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Objectives To investigate whether wearing a pelvic belt during a trunk stability exercise program positively affects balance in patients with stroke. Materials and Methods Twenty-four patients with stroke were randomly allocated to the experimental or control group and performed a 60-min general physical therapy and an additional 30-min trunk stability exercise (five times/week for 6 weeks). Those in the experimental and control groups performed the trunk stability exercises with and without wearing the pelvic belt, respectively. Results The experimental group showed a significantly greater magnitude of improvements in balance than the control group (Postural Assessment Scale for Stroke: +18.3%, F (1, 22)=14.350, p=.001, η2=.395; Berg Balance Scale: +11%, F (1, 22)=19.062, p=.000, η2=.464; Timed Up and Go Test: −10.5%, F (1, 22)=8.562, p=.008, η2=.280; center of pressure path length with eyes open: −15.1%, F (1, 22)=6.770, p=.016, η2=.235; center of pressure path length with eyes closed: -19.5%, F (1, 22)=9.256, p=.006, η2=.296; center of pressure path velocity with eyes open: -22.6%, F (1, 22)=37.747, p=.000, η2=.632; center of pressure path velocity with eyes closed: −13.9%, F (1, 22)=6.511, p=.018, η2=.228, respectively). Conclusions Wearing a pelvic belt while performing trunk stability exercise programs could be a more effective approach for improving balance in patients with stroke.

This study examined whether the walking and balance ability of adult patients with chronic hemiplegic stroke are associated differentially with the degree of gain after two types of gait intervention. Twenty-four subjects with hemiplegic stroke were enrolled in this randomized study. Each subject participated in one of two gait intervention strategies: gait training with auditory feedback caused by active weight bearing on the paralyzed side (experimental group; EG), or general gait intervention over the ground (control group; CG). The walking and balance abilities were assessed before and after gait intervention. Significant improvements in the 10-m walking test, functional gait assessment (FGA) score, and center of pressure (COP) path length were observed after gait training in both groups (p 0.05). The EG showed a larger increase in the 10-m walking test, FGA score, and COP path length in the state of eyes opened and closed than the CG (18.2%, 27.0%, 24.8%, and 18.2%, respectively). The auditory feedback caused by active weight bearing on the paralyzed side appeared to be a more effective approach for improving the walking and balance ability in adult patients with hemiplegic stroke during walking training than general gait intervention.

Purpose This study was conducted to identify and to functionally characterize genetic variants in ST3GAL5 and ST8SIA1 in Korean patients with thyroid-associated ophthalmopathy (TAO). Materials and methods Genetic analyses were conducted using DNA samples from TAO patients (n=50) and healthy subjects (n=48) to identify TAO-specific genetic variants of ST3GAL5 or ST8SIA1. The effect of each genetic variant on the transcription or expression of these genes was examined. Additionally, correlations between functional haplotypes of ST3GAL5 or ST8SIA1 and clinical characteristics of the patients were investigated. Results Six promoter variants and one nonsynonymous variant of ST3GAL5 were identified, and four major promoter haplotypes were assembled. Additionally, three promoter variants and two major haplotypes of ST8SIA1 were identified. All ST3GAL5 and ST8SIA1 variants identified in TAO patients were also found in healthy controls. Promoter activity was significantly decreased in three promoter haplotypes of ST3GAL5 and increased in one promoter haplotype of ST8SIA1. Transcription factors activating protein-1, NKX3.1, and specificity protein 1 were revealed as having roles in transcriptional regulation of these haplotypes. The nonsynonymous variant of ST3GAL5, H104R, did not alter the expression of ST3GAL5. While no differences in clinical characteristics were detected in patients possessing the functional promoter haplotypes of ST3GAL5, exophthalmic values were significantly lower in patients with the ST8SIA1 haplotype, which showed a significant increase in promoter activity. Conclusion These results from genotype-phenotype analysis might suggest a possible link between the ST8SIA1 functional promoter haplotype and the clinical severity of TAO. However, further studies with larger sample sizes are warranted.

Spinal cord infarction is a rare condition and is easily misdiagnosed owing to its initial non-specific manifestation. We report a case of a 77–year-old man who presented with chest pain and upper back pain initially, and was misdiagnosed with a myocardial infarction. Four hours after admission, he complained of numbness in his entire left leg below the knee, with rapid deterioration of neurological symptoms. After 9 hours, loss of sensation progressed up to the T4 dermatome, strength of both lower extremities deteriorated to grade 0, and decrease in anal tone and deep tendon reflex was observed. Initial magnetic resonance imaging findings were normal; however, a signal change occurred 3 days after symptom onset. When patients present with acute chest pain and neurologic symptoms, the possibility of ischemic cardiac disease as well as any neurological manifestations must be investigated. Emergency physicians must remember the value of serial physical examinations.

Glyphosate-surfactant is one of the most commonly used herbicides in the world. Its key component, glyphosate, is a competitive inhibitor of the shikimate pathway, a metabolic pathway found only in plants. However, severe intoxication, including lethal cases by ingestion of, glyphosate-surfactant has been reported. We describe the full recovery of two patients from glyphosate-polyoxyethyleneamine surfactant intoxication and multi-organ system failure following continuous renal replacement therapy. Both patients developed persistent shock, acute kidney injury, lactic acidosis, hyperkalaemia and multi-organ failure despite of resuscitation. We believe that continuous renal replacement therapy should be initiated immediately for removal of glyphosate-polyoxyethyleneamine surfactant in patients with signs of cardiopulmonary compromise, lactic acidosis, and renal failure. We propose the addition of glyphosate-polyoxyethyleneamine surfactant to the list of toxins for which early haemodialysis should be indicated.

Neurofibromatosis 1 is an autosomal dominant disorder characterized by cafe-au-lait spots, cutaneous neurofibroma, and bony deformities. Vascular abnormality such as stenosis, aneurysm, or rupture associated with neurofibromatosis 1 is rare. Rupture of vertebral artery aneurysm into the thoracic cavity is extremely rare. The outcomes of patients with aneurysmal ruptures are very poor when spontaneous hemothorax occur. A 31-year-old woman presented to the emergency department with left shoulder pain and with both lower chest wall pain and left supraclavicular area swelling. The chest computed tomography scan revealed about 4-cm pseudo-aneurysm probable arising from the left vertebral artery with large hematoma at left supraclavicular area. Neurofibromatosis 1 is generally being regarded as a benign disease but has the potential for serious vascular complications. When aneurysms were ruptured, cervical hematoma, hemothorax, or hypotension was developed. It is potentially a life-threatening condition, so it must require emergent management. Emergency physicians must remember the relation of neurofibromatosis 1 and serious vascular complications and ensure rapid access to rule out vascular lesions, so as to prevent the life-threatening condition.

Introduction: Accidental foreign bodies ingestion is common in emergency department. However, if the objects are sharp, the complication rate is higher. Toothpick can cause severe complications of gastrointestinal tract due to being long, sharp ends on both sides, slender, and resistant to digestion. Case presentation: A 64-year-old man presented to the emergency department with fever and right upper abdominal pain for 3 days. The physical examination revealed severe pain with rebound tenderness in the right upper abdominal quadrant and positive Murphy’s sign. The provisional diagnosis of acute cholecystitis was made. The contrast abdominal-pelvic computed tomography scan revealed linear-shaped lesion penetrating hepatic flexure of colon and proximal transverse colon. The patient showed deterioration of vital sign, and therefore, emergency laparotomy was performed. Colon perforation by wooden toothpick was diagnosed. Discussion and conclusion: Toothpick ingestion without awareness is rare but fatal, especially when physicians failed to suspect foreign body ingestion. We think of this as one of the differential diagnoses, so we use contrast computed tomography scan.

Background Endotracheal tube (ETT) obstruction or narrowing in patients undergoing general anesthesia due to dissection of reinforced ETT is unusual. Case Report A 26-year-old woman was transferred to the emergency department due to drowsy mental status after surgery. She was intubated by reinforced ETT with grossly normal external appearance, but the inner layer of ETT was dissected, the inner diameter was narrowed, and the extent of protrusion of inner layer of ETT was more severe at the distal end. Therefore, the patient had to breathe through a very small diameter ETT, and hypercapnia and CO2 narcosis developed. Why Should an Emergency Physician Be Aware of This? Although rare, obstruction by dissection of ETT can be life-threatening if diagnosis is delayed. Therefore, emergency physicians should keep in mind the possibility of ETT dissection when peak airway pressures or EtCO2 values are elevated in intubated patients.

Background The anterior surgical approach to the cervical spine is known to be safe, and damage to the hypoglossal nerve and trigeminal pathway after the surgery is uncommon. However, once damage to those nerves occurs, the patient's quality of life can be severely impaired by discomfort and disability. Case Description We report the case of a 59-year-old male with concomitant and irreversible hypoglossal nerve and trigeminal system dysfunction after cervical spine surgery by the anterior approach confirmed by an electrodiagnostic study. He had undergone anterior cervical disc fusion through right-sided approach for a herniated intervertebral disc on the C3-4 level and direct cord compression. He had difficulty with tongue movement, dysarthria, and hypesthesia along the lower margin of the right mandible immediately after the surgery. An electrodiagnostic study revealed hypoglossal neuropathy and trigeminal somatosensory pathway dysfunction. Even though the patient received rehabilitation therapy for impaired tongue movement for more than 2 years, this function did not recover. Conclusions It is important to be aware of the complexity of the anatomy of vulnerable structures, including hypoglossal nerves and the trigeminal nerve system at the cervical spine level, to prevent damage to important neural structures during surgical procedures.

Introduction: In the background of the increased suicide rate in the second decade of life, analysis of the characteristics of poisoning-related attempted suicide in adolescents and evaluation of the differences from adults may form an important basis for establishing measures to prevent deaths from poisoning. Objective: We aimed to investigate the types of toxic substances ingested for attempted suicide by poisoning in adolescents admitted to the emergency department (ED). Method: This cross-sectional study retrospectively analyzed and investigated the medical records of patients aged 13 or older, admitted to the ED of a tertiary medical institute over a period of 3 years, for attempted suicide by poisoning. Results: The psychiatric diagnoses among patients in the adolescent group included depression (75.8%), bipolar disorder (12.5%), and panic disorder (12.5%). In terms of the type of drug used for poisoning, antidepressants or anti-psychotics and sleeping pills were the most commonly used in the adolescent (43 subjects, 45.2%) and adult (286 subjects, 37.6%) groups, respectively. Conclusion: As there is a higher chance of poisoning by easily accessible drugs, the emergency physician needs to investigate any preceding diagnoses of psychiatric or medical illnesses in the adolescent patients attempting suicide with unknown drugs.

Erigeron annuus (L.) Pers. water extract (EAW) was investigated for its anti-obesity effects in C57BL/6J mice on a high-fat diet. Mice were divided into groups fed normal and high-fat diets (ND and HFD, respectively), and HFD mice were treated with EAW (50, 100, and 200 mg/kg/day) for 8 weeks. Inhibition of HFD-induced obesity by EAW was evaluated using biochemical parameters, immunohistochemistry, real-time PCR, and immunoblot assay. EAW supplementation significantly diminished the final body weight, adipose tissue size, and epididymal adipose tissue volume compared with mice with obesity induced by HFD (p

9053 Background: While osimertinib showed impressive efficacy and safety profile in 1st-line setting for EGFR mutation-positive (EGFR M+) NSCLC patients, there are no standard targeted therapy following progression. Thus, interest has been growing on sequential treatment of osimertinib as 2nd-line treatment for patients acquiring T790M resistance mutation after 2nd generation EGFR TKIs. We did a retrospective study to support the hypothesis that sequential approach of afatinib followed by osimertinib represents a practical treatment option in ‘real-world’ practice. Methods: In this non-interventional, multicenter study, EGFR M+ NSCLC patients had to start 1st-line afatinib treatment ≥ 13 months prior to data entry. They were categorized into 4 cohorts according to 2nd-line treatments with retesting results: T790M+ patients sequentially treated with osimertinib in cohort A, T790M patients treated with chemotherapy or other treatments in cohort B, and patients with unknown mutation status in cohort C. Cohort D included patients who were still ongoing with afatinib. Primary outcome was the time on treatment (TOT) of patients receiving 1st-line afatinib (TOT-1) followed by 2nd-line treatments (TOT-2). Secondary endpoints were acquisition rate of T790M after progression, objective response rates of afatinib (ORR-1) and 2nd-line treatments (ORR-2), and overall survival (OS). Results: Among a total of 761 enrolled patients, 737 patients excluding 24 screening failures were allocated into cohort A (n=116), B (n=143), C (n=111), and D (n=367). Median age was 62 years (22 - 90) with 53.05% of female proportion. Brain metastasis was discovered in 38.94% at initial diagnosis. Regarding genotypes of EGFR mutations, del19 was 57.53%, 31.48% for L858R, 7.33% for uncommon mutations, and 3.66% for compound mutation. Median TOTs in cohort A, B, C, and D were 35.09 months (95% CI, 30.09 to 43.53), 18.76 months (95% CI, 16.92 to 20.20), 12.02 months (95% CI, 10.22 to 14.98), and 42.61 months (95% CI, 30.95 to 59.23), respectively. Particularly, in cohort A, median TOT-1 and TOT-2 were 17.43 months (95% CI, 15.21 to 19.32) and 11.04 months (95% CI, 7.10 to 14.13), respectively. Retesting was attempted in 262 of 370 patients (70.81%) with 44.27% of T790M detection rate. ORR-1 and -2 in cohort A, B, and C were 84.48% and 56.03%, 82.52% and 29.08%, 54.95% and 21.70%, respectively and 68.94% of ORR for cohort D. Median OS has was not reached. Conclusions: These data suggest that, in real-world practice, sequential afatinib followed by osimertinib be a feasible and effective therapeutic strategy for EGFR M+ NSCLC patients acquiring T790M during the period of afatinib treatment. Of note, median TOT in cohort D is over 3.5 years, suggesting that 1st-line afatinib potentially allow certain patients to maintain long-term, chemotherapy-free state. Further analysis is currently being undertaken and will be presented.

Neuropsychiatric systemic lupus erythematosus (NPSLE) involves the central and peripheral nervous system in patients with systemic lupus erythematosus (SLE). It is essential to specify the problems faced by patients with NPSLE because it causes diverse disabilities and impairs quality of life. After performing a comprehensive evaluation, tailored management should be provided for the patient's specific problems. We report here the case of a 30-year-old female with SLE who experienced serious neuropsychiatric symptoms cerebral infarction followed by posterior reversible encephalopathy syndrome and peripheral polyneuropathy. We systemically assessed the patient using the International Classification of Functioning, Disability and Health model as a clinical problem-solving tool and provided comprehensive rehabilitation by focusing on her problems.

Epigastric pain is a common symptom in the emergency department. Most epigastric pain is not fatal, except in acute myocardial infarction, aortic dissection, and abdominal aneurysm rupture. Epigastric pain can also be the only symptom of isolated spontaneous gastric artery dissection. We report the case of a 51-year-old woman diagnosed with neurofibromatosis who initially presented with only epigastric pain. She was initially misdiagnosed with gastritis, treated conservatively, and discharged. Two hours later, she returned to the emergency department with persistent epigastric pain and rebound tenderness in the epigastric area. Angiography revealed a left hepatic arterial aneurysm and right gastric artery dissection, which were subsequently embolized. Although extremely rare, patients presenting with epigastric pain at risk of vasculopathies should be considered for isolated spontaneous gastric artery dissection. Early recognition and definitive therapy lead to a favorable outcome.

[Purpose] This study compared the activity of the quadriceps femoris muscle according to the angle of ankle abduction during a lunge exercise. [Subjects and Methods] Fifteen male healthy volunteers participated in the study. All participants performed the lunge exercise with different angles of ankle abduction (0°, 20°, 40°, 60°). The activity of the rectus femoris (RF), vastus lateralis (VL) and vastus medialis oblique (VMO) muscles were recorded for the four angles by using a surface electromyography system. [Results] There were significant differences between the rectus femoris (RF), vastus lateralis (VL) and vastus medialis oblique (VMO) with every angle of the ankle joint. The most significantly increased muscle activity was evident in the vastus medialis oblique (VMO) when the ankle abduction was 60°. [Conclusion] These findings suggest that as the ankle abduction angle increases during the lunge exercise, the muscle activity of the quadriceps femoris muscle increases and this could be helpful in the selective muscle strengthening of the vastus medialis oblique muscle (VMO) with the ankle in the 60° abduction position.

[Purpose] The purpose of this study was to identify the effects of extracorporeal shock wave therapy on the pain and function of patients with degenerative knee arthritis. [Subjects and Methods] Twenty patients with degenerative knee arthritis were divided into a conservative physical therapy group (n=10) and an extracorporeal shock wave therapy group (n=10). Both groups received general conservative physical therapy, and the extracorporeal shock wave therapy was additionally treated with extracorporeal shock wave therapy after receiving conservative physical therapy. Both groups were treated three times a week over a four-week period. The visual analogue scale was used to evaluate pain in the knee joints of the subjects, and the Korean Western Ontario and McMaster Universities Osteoarthritis Index was used to evaluate the function of the subjects. [Results] The comparison of the visual analogue scale and Korean Western Ontario and McMaster Universities Osteoarthritis Index scores within each group before and after the treatment showed statistically significant declines in scores in both the conservative physical therapy group and extracorporeal shock wave therapy group. A group comparison after the treatment showed statistically significant differences in these scores in the extracorporeal shock wave therapy group and the conservative physical therapy group. [Conclusion] extracorporeal shock wave therapy may be a useful nonsurgical intervention for reducing the pain of patients with degenerative knee arthritis and improving these patients' function.

[Purpose] The purpose of this study was to examine the effects of the cervical flexion angle on muscle fatigue and pain in the cervical erector spinae and upper trapezius in normal adults in their 20s. [Subjects and Methods] The study’s subjects were 14 normal adults. After sitting on a chair with their back against the wall, they held a smartphone with both hands for 10 minutes and fatigue and pain in the neck and shoulder muscles were measured at different cervical flexion angles (0°, 30°, and 50°). Electromyography was performed to analyze the muscle fatigue of the right upper trapezius, left upper trapezius, right cervical erector spinae, and left cervical erector spinae, and a CommanderTM Algometer was used to measure pain. The cervical range of motion was used as an instrument to compare and analyze the cervical flexion angles. [Results] The study’s results showed statistically significant differences in the muscle fatigue and pain of the right upper trapezius and left upper trapezius depending on the cervical flexion angle and a post-hoc test showed statistically significant lower levels of muscle fatigue and pain at 50° than at 0° or 30°. No statistically significant differences were found between the right cervical erector spinae and left cervical erector spinae. [Conclusion] The cervical flexion angle during smartphone use may influence the muscle fatigue and pain of the upper trapezius.

[Purpose] The purpose of this study was to identify the effects of changes in support and inclined boards on lower-extremity muscle activity. [Subjects and Methods] The study subjects were 15 healthy adult males. Aero-Step equipment was used as an unstable support, and an inclined board was used to maintain angles of 0° and 20°. Electromyography was employed to analyze lower-extremity muscle activity. [Results] The vastus lateralis, vastus medialis, rectus femoris, gastrocnemius, soleus, and tibialis anterior muscles showed significant differences according to changes in the support and inclined board. In post-hoc tests the vastus lateralis, vastus medialis, and rectus femoris muscles showed significantly increased activity when exercises were performed on the unstable inclined board (20°) than the stable support (0°), unstable support (0°), or stable inclined board (20°). The gastrocnemius, soleus, and tibialis anterior muscles showed significantly increased activity when exercises were performed on the unstable support (0°), stable inclined board (20°), or unstable inclined board (20°) than on the stable support (0°). [Conclusion] An unstable support and increased slope of the inclined board may increase lower-extremity muscle activity.

Background There has been a steady increase in the aging population and an increase in the need for long-term care beds in institutions and hospitals (LTCHs) in Korea. The aim of this study was to investigate prognosis and to identify factors contributing to mortality of critically ill patients with respiratory problems who were directly transferred to intensive care units (ICU) from LTCHs. Methods Following a retrospective review of clinical data and radiographic findings between July 2009 and September 2016, we included 111 patients with respiratory problems who had visited the emergency room (ER) transferred from LTCHs due to respiratory symptoms and who were then admitted to the ICU. Results The mean age of the 111 patients was 79 years, and 71 patients (64%) were male. Pneumonia developed in 98 patients (88.3%), pulmonary thromboembolism in 4 (3.6%) and pulmonary tuberculosis in 3 (2.7%). Overall mortality was 19.8% (22/111). Multiple-drug-resistant (MDR) pathogens (odds ratio [OR], 17.43; 95% confidence interval [CI], 1.96–155.40) and serum albumin levels

Introduction The extensor hallucis longus (EHL) muscle is important for diagnosis of neurologic lesions. It is also a target muscle for treatment. We investigated EHL with ultrasonography to determine optimal needle placement for safety and accuracy. Methods A total of 96 legs of 48 healthy volunteers were examined through ultrasonography. Four published electromyographic methods for finding the EHL were assessed. We identified the midpoint of EHL (MD) using landmarks to determine optimal needle placement. Results Mean values of bimalleolar line-MD on skin (MD-S) and tibial crest-MD-S were 10.5 ± 1.2 cm and 3.6 ± 0.4 cm, respectively. The depth of MD was 1.6 ± 0.2 cm. According to 4 EMG methods, the probability of needle penetrating EHL was 13% to 79% and that of needle penetrating the neurovascular bundle was 50% to 89%. Conclusions Using ultrasonography, we could determine optimal needle placement in the EHL. Muscle Nerve 59:331-336, 2019.

[Purpose] This study examines the effect of isometric contraction of the upper limb on the affected side in the supine position on the activity of body trunk muscles on the opposite side of normal adults. [Participants and Methods] The research participants included 10 normal adults. A handheld dynamometer device was used to measure the isometric contraction of the upper limb. The muscle activity of the body trunk was analyzed by electromyography. [Results] The muscle activities of rectus abdominis, internal oblique abdominis, erector spinae muscle, and multifidus muscle of the body trunk on the opposite side were significantly larger in the case of the adduction and flexion of the shoulder joint on the affected side than in the case of abduction and extension. [Conclusion] The isometric contraction induced by the adduction and flexion of the shoulder joint on the affected side altered the muscle activity of the body trunk on the opposite side.

To evaluate the usefulness of anterior capsular abnormality, thickening, and abnormal signal intensity on MRI for the diagnosis of adhesive capsulitis of the shoulder. This retrospective study included 29 patients with adhesive capsulitis and 20 controls. Clinical criteria with significant restricted passive motion was used for the diagnosis of adhesive capsulitis. The anterior capsular thickness and signal intensity were evaluated on the thickest portion of anterior glenohumeral joint capsule, located deep to the subscapularis muscle. In addition, the previously known MR findings of adhesive capsulitis, such as humeral and glenoid capsular thickness in axillary recess, maximal axillary capsular thickness, and coracohumeral ligament thickness, were measured. The presence of humeral and glenoid capsular abnormal hyperintensity in axillary recess, abnormal hyperintensity, and obliteration of the subcoracoid fat triangle were also evaluated. All MRI findings significantly differed between adhesive capsulitis and controls. Among MR findings, multivariable analysis showed that anterior capsular thickness, maximal axillary capsular thickness, and anterior capsular abnormal hyperintensity were variables that could differentiate adhesive capsulitis from the control group, with odds ratios of 7.97, 17.75, and 12.41, respectively (p

Stroke rehabilitation requires repetitive, intensive, goal-oriented therapy. Virtual reality (VR) has the potential to satisfy these requirements. Game-based therapy can promote patients' engagement in rehabilitation therapy as a more interesting and a motivating tool. Mobile devices such as smartphones and tablet PCs can provide personalized home-based therapy with interactive communication between patients and clinicians. In this study, a mobile VR upper extremity rehabilitation program using game applications was developed. The findings from the study show that the mobile game-based VR program effectively promotes upper extremity recovery in patients with stroke. In addition, patients completed two weeks of treatment using the program without adverse effects and were generally satisfied with the program. This mobile game-based VR upper extremity rehabilitation program can substitute for some parts of the conventional therapy that are delivered one-on-one by an occupational therapist. This time-efficient, easy to implement, and clinically effective program would be a good candidate tool for tele-rehabilitation for upper extremity recovery in patients with stroke. Patients and therapists can collaborate remotely through these e-health rehabilitation programs while reducing economic and social costs.

OBJECTIVES Facial bone fractures secondary to head trauma are more common in children than in adults. Recently, multidetector row computed tomography (CT) has been considered superior to conventional radiography. Some studies have reported that facial soft tissue injuries require both facial and brain CT and that brain CT is helpful in screening facial bone fractures. However, these studies included only adult patients. The aim of this study was to evaluate the diagnostic performance of brain CT and the need for additional facial CT to detect facial bone fractures in emergency pediatrics. METHODS This multicenter study was conducted retrospectively in 2 tertiary hospitals in Seoul, Republic of Korea. The data were collected from the medical records of pediatric patients younger than 8 years who had undergone both brain and facial CT on the same day in the emergency department. All CT scans were retrospectively and independently evaluated by 1 board-certified radiologist and 1 board-certified emergency medicine physician. A P value of

Several abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) have been developed for use in high-volume clinical situations such as emergency departments. In this study, we developed a new abbreviated version of AUDIT called the Screening Tool for At-risk Drinking (STAD) for young and middle-aged adults, consisting of two questions that reflect the structure of the AUDIT questionnaire using data from the Korea National Health and Nutrition Examination Survey (KNHANES). To derive the abbreviated test considering AUDIT item structure, we performed confirmatory factor analysis on the 10 AUDIT questions in the Korea National Health and Nutrition Examination Survey (KNHANES) IV. To validate the new abbreviated test, we analyzed the sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) on the KNHANES V-VI except for the KNHANES VI-2. Based on the two-factor structure of AUDIT, question (Q) 3 and Q7 were finally selected for STAD. In validation, AUROC was significantly wider for STAD than for AUDIT-QF, which has the same number of questions. There was no significant difference between AUDIT-C, consisting of three questions, and STAD. It can be used as a simple and reliable screening test in clinical settings.

Objectives: Interpersonal stress is a major cause and aggravating factor of Hwabyung. The purpose of this study was to compare communication type and stress coping style between the Hwabyung pa-tients group and non-Hwabyung patients group.Methods: The total number of study participants was 101. Based on the Hwabyung symptom scale, the study participants were divided into Hwabyung patients group (30 patients) and non-Hwabyung pa-tients group (43 patients; control group), and the others were excluded from the study . All included patients were administered the Virginia Satir's communication type questionnaire and stress coping scale based on Folkman & Lazarus's theory. The independent t-test was used to determine the stat-istical significance between the features of communication types and stress coping styles in each group. In addition, Spearman correlation analysis was used to identify the relationship between com-munication types and stress coping styles.Results and Conclusions: 1. Communication types differed significantly between the Hwabyung pa-tients group and non-Hwabyung patients group. 2. Hwabyung patients scored significantly higher in each dysfunctional communication type than functional communication type. Scores of placating stance and super-reasonable stance, which were subtypes of dysfunctional communication type, were high in the Hwabyung patients group. The non-Hwabyung patients group scored the highest in Congruent stance, classified as functional communication type. 3. Stress coping style was not sig-nificantly different between the two groups.Key Words: Hwabyung, Satir, Communication type, Stress coping.

Objective Intentional and accidental drug intoxication is commonly seen in the emergency department. When treating intoxicated patients, accessing the amount of the ingested drug is crucial albeit often difficult. We investigated the accuracy of estimating tablet counts when participants were asked to hold tablets in their fists and hands (semi-quantitative terms). Methods The widths and lengths of the participants’ hands were measured. Then, the subjects were asked to hold 5-mm round, 10-mm round, 10-mm oval, and 15-mm elliptical tablets using their hands and fists and to estimate the number of tablets they were holding. Differences between the estimated and actual numbers of tablets were examined. Results A total of 47 members of the public and 32 healthcare professionals were included in our study. In our analyses of the differences between the actual and estimated amounts of tablets held in the participants’ hands and fists, we found that the actual amount was higher than the estimated amount for all tablet types and in both groups. When participants held the tablets in the same manner (handful or fistful), the differences between the actual and estimated amounts were greater for 5- than 15-mm-sized tablets (P

Objectives: Tremor is a common disorder causing abnormal movements, it is defined as, “rhythmic, in-voluntary movements of a part of the body against ones own volition.”. The purpose of this study is to report the effects of Korean Medicine (Acupuncture and herbal-medication) for oromandibular tremor resulting from Deficiency Syndrome.Methods: We treated 6 patients suffering from oromandibular tremor who received hospital treat-ment in DongEui Medical Center from March to June in 2015.Results: After the treatments, oromandibular tremor decreased or disappeared. And some other ac-companying symptoms were improved.Conclusions: These results suggests that Korean medical treatments (Acupuncture and herb-medi-cation) might be effective for treating oromandibular tremor resulting from Deficiency Syndrome.Key Words: Oromandibular tremor, Jaw tremor, Orofacial dyskinesia, Korean medicine, Deficiency syndrome.

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Superwarfarins are widely used as rodenticides. They are similar to warfarin, but they are more potent and act longer. In case of poisoning, they cause severe bleeding, usually from multiple sites. Prolonged treatment with high doses of vitamin K and/or fresh frozen plasma (FFP) transfusions may be necessary. Awareness of the problem of superwarfarin intoxication among physicians remains low and cases may go undiagnosed for days or weeks, resulting in increased morbidity and even mortality. We presented a case of delayed diagnosis of superwarfarin ingestion. The patient presented to emergency department with epistaxis, melena, and gross haematuria. He was treated with vitamin K and the International Normalised Ratio (INR) dropped from >7.0 to 1.4. The patient was discharged. However, 3 weeks later, the patient presented with haemarthrosis. Blood investigation revealed INR value >7.0 again. The patient finally received treatment with FFP and vitamin K. This case illustrates the importance to consider superwarfarin ingestion when patients presented with poisoning with coagulopathy. (Hong Kong j.emerg.med. 2015;22:324-327)

Cyanide intoxication results in severe metabolic acidosis and catastrophic prognosis with conventional treatment. Indications of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) are expanding to poisoning cases. A 50-year-old male patient arrived in the emergency room due to mental change after ingestion of cyanide as a suicide attempt 30 minutes prior. He was comatose, and brain stem reflexes were absent. Initial laboratory analysis demonstrated severe metabolic acidosis with increased lactic acid of 25 mM/L. Shock and acidosis were not corrected despite a large amount of fluid resuscitation with high-dose norepinephrine and continuous renal replacement therapy. We decided to apply ECMO and CRRT to allow time for stabilization of hemodynamic status. After administration of antidote infusion, although the patient had the potential to progress to brain death status, vital signs were improved with correction of acidosis. We considered the evaluation for organ donation. We report a male patient who showed typical cyanide intoxication as lethal metabolic acidosis and cardiac impairment, and the patient recovered after antidote administration during vital organ support through ECMO and CRRT.

Objective Occupational stress can have a harmful effect on the individual both physically and psychologically. In Korea, occupational stress of physician is rarely demonstrated. Although it is well reported that physicians tend to have a high incidence of minor psychiatric disorders, the magnitude of the problem remains unclear. Interns and residents are thought to be under substantial amount of stress, and tend to have psychiatric disorder. In this paper, we aimed to evaluate the relationship between the occupational stress and depression of residents. Methods The participants of this study were surgical and medical residents in a tertiary hospital in Korea. For measurement of occupational stress, we used an occupational stress scale. In addition, to evaluate the prevalence of depression, we used the Beck Depression Inventory. Results Female doctors showed higher degree of occupational stress than the males. The interns and chief residents showed higher degree of occupational stress than the other residents. Interestingly, in this study, most of the participants experienced a depressive mood. Compared with the general population, job demand and culture of workplace were high. Occupational stress was the only significant predictor of a depressive mood. Conclusion Hospital residents experience a high degree of occupational stress leading to a depressed mood due to various risk factors. Therefore, it is essential to recognize the occupational stress of residents early, to encourage positive competition and peer and social support, and to help improve the residents’ ability to cope with stress.

Functional brain imaging studies have suggested that the superior temporal gyrus (STG) and the middle temporal gyrus (MTG) are involved in phonological and lexical-semantic processing, respectively. However, the precise role of the posterior temporal lobe is not fully understood. To clarify the functional relevance of the left posterior STG and MTG during language processing, we used neuronavigation-guided repetitive transcranial magnetic stimulation (rTMS). The reaction times and error rates for 12 healthy volunteers performing auditory repetition and lexical-semantic decision tasks were compared before and during rTMS stimulation. We applied 1 Hz rTMS over the left posterior STG or MTG or sham stimulation for 10 min in a random order. Stimulation of the left posterior MTG significantly slowed the response time for the lexical-semantic decision task from 478.9±56.5 to 583.1±80.0 ms. However, stimulation over the left posterior STG or MTG did not affect the response time or the error rate for the auditory repetition task. Our results suggest that the left posterior MTG might be involved in lexical decision making. Neuronavigation-guided rTMS virtual lesion studies could help determine the functional roles of specific brain areas in language processing, and our findings provide new evidence supporting the use of neuromodulation through rTMS for patients with aphasia.

Although spinal cord injury without radiographic abnormality (SCIWORA) literally refers to the specific type of spinal cord injury, however, some extents of spinal cord injuries can be detected by magnetic resonance imaging (MRI) in most of cases. We introduce an atypical case of spinal cord injury without radiologic abnormality. A 42-year-old male tetraplegic patient underwent MRI and computed tomography, and no specific lesions were found in any segments of the spinal cord. Moreover, the tetraplegic patient showed normal urodynamic function despite severe paralysis and absent somatosensory evoked potentials from the lower limbs.

Purpose: To reduce problems caused by alcohol drinking, it is necessary to identify those with ‘at-risk drinking’ behavior to maximize therapeutic access or intervention. To this end, we sought to determine the cut-off point for screening of at-risk drinking by the Korean version of the AUDIT-C (Alcohol Use Disorder Identification Test-Consumption). Materials and methods: We obtained data from the scientific research project of “the supervision of the Korea Center for Disease Control and Prevention (KCDCP)” in 2010. Injured patients over an 18-year-of age who visited an emergency department of an academic tertiary hospital from May to September 2010 were recruited to perform the AUDIT. The total number of patients who underwent the screening test was 640, 12.7% of the entire patients studied. Among them, 375 patients (58.4%) were men, and 265 patients (41.4%) were women. At-risk drinking was diagnosed based on the AUDIT total score and the cut-off points of the AUDIT-C were determined. Results: Cut-off points were 5 for men [Area Under the Receiver Operation Characteristic (AUROC) 0.956], 4 for women (AUROC 0.966), and 4 in elders >65-year-of age (AUROC 0.972). Conclusion: This study is the first research about the cut-off points of Korean version of AUDIT-C for patients including women and elders to screen for at-risk drinking in South Korea. AUDIT-C is a useful and accurate tool to screen patients for at-risk drinking. Keywords: Alcohol drinking, Mass screening, Substance abuse detection, Substance abuse detection

Smart TVs are rapidly replacing conventional TVs. In a number of countries, set-top boxes (STB) are widely used to relay TV channels to smart TVs. In such cases, smart TVs cannot identify which TV channel they are receiving. This situation makes it challenging for smart TVs to provide their users with a variety of personalized services, such as context-aware services and recommendation services. In this paper, we introduce our TV channel matching system that resolves such problems. We propose strategies for scaling-out the matching system and improving its accuracy.

Background The trend of increasing numbers of patients with type 2 diabetes emphasizes the need for active screening of high-risk individuals and intensive lifestyle modification (LSM). Methods/design The community-based Korean Diabetes Prevention Study (C-KDPS) is a randomized controlled clinical trial to prevent type 2 diabetes by intensive LSM using a web-based program. The two public healthcare centers in Korea are involved, and 420 subjects are being recruited for 6 months and will be followed up for 22 months. The participants are allocated randomly to intensive LSM (18 individual sessions for 24 weeks) and usual care (control group). The major goals of the C-KDPS lifestyle intervention program are: 1) a minimum of 5–7% loss of initial body weight in 6 months and maintenance of this weight loss, 2) increased physical activity (≥ 150 min/week of moderate intensity activity), 3) balanced healthy eating, and 4) quitting smoking and alcohol with stress management. The web-based program includes education contents, video files, visit schedules, and inter-communicable keeping track sites. Primary outcomes are the diagnoses of newly developed diabetes. A 75-g oral glucose tolerance test with hemoglobin A1c level determination and cardiovascular risk factor assessment is scheduled at 6, 12, 18, and 22 months. Discussion Active screening of high-risk individuals and an effective LSM program are an essential prerequisite for successful diabetes prevention. We hope that our C-KDPS program can reduce the incidence of newly developed type 2 diabetes and be implemented throughout the country, merging community-based public healthcare resources and a web-based system. Trial registration Clinical Research Information Service (CRIS), Republic of Korea (No. KCT0001981 ). Date of registration; July 28, 2016.

Oleanolic acid is known to possess beneficial effects on the regulation of the cardiovascular homeostasis. However, the exact nature of the role of oleanolic acid on the regulation of body fluid balance and blood pressure homeostasis and its mechanisms involved are not well defined. Experiments were performed to identify the effects of oleanolic acid on the renin-angiotensin system and cardiac natriuretic hormone (ANP) system, and also renal function and blood pressure in normotensive and renovascular hypertensive rats. The change in the plasma levels of hormones and the expressions of renin, angiotensin II receptors, ANP, natriuretic peptide receptor-C, M2 muscarinic receptor and GIRK4 were determined in the kidney, heart and aorta. Oleanolic acid was administered orally for 1 or 3 weeks. Here, we found that oleanolic acid suppressed plasma levels of renin activity and aldosterone and intrarenal levels of renin and angiotensin II type 1 receptor expression and increased angiotensin II type 2 receptor in normotensive and hypertensive rats. Also, oleanolic acid increased plasma levels of ANP. Further, oleanolic acid suppressed angiotensin II type 1 receptor and natriuretic peptide receptor-C expression and increased angiotensin II type 2 receptor and ANP expression in the heart and aorta. Along with these changes, oleanolic acid accentuated urinary volume, electrolyte excretion and glomerular filtration rate in normotensive rats and suppressed arterial blood pressure in hypertensive rats. These findings suggest that beneficial effects of oleanolic acid on the cardiorenal system are closely associated with its roles on the renin-angiotensin system and cardiac natriuretic hormone system.

Objective Most patients with head trauma require brain computed tomography (CT) in the emergency department. However, the requirement for facial CT remains controversial. The aim of this study was to evaluate the diagnostic value of brain CT alone for detection of facial fractures and its ability to determine the requirement for additional facial CT. Methods This retrospective multicenter study was conducted in two tertiary hospitals in Seoul, Republic of Korea, between January 2014 and December 2015. Data were collected from the medical records of adult patients (aged over 18 years) who had undergone both brain and facial CT on the same day as their presentation to the emergency department with blunt trauma to the head and face. The same radiologist analyzed all brain and facial CT images. Results Eight hundred and sixty patients (668 men, 192 women; mean age 48.60±18.2 years) were identified to have had facial fractures. There was a statistically significant predominance of men but not of any particular age group. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of brain CT were 83.72%, 98.87%, 97.17%, 92.92%, and 94.08%, respectively. Conclusion These findings suggest that brain CT has high diagnostic value for detection of upper facial bone fractures with high accuracy and can aid emergency physicians when determining the requirement for additional facial CT.

This study investigates the nature of licensing predicates of expletive negation (ExN) and the role of ExN in Korean/Japanese and French. Recently, ExN-licensing predicates have been analyzed as a subcase of nonveridicality (Knuppel 2001 cited from Godard 2004; Choi and Lee 2009; Yoon 2009, 2013), which introduces polarity alternatives (p and \( \neg \) p) of an embedded complement (Hamblin 1973; Martin 1987; Giannakidou 1997 among others). However, not all nonveridical predicates license ExN. We account for this overgeneration problem of nonveridicality by restricting ExN-licensing predicates to the predicates whose meaning are neg-raisers or can be lexically decomposed into opinion neg-raisers, which are involved in the belief case. On the other hand, in Korean and Japanese, epistemic predicates which are not nonveridical in the sense of Giannakidou (1997) license ExN. We solve the problem by assuming veridicality-suspension by virtue of the question complementizer. This paper analyzes the complement containing ExN in parallel with the positively biased negative question, and argues that regardless of its semantic expletive reading, it implicates that the attitude holder holds a bigger belief of the embedded proposition p than \( \neg \) p. The analysis solves the ‘double negation effect’ with the predicates douter ‘doubt’ and nier ‘deny’ in French and the frozen expression of ExN with epistemic predicates in Korean and Japanese.

Background. Computed-tomography (CT) is increasingly performed among patients who visit an emergency department (ED), many of whom require the administration of intravenous contrast, to make an accurate diagnosis of their condition and offer prompt treatment. Though the safety profile of new intravenous contrast agents has improved, patients are still exposed to significant risk from potentially life-threatening reactions. Materials and Methods. This is a prospective study. Subjects were patients over the age of 18, or their family representative, who visited the ED. Subjects were randomly assigned to either the original routine explanation for consent or the video-assisted explanation. Patients completed a questionnaire about contrast adverse effects and the proposed treatment. Results. Mean values of the degree of understanding of informed consent were relatively higher in the video-assisted group. When assessing the proficiency of the informer, the score for understanding and satisfaction was higher in the attending staff informed group than the house staff informed group. Conclusion. This study showed a higher level of understanding in the group that was provided information using visual aids, rather than in the traditional way. Also, a higher level of understanding and satisfaction was shown among those who were given explanations by an attending staff member. The busy ED, due to factors such as overcrowding, is expected to see benefit from appropriately utilizing multimedia visual aids, and also from more experienced medical staff providing information.