Loading...
Sign In    Register

Table of Content

    15 June 2014, Volume 5 Issue 2
    Previous Issue    Next Issue
    Original Articles
    Attributes of cancer patients admitted to the emergency department in one year
    Muallaoglu Sadik, Karagün Ozlem, Mertsoylu Huseyin, Besen AliAyberk, Sezer Ahmet, Ozyilkan Ozgur
    2014, 5(2):  85-90.  doi:10.5847/wjem.j.issn.1920-8642.2014.02.001
    Asbtract    HTML    PDF (277KB)   

    BACKGROUND: Cancer patients frequently visit the emergency department (ED) with various symptoms of cancer. The purpose of this study was to determine the clinical characteristics and 1-year survival rate of cancer patients in the ED of a university hospital.
    METHODS: We conducted a retrospective review of 408 cancer patients who visited the ED between January 2011 and December 2011. Patient information on demographics, chief complaints, findings, and survival was gathered from the hospital registry and corresponding health administration.
    RESULTS: The study included 240 (58.8%) males and 168 (41.2%) females with a median age of 57.9 years (range 19-87). Regarding cancer staging, 266 patients (65.3%) had metastatic disease and 142 (34.7%) had local and loco-regional disease. The hospitalization rate was 59.6%. The most common symptoms were shortness of breath (23.2%), pain (17.8%), fever (14.2%), and nausea/vomiting (14.4%). The most common cancer sites were the lung (32.5%), gastrointestinal system (25.4%), and breast (9.3%). The initial evaluation determined progressive disease (42.4%), chemotherapy effects (20.7%), infections (17.2%), radiotherapy effects (4.7%), extravasation (1.8%), anemia (1.4%), and unknown (11.3%). During follow up, 191 (46.8%) patients died after admission to the ED. The 1-year overall survival of all patients was 7.3 months.
    CONCLUSIONS: Symptom management in cancer patients is a complex multifaceted concern for the emergency physician. Because of the increasing prevalence of cancer patients, emergency physicians should develop consensus algorithms in collaboration with the relevant disciplines to manage the commonly encountered problems.

    An assessment of antioxidant status in patients with carbon monoxide poisoning
    Suat Zengin, Behcet A, Sahin Karta, Basri Can, Mustafa Orkmez, Abdullah Taskın, Ugur Lok, Bediha Gulen, Cuma Yildirim, Seyithan Taysi
    2014, 5(2):  91-95.  doi:10.5847/wjem.j.issn.1920-8642.2014.02.002
    Asbtract    HTML    PDF (310KB)   

    BACKGROUND: Carbon monoxide poisoning (COP) is an important cause of mortality and morbidity worldwide. This study was to investigate the levels of serum paraoxonase (PON), arylesterase (ARYL), ceruloplasmin (Cp), and sulfhydryl (-SH) in the treatment of COP, and to further understand the pathophysiology of COP.
    METHODS: This prospective study comprised 107 individuals with COP (group 1) and 50 healthy volunteers (group 2). Serum, plasma, and erythrocyte samples were taken on admission from all participants with COP. This process was repeated in the 90th and 180th minutes of treatment. Samples were taken from the control group only once. The levels of plasma PON, ARYL, Cp activity and -SH were measured in both groups.
    RESULTS: Age, gender, and carboxyhemoglobin level were not correlated with PON, ARYL, Cp, and -SH levels. PON, ARYL, and -SH levels were significantly decreased in group 1 compared with group 2. Conversely, Cp was significantly elevated in group 1 in contrast to group 2. Although ARYL was lower on admission in patients with COP than that was observed in the 90th and 180th minutes (P<0.001), Cp was higher on admission than at the other time points (P<0.001).
    CONCLUSIONS: Participants with COP had decreased levels of antioxidants (PON, ARLY, and -SH). COP represses the antioxidant system.

    Clinical and procedural predictors of no-reflow in patients with acute myocardial infarction after primary percutaneous coronary intervention
    Hua Zhou, Xiao-yan He, Shao-wei Zhuang, Juan Wang, Yan Lai, Wei-gang Qi, Yi-an Yao, Xue-bo Liu
    2014, 5(2):  96-102.  doi:10.5847/wjem.j.issn.1920-8642.2014.02.003
    Asbtract    HTML    PDF (404KB)   

    BACKGROUND: The treatment of acute myocardial infarction (AMI) is thought to restore antegrade blood flow in the infarct-related artery (IRA) and minimize ischemic damage to the myocardium as soon as possible. The present study aimed to identify possible clinical predictors for no-reflow in patients with AMI after primary percutaneous coronary intervention (PCI).
    METHODS: A total of 312 consecutive patients with AMI who had been treated from January 2008 to December 2010 at the Cardiology Department of East Hospital, Tongji University School of Medicine were enrolled in this study. Inclusion criteria were: (i) patients underwent successfully primary PCI within 12 hours after the appearance of symptoms; or (ii) patients with ischemic chest pain for more than 12 hours after a successful primary PCI within 24 hours after appearance of symptoms. Exculsion criteria were: (i) coronary artery spasm; (ii) diameter stenosis of the culprit lesion was ≤50% and coronary blood flow was normal; (iii) patients with severe left main coronary or multivessel disease, who had to require emergency revascularization. According to thrombolysis in myocardial infarction (TIMI), the patients were divided into a reflow group and a no-reflow group. The clinical data, angiography findings and surgical data were compared between the two groups. Univariate and multivariate logistic regressions were used to determine the predictors for no-reflow.
    RESULTS: Fifty-four (17.3%) of the patients developed NR phenomenon after primary PCI. Univariate analysis showed that age, time from onset to reperfusion, systolic blood pressure (SBP) on admission, Killip class of myocardial infarction, intra-aortic balloon pump (IABP) use before primary PCI, TIMI flow grade before primary PCI, type of occlusion, thrombus burden on baseline angiography, target lesion length, reference luminal diameter and method of reperfusion were correlated with no-reflow (P<0.05 for all). Multiple logistic regression analysis identified that age >65 years [OR=1.470, 95% confidence interval (CI) 1.460-1.490, P=0.007], long time from onset to reperfusion >6 hours (OR=1.270, 95%CI 1.160-1.400, P=0.001), low SBP on admission <100 mmHg (OR=1.910, 95%CI 1.018-3.896, P=0.004), IABP use before PCI (OR= 1.949, 95%CI 1.168-3.253, P=0.011), low (≤1) TIMI flow grade before primary PCI (OR=1.100, 95%CI 1.080-1.250, P<0.001), high thrombus burden (OR=1.600, 95%CI 1.470-2.760, P=0.030), and long target lesion (OR=1.948, 95%CI 1.908-1.990, P=0.019) on angiography were independent predictors of no-reflow.
    CONCLUSION: The occurrence of no-reflow after primary PCI for acute myocardial infarction can predict clinical, angiographic and procedural features.

    Treatment of postoperative infectious complications in patients with human immunodeficiency virus infection
    Bao-chi Liu, Lei Zhang, Jin-song Su, Andy Tsun, Bin Li
    2014, 5(2):  103-106.  doi:10.5847/wjem.j.issn.1920-8642.2014.02.004
    Asbtract    HTML    PDF (290KB)   

    BACKGROUND: Antibiotics are widely given for surgical patients to prevent infection. Because of the lack of study on the rational use of antibiotics in patients with human immunodeficiency virus (HIV) -infected during surgical procedures, we analyzed the risk factors affecting postoperative infectious complications in HIV-infected patients and explore the rational use of perioperative antibiotics.
    METHODS: This retrospective study consisted of 308 HIV-infected patients, 272 males and 36 females, who had undergone operation at the Shanghai Public Health Clinical Center from November 2008 to April 2012. The patients were divided into postoperative infection and non-infection groups. Their age and clinical variables were compared. The correlation between surgical incision, surgical site infection (SSI) and postoperative sepsis was analyzed. Prophylactic antibiotics were used for patients with type I and II incisions for less than 2 days. Patients with type III incisions were given antibiotics until the infection was controlled. Antiretroviral therapy (ART) was prescribed preoperatively for patients whose preoperative CD4 count was <350 cells/µL. For those patients whose preoperative CD4 count was <200 cells/µL, sulfamethoxazole and fluconazole were given preoperatively as prophylactic agents controlling Pneumocystis carinii pneumonia and fungal infection.
    RESULTS: A total of 196 patients developed postoperative infectious complications, and 7 patients died. Preoperative CD4 counts, ratio of CD4/CD8 cells, hemoglobin level, and postoperative CD4 counts, hemoglobin and albumin levels were risk factors of perioperative infection in HIV-infected patients. Patients with a preoperative CD4 count <200 cell/µL, anemia, a postoperative CD4 count <200 cell/µL or albumin levels <35 g/L were correlated with a higher rate of perioperative infection. There was a significant correlation between SSI and the type of surgical incision. The rate of SSI in patients with type I surgical incision was 2% and in those with type II surgical incision was 38%. All the patients who received type III surgical incision developed SSI, and they were more likely to develop postoperative sepsis.
    CONCLUSIONS: HIV-infected patients are more likely to develop postoperative infectious complications. The rational use of antibiotics in HIV-infected patients could help to reduce the rate of postoperative infectious complications in these patients.

    Techniques of rapid sequence induction and intubation at a university teaching hospital
    Endale G. Gebremedhn, Kefale D. Gebeyehu, Hintsawit A. Ayana, Keder E. Oumer, Hulgize N. Ayalew
    2014, 5(2):  107-111.  doi:10.5847/wjem.j.issn.1920-8642.2014.02.005
    Asbtract    HTML    PDF (236KB)   

    BACKGROUND: Rapid sequence induction and intubation (RSII) is a medical procedure involving a prompt induction of general anesthesia by using cricoid pressure that prevents regurgitation of gastric contents. The factors affecting RSII are prophylaxis for aspiration, preoxygenation, drug and equipment preparation for RSII, ventilation after induction till intubation and patient condition. We sometimes saw difficulties with the practice of this technique in our hospital operation theatres. The aim of this study was to assess the techniques of rapid sequence induction and intubation.
    METHODS: Hospital based observational study was conducted with a standardized checklist. All patients who were operated upon under general anesthesia during the study period were included. The techniques of RSII were observed during the induction of anesthesia by trained anesthetists.
    RESULTS: Altogether 140 patients were included in this study with a response rate of 95.2%. Prophylaxis was not given to 130 patients (92.2%), and appropriate drugs were not used for RSII in 73 patients (52.1%), equipments for difficult intubation in 21 (15%), suction machines with catheter not connected and turned on in 122 (87.1%), ventilation for patients after induction and before intubation in 41 (29.3%), cricoid pressure released before cuff inflation in 12 (12.1%), and difficult intubation in 8 (5.7%), respectively. RSII with cricoid pressure was applied appropriately in 94 (67.1%) patients, but cricoid pressure was not used in 46 (32.9%) patients.
    CONCLUSIONS: The techniques of rapid sequence induction and intubation was low. Training should be given for anesthetists about the techniques of RSII.

    Road traffic accidents in hilly regions of northern India: What has to be done?
    Anil Kumar Joshi, Chitra Joshi, Mridu Singh, Vikram Singh
    2014, 5(2):  112-115.  doi:10.5847/wjem.j.issn.1920-8642.2014.02.006
    Asbtract    HTML    PDF (238KB)   

    BACKGROUND: Road traffic accidents (RTA) are responsible for 1.2 million deaths worldwide each year. RTA will become the 3rd largest contributor to the global burden of diseases after ischemic heart diseases (IHD) and depression. We conducted a retrospective study on RTA in a tertiary center in the hilly district of Uttarakhand in India.
    METHODS: The number of RTA, pattern of RTA, the number of patients killed and injured, the pattern of injury causing death and disability, the severity of accidents, and the type of disability were noted from December 2009 to November 2011. The accident severity was calculated as the number of patients killed per 100 accidents. The methods for reducing the incidence of RTA were observed, and the role of policy makers was studied.
    RESULTS: The majority of deaths and disabilities in Uttarakhand were due to road traffic accidents in the hilly districts of the states. The most common cause of RTA was driving fault followed by defective roads.
    CONCLUSION: Proper designing of roads and minimizing the fault of drivers are essential to prevent road traffic accidents in hilly regions.

    Changes of end-tidal carbon dioxide during cardiopulmonary resuscitation from ventricular fibrillation versus asphyxial cardiac arrest
    Qing-ming Lin, Xiang-shao Fang, Li-li Zhou, Yue Fu, Jun Zhu, Zi-tong Huang
    2014, 5(2):  116-121.  doi:10.5847/wjem.j.issn.1920-8642.2014.02.007
    Asbtract    HTML    PDF (323KB)   

    BACKGROUND: Partial pressure of end-tidal carbon dioxide (PETCO2) has been used to monitor the effectiveness of precordial compression (PC) and regarded as a prognostic value of outcomes in cardiopulmonary resuscitation (CPR). This study was to investigate changes of PETCO2 during CPR in rats with ventricular fibrillation (VF) versus asphyxial cardiac arrest.
    METHODS: Sixty-two male Sprague-Dawley (SD) rats were randomly divided into an asphyxial group (n=32) and a VF group (n=30). PETCO2 was measured during CPR from a 6-minute period of VF or asphyxial cardiac arrest.
    RESULTS: The initial values of PETCO2 immediately after PC in the VF group were significantly lower than those in the asphyxial group (12.8±4.87 mmHg vs. 49.2±8.13 mmHg, P=0.000). In the VF group, the values of PETCO2 after 6 minutes of PC were significantly higher in rats with return of spontaneous circulation (ROSC), compared with those in rats without ROSC (16.5±3.07 mmHg vs. 13.2±2.62 mmHg, P=0.004). In the asphyxial group, the values of PETCO2 after 2 minutes of PC in rats with ROSC were significantly higher than those in rats without ROSC (20.8±3.24 mmHg vs. 13.9±1.50 mmHg, P=0.000). Receiver operator characteristic (ROC) curves of PETCO2 showed significant sensitivity and specificity for predicting ROSC in VF versus asphyxial cardiac arrest.
    CONCLUSIONS: The initial values of PETCO2 immediately after CPR may be helpful in differentiating the causes of cardiac arrest. Changes of PETCO2 during CPR can predict outcomes of CPR.

    Protective role of retinoid X receptor in H9c2 cardiomyocytes from hypoxia/reoxygenation injury in rats
    Pei-ren Shan, Wei-wei Xu, Zhou-qing Huang, Jun Pu, Wei-jian Huang
    2014, 5(2):  122-127.  doi:10.5847/wjem.j.issn.1920-8642.2014.02.008
    Asbtract    HTML    PDF (559KB)   

    BACKGROUND: Retinoid X receptor (RXR) plays a central role in the regulation of intracellular receptor signaling pathways. The activation of RXR has protective effect on H2O2-induced apoptosis of H9c2 ventricular cells in rats. But the protective effect and mechanism of activating RXR in cardiomyocytes against hypoxia/reoxygenation (H/R)-induced oxidative iniury are still unclear.
    METHODS: The model of H/R injury was established through hypoxia for 2 hours and reoxygenation for 4 hours in H9c2 cardiomyocytes of rats. 9-cis-retinoic acid (9-cis RA) was obtained as an RXR agonist, and HX531 as an RXR antagonist. Cultured cardiomyocytes were randomly divided into four groups: sham group, H/R group, H/R+9-cis RA -pretreated group (100 nmol/L 9-cis RA), and H/R+9-cis RA+HX531-pretreated group (2.5 μmol/L HX531). The cell viability was measured by MTT, apoptosis rate of cardiomyocytes by flow cytometry analysis, and mitochondrial membrane potential (ΔΨm) by JC-1 fluorescent probe, and protein expressions of Bcl-2, Bax and cleaved caspase-9 with Western blotting. All measurement data were expressed as mean±standard deviation, and analyzed using one-way ANOVA and the Dunnett test. Differences were considered significant when P was <0.05.
    RESULTS: Pretreatment with RXR agonist enhanced cell viability, reduced apoptosis ratio, and stabled ΔΨm. Dot blotting experiments showed that under H/R stress conditions, Bcl-2 protein level decreased, while Bax and cleaved caspase-9 were increased. 9-cis RA administration before H/R stress prevented these effects, but the protective effects of activating RXR on cardiomyocytes against H/R induced oxidative injury were abolished when pretreated with RXR pan-antagonist HX531.
    CONCLUSION: The activation of RXR has protective effects against H/R injury in H9c2 cardiomyocytes of rats through attenuating signaling pathway of mitochondria apoptosis.

    Post-conditioning with gradually increased reperfusion provides better cardioprotection in rats
    Guo-ming Zhang, Yu Wang, Tian-de Li, Xiao-yan Li, Shao-ping Su, Yuan-yuan Sun, Xiu-hua Liu
    2014, 5(2):  128-134.  doi:10.5847/wjem.j.issn.1920-8642.2014.02.009
    Asbtract    HTML    PDF (438KB)   

    BACKGROUND: Rapid and complete reperfusion has been widely adopted in the treatment of patients with acute myocardial infarction (AMI), but this process sometimes can cause severe reperfusion injury. This study aimed to investigate different patterns of post-conditioning in acute myocardial ischemia-reperfusion injury, and to detect the role of mitogen activated protein kinase (MAPK) during the injury.
    METHODS: Rats were randomly divided into five groups: sham group, reperfusion injury (R/I) group, gradually decreased reperfusion group (GDR group, 30/10-25/15-15/25-10/30 seconds of reperfusion/ischemia), equal reperfusion group (ER group, 20/20 seconds reperfusion/ischemia, 4 cycles), and gradually increased reperfusion group (GIR group, 10/30-15/25-25/15-30/10 seconds of reperfusion/ischemia). Acute myocardial infarction and ischemic post-conditioning models were established in the rats. Six hours after reperfusion, 3 rats from each group were sacrificed and myocardial tissues were taken to measure the expressions of phosphorylation of extracellular signal-regulated protein kinase (P-ERK), phosphorylated c-Jun N-terminal kinase (P-JNK), mitogen-activated protein kinase p38 (p38 MAPK), tumor necrosis factor-α (TNF-α), caspases-8 in the myocardial tissue, and cytochrome c in the cytosol using Western blot. Hemodynamics was measured at 24 hours after reperfusion, the blood was drawn for the determination of cardiac enzymes, and the heart tissue was collected for the measurement of apoptosis using TUNEL. One-way analysis of variance and the Q test were employed to determine differences in individual variables between the 5 groups.
    RESULTS: Three post-conditioning patterns were found to provide cardioprotection (P<0.05) compared with R/I without postconditioning. GIR provided the best cardioprotection effect, followed by ER and then GDR. Apoptotic index and serum marker levels were reduced more significantly in GIR than in ER (P<0.05). The enhanced cardioprotection provided by GIR was accompanied with significantly increased levels of P-ERK 1/2 (1.82±0.22 vs. 1.54±0.32, P<0.05), and lower levels of p-JNK, p38 MAPK, TNF-α, caspase-8, caspase-9 and cytochrome in the cytoplasm (P<0.05), compared with ER. The infarct size was smaller in the GIR group than in the ER group, but this difference was not significant (16.30%±5.22% vs. 20.57%±6.32%, P<0.05). All the measured variables were improved more significantly in the GIR group than in the GDR group (P<0.05).
    CONCLUSION: Gradually increased reperfusion in post-conditioning could attenuate reperfusion injury more significantly than routine method, thereby the MAPK pathway plays an important role in this process.

    Effects of ramipril on ventricular arrhythmia after myocardial infarction in rabbits
    Ya Zhong, Ping Cao, Chuan-feng Tong, Xia Li
    2014, 5(2):  135-138.  doi:10.5847/wjem.j.issn.1920-8642.2014.02.010
    Asbtract    HTML    PDF (232KB)   

    BACKGROUND: Ventricular arrhythmia (VA) is one of the most common complications of myocardial infarction (MI), and ventricular tachycardia and fibrillation are the main causes for sudden cardiac death. This study aimed to explore the effect of ramipril on the occurrence of VA and its mechanism after MI in rabbits.
    METHODS: Twenty-four New Zealand rabbits purchased from the Wuhan Laboratory Animal Research Center were divided into three groups: sham-operated (SHAM) group (n=8), MI group (n=8) and MI with ramipril (RAM) group (n=8). Rabbits in the SHAM group received a median sternotomy without ligation of the left ventricular coronary artery. Rabbits in the MI and RAM groups received a median sternotomy followed by ligation of the left coronary artery. The successful anterior MI was confirmed by elevation of the ST segment with more than 0.2 mV in lead II and III. After MI, rabbits in the RAM group were fed with intragastric ramipril (1 mg/kg per day ) for 12 weeks. Before and 12 weeks after MI in the three groups, ventricular tachycardia or fibrillation (VT/VF) episodes and MAP in cadiocytes of the epicardium, mid-myocardium and endocardium were recorded by a multichannel physiograph. Student's t test and ANOVA were used for statistical analysis.
    RESULTS: VT/VF episodes were decreased more markedly in the RAM group than in the MI group after 12 weeks (2.6±0.8 vs. 12.4±2.9, P<0.05). Twelve weeks after MI, the duration of repolarization for 90% (APD90) of three-tier ventricular myocytes in the MI group was longer than that before MI (258.2±21.1 vs. 230.1±23.2, 278.0±23.8 vs. 245.8±25.4, 242.6±22.7 vs. 227.0±21.7, P<0.05). However, the APD90 was not significantly different at 12 weeks before and after MI in the RAM group (P>0.05). Moreover, the transmural dispersion of repolarization (TDR) was increased more markedly 12 weeks after MI in the MI group than in the SHAM and RAM groups (36.2±10.2 vs. 18.7±6.2, 24.9±8.7, P<0.05). But the TDR was not significantly different between the RAM and SHAM groups (18.7±6.2 vs. 24.9±8.7, P>0.05).
    CONCLUSION: Ramipril may reduce the incidence of malignant ventricular arrhythmia via improvement of transmembrance repolarization heterogeneity after MI.

    Changes in biological behaviors of rat dermal fibroblasts induced by high expression of MMP9
    Sheng-neng Xue, Juan Lei, Diao-zhu Lin, Chuan Yang, Li Yan
    2014, 5(2):  139-143.  doi:10.5847/wjem.j.issn.1920-8642.2014.02.011
    Asbtract    HTML    PDF (340KB)   

    BACKGROUND: The high level of matrix metalloproteinase 9 (MMP9) is thought to slow down the healing of diabetic foot ulcers. Whether it can influence the biological behaviors of skin fibroblasts and affect wound healing is still unclear. The present study aimed to observe changes in the biological behaviors of rat dermal fibroblasts induced by high expression of MMP9 and to clarify the possible mechanisms of wound healing for diabetic foot.
    METHODS: A cell model of skin fibroblast with high expression of MMP9 was established by co-culture of high glucose (22.0 mmol/L) and homocysteine (100 μmol/L). A control group was incubated with normal glucose (5.5 mmol/L). Realtime PCR, ELISA and gelatin zymography were used to detect the MMP9 mRNA, protein expression and activity of MMP9. Flow cytometry, CCK-8, ELISA assay, scratch test and transwell were used to detect cell proliferation, viability, collagen (hydroxyproline) secretion, horizontal migration and vertical migration of cells. The data were expressed as mean±SD. P value less than 0.05 was considered statistically significant.
    RESULTS: The expression of MMP9 mRNA, protein levels and the activity of MMP9 were much higher in the high MMP9 group than in the control group (7.05±1.02 vs. 1.00±0.00, 206.9±33.6 pg/mL vs. 40.4±5.9 pg/mL, and 1.47±0.13 vs. 0.57±0.12, respectively, P<0.01). The proportion of S-phase cells, proliferation index, cell viability, collagen (hydroxyproline) secretion, horizontal migration rate and the number of vertical migration cells were lower in the high MMP9 group than in the control group (P<0.01).
    CONCLUSION: Fibroblasts with a high expression of MMP9 decreased proliferation, activity, secretion and migration of collagens, suggesting that MMP9 may inhibit the biological behaviors of fibroblasts.

    Expression of tissue factor in rabbit pulmonary artery in an acute pulmonary embolism model
    Jing-xia Zhang, Yong-li Chen, Yu-ling Zhou, Qian-yu Guo, Xian-pei Wang
    2014, 5(2):  144-147.  doi:10.5847/wjem.j.issn.1920-8642.2014.02.012
    Asbtract    HTML    PDF (314KB)   

    BACKGROUND: Tissue factor (TF) is the initiation factor of the extrinsic coagulation pathway, and plays a critical role in the process of thrombosis. This study aimed to investigate the expression of TF and to explore their clinical effect on the pulmonary artery after acute pulmonary thromboembolism.
    METHODS: Thirty-four Japanese white rabbits (Level II animals) supplied by Tianjin Medical University were randomly assigned into: group A, specimens of the pulmonary artery taken 3 hours after pulmonary embolism (n=8); group B, specimens of the pulmonary artery taken 8 hours after pulmonary embolism (n=8); group C, specimens of the pulmonary artery taken 24 hours after pulmonary embolism (n=8); and control group, pseudo-operations performed without injection of autologous blood clots (n=10). The animal model of pulmonary thrombo-embolism was established by injection of autologous blood clots into the jugular vein through a 5F catheter, and was confirmed by digital subtraction angiography. The mRNA expression of TF in different parts of the pulmonary artery was accessed by RT-PCR. The q test was used if there was a significant difference in a given continuous variable among the three groups assessed by ANOVA. The experiment equipment was supplied by the State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, the Chinese Academy of Medical Sciences and Peking Union Medical College.
    RESULTS: The TF expression in the specimen adjacent to emboli was stable at 3, 8 or 24 hours after embolism. The mRNA expression of TF at 3 and 8 hours after embolism was lower in the specimens taken from the distal end of the morbid pulmonary artery than those adjacent to emboli. While at 24 hours after embolism, there were similar mRNA levels in specimens either adjacent or distal to emboli.
    CONCLUSION: The high level of TF expression in pulmonary artery tissue adjacent to emboli could lead to locally increased coagulation activity, indicating the necessity of initiating anti-coagulation treatment as soon as possible after acute pulmonary embolism.

    Case Reports
    Cushing's reflex in a rare case of adult medulloblastoma
    Daniel Aronovich, Alexander Scumpia, David Edwards
    2014, 5(2):  148-150.  doi:10.5847/wjem.j.issn.1920-8642.2014.02.013
    Asbtract    HTML    PDF (313KB)   

    BACKGROUND: Medulloblastoma is a primitive neuro-ectodermal tumor. It is common in childhood, but rarely seen at adult age, comprising only 1% of primary brain tumors.
    METHODS: We treated a 31-year-old man presented to the emergency department (ED) with a chief complaint of nausea and vomiting for one week duration. Immediate frozen section revealed a grade IV medulloblastoma. During the hospital course, the patient was given craniospinal irradiation with chemotherapy.
    RESULTS: The patient was eventually discharged from the hospital to an assisted living facility after an uneventful 15-day course with the aid of social work.
    CONCLUSIONS: Despite intracranial tumors generally being slow growing masses, this patient demonstrates how quickly one can decompensate, and how important it is to recognize these clinical signs and symptoms of an intracranial lesion. Although these symptoms (i.e. Cushing response) are extremely rare, the ED physician should be aware and appreciate their clinical significance.

    Traumatic central cord syndrome in a 2-year-old child: minor trauma but major complication
    Neslihan Yücel, Cem Ertan, Mustafa S. Pepele, Ahmet Sığırcı
    2014, 5(2):  151-153.  doi:10.5847/wjem.j.issn.1920-8642.2014.02.014
    Asbtract    HTML    PDF (287KB)   

    BACKGROUND: Traumatic central cord syndrome (TCCS) is the most frequently encountered incomplete spinal cord injury, and it is a relatively rare situation in children younger than 15 years, but may have serious consequences.
    METHODS: We report the case of a 2-year-old female child with upper extremity weakness following a simple fall. All vitals and systemic examination findings were normal, except for 2/5 muscular strength in the upper extremities. While radiographic imaging showed no pathologic findings, MRI exposed spinal injury. The patient was treated conservatively with medication only. The medical treatment of the patient consisted of anti-edema treatment with methylprednisolone in the first 24 hours; 330 mg of methylprednisolone infused in the first hour, followed by 59 mg per hour during the next 23 hours. Along with pharmacological treatment, she received physiotherapy sessions during her 11-day hospitalization period.
    RESULTS: The child had full recovery within 6 months after conservative treatment.
    CONCLUSION: Neurological deficit without plain radiographic evidence in pediatric spinal trauma patients is a rare but significant incident.

    Survival from cardiac arrest due to sushi suffocation
    Toru Hifumi, Nobuaki Kiriu, Hiroshi Kato, Yuichi Koido, Yasuhiro Kuroda
    2014, 5(2):  154-156.  doi:10.5847/wjem.j.issn.1920-8642.2014.02.015
    Asbtract    HTML    PDF (234KB)   

    BACKGROUND: Sushi suffocation is relatively uncommon, and it is an unignorable cause of sudden death; however, no reports on sushi suffocation have been published.
    METHODS: A 60-year-old man was referred to our hospital for post resuscitative intensive care. He had choked on sushi and collapsed in the dining room of a mental hospital. A nursing assistant summoned a physician who attempted to extract the sushi. External cardiac massage was initiated after 7 minutes had elapsed and followed by endotracheal intubation. Return of spontaneous circulation was achieved after 7 minutes of resuscitation. A bronchoscopy demonstrated a large amount of shari in the trachea and right bronchus, which was removed with alligator forceps and a wire basket.
    RESULTS: Neurological recovery was evident on day 2 of admission. He was transferred back to the mental hospital with no neurological complications.
    CONCLUSION: Emergency physicians should consider sushi suffocation, including its clinical features and management.