model which we simulated with hypoxia-normoxia and hypoxia-hyperoxia environments. Methods After separation of neutrophils from the whole blood, they were divided into 3 experimental groups: normoxia-normoxia, hypoxia-normoxia, and hypoxia-hyperoxia groups. The production of H2O2, the expression of Toll-like receptor 4 (TLR4) receptor, and the extent of apoptosis of the neutrophils were checked. Results The in vitro hypoxia-normoxia and -hyperoxia models, which simulated the PCAS, showed initiation of the neutrophils' inflammatory reaction by hypoxia insult. Lipopolysaccharide amplifies such inflammation; therefore, prevention of secondary infection may be critical in postresuscitation patients. Temporary hyperoxia following hypoxic insult showed no difference in inflammatory reaction compared with hypoxia-normoxia. Rather, temporary hyperoxia may suppress or minimize inflammation by attenuation of TLR4 receptor. Conclusion It is well known that continuous hyperoxygenation after successful cardiac arrest harms patients, but temporary hyperoxygenation with 100% O2 in a clinical situation may be helpful.

Purpose: Visit to the emergency department of the pediatric patients has increased steadily every year. The number of pediatric patients visiting the emergency department has increased steadily each year. It is believed that through recurrent visits (re-visit), many of them are using the emergency room, understanding the characteristics of pediatric patients to re-visit to the emergency department and should help to improve the quality of emergency service. Due to this increase and the rise in recurrent visits by pediatric patients, it is important to understand the characteristics and needs of this group, as well as to improve the quality of emergency service. Methods: Patients under the age of 6 years with 6 months of history visiting local emergency centers were included in this study. It was practically observed medical record. Medical records of these patients were observed. During the study period, there were 9,448 visitations including re-visits; a total of 7,480 visits were confirmed as re-visits via patient surveys. Results: A total of 9,448 pediatric patients, under the age of 6 (32.4%), made visitations to an emergency medical center during a 6-month period, of which, 7,480 visits were attributed to revisits, and thus, overlapped. Among these with confirmed revisitations, patients with no more revisitation are 5,273, one-time revisitation are 1,428, two revisitations are 458, three revisitations are 199, and four or more revisitations are 122. The rate of revisitations is higher in in the younger age group. Conclusion: In this study, we found the characteristics of pediatric patients with revisitations to the emergency department; young age correlated to higher revisits. The use of EMS system increases in the group of patients with many re-visits, medical illnesses, hospitalization rates, and allergies.

With the emerging risks of drug-resistant viruses and pandemic influenza, rapid and accurate detection of influenza viruses and determination of their subtypes is a crucial component of patient management. This study evaluated the performance of the Verigene respiratory virus plus nucleic acid (Verigene RV+) test for the detection of influenza A/B and subtype determination compared it with conventional molecular methods. Nasopharyngeal swabs were collected from 228 patients with influenza-like illness (influenza A (n = 67), 2009-H1N1 (n = 21), influenza B (n = 80), mixed A & B (n = 3), mixed RSV A and influenza (n = 3), and influenza-negative (n = 54)). Patient samples were analyzed by Influenza A/B one-step typing (Seegene, Seoul, Korea), Seeplex RV15 ACE Detection (Seegene), Nanosphere Verigene RV+ assay (Nanosphere, Northbrrook, IL) and virus culture. Out of 228 samples, 109 (47.8%) were positive by culture, and an additional 65 (28.5%) were positive by Seeplex RV15 ACE Detection, Influenza A/B one-step typing or Nanosphere Verigene RV+ assay. In comparison tests with Seeplex RV15 ACE Detection RT-PCR, the sensitivity of the Verigene RV+ kit for detection of the influenza A, 2009-H1N1, influenza B, and mixed A & B was 97.1%, 100%, 100%, and 100%, respectively. The specificity of the Verigene RV+ was 100% for all types. The concordance between Verigene RV+ and Influenza A/B one-step typing for H1, H3, H1/H3 mixed, and 2009-H1N1 was 100% (26/26), 100% (35/35), 100% (4/4), and 100% (21/21), respectively. The Verigene RV+ assay showed acceptable sensitivity and specificity for detection and subtyping of influenza viruses compared with the conventional RT-PCR method. J. Med. Virol. 87: 18–24, 2015. © 2014 Wiley Periodicals, Inc.

Objectives Inflammation makes an influence on autonomic nervous system and a change in autonomic nervous activity affects heart rate. Heart rate variability (HRV) test can quantify the autonomous nervous activity. In this study, we evaluated the meaning of heart rate variability in sepsis patients. Methods Heart rate variability test was performed for sepsis patients and healthy volunteers. Normalised low frequency power, reflecting sympathetic activity, was compared to acute physiology and chronic health evaluation II (APACHE II) score and mortality in emergency department sepsis (MEDS) score in sepsis patients. Then the patients were divided into four groups: 1) severe sepsis patients, 2) sepsis patients admitted to general ward, 3) sepsis patients discharged within 24 hours and 4) healthy volunteers. We obtained averages for the HRV results in all four groups. The receiver operating characteristics curve was examined to determine whether or not HRV variables could be used to triage sepsis patients. Results Correlations between normalised low frequency power (LFnu) with APACHE II score and MEDS score were −0.595 and −0.514, respectively. Low frequency power (LF) and LFnu values decreased in sepsis patients with the higher scores observed in the discharged sepsis patients and healthy volunteers. The areas under the curve for the values of LF and LFnu in the admission and discharge groups were 0.746 and 0.635, respectively (pConclusion Variables related to heart rate variability are significantly correlated with the severity of sepsis patients. Although the HRV test alone cannot accurately predict the disposition of sepsis patients, in the emergency room setting it helps to assign beds to sepsis patients within the triage system, and avoid over-population. (Hong Kong j.emerg.med. 2014;21:73-79)

In Korea, the percentage of pipelines more than 21 years old is reaching 22.7% and the demand for renewal will increase rapidly. This study is intended to determine the validation of renewal through Contingent Valuation Method (CVM) and through the estimation of pipeline burst in the future. Considering calculated benefit and cost, analysis period and social discount rate, the benefit/cost ratio is calculated and the result of B/C value is 1.004. Since the ratio of benefit/cost is bigger than 1.0, pipeline renewal with rehabilitation and double-piping is financially validated in this study.

Objective. The purpose of this study is to identify problems of emergency transfu-sion at the bedside and to determine need for massive transfusion protocol. Methods. We included patients who met the criteria for “trauma team activation” and were admitted to division of trauma. The amount of blood product transfused in each unit was investigated for balanced transfusion. We also investigated the com-pliance with assessment of blood con-sumption score. The correlation between the time elapsed from patient visit to first transfusion order and time elapsed from first transfusion order to transfusion start was analyzed. Finally, we investigated vari-ous factors which serve to influence the decision-making process regarding early transfusion order. Results. Ratio of packed Red blood cells (pRBC): Fresh frozen plasma (FFP) was well-balanced, but platelet transfusion done was much lower than pRBC and FFP in emergency room. The application of emergency blood release did not match the criteria of assessment of blood consump-tion (ABC) score. The time from the first transfusion order to the transfusion start was found to be constant irrespective of time from patient visit to first transfusion order. And, the time from the first transfu-sion order to transfusion start did not dif-fer significantly among patients with early transfusion order and delayed transfusion order. Only systolic blood pressure of < 90 mmHg was identified as a major predictor for early transfusion order. Conclusion. Balanced transfusion is not easy and emergency transfusion could be delayed at the bedside. Integrated and sys-tematic structures for massive transfusion protocol would be invaluable and indis-pensable.

Influenza epidemics occur annually with variations in size and severity. Hospital-based Influenza Morbidity & Mortality was established to monitor influenza epidemics and their severity, which is composed of two surveillance systems: emergency room-based and inpatient-based surveillance. Regarding emergency room-based surveillance, influenza-like illness index (influenza-like illness cases per 1,000 emergency room-visiting subjects), number of laboratory-confirmed cases and the distribution of influenza types were estimated weekly. Inpatient-based surveillance included monitoring for hospitalization, complications, and mortality. The emergency room influenza-like illness index correlated well with the number of laboratory-confirmed influenza cases, and showed a bimodal peak at Week 4 (179.2/1,000 emergency room visits) and Weeks 13-14 (169.6/1,000 emergency room visits) of 2012. Influenza A was the predominant strain during the first epidemic peak, while influenza B was isolated exclusively during the second peak. In 2011-2012 season, the mean admission rate of emergency room-visiting patients with influenza-like illness was 16.3% without any increase over the epidemic period. Among the hospitalized patients with influenza, 33.6% (41 out of 122 patients) were accompanied by complications, and pneumonia (28.7%, 35 out of 122 patients) was the most common. Most fatal cases were caused by influenza A (96.2%) after the first epidemic peak. In conclusion, Hospital-based Influenza Morbidity & Mortality was effective for monitoring the trends in circulating influenza activity concurrently with its severity. In the 2011-2012 season, the influenza epidemic persisted for a ≥ 5-month period, with a bimodal peak of influenza A and B in sequence. Overall, influenza A was more severe than influenza B.

Background and objectives Diagnostic tests for influenza infection commonly use nasopharyngeal swabs (NPS) even though these are invasive to obtain. As an alternative specimen, we evaluated the diagnostic usefulness of saliva samples with rapid influenza diagnostic tests (RIDTs). Study design Both NPS and saliva samples were collected from 385 influenza suspected patients and analyzed using Sofia Influenza A + B Fluorescence Immunoassay (Quidel Corporation, San Diego, CA, USA), ichroma TRIAS Influenza A + B (Boditech, Chuncheon, Korea), SD Bioline Influenza Ag (Standard Diagnostic, Yonggin, Korea), BinaxNOW Influenza A/B antigen kit (Alere Inc., Waltham, MA, USA), and real-time reverse transcriptase PCR (RT-PCR). Results Of the 385 patients, 31.2% (120/385) were positive for influenza A, and 7.5% (29/385) were positive for influenza B virus with saliva or NPS by RT-PCR. The diagnostic sensitivity was slightly higher in NPS than in saliva samples for both influenza A and B by all of the four RIDTs. The diagnostic sensitivities of Sofia and ichroma TRIAS were significantly superior to those of the other conventional influenza RIDTs with both types of sample. The sensitivities of Sofia and ichroma TRIAS with saliva specimens were comparable to the sensitivities of the other two conventional RIDTs with NPS specimens. The simultaneous use of saliva and NPS samples exhibited improved sensitivity from 10.0% to 13.3% for influenza A and from 10.3% to 17.2% for influenza B compared to using NPS alone. Conclusions This study demonstrates that saliva is a useful specimen for influenza detection, and that the combination of saliva and NPS could improve the sensitivities of influenza RIDTs.

Nano-satellite has payload limitation to minimize weight and cost then minimum number of attitude sensors can be loaded which are sun sensor, magnetometer and gyroscope. However, The sun sensor cannot be used during eclipse, nano-satellite keeps estimating attitude with model propagator. Which contains the uncertainty, torque disturbance. For small satellite has too low moment of inertia to vulnerable to disturbance relatively. In this reason torque disturbance can be critical point to estimate attitude using propagator. The recursive attitude determination algorithm using Kalman filter is very widely used. For this reasons, attitude determination algorithms based on adaptive extended Kalman filter with disturbance torque are introduced. Which are P-scaling, Q-scaling and Q-estimation technic. In this paper, it is assumed disturbance torque represents the model uncertainty. This research shows it is possible to estimate the disturbance, angular rate and attitude of the satellites through the simulation. To solve the attitude determination problem for nano-satellite, It is possible to estimate not only attitude but also disturbance through the adaptive algorithms.

Rapid identification of Respiratory syncytial virus (RSV) is important in the management of infected patients. Rapid diagnostic tests (RDT) are widely used for this purpose. This study aimed to evaluate the clinical performance of four RSV antigen tests including the BinaxNow RSV Card test, SD Bioline RSV test, BD Veritor RSV test, and Humasis RSV antigen test in comparison with real-time RT-PCR as the reference method. Nasopharyngeal swabs were collected from 280 patients with symptoms of lower respiratory tract infection and stored at -80°C. All swabs were tested for RSV using four rapid antigen tests and real time RT-PCR. The sensitivity of the BinaxNow RSV Card test, SD Bioline RSV test, BD Veritor RSV test, and Humasis RSV Antigen tests were 62.5%, 61.3%, 65.0%, and 67.5% for RSV A, and 61.3%, 65.0%, 61.3%, and 67.5% for RSV B compared to real time RT-PCR, respectively. The specificity of BD Veritor RSV test was 95.8% and those of the other three RDTs was 100%. Commercial RSV antigen detection assays are useful tools for the rapid diagnosis of RSV infection. However, confirmatory testing is always recommended. J. Med. Virol. 88:1720-1724, 2016. © 2016 Wiley Periodicals, Inc.

BACKGROUND The role of migration inhibitory factor (MIF) is best understood in septic shock and septic disease; however, the role of MIF in a secondary infection after trauma has not yet been completely studied. This study aimed to evaluate the role of MIF in trauma patients. METHODS The patients in the study population were divided into two groups according to the results of their MIF levels. The initial MIF levels, trauma mechanism, revised trauma score, survival rate, length of stay (LOS) in the intensive care unit (ICU), level of leukocytes, and level of C-reactive protein (CRP) were compared between the groups. RESULTS Overall, 116 patients were enrolled from August 1, 2014 to July 31, 2015. LOS in ICU in the elevated MIF group was 5.67±7.54 days compared with 2.09±2.26 days in the normal MIF group. Further, CRP level in the elevated MIF group was higher than that in the normal MIF group. CONCLUSION In a place such as the department of emergency medicine, it is critical and important for emergency physicians to make a proper judgment and to prepare for the worst scenario. Therefore, the utilization of MIF level in trauma patients has a possibility for assisting emergency physicians.

Background The function of polymorphonuclear (PMN) cells can be influenced by the choice of resuscitation fluids in hemorrhagic shock. Widespread interest in the use of hypertonic solutions for resuscitation has led to extensive investigation of their immune-modulating properties. Hypertonic saline (HTS) is known to modulate immune reactions, preventing the multiorgan failure mediated by immune reactions in trauma and hemorrhagic shock. PMN cells play a key role in such immune-mediated inflammatory processes, and HTS is believed to affect these PMN cells. However, how these events influence the actual event of apoptosis has not yet been described. Thus, in the present study, we aimed to investigate the differences in the apoptosis of PMN cells when exposed to isotonic and hypertonic environments and the temporal relations between the interval of administration of HTS after the stimulation of PMN cells. Methods Whole blood was sampled from healthy volunteers, and the PMN cells were isolated. The isolated layer of PMN cells was washed twice with phosphate-buffered saline to yield the PMN cells. The number of cells was kept uniform, and an overall survival rate greater than 95% was maintained. After stimulation of the isolated PMN cells with N-formyl-methionyl-leucyl-phenylalanine, the PMN cells were allocated into 3 study groups (i.e., 1 isotonic group and 2 hypertonic groups with an osmolarity of 160 mM and 180 mM each). The extent of apoptosis was investigated in each group after culturing the PMN cells for 0, 1, 3, 6, 12, 15, 18, and 24 h. Depending on whether the PMN cells were stimulated with N-formyl-methionyl-leucyl-phenylalanine, they were also divided into stimulated and nonstimulated groups. In the stimulated group, the hypertonic environment was fostered immediately (HTS 0 h) and 6 h (HTS 6 h) after stimulation, which was accomplished after allocating the cells into an isotonic group (140 mM) and a hypertonic group (180 mM), according to the concentration of the culture medium. The PMN cells were then cultured at 37°C for 15 h with 5% carbon dioxide incubation. Each PMN suspension was labeled with Annexin V-fluorescein isothiocyanate and propidium iodide. Each sample underwent immediate flow cytometric analysis. PMN cells with high propidium iodide uptake were considered nonviable (necrotic). Among the viable PMN cells, those with no Annexin V uptake were considered normal and those with Annexin V uptake were considered apoptotic. Results Decreased apoptosis was observed in the PMN cells stimulated with N-formyl-methionyl-leucyl-phenylalanine. Increased apoptosis was observed in the stimulated PMN cells incubated in hypertonic condition compared with the cells incubated in isotonic condition. Early HTS administration demonstrated increased apoptosis compared with late administration. Conclusions HTS treatment resulted in increased PMN apoptosis and an anti-inflammatory effect. Decreased apoptosis (prolonged lifespan) has been implicated in neutrophil-mediated tissue damage. HTS, by increasing the apoptosis of PMN cells, attenuates the postinjury inflammatory response. Also, early treatment with HTS was more efficient than delayed treatment.

Trauma-induced suppression of cellular immune function contributes to sepsis, multiple organ dysfunction syndrome (MODS) and mortality. Macrophage migration inhibitory factor (MIF) has been revealed to be central to several immune responses. However, the role of MIF in trauma-like conditions is unknown. Therefore, the present study evaluated MIF in macrophages and polymorphonuclear neutrophils (PMNs). The effects of hypertonic saline (HTS) on lipopolysaccharide (LPS)-induced MIF levels were evaluated in macrophages. MIF concentrations were determined by an enzyme-linked immnosorbent assay (ELISA) and cell lysates were used for western blot analysis. The effects of HTS on N-formyl-methionyl-leucyl-phenylalanine (fMLP)-induced MIF were evaluated in PMNs. MIF concentrations were determined by ELISA, western blotting and real time-polymerase chain reaction (RT-PCR) to determine MIF expression. MIF levels, which were measured by the ELISA, increased by 1.24±0.38 ng/ml in the supernatants of LPS-stimulated macrophages compared with the controls (0.79±0.07 ng/ml) at 2 h. HTS10 (150 mmol/l) partially restored MIF levels (0.84±0.22 ng/ml; P

Many patients visit the emergency department (ED) with abdominal pain. Sometimes, physicians are faced with diagnostic challenges, particularly for older patients. We recently had an elderly female patient who visited the ED several times with non-specific abdominal pain caused by an unusual hernia. One year before, an 81-year-old female visited our ED complaining of abdominal pain radiating to the right inguinal/femoral area. An incarcerated obturator hernia was found on an abdomino-pelvic computed tomography (CT) scan, and she underwent a laparoscopic hernioplasty. However, 1 year later, she revisited complaining of abdominal pain similar to the previous episode. Eventually, the diagnosis of recurrent obturator hernia was made, and a second operation was performed. An obturator hernia may be the cause of non-specific abdominal pain and small bowel obstruction in elderly emaciated females. Recognising the clinical signs and characteristics of this disease is necessary for a prompt diagnosis and treatment.

Purpose: Macrophage migration inhibitory factor (MIF) may serve as a general marker for systemic inflammation in septic and nonseptic acute critical illness. Additionally, our previous experiment has demonstrated that immunosuppressant Prostaglandin E2 (PGE2) lowered MIF levels and inhibited T-cells proliferation when compared to control levels. The addition of hypertonic saline (HTS) increased MIF production as compared with PGE2-stimulated T-cells in concordance with restore PGE2-suppressed T-cells proliferation. Generally, HTS has been well known for its anti-inflammatory effect so far. Therefore, the experiments were conducted to evaluate MIF after stimulating lipopolysaccharide (LPS) either in the presence or absence of HTS in monocyte, in response to early phase injury. Methods: Human acute monocytic leukemic cell line (THP-1) cells were cultured in RPMI media, to a final concentration of 1 × 106 cells/mL. The effect of HTS on LPS-induced MIF was evaluated in monocyte with 1 μg/mL LPS. HTS at 10, 20 or 40 mmol/L above isotonicity was added. MIF concentrations of the supernatant were determined by enzyme-linked immunosorbent assay, and cell lysates were used for Western blots analysis to determine the MIF expression. Results: MIF concentrations in the cell supernatant increased in LPS-induced cells compared to control cells. Also, levels of MIF protein expression were higher in LPS stimulating cells. However, the addition of HTS to LPS stimulated cell restored MIF concentrations and MIF expression. Conclusion: The role of HTS in maintaining physiological balance in human beings, at least in part, should be mediated through the MIF pathway.

Heat stroke is caused by losing control of one's body temperature. It can be life threatening without proper treatment. In this case report, we describe a heat stroke patient treated with an external-cooling device, which is commonly used for therapeutic hypothermia after cardiac arrest. A 67-year-old woman was found unconscious with spontaneous breathing in a sauna. Her body temperature was 40.5°C when she arrived at the emergency department, and she was diagnosed with heat stroke. At seven hours after applying the Arctic Sun Temperature Management System (Medivance), her body temperature declined to 36.5°C, with neurologic improvement (Glasgow Coma Scale score increased from 3 to 12). She was admitted to an intensive care unit and discharged 14 days after admission without any neurological sequelae. In conclusion, an external-cooling device can be used effectively for heat stroke, in addition to therapeutic hypothermia after cardiac arrest.

ObjectivesThe number of paediatric patients visiting the emergency department (ED) continues to rise. In South Korea, approximately 25% of the patients who visit the ED are paediatric patients. In the USA, about 20% of the paediatric population were found to have visited the ED in the past year. A recent study demonstrated that 4.5%–8% of patients account for 25% of all ED visits. Therefore, the aim of this study was to identify the characteristics of recurrent visits.MethodsDesign: retrospective observational study. Setting: this study examined and analysed medical record data involving three tertiary EDs. Participants: a total of 46 237 ED visits by patients ResultsExcluding patients with multiple visits, the total number of paediatric patients who fit the study criteria was 33 765. Among these patients, 23 384 (69.2%) had no recurrent ED visits in the subsequent year after their first visit. A total of 15 849 (46.8%) patients were toddlers (between age 1 and 4 years). In the patient group without a recurrent visit, fever was the most common diagnosis.ConclusionsOur study reviewed medical records to inspect the characteristics of patients who return to care. Higher recurrent visit frequency was associated with using the 119 rescue centre service, having a medical condition, with younger age and a higher rate of hospitalisation. Analysis of the factors associated with frequent ED visits will help to improve care for paediatric patients who visit the ED.

Background: The optimal duration of dual antiplatelet therapy remains controversial. Methods and Results: Between December 2006 and March 2008, 823 patients were enrolled in a prospective multicenter registry for 3-month dual antiplatelet therapy (aspirin 100-200mg+clopidogrel 75mg daily) followed by aspirin mono-therapy after zotarolimus-eluting stents (ZES). Major exclusion criteria were: cardiogenic shock, stent thrombosis (ST)-segment elevation myocardial infarction (MI) within 48h, previous drug-eluting stent implantation, severe left ventricular dysfunction, bifurcation lesions requiring 2-stenting, left main and graft lesions. The primary outcome was a composite of cardiac death, MI, or ST at 1 year. The median duration of dual antiplatelet therapy was 95 days (interquartile range 90-101). At 1 year, 3 patients (0.4%) had cardiac deaths, 3 patients (0.4%) had MI, and 4 patients (0.5%) had definite or probable ST, leading to the primary outcome in 5 patients (0.6%). Death, MI, or any revascularization occurred in 68 patients (8.3%). Among patients who were event-free at 3 months (n=812), clopidogrel was discontinued at 3 months in 661 patients and was continued for longer than 3 months in 151 patients. Discontinuation of clopidogrel at 3 months did not increase the primary outcome (HR 0.90; 95%CI, 0.09-9.02), death, MI, or any revascularization (HR 0.89; 95%CI, 0.48-1.67) after adjustment for the propensity score. Conclusions: Three-month dual antiplatelet therapy seems to be feasible after ZES implantation in relatively low-risk patients. (Circ J 2010; 74: 2314-2321)

Background. T-cell dysfunction after trauma is characterized by decreased T-cell proliferation. Hypertonic saline (HS) restores T-cell proliferation by an unknown mechanism. Arginine and regulation of arginine metabolism plays an important role in normal T-cell function. We hypothesize that HS restoration of T-cell dysfunction is dependent on an arginine mediated mechanism. Material and Methods. Jurkat cells were cultured in both 0 mM and 1.14mM arginine media. Cell proliferation was suppressed using prostaglandin E2 (PGE 2 ) and treated with HS at 20 and 40mM above isotonicity. Arginase activity was blocked by norNOHA. Cell proliferation, arginase activity, and nitrite accumulation were measured. Results. PGE 2 caused a 15.0% inhibition of Jurkat cell proliferation compared with control (P < 0.05). HS reversed PGE 2 suppressed Jurkat cell proliferation to normal. PGE 2 suppression decreased mean arginase activity (66.5 ± 15 nmol/min/mg) compared with controls (98.4 ± 14 nmol/min/mg) (P < 0.05). Cells treated with HS had higher arginase activity (123.8 ± 38 nmol/ min/mg) then PGE 2 suppressed cells and controls (P < .05). Conversely, nitrite was decreased by 14.5% ± 3.1% in HS treated cells compared with PGE 2 suppression (P < 0.05). HS did not restore PGE 2 cell suppression when arginase I was blocked by norNOHA, nor when cells were cultured in arginine-free media. Conclusions. Arginine is essential in restoring Jurkat cell proliferation by HS. HS may restore T-cell dysfunction by increasing arginine transport and arginine metabolism by arginase I. HS treatment will not restore suppressed T-cell proliferation without adequate extracellular concentrations of arginine.

Loss of intestinal barrier function after burn injury allows movement of intraluminal contents across the mucosa, which can lead to the development of distant organ injury and multiple organ failure. Tight junction function is highly regulated by membrane-associated proteins including occludin and zonula occludens protein 1 (ZO-1), which can be modulated by systemic inflammation. We hypothesized that (1) burn injury leads to gut barrier injury, and (2) phosphodiesterase inhibition will attenuate these burn-induced changes. Male balb/c mice undergoing a 30% steam burn were randomized to resuscitation with normal saline or normal saline + pentoxifylline (PTX; 12.5 mg/kg). Intestinal injury was assessed by histological diagnosis and TNF-alpha levels using enzyme-linked immunosorbent assay. Intestinal permeability was assessed by measuring the plasma concentration of fluorescein isothiocyanate-dextran after intraluminal injection in the distal ileum. Occludin and ZO-1 levels were analyzed by immunoblotting and immunohistochemistry. Thirty percent total body surface area (TBSA) burn results in a significant increase in intestinal permeability. Treatment with PTX after burn attenuates intestinal permeability to sham levels. Burn injury resulted in a marked decrease in the levels of tight junction proteins occludin and ZO-1 at 6 and 24 h. The use of PTX after burn significantly decreases the breakdown of occludin and ZO-1. Pentoxifylline also attenuates the burn-induced increase in plasma and intestinal TNF-alpha. Confocal microscopy demonstrates that PTX attenuates the burn-induced reorganization of occludin and ZO-1 away from the tight junction. Pentoxifylline attenuates burn-induced intestinal permeability and decreases the breakdown and reorganization of intestinal occludin and ZO-1. Therefore, phosphodiesterase inhibition may be a useful adjunct strategy in the attenuation of burn-induced gut barrier injury.

Aims Under normal conditions, the intestinal mucosa acts as a local barrier to prevent the influx of luminal contents. The intestinal epithelial tight junction is comprised of several membrane associated proteins, including zonula occludens-1 (ZO-1) and occludin. Disruption of this barrier can lead to the production of pro-inflammatory mediators and ultimately multiple organ failure. We have previously shown that Pentoxifylline (PTX) decreases histologic gut injury and pro-inflammatory mediator synthesis. We hypothesize that PTX prevents the breakdown of ZO-1 and occludin in an in vitro model of immunostimulated intestinal cell monolayers. Main methods Caco-2 human enterocytes were grown as confluent monolayers and incubated under control conditions, or with PTX (2 mM), Cytomix (TNF-α, IFN-γ, IL-1), or Cytomix + PTX for 24 h. Occludin and ZO-1 protein levels were analyzed by Western blot. Confocal microscopy was used to assess the cytoplasmic localization of ZO-1 and occludin. Key findings Cytomix stimulation of Caco-2 cells resulted in a 50% decrease in both occludin and ZO-1 protein. Treatment with Cytomix + PTX restored both occludin and ZO-1 protein to control levels. Confocal microscopy images show that Cytomix caused an irregular, undulating appearance of ZO-1 and occludin at the cell junctions. Treatment with PTX prevented the Cytomix-induced changes in ZO-1 and occludin localization. Significance Treatment with PTX decreases the pro-inflammatory cytokine induced changes in the intestinal tight junction proteins occludin and ZO-1. Pentoxifylline may be a useful adjunct in the treatment of sepsis and shock by attenuating intestinal barrier breakdown.

To compare the prognostic abilities of lactic acidosis and hyperlactatemia and determine the influence of metabolic acidosis when attempting to predict the outcome of septic patients using serum lactate levels.126 patients with severe sepsis or septic shock were prospectively included in this study at an emergency department. Haemodynamic variables, simplified acute physiology score (SAPS) II, arterial blood gas studies and serum lactate levels were obtained at the time of presentation (0 h) and 4 h after presentation. The probability of mortality was calculated using SAPS II scores and compared with actual inhospital mortality at different serum lactate levels and arterial pH. Survival curves for lactic acidosis and severe hyperlactatemia were analysed using the Kaplan-Meier method.The calculated probability of mortality decreased from 35.7% (95% CI 30.2 to 41.2) at presentation to 29.3% (95% CI 24.2 to 34.4) at 4 h post-presentation. 27.0% of patients (34) died in hospital. Arterial pH and SAPS II scores were independent factors for predicting mortality of septic patients, at 0 h and 4 h. Serum lactate levels were closely related to severity of illness and metabolic acidosis in septic patients. Patients with lactic acidosis had significantly higher inhospital mortality than patients with normal pH and normal lactate levels by Kaplan-Meier survival analysis as determined based on measurements made at 0 h and 4 h (p0.001, p0.001 by the log-rank test, respectively). No significant difference in survival was found between patients with hyperlactatemia and those with normal pH and serum lactate levels.Lactic acidosis not hyperlactatemia was found to predict inhospital mortality more exactly in severe sepsis and septic shock patients. The acid-base state should be considered when attempting to predict the outcome of septic patients using serum lactate levels.

Extracorporeal life support has been used as an extension of conventional cardiopulmonary resuscitation (CPR). However, the appropriate indications for extracorporeal CPR (ECPR) including the duration of CPR are unknown. We present a case of a male, 37-year-old out-of-hospital cardiac arrest patient who received prolonged CPR followed by ECPR. Despite advanced cardiac life support, he did not regain a sustained spontaneous circulation and had recurrent ventricular fibrillation (VF) during the prolonged CPR. VF was unresponsive to CPR, defibrillation, adrenaline (epinephrine), and antiarrhythmics. The CPR time before ECPR was approximately 2h. During extracorporeal life support, the VF did not recur and percutaneous coronary angioplasty was achieved. Ultimately, the patient was discharged without neurological complications. Although cardiac arrest occurred out-of-hospital and CPR was performed for a long time, a patient might be a candidate for ECPR if perfusing rhythms are restored transiently but not successfully maintained due to recurrent VF. ECPR may be used for VF unresponsive to standard CPR techniques.

Sepsis in severely injured patients is one of the leading causes of death in hospitals. The incidence of and risk factors for sepsis after trauma have been studied outside, but not within Korea. Therefore, this study investigated the incidence of sepsis and the independent risk factors for sepsis in moderately to severely injured patients in Korea. The electronic medical records of patients who visited the emergency department from January 2010 to December 2012 were reviewed retrospectively. Patients older than 18 years of age with an Injury Severity Score (ISS) greater than or equal to nine points were included. A total of 183 patients met the study inclusion criteria. The median ISS was 14 (range 9–17) points and 15 (8 %) patients developed sepsis. The patients’ age [adjusted OR, 1.053; 95 % confidence intervals (CI), 1.015–1.094], ISS (adjusted OR, 1.114; 95 % CI, 1.046–1.187), and emergency surgery (adjusted OR, 3.727; 95 % CI, 1.051–13.221) were independent risk factors for post-traumatic sepsis. Among the risk factors identified in the literature, our research confirmed only the patients’ age and ISS as risk factors for sepsis after trauma, and, additionally, identified emergency surgery as a risk factor in Korean patients. Therefore, trauma patients who have any of the risk factors mentioned above have a high risk of post-traumatic sepsis, which requires certain precautionary clinical measures.

This study compared the trauma outcome between urban and suburban hospitals. The medical records of patients admitted to the intensive care unit (ICU) following trauma, obtained from 1994 to 1995 and 2002 to 2003, were examined. One was a tertiary university teaching hospital with regional emergency medical center (EMC), and the other was a small general hospital in a suburban area. Since 1999, the suburban hospital has enlarged its capacities to include EMC. In this study, the standardizing W (Ws), 95% confidence interval (CI) of Ws, and the predicted survival rate (Ps) were calculated using the Trauma and Injury Severity Score (TRISS) method. From 1994 to 1995, 225 and 121 records of the urban and suburban hospital were reviewed, respectively. The performance of trauma care in the urban hospital was more accurate than that in the suburban (95% CI of the Ws in urban and small suburban hospital: –2.30 to 2.73 and –11.40 to –5.90, respectively). The actual survival rate of the suburban hospital was significantly lower than the predicted survival rate at all revised trauma score (RTS). From 2002 to 2003, 315 and 268 medical records of urban and suburban hospital were reviewed, respectively. The 95% CI of the Ws in urban and suburban hospital was –3.56 to 0.24 and –3.73 to 0.26, respectively. In addition, there were no differences in the distribution of actual survival rate that was compared with the predicted survival rate according to injury severity score (ISS) and RTS in each hospital. After increasing the capacity of the suburban hospital, the trauma care performance was more accurate, and the ability of the physiologic support had improved. In addition, a larger suburban hospital could manage more severely injured patients without the need for transfer (mean ISS from 1994–1995 to 2002–2003: 21.0 vs. 24.3, p = 0.059, mean RTS: 7.0 and 6.2, p = 0.003; transfer:admission ratio = 0.182:0.056, respectively, p = 0.01). In conclusion, under the well-constructed emergency medical service system, the enlargement of the capacities of emergency and intensive care should improve the performance of trauma care in suburban hospital.

Objectives: This study investigated the effect of hypertonic saline on the role of polymorphonuclear neutrophils (PMNs) in the inflammatory response and the effect of hypertonic saline infused at different phases in relation to an inflammatory stimulus. Materials and methods: PMNs were isolated from peripheral blood of healthy volunteers (Boyum’s method) and cultured in three different media ([Na + ] = 140 mmol/l, 180 mmol/l, and 200 mmol/l). PMNs were then stimulated with fMLP ( N -formyl-methionyl-leucyl-phenylalanine) and H 2 O 2 synthesis was quantified by flow cytometry at 5, 30, 60, 120, and 180 minutes. PMNs were treated with hypertonic saline before, simultaneously with, and after fMLP stimulation, and H 2 O 2 synthesis quantified again. Results: H 2 O 2 synthesis was two or three times higher in fMLP stimulated than in non-stimulated PMNs, and it reached maximum level at 120 minutes. In the absence of fMLP stimulation, there was no significant difference between control and hypertonic saline with regard to activity of H 2 O 2 synthesis. In the presence of fMLP stimulation, H 2 O 2 synthesis significantly decreased in PMNs treated with hypertonic saline. There was no significant difference between the two hypertonic saline solutions ([Na + ] = 180 mmol/l and 200 mmol/l) with regard to H 2 O 2 synthesis. However, H 2 O 2 synthesis decreased in PMNs treated with hypertonic saline before and simultaneously with fMLP stimulation, but was not significantly decreased in the cells treated with hypertonic saline after fMLP stimulation. Conclusions: Hypertonic saline appears to decrease H 2 O 2 in stimulated neutrophils. This may be a further beneficial role of hypertonic saline when used clinically as an early resuscitation fluid.

Recognizing the composite correction program (CCP) has been successful in improving drinking water quality in the USA, the Ministry of Environment (MoE) of Korea has initiated a similar program since 1998. After three years' work, the research team has proposed an evaluation program. Water treatment plants have been classified into four groups based on their capacities because this has best represented current standings of the plant. Group 1 consists of small plants having a capacity of less than 5,000 m 3 /day. The plants in Group 4 have capacities of more than 100,000 m 3 /day. Group 2 consists of small to medium sized plants of 5,000-50,000 m 3 /day, whereas the plants in Group 3 have capacities between 50,000 m 3 /day and 100,000 m 3 /day. The evaluation documents and the treatment goals for each group also have been established in consideration of manpower and characteristics of the facilities. The disinfection goal has been set up to ensure 0.5 log removal of Giardia regardless of the group, whereas the turbidity goal has been differentiated from 0.1 NTU to 0.5 NTU. A flow chart and a detailed inspection list identifying the vulnerable points of the plant have been prepared to help the operators to know how best to improve the performance. The education programs for operators also have been practiced. The MoE has prepared a quantitative evaluation list to score water treatment plants by their capacities, facilities, manpower and the local government's financial supports. The MoE has graded water treatment plants nationwide and local governments have been ranked by the plants in their areas. The resulting grades have been announced annually so that community citizens knew where their community was positioned and how much attention their local government has paid to the waterworks. The performance evaluation program strongly backed up by the MoE is going to be spread out nationwide step-by-step. Thus, things are happening in Korea. However, some of the concepts and principles could be referred to the countries that are planning to introduce a similar program.