Evaluation of Emergency Care for Foreign Patients in Korea

PURPOSE: The purpose of this study was to investigate current statistics relating to foreigners who visit a Korean emergency department (ED). METHODS: Subjects included in this study were 125,263 patients who visited one Korean ED from January 1, 2008 to December 31, 2010. We divided subjects into two groups, natives (Koreans) and foreigners (non-Koreans). We compared the two groups according to their age, sex, chief medical complaints, department to which they were referred, their final diagnosis, results of treatment applied, ED residence time, mortality rate, total billed cost of treatment, balance of any unpaid bills and method of visiting the ED. RESULTS: Of the total patients included in the study, 119,864 (95.7%) were natives and 5,399 (4.3%) were foreigners. In natives, the majority were 0 to 10 years old (35.1%), while foreigners were mostly 41 to 50 (22.8%) years old. The most common symptom in both natives and foreigners was fever. The most common diagnosis for foreigners was head, face, and neck injury (13.8%). The main referred departments for foreigners were internal medicine (20.1%), pediatric medicine (16.9%), and orthopedics (14.3%). The admission rate for foreigners (13.0%), was lower than that of natives (17.3%). The mortality rate for foreigners (0.5%) was higher than that of natives (0.3%). The ED residence time for foreigners was higher than that of natives. The total billed cost of treatment and balance of unpaid money by foreigners was higher than that of natives. For foreigners, the proportion of medical fees paid from personal accounts and industrial medical insurance were higher than those of natives. CONCLUSION: Medical insurance and policy for the management of foreigners who visit the ED must be improved.

Difference in Management Between Native Koreans and Foreigners with Penetrating Wounds In the Emergency Room

PURPOSE: With the increasing numbers of foreign residents in Korea, the need for an emergency medical care system for foreign patients seems to be growing. Sometimes, a foreigner admitted to an emergency room is not treated sufficiently due to the absence of insurance, facility in the Korean language, and a guardian. The management of a foreigner with trauma in the ER is difficult due to various problems such as social and economic status. The purpose of this study was to investigate the current management status of foreigners with penetrating wounds in the emergency room. METHODS: This study is an analysis of 580 patients that were diagnosed with penetrating wounds in one teaching Hospital from Jan. 1, 2008 to Dec. 31, 2008. We analyzed results according to nationality, alcohol ingestion, intentional or accidental trauma, trauma mechanism, injury severity, management time in the ER, and outcome in the ER. RESULTS: Of the total 580 patients, 486 patients (83.8%) were native Koreans and 94 patients (16.2%) were foreigners. According to the Revised Trauma Score, the average score of native Korean patients was 7.808, and the average score of foreign patients was 7.638. Of native Korean patients, 22.6% had knife wounds while 38.3% of foreign patients did. Of native Korean patients, 17.3% experienced intentional trauma while 33.0% of the foreign patients did. Of native Korean patients, 22.5% had ingested alcohol while 49.4% of the foreigners had. Of native Korean patients, 10.5% were admitted while 7.6% of the foreign patients were. Of native Korean patients, 14.2% were discharged against medical advice (DAMA), while 18.5% of foreign patients were. Of native Korean patients, 1.2% ran away while 8.7% of the foreign patients did. CONCLUSION: Stabbing was the most common cause of penetrating wounds in foreigner patients in this study. Intentional trauma was more common in foreigners with penetrating wounds than in native Koreans. The severity was higher in foreigners with penetrating wounds than it was in native Koreans, and patients who ran away or were discharged against medical advice were more commonly foreigners with penetrating wounds. Social insurance or policy is needed for the management of foreigners with penetrating wounds.

Akt is involved in the inhibition of cell proliferation by EGF

Axin is a negative regulator of the Wnt/beta-catenin pathway and is involved in the regulation of axis formation and proliferation. Involvement of Axin in the regulation of other signaling pathways is poorly understood. In this study, we investigated the involvement of Akt in growth regulation by Axin in L929 fibroblasts stimulated by EGF. Akt activity was increased by EGF treatment and Ras activation, respectively. Both the EGF- and Ras-induced Akt activations were abolished by Axin induction, as revealed by both Western blot and immunocytochemical analyses. The proliferation and Akt activation induced by EGF were decreased by Axin induction, and the effects of EGF were abolished by treatment of an Akt-specific inhibitor. Therefore, Axin inhibits EGF-induced proliferation of L929 fibroblasts by blocking Akt activation.

Field Trial on the control effect of fipronil bait against German cockroaches

A field trial on the control effect of fipronil poison bait against German cockroaches (Blatella germanica) was carried out at different restaurant types in Sinchon, Seoul, Republic of Korea. Monitoring was performed applying food baited traps for 2 days per week. Reduction rates of German cockroaches by applying fipronil baits were 90.9% at Korean restaurants, 96.4% at Chinese restaurants, and 89.4% in beer hall kitchens after 4 weeks of the treatment. Overall average of the reduction rate was 93.9%. As the natural reduction rate at untreated restaurants was 11.5% after 4 weeks, a correction of the average reduction rate by applying the Abbot formula was 93.1%.

Transforming variant of Met receptor confers serum independence and anti-apoptotic property and could be involved in the mouse thymic lymphomagenesis

Met tyrosine kinase receptor, the receptor of hepatocyte growth factor/scatter factor (HGF/SF), is present in mouse tissues as two major isoforms differing by a 47-aminoacid segment in the juxtamembrane domain via alternative splicing of exon 14. We found that the smaller isoform of Met (Sm-Met) was highly transformable in both in vitro and in vivo tumorigenesis assays. In this report, close examination of the transforming activity of the Sm-Met showed that the expression of Sm-Met conferred the cells serum independence and anti- apoptotic property when treated with doxorubicin. These properties of Sm-Met seemed to be originated from its far longer maintenance of tyrosine kinase activity after the binding of HGF/SF. Interestingly, the longer maintenance of activated status was accompanied with more increase of tyrosine phosphorylation of Stat3 protein. Moreover, we have tried to find (an) animal tumorigenesis model(s) showing the increase in the expression of this transforming variant of Met. In gamma-ray-induced mouse thymic lymphoma model, the expression of the mRNAs for Sm-Met was significantly increased as well as those of wild type Met and HGF/SF, suggesting a possible role of the Sm-Met in tumorigenesis in vivo.

p21Cip/WAF1 activation is an important factor for the ERK pathway dependent anti-proliferation of colorectal cancer cells

p21Cip/WAF1, an important regulator of cell proliferation, is induced by both p53- and extracellular signal regulated kinase (ERK) pathways. The induction of p21Cip/WAF1 occurs by prolonged activation of the ERKs caused by extracellular stimuli, such as zinc. However, not all the cells appeared to respond to ERK pathway dependent p21Cip/WAF1 induction. Here we investigated the cause of such difference using colorectal cancer cells. p21Cip/WAF1 induction and concomitant reduction of bromodeoxyuridine (BrdU) incorporation were observed by zinc treatment within HT-29 and DLD-1. However, HCT-116 cells with high endogenous p21Cip/WAF1 levels did not show any additional increment of p21Cip/WAF1 levels by zinc treatment and did maintain high BrdU incorporation level. The p21Cip/WAF1 induction by zinc depended upon prolonged activation of extracellular signal regulated kinase (ERK) was not observed in HCT-116 cells. The percentage of BrdU positive cells was 50% higher in p21Cip/WAF1 -/- HCT-116 cells compared to p21Cip/WAF1 +/+ HCT- 116 cells, and no cells induced p21Cip/WAF1 incorporated BrdU in its nucleus, yet confirming the importance of p21Cip/WAF1 induction in anti- proliferation. These results again support that p21Cip/WAF1 induction is a determinant in the regulation of colonic proliferation by the ERK pathway.

Serological observation of Toxoplasma gondii prevalence in Apodemus agrarius, a dominant species of field rodents in Korea

Field rodents involved in ecological food chains and which are the prey of carnivores in the natural environment may serve as reservoir hosts for Toxoplasma gondii infection in humans, however, no data has been published to date in Korea. A total of 1,008 Apodemus agrarius, a dominant species of field rodents in Korea, were trapped at various locations around the country, and their serum antibody (IgG) levels to T. gondii were examined by ELISA. The mean absorbance was 0.11, and fifteen samples (1.49%) showed positive titers from 0.18 to 0.59. The seropositive samples were analyzed by immunoblot. Five of them showed reactive bands to T. gondii water soluble antigens of 30, 35, and 43 kDa. This immunoblot analysis showed very similar patterns to that obtained using sera of experimentally infected mice with T. gondii. The present study presents indirect evidence of the existence of T. gondii in field rodents in Korea.

Immunoblot Analysis of Allergens in Mosquito, Culex pipiens / 소아알레르기및호흡기학회지

PURPOSE: Adverse reactions to mosquito bites have been recognized for some time, and these usually consist of large swellings, generalized urticaria, angioedema, and less frequently asthma. There have been some efforts to define immunologic characteristics of mosquito allergens throughout the world. But, in Korea, the immunologic analysis of mosquito allergen have not been made. METHODS: Extracts of locally distributed female mosquito Culex pipiens, were prepared from their heads and thoraxes. By sodium dodecylsulfate-polyacrylamide gel electrophoresis, proteins of two extracts were isolated. Then their proein bands were transferred to nitrocellulose membrane. Immunoblotting was performed with sera of allergic patients to mosquito bites, then completed by antibodies to human IgE. RESULTS: Immunoblotting showed IgE binding proteins weighing 70 kD, 60 kD, 34 kD in Culex pipiens. CONCLUSION: We found that mosquito antigens induced IgE response, and it suggested that species-specific antigens exist. Further investigation using salivary gland extracts from Culex genus are needed in identifying specific allergens.

Identification and purification of IgE-reactive proteins in German cockroach extract

Cockroaches have been implicated as a cause of respiratory allergy in urban areas worldwide. IgE-reactive German cockroach proteins were identified with molecular weights (MWs) of 90, 66, 50, 43 and 36 KD by immunoblot analysis in both immune BALB/c mice and sensitized humans. Prominent IgE-reactive proteins were purified using FPLC by ion-exchange chromatography, gel filtration and hydrophobic chromatography. The N-terminal amino acid sequence of a purified protein with a MW of 66 KD on SDS-PAGE was Val-Thr-Leu-Lys-Lys(Val)-Met-Ile-Lys-Thr-Phe-Tyr. No homologous protein was found through a search of GenBank that indicated a novel IgE-reactive protein in German cockroach extract. Another purified protein with a MW of 36 KD reacted strongly with a monoclonal antibody against Bla g 2.

Comparative Study of Spinal Anesthesia between 0.5% Hyperbaric Bupivacaine( Marcaine )and Tetracaine( Pantocaine ) / 대한마취과학회지

BACKGROUND: The aim of this study was to compare the difference in hemodynamic change and in sensory or motor block between hyperbaric tetracaine and bupivacaine in spinal anesthesia. METHODS: The sixty-three patients, belonged to ASA class 1 and 2, were divided into tetracaine group and bupivacaine group. The patients were administered 0.5% hyperbaric tetracaine(Pantocaine ) in tetracaine group and 0.5% hyperbaric bupivacaine(Marcaine ) in bupivacaine group, intrathecally. After intrathecal injection of the agents, we measured the change of sensory block level according to pinprick test, the motor block by the modified Bromage score until fixations was achieved, and the blood pressure and heart rate. RESULTS: The two groups did not differ significantly with loss of sensory level and onset time. Bupivacaine group was revealed a slower fixations of motor block than tetracaine group(p<0.05). Changes of systolic blood pressure and mean arterial blood pressure of bupivacaine group were less than tetracaine group(p<0.05) in 2~25 minutes and 6~15 minutes, respectively. Diastolic blood pressure and heart rate were not different statistically in two groups. CONCLUSION: Spinal anesthesia with hyperbaric bupivacaine was revealed less changes of systolic blood pressure and mean arterial blood pressure than hyperbaric tetracaine, although fixation of motor block was delayed onset. Therefore, we thought that spinal anesthesia with hyperbaric bupivacaine may be used more safe than hyperbaric tetracaine in hemodynamical troublesome case.

The Effects of Intraperitoneal Carbon Dioxide Insufflation and Head-down Tilt Position on Intracranial Pressure / 대한마취과학회지

BACKGROUND: The laparoscopy requires CO2 insufflation and posture changes for operational convenience. However, above circumstances affect the cardiopulmonary systems significantly. And then intracranial pressure (ICP) may be also influenced. METHODS: To ascertain the changes of ICP, an experimental study was performed, in which the parameters of hemodynamic status, arterial blood gas components and ICP were measured from twelve cases of Korean mongrel dogs. Pneumoperitoneum was produced by CO2 insufflation(15 mmHg) and then posture was altered from horizontal to head-down tilt of 20, 30 and 40 degree*. The measurements were obtained before (control), after CO2 insufflated horizontal position at 20, 40 and 60 minute in CO2 insufflated tilt** and CO2 deflated horizontal***. RESULTS: MAP and HR were not related to the insufflated time and degree of tilt. CVP and PCWP were significantly increased after CO2 insufflated tilt (p<0.01), but returned to control after deflated supine. PaCO2 was not significantly changed after CO2 insufflated supine, but grdually increased with degree of tilt and time (p<0.01). ICP was increased at 40 and 60 minute of 20degree, and at 20 minute of 30degree(p<0.05), then markedly increased at 40 and 60 minute of 30degree, and at 20, 40 and 60 minute of 40degreetilt (p<0.01). The increment of ICP was parallel with time and degree of tilt. But, ICP was returned to control after deflated supine. CONCLUSIONS: ICP was increased significantly during laparoscopy in head-down tilt, although it was reversible. Therefore, the patient must be given special attention during laparoscopy in whom the increment of ICP may be harmful.