ABSTRACT
Objective@#This study examined whether the preventive effects of the safety belt on traumatic brain injury (TBI) from motor vehicle collisions (MVCs) differ according to the occupants’ age. @*Methods@#This study was a retrospective, observational study. This study evaluated the crash data from 2011 to 2016 obtained from the Emergency Department-based Injury In-depth Surveillance registry. The injured occupants were categorized by age into young adults (age, 18-35 years; n=35,032), middle-aged adults (age, 36-55 years; n=34,507), and older adults (aged older than 55 years, n=21,895). The primary (TBI), secondary (intensive care unit [ICU] admission), and tertiary endpoint (mortality) were set. Multivariate logistic regression analysis was performed, and the adjusted odds ratios (aORs) of subgroups were calculated for study outcomes adjusted for any potential confounders. @*Results@#Among 91,434 patients, 61,205 used seat belts at the time of the crashes. Compared to the unbelted group, the belted group was less likely to have a TBI. A comparison of the aOR of subgroups for TBI revealed the odds ratio reduction to be the highest in young adults (aOR, 0.39; 95% confidence interval [CI], 0.32-0.47), followed by middle-aged adults (aOR, 0.39; 95% CI, 0.33-0.47) and older adults (aOR, 0.49; 95% CI, 0.42-0.56). In addition, seat belt use had a preventive effect on ICU admission and mortality at all subgroups, the effect of which decreased with age. @*Conclusion@#The protective effects of seat belts on TBI, ICU admission, and mortality from MVCs were reduced with age.
ABSTRACT
Objective@#This study examined whether the preventive effects of the safety belt on traumatic brain injury (TBI) from motor vehicle collisions (MVCs) differ according to the occupants’ age. @*Methods@#This study was a retrospective, observational study. This study evaluated the crash data from 2011 to 2016 obtained from the Emergency Department-based Injury In-depth Surveillance registry. The injured occupants were categorized by age into young adults (age, 18-35 years; n=35,032), middle-aged adults (age, 36-55 years; n=34,507), and older adults (aged older than 55 years, n=21,895). The primary (TBI), secondary (intensive care unit [ICU] admission), and tertiary endpoint (mortality) were set. Multivariate logistic regression analysis was performed, and the adjusted odds ratios (aORs) of subgroups were calculated for study outcomes adjusted for any potential confounders. @*Results@#Among 91,434 patients, 61,205 used seat belts at the time of the crashes. Compared to the unbelted group, the belted group was less likely to have a TBI. A comparison of the aOR of subgroups for TBI revealed the odds ratio reduction to be the highest in young adults (aOR, 0.39; 95% confidence interval [CI], 0.32-0.47), followed by middle-aged adults (aOR, 0.39; 95% CI, 0.33-0.47) and older adults (aOR, 0.49; 95% CI, 0.42-0.56). In addition, seat belt use had a preventive effect on ICU admission and mortality at all subgroups, the effect of which decreased with age. @*Conclusion@#The protective effects of seat belts on TBI, ICU admission, and mortality from MVCs were reduced with age.
ABSTRACT
PURPOSE@#Acute carbon monoxide (CO) poisoning is one of the most common types of poisoning and a major health problem worldwide. Treatment options are limited to normobaric oxygen therapy, administered using a non-rebreather face mask or hyperbaric oxygen. Compared to conventional oxygen therapy, high-flow nasal cannula oxygen (HFNC) creates a positive pressure effect through high-flow rates. The purpose of this human pilot study is to determine the effects of HFNC on the rate of CO clearance from the blood, in patients with mild to moderate CO poisoning.@*METHODS@#CO-poisoned patients were administered 100% oxygen from HFNC (flow of 60 L/min). The fraction of COHb (fCOHb) was measured at 30-min intervals until it decreased to under 10%, and the half-life time of fCOHb (fCOHb t(1/2)) was subsequently determined.@*RESULTS@#At the time of ED arrival, a total of 10 patients had fCOHb levels ≥10%, with 4 patients ranging between 10% and 50%. The mean rate of fCOHb elimination patterns exhibits logarithmic growth curves that initially increase quickly with time (HFNC equation, Y=0.3388*X+11.67). The mean fCOHbt1/2 in the HFNC group was determined to be 48.5±12.4 minutes.@*CONCLUSION@#In patients with mild to moderate CO poisoning, oxygen delivered via high flow nasal cannula is a safe and comfortable method to treat acute CO toxicity, and is effective in reducing the COHb half-life. Our results indicate HFNC to be a promising alternative method of delivering oxygen for CO toxicity. Validating the effectiveness of this method will require larger studies with clinical outcomes.
ABSTRACT
PURPOSE: We compared characteristics and outcomes of pulmonary tuberculosis in homeless and non-homeless patients. METHODS: A retrospective, cross-sectional study was conducted in a Seoul municipal medical center between January 2007 and December 2011. All adult patients diagnosed with pulmonary tuberculosis were included. We classified these patients into homeless and non-homeless and compared the disease characteristics, risk factors, mortality, treatment completion rate, and resistance rate. RESULTS: All 157 patients were diagnosed with pulmonary tuberculosis (75 homeless and 82 non-homeless). Most homeless patients were male (97.3%) and had higher emergency medical service (EMS) use (77.3%). Additionally, most homeless patients used alcohol l(76%) and smoked (77.3%). When compared with the non-homeless group, the homeless group had a higher in-hospital mortality rate (14.7%; adjusted odds ratio (OR), 4.69; 95% confident interval (CI), 1.03-21.34), and were more likely to be admitted for (adjusted OR=3.27(1.07-9.97)), but not to complete tuberculosis treatment (adjusted OR=9.10(2.24-36.98)). CONCLUSION: Pulmonary tuberculosis showed higher mortality in homeless than non-homeless patients. Additionally, homeless had a lower treatment completion rate and fewer resistant microorganisms.
Subject(s)
Adult , Humans , Male , Cross-Sectional Studies , Emergency Medical Services , Hospital Mortality , Odds Ratio , Retrospective Studies , Risk Factors , Smoke , Tuberculosis , Tuberculosis, PulmonaryABSTRACT
PURPOSE: To understand the pathophysiology of diabetic erectile dysfunction (ED) and to review the current strategies against diabetic ED. MATERIALS AND METHODS: A systematic search was performed of MEDLINE databases to obtain articles pertaining to the pathophysiology and management of diabetic ED. RESULTS: No single etiology has been identified as the principal cause of ED. Studies from non-penile tissue have indicated hyperglycemia-induced mitochondrial superoxide production activates the four damaging pathways by inhibiting glyceraldehyde-3-phosphate dehydrogenase (GAPDH). It appears that these mechanisms provide molecular basis on which diabetes can affect erectile function by increasing reactive oxygen species, forming advanced glycation end products (AGEs) and activating protein kinase C pathway. Consequently, impaired vasorelaxation, enhanced vasoconstriction, nitrergic neural degeneration and structural and functional alteration of cavernosal integrity have been observed in subjects with diabetes. Furthermore, significant hypogonadism often exists in diabetic men, further complicating the understanding of diabetic ED. The treatment of diabetic ED is multimodal. Adequate control of hyperglycemia and comorbidities is prerequisite for the application of various treatments. The type 5 phosphodiesterase inhibitors (PDE5Is) are the mainstay of oral treatment of ED. Vacuum erection device and intracavernosal injection are still viable option when the treatment of PDE5I has failed. Patients with irreversible damage of the erectile mechanism are candidates for penile prosthesis implantation. Current concepts suggest that therapeutic prospects on the horizon include gene therapy, growth factor therapy and novel pharmacotherapies such as anti-AGE drugs. CONCLUSIONS: The current understading of diabetic ED is far from being satisfactory to offer adequate treatment. Future strategies in the evolution of the treatment of diabetic ED are aimed at correcting or treating underlying mechanisms.
Subject(s)
Humans , Male , Comorbidity , Erectile Dysfunction , Genetic Therapy , Hyperglycemia , Hypogonadism , Oxidoreductases , Penile Implantation , Phosphodiesterase Inhibitors , Protein Kinase C , Reactive Oxygen Species , Superoxides , Vacuum , Vasoconstriction , VasodilationABSTRACT
PURPOSE: Conflicting results have been reported for western populations on associations of serum insulin-like growth factor I (IGF-I) and major IGF-binding protein-3 (IGFBP-3) with the risk of prostate cancer. However, few data have been available for oriental populations. We undertook a matched case-control study in a low-risk Korean population to extend our knowledge about potential associations. MATERIALS AND METHODS: Serum IGF-I and IGFBP-3 levels were determined for 330 men (165 cases and 165 healthy age-matched controls). Conditional logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for the association between plasma IGF levels and prostate cancer. We also investigated the potential influence of the associations according to clinical risk for advanced disease at diagnosis. RESULTS: We noted that the risks of prostate cancer were unrelated to the IGF-1 level and IGF-I/IGFBP-3 molar ratio. In contrast, a strong inverse association was observed between IGFBP-3 levels and the risk for prostate cancer. Men in the highest quartile of IGFBP-3 levels had a 71% reduced risk of prostate cancer compared with men in the lowest quartile (OR=0.29, 95% CI: 0.11-0.64, P(trend)<0.001). Subgroup analysis revealed a significant inverse association between plasma IGFBP-3 and the likelihood of a high risk prostate cancer. CONCLUSIONS: Plasma IGFBP-3 levels were inversely associated with the risk of prostate cancer and the likelihood for high-risk disease, suggesting that IGFBP-3 plays a protective role against prostate cancer in the Korean population.
Subject(s)
Humans , Male , Case-Control Studies , Insulin-Like Growth Factor Binding Protein 3 , Insulin-Like Growth Factor I , Logistic Models , Molar , Odds Ratio , Plasma , Prostate , Prostatic NeoplasmsABSTRACT
PURPOSE: Asymmetrical dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase (NOS) and the major metabolic pathway of ADMA is enzymatic degradation via dimethylarginine dimethylaminohydrolasease (DDAH). In this study, we hypothesized that an elevated cavernosal ADMA level might result from poor DDAH activity in the corpus cavernosum. We examined whether ADMA was accumulated in our atherosclerotic rat model of vasculogenic erectile dysfunction (VED). MATERIALS AND METHODS: Twelve 12-wk-old Sprague-Dawley rats were grouped in either the atherosclerosis group (AS, n=6) or the control (n=6) group. The AS group received a 1% cholesterol diet for 6 weeks and the rats were also treated with NG-nitro-L-arginine methyl ester (3mg/ml) for the initial 2 weeks. The control group received a normal diet. Six weeks later, all the rats were anesthetized with urethane (1.6g/kg) and cavernous electrostimulation was done under continuous arterial and cavernosal pressure monitoring (6V, 0.5ms, 20Hz, 50sec). The methylarginine level in both the AS group and the control group was measured respectively. Also, the NOS activity and DDAH activity in the corpus cavernosum were evaluated. RESULTS: Upon cavernous electostimulation, the peak intracavernosal pressure (ICP) of the control group was 88.5+/-5.5mmHg (n=6). In contrast, the peak ICP level was markedly reduced in the atherosclerotic group to 54.2+/-4.8mmHg (n=6, p<0.001). The cavernosal level of ADMA in the control group was 320.5+/-23.6micrometer and it was 860.7+/-34.7micrometer in the AS group. The constitutive NOS activity in the rat corpus cavernosum of the AS group was markedly reduced compared to the control group. Also, the cavernosal DDAH activity was reduced in the AS rats and the activity showed significant negative correlation with the cavernosal ADMA level. CONCLUSIONS: In this study, we have demonstrated that the dysregulation of DDAH activity may be one of the causes of decreased NOS activity in atherosclerotic erectile dysfunction.
Subject(s)
Animals , Male , Rats , Atherosclerosis , Cholesterol , Diet , Erectile Dysfunction , Metabolic Networks and Pathways , Models, Animal , NG-Nitroarginine Methyl Ester , Nitric Oxide Synthase , Rats, Sprague-Dawley , UrethaneABSTRACT
PURPOSE: Regarding for erectile dysfunction(ED), Sildenafil has produced satisfactory clinical results. However, Some patient discontinue sildenafil treatment for a variety of reasons after successful restoration of erectile function. We investigated the reasons for such discontinuations of sildenafil after restoration of erectile function by sildenafil medication. MATERIALS AND METHODS: After sildenafil medication, one hundred fifty six patients whose score of erectile function domain of the 15-item International Index of Erectile Function(IIEF) increased to 26 or more, were included in this study. Six-months after the first sildenafil prescription, compliance to medication and the reason for discontinuity were reviewed by chart or surveyed by telephone. RESULTS: In 156 successfully treated patients, 54(34.6%) discontinued sildenafil medication. The 2 most common reasons for discontinuation were trouble in the partners' or patients' emotional readiness for restoration of sexual activity after long-term abstinence and fear of possible side effects. CONCLUSIONS: After restoration of erectile function, many patients discontinued the use of sildenafil medication. The reasons for discontinuing the medication were primarily emotional or relationship-oriented issues. The counseling of both partners and education about the effects and side effects of the drugs are recommended to promote the successful recovery of sexual activity.
Subject(s)
Humans , Male , Compliance , Counseling , Education , Erectile Dysfunction , Prescriptions , Sexual Behavior , Telephone , Sildenafil CitrateABSTRACT
PURPOSE: The analgesic efficacy of the periprostatic nerve blockade during transrectal ultrasound guided prostatic biopsies was evaluated. MATERIALS AND METHODS: A transrectal ultrasound guided prostate biopsy was performed in 90 men due to abnormal digital rectal examinations or elevated prostate specific antigens. During the biopsy, two groups of 45 patients were randomly assigned to receive either an injection of 1% lidocaine or no prior analgesia. Immediately after the biopsy the pain score was independently recorded by the patients using a 10-point linear scale. RESULTS: The mean intraoperative pain scores were 2.7+/-1.7 and 4.9+/-2.6 in the lidocaine and control groups, respectively, and were significantly different (p<0.001). The mean immediate postoperative pain scores were 0.7+/-0.7 and 1.5+/-1.3 in the lidocaine and control groups, respectively, and were not significantly different (p=0.057). There were no differences in the complication rates between the two groups. CONCLUSIONS: Our results show a significant benefit of periprostatic anesthesia over that in the controls (no anesthesia applied) in our randomized trial. This safe, simple and rapid technique should be applied before a transrectal ultrasound guided prostatic biopsy to reduce undue patient discomfort.
Subject(s)
Humans , Male , Analgesia , Anesthesia , Biopsy , Digital Rectal Examination , Lidocaine , Nerve Block , Pain, Postoperative , Prostate , Prostate-Specific Antigen , UltrasonographyABSTRACT
PURPOSE: Although shockwave induced injury to the normal kidney is regarded as negligible, it may be more prominent, and harmful, in case of uncontrolled hypertension. The purpose of our study was to investigate the effects of a repetitive focused shockwave on the renal morphology and blood pressure of spontaneous hypertensive rats (SHR), and to compare the results with normotensive controls. MATERIALS AND METHODS: At 14 weeks of age, 10 SHRs received four separate shockwave treatments (1,000 shocks per treatment at 17.2kV) at one week intervals, with 10 normotensive controls receiving the same treatment. At 20 weeks of age, their subsequent changes in blood pressure and renal morphology were compared. RESULTS: In the SHR group, the renal shockwave treatment retarded their somatic growth, whereas in the control group, which received same treatment, there was no significant growth delay. Renal morphologic damages, such as interstitial hemorrhages, were more prominent in the hypertensive group than in the normotensive controls. CONCLUSIONS: Our results clearly showed that spontaneous hypertensive rats were more prone to shockwave induced renal injury. Careful noting of a family history of hypertension, and the proper antihypertensive treatment, are necessary steps to prevent or reduce possible complications.
Subject(s)
Animals , Humans , Rats , Blood Pressure , Genetic Predisposition to Disease , Hemorrhage , Hypertension , Kidney , ShockABSTRACT
PURPOSE: Transurethral alprostadil, newly developed treatment modality for patients with erectile dysfunction, may have untoward effects on human sperm. Although previous studies indicated that remained alprostadil had no significant effects on the motility, viability and membrane integrity of human sperm, the possibility that alprostadil might have roles in sperm hyperactivation and acrosomal reaction still exists. So we have evaluated the effects of alprostadil on motility parameters and acrosomal reaction of human sperm in vitro. MATERIALS AND METHODS: Eight healthy volunteers provided semen samples that were incubated with 0.1mg/ml and 0.4mg/ml of alprostadil which respectively represented similar and exaggerated concentration after transurethral administration. Control incubations included polyethylene glycol 1450, the fomulation vehicle, and Ham's F-10 buffer. Serial evaluations of several computer generated measurements of sperm motion were performed after 30, 60 and 120 minutes of incubation. After 120 minutes, we performed simultaneous fluorescein isothiocyanate labelled Pisum sativum lectin/Hoechst 33258 staining to evaluate acrosomal status. RESULTS: The alprostadil group showed decreases in linearity, increases in amplitude of lateral head displacement, and increased fraction of hyperactivated sperm with statistical significance (ANOVA, p<0.05). The fraction of spontaneous acrosomal reaction was increased significantly in the alprostadil group compared with that of control group without a dose- response relationship. CONCLUSIONS: Alprostadil administration in vitro changed several computer assisted sperm motion analysis parameters and increased spontaneous acrosomal reaction. For further evaluation of the effects of remained alprostadil on sperm and fertility, a well- controlled in vivo study will be needed.
Subject(s)
Humans , Male , Alprostadil , Erectile Dysfunction , Fertility , Fluorescein , Head , Healthy Volunteers , Membranes , Pisum sativum , Polyethylene Glycols , Semen , SpermatozoaABSTRACT
PURPOSE: Nitric oxide (NO) and phosphodiesterases (PDEs) play key roles in mediating relaxation of corpus cavernosal smooth muscle by increasing intracellular cGMP level. Here, we investigated effects of NO-donor (sodium nitroprusside, SNP) and penile specific type-V PDE inhibitor (zaprinast) in human and rabbit corpus cavernosal cells and tissues in vitro. MATERIALS AND METHODS: The cultured smooth muscle cells and tissues of human and rabbit corpus cavernosum were treated with increasing concentrations of SNP or zaprinast for 5 and 20 minutes, respectively, and intracellular cGMP levels were measured by radioimmunoassay. Organ bath study was performed to measure the relaxation effects of drugs on precontracted corpus cavernosal muscle strips. RESULTS: Although both NO-donor and type-V PDE inhibitor effectively stimulated the accumulation of cGMP in a dose-dependent manner, magnitude of cGMP increase and specificity of drug were found to be species-dependent. In human corpus cavernosal tissues, cGMP was increased upto 10- and 5-folds by SNP and zaprinast, respectively. However, magnitude of increase was much less in cultured smooth muscle cells. In rabbit, SNP effect was most prominent in cultured cells and effects of SNP and zaprinast were modest in tissues. Both agents also resulted in effective relaxation of human and rabbit cavernosal tissue strips. Similar patterns of dose-response curves were shown between results from the organ bath studies and cGMP radioimmunoassay with cavernosal smooth muscle cells. CONCLUSIONS: Present results show that effects of SNP and zaprinast are not coincident in different species, suggesting possible species-specificities of these two agents. Measurement of cGMP changes in cultured cavernosal smooth muscles cells could be reflected to the relaxation effects of drugs on corpus cavernosal muscle strips.