Publications by authors named "Junho Cho"

35 Publications

Consent for withholding life-sustaining treatment in cancer patients: a retrospective comparative analysis before and after the enforcement of the Life Extension Medical Decision law.

BMC Med Ethics 2021 Jun 17;22(1):72. Epub 2021 Jun 17.

Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu 120-752, Seoul, Republic of Korea.

Background: The Life Extension Medical Decision law enacted on February 4, 2018 in South Korea was the first to consider the suspension of futile life-sustaining treatment, and its enactment caused a big controversy in Korean society. However, no study has evaluated whether the actual implementation of life-sustaining treatment has decreased after the enforcement of this law. This study aimed to compare the provision of patient consent before and after the enforcement of this law among cancer patients who visited a tertiary university hospital's emergency room to understand the effects of this law on the clinical care of cancer patients.

Methods: This retrospective single cohort study included advanced cancer patients aged over 19 years who visited the emergency room of a tertiary university hospital. The two study periods were as follows: from February 2017 to January 2018 (before) and from May 2018 to April 2019 (after). The primary outcome was the length of hospital stay. The consent rates to perform cardiopulmonary resuscitation (CPR), intubation, continuous renal replacement therapy (CRRT), and intensive care unit (ICU) admission were the secondary outcomes.

Results: The length of hospital stay decreased after the law was enforced from 4 to 2 days (p = 0.001). The rates of direct transfers to secondary hospitals and nursing hospitals increased from 8.2 to 21.2% (p = 0.001) and from 1.0 to 9.7%, respectively (p < 0.001). The consent rate for admission to the ICU decreased from 6.7 to 2.3% (p = 0.032). For CPR and CRRT, the consent rates decreased from 1.0 to 0.0% and from 13.9 to 8.8%, respectively, but the differences were not significant (p = 0.226 and p = 0.109, respectively).

Conclusion: After the enforcement of the Life Extension Medical Decision law, the length of stay in the tertiary university hospital decreased in patients who established their life-sustaining treatment plans in the emergency room. Moreover, the rate of consent for ICU admission decreased.
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http://dx.doi.org/10.1186/s12910-021-00644-0DOI Listing
June 2021

GraS sensory activity in is modulated by the "guard loop" of VraG and the ATPase activity of VraF.

J Bacteriol 2021 Jun 7:JB0017821. Epub 2021 Jun 7.

Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.

Antimicrobial peptides (AMPs) are one of the key immune responses that can eliminate pathogenic bacteria through membrane perturbation. As a successful skin commensal, can sense and respond to AMPs through the GraXRS two-component system and an efflux system comprising the VraG permease and VraF ATPase. GraS is a membrane sensor known to function in AMP resistance through a negatively charged, 9-residue extracellular loop which is predicted to be linear without any secondary structure. An important question is how GraS can impart effective sensing of AMPs through such a small unstructured sequence. In this study, we verified the role of and in AMP sensing in as demonstrated by the failure of the Δ or Δ mutants to sense. Deletion of the extracellular loop of VraG did not affect sensing but reduced survival against polymyxin B. Importantly, a specific region within the extracellular loop, termed the guard loop (GL), has inhibitory activity since sensing of polymyxin B was enhanced in the ΔGL mutant, indicating GL may act as a gate keeper to sensing. Bacterial two-hybrid analysis demonstrated that the extracellular regions of GraS and VraG interact, but interaction appears dispensable to sensing activity. Mutation of the extracellular loop of VraG, GL and the active site of VraF suggested that an active detoxification function of VraG is necessary for AMP resistance. Altogether, we provide evidence for a unique sensory scheme that relies on the function of a permease to impart effective information processing. has become an important opportunistic pathogen responsible for nosocomial and device-related infections that account for considerable morbidity worldwide. A thorough understanding of the mechanisms that enable to colonize human skin successfully is essential for the development of alternative treatment strategies and prophylaxis. Here, we demonstrate the importance of an antimicrobial peptide response system in a clinically relevant strain. Furthermore, we provide evidence for a unique sensory scheme that would rely on the detoxification function of a permease to effect information processing.
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http://dx.doi.org/10.1128/JB.00178-21DOI Listing
June 2021

Experimental demonstration of a 4,294,967,296-QAM-based Y-00 quantum stream cipher template carrying 160-Gb/s 16-QAM signals.

Opt Express 2021 Feb;29(4):5658-5664

We demonstrate a 4,294,967,296-quadrature amplitude modulation (QAM) based Y-00 quantum stream cipher system carrying a 160-Gb/s 16-QAM signal transmitted over 320-km SSMF. The ultra-dense QAM cipher template is realized by an integrated two-segment silicon photonics I/Q modulator.
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http://dx.doi.org/10.1364/OE.405390DOI Listing
February 2021

The extracellular loop of the membrane permease VraG interacts with GraS to sense cationic antimicrobial peptides in Staphylococcus aureus.

PLoS Pathog 2021 Mar 1;17(3):e1009338. Epub 2021 Mar 1.

Department of Microbiology and Immunology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States of America.

Host defense proteins (HDPs), aka defensins, are a key part of the innate immune system that functions by inserting into the bacterial membranes to form pores to kill invading and colonizing microorganisms. To ensure survival, microorganism such as S. aureus has developed survival strategies to sense and respond to HDPs. One key strategy in S. aureus is a two-component system (TCS) called GraRS coupled to an efflux pump that consists of a membrane permease VraG and an ATPase VraF, analogous to the BceRS-BceAB system of Bacillus subtilis but with distinct differences. While the 9 negatively charged amino acid extracellular loop of the membrane sensor GraS has been shown to be involved in sensing, the major question is how such a small loop can sense diverse HDPs. Mutation analysis in this study divulged that the vraG mutant phenocopied the graS mutant with respect to reduced activation of downstream effector mprF, reduction in surface positive charge and enhanced 2 hr. killing with LL-37 as compared with the parental MRSA strain JE2. In silico analysis revealed VraG contains a single 200-residue extracellular loop (EL) situated between the 7th and 8th transmembrane segments (out of 10). Remarkably, deletion of EL in VraG enhanced mprF expression, augmented surface positive charge and improved survival in LL-37 vs. parent JE2. As the EL of VraG is rich in lysine residues (16%), in contrast to a preponderance of negatively charged aspartic acid residues (3 out of 9) in the EL of GraS, we divulged the role of charge interaction by showing that K380 in the EL of VraG is an important residue that likely interacts with GraS to interfere with GraS-mediated signaling. Bacterial two-hybrid analysis also supported the interaction of EL of VraG with the EL of GraS. Collectively, we demonstrated an interesting facet of efflux pumps whereby the membrane permease disrupts HDP signaling by inhibiting GraS sensing that involves charged residues in the EL of VraG.
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http://dx.doi.org/10.1371/journal.ppat.1009338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7951975PMC
March 2021

Transmission of 30-GBd polarization-multiplexed probabilistically shaped 4096-QAM over 50.9-km SSMF.

Opt Express 2019 Oct;27(21):29916-29923

We demonstrate the transmission of a 30-GBd polarization-multiplexed probabilistically shaped 4096-ary quadrature amplitude modulation (QAM) signal over 50.9-km standard signal-mode fiber (SSMF), with a net single-carrier bit rate of 484.4 Gb/s carrying 16.1 information bits per symbol (a potential spectral efficiency of 15.9 bits/s/Hz when taking into account a 0.01 spectral roll-off). The signal is generated from 28-nm complementary metal-oxide-semiconductor (CMOS) digital-to-analog converters (DACs) with 8-bit nominal resolution and is received by an intradyne coherent receiver with a laser that has a linewidth of ∼1 kHz.
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http://dx.doi.org/10.1364/OE.27.029916DOI Listing
October 2019

The latitudinal gradient in rock-inhabiting bacterial community compositions in Victoria Land, Antarctica.

Sci Total Environ 2019 Mar 6;657:731-738. Epub 2018 Dec 6.

Division of Polar Life Sciences, Korea Polar Research Institute, Incheon 21990, Republic of Korea. Electronic address:

The harsh conditions in Victoria Land, Antarctica have formed a simple ecosystem dominated by microbes that use rocks as shelters to avoid environmental stressors. The area is composed of basement rocks that illustrate the history of complex deformation, thus it is highly valuable not only in perspectives of geology but also in biological aspects. Because this region is inhospitable to higher-level organisms and receives least external influences, it can be an ideal environment to investigate the relationship between rock-inhabiting bacterial communities and environmental factors. In such conditions, inorganics dissolved from minerals can be considered as key factors influencing rock-inhabiting bacterial communities. Thus, the present study attempted to explore rock-inhabiting bacterial communities throughout Victoria Land, to identify environmental parameters that are more influential on bacterial community compositions, and to investigate latitudinal gradients in environmental parameters and rock-inhabiting bacterial communities. The results suggested that (i) rock-inhabiting bacterial communities in Victoria Land predominately consisted of either Actinobacteria or Proteobacteria; (ii) latitudinal gradients in rock-inhabiting bacterial community compositions and some environmental parameters were observed; (iii) latitude, pH, nitrate, and sulfate significantly correlated with the dominant phyla; and (iv) the Classification and Regression Tree (CART) analysis demonstrated that latitude, pH, and sulfate concentrations could explain the dominant phylum with 89% accuracy. These findings can provide important insight into the link between environmental factors and rock-inhabiting bacterial community compositions in conditions with extremely cold temperatures and high levels of radiation, which could also be of interest in astrobiology.
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http://dx.doi.org/10.1016/j.scitotenv.2018.12.073DOI Listing
March 2019

Flipped-classroom training in advanced cardiopulmonary life support.

PLoS One 2018 5;13(9):e0203114. Epub 2018 Sep 5.

Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.

Background: The effects of the flipped classroom have been demonstrated in various fields of education in recent years. Training in emergency medicine is also beginning to gradually implement the flipped classroom; however, its practical effect in emergency medicine contexts is not yet clear.

Objective: The present study investigates the effects of the flipped classroom on advanced cardiopulmonary life support (ACLS) training implemented among practicum students in emergency medicine.

Methods: The study randomly assigned into control and experimental conditions 108 fourth year students in the College of Medicine at Yonsei University, in Seoul, who were scheduled to take clinical practice in emergency medicine between March and July 2017. Students were taught about ACLS in either a traditional lecture-based classroom (control condition) or a flipped classroom (experimental condition); then, simulation training with ACLS scenarios was carried out. Finally, each student was rated on performance using a rating form developed in advance.

Results: ACLS simulation scores of the students in the flipped classroom were 70.9±10.9, which was higher than those of the students in the traditional classroom (67.1±11.3); however, this difference was not statistically significant (p = 0.339). In addition, the difference in student satisfaction as measured on a survey was statistically insignificant (p = 0.655).

Conclusions: Competency assessment after simulation-based training in ACLS undergone by senior medical students randomly assigned to flipped and traditional classrooms showed no statistical difference in competency between the two groups.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203114PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124753PMC
February 2019

Effect of flashlight guidance on manual ventilation performance in cardiopulmonary resuscitation: A randomized controlled simulation study.

PLoS One 2018 13;13(6):e0198907. Epub 2018 Jun 13.

Department of Emergency Medicine, College of Medicine, Yonsei University, Seoul, Korea.

Several auditory-based feedback devices have been developed to improve the quality of ventilation performance during cardiopulmonary resuscitation (CPR), but their effectiveness has not been proven in actual CPR situations. In the present study, we investigated the effectiveness of visual flashlight guidance in maintaining high-quality ventilation performance. We conducted a simulation-based, randomized, parallel trial including 121 senior medical students. All participants were randomized to perform ventilation during 2 minutes of CPR with or without flashlight guidance. For each participant, we measured mean ventilation rate as a primary outcome and ventilation volume, inspiration velocity, and ventilation interval as secondary outcomes using a computerized device system. Mean ventilation rate did not significantly differ between flashlight guidance and control groups (P = 0.159), but participants in the flashlight guidance group exhibited significantly less variation in ventilation rate than participants in the control group (P<0.001). Ventilation interval was also more regular among participants in the flashlight guidance group. Our results demonstrate that flashlight guidance is effective in maintaining a constant ventilation rate and interval. If confirmed by further studies in clinical practice, flashlight guidance could be expected to improve the quality of ventilation performed during CPR.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198907PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5999285PMC
January 2019

On line rates, information rates, and spectral efficiencies in probabilistically shaped QAM systems.

Opt Express 2018 Apr;26(8):9784-9791

We carefully revisit the definitions of line rates, information rates, and spectral efficiencies in probabilistically shaped optical transmission systems. Generally accepted definitions for uniform quadrature amplitude modulation (QAM) systems are extended to more generally apply to systems with probabilistically shaped QAM, as well as to systems using pilot symbols of different QAM order than the information symbols. Based on the proper definitions, we correct erroneous claims in a recently reported work.
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http://dx.doi.org/10.1364/OE.26.009784DOI Listing
April 2018

Probabilistically shaped PDM 4096-QAM transmission over up to 200 km of fiber using standard intradyne detection.

Opt Express 2018 Feb;26(4):4522-4530

We demonstrate transmission of a probabilistically shaped polarization-division multiplexed 3-GBd 4096-QAM signal over up to 200 km of backward Raman amplified Corning® Vascade® EX2000 fiber. The 3-GBd signal with a root-raised-cosine roll-off of 0.01 has the potential to generate a spectral efficiency of 19.77 bit/s/Hz over 50 km of fiber.
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http://dx.doi.org/10.1364/OE.26.004522DOI Listing
February 2018

Simulated internal jugular vein cannulation using a needle-guiding device.

Am J Emerg Med 2018 11 12;36(11):1931-1936. Epub 2018 Feb 12.

Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea. Electronic address:

Background: Using a two-dimensional ultrasound-guided approach does not guarantee success during the first attempt at internal jugular vein cannulation. Our randomized, parallel simulation study examined whether a new disposable device could improve the success rate of the first attempt at ultrasound-guided internal jugular vein cannulation of a simulated internal jugular vein.

Methods: Eighty-eight participants were randomized to perform needle insertion for internal jugular vein cannulation of a phantom using the ultrasound-guided approach with (case group) or without (control group) this new device. The primary outcome was the success rate of the first attempt. The secondary outcome was the frequency of mechanical complications such as arterial puncture and posterior wall puncture, procedure time, and level of difficulty.

Results: Among 44 participants using the device, 33 (75.0%) achieved successful cannulation on the first attempt. However, only 12 (27.3%) of the 44 participants not using the device recorded success during the first attempt (risk difference, 0.477; 95% confidence interval [CI] 0.294-0.661; P<0.001). The number of attempts was significantly lower (risk difference, -3.955; 95% CI, -5.014 to -3.712; P<0.001) when participants performed cannulation with the device (1.63±1.71) than without the device (5.59±5.78). Our study also showed that participants were comfortable when performing the ultrasound-guided approach with the new device (risk difference, -1.955; 95% CI, -2.016 to -1.493; P<0.0001).

Conclusions: The new disposable device was effective for successful first attempts at needle insertion during ultrasound-guided internal jugular vein cannulation. Future clinical trials are needed to assess the effectiveness of this device.
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http://dx.doi.org/10.1016/j.ajem.2018.02.012DOI Listing
November 2018

MazEF toxin-antitoxin proteins alter Escherichia coli cell morphology and infrastructure during persister formation and regrowth.

Microbiology (Reading) 2017 03 29;163(3):308-321. Epub 2017 Mar 29.

Department of Biochemistry and Molecular Biology, Oklahoma State University, Stillwater, OK 74078, USA.

When exposed to antibiotics, many bacteria respond by activating intracellular 'toxin' proteins, which arrest cell growth and induce formation of persister cells that survive antibiotics. After antibiotics are removed, persisters can regrow by synthesizing 'antitoxin' proteins that sequester toxin proteins. In Escherichia coli, MazE antitoxin sequesters the activity of MazF toxin, which extensively cleaves cellular RNAs. Although the functions of MazEF proteins are well characterized, there is surprisingly little known about their effects on cell structure. Here, using a combination of microscopy techniques, we visualized the effects of MazEF and three bactericidal antibiotics on E. coli cell morphology and infrastructure. When ectopically expressed in E. coli, MazF temporarily stalled cell growth and induced persister formation, but only mildly elevated DNA mutagenesis. Viewed by electron microscopy, MazF-expressing persister cells were arrested in cell growth and division. Their chromosomal DNAs were compacted into thread-like structures. Their ribosomes were excluded from their nucleoids. After exposure to ciprofloxacin, persister regrowth was activated by MazE. Cell division remained inhibited while cells became extraordinarily elongated, then divided multiple times during stationary growth phase. This extreme filamentation during persister regrowth was unique to ciprofloxacin-treated persisters, likely caused by inhibition of cell division during regrowth, and was not observed with kanamycin-treated persisters.
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http://dx.doi.org/10.1099/mic.0.000436DOI Listing
March 2017

Network Allocation Vector (NAV) Optimization for Underwater Handshaking-Based Protocols.

Sensors (Basel) 2016 Dec 24;17(1). Epub 2016 Dec 24.

School of Electronics Engineering, Kyungpook National University, Daegu 41566, Korea.

In this paper, we obtained the optimized network allocation vector (NAV) for underwater handshaking-based protocols, as inefficient determination of the NAV leads to unnecessarily long silent periods. We propose a scheme which determines the NAV by taking into account all possible propagation delays: propagation delay between a source and a destination; propagation delay between a source and the neighbors; and propagation delay between a destination and the neighbors. Such an approach effectively allows the NAV to be determined precisely equal to duration of a busy channel, and the silent period can be set commensurate to that duration. This allows for improvements in the performance of handshaking-based protocols, such as the carrier sense multiple access/collision avoidance (CSMA/CA) protocol, in terms of throughput and fairness. To evaluate the performance of the proposed scheme, performance comparisons were carried out through simulations with prior NAV setting methods. The simulation results show that the proposed scheme outperforms the other schemes in terms of throughput and fairness.
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http://dx.doi.org/10.3390/s17010032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298605PMC
December 2016

The Poisoning Information Database Covers a Large Proportion of Real Poisoning Cases in Korea.

J Korean Med Sci 2016 Jul 27;31(7):1037-41. Epub 2016 Apr 27.

Department of Emergency Medicine, Jeju National University, Jeju, Korea .

The poisoning information database (PIDB) provides clinical toxicological information on commonly encountered toxic substances in Korea. The aim of this study was to estimate the coverage rate of the PIDB by comparing the database with the distribution of toxic substances that real poisoning patients presented to 20 emergency departments. Development of the PIDB started in 2007, and the number of toxic substances increased annually from 50 to 470 substances in 2014. We retrospectively reviewed the medical records of patients with toxic exposure who visited 20 emergency departments in Korea from January to December 2013. Identified toxic substances were classified as prescription drug, agricultural chemical, household product, animal or plant, herbal drug, or other. We calculated the coverage rate of the PIDB for both the number of poisoning cases and the kinds of toxic substances. A total of 10,887 cases of intoxication among 8,145 patients was collected. The 470 substances registered in the PIDB covered 89.3% of 8,891 identified cases related to poisoning, while the same substances only covered 45.3% of the 671 kinds of identified toxic substances. According to category, 211 prescription drugs, 58 agricultural chemicals, 28 household products, and 32 animals or plants were not covered by the PIDB. This study suggested that the PIDB covered a large proportion of real poisoning cases in Korea. However, the database should be continuously extended to provide information for even rare toxic substances.
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http://dx.doi.org/10.3346/jkms.2016.31.7.1037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4900993PMC
July 2016

Neurologic outcome of comatose survivors after hanging: a retrospective multicenter study.

Am J Emerg Med 2016 Aug 26;34(8):1467-72. Epub 2016 Apr 26.

Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea. Electronic address:

Purpose: The aim of this study is to identify the neurologic outcome of hanging patients and prognostic factors.

Materials And Methods: We retrospectively investigated comatose hanging patients who arrived at the emergency departments (EDs) of twelve academic tertiary care centers during a period of seven years (2006-2012). Patients were analyzed separately according to whether out-of-hospital cardiac arrest (OHCA) occurred or not. The neurologic outcome was evaluated using the Cerebral Performance Category (CPC) at the time of hospital discharge.

Results: A total of 1118 patients were admitted to the ED after hanging attempts. There were 159 comatose patients who did not experience OHCA. Twelve (7.5%) of 159 patients were discharged from the hospital with a poor neurologic outcome (CPC 3-5). These 12 patients received only conservative management without therapeutic hypothermia. On multivariate logistic regression analysis, mental state upon ED arrival and arterial pH were predicting factors for poor prognosis. One hundred twenty-one patients suffered OHCA and experienced restored spontaneous circulation after cardiopulmonary resuscitation. Among them, only five (4.1%) patients recovered consciousness to the level of CPC 1-2. The initial arterial pH and HCO3(-) were prognostic factors in hanging patients with OHCA.

Conclusions: Even though cardiac arrest did not occur after hanging injuries, 7.5% of patients could not recover consciousness. Therapeutic hypothermia should be considered for such patients. If OHCA occurred after the hanging injury, the proportion of patients with good neurologic outcome was very low at 4.1%.
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http://dx.doi.org/10.1016/j.ajem.2016.04.036DOI Listing
August 2016

Escherichia coli persister cells suppress translation by selectively disassembling and degrading their ribosomes.

Mol Microbiol 2015 Jan 19;95(2):352-64. Epub 2014 Dec 19.

Department of Biochemistry and Molecular Biology, Oklahoma State University, Stillwater, OK, 74078, USA.

Bacterial persisters are rare, phenotypically distinct cells that survive exposure to multiple antibiotics. Previous studies indicated that formation and maintenance of the persister phenotype are regulated by suppressing translation. To examine the mechanism of this translational suppression, we developed novel methodology to rapidly purify ribosome complexes from persister cells. We purified His-tagged ribosomes from Escherichia coli cells that over-expressed HipA protein, which induces persister formation, and were treated with ampicillin to remove antibiotic-sensitive cells. We profiled ribosome complexes and analyzed the ribosomal RNA and protein components from these persister cells. Our results show that (i) ribosomes in persisters exist largely as inactive ribosomal subunits, (ii) rRNAs and tRNAs are mostly degraded and (iii) a small fraction of the ribosomes remain mostly intact, except for reduced amounts of seven ribosomal proteins. Our findings explain the basis for translational suppression in persisters and suggest how persisters survive exposure to multiple antibiotics.
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http://dx.doi.org/10.1111/mmi.12884DOI Listing
January 2015

Assessment of emergency airway management techniques in Korea using an online registration system: a multicenter study.

J Emerg Med 2015 Jan 27;48(1):1-9. Epub 2014 Sep 27.

Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.

Background: The investigators developed a Web-based online registration system to identify the current status of trauma airway management.

Objectives: The purpose of the study was to identify first-pass success (FPS) rate of the intubation methods and devices that are currently used, as well as the factors that affect FPS in trauma patients.

Methods: This study was designed as a prospective, observational multi-center study. We obtained clinical data of intubated trauma patients in 13 academic emergency departments in Korea. After performing an intubation, each patient's data were entered into a Web-based registry. Logistic regression analyses were conducted to identify the factors that affect FPS.

Results: The FPS rate was 80.6% in all trauma patients. The curved-blade laryngoscope was the most commonly used instrument, and was applied to 1395 patients (76.2%) during first attempt. Video laryngoscopy was applied to 341 patients (18.6%). In the multivariate logistic regression analysis, factors that affected FPS in difficult airway trauma patients were emergency physicians, senior physicians, and video laryngoscopy (odds ratio 2.42, 95% confidence interval 1.04-5.65; 1.80, 1.16-2.79; and 2.16, 1.39-3.33, respectively).

Conclusions: Emergency physicians in Korea are prepared for trauma patient airway management. The backup by experienced senior physicians, and preparation and training for video laryngoscope could assist FPS for trauma patients.
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http://dx.doi.org/10.1016/j.jemermed.2014.06.044DOI Listing
January 2015

Beach injuries occurring during summer in Busan, South Korea.

Travel Med Infect Dis 2014 Sep-Oct;12(5):545-6. Epub 2014 Sep 6.

Department of Emergency Medicine, Inje University, Haeundae Paik Hospital, Busan, Republic of Korea.

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http://dx.doi.org/10.1016/j.tmaid.2014.08.007DOI Listing
March 2015

Assessing safety attitudes among healthcare providers after a hospital-wide high-risk patient care program.

Yonsei Med J 2014 Mar;55(2):523-9

Department of Emergency Medicine, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea.

Purpose: Cardiopulmonary resuscitation (CPR) is commonly performed in high-risk, high intensity situations and is therefore a good procedure around which to develop and implement safety culture strategies in the hospital. The purpose of this study was to evaluate the impact of a hospital-wide quality improvement program on the management of sudden cardiac arrests by assessing healthcare providers' attitudes towards patient safety.

Materials And Methods: This study was designed as a prospective cohort study at a single academic medical center. The comprehensive hospital-based safety program included steps to identify areas of hazard, partner units with the Resuscitation Committee, and to conduct a Safety Attitudes Questionnaire (SAQ). The SAQ evaluated 35 questions in seven domains to assess changes in patient safety culture by comparing the results before and after the hospital- wide high risk patient care improvement program.

Results: The response rates of the pre- and post-SAQ survey were 489 out of 1121 (43.6%) and 575 out of 1270 (45.3%), respectively. SAQ survey responses revealed significant improvement in all seven domains of the questionnaire (p-values of 0.006 and lower). In a subgroup analysis, doctors and nurses showed improvement in five domains. Both doctors and nurses did not show improvement in the "sharing information" domain.

Conclusion: A hospital-wide quality improvement program for high-risk, high reliability patient care involving CPR care was shown to be associated with a change in healthcare providers' attitudes towards patient safety. Through an immersive and active program on CPR care, change in healthcare providers' attitudes towards patient safety was initiated.
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http://dx.doi.org/10.3349/ymj.2014.55.2.523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3936643PMC
March 2014

Clinical significance of national patients sample analysis: factors affecting mortality and length of stay of organophosphate and carbamate poisoned patients.

Healthc Inform Res 2013 Dec 31;19(4):278-85. Epub 2013 Dec 31.

Department of Emergency Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

Objectives: This study considered whether there could be a change of mortality and length of stay as a result of inter-hospital transfer, clinical department, and size of hospital for patients with organophosphates and carbamates poisoning via National Patients Sample data of the year 2009, which was obtained from Health Insurance Review and Assessment Services (HIRA). The utility and representativeness of the HIRA data as the source of prognosis analysis in poisoned patients were also evaluated.

Methods: Organophosphate and carbamate poisoned patients' mortality and length of stay were analyzed in relation to the initial and final treating hospitals and departments, as well as the presence of inter-hospital transfers.

Results: Among a total of 146 cases, there were 17 mortality cases, and the mean age was 56.8 ± 19.2 years. The median length of stay was 6 days. There was no inter-hospital or inter-departmental difference in length of stay. However, it significantly increased when inter-hospital transfer occurred (transferred 11 days vs. non-transferred 6 days; p = 0.037). Overall mortality rate was 11.6%. The mortality rate significantly increased when inter-hospital transfer occurred (transferred 23.5% vs. non-transferred 7.0%; p = 0.047), but there was no statistical difference in mortality on inter-hospital and inter-department comparison at the initial treating facility. However, at the final treating facility, there was a significant difference between tertiary and general hospitals (5.1% for tertiary hospitals and 17.3% for general hospitals; p = 0.024), although there was no significant inter-departmental difference.

Conclusions: We demonstrated that hospital, clinical department, length of stay, and mortality could be analyzed using insurance claim data of a specific disease group. Our results also indicated that length of stay and mortality according to inter-hospital transfer could be analyzed, which was previously unknown.
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http://dx.doi.org/10.4258/hir.2013.19.4.278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920040PMC
December 2013

Current status of emergency airway management for elderly patients in Korea: Multicentre study using the Korean Emergency Airway Management Registry.

Emerg Med Australas 2013 Oct 9;25(5):439-44. Epub 2013 Sep 9.

Department of Emergency Medicine, Inje University Haeundae Paik Hospital, Busan, Korea.

Objective: We report the current status of emergency airway management in elderly Korean patients by analysing a multicentre registry database in order to provide quality emergency airway management to elderly patients.

Methods: The present study was designed as a retrospective, subgroup analysis of the registry of Korean Emergency Airway Management Society. We analysed rapid sequence intubation rate, first pass success rate and complications.

Results: The study consisted of 4891 patients aged 65 years and older. The anticipation rate of difficult airway for age younger than 65 years, age 65 years and older and age 80 years and older was 15.8% (805/5090; 95% confidence interval [CI], 14.8-16.8), 12.0% (376/3146; 95% CI, 10.9-13.1) and 8.5% (97/1140; 95% CI, 7.0-10.0) respectively (P < 0.001). Rapid sequence intubation was performed on 27.8% (1683/6051; 95% CI, 26.7-29.0) of the patients aged younger than 65 years, 26.5% (954/3599; 95% CI, 25.1-28.0) of the patients aged between 65 and 79 years and 25.2% (325/1292; 95% CI, 22.8-27.6) of the patients aged 80 years and older (P = 0.097). First pass success was shown in 4837 (79.9%; 95% CI, 78.9-80.9) of 6051 patients aged less than 65 years, 2868 (79.7%; 95% CI, 78.3-81.0) of 3599 patients aged between 65 and 79 years and 1069 (82.7%; 95% CI, 80.5-84.7) of 1292 patients aged 80 years and older (P = 0.047). No differences were found between each group in the comparison of complication incidence by age (P = 0.686).

Conclusions: Similar success and complication rates were found for emergency airway management in elderly patients compared with patients aged less than 65 years.
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http://dx.doi.org/10.1111/1742-6723.12122DOI Listing
October 2013

Characterization of the Stoichiometry of HMGA1/DNA Complexes.

Open Biochem J 2013 4;7:73-81. Epub 2013 Sep 4.

Department of Chemistry and Biochemistry, Miami University, Oxford, OH 45056, USA.

High-mobility group A1 (HMGA1) non-histone chromatin architectural transcription factors regulate gene expression, embryogenesis, cell differentiation, and adaptive immune responses by binding DNA and other transcription factors. HMGA1 has also been shown to be highly over-expressed in many human cancers and is considered to be a valuable cancer biomarker. Elevated HMGA1 expression levels also make cancer cells resistant to chemotherapy. Here, HMGA1/DNA complex formation was investigated using electrophoretic mobility shift assays (EMSA). Collectively, the EMSA results indicated that full length HMGA1 mixed with DNA containing three AT-hook binding sites formed four distinct HMGA1/DNA complexes ranging in stoichiometry from 1:2 to 3:1 in HMGA1:DNA ratio. The data indicated that the distribution of complexes with different HMGA1 to DNA stoichiometries depended on the molar ratio of HMGA1 to DNA in solution, which could have significant biological implications given that HMGA1 is highly over-expressed in human cancer cells. The two naturally occurring isoforms of HMGA1, HMGA1a and HMGA1b, the latter containing an 11 amino acid deletion between the first and second AT-hooks, were observed to have slightly different DNA binding profiles. Finally, HMGA1 binding affinity to DNA was found to be influenced by the DNA A:T segment sequence context, with higher specificity be observed in HMGA1 binding to TnAn segments, which have two local minor groove minima on either side of the TpA step, compared to An:Tn segments, which have a single minor groove minimum at the 3' end of the An run, implying AT-hook binding favors narrow minor groove structure.
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http://dx.doi.org/10.2174/1874091X01307010073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3778555PMC
September 2013

Prevertebral paraspinal inflammation presenting with acute abdominal pain.

BMJ Case Rep 2013 Aug 9;2013. Epub 2013 Aug 9.

Department of Emergency Medicine, Inje University Haeundae Paik Hospital, Busan, Republic of Korea.

CT or MRI evaluation as a further diagnostic modality may be recommended in a patient showing vague clinical manifestation in the second order when patients present with subjective discomfort and simple and initial radiological modalities do not show any specific abnormal findings.
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http://dx.doi.org/10.1136/bcr-2013-008653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3762442PMC
August 2013

Improving the safety of continuously infused fluids in the emergency department.

Int J Nurs Pract 2013 Feb;19(1):95-100

Department of Emergency Medicine, Inje University College of Medicine, Busan, Korea.

When an unexpected crisis happens to patients with multiple continuous infusion fluids in the emergency department (ED), nurses need to recognize specific medication promptly and accurately for appropriate action. This study aims to evaluate the efficiency of colour-coded label system in ED fluids during an uneventful crisis simulation event. Promptness and accuracy of finding the correct fluid between the pre- and postintervention in each three groups (emergency nurses, intensive care unit nurses and nursing students) for three different scenarios (potassium, heparin and normal saline scenario) were assessed. Time improvement for all three groups from pre- to postintervention for all three scenarios were statistically significant (P < 0.001). There were no incorrect fluids indicated by all three groups of participants at postintervention analysis. Colour-coded labelling system in a simulated environment significantly improved the promptness and accuracy of finding the correct fluid from multiple infused continuous fluids.
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http://dx.doi.org/10.1111/ijn.12022DOI Listing
February 2013

Metabolic Profiling Comparison of Human Pancreatic Ductal Epithelial Cells and Three Pancreatic Cancer Cell Lines using NMR Based Metabonomics.

J Mol Biomark Diagn 2012 Apr 12;3(2). Epub 2012 Mar 12.

Department of Chemistry and Biochemistry, Miami University, Oxford, Ohio, USA.

Metabolic profiles of hydrophilic and lipophilic cell extracts from three cancer cell lines, Miapaca-2, Panc-1 and AsPC-1, and a non-cancerous pancreatic ductal epithelial cell line, H6C7, were examined by proton nuclear magnetic resonance spectroscopy. Over twenty five hydrophilic metabolites were identified by principal component and statistical significance analyses as distinguishing the four cell types. Fifteen metabolites were identified with significantly altered concentrations in all cancer cells, e.g. absence of phosphatidylgrycerol and phosphatidylcholine, and increased phosphatidylethanolamine and cholesterols. Altered concentrations of metabolites involved in glycerophospholipid metabolism, lipopolysaccharide and fatty acid biosynthesis indicated differences in cellular membrane composition between non-cancerous and cancer cells. In addition to cancer specific metabolites, several metabolite changes were unique to each cancer cell line. Increased N-acetyl groups in AsPC-1, octanoic acids in Panc-1, and UDP species in Miapaca-2 indicated differences in cellular membrane composition between the cancer cell lines. Induced glutamine metabolism and protein synthesis in cancer cells were indicated by absence of glutamine other metabolites such as acetate, lactate, serine, branched amino acids, and succinate. Knowledge of the specifically altered metabolic pathways identified in these pancreatic cancer cell lines may be useful for identifying new therapeutic targets and studying the effects of potential new therapeutic drugs.
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http://dx.doi.org/10.4172/2155-9929.S3-002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4655885PMC
April 2012

Analysis of soft-decision FEC on non-AWGN channels.

Opt Express 2012 Mar;20(7):7915-28

Bell Labs, Alcatel-Lucent, 1649 Sangam-Dong, Mapo-Gu, Seoul 121-904, South Korea.

Soft-decision forward error correction (SD-FEC) schemes are typically designed for additive white Gaussian noise (AWGN) channels. In a fiber-optic communication system, noise may be neither circularly symmetric nor Gaussian, thus violating an important assumption underlying SD-FEC design. This paper quantifies the impact of non-AWGN noise on SD-FEC performance for such optical channels. We use a conditionally bivariate Gaussian noise model (CBGN) to analyze the impact of correlations among the signal's two quadrature components, and assess the effect of CBGN on SD-FEC performance using the density evolution of low-density parity-check (LDPC) codes. On a CBGN channel generating severely elliptic noise clouds, it is shown that more than 3 dB of coding gain are attainable by utilizing correlation information. Our analyses also give insights into potential improvements of the detection performance for fiber-optic transmission systems assisted by SD-FEC.
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http://dx.doi.org/10.1364/OE.20.007915DOI Listing
March 2012

HMGA-targeted phosphorothioate DNA aptamers increase sensitivity to gemcitabine chemotherapy in human pancreatic cancer cell lines.

Cancer Lett 2012 Feb 10;315(1):18-27. Epub 2011 Oct 10.

Department of Chemistry and Biochemistry, Miami University, Oxford, OH 45056, United States.

Elevated high mobility group A (HMGA) protein expression in pancreatic cancer cells is correlated with resistance to the chemotherapy agent gemcitabine. Here, we demonstrate use of HMGA-targeted AT-rich phosphorothioate DNA (AT-sDNA) aptamers to suppress HMGA carcinogenic activity. Cell growth of human pancreatic cancer cells (AsPC-1 and Miapaca-2) transfected with AT-sDNA were monitored after treatment with gemcitabine. Significant increases in cell death in AT-sDNA transfected cells compared to non-AT-rich sDNA treated cells were observed in both cell lines. The data indicate the potential use of HMGA targeted DNA aptamers to enhance chemotherapy efficacy in pancreatic cancer treatment.
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http://dx.doi.org/10.1016/j.canlet.2011.10.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3914216PMC
February 2012

HMGA-targeted phosphorothioate DNA aptamers increase sensitivity to gemcitabine chemotherapy in human pancreatic cancer cell lines.

Cancer Lett 2012 Feb 10;315(1):18-27. Epub 2011 Oct 10.

Department of Chemistry and Biochemistry, Miami University, Oxford, OH 45056, United States.

Elevated high mobility group A (HMGA) protein expression in pancreatic cancer cells is correlated with resistance to the chemotherapy agent gemcitabine. Here, we demonstrate use of HMGA-targeted AT-rich phosphorothioate DNA (AT-sDNA) aptamers to suppress HMGA carcinogenic activity. Cell growth of human pancreatic cancer cells (AsPC-1 and Miapaca-2) transfected with AT-sDNA were monitored after treatment with gemcitabine. Significant increases in cell death in AT-sDNA transfected cells compared to non-AT-rich sDNA treated cells were observed in both cell lines. The data indicate the potential use of HMGA targeted DNA aptamers to enhance chemotherapy efficacy in pancreatic cancer treatment.
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http://dx.doi.org/10.1016/j.canlet.2011.10.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3914216PMC
February 2012

A pilot study of the Tele-Airway Management System in a hospital emergency department.

J Telemed Telecare 2011 19;17(1):49-53. Epub 2010 Nov 19.

Department of Emergency Medicine, Inje University College of Medicine, Busan, Korea.

We developed a telemedicine system for remote guidance of emergency airway management called the Tele-Airway Management System (TAMS). In a pilot study we examined the usefulness of the TAMS for intubations of actual patients in a hospital emergency department. Twenty-five patients were allocated randomly either to a TAMS group or to an on-scene directed (OSD) group. A total of 12 were intubated using the TAMS. The mean time to intubation (TAMS 62 s vs. OSD 56 s) and the success rate was not different between the two groups (P > 0.05). There were two oesophageal intubations in the TAMS group and four in the OSD group, but this was not significantly different (P = 0.36). There were no mechanical or technical errors such as disconnection during use of the TAMS. The pilot study demonstrated the feasibility of the TAMS as an alternative to OSD. However, a larger study will be required to determine non-superiority or equivalence.
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http://dx.doi.org/10.1258/jtt.2010.100202DOI Listing
May 2011