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다발성 외상 후 횡문근융해증 환자에서의 손상초기 급성신부전의 예측인자
문중범,이강현,황성오,이진웅,한병근,최승옥,강성준 대한응급의학회 2001 대한응급의학회지 Vol.12 No.3
Background: Acute renal failure(ARF) is a serious complication of rhabdomyolysis after multiple trauma, and may increase morbidity and mortality. The aim of this study was to elucidate predicting factors for the development of ARF induced by rhabdomyolysis at an early stage of multiple trauma. Methods: This prospective, observational study was conducted at the emergency department of a level I trauma center. Patients with acute multiple trauma, whose plasma levels of creatine phosphokinase(CPK) were higher than 1,000 IU, were included in this study. We excluded patients with any history of myocardial infarction, stroke, underlying renal disease, and/or infectious disease. We collected clinical and laboratory data including age, heart rate, mean arterial blood pressure, injury severity score, serum myoglobin, lactic dehydrogenase, creating phosphokinase, and base excess. Collected data were compared between patients who had ARF and patients who did not have ARF. Results: Eighty-eight patients were enrolled in this study. Eighteen patients(20.5%) developed ARF. The injury severity score(ISS)(p=0.001), the base excess(p<0.001), CPK(p=0.003), and myoglobin(p<0.001) were higher in patients with ARF than in patient without ARF. Logistic regression analysis revealed that early predictors for ARF were high ISS, high base excess, high CPK, and high myoglobin. Conclusion: We could identify early predicting factors for acute renal failure induced by rhabdomyolysis, these factors included ISS, serum CPK and myoglobin, and base excess in the arterial blood gas analysis performed at the emergency department.
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조준휘,문중범,박찬우,옥택근,신명철,김가을,박윤수,원무호 대한응급의학회 2020 대한응급의학회 학술대회초록집 Vol.2020 No.2
Introduction Oxcarbazepine(OXC), a voltage-gated sodium channel blocker, is a new antiepileptic medication. OXC is also used for the treatment of bipolar disorders. In this study, we investigated the protective effect of OXC and its mechanisms in the cornu ammonis 1subfield (CA1) of gerbils subjected to 5min of transient global cerebral ischemia (tGCI). Material & Method Transient ischemia led to death of most pyramidal neurons in CA1 at 5days after tGCI. OXC (100 and 200mg/kg) was intraperitoneally administered once at 30 min after tGCI. Result Treatment with 200mg/kg OXC, not 100 mg/kg OXC, significantly protected CA1 pyramidal neurons from tGCI-induced injury. OXC treatment significantly decreased superoxide anion production, 4-hydroxy-2-nonenal and 8-hydroxyguanine levels in ischemic CA1 pyramidal neurons. In addition, the treatment restored levels of superoxide dismutases, catalase, and glutathione peroxidase. Furthermore, the treatment distinctly inhibited tGCI-induced microglia activation and significantly reduced levels of pro-in?ammatory cytokines (interleukin-1β and tumor necrosis factor-α). Conclusion OXC treatment significantly enhanced expressions of nuclear factor erythroid 2-related factor 2 (Nrf2) and its downstream protein heme oxygenase-1 in ischemic CA1; however, the forenamed effects of OXC were abolished by brusatol (an inhibitor of Nrf2).
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조준휘,문중범,박찬우,옥택근,신명철,김가을,박윤수,원무호 대한응급의학회 2020 대한응급의학회 학술대회초록집 Vol.2020 No.2
Introduction Hypothermia has focused on improving rates of resuscitation to increase survival rates in cardiac arrest (CA) patients. For this, it needs to understand what body temperature affects neuronal damage/death in the brain during CA. Material & Method Here, we used adult male rats (12?week-old) which were subjected to 4 conditions as follows: (i) whole body normothermia (37±0.5℃) plus (+) no asphyxial CA, (ii) whole body normothermia+CA, (iii) whole body hypothermia (33±0.5℃)+CA, (iv) body hypothermia/brain normothermia+CA, and (v) brain hypothermia/body normothermia+CA. Result Survival rate after resuscitation was significantly high in groups of whole body hypothermia+CA and body hypothermia/brain normothermia+CA, but not in groups of whole body normothermia+CA and brain hypothermia/ body normothermia+CA. However, the group of hypothermia/brain normothermia+CA exhibited higher neuroprotective effect against asphyxial CA injury: neurological deficit and neuronal death in the hippocampus were improved compared to those in the group of whole body normothermia+CA. In addition, neurological deficit and neuronal death in the group of brain hypothermia/body normothermia+CA were was similar to those in the group of whole body normothermia+CA. Conclusion Our present study suggests that regional temperature in patients during CA can significantly affect outcomes in survival rate and neurological recovery.
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조준휘,문중범,박찬우,옥택근,신명철,김가을,박윤수,원무호 대한응급의학회 2020 대한응급의학회 학술대회초록집 Vol.2020 No.2
Introduction The objective of this study was to determine the effect of a brief TI in the hippocampus of high-fat diet (HFD)- induced obese gerbils and related mechanisms. Material & Method Gerbils were maintained on HFD or normal diet (ND) for 12weeks and subjected to a 2min of TI. HFD gerbils were heavier with higher blood glucose, serum total cholesterol, triglycerides and leptin levels. Result Massive loss of pyramidal neurons occurred in the hippocampal cornu ammonis 1 (CA1) field of HFD animals at 5 days after 2min of TI, although 2min of TI did not elicit death of pyramidal neurons in ND gerbils. The HFD group showed significantly increased levels of oxidative stress indicators (dihydroethidium and 4-hydroxynonenal) and proinflammatory cytokines (tumor necrosis factor-α and interleukin-1β) as well as microglia activation in pre-and/or post-ischemic phases compared to the ND group. Levels of mammalian target of rapamycin (mTOR) and phosphorylated-mTOR in the CA1 field of the HFD group were also significantly higher than the ND group. Conclusion It might be closely associated with abnormal increase of mTOR activation-mediated severe oxidative stress and neuroinflammation in pre- and/or post-ischemic phases.
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조준휘,문중범,박찬우,옥택근,신명철,김가을,박윤수,원무호 대한응급의학회 2020 대한응급의학회 학술대회초록집 Vol.2020 No.2
Introduction We investigated neuroprotective effect of post-risperidone (RIS) treatment against transient ischemic injury and its mechanisms in the gerbil brain. Material & Method Transient ischemia (TI) was induced in the telencephalon by bilateral common carotid artery occlusion (BCCAO) for 5 min under normothermic condition (37 ± 0.2ºC). Post-treatment of RIS induced hypothermia until 12 h after TI in the TI-induced animals under uncontrolled body temperature (UBT) compared to that under controlled body temperature (CBT) (about 37ºC). Result Neuroprotective effect was statistically significant when we used 5 and 10 mg/kg doses (P < 0.05, respectively). In the RIS-treated TI group, many CA1 pyramidal neurons of the hippocampus survived under UBT compared to those under CBT. In this group under UBT, post-treatment with RIS to TI-induced animals markedly attenuated the activation of glial cells, increases of oxidative stress markers (dihydroethidium, 8-OHdG and 4-HNE), and a decrease of superoxide dismutase 2 in their CA1 pyramidal neurons. Conclusion Our findings indicate that RIS-induced hypothermia can effectively protect neuronal cell death from TI injury through attenuation of glial activation and maintenance of antioxidants, showing that 5-HT2A receptor is involved in RIS-induced hypothermia.
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응급센터에 내원한 급성 복통 환자의 진단관련 변수들이 초진 정확도에 미치는 영향 분석
조광윤,문중범,김동원,안무업,이재성,천승환,손유동,최기훈,조준휘,이태헌,김남호,서정열 대한노인병학회 2009 Annals of geriatric medicine and research Vol.13 No.4
Background: Abdominal pain is a common complaint seen at emergency centers. Various diseases can cause abdominal pain making it difficult to make a correct diagnosis. In the elderly, however, the consequences of an incorrect or delayed diagnosis can be more critical. We investigated the accuracy of initial diagnoses in the emergency center and analyzed the associations among medical factors including age. Methods: We compared the ICD 10 codes of initial diagnoses to the codes of final diagnoses, defined the ‘degree of agreement’ using a 5 point scale, and classified patients into ‘high degree of agreement’ or ‘low degree of agreement’ groups. According to the severity of illness, we classified patients as ‘admission’ or ‘out patient follow up’. According to their illness, we classified them as ‘surgical’ or ‘medical’. According to age, we classified them as ‘elderly’ or ‘adult’. Finally, we analyzed the statistical significance of each association. Results: Overall, admitted patients and surgical diagnoses had higher degrees of agreement. ‘Elderly’ patients had no significant difference in ‘degree of agreement’ from ‘adult’ patients. Conclusion: Among patients presenting with acute abdominal pain to the emergency center, the degree of agreement between initial diagnosis and final diagnosis is dependent on the diagnostic characteristics of the disease, and not on the age of the patients. Further studies on the diagnostic accuracy of individual diseases are needed. Additional diagnosis associated variables, for example comorbidity and prognosis, needs to be studied regarding relationship to dia- gnostic accuracy.
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