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ABSTRACT: AIM: This is first clinical trial to evaluate whether successful endotracheal intubation (ETI) using a video-laryngoscope (VL) (GlideScope(®)) can be performed easily without chest compression interruptions during actual cardiopulmonary resuscitation (CPR) after brief VL training, regardless of the physicians' levels of experience with successful ETI in the past. METHODS: We performed a prospective, clinical observation study. After completing a brief 1-hour VL training, 14 emergency physicians intubated arrest victims using a VL during CPR in the emergency department for a period of 1 year. All CPRs were recorded by video and were reviewed retrospectively. Outcomes were based on the success rate of the first ETI attempt, the time until the first successful ETI attempt (TUS), and chest compression interruptions during ETI. The outcomes were compared based on the physicians' varying experience with successful ETI in the past. RESULTS: Of 71 CPRs, all cases were successful, and 66 cases (93%) were successful at the first ETI attempt with no significant chest compression interruptions. The median TUS was 41.5 [33.8, 61.2] sec. There were no differences between less and more experienced physicians in the success rate of the first ETI attempts (97.3% vs. 88.2%; p=0.187), or the median TUS (41.5 [33.5, 58.0] vs. 42.0 [33.8, 64.3] sec; p=0.842). CONCLUSIONS: In a clinical setting, the utilisation of a VL had a high success rate for the first ETI attempt with notably few chest compression interruptions, regardless of the physicians' varying experience with successful ETI in the past.
Resuscitation 03/2013; · 3.60 Impact Factor
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ABSTRACT: This study evaluated whether measurements of plasma neutrophil gelatinase-associated lipocalin (NGAL) can predict acute kidney injury (AKI) in adult burn patients, and assessed the use of this biomarker in risk stratification. We performed a prospective observational study of consecutive patients with major burns admitted to the burn center within 12 hours of injury. Samples for plasma NGAL assay were obtained three times (at admission, day 3, and day 7). The main outcome measures were occurrence of AKI based on Risk-Injury-Failure classification and mortality. A total 45 patients with burns injury were enrolled. There was a high prevalence (11 of 45, 24.4%) of AKI in burn patients. All patients with AKI developed AKI after hospital day 8. Multivariate logistic regression analysis demonstrated that burn size and abbreviated burn severity index were independent risk factors of AKI. Patients who developed AKI had significantly higher admission plasma NGAL levels, hospital day 3 NGAL levels, and hospital day 7 NGAL levels. Especially, hospital day 7 NGAL levels strongly correlated with AKI. For concentration in plasma NGAL at hospital day 7, the area under the receiver operating characteristic curve was 0.903, sensitivity was 87%, and specificity was 91% for a cutoff value of 125 ng/ml. The mean plasma NGAL at hospital day 7 of patients who died was significantly higher than that of patients who did not (485 ng/ml vs 111 ng/ml, P = .001). Plasma NGAL levels are early predictive biomarkers for AKI and its clinical outcomes after burn injury.
Journal of burn care & research: official publication of the American Burn Association 03/2013; · 1.37 Impact Factor
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ABSTRACT: AIM: This is the first study to identify the factors associated with hyperventilation during actual cardiopulmonary resuscitation (CPR) in the emergency department (ED). METHODS: All CPR events in the ED were recorded by video from April 2011 to December 2011. The following variables were analysed using review of the recorded CPR data: ventilation rate (VR) during each minute and its associated factors including provider factors (experience, advanced cardiovascular life support (ACLS) certification), clinical factors (auscultation to confirm successful intubation, suctioning, and comments by the team leader) and time factors (time or day of CPR). RESULTS: Fifty-five adult CPR cases including a total of 673min sectors were analysed. The higher rates of hyperventilation (VR>10/min) were delivered by inexperienced (53.3% versus 14.2%) or uncertified ACLS provider (52.2% versus 10.8%), during night time (61.0 versus 34.5%) or weekend CPR (53.1% versus 35.6%) and when auscultation to confirm successful intubation was performed (93.5% versus 52.8%) than not (all p<0.0001). However, experienced (25.3% versus 29.7%; p=0.448) or certified ACLS provider (20.6% versus 31.3%; p<0.0001) could not deliver high rate of proper ventilation (VR 8-10/min). Comment by the team leader was most strongly associated with the proper ventilation (odds ratio 7.035, 95% confidence interval 4.512-10.967). CONCLUSIONS: Hyperventilation during CPR was associated with inexperienced or uncertified ACLS provider, auscultation to confirm intubation, and night time or weekend CPR. And to deliver proper ventilation, comments by the team leader should be given regardless of providers' expert level.
Resuscitation 08/2012; · 3.60 Impact Factor
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Jin Hee,
Pramod Darvin,
Eun Joung Lim,
Youn Hee Joung, Dae Young Hong,
Eui U Park,
Seung Hwa Park,
Soo Keun Choi,
Eon-Soo Moon,
Byung Wook Cho,
Kyung Do Park,
Hak Kyo Lee,
Myong-Jo Kim,
Dong-Sik Park,
Ill-Min Chung,
Young Mok Yang
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ABSTRACT: Background: Cancer is one of the highly virulent diseases known to humankind with a high mortality rate. Breast cancer is the most common cancer in women worldwide. Sorghum is a principal cereal food in many parts of the world, and is critical in folk medicine of Asia and Africa. In the present study, we analyzed the effects of HSE in metastatic breast cancer. Methodology/Principal Findings: Preliminary studies conducted on MDA-MB 231 and MCF-7 xenograft models showed tumor growth suppression by HSE. Western blotting studies conducted both in vivo and in vitro to check the effect of HSE in Jak/STAT pathways. Anti-metastatic effects of HSE were confirmed using both MDA-MB 231 and MCF-7 metastatic animal models. These studies showed that HSE can modulate Jak/STAT pathways, and it hindered the STAT5b/IGF-1R and STAT3/ VEGF pathways not only by down-regulating the expression of these signal molecules and but also by preventing their phosphorylation. The expression of angiogenic factors like VEGF, VEGF-R2 and cell cycle regulators like cyclin D, cyclin E, and pRb were found down-regulated by HSE. In addition, it also targets Brk, p53, and HIF-1a for anti-cancer effects. HSE induced G1 phase arrest and migration inhibition in MDA-MB 231 cells. The metastasis of breast cancer to the lungs also found blocked by HSE in the metastatic animal model. Conclusions/Significance: Usage of HS as a dietary supplement is an inexpensive natural cancer therapy, without any side effects. We strongly recommend the use of HS as an edible therapeutic agent as it possesses tumor suppression, migration inhibition, and anti-metastatic effects on breast cancer.
PLoS ONE 07/2012; · 4.09 Impact Factor
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Se Hyung Pak,
Youn Hee Joung,
Jin Hee Park,
Eun Joung Lim,
Pramod Darvin,
Yoon Mi Na, Dae Young Hong,
Boram Lee,
Tae Sook Hwang,
Taegyu Park,
Sang-Kyu Ye,
Eon-Soo Moon,
Byung Wook Cho,
Kyung Do Park,
Hak Kyo Lee,
Ill-Min Chung,
Young Mok Yang
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ABSTRACT: Hsp90α is a molecular chaperone protein involved in the structural maturation of oncogenic signaling proteins. Hsp90 was recently identified as an anticancer target; various studies are ongoing to find ways for managing cancer through Hsp90α. However, this approach is limited by reported side-effects. Hypoxia is a hallmark of solid tumors, including those of breast cancer and the extent of tumor hypoxia is associated with resistance to treatment and poor prognosis. One of the major signaling pathways in cancer cells, the Jak2/STAT5b pathway, has been found to be closely correlated with hypoxia. The objective of this study was to investigate the role of Jak2/STAT5b in the regulation of Hsp90α expression so that Hsp90α targeting can be achieved indirectly by modulating the Jak2/STAT5b pathway. We examined the role of the Jak2/STAT5b pathway in the expression of Hsp90α under hypoxic conditions by immunoblotting, reporter gene assays, EMSA and RNA interference analysis. With the help of in vivo models, we also analyzed the expression of Hsp90α in different parts of solid tumor tissues. We found a close association between hypoxic stress and Hsp90α expression. We also determined that STAT5b regulates the expression of Hsp90α during hypoxic stimulation. Under hypoxic conditions the expression of Hsp90α and STAT5b were proportional. siRNA analysis and nucleotide analysis showed that the promoter of Hsp90α has a STAT5b binding domain. Our work confirmed that STAT5b is one of the transcription factors that regulate Hsp90α. We, therefore, concluded that under hypoxic conditions, the Jak2/STAT5b pathway regulates Hsp90α expression and it could serve as a promising target for the treatment of solid tumors.
International Journal of Oncology 04/2012; 41(1):161-8. · 2.40 Impact Factor
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ABSTRACT: OBJECTIVE: To evaluate whether endotracheal intubation in patients with cervical spine immobilisation by a semirigid neck collar is easier using the Disposcope endoscope (DE), a new video laryngoscope, than with the Macintosh laryngoscope (ML). METHODS: Sixty-eight medical interns who participated in a training programme for endotracheal intubation using the DE and ML were recruited to the randomised crossover trial 1 week after completing the training programme. In the trial, they used both the DE and the ML to perform intubation on a manikin wearing a semirigid neck collar. The time required to view the vocal cords and to complete intubation, successful endotracheal intubation, modified Cormack-Lehane classification (CL grade) and dental injury were recorded and analysed. RESULTS: The mean (SD) time to view the vocal cords was significantly shorter with the DE than with the ML (10.0 (7.0) vs 20.8 (18.9) s; p<0.0001). There were higher rates of CL grades 1 and 2a (69.1% and 22.1%) using the DE than with the ML (10.3% and 14.7%). All 68 participants had a higher rate of successful endotracheal intubation using the DE than using the ML (68 (100%) vs 47 (69.1%); p<0.0001). It took less time to complete endotracheal intubation with the DE than with the ML (p<0.0001). CONCLUSIONS: In patients with cervical spine immobilisation by a semirigid neck collar, the DE may be a more effective device for endotracheal intubation than the ML.
Emergency Medicine Journal 04/2012; · 1.44 Impact Factor
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Eun Joung Lim, Dae Young Hong,
Jin Hee Park,
Youn Hee Joung,
Pramod Darvin,
Sang Yoon Kim,
Yoon Mi Na,
Tae Sook Hwang,
Sang-Kyu Ye,
Eon-Soo Moon,
Byung Wook Cho,
Kyung Do Park,
Hak Kyo Lee,
Taekyu Park,
Young Mok Yang
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ABSTRACT: Breast cancer is the most aggressive form of all cancers, with high incidence and mortality rates. The purpose of the present study was to investigate the molecular mechanism by which methylsulfonylmethane (MSM) inhibits breast cancer growth in mice xenografts. MSM is an organic sulfur-containing natural compound without any toxicity. In this study, we demonstrated that MSM substantially decreased the viability of human breast cancer cells in a dose-dependent manner. MSM also suppressed the phosphorylation of STAT3, STAT5b, expression of IGF-1R, HIF-1α, VEGF, BrK, and p-IGF-1R and inhibited triple-negative receptor expression in receptor-positive cell lines. Moreover, MSM decreased the DNA-binding activities of STAT5b and STAT3, to the target gene promoters in MDA-MB 231 or co-transfected COS-7 cells. We confirmed that MSM significantly decreased the relative luciferase activities indicating crosstalk between STAT5b/IGF-1R, STAT5b/HSP90α, and STAT3/VEGF. To confirm these findings in vivo, xenografts were established in Balb/c athymic nude mice with MDA-MB 231 cells and MSM was administered for 30 days. Concurring to our in vitro analysis, these xenografts showed decreased expression of STAT3, STAT5b, IGF-1R and VEGF. Through in vitro and in vivo analysis, we confirmed that MSM can effectively regulate multiple targets including STAT3/VEGF and STAT5b/IGF-1R. These are the major molecules involved in tumor development, progression, and metastasis. Thus, we strongly recommend the use of MSM as a trial drug for treating all types of breast cancers including triple-negative cancers.
PLoS ONE 04/2012; Lim EJ, Hong DY, Park JH, Joung YH, Darvin P, et al. (2012) Methylsulfonylmethane Suppresses Breast Cancer Growth by Down-Regulating STAT3 and STAT5b Pathways. PLoS ONE 7(4): e33361. doi:10.1371/journal.pone.0033361. · 4.09 Impact Factor
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Jin Hee Park,
Pramod Darvin,
Eun Joung Lim,
Youn Hee Joung, Dae Young Hong,
Eui U Park,
Seung Hwa Park,
Soo Keun Choi,
Eon-Soo Moon,
Byung Wook Cho,
Kyung Do Park,
Hak Kyo Lee,
Myong-Jo Kim,
Dong-Sik Park,
Ill-Min Chung,
Young Mok Yang
[show abstract]
[hide abstract]
ABSTRACT: Cancer is one of the highly virulent diseases known to humankind with a high mortality rate. Breast cancer is the most common cancer in women worldwide. Sorghum is a principal cereal food in many parts of the world, and is critical in folk medicine of Asia and Africa. In the present study, we analyzed the effects of HSE in metastatic breast cancer.
Preliminary studies conducted on MDA-MB 231 and MCF-7 xenograft models showed tumor growth suppression by HSE. Western blotting studies conducted both in vivo and in vitro to check the effect of HSE in Jak/STAT pathways. Anti-metastatic effects of HSE were confirmed using both MDA-MB 231 and MCF-7 metastatic animal models. These studies showed that HSE can modulate Jak/STAT pathways, and it hindered the STAT5b/IGF-1R and STAT3/VEGF pathways not only by down-regulating the expression of these signal molecules and but also by preventing their phosphorylation. The expression of angiogenic factors like VEGF, VEGF-R2 and cell cycle regulators like cyclin D, cyclin E, and pRb were found down-regulated by HSE. In addition, it also targets Brk, p53, and HIF-1α for anti-cancer effects. HSE induced G1 phase arrest and migration inhibition in MDA-MB 231 cells. The metastasis of breast cancer to the lungs also found blocked by HSE in the metastatic animal model.
Usage of HS as a dietary supplement is an inexpensive natural cancer therapy, without any side effects. We strongly recommend the use of HS as an edible therapeutic agent as it possesses tumor suppression, migration inhibition, and anti-metastatic effects on breast cancer.
PLoS ONE 01/2012; 7(7):e40531. · 4.09 Impact Factor
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ABSTRACT: To compare the time-dependent changes in the quality of chest compressions in 30:2 cardiopulmonary resuscitation (CPR) and hands-only cardiopulmonary resuscitation (HO-CPR) and to evaluate how individual rescuer factors affect the quality of chest compressions over time for both CPR techniques.
Total 1028 adult hospital and university workers participated in CPR training programs including sessions of 30:2 CPR and HO-CPR. Tests of both CPR methods were performed in a random order using a manikin with Skill-Reporter™. Data were collected from 863 subjects. The time-dependent changes in chest compressions quality and the effects of individual rescuer factors (age, gender, body mass index (BMI), prior CPR training and experience) were analysed using the general linear model for a repeated-measures procedure.
In HO-CPR, the mean proportion of correct compressions depth (MPCD) decreased significantly throughout the time sectors following 20-40s (74.4-50.4% in 100-120 s) compared to 30:2 CPR (83.4-76.3% in 100-120 s) (p<0.0001). A significant decline of MPCD (MPCD<70%) was initially observed at 40-60s in HO-CPR, however, this pattern was not observed in 30:2 CPR. Individual rescuer factors minimally affected the time-dependent change in MPCD during 30:2 CPR. For HO-CPR, all rescuer factors except for male or obese/overweight (BMI≥25) were associated with a significant declines of MPCD, and these decline were usually observed from 40 to 60s.
Switching rescuers at an interval of 2-min is reasonable for 30:2 CPR. However, for HO-CPR switching rescuers every 1-min may be preferable except when rescuers are male or obese/overweight (BMI≥25).
Resuscitation 11/2011; 83(3):353-9. · 3.60 Impact Factor
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ABSTRACT: The aim of the study is to compare the accuracy of manually delivered target tidal volumes (TVs) with the conventional paediatric self-inflating bags (CPBs) versus the novel paediatric self-inflating bags (NPBs) during simulated advanced paediatric resuscitation.
Before the trial begun, four target TV ranges were established using the Broselow™ Tape as a reference: 36-70 ml for 6-10 kg, 60-105 ml for 10-15 kg, 90-168 ml for 15-24 kg and 144-210 ml for 24-30 kg. An NPB with four surface marks matching the target TV ranges was prepared. Senior medical students (N=73) were enrolled. After 1 week of training in TV delivery with both CPB and NPB, subjects participated in a test simulation. Using the CPB and NPB in a random cross-over design, participants delivered 10 ventilations to test lungs connected to gas flow analysers for the randomly assigned target TV ranges.
Each of the 730 values for TV and peak inspiratory pressures (PIPs) delivered by CPB and NPB were analysed. The proportion of accurate TV delivery was higher with NPB than with CPB: 84.2% versus 45.9% for 36-70 ml, 93.2% versus 42.7% for 60-105 ml, 96.0% versus 70.3% for 90-168 ml and 91.2% versus 62.6% for 144-210 ml, respectively (all p<0.0001). Compared with NPB, CPB delivery was more varied and was more frequently out of range. There were no significant differences in PIP between the CPB and NPB.
NPB is useful as a ventilation device for the accurate delivery of TV to small children of varying weights.
Resuscitation 08/2011; 83(1):101-6. · 3.60 Impact Factor
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ABSTRACT: To overcome limitations of inaccurate tidal volume (TV) delivery by conventional selfinflating paediatric and adult bags during paediatric and adolescent resuscitation, we designed a novel target volume marked bag (TVMB) with four compression points marked on an adult bag surface. The aim of this study was to evaluate the TVMB in delivering preset TV.
Fifty-three subjects (28 doctors, 17 nurses, 8 paramedics) participated in this simulation trial. TVMB, paediatric bag and adult bag were connected to a gas flow analyser for measuring TV and peak inspiratory pressure (PIP). In a random cross-over setting, participants delivered 10 ventilations using the adult bag, paediatric bag or TVMB in each of four target volume ranges (100-200 ml, 200-300 ml, 300-400 ml, 400-500 ml). We compared TV and PIP for the adult bag, paediatric bag and TVMB in each subject.
Compared with the paediatric bag, TVMB showed higher rates of accurate TV delivery in the 200-300 ml target volume range (87-90% versus 32-35%; p < 0.05). Compared with the adult bag, TVMB showed higher rates of accurate TV delivery in all target volume ranges (75-90% versus 45-50%; p < 0.05). The frequency of too high or low TV delivery was higher with the adult bag than TVMB (20-30% versus 0-5%; p < 0.05). There was no significant difference in PIP between the paediatric bag and TVMB (within 5 cm H(2)O; p < 0.05).
TVMB could deliver accurate TV in various target volume ranges for paediatric and adolescent resuscitation.
Resuscitation 03/2011; 82(6):749-54. · 3.60 Impact Factor
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ABSTRACT: We demonstrated that upregulation of both gene expression of endoplasmic reticulum (ER) stress chaperones (BiP, calnexin, calreticulin, and PDI) and ER stress sensors (ATF6, IRE1 and PERK) was induced by lidocaine, a local anesthetic, in PC12 cells. In addition to gene regulation, lidocaine also induced typical ER stress phenomena such as ART6 proteolytic cleavage, eIF2 alpha phosphorylation, and XBP1 mRNA splicing. In in vivo experiments, while lidocaine downregulated gene expression of antiapoptotic factors (Bcl-2 and Bcl-xl), pro-apoptotic factor (Bak and Bax) gene expression was upregulated. Furthermore, lidocaine induced apoptosis, as measured histochemically, and upregulated PARP1, a DNA damage repair enzyme. These results are the first to show that lidocaine induces apoptosis through ER stress in vitro and in vivo.
International Journal of Molecular Sciences 01/2011; 12(11):7652-61. · 2.60 Impact Factor
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Eun-Joung Lim,
Youn-Hee Joung,
Se-Mi Jung,
Se Hyung Park,
Jin Hee Park,
Sang Yoon Kim,
Tae Sook Hwang, Dae Young Hong,
So Chung Chung,
Sang-Kyu Ye,
Eon-Soo Moon,
Eui U Park,
Taekyu Park,
Ill-Min Chung,
Young Mok Yang
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ABSTRACT: Cyclin D1 and insulin-like growth factor 1 receptor (IGF-1R) are key regulators of cell proliferation that are overexpressed in most breast cancers. The purpose of the present study was to investigate the molecular mechanism by which hemin exerts its inhibitory effects on aggressive breast cancer cells. We found that hemin regulates cyclin D1 and IGF-1R proteins and insulin-like growth factor-1 gene expression through STAT5b in breast cancer cells. We confirmed that STAT5b, cyclin D1, and IGF-1R is up-regulated by hypoxia, and the increased STAT5b binds strongly to the STAT5-binding sites contained within the distal 5'-flanking region of IGF-1 gene in breast cancer cells. EMSA studies showed that STAT5 binding activity to the IGF-1 and cyclin D1 promoter was distinctly decreased by hemin in STAT5b-transfected COS-7 or MDA-MB 231 cells. IGF-1 gene expression was also decreased by hemin in mammary epithelial cells. STAT5b expression was inhibited in siRNA experiments and by hemin, leading to decreased levels of IGF-1. These results provide a basis for molecular targets in cancer treatment via the STAT5b/IGF-1 or /cyclin D1 pathway in solid tumor cells. These data indicate that hemin inhibits the cyclin D1 and IGF-1 expression via STAT5b under hypoxia in ERalpha-negative breast cancer cells. These findings are valuable toward understanding the role of hemin-induced inhibition of cyclin D1 and IGF-1 expression under hypoxia in invasive and metastatic breast cancer.
International Journal of Oncology 05/2010; 36(5):1243-51. · 2.40 Impact Factor
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ABSTRACT: This study investigated the telomerase expression in peripheral blood mononuclear cells (PBMCs) and the relationship between the serum level of several soluble factors such as vascular endothelial growth factor (VEGF), hepatocyte growth factor, interleukin (IL)-6, IL-8, and matrix metallopeptidase-9 and the clinicopathological features of patients with head and neck squamous cell carcinoma (HNSCC).
Peripheral blood samples were collected from 50 HNSCC patients and 15 normal controls. The telomerase activity in the PBMCs was measured by Telomere Repeat Amplification Protocols. The serum levels of the soluble factors were analyzed by enzyme-linked immunosorbent assay.
The expression of telomerase in the PBMCs of HNSCC patients was significantly correlated with the N and American Joint Committee on Cancer (AJCC) stages. The serum VEGF level was significantly higher in the patients with an advanced T stage, N stage and AJCC stage. Serum VEGF was significantly related with the expression of telomerase in the PBMCs. The telomerase expression and the VEGF expression were shown to be independent factors associated with poor survival.
The telomerase expression in the PBMCs and the serum VEGF level of HNSCC patients were significantly correlated with the N stage, the AJCC stage and the prognosis.
Clinical and Experimental Otorhinolaryngology 12/2009; 2(4):186-92. · 0.92 Impact Factor
