[Show abstract][Hide abstract] ABSTRACT: Background
Hypertonic saline is often used to resuscitate patients experiencing shock. In such conditions, polymorphonuclear cells and Toll-like receptors (TLRs) form an essential part of early induced innate immunity.
To investigate the immunomodulatory effect of hypertonic saline on polymorphonuclear cells by evaluating the changes in TLR-4 receptors and proinflammatory cytokines.
Polymorphonuclear cells were isolated from whole blood using Polymorphprep (Axis-Shield, Oslo, Norway). The isolated polymorphonuclear cells were plated at a density of 1 × 106 cells/mL in 6-well flat-bottomed culture plates and were stimulated with 1 μg/mL lipopolysaccharide or N-formyl-methionyl-leucyl-phenylalanine. The stimulated polymorphonuclear cells were cultured in hypertonic saline at 10, 20, or 40 mmol/L above isotonicity. After that, the changes in TLR-4 and cytokines were measured by quantitative real-time polymerase chain reaction and flow cytometry.
The level of TLR-4 mRNA expression decreased after stimulation with N-formyl-methionyl-leucyl-phenylalanine, but hypertonic saline did not affect the TLR-4 mRNA expression. TLR-4 mRNA expression was clearly induced upon stimulation with lipopolysaccharide, and the addition of hypertonic saline restored TLR-4 mRNA expression in polymorphonuclear cells. The interleukin-1β mRNA expression was decreased in the hypertonic environment. On the other hand, the tumor necrosis factor-α value was not influenced by the addition of hypertonic saline.
Hypertonic saline has an immunomodulatory effect on polymorphonuclear cells through the TLR-4 pathway, and the interleukin–1β-associated pathway is influenced more by hypertonic saline than is the tumor necrosis factor–α-associated pathway.
Current Therapeutic Research 01/2014; 76:58–62. · 0.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Social factors may affect the available sources of toxic substances and causes of poisoning; and these factors may change over time. Additionally, understanding the characteristics of patients with acute toxic poisoning is important for treating such patients. Therefore, this study investigated the characteristics of patients with toxic poisoning. Patients visiting one of 3 hospitals in 2003 and 2011 were included in this study. Data on all patients who were admitted to the emergency departments with acute toxic poisoning were retrospectively obtained from medical records. Total 939 patients were analyzed. The average age of patients was 40.0 ± 20 yr, and 335 (36.9%) patients were men. Among the elements that did not change over time were the facts that suicide was the most common cause, that alcohol consumption was involved in roughly 1 of 4 cases, and that there were more women than men. Furthermore, acetaminophen and doxylamine remained the most common poisoning agents. In conclusion, the average patient age and psychotic drug poisoning has increased over time, and the use of lavage treatment has decreased.
Journal of Korean medical science 10/2013; 28(10):1424-30. · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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<0.05). Also, western blotting was performed and MIF protein levels were higher in the LPS-stimulated macrphages (20% increase in band density) compared with the controls (P<0.05). The addition of HTS decreased MIF protein expression. MIF levels in fMLP-stimulated PMN cells were unchanged compared with the controls according to the ELISA, western blotting and RT-PCR. No effects were observed following treatment with HTS. MIF concentrations and MIF expression were higher in LPS-stimulated macrophages than controls and HTS restored MIF levels to those of the controls. MIF levels were unchanged in PMNs stimulated by fMLP.
Experimental and therapeutic medicine 01/2013; 5(1):362-366. · 0.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Most trauma patients visit the hospital via the emergency department. They are at high risk for tetanus infection because many trauma patients are wounded. Tetanus immunity in the Korean population has been revealed to be decreased in age groups over 20 years old. It is important for emergency physicians to vaccinate patients with the tetanus booster in wound management. METHODS: Questionnaires were sent to the directors of the emergency departments of resident training hospitals certified by the Korean Society of Emergency Medicine. RESULTS: Two thirds of the emergency department directors surveyed reported applying tetanus prophylaxis guidelines to more than 80% of wounded patients. However, about 45% of clinicians in the emergency departments considered giving less than half of the wounded patient tetanus booster vaccinations, and there were no distinct differences in tetanus booster vaccination rates among different age groups. Most emergency physicians are familiar with tetanus prophylaxis guidelines for wound management. However, more than half of the emergency department directors reported that the major reason for not considering tetanus-diphtheria vaccination was due to assumptions that patients already had tetanus immunity. CONCLUSION: Attitude changes should be encouraged among emergency physicians regarding tetanus prophylaxis. As emergency physicians are frequently confronted with patients that are at a high risk for tetanus infection in emergency situations, they need to be more informed regarding tetanus immunity epidemiology and encouraged to administer tetanus booster vaccines.
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 05/2012; 20(1):35. · 1.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: 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 E(2) (PGE(2)) 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 PGE(2)-stimulated T-cells in concordance with restore PGE(2)-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.
Human acute monocytic leukemic cell line (THP-1) cells were cultured in RPMI media, to a final concentration of 1 × 10(6) 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.
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.
The role of HTS in maintaining physiological balance in human beings, at least in part, should be mediated through the MIF pathway.
Journal of the Korean Surgical Society. 01/2012; 82(1):1-7.
[Show abstract][Hide abstract] ABSTRACT: Trauma-induced suppression of cellular immune function likely contributes to sepsis, multiple organ dysfunction syndrome and death. T cell proliferation decreases after traumatic stress. The addition of prostaglandin E(2) (PGE(2)), which depresses immune function after hemorrhage and trauma, to T-cells decreases T-cell proliferation; and hypertonic saline restores PGE(2)-induced T-cell suppression. Recently, it has become apparent that macrophage migration inhibitory factor (MIF) plays a central role in several immune responses, including T-cell proliferation. However, the role of MIF in mediating hypertonic saline (HTS) restoration of T cell dysfunction is unknown. Therefore, we hypothesize that T cell immune restoration by HTS occurs, at least in part, by a MIF-mediated mechanism.
Jurkat cells were cultured in Roswell Park Memorial Institute media, at a final concentration of 2.5 × 10(6) cell/mL. The effects of HTS on T-cell proliferation following PGE(2)-induced suppression were evaluated in Jurkat cells: HTS at 20 or 40 mmol/L above isotonicity was added. MIF levels were determined by enzyme-linked immunosorbent assay and western blot analysis.
PGE(2) caused a 15.0% inhibition of Jurkat cell proliferation, as compared to the control. MIF levels decreased in PGE(2)-suppressed cells, as compared to the control. MIF levels were higher in cells treated with HTS than PGE(2)-stimulated cells.
The role of HTS in restoring Jurkat cells proliferation suppressed by PGE(2), at least in part, should be mediated through a MIF pathway.
Journal of the Korean Surgical Society. 10/2011; 81(4):229-34.
[Show abstract][Hide abstract] ABSTRACT: The Ganoderma species are mushrooms used for herbal medicinal purposes in northeast Asia. Two cases of simultaneous reversible pancytopenia following the consumption of decoction of Ganoderma neojaponicum Imazeki are presented. Other than decoction of G. neojaponicum Imazeki no cause of pancytopenia could be identified. The patients recovered fully after conservative treatment. People who consume herbal medicines are often not aware of their side effects. Patients should be knowledgeable regarding the possible side effects of Ganoderma prior to its consumption.
[Show abstract][Hide abstract] ABSTRACT: Hypertonic saline (HS) restores prostaglandin E(2) (PGE(2))-induced T-cell suppression in the presence of 1100 microM arginine. However, under arginine-free culture conditions, HS dose not restore T-cell proliferation. Therefore, we wanted to determine if HS can restore PGE(2)-induced T-cell suppression in the presence of 80 microM of arginine, the physiologically relevant arginine concentration. We also wanted to determine the concentration of arginine that induces HS restoration of PGE(2)-suppressed T-cell proliferation and whether HS restoration of T-cell dysfunction is dependent on the injection time of HS.
Jurkat cells were cultured in media containing 0, 40, 80, 400, 800, or 1100 microM arginine. In both the PGE(2)-stimulated and HS-treated group, we measured cell proliferation using MTT assay and arginase activity. We also measured cell proliferation relative to HS injection time.
In 80 microM arginine, HS did not restore Jurkat cell proliferation that had been suppressed by PGE(2). Increased concentrations of arginine in the media increased MTT cell proliferation. In 800 microM arginine media, HS restored PGE(2)-suppressed Jurkat cell proliferation to normal. HS restored PGE(2)-suppressed Jurkat cell proliferation when it was added at 2 h, similar to at same time and 1 h after PGE(2) stimulation.
In order to restore PGE(2)-suppressed Jurkat cell proliferation, HS requires at least 800 microM arginine. HS restored PGE(2)-suppressed Jurkat cell proliferation even though HS was added at 2 h after PGE(2) stimulation.
Journal of Surgical Research 09/2010; 163(1):e17-22. · 2.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This report introduces and discusses the present state of the helicopter emergency medical services (HEMS) in the metropolitan area of South Korea. The data of patients transported by HEMS from April 2007 to June 2009 were provided by Seoul Metropolitan Fire and Disaster Management Department. The data of patients subsequently transported to Korea University Guro Hospital were analyzed. During the study period, 725 emergency rescue calls were dispatched and 703 patients were rescued, of which 562 patients were judged by an emergency medical technician to be in a nonemergent condition and were referred to ground emergency medical services and 141 patients were judged as having an emergent situation and were directly transported to a nearby hospital. The data of patients who were transported to Korea University Guro Hospital by HEMS were as follows. The mean age was 51.7±12.1 years; 75.6% were male patients; 28 patients (68.3%) were traumatically injured; the mean of the injury severity score was 13.5±14.7, and 13 patients (46.4%) had an injury severity score of more than 15. No procedures other than basic life support were performed by the emergency medical technicians during transport. The role of HEMS in South Korea is limited to transporting injured patients from locations that cannot be approached by ground emergency medical services. Even though HEMS is essential considering the local mountainous geography of Seoul, Korea, overutilization of HEMS is still suspected in the metropolitan area.
European Journal of Emergency Medicine 09/2010; 18(3):176-8. · 0.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 53-year-old male visited our emergency department after ingesting an unknown amount of methyl ethyl ketone peroxide. At presentation, he was hypotensive with reduced conscious level. Despite resuscitation, he died about 6 h after admission. On simple radiography, it was found that the patient had diffused gastric emphysema. We assumed that the unique radiologic findings were derived from the increased upper gastrointestinal tract pressure that occurred during bag-valve-mask ventilation with the patient having severely damaged gastric mucosa.
[Show abstract][Hide abstract] ABSTRACT: It is important for preventing hyperventilation so as to improve the outcomes of patients with severe traumatic brain injuries. End-tidal CO2 (Petco2) reflects arterial CO2 (Paco2), noninvasively and continuously. The aim of this study is to examine the concordance between Paco2 and Petco2 among adults presenting to the emergency department with severe traumatic brain injury and to elucidate the patient groups who had discordance.
From July 1, 2006 to December 31, 2007, 77 patients who presented in the emergency department of the hospital after severe brain injury were enrolled. Glasgow Coma Scale, blood pressure, heart rate, respiration rate, body temperature, arterial blood gas variables, and serum lactate levels were measured under the mechanical ventilation support. Finally, Injury Severity Score and Abbreviated Injury Scale of head and chest were recorded. The concordance between Petco2 and Paco2 was analyzed using Bland-Altman plot. We defined that normal gap of Paco2 and Petco2 [P(a-et)co2] is -5 mm Hg to 5 mm Hg, and compared the normal and high P(a-et)co2 groups to find the factors affecting the P(a-et)co2.
Sixty-six patients after exception of 11 patients with nontraumatic brain injury were analyzed. Ten patients (15.2%) were below 30 mm Hg of Paco2. Pearson's correlation coefficient between Paco2 and Petco2 was 0.666 (p < 0.001) and the concordance between Paco2 and Petco2 was 77.3%. The patients with high P(a-et)co2 showed significantly higher Injury Severity Score, lower systolic blood pressure, lower arterial pH, lower base deficit, and higher serum lactate levels than patients with normal P(a-et)co2. Patients with severe chest trauma, hypotension, and metabolic acidosis increased the risk of the discordance between Paco2 and Petco2. Twenty-eight patients who had no hypotension, no metabolic acidosis, and no severe chest trauma showed concordance rate of 100.0% between Paco2 and Petco2.
Severe chest trauma and hemodynamic and tissue perfusion state should be considered when attempting to monitor the hyperventilation in severe brain injury patients using Petco2.
The Journal of trauma 09/2009; 67(3):526-30. · 2.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to determine the clinical value of arterial minus end-tidal CO(2) [P(a-et)CO(2)] and alveolar dead space ventilation ratio (V(dA)/V(t)) as indicators of hospital mortality in patients that have been resuscitated from cardiac arrest at emergency department.
Forty-four patients with a return of spontaneous circulation (ROSC) after cardiac arrest were studied in the emergency department of a university teaching hospital from March 2004 to February 2006. Mean arterial pressure (MAP), serum lactate, arterial blood gas studies, end-tidal CO(2) (EtCO(2)), P(a-et)CO(2), and V(dA)/V(t) were evaluated at 1 h after ROSC. We compared these variables between hospital survivors and non-survivors.
The rates of ventricular fibrillation and pulseless ventricular tachycardia in hospital survivors were higher than those of non-survivors (53.0 and 9.7%, respectively, p=0.002). Hospital survivors had significantly higher MAP, lower serum lactate, lower P(a-et)CO(2), and lower V(dA)/V(t) value than non-survivors. Receiver operator characteristic (ROC) curves of serum lactate, P(a-et)CO(2), and V(dA)/V(t) showed significant sensitivity and specificity for hospital mortality. Specifically, lactate > or = 10.0 mmol/L, P(a-et)CO(2) > or = 12.5 mmHg, and V(dA)/V(t) > or = 0.348 were all associated with high hospital mortality (p=0.000, 0.001 and 0.000, respectively).
This study showed that high serum lactate, high P(a-et)CO(2) and high V(dA)/V(t) during early ROSC in cardiac arrest patients suggest high hospital mortality. If future studies validate this model, the P(a-et)CO(2) and V(dA)/V(t) may provide useful guidelines for the early post-resuscitation care of cardiac arrest patients in emergency departments.