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Background The older population (≥65 years) has rapidly increased in size in recent years. Among them, the middle-to-oldest-old (≥75 years) tend to have a poor health status. Therefore, subdivision and evaluation of older patients with traumatic injury are required. We focused on the risk of femoral intertrochanteric fractures occurring in older adults due to minor falls and compared young-old and middle-to-oldest-old populations. Methods The medical records of patients who visited the emergency center due to hip injuries between March 2017 and March 2019 were retrospectively analyzed. Patients were divided into older adult (≥65 years) and non-older (age 18–64 years) groups; the older adult group was subdivided into young-old (65–74 years), middle-old (75–84 years), and oldest-old (≥85 years) groups. This study investigated the occurrence rate of femoral intertrochanteric fractures and related factors. Results The older adult group had a higher incidence of femoral intertrochanteric fractures than that in the non-older adult group (95.3% vs. 4.7%, p

Background: This study aimed to evaluate the relationship between systolic blood pressures (SBPs) within 10 hours after intravenous recombinant tissue plasminogen activator (rtPA) treatment and early neurological outcomes in geriatric and nongeriatric patients with acute ischemic stroke (AIS). Methods: This was a retrospective observational study of patients with AIS who received intravenous rtPA between January 2010 and May 2015. Clinical factors were compared between geriatric and nongeriatric patients. SBPs at the time of rtPA bolus and every hour thereafter were collected. The primary outcome was major neurological improvement (MNI) at 24 hours after thrombolysis. Results: Serial measures of SBP revealed different 10-hour courses between patients with and without MNI in the geriatric group. The difference in SBP tendency was statistically significant (p=0.049). In contrast, there was no significant difference in SBP change in the nongeriatric group (p=0.251). In univariate analysis, geriatric patients with MNI showed higher frequency of very early neurological improvement (VENI) at 1 hour after rtPA infusion (p=0.023) and lower level of SBP at 3 hours and 10 hours (p=0.037 and p=0.046, respectively). In multivariate analysis using a logistic regression model, VENI at 1 hour and SBP value after 10 hours were independently related to MNI. Conclusion: SBP level and its change during the first 10 hours after intravenous rtPA treatment are different between geriatric and nongeriatric patients. In the geriatric group, SBP decrease is predictive of neurological state at 24 hours after thrombolysis. In the nongeriatric group, SBP decrease is not associated with neurological outcome.

Background: Social changes related to the elderly in regard to factors such as population, region, cohabitant status and depression incidence, have recently been observed. The aim of our study was to investigate the characteristics of elderly suicide attempters according to these changes. Methods: We retrospectively reviewed the medical records of suicide attempters who visited an Emergency Department between January 2013 and March 2016. Patients were classified into an elderly or non-elderly group. Data included demographic, socioeconomic, and clinical characteristics. The Risk-Rescue Rating Scale (RRRS) and Suicide Intent Scale (SIS) scores were calculated. Results: Of 340 patients, 78 were elderly. Male sex, lower educational and financial status, chronic disease, and depression were more common in the elderly group, while previous history of suicide attempt was more frequent in the non-elderly group. RRRS was higher in the elderly group, while SIS was not significantly different between the 2 groups. Unlike the non-elderly group, no correlation between suicide lethality and intention was found in the elderly group. Multiple logistic regression analysis identified that chronic disease, depression, unemployment, cohabitation, and high lethality were risk factors of suicidal attempts in the elderly. Similar results were observed in the study classified by suicide method. Conclusion: Chronic disease, depression, unemployment, and lethality were found to be risk factors of suicidal attempts in the elderly. However, unlike previous reports, several risk factors, including male sex, cohabitation, and suicide intention took on a different aspect in our study. The differences in these characteristics can be an important guide aiming to develop specific elderly suicide precautions.

Background: In patients with foreign bodies in their digestive systems, old age is associated with higher rates of incidence and complications. Therefore, we compared the characteristics of geriatric patients with nongeriatric patients who were found to have with foreign bodies in their digestive systems. Methods: We retrospectively analyzed 497 cases of foreign bodies in the digestive system over the period from 2010 through 2014. Patients were divided into two groups: nongeriatric (20-64 years, n=404) and geriatric (≥65 years, n=93). Results: The geriatric patients had more underlying diseases (12.0% vs. 3.0%), took longer to arrive at the hospital (8.92± 21.31 hours vs. 4.50±14.76 hours, p

Background: Incidence rate of ureterolithiasis has been increasing worldwide in general, with an especially rapid increase in the elderly, over 65 years of age. Therefore, the characteristics of geriatric patients diagnosed with uureterolithiasis in an Emer- gency Center were examined. Methods: A total of 613 consecutive patients who were diagnosed with ureterolithiasis through computed tomography from January 2012 to March 2014 were analyzed retrospectively. The patients were divided in two groups: the geriatric group and nongeriatric group. Results: Among the 613 patients, there were 64 geriatric patients (≥65 years, 10.4%) and 549 nongeriatric patients (

Brain inflammation plays a pivotal role in the pathogenesis of chronic neurodegenerative disorders, including Alzheimer's disease and Parkinson's disease. We investigated the effects of treadmill exercise and wheel exercise on spatial learning ability in relation with long-term potentiation (LTP) using lipopolysaccharide-induced brain inflammation in the rats. Brain inflammation was induced by an injection of LPS into the cerebral ventricle. We found that brain inflammation impaired spatial learning ability and suppressed the induction of LTP in the hippocampus, as well as weakening expressions of brain-derived neurotrophic factor (BDNF) and its receptor tyrosine kinase B (Trk-B) with the phosphorylated cyclic AMP response element binding protein (p-CREB). Both treadmill exercise and wheel exercise significantly improved spatial learning ability deteriorated by brain inflammation. These effects can be ascribed to the long-lasting effect of exercise on LTP through enhancement of the expressions regarding BDNF, TrkB, and p-CREB. Treadmill exercise and wheel exercise exerted similar effects on these factors. We infer that exercise may alleviate brain inflammation-induced learning impairment.

This study aims to identify the therapeutic effect of Korean red ginseng (KRG) on the expression of inflammatory cytokines in rats with focal cerebral ischemia/reperfusion injury. Adult male Sprague-Dawley rats were subjected to transient middle cerebral artery occlusion (tMCAO) for two hours. They were fed KRG extract (100 mg/kg/day per orally) or saline after reperfusion. Tests for neurological deficits, using the modified neurologic severity score and the corner turn test, were performed before the ischemic event, and one, three, and seven days after tMCAO. Serum levels of cytokines were measured three and seven days after the operation, using enzyme-linked immunosorbent assays. The infarct volume was assessed after seven days by staining brain tissue with 2% 2, 3, 5-triphenyltetrazolium chloride. Oral administration of KRG significantly reduced the infarct volumes and rapidly improved neurological deficits. Serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and IL-6 were higher in tMCAO-operated rats than in the sham-operated rats. These changes were attenuated by daily KRG intake for seven days. Serum IL-10 levels were significantly increased in KRG-fed rats, as compared to sham-operated and saline-fed rats. Our results suggested that KRG provides neuroprotection for rats with focal cerebral ischemia/reperfusion injury. This neuroprotection may be due to raised IL-10 expression and a reduction in the serum levels of TNF-α, IL-1β, and IL-6.

The objective of this study was to examine antioxidant and anticytokine effects of bovine colostrum (BC) in an intestinal ischemia/reperfusion injured rat model. Forty Sprague-Dawley rats were induced intestinal ischemia/reperfusion injury. After reperfusion the rats were given BC, 0.9% saline or low fat milk (LFM) orally. The antioxidative activities using superoxide dismutase (SOD), glutathione peroxidase (GSH-PX), catalase (CAT), and malondialdehyde (MDA) were analyzed in this study. Serum cytokine levels [tumor necrosis factor (TNF)-α, interlukin (IL)-1β, IL-6, and IL-10] were also checked. SOD (1.53±0.23 U/mg of protein), GSH-PX (7.62±0.66 U/mg of protein), and CAT (42.16±3.16 U/mg of protein) activities increased and MDA level (0.58±0.05 mmol/mg of protein) decreased significantly in rats fed BC compared to rats fed saline or LFM (p

To describe the CT findings of focal osteolysis following total hip replacement (THR). CT imaging features of 30 THRs with focal osteolysis visualized on follow-up radiographs and undertaken revision surgery were reviewed. On CT scans, the shape and anatomic location of osteolytic lesions was recorded, as well as their size and number. The presence of cortical disruption or expansion, liner wear, metallosis, and heterotopic ossification was also noted. In each case, surgical and histologic findings were correlated with imaging features. Focal osteolysis was common in the superior part of acetabular and femoral components. CT features of focal osteolysis were multiple, expansile, oval, or round radiolucencies, which were conglomerated into multilobular shape. The cortex adjacent to the osteolytic lesions revealed irregular thinning and discontinuity (29/30, 97%) accompanied by a few tiny fragments. Liner wear was common (27/30, 90%), and metallosis was frequent (8/30, 26.7%). Pathologic results were foreign body reaction in 20 patients, chronic inflammation in eight, and fibrosis in two. CT appearances of focal osteolysis following THR are multilobulated lucent areas with expansile periosteal reaction and cortical abnormalities, mimicking infection or tumor. We consider that CT is useful for the prediction and assessment of the nature and extent of focal osteolysis.

ACADEMIC EMERGENCY MEDICINE 2011; 18:440–442 © 2011 by the Society for Academic Emergency Medicine Abstract Objectives: This study aimed to investigate the potential of C-reactive protein (CRP) as a predictor of death within 14 days in acutely symptomatic patients with advanced cancer admitted to the emergency department (ED). Methods: A prospective observational study was conducted of 126 consecutive patients with advanced cancer who were admitted to the ED because of acute symptoms. The patients were categorized into two groups according to serum CRP levels (cutoff 9.2 mg/dL). Demographic characteristics, disease-related factors, clinical symptoms and signs, and laboratory data were collected. Univariate and multivariate analyses were performed to evaluate the relationship between clinical findings and 14-day mortality. Results: Median survival was 26.5 days (interquartile range = 8.0–79.5 days). In univariate analysis, serum CRP level (≥9.2 mg/dL), chemotherapy, age (≥65 years), altered mental status, hypotension, and leukocytosis were significant. Multivariate regression analysis revealed that among these variables, serum CRP level (hazard ratio [HR] = 2.444, 95% confidence interval [CI] = 1.298 to 4.603, p = 0.006) and chemotherapy (HR = 0.452, 95% CI = 0.236 to 0.863, p = 0.016) were independent prognostic factors for 14-day mortality. Conclusions: Serum CRP levels may provide information on death within 14 days after the ED visit in patients with advanced cancer.

Objectives The spiral computed tomography (CT) with the advantage of low radiation dose, shorter test time required, and its multidimensional reconstruction is accepted as an essential diagnostic method for evaluating the degree of injury in severe trauma patients and establishment of therapeutic plans. However, conventional sequential CT is preferred for the evaluation of traumatic brain injury (TBI) over spiral CT due to image noise and artifact. We aimed to compare the diagnostic power of spiral facial CT for TBI to that of conventional sequential brain CT. Methods We evaluated retrospectively the images of 315 traumatized patients who underwent both brain CT and facial CT simultaneously. The hemorrhagic traumatic brain injuries such as epidural hemorrhage, subdural hemorrhage, subarachnoid hemorrhage, and contusional hemorrhage were evaluated in both images. Statistics were performed using Cohen's κ to compare the agreement between 2 imaging modalities and sensitivity, specificity, positive predictive value, and negative predictive value of spiral facial CT to conventional sequential brain CT. Results Almost perfect agreement was noted regarding hemorrhagic traumatic brain injuries between spiral facial CT and conventional sequential brain CT (Cohen's κ coefficient, 0.912). To conventional sequential brain CT, sensitivity, specificity, positive predictive value, and negative predictive value of spiral facial CT were 92.2%, 98.1%, 95.9%, and 96.3%, respectively. Conclusion In TBI, the diagnostic power of spiral facial CT was equal to that of conventional sequential brain CT. Therefore, expanded spiral facial CT covering whole frontal lobe can be applied to evaluate TBI in the future.

Aims Parkinson's disease is a debilitating neurodegenerative disorder characterized by the gradual loss of dopaminergic neurons. We investigated the effects of treadmill exercise on dopaminergic neuronal loss and microglial activation using 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine/probenecid (MPTP/P)-induced Parkinson's disease mice. Main methods Parkinson's disease was induced in mice by injection of MPTP/P. The mice in the exercise groups were put on a treadmill to run for 30 min/day, five times per week for four weeks. Motor balance and coordination was measured using rota-rod test. Expressions of inducible nitric oxide synthase (iNOS) and phosphorylated extracellular signal-regulated kinase (p-ERK), phosphorylated NH 2 -terminal kinase (p-JNK), phosphorylated p-38 (p-p38), CD200, and CD200 receptor were determined by western blotting. Expressions of tyrosine hydroxylase (TH) and CD11b were evaluated by immunohistochemistry. Key findings Parkinson's disease mice displayed poor motor balance and coordination with loss of nigrostriatal dopaminergic neurons. iNOS expression was enhanced via up-regulation of phosphorylated mitogen-activated protein kinases (p-MAPKs) signaling, such as p-ERK, p-JNK, and p-p-38 in the Parkinson's disease mice. Microglial activation was also observed in the Parkinson's disease mice, showing increased CD11b expression with suppressed CD200 and CD200 receptor expressions. Treadmill exercise prevented the loss of nigrostriatal dopaminergic neurons, and ameliorated the motor balance and coordination dysfunction in the Parkinson's disease mice. Treadmill exercise suppressed iNOS expression via down-regulation of MAPKs and also inhibited microglial activation in the Parkinson's disease mice. Significance Treadmill exercise prevented dopaminergic neuronal loss by inhibiting brain inflammation through suppression of microglial activation in the Parkinson's disease mice.

Background There is limited literature describing clinical predictors for critically ill patients with cancer who present to the emergency department (ED). Purpose The aim of this study was to investigate the usefulness of the Sequential Organ Failure Assessment (SOFA) score at the time of ED presentation for predicting short-term mortality in patients with advanced cancer. Methods This was a prospective observational study of 108 consecutive patients with advanced cancer who presented to the ED. The outcome was defined as death within 14 days after admission. Results The median survival time of the study subjects was 26.5 days (interquartile range, 9.0-78.0 days), and 31 patients (28.7%) died within 14 days after admission. In univariate analysis, SOFA score (≥4), previous chemotherapy, and altered mental status were predictive of 14-day mortality. Of those variables, only SOFA score was an independent predictor in multivariate analysis. Conclusions The use of the SOFA score is an acceptable method for risk stratification and prognosis of patients with advanced cancer in the ED. This score can help clinicians to predict 14-day mortality and plan appropriate treatment for critically ill patients with cancer who present to the ED.

An infected aortic aneurysm, or mycotic aneurysm, is a rare arterial dilatation due to destruction of the infected vessel wall. Common pathogens resulting in an infected aortic aneurysm are Salmonella and Clostridium species, as well as Staphylococcus aureus; Morganella morganii, on the other hand, is very rare. An infected abdominal aortic aneurysm has tendencies to grow rapidly and to rupture. The mortality rate is high in patients undergoing emergent surgical intervention. We report the case of a 65-year-old man who presented with an infected abdominal aortic aneurysm caused by M. morganii. A high index of suspicion and imaging tests are necessary in order to diagnose an infected aortic aneurysm.

This study evaluated whether or not bovine colostrum (BC) is able to treat or prevent intestinal barrier damage, bacterial translocation, and the related systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) in an intestinal ischemia/reperfusion (I/R)-injured rat model. Fifty Sprague-Dawley rats were used. The rats' intestinal I/R injuries were induced by clamping the superior mesenteric artery for 30 minutes. After 3 hours of reperfusion and then twice daily reclamping during the experiment, the experimental group was given BC (4 mL/kg/day) perorally, and the other groups received 0.9% saline and low fat milk (LFM) after intestinal I/R injury. Seventy-two hours later we assessed (1) intestinal damage and intestinal permeability, (2) enteric bacterial count and bacterial translocation, (3) serum albumin, protein, and hepatic enzyme levels, (4) pathologic findings of ileum and lung, (5) activity of oxygen-free radical species, and (6) pro-inflammatory cytokines (tumor necrosis factor-alpha and interleukin-1beta). Intestinal damage, intestinal permeability, and bacterial translocation to other organs were significantly reduced in rats fed with BC after I/R when compared to rats fed LFM/saline after I/R (P.05). In the evaluation of acute lung injury, neutrophils were found only in the lungs of the saline-fed group after I/R, and the wet/dry ratio of the lung tissue was significantly reduced in the BC-fed group after I/R compared to other I/R groups. A marked difference was found between LFM/saline-fed groups and BC-fed groups regarding malondialdehyde (P.05) and pro-inflammatory cytokines (P.01). In conclusion, BC may have beneficial effects in treating and preventing intestinal barrier damage, bacterial translocation and the related SIRS and MODS in the intestinal I/R-injured rat model.

Extraskeletal myxoid chondrosarcoma is a rare soft-tissue sarcoma that usually occurs in deep soft tissues, especially those of the proximal extremities and limb girdles, but is rare in children. We present an unusual case of a tumor arising in the perineum and involving the bulbous urethra in a 21-month-old boy. The patient was treated with surgical excision and urethroplasty followed by combination chemotherapy.

Purpose: To evaluate Doppler sonographic findings of acute renal vein thrombosis in rabbit model induced by renal vein ligation, with an emphasis on the changes in resistive index (RI) on serial follow-up. Materials and Methods: Conventional and Doppler sonographies were performed immediately after ligation and 24, 48, and 72 hours after ligation in 12 rabbits weighing 4.5-5.0 kg. We focused on changes in kidney size and echogenicity with conventional sonography and resistive index by time interval and Doppler waveforms with Doppler sonography. Results: Kidney size increased markedly immediately after ligation, and increased slowly until 48 hours after ligation with no change observed afterwards. Echogenicity increased both in the renal cortex and the medulla. RI increased remarkably to an average of 1.38 immediately after ligation, and increased to a peak average of 1.64 48 hours after ligation. After 72 hours RI decreased slightly to 1.59. Reverse 'plateau-like' diastolic waveform was seen in 27 trials (56%) on follow up Doppler sonograms. Conclusion: The increase in RI was thought to be due to the increase in renal arterial vascular resistance caused by venous outflow obstruction. The decrease in RI with time suggested adaptation of intrarenal circulation to renal vascular change. Also, the reverse 'plateau-like' diastolic waveform was the predominant waveform.

Purpose: To determine the presence of cruciate ligament tears following avulsion injuries involving the ACL and PCL, and to correlate the findings with those of surgery. Materials and Methods: Between March 1997 and May 2002, avulsion injury involving the ACL or PCL was diagnosed in 19 patients. Ten of these [8 males and 2 females aged 10-51 (avergae, 27.7) years] were included in this study. We assessed the presence of cruciate ligament tears at MR imaging, correlating the findings with those of surgery. Associated intra-articular injuries, treatment methods and follow-up results were also evaluated. Results: Among Seven patients with ACL avulsion injury, this was assessed at MR imaging as complete tear (n=1), partial tear (n=5), or intact (n=1), while all MR images of PCL avulsion injury (n=3) showed that this was partial tear. All imaging findings corresponded with the surgical findings. In four patients there was associated knee injury involving, respectively, tears of the medial meniscus, lateral meniscus, PCL and MCL, and popliteal ligament. Conclusion: Our findings showed that with one exception, patients with avulsion injury of the ACL or PCL had suffered either a partial or complete tear. MR imaging may be useful in the diagnosis of tears of the cruciate ligament which have not been noticed at surgery or arthroscopy in avulsion injuries involving the ACL and PCL