ObjectiveThis study investigated the preventable death rate in Daegu, South Korea, and assessed affecting factors and preventable factors in order to improve the treatment of regional trauma patients.MethodsAll traumatic deaths between January 2012 and December 2012 in 5 hospitals in Daegu were analyzed by panel review, which were classified into preventable and non-preventable deaths. We determined the factors affecting trauma deaths and the preventable factors during trauma care.ResultsThere were overall 358 traumatic deaths during the study period. Two hundred thirty four patients were selected for the final analysis after excluding cases of death on arrival, delayed death, and unknown causes. The number of preventable death was 59 (25.2%), which was significantly associated with mode of arrival, presence of head injury, date, and time of injury. A multivariate analysis revealed that preventable death was more likely when patients were secondly transferred from another hospital, visited hospital during non-office hour, and did not have head injuries. The panel discovered 145 preventable factors, which showed that majority of factors occurred in emergency departments (49.0%), and were related with system process (76.6%).ConclusionThe preventable trauma death rate in Daegu was high, and mostly process-related.

Splenic artery aneurysm is the third most common type of intra-abdominal aneurysm, with a prevalence rate of 0.01% to 10.4% in the general population. Splenic artery aneurysm is usually asymptomatic and is typically detected by chance and does not require surgical management; however, if rupture occurs, although rare, the patient’s situation can become critical. We report our experience with a man who presented with left flank and left shoulder pain. His symptoms were caused by multiple hematomas confined to the spleen, but 2 days after admission, he developed delayed hemoperitoneum and required surgical management. We believe that his condition was due to delayed intraperitoneal bleeding called the double-rupture phenomenon; emergency physicians must consider this phenomenon when taking care of splenic artery aneurysm patients.

Angiotensin II (Ang II) exerts some of its effects on the vasculature by stimulating chemokines and 12-lipoxygenase (12-LO). In addition, a high expression of chemokines by Ang II has been observed in vascular smooth muscle cells (VSMCs) in spontaneously hypertensive rats (SHR). In this study, the action mechanism of Ang II on CCL5 expression in SHR VSMCs was examined. Expression of CCL5 in SHR thoracic aorta tissues and VSMCs was lower than that in normotensive Wistar-Kyoto rats (WKY) thoracic aorta tissues and VSMCs. Moreover, Ang II inhibited CCL5 expression in SHR VSMCs, but not in WKY VSMCs. Inhibition of CCL5 by Ang II was mediated by both Ang II subtype 1 receptor (AT 1 R) and subtype 2 receptor (AT 2 R) activation in SHR VSMCs. However, Ang II did not inhibit CCL5 expression in SHR VSMCs that were transfected with 12-LO small interfering RNA. In addition, 12-LO metabolite, 12(S)-hydroxyeicosatetraenoic acid (HETE) inhibited CCL5 mRNA expression in SHR VSMCs. The expression of Ang II-induced 12-LO was also blocked by both AT 1 R and AT 2 R inhibitors. Mitogen-activated protein (MAP) kinase, extracellular signal-regulated kinase (ERK)1/2, p38 and Jun N-terminal kinase pathways all mediated the inhibitory action of Ang II on CCL5 expression in SHR VSMCs. Taken together, the inhibitory action of Ang II on CCL5 expression was shown to be mediated by the 12-LO pathway through the activation of both of AT 1 R and AT 2 R and this process was associated with MAP kinase pathways in SHR VSMCs. This result suggests that upregulation of 12-LO by Ang II leads to the downregulation of CCL5 expression in SHR VSMCs.

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marker of myocardial necrosis. Elevation of serum cTnT has been shown to identify patients with ACS at increased risk for adverse clinical outcomes (2,4). Creatine phosphokinase is well known cardiac biomarker, already has been used in patients with acute ischemic chest pain, which especially elevated its fraction of MB isoenzyme. Recently, CK-MB became to be calculated quantitatively in the clinical laboratory (4,5). So, several new cardiac markers have emerged as strong indicators or predictors among patients with ACS and are now routinely used in the emergency department (ED). We hypothesized that simultaneous assessment of all 3 biomarkers could provide complementary information and enable emergency physicians to assess the patient more effectively among the patients with acute myocardial infarction (AMI).