Association between Smoking and Delayed Neuropsychological Sequelae in Acute Carbon Monoxide Poisoning

PURPOSE: This study examined the association between smoking and delayed neuropsychological sequelae (DNS) in acute carbon monoxide (CO) poisoning. METHODS: Patients admitted to the medical center emergency department from March 2016 to March 2017 because of CO poisoning were examined retrospectively. The patients were divided into two groups: DNS and Non-DNS group. Multiple factors were analyzed to explain DNS, which was assessed by motor disturbances, cognitive impairment, dysphagia, Parkinson-like syndromes, epilepsy, and emotional lability in CO poisoning. RESULTS: A total of 120 patients were included. The factors related to DNS were smoking (pack-years) (p=0.002) and initial carbon monoxide-hemoglobin level (p=0.015). On the other hand, after multivariate logistic regression analysis, smoking (Odds ratio 1.07; 95% CI, 1.02-1.13; p=0.004) was the only factor associated with DNS. CONCLUSION: Smoking is a very reliable factor for predicting the occurrence of DNS. A history of smoking in patients who suffer from CO intoxication is important. If a patient smokes, treatment should be started actively and as soon as possible.

Histological Analysis of In Vitro Co-Culture and In Vivo Mice Co-Transplantation of Stem Cell-Derived Adipocyte and Osteoblast

Many researchers have focused on the role of adipocytes in increasing efficient bone tissue engineering and osteogenic differentiation of stem cells. Previous reports have not reached a definite consensus on whether adipocytes positively influence in vitro osteogenic differentiation and in vivo bone formation. We investigated the adipocyte influence on osteogenic differentiation from adipose-derived stromal cells (ADSCs) and bone formation through histological analysis in vitro and in vivo. Using the direct co-culture system, we analyzed the influence of adipocytes to promote the differentiation fate of ADSCs. Using co-transplantation of ADSC-derived adipocytes and osteoblasts into the dorsal region of mice, the osteogenesis and bone quality were determined by histological morphology, radiography, and the measurement of the Ca²⁺ concentration. The adipocyte negatively affected the osteoblast differentiation of ADSCs in the in vitro system and induced osteogenesis of osteoblasts in the in vivo system through co-transplantation. Interestingly, in the co-transplanted adipocytes and osteoblasts, the bone formation areas decreased in the osteoblast only group compared with the mixed adipocytes and osteoblast group 6 weeks after transplantation. Conversely, co-transplantation and osteoblast transplantation had similar degrees of calcification as observed from radiography analysis and the measurement of the Ca²⁺ concentrations. Our results revealed that adipocytes inhibited osteoblast differentiation in vitro but enhanced the efficacy of osteogenesis in vivo. In addition, the adipocytes controlled the activity of osteoclasts in the newly formed bone tissue. Our approach can be used to reconstruct bone using stem cell-based tissue engineering and to enhance the understanding of the role adipocytes play.

Problems with Transferring Major Trauma Patients to Emergency Medical Center of a University Hospital from Another Medical Center

PURPOSE: The incidence of multiple trauma is increasing nowadays and is the leading cause of death among young adults. Initial treatment is well known to be crucial in multiple trauma victims. However, many indiscriminate transfers occur due to the lack of a well-organized trauma system in Korea. The objective of this study is to demonstrate the current serious state in which major trauma patients are transferred to the Emergency Medical Center of a university hospital from another medical center. METHODS: From November 2009 to October 2010, we performed a retrospective study to analyze the characteristics of patients who visited the Ajou University Medical Center located in Gyeonggi-do. We evaluated the ISS (injury severity score), and a score over 15 point was identified as major trauma. The major trauma patients were separated into two groups according to the visit route, and the characteristics of each group were analyzed. RESULTS: Among the 88,862 patients who visited to the Emergency Medical Center, trauma patients accounted for 19,950, and 343 of them were evaluated as major trauma patients. Among the 343 patients, 170 patients had been transferred from other medical centers. The proportion of males to females was 3.3:1, and the mean ISS was 22.7. The leading cause of trauma was motor vehicle accidents. Of the total 170 patients, 77.6% were admitted to the Intensive care unit and 36.3% underwent surgery. The 170 patients that had been transferred to our medical center, 78.8% were transferred from Gyeonggi-do, 15.3% were transferred from other regions, and 5.9% were miscellaneous. CONCLUSION: Almost half of the major trauma victims treat at our medical center had been transferred from other medical centers. Establishing a traumatic system, supported by well-organized trauma centers and emergency medical services, that can reduce inappropriate transfers among medical facilities is essential.

Depression and Its Infl uencing Factors among Korean Medical and Engineering Students in Urban Areas using Zung Self-Rating Depression Scale / 가정의학회지

BACKGROUND: It is a well known fact that students majoring in medicine and engineering suffer from higher stress level and depression than students in other majors. This study was done to assess the prevalence of depression and the infl uencing factors among the university students majoring in either medicine or engineering and to compare the depression prevalence between the two groups. METHODS: The study randomly selected 640 students either majoring in medicine or engineering from two universities in Kyung-Gi province, Korea. Each of 320 students majoring in either of the two majors from each university was recruited. Among 640 students, 360 students, who were composed of 172 medical students and 188 engineering students was finally chosen for the analysis. The Zung Self-Rating Depression Scale was used to measure the depression state. RESULTS: The average Zung depression score of university students was 49.2 alpha 9.8. Medical students had a higher score of 52.4 alpha 9.3 as compared to engineering students, who scored 46.3 +/- 9.4. Overall depression rate was 42.8%. Medical students had a higher depression rate (52.3%) than engineering students (34.0%). The logistic analysis showed that infl uencing factors on depression state were sex, grade, major, stress and satisfactory sleep. The main source of stress for medical students was the grades from classes whereas job search was for engineering students. There were differences between the two groups in managing the stress. Medical students chose alcohol drinking or smoking for stress management whereas engineering students playing selected video games as their outlet. CONCLUSION: Medical students from urban areas seemed to be depressed more than engineering students. Their stress management methods among the subjects were drinking, smoking, and playing video games which may cause further physical and psychological problems in the future.