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The goal of this study was to assess the feasibility of three models for detecting hydronephrosis through ultrasound images using state-of-the-art deep learning algorithms. The diagnosis of hydronephrosis is challenging because of varying and non-specific presentations. With the characteristics of ready accessibility, no radiation exposure and repeated assessments, point-of-care ultrasound becomes a complementary diagnostic tool for hydronephrosis; however, inter-observer variability still exists after time-consuming training. Artificial intelligence has the potential to overcome the human limitations. A total of 3462 ultrasound frames for 97 patients with hydronephrosis confirmed by the expert nephrologists were included. One thousand six hundred twenty-eight ultrasound frames were also extracted from the 265 controls who had normal renal ultrasonography. We built three deep learning models based on U-Net, Res-UNet and UNet++ and compared their performance. We applied pre-processing techniques including wiping the background to lessen interference by YOLOv4 and standardizing image sizes. Also, post-processing techniques such as adding filter for filtering the small effusion areas were used. The Res-UNet algorithm had the best performance with an accuracy of 94.6% for moderate/severe hydronephrosis with substantial recall rate, specificity, precision, F1 measure and intersection over union. The Res-UNet algorithm has the best performance in detection of moderate/severe hydronephrosis. It would decrease variability among sonographers and improve efficiency under clinical conditions. [ABSTRACT FROM AUTHOR]

Breast cancer is the most common neoplasm in the world among women. The age-specific incidences and onset ages vary widely between Asian and Western countries/regions. Invasive breast cancer cases among women from 1997 to 2011 were abstracted from the International Agency for Research on Cancer and the Taiwan Cancer Registry. Age-period-cohort analysis was performed to examine the trends. The cohort effect was prominent in South Korea, Taiwan, Japan, and Thailand, possibly related to the timing of westernization. The risk of breast cancer initially rose with the birth cohorts in Hong Kong and India (both former British colonies), peaked, and then declined in recent birth cohorts. Unlike other Asian countries/regions, virtually no birth cohort effect was identified in the Philippines (a Spanish colony in 1565 and the first Asian country to adopt Western cultural aspects). Moreover, an at-most negligible birth cohort effect was identified for all ethnic groups (including Asian immigrants) in the United States. This global study identified birth cohort effects in most Asian countries/regions but virtually no impact in Western countries/regions. The timing of westernization was associated with the birth cohort effect. [ABSTRACT FROM AUTHOR]

To the Editor, The International Liaison Committee on Resuscitation (ILCOR) published updated guidelines for Advanced Life Support (ALS).[1] The structured ALS provider course is designed to help disseminate the knowledge and enhance the skills of health professionals in the early recognition and intervention of cardiac arrest, acute coronary syndromes, respiratory distress, and shock.[2] Ultrasound (US) is an increasingly used diagnostic tool in emergency and critical care settings, as an integral part of resuscitation and other critical scenarios. It included 3 important critical scenarios: cardiac arrest, chest pain/dyspnea, and shock in which the US-CAB protocol, the RUSH protocol, and the cardiac assessment plus the BLUE protocol (Fig. Although no significant difference existed between the immediate and recalling skill assessment (4.2 ± 0.5, vs. 4.0 ± 0.7, p = 0.203), the emergency medicine residents performed more sonographic examinations and the skill performance was better in the recalling, comparing with that of internal medicine residents (Supplementary file 2). [Extracted from the article]

Traumatic thyroid hemorrhage is a rare but potentially life-threatening condition. Bilateral thyroid hemorrhage is even rarer. Herein, we report a case of traumatic bilateral thyroid hemorrhage treated with nonoperative management. A 49-year-old woman with preexisting goiter presented to the emergency department after a traffic accident. She had neck swelling and tenderness; however, no stridor or respiratory distress was noted. Traumatic bilateral thyroid hemorrhage with mild tracheal deviation to the right was diagnosed after computed tomography. Nonoperative management and intensive monitoring were applied for no signs of airway compromised. The patient was discharged after 5 days of hospital stay uneventfully. 6-month follow-up revealed stationary condition and normal thyroid function tests. This rare case demonstrated successful nonoperative management on the blunt injury of the neck, complicated with bilateral thyroid hemorrhage. [ABSTRACT FROM AUTHOR]

Background We previously developed a US-CAB protocol for evaluation of circulatory-airway-breathing status during cardiopulmonary resuscitation (CPR). This study aimed at validating its application in real CPR scenarios and the potential impact on CPR outcomes. Methods The US-CAB protocol was implemented at the emergency department of National Taiwan University Hospital since January 2016. The US images, initiation time and operation duration of each US-CAB procedure, and relevant CPR information were recorded for analysis. Results From January 2016 to March 2017, 177 cardiac arrest patients receiving US-CAB were included. The durations of US-C-A-B procedure were 9.0 ± 1.4, 7.5 ± 1.5, and 16.0 ± 1.9 s, respectively. Cardiac activity was identified in 47 cases (26.6%), with higher rates of return of spontaneous circulation (ROSC) (95.7% vs . 21.5%, p < .0001) and survival to hospital discharge (25.5% vs . 10.0%, p < .01). Detection of cardiac activity after 10 min of CPR exhibited 100% sensitivity, specificity, positive and negative predictive value for ROSC. Cardiac tamponade was noted in eight patients. ROSC was achieved in two (25.0%) after pericardiocentesis, and aortic dissection was diagnosed in one (12.5%). Confirmation of correct intubation was significantly faster by US than by capnography (7.4 ± 1.4 vs. 38.3 ± 110.2 s, p < .001). US detected 21 (11.9%) esophageal intubations and 3 (1.7%) one-lung intubations. All were promptly corrected. Conclusion The US-CAB protocol is feasible in real CPR scenarios. It confers diagnostic value and prognostic implications which potentially impact the efficacy and outcomes of CPR. However, a future prospective multi-center study to validate its feasibility and indicate the need of structured training is mandated. [ABSTRACT FROM AUTHOR]

Introduction: Success in nonoperative management is only based on the clinical symptoms of patients with acute appendicitis. However, imaging studies can provide further insight into the status of the appendix to monitor treatment response if immediate appendectomy is not undertaken. This study investigates sonographic resolution following nonoperative management and assesses the feasibility of incorporating ultrasound into patient care. Materials and Methods: Adult patients with acute appendicitis who had been successfully treated with nonoperative management were enrolled and received repeat sonographic examinations using 3-day intervals until sonographic resolution. The relationship between the time to achieve sonographic resolution and clinical parameters was identified using negative binomial regression models. Results: From January 2003 to December 2009, 128 patients were successfully treated with nonoperative management. Eighty patients completed sonographic examinations until achieving resolution. Sonographic resolution was achieved on 17 ± 12 days (range, 3-69 days). Ninety-five percent of the patients achieved sonographic resolution within 41 days. The appendicolith was positively related to the time to achieve sonographic resolution (rate ratios, 1.63; 95 % confidence intervals, 1.06-2.51). Conclusions: Ultrasound can be used to evaluate the condition of the appendix to monitor treatment response following nonoperative management on the sixth week. An appendicolith delays sonographic resolution of appendicitis. [ABSTRACT FROM AUTHOR]

Abstract: Aim of study: Unrecognized one-lung intubations (also known as main-stem intubation) can lead to hypoventilation, atelectasis, barotrauma, and even patient death. Many traditional methods can be employed to detect one-lung intubation; however, each of these methods has limitations and is not consistently reliable in emergency settings. This study aimed to assess the accuracy and timeliness of ultrasound to confirm proper endotracheal intubation. Methods: This was a prospective, single-center, observational study conducted at the emergency department of a national university teaching hospital. Patients received emergency tracheal intubation because of respiratory failure or cardiac arrest. After intubation, bedside ultrasound was performed with a transducer placed on the chest bilaterally at the mid-axillary line, to identify lung sliding over the lungs bilaterally during ventilation. Chest radiography was used as the criterion standard for confirmation of endotracheal tube position. Results: One hundred and fifteen patients needing tracheal intubation were included, and nine (7.8%) had one-lung intubations. The overall accuracy of ultrasound to confirm proper endotracheal intubation was 88.7% (95% confidence interval (CI): 81.6–93.3%). The positive predictive value was 94.7% (95% CI: 87.1–97.9%) in the non-cardiac-arrest group and 100% (95% CI: 87.1–100.0%) in the cardiac-arrest group. The median operating time of ultrasound was 88s (interquartile range [IQR]: 55.0, 193.0), and of chest radiography was 1349s (IQR: 879.0, 2221.0) post intubation. Conclusions: In this study, the positive predictive value of bilateral lung sliding in confirming proper endotracheal intubation was high, especially among patients with cardiac arrest. Considerable time advantage of ultrasound over chest radiography was demonstrated. [Copyright &y& Elsevier]

Background: This prospective study investigates recurrence rates and identifies predictive factors for recurrence following successful nonoperative treatment in adult patients with acute appendicitis. Methods: Between January 2003 and December 2009, adult patients with acute appendicitis who received successful nonoperative management were enrolled. Cumulative recurrence rates were calculated using the Kaplan-Meier method. Recurrence-free curves were compared using with the log-rank test. Cox regression models were employed to identify parameters that significantly and independently predict recurrence. Results: During the study period, 128 patients were enrolled. The median follow-up period was 12 months (range = 1-90 months). Twenty (16%) patients developed recurrent appendicitis during follow-up. Twenty-one (16%) patients underwent interval appendectomy (IA). There was no significant difference between nonperforated (NPA) and perforated appendicitis (PA) groups with respect to recurrence rates (16% at the 9th month). Moreover, male gender was significantly associated with recurrence (HR 3.45; 95% CI, 1.15-10.39). Analytical results remained significant after excluding IA patients. Conclusions: Since the recurrence rate is similar between NPA and PA, nonoperative treatment can be used for PA patients. Roughly 20% of the adult patients selected for nonoperative treatment experienced recurrence. Males were more susceptible than females to recurrent appendicitis. [ABSTRACT FROM AUTHOR]

Objectives: To determine the incidence of sonographic hepatic portal venous gas (HPVG) and to clarify the relationship between the presence of HPVG and clinical outcomes in patients with out-of-hospital cardiac arrest (OHCA). Methods: From April 2002 to January 2003, patients with non-traumatic OHCA were prospectively enrolled in a tertiary medical centre in Taipei, Taiwan. Emergency abdominal sonography during resuscitation was performed to detect the presence of HPVG within the first 10 min on arrival of the emergency department (ED). Results: HPVG was detected in 16 (36%) of the 44 patients enrolled in this study. The patients with HPVG were older (P=0.039), their cardiac arrest was witnessed less frequently (P=0.01), they received more prolonged resuscitation (P=0.008), and needed more accumulated doses of adrenaline (epinephrine) (P=0.002). These patients had a considerably lower incidence of return of spontaneous circulation (ROSC) (P<0.001), less survival to hospital admission (P<0.001), less 24 h survival (P<0.001) and less survival to discharge (P=0.036). In a multiple regression analysis, HPVG was noted as an independent factor negatively associated with ROSC. Conclusion: HPVG is not uncommon in patients receiving resuscitation for OHCA and is associated with poor outcome in these patients. [Copyright &y& Elsevier]

Appendicitis remains the most common cause of acute abdomen requiring surgery. The clinical diagnosis could be challenging. Ultrasound (US) and computed tomography (CT) have been widely used as diagnostic tools for appendicitis. Unlike CT, US is usually readily available without ionizing radiation. But sometimes, appendix could not be directly visualized due to interference by bowel gas. Improved sonographic techniques have led to a higher rate of successful visualization of the appendix. In this section, the sono-anatomy of the appendix and sonographic techniques will be presented. [ABSTRACT FROM AUTHOR]

Airway ultrasound is a valuable, non-invasive, simple, and portable diagnostic tool point. Ultrasound enables us to identify important sonoanatomy of the upper airway such as thyroid cartilage, epiglottis, cricoid cartilage, cricothyroid membrane, tracheal cartilages, and esophagus. Understanding this applied sonoanatomy facilitates clinicians to use ultrasound in assessment of airway anatomy for endotracheal and esophageal intubation, difficult intubation, endotracheal tube position and depth, assessment of airway size, ultrasound-guided invasive procedures such as percutaneous needle cricothyroidotomy and tracheostomy, prediction of post-extubation stridor and detecting upper airway pathologies. Better technological advancements, portability, and availability of ultrasound in most critical settings will make airway ultrasound to become the potential first-line non-invasive airway assessment tool in the future. [ABSTRACT FROM AUTHOR]

Background: Outbreaks of emerging infectious diseases, such as COVID-19, have negative impacts on bystander cardiopulmonary resuscitation (BCPR) for fear of transmission while breaking social distancing rules. The latest guidelines recommend hands-only cardiopulmonary resuscitation (CPR) and facemask use. However, public willingness in this setup remains unknown. Methods: A cross-sectional, unrestricted volunteer Internet survey was conducted to assess individuals' attitudes and behaviors toward performing BCPR, pre-existing CPR training, occupational identity, age group, and gender. The raking method for weights and a regression analysis for the predictors of willingness were performed. Results: Among 1,347 eligible respondents, 822 (61%) had negative attitudes toward performing BCPR. Healthcare providers (HCPs) and those with pre-existing CPR training had fewer negative attitudes (p < 0.001); HCPs and those with pre-existing CPR training and unchanged attitude showed more positive behaviors toward BCPR (p < 0.001). Further, 9.7% of the respondents would absolutely refuse to perform BCPR. In contrast, 16.9% would perform BCPR directly despite the outbreak. Approximately 9.9% would perform it if they were instructed, 23.5%, if they wore facemasks, and 40.1%, if they were to perform hands-only CPR. Interestingly, among the 822 respondents with negative attitudes, over 85% still tended to perform BCPR in the abovementioned situations. The weighted analysis showed similar results. The adjusted predictors for lower negative attitudes toward BCPR were younger age, being a man, and being an HCP; those for more positive behaviors were younger age and being an HCP. Conclusions: Outbreaks of emerging infectious diseases, such as COVID-19, have negative impacts on attitudes and behaviors toward BCPR. Younger individuals, men, HCPs, and those with pre-existing CPR training tended to show fewer negative attitudes and behaviors. Meanwhile, most individuals with negative attitudes still expressed positive behaviors under safer measures such as facemask protection, hands-only CPR, and available dispatch instructions. [ABSTRACT FROM AUTHOR]

Ultrasound is used in cardiopulmonary resuscitation (CPR) and advanced life support (ALS). However, there is divergence between the recommendations of many emergency and critical care societies who support its use and the recommendations of many international resuscitation organizations who either recommend against its use or recommend it only in limited circumstances. Ultrasound offers potential benefits of detecting reversable causes of cardiac arrest, allowing specific interventions. However, it also risks interfering with ALS protocols and increasing unhelpful interventions. As with many interventions in ALS, the evidence base for ultrasound use is weak, and well-designed randomized trials are needed. This paper reviews the current theory and evidence for harms and benefits. [ABSTRACT FROM AUTHOR]

Background: We previously developed a US-CAB protocol for evaluation of circulatory-airway-breathing status during cardiopulmonary resuscitation (CPR). This study aimed at validating its application in real CPR scenarios and the potential impact on CPR outcomes.Methods: The US-CAB protocol was implemented at the emergency department of National Taiwan University Hospital since January 2016. The US images, initiation time and operation duration of each US-CAB procedure, and relevant CPR information were recorded for analysis.Results: From January 2016 to March 2017, 177 cardiac arrest patients receiving US-CAB were included. The durations of US-C-A-B procedure were 9.0 ± 1.4, 7.5 ± 1.5, and 16.0 ± 1.9 s, respectively. Cardiac activity was identified in 47 cases (26.6%), with higher rates of return of spontaneous circulation (ROSC) (95.7% vs. 21.5%, p < .0001) and survival to hospital discharge (25.5% vs. 10.0%, p < .01). Detection of cardiac activity after 10 min of CPR exhibited 100% sensitivity, specificity, positive and negative predictive value for ROSC. Cardiac tamponade was noted in eight patients. ROSC was achieved in two (25.0%) after pericardiocentesis, and aortic dissection was diagnosed in one (12.5%). Confirmation of correct intubation was significantly faster by US than by capnography (7.4 ± 1.4 vs. 38.3 ± 110.2 s, p < .001). US detected 21 (11.9%) esophageal intubations and 3 (1.7%) one-lung intubations. All were promptly corrected.Conclusion: The US-CAB protocol is feasible in real CPR scenarios. It confers diagnostic value and prognostic implications which potentially impact the efficacy and outcomes of CPR. However, a future prospective multi-center study to validate its feasibility and indicate the need of structured training is mandated. [ABSTRACT FROM AUTHOR]

Taiwan is an endemic area for chronic hepatitis disease. Since the early 1980's, liver cancer has become the first cancer mortality causes among other cancers in Taiwan. Besides, liver cirrhosis and chronic liver diseases are the sixth rank and seventh rank in the causes of death, respectively. This is a serious disease affecting people's health and it brings a lot of medical cost as well. This study develops a medical cost forecasting model for the acute hepatitis patients in the emergency room. In order to consider the uncertainty and hesitation in the human being's thinking, this study employs the intuitionistic fuzzy logic (IFL) since it considers membership, non-membership, and hesitation values simultaneously. The proposed model combines the intuitionistic fuzzy neural network (IFNN) with Gaussian membership function and Yager-Generating function to enhance the performance of FNN. Furthermore, a back-propagation learning algorithm and genetic algorithm (GA) are applied in order to optimize the parameters and weights of the proposed IFNN. The proposed IFNN is applied to solve ten benchmark datasets including the nonlinear control and prediction problems. The computational results showed that the GA-IFNN is more efficient than conventional algorithms, such as an artificial neural network (ANN), a fuzzy neural network (FNN), and a support vector regression (SVR). In the real-world problem, the proposed method can really support physicians in planning medical resources and make a good decision to make the most efficient use of limited resources. [ABSTRACT FROM AUTHOR]

Background: An updated overview of ultrasound (US) for diagnosis of acute cholecystitis (AC) remains lacking. This systematic review was conducted to evaluate the diagnostic performance of US for AC. Methods: A systematic review was conducted following PRISMA guidelines. We meticulously screened articles from MEDLINE, Embase, and the Cochrane Library, spanning from inception to August 2023. We employed the search strategy combining the keywords "bedside US", "emergency US" or "point-of-care US" with "AC". Two reviewers independently screened the titles and abstracts of the retrieved articles to identify suitable studies. The inclusion criteria encompassed articles investigating the diagnostic performance of US for AC. Data regarding diagnostic performance, sonographers, and sonographic findings including the presence of gallstone, gallbladder (GB) wall thickness, peri-GB fluid, or sonographic Murphy sign were extracted, and a meta-analysis was executed. Case reports, editorials, and review articles were excluded, as well as studies focused on acalculous cholecystitis. The study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Results: Forty studies with 8,652 patients were included. The majority of studies had a low risk of bias and applicability concerns. US had a pooled sensitivity of 71% (95% CI, 69–72%), a specificity of 85% (95% CI, 84–86%), and an accuracy of 0.83 (95% CI, 0.82–0.83) for the diagnosis of AC. The pooled sensitivity and specificity were 71% (95% CI, 67–74%) and 92% (95% CI, 90–93%) performed by emergency physicians (EPs), 79% (95% CI, 71–85%) and 76% (95% CI, 69–81%) performed by surgeons, and 68% (95% CI 66–71%) and 87% (95% CI, 86–88%) performed by radiologists, respectively. There were no statistically significant differences among the three groups. Conclusion: US is a good imaging modality for the diagnosis of AC. EP-performed US has a similar diagnostic performance to radiologist-performed US. Further investigations would be needed to investigate the impact of US on expediting the management process and improving patient-centered outcomes. [ABSTRACT FROM AUTHOR]

The article presents the authors' response to comments on their article "Male gender is a risk factor for recurrent appendicitis following nonoperative treatment," which appeared in a 2011 issue. The authors state that study results provide evidence that roughly 20% of adult patients selected for nonoperative treatment experience recurrence. The authors clarify that gynecologists were consulted in the study for women with right iliac fossa pain to exclude gynecological pathology.

Point-of-care ultrasound (PoCUS) has high sensitivity and specificity in diagnosing uncomplicated colonic diverticulitis in Western patients. Evidence regarding the accuracy of PoCUS in Asian patients in which diverticulitis frequently occurs in the right-side colon is lacking. This multicenter, 10-y study was aimed at evaluating the diagnostic accuracy of PoCUS in various locations of uncomplicated diverticulitis among Asians. A convenience sample of patients with suspected colonic diverticulitis who had undergone computed tomography (CT) were eligible. Patients undergoing PoCUS before CT were included. The primary outcome was the diagnostic accuracy of PoCUS in the various locations, compared with the final diagnosis made by the expert physicians. The sensitivity, specificity, positive predictive value and negative predictive value were computed. The logistic regression model was used to investigate the possible factors related to the accuracy of PoCUS. A total of 326 patients were included. The overall accuracy of PoCUS was 92% (95% confidence interval [CI]: 89.1%–95.0%) and was lower in the cecum (84.3%, 95% CI: 77.8%–90.8%), compared with other locations (p < 0.0001). Nine of 10 false positives had the final diagnosis of appendicitis: 5 had an outpouching structure whose origin in the cecum could not be traced and 4 had elongated "diverticula." Moreover, body mass index was negatively associated with the accuracy of PoCUS in cecal diverticulitis (odds ratio: 0.79, 95% CI: 0.64–0.97) after adjusting for other covariates. Point-of-care ultrasound exhibits high diagnostic accuracy in diagnosing uncomplicated diverticulitis in the Asian population. However, the accuracy varies according to location, and was relatively low in the cecum. [ABSTRACT FROM AUTHOR]

Background: There is no sufficient overview of outcomes in right-sided and left-sided colonic diverticulitis (CD) following non-operative management. This systematic review was conducted to evaluate the recurrence/treatment failure in right-sided and left-sided CD. Methods: A systematic review was conducted following PRISMA guidelines. MEDLINE, Embase, and Cochrane Library from inception to Dec 2021 were searched. The study characteristics, recurrence/treatment failure, and risk factors for recurrence/treatment failure were extracted. Proportional meta-analyses were performed to calculate the pooled recurrent/treatment failure rate of right-sided and left-sided CD using the random effect model. Logistic regression was applied for the factors associated with the recurrence/treatment failure. Results: Thirty-eight studies with 10,129 patients were included, and only two studies comprised both sides of CD. None of the studies had a high risk of bias although significant heterogeneity existed. The pooled recurrence rate was 10% (95% CI 8–13%, I2 = 86%, p < 0.01) in right-sided and 20% (95% CI 16–24%, I2 = 92%, p < 0.01) in left-sided CD. For the uncomplicated CD, the pooled recurrence rate was 9% (95% CI 6–13%, I2 = 77%, p < 0.01) in right-sided and 15% (95% CI 8–27%, I2 = 97%, p < 0.01) in the left-sided. Age and gender were not associated with the recurrence of both sides. The treatment failure rate was 5% (95% CI 2–10%, I2 = 84%, p < 0.01) in right-sided and 4% (95% CI 2–7%, I2 = 80%, p < 0.01) in left-sided CD. The risk factors for recurrence and treatment failure were limited. Conclusion: Non-operative management is effective with low rates of recurrence and treatment failure for both right-sided and left-sided CD although left-sided exhibits a higher recurrence. The recurrence rates did not differ between patients receiving antibiotics or not in uncomplicated CD. Age and sex were not associated with the recurrence although other risk factors were dispersing. Further risk factors for recurrence and treatment failure would be investigated for precise clinical decision-making and individualized strategy. [ABSTRACT FROM AUTHOR]

Aim: Little is known regarding the actual utilization of point-of-care ultrasound (PoCUS) after training. This study aims to investigate the clinical utilization of PoCUS by first post-graduate year (PGY-1) residents after training.Material and Methods: This prospective study was conducted at the emergency department (ED). A PoCUS curriculum was implemented and the objective structured clinical examination (OSCE) scores were obtained after training. The sonographic examinations performed by the residents were collected. The primary outcomes were the numbers, imaging quality, and accuracy of the sonographic examinations after the curriculum, compared with those before the curriculum.Results: Two hundred and thirtynine residents participated with the median OSCE score of 4 (IQRs, 4-5) and 170 (71%) used PoCUS during clinical practice. The number that each resident performed increased [before vs. after, 0 (0-1) vs. 3 (0-5), p<0.0001], the image quality was better [before vs. after, 3 (2-3) vs. 3 (3), p<0.0001] and the accuracy improved (before vs. after, 117/129 vs. 730/772, p<0.0001) after the curriculum. The residents were categorized into 4 groups based on the utilization: group 1 performed PoCUS before and after the curriculum; group 2 performed only after the curriculum; group 3 performed only before the curriculum; the last did not use. No significant differences existed in the OSCE score between the 4 groups. Group 1 performed more examinationswith better image quality and groups 1 and 2 used ≥2 applications after the curriculum. However, nearly 30% of residents did not use PoCUS, and "chose other imaging priorities" (40/69, 58%) was the main feedback.Conclusions: A PoCUS training had a positive impact on the clinical utilization by the novice residents. More than 70% of residents integrated PoCUS into clinical practice and used self-formatted US techniques. The OSCE scores could not predict further utilization. [ABSTRACT FROM AUTHOR]

Evidence regarding the recurrence of diverticulitis is limited in Asian patients. This study aims to investigate recurrence rates and identify predictive factors for the recurrence of diverticulitis following successful nonoperative treatment in Asian patients. A multicenter, retrospective cohort study was conducted between 2012 and 2018. Adult patients with computed tomography (CT)-proven colonic diverticulitis were included. The primary outcome was the recurrence of diverticulitis, which was defined as another episode of occurrence of the infection after index hospital stay. Cumulative recurrence rates were calculated using the Kaplan–Meier method. Cox regression models were employed to identify parameters that significantly and independently predicted recurrence. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. A total of 929 patients were included. Diverticulitis in the cecum/ascending occurred in 675 (72.6%) patients. The average follow-up period was 651 days. Recurrence was observed in 115 (12.4%) patients and most significantly observed in patients with sigmoid diverticulitis (HR, 2.24; 95% CIs 1.59–3.97), followed by those with descending colon diverticulitis (HR, 1.92; 95% CIs 1.17–3.25). Although most of the Asian patients had right-sided colonic diverticulitis, those with sigmoid diverticulitis had the highest risk of recurrence. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to investigate the characteristics of patients after free falls at the Level-I trauma centers. The factors associated with survival were differentiated.Methods: This retrospective study was conducted at the National Taiwan University Hospital, the Hsin-Chu branch, and the Yun-Lin branch, all accredited as Level-I trauma centers between January 2010 and September 2020. Adult patients with falls from height of more than one story (i.e. 3.6 m) were included. Clinical data were obtained from electronic medical records. Odds ratios (OR) were computed with 95% confidence intervals (CIs) for significant parameters for survival.Results: A total of 371 patients were included. Only 2 survived to discharge with poor neurologic outcomes in 101 patients with OHCA. The overall mortality rate was 98% and 11% in patients with and without OHCA. A higher falling height with a one-meter increase (OR, 1.14, 95% CI, 1.10-1.19) was significantly related to OHCA, especially the height over 6 m (OR, 3.07, 95% CI, 1.19-7.94). A higher trauma injury severity score (TRISS) was significantly related to survival among patients without OHCA (OR, 1.07, 95% CI, 1.04-1.11), especially TRISS≧0.945 (OR, 5.21, 95% CI, 1.28-21.24). Patients without severe head/neck injury of Abbreviated Injury Scale (AIS)≧3 (OR, 0.17, 95% CI, 0.07-0.42) were positively associated with survivors among patients without OHCA.Conclusion: Patients with traumatic OHCA following falls had a high mortality rate of 98% and dismal outcomes, compared with non-traumatic OHCA. Falling heights, especially over 6 m was associated with OHCA. Patients without OHCA had a mortality rate of 11%. Patients with a higher TRISS, especially more than 0.945, or without severe head injury had more chances to survive in the non-OHCA group. The study provided the evidence to guide termination of high futility resuscitation for traumatic OHCA secondary to falls to conserve the clinical resources. [ABSTRACT FROM AUTHOR]

Spontaneous spinal epidural hematoma (SEH) is extremely rare in patients with end‐stage renal disease (ESRD). We report a case of a 71‐year‐old man with ESRD presented with progressive left limb weakness. Magnetic resonance imaging (MRI) revealed spinal cervical SEH involving C3‐5 level. The patient received emergent decompression laminectomy with the evacuation of the epidural hematoma. [ABSTRACT FROM AUTHOR]

Proper endotracheal tube (ETT) size selection and identification of potentially difficult airways are important to reduce laryngeal injury during intubation. However, controversies exist concerning transverse subglottic diameter—the narrowest part of the airway—and the distance to pre-epiglottic space. Because few studies have reported the distance from skin to the midpoint of the epiglottis (DSE) among normal individuals, whether the DSE varies between individuals and by ethnicity remains uncertain. The present study aims to investigate the sonographic subglottic diameter and DSE among healthy Chinese adults. Healthy volunteers were recruited at National Taiwan University Hospital between October and November 2019. Exclusion criteria included pre-existing airway or respiratory diseases, neck tumors, and a history of neck operation. Age, sex, height, weight, body mass index (BMI), sonographic DSE, and transverse subglottic diameter were recorded. A total of 124 participants were enrolled. The average age was 32.5 ± 10.4 years and 63 participants (51%) were males. The subglottic diameter was positively associated with sex (males, 14.40 mm; females, 11.10 mm, p < 0.001) and BMI (underweight, 12.13 mm; normal weight, 12.47 mm; overweight, 13.80 mm; obese, 13.67 mm, p = 0.007). Moreover, the DSE was shorter in males (male, 16.18 mm; females, 14.54 mm, p < 0.001) and participants with increased BMI (underweight, 13.70 mm; normal weight, 15.06 mm; overweight, 16.58 mm; obese, 18.18 mm, p < 0.001). As compared with other ethnicity, a smaller size of subglottic diameter and a shorter DSE were noted among Chinese participants, and we suggest that a relatively smaller size of endotracheal tube selection should be considered in tracheal intubations. [ABSTRACT FROM AUTHOR]

Background: Percutaneous cholecystostomy tube (PCT) has been effectively used for the treatment of acute cholecystitis (AC) for patients unsuitable for early cholecystectomy. This retrospective study investigated the recurrence rate after successful PCT treatment and factors associated with recurrence. Methods: We reviewed patients treated with PCT for AC from October 2004 through December 2013. Patients with successful PCT treatment were those who were free from persistent PCT drainage. We used multivariable logistic regression analysis sequentially to identify factors associated with each outcome. Results: The study included 184 patients (mean age: 70.1 years). The average duration for parenteral antibiotics was 14.4 days and 20.0 days for PCT drainage. The one-year recurrence rate was 9.2% (17/184) with most recurrences occurring within two months (6.5%, 12/184) of the procedure. Complicated cholecystitis (odds ratio [OR]: 4.67; 95% confidence interval [CI]: 1.44–15.70; P = 0.01) and PCT drainage duration >32 days (OR: 4.92; 95% CI: 1.03–23.53; P = 0.05) positively correlated with one-year recurrence; parenteral antibiotics duration >10 days (OR: 0.21; 95% CI: 0.05–0.68; P = 0.01) was inversely associated with one-year recurrence. Conclusions: The recurrence rate was low for patients after successful PCT treatment. Predictors for recurrence included the severity of initial AC and subsequently provided treatments. [ABSTRACT FROM AUTHOR]

Correction to: I Scientific Reports i https://doi.org/10.1038/s41598-022-08708-w, published online 16 March 2022 The original version of this Article contained an error in Reference 6, which was incorrectly given as Gill, H. I et al. i Sedation management during therapeutic hypothermia for neonatal encephalopathy: Atropine premedication for endotracheal intubation causes a prolonged increase in heart rate. The correct reference is listed below: Park, S. J., Choi, S. I., Lee, S. H., & Lee, K. Y. Image-guided conservative management of right colonic diverticulitis. [Extracted from the article]

Correction to: I Scientific Reports i https://doi.org/10.1038/s41598-022-08708-w, published online 16 March 2022 The original version of this Article contained an error in Reference 6, which was incorrectly given as Gill, H. I et al. i Sedation management during therapeutic hypothermia for neonatal encephalopathy: Atropine premedication for endotracheal intubation causes a prolonged increase in heart rate. The correct reference is listed below: Park, S. J., Choi, S. I., Lee, S. H., & Lee, K. Y. Image-guided conservative management of right colonic diverticulitis. [Extracted from the article]

Background: Few studies have followed patients who received antibiotic treatment for acute cholecystitis (AC). The present retrospective study investigated recurrence rates of AC and analyzed factors associated with recurrence after antibiotic treatment in adult AC patients. Methods: We analyzed patients treated with antibiotics for AC between October 1, 2004, and November 30, 2010. A Cox proportional hazards model was used to identify factors associated with early recurrence. Generalized additive models were applied to detect the nonlinear effects of continuous covariates. Results: The study included 226 patients (mean age: 62.2 years; 144 men [63.7 %]). The average duration of parenteral antibiotics was 8.0 days. Second-generation cephalosporins were administered to 199 patients (88.1 %). The Kaplan-Meier plot indicated that recurrences were more frequent within 100 days of AC; these were defined as early recurrences. The recurrence rate was 13.7 % (31/226) at a median follow-up of 308.5 days (early recurrences: 19/226 [8.4 %]). The duration of parenteral antibiotic use significantly correlated with early recurrence (hazard ratio: 0.83; 95 % confidence interval, 0.73-0.95; p = 0.005). Generalized additive models revealed that patients using parenteral antibiotics longer than 8 days were less likely to suffer from early recurrence. Conclusions: The rate of recurrence of AC in patients who received antibiotics alone was low. The recurrence rate was higher within 100 days of AC. Because of the inherent limitations of a retrospective study, further research is needed to identify factors associated with early recurrence. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study aimed to evaluate the accuracy of tracheal ultrasonography for assessing endotracheal tube position during cardiopulmonary resuscitation (CPR). Methods: We performed a prospective observational study of patients undergoing emergency intubation during CPR. Real-time tracheal ultrasonography was performed during the intubation with the transducer placed transversely just above the suprasternal notch, to assess for endotracheal tube positioning and exclude esophageal intubation. The position of trachea was identified by a hyperechoic air–mucosa (A–M) interface with posterior reverberation artifact (comet-tail artifact). The endotracheal tube position was defined as endotracheal if single A–M interface with comet-tail artifact was observed. Endotracheal tube position was defined as intraesophageal if a second A–M interface appeared, suggesting a false second airway (double tract sign). The gold standard of correct endotracheal intubation was the combination of clinical auscultation and quantitative waveform capnography. The main outcome was the accuracy of tracheal ultrasonography in assessing endotracheal tube position during CPR. Results: Among the 89 patients enrolled, 7 (7.8%) had esophageal intubations. The sensitivity, specificity, positive predictive value, and negative predictive value of tracheal ultrasonography were 100% (95% confidence interval [CI]: 94.4–100%), 85.7% (95% CI: 42.0–99.2%), 98.8% (95% CI: 92.5–99.0%) and 100% (95% CI: 54.7–100%), respectively. Positive and negative likelihood ratios were 7.0 (95% CI: 1.1–43.0) and 0.0, respectively. Conclusions: Real-time tracheal ultrasonography is an accurate method for identifying endotracheal tube position during CPR without the need for interruption of chest compression. Tracheal ultrasonography in resuscitation management may serve as a powerful adjunct in trained hands. [Copyright &y& Elsevier]

Abstract: Objectives: This study aimed to assess the diagnostic accuracy and timeliness of using tracheal ultrasound to examine endotracheal tube placement during emergency intubation. Methods: This was a prospective, observational study, conducted at the emergency department of a national university teaching hospital. Patients received emergency intubation because of impending respiratory failure, cardiac arrest, or severe trauma. The tracheal rapid ultrasound exam (T.R.U.E.) was performed during emergency intubation with the transducer placed transversely at the trachea over the suprasternal notch. Quantitative waveform capnography was used as the criterion standard for confirmation of tracheal intubation. The main outcome was the concordance between the T.R.U.E. and the capnography. Results: A total of 112 patients were included in the analysis, and 17 (15.2%) had esophageal intubations. The overall accuracy of the T.R.U.E. was 98.2% (95% confidence interval [CI]: 93.7–99.5%). The kappa (κ) value was 0.93 (95% CI: 0.84–1.00), indicating a high degree of agreement between the T.R.U.E. and capnography. The sensitivity, specificity, positive predictive value, and negative predictive value of the T.R.U.E. were 98.9% (95% CI: 94.3–99.8%), 94.1% (95% CI: 73.0–99.0%), 98.9% (95% CI: 94.3–99.8%) and 94.1% (95% CI: 73.0–99.0%). The median operating time of the T.R.U.E. was 9.0s (interquartile range [IQR]: 6.0, 14.0). Conclusions: The application of the T.R.U.E. to examine endotracheal tube placement during emergency intubation is feasible, and can be rapidly performed. [Copyright &y& Elsevier]

The article describes the case of a 33-year-old man with a history of diabetes mellitus who presented with scrotal pain for 3 days. The results of his physical examination showed a left red tender scrotal mass. He was diagnosed with Fournier's gangrene (FG), a fulminant necrotizing fasciitis of the perinium. One of the complications associated with the disease is acute renal failure.