Initial Management of Pediatric Trauma

Multiple traumas is the leading cause of death and disability in children. There are fewer resources and less attention to the treatment of an injured child compared with that of an injured adult. There is no pediatric trauma center in Korea. Insufficient training and lack of experience in the management of injured children may be the key factors that contribute to children disability and deaths. Primary survey in pediatric trauma does not differ from that in adult trauma, and the basic concepts of advanced life support that have been used for adults remain applicable and critical for injured children. We need to remember the differences in physiology, anatomy of the airway, response to blood loss, thermoregulation, and special equipment for successful resuscitation. Thus, we need to pay close attention to the initial approach for pediatric trauma patients. This review provides the basis for strategies of initial management of pediatric trauma: Airway and cervical spine protection, breathing, circulation, disability, exposure and environmental control

Association of age-adjusted shock index with mortality in children with trauma: a single-center study in Korea

Purpose This study was performed to investigate the association of high age-adjusted shock index (AASI) with mortality in Korean children with trauma. Methods The data of children (aged < 15 years) with trauma who visited a university hospital in Korea from 2010 through 2018 were reviewed. High AASI was defined by age groups as follows: < 12 months, ≥ 2.7; 12-23 months, ≥ 2.1; 2-4 years, ≥ 1.9; 5-11 years, ≥ 1.5; and 12-14 years, ≥ 1.1. Age, sex, transfer status, injury mechanism, hypotension, tachycardia, base deficit, hemoglobin concentration, trauma scores, hemorrhage-related procedures (transfusion and surgical interventions), and severe traumatic brain injury were compared according to high AASI and in-hospital mortality. The association of high AASI with the mortality was analyzed using logistic regression. Results Of the 363 enrolled children, 29 (8.0%) had high AASI and 24 (6.6%) died. The children with high AASI showed worse trauma scores and underwent hemorrhage-related procedures more frequently, without a difference in the rate of the traumatic brain injury. High AASI was associated with in-hospital mortality (survivors, 6.5% vs. non-survivors, 29.2%; P = 0.001). This association remained significant after adjustment (adjusted odds ratio, 6.42; 95% confidence interval, 1.38-29.82). The other predictors were Glasgow Coma Scale (for increment of 1 point; 0.62; 0.53-0.72) and age (for increment of 1 year; 0.84; 0.73-0.97). High AASI showed a 29.2% sensitivity and 93.5% specificity for the mortality. Conclusion High AASI is associated with mortality, and have a high specificity but low sensitivity in Korean children with trauma. This predictor of mortality can be used prior to obtaining the results of laboratory markers of shock

The predictive significance of CD20 expression in B-cell lymphomas

<p>Abstract</p> <p>Background</p> <p>In our recent study, we determined the cut-off value of CD20 expression at the level of 25 000 molecules of equivalent soluble fluorochrome (MESF) to be the predictor of response to rituximab containing treatment in patients with B-cell lymphomas. In 17.5% of patients, who had the level of CD20 expression below the cut-off value, the response to rituximab containing treatment was significantly worse than in the rest of the patients with the level of CD20 expression above the cut-off value. The proportion of patients with low CD20 expression who might not benefit from rituximab containing treatment was not necessarily representative. Therefore the aim of this study was to quantify the CD20 expression in a larger series of patients with B-cell lymphomas which might allow us to determine more reliably the proportion of patients with the CD20 expression below the cut-off.</p> <p>Methods</p> <p>Cytological samples of 64 diffuse large B-cell lymphomas (DLBCL), 56 follicular lymphomas (FL), 31 chronic lymphocytic leukemias (CLL), 34 mantle cell lymphomas (MCL), 18 marginal zone lymphomas (MZL) and 15 B-cell lymphomas unclassified were analyzed for CD20 expression by quantitative four-color flow cytometric measurements using FACSCalibur flow cytometer (BD Biosciences).</p> <p>Results</p> <p>The range of CD20 expression in different B-cell lymphomas was very broad, varying from 2 737 to 115 623 MESF in CLL and 3 549 to 679 577 MESF in DLBCL. However, when we compared the CD20 expression in the groups of patients with DLBCL, FL, MCL, MZL, CLL and B-cell lymphomas unclassified, it was found to be significantly lower (p = 0.002) only in CLL but did not significantly differ in other lymphoma types (p = NS). Fifty-three out of 218 (24.3%) patients with B-cell lymphomas had the CD20 expression below the cut-off value.</p> <p>Conclusions</p> <p>The CD20 expression in CLL is significantly lower than in most histological types of mature B-cell lymphomas in which it appears to be comparable. Approximately 25% of B-cell lymphoma patients have the CD20 expression below the cut-off value showing that the low CD20 expression might be more common than presumed from our previous study.</p

Hepatitis B and C virus prevalence in a rural area of South Korea: the role of acupuncture

A cross-sectional study evaluated the prevalence of and the risk factors for hepatitis C and B viruses among 700 adults above the age of 40 years in a rural area of South Korea. Seropositivity for hepatitis C virus antibody (11.0%, 95% confidence interval: 8.7–13.6) was higher than that for hepatitis B surface antigen (4.4%, 95% confidence interval: 3.0–6.2). Anti-hepatitis C virus seropositivity was associated with a history of repeated acupuncture (odds ratio=2.1, 95% confidence interval: 1.1–4.0), and blood transfusion (odds ratio=5.5, 95% confidence interval: 1.6–19.3) before 1992 when hepatitis C virus screening in blood donors became mandatory. Hepatitis C virus 2a was the most prevalent genotype, followed by 1b. Hepatitis C virus risk attributable to acupuncture was 38% (9% for men and 55% for women). Safer acupuncture practice has become a priority for hepatitis C virus prevention in South Korea

Apoptosis-Related Gene Expression Profiling in Hematopoietic Cell Fractions of MDS Patients

Contains fulltext : 168172.pdf (publisher's version ) (Open Access)Although the vast majority of patients with a myelodysplastic syndrome (MDS) suffer from cytopenias, the bone marrow is usually normocellular or hypercellular. Apoptosis of hematopoietic cells in the bone marrow has been implicated in this phenomenon. However, in MDS it remains only partially elucidated which genes are involved in this process and which hematopoietic cells are mainly affected. We employed sensitive real-time PCR technology to study 93 apoptosis-related genes and gene families in sorted immature CD34+ and the differentiating erythroid (CD71+) and monomyeloid (CD13/33+) bone marrow cells. Unsupervised cluster analysis of the expression signature readily distinguished the different cellular bone marrow fractions (CD34+, CD71+ and CD13/33+) from each other, but did not discriminate patients from healthy controls. When individual genes were regarded, several were found to be differentially expressed between patients and controls. Particularly, strong over-expression of BIK (BCL2-interacting killer) was observed in erythroid progenitor cells of low- and high-risk MDS patients (both p = 0.001) and TNFRSF4 (tumor necrosis factor receptor superfamily 4) was down-regulated in immature hematopoietic cells (p = 0.0023) of low-risk MDS patients compared to healthy bone marrow

MYC-containing amplicons in acute myeloid leukemia: genomic structures, evolution, and transcriptional consequences.

Double minutes (dmin), homogeneously staining regions, and ring chromosomes are vehicles of gene amplification in cancer. The underlying mechanism leading to their formation as well as their structure and function in acute myeloid leukemia (AML) remain mysterious. We combined a range of high-resolution genomic methods to investigate the architecture and expression pattern of amplicons involving chromosome band 8q24 in 23 cases of AML (AML-amp). This revealed that different MYC-dmin architectures can coexist within the same leukemic cell population, indicating a step-wise evolution rather than a single event origin, such as through chromothripsis. This was supported also by the analysis of the chromothripsis criteria, that poorly matched the model in our samples. Furthermore, we found that dmin could evolve toward ring chromosomes stabilized by neocentromeres. Surprisingly, amplified genes (mainly PVT1) frequently participated in fusion transcripts lacking a corresponding DNA template. We also detected a significant overexpression of the circular RNA of PVT1 (circPVT1) in AML-amp cases versus AML with a normal karyotype. Our results show that 8q24 amplicons in AML are surprisingly plastic DNA structures with an unexpected association to novel fusion transcripts and circular RNAs

MAI-JSQ: A Cross-Layer Design for Real-Time Video Streaming in Wireless Networks

We propose a cross--layer design for the real--time streaming of prerecorded video with prefetching to clients in wireless CDMA networks. Our design exploits the recently discovered temporal correlation structure of the multiple access interference (MAI) which enables accurate prediction of the MAI levels. Based on the MAI prediction, we optimize the transmissions of the video traffic so as to make judicious use of the radio resources and therefore to achieve small video playback starvation probabilities. A key component of our transmission control is the Join--the--Shortest--Queue (JSQ) scheduling, which selects the client with the smallest prefetched reserve for transmission (provided that the client&apos;s predicted MAI is low). Our simulation results indicate that in typical scenarios, the starvation probabilities using our cross--layer design with the MAI prediction, are at least one order of magnitude smaller than of the conventional JSQ protocol with link probing at the link/MAC layer

A modular algorithm-theoretic framework for the fair and efficient collaborative prefetching of continuous media (extended version

Bursty continuous media streams with periodic playout deadlines (e.g., VBR-encoded video) are expected to account for a large portion of the traffic in the future Internet. By prefetching parts of ongoing streams into client buffers these bursty streams can be more efficiently accommodated in packet-switched networks. In this paper we develop a modular algorithm-theoretic framework for the fair and efficient transmission of continuous media over a bottleneck link. We divide the problem into the two subproblems of (i) assuring fairness, and (ii) efficiently utilizing the available link capacity. We develop and analyze algorithm modules for these two subproblems. Specifically, we devise a bin packing algorithm for subproblem (i), and a “layered prefetching” algorithm for subproblem (ii). Our simulation results indicate that the combination of these two algorithm modules compares favorably with existing monolithic solutions. This demonstrates the competitiveness of the decoupled modular algorithm framework, which provides a foundation for the development of refined algorithms for fair and efficient prefetching

Optimized protein extraction for quantitative proteomics of yeasts

BACKGROUND: The absolute quantification of intracellular protein levels is technically demanding, but has recently become more prominent because novel approaches like systems biology and metabolic control analysis require knowledge of these parameters. Current protocols for the extraction of proteins from yeast cells are likely to introduce artifacts into quantification procedures because of incomplete or selective extraction. PRINCIPAL FINDINGS: We have developed a novel procedure for protein extraction from S. cerevisiae based on chemical lysis and simultaneous solubilization in SDS and urea, which can extract the great majority of proteins to apparent completeness. The procedure can be used for different Saccharomyces yeast species and varying growth conditions, is suitable for high-throughput extraction in a 96-well format, and the resulting extracts can easily be post-processed for use in non-SDS compatible procedures like 2D gel electrophoresis. CONCLUSIONS: An improved method for quantitative protein extraction has been developed that removes some of the sources of artefacts in quantitative proteomics experiments, while at the same time allowing novel types of applications